COVID-19 Primer: Facts Not Fiction

With the wealth of information from the CDC and other sources, official sources, endlessly repeated, the real information that both the public and healthcare professional need to have, in fact must have, what can be expected, what is expected of them, is forgotten.

This is what we address today, when to seek treatment, what will happen when you do seek treatment and, for medical professionals, the procedures necessary to make a diagnosis, to keep patients safe and to operate with safety and effectiveness.

By now every person that can see, hear or even read knows that the symptoms for COVID-19 are:

• difficulty breathing
• dry cough
• fever

Chances are, if you have these symptoms and you haven’t been exposed, knowingly, to a risk factor, overseas travel, a previously diagnosed patient or been stupid enough to get on an airplane (cigar shaped germ infuser), you probably have a form of the flu.

It is for medical professionals to ascertain this, once you reach the threshold of seeking treatment, something that becomes more frightening every day with hospitals banning visitors and those looking for help afraid they may be shipped off to a military base for quarantine.

This won’t happen and we are here to tell you exactly what will happen, what choices you will have, and for healthcare professionals who don’t have access we give information to set up screening and treatment protocols.

Information for Healthcare Professionals to set up protocols for screening and beginning the treatment for coronovirus:

WARNING:

• If you are asked to put on a mask, you must comply and this includes visitors.
• You will not post anything on social media that puts your facility at risk for HIPPA violation.
• Safeguard boxes of masks.
• Wash hands with soap and water to conserve hand sanitizers.

Emergency Department or Intake Area

• Registration will receive patients and provide a mask while taking information.
• Patient will then be taken to Triage Room (negative pressure/an isolation technique used in medical centers and hospitals to prevent cross-contamination from room to room. This requires ventilation that creates a negative pressure to allow the air to flow into the room but not to leave the room. Scientifically we know that air flows from areas of higher pressure to those of negative pressure, so this prevents contaminated air from escaping the room) and screening questions will be asked by an RN.
• If the patient are not suspected to be potentially COVID-19 positive they will be directed to an area where they will be seated 6 feet away from anyone else (ER waiting area is also negative pressure.)
• If Illness and/or Exposure is suspected from the screening, the patient will immediately put on a mask and moved to negative pressure ER room where they will receive the Rapid Flu Test.
• If the Rapid Flu Test is negative they will move to the next step of ruling out any other possible causes and contact infection prevention for high probability.
• If probability is still high patient will have a Viral Load Test (RPP), with the results taking up to 24 hours. This test must he approved by Infection Prevention or Infectious Disease.

Next Step- Home or Inpatient Decision:

• Now the decision has to be made as to either send patient home with self-quarantine instructions (14 days) OR high probability of virus and also ill, then proceed to inpatient negative pressure room for treatment as if the patient has COVID-19 (even though not yet tested.)

INPATIENT:

• Viral Panel Results are analyzed and if those are highly probable, then COVID-19 test is ordered.
• The COVID-19 test results are expected in 24-48 hours (high volumes can affect results times. An oral-pharyngeal, nasal-pharyngeal, and sputum sample will be obtained.
• These samples are sent to the State Department of Health designated lab and validated with the CDC.

PRECAUTIONS:

• Nurses will wear the Mid-Level Biological PPE or a PAPR hood (high level) with mid-level biological gown.
• Nurses will clean the room per a step by step guide (not environmental staff-to conserve PPE and ensure the primary caregiver knows what surfaces have been cleaned)
• Patient will travel with surgical mask.
• No visitors (unless comfort care final moments.)

Information for potential patient

Just what symptoms will I have that will lead me to seek healthcare?

• Basically, there are three areas of health concern for possible infection with COVID-19.
• Are you ill with an elevated temperature, do you have a cough, are you feeling short of breath?
• The typical additional symptoms that occur with the common cold and the flu, such as runny nose, sneezing, watery eyes, diarrhea, nausea, vomiting are not symptoms of coronavirus (COVID-19.)

That being said, you could have a mixture of viruses but the lung involvement (the beginnings of pneumonia) will be experienced with any shortness of breath. Unexplained shortness of breath i.e. you have not been jogging or physically exerting yourself.  Difficulty breathing, if you do not have an elephant sitting on your chest, is a clear sign that you are not getting enough oxygen and we all know that oxygen is ultimately necessary for life.

If you seek healthcare for difficulty in breathing you will be asked if you have you been traveling in an area that has been affected with COVID-19 (which really can be almost anywhere now with so many countries having positive cases of COVID-19) in the past 14 days? Likely, you have been on an airplane for this travel? Also, have you been in contact with someone who has a confirmed case of COVID-19.  A yes answer to either of these questions makes your current illness suspicious of the possibility of COVID-19. Then, if you also have a cough and are short of breath you are treated as if you have COVID-19 with immediate placement of a facemask and isolation. The person who is questioning you will wear personal protective equipment (PPE) and will alert an Infection Prevention Department which most facilities will have put into operation.

Your temperature will be measured, and notes will be made of whether you have a respiratory illness represented by cough and or shortness of breath. An Infection Prevention Person will collect specimens to test for COVID-19. Most testing will probably be done at a site in the Emergency Department or any area specifically set aside for testing only.

