CT health professionals monitoring coronavirus; urge vigilance, not alarm

Dr. Dan Bausch, director of the United Kingdom Public Health Rapid Support Team, addressed students at Quinnipiac University’s Frank H. Netter MD School of Medicine. Bausch, who specializes in emerging tropical viruses, spoke about the new coronavirus outbreak in China, as well as the previous SARS, H1N1 and ebola outbreaks.

Connecticut officials and institutions are monitoring the spread of a new virus that has infected hundreds of people in China, while experts are urging awareness but quelling panic about the outbreak’s potential spread in the United States.

Forty people have died in China and more than 800 people have been infected by the novel coronavirus, or 2019-nCoV, according to the New York Times. The epicenter of the outbreak is in Wuhan, a city of about 11 million people in central China; transportation in the city and at least a dozen others has been shut down in an effort to contain the illness.

“It’s a time for vigilance, but not panic,” said Dr. Dan Bausch, director of the United Kingdom Public Health Rapid Support Team, who spoke to students at Quinnipiac University on Friday. “We have a few cases imported into the United States now, and that’s not unusual or unexpected at this phase. It’s a very rapidly evolving situation, and we have to monitor as it goes forward.”

There have been two confirmed cases of the virus in the United States: a man in Snohomish County, Washington tested positive for the virus earlier this week, and the Centers for Disease Control and Prevention confirmed a second case in Chicago on Friday. Both patients had recently been traveling in Wuhan.

“We are keeping a very close eye on this in Connecticut and following the CDC guidelines,” Department of Public Health spokesman Av Harris said. “We have been and remain in close contact with local health departments, health care facilities, and medical providers to share with them the national guidance on this from CDC.”

Coronaviruses are a family of viruses that typically “only cause mild respiratory disease, such as the common cold,” but have also caused severe acute respiratory syndrome, or SARS, and Middle East respiratory syndrome, according to the CDC.

The new strain is “more virulent,” said Dr. Richard Sutton, a professor in Yale School of Medicine’s Section of Infectious Diseases. “For whatever reason, SARS and MERS and this one have much higher case fatality rates.” What’s not known yet is how it transmits, or how efficiently it moves: while there has been information so far that “suggests human-to-human spread,” that hasn’t been determined, he said.

Doctors also don’t yet know “what may make people more contagious, or what can prevent that transmission,” said Dr. Richard Martinello, medical director for infection prevention at Yale New Haven Health.

“While CDC considers this a serious public health threat, based on current information, the immediate health risk from 2019-nCoV to the general American public is considered low at this time,” the agency said in a news release Friday.

In an email sent to local health departments and doctors Friday, State Epidemiologist Dr. Matthew Cartter said that “healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness.”

If a patient has symptoms and has recently traveled to Wuhan or been in close contact with someone else who is under investigation for the coronavirus, they meet the CDC’s criteria for being treated as possible “patients under investigation.” Healthcare providers should contact DPH, and have patients wear surgical masks and be evaluated privately or in isolation, if possible, Cartter said in the email.

The CDC said it is “implementing public health entry screening” for incoming passengers from Wuhan at New York’s JFK Airport, as well as Los Angeles, San Francisco, Atlanta and Chicago.

There are no current screenings or precautions in place at Bradley International Airport, “because we don’t receive any direct flights from the impacted region,” spokesman Ryan Tenny said. “We do continue to closely monitor the situation and will adjust as necessary.”

Yale New Haven Hospital staff members have been instructed to screen patients with acute respiratory infections about their recent travel and contacts. Martinello said the focus for the last two weeks has been on ensuring that the staff is aware of the need to ask about travel history, and of the protocol for what to do if a case is suspected, by isolating the patient and taking precautions.

“We’re starting to think about what our resources are, in terms of simple things like gloves, masks and respirators,” he said. “Do we have enough for our anticipated needs as weeks go on?”

“We’re approaching this from an abundance of caution,” Martinello said.

