While the number of domestic COVID-19 cases in the United States remains encouragingly low, until now, testing of PUIs (Patients Under Investigation) has been limited (see chart below) to those with recent travel to China or suspected contact with a known case.
Attempts to expand testing have been hampered by an inconsistent and unreliable validation test, which - according to the a CIDRAP News report late yesterday (see Feds to allow state public health labs to test for COVID-19 - is a step that is no longer required.
With an expanding number of countries with large numbers of COVID-19 cases (South Korea, Italy, Iran, Japan, etc.) - and the discovery of what appears to be a community acquired case in California (see California Reports A Possible Community Acquired COVID-19 Case) - the CDC late yesterday released revised criteria for evaluating, testing, and reporting suspect cases.
The biggest changes involve adding 4 countries (Iran, Italy, Japan & South Korea) to the `Countries With Widespread or Community Transmission' testing list, and allowing clinicians to test patients with no relevant travel history who are hospitalized with ARDS or pneumonia and have no alternate explanatory diagnosis.I've only posted the highlights below. Clinicians and other interested parties will want to follow the link and read the update in its entirety.
Evaluating and Reporting Persons Under Investigation (PUI)Summary of Recent Changes
Revisions were made on February 27, 2020, to reflect the following:Information updated in the “Criteria to Guide Evaluation of PUI for COVID-19” section.
Updated February 27, 2020
Limited information is available to characterize the spectrum of clinical illness associated with coronavirus disease 2019 (COVID-19). No vaccine or specific treatment for COVID-19 is available; care is supportive.
The CDC clinical criteria for a COVID-19 person under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available.
Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness. CDC guidance for evaluating and reporting a PUI for MERS-CoV remains unchanged.
Criteria to Guide Evaluation of PUI for COVID-19
Local health departments, in consultation with clinicians, should determine whether a patient is a PUI for COVID-2019. The CDC clinical criteria for COVID-19 PUIs have been developed based on available information about this novel virus, as well as what is known about Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). These criteria are subject to change as additional information becomes available.