Morbidity and Mortality Weekly Report

Early Release / Vol. 69 February 5, 2020

Initial Public Health Response and Interim Clinical Guidance for

the 2019 Novel Coronavirus Outbreak — United States,
December 31, 2019–February 4, 2020
Anita Patel, PharmD1; Daniel B. Jernigan, MD1; 2019-nCoV CDC Response Team

On December 31, 2019, Chinese health officials reported aggressive measures to slow transmission of 2019-nCoV in
a cluster of cases of acute respiratory illness in persons associ- the United States (4,5). These measures require the identi-
ated with the Hunan seafood and animal market in the city of fication of cases and their contacts in the United States and
Wuhan, Hubei Province, in central China. On January 7, 2020, the appropriate assessment and care of travelers arriving from
Chinese health officials confirmed that a novel coronavirus mainland China to the United States. These measures are
(2019-nCoV) was associated with this initial cluster (1). As of being implemented in anticipation of additional 2019-nCoV
February 4, 2020, a total of 20,471 confirmed cases, including cases in the United States. Although these measures might not
2,788 (13.6%) with severe illness,* and 425 deaths (2.1%) had prevent the eventual establishment of ongoing, widespread
been reported by the National Health Commission of China transmission of the virus in the United States, they are being
(2). Cases have also been reported in 26 locations outside of implemented to 1) slow the spread of illness; 2) provide time
mainland China, including documentation of some person- to better prepare health care systems and the general public
to-person transmission and one death (2). As of February 4, to be ready if widespread transmission with substantial asso-
11 cases had been reported in the United States. On January 30, ciated illness occurs; and 3) better characterize 2019-nCoV
the World Health Organization (WHO) Director-General infection to guide public health recommendations and the
declared that the 2019-nCoV outbreak constitutes a Public development of medical countermeasures including diagnos-
Health Emergency of International Concern.† On January 31, tics, therapeutics, and vaccines. Public health authorities are
the U.S. Department of Health and Human Services (HHS) monitoring the situation closely. As more is learned about this
Secretary declared a U.S. public health emergency to respond novel virus and this outbreak, CDC will rapidly incorporate
to 2019-nCoV.§ Also on January 31, the president of the new knowledge into guidance for action by CDC and state
United States signed a “Proclamation on Suspension of Entry and local health departments.
as Immigrants and Nonimmigrants of Persons who Pose a Risk Some coronaviruses, such as Middle East Respiratory
of Transmitting 2019 Novel Coronavirus,” which limits entry Syndrome (MERS) and Severe Acute Respiratory Syndrome
into the United States of persons who traveled to mainland (SARS), are the result of human-animal interactions.
China to U.S. citizens and lawful permanent residents and their Preliminary investigation of 2019-nCoV also suggests a zoo-
families (3). CDC, multiple other federal agencies, state and notic origin (6), but the exact origin has not yet been deter-
local health departments, and other partners are implementing mined. Person-to-person spread is evident (7); however, how
easily the virus is transmitted between persons is currently
* Includes any of the following: dyspnea, respiratory rate >30 breaths per minute,
hypoxemia, or chest x-ray with multilobar infiltrates or >50% progression of unclear. 2019-nCoV is similar to coronaviruses that cause
pulmonary infiltration within 24–48 hours per WHO. https://www.who.int/ MERS and SARS, which are transmitted mainly by respira-
docs/default-source/coronaviruse/situation-reports/20200123-sitrep-3-2019- tory droplets. Signs and symptoms of patients with confirmed
ncov.pdf.
† https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second- 2019-nCoV infection include fever, cough, and shortness of
meeting-of-the-international-health-regulations-(2005)-emergency-committee- breath (8). Based on the incubation period of illness from
regarding-the-outbreak-of-novel-coronavirus-(2019-ncov).
§ https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV. MERS and SARS coronaviruses, CDC believes that symptoms
aspx. of 2019-nCoV infection occur within 2 to 14 days following

