Everything You Need to Know About COVID-19

FREE ONLINE COURSE

Infection Control - COVID-19

covid-19

At the end of this course, the student should be able to:

  1. Know the basic facts about COVID-19;

  2. Understand how COVID-19 spreads;

  3. Explain how to protect oneself from COVID-19;

  4. Know how to handle face masks and PPEs, and understand their importance;

  5. Obtain the perspective of a healthcare personnel (HCP) on the front lines;

  6. Understand signs and symptoms, and how testing takes place;

  7. Demonstrate how to take care of COVID-19 patients (critical and non-critical);

  8. And lastly, learn what COVID-19 pneumonia is.

covid-19

Basic Facts About COVID-19

covid-19

A novel coronavirus is a new coronavirus that has not been previously identified. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among humans and cause mild illness, like the common cold.

A diagnosis with coronavirus 229E, NL63, OC43, or HKU1 is not the same as a COVID-19 diagnosis. Patients with COVID-19 will be evaluated and cared for differently than patients with common coronavirus diagnosis.

On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. Formerly, this disease was referred to as “2019 novel coronavirus” or “2019-nCoV”.

There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses. COVID-19 is a new disease, caused by a novel (or new) coronavirus that has not previously been seen in humans. The name of this disease was selected following the World Health Organization (WHO) best practice for naming of new human infectious diseases.

People in the U.S. may be worried or anxious about friends and relatives who are living in or visiting areas where COVID-19 is spreading. Some people are worried about the disease. Fear and anxiety can lead to social stigma, for example, towards Chinese or other Asian Americans or people who were in quarantine.

Stigma is discrimination against an identifiable group of people, a place, or a nation. Stigma is associated with a lack of knowledge about how COVID-19 spreads, a need to blame someone, fears about disease and death, and gossip that spreads rumors and myths.

Stigma hurts everyone by creating more fear or anger towards ordinary people instead of the disease that is causing the problem.

People can fight stigma and help, not hurt, others by providing social support. Counter stigma by learning and sharing facts. Communicating the facts that viruses do not target specific racial or ethnic groups and how COVID-19 actually spreads can help stop stigma.

How does COVID-19 spread?

Coronaviruses are a large family of viruses. Some cause illness in people, and others, such as canine and feline coronaviruses, only infect animals. Rarely, animal coronaviruses that infect animals have emerged to infect people and can spread between people. This is suspected to have occurred for the virus that causes COVID-19. Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) are two other examples of coronaviruses that originated from animals and then spread to people. More information about the source and spread of COVID-19 is available on the Situation Summary: Source and Spread of the Virus.

The virus that causes COVID-19 is spreading from person-to-person. Someone who is actively sick with COVID-19 can spread the illness to others. That is why CDC recommends that these patients be isolated either in the hospital or at home (depending on how sick they are) until they are better and no longer pose a risk of infecting others.

How long someone is actively sick can vary so the decision on when to release someone from isolation is made on a case-by-case basis in consultation with doctors, infection prevention and control experts, and public health officials and involves considering specifics of each situation including disease severity, illness signs and symptoms, and results of laboratory testing for that patient.

Current CDC guidance for when it is OK to release someone from isolation is made on a case by case basis and includes meeting all of the following requirements:

  • The patient is free from fever without the use of fever-reducing medications.

  • The patient is no longer showing symptoms, including cough.

  • The patient has tested negative on at least two consecutive respiratory specimens collected at least 24 hours apart.

Someone who has been released from isolation is not considered to pose a risk of infection to others.

Quarantine means separating a person or group of people who have been exposed to a contagious disease but have not developed illness (symptoms) from others who have not been exposed, in order to prevent the possible spread of that disease. Quarantine is usually established for the incubation period of the communicable disease, which is the span of time during which people have developed illness after exposure. For COVID-19, the period of quarantine is 14 days from the last date of exposure, because 14 days is the longest incubation period seen for similar coronaviruses. Someone who has been released from COVID-19 quarantine is not considered a risk for spreading the virus to others because they have not developed illness during the incubation period.

Coronaviruses are generally thought to be spread from person-to-person through respiratory droplets. Currently there is no evidence to support transmission of COVID-19 associated with food. Before preparing or eating food it is important to always wash your hands with soap and water for 20 seconds for general food safety. Throughout the day wash your hands after blowing your nose, coughing or sneezing, or going to the bathroom.

