Note: This health alert is an update to a previous health alert released by the Pennsylvania Department of Health. The information below is current as of February 27, 2020 but may be modified in the future.
- An important change from previous guidance is that travelers from newly affected geographic areas (in bold) who develop illness need to be evaluated, including:
- China
- Iran
- Italy
- Japan
- South Korea
- Health care providers should contact the Pennsylvania Department of Health at 1-877-PAHEALTH or local health department about possible cases of coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, shortened to SARS-CoV-2
- Clinical specimens should be collected from Patients under Investigation (PUIs) for routine testing of respiratory pathogens at either clinical or public health labs
- Testing at the PA DOH Bureau of Laboratories (BOL) and/or Centers for Disease Control and Prevention (CDC) must be approved by PA DOH Bureau of Epidemiology
- Specimens cannot be sent to CDC until a CDC nCoV ID number has been issued
Evaluating and Reporting Persons Under Investigation (PUI)
Summary of Recent Changes
Revisions were made on February 27, 2020, to reflect the following:
- Information updated in the “Criteria to Guide Evaluation of PUI for COVID-19” section.
Updated February 27, 2020
Limited information is available to characterize the spectrum of clinical illness associated with coronavirus disease 2019 (COVID-19). No vaccine or specific treatment for COVID-19 is available; care is supportive.
The CDC clinical criteria for a COVID-19 person under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available.
Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness. CDC guidance for evaluating and reporting a PUI for MERS-CoV remains unchanged.
Criteria to Guide Evaluation of PUI for COVID-19
DOH and local health departments, in consultation with clinicians, should determine whether a patient is a PUI for COVID-2019. The CDC clinical criteria for COVID-19 PUIs have been developed based on available information about this novel virus, as well as what is known about Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). These criteria are subject to change as additional information becomes available.
Affected Geographic Areas with Widespread or Sustained Community Transmission
Last updated February 26, 2020
- China
- Iran
- Italy
- Japan
- South Korea
See all COVID-19 Travel Health Notices.
The criteria are intended to serve as guidance for evaluation. In consultation with DOH or their local health department, patients should be evaluated on a case-by-case basis to determine the need for testing. Testing may be considered for deceased persons who would otherwise meet the PUI criteria.
Recommendations for Reporting, Testing, and Specimen Collection
Healthcare providers should immediately notify both infection control personnel at their healthcare facility and DOH or their local health department in the event of a PUI for COVID-19. Please call DOH (877-PA-HEALTH) or your local health department to discuss any possible exposures.
Testing for other respiratory pathogens should not delay specimen shipping to the Pennsylvania Department of Health Bureau of Labs (BOL). If a PUI tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI. This may evolve as more information becomes available on possible COVID-19 co-infections.
For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for COVID-19.
To increase the likelihood of detecting COVID-19, CDC and DOH recommend collecting and testing multiple clinical specimens from different sites, including two specimen types—lower respiratory and upper respiratory. Additional specimen types (e.g., stool, urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset. Additional guidance for collection, handling, and testing of clinical specimens is available.
Interim Healthcare Infection Prevention and Control Recommendations for Persons Under Investigation for COVID-19
- Interim Infection Prevention and Control Recommendations for Patients with Confirmed COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings
- Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
- CDC Health Alert Network Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV)
Additional Resources:
- World Health Organization (WHO) Coronavirus
- WHO guidance on clinical management of severe acute respiratory infection when COVID-19 is suspected
Originally released by the Pennsylvania Department of Health on February 27, 2020.
