Update and Resources on Outbreak of 2019 Novel Coronavirus
(COVID-19)
Free resource for occupational health clinicians
A Physician's Guide for Workers’ Return to Work During COVID
TB Tests and mRNA COVID-19 Vaccines
COVID-19 vaccination is an important tool to help stop the pandemic, and CDC recommends healthcare personnel be among those offered the first doses of COVID-19 vaccines. As the U.S. COVID-19 vaccination program continues, some may have questions about the interaction between new COVID-19 mRNA vaccines and tests used for tuberculosis (TB) infection.
There are no data to inform the impact of the COVID-19 mRNA vaccines on either the tuberculin skin test (TST) (administered by intradermal placement of 0.1 cc of purified protein derivative) or the interferon gamma release assay (IGRA). There is no immunologic reason to believe that a TST or blood draw for IGRA will impact the effectiveness of COVID-19 mRNA vaccines.
According to the Vaccine Recommendations and Guidelines of the Advisory Committee on Immunization Practices (ACIP), inactive vaccines do not interfere with TB test results. Vaccination with live viruses (such as the MMR vaccine) can cause mild immune system suppression, and may reduce the reactivity of the TST, possibly causing a false-negative reaction.
Although the COVID-19 mRNA vaccine is not a live virus vaccine, not enough is yet known of the potential impact of mRNA vaccines on immune responses to say conclusively whether the COVID-19 mRNA vaccine could have a potential effect on TST or IGRA test results during the first 4 weeks after COVID-19 vaccination.
Visit this website for more information.
COVID-19 Update (Dec 1, 2020)
As part of NIOSH’s efforts to keep our stakeholders up to date on the CDC and NIOSH COVID-19 response, here is a summary of new information available.
- A new scientific brief highlights evidence that cloth masks help to block virus-carrying respiratory droplets from reaching others when the wearer has COVID-19. Cloth masks can also help block the amount of virus-carrying droplets that a mask wearer inhales if someone nearby is infected.
- The workplaces and businesses webpage was updated to provide one central location for all work-related COVID-19 resources.
- A new infographic provides tips to ensure that employers and employees are prepared to assist when a COVID-19 case is identified in the workplace. The infographic is a part of the recommendations provided for COVID-19 Case Investigation and Contact Tracking in Non-Healthcare Workplaces: Information for Employers.
- The critical infrastructure sector response planning webpage as updated to reflect new scientific evidence, evolving epidemiology, and the need to simplify the assessment of risk.
- New school resources are also available: The Cleaning, Disinfection, and Hand Hygiene in Schools toolkit is now available to aid school administrators as they consider how to protect the health, safety, and wellbeing of students, teachers, other school staff, families, and communities and prepare for educating students. The school health personnel webpage provides information and resources to help school nurses and other healthcare personnel perform these new roles and responsibilities during the COVID-19 pandemic. Resources for self-care are also included.
CDC recently updated the 2019 Novel Coronavirus website to provide additional guidance for recommendations listed in the Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (2019-nCoV) in a Healthcare Setting.
OSHA has a webpage for the COVID 19. Here is the link to that page: https://www.osha.gov/SLTC/covid-19/standards.html
For more information, please visit the COVID-19 webpage. To stay up to date on new developments, sign up for the COVID-19 newsletter
It address recordkeeping, Hazard Assessment, etc..
OSHA Log: https://www.osha.gov/SLTC/covid-19/standards.html
Recording Workplace Exposures to COVID-19
COVID-19 can be a recordable illness if a worker is infected as a result of performing their work-related duties. However, employers are only responsible for recording cases of COVID-19 if all of the following are met:
- The case is a confirmed case of COVID-19 (see CDC information on persons under investigation and presumptive positive and laboratory-confirmed cases of COVID-19);
- The case is work-related, as defined by 29 CFR 1904.5; and
- The case involves one or more of the general recording criteria set forth in 29 CFR 1904.7 (e.g. medical treatment beyond first-aid, days away from work).
CDC Elastomeric Respirator Use Guidance: The CDC has posted guidance for the use of reusable elastomeric particulate respirators to provide respiratory protection to healthcare practitioners (HCP) against pathogens as a component of a formally developed and implemented written respiratory protection program.
To access this information, see the Elastomeric Respirators: Strategies During Conventional and Surge Demand Situations webpage.
APIC has created a new fact sheet for infection preventionists (IPs) to share with their colleagues and patients during the ongoing coronavirus situation. The new fact sheet was developed in collaboration with APIC's Communications Committee.
See the PDF version of the fact sheet here. This resource is available to download, print, and disseminate as needed.
AOHP recommends that members update pandemic preparedness plans. Stay connected for resources to assist you with these efforts. Be sure to report your specific supply concerns and shortages to your state health department. Join the AOHP Listserv Group to post questions and share information with your fellow AOHP members.
The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) continue to closely monitor the outbreak of respiratory illness caused by the novel coronavirus (COVID-19) first identified in Wuhan, Hubei Province, China. Check the resources below for updates.
