Coronavirus Outbreak – U.S. Hospitals Must be Prepared

Coronavirus Outbreak

It is time U.S. hospitals prepared for another emerging infectious disease – Coronavirus infection, after Zika and Ebola.

With the recent Coronavirus outbreak, first identified in Wuhan, Hubei Province, China, U.S. hospitals are getting prepared to screen and treat patients with this deadly viral infection. The Centers for Disease Control and Prevention (CDC) along with the World Health Organization (WHO) is closely monitoring this outbreak. According to WHO, the main symptoms of this infection are fever and lesions in both lungs. Some patients have reported difficulty breathing too.

Advisory Board says that as of now, Officials in China have reported 132 deaths and 5,974 confirmed cases of this virus. Coronaviruses are a large family of viruses that cause a range of illnesses including the common cold and more severe diseases such as MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome). Coronaviruses are transmitted between animals and people. The first case of novel coronavirus in the U.S. was reported on January 22 in Washington State.

There is no vaccine or specific treatment available for 2019-nCoV (2019 novel coronavirus). The CDC clinical criteria for a 2019-nCoV patient 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.

2019-nCoV Spreads to the U.S

Now, five cases of the virus have been confirmed in the United States, including people in Arizona, California, Illinois and Washington. All of them had travelled to Wuhan, China, where the outbreak began. However, CDC is monitoring 110 people across 26 states for possible infection and expect to see more cases in the U.S.

The CDC recently announced that it has deployed more than 100 staffers in 3 US airports to screen for the emerging coronavirus from China.

What U.S. Hospitals Should Do

In an advisory, the American Hospital Association (AHA) has advised its members to follow CDC’s interim guidance, when evaluating patients with fever and acute respiratory illness. Based on this Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV), patients in the United States who meet the following criteria should be evaluated as patient under investigation (PUI):

  • Fever and symptoms of lower respiratory illness (last 14 days before symptom onset)
  • History of travel from Wuhan City, China
  • Close contact with a person who is under investigation for 2019-nCOV while that person was ill, or
  • Close contact with an ill laboratory-confirmed 2019-nCoV patient

As a part of emergency preparedness for infectious disease, it is crucial that hospitals make changes in their EHR systems. They can also incorporate coronavirus-specific questions into their EHR systems. For instance, Massachusetts General Hospital has a travel navigator alert in its EHR that documents areas of concern for certain infectious diseases. There will be questions on travel to certain areas. If patients answer “yes,” it would trigger the automated alert for specific testing and care precautions. Providers should also inform their medical transcription companies to make such changes in their EHR system for better medical records management.

Health care providers should –

  • Obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness
  • Evaluate patients and discuss their case with public health departments, if their clinical presentation is vague
  • Provide isolated treatments for patients at risk of having the virus
  • Notify about any PUI to both infection control personnel at the healthcare facility and local or state health department
  • Advise everyone in their locality to avoid unnecessary travel to Wuhan, China
  • Recommend patients who traveled to China in the past 14 days and have fever, cough, or difficulty breathing, to seek medical care right away and to avoid contact with others
  • Make PUIs wear a surgical mask as soon as they are identified
  • Assess suspected patients in a private room with the door closed, ideally an airborne infection isolation room

Providers and staff caring for PUIs should wear gloves, gowns, masks, eye protection, and respiratory protection. To increase the probability of detecting 2019-nCoV infection, CDC recommends collecting and testing multiple clinical specimens from different sites, including all three specimen types-lower respiratory, upper respiratory, and serum specimens. Currently, diagnostic testing for 2019-nCoV can be conducted only at CDC. Providers must also stay updated by accessing AHA’s webpage for hospitals about the outbreak.