Current definition of COVID 19 needs a change

Investigate all H1N1 negative pneumonia and at risk co-morbid patients for COVID 19, says Dr KK Aggarwal

COVID 19, H1N1 negative pneumonia, Hubei Province, PUI, KK Aggarwal, CMAAO, Past national President IMA

The current definition of COVID 19 is suspect case

A. Patients with severe acute respiratory infection (fever, cough, and requiring admission to hospital), AND with no other etiology that fully explains the clinical presentation AND at least one of the following:

·       a history of travel to or residence in the city of Wuhan, Hubei Province, China in the 14 days prior to symptom onset, or

·       patient is a health care worker who has been working in an environment where severe acute respiratory infections of unknown etiology are being cared for.

B. Patients with any acute respiratory illness AND at least one of the following:

·       close contact with a confirmed or probable case of COVID 19 in the 14 days prior to illness onset, or

·       visiting or working in a live animal market in Wuhan, Hubei Province, China in the 14 days prior to

·       symptom onset, or worked or attended a health care facility in the 14 days prior to onset of symptoms where patients with hospital associated COVID 19 infections have been reported.


Why change?

1.     A California coronavirus patient had to wait days to be tested because of restrictive federal criteria, which include travel to China or contact with someone known to be infected. Yet the patient tested positive, and may be the first person to be infected through community spread in the United States, the Centers for Disease Control and Prevention said Wednesday. The new case appears to be one in which the source of infection is unknown, suggesting that the virus may be spreading within the community.

2.     CDC has already revised it Criteria to Guide Evaluation of PUI (person under investigation) for COVID-19

1.     Fever or signs/symptoms of lower respiratory illness (cough or shortness of breath)       AND Any person, including health care workers who has had close contact with a laboratory-confirmed4 COVID-19 patient within 14 days of symptom onset

2.     Fever and signs/symptoms of a lower respiratory illness (cough or shortness of breath) requiring hospitalization      AND A history of travel from affected geographic areas (China, Iran, Italy, Japan, South Korea) within 14 days of symptom onset

3.     Fever with severe acute lower respiratory illness (pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (e.g., influenza) AND      No source of exposure has been identified.

The CDC should add “all at risk patients with fever with cough and negative H1N1 should have evaluation for possible corona virus COVID 19.

Dr KK Aggarwal is President with CMAAO, HCFI and Past National President IMA.

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