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Posted on: January 24, 2020

Novel Coronavirus (2019-nCoV) Respiratory Infection Updated Guidance for Health Care Providers

Requested Actions 

  • Be aware that 
    • 2019-nCoV has been confirmed in a traveler who returned to Snohomish County from Wuhan, China, on January 15; and 
    • approximately 50 contacts from health care and occupational settings are being monitored by public health for development of symptoms.  Obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness.
  • 2019-nCoV should be suspected in patients who present with:
    • fever AND symptoms of lower respiratory illness (e.g., cough, difficulty breathing) AND in the 14 days before symptom onset:
      • have a history of travel from Wuhan City, China --or--
      • had close contact with a person who is under investigation for 2019-nCoV while that person was ill.
    • fever OR symptoms of lower respiratory illness (e.g., cough, difficulty breathing) AND in the 14 days before symptom onset had close contact with an ill lab-confirmed 2019-nCoV patient. 
  • Use the attached tool (document linked here) to guide your triage and infection control for potential cases. 
  • Ask patients with suspected 2019-nCoV infection to wear a surgical mask as soon as they are identified and evaluate them in a private room with the door closed, ideally an airborne infection isolation room if available. 
  • All healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., gown, gloves, N95 mask or PAPR, and face shield or goggles).
  • Immediately notify both infection control personnel at your healthcare facility and SHD Communicable Disease Program at 425-339-5278 in the event of a suspected case of 2019-nCoV.
  • Among suspected cases, please collect specimens for influenza and viral respiratory panel testing through your clinical laboratory. Also prepare to collect lower respiratory, upper respiratory, serum specimens, stool, and urine upon direction from public health. Such specimens should be refrigerated. Public health will provide further guidance and facilitation regarding specimen collection, storage, and shipping at the time of your telephone consultation with them.

Background

The Snohomish Health District (SHD) is actively involved with the Washington State Department of Health (DOH), neighboring local public health agencies, and the Centers for Disease Control and Prevention (CDC) in addressing the recently diagnosed case of novel coronavirus infection (2019-nCoV) connected to the outbreak that has emerged in Wuhan City, Hubei Province, China. Current local public health activity is focused on monitoring of contacts for development of symptoms and, if indicated, isolating and collecting specimens for testing. No additional cases have been diagnosed at this time among the case’s contacts.

Our initial communication earlier this week stated that that no health care providers to date had been infected in China, where the outbreak appears to have originated from a market where live animals were sold. More recent reports indicate that a small number of health care providers have indeed been infected in China and there is evidence of several generations of person-to-person spread in some non-health care settings. Although occupational or nosocomial transmission appears less than for MERS or SARS, these findings make infection control measures a priority in the evaluation of suspected cases.

SHD seeks to raise awareness among clinicians to maintain vigilance, promptly institute appropriate infection control precautions, and notify public health when patients with a compatible clinical and epidemiologic history present for care. Please use the attached tool (document linked here) to guide your evaluation and infection control measures.

Coronaviruses (CoVs) are a large family of viruses, most causing mild respiratory illness in people and others that circulate among animals, including camels, cats and bats. Rarely, animal coronaviruses can evolve and infect people—often with a more virulent strain-- such as has been seen with MERS and SARS. Past MERS and SARS outbreaks have been complex, requiring comprehensive public health responses to control transmission. With this novel virus, we have limited information about severity and natural history of illness, mode of transmission, and duration of contagiousness. The case fatality rate reported from China (currently 17 [3%] of 571) appears lower than for MERS and SARS; 95 (17%) are reported as “severely ill” (not further specified). Typically, transmission of CoVs is via respiratory droplet (directly via cough-or-sneeze or indirectly via hands or fomites) with incubation periods of up to 14 days. Nevertheless, out of an abundance of caution, currently recommended infection control measures for 2019-nCoV include the potential for airborne transmission.

SHD is working closely with DOH and CDC to prevent the spread of this condition from the original case and contacts and to learn more as we go about the best methods for doing so. This is a rapidly evolving situation. SHD will continue to keep you posted as meaningful updates occur. Meanwhile, we urge you to follow these guidelines and assist us in reassuring people in our community that they are not at risk for 2019-nCoV infection if they have not recently traveled from the affected area or had recent close contact with a patient suspected or known to have the infection. SHD appreciates the ongoing efforts of health care providers, Providence Regional Medical Center Everett, DOH and CDC in this challenging and high-profile situation.

Additional Resources

General

Snohomish Health District
https://www.snohd.org/CivicAlerts.aspx?AID=246

Washington State Department of Health
https://www.doh.wa.gov/Emergencies/Coronavirus

Centers for Disease Control and Prevention
https://www.cdc.gov/coronavirus/2019-ncov/index.html

World Health Organization
https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Information for Healthcare Professionals
https://www.cdc.gov/coronavirus/2019-nCoV/guidance-hcp.html
https://www.doh.wa.gov/Emergencies/Coronavirus/Resources

Interim Guidance for Preventing Transmission in Homes and Communities
https://www.cdc.gov/coronavirus/2019-ncov/guidance-prevent-spread.html

Guidance for Travelers
https://wwwnc.cdc.gov/travel/notices/watch/novel-coronavirus-china

Phone line for questions/information from the public
1-800-525-0217, then press #

Public Health Insider (Public Health Seattle & King County)
https://publichealthinsider.com/2020/01/21/questions-and-answers-about-a-novel-coronavirusin-washington/

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