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

[Walti, LPN, LVN, RN, EMT-I]

Just curious as to any possible lags in reporting. Looking at Covid-19 update on the mainstream media online and I'm not seeing much. We do have a case south of me that is reported to have been a person who had returned from mainland China travel around the end of January. Lost Coast Outpost is an online newsletter serving Humbolt County in Northern California. Go to their website for more information. Diagnosis was confirmed yesterday yet nothing on the web other than this. I wonder how many other cases are out there that we are not hearing about.

[MunoRN, RN]

10 minutes ago, Walti said:

Just curious as to any possible lags in reporting. Looking at Covid-19 update on the mainstream media online and I'm not seeing much. We do have a case south of me that is reported to have been a person who had returned from mainland China travel around the end of January. Lost Coast Outpost is an online newsletter serving Humbolt County in Northern California. Go to their website for more information. Diagnosis was confirmed yesterday yet nothing on the web other than this. I wonder how many other cases are out there that we are not hearing about.

I'm not having any trouble finding coverage on this from various tv and print outlets, including the more prominent ones.

[SummitRN, BSN, RN]

So what is your hospital procedure to move someone from ED to an AIIR in a unit? Mask the patient and clear the way? Anything more complex than that?

[NRSKarenRN, BSN, RN]

CDC has updated webpage for COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

See Health professional section, Infection control:

https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html

Quote

1. Minimize Chance for Exposures

...Upon Arrival and During the Visit

Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough):Identify patients at risk for having COVID-19 infection before or immediately upon arrival to the healthcare facility.

Implement triage procedures to detect persons under investigation (PUI) for COVID-19 during or before patient triage or registration (e.g., at the time of patient check-in) and ensure that all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of SARS-CoV-2, the virus that causes COVID-19, or contact with possible COVID-19 patients.

Implement respiratory hygiene and cough etiquette (I.e., placing a facemask over the patient’s nose and mouth if that has not already been done) and isolate the PUI for COVID-19 in an Airborne Infection Isolation Room (AIIR), if available. See recommendations for “Patient Placement” below. Additional guidance for evaluating patients in you.S. for COVID-19 infection can be found on the CDC COVID-19 website.

Inform infection prevention and control services, local and state public health authorities, and other healthcare facility staff as appropriate about the presence of a person under investigation for COVID-19.

Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% alcohol-based hand sanitizer (ABHS), tissues, no touch receptacles for disposal, and facemasks at healthcare facility entrances, waiting rooms, patient check-ins, etc.

2. Adherence to Standard, Contact, and Airborne Precautions, Including the Use of Eye Protection

Standard Precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the healthcare setting. Elements of Standard Precautions that apply to patients with respiratory infections, including those caused by COVID-19, are summarized below. Attention should be paid to training on correct use, proper donning (putting on) and doffing (taking off), and disposal of any PPE. This document does not emphasize all aspects of Standard Precautions (e.g., injection safety) that are required for all patient care; the full description is provided in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. All HCP (see section 3 for measures for non-HCP visitors) who enter the room of a patient with known or suspected COVID-19 (I.e., PUI) should adhere to Standard, Contact, and Airborne Precautions, including the following:

Patient Placement

Place a patient with known or suspected COVID-19 (I.e., PUI) in an AIIR that has been constructed and maintained in accordance with current guidelines.

AIIRs are single patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation). Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter before recirculation. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized. Facilities should monitor and document the proper negative-pressure function of these rooms.

If an AIIR is not available, patients who require hospitalization should be transferred as soon as is feasible to a facility where an AIIR is available. If the patient does not require hospitalization they can be discharged to home (in consultation with state or local public health authorities) if deemed medically and socially appropriate. Pending transfer or discharge, place a facemask on the patient and isolate him/her in an examination room with the door closed. Ideally, the patient should not be placed in any room where room exhaust is recirculated within the building without HEPA filtration.

Once in an AIIR, the patient’s facemask may be removed. Limit transport and movement of the patient outside of the AIIR to medically-essential purposes. When not in an AIIR (e.g., during transport or if an AIIR is not available), patients should wear a facemask to contain secretions....

[NRSKarenRN, BSN, RN]

Found at CNN 2/25/20:

Gilead Sciences drug remdesivir may help treat coronavirus symptoms, according to WHO

https://www.cnn.com/2020/02/24/investing/gilead-sciences-coronavirus-who-remdesivir/index.html

Chinese scientists ask for patent on US drug Remdesivir to fight virus --- intellectual property rights at stake here as Chinese firm BrightGene copies Gilead's Remdesivir drug in China.

https://www.inquirer.com/wires/ap/chinese-scientists-ask-patent-us-drug-fight-virus-20200206.html

https://www.fiercepharma.com/pharma-asia/chinese-firm-copies-gilead-s-remdesivir-most-promising-drug-against-new-coronavirus

[Walti, LPN, LVN, RN, EMT-I]

Very informative and helpful articles. I'm concerned about the ability of supply chains and manufactures to keep up with a greatly increased demand for PPEs. Can Tyvek bio-hazard suits be sprayed with disinfectants? Can gloves be dipped in sanitizing solution? Has anyone figured out a way to safely reuse N-95 masks? I can't help but feel we will rapidly run out of supplies.

