HONOLULU – Although the risk to the general public is low, the Hawai‘i Department of Health (DOH) is working with state, county, and federal partners including the medical community and the Centers for Disease Control and Prevention (CDC) to actively prepare for possible cases of the 2019 novel coronavirus (2019-nCoV). Last week, the DOH alerted the medical community and information for healthcare providers has been posted at www.health.hawaii.gov.
Currently, there are no cases of 2019-nCoV identified in Hawai‘i and the risk to the general public is low. The novel coronavirus originated in Wuhan, China and currently there are more than 6,000 cases confirmed in China and at least 17 countries. This includes 132 deaths in China. There have been at least 5 cases in the U.S. of people who traveled to Wuhan or other areas in China and no evidence of person to person spread of the virus in the U.S.
“The Hawai‘i Department of Health is working closely with our emergency response network to put proactive measures in place to protect our residents and visitors,” said Health Director Bruce Anderson. “Because Hawai‘i is a major travel destination, planning and preparing for possible outbreaks is an ongoing activity. The emergence of the 2019 coronavirus in Wuhan and its potential to spread to areas outside of China poses an increased threat to travelers and Hawai‘i residents and we’ve ramped up our efforts.”
“We are advising people not to travel to China at this time,” said Anderson. “Various areas in China have been placed under quarantine by the Chinese government, and travel within the country is either completely prohibited or significantly curtailed to prevent the spread of this disease.”
To date, the DOH has taken the following actions:
Issued a Medical Advisory on Jan. 21, 2020 to ensure healthcare providers are aware of the situation, understand response urgency to report potential cases to DOH immediately, conduct specimen collection and infection control measures;
· Continually updating DOH website to provide information as it evolves: https://health.hawaii.gov/docd/advisories/novel-coronavirus-2019/
· Monitoring our respiratory disease surveillance system to ensure Hawai‘i is prepared should a person potentially exposed or infected with 2019-nCoV be identified;
· Collaborating and frequently communicating with CDC, other state health departments, and state public health partners (e.g., EMS/first responders, airport personnel, infection control partners) to closely monitor the situation nationally and internationally;
· Working with healthcare facilities to ensure hospitals and healthcare providers are up to date on infection control recommendations and patient assessment in the event they encounter a person potentially infected with 2019-nCoV; and
· Communicating regularly with travel partners, public and private, to ensure the latest CDC guidance and information is being shared with all relevant personnel.
Yesterday, the CDC reported that active airport screening of all incoming passengers from Wuhan, China is being expanded from five major U.S. airports (SFO, LAX, JFK, ATL, and ORD) to all 20 U.S. airports with CDC quarantine stations. The Daniel K. Inouye International Airport in Honolulu is one of the 20 airports nationwide with a quarantine station under federal authority, specifically CDC and Customs and Border Protection (CBP).
People who have become sick after travel to China, particularly Hubei Province are advised to do the following:
· Seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.
· Stay home. Except for seeking medical care, avoid contact with others.
· Do not travel while sick.
· Cover your mouth and nose with a tissue or sleeve (not your hands) when coughing or sneezing.
· Wash hands often with clean soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
“We investigate all reports of persons with potential 2019 novel coronavirus infection to quickly identify persons with likely infection as well as those who may have been exposed to them,” said Dr. Sarah Park, State Epidemiologist. “Lab testing to confirm this infection is conducted at CDC in Atlanta, Georgia. This is the only U.S. laboratory that can conduct testing for the 2019 novel coronavirus at this time.”
DOH also recommends that everyone get vaccinated for influenza (“the flu”) to reduce the number of flu cases in Hawai‘i clinics and hospitals. This will help reduce confusion as persons with influenza will have signs and symptoms like 2019-nCoV. DOH strongly recommends that residents six months and older protect themselves against flu by receiving the seasonal influenza vaccination.
DOH has extensive protocols in place for infectious disease outbreak control and prevention activities. The department works with federal, state, county, private, and non-profit organizations statewide on preparedness activities and prevention measures continually, this includes exercises and drills with EMS, hospitals, HI-EMA, Medical Reserve Corps, law enforcement, and other partners. For more information on public health preparedness activities in Hawai‘i visit https://health.hawaii.gov/prepare/about-us/office-of-public-health-preparedness/
For information on the 2019-nCoV outbreak, including information for clinicians and public health professionals, visit the following websites.
2019 Novel Coronavirus (2019-nCoV)
Frequently Asked Questions
Revised January 29, 2020
What is 2019-nCoV?
2019 Novel Coronavirus (also called 2019-nCoV) is a new respiratory virus that was first identified in the central Chinese city of Wuhan, in Hubei Province. It has since spread to other cities across China as well as several other countries, including the United States.
How many people have been infected?
This is a rapidly changing situation. Thousands may have been infected in China, especially in and around Wuhan in Hubei Province, with over 100 deaths. Outside of China, however, spread is at this time very limited.
