COVID-19 Travel Update and Health Information

February 24, 2020

As is apparent in news reports, the worldwide COVID-19 (formerly 2019-nCoV or novel coronavirus) outbreak situation is rapidly evolving. We write with an update on how the latest information affects the Yale campus and any plans you may have for traveling abroad.  

You can find the following in this email:

  • Travel safety
  • Infection prevention through voluntary self-isolation in the Yale community
  • Infection control mandate for people arriving from mainland China
  • University preparations for COVID-19
  • Information about COVID-19 infection and prevention

TRAVEL SAFETY

If you will be traveling, we urge you to:

  • Stay alert to changes and developments that may affect your plans. Monitor travel advisories, including potential restrictions on border crossings, and be ready to change your plans if conditions change. View the list of CDC travel notices here.
  • Register your travel and download the ISOS app
  • If you should feel ill while traveling, call ISOS 215-942-8478 for advice before going to a health care facility. ISOS medical staff can provide advice on how to get treatment but will not be able to get you out of a country if any government restrictions have been put in place.  

All travel should be deferred to any country for which the Centers for Disease Control and Prevention (CDC) has issued a “Level 3, Avoid Nonessential Travel.” China is in this category, and South Korea was added on February 24. Therefore, all travel to China and South Korea should be cancelled or deferred to a later date.

The CDC has issued alerts “Level 2, Practice Enhanced Precautions” for Iran, Italy, and Japan. Travel may continue to these countries, but you may wish to reconsider your plans because the situation is changing rapidly. Older adults and those with chronic medical conditions are at higher risk for severe disease and should consider postponing nonessential travel.

CDC has issued “Watch - Level 1, Practice Usual Precautions” for Hong Kong. There are no travel restrictions, but travelers should practice routine precautions to avoid illness (see below).  

Yale travelers should keep several points in mind:

  • Do not travel to Level 3 countries.
  • Level 2 countries may be elevated on short or no notice to Level 3.
  • There are likely to be more countries for which Level 2 alerts are issued.
  • Reported number of cases may not indicate the severity of the outbreak in a particular location due to reporting delays or other anomalies.  
  • The response of governments will vary dramatically.  
  • If the current pattern continues, the U.S. government may ban travel into the U.S. from countries changed to Level 3 by individuals who are not U.S. citizens or lawful permanent residents. U.S. citizens and permanent residents will be required to self-isolate for at least 14 days. As of today, these restrictions only apply to China, but that may change at any time.
  • If CDC guidance changes, Yale will respond accordingly. It is possible that CDC could recommend that individuals returning from a Level 2 country should self-isolate. CDC also may increase the time period for self-isolation beyond the current 14 days. Keep this in mind as you make your travel decisions.  

We are continuing to monitor the situation and will issue additional guidance as needed. 
 
INFECTION PREVENTION THROUGH VOLUNTARY SELF-ISOLATION IN THE YALE COMMUNITY

On February 3, 2020, Yale University responded to guidance from the CDC by initiating voluntary self-isolation and self-monitoring for travelers arriving from mainland China. Yale Health registered 109 students, staff, faculty, family members, and visitors, most of whom have now completed the 14-day monitoring period. We are pleased to say that we have had no cases of infection to date, and we extend heartfelt thanks to all of the registrants for their cooperation. 

INFECTION CONTROL MANDATE FOR PEOPLE ARRIVING FROM MAINLAND CHINA

There has been no community spread of COVID-19 in the U.S. to date. The national public health strategy has prioritized prevention of infection through limitations on travel as well as quarantine or self-isolation of people arriving from China. Infection control mandates for arriving travelers include the following:

  • Individuals who are not U.S. citizens or permanent residents and who have been in China in the last 14 days will be denied entry.
  • Other travelers from mainland China must now arrive in the U.S. through 11 designated airports where they undergo screening for symptoms and/or risks of infection. 
  • Arrivals with recent travel to Hubei Province will be quarantined for 14 days. 
  • If they are asymptomatic, travelers from mainland China outside Hubei Province will receive a health information card and be required to undergo a 14-day period of self-isolation and monitoring with public health supervision at their travel destinations.
    • The State of Connecticut Department of Public Health will delegate to Yale Health the responsibility for monitoring members of the Yale community registered for this program. We will provide affected individuals with detailed health information and daily assistance.

You can read more about these infection control measures.

