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January 17, 2020

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See updated CDC guidance for evaluation of patients under investigation (PUI) for 2019- nCoV, prevention and infection control guidance, including the addition of an eye protection recommendation, and information on specimen collection.

Criteria to Guide Evaluation of PUI for 2019-nCoV
  • Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness.

  • Patients who meet the following criteria should be evaluated as a PUI in association with the outbreak of 2019-nCoV in Wuhan City, China:

    1. Fever1 AND symptoms of lower respiratory illness (e.g., cough, shortness of breath) AND in the last 14 days before symptom onset,
      • History of travel from Wuhan City, China
      • Close contact2 with a person who is under investigation for 2019-nCOV while that person was ill.

    2. Fever1 OR symptoms of lower respiratory illness (e.g., cough, shortness of breath) AND in the last 14 days before symptom onset,
      • Close contact2 with an ill laboratory-confirmed 2019-nCoV patient.

  • The criteria are intended to serve as guidance for evaluation. Patients should be evaluated and discussed with Public Health on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain travel or exposure).
Recommendations for reporting, testing, and specimen collection
  • Healthcare providers should immediately notify both infection control personnel at their healthcare facility (HCF) and Public Health (206-296-4774) in the event of a PUI for 2019-nCoV.

  • At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC. Public Health will work with HCF to facilitate collection, storage and shipment of specimens to CDC. Testing for other respiratory pathogens should not delay specimen shipping to CDC.

  • If a PUI tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI. This may evolve as more information becomes available on possible 2019 nCoV co-infections.

  • For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for 2019-nCoV. To increase the likelihood of detecting 2019-nCoV infection, CDC recommends collecting and testing multiple clinical specimens from different sites, including all three specimen types—lower respiratory, upper respiratory, and serum specimens. Additional specimen types (e.g., stool, urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset. Additional guidance for collection, handling, and testing of clinical specimens
Interim healthcare infection prevention and control recommendations for patients under investigation for 2019-nCoV
  • PUI for 2019-nCoV 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, ideally an airborne infection isolation room 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).


1 Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to guide testing of patients in such situations.

2 Close contact is defined as: a) being within approximately 6 feet (2 meters), or within the room or care area, of a novel coronavirus 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 healthcare waiting area or room with a novel coronavirus case; or, b) having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on) while not wearing recommended personal protective equipment. 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 novel coronavirus (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to those exposed in healthcare settings.

Chinese authorities report most patients in the Wuhan City outbreak have been epidemiologically linked to a large seafood and animal market, suggesting a possible zoonotic origin to the outbreak. Chinese authorities additionally report that they are monitoring several hundred healthcare workers who are caring for outbreak patients; no spread of this virus from patients to healthcare personnel has been reported to date. Chinese authorities are reporting no ongoing spread of this virus in the community, but they cannot rule out that some limited person-to-person spread may be occurring. China has reported that two of the patients have died, including one with pre-existing medical conditions.

Thailand and Japan have confirmed additional cases of 2019-nCoV in travelers from Wuhan, China. It is possible that more cases will be identified in the coming days. This is an ongoing investigation and given previous experience with MERS-CoV and SARS-CoV, it is possible that person-person spread may occur. There is much more to learn about the transmissibility, severity, and other features associated with 2019-nCoV as the investigations in China, Thailand, and Japan continue.