Novel Coronavirus in China

Warning – Level 3, Avoid Nonessential Travel

Alert – Level 2, Practice Enhanced Precautions
Watch – Level 1, Practice Usual Precautions

KEY POINTS
• CDC recommends that travelers avoid all nonessential travel to China.
• There is an ongoing outbreak of respiratory illness caused by a novel (new) coronavirus that can be spread from person to person.
• Chinese officials have closed transport within and out of Wuhan and other cities in Hubei province, including buses, subways, trains, and the international airport. Other locations may be affected.
• Older adults and people with underlying health conditions may be at increased risk for severe disease.
• The situation is evolving. This notice will be updated as more information becomes available.

WHAT IS THE CURRENT SITUATION?
• CDC recommends that travelers avoid all nonessential travel to China. In response to an outbreak of respiratory illness, Chinese officials have closed transport within and out of Wuhan and other cities in Hubei province, including buses, subways, trains, and the international airport. Additional restrictions and cancellations of events may occur.
• There is limited access to adequate medical care in affected areas.

A novel (new) coronavirus is causing an outbreak of respiratory illness that began in the city of Wuhan, Hubei Province, China. This outbreak began in early December 2019 and continues to grow. Initially, some patients were linked to the Wuhan South China Seafood City (also called the South China Seafood Wholesale Market and the Hua Nan Seafood Market).

Chinese health officials have reported thousands of cases in China and severe illness has been reported, including deaths. Cases have also been identified in travelers to other countries, including the United States. Person-to-person spread is occurring in China. The extent of person-to-person spread outside of China is unclear at this time.

Coronaviruses are a large family of viruses. There are several known coronaviruses that infect people and usually only cause mild respiratory disease, such as the common cold. However, at least two previously identified coronaviruses have caused severe disease — severe acute respiratory syndrome (SARS) coronavirus and Middle East respiratory syndrome (MERS) coronavirus.

Signs and symptoms of this illness include fever, cough, and difficulty breathing. This novel coronavirus has the potential to cause severe disease and death. Available information suggests that older adults and people with underlying health conditions or compromised immune systems may be at increased risk of severe disease.

In response to this outbreak, Chinese officials are screening travelers leaving some cities in China. Several countries and territories throughout the world are reported to have implemented health screening of travelers arriving from China.
On arrival to the United States, travelers from China may be asked questions to determine if they need to undergo health screening. Travelers with signs and symptoms of illness (fever, cough, or difficulty breathing) will have an additional health assessment.

WHAT CAN TRAVELERS DO TO PROTECT THEMSELVES AND OTHERS?
CDC recommends avoiding nonessential travel to China. If you must travel:
• Avoid contact with sick people.
• Discuss travel to China with your healthcare provider. Older adults and travelers with underlying health issues may be at risk for more severe disease.
• Avoid animals (alive or dead), animal markets, and products that come from animals (such as uncooked meat).
• Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.

If you were in China in the last 14 days and feel sick with fever, cough, or difficulty breathing, you should:
• Seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.
• Avoid contact with others.
• Not travel while sick.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
• Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.

CLINICIAN INFORMATION
Healthcare providers should obtain a detailed travel history for patients with fever and respiratory symptoms. For patients with these symptoms who were in China on or after December 1, 2019, and had onset of illness within 2 weeks of leaving, consider the novel coronavirus and notify infection control personnel and your local health department immediately.
Although routes of transmission have yet to be definitively determined, CDC recommends a cautious approach to interacting with patients under investigation. Ask such patients to wear a surgical mask as soon as they are identified. Conduct their evaluation in a private room with the door closed, ideally an airborne infection isolation room, if available. Personnel entering the room should use standard precautions, contact precautions, and airborne precautions, and use eye protection (goggles or a face shield). For additional infection control guidance, visit CDC’s Infection Control webpage.

FOR ADDITIONAL INFORMATION, PLEASE SEE:
• Novel Coronavirus 2019, Wuhan, China
• Information for Healthcare Professionals
• Interim Recommendations for Airline Crew: Novel Coronavirus in China
• WHO, Coronavirus
• U.S. Department of State China Travel Advisory

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