Is 2019-nCoV a danger in Hawaii? In the United States? How many people have been infected in the United States?
2019-nCoV is a great concern in China, but in the US the likelihood of someone getting sick is low at this time. There are only a handful of confirmed cases, in Washington State, California, Arizona, and Illinois, all related to travel to China. There are no cases in Hawaii at this time.
Is the United States in danger because of 2019-nCoV?
Although 2019-nCoV is a serious concern, CDC believes the immediate risk to the US public is low at this time. However, risk depends on exposure; healthcare workers and family members caring for people with 2019-nCoV may be at greater risk of infection than the general public.
What are coronaviruses?
Coronaviruses are a large family of viruses named for the crown-like spikes on their surface. They are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, these animal coronaviruses can infect people and then spread between people.
Human coronaviruses are also common throughout the world and can cause mild to moderate illness (e.g., “the common cold”). Some coronaviruses that infect humans are known to cause severe illness, like the coronaviruses that cause MERS (Middle East Respiratory Syndrome) and SARS (severe acute respiratory syndrome).
2019-nCoV is a new (or novel) coronavirus that originated in Wuhan, China, and is associated with an outbreak of pneumonia. It may have originated in animals, but it can now be spread from human to human.
So is 2019-nCoV the same as SARS and MERS?
No, they are different coronaviruses.
How does 2019-nCoV spread?
Health officials and investigators are still learning about how 2019-nCoV is spread. Although it is thought to have originated with animals, it now seems to be spreading from person to person. So far in the United States, there has been no person-to-person spread.
It is thought to spread mainly through respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (the flu) spreads. Like SARS and MERS, the spread of 2019-nCoV may generally occur through close contact.
There may be some spread when a person touches a surface or object that has the virus on it and then touches his or her own mouth, nose, or possibly their eyes. Frequent handwashing, with soap and water for 20 seconds or with alcohol-based hand sanitizer, can help prevent spread.
What is the source of 2019-nCoV?
Public health officials and their partners are working hard to identify the source of 2019-nCoV. Some coronaviruses circulate among animals but can be spread to people. Many of the patients early in the outbreak in Wuhan, China had some link to a large seafood and animal market in Wuhan, which suggested the virus came from an animal source. Scientists are analyzing the genetic tree of this virus to find out its specific source.
How long is a person with 2019-nCoV infection contagious?
At this time, CDC and others are studying available data to better understand this. Very likely as with other coronaviruses, a person is infectious as long as they are ill. However, we continue to monitor the situation to update the information
Symptoms and Treatment
What are the symptoms of 2019-nCoV?
Patients with 2019-nCoV have reported mild to severe respiratory illness, including the following symptoms:
· Shortness of breath or difficulty breathing
Some patients may not report fever, especially the very young, elderly, immunosuppressed, and people taking certain fever-lowering medications . Persons with a travel history to China in the past 14 days should seek medical attention immediately should they develop symptoms.
How long does it take for symptoms to appear?
CDC believes the symptoms of 2019-nCoV may appear as early as 2 days after exposure and as long as 14 days after exposure.
Are there complications from 2019-nCoV?
Many patients with 2019-nCoV have developed pneumonia in both lungs. In some cases, death has occurred.
How is 2019-nCoV treated?
There are no specific antiviral treatments for 2019-nCoV. People who are infected should receive supportive care to help relieve symptoms.
Should I be tested for 2019-nCoV infection?
If you have traveled from China in the past two weeks and have symptoms of respiratory illness, such as cough or shortness of breath, or if you have had close contact with someone who has had these symptoms within 14 days of travel to China, call ahead to a healthcare provider and mention your recent travel or close contact. The healthcare provider will work with HDOH to determine if you need to be tested.
Where is the testing done?
Although your local healthcare provider will take your sample to submit to the HDOH state public health laboratory, at this time HDOH must send samples to CDC in Atlanta, Georgia to test for the new virus. The HDOH state public health laboratory in Hawaii may have the ability to conduct the test within the next several weeks.
Prevention and Protection
Is there a vaccine for 2019-nCoV?
There is currently no vaccine to protect against this virus. The way to prevent infection is to avoid being exposed.
Does the flu shot provide any protection against 2019-nCoV?
The annual flu vaccination does not protect against 2019-nCoV but it is recommended for all persons 6 months of age or older in order to protect themselves from getting influenza (the flu).
Why should I get the flu shot then?
Because symptoms of 2019-nCoV are similar to symptoms of influenza (the flu), reducing the number of flu cases (by getting the flu shot) can help reduce the burden on healthcare
providers and facilities by reducing the number of patients they see with flu-like symptoms that could potentially be 2019-nCoV.
The flu shot also prevents you from getting influenza and spreading it to others, especially very young people, elderly people, and those with compromised immune systems. For these people, influenza can be severe or even deadly.
