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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

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
1.
To  KK , Tsang  OT , Leung  WS ,  et al.  Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study.   Lancet Infect Dis. Published online March 23, 2020. doi:10.1016/S1473-3099(20)30196-1PubMedGoogle Scholar
2.
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
3.
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/NEJMoa2005412PubMedGoogle Scholar
4.
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
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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
6.
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
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