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Don’t panic, but prepare: What you need to know now about the novel coronavirus

EMS providers may find themselves face to face with this new and highly infectious virus – here’s how to protect yourself and the patients you transport


Sponsored by Medline
 

By Laura Neitzel, EMS1 BrandFocus Staff

The term “pandemic” demands attention and rightfully strikes fear in the hearts of the public. The mere prospect of a potentially lethal, fast-multiplying virus being transmitted from one continent to another in a matter of days can cause global panic in a world interconnected by numerous modes of transportation and 24/7 news.

Illustration of the 2019-nCoV viewed through an electron microscope. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion. (image/CDC)
Illustration of the 2019-nCoV viewed through an electron microscope. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion. (image/CDC)

Although as of this writing the World Health Organization has not yet declared a pandemic, there is concern over the newest viral threat recently discovered in China. The novel coronavirus (2019-nCoV) is one in a family of viruses that can cause acute respiratory distress. Although little is yet known about nCoV, it is related to the SARS and MERS viruses that swept through Asia and the Middle East in 2003 and 2012. The nCoV strain has infected over 40,000 people since it was first reported on December 31, 2019, and the number of people infected grows daily.

As a newly discovered virus about which little is known, there is no vaccine to prevent it and no known medical treatment to control it. Emergency evacuations, travel restrictions, quarantine and other large-scale precautions are being taken to prevent the spread of nCoV from one country to the next, but the reality is that no one knows where it may spread next or when.

Treating symptoms in those infected and preventing the spread of the disease is critical to helping keep illnesses and fatalities to a minimum. This is where EMS providers may find themselves serving as the front lines of defense.

EMS1 spoke with Rosie D. Lyles, MD, MHA, MSc, current director of clinical affairs for Medline, about what EMS providers need to know to protect themselves and their patients.

First, what is 2019-nCov?

2019-nCov is a new respiratory virus, from a large family of envelope viruses called Coronaviruses; some causing illness in people and other circulate among animals, including camels, cats and bats. When we [public health] first heard about it, we were under the impression that it originally transmitted from animals to humans at an animal and seafood market in Wuhan, China. But we’re learning now that it can be transmitted person to person because the growing number of patients who have not had exposure to animal markets were positive for the virus.

What are the signs and symptoms?

The nCoV virus is very similar to influenza in that you would see someone with fever and cough; however respiratory distress (shortness of breath) is an additional symptom. We do know there are certain patients who have a higher risk factor, such as those with underlining health conditions. Very elderly patients, as well as younger patients, are very susceptible to the virus, much as they would be to influenza (the flu).

When do symptoms present?

This is a very contagious virus that has, as far as we can tell, a wide range of incubation period. Someone could be exposed to the virus but not show any signs and symptoms until two to 14 days later. That is part of the reason there is such a concern about people traveling from country to country. They may be exposed to it, but do not show any signs and symptoms until a week or two later.

If the signs and symptoms are similar to other viruses, like influenza, how can an EMS provider distinguish a possible nCoV infection from the flu?

I think EMS can ask the right questions about patient’s symptoms like, “Do you have a fever, cough, shortness of breath/difficulty breathing?” Also ask the next two critical questions, “Have you traveled to mainland China within 14 days of symptom onset? Or, have you been in close physical contact with a person confirmed with 2019-nCoV infection?” If they say yes, the EMS provider should provide the patient with a facemask and continue with their preventive actions.

How concerned should an EMS provider be about nCoV?

I think they should be concerned about all pathogens (i.e. MRSA, C.diff, flu and nCoV) because they can cause mild to severe illness and in some cases death, unfortunately. We need to practice everyday preventive actions and infection control strategies to prevent the spread of these pathogens.

From a clinician standpoint, we have to put this virus into perspective. We are in flu and respiratory disease (i.e. respiratory syncytial virus) season right now, and these viruses cause millions of medical visits that ultimately lead to hospitalization. However, the flu kills several thousands of patients just in the U.S. each year. Nevertheless, we are taking aggressive measures to prevent the spread of nCoV in the U.S.

As EMS personnel, your job is not only to treat an illness and injuries that require an urgent medical response, but also to act as if you are an out-of-hospital emergency room. EMS professionals should take precautions to protect themselves, the patient and their environment (the vehicle). They should have awareness of the latest information from their public health department and CDC, ask the right questions from patients (signs and symptoms) and continue to practice everyday preventive actions (good hand hygiene, cleaning and disinfecting their environment).

How should an EMS provider protect themselves and their patients from exposure to the virus?

Since it's still so early and we're still learning more information day by day, we should follow the standard precautions that the CDC recommends for healthcare providers: To wear personal protective equipment (gloves, respiratory protection masks and eye protection). In addition, EMS should place a facemask on suspect patients who have those signs and symptoms.

What we do know is that coronavirus itself can last on dry surfaces for about three hours, compared to influenza virus, for example, that can last from 24 to 48 hours. A recent analysis of 22 studies indicates that other strains of human coronaviruses like SARS, which is very similar to what we are currently dealing with, can persist on inanimate surfaces like metal, glass or plastic for up to nine days.

EMS providers should be sure to keep their environment clean, just on a regular basis, because you just never know if this could be influenza, the coronavirus, or it could be MRSA ─ it could be any type of pathogen. So they should just be more vigilant to make sure they're implementing regular infection control strategies to prevent the spread of any type of pathogen.

What should EMS providers keep top of mind?

We have to make sure that everyone knows they play a vital role in preventing infection and the spread of nCoV and other infectious pathogens like the flu. There is no vaccine to prevent the nCoV and we have to be proactive and consistent with optimal daily preventive actions to prevent this respiratory virus:

  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces.

To learn more about nCoV, watch this video from the CDC:

 

To learn about specific recommendations for 911 PSAPs, EMS clinicians and medical first responders, read the latest guidance from the CDC.

To learn about infection control procedures for emerging pathogens, watch this video from Medline.

 

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