Thanks through CDC (Centers for Disease Control and Prevention) as the reference for the update on 2/27/2020:
Limited information is available to characterize the spectrum of clinical illness associated with coronavirus disease 2019 (COVID-19). No vaccine or specific treatment for COVID-19 is available; care is supportive.
Affected Geographic Areas with Widespread or Sustained Community Transmission (Remember Widespread or Sustained and the U.S. is not a widespread yet).
Last updated February 26, 2020
- China
- Iran
- Italy
- Japan
- South Korea
The CDC clinical criteria for a COVID-19 person under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available.
Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness. CDC guidance for evaluating and reporting a PUI for MERS-CoV remains unchanged.
Healthcare providers should immediately notify their localexternal icon or stateexternal icon health department in the event of a PUI for COVID-19.
Criteria to Guide Evaluation of PUI for COVID-19
Local health departments, in consultation with clinicians, should determine whether a patient is a PUI for COVID-2019. The CDC clinical criteria for COVID-19 PUIs have been developed based on available information about this novel virus, as well as what is known about Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). These criteria are subject to change as additional information becomes available.
| Clinical Features | & | Epidemiologic Risk |
|---|---|---|
| Fever1 or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath) | AND | Any person, including health care workers2, who has had close contact3 with a laboratory-confirmed4 COVID-19 patient within 14 days of symptom onset |
| Fever1 and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization | AND | A history of travel from affected geographic areas5 (see below) within 14 days of symptom onset |
| Fever1 with severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization6 and without alternative explanatory diagnosis (e.g., influenza)7 | AND | No source of exposure has been identified |
The criteria are intended to serve as guidance for evaluation. In consultation with public health departments, patients should be evaluated on a case-by-case basis to determine the need for testing. Testing may be considered for deceased persons who would otherwise meet the PUI criteria.
Recommendations for Reporting, Testing, and Specimen Collection
Updated February 3, 2020
Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of a PUI for COVID-19. State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a COVID-19 PUI case investigation form available below.
CDC’s EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays.
Testing for other respiratory pathogens should not delay specimen shipping to CDC. If a PUI tests 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 COVID-19 co-infections.
For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for COVID-19.
To increase the likelihood of detecting COVID-19, CDC recommends collecting and testing multiple clinical specimens from different sites, including two specimen types—lower respiratory and upper respiratory. Additional specimen types (e.g., stool, urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset.