March 4, 2020
NYC DOHMH Alert #3
:
New York City Resident Diagnosed with 2019 Novel Coronavirus (COVID-19) Infection;
NYC Health Department Now Performing COVID-19 Testing;
Clarification of New CDC Testing Criteria
• The 2019 novel coronavirus disease (COVID-19) outbreak continues to expand worldwide, with community transmission on several continents.
• Two people in New York City (NYC) have been diagnosed with COVID-19.
• The NYC Public Health Laboratory is now able to perform COVID-19 testing.
• Providers wanting to request COVID-19 testing should be familiar with the Centers for Disease Control and Prevention’s (CDC) updated testing criteria for Persons Under Investigation (PUI) for COVID-19. (See Table below)
• Prepare to prevent and minimize the spread of COVID-19. Develop plans and protocols to:
--Promptly identify, isolate, and evaluate persons with possible COVID-19
--Notify the NYC Health Department if patients meet CDC PUI testing criteria
--Once approved, collect clinical specimens for diagnostic testing for COVID-19
As of March 3, 2020, two individuals have been diagnosed with COVID-19 in New York City. It is expected that given the continuing spread of the virus around the globe, with time additional persons infected with COVID-19 will be identified in NYC.
Providers also should be aware of recent updates to the CDC criteria for a person under investigation (PUI) for COVID-19, which were published in a CDC Health Advisory (
https://emergency.cdc.gov/han/2020/HAN00428.asp
) distributed on February 28, 2020 (see Table below). Prior to these changes, CDC COVID-19 PUI criteria were based entirely on a combination of clinical and epidemiologic features. A new category of PUI was introduced with the following criteria:
• patients without identified sources of exposure AND
• fever with severe acute lower respiratory illness (e.g., pneumonia, ARDS [acute respiratory distress syndrome] requiring hospitalization and without an alternative explanatory diagnosis (e.g., influenza).
This new CDC COVID-19 PUI criterion for severe acute lower respiratory disease allows COVID-19 testing for patients in whom there is a high index of clinical suspicion. For patients with severe acute lower respiratory disease who do not have an identified epidemiologic risk factor for COVID-19, clinicians should perform routine evaluation, including testing for common causes of community-acquired pneumonia, before notifying the NYC Health Department of the case and requesting testing for COVID-19, unless there is a high index of clinical suspicion for COVID-19. If COVID-19 is on the differential diagnosis, please implement appropriate infection control precautions (
https://www.cdc.gov/coronavirus/2019-ncov/infection-control/index.html
) until discussing with a NYC Health Department clinician.
For severe lower respiratory illness in hospitalized patients with no identified epidemiologic risk, clinical features that may increase suspicion of COVID-19 include:
• acute respiratory distress syndrome
• infiltrative process on chest x-ray (e.g., bilateral infiltrates consistent with viral pneumonitis).
• bilateral ground-glass opacities on chest computerized tomography
• unexplained lymphopenia or thrombocytopenia
If the clinical and radiologic presentation are equivocal, the following epidemiologic exposures within the 14 days preceding symptom onset should increase suspicion for COVID-19: close contact with an ill traveler who was in an affected country, or being a healthcare provider who may have had exposure to an unrecognized case of COVID-19.
The NYC Health Department asks that all healthcare providers report all patients with suspected COVID-19 and especially those in whom testing, in their clinical judgment, is likely to yield a COVID-19 diagnosis. To discuss any patient with a NYC Health Department clinician, call the Provider Access Line (PAL) at 866-692-3641.
