Novel Coronavirus Pneumonia (NCP) and other fever disease diagnosis in Beijing United Family Hospital

February 13, 2020 

Novel Coronavirus Pneumonia (NCP) and other fever disease diagnosis in Beijing United Family Hospital

Based on official Beijing Health Authority COVID-19 testing protocols, below are some Frequently Asked Questions for fever screening and testing procedures for patients coming to Beijing United Family Hospital (BJU).

All patients coming to our hospitals or clinics will be greeted at the door, where their symptoms, travel history and temperature will be assessed. Patients without relevant issues will be directed to our regular clinics. Patients with fever or issues potentially related to COVID-19 will be directed to our Fever Clinic. Workflows, patient flows and airflows in the fever clinics have been designed to be totally separate from other areas of the clinics and hospitals to prevent any potential cross contamination.

1. If a patient has a fever, and comes to BJU for testing, what types of tests are used?
2. In BJU, adult fever patients will be seen in the fever clinic and children with a fever will be seen in pediatric fever clinic. Both fever clinics are open 24 hours a day. The doctor in the fever clinic will provide some laboratory tests and imaging examinations for proper diagnosis. If the fever is caused by surgical reasons, the patient will be transferred to the surgeon for further treatment. For adult fever patients with respiratory symptoms and travel/contact history of high risk of pneumonia, more tests will be done to rule out other types of respiratory infection, for example mycoplasma pneumonia, streptococcus pneumonia, bacterial infection, etc. For pediatric fever patients, other kinds of commonly seen virus also will be tested for, for example RSV and adenovirus.

COVID-19 RNA test is used for suspected cases only. The specimens are sent to the Beijing Chaoyang Center for Disease Control and Prevention (CDC) from officially designated fever clinics (such as BJU) which are nominated by the local government. Currently CDC will accept specimens from suspected cases only and does not provide the RNA test kits to hospitals with non-suspected cases (such as BJU) for screening purposes.

1. Can BJU receive suspected COVID-19 specimen samples from on-site embassy or consulate fever clinics?
2. BJU cannot receive specimens of suspected COVID-19 cases from other facilities for COVID-19 testing since the specimen transportation to the CDC needs a special certificate.

1. What are the regulations regarding the location of patients with suspected COVID-19 when such testing is occurring?
2. Beijing United Family Hospital has qualified fever clinics for adult and pediatric patients separately. If one of our first line doctors finds a suspected case based on temperature, lung x-ray or CT exam (the CT machine is completely sterilized between patients that are tested.), travel and contact history and blood test results, we will organize a COVID-19 multidisciplinary team (MDT) consultation which consists of Chief Medical Officer, pulmonologists, radiologists, lab physicians and other related doctors.

If the case is confirmed by MDT consultants, we will send throat swab and blood specimens to the CDC for the COVID-19 RNA test. This patient will be observed in our hospital. If the test result is negative, we must send a second throat swab to the CDC for a repeat test 24 hours later. The patient can be discharged only if both

RNA tests are negative. If the RNA test result is positive, this patient will be transferred to either the Beijing DiTan or the Beijing YouAn infectious disease hospital based on government arrangements. These are both specialized hospitals with deep experience in treating and containing such communicable diseases.

While the patient is waiting for the test results, the patient will stay under our care in a negative pressure observation room. We will do all that we can to make the patient comfortable and cared for while waiting for the definitive diagnosis.

1. What samples need to be gathered?
2. A doctor and a nurse working in the BJU fever clinic collect the appropriate throat swab specimens and fill out the test request form provided by CDC. Then specimens are then sent to the laboratory. Lab staff pack specimens in our special transportation box based on CDC requirements and send them to CDC for testing. Sputum/throat swab (by special tube) should be collected, also 1* 5ml yellow tube and 1* 2ml purple tube blood should also be collected.

1. How long does it take for results to come back?
2. CDC is currently running tests 3 times daily. Results will be ready within 4-6 hours after testing.

1. If a patient tested positive, would they remain for treatment at BJU or be transferred elsewhere. If so, do you know where?
2. If the RNA test is positive for COVID-19 we must transfer this patient by emergency 120 ambulance to one of the above-mentioned designated hospitals based on government arrangements. If both hospitals are unavailable, the patient will be brought to another designated hospital. For any other indications the patient can be hospitalized at United Family Hospital.

1. How can I contact BJU for fever related questions?
2. 24hr Service Center: 4008-919191
3. BJU 24hr fever clinic phone number: 59277155
4. BJU hotline: 59277053, 9am to 5pm. Email: bju.yqfk@ufh.com.cn.  Answers are provided by a Family Medicine physician.
5. Referral Center: for referring patients to BJU for admission please phone: 13911727074
6. Marketing CRM team: Maggie Fu (13910128735/Maggie.fu@ufh.com.cn); Han Wei (18301617016/ han.wei@ufh.com.cn); Rita Jian (rita.jian@ufh.com.cn ); Sarah Robbins (sarah.robbins@ufh.com.cn).

If a patient has concerns about COVID-19 signs or symptoms the following steps will be taken at BJU:

1. Present to BJU fever triage area for assessment
2. Be assessed for risk. If the patient has fever or cough/difficulty breathing, or contact history, they will be sent to the fever clinic
3. A fever clinic doctor will see the patient, order tests and examinations for the purpose of diagnosis and differential diagnosis. For patients whom COVID-19 cannot be ruled out , further assessment will be carried out by BJU’s multidisciplinary team (MDT)
4. If the MDT determines that the patient is a suspected case, respiratory swabs and blood specimens will be gathered and sent to the CDC. Meanwhile the local CDC and Health Committee will be called with our suspected case report.
5. Upon receipt CDC will run RNA tests in one of three daily batches
6. Results will be available 4-6 hours after the test is performed
7. The patient will remain in the BJU isolation room while waiting for results
8. If the test is positive the patient will be transferred out and receive care for COVID-19
9. If the test is negative, samples will be gathered and tested again 24 hours later
10. The patient will remain in isolation at BJU until results are achieved
11. If the test is positive, the patient will receive care as a case of COVID-19 in either the Beijing Ditan or the Beijing Youan infectious disease hospital
12. If negative, the patient will be discharged, or admitted to BJU as their condition requires.

 Please note that this information may change as the situation evolves.