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Update on the 2019-nCoV Crisis and CDC Recommendations

On January 30, 2020 the World Health Organization (WHO) declared the recent outbreak of the novel coronavirus (2019-nCoV) a global emergency.1  “This measure, taken only five times in the history of the WHO, occurs when an extraordinary event is determined to constitute a public health risk through the international spread of disease.  As suspected and confirmed cases grow in China and around the world, healthcare professionals globally are reviewing their risk management programs to ensure readiness for a potentially-serious, rapid contagion.”2

The magnitude of this crisis has been growing exponentially. As of Thursday morning, February 13, the latest statistics on the outbreak are as follows:

  • China said it confirmed 15,152 new cases and 254 additional deaths and that those figures include the ones reported earlier by Hubei province.
  • China’s Hubei province reported an additional 242 deaths and 14,840 new cases as of Feb. 12.
  • The province said it is starting to include “clinically diagnosed” cases in its figures and that 13,332 of the new cases fall under that classification.3

As a public service to clinicians and healthcare providers everywhere, Elmed is publishing the Center for Disease Control and Prevention (CDC) guidelines for evaluating and reporting persons under investigation (PUI) for possibly having contracted the virus.

    Evaluating and Reporting Persons Under Investigation (PUI)

Updated February 12, 2020. Limited information is available to characterize the spectrum of clinical illness associated with 2019-nCoV. No vaccine or specific treatment for 2019-nCoV infection is available; care is supportive.

The CDC clinical criteria for a 2019-nCoV 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.

Health care 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 Persons Under Investigation (PUI) for 2019-nCoV

Patients in the United States who meet the following criteria should be evaluated as a PUI for 2019-nCoV.

     
Fever1 or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath) AND Any person, including health care workers, who has had close contact2 with a laboratory-confirmed3,4 2019-nCoV patient within 14 days of symptom onset
Fever1 and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) AND A history of travel from Hubei Province, China5 within 14 days of symptom onset
Fever1 and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization4 AND A history of travel from mainland China5 within 14 days of symptom onset
   
     
     

The criteria are intended to serve as guidance for evaluation. Patients should be evaluated and discussed with public health departments on a case-by-case basis. For severely ill individuals, testing can be considered when exposure history is equivocal (e.g., uncertain travel or exposure, or no known exposure) and another etiology has not been identified.

Collection

Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of a PUI for 2019-nCoV. State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a 2019-nCoV PUI case investigation form available below.

CDC’s EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays. At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC.

Testing for other respiratory pathogens should not delay specimen shipping to CDC. 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 2019-nCoV 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 2019-nCoV.

To increase the likelihood of detecting 2019-nCoV infection, CDC recommends 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.4

 

1 World Health Organization. (2019, January 30). Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) [Press release].

2 https://www.asp.com/media/preventing-spread-coronavirus-contaminated-medical-devices

3 CNBC Published Wed, Feb 12 20206:59 PM EST, updated Thurs, Feb 13 20207:50 AM EST

4 https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

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