Avian Flu Diary: CDC: Infection Control Guidance For Home Care Of MERS-CoV Cases

Credit CDC

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While we’ve not seen any MERS-CoV cases diagnosed here in the United States, if cases continue to show up on the Arabian peninsula, the odds favor having the virus turn up here eventually.

While that wouldn’t necessarily lead to a serious epidemic, it would require a coordinated public health response. To avoid further spread, steps would have to be taken regarding hospitalization of those severely ill, the isolation of those mildly affected, and the monitoring of their close contacts.

Steps similar to those taken a decade ago to bring SARS under control in Asia and Canada (see EID Journal: A Brief History Of Quarantine).

I would also note that this current guidance doesn’t recommend quarantine of asymptomatic contacts (`Asymptomatic exposed persons do not need to limit their activities outside the home.’)

Since some people only experience mild symptoms with MERS, it makes sense to treat them at home, rather than expose them (and others in the hospital) to additional infection risk. In today’s MMWR, the CDC unveiled new guidance for the home isolation and care of MERS cases, should they begin to appear in this country;

CDC has issued new guidance for care and management of MERS-CoV patients in the home and guidance for close contacts of these patients (http://www.cdc.gov/coronavirus/mers/hcp/home-care.html).

Persons who are confirmed, or being evaluated for MERS-CoV infection, and do not require hospitalization for medical reasons should be isolated in their homes as long as the home is deemed suitable for isolation.

CDC currently recommends MERS-CoV patients should be isolated at home until public health authorities or a health-care provider determine that they are no longer contagious.

Persons who might have been exposed†† to MERS-CoV should be monitored for fever and respiratory symptoms for 14 days after the most recent exposure. Asymptomatic exposed persons do not need to limit their activities outside the home. If persons exposed to MERS-CoV have onset of symptoms, they should contact a health-care provider as soon as possible and follow the precautions for limiting possible exposure of other persons to MERS-CoV.

This new guidance is divided into two parts. This first part is for public health officials who must decide if home care is a viable option for mildly affected MERS cases.

Interim Home Care and Isolation Guidance for MERS-CoV

This guidance is for local and state health departments, infection prevention and control professionals, healthcare providers, and healthcare workers who are coordinating the home care and isolation of ill¹ people who are being evaluated for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection. The guidance is based on what is currently known about viral respiratory diseases and MERS-CoV. CDC will update this guidance as needed.

Ill people who are being evaluated for MERS-CoV infection and do not require hospitalization for medical reasons may be cared for and isolated in their home. Isolation is defined as the separation or restriction of activities of an ill person with a contagious disease from those who are well.

Before the Ill Person is Isolated at Home

A healthcare professional should:

Assess whether the home is suitable and appropriate for isolating the ill person. You can conduct this assessment by phone or direct observation.

The home should have a functioning bathroom that only the ill person and household members use. If there are multiple bathrooms, one should be designated solely for the ill person.

The ill person should have his or her own bed and preferably a private room for sleeping.

Basic amenities, such as heat, electricity, potable and hot water, sewer, and telephone access, should be available.

If the home is in a multiple-family dwelling, such as an apartment building, the area in which the ill person will stay should use a separate air-ventilation system, if one is present.

There should be a primary caregiver who can follow the healthcare provider’s instructions for medications and care. The caregiver should help the ill person with basic needs in the home and help with obtaining groceries, prescriptions, and other personal needs.

Contact your local or state health department if you have not already done so.

If the Home is Suitable and Appropriate for Home Care and Isolation

You should:

Provide CDC’s Interim Guidance for Preventing MERS-CoV from Spreading in Homes and Communities to the ill person, the caregiver, and household members.

The second part of this guidance is directed to patients, caregivers, household members, and close contacts. .

Interim Guidance for Preventing MERS-CoV from Spreading in Homes and Communities

CDC wants to make sure that you are protected if there is ever a case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in the United States. The following guidance may be able to help prevent MERS-CoV from spreading in homes and communities. The guidance is based on what we currently know about other viral respiratory diseases and MERS-CoV. CDC will update this guidance as needed.

This guidance is for:

ill¹ people being evaluated by a healthcare provider for a possible MERS-CoV infection who can receive care at home and do not need to be hospitalized, and

caregivers, household members, and other people who have had close contact with someone who is being evaluated for MERS-CoV infection.

People Being Evaluated for MERS-CoV Infection

You should be cared for and isolated in your home if you:

are ill and are being evaluated for MERS-CoV infection, and

do not need to be hospitalized for medical reasons.

You should follow the prevention steps below while you are:

ill and being evaluated for MERS-CoV infection, and

until a healthcare provider or local or state health department says you can return to your normal activities.

Prevention Steps

Stay home
You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas, and do not use public transportation.

Separate yourself from other people in your home
As much as possible, you should stay in a different room from other people in your home. Also, you should use a separate bathroom, if available.

Call ahead before visiting your doctor
Before your medical appointment, call the healthcare provider and tell him or her that you may have MERS-CoV infection. This will help the healthcare provider’s office take steps to keep other people from getting infected.

Wear a facemask
You should wear a facemask when you are in the same room with other people and when you visit a healthcare provider. If you cannot wear a facemask, the people who live with you should wear one while they are in the same room with you.

Cover your coughs and sneezes
Cover your mouth and nose with a tissue when you cough or sneeze, or you can cough or sneeze into your sleeve. Throw used tissues in a lined trash can, and immediately wash your hands with soap and water.

Wash your hands
Wash your hands often and thoroughly with soap and water. You can use an alcohol-based hand sanitizer if soap and water are not available and if your hands are not visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing household items
You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people in your home. After using these items, you should wash them thoroughly with soap and warm water.

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You’ll find detailed infection control guidance on this page also, with advice regarding the wearing of facemasks, gowns & gloves, along with surface and laundry disinfection instructions. Last month, the World Health Organization released similar guidance (see WHO: Homecare Advice For Mild MERS-CoV Cases).

Most of this infection control advice is valid whether you are dealing with MERS-CoV, pandemic flu, or seasonal flu. All are infectious, and all should be treated with respect.

The CDC has recommended keeping a box of surgical masks, and some exam gloves on hand for just these sorts of home care scenarios, something you may want to stock up on now, while they are easily available (for more, see The Great Mask Debate Revisited).

For general care instructions for someone with influenza, MERS-CoV, or any other respiratory virus a good place to start is with the Home Care Guide: Providing Care at Home During Pandemic Flu by the Santa Clara County Health Department, California and is available on CIDRAP’s Public Health Practices website.

Home Care Guide (Vietnamese) Download pdf, 551 KB

Home Care Guide (Spanish)Download pdf, 203 KB

Home Care GuideDownload pdf, 6 MB

The Home Care Guide provides the public with a comprehensive description of how to care for sick family members at home during a pandemic. It includes lists of emergency supplies, guidelines on how to limit the spread of disease at home, instructions on how to take care of sick household members safely and effectively and basic information about pandemic flu. This guide was created prior to the emergence of novel H1N1 flu virus in 2009. Therefore, the fact sheets located under the attachments tab in the guide contain some generalized information about pandemics, as well as information about avian influenza that may need to be updated. The guide is available in English, Spanish, and Vietnamese.