February 24, 2020 at 12:00 pm
As the newly identified coronavirus (COVID-19) enters its 3rd month, cases both in China and throughout the world continue to rise. Here's what we know so far:
- Infected persons can have symptoms ranging from none to mild to severe.
- 80% of those who have died are aged >60 years, and 75% have underlying health conditions.
- Approximately two-thirds of those confirmed to have COVID-19 are men.
- Although children can be infected by COVID-19, most do not develop severe symptoms.
- The COVID-19 mortality rate is estimated to be 2% (higher than seasonal flu but far lower than SARS). However, because so many people who have been infected have no, or mild, symptoms, they have not been tested. Therefore, the mortality rate is likely to be lower than 2%.
- There have been over 50 confirmed COVID-19 cases in the U.S. This number is expected to rise quickly. Only 1 U.S. citizen has died; however, he was living in China.
- All people entering the U.S. from China are now screened by the CDC at U.S. airports currently approved to accept flights from China. Those with symptoms are taken to the hospital for further testing. Those without symptoms are placed in a 14-day quarantine.
- The currently accepted incubation period remains 2-14 days. However, there have been a number of cases where the incubation period was longer than 14 days.
- There currently has been no community-acquired infection of COVID-19. The only people who have been infected who had not traveled to China (or been on one of the cruise ships where COVID-19 was present) were 2 spouses of patients infected in China. The spouses had close, prolonged contact with infected persons who had become infected in China and had then traveled home.
- Many healthcare workers treating patients infected with COVID-19 have become infected themselves. Some have died. Some patients both within China and in other countries became infected in the hospital while being treated for other medical conditions. The risk of nosocomial infection remains high at this time.
Healthcare facilities must take the following steps to protect both patients and healthcare staff from COVID-19 infection:
- Conduct a hazard assessment for ALL hospital staff, no matter what the job title, that includes job responsibilities and proximity to patients who have confirmed, or are under investigations for, COVID-19.
- Conduct training for ALL hospital staff, not just healthcare staff, on COVID-19 including identification, symptoms, modes of transmission, incubation period and protective measures determined by the hazard assessment.
- Make sure there is an adequate supply of surgical masks for suspected or confirmed cases of COVID-19 patients. (Note: surgical masks do not protect the wearer. For protection from exposure, a respirator and other PPE is required.)
- Make sure there is an adequate supply of PPE (gloves, gowns, goggle or face shields, N95 respirators or powered air-purifying respirators [PAPRs]) for all those determined by the hazard assessment to need them.
- Make sure there are designated negative pressure rooms both in the ED and on designated in-patient units for PUIs (Persons Under Investigation) or confirmed cases of COVID-19.
- Make sure negative pressure rooms are checked on a daily basis to confirm that adequate negative pressure is maintained.
- Make sure there is adequate RN staffing to conduct pre-registration identification of COVID-19 PUIs and confirmed cases.
- Make sure there is adequate in-patient staffing for units designated to treat or investigate COVID-19 PUIs and confirmed cases. The CDC recommends assigning staff from each shift to care for these patients alone in order to help prevent nosocomial infection of other patients.
- Make sure there is adequate staffing to allow additional staff to help staff assigned to the patient to assist with PPE donning/doffing as well as an observer (as was done for Ebola).
- Make sure there are protocols in place to mask family and other visitors who enter the hospital with the COVID-19 PUI or confirmed case.
