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Confronting COVID-19
in Philadelphia
continued from page 7

COVID-19 has spread more rapidly around the globe than
its predecessors, SARS (15%) or MERS-CoV, suggesting higher
transmissibility. A study of more than 72,000 COVID-19 cases
reported in mainland China revealed a higher CFR for older
patients (8% in patients 70-79 and 18.8% for patients 80 and
older).2 Another recent study reviewed data from the Diamond
Princess cruise ship and calculated the reproductive number
(R0)-the number of people a single case is likely to infect-at
2.28, which is consistent with other early findings.3 The Report
of the WHO-China Joint Mission on Coronavirus Disease 2019
found that 80% of laboratory confirmed patients have mild to
moderate disease and recover.1 That report further suggests that
most transmission seems to occur between close contacts, such as
household members.1
Currently, there is no vaccine or specific treatment aside from
supportive care, although vaccine is in development, and various
antiviral clinical trials are occurring globally, including a National
Institutes of Health (NIH) trial of remdesivir, to treat COVID-19.
Unfortunately, clinical guidance that could help physicians to
better treat patients with the disease remains sparse.
Several Months Away from a Vaccine
While we may still be months away from licensed vaccine or
antiviral therapies, there are many non-pharmaceutical interventions that public health, health care, and the broader community
can take to counter community-wide transmission. Since the
outbreak began to escalate in China, the Philadelphia Department of Public Health (PDPH) has been conducting detection
and containment activities in alignment with the guidance issued
by the Centers for Disease Control and Prevention (CDC), while
also quietly ramping up its efforts to prepare for widespread local
transmission.

In 2019, PDPH updated its Pandemic Influenza Response
Plan and convened partner agencies for two workshops to review
key strategies and implementation protocols. Many elements of
the Pandemic Influenza Response Plan, particularly those that focus on surveillance, disease containment, community mitigation,
and interagency coordination, are translatable to this outbreak.
Staff from PDPH's Division of Disease Control and the Health
Commissioner's Office have been meeting regularly to ensure
ongoing internal planning and communication with a range of
partner agencies so that Philadelphia will be prepared if or when
cases begin to occur locally.
Early response strategies, including travel restrictions, airport
screening, and monitoring of passengers who had recently traveled from mainland China, focused heavily on containment of
imported cases. With multiple cases in California, Washington,
New York and other states confirmed in recent days-none of
whom reported recent travel history or exposure to a known
case-as well as a growing number of presumptive positive cases,
it appears that community transmission is now occurring on
some level in the United States.
With the potential for widespread community transmission
now imminent, detection and containment of cases will rely heavily on the health care community and the ability of providers to
quickly identify and isolate potential cases and communicate with
the local health authority (PDPH in Philadelphia) to coordinate
laboratory testing and clinical management. Rapid case identification is critical so that PDPH can identify and manage contacts
of cases.
Characteristic Symptoms
Fever, cough and shortness of breath are characteristic symptoms, although a range of other symptoms has also been reported.

PDPH has developed tailored guidance for outpatient settings, as well as posters that can be displayed in waiting areas. These
materials are available electronically on the PDPH Health Information Portal (HIP). PDPH regularly posts updated guidance
and other materials for clinical providers on the HIP: https://hip.phila.gov/
Providers can also sign up to receive Health Alerts, which are issued when significant updates occur: https://hip.phila.gov/
HealthAlerts
Both suspect cases and potentially exposed persons should be immediately reported to PDPH at the following numbers:
business hours: 215-685-6742; after hours: 215-686-4514. *

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Philadelphia Medicine Spring 2020

Table of Contents for the Digital Edition of Philadelphia Medicine Spring 2020

Philadelphia Medicine Spring 2020 - 1
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