Coronavirus: Be Diligent and Don’t Panic!

The Coronavirus is very newsworthy at this point, but it is also very important to realize that during the 2018-19 influenza season, the United States reported an estimated 16.5 million people went to a health care provider for the flu, and more than 34,000 people died in the U.S. We need to keep a focus on the impact of influenza and infection prevention measures to reduce the spread of this dangerous virus.

Coronaviruses are a family of viruses that can cause respiratory viruses which presents as the common cold but may also cause severe types of pneumonia. You may be familiar with two other coronavirus illnesses, the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

At present we are dealing with a new or novel coronavirus (2019 nCoV) first detected in Wuhan City, China. This infection which originally was spread from animals to humans has now been spread person to person and has been reported in many international locations including the United States.

While the numbers are very low, now is the time to plan. To start with, there are two concepts that should serve as the foundation of your plan: Be diligent and DON’T panic! The CDC is constantly monitoring this rapidly developing situation and has provided many resources to assist healthcare providers as the situation continues to unfold. As always, be strict about basic infection control: hand hygiene, appropriate use of personal protective equipment (PPE), respiratory hygiene, and cough etiquette.

Create a Plan

It is important to monitor reliable resources for an indication of illness that may be present in your community. The CDC is the go-to agency for the US at this time and will provide guidance to state and local health departments through the CDC Health Alert Network (HAN)

For healthcare providers, the following direction on patient evaluation has been provided by the CDC.

Clinical Features	AND	Epidemiologic Risk
Fever or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath)	AND	Any person, including health care workers, who has had close contact with a laboratory-confirmed3 2019-nCoV patient within 14 days of symptom onset
Fever and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath)	AND	A history of travel from Hubei Province, China within 14 days of symptom onset
Fever and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization⁴	AND	A history of travel from mainland China within 14 days of symptom onset

The CDC has provided a complete flowchart on patient assessment and the provision of safe care.

Patients meeting these criteria should be immediately reported to your local health department. Implement the following infection control measures in your facility.

Minimize the chance of exposure. When possible, patients with respiratory illness should be identified prior to arrival through a triage process. Any patient with respiratory symptoms should be provided a face mask and encouraged to perform hand hygiene and cough etiquette. If the patient meets the criteria for possible 2019 nCoV they should be placed as quickly as possible in an exam room. The best-case scenario is to be placed in an Airborne Infection Isolation Room, but for most outpatient facilities, this is not possible.
Patient care should be delivered by a dedicated team in order to minimize worker exposure. Appropriate PPE should be utilized including gloves, gown, eye protection (goggles or face shield) and a mask. The N-95 respirator mask provides the highest level of protection against respiratory viruses but must be utilized in conjunction with a written Respiratory Protection Program.
Isolation of patients with possible infection should be determined on a case by case basis in conjunction with the CDC.

The CDC offers the following direction for this potential health threat:

“The risk to individuals is dependent on exposure. At this time, some people will have an increased risk of infection, for example, healthcare workers caring for 2019-nCoV patients and other close contacts. For the general American public, who are unlikely to be exposed to this virus, the immediate health risk from 2019-nCoV is considered low. The goal of the ongoing U.S. public health response is to prevent the sustained spread of 2019-nCov in this country.”

NOTE: This is a BRIEF recap of the basic infection control measures. Complete guidance is provided on the CDC 2019 Novel Coronavirus webpage.

Remember: Be diligent and don’t panic.