Asking This One Question May Help Slow Down Coronavirus Outbreak

  • Asking all patients about their recent travel history could help slow the spread of COVID-19, say infectious disease experts.
  • The main symptoms of COVID-19 (fever, cough, and shortness of breath) and other emerging infectious diseases also occur with other illnesses.

In recent weeks, a lot of attention has focused on ways to slow the COVID-19 outbreak. At the top of the list is the development of a vaccine.

While medical advances are certain to play some role in curtailing the spread of COVID-19, it could be up to 2 years before a vaccine is widely available.

In the meantime, infectious disease specialists say there’s a simpler way to help prevent transmission of not just COVID-19 but also other emerging infectious diseases: asking all patients about their recent travel.

Dr. Trish Perl, chief of infectious diseases and geographic medicine at UT Southwestern Medical Center in Dallas, and Dr. Connie S. Price of the University of Colorado School of Medicine, write today in a commentary in the Annals of Internal Medicine that travel history should be collected alongside other routine patient information, such as temperature and blood pressure.

“The current outbreak is an opportune time to consider adding travel history to the routine,” said Perl in a news release. “The COVID-19 outbreak is clearly moving at a tremendous pace, with new clusters appearing daily.”

Travel history can slow spread of COVID-19

The main symptoms of COVID-19 (fever, cough, and shortness of breath) and other emerging infectious diseases also occur with other illnesses. A few questions about travel history could help put signs of infection in context, say Perl and Price.

These questions could easily be added to electronic health records, with additional questions triggered based on a patient’s responses.

Depending on a patient’s answers, doctors might order additional testing or take steps to prevent staff and other patients from being exposed to the virus.

This might include bringing patients in through an alternate entrance away from other patients and having staff wear protective gear, such as masks, gloves, and gowns. With SARS, these kinds of preventive measures helped end the outbreak.

The standard vital signs are all collected during a healthcare visit, but travel history is something that could be gathered even before a person shows up at the doctor’s office or hospital.

“We want people to call ahead so they’re not exposing others to possible infection,” said Krys Johnson, PhD, an assistant professor of epidemiology in the college of public health at Temple University in Philadelphia.

Dr. Louis J. Morledge, an internist who specializes in travel medicine at Lenox Hill Hospital and NYU Langone Health in New York City, agrees that asking about travel history should be common practice during the COVID-19 outbreak.

“Since this is an evolving situation, protocols need to be in place in every practice to screen patients [about their travel] before they get to your office, so patients can be advised accordingly and so you can protect your staff and other patients,” Morledge said.

In his practice, “we’re asking whether or not the patient or family members have traveled internationally in the last 30 days, and where they’ve traveled to,” he said. “We’re also asking questions specifically about travel to mainland China.”

Preparing for future outbreaks

One of the starkest examples of what can happen when doctors are unaware of a patient’s recent travel occurred in 2014 during an Ebola outbreak that was based in West Africa.

A man with Ebola who had recently traveled to Liberia showed up at a Dallas emergency department with fever, abdominal pain, and headache. He was prescribed antibiotics for a possible sinus infection and discharged from the hospital.

Three days later, the man returned to the hospital with worsening symptoms. He later died.

Two nurses who tended to him also contracted Ebola.

With more than 89,000 confirmed cases of COVID-19 to date and more than 3,000 deaths worldwide, many doctors’ offices and hospitals in major cities like New York and Los Angeles are already asking patients about their travel history.

But Johnson says even healthcare professionals in smaller cities and towns should be asking these questions.

“People travel from abroad to major airports like Philadelphia and New York and then into regional airports,” she said. “So even people in rural areas can still come into contact with infectious diseases.”

A lot of the focus right now is on COVID-19. But climate change, increasing global travel, and continued interactions between people and wild animals make it likely that new infectious diseases will continue to show up in people.

Because of that, Johnson says asking about a patient’s travel history should be a routine part of medical practice, even after the current outbreak is over.

“We live in a global society,” Johnson said. “There are plenty of places in the world that have diseases that are endemic to those areas — which means they just exist in that population — but aren’t endemic to the United States.”

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