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Author: UCA Admin/Thursday, January 30, 2020/Categories: Industry News
Jasmeet Bhogal, MD
President, College of Urgent Care Medicine
Sean McNeeley, MD FCUCM
Immediate Past President, Urgent Care Association
Joseph Toscano, MD
Clinical Content Advisor, Urgent Care Association
<<< PLEASE NOTE: This is a rapidly evolving and changing situation. The official CDC webpages with up to date information can be accessed at https://www.cdc.gov/coronavirus/2019-ncov/index.html (CDC main page) and https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html (for healthcare professionals) >>>
Situation: On January 21, 2020, the CDC confirmed the first case of 2019 Novel Coronavirus (2019-nCoV) in the United States. The case was detected in Washington State. Since then, a total of 5 11 [udpated 2/3/2020] cases have been confirmed. These cases have been confirmed in the states of Washington, California, Arizona, and Illinois, and Massachusetts [updated 2/3/2020]. Outside of the U.S., confirmed cases have been identified in: China, Hong Kong, Macau, Taiwan, Australia, Cambodia, Canada, France, Germany, Japan, Malaysia, Nepal, Sri Lanka, Singapore, Thailand, The Republic of Korea, Vietnam. This situation is still evolving and recommendation could change based on prevalence and better defined method of spread.
Background: The 2019 Novel Coronavirus is a new respiratory virus that was identified in Wuhan, Hubei Province, China. Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Patients with confirmed 2019-nCoV infections have reported the symptoms of fever, cough, shortness of breath. According to the CDC, at this time, the symptoms of 2019-nCoV may appear in as few as 2 or as long as 14 days after exposure.
Ideally, patients who are PUI (Patients Under Investigation) are directed to a location ready for them with appropriate PPE (Personal Protective Equipment), negative pressure isolation room and method to test sputum, blood and nasopharynx. Most often this is an Emergency Department.
The CDC has also developed the following criteria for evaluation of PUI:
1. Fever and symptoms of lower respiratory illness (e.g., cough, difficulty breathing), and, in the last 14 days before symptom onset, a history of travel from Wuhan City, China. Hubei Province, China. [CDC criteria updated 2/3/2020]
2. Fever or symptoms of lower respiratory illness (e.g., cough, difficulty breathing), and, in the last 14 days, contact with an ill laboratory-confirmed 2019-nCoV patient.
Please be advised that:
Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. The CDC recommends using clinical judgment to guide testing of patients in such situations.
According to the CDC, close 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.
At this time, the diagnostic testing for 2019-nCoV is only being performed by the CDC.
Specimens collected should be sputum, nasopharyngeal and oropharyngeal swabs (synthetic fiber swabs with plastic shafts in separate vials of viral transport medium), and serum.
Mid patients can be tested by nasopharyngeal swabs and potentially sent home if your local health department and the CDC agrees. These patients can be seen in an urgent care setting assuring proper respiratory precautions and testing is performed prior to discharge. Patients who are more ill should be transferred to an emergency department assuring all parties are aware that they are PUI. Based on prevalence this may change. Current expectation is a very low number of PUI.
The following should be in place for potential patients
1. Signage asking them to mention travel history
2. A way to quickly triage potential PUI
3. A process to put patients in isolation
4. Proper PPE
a. N95 mask and proper use
d. Isolation sign
5. Contact info for local infection control
6. Swabs as needed
7. Transportation method
8. Method to clean exam room after PUI leaves
9. List of potential exposed individuals (staff, patients)
b. Patients potentially exposed
c. Media statement, if needed
CDC link for specimen collection: https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html
All patients should be masked on arrival. CDC is recommending a surgical mask for patients and N-95 for healthcare providers.
Testing for other respiratory pathogens by the provider should be done as part of the initial evaluation and should not delay specimen shipping to CDC.
CDC is recommending that healthcare providers should immediately notify their local or external icon state health department in the event of a PUI for 2019-vCoV. State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100.
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