Current Definition of COVID-19 needs a change

“Current Definition of COVID-19 needs a change: Investigate all H1N1-negative pneumonia and at risk co-morbid patients for COVID-19”

New Delhi, February 29, 2020:

Current definition 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.

(Source: https://mohfw.gov.in/sites/default/files/Corona%20Discharge-Policy.pdf )

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Why change?

1. A California patient with coronavirus infection had to wait for days to be tested owing to restrictive federal criteria, which include travel to China or contact with someone known to be infected. Yet the patient tested positive. This patient could be the first person to be infected by means of community spread in the United States, stated the Centers for Disease Control and Prevention. 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 its Criteria to Guide Evaluation of PUI (person under investigation) for COVID-19
3. Fever or signs/symptoms of lower respiratory tract illness (cough or shortness of breath)       AND Any person, including healthcare workers who had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset
4. Fever and signs/symptoms of a lower respiratory tract illness (cough or shortness of breath) that require hospitalization      AND history of travel from affected areas (China, Iran, Italy, Japan, South Korea) within 14 days of symptom onset
5. Fever with severe acute lower respiratory tract illness (pneumonia, ARDS) that requires hospitalization and has no alternative explanatory diagnosis (e.g., influenza) AND      No source of exposure identified.

(Source: CDC)

Comments: The CDC should add “all at risk patients with fever and cough and H1N1-negative should have evaluation for possible coronavirus COVID-19”.