CDC: Healthcare Professionals: Frequently Asked Questions and Answers

Straight from the CDC website: Updated March 17, 2020

Click here for General Public FAQs and also the general COVID-19 Novel Coronavirus FAQ.

Q: What are the clinical features of
COVID-19?

A: The clinical spectrum of COVID-19 ranges from mild disease with non-specific
signs and symptoms of acute respiratory illness, to severe pneumonia with
respiratory failure and septic shock. There have also been reports of
asymptomatic infection with COVID-19. See also Interim Clinical Guidance for Management of
Patients with Confirmed Coronavirus Disease 2019 (COVID-19).

Q: Who is at risk for COVID-19?

A: Currently, those at greatest risk
of infection are persons who have had prolonged, unprotected close contact with
a patient with symptomatic, confirmed COVID-19 and those who live in or have
recently been to areas with sustained transmission.

Q: Who is at risk for severe
disease from COVID-19?

The available data are currently
insufficient to identify risk factors for severe clinical outcomes. From the
limited data that are available for COVID-19 infected patients, and for data
from related coronaviruses such as SARS-CoV and MERS-CoV, it is possible that
older adults, and persons who have underlying chronic medical conditions, such
as immunocompromising conditions, may be at risk for more severe outcomes. See
also See also Interim Clinical Guidance for Management of
Patients with Confirmed Coronavirus Disease 2019 (COVID-19).

Q: When is someone infectious?

A: The onset and duration of viral
shedding and period of infectiousness for COVID-19 are not yet known. It is
possible that SARS-CoV-2 RNA may be detectable in the upper or lower
respiratory tract for weeks after illness onset, similar to infection with
MERS-CoV and SARS-CoV. However, detection of viral RNA does not necessarily
mean that infectious virus is present. Asymptomatic infection with SARS-CoV-2
has been reported, but it is not yet known what role asymptomatic infection
plays in transmission. Similarly, the role of pre-symptomatic transmission
(infection detection during the incubation period prior to illness onset) is
unknown. Existing literature regarding SARS-CoV-2 and other coronaviruses (e.g.
MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2–14
days.

Q: Which body fluids can spread
infection?

A: Very limited data are available
about detection of SARS-CoV-2 and infectious virus in clinical specimens.
SARS-CoV-2 RNA has been detected from upper and lower respiratory tract
specimens, and SARS-CoV-2 has been isolated from upper respiratory tract
specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in
blood and stool specimens, but whether infectious virus is present in
extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA
detection in upper and lower respiratory tract specimens and in extrapulmonary
specimens is not yet known but may be several weeks or longer, which has been
observed in cases of MERS-CoV or SARS-CoV infection. While viable, infectious SARS-CoV
has been isolated from respiratory, blood, urine, and stool specimens, in
contrast – viable, infectious MERS-CoV has only been isolated from respiratory
tract specimens. It is not yet known whether other non-respiratory body fluids
from an infected person including vomit, urine, breast milk, or semen can
contain viable, infectious SARS-CoV-2.

Q: Can people who recover from
COVID-19 be infected again?

A: The immune response to COVID-19
is not yet understood. Patients with MERS-CoV infection are unlikely to be
re-infected shortly after they recover, but it is not yet known whether similar
immune protection will be observed for patients with COVID-19.

Q: How should healthcare personnel
protect themselves when evaluating a patient who may have COVID-19?

A: Although the transmission
dynamics have yet to be determined, CDC currently recommends a cautious
approach to persons under investigation (PUI) for COVID-19. Healthcare
personnel evaluating PUI or providing care for patients with confirmed
COVID-19 should use, Standard  Transmission-based Precautions. See the
Interim Infection Prevention and Control Recommendations for Patients with
Known or Patients Under Investigation for Coronavirus Disease 2019 (COVID-19)
in Healthcare Settings.

Q: Are pregnant healthcare personnel
at increased risk for adverse outcomes if they care for patients with COVID-19?

A: Pregnant healthcare personnel
(HCP) should follow risk assessment and infection control guidelines for HCP
exposed to patients with suspected or confirmed COVID-19. Adherence to
recommended infection prevention and control practices is an important part of
protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy
is very limited; facilities may want to consider limiting exposure of pregnant
HCP to patients with confirmed or suspected COVID-19, especially during
higher risk procedures (e.g., aerosol-generating procedures) if feasible based
on staffing availability.

Q: Should any diagnostic or
therapeutic interventions be withheld due to concerns about transmission of
COVID-19?

A: Patients should receive any
interventions they would normally receive as standard of care. Patients with
suspected or confirmed COVID-19 should be asked to wear a surgical mask as soon
as they are identified and be evaluated in a private room with the door closed.
Healthcare personnel entering the room should use Standard and Transmission-based Precautions.

Q: How do you test a patient for
SARS-CoV-2, the virus that causes COVID-19?

A: See recommendations for
reporting, testing, and specimen collection at Interim Guidance for Healthcare Professionals.

Q: Will existing respiratory virus
panels, such as those manufactured by Biofire or Genmark, detect SARS-CoV-2,
the virus that causes COVID-19?

