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RIDOH Provider Advisory

February 10, 2019

Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with 2019 Novel Coronavirus (2019-nCoV)

CDC is closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus (“2019-nCoV”) that was first detected in Wuhan, Hubei Province, China and which continues to expand. The Rhode Island Department of Health (RIDOH) advises healthcare providers and facilities to conduct travel screening, and implement standard, contact, and airborne isolation in any patients with a fever or respiratory illness who report travel to China within 14 days of symptom onset. Recommendations are likely to change as we learn more about this developing situation and RIDOH will update providers accordingly. Please consult the latest from CDC and RIDOH, as well as the updated guidance for providers from CDC found on RIDOH's 2019 Novel Coronavirus Information for Healthcare Providers web page.

Any suspected cases of 2019 novel coronavirus should be reported to RIDOH immediately. For any questions and to report cases, please call the Rhode Island Department of Health Center for Acute Infectious Disease Epidemiology at 401-222-2577 during business hours (Monday – Friday, 8:30 a.m. – 4:30 p.m.) or 401-276-8046 after hours.

Background

Chinese health officials have reported tens of thousands of infections with 2019-nCoV in China, with the virus spreading from person-to-person in many parts of that country. Transmission to healthcare personnel (HCP) in China has also been reported in the media; however, there is not yet detailed information about those transmission events. Infections with 2019-nCoV, most of them associated with travel from Wuhan, are also being reported from a growing number of international locations, including the United States. The first confirmed instance of person-to-person spread of 2019-nCoV in the United States was reported on January 30, 2020.

Much is unknown about 2019-nCoV. Current knowledge is largely based on what is known about similar coronaviruses. Coronaviruses are a large family of viruses that are common in humans and in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with SARS-CoV, MERS-CoV, and likely now with 2019-nCoV.

Early reports suggest spread from person-to-person most likely happens during close exposure to a person infected with 2019-nCoV. Person-to-person spread may occur similar to other coronaviruses, mainly via respiratory droplets produced when an infected person coughs. These droplets can land in the mouths, noses, or eyes of people who are nearby or possibly be inhaled into the lungs. Currently, the extent to which touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, contributes to transmission is unclear.

Purpose

This interim guidance is intended to assist with assessment of risk, monitoring, and work restriction decisions for HCP with potential exposure to 2019-nCoV. For guidance on assessment and management of exposure risk in non-healthcare settings, refer to the Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential 2019 Novel Coronavirus (2019-nCoV) Exposure in Travel-associated or Community Settings. The guidance for non-healthcare settings can also be used to identify the movement, public activity and travel restrictions that apply to the HCP included here.

Because of their often extensive and close contact with vulnerable individuals in healthcare settings, a conservative approach to HCP monitoring and restriction from work was taken to quickly identify early symptoms and prevent transmission from potentially contagious HCP to patients, HCP, and others visiting or working in a healthcare setting. For this reason, the signs and symptoms* described in this guidance are more inclusive than those described when assessing exposures for individuals not working in healthcare. Healthcare facilities should have a low threshold for evaluating symptoms and testing symptomatic HCP, particularly those who fall into the high- and medium-risk categories described in this guidance.

This guidance is based on the currently limited information available about 2019-nCoV. Based on these uncertainties, the recommendations regarding which HCP are restricted from work may not prevent all transmission or anticipate every potential scenario, and will change if indicated by new information.

Healthcare facilities, in consultation with public health authorities should use clinical judgement as well as the principles outlined in this guidance to assign risk and determine need for work restrictions. CDC remains available for further consultation by calling the Emergency Operations Center at 770-488-7100. This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States.

Other Resources

For guidance on risk assessment and public health management of persons not working in a U.S. healthcare setting refer to: Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential 2019 Novel Coronavirus (2019-nCoV) Exposure in Travel-associated or Community Settings.

For infection prevention and control guidance for healthcare settings caring for Persons with Known or Under Investigation (PUI) for 2019 Novel Coronavirus (2019-nCoV), refer to the Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (2019-nCoV) in a Healthcare Setting.

For more information, please read CDC's full guidance document, including definitions in this guidance, defining exposure risk category (with Table 1, "Epidemiologic Risk Classification1 for Asymptomatic Healthcare Personnel Following Exposure to Patients with 2019 Novel Coronavirus Infection or their Secretions/Excretions in a Healthcare Setting, and their Associated Monitoring and Work Restriction Recommendations"); and recommendations for monitoring based on 2019-nCoV exposure risk.
Rhode Island healthcare providers

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