infection prevention
By Phenelle Segal, RN, CIC, FAPIC
COVID-19: The Journey From Mitigation to the
‘New Normal’
In
early January, clinicians in the United States were
alerted to cases of a respiratory illness occurring since
late December 2019 in dozens of patients from Wuhan,
China. Clinicians were told to closely evaluate patients with
symptoms and a history of recent travel to and from the af-
fected area. On Jan. 21, 2020 the Centers for Disease Control
and Prevention (CDC) officially confirmed the first case of a
novel coronavirus in the state of Washington; the patient had
returned from Wuhan on Jan. 15 and presented to a medical
facility there. Due to his history of travel and respiratory
symptoms, a new coronavirus illness was suspected, and a
Real time Reverse Transcription-Polymerase Chain Reaction
(rRT-PCR) test was run and confirmed the medical center’s
suspicion. Within a month from first hearing about the initial
cases, the world began experiencing the unprecedent 2019
Novel Coronavirus (2019-nCoV) pandemic.
When first identified in Wuhan, the virus was thought
to spread from animal to humans, with no evidence that it
was spreading from human to human. Upon reaching the
U.S., it was becoming more evident that person-to-person
spread was a concern in China, but its rate and ability to
spread remained unclear.
Healthcare facilities, particularly acute-care hospitals were
overrun by sick patients, many of them requiring intensive
care treatment with or without the use of a ventilator. Very
ill patients have had a prolonged clinical course and delayed
discharge due to an unprecedented list of clinical conditions.
The huge influx of patients resulted in a tremendous shortage
of personal protective equipment (PPE) and ventilators.
The shortages were dependent on the region and directly
proportional to the number of cases. After several weeks
of frenzied care provided to hundreds of thousands of ill
patients, many healthcare workers were and continue to be
stricken with COVID-19 and several deaths have occurred.
Initial Mitigation Steps
Since CDC first heard of a surge in cases in Wuhan, the
agency began preparing as best as possible, aware of the
fact that it was a matter of time before the U.S. would see
an influx. In conjunction with the White House, the following
steps were taken and several remain in place to date:
●Developed
an alert system for healthcare providers from
the beginning of January.
●Provided
guidance to clinicians about signs and
symptoms as they were identified from Wuhan, and
requesting they be alert for a positive travel history to and
from potentially infected countries.
●Provided
viral testing guidance.
●Provided
preliminarily guidance for the care of patients
in the home who may develop COVID-19.
●Provided
guidance for airport screening of passengers
10
coming into several major international airports.
●Assisted
with developing a diagnostic test to detect
this virus in clinical specimens.
●Activated
its Emergency Operations Center to prepare
for future support to healthcare providers.
●Deployed
a team to Washington state to begin contract
tracing and other support.
●Ordered
each state to issue executive orders to shut
down non-essential businesses, public gatherings, sports
events, entertainment and stay at home orders.
●Ordered
outpatient healthcare providers to cease
providing non-urgent/non-emergent services including
elective surgeries.
●Implemented
social distancing strategies to curb the
spread from close contact.
●Banned
hospitals and nursing homes from visitors.
●Issued
guidance for healthcare facility employees,
vendors and essential persons to universally mask while in
the building.
●Suggested
individual states and counties implement
face coverings for the general public.
Ongoing Mitigation
●Guidance
was and continues to be released at an
accelerated rate for the community and healthcare industry.
● Ongoing updates from many sources were and continue
to be very helpful in developing plans for healthcare facilities.
●CDC
deployed additional personnel to “hot zones”.
●Conference
calls for healthcare providers and community
were set up and continue to take place.
●Guidance
provided for agencies and companies
developing additional tests including antibody tests.
●Guidance
for companies and agencies reviewing and
trialing medications to treat ill patients.
●Providing
input for agencies and companies researching
vaccine development.
Returning to the New Normal
Three months into the pandemic, the White House has
introduced guidelines to reopen the country using a three-
phased approach. Besides other industries, the first and
second phase includes resuming outpatient and inpatient
elective surgery respectively. Visitor bans will continue to be
strictly upheld during phase one and for the most part phase
two for hospitals and nursing homes. Every state will need to
develop “reopening plans,” which is expected to be extremely
challenging and will require a multi-disciplinary team approach.
Outpatient surgery centers are closed to elective procedures
with urgent or emergent procedures allowed at the discretion
of the medical providers. Elective procedures are on hold in
hospitals too. During the ban of elective procedures, staff
were responsible for developing initial plans for screening
patients and physical distancing protocols. In addition,
may 2020 • www.healthcarehygienemagazine.com