Travel history should become routine in medical assessments to slow pandemics' spread

March 04, 2020

DALLAS - March 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," says Perl, who studies outbreaks and pandemics. "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."

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."
-end-
The article appears in the March 3 Annals of Internal Medicine. The authors reported no funding support or conflicts of interest.

About UT Southwestern Medical Center

UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution's faculty has received six Nobel Prizes, and includes 22 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,500 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 105,000 hospitalized patients, nearly 370,000 emergency room cases, and oversee approximately 3 million outpatient visits a year.

UT Southwestern Medical Center

Related Blood Pressure Articles from Brightsurf:

Children who take steroids at increased risk for diabetes, high blood pressure, blood clots
Children who take oral steroids to treat asthma or autoimmune diseases have an increased risk of diabetes, high blood pressure, and blood clots, according to Rutgers researchers.

High blood pressure treatment linked to less risk for drop in blood pressure upon standing
Treatment to lower blood pressure did not increase and may decrease the risk of extreme drops in blood pressure upon standing from a sitting position.

Changes in blood pressure control over 2 decades among US adults with high blood pressure
National survey data were used to examine how blood pressure control changed overall among U.S. adults with high blood pressure between 1999-2000 and 2017-2018 and by age, race, insurance type and access to health care.

Transient increase in blood pressure promotes some blood vessel growth
Blood vessels are the body's transportation system, carrying oxygen and nutrients to cells and whisking away waste.

Effect of reducing blood pressure medications on blood pressure control in older adults
Whether the amount of blood pressure medications taken by older adults could be reduced safely and without a significant change in short-term blood pressure control was the objective of this randomized clinical trial that included 534 adults 80 and older.

Brain blood flow sensor discovery could aid treatments for high blood pressure & dementia
A study led by researchers at UCL has discovered the mechanism that allows the brain to monitor its own blood supply, a finding in rats which may help to find new treatments for human conditions including hypertension (high blood pressure) and dementia.

Here's something that will raise your blood pressure
The apelin receptor (APJ) has been presumed to play an important role in the contraction of blood vessels involved in blood pressure regulation.

New strategy for treating high blood pressure
The key to treating blood pressure might lie in people who are 'resistant' to developing high blood pressure even when they eat high salt diets, shows new research published today in Experimental Physiology.

Arm cuff blood pressure measurements may fall short for predicting heart disease risk in some people with resistant high blood pressure
A measurement of central blood pressure in people with difficult-to-treat high blood pressure could help reduce risk of heart disease better than traditional arm cuff readings for some patients, according to preliminary research presented at the American Heart Association's Hypertension 2019 Scientific Sessions.

Heating pads may lower blood pressure in people with high blood pressure when lying down
In people with supine hypertension due to autonomic failure, a condition that increases blood pressure when lying down, overnight heat therapy significantly decreased systolic blood pressure compared to a placebo.

Read More: Blood Pressure News and Blood Pressure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.