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from food products or packaging that are shipped over a period of days or weeks at ambient, refrigerated, or frozen temperatures.

Learn what is known about the spread of COVID-19.

It is not yet known whether weather and temperature impact the spread of COVID-19. Some other viruses, like the common cold and flu, spread more during cold weather months but that does not mean it is impossible to become sick with these viruses during other months.  At this time, it is not known whether the spread of COVID-19 will decrease when weather becomes warmer. There is much more to learn about the transmissibility, severity, and other features associated with COVID-19 and investigations are ongoing.

Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

Protecting Yourself Against COVID-19

This is a rapidly evolving situation and the risk assessment may change daily. The latest updates are available on CDC’s Coronavirus Disease 2019 (COVID-19) website. There have been cases of COVID-19 in the U.S. related to travel and person-to-person spread. U.S. case counts are updated regularly on Mondays, Wednesday, and Fridays.

Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness including older adults, and people who have serious chronic medical conditions like heart disease, diabetes, and lung disease.

If you are at higher risk of getting very sick from COVID-19, you should: stock up on supplies; take everyday precautions to keep space between yourself and others; when you go out in public, keep away from others who are sick; limit close contact and wash your hands often; and avoid crowds, cruise travel, and non-essential travel. If there is an outbreak in your community, stay home as much as possible. Watch for symptoms and emergency signs. Watch for symptoms and emergency signs. If you get sick, stay home and call your doctor. More information on how to prepare, what to do if you get sick, and how communities and caregivers can support those at higher risk is available on People at Risk for Serious Illness from COVID-19.

You should only wear a mask if a healthcare professional recommends it. A face mask should be used by people who have COVID-19 and are showing symptoms. This is to protect others from the risk of getting infected. The use of facemasks also is crucial for health workers and other people who are taking care of someone infected with COVID-19 in close settings (at home or in a healthcare facility).

There is still a lot that is unknown about the newly emerged COVID-19 and how it spreads. Two other coronaviruses have emerged previously to cause severe illness in people (MERS-CoV and SARS-CoV). The virus that causes COVID-19 is more genetically related to SARS-CoV than MERS-CoV, but both are beta-coronaviruses with their origins in bats. While we don’t know for sure that this virus will behave the same way as SARS-CoV and MERS-CoV, we can use the information gained from both of these earlier coronaviruses to guide us. In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from products or packaging that are shipped over a period of days or weeks at ambient temperatures. Coronaviruses are generally thought to be spread most often by respiratory droplets. Currently, there is no evidence to support transmission of COVID-19 associated with imported goods and there have not been any cases of COVID-19 in the United States associated with imported goods. Information will be provided on the Coronavirus Disease 2019 (COVID-19) website as it becomes available.

Best Practices in Decontaminating and Reusing N95 Masks

A team of 60 scientists, engineers, students and clinicians that includes a Georgetown physicist yesterday unveiled N95decon.org, a website that synthesizes the scientific literature about mask decontamination.

As health workers and first responders attempt to stem a pandemic without adequate protective gear, they are forced to consider decontaminating and reusing N95 masks to safeguard those whose jobs expose them to the virus that causes COVID-19.

Daniel Blair, an associate professor in Georgetown’s Department of Physics and Institute for Soft Matter, is part of the team helping to create a set of best practices for the decontamination and reuse of N95 Personal Protection Equipment (PPE).

covid-19 face mask

“We realized that there was a critical need for clinicians on the front line to have the most accurate and well-researched data available to them when considering reusing N95 masks,” Blair says. “Our overarching goal is that this work provides a guide that is based in the most up-to-date science for the people that need protection in situations where resources are scarce.”

Team members, which include scientists from Stanford, Harvard, the University of California, Berkeley and the University of Chicago, scoured hundreds of peer-reviewed publications over the last few weeks and held continuous online meetings to review studies of decontamination methods.

These methods previously have been used to inactivate previous viral and bacterial pathogens, and the team assessed the potential for these methods to neutralize the novel SARS-CoV-2 virus that causes Covid-19.

The goal of the new website is to provide overwhelmed health officials who don’t have time to study the literature themselves, with reliable, pre-digested scientific information about the pros and cons of three different decontamination methods the team believes offer the best options should local shortages force a choice between decontamination, reuse or going unmasked.

