by Communicable Disease Branch, Colorado Department of Public Health and Environment

The Centers for Disease Control and Prevention (CDC) is closely monitoring an outbreak caused by a novel (new) coronavirus (2019-nCoV) that was first identified in Wuhan City, Hubei Province, China in December 2019. Since then, more than 30,000 cases have been reported, with the vast majority in mainland China. While initially there was speculation of zoonotic transmission, the virus is now spreading between people, including from patients to health care workers. Person-to-person transmission has now occurred in the United States as well.

Coronaviruses are a family of viruses which includes SARS and MERS as well as a number of other common coronaviruses (including HKU1, 229E, NL63 and OC43) which circulate regularly in the United States and generally cause mild upper respiratory infections. Many patients are concerned when they test positive for coronavirus on a respiratory pathogen panel, but according to CDC, 2019-nCoV is not cross reactive with other coronaviruses on PCR panels such as Biofire (meaning if a person has 2019-nCoV they will not test positive for coronavirus on a commercial PCR test).

As of Feb. 6, 2020 there are 12 confirmed cases of 2019-nCoV in the United States, with cases in Arizona, California, Illinois, Massachusetts, Washington State and Wisconsin. There have been no confirmed cases in Colorado. The Colorado Department of Public Health and Environment (CDPHE) is asking providers to please contact us or your local public health agency (LPHA) about any patient with fever or respiratory symptoms who reports travel to China in the 14 days before they became ill. We will work with clinicians and patients to determine who needs to be tested for 2019-nCoV; currently CDC is requesting nasopharyngeal and oropharyngeal swabs be collected (details at https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html). All specimens are being sent to the CDPHE laboratory and then forwarded on to CDC for testing, although we anticipate that our state public health laboratory will have the capacity to test for 2019-nCoV within the next few weeks. In many situations, those who are identified as Patients Under Investigation (PUIs) who do not require hospitalization can be self-isolated at home while results are pending, but public health will make this determination on a case-by-case basis.

When evaluating a patient with suspected 2019-nCoV, the patient should be masked immediately and moved to a private room with the door closed; an airborne infection isolation room (AIIR) should be utilized if available. If an AIIR is not available, place a facemask on the patient and isolate him/her in an examination room with the door closed. Ideally, the patient should not be placed in any room where room exhaust is recirculated within the building without HEPA filtration. Health care providers should follow standard, contact and airborne precautions with eye protection (e.g. isolation gown, fit tested N-95 or higher respirator, gloves and eye protection or full face shield) while in the examination room. Personal protective equipment (PPE) should be donned prior to entering the patient room and should be disposed of immediately upon exiting. PPE should not be worn for care of more than one patient. Collecting diagnostic respiratory specimens (e.g. nasopharyngeal swabs) may induce coughing or sneezing and requires the use of PPE as described above. Individuals in the room during the procedure should, ideally, be limited to the patient and the health care provider obtaining the specimen. Patients who require hospitalization should be transferred as soon as is feasible to a facility where AIIR is available. If the patient does not require hospitalization they can be discharged to home (in consultation with state or local public health authorities) if deemed medically and socially appropriate.

This is not a comprehensive list of recommendations for preventing transmission of 2019-nCoV in health care settings. You can find and review the most current detailed interim infection prevention recommendations for health care settings at the following webpage: https://www.colorado.gov/pacific/cdphe/resources-local-public-health-agencies-and-healthcare-providers. Clinicians or infection preventionists can use our Initial Assessment Form to collect information to help determine if the patient is at risk for 2019-nCoV (https://drive.google.com/file/d/1wapi65VeNUx6KA3OsrPfJZ6ATe1U9y-N/view).

Treatment for 2019-nCoV is primarily symptomatic; in some cases, investigational antivirals may be available through CDC but it is unknown at this time whether they might be effective. CDC has noted that in the case of MERS, use of steroids was associated with delayed clearance of the virus (https://www.ncbi.nlm.nih.gov/pubmed/29161116), and has therefore stated that clinicians may wish to avoid steroids unless they are clearly indicated (for example for underlying COPD or in the case of refractory septic shock).

As the epidemiology of this epidemic changes, definitions for PUI and indication for testing is likely to evolve. To keep up to date on coronavirus, we recommend the following resources:

To report a case of 2019-nCoV or if you have any questions about our guidance, please contact CDPHE or your local health department. You can reach an epidemiologist at CDPHE that works on 2019-nCoV by calling 303-692-2700 or 303-370-9395. You can also email Dr. Alexis Burakoff at alexis.burakoff@state.co.us with any questions.


Categories: Communications, Colorado Medicine, ASAP