Located in the heart of Chinatown, where just days ago many residents had celebrated the Lunar New Year with relatives from China, Tufts Medical Center would seem to be the first place in Boston where the novel coronavirus might show up.
But so far the hospital has not seen even a suspected case of the illness that has sickened thousands in China, Tufts officials said.
Local residents have called with questions and concerns, or shown up asking to be checked out, but no one has met the CDC criteria to test for coronavirus, said Dr. Shira I. Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center.
If that happened, she said, the hospital has protocols in place. All hospitals in the state have made similar arrangements, but at Tufts “we simply have that heightened level of awareness,” Doron said.
“Our Chinese community patients are concerned about themselves and their family members more so than the general population,” Doron said. “They need extra reassurance.”
For example, all of the hospital’s informational materials are translated into Chinese, and it has “stepped up” its interpreter services since the outbreak in the central China city of Wuhan, Doron said.
“We are getting a lot of calls from returning travelers. We have a lot walking in,” Doron said. “But none have met criteria for any sort of investigation for coronavirus.”
Every patient who comes to the hospital — whether for a doctor’s appointment, an emergency room visit, or a blood test — is asked whether they have traveled abroad within the last 30 days, a rule that has been in place for years. Guidelines from the Centers for Disease Control and Prevention for coronavirus recommend asking about travel over the past 14 days, but Tufts is casting a wider net to capture other emerging illnesses that may arise, Doron said.
Patients who have traveled abroad are asked where they went and about any symptoms they may have, particularly fever, cough, and rash. Then the staff member consults a computerized list of countries of concern to see if the patients’ symptoms might be related to a concerning disease. China is just one of the countries on the list, Doron said.
“MERS [Middle East respiratory syndrome, another coronavirus] is still out there. Ebola is still out there,” Doron said. “We certainly wouldn’t want to miss a case of Ebola while we’re focusing on coronavirus.”
If a patient meets the CDC criteria to test for coronavirus — travel to Wuhan within 14 days of symptom onset, or close contact with someone with a confirmed or suspected case of coronavirus, plus a fever, cough, or difficulty breathing — the patient would be put in isolation, and the hospital’s emergency management team would be notified.
The patient would be held in a negative-pressure room that prevents infectious agents from escaping. Visitors would be prohibited, and staff members would don protective equipment before entering: a specialized mask known as an N-95 respirator, which filters out particles; face mask or goggles; and a gown and gloves. Health authorities would be notified and samples sent to the CDC for testing. (Eventually the state laboratories will be able to test for the virus.)
It’s not clear whether every patient would be admitted to the hospital, Doron added. The CDC has also provided guidelines on managing patients at home. “We’re getting mixed signals” on whether it’s necessary to hospitalize everyone, she said. “I would hope we could manage patients at home.”
It’s also not clear how long patients would stay in isolation after symptoms abate. Even if they still harbored the virus, patients who are no longer coughing don’t have a way to propel it to others, Doron noted, and may not be a contagion risk.
Hospitals throughout the state have years of experience preparing for emerging illnesses or outbreaks, and those efforts will easily translate into responding to coronavirus, said Dr. Daniel R. Kuritzkes, chief of the Division of Infectious Diseases at Brigham and Women’s Hospital.
“There are very well-established procedures for how to handle patients who may have a concerning respiratory infection,” Kuritzkes said.
As of Wednesday, the CDC was investigating 165 potential coronavirus cases in 36 states. Sixty-eight turned out to be negative, and 92 are pending. But the number of confirmed cases has held steady at five.
“Despite an aggressive public health investigation to find new cases, we have not,” Dr. Nancy Messonnier, director of National Center for Immunization and Respiratory Diseases, said in a phone call with reporters Wednesday. “I still expect that we will find additional cases.”
Emergency medical workers responded to Logan International Airport Wednesday afternoon to care for a passenger from Beijing who was reportedly sick. But the patient did not meet the criteria for possibly suffering from coronavirus, according to city health officials. The traveler was evaluated and declined transportation to a hospital. It’s not clear what symptoms the passenger had.