Facts about Coronavirus &Coronavirus Patients.
The Covid-19 pandemic is currently causing a standstill in many parts of the world. Economic, social, and religious activities are feeling the negative changes and difficulties associated with the virus. Halting the world’s usual activities is one of the control measures that aim at hindering the spread of COVID-19.
The disease started in Wuhan, China, late last year, and has since then spread across many continents in the world. COVID-19 patients show flu-like symptoms, which worsen with time leading to respiratory failure or a malfunctioning breathing system.
Symptoms can start with a fever, coughs, and sneezes, accompanied with severe headaches.
Such symptoms are mild and frequent in both the flu and common cold. However, the headaches are sharp in the case of COVID-19.
Corona is spread from one person to another through the droplets in the coughs and sneezes of infected people.
SARS-CoV2 has so far spread in most parts of the world, affecting our normal day to day activities.
It is the biggest bane of your existence in 2020—and perhaps the worst in your lifetime. Transmission rates are still on the rise, and medics are yet to discover a cure.
Healthcare professionals are dealing with the disease by remedying the symptoms, to help the patient’s immune system fight the virus.
However, this is not easy, because of the risk of infection the healthcare officials face when they handle and treat COVID-19 patients.
Infection rates of the disease have been on a rapid increase in most countries of the world. Due to this, most nations around the globe have started to adjust their operations to fight the pandemic.
Hospitals and Other Medical Institutions Have to Follow the Set COVID-19 Guidelines.
Hospitals and medical institutions across the world and in the United States of America are ramping up their daily services. Such steps aim to accommodate the current wave of the high influx of COVID-19 infected people brought into the hospitals.
The Center for Disease Control and Prevention (CDC) has given guidelines for the best process to follow when hospitalizing the COVID-19 patients.
To begin with, it helps to understand that not every COVID-19 infected individual needs an airborne infection isolation room (AIIR). All patients going through aerosol-generating procedures should be prioritized when allocating rooms.
Other COVID-19 victims are supposed to be placed in a single-person closed room.
Such rooms should be kept private, and each patient should stay in their rooms during their entire hospitalization period.
Patients should only leave when they are going for more advanced health care units, and if an emergency arises.
It is inherently clear that health care providers (HCPs) are at a significant risk of getting infections with the outbreak of the novel COVID-19 pandemic.
Due to the widespread absence of the PPE to protect the health care providers (HCPs), they can easily contract the disease as they conduct their work.
The Center for Disease Control and Prevention (CDC) advises that both hospitals and the other health care institutions designate entire units for COVID-19 patients.
Such hospitals should also have devoted health care providers in their facilities to take care of the corona victims. Observing such segregation will limit the exposure of many health care providers to the risk of infection.
The CDC also advises that the health care providers in such designated units should always change their gowns and gloves when dealing with different COVID-19 patients.
It also recommends that it is not necessary to change face masks and eye protection if you feel they are uncontaminated.
According to recent studies, the rate of infection of any disease from a patient to the health care service provider through the face masks or eye protection is very low.
Health care service providers must be very careful about touching their faces while providing health care services.
Other challenges health care institutions face, apart from PPE shortage, are ethical dilemmas. Such dilemmas are relative to CPR services and the risk of infection to the health care service providers.
Many hospitals are currently under pressure to review their do-not-resuscitate (DNR) policies amidst these troubling times, according to a recent Washington Post article.
It is a hard decision for doctors who are bound by different codes of ethics and conduct relative to their countries.
Ethical laws in diverse situations require the health care workers to save the lives of people through all means possible, and in most cases, even risk their own lives.
Conducting CPR during this Pandemic Requires Care and Appropriate PPE.
With respect to the COVID-19 pandemic, CPR has been identified as an aerosol-generating procedure (AGP) by the World Health Organization (WHO).
It raises a big question about the most appropriate practices to apply in a situation where a COVID-19 patient requires CPR services.
Cases of the virus within the world have now hit the three million mark.
In most of these cases, the virus is known to cause mild illness, but it can also lead to severe manifestations that may end in death.
Both the WHO and CDC have clearly emphasized on the standard principles of infection control measures and droplet precautions.
Some of the cornerstones of preventing infections of the disease are containment of respiratory secretions and effective hand hygiene.
Such actions are also applicable to other severe acute respiratory syndrome-related disorders.
Many cases of cardiac arrest happen outside the health care institutions in the United States of America, making it the leading cause of deaths in the country.
According to an American Journal of Emergency Medicine, over 350,000 cases were reported in the year 2016. Of these cases, more than 70% have been known to occur at home.
Over 200,000 cardiac arrest cases are reported in hospitals each year in the United States of America, according to a report given by the National Academies of Sciences, Engineering, and Medicine. Roughly 24% of the patients within these cases survive each year.
As we all know, cardiac arrests are a more significant concern among COVID-19 patients. Yet these days CPR comes with the risk of coronavirus infection to the health care service providers.
World Health Organization (WHO) has identified that airborne transmission of COVID-19 is an easy means of infection in any medical procedure that involves aerosol generation.
