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Thursday, February 27, 2020
Home News Nurse Practitioner News 11 Common Points of Confusion Around Novel Coronavirus 2019-nCoV

11 Common Points of Confusion Around Novel Coronavirus 2019-nCoV

With novel coronavirus, which began in Wuhan, China, at the end of 2019, dominating the news cycle, misinformation about the disease has inevitably followed.

To be sure, there are still many unknowns about 2019-nCoV, which comes from the same family as SARS and MERS. For example, the jury’s still out on exactly how contagious and deadly it is. At last count, some 27,000 people have tested positive for novel coronavirus, and more than 500 have died from it. While most of the outbreak has stayed within China, there are at least 12 cases in the U.S., a few of which came from person-to-person transmission.

RELATED: What Healthcare Providers Should Know About China’s Novel Coronavirus 2019-nCoV

To provide some clarification on the growing epidemic, Florence Health sat down with Patricia Stinchfield, MS, CPNP, CIC, senior director of infection prevention and control at Children’s Minnesota. Stinchfield is also vice president of the National Foundation for Infectious Diseases and has advised the Centers for Disease Control and Prevention on infectious disease issues representing NAPNAP for going on 16 years.

Common Misconceptions among Healthcare Professionals about Coronavirus

Stinchfield cautions that the medical community needs more research about the virus. But here’s what we do know — which often gets confused or misrepresented.

A coronavirus vaccine likely won’t be available for at least a year.

You’ve likely seen news bragging about the prowess of biotech companies building a vaccine. But Stinchfield stresses that the 90-day goal some have set is unrealistic because developers are starting from scratch, unlike with H1N1’s, which was an iteration of the standard flu shot.

“Anyone who says they can get it out in a few months doesn’t know very much about how vaccines are developed,” she explains. “It would be great if we could get it out soon … [but] you have to do human trials and you have to see if it works. The only way to know that is if, when coronavirus comes to the neighborhood near you, are immunized people not getting sick?”

She adds that “there’s a lot of great people working on it already.”

It’s unclear if a patient can transmit the disease before showing symptoms.

Again, many outlets covered the story of an allegedly asymptomatic woman traveling from China to Germany, attending a business meeting and infecting two fellow attendees. It turns out the authors of the report published in New England Journal of Medicine didn’t know the woman was actually displaying symptoms but had taken medication to treat them, according to follow-up research published in Science.

That said, asymptomatic transmission is certainly feasible, and Chinese officials say it’s occurred within their borders. Meanwhile, U.S. public health authorities call the possibility “worrisome,” but haven’t confirmed it either way.

Research into how contagious the virus is and its case fatality rate are ongoing.

Any assertions you hear about exactly how contagious or deadly the virus is are likely overzealous. Stinchfield says the current school of thought is that its R0 (the number of people who will catch the disease from an infected person in a population that’s never seen the disease before) is two. This is about the same as influenza and ebola. For context, measles’ R0 is 18.

Similarly, the case fatality rate (CFR) is “hard to determine at this stage of the game because we’re only a month or so in,” Stinchfield says. “So far we’ve seen a wide range of impact … Most people are putting it about 3 percent, but we still don’t know. It seems to be less than SARS, MERS, avian flu and small pox, but greater than regular influenza.”

The risks the virus presents to children and pregnant women is unclear.

Again, because the outbreak is so new, there isn’t enough data to determine whether certain populations are more at risk. With influenza, infants, elderly people, overweight people and pregnant people have a higher risk of severe complications. So far, there haven’t been any documented cases of a pregnant woman with coronavirus, Stinchfield notes.

RELATED: The Flu Shot is Less Effective in Certain Populations: 8 Facts to Share with Patients

Ask patients with coronavirus-like symptoms about their travel history.

Stinchfield strongly believes that a discussion about travel history should be a part of every patient visit. With the current outbreak, it’s even more important.

During initial triage, always ask about international travel. If patient says yes and has a fever, promptly mask the patient, place them in a room and finish asking travel history details, including where and when. 

The virus cannot live on surfaces for an extended period.

Stinchfield’s gotten questions about whether patients are at risk from packages shipped from China, and she says, in a word, no.

“Viruses [that affect humans] need a human environment to survive,” she explains. “This virus is a larger droplet virus that’s heavy, so it’s going to go out and down. If someone just coughed and you touch the surface they coughed on and touch your eyes, then it’s possible you could get infected, but not very likely.”

Wear basic personal protective equipment — no ebola suits necessary.

Viral photos of travelers and even healthcare professionals decked out in full-on ebola garb have made their way around the internet. But the truth is a disposable gown, gloves, mask, specifically the n95, and eye protection are the CDC recommendation. Make sure your facility has the appropriate equipment and you know the CDC guidelines for donning and doffing it.

RELATED: 6 Ways Healthcare Workers Unknowingly Spread Deadly Bacteria

“In the normal care of patients, staff may reuse masks too often or put them on wrong,” Stinchfield says. “It needs to cover your nose and mouth. Use one per patient, and it should always be in one of three places: in the box, on your nose and mouth or in the basket where you dispose of it.”

That said, due to supply chain concerns with novel Coronavirus, reusing your own N95 mask may be necessary as outlined in the CDC guidance, she adds.

Don’t hoard personal protective equipment.

Another consequence of the outbreak is a potential shortage of these supplies, which are frequently manufactured in China. But Stinchfield stresses there’s no need for individuals to start hoarding them.

Only treat with antibiotics under special circumstances.

The current approach to treating coronavirus is supportive care. You may have seen some recommendations involving antibiotics, but this only applies to patients with bacterial coinfections, Stinchfield says. For example, you’d give a patient with a viral infection who develops strep throat antibiotics. Think of coronavirus the same way.

There is no standard of care for treating the virus itself.

That said, there is no approved antiviral for coronavirus, but work is underway to develop an effective treatment. Recent research indicates antivirals for HIV could be one path forward, but they are not the current standard of care. Stinchfield adds that there’s no evidence Tamiflu is beneficial and that steroids should never be used on coronavirus patients with one exception — if they go into septic shock.

RELATED: 11 Most Common Mistakes Nurses and APPs Make When Preventing and Treating Sepsis

Otherwise, provide supportive care, primarily oxygen, IV fluids, a ventilator, balancing electrolytes.

Coronavirus in the U.S. should be less of a concern than seasonal influenza.

This, Stinchfield says, is the ultimate takeaway amidst all the uproar.

“It’s a new virus, so we don’t have antibodies to it, and that’s scary,” she says. But “people need to be paying as much attention to influenza as we are to coronavirus. Eventually coronavirus could get to that degree, but it might burnout. SARS didn’t come to every city in the US.”

What’s more, the worst may be yet to come with this year’s flu season. “Don’t lose sight of how dangerous influenza is,” Stinchfield says.

References:

Coronavirus 2019-nCoV Global Cases, Johns Hopkins.

New coronavirus can spread before symptoms start, German case suggests, LiveScience.

Study claiming new coronavirus can be transmitted by people without symptoms was flawed, Science.

Transcript for CDC Telebriefing: CDC Update on Novel Coronavirus, Centers for Disease Control and Prevention.

Prevention & Treatment of 2019 Novel Coronavirus, Centers for Disease Control and Prevention.

Cases of Novel Coronavirus Jump in China, New England Journal of Medicine.

Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection, Centers for Disease Control and Prevention.

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