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UPDATE: World Health Organization again decides against declaring a global emergency over coronavirus

For providers, travel history is key to determine whether to test for the virus in which symptoms can mirror that of the flu.

Susan Morse, Managing Editor

UPDATE: As of Monday, January 27, the coronavirus has killed at least 81 people in China and more than 2,700 others have been infected in more than a dozen countries, including five confirmed cases in the United States, according to CBS News. More than 60 additional people in the U.S. were being tested for the disease, the report said.

In addition, the outbreak has affected stock prices, with the Dow and S&P 500 falling 1.5 and 1.4%, respectively, according to The Wall Street Journal.

WHO reconvened again on Thursday, January 23 to decide whether to declare a public health emergency of international concern over the coronavirus originating in China. Several members considered that it is still too early to declare an emergency. The International Health Regulations Emergency Committee Committee stands ready to be reconvened in approximately ten days, or earlier should the Director-General deem it necessary, WHO said.

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The number of cases are increasing. Last week there were an estimated 557 reported cases in China; 17 people had died.

On Wednesday, the World Health Organization stopped short of declaring a public health emergency of international concern over the deadly coronavirus that has reportedly killed 17 people and sickened 291, including the first known case in the United States.

U.S. health officials confirmed Tuesday that a Seattle, Washington, resident in his 30s contracted the virus after returning from Wuhan, China, where the virus is believed to have originated. The man was placed in isolation at a local hospital, where his condition is reported as stable.

China today quarantined Wuhan to stop the virus from spreading.

While the Centers for Disease Control and Prevention said this isolated case poses little risk to healthcare workers and the public, it expects more cases to appear in the U.S.

An estimated 64% of the reported 291 cases of those infected are male, WHO said today.

Saying it needed more information before declaring a global emergency, WHO's International Health Regulations Emergency Committee plans to meet again on Wednesday, Jan. 23, in Geneva, Switzerland.

WHAT'S THE IMPACT FOR U.S. HOSPITALS

The coronavirus is an evolving story that Massachusetts General Hospital is closely watching, said Dr. David Hooper, chief of the Infection Control Unit at the hospital.

Other hospitals are also watching, as health officials have learned that the virus can be spread by contact with an infected person.

"We have an emergency preparedness for infectious disease that's robust," Hooper said. "We do a lot of training."

One way this is done is through technology. Mass General has a travel navigator alert in its EHR that documents areas of concern for certain infectious diseases.

Patients who answer "yes" to questions on travel to certain areas would trigger the automated alert for specific testing and care precautions.

"Travel history is key here," Hooper said of the coronavirus.

Mass General is also the closest large hospital to the Boston Logan International Airport. Currently, five airports are screening travelers for the virus: San Francisco International Airport, Los Angeles International Airport, John F. Kennedy International Airport in New York, Chicago's O'Hare International Airport and at Hartsfield-Jackson Atlanta International Airport.

The first three had non-stop flights from Wuhan, while passengers making a connecting flight would go to the screening airports. Hooper said.

Mass General is among 10 regional centers in the country that was set up to handle patients with the Ebola virus when that outbreak occurred around 2014. Mass General tested one patient for the disease, but the test came back negative.

"We acted as if he was an Ebola patient," Hooper said.

This means the patient was evaluated in an airborne infection isolation room.

The procedures are already in place to identify viruses of concern, such as the latest coronavirus, Hooper said.

Coronaviruses are a large family of viruses. Other coronaviruses are SARS and MERS. The coronavirus is starting to behave a bit like SARS when that virus emerged in 2002, Hooper said.

But providers need to be careful not to have blinders on in trying to rule out unusual diseases, Hooper cautioned.

This is because it's flu season, in which hundreds of patients are being seen for respiratory symptoms that have much in common with the coronavirus.

"We're in the middle of flu season," he said. "We see hundreds of flu cases."

Nationwide, from Oct .1, 2019, to Jan. 11, 2020, there were 13 million to 18 million flu illnesses, the CDC estimates, with 5.9 million to 8.5 million flu medical visits and at least 120,000 hospitalizations. There were 6,600 to 17,000 deaths.

The coronavirus MERS is still out there, while SARS totally went away after 8,000 cases and 800 deaths, Hooper said.

THE LARGER TREND

The outbreak of the 2019 novel coronavirus (2019-nCoV) in Wuhan City, Hubei Province, China, began in December, according to the CDC.

The Wuhan City outbreak has been epidemiologically linked to a large seafood and animal market. The market was closed on Jan. 1.

No vaccine or specific treatment for 2019-nCoV infection is available; care is supportive.

Patients in the U.S. who meet the following criteria should be evaluated: having a fever and symptoms of a lower respiratory illness such as cough and shortness of breath, and in the last 14 days before symptom onset, a history of travel from Wuhan City, China, or close contact with a person who  has been ill with the virus, according to CDC guidance.

Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed or taking certain fever-lowering medications.

Clinical judgment should be used to guide testing of patients in such situations. Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com