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention
 Early Release

infection. Preliminary information suggests that older adults

Summary
and persons with underlying health conditions or compro-
What is already known about this topic?
mised immune systems might be at higher risk for severe ill-
ness from this virus (9); however, many characteristics of this In December 2019, an outbreak of acute respiratory illness
caused by a novel coronavirus (2019-nCoV) was detected in
novel coronavirus and how it might affect individual persons mainland China. Cases have been reported in 26 additional
and potentially vulnerable population subgroups, such as the locations, including the United States.
elderly or those with chronic health conditions, remain unclear. What is added by this report?
Nine of the first 11 U.S. 2019-nCoV patients were exposed in
Epidemiology of First U.S. Cases Wuhan, China. CDC expects more U.S. cases.
On January 21, 2020, the first person in the United States What are the implications for public health practice?
with diagnosed 2019-nCoV infection was reported. As of
CDC, multiple other federal agencies, state and local health
February 4, a total of 293 persons from 36 states, the District departments, and other partners are implementing aggressive
of Columbia, and the U.S. Virgin Islands were under investiga- measures to substantially slow U.S. transmission of 2019-nCoV,
tion based on current patient under investigation (PUI) defini- including identification of U.S. cases and contacts and managing
tions,¶ and also included those being evaluated because they travelers arriving from mainland China to the United States. Interim
are close contacts. Of these PUIs, 11 patients have confirmed guidance is available at https://www.cdc.gov/coronavirus/index.
html and will be updated as more information becomes available.
2019-nCoV infection using a real-time reverse transcription–
polymerase chain reaction (RT-PCR) assay developed by CDC.
These 11 cases were diagnosed in the following states: Arizona transmission, and virulence associated with this novel virus.
(one), California (six), Illinois (two), Massachusetts (one), and Information learned from these investigations will help inform
Washington (one) (Table). Nine cases were in travelers from response actions. CDC has closely monitored the global
Wuhan. Eight of these nine cases were identified as a result impact of this virus with staff members positioned in CDC
of patients seeking clinical care for symptoms and clinicians offices around the world, including mainland China, and in
connecting with the appropriate public health systems. Two coordination with other countries and WHO. This coordina-
cases (one each in California and Illinois) occurred in close tion has included deploying CDC staff members to work with
contacts of two confirmed cases and were diagnosed as part WHO and providing active support to CDC offices in affected
of routine monitoring of case contacts. All patients are being countries. In addition, CDC in response to the escalating risks
monitored closely for progressing illness. No deaths have been of travel from China has issued a series of Travelers’ Health
reported in the United States. Notices for both Wuhan and the rest of China regarding the
2019-nCoV outbreak. On January 27, CDC issued a Level 3
Public Health Response travel notice for travelers to avoid all nonessential travel to
CDC established a 2019-nCoV Incident Management mainland China.**
Structure on January 7, 2020. On January 21, CDC activated U.S. quarantine stations, located at 18 major U.S. ports
its Emergency Operations Center to optimize coordination for of entry, are part of a comprehensive regulatory system
domestic and international 2019-nCoV response efforts. To authorized under section 361 of the Public Health Service
date, CDC has deployed teams to the U.S. jurisdictions with Act (42 U.S. Code Section 264), that limits the introduction
cases to assist with epidemiologic investigation and to work of infectious diseases into the United States to prevent their
closely with state and local partners to identify and monitor spread. On January 17, consistent with existing communicable
close contacts and better understand the spectrum of illness, disease response protocols, CDC Quarantine staff members
instituted enhanced entry screening of travelers on direct and
¶ Criteria to guide evaluation and testing of patients under investigation for
connecting flights from Wuhan, China, arriving at three major
2019-nCoV include 1) fever or signs or symptoms of lower respiratory tract U.S. airports: Los Angeles (LAX), New York City (JFK), and
illness (e.g., cough or shortness of breath) in any person, including a health San Francisco (SFO),†† which then expanded to include travel-
care worker, who has had close contact with a patient with laboratory-confirmed
2019-nCoV infection within 14 days of symptom onset; 2) fever and signs or ers arriving in Atlanta (ATL) and Chicago (ORD). These five
symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) airports together receive approximately 85% of all air travelers
in any person with a history of travel from Hubei Province, China, within from Wuhan, China, to the United States. U.S. Customs and
14 days of symptom onset; or 3) fever and signs or symptoms of lower respiratory
tract illness (e.g., cough or shortness of breath) requiring hospitalization in any
person with a history of travel from mainland China within 14 days of symptom
onset. More information is available at https://emergency.cdc.gov/han/ ** https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china.
han00427.asp and https://emergency.cdc.gov/han/han00426.asp. †† https://www.cdc.gov/media/releases/2020/p0117-coronavirus-screening.html.