The methods are heat and humidity; a specific wavelength of light called ultraviolet C (UVC); or treatment with hydrogen peroxide vapor.

The scientists did not endorse any one method but instead sought to describe the circumstances under which each technique could inactivate the virus provided rigorous procedures are followed.

How Effective Are Face Masks Against Coronavirus

The team determined that devices that rely on heat, for example, could be used under specific temperature, humidity and time parameters. With UVC devices – which emit a particular wavelength and energy level of light – considerations involve ensuring masks are properly oriented to the light so their entire surfaces are bathed in sufficient energy.

“While there is no perfect method for decontamination of N95 masks, it is crucial that decision-makers and users have as much information as possible about the strengths and weaknesses of various approaches,” said Manu Prakash, an associate professor of bioengineering at Stanford who helped coordinate the volunteer team. “Manufacturers currently do not recommend N95 mask reuse. We aim to provide information and evidence in this critical time to help those on the front lines of this crisis make risk-management decisions given the specific conditions and limitations they face.”

The good news is that the hydrogen peroxide vapors method has the potential advantage of decontaminating masks in volume, as the U.S. Food and Drug Administration has certified certain vendors to offer hydrogen peroxide vapor treatments on a large scale.

As the team unveiled the N95 decon website, the U.S. Centers for Disease Prevention and Control released a data-driven fact sheet and detailed overview for implementing each of these  recommended methods.

N95decon.org will help facilitate the safe and rapid deployment of these emergency measures by pointing decision-makers to sources of reliable and detailed how-to information provided by organizations, institutions and commercial services.

The researchers stressed that decontamination does not solve the N95 shortage, and expressed hope that new masks be made available in large numbers as soon as possible, so health care workers and first providers can be issued fresh protective gear whenever needed.

Team members have pledged to continue working together to update the N95decon.org website as new information becomes available, and to coordinate their research to plug the gaps in current knowledge and avoid duplication of efforts.

“The scientific volunteers who made this happen came together in this time of crisis to help workers and administrators make informed decisions about N95 decontamination and standard operating procedures based on their own specific circumstances,” said Hana El-Samad, a professor of biochemistry and biophysics at the University of California, San Francisco Medical Center in a joint statement the team issued in unveiling the website.

Source: Georgetown University

What Healthcare Professionals Should Know About COVID-19

Healthcare personnel (HCP) are on the front lines of caring for patients with confirmed or possible infection with coronavirus disease 2019 (COVID-19) and therefore have an increased risk of exposure to this virus. HCPs can minimize their risk of exposure when caring for confirmed or possible COVID-19 patients by following Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.

There is much to learn about the newly emerged COVID-19, including how and how easily it spreads. Based on what is currently known about COVID-19 and what is known about other coronaviruses, spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts.

Close contact can occur while caring for a patient, including:

  • being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time.

  • having direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, serum, blood, and respiratory droplets.

If close contact occurs while not wearing all recommended PPE, healthcare personnel may be at risk of infection.

Healthcare personnel caring for patients with confirmed or possible COVID-19 should adhere to CDC recommendations for infection prevention and control (IPC):

  • Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and placing them in an examination room with the door closed.

  • Use Standard and Transmission-Based Precautions when caring for patients with confirmed or possible COVID-19.

  • Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled.

  • Practice how to properly in a manner to prevent self-contamination.

  • Perform aerosol-generating procedures, in an AIIR, while following appropriate IPC practices, including use of appropriate PPE.

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed. Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2. Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.

If you have an unprotected exposure (i.e., not wearing recommended PPE) to a confirmed or possible COVID-19 patient, contact your supervisor or occupational health immediately.

If you develop symptoms consistent with COVID-19 (fever, cough, or difficulty breathing), do not report to work. Contact your occupational health services. 

For recommendations and guidance on persons under investigation; infection control, including personal protective equipment guidance; home care and isolation; and case investigation, see Information for Healthcare Professionals. For information on specimen collection and shipment, see Information for Laboratories. For information for public health professionals on COVID-19, see Information for Public Health Professionals.

Very Useful Links and Downloads

Source: Centers for Disease Control and Prevention

How to Triage for Signs & Symptoms

https://www.youtube.com/watch?v=TjcoN9Aek24

Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with fever, cough, and difficulty breathing. Read about COVID-19 Symptoms.

