COVID-19: Safety/Advocacy Tools

January 28, 2020
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As the Coronavirus Pandemic continues to unfold, NYSNA’s Health and Safety team will provide periodic updates to deliver the news that nurses need to know.

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Resources

Updated 2019-nCoV information

3/17/2020

Safe nurses, safe communities: the union approach to managing the COVID-19 crisis

3/15/2020

COVID-19 UPDATE, MARCH 15: School Closures/Survey

3/10/2020 Update:

Release: Nurses Issue Call for Help in the Public Health Battle Against Coronavirus

2/24/2020 Update:

As the newly identified coronavirus (COVID-19) enters its 3rd month, cases both in China and throughout the world continue to rise. Here's what we know so far:
  • Infected persons can have symptoms ranging from none to mild to severe.
  • 80% of those who have died are aged >60 years, and 75% have underlying health conditions.
  • Approximately two-thirds of those confirmed to have COVID-19 are men.
  • Although children can be infected by COVID-19, most do not develop severe symptoms.
  • The COVID-19 mortality rate is estimated to be 2% (higher than seasonal flu but far lower than SARS). However, because so many people who have been infected have no, or mild, symptoms, they have not been tested. Therefore, the mortality rate is likely to be lower than 2%.
  • There have been over 50 confirmed COVID-19 cases in the U.S.  This number is expected to rise quickly. Only 1 U.S. citizen has died; however, he was living in China.
  • All people entering the U.S. from China are now screened by the CDC at U.S. airports currently approved to accept flights from China. Those with symptoms are taken to the hospital for further testing. Those without symptoms are placed in a 14-day quarantine.
  • The currently accepted incubation period remains 2-14 days. However, there have been a number of cases where the incubation period was longer than 14 days.
  • There currently has been no community-acquired infection of COVID-19. The only people who have been infected who had not traveled to China (or been on one of the cruise ships where COVID-19 was present) were 2 spouses of patients infected in China. The spouses had close, prolonged contact with infected persons who had become infected in China and had then traveled home. 
  • Many healthcare workers treating patients infected with COVID-19 have become infected themselves. Some have died. Some patients both within China and in other countries became infected in the hospital while being treated for other medical conditions. The risk of nosocomial infection remains high at this time.

Healthcare facilities must take the following steps to protect both patients and healthcare staff from COVID-19 infection:
  • ​Conduct a hazard assessment for ALL hospital staff, no matter what the job title, that includes job responsibilities and proximity to patients who have confirmed, or are under investigations for, COVID-19.
  • Conduct training for ALL hospital staff, not just healthcare staff, on COVID-19 including identification, symptoms, modes of transmission, incubation period and protective measures determined by the hazard assessment.
  • Make sure there is an adequate supply of surgical masks for suspected or confirmed cases of COVID-19 patients. (Note: surgical masks do not protect the wearer. For protection from exposure, a respirator and other PPE is required.)
  • Make sure there is an adequate supply of PPE (gloves, gowns, goggle or face shields, N95 respirators or powered air-purifying respirators [PAPRs]) for all those determined by the hazard assessment to need them. 
  • Make sure there are designated negative pressure rooms both in the ED and on designated in-patient units for PUIs (Persons Under Investigation) or confirmed cases of COVID-19.
  • Make sure negative pressure rooms are checked on a daily basis to confirm that adequate negative pressure is maintained.
  • Make sure there is adequate RN staffing to conduct pre-registration identification of COVID-19 PUIs and confirmed cases.
  • Make sure there is adequate in-patient staffing for units designated to treat or investigate COVID-19 PUIs and confirmed cases. The CDC recommends assigning staff from each shift to care for these patients alone in order to help prevent nosocomial infection of other patients.
  • Make sure there is adequate staffing to allow additional staff to help staff assigned to the patient to assist with PPE donning/doffing as well as an observer (as was done for Ebola).
  • Make sure there are protocols in place to mask family and other visitors who enter the hospital with the COVID-19 PUI or confirmed case.

2/5/2020 Update:

After holding steady for several days, the number of confirmed 2019-nCoV patients in the U.S. has increased from 11 to 12 today. A patient in Wisconsin was diagnosed today. According to the CDC, all patients are doing well.

