COVID-19 Resources

2019 novel coronavirus (COVID-19) is a new strain of a virus causing an outbreak of respiratory illnesses. The illness was first detected in Wuhan, China, in December 2019, with cases now identified in the United States and multiple other countries. On Feb. 11, 2020, the Word Health Organization officially named this current illness COVID-19.¹ For the most current statistics, please refer to the Johns Hopkins Coronavirus Resource Center for Coronavirus COVID-19 Global Cases tracking.

Overview

The COVID-19 is from a large family of human coronaviruses named for crown-like spikes on their surface with the main subgroupings classified as alpha, beta, gamma, and delta. First identified in the 1960s, there are seven coronaviruses that can infect humans:²

• 229E (alpha coronavirus)
• NL63 (alpha coronavirus)
• OC43 (beta coronavirus)
• HKU1 (beta coronavirus)
• MERS-CoV (beta coronavirus)
• SARS-CoV (beta coronavirus)
• 2019 novel coronavirus

Coronavirus infections range from the common cold to the rare and deadly varieties of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The MERS-CoV, SARS-CoV, and COVID-19 are examples of virus evolution that began with animals and have now become a threat to humans..

Signs and symptoms

If exposure to COVID-19 and/or fever or other symptoms occur, a healthcare provider should be contacted for medical advice.

Person-to-person spread occurs similarly to influenza and other respiratory illnesses. The incubation period is between two and 14 days post-exposure, with symptoms ranging from absent or minimal to acute, severe respiratory complications that may result in death.

Acute signs and symptoms include:

• Fever
• Cough
• Shortness of breath
• Runny nose
• Headache
• Sore throat
• General malaise

Severe symptoms may involve:

• Coughing with mucus production
• Increasing shortness of breath
• Chest pain or tightness 

The illness can easily progress to infection causing pneumonia, severe acute respiratory syndrome, kidney failure and death. Those with the highest risk include anyone with cardiac and respiratory diseases or weakened immune systems, as well as infants and older adults. It is also not unusual for the immunocompromised patient to experience atypical symptoms such as hemoptysis and diarrhea.^3,4

Transmission

How COVID-19 Spreads

There is much to learn about the newly emerged COVID-19, including how and how easily it spreads. Close contact can occur while caring for a patient or infected person, including:

• Being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time.
• Naving direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, serum, blood, and respiratory droplets.

Transmission occurs when a non-infected person comes in contact with airborne or surface droplets of an infected person (for example, through coughing, sneezing or touching).

The virus remains a serious public health threat. Recommendations for health care workers include standard, contact and airborne precautions with use of eye protection, if the following occurs and COVID-19 is suspected:

• Coughing and sneezing
• Close personal contact
• Touching objects and surfaces that have the virus and touching mouth, nose or eyes

Transmission through fecal contamination is also possible, although rare. .

Diagnosis

Confirmatory diagnostic laboratory testing for COVID-19 has been delivered to state and local public health departments from the CDC. Commercial manufacturers are also developing quick test kits for medical providers. While the CDC has guidance for who should be tested for COVID-19, decisions about diagnostic testing are, but decisions are made at the discretion of state and local health departments and/or individual clinicians.

The CDC recommends collecting and testing multiple clinical specimens that include at least three lower and upper respiratory sputum samples and serum specimens whenever available. Additional specimen types such as stool and urine may also be collected and stored.

Notification to local health departments should begin immediately if the 2019 nCoV is suspected. The CDC’s Emergency Operations Center can assist with specimen collection, storage and shipping, including after hours and on weekends and holidays, if needed.

Lower respiratory aspirate or sputum should be collected in a sterile, leak proof, screw-cap sputum collection cup or sterile dry container and then refrigerated. Sample should be refrigerated at 2-8℃ and shipped overnight on an ice pack. Recommendations for upper respiratory samples such as nasopharyngeal or oropharyngeal swabs or aspirate include the use of synthetic fiber swabs, but only those with plastic shafts. Nasopharyngeal and oropharyngeal specimens should be maintained separately and placed immediately into sterile tubes with 2-3 ml of viral transport media. Refrigeration at 2-8℃ and shipping overnight on ice pack is necessary.