Call your healthcare professional if you feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19, or if you live in or have recently traveled from an area with ongoing spread of COVID-19.

Your healthcare professional will work with your state’s public health department and CDC to determine if you need to be tested for COVID-19.

State and local health departments who have identified a person under investigation (PUI) should immediately notify CDC’s Emergency Operations Center (EOC) to report the PUI and determine whether testing for COVID-19 at CDC is indicated. The EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays.

For more information on specimen collection see CDC Information for Laboratories.

Using the CDC-developed diagnostic test, a negative result means that the virus that causes COVID-19 was not found in the person’s sample. In the early stages of infection, it is possible the virus will not be detected.

For COVID-19, a negative test result for a sample collected while a person has symptoms likely means that the COVID-19 virus is not causing their current illness.

People in the U.S. may be worried or anxious about friends and relatives who are living in or visiting areas where COVID-19 is spreading. Some people are worried about the disease. Fear and anxiety can lead to social stigma, for example, towards Chinese or other Asian Americans or people who were in quarantine.

Stigma is discrimination against an identifiable group of people, a place, or a nation. Stigma is associated with a lack of knowledge about how COVID-19 spreads, a need to blame someone, fears about disease and death, and gossip that spreads rumors and myths.

Stigma hurts everyone by creating more fear or anger towards ordinary people instead of the disease that is causing the problem.

People can fight stigma and help, not hurt, others by providing social support. Counter stigma by learning and sharing facts. Communicating the facts that viruses do not target specific racial or ethnic groups and how COVID-19 actually spreads can help stop stigma.

What to Expect When Getting Tested for COVID-19

The COVID-19 test is simple. A doctor will swab the inside of a patient’s nose or at the back of their throat. The sample will then be kept cool (between 35° to 45°F) and sent to a commercial lab.

However, if a sample is not processed within four days, it must be frozen, or a new sample is required. Once you have been approved for a test, it should take 48 hours to receive results, though in some cases it is taking up to a week. The process includes:

  • ‍Nasal Swab. You should be seated and directed to angle the head back at 70 degrees, then the clinician applies the nasal swab, working it into the back of the nasal cavity before it reaches the posterior nasopharynx. This may be a little unpleasant because the clinicians move the swab to get enough sample material. Don’t worry though, it’s fairly quick.

Nasal swab and throat swab for COVID-19 testing.

  • ‍Throat Swab. For the throat swab, you will be asked open your mouth and the clinician will insert the swab as gently as possible into the back of the throat toward the tonsils. The swab should be touched over both tonsillar pillars, before removing and securing the sample.

  • ‍Lower Respiratory Specimen. The final sample involved first rinsing your mouth with water. After this is done, you will be asked to cough up a specimen of sputum directly into a sterile sputum collection cup. This will subsequently be sealed by the clinician and sent off with your other samples to the nearest laboratory.

For patients who do not have insurance or a regular health care provider, there are 14 health centers dedicated to serving Los Angeles County with free and low-cost services. Find a care center on the link provided below.  Be mindful to call ahead of time for some clinics have limited hours. The federal government has pledged that the costs for COVID-19 tests will be waived for all Americans. You will need to work with your health care provider for more information on your specific treatment costs.

Blood Test vs. Swab Test vs. Saliva Test, Which Works Best?

There are currently two main tests for the COVID-19, the PCR swab test and antibody blood test. There are no FDA approved at-home tests, but there is a newly developed saliva test that decreases contact between those administering the test and potentially infected individuals.

covid-19, covid19. coronavirus

How Does Coronavirus Swab Test (PCR) Work?

RT-PCR, or real time polymerase chain reaction, is used to detect coronavirus from a nasopharyngeal (nasal secretions) sample, also known as a nasal swab. RT-PCR is the method being used to determine the results of tests done via a testing kit. PCR COVID-19 tests are mostly being produced by Roche Diagnostics, LabCorp and Thermo Fisher Scientific.

The RT-PCR technique targets a specific segment of the virus’ genetic material to detect the presence of COVID-19 in a person. RT-PCR works by making thousands of copies of this genetic material to qualitatively assess if the virus is present. The tests only detect the virus while the person is currently infected.