CDC:
WHO:
CMS:
FDA:
ACOEM
Resources from Johns Hopkins
This list of literature for COVID-19, is created by D.M. Needham MD, PhD; C. Hickmann, PT, MSc, PhD; P. Nydahl, RN PhD and the Johns Hopkins University Outcomes. Click here to download the list.
Damaged/Degraded Head Straps on Stockpiled NIOSH-approved FFRs
NIOSH is aware that many different NIOSH-approved filtering facepiece respirator (FFR) models were stockpiled for prolonged times and are now distributed for use during the COVID-19 response. These FFRs are made using different materials (e.g., filtering media and strap material), which may age or degrade over time and become damaged. Generally, FFRs are not designed for long-term storage, and many models may have shelf lives designated by the NIOSH approval holder. The shelf life information is generally found on the packaging or the approval holder’s website.
NIOSH has received multiple inquiries concerning the identification and replacement of damaged straps on large caches of NIOSH-approved N95 FFRs that have since passed their designated shelf life.
Users should perform a visual inspection of each respirator prior to donning per the user instructions. Additional questions and concerns related to the condition of the respirator should be directed to the approval holder.
For more information, see the NIOSH conformity assessment notice 2020-1028, dated May 2020.
N95 Decon and Reuse
Univ Nebraska MC has published their method for UV Decontamination of N95 masks to enable reuse. https://www.nebraskamed.com/sites/default/files/documents/covid-19/n-95-decon-process.pdf Summary
The Centers for Disease Control and Prevention (CDC) continues to closely monitor an outbreak of respiratory illness caused by a novel coronavirus (2019-nCoV) that was initially detected in Wuhan City, Hubei Province, China in December 2019.
This CDC Health Alert Network (HAN) Update provides a situational update and interim guidance to state and local health departments that supersede guidance in CDC’s HAN 426 distributed on January 17, 2020. It also adds
Early in the outbreak, many of the patients with respiratory illness caused by 2019-nCoV in China had exposure to a large seafood and live animal market, suggesting animal-to-human transmission. More recently, cases have been confirmed with no exposure to animal markets, indicating that person-to-person spread of the virus has occurred. Chinese officials report that sustained person-to-person spread in the community is occurring in China.
The first US case-patient was identified on January 21, 2020, and had recently traveled from Wuhan, China. Since that time, six additional cases have been confirmed in the United States, four among persons who traveled from Wuhan, and one a close contact of a confirmed case. Globally, reported illnesses in people with 2019-nCoV have ranged from mild (no or few signs and symptoms), to severe, including death. These findings are consistent with other coronaviruses, including Severe Acute Respiratory Syndrome (SARS) (https://www.cdc.gov/sars/) and Middle East Respiratory Syndrome (MERS) (https://www.cdc.gov/coronavirus/mers/index.html). Additional information about 2019-nCoV is needed to better understand transmission, disease severity, and risk to the general population. The goal of the ongoing US public health response is to identify and contain this outbreak and prevent sustained spread of 2019-nCoV in the United States.
Recommendations for Screening of Patients for 2019-nCoV in Healthcare Facilities
Recommendations for screening of patients for possible 2019-nCoV infection are based on (1) current knowledge of the characteristics of clinical illness observed in early cases, and (2) the geographic distribution of current cases. They reflect the current public health goal of rapidly containing and preventing transmission of 2019-nCoV illness.
Patients presenting to healthcare facilities should be assessed for exposures associated with risk of 2019-nCoV infections (e.g., travel to China or close contact with a confirmed case) and for symptoms consistent with 2019-nCoV infection (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html). The assessment is intended to allow healthcare providers to make decisions about appropriate infection control and management of patients. Note that the signs and symptoms of 2019-nCoV overlap with those associated with other viral respiratory tract infections. Given the time of year, common respiratory illnesses, including influenza, should also be considered in patients who are screened.
Clinicians should ask:
- Does the person have fever or symptoms of lower respiratory infection, such as cough or shortness of breath?
AND
- Has the patient traveled to mainland China within 14 days of symptom onset?
OR
- Has the patient had close contact1 with a person confirmed with 2019-nCoV infection?
If a patient meets these criteria:
To minimize the risk that other people will be exposed to individuals who may have 2019-nCoV, patients who report having these symptoms should be asked to wear a surgical mask as soon as they are identified and directed to a separate area, if possible, with at least 6 feet (2 meters) separation from other persons. Patients should be evaluated in a private room with the door closed, ideally an airborne infection isolation room (AIIR), if available. Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). For more information about this, see CDC’s Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (2019-nCoV) in a Healthcare Setting (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html).
Clinicians should immediately notify the healthcare facility’s infection control personnel and local health department. The health department will determine if this patient needs to be considered a PUI for 2019-nCoV and be tested for infection.
