Since our last article, the novel Coronavirus has gotten a new name (COVID-19) and has come to the east coast. As of March 7, 2020, there have been 164 confirmed cases in the U.S. of COVID-19 with 11 deaths, and 44 confirmed cases in New York.
Internationally, the mortality level from COVID-19 is around 3.5 percent and over 80 percent of cases (approximately 80,000) have been found in China. While it was inevitable that COVID-19 would come to the U.S., the huge jump in cases noted in the past week seems concerning. The increase occurred for a few reasons. For starters, as with any respiratory communicable illness, the rate of transmission increases in a local area due to its spread in the air via respiratory droplets and saliva (air in close proximity to an infected person only), physical contact, and contact with a contaminated object or surface.
Another reason for the sudden surge is in mid-February, the CDC sent state health agencies faulty COVID-19 diagnostic test kits. Essentially, when these diagnostic kits were tested in state labs prior to being approved for patient use, they were giving unreliable results. As a result, those kits could not be used and all tests had to be shipped to the CDC lab to be run. A patient had to have a high suspicion for COVID-19 in order to indicate testing was necessary, as diagnostic kits were limited. However, in the past week, the CDC has procured enough testing kits to test more than 75,000 people. This has lowered the threshold for testing people with respiratory symptoms, and can be an explanation for the sudden increase in COVID-19 prevalence in the U.S. As of Wednesday, anyone who requests to be tested for COVID-19 can be tested, as long as a physician or an APP agree.
Tests are still limited so it’s up to the provider’s discretion of who should be tested. We also cannot forget we’re in the midst of flu season. The flu has a similar clinical presentation, so there is no quick way to discern who should be tested. This has proven to become even more difficult now with community transmission cases being reported.
As a nurse practitioner who works with an immunocompromised population, I became curious how a clinician can refer a patient to be tested for COVID-19. Fortunately, at my institution, no patient or employee has been deemed high-risk or concerning for COVID-19 yet, but it is pertinent to know in case the scenario arises. If a patient presented with respiratory symptoms, such as difficulty breathing, cough, or an increase in secretions, I would first test for influenza and other common respiratory viruses, which include other strains of the coronavirus. This test is done by taking a swab of nasal and oral secretions. Hospitals or clinics with labs can test for these common virus strains and the turnaround time is quite fast. If the respiratory viral panel were negative and I was concerned for COVID-19, I would have to call the local health department where the patient resides and speak to a health officer about the case. Then I would send another respiratory swab of the nose and mouth and sputum to a local health department lab to be tested. In the interim, the patient would have to remain in isolation in a private room with the door closed. All healthcare providers would have to enter the room wearing respirators, an eye shield, disposable gowns, and gloves. Now that these swabs do not have to be sent to the CDC lab, the diagnostic waiting time has been cut back, but it still takes much longer than being able to test on site.
On Thursday, Congress approved a total of $8.3 billion for emergency aid. The assistance would increase the production of test kits, source protective equipment for healthcare personnel, and fund agencies to help quarantine and diagnose in the community. In addition, the Food and Drug Administration (FDA) has expanded its Emergency Use Authorization policy so efficient labs can create their own tests off the CDC’s model. This will hopefully lead to an increased ease in testing for COVID-19 and the ability to test on site, i.e. in a hospital or at a clinic as commercial labs scramble to create their own diagnostic tests.
It is important to note that COVID-19 is not a pandemic. Yes, it is prudent to be aware of how and where COVID-19 is spreading, but it is important to keep the threat in perspective and prevent unnecessary panic. The flu is more prevalent than COVID-19 and is around every winter season. The flu does not cause the average person to go into a panic and hoard facemasks and hand sanitizer, so neither should the novel coronavirus. COVID-19 is a short-term virus and most cases are mild. Those who are most at risk for poor outcomes are the elderly, the immunocompromised, and those with baseline respiratory illnesses. The concern of preventing spread is mainly in their interest.
That should not downplay the significance of the virus and its potential spread. We all need to be prudent if measured in preventing the situation from getting worse. But we should also keep perspective while taking the most responsible actions we can on a personal level. Ultimately, it comes down to each of us keeping a few simple preventative measures front of mind. Wash your hands, take your multivitamins, and just follow the CDC recommendations. If you do, you’re taking a big step in the right direction.
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