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Posted on: February 28, 2020

February 28, 2020 COVID-19 Updated Guidance for Clinicians

Corrected March 1, 2020

Clinical Guidance & Requested Actions

  • Sustained person-to-person transmission of COVID-19 in large numbers has been established in nations near to and far from China, including South Korea (1766), Italy (528), Iran (245), and Japan (189). For a world map of aggregated case counts updated daily, visit:
  • In response to the growing global COVID-19 outbreak, the Centers for Disease Control and Prevention (CDC) has issued travel alerts for these countries with community transmission. See Travel Health Notices at for details and monitor frequently for updates to the list.
  • Definition of a person under investigation (PUI) eligible for testing has thus been updated to include returning travelers returning in the past 14 days from affected countries with a CDC Travel Alert Level 2 or higher: mainland China, South Korea, Japan, Italy and Iran.

chart for health revised alert 03012020

  • Follow CDC guidance for infection control and personal protective equipment when evaluating patients meeting these PUI criteria. Visit: for details.  
  • Perform rapid influenza and respiratory viral panel testing for all patients meeting PUI criteria or for whom you otherwise plan to notify or consult the Snohomish Health District (SHD).
  • Immediately notify your facility’s infection control personnel and the SHD Communicable Disease Program (425-339-5278) in the event you identify a PUI for COVID-2019. 
  • This is a new and rapidly changing situation.  Case definitions, laboratory capacity and clinical guidance is likely to change frequently.  Stay tuned for updates and frequently monitor CDC’s and the Washington State Department of Health’s websites for COVID-19.


  • Changes in novel coronavirus nomenclature have replaced the prior “2019-nCoV” designation. The novel coronavirus itself is now referred to as SARS-CoV-2 (for its genetic relatedness to the SARS coronavirus) and the disease it causes is referred to as COVID-19 (coronavirus disease 2019). 
  • The vast majority of new COVID-19 cases occurring outside China are no longer linked to travel in China. Note in the figure below that China-associated cases are red; cruise line, blue; and presumed local transmission, green.

covid chart 02282020


  • Nationwide, 14 total cases have been diagnosed in the United States (US); two of these represented domestic secondary transmission from imported cases to a close contact.  COVID-19 positive results were also found among US residents repatriated from Wuhan (3) and the Diamond Princess cruise ship (42).  
  • To-date in Washington State, we still have had only the one COVID-19 case diagnosed in mid-January.  No secondary cases emerged from that case’s contacts. Two additional Washington residents (one from Snohomish County) were among asymptomatically infected passengers on a cruise ship who were repatriated in mid-February. Statewide, twenty-six persons under investigation have tested negative for SARS-CoV-2 and two have pending results at this time.
  • The new availability of SARS-CoV-2 testing locally at the Washington State Public Health Laboratories beginning February 28 should improve turnaround time on results of SARS-CoV-2 testing which previously was taking up to seven days due to shipping and waiting lines for finite capacity at CDC in Atlanta.


CDC’s Information for Health Care Professionals

Washington State Department of Health

Snohomish Health District 

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