Potential Cases in New York State

Of the 3 persons under investigation (PUIs) for 2019-nCov in NYC, 1 (Bellevue) has tested negative. We are awaiting the test results for the other 2.

Testing and Response in the U.S.

As of 2/5/2020, the total number of people nationwide who have tested positive for nCov is 12, 206 have tested negative, and test results are pending for 76. These numbers are updated by the CDC several times per week.

2019-nCov testing will now be allowed in all qualified public health labs, significantly speeding up the time between specimen collection and confirmation of nCoV status.

Travel and Quarantine

2 evacuation flights from Wuhan have landed in the U.S. today, and 2 more will be landing tomorrow. Planes will be landing in San Francisco, San Diego, San Antonio and Nebraska. All passengers will be held under government quarantine for 14 days.

Passengers returning to the U.S. from China (other than Wuhan) are assessed by the CDC at airports upon entry and are in home quarantine for 14 days. The CDC works with local and state departments of health to conduct daily monitoring and assess monitoring plans for each individual on home quarantine.

Morbidity and Mortality

China, where all but 2 of the nCoV related deaths have occurred, reports that the mortality rate appears to be holding steady at 2%. Of those who have died, 80% were over the age of 60 and 75% had underlying health conditions. Two-thirds of those who have died are men. At this time it seems that children who are infected are unlikely to have serious symptoms. The incubation period continues to be considered 2-14 days.

Public Health Response

The CDC and the Office of the Assistant Secretary for Preparedness and Response (ASPR) have been working on building the national stockpile of PPE, particularly for healthcare workers. Their focus is not just on the current outbreak of coronavirus, but also any future pandemic situations.

Although nCoV cases in the U.S. have been limited, the CDC is preparing for a much larger outbreak. This is a far better response than we saw with SARS and Ebola. And there is a faster, better response to healthcare worker safety than in other outbreaks.

NYSNA continues to work to make sure all of our members are properly protected. If you have concerns regarding your facility's preparedness to handle 2019-nCoV cases, please contact your NYSNA rep, LBU leadership, or the NYSNA Health & Safety representatives.

2/2/2020 Update:

U.S. declares public health emergency

Non-U.S. citizens who have been to China within the past 14 days are barred from entry to the U.S.

U.S. citizens who have been in Hubei Province within the past 14 days are subject to a mandatory 14 day quarantine. Those U.S. citizens who have been in China (outside of Hubei) within the past 14 days are subject to a 14 day self-quarantine.

Still awaiting test results from possible nCoV case in NYC

1st death from nCoV outside China -- in the Philippines.
Spread of the disease has not yet peaked.

1/31/2020 Update:

An additional case of 2019-nCoV confirmed in the U.S.

The spouse of someone with a confirmed case of 2019-nCoV has contracted the illness. The initial patient had traveled from Wuhan, China to her home in Chicago, IL. Her husband and other close contacts were being monitored for symptoms, and her husband, who had not been to China, became symptomatic. His case is now confirmed. The first patient is recovering. It is not yet known the severity of illness in her spouse.

While this is the first time person-to-person transmission has occurred in the U.S., the risk of "community transmission" is still low as the 2nd patient had sustained, prolonged, close contact with the initial patient.

As of this time no one outside of China has died of the disease.

There are currently approximately 10,000 people with confirmed 2019-nCoV infections. The vast majority of these cases are in China. The actual number is likely to be far higher as, due to a short of testing kits in China, only those with severe symptoms are being tested. The mortality rate is currently considered to be approximately 2%. However, it may be considerably lower as most infected persons with mild symptoms are not being captured in the current data. For comparison purposes, the mortality rate for the 2003 SARS outbreak was approximately 15% (and higher for older patients).

WHO declares global health emergency

The World Health Organization today declared a 2019-nCoV global health emergency. This should help in developing a coordinated, global response to the epidemic.

New York State

New York State has had 11 persons under investigation (PUI) so far. 7 of those have tested negative for 2019-nCoV, and the state is awaiting test results for the other 4. To date there have been no confirmed cases in the state.

