By now, we have all been aware of an outbreak of respiratory illness caused by a novel coronavirus (COVID-19 ) that was initially detected in Wuhan City, Hubei Province, China. Is your facility prepared? Are you up to date on recommendations about staff, visitors and even residents who have recently returned from international travel?
This new virus is acting much like other respiratory viruses – it seems to be more deadly to those with advanced age or underlying medical conditions like COPD, diabetes, renal failure, etc. It is important that we develop a plan to protect our residents.
The most important thing to realize as you develop your policies and procedures and emergency preparedness is that this situation is changing rapidly. The best and most frequently updated recourse is the CDC’s website - You should assign responsibility for a staff person to check for changes frequently, as recommendations have been modified and likely will continue to change. Your county Department of Public Health is also a vital resource, and they are very helpful as questions occur.
As of February 3, the CDC published Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential 2019 Novel Coronavirus (COVID-19) Exposure in Travel-associated or Community Settings. CDC has assigned a medium-risk level to travelers from mainland China outside Hubei Province who have no known high-risk exposures.
If asymptomatic, these individuals, who have traveled out of China on or after February 3, to the extent possible, are instructed to remain at home or in a comparable setting. They must avoid congregate settings, limit public activities, and practice social distancing for 14 days after leaving. They should not be working at your facility, visiting with your residents, or volunteering at your facility. If they develop any respiratory symptoms or fever they are to notify their health provider immediately.
Staff who traveled from Wuhan or anywhere in Hubei province prior to that date should remain away from work until 14 days from departure has passed. You should decide on and enforce policies that include inquiry about recent travel. You will need to develop a policy about staff who traveled from elsewhere in China prior to February 3. Current CDC guidance is they may return to work, but as a healthcare facility caring for frail seniors you may decide on a more stringent approach – your county Department of Public Health can help.
Currently, the CDC is treating the Special Administrative Regions of Hong Kong and Macau, or the island of Taiwan differently than mainland China. We are asking travelers whose exposure is limited to those sites to wear a mask until 14 days from departure has passed. This is likely to change as the infection rate in those areas change – this will need frequent checking of the CDC guidance.
CDC has also published their guidance for healthcare facilities – it is available here.
One challenge is that many vendors of the recommended personal protective equipment, particularly N-95 respirator masks, are out of supplies due to a worldwide shortage associated with this outbreak. If you already have a fit-testing program in place, now is the time to be sure your staff is protected with a well-fitting and appropriately-sized respirator. If you don’t have a fit-testing program, it is time to implement one. Also, eye protection is part of the recommended infection control measures, so goggles or face masks are needed in adequate quantities for your staff.
It is still flu season, and the risk of flu remains much higher than that from this new virus. Every week thousands are dying from pneumonia and influenza. Weekly updates are available from the CDC here. Staff should be encouraged to get vaccinated if they haven’t yet been. All staff need to be told to stay home if sick – this is irrespective of the new virus and must remain our everyday practice specifically to protect our residents, staff and visitors from infection from sick staff.
As of February 14, when I am writing this, there are only 15 confirmed cases in the US. Hopefully our control measures will make this outbreak largely spare the US. It does offer us a chance to review our policies and supply stock to deal with outbreaks, even if it doesn’t spread within the US. We can see from this outbreak that in our age of international travel, outbreaks can spread rapidly around the world, and this most certainly will not be the last one we have to deal with.
Added 3/2/2020:
AMDA COVID-19 Guideline released February 28, 2020