It is important to know that if the sample is not taken properly, it may yield false negative results. Therefore, if your swab test comes back negative, you cannot certainly rule out the chance of having COVID-19. For this reason, it’s very important for health care workers to be thorough while testing people. The test is also somewhat invasive so both, the patient and worker may wear personal protective equipment to ensure caution.

PCR tests can take up to several days to process; however, in some instances rapid test results can be delivered in less than an hour.

What Is The Blood Test (Antibody)? And How Does It Work?

This test checks to see if individuals have immunity to the COVID-19 virus by looking for a specific antibody in the bloodstream. Antibodies are small proteins that are part of our immune system. They are produced to defend our body against a specific virus, for example, COVID-19. The blood test looks for the specific antibodies that fight infection from the coronavirus. According to the Centers of Disease Control, it normally takes one to two weeks after someone becomes sick with COVID-19 for their body to make antibodies others may take even longer to develop antibodies.

The test checks to see if we have the antibodies for COVID-19. Antibody levels are detected through a test called ELISA, or serological enzyme-linked immunosorbent assay, and ultimately tests for the amount of antibodies in the blood for the specific virus. In the past, it’s been used as a diagnostic test for other diseases and viruses. The test tells us if we already had the virus, but it is not currently being used for quick detection like the swab test. Antibody tests can detect the virus even after the patient has recovered.

The antibody test was recently developed by doctors at Mount Sinai Hospital in New York. The test has two major implications. First, it can be used to identify potential blood donors. Blood from COVID-19 survivors can possibly be used to treat current COVID-19 patients. Second, the antibody blood test can be used to eventually test asymptomatic individuals. Ideally, if people have the antibodies for COVID-19, they can return to work with a low risk of infection.

The New Saliva Test 

As of April 13, 2020 the FDA approved the use of saliva samples as a means of emergency testing for COVID-19. This test is less invasive than taking a nasopharyngeal sample and involves giving a saliva sample in a tube.

The new saliva test uses a similar protocol to that of the nasopharyngeal RT-PCR test. The test amplifies a segment of the viral genetic code to detect the presence of the virus.

This test was developed at Rutgers University and is not currently approved for at home administration. The implications of this test include decreasing the risk of health care professionals who previously had to come into close contact with patients in order to administer a test.

Source: talktomira.com

Where to Get Tested for COVID-19 in Los Angeles

COVID-19 is easily spread by sneezing, coughing, etc. Therefore, simply avoiding contact is among the most optimal choices you can make during this time. Self-quarantine means staying at home as much as possible. If you are able to miss school and work, it is suggested you do so. If you have traveled to a high-risk location recently, it is imperative.

The point is to avoid social settings and public space and avoid public transportation including small spaces like cabs and ride-shares. You can ask the following questions to screen yourself:

  • Have you been experiencing a fever or symptoms of lower respiratory illness, such as cough or shortness of breath?

  • Have you traveled to geographic areas with sustained transmission of COVID-19 within 14 days of symptom onset?

  • Have you had close contact with a person confirmed with COVID-19 infection?

If you have been in the same room as someone who has had COVID-19, you should disinfect the room. This link from the LA County Department of Public Health describes the proper way to deep clean a room that may have been infected:

If you happen to answer yes to two or more of the self screening questions above, then calling your local clinic or primary care doctor would be the better choice. According to the Los Angeles County Department of Public Health website, there are several clinics you can call to see if you can get tested for coronavirus COVID-19. It is recommended to first check in with your primary care provider and see if they’re conducting COVID-19 testing. If your doctor is not testing, you can call your local urgent care.

If you are healthy, have no exposure history, and have no symptoms, you are not guaranteed to be tested due to the limited test kits and protective gear supply caused by the COVID-19 crisis.

UC San Francisco, UC Los Angeles, UC San Diego, and Stanford are all offering tests for the novel coronavirus — and UC Davis is currently in the process of getting three different types of tests online. Here’s where you can get a COVID-19 test:

Antelope Valley Public Health Center
335-B East Avenue K6
Lancaster, CA 93535
661-471-4861

Central Public Health Center
241 N. Figueroa Street
Los Angeles, CA 90012
(213) 240-8204

Curtis R. Tucker Public Health Center
123 W. Manchester Blvd.
Inglewood, CA 90301
(310) 419-5325

‍Glendale Public Health Center
501 N. Glendale Ave
Glendale, CA 91206
(818) 500-5762

The full list is available on this link: