U.S. declares public health emergency—what you need to know

Outbreak of a novel coronavirus generated a coordinated U.S. public health response to curb pandemic fears, but as confirmed domestic cases increase, America's health care providers are put on alert.

Retroactive to Jan. 27, Health and Human Services (HHS) Secretary Alex Azar declared a public health emergency to aid response to COVID-19, the "Wuhan coronavirus," as the Centers for Disease Control and Prevention (CDC) now confirms at least 13 cases of the respiratory illness and a confirmed instance of person-to-person transmission on U.S. soil. As of Feb. 11, the World Health Organization (WHO) reports 146 confirmed cases in at least 24 countries outside of China, where COVID-19 has infected over 42,700 and killed at least 1,017 people.

"While this virus poses a serious public health threat, the risk to the American public remains low at this time, and we are working to keep this risk low," Secretary Azar said.

Initially identified in Wuhan City, China, in December, COVID-19 is in the same family of viruses ranging in severity from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Patients with COVID-19 reportedly have mild to severe respiratory illness with fever, cough or shortness of breath and symptoms appearing 2 to 14 days after exposure, the CDC says. Spreading like influenza—either via direct contact or exchange of bodily fluids—health officials stress a seasonal influenza vaccine will not be protective against COVID-19 .

To that point, U.S. public health authorities have allayed concerns by saying Americans have more to fear from seasonal influenza activity—itself responsible for at least 19 million cases and 10,000 deaths in the U.S. this year alone —than COVID-19 . Yet, as global concerns escalate, especially given the novel nature of the virus, health officials are taking preemptive action.

In late January, the WHO declared COVID-19 an international public health emergency with the U.S. following suit, first by barring entry to foreign travelers recently visiting China and then by the State Department advising against travel to China. Now, the HHS is providing greater flexibility to public health authorities in mobilizing disease surveillance, prevention and containment efforts. And additionally, the CDC is providing interim guidance for health care professionals.

Given the severity of the situation, the AOA Health Policy Institute (HPI) is providing information relevant to the eye health and vision care community regarding COVID-19 because "every doctor of optometry should understand the risks associated with this outbreak to ensure continued ability to care for patients."

AOA HPI on COVID-19

In a statement released Jan. 30 and updated on Feb. 12, the AOA HPI consolidated relevant information on the coronavirus, general public health guidance and infection control protocols that all doctors of optometry should be aware of and actively employ, bearing in mind the evolving nature of the outbreak. Even the WHO and CDC acknowledge current understanding of the disease remains very limited, yet there are several points that doctors of optometry need to know:

• COVID-19 may cause ocular signs and symptoms, including photophobia, irritation, conjunctival injection and ocular discharge. As of Feb. 10, new information is emerging that identifies the conjunctiva as an alleged route of exposure; COVID-19 may enter the body through the eyes and spread to the whole body through the superficial blood vessels within the conjunctiva. All front-line medical staff should pay attention to eye protection.
• Infection control protocol and proper hygiene must be observed—including thorough handwashing, use of protective gloves and disinfecting equipment, in addition to other CDC recommendations—no matter the size of the practice.
• Monitor potential coronavirus activity in your community or region, as well as encourage ill patients to remain at home.   Michael Dueñas, O.D., AOA chief public health officer, reiterates that the U.S. public health system relies on the involvement of health care providers and organizations.

The AOA HPI is closely monitoring any and all developments related to COVID-19, including attending a Feb. 11 briefing at The Aspen Institute with representatives from the CDC, National Institutes of Health and White House. Michael Dueñas, O.D., AOA chief public health officer, reiterates that the U.S. public health system relies on the involvement of health care providers and organizations.

"As such, both the AOA and its members have significant roles to play in providing public health services during disease outbreaks, such as the COVID-19 outbreak," Dr. Duenas says. "This includes but may not be limited to (1) aiding the monitoring and diagnosis of individuals' COVID-19 health status; (2) informing, educating and empowering individuals about ways to prevent its transmission, including implementing CDC policies and procedures for health professionals; (3) participating in regulatory reporting through the interim 2019 novel coronavirus patient under investigation form; and (4) linking these PUI's to needed personal health services."

Additionally, the CDC advises health care providers be mindful of the currently understood characteristics of COVID-19 clinical illness, as well as patients' exposure risk, noting that many signs and symptoms of COVID-19 overlap with those associated with other viral respiratory tract infections. Therefore, clinicians are urged to ask:

• Does this patient have fever or symptoms of lower respiratory infection, such as cough or shortness of breath?
  
  AND
  
  
• Has the patient traveled to mainland China within 14 days of symptom onset?
  
  OR
  
  
• Has the patient had close contact with a person confirmed with COVID-19 infection?

If patients meet these criteria, the CDC urges clinicians to immediately notify the local health department.

Given the severity of the situation, the HHS' Office for Civil Rights also issued a bulletin to ensure covered entities and business associates are aware of the ways protected health information may be shared under the HIPAA Privacy Rule during an outbreak. Find more information on HIPAA concerns and COVID-19 PUI reporting.