Even if you never see a single case, all nurses are in a great spot to help patients cope with the threat of coronavirus. This new virus that causes respiratory illness and pneumonia originated in Wuhan, China and had been responsible for at least 800 deaths and 37,198 infections as of Feb. 9, 2020, according to China’s National Health Commission. It has the global healthcare community and patients worldwide in a fluster. In the U.S. there were at least 12 confirmed cases as of Feb. 9, 2020, according to the CDC, with another 100 cases pending. With the virus entering this country and Chinese experts warning that it can spread before its hosts experience symptoms, nurses may encounter patients in a tizzy over Wuhan coronavirus.
Instead of joining in the mayhem, 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 February 2020:
What is coronavirus?
According to the CDC, this Wuhan coronavirus is new. But it's still part of the larger family of coronaviruses, "some causing illness in people and others that circulate among animals, including camels, cats, and bats. Rarely, animal coronaviruses can infect people exposed to infected animals, and then spread among people, as has been seen with MERS-CoV and SARS-CoV, and now 2019-nCoV."
The brand-new virus is called the 2019 Novel Coronavirus, 2019-nCoV for short. According to Nurse.org, "2019-nCoV 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. The 2019-nCoV is thought 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."
Bats may have played a part, according to Scientific American. "The most recent analysis of the 2019-nCoV genome found it shares 96 percent of its RNA with a coronavirus previously identified in a specific bat species in China," it said. "But there were no bats being sold at the animal market in Wuhan, China, where the current outbreak is thought to have begun, suggesting an intermediate host species was likely involved."
How far it's spread
Chinese authorities identified the new coronavirus as originating in Wuhan City, but as of February 2020, there were confirmed cases outside the city and in the U.S. and some 27 other international locations, ranging from Japan and Italy to Finland, India and Australia, according to the CDC.
How it's getting transmitted
There's still a lot we don't know about how coronavirus spreads, according to a Jan. 24, 2020 bulletin from 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 current estimated mortality rate for the new coronavirus appears to be about 2 percent, but that figure may change as the outbreak unfolds and more cases are detected," noted Scientific American.
What are the symptoms?
"So far, the CDC says that 2019-nCoV causes 'mild to severe respiratory symptoms' (thanks, CDC, that’s a super helpful range) which have included fever, cough and shortness of breath," according to Nurse.org. "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."
Clinical criteria for Wuhan coronavirus
So could one of your patients actually have this new coronavirus? According to the CDC, clinical features that include "fever or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath)" should only be considered as criteria for 2019-nCoV when accompanied by the epidemiological risks of either "close contact with a laboratory-confirmed 2019-nCoV patient within 14 days of symptom onset" or "a history of travel from Hubei Province, China within 14 days of symptom onset." When the same clinical features also require hospitalization, the epidemiological risk is expanded to include anyone with “a history of travel to mainland China within 14 days of the onset of symptoms." If patients are worried about their respiratory symptoms but haven't been close to someone with a confirmed case of 2019-nCoV, a nurse should be able to allay their fears.
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 in China
China is taking strict precautions with the Wuhan coronavirus, according to a CDC bulletin updated Feb. 4, 2020. "Chinese officials have closed transport within and out of Wuhan and other cities in Hubei province, including buses, subways, trains, and the international airport." In the same communication, the CDC recommended that "travelers avoid all nonessential travel to the People’s Republic of China (this does not include the Special Administrative Regions of Hong Kong and Macau, or the island of Taiwan)" due to the "ongoing outbreak of respiratory illness caused by a novel (new) coronavirus that can be spread from person to person," adding that "older adults and people with underlying health conditions may be at increased risk for severe disease."
What it means for patients in the U.S.
The bottom line: Be wary but don't panic. According to Nurse.org, "to put things into perspective, the CDC estimates that the influenza virus has already killed between 8,200 and 20,000 people this flu season, so the three cases of a brand-new virus in the country aren’t an immediate cause for widespread panic just yet." But the spread of coronavirus to the U.S. should make people wary, especially since it can be spread before its sufferers experience any symptoms.
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."
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."
How nurses should handle potential coronavirus sufferers
As of January 26, 2020, "there is no real reason to do anything other than standard precautions when caring for your patients," Nurse.org advised. "As with any suspected case of a respiratory virus (like the flu!), you can ensure you are following your hospital’s protocol of using face masks for patients who you suspect are infected. Above all, proper hand-washing is always the most important step you can take."
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." The CDC and Nurse.org will also issue ongoing information about coronavirus and its implications for the nursing community.
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