Understanding and Managing Respiratory Illnesses

Respiratory illness season is upon us. These viruses can take root in the nose, mouth, airway, and/or lungs. Illnesses that have been reported are Influenza (flu), Respiratory Syncytial Virus (RSV), and COVID-19. Common signs and symptoms among all these illnesses can range from fever, cough, runny/stuffy nose, chills, sore throat, and muscle/body aches. Some additional illness-specific symptoms include:

• COVID-19: new loss of taste or smell.
• RSV: Wheezing.
• COVID-19 and Influenza can present with similar symptoms. Testing is the only way to distinguish between the two.

Illness Transmission

All the illnesses are transmitted differently. COVID-19 is reportedly transmitted by a combination of droplets and airborne particles. These particles can travel up to 6 feet and may be carried through the air in droplets so small that they stay in air currents and can be inhaled. The flu virus is reportedly spread by large droplets when a person coughs, talks, or sneezes. RSV can be spread through contact with droplets from the nose and throat of infected people when they cough and sneeze, direct contact (such as kissing the face of a child) or touching a surface with the virus on it (such as a doorknob), and then touching your face.

There are similar ways to prevent the spread of illness. Hand hygiene is the single most critical measure in reducing transmitting organisms to your patients and your coworkers. Frequently washing your hands for 20 seconds with soap and water and whenever your hands are visibly soiled or dirty, along with using hand sanitizer are three best practices when it comes to hand hygiene. Another possible way to prevent the spread of illness is through vaccination, which, according to the CDC, is the best way to prevent spread.

Preventing Transmission 

However, there are other everyday ways to prevent transmission that can be done in healthcare to reduce the spread of these illnesses. To prevent the spread of respiratory illnesses, the CDC states that source control (masking) should be utilized when hospital admission rates are high and when levels of illness are high in your community. Signs can be posted at the entrance of your facility and/or messaging on your business website, or messaging during appointment reminders. Non-urgent treatment should be postponed for patients with suspected or confirmed respiratory illnesses.

Personal protective equipment (PPE) should be utilized and available during the delivery of healthcare. Use is determined based on the risk of exposure to blood, bloody saliva, and possible respiratory illness. PPE is to be provided and maintained by the employer. The different types of PPE are gowns, gloves, masks, eye protection, and N-95 respirators. N-95 respirators should be available and considered to be used during any aerosol generating procedures. Commonly known procedures that create aerosols in medical facilities are intubation, tracheotomy, CPR, bronchoscopy, and sputum induction. Dental equipment known to create aerosols are ultrasonic scalers, high-speed dental handpieces, air/water syringe, air polishing, and air abrasion. It should be noted that fit testing is required for all N-95s prior to their first use and annually thereafter if an employee could be exposed to people who have or may have COVID-19.

Employee Guidance

If an employee is sick with a respiratory illness, they should follow the CDC’s guidance on when to return to work:

• COVID-19: The guidance says that employees with mild to moderate illness of COVID-19, who are not moderately to severely immunocompromised may return to work after five days have passed since symptoms first occurred (day 0) and COVID-19 testing is performed. If a NAAT (PCR) test is negative on day 5, then return to work on day 7. If an antigen test (home tests are an example) is negative on day 5, then repeat the test 48 hours later. If both tests are negative, return to work. If either test is positive, on day 5 or 7, return to work on day 10. If testing is NOT performed, then return to work on day 10. Employees must be fever free for 24 hours and symptoms have improved.
• Flu: Employees with confirmed flu who have a fever should be fever free for 24 hours without the use of fever-reducing medicine. Employees with suspected or confirmed flu, who do not have a fever, should stay home from work at least 4-5 days after the onset of symptoms.
• RSV: Employees with RSV are contagious for 3-8 days. Employees can return to work when fever free for at least 24 hours and symptoms have improved.

With these measures in place and following the guidance from the CDC and other resources, we can provide a safe, healthful environment for our patients as well as our employees.