On Wednesday, the Centers for Disease Control and Prevention confirmed the first case of novel coronavirus where the patient reportedly did not have travel history to areas or exposure to someone sick with COVID-19.
The CDC is investigating the United States’ first possible case of community spread, where the source of infection is unknown, in California. Public health officials said it’s also possible the patient caught the virus from a recently returned traveler.
“Astute clinicians” noticed the patient’s symptoms, according to CDC’s news release. The New York Times reports the providers who first saw the patient last week wanted testing done as soon as possible, but CDC delayed because the patient did not meet its testing criteria for COVID-19 at the time.
On Thursday, the CDC revised its guidelines for determining “persons under investigation” for novel coronavirus. In addition to patients with symptoms and a history of travel or exposure or a confirmed COVID-19 patient, those with severe illness and no other explanation for their symptoms should be tested.
The news of the California patient came just one day after CDC announced that it’s only a matter of time before novel coronavirus reaches the level of community spread in the U.S.
“It’s not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen and how many people in this country will have severe illness,” Nancy Messonnier, MD, head of CDC’s National Center for Immunization and Respiratory Diseases, told reporters Tuesday.
The disease has begun to spread in Europe and the Middle East, especially Iran and Italy. On Wednesday, the number of new cases outside China for the first time surpassed those inside.
This development makes containment at U.S. borders more challenging. At last count in the U.S., there were 15 local diagnoses of novel coronavirus, 12 of which were travel-related. Current primary containment measures include restricting travel to China, where the outbreak began, and isolating suspected patients.
However, it’s unlikely these practices will be effective as local spread begins —because when the disease hits, “it [moves] quite rapidly,” Dr. Messonnier said. She advised the public to prepare for disruptions to daily life, including school closures, required working from home and delayed, elective medical procedures.
The beginning of community spread is yet another reason for clinicians and healthcare administrators to be on high alert for COVID-19 and ways to protect themselves.
The CDC revealed earlier this month that some 1,700 frontline healthcare workers in China had become ill with the virus. At least six have died, in part because of shortage of necessary protective equipment, especially face masks.
“Breakdown in infection control in healthcare settings is actually something that infection control practitioners work at every single day because these risks do exist,” Dr. Messonnier said at a Feb. 14 press briefing. “Healthcare workers have to maintain a high level of precision every day … There’s a lot that we don’t know so we need to air on the side of caution.”
As public health officials scramble to keep HCPs safe, here are five ways, per the CDC’s infection prevention guidelines, to protect yourself right now.
Prepare when scheduling appointments.
Ask patients if they have symptoms of the novel coronavirus and/or a recent history of travel to China. Tell these patients to take appropriate preventive action, like wearing a face mask, containing their cough, etc., when arriving at the healthcare facility.
Keep patients in airborne infection isolation rooms.
Patients may remove face masks when inside these rooms. Outside, they should wear masks, and should only be outside the room when being transported to medically essential procedures. Only essential staff should enter the room. These patients should also have dedicated HCPs.
Practice hand hygiene.
Clean your hands with ABHS before and after all patient contact, after contact with potentially infectious material, and before putting on and upon removal of personal protective equipment.
Wear personal protective equipment.
Follow the correct protocol for wearing gloves, gowns, respiratory and eye protection when interacting with a patient with suspected COVID-19. Make sure you also follow the CDC guidelines for donning and doffing these articles, as well as how to dispose of them.
Be careful with aerosol-generating procedures.
These procedures are likely to inducing coughing in the patient and should be avoided, if possible. These procedures should happen in an AIIR, and HCPs present should make an extra effort to wear their PPE correctly. All surfaces in the room should be cleaned promptly afterward. These recommendations also apply for collecting a respiratory sample for testing, which can also induce coughing.
As of February 27, there were more than 82,000 confirmed cases of the virus in 48 countries and at least 2,800 deaths.
CDC Confirms Possible Instance of Community Spread of COVID-19 in U.S., Centers for Disease Control and Prevention.
Coronavirus Disease 2019 (COVID-19) in the U.S., Centers for Disease Control and Prevention.
Interim Infection Prevention and Control Recommendations for Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) or Persons Under Investigation for 2019-nCoV in Healthcare Settings, Centers for Disease Control and Prevention.
CDC Media Telebriefing: Update on COVID-19 February 14, 2020, Centers for Disease Control and Prevention.