For Healthcare Providers

Coronavirus disease, known as COVID-19, is the disease caused by the SARS-CoV-2 virus. On February, 12 2020, the novel Coronavirus was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) while the disease resulting from this is now referred to as Coronavirus disease, COVID-19. It is a novel strain of coronavirus that has not been previously identified in humans. The 2019 novel Coronavirus was initially identified in China at the end of 2019.

Symptoms of COVID-19 range from mild non-specific symptoms such as cough, fever, muscle aches, malaise, shortness of breath to severe pneumonia with respiratory failure, septic shock and multi-organ failure. There have also been some reported cases of persons with asymptomatic infection with Coronavirus disease (COVID-19).

Coronaviruses are viruses that are commonly found in some animals but until now were not known to affect humans. After animals have been infected, the virus has now been seen to be transmissible to humans. There are several animals that are known to be sources of the Coronavirus including bats. Others like the Severe Acute Respiratory Syndrome (SARS) were originally found in civet cats and then the Middle East respiratory syndrome coronavirus (MERS-CoV) which was initially found in camels. 

The novel Coronavirus was initially identified in China at the end of 2019 and is a new strain that was not previously identified in humans. The novel Coronavirus is similar to the SARS virus which was first identified in the early 2000s. Although the available data on this virus is limited, it appears to have very similar properties and characteristics with the 2003 SARS virus.

SARS reportedly emerged towards the end of 2002 in China and there were more than eight thousand SARS-cases reported in over thirty countries in less than a twelve month period. The mortality rate from SARS then was noted to be high. The current novel Coronavirus (COVID-19) outbreak led to around ten thousand reported cases during the first twenty eight days of the first reported outbreak.

Since then several cases have been reported in other countries. There is currently limited data to ascertain how deadly the novel Coronavirus (COVID-19) is early reports still indicate that it is less fatal than the SARS coronavirus. Both the influenza and SARS-CoV-2 can be transmitted from person-to-person however both viruses are distinctly different.

Information is constantly unfolding so it is premature at this time to accurately determine the exact mechanism of spread for the SARS-CoV-2 however initial data indicates that the SARS-CoV-2 is as transmissible similar to the SARS and other pandemic influenza strains. 

At this time, the people at greatest risk of infection are people who have been exposed to confirmed cases of Coronavirus disease (COVID-19) or recent travel to affected regions.

Limited data currently exists to support the identification of risk factors for developing severe disease from Coronavirus (COVID-19) infection. However people at higher risk of developing similar viral and severe infections are extremes of age (infants and older adults), people with underlying chronic medical conditions and immunocompromised patients

Animals are the main source of the virus however this virus is now transmissible from person-to-person. More information is still needed to fully determine the mode of transmission as there is still not enough epidemiological information to determine the ease and sustainability of spread amongst humans. It appears that the Coronavirus (COVID-19) is spread mainly via respiratory droplets that people cough, sneeze or exhale.

The incubation period for the Coronavirus (COVID-19) is currently estimated at between two and 14 days. The incubation period is the time between exposure to the virus and the time of actual onset of clinical symptoms. By this stage, we already know that the virus can be transmitted when infected people have already begun to display signs of illness or flu-like symptoms. It is however still to be determined if asymptomatic or mild cases can transmit the virus. 

Person-to-person transmission has been confirmed however more information is needed to fully determine the mode of transmission. 

Typically, from existing literature, the incubation period for other Coronaviruses such as MERS-CoV, SARS-CoV indicate the incubation period is typically anywhere from 2 - 14 days. However the exact onset and duration of viral shedding for Coronavirus (COVID 19) and period of infectiousness for COVID-19 are not known at this time. 

As already known, similar viruses like SARS-CoV-2 RNA, MERS-CoV and SARS-CoV may be detectable in the respiratory tract of affected people for weeks after onset of illness. It should be noted that detection of viral RNA does not necessarily mean that an infectious virus is present as there have been cases of asymptomatic infection with similar viruses. 

