Coronavirus (COVID-19): We Want to Hear from You

[tnbutterfly - Mary]

The Coronavirus/COVID-19 has been all over the news since its appearance in Wuhan, China in December. Eleven cities in China have been locked down and travel restrictions imposed on tens of millions of people in an attempt to contain the spread of the deadly virus with reports of more than 900 confirmed cases of infection and more than 2 dozen reported deaths. Infections have been confirmed in South Korea, Japan, Nepal, Thailand, Singapore, Vietnam, and now this deadly virus has now made its appearance in the United States. Two confirmed cases have been identified - one in Washington on January 21 and another in Chicago today. Health officials have reported 63 people from 22 states are under observation for the virus.

We want to keep you up-to-date on the latest news. We need your help. Are you in an area where the Coronavirus/COVID-19 has been identified or where people are under observation for possible infection? We want to hear your story.

What precautions/screening/guidelines have been implemented in your place of work, airports, schools, etc?

Please complete the form below and let us know if you are willing to share your story.

Would you like to write an article to help us keep up with the unfolding Coronavirus / COVID-19 story - historical evolution, what is it, mode of transmission, signs and symptoms, precautions, screening, diagnosis, etc. If so, send me a Private/Personal Message

Wuhan Coronavirus Form

[EngineerPaul]

On 1/25/2020 at 10:11 AM, OliveOyl91 said:

Our hospital has also discontinued using N95 masks and anyone working with airborne patients is required to use a PAPR.

That is a very good choice, as the N95 filters are not good for much other than non toxic and non irritating dust. Also provide no protection that I can see against infection, chemical or anything else. The only drawback of the PAPR is having a spare battery that is charged. They are very effective, and I have used them around toxic chemicals.

[2BS Nurse, BSN]

Is there a source out there that confirms airborne, not droplet transmission?

[MunoRN, RN]

1 hour ago, 2BS Nurse said:

Is there a source out there that confirms airborne, not droplet transmission?

I think some have been confused by the CDC's "abundance of caution" recommendation to add airborne precautions even though we already know that coronavirus transmits through droplet and contact pathways. Different strains within a viral species can have significantly different effects on the host, but the mode of transmission is specific to the virus species.

[2BS Nurse, BSN]

It's important to not confuse droplet vs. airborne route. At this point, in the outpatient setting, we are being told to wear a procedural mask or N95 if fitted.

For now, The CDC has posted:

• the air by coughing and sneezing
• close personal contact, such as touching or shaking hands
• touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands
• rarely, fecal contamination

https://www.cdc.gov/coronavirus/about/transmission.html

I know this could change in the near future. I wish they would post more details about how specific persons (especially health care workers) were infected.

[SummitRN, BSN, RN]

4 hours ago, 2BS Nurse said:

Is there a source out there that confirms airborne, not droplet transmission?

1. "Transmission dynamics have yet to be determined."

2. MERS-CoV and SARS-CoV had airborne transmission even if the primary transmission was droplet or fecal-oral.

3. A distressing number of Chinese HCWs have contracted 2019-nCoV, that they will admit: 17 including 1 fatality.

[SummitRN, BSN, RN]

On 1/27/2020 at 4:20 AM, EngineerPaul said:

In answer to your question, airplane travel is an increased risk. I say that based on the fact that it is said to be airborne transmission, and an airplane is a confined space where many are in close proximity to each other much more so than what is found in most offices or homes.

Aircraft ventilation systems have impressive airflow. The cabin air turnover rate exceeds your average hospital room and is more like an isolation room. The air supply is a combo of (heated) fresh air and HEPA filtered recirc. Because of this, infection rates on commercial airliners are remarkably low and usually limited to contact transmission or people seated very close to a contagious person.

In the airport and on trains is a totally different set of risks and to me a larger worry than transmission on the aircraft.

[MunoRN, RN]

8 hours ago, SummitRN said:

1. "Transmission dynamics have yet to be determined."

2. MERS-CoV and SARS-CoV had airborne transmission even if the primary transmission was droplet or fecal-oral.

3. A distressing number of Chinese HCWs have contracted 2019-nCoV, that they will admit: 17 including 1 fatality.

Neither MERS nor SARS were found to have airborne transmission and this would be extremely unusual for a coronavirus or any virus.

[SummitRN, BSN, RN]

11 hours ago, MunoRN said:

Neither MERS nor SARS were found to have airborne transmission and this would be extremely unusual for a coronavirus or any virus.

