Abstract
COVID-19 is the new term describing the clinical disease caused by novel Coronavirus. First described in December 2019 in the Hubei Province of China, COVID-19 has now been identified in 33 countries outside of China, including 4 (Afghanistan, Bahrain, Iraq, and Oman) that have been reported within the last 24 hours of writing.
More than 80,000 confirmed cases of COVID-19 have been identified globally, with the overwhelming majority (77,780) occurring within China. At the time of writing, mortality rates have reached 2,666 in China alone. The Centers for Disease Control (CDC) and other world health agencies are working to respond to this growing threat. Preparing for a global pandemic requires international cooperation to educate and prepare health care organizations, providers, and communities, as well as to develop guidance for health care facilities and workers to care for affected and exposed individuals. In the United States, travel warnings are currently at Level 4, and travel restrictions have been updated to include suspension of entry of foreign nationals who have been in China within the past 14 days, and health monitoring with possible quarantine of up to 14 days upon entry for all U.S. citizens, residents, and immediate family members who have been in Hubei province and other parts of mainland China.
While we continue to learn about COVID-19, the CDC guidance uses information gathered from similar coronaviruses. Person-to-person spread through respiratory droplets is thought to be the primary mode of transmission, although contact with a contaminated surface and subsequently introducing it into your mouth, nose, or eyes may also transmit the virus. While the clinical presentation can vary from asymptomatic infection to fatal illness, fever, cough, fatigue, and shortness of breath are frequently early symptoms. Current reports describe acute respiratory distress syndrome in 17%–29% of hospitalized patients.
The World Health Organization (WHO) defines a “confirmed case” as a person with laboratory confirmation of 2019-nCoV infection, irrespective of clinical signs and symptoms. A “suspect case” is defined as a patient with severe acute respiratory infection (fever, cough, and requiring admission to hospital) and with no other etiology that fully explains the clinical presentation and a history of travel to or residence in China during the 14 days prior to symptom onset. Alternatively, a patient with any acute respiratory illness and one or more of the following during the 14 days prior to symptom onset are considered suspect: contact with a confirmed or probable case of 2019-nCoV infections or who have worked in or attended a health care facility where patients with confirmed or probable 2019-nCoV acute respiratory disease patients were being treated.
COVID-19 Prevention and Control Recommendations During Health Care Delivery (Resource WHO and CDC Web Sites—Accessed February 26, 2020)
Educate yourself and your staff about early recognition, triage, and transmission precautions. Ensure that policies are in place to minimize staff and patient opportunities for exposure to potentially infectious individuals. Use caution when interacting with patients under investigation for COVID-19. Ask these patients to wear a medical mask as soon as they are identified. Provide a separate waiting area for symptomatic patients. Prioritize the care of symptomatic patients. Evaluate and examine suspected or confirmed patients in a private space with the door closed.
Standard precautions should be practiced at all times. Contact and airborne precautions should be implemented and, in confirmed cases, continued until the patient is asymptomatic. This includes eye protection, a medical mask, a long-sleeved gown, and disposable gloves before entering the patient's room. Respiratory protection, such as a N95, is required when performing aerosol-generating procedures.
All patients suspected of COVID-19 should be tested. Hospitalized patients with suspected or confirmed COVID 19 infections should be admitted to an AAIR (single patient room at negative pressure; see https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.htmlfor for additional details). Exposed health care workers should be monitored for early signs of illness.
In addition, Pediatric Allergy, Immunology, and Pulmonology is pleased to introduce a new feature entitled My Corner: Highlighting Important Topics in Allergy, Immunology, and Pulmonology from Around the World. We are honored to have Dr. Nemr Eid serve as the section editor and facilitator for this segment. Dr. Eid is a practicing pediatric pulmonologist and Professor of Pediatrics at the University of Louisville in Louisville, Kentucky. In this section, we encourage our readers to engage with both our authors and our readership about hot topics in our field.