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

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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