The Centers for Disease Control and Prevention is monitoring an outbreak of respiratory illness caused by a newly-identified coronavirus (2019-nCoV). Cases were first detected in Wuhan City, China in December 2019 and infection was initially linked to exposure to animal markets. However, the rapid increase in the number of reported cases among persons without animal market exposure suggests person-to-person transmission. The situation is rapidly evolving but there are currently 894 confirmed cases and 26 deaths in China. 2019-nCoV has also been detected among travelers from Wuhan City in Japan, South Korea, Thailand, Singapore, Nepal and the U.S. The CDC now recommends limiting all nonessential travel to Wuhan City and has also implemented entry screening at five U.S. airports that receive direct and connecting flights from Wuhan City. Coronaviruses are part of a large group of viruses that can cause illness in both people and animals and can sometimes cause outbreaks. Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) are both caused by coronaviruses. It is not clear how easily 2019-nCoV spreads between people, but respiratory droplet transmission is suspected.
Risk Assessment and Public Health Actions in Philadelphia
Philadelphia does not receive incoming flights from Wuhan City or other cities in China, thus the risk of importation from a returning traveler is low. However, it will be important to maintain vigilance when evaluating patients with acute respiratory illness and consistently take a detailed travel history. Providers should consider 2019-nCoV for any patient with fever and symptoms of lower respiratory tract illness (cough, shortness of breath) who within 14 days of symptom onset reports:
- History of travel from Wuhan City, China
- Close contact with a person with suspected 2019-nCoV while that person was symptomatic
- Close contact with an ill person with confirmed 2019-nCoV
For persons who fulfill these criteria, please take the following actions:
- Promptly notify infection prevention personnel at your facility and report case to PDPH (business hours: (215) 685-6742, after hours: (215) 686-4514).
- Place surgical mask on patient and move patient to a private room as soon as possible. Use an airborne infection isolation room if available.
- All staff working with the patient should use standard, contact and airborne precautions (N95 mask) with eye protection.
- For patients approved as a 2019-nCoV Patient Under Investigation, collect 3 types of specimens while maintaining proper infection control measures:
- lower respiratory specimen: bronchoalveolar lavage, tracheal aspirate, OR sputum
- upper respiratory specimens: nasopharyngeal (np) swab AND oropharyngeal swab OR np aspirate or wash
PDPH will assist sites with submission of specimens and supporting documentation for testing at CDC. Specimens will need to be refrigerated and shipped on ice overnight to CDC. For further details, visit: https://www.cdc.gov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html.
- Collect a NP swab or aspirate for influenza and respiratory virus testing, since these viruses are currently circulating in the community – these are more likely to be a cause of acute respiratory illness even among returning travelers.
Asymptomatic persons who report travel to Wuhan City or contact with a suspected or confirmed case within 14 days should follow CDC guidance to self-monitor for development of respiratory symptoms or fever. At this time, exposed asymptomatic persons do not need to be isolated from others. PDPH will continue to monitor the situation closely.
For updates, see: https://hip.phila.gov/EmergentHealthTopics/2019-nCoV.
Originally released by the Philadelphia Department of Public Health on January 24, 2020.