Serum collection requires 5-10 ml for children and adults and 1 ml of whole blood for infants in serum separator tubes. The tubes should be stored upright for a minimum of 30 minutes and centrifuged for 10 minutes at 1000-1300 relative centrifugal force. Serum should then be removed, placed in a separate sterile tube for shipping, refrigerated at 2-8℃ and shipped overnight to the CDC on ice pack. If any specimens are frozen at -70°C, shipping overnight on dry ice is advised. All samples should be accompanied by a completed CDC Form 50.34 with test selection of “Respiratory virus molecular detection (non-influenza) CDC-10401.”

The following criteria for evaluating suspected cases of 2019 Novel Coronavirus (COVID-19) in the U.S. is recommended⁵:

• Fever and symptoms of lower respiratory illness and in the last 14 days before symptom onset, a history of travel from Wuhan City, China or in the last 14 days before symptom onset, close contact with a person who is under investigation for COVID-19 while that person was ill.
• Fever or symptoms of lower respiratory illness and in the last 14 days, close contact with an ill laboratory-confirmed COVID-19 patient; WHO identifies close contacts as health care associated exposure including the provision of direct care to nCoV patients, working with infected health care workers, visiting patients or being in close proximity with an nCoV patient. Additionally, working or sharing a classroom environment with an nCoV patient, traveling with an nCoV patient in any kind of conveyance, or living in the same household as an nCoV patient.

Treatment

Currently, there is no vaccine or specific antiviral treatment that prevents COVID-19.6 For those infected, supportive care for symptom relief and the necessary treatment to support vital organ function in severe cases is indicated. Supportive measures include over-the-counter medication, rest, and fluids.

Prevention and transmission-reduction strategies include the following:^7,8,9

• Wash hands, preferably with soap and water for 20 seconds and use hand sanitizer if soap is not available.
• Avoid touching face, nose, or mouth prior to handwashing.
• Avoid close contact with those who are ill.
• Clean and disinfect surfaces.
• Cover coughs and sneezes.
• Stay home when ill.
• Wear a surgical mask when possible and evaluate suspected patients in a private room or a reverse isolation room for airborne infections..

Guidance for health care providers

Personal Protective Equipment (PPE) Burn Rate Calculator

PPE Sequence

Health care workers should continue to follow standard, contact and airborne precautions and use eye protection. Current recommendations include regular hand washing, covering mouth and nose when coughing and sneezing, and avoiding close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing, if possible.

The CDC has summarized specific recommendations for PPE based on the current COVID-19 situation as well as a list of N95 respirator alternatives.

The CDC recommends utilization of alternatives to N95 respirators where feasible. These include other classes of filtering face piece respirators, elastomeric half-mask and full face piece air purifying respirators, or powered air purifying respirators (PAPRs) when possible. All of these alternatives will provide equivalent or higher protection than N95 respirators.

The National Institute for Occupational Safety and Health (NIOSH) approves other filtering face piece respirators that are at least as protective as the N95. These include N99, N100, P95, P99, P100, R95, R99, and R100.

References

1. 2019 novel coronavirus (COVID-19) in the U.S. Centers for Disease Control and Prevention website. Accessed February 13, 2020.
2. Human coronavirus types. Centers for Disease Control and Prevention website. Accessed January 27, 2020.
3. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;1. doi:10.1016/s0140-6736(20)30183-5.2.
4. 2019 novel coronavirus, Wuhan, China, symptoms. Centers for Disease Control and Prevention website. Accessed January 28, 2020.
5. Criteria to guide evaluation of patients under investigation (PUI) for COVID-19. Centers for Disease Control and Prevention website. Accessed January 28, 2020.
6. Paules C, Marston HD, Fauci AS. Coronavirus infections-more than just the common cold. JAMA. Published online January 23, 2020. https://jamanetwork.com/journals/jama/fullarticle/2759815. doi:10.1001/jama.2020.0757. Accessed January 28, 2020.
7. How COVID-19 spreads. Centers for Disease Control and Prevention website. Accessed January 27, 2020.
8. Coronavirus. Accessed January 27, 2020.
9. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. World Health Organization website. Accessed January 28, 2020.

