Quality and Population Health

Coronavirus Update 2/19/2020

The outbreak of the novel coronavirus (2019-nCoV newly renamed COVID-2019) in China is continuing to evolve. While the immediate risk in the US is still considered low, this is a potentially serious public health threat. A multidisciplinary task force at Englewood Health has been established to monitor the situation and implement responses.

The following information was previously published in the February 5 medical staff newsletter. Please note CDC updated suspect case definition, and make sure to use the correct PUI form – see here.

Symptoms of COVID-2019

There is limited information at this time on the full range of clinical illness associated with the virus, but it is causing mild to severe symptoms consistent with a respiratory illness including fever, cough, and shortness of breath. 

Screening and Infection Control

All patients should be screened for the following:

See below (click on image to enlarge).

Footnotes

1Fever may be subjective or confirmed

2Close contact is defined as—

a) being within approximately 6 feet (2 meters) of a COVID-2019 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a COVID-2019 case

– or –

b) having direct contact with infectious secretions of a COVID-2019 case (e.g., being coughed on)

If such contact occurs while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection), criteria for PUI consideration are met”

See CDC’s updated Interim Healthcare Infection Prevention and Control Recommendations for Persons Under Investigation for 2019 Novel Coronavirus.

Data to inform the definition of close contact are limited. Considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with COVID-2019 (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to those exposed in health care settings.

3Documentation of laboratory-confirmation of COVID-2019 may not be possible for travelers or persons caring for patients in other countries.

4Category also includes any member of a cluster of patients with severe acute lower respiratory illness (e.g., pneumonia, ARDS) of unknown etiology in which COVID-2019 is being considered that requires hospitalization. Such persons should be evaluated in consultation with state and local health departments regardless of travel history.

5For persons with travel to China within 14 days that are being regularly monitored by local health departments or referred for evaluation from border screening, testing for nCoV can be considered at the discretion of the health officials for all persons with illnesses with fever and lower respiratory symptoms (those hospitalized and those not hospitalized).

 

 

A patient identified with suspected COVID-2019 should be:

  • Given a surgical mask
  • Immediately isolated in a private room with the door closed, ideally in an airborne infection isolation room or a room where the exhaust is recirculated with HEPA filtration.
  • Tested (follow procedure below)
  • Patients with mild COVID-2019 illness who do not require hospitalization may be discharged home and isolated in a residential setting. Additional guidance can be found at: https://www.cdc.gov/coronavirus/2019-ncov/guidance-home-care.html

Healthcare personnel entering the rooms should follow standard, contact, and airborne precautions and wear gown, gloves, eye protection and an N95 mask.

If you cared for a patient with suspected or confirmed COVID-2019, you should monitor yourself for symptoms. Further guidance can be found on the NJDOH website at https://www.nj.gov/health/cd/topics/ncov.shtml

Testing and Reporting

Testing at this time is only being performed by the CDC. If a patient meets the suspect case definition, please follow instructions for specimen collection and reporting to the appropriate health agencies.

Patients should not be sent to the emergency department for COVID-2019 testing. Patients should only be sent the emergency department if they require acute emergent care or hospitalization due to their severity of illness. If you are sending a patient to the emergency department, have the patient wear a surgical mask and inform the receiving facility. For Englewood, the ED number is 201-894-3441.  

Prevention

In addition to following the infection control procedures for patients with suspected or confirmed COVID-2019, preventive actions you can take are the same as for cold and flu:

  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Stay home when you are sick.
  • Follow proper cough/sneeze etiquette.
  • Clean and disinfect frequently touched objects and surfaces.

Further Updates and More Information

We will continue to keep you updated on this situation and provide new information when available. All messages and resources will be posted on the Infection Prevention page of the ePortal (Departments – Infection Prevention). If you have further questions, please use your chain of command. The Infection Prevention team is also available as 201-894-3439 or 3676.

We also encourage healthcare workers to access the latest information on the CDC and NJDOH websites. Thank you for your support as we work to ensure the safest patient care and minimize this risk to our teams and community.