CIDRAP-(Center for Infectious Disease Research and Policy)-Updates & Reports

Experts offer first US nCoV clinical guidance
http://www.cidrap.umn.edu/news-perspective/2020/02/experts-offer-first-us-ncov-clinical-guidance

Today both the Journal of the American Medical Association (JAMA) and the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report (MMWR) published initial clinical guidelines, which aim to help US healthcare providers identify and correctly handle suspected cases involving the novel coronavirus (2019-nCoV).

2019-nCoV was first identified in Wuhan, China, the country that continues to report more than 99% of cases (see related CIDRAP News story). US officials today confirmed the 12th US case (see related CIDRAP News story).

Intensive care often needed

The virus, which shares similarities with both MERS-CoV (Middle East respiratory syndrome coronavirus) and the SARS (severe acute respiratory syndrome) virus, causes acute respiratory distress syndrome in about one third of patients that requires intensive care, writes Carlos del Rio, MD, of the Emory University School of Medicine, and Preeti N. Malani, MD, MSJ, of the University of Michigan, in the JAMA article.

Most clinical presentations of the virus will be nonspecific and include fever and a dry cough, with about 30% of patients also experiencing shortness of breath.  

Based on case reports from China, the median age of patients is between 49 and 56 years, and cases in children have been rare.

"When a patient presents with fever and respiratory symptoms (in particular a dry cough), clinicians should obtain a detailed travel history. If the patient has a history of travel to Hubei Province in the last 14 days, they should be considered a person under investigation (PUI)," the authors write. As should patients who had any travel to China in the preceding 14 days, and any patients who had close contact with a confirmed 2019-nCoV patient.

Upon identifying a PUI, clinicians should immediately notify their health facilities' infection prevention team and state health authorities. If the novel coronavirus is suspected, the patient should have a face mask placed immediately, and healthcare practitioners should wear N95 respirators.

"What interventions will ultimately control this outbreak is unclear because there is currently no vaccine, and the effectiveness of antivirals is unproven. However, basic public health measures such as staying home when ill, handwashing, and respiratory etiquette including covering the mouth and nose during sneezing and coughing were effective in controlling SARS," which also originated in China, the authors conclude.

CDC suggests special isolation, if possible

In MMWR, CDC experts' interim clinical guidelines are based on the management and prevention of respiratory illnesses, including influenza, MERS, and SARS.

The MMWR guidelines identify the same three types of PUIs—symptomatic patients with (1) a travel history to Wuhan, (2) a travel history to China, or (3) close contact with a confirmed 2019-nCoV case—but also suggest patients be immediately placed in some form of medical isolation.

"These patients should be asked to wear a surgical mask as soon as they are identified, and directed to a separate area, if possible, separated by at least 6 ft (2 m) from other persons. Patients should be evaluated in a private room with the door closed, ideally an airborne infection isolation room, if available. Health care personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or a face shield)," the authors write.

The CDC experts recommend testing both the upper and lower respiratory tracts of PUIs, and encouraged the continued use of the influenza vaccine to protect all patients from seasonal influenza which is currently circulating in the United States.

"The critical role that the U.S. health care system plays in halting or significantly slowing U.S. transmission of 2019-nCoV is already evident: eight of the first 11 U.S. cases were detected by clinicians collaborating with public health to test persons at risk," the authors concluded.

"The early recognition of cases in the United States reduces transmission risk and increases understanding of the virus, including its transmission and severity, to inform national and global response actions."

See also:

Feb 5 JAMA viewpoint

Feb 5 MMWR interim clinical guidance

As cruise ship COVID-19 numbers climb, nations evacuate passengers
http://www.cidrap.umn.edu/news-perspective/2020/02/cruise-ship-covid-19-numbers-climb-nations-evacuate-passengers

Filed Under:
COVID-19
Lisa Schnirring | News Editor | CIDRAP News
| Feb 16, 2020

The United States and other countries are evacuating their citizens from the Diamond Princess cruise ship quarantined in Japan where the number of infected people on the ship has risen to 355, as the number of local COVID-19 cases continues to grow in Singapore and Japan and as Hawaiian health officials investigate a connection to a Japanese visitor.

In other developments, China now has 68,500 cases involving the novel coronavirus, two more deaths were reported outside the mainland—one in France and one in Taiwan—and a passenger who disembarked from the Westerdam cruise ship has tested positive for the virus.

An international joint mission led by the World Health Organization (WHO) arrived in China and met with their colleagues from China for the first time today. On Twitter, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said, "We look forward to this vitally important collaboration contributing to global knowledge about the COVID19 outbreak."

Diamond Princess infections reach 355

Yesterday, Japan's health ministry reported 67 new cruise ship infections (38 asymptomatic) and today the agency reported 70 new cases (38 asymptomatic), bringing the total to 355.

Meanwhile, a number of countries, including the United States, are evacuating their citizens from the quarantined cruise ship, which has been in Japan's Yokohama port since Feb 3. In a statement yesterday, the US Centers for Disease Control and Prevention (CDC) said it was working with the State Department to bring US citizens home on charter flights. There are about 400 Americans on the ship.

