COVID-19 An Overview

APPRECIATION• Dr. Larry Fontanilla,

Thurston County MPD• Thurston County Fire

Agencies

• Dr. Tom Rea, King County MPD

• Dr. Michael Sayre, Medical Director Seattle Fire Department

• Staff at King County Public Health

• Centers for Disease Control and Prevention

OBJECTIVES

• Background• Epidemiology• Patient Screening• PPE• Treatment• Transportation • Decontamination• Exposure

BACKGROUND

• Wuhan City • Population: 11 million• Capital city of Hubei province• City Flower: Plum Blossom

• Hubei Province• Population: 58.5 million• POI: Wudang Mountains, Yellow

Crane Tower, and Hubei University • Hubei = “north of the lake”

ORIGIN STORY

Betacoronaviruses

• SARS-CoV-2 (which causes COVID-19)

• MERS-CoV

• SARS-CoV

Presenter

Presentation Notes

Figure 1. Distribution of Patients with Covid-19 across Mainland China.Shown are the official statistics of all documented, laboratory-confirmed cases of coronavirus disease 2019 (Covid-19) throughout China, according to the National Health Commission as of February 4, 2020. The numerator denotes the number of patients who were included in the study cohort and the denominator denotes the number of laboratory-confirmed cases for each province, autonomous region, or provincial municipality, as reported by the National Health Commission. Many initial patients can be traced back to a large seafood market in Wuhan City, China

Presenter

Presentation Notes

Current travel guidance = https://www.cdc.gov/coronavirus/2019-nCoV/summary.html CDC also recommends that all travelers reconsider cruise ship voyages into or within Asia at this time. Image From the New York Times: https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html

Presenter

Presentation Notes

So, what do the first 70k look like?

Where do we get our information?

EPIDEMIOLOGY

Spectrum of disease (N = 44 415)• Mild: 81% (36 160 cases)

• Severe: 14% (6168 cases)

• Critical: 5% (2087 cases)

Age distribution (N = 44 672)• ≥80 years: 3% (1408 cases)

• 30-79 years: 87% (38 680 cases)

• 20-29 years: 8% (3619 cases)

• 10-19 years: 1% (549 cases)

• <10 years: 1% (416 cases)

Initial Overall CaseFatality Rate = 2.3%

IMPORTANTMORTALITY STATISTIC

<1% mortality in those without comorbidities

CASE FATALITY vs. TRANSMISSION

TRANSMISSION

CLINICAL PRESENTATION

Fever = 83-98%

Dry Cough = 76-82%

Fatigue and myalgias = 11-44%

Other symptoms reported:

HeadacheSore ThroatAbdominal PainDiarrhea

PATIENT IDENTIFICATION (SCREENING)

COVID-19 Identification Algorithm

Clinical Features & Epidemiologic Risk

Fever* and symptoms of lower respiratory illness (e.g., cough, difficulty breathing)*>100.5 °F

AND In the last 14 days before symptom onset, a history of travel outside of the US.

– or –In the last 14 days before symptom onset, contact with a person who is under investigation or confirmed infection for COVID-19.

TCOMM NOTIFICATION

Positive screenings by TCOMM will be notified to providers in the following manner:• The positive screen will be placed in the

MDT feed for the incidentAND• The positive screen will be indicated

over the air via the following phrase:

“CD Precautions Advised”

PPE•Mask•Eyewear•Gloves•Gown

N95 MASKS

Until Otherwise Notified, N95 Masks shall be single patient use under the following conditions:

• The patient has screened positively for potentially having COVID-19

• The patient is presenting with fever or respiratory symptoms, but has screened negative for COVID-19

PATIENT CONTACT AND TRANSPORT FLOW CHART

LIMIT EQUIPMENT • One gurney• One transport unit• Consider necessity of AED, ALS monitor, jump

bags, drug kits, etc.

LIMIT PERSONNEL SEE PDF FLOWCHART FOR PATIENT CONTACT AND TRANSPORT

TREATMENT DOs• Hand a surgical mask to any patient

you suspect of having an infectious disease of respiratory origin

• For those patients you suspect of having COVID-19, administer supportive O2 therapy via NRB mask

• Limit therapies to those that are absolutely necessary

• If advanced interventions are necessary for respiratory support, consider iGel placement if clinically appropriate. Do not withhold life saving interventions when appropriate. Ultimately, use good judgement

HIGH RISK TREATMENTSConsider the risk of aerosol generating procedures such as:

• INTUBATIONS• NON-INVASIVE VENTILATION

(BiPAP®)• SUCTIONING• ADMINISTRATION OF NEBULIZED

MEDICATIONSTHESE ARE CONSIDERED HIGH RISK PROCEDURES

TRANSPORTATION

Only ONEtransporting unit is to be used for

any positively screened

potential COVID-19 patient.

TRANSPORTATION

Run vents/exhaust fans during transportation

Driver should maintain N95 Mask and eyewear

When parked and on scene, open rear doors in the event the patient needs an aerosolizing procedure performed and weather permits

DECONTAMINATION

Products approved for use:

• Cavi Wipes• Stryker Wipes• Cetylcide Spray• Bleach Solutions• Lysol• Other agents

approved for disinfection of “coronaviruses”

NON-TRANSPORTING UNIT

PPE disposal after patient contact

• Proper disposal of PPE• Use alcohol-based hand sanitizer• Change clothing • Wash hands when available

TRANSPORTING UNIT

• Decontaminate surface areas and equipment with approved cleaning agents

• Use alcohol-based hand sanitizer• Change clothing • Wash hands when available

What is an exposure?

How to differentiate

between quarantine

and isolation?

QUARANTINE• Asymptomatic • Lower risk of transmission• “Self-quarantine” at home• Monitor with Thurston County Public Health and Social

Services (TC-PHSS) for symptoms• Report signs and symptoms immediately to TC-PHSS

ISOLATION• Symptomatic

• High risk of transmission • “Self-isolate” at home pending public health investigation • Current guidance from CDC and DOH are that patients must

have 2 negative tests to be removed from isolation

If you are wearing appropriate PPE (N95 mask, eyewear, gloves, and gown), you are not exposed

EXPOSURE

LOW RISK• ≥ 6 feet from the patient

• Gown failure• Glove failure

These do not constitute the need for quarantine

HIGH RISK• ≤ 6 feet from the patient

• Eyewear failure• N95 mask failure

• Broken elastic band that resulted in removal• Involuntary removal within 6 feet of patient

These do constitute the need for quarantine

NOTIFICATION

In the event that appropriate PPE is not worn and a “high risk” exposure is experienced:

Notify patient’s destination hospital that a provider exposure has occurred

Following hospital notification, immediately notify your command

QUARANTINE (PART 1)

The provider will be placed in quarantine until one of the following occurs:

• The hospital will run tests on any pathogens that are able to be identified (i.e. influenzas, pneumonias, other strains of the coronavirus, etc.) – NOT SARS-CoV-2 (COVID-19)…see next slide.

• If any test returns positive, quarantine is no longer warranted

• Provider is authorized to immediately return to work

QUARANTINE (PART 2)

• Thurston County Public Health and Social Services, along with the DOH, will authorize testing of the exposed provider

• If the SARS-CoV-2 (COVID-19) test comes back negative, quarantine is no longer warranted

• Providers that return negative results will immediately be authorized to return to work

• Providers should continue to monitor for signs/symptoms over the next 10 days

QUESTIONS

Command should be contacted for any questions or reports related to exposures

The on-call duty officer with public health can be reached through TCOMM by requesting a callback from the “on-call public health duty officer” – be prepared to provide TCOMM with a callback phone number