Clinician Alert: the CDC continues to track an outbreak of a new coronavirus

January 31, 2020

This alert updates a previous alert sent Jan. 22

The Centers for Disease Control and Prevention (CDC) continues to closely track the outbreak of thousands of cases of novel (new) coronavirus that began last month in China and has now spread to other countries including the United States.

The information in this alert is PROVISIONAL and is expected to change as more information becomes available from global and national sources.

Reported symptoms range from mild to severe illness and death. Severe cases typically include  fever, cough, and dyspnea. CDC notes that fever may be subjective or confirmed. Multiple governmental agencies are working together to minimize the risk of imported cases of the virus.

Testing

CDC has expanded their criteria for testing. Turnaround time is currently at least one week. Testing will not be available locally for at least several more weeks.

[View this flowchart for evaluation of patients who may be ill with or who may have been exposed to virus]

We recommend that you ask people presenting with fever along with cough or dyspnea about travel to or from mainland China (and Hubei Province in particular) in the last 14 days. 

Anyone with travel to Hubei Province in the last 14 days with compatible symptoms should be promptly isolated, preferably in a negative pressure room with standard, contact, and airborne precautions along with eye protection. These patients should be tested; contact the local health department where they reside or are staying.

Patients whose only exposure risk is China (outside of Hubei Province) should be isolated, preferably in a negative pressure room with standard, contact, and airborne precautions along with eye protection; if none available, a private room with door closed and masking of patient and provider with surgical masks is acceptable. 

If a patient does not need to be admitted, recommend home isolation while ill and return as needed if symptoms worsen. See CDC guidance for home care and contact the local health department where they reside or are staying.

Patients sick enough to be hospitalized should be tested for novel coronavirus and other respiratory pathogens as indicated. They should also be reported to the local health department where they reside or are staying.

To arrange for testing of an Oregon patient, please obtain approval from the Oregon Health Authority, and arrange for shipping to the Oregon State Public Health Laboratory. 

Specimen collection

All specimens should be stored on 2–8°F and shipped on an ice pack. Label each specimen container with the patient’s ID number (e.g., medical record number), unique specimen ID (e.g., laboratory requisition number), specimen type (e.g., serum) and the date the sample was collected. We would like you to collect the following specimens from the lower respiratory tract, the upper respiratory tract, and serum. Full specimen guidance is here.

What to know about the infectious period

Chinese authorities and a recent Lancet case report suggest that transmission of this virus is possible before an infected person shows symptoms.

Based on experience with other similar viruses and the apparent mode of droplet transmission for this coronavirus, viral load, and presumably shedding, is much higher when people are symptomatic, and they are more likely to expose other people if they are actively coughing.

Current public health plans for contact follow up will focus on those with close (within 6 feet), prolonged contact with a person likely or confirmed to have the virus. Meaningful exposures of others would be those that are close and prolonged in the 7 days prior to onset of symptoms through the time at which the ill person is in isolation.