COVID-19 continues spread in U.S., CDC issues recommendations for high-risk patients

More cases of the novel coronavirus disease (COVID-19) are being reported around the world, including in the U.S., and ACP and the CDC have both developed updated information for health care professionals.

As of Sunday, March 8, the CDC has recommended that those at higher risk of getting very sick from COVID-19 should take everyday precautions to keep space between themselves and others and avoid crowds as much as possible. “Higher risk” was defined as older adults (not specified by the CDC, but many experts have focused on those ages 60 years and older) and those with serious chronic medical conditions such as heart disease, diabetes, and lung disease. In communities with COVID-19 outbreaks, patients in these risk groups should stay home as much as possible, the CDC said. The agency also specifically recommended against cruise travel.

ACP is collaborating with the Infectious Diseases Society of America (IDSA) and the CDC to obtain the most accurate and updated information and has gathered COVID-19 resources for internists, including educational activities, on a regularly updated webpage. The CDC and FDA have announced efforts to increase the supply of respirators for health care personnel. The CDC offers webpages with guidance for clinicians and general information on the disease (including a “What's New” box at the bottom of the page). The IDSA is also maintaining a resource page online.

Last week, the CDC expanded its criteria for testing patients for COVID-19, but the supply of tests was limited in many areas. Multiple private clinical laboratories announced they would begin performing tests under an Emergency Use Authorization from the FDA. Johns Hopkins University is also gathering and reporting data on the outbreak, including daily situation reports with case counts from around the world through its Center for Health Security and a map of cases and deaths from its School of Systems Science and Engineering.

The World Health Organization (WHO) situation report for March 9 listed more than 109,000 cases of COVID-19 in 105 countries, with 3,809 deaths. The WHO Director-General, Tedros Adhanom Ghebreyesus, gave a media briefing on March 9 in which he called for countries to implement a “comprehensive, blended strategy” toward controlling the spread of COVID-19. “Countries that continue finding and testing cases and tracing their contacts not only protect their own people, they can also affect what happens in other countries and globally,” he said. —5-march-2020

In Italy, new restrictions on travel and public events were put in place March 9 throughout the country, according to the New York Times. Earlier reports indicated that hospitals in Lombardy are severely overtaxed, with need for intensive care outstripping availability. A new study in Annals of Internal Medicine published March 10 estimated the incubation period of COVID-19 based on news reports and press releases from Jan. 4 to Feb. 24 and found that the median incubation period is 5.1 days and that 97.5% of patients who will develop symptoms do so within 11.5 days, supporting current quarantine recommendations of 14 days.