Criteria to Guide Evaluation and Testing of Patients Under Investigation (PUI) for 2019-nCoV
Local health departments, in consultation with clinicians, should determine whether a patient is a PUI for 2019-nCoV. The CDC clinical criteria for 2019-nCoV PUIs have been developed based on available information about this novel virus, as well as what is known about SARS and MERS. These criteria are subject to change as additional information becomes available.
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Clinical Features
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AND
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Epidemiologic Risk
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Fever2 or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath)
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AND
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Any person, including health care workers, who has had close contact1 with a laboratory-confirmed3 2019-nCoV patient within 14 days of symptom onset
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Fever2 and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath)
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AND
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A history of travel from Hubei Province, China within 14 days of symptom onset
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Fever2 and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization4
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AND
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A history of travel from mainland China within 14 days of symptom onset
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These criteria are intended to serve as guidance for evaluation and testing. Patients should be evaluated and discussed with public health departments on a case-by-case basis for possible 2019-nCoV infection. Testing decisions might be further informed by the clinical presentation or exposure history (e.g., uncertain travel or exposure), and the presence of an alternative diagnosis that explains their clinical presentation.
Recommendations for Reporting, Testing, and Specimen Collection
Healthcare providers should immediately notify infection control personnel at their healthcare facility if a patient is classified a PUI for 2019-nCoV. State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a2019-nCoV PUI case investigation form (https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html#reporting-testing-specimen-collection). CDC’s EOC will assist local and state health departments with obtaining, storing, and shipping appropriate specimens to CDC, including afterhours or on weekends or holidays. Currently, diagnostic testing for 2019-nCoV can be done only at CDC. Testing for other respiratory pathogens should not delay specimen shipping to CDC.
For initial diagnostic testing for 2019-nCoV, CDC recommends collecting and testing upper respiratory (nasopharyngeal AND oropharyngeal swabs), and lower respiratory (sputum, if possible)) for those patients with productive coughs. Induction of sputum is not indicated. Specimens should be collected as soon as possible once a PUI is identified, regardless of the time of symptom onset. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for 2019 Novel Coronavirus (2019-nCoV) (https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html).
Recommendations for Healthcare Providers
No vaccine or specific treatment for 2019-nCoV infection is available. At present, medical care for patients with 2019-nCoV is supportive.
Persons with confirmed or suspected 2019-nCoV infection who are hospitalized should be evaluated and cared for in a private room with the door closed, ideally an airborne infection isolation room, if available. For more information, see Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (2019-nCoV) in a Healthcare Setting (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html).
Home care and isolation may be an option, based on clinical and public health assessment, for some persons. Please see Interim Guidance for Preventing the Spread of 2019 Novel Coronavirus (2019-nCoV) in Homes and Communities (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html).
Those isolated at home should be monitored by public health officials to the extent possible. Refer to Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus (2019-nCoV) (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html) for more information.
Notes
1Close contact is defined as:
a) being within approximately 6 feet (2 meters), or within the room or care area, of a 2019-nCoV case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); close contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a 2019-nCoV case
- or -
b) having direct contact with infectious secretions of a 2019-nCoV case (e.g., being coughed on) while not wearing recommended personal protective equipment.
2Fever may be subjective or confirmed
See CDC’s updated Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (2019-nCoV) in a Healthcare Setting (https://www.cdc.gov/coronavirus/2019-ncov/infection-control.html).
Data to inform the definition of close contact are limited. Considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with 2019-nCoV (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to those exposed in health care settings.
3 Documentation of laboratory-confirmation of 2019-nCoV may not be possible for travelers or persons caring for patients in other countries.
4 Category also includes any member of a cluster of patients with severe acute lower respiratory illness (e.g., pneumonia, ARDS) of unknown etiology in which 2019-nCoV is being considered that requires hospitalization. Such persons should be evaluated in consultation with state and local health departments regardless of travel history.
For More Information
More information is available at the 2019 Novel Coronavirus website (https://www.cdc.gov/coronavirus/2019-ncov/index.html) or by calling 800-CDC-INFO | 800-232-4636) | TTY: (888) 232-6348
Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak - United States, December 31, 2019-February 4, 2020 (MMWR Weekly/February 7, 2020. On February 5, 2020, this report was posted online as an MMWR Early Release.), describes 9 of the first 11 U.S. 2019-nCoV patients who were exposed in Wuhan, China. CDC expects more U.S. cases and is collaborating with multiple other federal agencies, state and local health departments, and other partners to implement aggressive measures to substantially slow U.S. transmission of 2019-nCoV, including identifying U.S. cases and contacts and managing travelers arriving from mainland China to the United States. Interim guidance is available at https://www.cdc.gov/coronavirus/index.html and will be updated as more information becomes available.
The second report, Persons Evaluated for 2019 Novel Coronavirus - United States, January 2020, takes an in-depth look at how CDC responded to clinical inquiries regarding approximately 650 persons in the United States and tested 210 for 2019-nCoV, one-fifth of whom reported no recent travel-related risk but had close contact with a 2019-nCoV patient or a person under investigation for 2019-nCoV in the United States. (MMWR Early Release/February 7, 2020/69)