We know that China has ramped up production wherever they can and is still having a hard time with supply versus demand. I kind of wonder about what levels we have here. As I recall many of of our gloves were produced in Malaysia. International shipping is way down and we will be having hard times getting product from overseas suppliers.

[SummitRN, BSN, RN]

1 hour ago, Walti said:

Very informative and helpful articles. I'm concerned about the ability of supply chains and manufactures to keep up with a greatly increased demand for PPEs. Can Tyvek bio-hazard suits be sprayed with disinfectants? Can gloves be dipped in sanitizing solution? Has anyone figured out a way to safely reuse N-95 masks? I can't help but feel we will rapidly run out of supplies.

We know that China has ramped up production wherever they can and is still having a hard time with supply versus demand. I kind of wonder about what levels we have here. As I recall many of of our gloves were produced in Malaysia. International shipping is way down and we will be having hard times getting product from overseas suppliers.

It's not advisable to try to disinfect gloves, tyvek suits, or disposable. Gloves and gowns are too fragile for repeat use.

You can use washable gowns instead of disposable gowns if your employer has them. They would go through the soiled linens after use and regular handling hospital laundering is appropriate.

There are some domestic manufacturers ramping up production. It may be possible to sterilize N95s if the situation become dire, but there is no recommended process.

Some goggles are made to be cleaned and reused.

[Gampopa]

The CDC recommends for healthcare providers to use glove, gown, N95 and eye protection in an AIIR room for COVID19 patients. Yet, in nearly all photos of anyone dealing with COVID19 they are in full body isolation suits with shoe and head coverings. I'm having some cognitive dissonance between what the DCD says to do and what other countries are doing. What am I missing?

[Walti, LPN, LVN, RN, EMT-I]

I'm wondering if we may need to rethink these protocols. Not sure about gloves as they certainly have a limited life. Masks might be possible. What temperature kills the virus and can masks stand up to heating? UV light might also be a possibility.

Tyvek is quite durable and I wouldn't think of it as a fragile gown. They make rain suits out of it. It would probably stand up to being sprayed down with a disinfectant. Might just be a cost effective thing as to re-use and that might be a luxury no longer feasible or practical. I always thought the paper gowns were a poor joke and the cloth gowns maybe a bit better.

The bean counters are always trying to save money. Many of there decisions are penny smart and pound foolish. I remember when we changed to a cheaper IV start kit. Our ER would go through a 100 a day and over a years time a dime cheaper per set sounds good. But if you had to pay a nurse 50 cents more in time spent to gather additional supplies it was not cost effective.

Just my thoughts. I'm retired and no longer on the front lines. I truly wish all of you currently practicing the best of luck. Keep on your infection control staff for updates and argue with the accountants if they are endangering you. Heck, they will probably be working from home.

[toomuchbaloney]

https://www.nytimes.com/2020/02/27/us/politics/us-coronavirus-pence.html

All messaging, even from scientists, must come through the office of the Vice President.

Should we be concerned that information from the USA will be unreliable and spun for political purposes? Was the president honest and truthful with the public about this issue last evening? What did his focus of concern seem to be?

When will the CDC and NIH be back to pre budget cut function?

Now that we have a case with unknown route or source for transmission, during influenza season, and no widely available or reliable test to confirm infection...how will we know who is infected?

I'm glad that I'm retired.

Millions of Americans cannot afford to miss work. Many employers don't provide adequate sick time. Someone must care for children if daycare or schools limit services. Millions don't have health insurance. If a vaccine is developed will it be provided free to the public?

[SummitRN, BSN, RN]

12 hours ago, Walti said:

I'm wondering if we may need to rethink these protocols. Not sure about gloves as they certainly have a limited life. Masks might be possible. What temperature kills the virus and can masks stand up to heating? UV light might also be a possibility.

Tyvek is quite durable and I wouldn't think of it as a fragile gown. They make rain suits out of it. It would probably stand up to being sprayed down with a disinfectant. Might just be a cost effective thing as to re-use and that might be a luxury no longer feasible or practical. I always thought the paper gowns were a poor joke and the cloth gowns maybe a bit better.

The bean counters are always trying to save money. Many of there decisions are penny smart and pound foolish. I remember when we changed to a cheaper IV start kit. Our ER would go through a 100 a day and over a years time a dime cheaper per set sounds good. But if you had to pay a nurse 50 cents more in time spent to gather additional supplies it was not cost effective.

Just my thoughts. I'm retired and no longer on the front lines. I truly wish all of you currently practicing the best of luck. Keep on your infection control staff for updates and argue with the accountants if they are endangering you. Heck, they will probably be working from home.

There are a lot of dead nurses and doctors who died from having to reuse PPE in the 2014 Ebola outbreak. Yea, they disinfected their PPE...

Reusing single use PPE is pennywise and poundfoolish to a T.

[MunoRN, RN]

Spread of Coronavirus vs SARS, MERS, and Ebola. Seems fine at first, then...