2 MMWR  /  February 5, 2020  /  Vol. 69

 Early Release

TABLE. Characteristics of initial 2019 novel coronavirus cases (N = 11) — United States, January 21–February 4, 2020
Date
laboratory confirmation
Case State Approximate age (yrs) Sex Place of exposure announced
1 Washington 30s M Wuhan 1/21/2020
2 Illinois 60s F Wuhan 1/24/2020
3 Arizona 20s M Wuhan 1/26/2020
4 California 30s M Wuhan 1/27/2020
5 California 50s M Wuhan 1/27/2020
6 Illinois 60s M Household Illinois 1/30/2020
7 California 40s M Wuhan 1/31/2020
8 Massachusetts 20s M Wuhan 2/01/2020
9 California 50s F Wuhan 2/02/2020
10 California 50s M Wuhan 2/02/2020
11 California 50s F Household California 2/02/2020
Abbreviations: F = female; M = male.

Border Protection officers identified travelers arriving from Laboratory and Diagnostic Support
Wuhan and referred them to CDC for health screening.§§ Any Chinese health officials posted the full 2019-nCoV genome
traveler from Wuhan with signs or symptoms of illness (e.g., sequence on January 10, 2020, to inform the development
fever, cough, or difficulty breathing) received a more compre- of specific diagnostic tests for this emergent coronavirus
hensive public health assessment performed by CDC public (1). Within a week, CDC developed a Clinical Laboratory
health and medical officers.¶¶ All travelers from Wuhan were Improvement Amendments–approved real-time RT-PCR test
also provided CDC’s Travel Health Alert Notice (T-HAN)*** that can diagnose 2019-nCoV respiratory samples from clini-
that advised them to monitor their health for 14 days and cal specimens. On January 24, CDC publicly posted the assay
described recommended actions to take if relevant symptoms protocol for this test (https://www.cdc.gov/coronavirus/2019-
develop. As of February 1, 2020, a total of 3,099 persons on nCoV/lab/index.html). On January 4, 2020, the Food and
437 flights were screened; five symptomatic travelers were Drug Administration issued an Emergency Use Authorization
referred by CDC to local health care providers for further to enable emergency use of CDC’s 2019-nCoV Real-Time
medical evaluation, and one of these persons tested positive RT-PCR Diagnostic Panel. To date, this test has been limited
for 2019-nCoV. to use at CDC laboratories. This authorization allows the use
On January 24, 2020, travel bans began to be instituted of the test at any CDC-qualified lab across the country. CDC is
by the Chinese government, resulting in restricted travel in working closely with FDA and public health partners, includ-
and out of Hubei Province, including the city of Wuhan, ing the American Public Health Laboratories, to rapidly share
and fewer travelers undergoing entry screening in the these tests domestically and internationally through CDC’s
United States. In response to the escalating risks associated International Reagent Resource (https://www.internationalre-
with travel from mainland China, on January 31, 2020, the agentresource.org/). In addition, CDC uploaded the genome
Presidential Proclamation further refined the border health of the virus from the first reported cases in the United States to
strategy to temporarily suspend entry, undergo additional GenBank, the National Institutes of Health genetic sequence
screening, or possible quarantine for individuals that have database of publicly available DNA sequences (https://www.
visited China (excluding Hong Kong, Macau, and Taiwan) ncbi.nlm.nih.gov/genbank/). CDC also is growing the virus
in the past 14 days. These enhanced entry screening efforts in cell culture, which is necessary for further studies, including
are taking place at 11 airports at which all air travelers from for additional genetic characterization. Once isolated, the virus
China are being directed. will be made available through BEI Resources (https://www.
beiresources.org/) to assist research efforts.
§§ CDC’s initial health screening includes a measurement of each traveler’s
temperature with a handheld noncontact thermometer, observation of these
travelers for visible signs of respiratory illness (e.g., cough or difficulty Clinical and Infection Control Guidance
breathing), and review of symptoms through a self-administered Additional information about 2019-nCoV is needed to bet-
questionnaire.
¶¶ The more comprehensive public health assessment determines, based on the ter understand transmission, disease severity, and risk to the
traveler’s illness and exposure, whether the traveler should be taken to a general population. Although CDC and partners are actively
hospital for further medical evaluation and care, which might include testing
for 2019-nCoV.
learning about 2019-nCoV, initial CDC guidance is based
*** https://www.cdc.gov/coronavirus/2019-ncov/travelers/communication- on guidance for management and prevention of respiratory
resources.html. illnesses including influenza, MERS, and SARS. No vaccine

