Adding travel history to routine medical assessments could help stem pandemics' spread

UT Southwestern Medical CenterMar 4 2020

Integrating travel history information into routine medical assessments could help stem the rapidly widening COVID-19 epidemic, as well as future pandemics, infectious disease specialists recommend in the Annals of Internal Medicine.

Trish Perl, M.D., M.Sc., Chief of Infectious Diseases and Geographic Medicine at UT Southwestern Medical Center, and Connie Savor Price, M.D., of the University of Colorado School of Medicine, say it's time to add travel history to routine information such as temperature and blood pressure collected in electronic medical records.

We have the infrastructure to do this easily with the electronic medical record, we just need to implement it in a way to make it useful to the care teams. Once the infrastructure is built, we'll also need to communicate what is called 'situational awareness' to ensure that providers know what geographic areas have infections so that they can act accordingly."

Trish Perl, M.D., M.Sc., Chief of Infectious Diseases and Geographic Medicine at UT Southwestern Medical Center

A simple, targeted travel history can help put infectious symptoms in context for physicians and caregiver teams, and, if deemed appropriate, trigger more detailed history, further testing, and rapid implementation of protective measures for others in affected households, co-workers or other daily contacts, and health care personnel. Shared electronic health records also can integrate travel history with computerized decision-making support to suggest specific diagnoses in recent travelers, the authors note, in much the same way as trained medical teams routinely ask about tobacco exposure to ascertain levels of cancer and heart disease risk.

The emergence of novel respiratory diseases in the past two decades - including Severe Acute Respiratory Syndrome (SARS) in 2002-2003, Middle East Respiratory Syndrome (MERS) in 2012-2013, Western Africa-based Ebola in 2014, and now COVID-19 from China - demonstrate the need for change. With each wave, "the urgent threat of communicable diseases comes with significant morbidity and mortality, tremendous health care disruptions and resource utilization, and collateral economic and societal costs," Perl and Price write.

"MERS and SARS were associated with very specific travel. MERS was associated with travel to the Arabian Peninsula, and SARS was associated with travel primarily to Hong Kong, Singapore, and Beijing," Perl says. "Currently COVID is similar in that there are geographic clusters, but those lines may be blurring as the outbreak expands. The challenges and potential stress on the public health infrastructure, including the hospitals which are part of this, will be notable in that we could see large numbers of patients. Our role will not only be to care for these patients but to communicate to them the strategies that they can use to protect themselves."

The Annals commentary suggests that a simple script could be strategically and carefully developed to elicit clues for emerging infectious diseases and information about current emerging pathogen threats. The information could be collected along with the four gold standard vital signs - temperature, heart rate, respiratory rate, and blood pressure - currently used to help U.S.-based medical teams assess patients' health status, triage to appropriate care, determine potential diagnoses, and predict recovery.

"The current outbreak is an opportune time to consider adding travel history to the routine. The COVID outbreak is clearly moving at a tremendous pace, with new clusters appearing daily," says Perl, who holds the Jay P. Sanford Professorship in Infectious Diseases at UTSW. "This pace is a signal to us that it is a matter of time before we will see more of these infections in the U.S. What is different with this outbreak is that this virus is more fit and transmissible and hence there has been much more transmission."