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Symptom Screening at Illness Onset of Health Care Personnel With SARS-CoV-2 Infection in King County, Washington

Educational Objective
To understand how King County, Washington used the spectrum of early symptoms to identity COVID-19

1 Credit CME

JAMA

Published Online: April 17, 2020

Research Letter

Article Information and Disclosures

Eric J. Chow, MD, MS, MPH¹;

Noah G. Schwartz, MD¹;

Farrell A. Tobolowsky, DO, MS¹;

Rachael L. T. Zacks, MD¹;

Melinda Huntington-Frazier, MSN²;

Sujan C. Reddy, MD³;

Agam K. Rao, MD³

Author Affiliations

¹Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
²Public Health–Seattle and King County, Seattle, Washington
³Centers for Disease Control and Prevention COVID-19 Emergency Response, Atlanta, Georgia

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As the coronavirus disease 2019 (COVID-19) pandemic continues, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposures among US health care personnel (HCP) during health care delivery and from community contacts will increase. Results from real-time reverse transcriptase–polymerase chain reaction suggest that high viral loads may be detected soon after illness onset, including in minimally symptomatic persons.¹ Current COVID-19 HCP screening guidance² includes assessing fever and respiratory symptoms (cough, shortness of breath, or sore throat) with clinical discretion for evaluation for other symptoms (eg, myalgias). We assessed the spectrum of symptoms at onset of COVID-19 among HCP and evaluated current screening criteria for identifying COVID-19 cases early in illness course.

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Article Information

Corresponding Author: Eric J. Chow, MD, MS, MPH, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, H24-7, Atlanta, GA 30329 (echow@cdc.gov).

Published Online: April 17, 2020. doi:10.1001/jama.2020.6637

Author Contributions: Dr Chow had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chow, Schwartz, Zacks, Reddy, Rao.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Chow, Tobolowsky, Reddy, Rao.

Critical revision of the manuscript for important intellectual content: Chow, Schwartz, Zacks, Huntington-Frazier, Reddy, Rao.

Administrative, technical, or material support: Zacks, Huntington-Frazier, Reddy.

Supervision: Reddy, Rao.

Conflict of Interest Disclosures: None reported.

Funding/Support: The case investigations, analysis, and manuscript preparation were completed as part of official duties at the Centers for Disease Control and Prevention (CDC).

Role of the Funder/Sponsor: The CDC designed and conducted this study; received, managed, analyzed, and interpreted the data; prepared, reviewed, and approved the manuscript; and had a role in the decision to submit the manuscript for publication.

Disclaimer: The findings and conclusion in this report are those of the authors and do not necessarily represent the official position of the CDC.

Additional Contributions: We thank Temet M. McMichael, PhD, Claire Brostrom-Smith, MSN, Vance Kawakami, DVM, David Baure, RN, Eileen Benoliel, RN (Public Health–Seattle and King County), Hammad Ali, PhD, Dustin W. Currie, PhD, Jonathan Dyal, MD, Michael J. Hughes, MPH, and Lisa Oakley, PhD (CDC), for assisting with data collection and Meagan Kay, DVM, James Lewis, MD, Jeffrey S. Duchin, MD (Public Health–Seattle and King County), John Jernigan, MD, Margaret A. Honein, PhD, and Thomas A. Clark, MD (CDC), for providing critical feedback on the manuscript. None of these individuals received compensation for their contributions to this study.

References

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Centers for Disease Control and Prevention. Coronavirus disease 2019: potential exposure at work. Published online March 7, 2020. Accessed April 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

McMichael TM , Currie DW , Clark S , et al. Epidemiology of COVID-19 in a long-term care facility in King County, Washington. N Engl J Med. Published online March 27, 2020. doi:10.1056/NEJMoa2005412 PubMed Google Scholar

Centers for Disease Control and Prevention. Priorities for testing patients with suspected COVID-19 infection. Accessed April 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/downloads/priority-testing-patients.pdf

Centers for Disease Control and Prevention. Coronavirus disease 2019: infection control guidance. Updated April 13, 2020. Accessed April 13, 2020. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html

Centers for Disease Control and Prevention. Coronavirus disease 2019: nursing homes and long-term care facilities. Accessed April 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.