2019 Novel Coronavirus (2019-nCoV) (COVID-19) Guidelines

Updated: Feb 14, 2020
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print
Guidelines

CDC Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV) (COVID-19)

The CDC has issued interim guidance for the 2019-nCoV outbreak, including screening, testing, and treatment recommendations. [28]

Patient screening in healthcare facilities

Screening recommendations are based on the overall objective of rapidly containing transmission of COVID-19 and preventing further spread.

Patients who present for care should undergo assessment for exposures associated with COVID-19 risk and for symptoms known to be consistent with this infection. Importantly, the known signs and symptoms of COVID-19 overlap with those of other viral respiratory tract infections, so other respiratory illnesses (eg, influenza) should be included in the differential diagnoses.

Patients with fever or symptoms of lower respiratory tract infection (eg, cough, shortness of breath) who have travelled to mainland China within the preceding 14 days or who have had close contact with an individual with confirmed COVID-19 should prompt an infection control protocol, as follows:

  • The patient should be a given a surgical mask to wear.
  • He or she should be directed to a separate area, if possible, that is at least 6 feet away from other people.
  • Further evaluation should be conducted in a private room with the door closed. An airborne infection isolation room (AIIR), if available, is ideal.

Healthcare personnel who enter this room should observe standard precautions and contact precautions and should use eye protection.

The healthcare facility’s infection control personnel and local health department should be contacted immediately to determine if the patient should be considered a patient under investigation (PUI) for 2019-nCoV and to undergo testing for the virus.

Criteria to guide evaluation and testing of patients under investigation for COVID-19

Whether a patient is a PUI for COVID-19 should be determined by the local health department in consultation with clinicians. CDC’s clinical criteria have been developed based on known information about this novel virus and are informed by details known about SARS and MERS.

Table 1. CDC Clinical Criteria for COVID-19 (Open Table in a new window)

Clinical Features

AND

Epidemiologic Risk

Fever or signs/symptoms of lower respiratory illness

AND

A history of close contact with an individual with laboratory-confirmed COVID-19 within 14 days of symptom onset

Fever and signs/symptoms of a lower respiratory illness

AND

A history of travel from Hubei Province, China, within 14 days of symptom onset

Fever and signs/symptoms of a lower respiratory illness requiring hospitalization

AND

A history of travel from mainland China within 14 days of symptom onset

Reporting, testing, and specimen collection

In the event that a patient is classified a PUI for COVID-19, infection-control personnel at the healthcare facility should immediately be notified. Upon identification of a PUI, state health departments should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a 2019-nCoV PUI case investigation form. The EOC will provide assistance with the obtaining, storing, and shipping of appropriate specimens to the CDC. Diagnostic testing for COVID-19 can be performed only at the CDC.

The CDC recommends collecting and testing upper respiratory specimens (oropharyngeal and nasopharyngeal swabs) and lower respiratory specimens (sputum, if possible) in patients with a productive cough for initial diagnostic testing. Sputum induction is not indicated. Once a PUI is identified, specimens should be collected as soon as possible.

Treatment of COVID-19

Treatment of COVID-19 is supportive, as no vaccine or specific treatment is yet available.

Hospitalized patients with COVID-19 should be managed in a private room with the door closed (an AIIR is ideal).

Home care and isolation may be an option for some persons, based on an assessment of clinical and public health. Such patients should be monitored by public health officials to the extent possible.