At this time, it is not yet proven if other non-respiratory body fluids from an infected person such as urine, breast milk etc. can be reservoirs of the Coronavirus (COVID-19). Similar viruses like SARS-CoV-2 RNA have been detected from respiratory tract specimens and bronchoalveolar lavage fluid.

SARS-CoV-2 RNA has been detected in blood and stool specimens as well. Infectious SARS-CoV has been isolated from respiratory, urine, stool and blood samples. Infectious MERS-CoV has only been isolated from respiratory tract specimens. 

At this time the re-infection mechanism is not known. Similar infections like MERS-CoV have a lower probability of developing recurrence so quickly after recovery. 

It is recommended that Medical First Responders, Emergency Personnel and Healthcare Workers utilize Personal Protective Equipment (PPE). All Healthcare Workers who will directly provide care for people with suspected Coronavirus disease (COVID-19) infection will need to follow Standard, Contact, and Airborne Precautions.

Diagnostic or therapeutic procedures that are indicated need to be performed based on the standard of care, however patients with suspected or confirmed Coronavirus disease (COVID-19) need to be placed in airborne isolation rooms.

Patients with suspected or confirmed Coronavirus disease (COVID-19) should wear protective masks to avoid further spread. Healthcare providers involved in the care of these patients must utilize Personal Protective Equipment (PPE).

All Healthcare providers who will directly provide care for people with suspected Coronavirus disease (COVID-19) infection will need to follow Standard, Contact, and Airborne Precautions.

At this time, there is no specific treatment for the Coronavirus disease (COVID-19). Patients with Coronavirus-associated infections are treated for clinical symptoms such as shortness of breath, fever.

The mainstay of treatment is supportive care which includes adequate fluid management, supplemental oxygen, use of antivirals where indicated and treating any additional superimposed conditions like bacterial pneumonia and others. Patients with severe disease need to be monitored closely as they can rapidly develop septic shock, multi-organ failure. 

Corticosteroids are NOT routinely recommended for the management of viral pneumonia or Acute Respiratory Distress Syndrome (ARDS) and should be avoided unless they are indicated for another clinical condition such as refractory septic shock, Chronic Obstructive Pulmonary Disease (COPD exacerbation) and others. At the time of this posting, there are currently no specific antiviral drugs for the treatment of Coronavirus disease (COVID-19). 

With community spread and new presentations being noted in many parts of the world, testing criteria is rapidly changing. If you need to test a PUI (Person under investigation) for COVID-19, check with your local health department or hospital for testing options.  Many private laboratories now offer commercially approved testing. 

At the time of this posting, there is currently no approved post-exposure prophylaxis for people who may have been exposed to COVID-19. 

Healthcare providers should promptly inform and notify the necessary agencies including infection control personnel at their healthcare facility and their local or state health department in the event of a Person Under Investigation (PUI) for COVID-19. 

Not all patients with suspected or confirmed Coronavirus disease (COVID-19) require admission to the hospital. Hospitalization will depend on the the clinical presentations and findings for each individual case.

Patients with clinical presentation warranting in-patient management for supportive care should be admitted to the hospital and placed under appropriate isolation precautions. There are instances where patients may initially present mild clinical symptoms which could worsen in the subsequent days. It is imperative that the decision to hospitalize patients versus managing them outpatient be made on a case-by-case basis.

Additional factors that will determine the management setting for these patients also include the ability of the patient to engage in monitoring, the ability for safe isolation at home, and the risk of further transmission of the virus in the patient’s home setting. 
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For more information, see Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for Coronavirus Disease 2019 (COVID-19) in a Healthcare Setting and Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19).

Patients with confirmed COVID-19 infections can be discharged from the healthcare facility when they are noted to be clinically stable and not displaying signs of active infection. However, isolation should be maintained at home if the patient returns home earlier than the time period recommended for discontinuation of hospital isolation precautions.

The decision to discontinue precautions in the hospital setting or at home can be made on a case-by-case basis in conjunction with recommendations from the clinicians, infection prevention and control specialists, and the department of Public Health based upon multiple factors, including signs and symptoms of disease, severity of disease and results of diagnostic testing for COVID-19 in respiratory specimens.