Update: COVID-19 (Novel Coronavirus) Clinical Evaluation Update

Posted Feb. 28, 2020. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.


The worldwide outbreak of COVID-19 (previously known as nCoV-19 or novel coronavirus) that originated in Wuhan City, Hubei Province, China in late December continues to evolve. While almost 94% of the 84,119 confirmed cases globally have occurred in China, recently more cases have been identified in countries outside China than in China. Accordingly, the Centers for Disease Control & Prevention (CDC) revised its clinical and epidemiological criteria for evaluating patients for suspected COVID-19 and subsequent testing. Currently, those revisions include expanding criteria to persons who traveled to China, Italy, Iran, Japan and South Korea to reflect ongoing community transmission in those countries.  

As of Feb. 28, the Washington State Public Health Laboratory will be testing for COVID-19 six days per week, dramatically reducing burden on CDC resources and subsequent wait times for test results.  

Public health continues to recommend healthcare providers consider COVID-19 in a patient who has traveled from affected geographic areas with widespread or sustained community transmission presenting with fever, cough or shortness of breath AND requiring hospitalization. Testing is restricted to the case definition criteria described below. Public health will not authorize testing for asymptomatic individuals.  

For all patients:

  • Obtain a detailed travel history for patients being evaluated with fever and symptoms of acute lower respiratory illness (cough and/or shortness of breath).
  • Use the guidance below to assist in screening for possible COVID-19 infection
CLINICAL FEATURES & EPIDEMIOLOGIC RISK
Fever1or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath) AND Any person, including healthcare workers2, who has had close contact3 with a laboratory-confirmed4 COVID-19 patient within 14 days of symptom onset
Fever1and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization AND A history of travel from affected geographic areas5 (see below) within 14 days of symptom onset
Fever1 with severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (e.g., influenza)6 AND No source of exposure has been identified
1Fever may be subjective or confirmed
2For healthcare personnel, testing may be considered if there has been exposure to a person with suspected COVID-19 without laboratory confirmation
3Close contact is defined as— a) being within approximately six feet of a COVID-19 case for a prolonged period; or b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)
4Documentation of laboratory-confirmation of COVID-19 may not be possible for travelers or persons caring for COVID-19 patients in other countries.
5Affected areas are defined as geographic regions where sustained community transmission has been identified. Relevant affected areas will be defined as a country with at least a CDC Level 2 Travel Health Notice. See all COVID-19 Travel Health Notices.
6 Category includes single or clusters of patients with severe acute lower respiratory illness (e.g., pneumonia, ARDS) of unknown etiology in which COVID-19 is being considered

When to suspect COVID-19:

  • COVID-19 should be suspected in patients who present with:
    • fever AND symptoms of lower respiratory illness (e.g., cough, difficulty breathing) requiring hospitalization AND in the 14 days before symptom onset:
    • fever OR symptoms of lower respiratory illness (e.g., cough, difficulty breathing) AND in the 14 days before symptom onset had close contact with an ill lab-confirmed COVID-19 patient.
  • While there have been concerns voiced in the media about asymptomatic infections, public health will not approve specimens for testing from asymptomatic individuals with travel from affected countries or for symptomatic individuals who have had contact with asymptomatic people who had travel from affected areas

If above criteria are met to suspect COVID-19:

  • Ask patients with suspected COVID-19 infection to wear a surgical mask as soon as they are identified and evaluate them in a private room with the door closed, ideally an airborne infection isolation room if available.
  • All healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., gown, gloves, N95 mask or PAPR, and face shield or goggles).
  • Immediately notify both infection control personnel at your healthcare facility and Spokane Regional Health District at 509-869-3133 in the event of a suspected case of COVID-19.
  • Collect an upper respiratory specimen (NP or OP swab) and store in viral transport medium. Specimens should be refrigerated and shipped cold. Public health will provide guidance and facilitation regarding specimen collection, storage, and shipping to the Washington State Public Health Lab.
    • Concurrent local commercial testing of a second upper respiratory specimen should occur with a respiratory pathogen panel to rule out other infectious causes, including but not limited to influenza.
  • Outpatient settings should consider transfer of a patient presenting with possible COVID-19 infection to an emergency department where PPE and an airborne infection isolation room may be more readily available to help aid in the safe collection of specimens and minimize risk to healthcare workers.

Washington State Department of Health and CDC have compiled additional guidance for healthcare providers, which is available on their website (this is a rapidly evolving situation and you should continue to check for updates to these documents): https://www.doh.wa.gov/Emergencies/Coronavirus/Resources

CDC Clinician Outreach and Communication Activity: Coronavirus Disease 2019 (COVID-19) Update—What Clinicians Need to Know to Prepare for COVID-19 in the United States

When: Thursday March 5, 11 a.m. to 12 p.m. Pacific
What: During this COCA Call, clinicians will learn what they can do to prepare for COVID-19 including identifying persons under investigation, applying infection prevention and control measures, assessing risks for exposures, optimizing the use of personal protective equipment supplies, and managing and caring for patients (inpatient and at home).
Where:  Please click the link to join:  https://zoom.us/j/695903771
Or Telephone: US: +1 646 876 9923 or +1 669 900 6833
Webinar ID: 695 903 77
Archive: If you are unable to attend this live COCA Call, it will be available to view on-demand a few hours after the call.  

Additional Resources