MMWR  /  February 5, 2020  /  Vol. 69 3

 Early Release

or specific treatment for 2019-nCoV infection is currently should use standard precautions, contact precautions, airborne
available. At present, medical care for patients with 2019-nCoV precautions, and eye protection (e.g., goggles or a face shield).
is supportive. Clinicians should immediately notify the health care facility’s
On January 31, CDC published its third Health Advisory infection control personnel and local health department. The
with interim guidance for clinicians and public health prac- health department will determine whether the patient needs to
titioners.††† In addition, CDC issued a Clinical Action be considered a PUI for 2019-nCoV and be tested for infection.
Alert through its Clinician Outreach and Communication If directed by the health department, to increase the likeli-
Activity network on January 31.§§§ Interim guidance for hood of detecting 2019-nCoV infection, CDC recommends
health care professionals is available at https://www.cdc. collecting and testing both upper and lower respiratory tract
gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. specimens.**** Additional specimen types (e.g., stool or urine)
Health care providers should identify patients who might may be collected and stored. Specimens should be collected
have been exposed and who have signs or symptoms related as soon as possible once a PUI is identified regardless of time
to 2019-nCoV infection, isolate these patients, and inform since symptom onset.
public health departments. This includes obtaining a detailed For persons who might have 2019-nCoV infection and their
travel history for patients being evaluated with fever and close contacts, information and guidance on how to reduce
lower respiratory tract illness. Criteria to guide evaluation the risk for transmitting and acquiring infection is available
and testing of PUIs for 2019-nCoV include 1) fever or signs at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-
or symptoms of lower respiratory tract illness (e.g., cough prevent-spread.html. Close contacts should immediately
or shortness of breath) in any person, including health care call their health care providers if they develop symptoms. In
workers, who has had close contact¶¶¶ with a patient with addition, CDC is working closely with state and local health
laboratory-confirmed 2019-nCoV infection within 14 days partners to develop and disseminate information to the pub-
of symptom onset; 2) fever and signs or symptoms of lower lic on general prevention of respiratory illness, including the
respiratory tract illness (e.g., cough or shortness of breath) 2019-nCoV. This includes everyday preventive actions such as
in any person with a history of travel from Hubei Province, washing your hands, covering your cough, and staying home
China, within 14 days of symptom onset; or 3) fever and signs when you are ill. Additional information and resources for this
or symptoms of lower respiratory tract illness (e.g., cough or outbreak are available on the CDC website (https://www.cdc.
shortness of breath) requiring hospitalization in any person gov/coronavirus/2019-ncov/index.html).
with a history of travel from mainland China within 14 days
Discussion
of symptom onset. Additional nonhospitalized PUIs may be
tested based on consultation with state and local public health The 2019-nCoV has impacted multiple countries, caused
officials. Clinicians should evaluate PUIs for other possible severe illness, and sustained person-to-person transmission
causes of illness (e.g., influenza and respiratory syncytial virus) making it a concerning and serious public health threat.
as clinically indicated. It is unclear how this virus will impact the U.S. over time.
CDC currently recommends a cautious approach to the For the general population, who are unlikely to be exposed
examination of PUIs. These patients should be asked to wear to this virus at the current time, the immediate health risk
a surgical mask as soon as they are identified, and directed to from 2019-nCoV is considered low. CDC, multiple other
a separate area, if possible, separated by at least 6 ft (2 m) from federal agencies, state and local health departments, and other
other persons. Patients should be evaluated in a private room partners are implementing aggressive measures to slow U.S.
with the door closed, ideally an airborne infection isolation transmission of 2019-nCoV (4,5). These measures require the
room, if available. Health care personnel entering the room identification of cases and contacts in the United States and the
effective management of the estimated 14,000 travelers arriv-
††† https://emergency.cdc.gov/han/han00427.asp. ing from mainland China to the United States each day (3).
§§§ https://emergency.cdc.gov/coca/calls/2020/callinfo_013120.asp. These measures are being implemented based on the assump-
¶¶¶ Close contact is defined as 1) being within approximately 6 ft (2 m) of a
2019-nCoV patient for a prolonged period while not wearing recommended tion that there will be more U.S. 2019-nCoV cases occurring
personal protective equipment (PPE) (e.g., gowns, gloves, National Institute with potential chains of transmission, with the understanding
for Occupational Safety and Health–certified disposable N95 respirator, and that these measures might not prevent the eventual establish-
eye protection); close contact can occur while caring for, living with, visiting,
or sharing a health care waiting area or room with a 2019-nCoV patient; or ment of ongoing, widespread transmission of the virus in the
2) having direct contact with infectious secretions of a 2019-nCoV patient United States.
(e.g., being coughed on) while not wearing recommended PPE.
**** https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-
specimens.html.