SARS-CoV, the closest related of the betacoronaviruses to 2019-nCoV, was thought to have limited airborne spread and certainly it couldn't be ruled out. Unfortunately, we just don't have enough information, just as with 2019-nCoV. That SARS was not primarily airborne is known mostly to inference based on transmission patterns and an R(0) lower than other airborne diseases, which is more consistent with droplet/contact diseases. Except we also saw unusual variation in R(0): some wild high outliers, "superspreaders," with SARS... and apparently also with 2019-nCoV. Johns Hopkins situation update discussed this last night.

And so, airborne precautions are recommended for both 2019-nCoV and SARS.

There is a lot of murkiness on transmission modes even with more common viruses.

[Kat Mandu, BSN, RN]

Read today in USA Today that "The State Department said it was working with Chinese officials to identify alternative routes for US citizens to depart Wuhan over land."

"Those provided seats on the plan will face health screenings before boarding. The flight will refuel in Anchorage, Alasjam and the state's Health Department said anyone who appears ill won't be allowed on the plane. Passengers will then be screened "numerous times" during the flight and again in Alaska before continuing on to California," the department said in a statement.

Wonder how many nurses will be involved in the screenings? Ironic, really. Back in the day of early commercial airplane flights, the first flight attendants were all registered nurses. This requirement disappeared when many nurses left to enlist during WWII

https://www.thevintagenews.com/2016/09/11/first-flight-attendants-registered-nurses-requirement-disappeared-many-nurses-left-enlist-wwii/

[SummitRN, BSN, RN]

On 1/28/2020 at 4:18 PM, kittyboxers said:

Wonder how many nurses will be involved in the screenings? Ironic, really. Back in the day of early commercial airplane flights, the first flight attendants were all registered nurses. This requirement disappeared when many nurses left to enlist during WWII

It stayed gone due to the advent of pressurized aircraft

[HappyNurse, BSN, RN]

We have seen an influx of hypoxic respiratory failure/pneumonia cases on our hospice floor. I am concerned that although screenings are happening in ED departments of travelers from Wuhon, China, or contact with Wuhon sick travelers, we are not testing suspicious cases if they are not coming from China. If this is spreading we have no way of knowing if we are only testing these specific travelers. We have more Hypoxic respiratory failure/pneumonia cases dying in hospice right now than I have ever seen. None of these people are being put in isolation because none have been tested for the coronavirus. I am just very concerned and I feel very unprotected at work since we do not know all the details about this fast spreading virus yet. Depending on the incubation period being known for sure, this could be really bad for the United States. What further worries me is that we cannot yet get a rapid test to our Dr’s who are calling the cdc with suspicious cases. The only tests that are going to the cdc are patients from Wuhon, China or China . We are not sending any other suspicious cases to the cdc nor do our dr’s have any way to test at our US hospitals. So if someone does have it due to random contact, there is no accurate diagnosis, and the death certificates say hypoxic respiratory failure or pneumonia, are they really pneumonia? What do you all think? Is anyone else feeling this way

[scribblz, BSN, CNA, LPN]

1 hour ago, HappyNurse said:

We have seen an influx of hypoxic respiratory failure/pneumonia cases on our hospice floor. I am concerned that although screenings are happening in ED departments of travelers from Wuhon, China, or contact with Wuhon sick travelers, we are not testing suspicious cases if they are not coming from China. If this is spreading we have no way of knowing if we are only testing these specific travelers. We have more Hypoxic respiratory failure/pneumonia cases dying in hospice right now than I have ever seen. None of these people are being put in isolation because none have been tested for the coronavirus. I am just very concerned and I feel very unprotected at work since we do not know all the details about this fast spreading virus yet. Depending on the incubation period being known for sure, this could be really bad for the United States. What further worries me is that we cannot yet get a rapid test to our Dr’s who are calling the cdc with suspicious cases. The only tests that are going to the cdc are patients from Wuhon, China or China . We are not sending any other suspicious cases to the cdc nor do our dr’s have any way to test at our US hospitals. So if someone does have it due to random contact, there is no accurate diagnosis, and the death certificates say hypoxic respiratory failure or pneumonia, are they really pneumonia? What do you all think? Is anyone else feeling this way

While this outbreak is alarming, I feel statistically it's still an outlier concern for me. I'm much more concerned about the flu than anything else. For patients with respiratory symptoms you could always nursing judgement put them on contact/droplet precautions which would greatly minimize the risk of transmission as pretty much all respiratory viruses are known to transmit that way while airborne transmission I believe is not fully confirmed for Corona.

Regarding the deaths on your floor, is it possible that as a hospice floor your patients have multiple terminal commorbities and are not treated as aggressively as on other floors because that is not in line with the values of hospice? Do they work them up with imaging, sputum cultures and swabbing for everything ? Or do they just treat the symptoms?

Hopefully they get a swab protocol for this soon just like they do for MRSA, flu & RSV.