At the time of our first post a month ago, COVID-19 (formerly known WN-CoV infection) over 6000 cases and 132 deaths were reported. The now renamed virus infection is worldwide, has infected more than 92,000 people and led to more than 3,200 deaths. It has touched all the continents, affecting over 70 countries, causing the World Health Organization to issue that the outbreak has reached the "highest level' of risk for the entire world. We now know that the virus is here in the USA and with strong evidence that there is community spread of the infection with at least four of US cases having no travel-related history. The United States has just announced its very first death in the US at the time of writing this post. California reported its second case on Friday February 28th 2020, and this was followed hours later by cases reported in in Oregon and Washington. Amidst efforts to contain transmission, treat infected patients and the evolving understanding of COVID-19 epidemiology including the immunologic status of persons who have recovered from infections viz-a-viz transmisibility, there are those that have concluded that this outbreak meets the criteria to be described as a pandemic. Particularly now that we are faced with community spread of the COVID-19 virus in the USA as well as other parts of the world, primary care providers are at the front-line and can be the first port of call for an infected patient, hence they are at increased risk of exposure to and infection with COVID-19. That said, their vigilance and actions will make huge difference in containement efforts, stemming transmisson, protecting themselves, staff and the public. Educating staff and patients about the Wuhan coronavirus infection, the symptoms of the disease which includes fever, runny nose,sore throat, cough and difficulty breathing, is paramount. Knowing what to do even in the most remotely suspect-case and following the CDC published guildlines is critical to protecting staff, oneself and the public at large. General tips regarding potential encounter with COVID-19 infection remain valid. High level of suspicion and early identification of potential cases calls for elucidating answers to questions regarding recent travel to China, Italy, Iran, or South Korea. Not the least important is elucidating possible contact, household or workplace history etc early in the encounter of any suspect case. While travel history remains important, with community spread established now, the absence of a positive travel history does not rule out the COVID-19 infection. CDC website provides constantly updated and important guidelines on how to continue to approach this rapidly evolving outbreak of respiratory disease . Telephone or telemedicine encounters and interviews offer unique opportunity to engage, triage and evaluate a patient with respiratory symptoms and determine best setting for additional evalaution and how to recieve additional care before any physical contact with healthcare staff or members of the public may happen with a potential COVID-19 case.
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html