A: No. These multi-pathogen
molecular assays can detect a number of human respiratory viruses, including
other coronaviruses that can cause acute respiratory illness, but they do not
detect COVID-19.

Q: How is COVID-19 treated?

Not all patients with COVID-19 will
require medical supportive care. Clinical management for hospitalized patients
with COVID-19 is focused on supportive care of complications, including
advanced organ support for respiratory failure, septic shock, and multi-organ
failure. Empiric testing and treatment for other viral or bacterial etiologies
may be warranted.

Corticosteroids are not routinely
recommended for viral pneumonia or ARDS and should be avoided unless they are
indicated for another reason (e.g., COPD exacerbation, refractory septic shock
following Surviving Sepsis Campaign Guidelines).

There are currently no antiviral
drugs licensed by the U.S. Food and Drug Administration (FDA) to treat
COVID-19. Some in-vitro or in-vivo studies suggest potential
therapeutic activity of some agents against related coronaviruses, but there
are no available data from observational studies or randomized controlled
trials in humans to support recommending any investigational therapeutics for
patients with confirmed or suspected COVID-19 at this time. Remdesivir, an
investigational antiviral drug, was reported to have in-vitro activity against
COVID-19. A small number of patients with COVID-19 have received intravenous
remdesivir for compassionate use outside of a clinical trial setting. A randomized placebo-controlled clinical trial
of remdesivirexternal icon for
treatment of hospitalized patients with COVID-19 respiratory disease has been
implemented in China. A randomized open label trialexternal icon of combination lopinavir-ritonavir treatment has been also
been conducted in patients with COVID-19 in China, but no results are available
to date. trials of other potential therapeutics for COVID-19 are being planned.
For information on specific clinical trials underway for treatment of patients
with COVID-19 infection, see clinicaltrials.govexternal icon.

See Interim Clinical Guidance for Management of
Patients with Confirmed Coronavirus Disease 2019 (COVID-19)

Q: Should post-exposure prophylaxis
be used for people who may have been exposed to COVID-19?

A: There is currently no
FDA-approved post-exposure prophylaxis for people who may have been exposed to
COVID-19. For more information on movement restrictions, monitoring for
symptoms, and evaluation after possible exposure to COVID-19 See Interim US Guidance for Risk Assessment and
Public Health Management of Persons with Potential Coronavirus Disease 2019
(COVID-19) Exposure in Travel-associated or Community Settings and Interim U.S Guidance for Risk Assessment and
Public Health Management of Healthcare Personnel with Potential Exposure in a
Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19).

Q: Whom should healthcare providers
notify if they suspect a patient has COVID-19?

A: Healthcare providers should
consult with local or state health departments to determine whether patients
meet criteria for a Persons Under Investigation (PUI). Providers should immediately notify infection control
personnel at their facility if they suspect COVID-19 in a patient.

Q: Do patients with confirmed or
suspected COVID-19 need to be admitted to the hospital?

A: Not all patients with COVID-19
require hospital admission. Patients whose clinical presentation warrants
in-patient clinical management for supportive medical care should be admitted
to the hospital under appropriate isolation precautions. Some patients with an
initial mild clinical presentation may worsen in the second week of illness.
The decision to monitor these patients in the inpatient or outpatient setting
should be made on a case-by-case basis. This decision will depend not only on
the clinical presentation, but also on the patient’s ability to engage in monitoring,
the ability for safe isolation at home, and the risk of transmission in the
patient’s home environment. For more information, see Interim Infection Prevention and Control
Recommendations for Patients with Known or Patients Under Investigation for
Coronavirus Disease 2019 (COVID-19) in a Healthcare Setting and Interim Guidance for Implementing Home Care of
People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19).

Q: When can patients with confirmed
COVID-19 be discharged from the hospital?

A: Patients can be discharged from
the healthcare facility whenever clinically indicated. Isolation should be
maintained at home if the patient returns home before the time period
recommended for discontinuation of hospital Transmission-Based Precautions
described below.

Decisions to discontinue
Transmission-Based Precautions or in-home isolation can be made on a
case-by-case basis in consultation with clinicians, infection prevention and
control specialists, and public health based upon multiple factors, including
disease severity, illness signs and symptoms, and results of laboratory testing
for COVID-19 in respiratory specimens.

Criteria to discontinue
Transmission-Based Precautions can be found in: Interim Considerations for Disposition of
Hospitalized Patients with COVID-19

Q: Are pregnant healthcare personnel
at increased risk for adverse outcomes if they care for patients with COVID-19?

A: Pregnant healthcare personnel
(HCP) should follow risk assessment and infection control guidelines for HCP
exposed to patients with suspected or confirmed COVID-19. Adherence to
recommended infection prevention and control practices is an important part of
protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy
is very limited; facilities may want to consider limiting exposure of pregnant
HCP to patients with confirmed or suspected COVID-19, especially during
higher risk procedures (e.g., aerosol-generating procedures) if feasible based
on staffing availability.

Q: What do I need to know if a
patient with confirmed or suspected COVID-19 asks about having a pet or other
animal in the home?

A: See COVID-19 and Animals.