≥90% of participants will know how to prevent, identify and treat COVID-19.
≥90% of participants will know how to prevent, identify and treat COVID-19.
After completing this continuing education course, the participant will be able to meet the following objectives:
Cases of Coronavirus Disease (COVID-19) in the U.S. is updated daily at 4 PM and found here. The Center for Disease Control (CDC) is closely monitoring the outbreak of the novel (new) coronavirus first discovered in China. Current quarantines will not be enough to stop the spread.1 The unknown nature of the virus implies that it is only a matter of time before the virus becomes established in the U.S.
On 1/31/20, President Trump signed a proclamation to suspend entry to those persons who pose a risk of transmitting the 2019 novel coronavirus.2 At this time, that is defined as people who were physically present within the People’s Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States. In addition, medical screening and quarantine may be implemented.
The following are the most recent recommended testing for individuals with signs or symptoms consistent with COVID-193:
Recommended testing for asymptomatic individuals with known or suspected exposure to SARS-CoV-2 to control transmission3:
Testing is recommended for all close contacts of persons with SARS-CoV-2 infection. Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.
In some settings, broader testing, beyond close contacts, is recommended as a part of a strategy to control transmission of SARS-CoV-2. This includes high-risk settings that have potential for rapid and widespread dissemination of SARS-CoV-2 or in which populations at risk for severe disease could become exposed. Expanded testing might include testing of individuals on the same unit or shift as someone with SARS-CoV-2 infection, or even testing all individuals within a shared setting (e.g., facility-wide testing).
Health care professionals (HCP) should obtain a detailed travel history for patients being evaluated with fever, and acute respiratory illness.4 CDC reasons that symptoms may appear between 2 and 14 days after exposure.5 In confirmed COVID-19 infections, symptoms range from mild to death. Symptoms can include5:
This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.
Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately5:
Symptoms differ with severity of the disease. For example, fever, cough, and shortness of breath are more commonly reported among people who are hospitalized with COVID-19 than among those with milder disease (non-hospitalized patients). Atypical presentations occur often, and older adults and persons with medical comorbidities may have delayed presentation of fever and respiratory symptoms. In one study of 1,099 hospitalized patients, fever was present in only 44% at hospital admission but eventually developed in 89% during hospitalization. Fatigue, headache, and muscle aches (myalgia) are among the most commonly reported symptoms in people who are not hospitalized, and sore throat and nasal congestion or runny nose (rhinorrhea) also may be prominent symptoms. Many people with COVID-19 experience gastrointestinal symptoms such as nausea, vomiting or diarrhea, sometimes prior to developing fever and lower respiratory tract signs and symptoms. Loss of smell (anosmia) or taste (ageusia) preceding the onset of respiratory symptoms have been commonly reported in COVID-19 especially among women and young or middle-aged patients who do not require hospitalization. While many of the symptoms of COVID-19 are common to other respiratory or viral illnesses, anosmia appears to be more specific to COVID-19.6
The illness severity can range from mild to critical6:
Lymphopenia is the most common laboratory finding in COVID-19 and is found in as many as 83% of hospitalized patients. Lymphopenia, neutrophilia, elevated serum alanine aminotransferase and aspartate aminotransferase levels, elevated lactate dehydrogenase, high CRP, and high ferritin levels may be associated with greater illness severity. Elevated D-dimer and lymphopenia have been associated with mortality. Procalcitonin is typically normal on admission but may increase among those admitted to an ICU. Patients with critical illness had high plasma levels of inflammatory markers, suggesting potential immune dysregulation.6
Chest radiographs of patients with COVID-19 typically demonstrate bilateral air-space consolidation, though patients may have unremarkable chest radiographs early in the disease. Chest CT images from patients with COVID-19 typically demonstrate bilateral, peripheral ground-glass opacities. Because this chest CT imaging pattern is non-specific and overlaps with other infections, the diagnostic value of chest CT imaging for COVID-19 may be low and dependent upon radiographic interpretation.
The virus is thought to spread mainly from person-to-person.
How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious, like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, which means it goes from person-to-person without stopping.
The virus that causes COVID-19 is spreading very easily and sustainably between people. Information from the ongoing COVID-19 pandemic suggests that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious. In general, the more closely a person interacts with others, and the longer that interaction, the higher the risk of COVID-19 spread.