Evolving Practices at Epicenter Organizations | March 25

The University of Washington Medicine reviewed their latest updates on dealing with the virus. Nebraska Medicine discussed pandemic planning and modeling, along with clinical care issues and just-in-time training for your staff. The University of Utah Hospitals and Clinics shared how they are evaluating the numerous strategies either for direct antiviral management or management of disease progression. Our speakers:

• Dr. Angela Hewlett, MD, MS, Nebraska Medicine
• Dr. Mark Rupp, MD, Nebraska Medicine
• Terry Micheels, MSN, RN, Nebraska Medicine
• Frank Venuto, Nebraska Medicine
• Dr. Kelly Caverzagie, MD, FACP, FHM, Nebraska Medicine
• Christopher Kim, MD, MBA, SFHM, University of Washington Medical Center
• Dr. Emily Spivak, MD, MS, University of Utah Hospitals and Clinics

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Key takeaways | March 25

During the webinar, experts from three member organizations discussed pandemic planning and modeling, staff training, and clinical care issues, in addition to numerous strategies either for direct antiviral management or management of disease progression. A summary of their remarks appears below:

1. Clinical deterioration is noted around the second week of illness.
2. Retrain staff on proper donning and doffing.
3. Need to develop a very strong policy around PPE to address the following right away:
1. Where kept, how requested, how distributed
2. Dashboard to know how much PPE you have at any given time
3. How to enforce this policy in a strong manner
4. Develop criteria for extended use and re-use of N95s. (e.g., able to seal (test elastic bands), were not worn during aerosol generating procedure, and not soiled, damaged or moist)
5. UV decontamination for 7 cycles; Use bag with handles to store masks so they don’t crease, and label sides of bag front/back so staff know which way to hang mask off handles. Label masks directly with name, date of first use, and tally marks for number of decontaminations.
1. If using UVGI to decontaminate masks, paint room with reflective UV paint.
6. Develop robust communication methods to staff and be as transparent as possible. Consider:
1. Weekly FAQs and town hall meetings
2. Organize all your information in a centralized location for staff, have someone with clinical knowledge organize the information so it can be easily accessed.
7. Develop Craig’s list-like site for staff to ask for and offer services to fellow staff.
8. Consider developing a daily contact with treatment teams to discuss appropriate therapy for COVID-19 patients and use COVID-19 pager for questions.
9. Restrict all COVID-19 antimicrobial prescriptions to review and approval by an antimicrobial stewardship committee.
10. To prepare for a community surge in your area, determine where you could utilize extra patient care space. (e.g. dorm rooms, ORs, conference space)

Managing the Initial Impact | March 18

Experts from the Miriam Hospital (Lifespan) and University of Chicago Medicine shared updates
on their experiences managing the COVID-19 outbreak in their facilities. Our speakers:

• Maria Ducharme, DPN, RN, Senior Vice President, Patient Care Services, and Chief Nursing
  Officer, Miriam Hospital
• G. Dean Roye, M.D., FACS, Senior Vice President, Medical Affairs and Chief Medical Officer,
  Miriam Hospital
• Thomas Spiegel, MD, MS, BA, ED, Medical Director, University of Chicago Medicine

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COVID-19 Clinical and Supply Update | March 11

Emory infectious disease experts shared the latest information on COVID-19 contagion, an update from their Feb. 5 presentation. Our speakers:

• Marybeth Sexton, MD, Assistant Professor of Medicine, Emory University School of Medicine
• Kari Love, RN, MS, CIC, FAPIC, Program Director, Emory Healthcare 

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What Hospitals Need to Know | Feb. 5

Experts from Emory and Society for Healthcare Epidemiology (SHEA) of America Outbreak Response Training Program share the latest details about the novel coronavirus (COVID-19) outbreak and outlined action steps that hospitals can take to address the spread of the virus. Our speakers:

• Marybeth Sexton, MD, Assistant Professor of Medicine, Emory University School of Medicine
• Kari Love, RN, MS, CIC, FAPIC, Program Director, Emory Healthcare
• Jennifer Hanrahan, DO, MSC, chair of the Society for Healthcare Epidemiology of America

Watch now