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Novel Coronavirus (COVID-19) Health Alert

Published: February 28, 2020

The Sonoma County Department of Health Services (DHS) has issued a Health Alert as a result of updated guidance for persons under investigation (PUI), infection control guidelines, and geographic areas impacted by the 2019 Novel Coronavirus (COVID-19).

First case of COVID-19 treated in Sonoma County

DHS announced on February 25, 2020 that a COVID-19 positive patient was transferred late Monday evening to a hospital in the County. The patient is among one of the recent US evacuees from the quarantined Diamond Princess cruise ship in Japan. Sonoma County is one of several jurisdictions in the Bay Area to receive a COVID-19 patient from Travis Air Force Base. The patient is currently isolated in an Airborne Infection Isolation Room (AIIR) as per Centers for Disease Control and Prevention (CDC) guidelines. As we are likely to care for additional patients with COVID-19, the County is working with local, state and federal partners to ensure that infection control protocols are followed and that health care facilities have the necessary personal protective equipment (PPE) for their staff. 

On February 26, 2020 CDC announced a confirmed case of COVID-19 in a Solano County, California resident who reportedly did not have relevant travel history or exposure to another known patient with COVID-19. At this time, the patient’s exposure is unknown.  It is possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States. Community spread means spread of an illness for which the source of infection is unknown. It’s also possible, however, that the patient may have been exposed to a returned traveler who was infected.

The County has been preparing for several weeks to respond to an increase in COVID-19 cases locally and is vigilant in monitoring and shoring up resources to respond at this time. DHS met with the County Health Care Coalition on February 28, 2020 to discuss hospital and clinic plans and exercises to ensure our healthcare facilities are prepared to care for additional COVID-19 patients. 

Updated Guidance Regarding Persons Under Investigation (PUI)

As a reminder, Department of Health Services, in consultation with clinicians will determine whether a patient is a PUI for COVID-2019 as per current CDC guidance. Yesterday the CDC updated the guidelines for determining whether a patient should be tested for COVID-19 (see table below). Significant changes include the addition of Iran, Italy, Japan and South Korea to China to affected geographic areas as considerations for testing; as well as consideration of patients hospitalized with severe lower respiratory illness without an alternative diagnosis to explain symptoms.  

Clinical Features

Fever1or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath) AND

Epidemiologic Risk

Any person, including health care workers2, who has had close contact3 with a laboratory-confirmed4 COVID-19 patient within 14 days of symptom onset

Clinical Features

Fever1 and signs/symptoms of a lower respiratory illness (e.g. cough or shortness of breath) requiring hospitalization AND

Epidemiologic Risk

A history of travel from affected geographic areas5 within 14 days of symptom onset

Clinical Features

Fever1 with severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization4 and without alternative explanatory diagnosis (e.g., influenza)6AND

Epidemiologic Risk

No source of exposure has been identified.

3Close contact is defined as:

  1. being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case
    – or –
  1. having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)

If such contact occurs while not wearing recommended personal protective equipment (PPE) (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection), criteria for PUI consideration are met.

Additional information is available in CDC’s updated Interim Healthcare Infection Prevention and Control Recommendations for Patients with Confirmed COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings ( https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html).

Infection Control Protocols

Infection control procedures including administrative rules and engineering controls, environmental hygiene, correct work practices, and appropriate use of personal protective equipment (PPE) are all necessary to prevent infections from spreading during healthcare delivery. Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility. All healthcare facilities must ensure that their personnel are correctly trained and capable of implementing infection control procedures; individual healthcare personnel should ensure they understand and can adhere to infection control requirements. 

Please review detailed infection control guidelines and FAQ’s for Healthcare Personnel:

Updated Geographic Areas Affected by COVID-19

Affected Geographic Areas with Widespread or Sustained Community Transmission (last updated February 26, 2020):

  • China
  • Iran
  • Italy
  • Japan
  • South Korea

See all COVID-19 Travel Health Notices

Thank you for your on-going efforts to stay informed about new developments related to COVID-19. We will continue to keep you informed through these alerts, updating our website regularly and hosting webinars or conference calls. 

Celeste Phillip, MD, MPH
Sonoma County Health Officer