Such procedures include bronchoscopy, endotracheal intubation, and manual ventilation before intubation, open suctioning, and CPR. Risks and dangers in these medical activities have led to more concerns among the health care officers and workers.
Conducting CPR on COVID-19 patients or suspected infected people should only occur in an emergency department (ED) setting, which has its staff in full PPE. PPE consists of a full long-sleeved gown, gloves and eye protection, and is commonly known as FFP3.
Patients can receive defibrillator treatment if they are in cardiac arrest outside of the ED setting if they have a shockable rhythm. Once you attain this normal rhythm state, then you can successfully resuscitate a patient.
Amidst conflicting European guidelines, it was stated that “Consensus is evolving that chest compressions are highly likely to be generating, at the very least, droplets and probably airborne particles.” Said Jerry Nolan, FRCA, FRCP, FFICM, FCEM (Hon), who is the chair of both the European Resuscitation Council and the Resuscitation Council UK’s executive committee.
He also said that the survival rates are about 50% in cases where the heart can be shocked but run low to about 10% to 15% for hearts that cannot be shocked.
According to audit data from the year 2018 to 2019, 24% of patients with cardiac arrest survived in UK hospitals. Dr. Nolan showed some uncertainties about knowing the results in COVID-19 patients because there is no much history of the same.
He said that no resuscitation policy outside the ED could become handy when things get worse. “Healthcare staff members are extremely stressed about managing patients with [COVID-19], and they need clear advice.” Said Dr. Nolan.
“Unexpected cardiac arrest among these patients may not be common. But I think we must do all we can to plan and, where appropriate, implement do-not-attempt cardiopulmonary resuscitation decisions.
We can also closely track these patients and intervene before they have a cardiac arrest.” Said Dr. Nolan, while addressing the DNR policy.
The UK’s Resuscitation Council indicated in its most recent statements that they are still waiting for results from an international evidence review process. After this, they can start updating the current recommendations.
The CDC, together with the American Heart Association (AHA), recommended the following recommendations for both noninvasive ventilation and endotracheal intubation:
- Aerosol-generating procedures should ideally occur in AIIRs.
- Healthcare practitioners should have adequate respiratory PPE (i.e., N95 respirators).
- AIIRs should undergo appropriate cleaning and disinfection after each procedure.
- Limit the number of providers available for aerosol-generating procedures.
- Rapid sequence intubation should be adopted for patients requiring intubation.
- Avoid procedures that may generate aerosols, including bag-valve-mask, nebulizers, and noninvasive positive pressure ventilation.
- Adopt endotracheal intubation for acute respiratory failure to avoid the use of high-flow nasal oxygenation.
The organizations also gave the following guidelines to be followed by any new health care service providers offering the services:
- Emergency medical dispatchers should screen callers for signs, symptoms, and risk factors of COVID-19.
- Prehospital care providers, healthcare facilities, and other necessary providers should be notified in advance if a COVID-19 patient needs emergency transport.
- All emergency medical services (EMS) clinicians and staff should follow the set hand hygiene and infection prevention strategies.
- Appropriate PPE should be donned according to the guidelines.
When responding to COVID-19 infected people with unknown symptoms or signs of respiratory infections in their health history, the EMS personnel should always be cautious.
Standard precautions, donning the PPE as mentioned earlier, and maintaining a social distance of over 6 feet are some of the ways to stay safe.
Transport vehicles handling COVID-19 patients should have an isolation barrier between the driver and patient sections.
Every other person in the health care institution should be separated from the COVID-19 patient or suspected persons unless they are wearing appropriate PPE.
Every other person in a vehicle carrying a patient or suspected person should be in a PPE.
In any case, those aerosol-generating procedures (AGPs) are needed in Ems transport, ventilation, heating, and air conditioning (HVAC) systems should always run continuously. Any ventilator equipment such as bag valve masks under use should be of high efficiency, and the vehicle’s windows should always be open.
The AHA has issued interim guidance for both CPR and emergency cardiovascular care for COVID-19 patients or suspected infected people. Such recommendations aim to help reduce the risk for transmission of the virus that causes COVID-19.
“Health care providers need to focus on helping people during this challenging time, and the [AHA] is doing everything it can to make it easier.” Said Comilla Sasson, MD, Ph.D., vice president for emergency cardiovascular care science and innovation at the AHA.
The AHA advises that the standards and transmission-based precautions should be keenly observed when caring for patients with suspected or confirmed COVID-19.
Aerosol-generating procedures (AGPs), such as CPR and endotracheal intubation, expose health care service providers to a very considerable risk of disease transmission, and should always be done in AIIRs. All involved health care personnel should also use respiratory protection.
Only health care service providers providing essential services for patient care and procedural support should be present when the medical procedure is occurring. Also, the room should always be clean and disinfected after the process.
All patients with known or suspected COVID-19 should always receive care in separate single-personal rooms. Any Door should stay shut, and AIIRs reservation should be for patients undergoing aerosol-generating treatment procedures.
Any N95 respirators or other respirators that provide a higher level of protection should be used instead of face masks during aerosol-generating procedures.
