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2019 Novel Coronavirus Traveler Monitoring Guidance

This document provides a guide to the response processes for the 2019 Novel Coronavirus

(2019 nCoV) outbreak. This guidance document and the recommendations provided will

continue to be amended as needed. Therefore, it is important to ensure the current version of

this document and the referenced guidance documents are used. The outbreak is ongoing, so

in lieu of a summary being provided here, please see current situation reports at the following

links:

Centers for Disease Control and Prevention (CDC):

https://www.cdc.gov/coronavirus/2019-nCoV/summary.html

World Health Organization: https://www.who.int/emergencies/diseases/novel-

coronavirus-2019/situation-reports/

Jump to Appendices

Patients Under Investigation (PUIs)

The current PUI definition and guidance are available here:

https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. Any identified PUI

should be reported immediately to either the local public health agency or the Department of

Health and Senior Services’ Bureau of Communicable Disease Control and Prevention (BCDCP)

at 573-751-6113 or 800-392-0272 (24/7) in order to facilitate testing and ensure appropriate

isolation measures.

Background

The CDC has implemented active monitoring of travelers to the US whose travel originates in

China. These travelers are now arriving to the US at one of 11 airports where entry screening is

being conducted by Customs and Border Patrol (CBP) and CDC. The screening process for

travelers includes a temperature check, evaluation of symptoms, and assessment of potential

risk factors. In addition, travelers are expected to receive Travel Health Alert Notice Cards that

communicate what to expect next, copies of which are included as Appendix A.

The implementation of active monitoring means that the state or local public health authorities

assume responsibility for establishing regular communication with potentially exposed

individuals, including checking daily to assess for the presence of the symptoms of 2019 nCoV.

The purpose of active monitoring is to ensure that, if individuals with epidemiologic risk factors

become ill, they are identified as soon as possible after symptom onset so they can be rapidly

isolated and evaluated. The active monitoring of these individuals is to continue for 14 days

after the last potential exposure. Fourteen days is believed to be the maximum amount of time

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it can take from the time a person is infected with the 2019 nCoV until that person develops

symptoms of infection.

Specifically, active monitoring should consist of, at a minimum, twice daily reporting of measured temperatures and symptoms consistent with 2019 nCoV infection by the individual to the public health authority, including:

Fever

Cough

Sore throat

Difficulty breathing

Headache

Chills

Muscle aches

Vomiting

Abdominal pain

Diarrhea

Temperature should be measured using an FDA-approved thermometer (e.g. oral, tympanic or noncontact). People being actively monitored should measure and record their temperature twice daily, monitor themselves for symptoms, report as directed to the public health authority, and immediately notify the public health authority if they develop fever or other symptoms. In addition, active monitoring will also include the daily reporting of the intent to travel in-state or out-of-state. In the event a traveler does not report in, state or local public health officials will take immediate steps to locate the individual to ensure that active monitoring continues on a daily basis.

The CDC has provided guidance (https://www.cdc.gov/coronavirus/2019-ncov/php/risk-

assessment.html) that includes recommendations pertaining to the active monitoring of travelers. Per the interim guidance, federal communicable disease regulations, including those applicable to isolation and other public health orders, apply principally to arriving international travelers and in the setting of interstate movement. State and local authorities have primary jurisdiction for isolation and other public health orders within their borders. Thus, CDC recognizes that state and local jurisdictions may make decisions about isolation, other public health orders, and active (or direct active) monitoring that impose a greater level of restriction than what is recommended by federal guidance, and that decisions and criteria to use such public health measures may differ by jurisdiction.

Initial disposition of screened travelers

As part of the entry screening process, travelers who are symptomatic will immediately be placed in isolation and not allowed to continue their travel. Asymptomatic individuals determined to be in the high risk category will be quarantined and not be permitted to complete their itineraries.

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Travelers who are asymptomatic and are determined to be in the medium, low, or no identifiable risk categories will be allowed to continue their travel. Active monitoring of medium risk travelers will be required by public health authorities for a period of 14 days following their last date of possible exposure (i.e., the date they left China).

Traveler health monitoring and follow-up

The CDC will notify the Missouri Department of Health and Senior Services (DHSS) when Missouri is the reported final destination state of a traveler from China. Upon receiving the notification, DHSS will notify the LPHA and provide the available information. The LPHA will be notified by DHSS as soon as the travel notification is received during the hours of 6:00 a.m. and 10:00 p.m. daily (including weekends and holidays). For travel notifications received after business hours or on weekends or holidays, DHSS will notify the LPHA’s emergency contact by phone.

