Coronavirus Disease (COVID-19)
What is Coronavirus Disease (COVID-19)
The Centers for Disease Control and Prevention (CDC) are closely monitoring an on-going outbreak of Coronavirus Disease (COVID-19) in Wuhan, China. Cases have been identified in multiple countries, including the United States. Coronaviruses are not a new family of viruses and are common in different species of animals including camels, cattle, cats, and bats.1 In humans, there are multiple strains that can cause mild respiratory symptoms or even the common cold. In years’ prior, other strains have been associated with SARS and MERS.
According to the CDC, early cases of COVID-19 identified a link to a large seafood and live animal market suggesting emergence from an animal reservoir and animal-to-person transmission. However, subsequent patients reporting no exposure to animal markets revealed person-to-person transmission. Person-to-person transmission occurs among close contacts (within approximately 6 feet) via respiratory droplets produced from coughs or sneezes.
Information that remains under on-going investigation includes additional modes of transmission, virus severity, spread of the virus in the absence of symptoms, and the length of time a patient can spread the virus. Symptoms associated with COVID-19 include mild to severe respiratory illness with symptoms of fever, cough, and shortness of breath.2 The CDC believes the incubation period lasts 2-14 days. However, the full scope of illness associated with COVID-19 remain under investigation.
While the overall risk to the American public is low, the U.S. Department of Homeland Security has activated travel restrictions and mandatory quarantine protocols to minimize the risk of exposure to COVID-19. The American Nurses Association supports ongoing efforts in the investigation, monitoring, and research of COVID-19 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.
What Nurses Need to Know
Preparedness, Early Identification, and Notification
Develop and educate all staff on a preparedness plan that provides infection control procedures and protocols used within your healthcare facility for the early identification, containment, and care of patients with symptoms associated with Coronavirus Disease (COVID-19) to prevent spread within your healthcare facility.
- Develop inpatient, ambulatory, and home care policies and procedures that are in line with current CDC guidelines for COVID-19
- Provide training to all personnel on screening and isolation procedures
- Provide updated training and guidelines on the use of Personal Protective Equipment (PPE), such as the use of gloves, gowns, masks, eye protection, and a face shield
- Display clear signage with instructions for the use of PPE
- Ensure consistent use of proper hand hygiene, standard precautions, contact precautions, and airborne precautions, along with the proper use of a National Institute for Occupational Safety and Health (NIOSH)-Approved N-95 respirator or higher
- Clearly display signage for patients that lists symptoms and instructions to wear a face mask before entering the healthcare facility if symptoms are present.
- Incorporate assessment questions to document a detailed travel history when patients present with fever, cough, or respiratory illness. Consider COVID-19 if the patient traveled to China within the last 14 days.
- Identify, in advance, airborne infection isolation rooms (AIIR) or negative pressure rooms, for quarantine and screening
- Outline staffing protocols to facilitate care of patients with COVID-19 and to minimize patient-to-patient transmission
- Have available for immediate notification of Patient’s Under Investigation (PUI) the infection control personnel at your facility and the local and state health department. Click here for additional Recommendations for Reporting, Testing, and Specimen Collection and the fillable COVID-19 PUI case investigation form
- For Patients Under Investigation (PUI), follow the Criteria to Guide Evaluation of PUI for COVID-19
Isolation, Quarantine, Monitoring, and Hospitalization
The CDC recommends several steps for identification and maintenance of COVID-19 along with detailed guidelines for isolation precautions to prevent transmission. Have clearly displayed a flowchart for early identification and assessment of COVID-19 At this time, the exact mode(s) of transmission remain undetermined, but person-to-person transmission has been identified.
- Have masks available for PUI to don before entering the healthcare facility
- Once identified, isolate the patient to airborne infection isolation rooms (AIIR) or negative pressure room and keep the door closed. Conduct the assessment in this room.
- Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (goggles or a face shield)
- Don Personal Protective Equipment (PPE) before entering the room
- Have guidelines for the proper use of PPE displayed throughout the healthcare facility
- Notify your infection control personnel and the local and state health department of suspected cases
How to Educate Your Patients and Minimize Spread within the Community
Per the CDC, it is known that coronavirus is part of a large family of viruses that can cause illness in people and animals.1 While the mode(s) of transmission of COVID-19 remain under investigation, the CDC provides the following interim guidance to help prevent COVID-19 from spreading among people in homes and communities4:
- Stay home except to get medical care, do not use public transportation or taxis
- Call first before visiting your healthcare provider to notify of the need for evaluation for COVID-19. Follow the instructions provided by your healthcare team.
- Separate yourself from other people in your home, utilize a separate bathroom
- Wear a facemask
- Cover your coughs and sneezes
- Wash your hands frequently with soap and water for at least 20 seconds
- Avoid sharing household items
- Monitor your symptoms
- For a full list of guidelines and recommended actions for preventing the spread of Coronavirus visit https://www.cdc.gov/coronavirus/2019-ncov/guidance-prevent-spread.html
Information for Healthcare Consumers
- Follow current travel recommendations to avoid all nonessential travel to China
- The current risk to the American public remains low
- It is still cold and flu season. It is not too late to get a flu shot. Stay home when sick.
- Wash your hands for at least 20 seconds with soap and water.
- If you are in close contact with an individual who has traveled to China within the past 14 days or with an individual with a confirmed or suspected diagnosis of COVID-19, follow the CDC’s guidelines to prevent spread within your home and community.
- If you have been exposed and develop fever, cough, or shortness of breath, stay home and call your health care team for instructions for testing and treatment.
Best Practice Resources
For best practice guidelines on infection control, standard precautions for all patient care and transmission-based precautions, visit:
- Infection Control Basics
- Healthcare Professional Preparedness Checklist For Transport and Arrival of Patients Potentially Infected with COVID-19
- Hospital Preparedness Checklist for Suspected or Confirmed COVID-19 Patients
- Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for COVID-19
- Link to Local health departments
- Link to State Health Departments
- Standard Precautions
- Transmission-Based Precautions
- Sequence for Putting on Personal Protective Equipment (PPE)
- Three Key Factors Required for a Respirator to be Effective
- Important Steps for Using NIOSH-Approved N95 Filtering Facepiece Respirators
- Strategies for Optimizing the Supply of N95 Respirators
- Frequently Asked Questions about Respirators and their Use
- Healthcare Professionals: Frequently Asked Questions and Answers
Information for People Traveling
The CDC recommends that travelers avoid all nonessential travel to Wuhan, China. If you must travel, or if you have traveled to Wuhan in the last 14 days and feel sick with fever, cough, or difficulty breathing, the CDC outlines the following recommendations to minimize your risk https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-wuhan-china
References and Resources
- Clinical Criteria for evaluation of COVID-19
- Link to Local Health Departments
- Link to State Health Departments
- World Health Organization
- Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for COVID-19
- Interim Guidance for Preventing COVID-19 from Spreading to Others in Homes and Communities
- 2019 Novel Coronavirus, Wuhan China Transmission. (2020, January 24). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html
- 2019 Novel Coronavirus, Wuhan China Symptoms and Complications. (2020, January 24). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html
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