4 MMWR  /  February 5, 2020  /  Vol. 69

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It is important for public health agencies, health care pro- Center for Emerging and Zoonotic Infectious Diseases, CDC;
viders, and the public to be aware of this new 2019-nCoV so Vaughn Barry, National Center for Injury Prevention and Control,
that coordinated, timely, and effective actions can help prevent CDC; Karlyn Beer, National Center for Emerging and Zoonotic
additional cases or poor health outcomes. The critical role that Infectious Diseases, CDC; Michael Bell, National Center for
the U.S. health care system plays in halting or significantly Emerging and Zoonotic Infectious Diseases, CDC; Sherri Berger,
Office of the Director, CDC; Joseph Bertulfo, Office of the Director,
slowing U.S. transmission of 2019-nCoV is already evident:
CDC; Holly Biggs, National Center for Immunization and
eight of the first 11 U.S. cases were detected by clinicians col- Respiratory Diseases, CDC; Jennifer Bornemann, Office of the
laborating with public health to test persons at risk. The early Director, CDC; Josh Bornstein, Office of the Director, CDC; Willie
recognition of cases in the United States reduces transmis- Bower, National Center for Emerging and Zoonotic Infectious
sion risk and increases understanding of the virus, including Diseases, CDC; Joseph Bresee, National Center for Immunization
its transmission and severity, to inform national and global and Respiratory Diseases, CDC; Clive Brown, National Center for
response actions. Emerging and Zoonotic Infectious Diseases, CDC; Alicia Budd,
2019-nCoV symptoms are similar to those of influenza National Center for Immunization and Respiratory Diseases, CDC;
(e.g., fever, cough, or sore throat), and the outbreak is occur- Jennifer Buigut, National Center for Emerging and Zoonotic
ring during a time of year when respiratory illnesses from Infectious Diseases, CDC; Stephen Burke, National Center for
influenza, respiratory syncytial virus, and other respiratory Immunization and Respiratory Diseases, CDC; Rachel Burke,
viruses are highly prevalent. To prevent influenza, all persons National Center for Immunization and Respiratory Diseases, CDC;
Erin Burns, National Center for Immunization and Respiratory
aged ≥6 months should receive an annual influenza vaccine,
Diseases, CDC; Jay Butler, Office of the Deputy Director of
and vaccination is still available and effective in helping to Infectious Disease, CDC; Russell Cantrell, Center for State, Tribal,
prevent influenza (10). Reducing the number of persons in Local and Territorial Support, CDC; Cristina Cardemil, National
the United States with seasonal influenza will reduce possible Center for Immunization and Respiratory Diseases, CDC; Jordan
confusion with 2019-nCoV infection and possible additional Cates, National Center for Immunization and Respiratory Diseases,
risk to patients with seasonal influenza. Public health authori- CDC; Marty Cetron, National Center for Emerging and Zoonotic
ties are monitoring the situation closely. As more is learned Infectious Diseases, CDC; Kevin Chatham-Stephens, National
about this novel virus and this outbreak, CDC will rapidly Center on Birth Defects and Developmental Disabilities, CDC;