The ways to test for COVID-19 are twofold:

• Either blood testing for antigens of the COVID-19 virus.
• Swabs of nose, mouth, and throat. The swabs may be from the nose (nasopharyngeal (NP) or from the back of the throat (oropharyngeal (OP).
• There may be an attempt to collect aspirates of fluids from the nose and or nasopharyngeal areas of the mouth.

After testing, you will either be sent home with instructions for self-isolation or admitted to the hospital, depending on the severity of your symptoms.

What makes COVID-19 a virus that bears close watching, especially if you have symptoms of the virus or the actual virus itself?

• There are clusters of COVID-19 on continents other than North America.
• There is an increased number of suspected and actual cases spreading into states across the U.S.
• There is an unusually high mortality (death or death producing) rate among these numbers of COVID-19 cases
• As a state develops positive cases of COVID-19, that state will implement procedures to try to contain the virus.

What are the differences and similarities between symptoms for COVID-19 and the flu?

• Both viruses may cause an elevated temperature and dry cough but COVID-19 produces more cases of difficulty in breathing and shortness of breath, which is the key sign to seek medical help.
• The regular influenza will come on very quickly (1 or 2 days) and produce fatigue, chills, headaches, which are less common with COVID-19. COVID-19 symptoms take longer to appear and do not generally include sneezing and a runny nose.

Other difference between COVID-19 and influenza are;

• That COVID-19 is far more infectious as it affects more people than the regular flu.
• The flu sometimes kills young and relatively health people as well as pregnant women.
• COVID-19 seems to be deadlier than any of the pandemic flus during the 50s and 60s.
• While COVID-19 is not as deadly as the Spanish flu, older individuals with serious heart and lung conditions as well as cancer, immunosuppressive diseases, and diabetes are a high risk.

Deaths due to COVID-19 are due to acute respiratory distress syndrome (ARDS) which makes breathing impossible by filling the lungs with fluid (pneumonia.) No drugs are available to treat COVID-19 and if breathing becomes more compromised the person will need to be placed onto a ventilator to support breathing while the body heals.

The human population has no immunity to COVID-19 because this is a first-time seen virus, a novel virus. Since humans have not been subjected to this virus in the past, there is no chance that there will be a natural immunity that help us to fight COVID-19 with our own body’s defenses.

Children are not becoming very ill when they get COVID-19 and seem to only contract it from family members who have tested positive.  Children are dying from influenza. Closing schools may be a measure that is too strong since children do not seem to be the breeding ground for this virus.  That being said, the teachers and administrators at schools are adults and thus they are susceptible to the virus.

On the positive side, people who become infected with COVID-19 and do not have underlying health conditions that have already compromised their immune systems and body organs systems, are not all succumbing to the virus. Not by a long shot!  About 80 to 90% of those who are infected with COVID-19 (novel coronavirus) have only moderate symptoms and many have no symptoms at all, which is the reason why this virus is so readily spread since the person does not realize he or she is ill for as long as 14 days.  Good prospect for the person who is ill with COVID-19 but bad news for how it will spread.

Take away the above facts about our current American and world-wide medical situation and realize that man and womankind are not doomed to be wiped off the face of the earth.  Currently we are more at risk from misinformation that would have us panic and turn on each other.  This misinformation, that would cause us to second guess are abilities to take care of our families, friends, and ourselves as we remain cognizant of the importance of remaining calm and focused on what is happening around us, must be ignored.

We have had anti-science thrust upon us with the current administration and those put in “charge” of our well-being. We have had anti-vaxing conspiracies thrown in our faces, stoking buttons of fear in those who cannot think for themselves. We have had most of what Obama accomplished removed, including Obamacare that sought to make sure everyone in America had access to affordable healthcare. Budgets for health programs and agencies were axed. Trump and his administration have pulled the plug on scientific and diplomatic work with other nations. The world is facing a huge hit to its global economy.  When the outbreak of COVID-19 has receded, and it will, businesses will be lost and some will remain. Certainly, businesses will have to adjust their health/illness restrictions to keep their employees safe and still working. With schools closing for three weeks basic childcare for the working parent will be lost and children who rely on the school lunch as their only “complete” meal of the day will be hungrier.  If  this global pandemic started as a way to hurt mankind for the benefit of whoever thought this up, we can wish that those will be found out and dealt with.  This may be simply a virus that just became too successful as it hijacks human cells to reproduce itself. Biggest question of all, is this a cover-up to keep us off of our game? If so, what is being hidden from us?

In the meantime, wash those hands with soap and water, especially since the hand sanitizer shelves are empty, keep your hands away from your eyes, nose, mouth, and face in general, stay home if you are ill, stay away from others who are ill, stay at home as much as possible, do not go into large groups, and above all help anyone who is truly struggling at this time. We will not lose our humanity despite the cause for our present condition…..Carol

Carol Duff, MSN, BA, RN

Carol graduated from Riverside White Cross School of Nursing in Columbus, Ohio and received her diploma as a registered nurse. She attended Bowling Green State University where she received a Bachelor of Arts Degree in History and Literature. She attended the University of Toledo, College of Nursing, and received a Master’s of Nursing Science Degree as an Educator.

She has traveled extensively, is a photographer, and writes on medical issues. Carol has three children RJ, Katherine, and Stephen – one daughter-in-law; Katie – two granddaughters; Isabella Marianna and Zoe Olivia – and one grandson, Alexander Paul. She also shares her life with her husband Gordon Duff, many cats, and two rescues.

• Carol’s Archives 2009-2013