Health Advisory - Providers and Public Health Practitioners Interim Guidance on Reporting cases of 2019 Novel Coronavirus (2019-nCoV)

City of St. Louis health care providers and public health practitioners: Please contact the City of St. Louis Department of Health 314-657-1501, to immediately report any patients who meet the criteria for evaluation as a Patient Under Investigation (PUI) for 2019-nCoV as noted below. 

Summary

The Centers for Disease Control and Prevention (CDC), the Missouri Department of Health and Human Services, the City of St. Louis Department of Health and other public health officials continue to closely monitor an outbreak of a 2019 novel coronavirus (2019-nCoV) that was originally reported in Wuhan City, Hubei Province, China and began in December 2019. While first thought to be spreading from animal-to-person, there are growing indications that limited person-to-person spread is happening. It’s unclear how easily this virus is spreading between people. On January 22, 2020, the CDC confirmed the first case of 2019 Novel Coronavirus (2019-nCoV) in the United States in the state of Washington. There have not been any cases in the City of St. Louis. The patient in the state of Washington recently returned from Wuhan, China. Coronaviruses are a large family of viruses. Some cause illness in people; numerous other coronaviruses circulate among animals, including camels, cats, and bats. Rarely, animal coronaviruses can evolve and infect people and then spread between people, such as has been seen with Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) (https://www.cdc.gov/coronavirus/mers/index.html) and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (https://www.cdc.gov/sars/index.html). 

Recommendations for Reporting, Testing, and Specimen Collection

Healthcare providers in the City of St. Louis should immediately notify infection control personnel at their healthcare facility and the City of St. Louis Department of Health at 314-657-1501 in the event of a PUI for 2019-nCoV. CDC’s EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during after hours or on weekends/holidays. At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC. Testing for other respiratory pathogens should not delay specimen shipping to CDC. If a PUI test is positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI. This may evolve as more information becomes available on possible 2019 nCoV co-infections. 

CDC Response

• CDC is closely monitoring this situation and is working with WHO.
• CDC established a 2019-nCoV Incident Management Structure on January 7, 2020. On January 21, 2020, CDC activated its Emergency Response System to better provide ongoing support to the 2019-nCoV response.
• First alerting clinicians on January 8, 2020, to be on the look-out for patients with respiratory symptoms and a history of travel to Wuhan, China.
• On January 21, 2020, CDC again updated its interim travel health notice for this destination to provide information to people who may be traveling to Wuhan City and who may get sick. The travel notice was raised from Level 1, Practice Usual Precautions, to a Level 2: Practice Enhanced Precautions advising travelers that preliminary information suggests that older adults with underlying health conditions may be at increased risk for severe disease.
• CDC began entry screening of passengers on direct and connecting flights from Wuhan, China, to the three main ports of entry in the United States on January 17, 2020, and will expand that screening to Atlanta and Chicago in the coming days. CDC, working with DHS, also will funnel all travelers from Wuhan, China, to the five airports conducting entry health screening. Together, the five airports will cover all travelers arriving in the United States whose travel originated from Wuhan, China.
• CDC issued an updated interim Health Alert Notice (HAN) Advisory to inform state and local health departments and health care providers about this outbreak on January 17, 2020. 
• A CDC team has deployed a team to support the ongoing investigation in the state of Washington in response to the first reported case of 2019-nCoV in the United States, including potentially tracing close contacts to determine if anyone else has become ill.
• CDC has developed a real-time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test that can diagnose 2019-nCoV. Currently, testing for this virus must take place at CDC, but in the coming days and weeks, CDC will share these tests with domestic and international partners through the agency’s International Reagent Resource.
• CDC has developed guidance for clinicians for testing and management of 2019-nCoV, as well as guidance for home care of patients with 2019-nCoV.
• CDC developed a diagnostic test to detect this virus in clinical specimens, accelerating the time it takes to detect infection. Currently, testing for this virus must take place at CDC, but in the coming days and weeks, CDC will share these tests with domestic and international partners
• On January 17, 2020, CDC began implementing public health entry screening at San Francisco (SFO), New York (JFK), and Los Angeles (LAX) airports. This week CDC will add entry health screening at two more airports – Atlanta (ATL) and Chicago (ORD).
• CDC has activated its Emergency Operations Center to better provide ongoing support to the 2019-nCoV response.
• CDC is working closely with the state of Washington and local partners. A CDC team has been deployed to support the ongoing investigation in the state of Washington, including potentially tracing close contacts to determine if anyone else has become ill.