Healthcare Hygiene magazine March 2020 - Page 10

under the microscope By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc Uncovering the Novel Coronavirus N ovel outbreaks from any microbe are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including whether and how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (e.g., vaccine or antivirals). The novel coronavirus (2019-nCoV) is a serious public health threat. The fact that it has caused severe illness and sustained person-to-person spread in China is concerning, but it is unclear how the situation in other parts of the world will unfold. As of Feb. 13, 2020, the Centers for Disease Control and Prevention (CDC) has reported 15 cases of 2019-nCoV, 318 negative, and 68 pending cases in the U.S., with no deaths. The outbreak first started in Wuhan, China, but cases have been identified in a growing number of other international locations. Johns Hopkins Center for Systems Science and Engineering (CSSE) has reported more than 40,000 cases with 910 deaths in 29 countries. With the growing concern over 2019-nCoV, exactly what questions should healthcare professionals and others (EVS, medical laboratory, etc.) be asking. How does 2019-nCoV spread? While there is much to learn regarding the transmission of this novel virus, spread is thought to occur from person-to-person via respiratory droplets among close contacts. Close contact can occur while caring for a patient, including: • Being within 6 feet (2 meters) of a patient with 2019-n-CoV for prolonged time periods. • 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, there may be risk of infection. How long (duration) can 2019-nCoV survive outside of a host? All viruses require a host to reproduce and survive. It is currently unclear if a person can get 2019-nCoV by touching a surface or object with virus on it and then touching his or her own mouth, nose, or their eyes. Some reports show coronavirus strains (229E) have survived more than three hours after drying onto porous and non-porous materials, including aluminum and sterile sponges; strain OC43 remained infectious up to one hour. Thus, it is prudent to remain vigilant in both the use of PPE and disinfection of surfaces in the control of 2019-nCoV. How can healthcare personnel (and other related professionals) protect themselves? According to the CDC, healthcare personnel caring for patients with confirmed or possible 2019-nCoV should adhere to CDC recommendations for infection prevention and control (IPC): • Assess and triage patients with acute respiratory symptoms and risk factors to minimize chances of exposure, 1 2 including use of facemasks on the patient and isolating them in an Airborne Infection Isolation Room (AIIR), if available. • Use Standard Precautions, Contact Precautions, and Airborne Precautions and eye protection when caring for patients. • Perform hand hygiene with alcohol-based handrub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of personal protective equipment (PPE), including gloves. • Practice proper use PPE in a manner to prevent self-contamination. • Perform aerosol-generating procedures, including collection of diagnostic respiratory specimens, in an AIIR, while following IPC practices, including use of appropriate PPE. What about environmental cleaning and disinfection? CDC states routine cleaning and disinfection procedures are appropriate for 2019-nCoV in healthcare settings. Products with EPA-approved emerging viral pathogens claims are recommended. Management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures. What do we currently know about the human-to-human transmission of this novel coronavirus? More specifically, once one person is infected, does the coronavirus appear to be significantly contagious in a human-to-human context? The modes of human-to-human transmission of the virus are still being determined, but given current evidence, it is most likely spread by the following, according to the CDC. • Through the air by coughing and sneezing • Close personal contact, such as touching or shaking hands • Touching an object or surface with the virus on it, then touching your mouth, nose or eyes before washing your hands • In rare cases, fecal contamination With current data available and my professional experience, I do not believe this novel virus is any more contagious than the influenza virus. At this time, both appear to have similar transmission rates (1.4 – 4) and case fatality rates (currently holding steady at about 2 percent). Of course, this could change, and it is why we must monitor the outbreak closely and rely on “confirmed and accurate” laboratory test results. Everyone should pay attention to reputable sources and heed the advice of the government and public health experts. The U.S. Department of State has issued a level 4 “do not travel” advisory for China. Proper perspective is critical. There is no need to panic. We should all do our part in not becoming part of the problem as a “super-spreader” of inaccurate or unchecked information surrounding this virus outbreak.  4 5 3 Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc, serves as chair and professor of the Clinical Laboratory Science Program at Texas State; associate director for the Translational Health Research Initiative; as well as associate dean for research in the College of Health Professions. Follow him on Twitter @RodneyRohde / @TXST_CLS, or on his website: 10 march 2020 •