Office of Emergency Coordination (OEC)

OEC Update: March 2020 (1) Coronavirus Disease 2019 (COVID-19): An Evolving Situation – Part-1

Past issues of the OEC Update are available at https://clphs.health.mo.gov/oec/updates.php.

Coronavirus Disease 2019 (COVID-19): An Evolving Situation

Public health officials worldwide are responding to an expanding outbreak of respiratory illness caused by a novel (new) coronavirus now named SARS-CoV-2. The disease caused by SARS-CoV-2 has been named coronavirus disease 2019 (COVID-19). Cases of COVID-19, which were first identified in China, are now occurring in many other parts of the world, including the U.S.

In some individuals, infection has resulted in severe illness and death. Sustained person-to-person transmission of SARS-CoV-2 is occurring in China, and community spread is also being reported in a number of countries outside China. CDC has called the COVID-19 outbreak a concerning and serious public health threat.

In the U.S. as of March 5, a total of 99 confirmed and presumptive COVID-19 cases* have been reported from 13 states. Ten individuals have died. These numbers will continue to increase,

Recently in the U.S., several instances of infection with SARS-CoV-2 have occurred in persons in multiple states with no travel history and no known source of exposure. These situations are potentially indicative of community spread of the virus. (See below for links to up-to-date information on what is a rapidly evolving situation.)

Public health officials have stated that there will be community spread of SARS-CoV-2 in the U.S., although it is presently unclear how significant the long-term impact of COVID-19 will be in this country, including how many people will develop severe illness.

CDC believes the current risk to persons in this country from the virus is low, but everyone should be prepared for the possibility that a COVID-19 outbreak might occur in their community in the future.

CDC, multiple other federal agencies, state and local health departments, and other partners are currently implementing aggressive measures to slow transmission of SARS-CoV-2. These measures include identification of potential cases and their contacts, and ensuring that appropriate precautions are put in place to help prevent further transmission of the virus.

Although these measures might not prevent the eventual establish-ment of ongoing, widespread transmission of SARS-CoV-2 in the U.S., slowing the spread of illness can be beneficial because it provides time to:

1. prepare health care systems and the general public to be ready if widespread transmission with substantial associated illness occurs, and

2. obtain a better understanding of SARS-CoV-2 infection to guide public health recommendations and the development of medical countermeasures including diagnostics, therapeutics, and vaccines.

*These are cases of COVID-19 reported to CDC or tested at CDC since January 21, 2020, with the exception of testing results for persons repatriated to the U.S. from Wuhan, China and Japan.

SARS-CoV-2 is a respiratory virus that can be transmitted from an infected person to close contacts. Transmission appears to be mainly through respira-tory droplets produced when an infect-ed person coughs or sneezes, similar to how other respiratory viruses spread.

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Clinical manifestations of SARS-CoV-2 infection have ranged from mild symptoms to severe illness and death. Asymptomatic infection has also been reported. Signs/symptoms can include fever, cough, and shortness of breath. Currently there is no specific antiviral treatment recommended for SARS-CoV-2 infection; those who are ill receive supportive care. There is also, at present, no vaccine to prevent infection.

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Interim recommendations have been provided to health care providers for evaluation of persons under investiga-tion (PUI) for COVID-19, as well as guidance for infection control and the collection of specimens for laboratory testing. Providers are instructed to immediately notify both infection control personnel at their health care facility and public health officials in the event of a PUI for COVID-19.

Illustration of a Coronavirus

2 In the absence of a vaccine for SARS-CoV-2, non-pharmaceutical interventions (NPIs) are of primary

importance for community preparedness and outbreak response. They include personal protective measures implemented by individuals and community measures implemented by affected communities. (These are the same basic measures that would be taken in the event of an influenza pandemic.)

– The goals of these interventions would include: 1) slowing acceleration of the number of cases, 2) reducing the peak number of cases and related demands on hospitals and infrastructure, and 3) reducing the number of overall cases and their associated health effects.

– This is illustrated in the following figure, taken from CDC’s pandemic influenza guidance.

Goals of community mitigation for pandemic influenza

Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017. MMWR Recomm Rep 2017;66(RR-1):3.

– Which interventions would be used at a particular time would be based on the specific situation, including the severity of disease and the transmissibility of the virus, as shown in the figure below, which is also taken from CDC’s pandemic influenza guidance.

Phased addition of nonpharmaceutical interventions (NPIs) to prevent the spread of pandemic influenza in communities

Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017. MMWR Recomm Rep 2017;66(RR-1):15.

3

– CDC has recently developed specific guidance on preventing COVID-19 spread in communities, which is available at https://www.cdc.gov/coronavirus/2019-ncov/community/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fpreparing-individuals-communities.html.

Though the COVID risk to persons in the U.S. is considered low at this time, DHSS always recommends everyday steps to help prevent the spread of respiratory viruses generally, including:

– Avoid close contact with people who are sick.

– Avoid touching your eyes, nose, and mouth with unwashed hands.

– Stay home when you are sick.

– Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

– Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

– Clean and disinfect frequently touched objects/surfaces with a regular household cleaning spray or wipe.

– CDC does NOT recommend that the general public use facemasks or respirators to protect themselves from respiratory viruses (including SARS-CoV-2).

– Receive an annual influenza vaccination.

Be aware that the situation with regard to COVID-19 is rapidly evolving and some recommendations may change.

Current information on COVID-19, including the status of the outbreak and current recommendations, is available from CDC at https://www.cdc.gov/coronavirus/2019-nCoV/index.html, and from DHSS at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/. For up-to-date information on COVID-19 cases in the U.S., go to https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html.

Sources

CDC’s 2019 Novel Coronavirus Website https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Patel A, Jernigan DB. Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak — United States, December 31, 2019–February 4, 2020. MMWR 2020;69:140–146. https://www.cdc.gov/mmw r/volumes/69/wr/pdfs/mm6905e1-H.pdf

Qualls N, Levitt A, Kanade N, et al. Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017. MMWR Recomm Rep 2017;66(No. RR-1):1–34. https://www.cdc.gov/mmw r/volumes/66/rr/pdfs/rr6601.pdf

CDC Media Telebriefing: Update on COVID-19 (February 25, 2020)

https://www.cdc.gov/media/releases/2020/a0225-cdc-telebriefing-covid-19.html