Coronavirus Disease 2019 (COVID-19) Outbreak Update #4

On February 26, 2020, NH DHHS issued a health alert update regarding the corona virus outbreak.

Key Points and Recommendations:

  1. Join us Tuesday, March 3, 2020 at 12:00 noon for a webinar to discuss the COVID-19 epidemic, including the evolving public health response. The webinar can be accessed at the following link and call-in information:
    Webinar link:
    Call-in Number: 1-646-558-8656
    Meeting ID: 852 671 104 
  2. In New Hampshire, there are currently no confirmed or suspect cases of COVID-19. However, in China and several other countries, there is sustained and widespread community transmission. You should monitor CDC’s travel advisories in order to appropriately counsel patients about travel and to know which travel itineraries present a higher risk for COVID-19 in symptomatic returning travelers. Travel advisories currently include the following countries:
    • Level 3 Travel Warning (avoid all nonessential travel due to widespread community transmission): Mainland China and South Korea
    • Level 2 Travel Alert (practice enhanced precautions due to sustained community transmission): Italy, Japan, Iran
    • Level 1 Travel Watch (practice usual precautions but multiple instances of community spread have been reported): Hong Kong
  3. DPHS recommends that healthcare reception and providers ask patients presenting with a fever or respiratory illness about travel to any country with a level 1, 2, or 3 travel advisory in the 14 days before symptom onset. 
  4. Any patient presenting with fever or respiratory illness within 14 days of travel to one of the listed countries should be evaluated under airborne infection isolation (AII) with recommended personal protective equipment (PPE) and reported immediately to the NH Division of Public Health Services (DPHS) at 603-271-4496 (after hours 603-271-5300).
    • A surgical mask should be placed on the symptomatic patient; the healthcare worker should wear gloves, gown, eye protection, and a fit-tested N95 respirator or PAPR when evaluating the patient.
    • If recommended PPE or AII is not available, we suggest limiting clinical evaluation as medically appropriate, and that minimally symptomatic patients who are not febrile nor short of breath (i.e., afebrile patients with only mild upper
    respiratory illness), and who are not in need of other medical attention, should be advised to stay at home and call if illness progresses. If more extensive medical attention is needed, the patient should be directed to a hospital for evaluation where appropriate PPE and isolation can be implemented. 
  5. The decision for COVID-19 testing will be made based on a patient’s travel risk factors, any exposure to sick individuals in other countries, the patient’s presenting signs and symptoms, and testing capacity. Currently COVID-19 testing is only available at the U.S. CDC, but in the coming weeks our NH Public Health Laboratories (PHL) will receive test kits from CDC and implement testing. 
  6. Any patient presenting with mild respiratory illness within 14 days of travel who do not need hospitalization and do not undergo COVID-19 testing should be instructed to stay at home and away from public places until their symptoms resolve and they begin to feel better. They should also be instructed that if their symptoms worsen they should take their temperature and seek health advice by phone from their healthcare provider or the NH DPHS by calling 603-271-4496 (after hours 603-271-5300). 
  7. Asymptomatic travelers from China should still be instructed to stay at home, avoid public settings, and self-monitor for symptoms for 14 days from their last day of travel to China. Travelers should contact the NH DPHS at 603-271-4496 (after hours 603-271- 5300) if they develop fever or respiratory illness within 14 days of travel. 
  8. Asymptomatic travelers to countries with identified COVID-19 community transmission other than China (i.e., those with a travel advisory) should be instructed to monitor for fever or respiratory symptoms. Travelers that feel feverish or develops respiratory symptoms should take their temperature, immediately limit contact with others, and seek health advice by phone from their healthcare provider or DPHS by calling 603-271-4496 (after hours 603-271-5300).