February 7, 2020in Doctor Resource

Physician reporting requirements for possible cases of novel Coronavirus

As of February 7, there were 34,401 confirmed cases of the novel coronavirus (nCov) with 717 deaths in China, plus one death in Hong Kong and one in the Philippines. In the Americas, no one has died so far from nCOv, with 12 confirmed cases in the United States (in CA, WA, AZ, WI, IL, and MA), and 7 in Canada.

Physicians should promptly report to local Public Health any person who they determine should be a patient under investigation (PUI) for novel coronavirus infection.* Doctors should immediately call their state's urgent on-call epidemiologist to report the details of a new PUI. Phone numbers for each US state and region can be found at https://www.cste.org/page/EpiOnCall.

For the evaluation of patients who may be ill with or who may have been exposed to 2019 Novel Coronavirus (2019-nCoV), here are the guidelines, per the CDC (as of Feb 2, 2020):

  1. Identify if in the past 14 days since first onset of symptoms a history of either travel to China or close contact with a person known to have 2019-nCoV illness
  2. AND the person has fever or symptoms of lower respiratory illness (e.g., cough or shortness of breath)
  • If both exposure risk and ill symptoms are present, advise isolation of the patient.
  • Instruct patient as needed depending on severity of illness and the health department consultation.
  • If additional examination or hospitalization is not needed, then offer home care and home isolation guidance.

Advise patient if they develop new or worsening fever or respiratory illness to do a virtual consultation (or call their doctor) to determine if in-person reevaluation is needed. If reevaluation is needed, advise them to call ahead, and to wear a facemask to the in-person visit.

To increase the likelihood of detecting novel coronavirus, CDC recommends collecting three specimens from each patient under investigation: lower respiratory, upper respiratory, serum. Details on how to collect and ship samples to CDC are at: https://www.cdc.gov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html

Testing for other respiratory pathogens should be done as part of the provider’s clinical evaluation. If a patient tests positive for another pathogen, and depending on the outcome of the provider’s consultation with Public Health, a patient may no longer be considered a PUI.

The World Health Organization (WHO) learned from previous coronavirus outbreaks (Middle-East Respiratory Syndrome and Severe Acute Respiratory Syndrome) that human-to-human transmission occurs through droplets, direct contact, and fomites, suggesting that the transmission method of nCoV can be similar.

The WHO recommends during this nCoV outbreak:

  • Avoiding close contact with people suffering from acute respiratory infections
  • Frequent hand-washing, especially after direct contact with ill people or their environment
  • Avoiding unprotected contact with farm or wild animals
  • People with symptoms of acute respiratory infection practicing cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands).
  • Within healthcare facilities, enhancing standard infection prevention and control practices in hospitals, especially in emergency departments

*Physician reporting of notifiable conditions that are not urgent nor related to outbreaks can follow local public health reporting guidelines. The CDC list of notifiable conditions that physicians need to report is at https://wwwn.cdc.gov/nndss/conditions/notifiable/2020/.

Robert Kwok

Robert Kwok

Robert Kwok, MD, Director of Health Informatics at HealthTap, is a board-certified physician who practiced medicine for 27 years. He earned his MD and pediatrics credentials at Baylor College of Medicine. Before HealthTap, he practiced clinical pediatrics in Northern California, most recently with Stanford Medicine.