A message from the Director of Infection Control and Healthcare Epidemiology:
Dear Colleagues:
The Centers for Disease Control and Prevention (CDC) continues to closely monitor an outbreak of 2019 Novel Coronavirus (2019-nCoV) in Wuhan City, Hubei Province, China that began in December 2019. So far, 2019-nCoV appears to cause mild upper respiratory infection in most patients. Severe illness resulting in death is an infrequent occurrence (<5%). However, information on modes of transmission, clinical complications, and international spread is still evolving.
Avoid Nonessential Travel: UTMB staff and students are advised to avoid non-essential travel to Wuhan, China. In the future, the CDC may issue travel advisory alerts for other destinations as well.
The following is the approach to evaluation and management of suspected cases of 2019-nCoV presenting at any UTMB outpatient or inpatient facility:
- Facemask: Patients will be immediately asked to wear a surgical facemask when presenting with any acute respiratory illness at any clinical location. The patient must wear the facemask until a complete evaluation is performed.
- Patient Screening: All patients presenting with acute respiratory symptoms should be screened for 2019-nCoV risks during the triage process.
- Criteria to guide the evaluation of patients for 2019-nCoV:
- Fever and symptoms of lower respiratory illness (e.g., cough, shortness of breath) and in the last 14 days before symptom onset, history of travel from China (Wuhan is the primary region, but any patient from China will be screened)
-or-
- In the last 14 days before symptom onset, close contact with a person who is under investigation for 2019-nCOV while that person was ill.
- Fever or symptoms of lower respiratory illness (e.g., cough, shortness of breath) and in the last 14 days before symptom onset, close contact with an ill laboratory-confirmed 2019-nCoV patient.
- An EPIC EMR clinical symptoms and travel screen function is being developed and will be operational by early next week.
Infection Control:
- All suspected cases of 2019-nCov should continue to wear facemasks and be immediately transferred to a private room with the door closed, ideally a negative pressure isolation room if available.
- Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions (or droplet precautions if airborne precautions are unavailable), and use eye protection (e.g., goggles or a face shield).
- Healthcare personnel will immediately inform the Infection Control Department of the suspected case by paging 409-643-3133.
- Patients requiring hospitalization will be placed in negative pressure isolation rooms.
- Room disinfection and handling of waste and laundry will follow routine procedures for respiratory viruses.
- Visitation of ill patients will be limited to close family members who will also follow infection precautions.
Laboratory Tests:
- For investigation of 2019-nCoV, collect upper respiratory sample (nasopharyngeal or oropharyngeal swab or aspirate), sputum and serum specimens. If patient is intubated, collect lower respiratory samples (bronchoalveolar lavage, tracheal aspirate).
- Place laboratory test order by choosing ‘Miscellaneous Test’ and specify in comments ‘Investigation to be sent to the State Lab for novel coronavirus 2019-nCoV. Contact Microbiology Lab Director’.
- Store and transport these samples to the UTMB Microbiology Laboratory at cold temperature (2-8oC).
- Also, collect nasopharyngeal or oropharyngeal aspirate or swab for routine Respiratory Virus Panel by PCR test to diagnose other common respiratory viruses present in the community. This PCR panel test for coronavirus strains, but it does NOT identify 2019-nCoV.
Treatment:
- Consultation with the UTMB Infectious Disease faculty will be required for all outpatient and inpatient encounters to appropriately diagnose the illness and to make decisions regarding hospitalization. Decisions to discharge home with self-isolation will be made in conjunction with the local health department authority. It is expected that until more information is available, abundant caution will be exercised by hospitalizing the suspect patient.
- There is no specific treatment of 2019-nCoV. Supportive care is needed.
Additional Questions:
- Contact the following persons via UTMB phone operator at 409-772-1011 or email.
Regards,
Janak Patel, MD
Director of Infection Control & Healthcare Epidemiology