The returning passengers will be subject to a 14-day quarantine and will be housed at two locations: Travis Air Force Base in California and Joint Base San Antonio-Lackland in Texas. Passengers will be screened before leaving Japan to avoid symptomatic people from boarding the plane. Once they return to the United States, the passengers will be housed separately from the evacuees from Hubei province.

Meanwhile, an 83-year-old American woman who was on the Westerdam cruise ship and disembarked in Cambodia has tested positive for the virus after arriving in Malaysia, Reuters reported yesterday. She is the first of the boat's passengers to test positive. Cambodia recently allowed the ship to dock after it was turned away by four other countries.

The woman initially tested negative in Cambodia, then was positive in a preliminary test in Malaysia. A second test confirmed the finding, according to the report. The test results for the woman's husband were negative. The couple were the only two with symptoms among the 145 ship passengers who entered Malaysia, which has now barred other Westerdam passengers. There are still 236 passengers and 747 crew on the boat.

Singapore, Japan totals rise

Over the weekend, Singapore and Japan reported more cases, nearly all local, and one of Japan's cases involves a traveler who got sick after arriving home from Hawaii.

In health ministry reports yesterday and today, Singapore—which has the most cases outside of China—reported 8 more cases, raising its total to 75. The health ministry said 5 were linked to a known church cluster, 2 were connected to known contacts, and 1 was part of an identified workplace cluster.

Meanwhile, Japan reported 6 more cases yesterday, raising its total to 43. Three patients are in Wakayama prefecture and appear to be part of a hospital cluster, including the wife of a man who worked at the facility.

Two of the people confirmed in Japan over the past few days are a husband and wife who recently vacationed in Japan. The Hawaii Department of Health said in a Feb 14 statement that the man, who was apparently diagnosed first, stayed for a few days in Maui then traveled to Oahu, where he experienced cold-like symptoms without fever.

The health department said the man was traveling with his wife and may have worn a mask during parts of his travel and added that he wore a mask during his flight back to Japan. Hawaiian officials are tracing contacts and have alerted health providers to be alert for more cases.

China's total grows to 68,500

Over the past 3 days, the number of daily COVID-19 cases reported in China declined, with 5,090 reported Friday, 2,641 yesterday, and 2,009 today. In an update today from the National Health Commission (NHC), the country reported 291 more serious cases and 142 more deaths, raising those respective totals to 11,272 and 1,665.
The World Health Organization (WHO) online COVID-19 dashboard shows that, although Hubei province is the main epicenter, four other provinces have more than 1,000 confirmed cases: Guangdong (1,316), Henan (1,231), Zhejiang (1,167), and Hunan (1,004)

Hubei province's government today announced new strict measures to curb the spread of the virus, Reuters reported. Authorities have barred all cars from the roads except for police cars, ambulances, public service vehicles, and those transporting goods. Government officials also announced health checks for all residents and said that companies must receive permission before resuming work.

Deaths in France, Taiwan

French health officials yesterday reported a death in an 80-year-old Chinese tourist who was hospitalized in Paris, marking the first such death in Europe, according to a Reuters report,

In Taiwan, health officials today reported the first death in the administrative region, one of two cases reported today, both apparently involving local transmission, according to an official statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The report said the man was in his 60s and had underlying health conditions.

FDA actions, 8th Canadian case, in-home test, new studies

In other COVID-19 developments over the last few days:

• The US Food and Drug Administration (FDA) posted a recent statement on its actions in response to the outbreak, including proactive medical product supply chain surveillance to track disruptions in critical items.
  
• British Columbia reported its fifth presumed positive patient, a woman in her 30s who recently returned from China, bringing Canada's total to eight.
  
  
• Doctors in London have set up a system to test people for COVID-19 in their homes and are pilot-testing it as a way to avoid unnecessary ambulance trips and hospital visits, BMJ reported on Feb 14. So far, 130 patients have been tested over the past 2 weeks.
  
  
• Rises in temperature and humidity may not lead to illness declines without the implementation of extensive public health measures, according to new projections from researchers based at Harvard University.
  
  
• Testing in about 8,300 close contacts in Wuhan revealed that 34% were positive for COVID-19 and 316 patients were coinfected with other respiratory viruses, including some with other coronaviruses, according to a preprint study published on medRxiv.
  
  

See also:
Feb 16 Tedros tweet
Feb 15 Japan health ministry cruise ship update
Feb 16 Japan health ministry cruise ship update
Feb 15 CDC press release
Feb 15 Reuters story on Westerdam development
Feb 15 Singapore health ministry statement
Feb 16 Singapore health ministry statement
Feb 15 Japanese health ministry statement
Feb 14 Hawaii Department of Health statement
Feb 16 China NHC daily update
Feb 16 Reuters story on Hubei province measures
WHO online COVID-19 dashboard
Feb 16 Reuters story on French death
Feb 16 AFD post