2019 Novel Coronavirus: Orange County Updates
March 4, 2020
The second and third Orange County cases of 2019 Novel Coronavirus Disease (COVID-19) were confirmed yesterday. Both cases had a history of recent international travel to a country with known local spread of COVID-19. The Orange County Health Care Agency (OCHCA) is identifying and contacting any community exposures to these cases.

Multiple cases of COVID-19 infection in persons without a history of international travel were identified last week in Northern California, Oregon and Washington state. These cases are the first indications of community transmission in this country. Several cases in Washington state have passed away, marking the country’s first COVID-19 deaths. Over 80,000 cases have been identified worldwide.  In addition to China, South Korea, Japan, Italy and Iran all are now reporting significant local transmission.

OCHCA’s public health laboratory can now perform COVID-19 clinical testing for patients.
Recommendations for Providers:
  • Immediately report all suspect cases of COVID-19 infection to the Orange County Health Care Agency at 714-834-8180 (after hours call 714-628-7008).
  • Take a detailed travel history for any patient presenting with fever and acute respiratory illness.
  • Assess hospitalized patients with respiratory illness for a clinical course consistent with COVID-19.
  • This situation continues to evolve rapidly; providers should consistently monitor CDC recommendations at https://www.cdc.gov/coronavirus/2019-ncov/index.html.
When to Test:
Today the CDC expanded the criteria for evaluation of Persons Under Investigation (PUI) to a wider group of symptomatic patients. CDC’s updated guidance can be found at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html .

The CDC recommends that clinicians use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.

In the coming weeks, it is anticipated that clinicians will have access to laboratory testing for diagnosing COVID-19 through clinical laboratories. For now, given limited capacity and no documented community spread in the county, OCHCA’s public health laboratory will continue to test patients with fever and acute respiratory illness who:

  • Have had close contact with a confirmed COVID-19 case

  • Develop symptoms within 14 days of returning from affected geographic areas with widespread or sustained community transmission including China, Iran, Italy, South Korea, and Japan.

  • Have severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (e.g., influenza), regardless of travel or exposure history.
Laboratory Testing:
The Orange County Health Care Agency Laboratory now has the capacity to test for COVID-19.

Diagnosis is confirmed by PCR testing of appropriate clinical specimens. CDC recommends the collection of:
  • Upper respiratory (nasopharyngeal AND oropharyngeal swabs)
  • Lower respiratory if available (tracheal aspirate, bronchoalveolar lavage specimens, or sputum)

If a lower respiratory tract specimen is not obtainable, upper respiratory may be submitted alone for testing.

Specimens should be stored at 2-8°C and sent by courier to Orange County Public Health Laboratory prior to shipment to the CDC.

More detailed guidance on specimen collection and laboratory biosafety can be found at:

Clinical Care:
Care is supportive. No vaccine or specific treatment for 2019-nCoV infection is available.
Infection Control Precautions:
Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility.

Patients who qualify for assessment for 2019-nCoV should be asked to wear a surgical mask as soon as they are identified. They should be evaluated in a private room with the door closed, ideally in an airborne infection isolation room if available. Healthcare personnel entering the room should utilize appropriate personal protective equipment (PPE), which includes gown, gloves, N-95 particulate respirator and goggles or a face shield.
Contact Information
For questions or concerns please contact the Communicable Disease Control Division at 714-834-8180.
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