PMC:7017962 / 9226-13568 JSONTXT

{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/7017962","sourcedb":"PMC","sourceid":"7017962","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7017962","text":"Discussion\nQuickly identifying persons at risk for 2019-nCoV is critical to slowing the potential spread of 2019-nCoV in the United States. This report describes CDC’s current approach to facilitating recommended diagnostic testing of persons who might have 2019-nCoV infection. In response to the emergence of 2019-nCoV in China during a time of rapidly evolving understanding of the epidemiology and clinical presentation of 2019-nCoV infection, CDC has provided consultation regarding persons suspected of being at risk for 2019-nCoV to public health officials and health care providers throughout the United States.\nEpidemiologic risk factors among the 210 persons tested for 2019-nCoV were not limited to travel: 20% of PUIs tested had not recently traveled to China but reported close contact with a person being evaluated for 2019-nCoV infection. Because person-to-person transmission is expected to continue, and as further travel restrictions are implemented, it is likely that the proportion of PUIs with such contact risk in the United States will increase among all persons evaluated for 2019-nCoV.\nCDC mobilized early in the response and state and local health departments similarly increased capacity to provide clinical consultation regarding 2019-nCoV. The collection of clinical and epidemiologic data that described characteristics of persons tested for 2019-nCoV helped to inform changes to criteria for PUI evaluation.\nOn January 31, 2020, CDC published updated PUI guidance (8) in response to the evolving global epidemiology of 2019-nCoV, including the rapid geographic expansion and documentation of person-to-person transmission (9). Updated guidance emphasizes 2019-nCoV testing for symptomatic persons in close contact with patients with laboratory-confirmed 2019-nCoV infection, persons returning from Hubei province in addition to Wuhan City, and persons from mainland China requiring hospitalization because of fever and lower respiratory tract illness. Additional refinements to this approach likely will be needed in the future as understanding of 2019-nCoV epidemiology continues to improve.\nThe findings in this report are subject to at least three limitations. First, the number of clinical inquiries received by CDC does not represent all inquiries received by health departments. Second, because the primary objective of this effort was to guide a timely public health response, some clinical and epidemiologic risk factor data might be incomplete. Finally, given the limited available epidemiologic information early in the outbreak, to provide some latitude for clinical decision-making regarding diagnostic testing, the PUI definition was not strictly applied in all cases.\nA coordinated national effort to diagnose 2019-nCoV among persons at high risk for infection is important to facilitate appropriate management and limit transmission in the United States. CDC’s website provides guidance for health care professionals on evaluating persons for 2019-nCoV (10). Clinicians should maintain a high index of suspicion for possible 2019-nCoV illness not only among persons with fever and lower respiratory tract illness who report travel from China in the past 14 days but also symptomatic persons who have had close contact with patients with laboratory-confirmed 2019-nCoV infection. Clinicians should consult their local and state health departments when they suspect possible 2019-nCoV illness to facilitate diagnosis and aid prevention efforts.\nSummary\n\nWhat is already known about this topic?\nDuring a 2020 outbreak of novel coronavirus (2019-nCoV) infection, CDC provided consultation to public health officials and health care providers evaluating persons at risk for 2019-nCoV infection.\n\nWhat is added by this report?\nDuring January 2020, CDC responded to clinical inquiries regarding approximately 650 persons in the United States and tested 210 for 2019-nCoV, one fifth of whom reported no recent travel-related risk but had close contact with a 2019-nCoV patient or a person under investigation for 2019-nCoV in the United States.\n\nWhat are the implications for public health practice?\nHealth care providers should remain vigilant regarding possible 2019-nCoV exposure not only among returning travelers, but also among persons in close contact with 2019-nCoV 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