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Coronavirus (COVID 19): Advice for hospital clinicians

Coronavirus (COVID 19): Advice for hospital clinicians
  1. The objective of the Coronavirus (COVID 19) response is to detect all infected people early to contain the infection
  2. Patients present with a spectrum of disease from mild respiratory illness without fever to severe disease 
  3. Test for Coronavirus (COVID 19) in patients with fever and/or respiratory symptoms who have travelled to or transited through mainland China in the 14 days before illness onset
  4. Patients can be discharged in home isolation while awaiting results
Infection can cause severe acute respiratory illness, but there is a spectrum of disease. Some confirmed cases have no history of fever and no fever at presentation, and some have presented with fever without respiratory symptoms.

All returned travellers who departed, or transited through, mainland China from 1 February on wards, should be in self-isolation for 14 days. As for close contacts of a person with confirmed Coronavirus (COVID 19) infection, these returned travellers should remain in self-isolation even if they have tested negative for Coronavirus (COVID 19).

See Home isolation guidance for close contacts and recently returned travellers from mainland China for more information on onward travel.

To contain Coronavirus (COVID 19), it is important to identify cases early by testing people at risk who have symptoms.
The large majority of patients are likely to be infectious only after onset of illness.
Identify possiblecases of Coronavirus (COVID 19):
Test patients who present who meet the current case definition
Isolate and apply infection control precautions to suspected patients:
Contact and droplet precautions are recommended for routine care of patients with suspected or confirmed Coronavirus (COVID 19) infection. This includes long sleeved gown, gloves, (for anticipated contact with patient or surrounds), surgical/procedural mask, protective eye wear/face shield.
On presentation of the patient whether or not respiratory symptoms are present, the patient should immediately be:
Given a surgical mask to put on, and directed to a single room (unless the patient is severely symptomatic in which case use a negative pressure room if available).
If a patient with confirmed Coronavirus (COVID 19) infection needs to be transferred out of their isolation room, the patient should wear a “surgical” face mask and follow respiratory hygiene and cough etiquette.
Aerosol-generating procedures
The potential for airborne spread of Coronavirus (COVID 19) is still unknown, but appropriate care should be taken during aerosol-generating procedures.
Airborne precautions should be used routinely for aerosol-generating procedures. Nebuliser use should be discouraged and alternative administration devices (e.g. spacers) should be used.
Aerosol-generating procedures include: tracheal intubation, non-invasive ventilation, tracheostomy, suctioning, cardiopulmonary resuscitation, manual ventilation before intubation, and bronchoscopy. Collection of respiratory specimens is not generally regarded as aerosol generating, but airborne precautions should be used for collection of specimens from severely symptomatic patients.
P2/N95 respirators should be used only when required. Unless used correctly, i.e. with fit-checking, they are unlikely to protect against airborne pathogen spread.
Airborne precautions may also be required where admitted patients are severely symptomatic, have high frequency/high volume interventions and risk assessed to require these additional precautions.
Testingfor Coronavirus (COVID 19):
For most patients with mild illness in the community, collection of respiratory specimens (i.e. nasopharyngeal or oropharyngeal swabs) is a low risk procedure and can be performed using contact and droplet precautions and the room does not need to be left empty after sample collection.
If the patient has severe symptoms suggestive of pneumonia, e.g. fever and breathing difficulty, or frequent, severe or productive coughing episodes then contact and airborne precautions should be observed.
Patients with these symptoms should be managed in hospital, and sample collection conducted in a negative pressure room, if available. Where negative pressure rooms are not available, a single room with en suite and door closed is advised.
Take two combined nose and throat viral swabs or nasopharyngeal viral swabs; alower respiratory tract sample (if obtainable) -sputum or an endotracheal tube aspirate; and EDTA blood and serum.
Test for alternative causes, including common respiratory viruses using multiplex PCR.
Reporting of suspect and confirmed cases
Notify infection controland the public health unit about confirmed cases and any suspected patients who are sufficiently unwell to warrant hospitalisationon clinical grounds.
Discuss management of confirmed or unstable suspect patients
For confirmed cases and severely unwell suspected cases, discuss management with health professionals.
Suspected cases can be discharge home to self-isolation, if admission is not clinically indicated
Suspected case patients who do not require admission can go home with advice to wear a face mask and isolate themselves at home while awaiting test results.
Where the home environment is not suitable for this, discuss the situation with your local Public Health Unit.
Suspected cases who are contacts of a confirmed case, and who departed, or transited through, mainland China from 1 February on wards, or who have been in Hubei, must stay in home isolation until the end of their 14 day self-isolation period,even if their swab is negative for Coronavirus (COVID 19).
These patients should be advised to seek health care again if they have new or worsening symptoms.

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