incorporate new knowledge into guidance for action. Kevin Chatham-Stevens, National Center on Birth Defects and
Developmental Disabilities, CDC; Nora Chea, National Center for
Acknowledgments Emerging and Zoonotic Infectious Diseases, CDC; Bryan
Arizona Department of Health Services; Maricopa County Christensen, National Center for Emerging and Zoonotic Infectious
Department of Public Health; California Department of Public Diseases, CDC; Victoria Chu, National Center for Immunization
Health; Los Angeles County Department of Public Health; Orange and Respiratory Diseases, CDC; Kevin Clarke, Center for Global
County Health Department; San Benito County Public Health Health, CDC; Angela Cleveland, National Center for Immunization
Services Department; Santa Clara County Public Health Department; and Respiratory Diseases, CDC; Nicole Cohen, National Center for
Illinois Department of Public Health; Chicago Department of Public Emerging and Zoonotic Infectious Diseases, CDC; Max Cohen,
Health; Cook County Department of Public Health; DuPage County Center for State, Tribal, Local and Territorial Support, CDC; Amanda
Health Department; Massachusetts Department of Public Health; Cohn, National Center for Immunization and Respiratory Diseases,
Washington State Department of Health; Snohomish Health District. CDC; Jennifer Collins, National Center for Emerging and Zoonotic
Infectious Diseases, CDC; Erin Conners, National Center for
2019-nCoV CDC Response Team Emerging and Zoonotic Infectious Diseases, CDC; Aaron Curns,
Fatuma Abdirizak, National Center for Immunization and National Center for Immunization and Respiratory Diseases, CDC;
Respiratory Diseases, CDC; Glen Abedi, National Center for Rebecca Dahl, National Center for Immunization and Respiratory
Immunization and Respiratory Diseases, CDC; Sharad Aggarwal, Diseases, CDC; Walter Daley, Center for Preparedness and Response,
National Center for Immunization and Respiratory Diseases, CDC; CDC; Vishal Dasari, Center for State, Tribal, Local and Territorial
Denise Albina, National Center for Emerging and Zoonotic Support, CDC; Elizabeth Davlantes, Center for State, Tribal, Local
Infectious Diseases, CDC; Elizabeth Allen, National Center for and Territorial Support, CDC; Patrick Dawson, National Center for
Emerging and Zoonotic Infectious Diseases, CDC; Lauren Andersen, Emerging and Zoonotic Infectious Diseases, CDC; Lisa Delaney,
National Center for Emerging and Zoonotic Infectious Diseases, National Institute for Occupational Safety and Health, CDC;
CDC; Jade Anderson, Center for Preparedness and Response, CDC; Matthew Donahue, Center for State, Tribal, Local and Territorial
Megan Anderson, Center for Preparedness and Response, CDC; Tara Support, CDC; Chad Dowell, National Institute for Occupational
Anderson, Center for State, Tribal, Local and Territorial Support, Safety and Health, CDC; Jonathan Dyal, National Center for
CDC; Kayla Anderson, National Center on Birth Defects and Immunization and Respiratory Diseases, CDC; William Edens,
Developmental Disabilities, CDC; Ana Cecilia Bardossy, National National Center for Immunization and Respiratory Diseases, CDC;