At UConn Health facilities, “everyone who presents for care is asked if they traveled outside USA in past 30 days,” spokeswoman Jennifer Walker said. “If yes, the location is linked to a CDC information page which lets the RN check if there are any outbreaks or concerns.”

While the novel coronavirus is dominating headlines, “we’re still experiencing a really bad flu season,” Martinello said. “We are seeing a lot of patients, many of them needing to be in our intensive care units. Based on the numbers alone, it’s a bad year.”

There have been 20 flu-related deaths in Connecticut as of Jan. 18, according to the Department of Public Health, and more than 3,700 people have tested positive for influenza. Nationwide, the CDC estimates that since October, there have been more than 140,000 hospitalizations related to the flu, and more than 8,200 flu deaths.

Some of the same preventative measures can be used to avoid both the flu and the coronavirus, said New Haven Health Department Epidemiologist Brian Weeks. He stressed basic hand hygiene, sneezing and coughing into your elbow to avoid spreading germs and staying home from school or work if you’re feeling sick. It’s not too late to get a flu shot, he said.

“With any kind of respiratory illness, it’s the very young children whose immune systems are developing, as well as the elderly, whose immune systems are weakening,” Weeks said. Conditions like asthma or chronic obstructive pulmonary disease can cause more severe symptoms.

“People don’t need to think it’s the zombie apocalypse, but they do need to keep in mind that they do their best efforts to make sure they stay healthy and other people stay healthy,” he said.

Connecticut universities, many of which have students who were recently traveling over holiday breaks, are also taking early precautions.

Wesleyan University notified students on Friday that a student came to the health center with a cough and fever; the student had been “at a large international airport where another person was identified to have the coronavirus,” spokeswoman Lauren Rubenstein said. “Out of an abundance of caution, we are working with the state Department of Public Health and the Centers for Disease Control to determine if the student has contracted the coronavirus or not. No diagnosis has been confirmed yet.”

The student is in isolation, and people the student has been in contact with are also being monitored. So far, “none of these individuals have exhibited symptoms of concern,” she said.

“This happens every once in a while, in our global culture, with so much travel” said Dr. Phil Brewer, Quinnipiac University Medical Director for Student Health and EMS. With illnesses like SARS, H1N1 (“swine flu”) and avian flu, “what starts out as an endemic in a small place in some country… can affect just about anybody anywhere.”

Brewer compared preparing for a local case of the virus to wearing a seat belt: “what are the odds that you’re going to have a crash in your car in the next week or month? Really low,” He said. “But you still wear your seat belt every single time, because there is a possibility. And this is kind of the same thing: the odds that we’re going to see somebody at Quinnipiac who has coronavirus is really really low, but we still have to take the necessary precautions.”

The first step, he said, is screening all patients for their recent travel history, to help with early recognition of potential cases. Quinnipiac is also starting to contact students from China who may have traveled there over the holiday break, he said. “We can contact them and see if they have any symptoms, and if so, have them come in to be seen,” he said. They’ll also emphasize that if students do develop any symptoms, “to come in early and not wait.”

If a student does report symptoms and a travel history that indicate they may have the virus, the school would notify Yale New Haven Hospital to prepare for a patient needing isolation before bringing them in, Brewer said. The Quinnipiack Valley Health District would also be contacted, to “collaboratively start contact tracing,” to determine people the sick person was in close contact with who also need to be monitored.

The University of Connecticut has about 2,700 undergraduate and graduate students from China across its campuses, spokeswoman Stephanie Reitz said. “However, we do know that a significant number of these students remained in the U.S. over the winter break and did not return to China, significantly lessening their chance for exposure to the virus.”

“All students and others on campus who come for treatment having developed a fever and symptoms of a lower respiratory illness are screened for recent travel,” she said. Students have also been encouraged to call the 24/7 nurse line with questions.

“Sacred Heart University health and wellness officials are monitoring the situation and are meeting to review and discuss best practices and protocols,” the university said in a statement.

Yale said in a statement that the university “will adhere to recommendations from both the Centers for Disease Control and Prevention (CDC) and the Connecticut Department of Public Health.”

Connecticut Media Group