NJ FMBA COVID-19 Update

Current Situation

 The virus causes a cough and fever in the majority of symptomatic cases. These are very broad symptoms and overlap with many other illnesses including influenza (we are in the midst of a comparatively heavy flu season).
 The virus can kill some individuals. Though we do not know all the facts, it appears that older populations and those with other diseases such as coronary artery disease and diabetes are affected more severely by the virus.
 There are currently no medications or vaccines for this virus. The only tools we have to control spread are old fashioned public health measures such as isolation, quarantine, and social distancing.

What we think that we know:
 The maximum incubation period is estimated to be 14 days. This is extrapolated from other corona viruses. The majority of individuals studied closely have come down with symptoms within 5-6 days of exposure.
 The disease appears to spread more commonly among close contacts (e.g. families). There are, however, documented cases of transmission in relatively limited settings (e.g. giving a ride to another individual).
 The disease does not appear to make children particularly ill. There is currently only one pediatric death in the world that has been attributed by the World Health Organization (WHO) to this disease. Once more testing is done, we may establish that children are a component of the transmission chain but appear to have relatively mild expression of illness.
 COVID-19 Operational Update Some with minimal symptoms appear to have a high viral load in their body, which may mean they are still capable of transmitting the disease.
Background
Late in December 2019, Chinese authorities announced a possible epidemic of viral pneumonia of unknown etiology centralized on a local seafood market in Wuhan, China. Estimated case onset was early December. The clinical syndrome includes fever and cough which in some cases can lead to difficulty breathing with bilateral lung infiltrates on radiologic imaging. The virus was identified as a novel coronavirus, now named “SARS-CoV2.” The disease it causes is called “COVID-19.”
On January 10, Chinese health authorities were able to preliminarily identify the novel virus and established the source of the outbreak to be associated with a large local seafood and animal market in Wuhan City, Hubei Province, China. This suggested a possible zoonotic origin to the outbreak.
Shortly after discovery of this novel virus, the US Centers for Disease Control and Prevention (CDC) established a formal response in order to provide ongoing support to the COVID 19 outbreak. CDC established a COVID-19 Incident Management System on January 7, 2020 and has been operationalizing all of its pandemic preparedness and response plans, working on multiple fronts to meet these goals, including specific measures to prepare communities to respond to local transmission of the virus that causes COVID-19.

HHS established a response effort from the Secretary’s Operations Center on January 28.
The first U.S. case of 2019-nCoV was confirmed in Washington State on January 20. CDC deployed a multidisciplinary team to Washington to assist with clinical management, contact tracing, and communications. Additional cases continue to be identified. CDC has deployed multidisciplinary teams to assist health departments with clinical management, contact tracing, and communications.
On January 30, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the outbreak a “public health emergency of international concern” (PHEIC). On January 31, the White House 2019 Novel Coronavirus Task Force announced the implementation of new travel policies regarding entry into the U.S. On January 31, the HHS Secretary declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to 2019-nCoV. FEMA established a planning team element at HHS to support the response on February 10.

Current Situation

 The virus causes a cough and fever in the majority of symptomatic cases. These are very broad symptoms and overlap with many other illnesses including influenza (we are in the midst of a comparatively heavy flu season).
 The virus can kill some individuals. Though we do not know all the facts, it appears that older populations and those with other diseases such as coronary artery disease and diabetes are affected more severely by the virus.
 There are currently no medications or vaccines for this virus. The only tools we have to control spread are old fashioned public health measures such as isolation, quarantine, and social distancing.

What we think that we know:
 The maximum incubation period is estimated to be 14 days. This is extrapolated from other corona viruses. The majority of individuals studied closely have come down with symptoms within 5-6 days of exposure.
 The disease appears to spread more commonly among close contacts (e.g. families). There are, however, documented cases of transmission in relatively limited settings (e.g. giving a ride to another individual).
 The disease does not appear to make children particularly ill. There is currently only one pediatric death in the world that has been attributed by the World Health Organization (WHO) to this disease. Once more testing is done, we may establish that children are a component of the transmission chain but appear to have relatively mild expression of illness.
 COVID-19 Operational Update Some with minimal symptoms appear to have a high viral load in their body, which may mean they are still capable of transmitting the disease.

What we don’t know:
 The exact modes of transmission. All corona viruses transmit predominantly through droplet transmission. CDC has recommended airborne isolation in the healthcare setting out of an abundance of precaution. Transmission through fomites (or objects, surfaces) has not been well delineated. There are some early studies showing that this virus can be found concentrated around sinks and toilets of patients’ rooms, but these were small studies and not conclusive. It is not known how long the virus stays alive on surfaces.
 Case fatality rate (CFR): We don’t know what percentage of the population that contracts the disease will die. This rate will predictably go down as more minimally symptomatic are found and tested. It could go down significantly if children are determined to be a big percentage of carriers. This still does not belie the fact that when focusing just on the older populations, a specific percentage become severely ill (percentage varies depending on source).

Things to watch:
 Diagnostic testing: Testing kits have been rolled out to state labs for the first time this past weekend. As more testing is done, more disease will be found. Though the goal is to test every individual who requires one, there will be an initial lag in the roll out of test kits.
 International spread: There are most likely countries with spread that have either poor public health capabilities or limitations on the ability to test. Though official case counts may be low, there is most likely higher numbers of infected people.
 International travel: Both CDC and DoS have issued travel advisories for multiple countries. These could change in the coming days and could impact US citizen travel even more.
 Domestic travel: Health actions are typically initiated in the US by State-Local-Tribal and Territorial (SLTT) authorities. It will be difficult to predict which ones will initiate any travel restrictions within their jurisdictions.
 Nonpharmaceutical interventions (NPIs): Broader NPIs such as school closures and social distancing are similarly determined at the SLTT level. These could affect planned meetings or in your home jurisdiction, childcare.
Some information below regarding COVID-19 if you want to send it out to the FMBA membership

CDC Dashboard:

John Hopkins University Dashboard:

CDC COVID-19:

CDC COVID-19 - What to do if you’re sick:

FDA Emergency Use Authorization (EUA) for PPE for COVID-19

CDC Respirators Beyond the Manufactured Shelf-life:

Posted Updated guidance regarding managing exposed Healthcare Personnel (HCP)


Posted Updated Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19) disease:

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New Jersey Firefighters Mutual Benevolent Association