MMWR  /  February 5, 2020  /  Vol. 69 5

 Early Release

Rachel Eidex, National Center for Emerging and Zoonotic Infectious National Center for Immunization and Respiratory Diseases, CDC;
Diseases, CDC; Lauren Epstein, National Center for Emerging and Alexander Landon, Office of the Director, CDC; Leslie Lee, National
Zoonotic Infectious Diseases, CDC; Mary Evans, National Center Center for Immunization and Respiratory Diseases, CDC; Jessica
for Injury Prevention and Control, CDC; Ryan Fagan, National Leung, National Center for Immunization and Respiratory Diseases,
Center for Emerging and Zoonotic Infectious Diseases, CDC; Kevin CDC; Stephen Lindstrom, National Center for Immunization and
Farris, National Center for Immunization and Respiratory Diseases, Respiratory Diseases, CDC; Ruth Link-Gelles, National Center for
CDC; Leora Feldstein, National Center for Immunization and Immunization and Respiratory Diseases, CDC; Joana Lively,
Respiratory Diseases, CDC; LeAnne Fox, National Center for National Center for Immunization and Respiratory Diseases, CDC;
Immunization and Respiratory Diseases, CDC; Mark Frank, Center Xiaoyan Lu, National Center for Immunization and Respiratory
for Preparedness and Response, CDC; Brandi Freeman, National Diseases, CDC; Brian Lynch, National Center for Immunization
Center for Immunization and Respiratory Diseases, CDC; Alicia and Respiratory Diseases, CDC; Lakshmi Malapati, National Center
Fry, National Center for Immunization and Respiratory Diseases, for Immunization and Respiratory Diseases, CDC; Samantha
CDC; James Fuller, Center for Global Health, CDC; Romeo Galang, Mandel, National Center for Immunization and Respiratory
National Center for Chronic Disease Prevention and Promotion, Diseases, CDC; Brian Manns, National Center for Immunization
CDC; Sue Gerber, National Center for Immunization and and Respiratory Diseases, CDC; Nina Marano, National Center for
Respiratory Diseases, CDC; Runa Gokhale, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Mariel Marlow,
Emerging and Zoonotic Infectious Diseases, CDC; Sue Goldstein, National Center for Immunization and Respiratory Diseases, CDC;
National Center for Immunization and Respiratory Diseases, CDC; Barbara Marston, Center for Global Health, CDC; Nancy McClung,
Sue Gorman, Center for Preparedness and Response, CDC; William National Center for Immunization and Respiratory Diseases, CDC;
Gregg, National Center for Immunization and Respiratory Diseases, Liz McClure, Center for Global Health, CDC; Emily McDonald,
CDC; William Greim, National Center for Emerging and Zoonotic National Center for Emerging and Zoonotic Infectious Diseases,
Infectious Diseases, CDC; Steven Grube, Office of the Director, CDC; Oliva McGovern, National Center for Immunization and
CDC; Aron Hall, National Center for Immunization and Respiratory Respiratory Diseases, CDC; Nancy Messonnier, National Center for
Diseases, CDC; Amber Haynes, National Center for Immunization Immunization and Respiratory Diseases, CDC; Claire Midgley,
and Respiratory Diseases, CDC; Sherrasa Hill, National Center for National Center for Immunization and Respiratory Diseases, CDC;
Immunization and Respiratory Diseases, CDC; Jennifer Hornsby- Danielle Moulia, National Center for Immunization and Respiratory
Myers, National Institute for Occupational Safety and Health, CDC; Diseases, CDC; Janna Murray, National Center for Immunization
Jennifer Hunter, National Center for Emerging and Zoonotic and Respiratory Diseases, CDC; Kate Noelte, Center for Preparedness
Infectious Diseases, CDC; Christopher Ionta, National Center for and Response, CDC; Michelle Noonan-Smith, Office of the Director,
Immunization and Respiratory Diseases, CDC; Cheryl Isenhour, CDC; Kristen Nordlund, National Center for Immunization and