UNIVERSITY PREPARATIONS FOR COVID-19

Because of the magnitude of the epidemic, the CDC and healthcare organizations across the country are making preparations in case we encounter community spread of COVID-19. In our own community, Yale Health, Yale Medicine, Yale School of Public Health, Yale Emergency Management, Yale-New Haven Hospital (YNHH), and public health authorities at the state and local level are collaborating closely. 

  • We have created a 24-hour hotline (203-432-6604) for concerned members of the community. 
  • We have developed and disseminated clinical protocols to facilitate consistent evaluation of patients with risk factors and/or symptoms of COVID-19 infection. 
  • In collaboration with Yale Medicine and YNHH, we have implemented a mandatory data field in our electronic medical record system to ensure consistent screening for travel history and symptoms compatible with COVID-19 infection. 
  • We have developed and disseminated protocols for limiting the spread of infection in the healthcare setting. 
  • We have relaunched the influenza vaccination drive and reminded our community that it is not too late to get the vaccine. Members of the Yale community can obtain the influenza vaccine free of charge at the Yale Health Center at 55 Lock Street daily from Monday to Friday 8:30 a.m. to 4:30 p.m.

INFORMATION ABOUT COVID-19 INFECTION AND PREVENTION

Facts About COVID-19 Infection
The risk of COVID-19 infection is dependent on exposure, but details about the new virus are still emerging. The most important route of transmission is likely close contact (six feet or less) with sick patients who spread respiratory droplets when they cough or sneeze. The risk of spread from asymptomatic people and from touching surfaces and objects contaminated with virus is much lower than droplet spread from sick patients. The reported incubation period (time from exposure to the onset of symptoms) ranges from two to 14 days. 

Severity of COVID-19 infection ranges from mild to severe, but the majority of cases in China have not required hospitalization. Critical illness has developed in 15 percent of Wuhan patients and up to 3 percent are dying of the disease. Fever of >100.4 F (>38 C), cough, and shortness of breath are the most frequently reported symptoms. COVID-19 symptoms overlap with those of influenza and other respiratory infections. Therefore, the CDC has published guidelines to identify patients at risk of COVID-19 and determine when testing is necessary.  

Prevention of COVID-19 Infection 
There is no vaccine for COVID-19 at present, so prevention is crucial. Here are some ways to avoid viral respiratory infections including COVID-19:

  • Avoid contact with people who are ill. 
  • Refrain from touching your eyes, nose, and mouth with unwashed hands.
  • Wash your hands often with soap and water for at least 20 seconds, especially after the bathroom; before eating; and after blowing your nose, coughing, or sneezing. Use alcohol-based hand sanitizer if soap and water are unavailable. 
  • Clean and disinfect frequently touched objects and surfaces. 
  • Facemasks are not recommended for healthy people to avoid respiratory viruses including COVID-19.

What to Do If You Become Ill 
If you experience fever, cough, or difficulty breathing and you have had contact with a confirmed COVID-19 patient and/or traveled from mainland China within 14 days of the onset of illness, stay home and contact a healthcare provider for guidance—do not go to a healthcare facility prior to calling your doctor or a hospital emergency room for instructions. 

  • If you are a Yale student or Yale Health member, you should contact Internal Medicine (203-432-0038), Student Health (203-432-0312), or Pediatrics (203-432-0206) from 8:30 a.m. to 5 p.m. For urgent attention 24 hours a day, 7 days a week, please call Yale Health Acute Care (203-432-0123).
  • If you are an Aetna member or have other healthcare coverage, please contact your physician. 
  • Avoid contact with others to limit spread. 
  • Cover your cough/sneeze with a tissue or sleeve, not your hands. Wash your hands with soap and water after coughing, sneezing, and blowing your nose. Use alcohol-based hand sanitizer if soap and water are unavailable.
  • Facemasks are recommended for people with symptoms of respiratory infection to minimize the risk of spread of infection. 

Information for Healthcare Workers
The CDC has issued detailed interim guidance for those who interact with potentially infected patients. Protect yourself and others by acquainting yourself with these recommendations.

Nondiscrimination
Yale University is committed to maintaining an environment of respect and freedom from discrimination and to supporting all members of our community affected by this global health threat. Bias, discrimination, and harassment are inimical to our values and violate Yale policies. For more information, please go to https://yalehealth.yale.edu/nondiscrimination-notice. 

For Additional Information

We are continuing to monitor developments related to COVID-19 and will keep you updated. To see this and past updates as well as important links, please visit Yale Health’s announcement webpage

Sincerely, 

Dr. Paul Genecin
Director, Yale Health

Donald L. Filer
Associate Vice President for Global Strategy