Infectious disease expert to clinicians on coronavirus: Just ask patients one question

Anthony Fauci, M.D., has some simple advice for clinicians faced with a patient with respiratory symptoms and a fever—the signs of coronavirus.

“Just ask them a question: 'Have you been in China recently?'” said Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, in a JAMA podcast.

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If the patient has been in China where the coronavirus outbreak began and is still growing rapidly, “you put a mask on the person, you put them in an isolation room and you contact the CDC,” said Fauci, about notifying the Centers for Disease Control and Prevention.

There are now 12 confirmed cases of coronavirus in the U.S. The 12th known case was confirmed in Wisconsin by the CDC, the Wisconsin Department of Health Services said in a statement Wednesday. The patient is an adult with a history of travel to Beijing prior to becoming ill and was exposed to known cases while in China.

Other cases in the U.S. were reported in California, Arizona, Illinois, Washington and Massachusetts.

Health officials expect to find additional cases of coronavirus infection in the U.S. and more cases of person-to-person spread among close contacts of those diagnosed with the virus, Nancy Messonnier, M.D., director of the CDC’s National Center for Immunization and Respiratory Diseases, said at a Monday briefing.

The U.S. declared a public health emergency on Jan. 31, and President Donald Trump signed a presidential proclamation temporary suspending entry into the U.S. of foreign nationals who pose a risk of transmitting the illness.

American citizens and permanent residents who fly to the U.S. from China are now subject to a two-week quarantine.

Officials in China reported Wednesday that at least 490 people have died from the coronavirus and 24,324 were confirmed to be infected. That was up from 425 deaths and 20,438 confirmed cases the day before, according to The New York Times.

Cases of the coronavirus have been concentrated in China, but more than 200 individuals have been detected with the virus in 28 locations outside China, including the U.S., Messonnier said Wednesday.

Fauci, who co-authored a JAMA viewpoint titled, “Coronavirus Infections—More than Just the Common Cold,” was interviewed in a podcast by JAMA Editor-in-Chief Howard Bauchner, M.D., about the disease.

Bauchner’s last question to Fauci was about what clinicians should do, because patients are likely to be anxious about the illness and may seek care.

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“You know, it’s easy,” Fauci said, directing doctors to the CDC’s guidance for healthcare professionals.

Fauci said the situation is, however, made more difficult by the fact it’s the peak of influenza season. “You're going to get a lot of people that are going to be coming in with respiratory infections,” he said. However, if a patient presents with a respiratory pulmonary issue, such as cough or shortness of breath, and fever, the important thing is to determine whether the patient has been in China.

The CDC says healthcare providers should notify both infection control personnel at their healthcare facility and their local or state health department in the event they have a patient under investigation (what the government calls a PUI) for coronavirus. State health departments are told to immediately contact the CDC’s emergency operations center.

Fauci’s advice echoed that of CDC officials who advised healthcare providers to watch for people with travel history to China and fever and respiratory symptoms. Healthcare providers caring for patients with coronavirus are also being advised to following recommended infection control procedures.

In a briefing Wednesday, Messonnier said health officials are now evaluating the national stockpile of personal protective equipment (PPE)—masks, gloves and gowns—that healthcare workers use to protect themselves from exposure to illnesses. “We’re working with healthcare and industry parties to understand the supply chain,” she said.

She urged healthcare workers to use PPE “appropriately” but not “excessively,” because the country may need to preserve supplies if the risk from coronavirus becomes higher. Naturally, if the outbreak lasts a long time, the projections of PPE stockpiles look very different than if the virus is short-lived, she said. "Currently, the risk to the public is low,” she said, and health officials do not think members of the public need to go out and buy protective masks.

JAMA has established a resource center for coronavirus, which includes updates on diagnosis and treatment.