At CDC’s request, the local/state public health agencies are expected to follow-up with the traveler and initiate active monitoring for the remainder of the 14 day monitoring period. The follow-up and monitoring will include making immediate contact with the traveler to conduct an initial evaluation of health and risk of exposure and conducting daily health checks as described in Appendix B, Traveler Risk Categories. In some instances, the monitoring may include movement restrictions such as limited use of commercial conveyance, exclusion from public places (which may include work), and the exclusion of travel to areas where the individual would be unable to be actively monitored by public health. The specific details of the active monitoring and implementation of possible travel restrictions will be determined following consultation with DHSS on a case-by-case basis, depending on the circumstances of each traveler. If travel restrictions are implemented, then any subsequent travel will need to be approved by the appropriate state and local authorities.

Protocol for active monitoring

DHSS receives initial travel notification. DHSS then notifies the LPHA.

LPHA contacts the traveler to verify their current location and to complete the 2019 Novel Coronavirus Traveler Evaluation Form, included as Appendix C (Note: a separate form is completed for each traveler).

The LPHA should also establish a clear understanding and ensure the following:

o Should they become ill, they would need to call public health before seeking any medical treatment unless it is a medical emergency.

o Provide the traveler all relevant public health telephone numbers and ask what their preferred healthcare facility is, should they need to be referred for care and testing. Note: The public health contact numbers provided must include a number that ensures a call is answered 24/7, including night, weekends, and holidays.

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o Inform the traveler the information provided will be discussed with DHSS and additional recommendations regarding monitoring and movement restrictions will be promptly provided. In the Interim we ask that they stay home and avoid public places pending additional recommendations.

LPHA promptly consults with DHSS to discuss findings from the evaluation of the traveler and determine the monitoring frequency and any needed movement restrictions.

LPHA promptly contacts traveler to inform them of the daily monitoring (times and methods) and of any movement restrictions.

Removed: LPHA responsibility to notify a health care facility that they are the preferred provider of an asymptomatic traveler. Advance notification to healthcare facilities of the expected arrival of symptomatic suspect PUIs should still take place.

The LPHA conducts daily monitoring for temperature, symptoms, and travel (see Traveler Risk Categories, Appendix B). The information is documented on the Traveler Daily Monitoring Log, included as Appendix D. The LPHA will report the temperature and symptom information to DHSS once each day during the monitoring period (including weekends and holidays). DHSS will report the information to CDC. (Note: Any fever or symptoms reported by the traveler to the LHPA should be reported to DHSS immediately). If the traveler states they have a fever or have other symptoms of 2019 nCoV infection, complete a CDC PUI form and discuss the findings with a BCDCP epidemiology team member in your region, the BCDCP main number 573-751-6113, or 800-392-0272 (24/7).

o The daily active monitoring by public health does not include coming into direct contact with the traveler or entering their home. The traveler can take their own temperature twice daily and report the reading and any other symptoms to the public health via remote monitoring using phone, email, text or other form of electronic reporting.

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Appendix A Traveler Health Alert Notice Cards

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Appendix B Traveler Risk Categories

Risk Level Definition of Contact Monitoring Activity Restriction

High Living in the same household as, being an intimate partner of, or providing care in a nonhealthcare setting (such as a home) for a person with symptomatic laboratory-confirmed 2019-nCoV infection without using recommended precautions for home care and home isolation (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html)

o The same risk assessment applies for the above-listed exposures to a person diagnosed clinically with 2019-nCoV infection outside of the United States who did not have laboratory testing.

Travel from Hubei Province, China

Daily active monitoring Remain quarantined (voluntary or under public health orders on a case-by-case basis) in a location to be determined by public health authorities. No public activities. Travel: controlled.

Medium Close contact with a person with symptomatic laboratory-confirmed 2019-nCoV infection, and not having any exposures that meet a high-risk definition.

o The same risk assessment applies for close contact with a person diagnosed clinically with 2019-nCoV infection outside of the United States who did not have laboratory testing.

o On an aircraft, being seated within 6 feet (two meters) of a traveler with symptomatic laboratory-confirmed 2019-nCoV infection; this distance correlates approximately with 2 seats in each direction (refer to graphic on page 2)

Living in the same household as, an intimate partner of, or caring for a person in a nonhealthcare setting (such as a home) to a person with symptomatic laboratory-confirmed 2019-nCoV infection while consistently using recommended precautions for home care and home isolation (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html)

Travelers from mainland China outside Hubei Province with no known high-risk exposure: Self-monitoring with public health supervision

All others in this category: Active monitoring

To the extent possible, remain at home or in a comparable setting. Avoid congregate settings, limit public activities, and practice social distancing. Travel: Recommendation to postpone additional long-distance travel after they reach their final destination. People who intend to travel should be advised that they might not be able to return if they become symptomatic during travel.

