Overview of Coronavirus

Covid-19 is the correct name for the illness, it should not be confused with the name of the virus. On Dec 31st WHO was being informed about the cases of Pneumonia of unknown etiology in Wuhan city. On 7th January, novel coronavirus has been identified by Chinese authorities. On 17th February, 75000 cases have been confirmed, 1800 death was recorded and human to human infections has been confirmed. From 21st January to 31st, different protocols for travelling has been issued by United States authorities. Isolation is done to isolate infected people, while quarantine is used to restrict the movements of suspected individuals. Criteria to guide evaluation includes; clinical features and epidemiological risks. The clinical features include; shortness of breath, cough or respiratory illness, and patients will these illnesses will require hospitalisation while assessment of the epidemiological risks criteria side by side. The epidemiological risk criteria include; Health care workers came into contact with the infected person, travel history of Hubei province within 14 days of symptoms onset.

Identify, isolate and inform

  1. At last, the health department will be informed about;  at-risk patient and their clinical status, assessment of the need to collect specimens from infected patients, decide the disposition
  2. If people are discharged then, they will be instructed regarding their case, home are guidance and isolation guidance will be provided
  3. Patients will be advised after discharge if they develop new illnesses, like fever or respiratory illness then they should call the clinic for reevaluation, and if reevaluation is needed then call ahead and wear a facemask

Patients entry points

The patient’s condition can be non-emergent, emergent, critical or the patient could have been expired. Signage can be used by patients to self-identify themselves, and the signage has to be prominently positioned so that people can easily read have a look at the signage.  The signage should be well-written, simple to follow instructions, written in languages that represent the community, should have pictograms. For isolation, current CDC recommendations have to be followed. The standard recommendations like airborne precautions if available, if not available then place the patient in the private room with the door close and they have to be wearing a mask. Contact precautions, like health care workers, should be wearing eye protection equipment.

Informing procedures

Donning order; hand hygiene, gown, respirator, eye protection, and then gloves. Doffing order 1; Hand hygiene, gown with gloves, hand hygiene, eye protection, hand hygiene, N95, hand hygiene. Doffing order 2; Hand hygiene, gown, gloves, hand hygiene, eye protection, hand hygiene, N95, Hand hygiene. Behavior in PPE has also been elaborated; five moments of hygiene include pictorial instructions that what should be done before touching a patient, before clean/aseptic procedure, after body fluid exposure risk, after touching patient surroundings. Instructions for rubbing the hands have also been provided in 8 simple steps.

For treatment and care

it is directed not to obtain viral cultures. Nasopharyngeal Swab essentials have also been provided that swab has to be made from synthetic fibre, the shaft has to be made from plastic but not from woods, swab has to be inserted half the distance from the nostril and to the ear, swab has to be rotated several times, gauze pad holds as a barrier when the snapping the breakpoint on the shaft for the prevention of the breaching glove. Clinical recommendations are provided; to contact local infection control and public health care immediately for concerns, the mild disease does not require hospitalisation, for viral pneumonia the care is the same (02 support, monitored fluid administration, nutrition, antibiotics will be considered for signs of bacterial superinfection). There are no known therapeutic or vaccines, experiment options are available for it. Corticosteroids should be avoided at all times for infected patients.

The clinical course has also been specified;  indicates according to Chinese research in Wuhan the majority of the patients have a mild illness,  severity range from mild to severe to fatal illness.  The clinical deterioration during the second week of the illness is explained as; 23-32 per cent of the hospitalized patients need intensive care, ARDS developed in 17-29 per cent of the hospitalized patients, secondary infections have also been developed in 10 per cent of the people, invasive mechanical ventilation in 4 to 10 per cent, ECMO is used in 3 to 5 per cent of the people.

Waste and disinfection

Packaging should take place at the same location where the waste is being generated, leak-proof biohazard bag should be lined with waste containers and it should be able to hold the waste without risking the leakage. Bags should be larger than the container so that they can overlap the container easily. The bag should be put into the waste container without the creation of an air pocket under the bag. Considerations for packaging the category B waste include; Container should be placed where the waste has been generated, waste containers should not be filled to more than ¾ full. Caution should be taken considering anything sharp within the container. Aerosolisation of the container should be prevented by placing the waste gently into the container. The waste should not be compressed in order to make room. To contain the Category B waste, the bag has to be removed through a method that might not create the aerosolisation of the contents. The overlap has to be lifted through 2 diagonal corners while wearing the gloves, the top should be twisted to create a neck and the neck should be firmly grasped before it is lifted out of the container. Closure methods include; balloon knot, Gooseneck, additionally, bunny ears method is strongly prohibited.

Disinfection prospects indicated that coronavirus can persist on inanimate objects for 9 days, and CDC guidelines can be followed for disinfection. Things to consider include; lockdown of the area until the disease status is known, who will do the cleaning, creation of cleaning checklist for routine and terminal cleaning, and the adjunct options could be; time, ultraviolet light, and vaporized hydrogen peroxide. Terminal decontamination includes; wearing PPE, preparing the equipment for disinfection and cleaning, removal of waste including lines and privacy curtains if used. The surfaces should be cleaned using a cleaning product. EPA approved disinfectants should be used in order to disinfect the surface that is also known to be effective for the pathogens. Creation and adherence to the facility protocols. For environmental cleaning, the medical equipment has to be dedicated and all non-dedicated and on disposable medical equipment has to be cleaned and disinfected according to the instructions provided by the manager and the concerned facility.

Emergency medical services and transport

It will be done to prevent the transmission of biological agents to workers, other persons, and the environment. Three main components are indicated in this section are education, training, and competencies. Identify, isolate, and inform strategy has also been applied for EMS. For identification, screening for travel history and symptoms, isolation of patient for the prevention of the exposure to unprotected personnel, and informing the supervisors, public health, and receiving the facility using local protocols. Appropriate PPE is provided and supportive care is being provided to the patients, transport is provided as per local and regional protocols. EMS should also be communicating with the receiving facility, and it could be any department like an emergency facility or any other type of facility.

Protections include; Standard protection, contact protection, airborne protection, and eye protection. Patients should be wearing masks, the driver should wear an N-95 respirator. Caution with aerosol producing procedures, donning and doffing checklist with competent providers and observers. Also, aerosol producing procedures include; Nebulised medications, airway suctioning, nebulized medication, positive pressure ventilation, endotracheal intubation, and CPR. Mission recovery guidelines include the cleaning and disinfection of the ambulance and also the waste management procedures. The post-mission health awareness, in this case, provides the guidelines that health care personnel should be alerted for the fever or respiratory symptoms for one incubation cycle (14 days). Also, if the symptoms are developing then self-isolation and notification to the supervisors or public health per-protocol are necessary in order to arrange an assessment of the medical condition.  EMS biosafety transport education and training also include various components like preparation of the vehicle, donning and doffing, clinical care guidelines, PPE breech, Biohazard spill, provider down, cleaning, and disinfection, waste management, medical surveillance, special equipment, physical and psychological stressors, destination guidelines. At the end of the video, NETEC resources have been provided; social media platforms like the Facebook page, twitter handle, and Instagram of NETEC are available for guidance and education. YouTube videos are also available on the NETEC channel in this particular context.

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