The death toll from the mysterious virus similar to SARS and MERS, which first struck Wuhan, China, in late December 2019, has reached 1,100. As of Feb. 12, there were more than 45,000 confirmed cases of 2019-nCoV, whose official name is COVID-19, in 28 countries, including the U.S., Canada, Thailand, South Korea, Taiwan and Japan. So far, only two deaths, in the Philippines and Hong Kong, were outside China, and majority of the outbreak has remained within Asia.
The World Health Organization has dubbed the situation an international public health emergency in an effort to coordinate the global response to the epidemic. The U.S. Health and Human Services Secretary Alex M. Azar II has also declared the virus a national emergency.
So far, there have been 13 cases in the United States, with 62 pending testing, according to the Centers for Disease Control and Prevention. At least two of these are confirmed, person-to-person transmission within the U.S., CNN reports. Thirty-seven states have patients currently under investigation for the virus. Experts stress the risk of contracting coronavirus within U.S. borders is still very low.
While the worst may be yet to come with the virus — on Sunday alone, the number of infections in mainland China rose 15 percent — experts predict the situation will stabilize by April and new transmissions will stop altogether by May, Axios reports.
To quell the spread of misinformation about coronavirus, the CDC has released 2019-nCoV guidelines for health professionals, which address testing and care procedures. The agency is updating them on a weekly basis. Here are the basics for nurses and APPs:
Know the symptoms of coronavirus.
The clinical presentation of 2019-nCoV includes a range of symptoms, from light coughing to severe pneumonia resulting in death. Fever, coughing and shortness of breath are most common. Symptoms usually appear from two days to two weeks after exposure.
The disease likely spreads from person to person through the respiratory droplets in an infected individual’s cough or sneeze. That said, it’s unclear how contagious the virus is, and health officials should consider the overall risk to the American public low at this time.
It’s unclear whether transmission by asymptomatic patients is possible.
One of the top reasons it’s been so difficult to predict the severity of the outbreak is a lack of data on how contagious it is. One report, which indicated that asymptomatic transmission is likely, gained much attention, but follow-up research called its findings into question. U.S. health officials have said it’s possible, but there’s not enough research to conclude either way.
There is no vaccine for novel coronavirus 2019-nCoV.
Various biotech companies are attempting to develop a vaccine for novel coronavirus 2019-nCoV in just a few months. At the last update on Feb. 7, the director of the National Institute of Allergy and Infectious Diseases (NIAID) said the government’s partnership with Moderna was on track to enter a vaccine into phase I trials within three months, MedPage Today reports.
For now, the best way to prevent the disease is to avoid contact with infected individuals. The CDC also recommends:
- Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact with people who are sick.
- 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.
Take a detailed travel history for patients with fever and acute respiratory illness.
It’s especially important to assess if the patient has been in a country with coronavirus or nearby within two weeks of symptom onset. Many EHR systems have already implemented a travel questionnaire feature in light of the outbreak.
As soon as possible, evaluate patients for 2019-nCoV based on the following criteria:
- Fever (but keep in mind that not all patients present with fever, such as the very young, elderly or immunosuppressed)
- Symptoms of lower respiratory illness (cough, difficulty breathing, etc.)
- Within 14 days of symptom onset, a history of travel from Hubei province, China
- Within 14 days of symptom onset, a history of travel from mainland China
- Within 14 days of symptom onset, close contact with an ill, laboratory-confirmed 2019-nCoV patient
Consider anyone with symptoms and possible exposure to the virus “a patient under investigation (PUI),” per the CDC.
Notify local authorities of suspected 2019-nCoV cases.
If you encounter a PUI for 2019-nCoV, immediately notify your employer’s infection control office and the local and state health departments. This way, the health department can contact the CDC’s Emergency Operations Center (EOC) and assist with collecting samples and send them off for testing. You may also contact CDC’s Emergency Operations Center directly at 770-488-7100.
Collect specimens for coronavirus testing as soon as possible.
Include lower respiratory, upper respiratory and serum specimens samples, as well as stool or urine, if possible. Collect the samples as soon as you can, regardless of when symptom onset took place. The CDC offers in-depth guidelines for collecting and handling specimens for coronavirus testing.
The CDC temporarily allowed testing at qualified, public-health labs around the country, but the accuracy of the kits is in question. In the meantime, continue to coordinate through your state and local health departments on shipping PUI sample.
The CDC has said that a positive test result indicates a likely infection, but a negative one doesn’t necessarily mean the patient does not have coronavirus. Develop all management decisions based on clinical observations, patient history and epidemiological information.
Follow infection control procedures with any patients under investigation.
Per WHO recommendations, ask patients to wear a medical mask, cover their nose and mouth while coughing or sneezing with a tissue or flexed elbow, and wash their hands after any contact with respiratory secretions. When scheduling appointments, ask patients if they have symptoms of a respiratory infection; if so, request they take appropriate preventive actions (for example, wearing a mask) when seeking healthcare, and keep them in a separate waiting room. Enforce preventive behavior among suspected 2019-nCoV and respiratory-infection patients for their entire visit.
Try to keep possible coronavirus patients in Airborne Infection Isolation Room (AIIR). Make sure all patients have equipment to practice prevention behavior at their disposal. This include: 60 to 95 percent alcohol-based hand sanitizer, tissues, no0touch receptacles for disposal, and face masks at entrances and patient check-ins, in waiting rooms, etc. Patients do not have to wear masks inside the AIIR.
Only essential personnel should enter AIIRs with possible 2019-nCoV patients. Wear personal, protective equipment, including medical masks, eye googles, long-sleeved gowns and gloves. This is especially important when collecting samples for testing, as swabbing often triggers coughing. Follow protocol when removing the clothing, and practice hand and respiratory hygiene. Wash your hands before and after visiting a PUI.
For more information, review the CDC guidelines, which also address triage areas, managing exposed HCPs, training and education.
Provide supportive care for coronavirus.
There’s no specific, antiviral treatment for 2019-nCoV. As a result, the CDC recommends supportive care to relieve symptoms. Avoid using steroids, unless the patient develops another condition that requires them for treatment, such as septic shock. If a patient develops a bacterial coinfection, use antibiotics.
Not every patient will require hospitalization. Just keep in mind that 2019-nCoV patients’ symptoms often worsen during the second week after onset. Unconfirmed by possible risk factors for more severe illness include: older age, underlying chronic medical conditions (lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabete) immuno-compromising conditions and pregnancy, per the CDC.
Monitor your own exposure risk.
The CDC divides healthcare workers’ risk of exposure to novel coronavirus into five categories: high, medium, low, no identifiable risk, and community/travel exposures. Each depends on what procedures you’ve been present for relating to 2019-nCoV patients and what persona, protective equipment you were wearing. Different degrees of risk also require different degrees of monitoring and possible isolation.
Follow the CDC’s preparedness checklist for healthcare providers.
Stay up to date on the signs and symptoms of coronavirus, diagnostic testing practices, and case definitions for MERS-CoV disease. Also, follow infection control policies, be alert for patients who meet the case definition and more.
Share with patients the CDC guidelines on preventing the virus from spreading to others at home and in communities.
It includes recommendations such as, “stay at home except to get medical care,” “separate yourself for other people in your home,” and “wear a face mask.”
Report 2: Estimating the potential total number of novel Coronavirus cases in Wuhan City, China, Imperial College London.
Last updated 2/10/2020