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Travel from mainland China outside Hubei Province AND not having any exposures that meet a high-risk definition

Low Being in the same indoor environment (e.g., a classroom, a hospital waiting room) as a person with symptomatic laboratory-confirmed 2019-nCoV infection for a prolonged period of time but not meeting the definition of close contact

On an aircraft, being seated within two rows of a traveler with symptomatic laboratory-confirmed 2019-nCoV infection but not within 6 feet (2 meters) (refer to graphic below) AND not having any exposures that meet a medium- or a high-risk definition (refer to graphic below)

Self-observation. Initial public health contact to educate the individual about symptoms, how to monitor their health, and what to do in the event that they develop symptoms.

No restriction

No Identifiable

Risk

Interactions with a person with symptomatic laboratory-confirmed 2019-nCoV infection that do not meet any of the high-, medium- or low-risk conditions above, such as walking by the person or being briefly in the same room.

None No restriction

Graphic: Sample seating chart for a 2019-nCoV aircraft contact investigation showing risk levels based on distance from the infected traveler.

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Appendix C 2019 Novel Coronavirus Interim Traveler Evaluation Form

Section I: Traveler Demographic Information

First Name:______________________________ Last Name:___________________________ MI:_____

Gender: □ Male □ Female Age:_______ Date of Birth: ____/_____/_______

Current Address: ______________________________________________________________________

City: __________________________ County:_____________________ State: ____________________

Phone1: (____)_____ - ________ Phone2: (____)_____ - ________ Email: ________________________

Emergency Contact Name:__________________________________ Phone (____)_____ - ___________

Occupation: ___________________________ Employer: ______________________________________

Dwelling: □ Single Family Home □ Multi-family Home □ Apartment

□ Dormitory □ Other:____________

Number of persons currently living in dwelling: _______

Does the traveler speak/understand English: □ Yes □ No □ Unknown If no, language:______________

Section II: Travel History Have you traveled to China in the past 14 days: □ Yes □ No (If yes, which provinces, cities, and dates of travel)

Province City Date Arrived Date Departed

____/_____/_______ ____/_____/_______

____/_____/_______ ____/_____/_______

____/_____/_______ ____/_____/_______

When did you arrive in the United States: Date Arrived ____/____/_______ Arrival Time: ___________

When did you arrive in (final destination): Date Arrived ____/____/_______ Arrival Time: ___________

Flight History: Please list all flights you have taken during the past 14 days.

Airline Flight

Number

Seat Number

Airport Name

Departure Departure Date

Airport Name Arrival

Date Departed

____/_____/_______ ____/_____/_______

____/_____/_______ ____/_____/_______

____/_____/_______ ____/_____/_______

____/_____/_______ ____/_____/_______

Did you sit in your assigned seat for all flights noted above: □ Yes □ No □ Unknown

If no, which flights did you not sit in your assigned seat number: _____________________________

If unknown, explain: _________________________________________________________________

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Section III: Clinical Information

Are you currently experiencing any of the following symptoms?

Description Fever (Subjective) Fever (Measured) If yes, max (________) Coughing Difficulty breathing Shortness of breath Sore throat Wheezing Pain with coughing or breathing Weak/Tired Abdominal Pain Diarrhea Other1: ____________________ Other2: ____________________

Symptoms □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No

Onset date

___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____

Resolved date

___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____ ___/___/_____

Are you taking any fever reducing medications? □ Yes □ No □ Unknown Do you have a specific hospital you plan to use if you become ill? □ Yes □ No □ Unknown If Yes, What hospital do you plan to use if you were to become ill: ______________________________ Hospital Location: Street _____________________ City ______________________ St _______

Section IV: Exposure Information:

(The following exposure questions are for the 14 days prior to the assessment)

1. Did you travel to Hubei Province, China? □ Yes □ No □ Unknown

2. Did you live in the same household with a person diagnosed with 2019 nCoV? □ Yes □ No □ Unknown

3. Were you an intimate partner of a person diagnosed with 2019 nCoV? □ Yes □ No □ Unknown

4. Did you provide care in a non-healthcare setting (such as a home) to a person diagnosed with 2019 nCoV?

□ Yes □ No □ Unknown If YES to any of the questions 2 – 4, please ask the following:

Did you wear Personal Protective Equipment (PPE)?

