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New Recommendations for Health Care Providers: 2019 Novel Coronavirus

February 7, 2020

The World Health Organization (WHO) has declared an international health emergency related to the recent outbreak of a novel coronavirus — here is what nurse practitioners (NPs) need to know.

The first cases of the novel (new) coronavirus were reported in Wuhan, China, on December 31, 2019. Currently, public health officials are working to identify the source and are tracking the spread of the virus. Reported illnesses have varied in severity, ranging from mild cases to severe ones resulting in death.

Describing a respiratory illness with symptoms of fever, cough and shortness of breath, the 2019 novel coronavirus (2019-nCoV) differs from coronaviruses that are already known to circulate among humans, including 229E, NL63, OC43 and HKU1. The 2019-nCoV is also not the same as SARS-CoV, first reported in 2002, or MERS-CoV, first reported in 2012. However, genetic analyses have suggested that the 2019-nCoV may have emerged from a virus related to SARS. Coronaviruses in general can cause illness in both humans and animals, and it has been suggested that 2019-nCoV may have been transmitted to humans from an animal, similar to SARS and MERS.

Human-to-human transmission has now been confirmed in China, as well as other countries around the world. 2019-nCoV infection has been confirmed in the U.S. concerning patients who have recently traveled to Wuhan. Person-to-person transmission has been seen among close contacts of returned travelers from Wuhan, but at this time, this virus is not currently spreading within the U.S. WHO has released daily situation reports monitoring the spread, treatment recommendations and response to the outbreak. It also maintains an updated situation dashboard on 2019-nCoV cases globally and reports that, to date, just 12 cases have been confirmed in the U.S. as a whole.

View the 2019-nCoV Situation Dashboard

To date, there is no specific medication or vaccination recommended by WHO or the Centers for Disease Control and Prevention (CDC) to treat or prevent 2019-nCoV. Updated February 2, 2020, the CDC has released interim guidance for health care professionals in the U.S. to combat the spread of this illness:

All 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.
Patients presenting with fever or symptoms of lower respiratory illness and who have been in close contact with a laboratory-confirmed 2019-nCoV patient within 14 days of the onset of symptoms should be evaluated as a patient under investigation.
Patients presenting with fever and symptoms of lower respiratory illness and who have traveled from Hubei Province, China, within 14 days of the onset of symptoms should be evaluated as a patient under investigation.
Patients presenting with fever and symptoms of lower respiratory illness requiring hospitalization and who have traveled to mainland China within 14 days of the onset of symptoms should be evaluated as a patient under investigation.

Review the Full CDC Guidance

The CDC has also released interim recommendations for infection prevention and control for patients under investigation or patients with confirmed 2019-nCoV:

Minimize the chance of exposure.
Adhere to standard, contact and airborne precautions.
Manage visitor access and movement within the facility.
Implement engineering controls.
Monitor and manage ill and exposed health care personnel.
Train and educate health care personnel.
Implement environmental infection control.
Establish reporting within health care facilities and to public health authorities.

Review the Full CDC Recommendations

On February 7, the Centers for Medicare & Medicaid Services (CMS) released two memoranda advising health care facilities and State Survey Agencies (SAs) of infection control procedures and laboratory tests.

The first, for health care facilities, outlines the importance of basic infection control practices and CDC recommendations on standard hand hygiene. It also encourages the review of appropriate personal protective equipment use and availability. The second, for SAs, includes details on the Federal Drug Administration’s (FDA’s) Emergency Use Authorization for the 2019-nCoV test to detect infections in humans.