CDC Updates Interim Guidance for Novel Coronavirus

February 05, 2020 04:58 pm News Staff – As of Feb. 3, the WHO had reported 17,391 confirmed cases of the novel coronavirus worldwide, including 2,838 cases reported in just the previous 24 hours. First detected in Wuhan, China, in December, the majority of cases (17,238) have remained within that country's borders, where the death tally has risen to 361.

At press time, U.S. cases numbered 11, including two cases of confirmed person-to-person transmission that occurred inside the United States.

Nancy Messonnier, M.D., director of the CDC's Center for the National Center for Immunization and Respiratory Diseases, said in a Feb. 3 telebriefing, "We expect to find additional cases of novel coronavirus infection in the United States. We expect to see more cases of person-to-person spread among close contacts. And we continue to expect this will happen given the explosive nature of this outbreak in China and our very aggressive public health response where we are putting a lot of resources into finding infections this virus."

As of that date, 82 people remained under investigation for 2019-nCoV pending test results.

You can continue to count on the AAFP to bring you the very latest updates on this rapidly evolving public health threat.

This illustration reveals the ultrastructural morphology exhibited by coronaviruses, such as the novel coronavirus virus responsible for an outbreak of respiratory illness first detected in Wuhan, China, in 2019.

Public Health Emergency

On Jan. 30, the World Health Organization declared a Public Health Emergency of International Concern about the current epidemic of 2019-nCoV in mainland China.

The following day, HHS Secretary Alex Azar declared 2019-nCoV a public health emergency domestically and ordered any U.S. citizens returning from China's Hubei province (where Wuhan is located) to be quarantined for up to two weeks to provide proper medical care and health screening.

That same day, the CDC announced in a media statement that under statutory authority of the HHS secretary, it had issued a federal quarantine order to 195 U.S. citizens who repatriated on Jan. 29 from Wuhan to March Air Force Base in Riverside, Calif.

The agency said medical staff will monitor the health of each traveler for 14 days, including performing temperature checks and observation for respiratory symptoms. Anyone who becomes symptomatic will receive medical care.

Story Highlights

Interim Guidance for Physicians

Importantly for family physicians during this outbreak, the CDC continues to regularly add to and update its interim guidance for health care professionals. As explained during a Jan. 31 webinar, this guidance includes criteria to evaluate patients under investigation for 2019-nCoV; recommendations for reporting, testing and specimen collection; and interim health care infection prevention and control recommendations.

An easy-to-print flowchart is intended to help health care professionals identify and assess 2019-nCoV. Other helpful tools include preparedness checklists health care professionals can use to ready their clinical facilities for patients with potential or confirmed 2019-nCoV infection.

Particularly noteworthy is interim clinical guidance for managing patients with confirmed 2019-nCoV infection, which the agency plans to regularly update as more information becomes available.

Regarding clinical presentation, the CDC said background on confirmed 2019-nCoV cases is limited and primarily includes patients hospitalized with pneumonia. The incubation period is about five days.

Frequently reported signs and symptoms include fever, cough and myalgia or fatigue at illness onset, with sore throat reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis and diarrhea.

Additionally, the CDC noted the fever course among patients with 2019-nCoV infection is not fully understood and can be prolonged and intermittent. Nearly all reported cases have occurred in adults (median age 59).

Asymptomatic infection has been described in one child with confirmed 2019-nCoV infection and chest abnormalities on CT, according to the guidance.

Information is also lacking on risk factors for severe illness, not much is known still, said the agency, although patients who are older or who have chronic medical conditions may be at higher risk for severe illness.

"Some reports suggest the potential for clinical deterioration during the second week of illness," the guidance noted. "In one report, among patients with confirmed 2019-nCoV infection and pneumonia, just over half of patients developed dyspnea a median of eight days after illness onset."

In 17% to 29% of those hospitalized, patients developed acute respiratory distress syndrome and in 10%, secondary infection developed. Between 23% and 32% of hospitalized patients required intensive care for respiratory support.

Among hospitalized patients with pneumonia, the CDC said the case fatality rate was as high as 11% to 15%. But that estimate includes only hospitalized patients and, therefore, is biased upward.

There is no specific treatment for 2019-nCoV infection, according to the agency.

"Clinical management includes prompt implementation of recommended infection prevention and control measures and supportive management of complications, including advanced organ support, if indicated," the agency said.

Corticosteroids should be avoided unless indicated for other reasons (e.g., COPD exacerbation or septic shock), because of the potential for prolonging viral replication.

Additional Resources

The CDC also has created interim guidance on implementing home care for patients with confirmed or suspected 2019-nCoV infection. This includes tips on assessing residency suitability for home care and precautions specific to home care.

Finally, the agency has compiled recent journal articles and publications on the infection, which will be updated as more are released.

According to Messonnier, the CDC is pulling out all the stops to control the virus.

"The goal of our public health response is to detect and contain introduction of this virus with the goal of preventing sustained spread of 2019 novel coronavirus in this country," she said. "Strong measures now may blunt the impact of this virus on the United States."

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