NOTE: Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date

SUMMARY:

The novel coronavirus, named SARS-CoV-2, is the pathogen underlying the pandemic (a global outbreak of disease). The disease associated with this virus has been officially named COVID-19. Coronaviruses represent a large family of viruses. They can cause human illness, but many are found in animals and, rarely, animal coronaviruses can evolve and infect people as was the case in previous infectious outbreaks such as MERS and SARS.

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• Symptoms
• Those at Risk
• Travel Warnings
• Recommendations for Reporting, Testing, and Specimen Collection
• Healthcare Personnel: Infection Prevention
• Discontinuation of Transmission-Based Precautions
• Hospital Discharge

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Symptoms

• Incubation period
  • Time from exposure to development of symptoms: 2 to 14 days
  • 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection (see ‘Related ObG Topics’ below)
  • Median time from exposure to symptoms onset: 4-5 days

• Signs and Symptoms
  • Fever (83% to 99%)
  • Cough (59% to 82%)
  • Fatigue (44% to 70%)
  • Anorexia (40% to 84%)
  • Shortness of breath (31% to 40%)
  • Sputum production (28% to 33%)
  • Myalgias (11% to 35%)

• Atypical presentations
  • Older adults: Especially those with comorbidities may have delayed presentation of fever and respiratory symptoms.
• Other symptoms that have been described in the literature (<10%)
  • Headache | Confusion | Rhinorrhea | Sore throat | Hemoptysis | Vomiting | Diarrhea
  • GI symptoms (diarrhea and nausea) may present prior to developing fever and lower respiratory tract signs | Anosmia or ageusia (taste) have also been reported (see ‘Related ObG Topics’ below) | CDC also lists chills and repeated shaking with chills as symptoms

Those at Risk

CDC Currently Considers the Following Individuals to be at Higher Risk

• Age
  • Risk of severe illness increases with age
  • Approximately 80% of COVID-19 deaths have been in the ≥65 age group
• People of any age with certain underlying medical conditions are at increased risk for severe illness from COVID-19
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Immunocompromised state (weakened immune system) from solid organ transplant
  • Obesity (body mass index [BMI] of 30 or higher)
  • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Sickle cell disease
  • Type 2 diabetes mellitus

Pediatric population: Medically complex conditions | Neurologic, genetic, metabolic conditions | Congenital heart disease

Those Who Might be at an Increased Risk

• Asthma (moderate-to-severe)
• Cerebrovascular disease (affects blood vessels and blood supply to the brain)
• Cystic fibrosis
• Hypertension or high blood pressure
• Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
• Neurologic conditions, such as dementia
• Liver disease
• Pregnancy
• Pulmonary fibrosis (having damaged or scarred lung tissues)
• Smoking
• Thalassemia (a type of blood disorder)
• Type 1 diabetes mellitus

Travel Warnings

• Updated travelers’ warnings can be found within the CDC Novel Coronavirus Summary page below (‘Learn More – Primary Sources’)

KEY POINTS:

Recommendations for Reporting, Testing, and Specimen Collection

Diagnostic Testing – Specimen Collection

• Obtain an upper respiratory specimen for initial diagnostic testing
  • A nasopharyngeal (NP) specimen collected by a healthcare professional or
  • An oropharyngeal (OP) specimen collected by a healthcare professional or
  • A nasal mid-turbinate swab collected by a healthcare professional or by a supervised onsite self-collection (using a flocked tapered swab) or
  • An anterior nares (nasal swab) specimen collected by a healthcare professional or by onsite or home self-collection (using a flocked or spun polyester swab) or
  • Nasopharyngeal wash/aspirate or nasal wash/aspirate (NW) specimen collected by a healthcare professional
• Lower respiratory tract specimens
  • Collect and test sputum in patients who develop a productive cough | Induction of sputum is not recommended
  • Under certain clinical circumstances (e.g., those receiving invasive mechanical ventilation), a lower respiratory tract aspirate or bronchoalveolar lavage sample should be collected and tested as a lower respiratory tract specimen

Note: CDC does not recommend using antibody testing to diagnose acute infection | Use a viral (nucleic acid or antigen) test to diagnose acute infection

Healthcare Personnel: Infection Prevention

• Healthcare personnel: CDC advises use of
  • Gloves
  • Gowns
  • Airborne precautions
  • Eye protection (e.g., goggles or a face shield)
• Face masks are an acceptable alternative when the supply chain of N95 respirators (or similar respirators that filter inspired air and offer respiratory protection) cannot meet the demand
• If respirators are in short supply, priority should be given to aerosol-generating procedures
• CDC addresses alternatives in the setting of face mask shortages on the page entitled Strategies for Optimizing the Supply of Facemasks (see ‘Learn More – Primary Sources’)
  

Discontinuation of Transmission-Based Precautions: Now Symptom-Based

Duration of Isolation

• For most persons with COVID-19 illness
  • Discontinue isolation and precautions 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms
  • A limited number of persons with severe illness may produce replication-competent virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; consider consultation with infection control experts
• For persons who never develop symptoms
  • Discontinue isolation and other precautions 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA

Role of PCR testing to discontinue isolation or precautions

• For severely immunocompromised individuals, a test-based strategy could be considered in consultation with infectious diseases experts
• For all others, a test-based strategy is no longer recommended except to discontinue isolation or precautions earlier than would occur under the strategy outlined above

Role of PCR testing after discontinuation of isolation or precautions

• For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery
  • Retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 infection
  • Quarantine is not recommended in the event of close contact with an infected person
• For persons who develop new symptoms consistent with COVID-19 during the 3 months after the date of initial symptom onset
  • If an alternative etiology cannot be identified by a provider, then the person may warrant retesting
  • Consult with infectious disease experts
  • Isolation may be considered during this evaluation based on consultation with an infection control expert, especially in the event symptoms develop within 14 days after close contact with an infected person

Hospital Discharge

• Patient can be discharged from hospital with COVID-19 when clinically indicated even if not having met criteria for discontinuation of Transmission-Based Precautions
• If not yet met criteria for discontinuation of Transmission-Based Precautions
  • Decision should be made with clinical care team and local or state public health departments
  • Take in to consideration patient’s home situation and whether it is appropriate for home isolation recommendations (e.g., separate bedroom, appropriate caregivers, access to PPE, potential risk to others in the home who may be at risk)

Learn More – Primary Sources:

CDC: 2019 Cases, Data, & Surveillance

CDC: COVID-19 and Older Adults

CDC: People of Any Age with Underlying Medical Conditions

CDC Coronavirus Disease 2019: Overview of Testing for SARS-CoV-2

CDC: Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)

CDC: Duration of Isolation and Precautions for Adults with COVID-19

CDC Coronavirus Disease 2019: Guidelines for Clinical Specimens

CDC: Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19

CDC: Coronavirus Disease 2019 Information for Travel

CDC FAQs for Healthcare Professionals

CDC: Strategies for Optimizing the Supply of Facemasks

CDC: Disposition of Hospitalized Patients with COVID-19

CDC: Implementing Home Care

WHO: Novel coronavirus Information Page

An ACP Physician’s Guide + Resources

BMJ: Coronavirus Updates

Lancet: Coronavirus Hub

NEJM: 2019 Novel Coronavirus

Annals of Internal Medicine: Content Related to Coronavirus in Annals of Internal Medicine

CDC: Standard Precautions

CDC: Contact and Airborne Precautions

CDC: Middle East Respiratory Syndrome (MERS)

CDC: Severe acute respiratory syndrome (SARS)

JAMA: What Is a Pandemic?

Related ObG Topics: