SummaryandAction
Items
- All patients with fever and/or lower respiratory illness should be asked for travel history from December
1,
2019 to present. Healthcare providers should be on the lookout
for people who recently
traveled from China and have fever and respiratory symptoms or for individuals with such symptoms
who have been in close contact
with a confirmed case of 2019-nCoV.
- All patients meeting specific criteria recommended by the Centers for Disease Control
and Prevention (CDC) and WVDHHR should be evaluated
as a patient under investigation (PUI) in association with the outbreak
of novel coronavirus and in
partnership with public health. - Emerging infectious diseases are reportable to the local health department within 24 hours per the West Virginia
Reportable Disease Rule (64CSR-7). Healthcare providers should immediately report all PUI for this outbreak
to their local health department. - Please note this is an evolving
situation and guidance will likely change based on new findings
and observations. Providers should
stay attuned to new information
and updated recommendations.
Background
There is a rapidly expanding outbreak in China of respiratory illness caused by a novel (new) coronavirus abbreviated “2019-nCoV”. This virus is spreading
from person-to-person in China and exported
cases have been detected in a growing
number of countries internationally. Imported cases of 2019-nCoV infection in people have been detected in the US. While limited person-to-person spread among close contacts
has been detected in the US, there is currently
no evidence that 2019-nCoV
is actively spreading across US communities.
Healthcare providers should obtain a detailed
travel history for patients being evaluated with fever and acute respiratory illness. Be on the lookout for people with recent travel history to China, especially Hubei province, who
also have fever and respiratory symptoms or meet other criteria outlined below.
Infection Prevention and Control Recommendations
Although transmission dynamics have yet to be determined, the CDC currently
recommends a cautious
approach to PUI for 2019-nCoV. Such patients should be asked to wear a surgical
mask as soon as they are
identified and be evaluated
in a private room with the door closed, ideally an airborne
infection isolation room if available. Healthcare personnel entering the room should
use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). As additional information becomes available, guidelines for infection
prevention and control are subject
to change. Healthcare providers are urged to check back regularly for the most up-to-date guidelines at https://www.cdc.gov/coronavirus/2019- nCoV/hcp/infection-control.html.
Clinical Presentation and Evaluation
Limited
information is available to characterize the spectrum
of clinical illness associated with 2019-nCoV; reported illnesses have ranged
from infected people with little to no symptoms to people being severely ill and dying. Symptoms can include
fever, cough and shortness of breath; the incubation period is estimated at 5 days (range of 2-14 days).
No vaccine or specific treatment
for 2019-nCoV infection
is
available; care is supportive.
Clinical criteria are subject to change as additional information becomes available. Healthcare providers are urged to
check back on these criteria regularly
at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html. Asof January 31, 2020, patients who meet one of the following
classifications should be evaluated
as a PUI for 2019-nCoV:
- Fever or signs/symptoms of lower respiratory
illness (e.g., cough, difficulty breathing) AND- History of closecontactwith a laboratory confirmed 2019-nCoV patient within 14 days of symptom onset
- Fever and signs/symptoms of lower respiratory illness (e.g.,
cough, difficulty breathing) AND- History
of travel from Hubei Province, China within 14 days of symptom
onset
- History
- Fever and signs/symptoms of lower respiratory illness (e.g.,
cough, difficulty breathing) requiring
hospitalization AND
- History
of travel from mainland China within 14 days of symptom onset
These criteria are intended
to serve as guidance for evaluation. Patients should be evaluated
and discussed with public health
on a case-by case
basis if their clinical presentation or exposure
history is uncertain. For the most up-to-date information visit: https://www.cdc.gov/coronavirus/2019-ncov/index.html.
Reporting
Clinicians
should immediately notify both infection control at their healthcare facility and their local health department in the event of a person under investigation for 2019-nCoV. Emerging infectious diseases are reportable to the local health department within 24 hours per the West Virginia
Reportable Disease Rule (64CSR-7). Contact information for West Virginia local health departments can be found at
http://www.dhhr.wv.gov/localhealth/pages/map.aspx.
Specimen Collection
To increase the likelihood of detecting 2019-nCoV infection, lower respiratory, upper respiratory, and serum specimens should be collected
from PUI. Additional specimen types (e.g., stool, urine) may be collected and stored. Healthcare providers should wait for shipping
instructions for collected
specimens. Testing for other respiratory pathogens should not delay reporting or specimen shipping. The Division
of Infectious Disease
Epidemiology will work with the local health
department and CDC to report PUI and coordinate specimen shipping and testing. At this time, diagnostic testing is only being conducted at CDC and all PUI specimens
must be routed through the West Virginia
Office of Laboratory Services.