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Infection preventionists keeping an eye on coronavirus.
Any news of a pneumonia cluster from an unknown pathogen is worrisome, but especially when it conjures memories of SARS-CoV (Severe Acute Respiratory Syndrome Coronavirus) and the lack of information sharing that occurred in 2003.
Thankfully, this has not been the case with the now identified novel coronavirus, first reported on December 31, that is causing an outbreak in Wuhan. Following lab tests that ruled out SARS-CoV, MERS-CoV, avian influenza, adenovirus, and influenza, Chinese authorities announced that they had isolated a novel coronavirus on January 7.
Currently called n-CoV2019, this virus has caused 41 confirmed cases and one death.The World Health Organization (WHO) has worked to maintain up-to-date information regarding the investigations and research into the virus and outbreak. Thankfully, there have been no infections among healthcare workers and no clear evidence of human-to-human transmission. Epidemiological links are suggesting exposure in one seafood market in Wuhan is likely a source for transmission.
Nevertheless, the New York Times is reporting this morning that “there may have been limited human-to-human transmission of a new coronavirus in China within families, and it is possible there could be a wider outbreak.”
Maria Van Kerkhove, acting head of WHO's emerging diseases unit, tells the newspaper that, “from the information that we have it is possible that there is limited human-to-human transmission, potentially among families, but it is very clear right now that we have no sustained human-to-human transmission.”
The WHO has stated that the “clinical signs and symptoms reported are mainly fever, with a few cases having difficulty in breathing, and chest radiographs showing invasive pneumonic infiltrates in both lungs. National authorities report that patients have been isolated and are receiving treatment in Wuhan medical institutions.” Currently, over 760 close contacts of cases are being followed up and the Wuhan Municipal Health Commission is working to identify retrospective cases and potential clusters. The seafood market that investigations have shown is likely to have an association with exposures, has been closed with environmental disinfection and sanitation efforts underway. Interestingly, the WHO also notes most cases were in handlers or frequent visitors to the seafood market.
From the infection prevention and control (IPC) perspective though, what should we be doing? The US Centers for Disease Control and Prevention (CDC) has provided situation reports and guidance for those in healthcare, in addition to risk assessments. The CDC is continuing to monitor the situation and has provided travel guidance for those traveling from or to Wuhan. Healthcare providers are encouraged to consider pneumonia related to the cluster for those patients with severe respiratory symptoms and travel to Wuhan since December 1, 2019 “and had onset of illness within two weeks of returning, and who do not have another known diagnosis that would explain their illness.”
The CDC encourages providers to notify infection prevention personnel and local and state health departments immediately if they have a patient meeting such criteria. Multiple respiratory tract specimens will be necessary, but it is also critical to maintain proper isolation to prevent further transmission. While there are many unknowns regarding the transmission dynamics and etiology of n-CoV2019, patients should be asked to wear a surgical mask and evaluated in a private room until they can be moved to a negative pressure room to maintain airborne/contact isolation.
Healthcare workers and anyone entering the room should then utilize a gown/gloves and N95 mask to maintain the airborne/contact isolation precautions. Given these recommendations and the changing nature of the outbreak, it is important to discuss with staff the recommendations, importance of travel screening for patients, and maintaining communication with IPC. Now is a great time to round in the urgent care and emergency departments to maintain continuous education and conversations about this evolving situation, but also ensure questions and concerns are met with real answers from CDC-provided guidance.