January 22, 2020

The Centers for Disease Control and Prevention (CDC) is responding to an outbreak of a novel (new) coronavirus that began in Wuhan City, China on Dec 1, 2019 (2019-nCoV). There have been over 400 reported cases in multiple countries, with the first case in the U.S. in Washington State reported Jan 21, 2020. The information in this alert is PROVISIONAL and is expected to change as more information becomes available from global and national

Sources. The initial cases were associated with an animal market in Wuhan City, China (population 11 million). Since then, there is evidence of person-to-person transmission. 

Symptoms reported to date include fever, cough, and dyspnea. CDC notes that fever may not be present in the very young, very old, immunosuppressed, and people taking antipyretics. The age range of cases in China is 15–80; those with underlying medical conditions may be at higher risk for severe disease.

Currently, three U.S. airports are screening travelers from Wuhan: San Francisco (SFO), Los Angeles (LAX), and New York (JFK), with plans to add screening to Atlanta (ATL) and Chicago (ORD) airports in the coming days. Symptomatic travelers from Wuhan will be sent from one of these airports to a local hospital for evaluation. Asymptomatic travelers from Wuhan will be given an information card with instructions on symptoms to watch for and how they can safely interact with healthcare professionals should symptoms develop.

Testing

We recommend that you ask people presenting with fever along with cough or dyspnea about travel to or from Wuhan within the preceding 14 days. Such patients should be isolated immediately, preferably in a negative-pressure room, and standard, contact, and airborne precautions observed along with eye protection. If patient does not need to be admitted, see CDC guidance for home care. Testing for the virus is currently available only at CDC. 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.

Guidance

Patient who plans to travel to China: Review CDC travel alert. Travelers to Wuhan, China, should avoid contact with sick people, animals (alive or dead), and animal markets. Travelers from Wuhan to the United States, and other countries, may be asked questions about their health and travel history upon arrival.

Patient who is well and has recently traveled to Wuhan City, China or has had contact with a known case: Counsel to watch for symptoms of fever, cough, trouble breathing within 14 days of arrival or within 14 days of last contact with the ill person. Symptomatic patients should call ahead to their usual source of health care to plan a clinic entry that minimizes exposure of others. They should be evaluated with standard, contact and airborne precautions (see below).

Patient who has fever OR symptoms of a lower respiratory illness (cough, difficulty breathing) AND Close contact with a lab-confirmed case in the last 14 days: Evaluate under standard, contact and airborne precautions with eye protection. Contact the local health department where the patient resides or is staying. Plan on collecting upper and lower respiratory specimens and serum for testing at CDC. If patient does not need to be admitted, see CDC guidance for home care

Patient who has fever AND symptoms of a lower respiratory illness (cough, difficulty breathing) AND History of travel to Wuhan City OR exposure to a possible case in the last 14 days: Evaluate under standard, contact and airborne precautions with eye protection. Contact the local health department where the patient resides or is staying. Plan on collecting upper and lower respiratory specimens and serum for testing at CDC. If patient does not need to be admitted, see CDC guidance for home care.

Healthcare Infection Control

CDC recommends standard, contact, and airborne precautions with eye protection for healthcare workers evaluating a possible case of 2019-nCoV. When possible, use phone triage and assessment to do a detailed travel history and determine if patients who might have 2019-nCoV needs to be seen in person. 

Follow guidance from your facility’s infection control practitioners which may include the following:

  • Use a negative pressure room if available; regardless of the type room being used, keep exam room door closed.

  • If a person with possible 2019-nCoV arrives unexpectedly, mask the patient and room them promptly.

  • If the patient is already in the clinic or waiting room, mask and room them immediately

  • If possible, schedule possible 2019-nCoV patients as the last patient of the day.

  • If feasible, consider patient evaluation outdoors at least 30 feet away from others. Once the patient is masked, escort the patient into the building for rooming.

  • If possible, suspected 2019-nCoV patients should be escorted into the building via an entrance that allows them to access an exam room without exposing others.

  • Minimize the number of healthcare workers interacting with the patient; caregivers

  • should follow CDC guidance, which includes eye protection and an N-95 mask or higher level of respiratory protection.

  • Collect all specimens and perform clinical interventions in the exam room if possible.

  • The exam room should not be used until 2 hours after the patient has left and the room has been thoroughly cleaned and disinfected.

Patients who are under evaluation for 2019-nCoV may isolate at home if they are not sick enough to be admitted. See CDC guidance for home care. Report all possible cases to the local public health authority:

  • Clackamas County Public Health: 503-655-8411

  • Clark County Public Health: 564-397-8182

  • Multnomah County Public Health: 503-988-3406

  • Washington County Public Health: 503-846-3594