This story has been updated.
Even if you never see a single case, all nurses are in a great spot to help patients cope with the threat of the coronavirus pandemic. This new virus that causes respiratory illness and pneumonia originated in Wuhan, China and has been responsible for at least 4,200 deaths as of March 11, 2020, according to the World Health Organization. It has the global healthcare community and patients worldwide in a fluster.
In the U.S. there have been at least 1,215 confirmed cases and 36 deaths—including the first reported death in Georgia—as of March 12, according to the Atlanta-based Centers for Disease Control and Prevention. As health officials and government leaders scramble to streamline operations and gain hold of a pandemic that’s upended daily life, nurses are likely to encounter concerned patients—and some with symptoms requiring testing.
Informed nurses can put groundless fears to rest, reinforce the points where patients should be concerned about coronavirus, encourage reasonable preventive measures and just generally help the public make sense of it all.
Of course, there is a lot of misinformation and emotional misinterpretation fueling fears and discouraging people from understanding their odds of contracting coronavirus and how to diminish them. Nurses owe it to their patients, friends and family to be a voice of reason, and this handy guide from reliable nurse and medical experts is a great starting point for communication.
Here's what nurses need to know about Coronavirus as of March 12:
What is coronavirus?
According to the CDC, coronaviruses are a large family of viruses that typically cause mild upper-respiratory tract illnesses. This novel coronavirus — COVID-19 — “has been described as a cross between the SARs virus and the MERs virus (both also coronaviruses), because it produces a very high inflammatory response in humans and infects both the upper and lower respiratory systems,” according to Nurse.org. It’s believed “to have originated specifically from the wild animal market in Wuhan, which sells seafood, processed meats, and live animals and a new study has theorized the virus most likely came from snakes and somehow made the jump into infecting humans.”
The CDC explains that the virus behind COVID-19, which has not previously been seen in humans, “is not the same as the coronaviruses that commonly circulate among humans and cause mild illness, like the common cold.” Patients with the disease will be treated differently than patients with these other common coronaviruses.
How far it's spread
Chinese authorities identified the new coronavirus as originating in Wuhan City, but as of March 2020, there were confirmed cases in more than 100 locations internationally, including in the United States, according to the CDC. On March 11, WHO characterized COVID-19 as a pandemic.
How it's spreading
There's still a lot we don't know about how coronavirus spreads, according to the CDC. "Current knowledge is largely based on what is known about similar coronaviruses," it said. "Most often, spread from person-to-person happens among close contacts (about 6 feet). Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. It’s currently unclear if a person can get 2019-nCoV by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes... There is much more to learn about the transmissibility, severity, and other features associated with 2019-nCoV and investigations are ongoing."
As for how coronavirus could pass from patients to nurses, that would most likely be via close contact, according to the CDC. This could include "being within approximately 6 feet (2 meters) of a patient with 2019-nCoV for a prolonged period of time" or "having direct contact with infectious secretions from a patient with 2019-nCoV. Infectious secretions may include sputum, serum, blood, and respiratory droplets. If close contact occurs while not wearing all recommended PPE, healthcare personnel may be at risk of infection."
How deadly is coronavirus?
The death rate varies widely based on age, health and location, but Dr. Anthony Fauci, the nation’s leading expert on infectious diseases estimates a mortality rate of about 1%. That’s 10 times more lethal than the flu.
Older people and people of all ages with severe underlying health conditions — like heart disease, lung disease and diabetes, for example — seem to be at higher risk of developing serious COVID-19 illness.
What are the symptoms?
According to the CDC, COVID-19 causes “mild to severe respiratory symptoms” similar to the flu, such as fever, cough and shortness of breath. People may also develop nasal congestion, runny nose, aches and pains and diarrhea. "It’s thought that after exposure to the virus, you could develop symptoms in as few as two days, or as long as two weeks. The virus can prove fatal when it leads to other complications, such as pneumonia and kidney failure," Nurse.org reports.
Clinical criteria for COVID-19
So could one of your patients actually have this new coronavirus? According to the CDC, clinicians are “strongly encouraged” to test for causes of respiratory illness if patients display "fever or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath).” Some epidemiological factors to consider on whether or not to test for COVID-19: patients with "close contact with a laboratory-confirmed 2019-nCoV patient within 14 days of symptom onset" or a history of travel from China, Iran, Italy, Japan or South Korea within 14 days of symptom onset.
If a patient does meet these criteria, the CDC advises healthcare professionals to have them don a surgical mask and move to a private room with a closed door (ideally an airborne infection isolation room). The nurse should follow standard airborne and contact precautions as the facility follows its protocol for notifying infection control and the local health department.
What this means for patients in the U.S.
As Hong Kong infectious disease expert Yuen Kwok-yung told TIME, "this new virus may be more infectious than SARS. Super spreading events must be occurring, otherwise the numbers would not jump so high." Experts are urging the public to take preventive measures as schools cancel classes, companies transition to remote work and gatherings across the nation are postponed or canceled altogether.
The bottom line: Be wary but don't panic.
How people can prevent passing coronavirus
No hazmat suits needed should be your first message to fretful patients. But the coronavirus scare and resulting publicity is a great chance to further the public's understanding of how they can avoid spreading respiratory illnesses, even those that don't involve symptoms until you're already ill. Essentially, "As with other respiratory illnesses, there are steps that everyone can take to reduce the risk of getting sick from circulating viruses, including coronavirus," Los Angeles County Department of Public Health Director Barbara Ferrer told CNN in response to two coronavirus victims being identified in Orange County and Los Angeles County in late January. "This includes remaining home when ill, washing hands with soap and water frequently, and getting vaccinated against flu." Here are the best precautionary measures against the coronavirus, from the CDC.
How nurses should handle potential coronavirus sufferers
The CDC has advised health care workers to treat potential and confirmed cases of the novel coronavirus with the level of precaution usually reserved for high-risk illnesses that spread easily through the air, like tuberculosis or measles. Workers should wear special protective masks (like N95 respirators or PAPRs), gloves, gowns and goggles.
“If respirators are not available, the agency says standard medical masks can be used instead for most coronavirus patient care,” according to the New York Times. “These looser-fitting masks protect against droplet transmission from coughs and sneezes, but do not filter out airborne pathogens.”
Patients with the virus should be isolated away from other patients, but severe cases may require a negative-pressure room. More about the CDC’s protocol for health care workers here.
As availability of diagnostic testing for COVID-19 increases, the CDC says clinicians will be able to access laboratory tests for diagnosing COVID-19 “through clinical laboratories performing tests authorized by FDA under an Emergency Use Authorization (EUA). Clinicians will also be able to access laboratory testing through public health laboratories in their jurisdictions.”
Where to find reputable sources of follow-up information
Since it's tough to wade through all the news and medical sources to stay abreast of coronavirus standards and developments, it's good to have a couple of go-to resources that are keeping up with the implications of coronavirus for nurses.
- The American Nurse Association has pledged to support "ongoing efforts in the investigation, monitoring, and research of 2019-nCoV along with the development of diagnostic criteria and tools, therapeutic treatment modalities, and prevention efforts to minimize further risk to the global population’s health. As the situation continues to rapidly evolve, ANA will continue to closely monitor the outbreak."
- AJC Coronavirus Newsletter: The AJC is covering the coronavirus outbreak with a focus on what it means to Atlanta and Georgia. Follow AJC for news updates, health information and helpful resources.
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