At the time of this publication, there are 11 cases of confirmed coronavirus in the United States, including a case of human-to-human transmission in Chicago. Despite the significant attention being paid to the coronavirus, we should still be more concerned about the seasonal influenza that is circulating and has claimed more than 10,000 lives, according to the Centers for Disease Control and Prevention (CDC).
Furthermore, many of the precautions healthcare providers should implement for a virus like the new coronavirus are similar to those that should have been in place for the flu as well. Concerning the coronavirus, the CDC released the following statement: "We continue to believe that the immediate health risk from this new virus to the general American public is low."
With that being said, the team at Infection Control Consulting Services (ICCS) is not advising inaction. Rather, non-acute care settings — which are typically not as prepared to respond to a potential case of an illness like the coronavirus — should ensure they are screening at the point of entry and managing the flu season and coronavirus appropriately. You will ultimately need to make decisions regarding preparation as it suits your setting.
Recommendations for Coronavirus Preparation and Response
The following are recommendations worth considering, some of which you have hopefully already instituted:
As soon as possible, institute enhanced screening of every patient by phone (as is typically done in the outpatient surgery setting) followed by screening upon admission (visitors, too) for elective admissions. Include questions about travel outside the United States, particularly China, and specific signs and symptoms such as a fever, sore throat, cough and runny nose. You do not want such patients in your facility in any event if they're symptomatic for the flu or other respiratory viruses.
Reschedule if the patient on the phone is suspicious for a respiratory illness. The screening staff should ask patients to let them know by phone if they wake up in the morning with any symptoms of the flu before coming into the facility. Since that may not happen, it is imperative to be prepared if someone arrives at the facility and is exhibiting symptoms.
If phone screening is not part of your practice, ICCS suggests that at the time of presentation at the front desk, staff should ask the same questions above of every patient and visitors. Front desk staff should have masks available to hand to patients and visitors, if necessary.
Fully implement a respiratory hygiene program, especially in the waiting room, mandating the donning of a mask to anyone exhibiting symptoms of a respiratory illness and immediate exiting of the facility. Some patients may present in the waiting room despite being telephone screened. Encourage hand hygiene in the waiting room, particularly after use of tissues following wiping a nose, covering a cough, etc.
There is a reported shortage of medical face masks. While the use of face masks is often warranted (as discussed earlier), and a shortage is quite concerning, at this juncture, staff members walking around in masks for the duration of a shift is impractical compared to placing a patient in a mask until they can leave the facility. However, if any healthcare worker must render care to a patient with a suspicious presentation, even if the patient is wearing a mask, we suggest healthcare workers wear one as well until the patient leaves.
N95 respirator masks are part of an OSHA/NIOSH respiratory program that is complex and mainly used in the hospitals or extenuating circumstances in other settings. To learn more about what is required to run a respiratory protection OSHA/NIOSH program, click here.
To review the interim coronavirus guidance from CDC, which includes screening, click here. (Note: This guidance receives regular updates.)
Coronavirus Assistance
Guidance will continue to evolve, and the team at ICCS will continue to closely monitor the situation. Facilities in need of assistance with coronavirus management or providing PPE and respiratory hygiene training to employees can contact ICCS.
