Health Advisory

SUMMARY:

• As of January 22, hundreds of confirmed cases of 2019-nCoV have been identified in China with several deaths. Travel associated cases have been identified in Thailand, Japan and South Korea, and one case has been identified in the United States in the state of Washington in a person reporting travel from Wuhan City.

• Coronaviruses are a large family of viruses that can cause disease ranging from the common cold to severe disease. Other coronavirus infections that recently emerged to infect people include those causing Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

• To date, person-to-person transmission of 2019-nCoV has been limited though it’s unclear how easily or sustainably the virus spreads between people. Signs and symptoms include fever, cough, difficulty breathing, and bilateral lung infiltrates on chest radiograph.

• CDC issued updated interim guidance to assist healthcare providers in the identification, evaluation, and reporting of a Patient Under Investigation (PUI) for 2019-nCoV in the United States (https://emergency.cdc.gov/han/han00426.asp).

SUGGESTED ACTIONS:

• Obtain a detailed travel history for patients with fever and acute respiratory illness.

• If a patient meets the criteria of a PUI (see next page), o Ask the patient to wear a surgical mask as soon as the PUI is identified.

• Evaluate the patient in a private room with the door closed, ideally in an airborne infection isolation room if available.
• Use standard, contact and airborne precautions, and eye protection (e.g., goggles or face shield).
• Immediately notify infection control personnel and the Fairfax County Health Department. We can be reached 24/7 at 703-409-8449.

• FCHD’s Acute Communicable and Emerging Disease Program will work with the Virginia Department of Health to coordinate laboratory testing at the CDC.

• Currently, 2019-nCoV testing is only available at CDC. Three specimen types (lower respiratory, upper respiratory and serum specimens) are recommended for this testing. If possible, more specimens (e.g., stool, urine) should be collected and stored until CDC determines if they should be tested.
• For biosafety reasons, virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI is not recommended.

• For more information on this rapidly evolving situation, please visit the CDC Novel Coronavirus 2019 website (https://www.cdc.gov/coronavirus/2019-nCoV/index.html or call the Fairfax County Health Department at 703-409-8449.

¹Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to guide testing of patients in such situations.

²Close contact is defined as—

a) being within approximately 6 feet (2 meters), or within the room or care area, of a novel coronavirus case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); close contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a novel coronavirus case.– or –

b) having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on) while not wearing recommended personal protective equipment.