The Centers for Disease Control and Prevention (CDC) continues to monitor the outbreak of 2019 novel coronavirus (2019-nCoV). Chinese health officials have reported thousands of infections with 2019-nCoV in China, with the virus spreading from person-to-person in many parts of that country. Outside China, several countries including the United States have identified 2019-nCoV infections, mostly imported from travel to Wuhan City, China. In response to the rapidly expanding outbreak of 2019-nCoV in China, CDC has revised criteria for guiding which patients should be evaluated for 2019-nCoV and expanded epidemiologic risk criteria to areas of China outside Wuhan City.
Patient Assessment and Management:
The risk of importation from a returning traveler remains low in Philadelphia. However, providers should maintain vigilance when evaluating patients with acute respiratory illness and consistently take a travel history. Providers should ask:
- Does the person have fever or symptoms of lower respiratory infection, such as cough or shortness of breath?
- Has the patient traveled to mainland China within 14 days of symptom onset?
- Has the patient had close contact with a person confirmed with 2019-nCoV infection?
For persons who fulfill the above criteria, please take the following actions, which are also summarized in the attached flowchart:
- Place surgical mask on patient and move patient to a private room as soon as possible. Use an airborne infection isolation room if available.
- Promptly notify infection prevention personnel at your facility and report the suspected case to PDPH (business hours: (215) 685-6742, after hours: (215) 686-4514).
- All staff working with the patient should use standard, contact and airborne precautions (N95 mask) with eye protection. Additional details are available at: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html.
- PDPH in collaboration with the Pennsylvania Department of Health (PADOH) will consult CDC, since testing for 2019-nCoV at CDC needs prior approval and coordinated through state and local health departments. Additional information on criteria that public health officials are using to guide the need for further evaluation and testing are available at: https://www.cdc.gov/coronavirus/2019- nCoV/hcp/clinical-criteria.html.
- For patients approved as a 2019-nCoV Patient Under Investigation and testing at CDC, initially collect the following upper respiratory and lower respiratory specimens for 2019-nCoV testing:
- Both nasopharyngeal (NP) and oropharyngeal (OP) swabs placed in viral transport media.
- For those with productive coughs, collect sputum. Sputum induction is not indicated.
- Collect an additional 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.
- PDPH and the PADOH Bureau of Laboratories will assist sites with submission of specimens and supporting documentation for 2019-nCoV testing at CDC. Specimens will need to be refrigerated and transported on ice packs. For further details, visit: https://www.cdc.gov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html.
Asymptomatic persons who report travel to China within 14 days should monitor for development of respiratory symptoms or fever. At this time, asymptomatic travelers do not need to be isolated from others while monitoring. If symptoms develop, the patient should be advised to seek care with advance notification to the healthcare facility and take steps to limit the transmission of respiratory viruses (i.e., staying home from work and school, hand washing, good respiratory etiquette).
- CDC: 2019 Novel Coronavirus Information for Healthcare Professionals: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
- PDPH: 2019-nCoV (Novel Coronavirus): https://hip.phila.gov/EmergentHealthTopics/2019-nCoV
- Flowchart to Identify and Assess 2019 Novel Coronavirus
Originally released by the Philadelphia Department of Public Health on February 1, 2020.