COVID-19

What is this all about?

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.

Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

What are the Symptoms of COVID-19?

For confirmed coronavirus disease 2019 (COVID-19) cases, reported illnesses have ranged from mild symptoms to severe illness and death. Symptoms can include:

• Fever
• Cough
• Shortness of breath

CDC believes at this time that symptoms of COVID-19 may appear in as few as 2 days or as long as 14 days after exposure. This is based on what has been seen previously as the incubation period of MERS-CoV viruses.

How to Prevent COVID-19?

There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). The best way to prevent illness is to avoid being exposed to this virus. However, as a reminder, CDC always recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:

• Avoid close contact with people who are sick.
• Avoid touching your eyes, nose, and mouth.     
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
•  Follow CDC’s recommendations for using a facemask.
• CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.
• Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of face masks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).
• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

What are the Causes and Risk Factors of COVID-19?

Causes

It's unclear exactly how contagious the new coronavirus is or how it spreads. It appears to be spreading from person to person among those in close contact. It may be spread by respiratory droplets released when someone with the virus coughs or sneezes.

It's not known if a person can catch the virus by touching a surface that an infected person has touched, and then putting his or her hand to the mouth.

Risk factors
Risk factors for infection with the new coronavirus appear to include:

• Recent travel from or residence in China
• Close contact with someone who has the new coronavirus — such as when a family member or health care worker takes care of an infected person
• People who are older or who have other existing medical conditions, such as diabetes and heart disease, may be at higher risk of becoming seriously ill with the new coronavirus. But there is still much unknown about the virus, and the CDC and WHO continue to investigate.

What nurses need to know about COVID-19?

1. Preparedness, Early Identification, and Notification

• Develop and educate all staff on a preparedness plan that provides infection control procedures and protocols used within your healthcare facility for the early identification, containment, and care of patients with symptoms associated with Coronavirus Disease (COVID-19) to prevent spread within your healthcare facility.
• Develop inpatient, ambulatory, and home care policies and procedures that are in line with current CDC guidelines for COVID-19
• Provide training to all personnel on screening and isolation procedures
• Provide updated training and guidelines on the use of Personal Protective Equipment (PPE), such as the use of gloves, gowns, masks, eye protection, and a face shield
•  Display clear signage with instructions for the use of PPE
• Ensure consistent use of proper hand hygiene, standard precautions, contact precautions, and airborne precautions, along with the proper use of a National Institute for Occupational Safety and Health (NIOSH)-Approved N-95 respirator or higher
• Clearly display signage for patients that lists symptoms and instructions to wear a face mask before entering the healthcare facility if symptoms are present.
• Incorporate assessment questions to document a detailed travel history when patients present with fever, cough, or respiratory illness. Consider COVID-19 if the patient traveled to China within the last 14 days.
• Identify, in advance, airborne infection isolation rooms (AIIR) or negative pressure rooms, for quarantine and screening
• Outline staffing protocols to facilitate care of patients with COVID-19 and to minimize patient-to-patient transmission
• Have available for immediate notification of Patient’s Under Investigation (PUI) the infection control personnel at your facility and the local and state health department. Click here for additional Recommendations for Reporting, Testing, and Specimen Collection and the fillable COVID-19 PUI case investigation form
• For Patients Under Investigation (PUI), follow the Criteria to Guide Evaluation of PUI for COVID-19

2. Isolation, Quarantine, Monitoring, and Hospitalization

The CDC recommends several steps for identification and maintenance of COVID-19 along with detailed guidelines for isolation precautions to prevent transmission. Have clearly displayed a flowchart for early identification and assessment of COVID-19. At this time, the exact mode(s) of transmission remain undetermined, but person-to-person transmission has been identified.

• Have masks available for PUI to don before entering the healthcare facility
• Once identified, isolate the patient to airborne infection isolation rooms (AIIR) or negative pressure room and keep the door closed. Conduct the assessment in this room.
• Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (goggles or a face shield)
• Don Personal Protective Equipment (PPE) before entering the room
• Have guidelines for the proper use of PPE displayed throughout the healthcare facility
• Notify your infection control personnel and the local and state health department of suspected cases

3. How to Educate Your Patients and Minimize Spread within the Community

Per the CDC, it is known that coronavirus is part of a large family of viruses that can cause illness in people and animals. While the mode(s) of transmission of COVID-19 remain under investigation, the CDC provides the following interim guidance to help prevent COVID-19 from spreading among people in homes and communities:

• Stay home except to get medical care, do not use public transportation or taxis
• Call first before visiting your healthcare provider to notify of the need for evaluation for COVID-19. Follow the instructions provided by your healthcare team.
•  Separate yourself from other people in your home, utilize a separate bathroom
• Wear a facemask
• Cover your coughs and sneezes
• Wash your hands frequently with soap and water for at least 20 seconds
• Avoid sharing household items
• Monitor your symptoms

Death toll of COVID-19

The death toll: The novel coronavirus has now killed more than 2,100 people, with eight deaths reported outside of mainland China. It has infected more than 76,000 people, with over 1,000 cases outside mainland China.

Latest update about COVID-19

• The latest numbers: The novel coronavirus has killed 3,200 people, the vast majority in mainland China. There are now close to 95,000 global cases, with infections in more than 70 countries and territories.
• In Italy: The country will close all schools and universities around the country until the middle of this month as officials work to contain the outbreak.
• South Korea confirms 3 new deaths and 438 additional cases of novel coronavirus.
• Malaysia confirms 14 additional cases of novel coronavirus.
• There are now 158 cases of novel coronavirus in US.
• Coronavirus briefing for all House members to convene Thursday morning.
• California governor: 11 passengers and 10 crew members on cruise ship are "symptomatic"

References:

https://www.who.int/health-topics/coronavirus

https://edition.cnn.com/asia/live-news/coronavirus-outbreak-03-07-20-intl-hnk/index.html

https://www.nbcnews.com/health/health-news/live-blog/coronavirus-updates-live-14-dead-across-u-s-trump-signs-n1151451

https://www.cdc.gov/coronavirus/index.html

https://www.worldometers.info/coronavirus/

https://www.ecdc.europa.eu/en/novel-coronavirus-china