New Jersey

To date there have been no PUIs or confirmed cases in NJ.

1/29/2020 Update:

The latest scientific information

The source of the virus has still not been confirmed. The full extent of the spread is still unknown partly due to a shortage of testing kits in China (patients with less severe symptoms are not always tested in order to save test kits for patients with more severe symptoms). The World Health Organization believes approximately 20% of infected persons are experiencing severe illness. The rest are experiencing milder symptoms.

Current cases worldwide

There are currently approximately 6,000 confirmed cases of 2019-nCoV worldwide, with the vast majority of cases in China. So far, the countries with confirmed cases include:

Australia
Cambodia
Canada
China/Hong Kong
France
Germany
Japan
Macau
Malaysia
Nepal
Singapore
South Korea
Sri Lanka
Taiwan
Thailand
United States
Vietnam

CDC screening at U.S. airports expanded

All flights from China to the U.S. will have passenger screening for 2019-nCoV at the following U.S. airports:

JFK
Newark
Philadelphia
Boston Logan
LAX
San Francisco
Chicago O'Hare
Atlanta
Houston
Dallas/Ft. Worth
El Paso
San Diego
Seattle/Tacoma
Honolulu
Anchorage
Minneapolis-St. Paul
Detroit
Miami
Washington Dulles
San Juan

Other travel information

The CDC's travel recommendation has been raised to a level 3 (no unnecessary travel to China).

Several airlines are beginning to cancel flights to/from China due to a large drop in demand.

New York/New Jersey region

There continue to be no confirmed cases on 2019-nCoV in the NY/NJ region.

1/27/2020 Update:

United States

To date there have been 5 confirmed cases of 2019-nCoV in the U.S. – 2 in CA, 1 in WA, 1 in Arizona and 1 in IL. As of 1/27/2020 there are 26 states that have had patients under investigation (PUI) for 2019-nCoV. Nationwide 5 persons have tested positive for 2019-nCoV, 32 have tested negative, and 73 are pending test results. Specimens from PUIs (unless they are ruled out for possible exposure) are sent by the states to the U.S. Centers for Disease Control (CDC) for testing. Testing to determine if someone is positive or negative for 2019-nCoV takes 6 hours. Genome sequencing to determine if there have been any genetic mutations takes longer. Genetic mutation can mean, among other things, that there is a change in how the disease is transmitted or the severity of the disease. At this time there has been no evidence of genetic mutation since the first case was identified in the U.S. a few days ago.

So far all patients with confirmed 2910-nCoV in the U.S. had traveled to Wuhan within the last few weeks.

New York State

In New York State there have been a total of 9 PUIs. The state is currently waiting for CDC testing results for 5 of those cases. At this time there a no confirmed cases of 2019-nCoV in New York State.

Currently JFK is the only airport in the NY/NJ region that is screening for 2019-nCoV. However, the CDC is expected to announce changes in travel recommendations in the next day or so. That may include changes in airport screening.

How to protect yourself

The CDC recommends that healthcare workers coming within 6 ft. of patients who may have 2019-nCoV take the following precautions:

1. Immediately place a surgical mask on the patient and remove to an isolation room
2. Wear PPE including:

    • gloves
    • gown
    • face protection (either face shield for goggles)
    • N95 respirator

3. Wash hands with warm water and soap frequently
4. Avoid touching mouth, nose and eyes with unwashed hands

Healthcare facilities should be educating healthcare staff on 2019-nCoV, putting in place triage procedures for fast identification of patients with travel history to China and symptoms of 2019-nCoV (fever, lower respiratory symptoms including cough and/or shortness of breath, and/or sore throat), making sure enough PPE is available and making sure enough space is available to quickly isolate patients who may have 2019-nCoV.

Hospitals are likely to be dealing with patient surges at this time due to influenza. An influx of additional patients due to confirmed or suspected 2019-nCoV could push healthcare facilities (and especially emergency departments) well past capacity. Click HERE for more information on managing flu surge.

Contact the NYSNA Occupational Health & Safety Representatives at healthandsafety@nysna.org.

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