This version was drafted February 3, 2020. These updates are meant to provide general information for the Lurie Children’s Community. Because the situation may rapidly evolve, for the most up-to-date information please go to CDC 2019 novel coronavirus site and Chicago Department of Public Health site (ChicagoHAN 2019-nCoV).
Coronaviruses are a large family of viruses that typical cause a mild illness like the common cold. From time to time new coronaviruses emerge and have the potential to cause severe disease and global epidemics. 2019 Novel Coronavirus, or 2019-nCoV, is a new respiratory virus identified as the cause of an outbreak in Wuhan, Hubei Province, China. Early cases were believed to be animal-to-human spread linked to a large seafood and animal market, but new cases among individuals without exposure to animal markets suggests person-to-person spread is occurring. The new coronavirus has resulted in thousands of confirmed cases in China, including cases outside Wuhan City, with additional cases being identified in a growing number of countries, including several cases identified in the United States.
Symptoms of those confirmed to have 2019-nCoV include fever, cough and shortness of breath. While most cases are relatively mild, some patients have had a severe respiratory illness. It is believed that symptoms may appear in as few as 2 days or as long as 14 days after exposure.
It is not clear yet how easily 2019-nCoV spreads from person-to-person, but generally coronaviruses spread through respiratory droplets via:
Currently, the general risk to those living in the US is very low. The full public health impact of 2019-nCoV worldwide is not yet completely understood. However, 2019-nCoV severity of illness and risk of dying seems less than other epidemics of new coronaviruses (SARS and MERS) over the past 20 years. As of early February, there have only been 10 cases in travelers (zero deaths) to the US and a single case in a close contact of a traveler. Thus, there has not been transmission to someone in the general community from a traveler.
At this time, laboratory diagnostic testing for 2019-nCoV can be conducted only at CDC. To increase the likelihood of detecting 2019-nCoV infection, CDC recommends collecting and testing multiple clinical specimens from different sites, including lower respiratory (sputum, tracheal aspirate, BAL), upper respiratory (NP/OP swab), and serum (blood) specimens. Additional specimen types (e.g., stool, urine) may be collected and stored. Testing should not be ordered until IP&C has been contacted who will provide further recommendations.
The 2019-nCoV strain can only be detected at a public health laboratory. The respiratory viral panel PCR test at Lurie detects some coronavirus strains that cause the common cold but does not detect 2019-nCoV. There is no cross reactivity between 2019-nCoV and the coronavirus strains on the respiratory viral panel PCR test.
There is no current antiviral treatment recommended for 2019-nCoV infection, however scientists and public health officials are assessing whether certain antivirals and monoclonal antibodies can be effective treatments. Individuals who have been infected with 2019-nCoV will receive supportive care to help manage symptoms.
If a patient is identified who may have respiratory illness caused by 2019-nCoV (based on symptoms and travel screen), the patient and family members should be immediately masked and placed in a negative pressure airborne isolation room. If an airborne isolation room is not available, place the patient and family in a private room with door closed Healthcare providers should report suspect 2019-nCoV cases immediately to Infection Prevention & Control via the 24 hours pager 7-4290. Infection Prevention & Control will provide guidance on additional questions to assess for risk of 2019-nCoV.
If you are called by a patient with a history of travel to China in the past 2 weeks, please ask about signs/symptoms of respiratory illness and/or exposure to someone known to have 2019-nCoV. If a patient with a significant travel or exposure history has symptoms of a respiratory illness, the patient will require medical evaluation. If a patient was exposed, but not yet symptomatic, additional education may be needed. Healthcare providers should report suspect symptomatic 2019-nCoV cases or known 2019-nCoV exposures immediately to Infection Prevention & Control via the 24 hours pager 7-4290 to guide plans for evaluation. Known 2019-nCoV exposures in an asymptomatic patient can be reported to Infection Prevention & Control within 1 business day. Please do not refer the patient to a medical facility without contacting them ahead of time so that steps can be taken to minimize exposure.
General protection measures are effective for respiratory viruses. The following PPE measures are recommended for patients identified as having respiratory illness caused by 2019-nCoV. Performing hand hygiene before and after each patient encounter is highly effective in protecting yourself and patients. All of the following are required when caring for a patient suspected of having 2019-nCoV:
There are no recommendations from the CDC or the health department that a pregnant healthcare should not care for someone with 2019-nCoV. The recommendation is for healthcare workers to don proper PPE including a gown, gloves, a N-95 respirator (if fit tested) or PAPR (if not fit tested/failed fit testing) and eye protection. With proper PPE use, the healthcare worker would be protected from risk of contracting this virus and other pathogens that are considered communicable.
First, please stay abreast on CDC travel advisories and strongly consider avoiding non-essential travel to impacted areas. Because of evolving travel restrictions, travelers to China may have difficulties returning to the US. Additional information about CDC travel advisory can be found here: https://wwwnc.cdc.gov/travel/notices/alert/novel-coronavirus-china.
Occupational medicine has implemented a system to advise employees who travel to China. The institution’s priority is to identify possible infection and maintain a safe and productive work environment by minimizing risk of transmission to others. Healthcare workers who have traveled to China in the past 14 days or plan travel to China in the near future must call the Return from Travel Abroad line at 312.227.2300 for a telephone triage health screening. A very detailed travel, symptom, and exposure screen will be completed to determine risk of 2019-nCoV. Employee and Corporate Health will work with Infection Prevention and Control to determine safe return-to-work status. If you have traveled to China and develop symptoms you should NOT report to work and should avoid contact with others. Contact your personal physician and occupational medicine. Occupational medicine will provide guidance on return-to-work status and further evaluation.
To report suspected patients or for further questions please contact Infection Prevention & Control via 24 hours pager at (7-2490).