First Case of 2019 Novel Coronavirus Identified in Orange County
January 26, 2020
The first confirmed case of 2019 novel coronavirus (2019-nCoV) in Orange County was identified yesterday. A second case was also confirmed yesterday in Los Angeles County. Both occurred in non-resident travelers from Wuhan who acquired infection there and appear to be unrelated. 
The Orange County Health Care Agency is working to identify any contacts of the Orange County case to monitor them for signs and symptoms of illness and to take measures to prevent transmission. No secondary person-to-person transmission has been identified. Because there is minimal risk to the county's general population, and OCHCA is following up directly with persons identified to be at risk, OCHCA has not altered the current provider recommendations for testing for 2019-nCoV (see When to Test below).
 
Recommendations for  Providers:
  • Providers should immediately report all cases of suspected 2019-nCoV infection to the Orange County Health Care Agency at 714-834-8180 (after hours contact the OCHCA physician on call at 714-628-7008).

  • Providers should take a detailed travel history for patients with fever and acute respiratory illness to identify potential exposures. If a patient reports recent travel to China, the provider should clarify which cities and provinces were visited.
Clinical Presentation:
Based on experience with other coronaviruses, 2019-nCoV’s incubation period is presumed to extend up to 14 days. The virus’s transmission dynamics have yet to be determined.

The primary clinical symptoms have been respiratory, including fever, cough, and shortness of breath. A significant proportion of cases have had pneumonia.  Cases of more mild illness are being identified as well; at this point it is not clear how many people infected with nCoV will develop severe illness.
When to Test:
Patients who meet the following criteria should be tested for 2019-nCoV:

----- 1)   Fever AND symptoms of lower respiratory illness (e.g., cough, shortness of
breath).

--------- AND in the 14 days before symptom onset:

-------- History of travel from Wuhan City, China
--------- -or-
--------- Close contact with a person who is under investigation for 2019-nCoV while that ------------- person was ill.

----- 2)   Fever  OR symptoms of lower respiratory illness (e.g., cough, shortness of breath).

--------- AND in the last 14 days before symptom onset, close contact with an ill ------------------------- laboratory-confirmed 2019-nCoV patient.

Note that these recommendations should serve as guidelines for providers. Fever may not always be present, and clinical judgment should always be used to guide testing. All laboratory testing for 2019-nCoV is currently performed by the CDC. 
Laboratory Testing:
All laboratory testing is currently being performed by the CDC. CDC will accept specimens for testing following a clinical case review by local public health.

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

If a lower respiratory tract specimen is not obtainable, upper respiratory and serum specimens 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 t he 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:
Patients who qualify for assessment for 2019-nCoV should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available. Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). Eye protection is considered important for preventing transmission of 2019 nCoV.

If a patient that has suspected or confirmed 2019-nCoV is being cared for in a facility that can provide airborne precautions, OCHCA will not routinely recommend transfer to an alternate facility for care. 
 
An All Facilities Letter was distributed by the California Department of Public Health today which reviewed infection control issues and recommendations for healthcare facilities. It can be found at https://www.cdph.ca.gov/Programs/CHCQ/LCP/CDPH%20Document%20Library/AFL-20-09.pdf . 
Care of Contacts:
  • Contacts who have symptoms consistent with coronavirus infection should receive immediate evaluation and care.

  • Asymptomatic contacts will be assessed for risk by OCHCA.

Recommendations for Travelers:
CDC recommends avoiding non-essential travel to Wuhan, China.

Updated traveler recommendations can be found at https://wwwnc.cdc.gov/travel/notices/alert/novel-coronavirus-china .
Contact Information:
For questions or concerns, please contact the Communicable Disease Control Division at 714-834-8180.
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