What emergency departments need to know about coronavirus
Wednesday, January 29, 2020
First reported in late December 2019 in the major central China city of Wuhan, the newly discovered coronavirus (2019-nCoV) is now rapidly spreading. As of Jan. 28, thousands have been sickened and the death toll exceeds 100. Eighteen countries, including the United States have confirmed 2019-nCoV cases. Four U.S. states — Illinois, Washington, California, and Arizona — report cases of the virus.
There is a possible zoonotic origin to the outbreak. Most patients in the Wuhan outbreak have an epidemiological link to the Huanan Seafood Wholesale Market, a large seafood and animal market, according to early reports by Chinese health authorities. However, a description of the first clinical cases published in The Lancet on Jan. 24 challenges that link.
Diagnosis and Treatment of 2019-nCoV
The CDC recommends that clinicians treat patients with fever and symptoms of lower respiratory illness who have a history of travel in Wuhan, or who were in close contact with a person suspected of having 2019-nCoV, as being patients under investigation (PUI).
While routes of transmission are still undetermined, healthcare providers should request that patients under investigation for 2019-nCoV wear surgical masks. Practitioners should conduct investigations in a private exam room with the door closed — ideally in an airborne infection isolation room.
All personnel entering the room should exercise standard precautions, contact precautions, and airborne precautions. Eye protection in the form of goggles or a face shield is recommended.
Healthcare providers should gather a detailed travel history for febrile patients with respiratory symptoms. For symptomatic patients who had been in China since Dec. 1, 2019, and had onset of symptoms within two weeks of leaving, healthcare providers should consider 2019-nCoV and notify infection control and local or state health department.
Upon notification, the health department should contact CDC’s Emergency Operations Center (EOC) at 770-488-7100. Health department officials should also complete a 2019-nCoV PUI case investigation form in either a .pdf or a Microsoft word format.
The EOC will guide health departments in the collection, storage, and shipment of specimens to the CDC, even during afterhours or on weekends and holidays. Only the CDC provides diagnostic testing for 2019-nCoV at this time.
Specifically, the CDC warns “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.”
The CDC provides recommendations of the collection and testing to increase the likelihood of detecting 2019-nCoV infection. Practitioners should collect and test multiple specimens of all three specimen types — lower respiratory, upper respiratory, and serum specimens — from different sites. Stool, urine, and other specimen types may be stored. Clinicians should collect specimens as soon as possible after identifying a PUI, regardless of symptom onset time.
There is limited information characterizing the spectrum of illnesses associated with this virus. No vaccine or specific treatment is currently available. The CDC recommends that travelers avoid unnecessary trips to China, and suggests those who have traveled to China and are symptomatic seek medical care, and avoid contact with others. Care for 2019-nCoV is supportive.
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