January 31, 2020
Kentucky Department for Public Health
2019-nCoV HEALTH ADVISORY UPDATE
The 2019 novel coronavirus (2019-nCoV), which was first identified in Wuhan, China, has now spread to much of China and many other countries, with over 10,000 cases internationally, and over 200 deaths reported. The United States experienced its first case in a traveler from Wuhan on January, 22, 2020 in Washington State, which was quickly followed by two cases in California, one in Arizona, and one in Illinois, all of whom reported travel to Wuhan, China. On January 30, CDC and Illinios announced the first person-to-person transmission of 2019-nCoV in the United States, between the Illinois case and her spouse, who did not travel to China. At the time of this writing, 241 individuals have been identified in the U.S. as “patients under investigation” (PUI), of which 114 tested negative and 6 are positive for 2019-nCoV.
Due to widespread transmission in China, CDC has now expanded the PUI designation to include: 1) those with symptoms (fever and lower respiratory symptoms) and travel from Hubei Province; or 2) those with symptoms (fever and lower respiratory symptoms) and requiring hospitalization and travel from mainland China in the past 14 days. They have also added a new designation 3) for any person, including healthcare workers, with symptoms (fever or lower respiratory symptoms) who have had close contact with a lab-confirmed 2019-nCoV patient within 14 days of symptom onset.
All travelers arriving in international ports of entry in the U.S. are being screened for symptoms and recent travel from or through China in the last 14 days. If the traveler is symptomatic and reports travel to China, they are further screened for in-depth travel history, any signs/symptoms of illness, patient contact information, and their temperature is checked. Symptomatic travelers will be immediately isolated and moved to a hospital. State and municipal health departments in the U.S. will be engaged for additional follow-up of others who might have been exposed to potential case patients.
If travelers are not symptomatic at the airport screening but report travel to China in the past 14 days, the traveler will be given a card written in both Chinese and English to carry with them to provide to healthcare providers if they develop symptoms and seek healthcare. The card instructs the ill traveler to call the healthcare facility in advance of coming to the facility. The English and Chinese versions of the traveler health card are attached to this advisory for your reference. At this time, CDC will not be notifying states of travelers who have travel history to China.
All patients should be assessed for international travel. Patients with fever, lower respiratory illness and travel to Hubei Province in China or patients with fever, lower respiratory illness, hospitalization, and travel to mainland China in the past 14 days, or who have had close contact with someone who is lab-confirmed with 2019-nCoV, are considered a “Patient Under Investigation” (PUI) (See attached Updated CDC PUI Guidelines 1-31-20).
NOTE: Due to regular circulation of various coronavirus strains in Kentucky, travel to China, exposure to other PUI, or to another confirmed case is required to be designated a PUI for 2019-nCoV. Please do not report cases of coronavirus that do not have the required exposure history.
For all 2019-nCoV PUI you should follow the below guidelines immediately:
1) Ask the patient to wear a surgical mask as soon as they are identified (Recognize, Identify, Isolate);
2) Evaluate the patient in a private room with the door closed, ideally an airborne infection isolation room;
3) Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or a face shield);
4) Obtain a detailed travel history;
5) Notify your healthcare facility’s infection control personnel;
6) Notify the Kentucky Department for Public Health (KDPH): 502-564-3261
– During regular business hours (8:00 am – 4:30 pm, M-F), call 502-564-3261 and ask for the Novel Coronavirus Response Team
– After hours or on weekends: Call 888-9-REPORT (888-973-7678)
7) Assist with/facilitate completion of Kentucky’s “Updated 2019-nCoV PUI Case Investigation Form 1-31-20” (attached) as needed. Please replace the earlier version with this form.
Testing, and Specimen Collection:
1) Note that FDA-approved respiratory panel assays will not detect 2019-nCoV;
2) Conduct routine testing for respiratory pathogens;
3) Coordinate with KDPH to collect and ship specimens to CDC for 2019-nCoV testing;
a. All specimen submission must be approved by KDPH before shipping. Please call the KDPH Reportable Disease Section at 502-564-3261 and ask for the Novel Coronavirus Response Team. After hours or on weekends, call 888-9-REPORT (888-973-7678);
b. CDC recommends collecting and testing multiple clinical specimens from different sites, including all three specimen types—lower respiratory, upper respiratory, and serum specimens;
c. For biosafety reasons, DO NOT perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for 2019-nCoV;
d. For additional guidance or coordination of specimen submission, contact Rachel Zinner or Teresa Fields at the KDPH Division of Laboratory Services at 502-564-4446;
4) Additional specimen types (e.g., stool, urine, whole blood) may be collected and stored to increase the likelihood of detecting 2019-nCoV infection;
5) Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset;
6) Additional guidance for collection, handling, and testing of clinical specimens is attached and is available at: https://www.cdc.gov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html
Persons under investigation who test positive for another respiratory pathogen should be clinically evaluated in consultation with public health authorities. As a result of this process, they may no longer be considered a PUI; however, this may evolve further as more information becomes available on possible 2019-nCoV co-infections.
Infection Prevention and Control Guidelines:
CDC has provided interim infection prevention and control recommendations for patients who have or who meet the PUI criteria in a healthcare setting. These include: minimize chance for exposures; adherence to standard, contact and airborne precautions, including the use of eye protection; managing visitor access in the facility; engineering controls; environmental measures; and several other items. Please find these guidelines at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html.
Please feel free to contact us with any questions. We continue to value what you do on the front lines of healthcare and public health. Your astute efforts in identifying and reporting cases of 2019-nCoV will be vital to effective prevention and control of this pathogen.
Doug Thoroughman, PhD, MS
State Epidemiologist (Acting)
CDC Career Epidemiology Field Officer Kentucky Department for Public Health Phone: 502-564-3418 x4315