National Center for Immunization and Respiratory Diseases, CDC; Respiratory Diseases, CDC; Emily Norton, National Institute for
Max Jacobs, Center for State, Tribal, Local and Territorial Support, Occupational Safety and Health, CDC; Sara Oliver, National Center
CDC; Kara Jacobs Slifka, National Center for Emerging and for Immunization and Respiratory Diseases, CDC; Mark Pallansch,
Zoonotic Infectious Diseases, CDC; Daniel Jernigan, National National Center for Immunization and Respiratory Diseases, CDC;
Center for Immunization and Respiratory Diseases, CDC; Michael Umesh Parashar, National Center for Immunization and Respiratory
Jhung, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Anita Patel, National Center for Immunization and
Diseases, CDC; Jamie Jones-Wormley, Center for Preparedness and Respiratory Diseases, CDC; Manisha Patel, National Center for
Response, CDC; Anita Kambhampati, National Center for Immunization and Respiratory Diseases, CDC; Kristen Pettrone,
Immunization and Respiratory Diseases, CDC; Shifaq Kamili, National Center for Health Statistics, CDC; Taran Pierce, National
National Center for Immunization and Respiratory Diseases, CDC; Center for Emerging and Zoonotic Infectious Diseases, CDC; Harald
Pamela Kennedy, National Center for Immunization and Respiratory Pietz, Center for Preparedness and Response, CDC; Satish Pillai,
Diseases, CDC; Charlotte Kent, Center for Surveillance, National Center for Emerging and Zoonotic Infectious Diseases,
Epidemiology and Laboratory Services, CDC; Marie Killerby, CDC; Lewis Radonovich, National Institute for Occupational Safety
National Center for Immunization and Respiratory Diseases, CDC; and Health, CDC; Sarah Reagan-Steiner, National Center for
Lindsay Kim, National Center for Immunization and Respiratory Emerging and Zoonotic Infectious Diseases, CDC; Amy Reel,
Diseases, CDC; Hannah Kirking, National Center for Immunization National Center for Immunization and Respiratory Diseases, CDC;
and Respiratory Diseases, CDC; Lisa Koonin, National Center for Heather Reese, National Center for Immunization and Respiratory
Immunization and Respiratory Diseases, CDC; Ram Koppaka, Diseases, CDC; Brian Rha, National Center for Immunization and
National Center for Immunization and Respiratory Diseases, CDC; Respiratory Diseases, CDC; Philip Ricks, Center for Global Health,
Christine Kosmos, Center for Preparedness and Response, CDC; CDC; Melissa Rolfes, National Center for Immunization and
David Kuhar, National Center for Emerging and Zoonotic Infectious Respiratory Diseases, CDC; Shahrokh Roohi, National Center for
Diseases, CDC; Wendi Kuhnert-Tallman, Deputy Director for Emerging and Zoonotic Infectious Diseases, CDC; Lauren Roper,
Infectious Diseases, CDC; Stephanie Kujawski, National Center for National Center for Immunization and Respiratory Diseases, CDC;
Immunization and Respiratory Diseases, CDC; Archana Kumar, Lisa Rotz, National Center for Emerging and Zoonotic Infectious

6 MMWR  /  February 5, 2020  /  Vol. 69

 Early Release

Diseases, CDC; Janell Routh, National Center for Immunization Corresponding author: Anita Patel, [email protected], 770-488-7100.
and Respiratory Diseases, CDC; Senthil Kumar Sakthivel, National 1Incident Manager, 2019-nCoV CDC Response, CDC.
Center for Immunization and Respiratory Diseases, CDC; Luisa
Sarmiento, National Institute for Occupational Safety and Health, All authors have completed and submitted the International
CDC; Jessica Schindelar, National Center for Emerging and Zoonotic Committee of Medical Journal Editors form for disclosure of
Infectious Diseases, CDC; Eileen Schneider, National Center for potential conflicts of interest. No potential conflicts of interest
Immunization and Respiratory Diseases, CDC; Anne Schuchat, were disclosed.
Office of the Director, CDC; Sarah Scott, Center for State, Tribal,
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