Health care providers (HCPs) should put on face masks if respirators are not available before getting into the patient’s room or care area. Health care facilities should return to the use of respirators for patients with known or suspected COVID-19 disease when they restore their stock.
Health care activities provide plenty of opportunities for pathogen transfer to both the hands and the clothes of the healthcare service providers.
Whenever the supply of safety gowns is minimal, health care facilities should always receive priority so that they use them in aerosol-generating procedures (AGPs) health care activities. In these activities, sprays and splashes are highly are more likely to occur.
When offering intubation services to a COVID-19 patient, it is always advised to use a rapid sequence of intubation with the necessary PPE. All aerosol-generating procedures (AGPs) health care activities should always be avoided at all costs. These include the use of bag valve masks, nebulizers, and also noninvasive positive-pressure ventilation.
It’s best that you directly go to the endotracheal intubation when an acute respiratory failure occurs in patients. Avoid any use of high-flow nasal oxygenation and mask continuous positive airway pressure (CPAP) or bi-level CPAP procedures. Both techniques come with significant risks of generating aerosols.
During this pandemic, emergency medical dispatchers should always interrogate callers so that they can find out the possibility of a COVID-19 incident. Such an interrogation process should not come before the provision of pre-arrival instructions to the caller whenever any immediate lifesaving interventions are required.
It is also essential to inform prehospital health care service providers of the presence of any suspected COVID-19 patient requiring emergent care.
All EMS clinical practices should be based on recent clinical recommendations and information about COVID-19 from the proper public health care authorities. The AHA concurs with the CDC in approving that AIIRs should be reserved for patients with COVID-19 infection undergoing aerosol-generating procedures (AGPs).
Even with the experienced low supply of PPE; generally, the AHA states that N95 ventilators or their equivalents are necessary for health care providers (HCPs) assisting in aerosol-generating procedures (AGPs). Surgical masks alone are insufficient for this purpose.
As we have seen earlier, gown use priority should always be prioritized for HCPs involved in aerosol-generating procedures (AGPs) or in cases whereby splashes or sprays are likely to occur.
COVID-19 patients with respiratory failure must receive prompt treatment through rapid intubation with appropriate PPE. Always avoid all the respiratory measures that generate aerosols such as bag valve masks, noninvasive positive pressure ventilation, and nebulizers.
Even though it is necessary to employ nasal oxygenation, it is essential to restrict the use of high-flow nasal oxygenation on patients suspected or confirmed to have COVID-19 disease.
It is also vital for medical institutions to ensure that all EMS specialists can practice the standard precautions when dealing with a suspected or COVID-19 confirmed patient. As we all know, hand hygiene, eye protection, face mask, disposable gloves, and gown are critical in protecting the health care providers from Coronavirus infection.
However, when this equipment becomes scarce, then use the gowns when handling a COVID-19 patient comes with a risk of aerosol projection. It applies especially in high-touch situations such as loading a patient to a gurney.
When an emergency occurs, respondents must ensure that they screen the patient and confirm the signs and symptoms related to COVID-19. It will help the EMS health care professionals coming to handle the patient to prepare and come well equipped with the right protective gear on their arrival.
In case one of the HCPs finds out that a patient might be having COVID-19 without carrying any precaution, then, interviews should occur. All interviews should happen while maintaining a social distance of over 6 feet until the patient applies a face mask, which should be as soon as possible.
It is also advised to always equip paramedics with respiratory equipment such as bag valve masks with HEPA filters in case the patients may require a CPR in the field.
When an aerosol-generating procedure (AGP) becomes a necessity in the ambulance, it is recommended that you open the back doors and perform the process away from any crowd. The ambulance HVAC system should be on while you are going on with the procedure.
It is also safer to ensure that family members or any other close contacts do not ride in the same ambulance with the patient suspected to be COVID-19 positive.
As we saw earlier, the ambulance driver should always be completely isolated from the patient. If the vehicle cannot achieve this kind of separation, the outside air vents near the driver should remain open. In such a situation, the rear exhaust ventilation fans should also be running on maximum to create negative pressure airflow.
In a few words:
As recommended by the CDC, not all COVID-19 patients should be put in an AIIR. All aerosol-generating procedures (AGPs) must receive the priority to utilize these rooms.
Hospitals should have specific entire units with devoted health care providers (HCPs) to care for coronavirus patients correctly.
The health care providers in the designated units should always change gloves and gowns when shifting from one patient to dealing with another.
Only the health care service providers providing essential services for patient care and procedural support should be present during the medical procedure. The room must be cleaned and disinfected after the process.
According to the CDC, the providers don’t need to change face masks and eye protection unless they doubt they could be contaminated.
Infection control measures taken against COVID-19 need to be absorbed from the community level via rigorous care in the hospital as well as outside.
It is also advisable that all EMS clinical practices should be based on the recent clinical recommendations and information about COVID-19 from the proper public health care authorities and EMS medical directions.
The AHA concurs with the CDC in approving that AIIRs should be reserved for patients with COVID-19 infection undergoing aerosol-generating procedures (AGPs).
All HCPs performing CPR should exercise all infection prevention recommendations, including appropriate use of PPE, to ensure the safety of the patient and theirs as well.
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