Coronavirus Outbreak Update | January 24, 2020

Coronavirus Outbreak Information

On December 31, 2019, an outbreak of pneumonia in Wuhan City, Hubei Province, China was reported to the World Health Organization. This outbreak is now known to be caused by the 2019 novel coronavirus (2019-nCoV).  As of January 21, 2020, the Centers for Disease Control and Prevention (CDC) reported approximately 300 human infections in China with six deaths. Exported cases have been confirmed in Thailand, Japan, The Republic of Korea, and the United States.

Initially, most patients reported exposure to a large seafood and animal market, suggesting animal-to-person spread. However, many recent patients do not report visiting animal markets, providing evidence that some person-to-person transmission is occurring.

At this time, limited information is available to characterize the clinical illness associated with 2019-nCoV and guidance is subject to change as additional information becomes available.

Coronavirus Symptoms

Patients infected with 2019-nCoV may experience:

  • fever
  • cough
  • dyspnea
  • chest tightness
  • pneumonia

More information may be found at: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Coronavirus Case Identification:

Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness. Patients in the United States who meet the following criteria should be evaluated as a patient under investigation (PUI) in association with the outbreak of 2019-nCoV.

Symptoms of the Coronavirus

  • Fever1 AND symptoms of lower respiratory illness (e.g., cough, difficulty breathing) AND
  • In the last 14 days before symptom onset, a history of travel from Wuhan City, China -or-
  • In the last 14 days before symptom onset, close contact2 with a person who is under investigation for 2019-nCoV while that person was ill.

- OR -

  • Fever1 OR symptoms of lower respiratory illness (e.g., cough, difficulty breathing) AND in the last 14 days before symptom onset, close contact2 with a person who is under investigation for 2019-nCoV while that person was ill.

Note: The criteria are intended to serve as guidance for evaluation. Patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain travel or exposure).

1Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to guide testing of patients in such situations.
2Close contact is defined as:

  • Being within approximately 6 feet (2 meters), or within the room or care area, of a novel coronavirus case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); close contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a novel coronavirus case.

– OR –

  • Having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on) while not wearing recommended personal protective equipment.

Coronavirus Case Reporting

Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local health department in the event a patient under investigation (PUI) for 2019-nCoV is identified. Local health departments should notify the Michigan Department of Health & Human Services (MDHHS).

MDHHS Communicable Disease Division

MDHHS Phone: (517) 335-8165

MDHHS Fax: (517) 335-8263

PUI Form: Click here for the patient under investigation cover sheet

The PUI form (linked above) should be completed by the physician and faxed to the MDHHS Communicable Disease Division at (517) 335-8263.

Suspect cases should be entered into the Michigan Disease Surveillance System (MDSS) under the "Novel Coronavirus" category with the Outbreak Name: "WUHAN19-20". Any questions regarding 2019-nCoV may be directed to the MDHHS Communicable Disease Division at (517) 335-8165.

Specimen Collection and Testing Recommendations

The CDC recommends collecting lower respiratory, upper respiratory, and serum specimens from suspect case-patients. Other specimen types (e.g., stool, urine) may be collected and stored. Specimens must be approved by the MDHHS Communicable Disease Division at (517) 335-8165 before submission to MDHHS Bureau of Laboratories (BOL). BOL will forward specimens to the CDC for confirmatory testing. Additional information on specimen collection and submission may be found at: https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html  

Interim guidance for laboratory professionals may be found at: https://www.cdc.gov/coronavirus/2019-nCoV/guidance-laboratories.html

Infection Control

As the transmission of this new virus is not yet fully understood, CDC and MDHHS recommend a cautious approach to PUIs. Patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally in an airborne infection isolation room. Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). Additional infection control information may be found at: https://www.cdc.gov/coronavirus/2019-nCoV/infection-control.html

For individuals who are confirmed to have, or are being evaluated for 2019-nCoV infection, but do not require hospitalization, please see the interim guidance on coordinating home care and isolation at: https://www.cdc.gov/coronavirus/2019-ncov/guidance-home-care.html

Travel Screening and Advisory Status

Exit screening is being conducted for airline passengers leaving Wuhan; entry screening is being performed in multiple countries, including at three U.S. airports (San Francisco, Los Angeles, and New York-JFK). Entry screening will be initiated at two additional U.S. airports (Chicago-ORD and Atlanta) later this week. The current CDC Health Alert being provided to travelers from Wuhan, China is attached. At this time, there are no recommendations for public health to actively monitor travelers from impacted areas. Travelers are instead asked to self-monitor for symptoms. The current CDC travel advisory is set at Alert-Level 2, Practice Enhanced Precautions.  Older adults with underlying comorbidities who are infected with 2019-nCoV may be at increased risk for severe disease. More information on travel safety and precautions may be found at: https://wwwnc.cdc.gov/travel/notices/alert/novel-coronavirus-china.

Local health departments should consider forwarding this information to colleges and universities who may have international student populations.