□ Yes □ No □ Unknown

If YES: Did the PPE worn include the following (check all that apply):

□ Gloves □ Facemask □ Other (List)?________________________________________________

If YES: How frequently did you wear PPE?

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□ Always □ Almost Always □ Sometimes

5. Did you work in healthcare while in China?

□ Yes □ No □ Unknown

If YES: Did you care for any patients diagnosed with 2019 nCoV □ Yes □ No □ Unknown

If YES: Did you wear PPE at all times while providing patient care? □ Yes □ No □ Unknown

If YES: Did PPE worn include the following (check all that apply):

□ N95 or higher respirator □ Powered air-purifying respirator (PAPR)

□ Full Face Shield □ Helmet □ Headpiece □ Single use body suit

□ Single-use (disposable) hood □ Boots

□ Single-use (disposable), fluid-resistant or impermeable boot covers shoe covers

□ Single-use (disposable) nitrile examination gloves with extended cuffs

□ Single-use (disposable) fluid-resistant or impermeable gowns

□ Single-use (disposable), fluid-resistant or impermeable apron

If YES: What was your last date of patient care duties: _________________________

6. Were you on an aircraft with an ill individual who was diagnosed with nCoV? □ Yes □ No □ Unknown

If YES: Please describe how close was the individual’s seat located from where you were sitting.

______________________________________________________________________________

7. Were you in the same indoor environment (e.g., a classroom, a hospital waiting room) as an ill

person diagnosed with 2019-nCoV? □ Yes □ No □ Unknown

If YES: Describe _________________________________________________________________ ______________________________________________________________________________________

Section V: Current Travel Plans Date Left China: ____/____/_______ Last Date to be Monitored: ____/____/_______

Current Jurisdiction (City, County):______________________________________________________

Does the traveler have plans to travel or attend group gatherings or public events during the monitoring period: □ Yes □ No □ Unknown

If Yes, Describe the plans to include locations, dates of travel, and modes of travel, and purpose of travel.

_____________________________________________________________________________________________ _____________________________________________________________________________________________

Date of first contact with Traveler: _____/_____/________

Interview Completed by: _____________________________________ Date: _____/_____/________

Interviewer Agency: _________________________________________

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Interviewer Contact Number (_____)_____-__________

Section VI: Monitoring, Movement

(The information in this section is to be completed following consultation with the appropriate local and state health officials based on information included in this questionnaire).

Exposure Risk: □ High Risk □ Medium Risk □ Low Risk □ No Identifiable Risk

Monitoring Frequency: □ Once Daily □ Twice Daily □ Other: ______________________

Monitoring Method (Check all that apply):

□ Video conference/recording □ Text □ Email □Other:________

Monitoring Method Description (ex. twice daily to include text in the morning and one by phone call in the evening): _________________________________________________________________________

Any movement restrictions required: □ Yes □ No □ Unknown

If YES, Check all that were implemented and discussed with the traveler: □ Avoid congregate settings □ Limit public activities □ Stay home from work □ Remain at home □ Stay home from school □ Practice social distancing

□ Others ________________________________________________________________ _________________________________________________________________

If YES, does the traveler agree to the required movement restrictions? □ Yes □ No □ Unknown

What hospital will the traveler use if he/she were to become ill during the monitoring period:

Hospital Name ________________________________________________________________________ Street: ______________________________ City: ____________________________ State: ___________

Has the hospital identified been notified that a traveler in their area is being monitored and will be

seeking medical care if needed during the monitoring period: □ Yes □ No □ Unknown

Hospital Contact Name: ___________________________________ Phone: (____) _____-___________

Infection Control Contact Name: ____________________________ Phone: (____) _____-___________ Hospital Contact or Infection Control afterhours/emergency number: Phone: (____) _____-___________

Public health agency the traveler will contact if they become ill: ________________________________

Public health agency the traveler will contact outside of business hours: _________________________

Lead Monitoring Agency: __________________________________ Phone: (____) _____-___________

Lead Monitoring Agency After Hours Emergency Contact: _____________________________________

Lead Monitoring Agency After Hours Emergency Contact Number: Phone: (____) _____-_____________

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Appendix D Traveler Daily Monitoring Log

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Appendix D Traveler Daily Monitoring Log

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