Travel to/from China
I recently traveled to China and now I am feeling sick. What should I do?
If you have traveled to Wuhan or elsewhere in China in the past 14 days and now feel sick with fever, cough, or difficulty breathing, you should do the following:
Stay home. Except for seeking medical care, avoid contact with others.
Seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.
Do not travel while sick.
Cover your mouth and nose with a tissue or sleeve (not your hands) when coughing or sneezing. Throw the tissue in the trash.
Wash your hands often with soap and water for at least 20 seconds. If no soap and water are available, use an alcohol-based hand sanitizer.
Clean and disinfect frequently touched objects and surfaces.
I’m a Hawaii resident now in China (or my family member is in China)? What should I or they do to avoid getting sick?
If you are in China, you should do the following:
Avoid contact with sick people.
Avoid contact with animals, both alive or dead.
Wash your hands often with soap and water for at least 20 seconds. If no soap and water are available, use an alcohol-based hand sanitizer.
Be aware that the US State Department has ordered all US citizens to leave Wuhan, China, and has arranged their departure.
Is it safe to go to China?
Because of community spread of 2019-nCoV in many cities in China, not just in Wuhan or Hubei Province, CDC recommends that travelers avoid all nonessential travel to China.
But I really need to go to China. What should I do to protect myself?
Although CDC recommends that travelers avoid all nonessential travel to China at this time, if you must go to China you should do the following:
Postpone your travel if you are currently sick.
Avoid contact with sick people while in China.
Avoid contact with live animals and animal products (especially raw meat) while in China.
Frequently wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
Older travelers and those with underlying health issues may be at risk for more severe disease and should discuss travel to China with their healthcare provider.
Be aware that there is limited access to adequate medical care in affected areas.
Should I be worried about products imported from China?
There is no evidence that you can become infected with 2019-nCoV from a product imported from China. 2019-nCoV appears to be related to coronaviruses like SARS and MERS which do not survive long on surfaces. Instead, they are usually spread from person to person through respiratory droplets.
What about animal products from China?
CDC currently has no evidence that animals or animal products imported from China pose a risk for spreading 2019-nCoV. CDC will update the situation if more information becomes available.
Is my pet at risk of getting 2019-nCoV? Do animals in Hawaii have 2019-nCoV?
Although this coronavirus seems to have come from an animal source, it is now spreading from person to person. People traveling to China should avoid both live and dead animals in China, but there is no reason to believe animals or pets in Hawaii or elsewhere in the United States might be spreading 2019-nCoV.
Situation in Hawaii
What is HDOH doing to monitor the situation with 2019-nCoV?
HDOH is doing a number of things to closely monitor the situation with 2019-nCoV:
HDOH is monitoring existing disease surveillance systems and reviewing response protocols with relevant in-state partners.
HDOH is collaborating and frequently communicating with CDC and state public health partners to closely monitor the situation and ensure Hawaii is prepared should a person potentially exposed or infected with 2019-nCoV be identified in Hawaii.
HDOH is working with healthcare facilities to ensure hospitals and healthcare providers are up to date on infection control recommendations in the event they encounter a person potentially infected with 2019-nCoV.
HDOH is communicating regularly with travel partners, public and private, to ensure the latest CDC guidance and information is being shared with all relevant personnel.
HDOH has been conducting illness surveillance of international travelers at the Daniel K. Inouye International Airport since October 2005 and continue to work with our airport partners on ongoing, regular surveillance.
What are hospitals in Hawaii doing to get ready?
HDOH is working with healthcare facilities to ensure hospitals and healthcare providers are up to date on infection control recommendations in the even they encounter a person potentially infected with 2019-nCoV.
Are there any cases of 2019-nCoV in Hawaii?
At this time, HCOH has not received any reports of persons potentially exposed or infected with 2019-nCoV.
Are passengers being screened at Daniel K. Inouye International Airport?
CDC and Customs and Border Protection (CBP) at Daniel K. Inouye International Airport (and 19 other US airports) have started monitoring for travelers with symptoms compatible with 2019-nCoV infection and a travel connection with China. They will refer them to CDC staff for evaluation at the quarantine station located at Daniel K. Inouye International Airport.
Furthermore, HDOH is communicating regularly with travel partners at Daniel K. Inouye International Airport to ensure the latest CDC guidance and information is being shared with airport personnel. HDOH has conducted illness surveillance at Daniel K. Inouye International Airport since October 2005 and continues to work with our airport partners on ongoing, regular surveillance.
All travelers from China will be given CDC’s Travel Health Notice, educating those travelers about what to do if they get sick with certain symptoms within 14 days after arriving in the United States.
Where can I find out more information?
For more information about 2019-nCoV, visit the Centers for Disease Control and Prevention (CDC) website at www.cdc.gov/coronavirus/novel-coronavirus-2019.html.
You can also visit the HDOH website at health.hawaii.gov/docd/advisories/novel-coronavirus-2019.