AAFP President: Prepare Your Office for Novel Coronavirus

CDC Confirms U.S. Cases, With Others Under Investigation

January 24, 2020 11:41 am Chris Crawford

As the CDC has continued to closely monitor an outbreak of respiratory illness caused by a novel coronavirus, dubbed 2019-nCoV,(www.cdc.gov) that was initially detected in Wuhan, China, the first case hit U.S. shores Jan. 21, when a patient in Washington state tested positive for the virus.

[Coronavirus]

This 3-D illustration depicts the Middle East respiratory syndrome coronavirus, which belongs to the same family of viruses as the novel coronavirus first detected last month in Wuhan, China. 2019-nCoV has spread well beyond that country's borders, with hundreds of cases now reported worldwide, including two confirmed and dozens of suspected cases identified in the United States.

With well more than 800 cases(www.nytimes.com) of 2019-nCoV now identified worldwide, and more information about the outbreak coming in daily -- sometimes hourly -- from the CDC, World Health Organization and local/state health departments, you can count on the AAFP to bring you the very latest updates on this rapidly evolving public health threat.

Confirmed and Suspected U.S. Cases

According to a Jan. 21 CDC press release,(www.cdc.gov) the Washington resident had recently returned from Wuhan, arriving at Seattle-Tacoma International Airport on Jan. 15, before U.S. health officials began conducting health screenings at major U.S. airports. The pneumonia outbreak caused by the novel coronavirus has been ongoing in Asia since December 2019.

Another suspected case popped up Jan. 23, when the Brazos County Health District announced(www.brazoshealth.org) that it was investigating possible 2019-nCoV in a Texas A&M University student who had recently traveled to Wuhan. And according to information released(www.cdc.gov) after a Jan. 24 CDC telebriefing, an additional case has now been confirmed in a Chicago resident who had recently traveled to Wuhan. In all, agency officials reported during that briefing, respiratory illness in 63 patients from 22 states is currently being investigated.

Story Highlights
  • As of Jan. 24, two confirmed cases of the novel coronavirus 2019-nCoV that was first detected in Wuhan, China, have been reported in the United States, with other suspected cases under investigation.
  • The CDC is offering multiple clinical resources family physicians can use to prepare for potential cases of 2019-nCoV, including interim guidance that provides criteria to evaluate patients with suspected infection, as well as recommendations for reporting, testing and specimen collection.
  • As the AAFP learns more about the quickly evolving 2019-nCoV epidemic from the CDC, World Health Organization and local/state health departments, it will provide critical updates to its members.

Given that "family physicians are the nation's canary in the proverbial epidemiological coal mine," said AAFP President Gary LeRoy, M.D., of Dayton, Ohio, Academy members should prepare for an influx of patients with respiratory symptoms.

"We are often the first point of contact for and recognition of these types of emerging global infections," he told AAFP News. "Therefore, we must proactively begin screening patients more carefully who report signs and symptoms of an acute respiratory illness after having traveled to China -- and in particular -- the Wuhan, China, area."

Additional Background

The CDC said that although initial reports were that 2019-nCoV spread only from animals to people, there are now indications that the virus is being transmitted from person to person. It remains unclear, however, how easily it can spread between people.

In addition to the hundreds of cases of 2019-nCoV infection that Chinese health officials have reported throughout China, cases also have been confirmed in Taiwan, Thailand, Japan and South Korea. Multiple countries, including the United States, have begun screening incoming air travelers from Wuhan for the virus.

According to CDC officials, coronaviruses are a large family of viruses, with some causing respiratory illness in people and others circulating among animals such as camels, cats and bats, the CDC said. Rarely, animal coronaviruses have evolved to infect humans and even to spread between people. Such was the case with severe acute respiratory syndrome, first detected in Asia in 2003, and Middle East respiratory syndrome, which first arose in Saudi Arabia in 2012.

Person-to-person spread of SARS and MERS is thought to have occurred between close contacts via respiratory droplets -- similar to how influenza and other respiratory pathogens spread. The precise transmission method of 2019-nCoV, however, remains unclear, said the CDC.

Symptoms associated with 2019-nCoV have included fever, cough and trouble breathing. Although severe illness and even deaths have been reported in China, many other patients have experienced milder illness.

Because only limited person-to-person spread of the virus has been confirmed in Asia, the CDC said it continues to consider that the overall risk 2019-nCoV poses to the American public remains low at this time.

Guidance for Family Physicians

The CDC issued a Health Alert Network advisory(emergency.cdc.gov) about the outbreak on Jan. 17, providing early interim guidance for health care professionals, including specifics on evaluating patients with suspected 2019-nCoV infection, as well as information about prevention and infection control.

The agency is now offering more detailed interim guidance for health care professionals,(www.cdc.gov) including clinical criteria for evaluating patients under investigation for the infection and recommendations for reporting, testing and specimen collection.

LeRoy said family physicians should start preparing to handle possible 2019-nCoV cases by placing signage in the waiting room asking patients to self-report any recent travel to China, which will alert staff to provide these patients with surgical masks and flag their charts to obtain a more detailed history.

The CDC recommends family physicians consider pneumonia related to the outbreak in patients who present with severe respiratory symptoms and who have traveled to Wuhan since Dec. 1, had onset of illness within two weeks of returning and who do not have another known diagnosis that would explain their illness.

If a patient presents with an acute respiratory illness and travel history to China (or other areas of the globe where 2019-nCoV is prevalent), it is essential that physicians immediately notify infection control personnel and report the individual to local and state health departments so confirmatory testing can be performed, LeRoy emphasized.

"Enhanced universal precautions (i.e., 20-second handwashing, gloves, mask, goggles, gown) should also be used with these individuals if they are demonstrating signs of an acute respiratory illness," he added.

If available, staff should designate a dedicated exam room to isolate patients with suspected 2019-nCoV infection for triaging and providing care for these individuals, LeRoy said.

"At this point in time, the CDC reports that it remains unclear how 'easily or sustainably' the virus is spreading between humans," he said. "Therefore, the use of surgical masks for these patients and isolation from other at-risk patients in your office is the best precaution."

The CDC has established a 2019-nCoV Incident Management Emergency Response System and developed a rapid test specific for the virus that should be available to public health departments within the next several weeks, LeRoy said.

Finally, the agency said it will continue to update its guidance, which the AAFP will relay to members as that information becomes available.

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Familydoctor.org: Novel Coronavirus(familydoctor.org)