It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about how this virus spreads.
Spread between animals and people
There is no vaccine to prevent COVID-19. The best way to prevent infection is to avoid exposure to this virus. The CDC always recommends everyday preventive actions to help prevent the spread of respiratory viruses, including5:
Treatment guidelines are evolving so quickly, that CDC is maintaining an electronic guideline available at www.covid19treatmentguidelines.nih.gov/. As of August 18, 2020, below are the treatment guidelines recommended by CDC.9
Major revisions to the Guidelines within the last month are as follows:
July 30, 2020
The recommendations in this section have been updated to allow the use of alternative corticosteroids (i.e., hydrocortisone, methylprednisolone, prednisone) in situations where dexamethasone may not be available. In addition, the results of the RECOVERY trial were updated based on data reported in a recently published paper.
General Considerations (Care of Critically Ill Patients with COVID-19)
The Goals of Care subsection has been expanded to include information on advance care planning, with emphasis on the importance of identifying surrogate decision-makers for critically ill patients with COVID-19.
July 24, 2020
Key Updates to the Guidelines
The recommendations for using remdesivir to treat COVID-19 have been revised to account for the patient’s supplemental oxygen requirements and the mode of oxygen delivery. In this revision, patients who require supplemental oxygen are divided into two groups:
Previously, the COVID-19 Treatment Guidelines Panel (the Panel) recommended using remdesivir for patients who were on high-flow oxygen, mechanical ventilation, or ECMO. This recommendation has been revised due to uncertainty regarding whether starting remdesivir confers clinical benefit in these patients.
The revised recommendations are as follows:
July 17, 2020
Key Updates to the Guidelines
In situations where remdesivir supplies are limited, the Panel recommends prioritizing remdesivir for use in hospitalized patients with COVID-19 who require supplemental oxygen but who are not mechanically ventilated or on extracorporeal membrane oxygenation (BI). The overall recommendations for the use of remdesivir are being revised and will be updated soon.
Corticosteroids (Including Dexamethasone)
The Corticosteroids (Including Dexamethasone) section is a new subsection of Immunomodulators Under Evaluation for Treatment of COVID-19. This new section is based on the Recommendations for Dexamethasone in Patients with COVID-19 section that was released on June 25, 2020. The Panel continues to recommend the use of dexamethasone in patients who are mechanically ventilated (AI) and in patients who require supplemental oxygen but who are not mechanically ventilated (BI). The new Corticosteroids (Including Dexamethasone) section also discusses the clinical data on the use of other corticosteroids in patients with COVID-19, the potential adverse effects of corticosteroids, other considerations when using corticosteroids, and recommendations for the use of dexamethasone in pregnant patients.
New Sections of the Guidelines
Other Updates to the Guidelines
Ensure facility policies and practices are in place to minimize exposures to respiratory pathogens, including COVID-19. Measures should be implemented before patient arrival, upon arrival, and throughout the duration of the affected patient’s presence in the healthcare setting.
Instruct patients and persons who accompany them to call ahead or inform HCP upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever) and to take appropriate preventive actions (e.g., wear a facemask upon entry to contain cough, follow triage procedures).7
Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% ABHS, tissues, no-touch receptacles for disposal, and facemasks at healthcare facility entrances, waiting rooms, patient check-ins, etc.7 Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use facemasks or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.
Ensure that patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) are not allowed to wait among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies.7
Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough).7 Implement respiratory hygiene and cough etiquette (i.e., placing a facemask over the patient’s nose and mouth if that has not already been done) and isolate a PUI for COVID-19 in an Airborne Infection Isolation Room (AIIR), if available.
Inform infection prevention and control services, local and state public health authorities and other healthcare facility staff as appropriate about the presence of a person under investigation for COVID-19.
Place a patient with known or suspected COVID-19 in an AIIR that has been constructed and maintained in accordance with current guidelines.7 AIIRs are single-patient rooms at negative pressure relative to the surrounding areas and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation). Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter before recirculation. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized. Facilities should monitor and document the proper negative-pressure function of these rooms.
If an AIIR is not available, patients who require hospitalization should be transferred as soon as is feasible to a facility where an AIIR is available.7 If the patient does not require hospitalization they can be discharged to home (in consultation with state or local public health authorities) if deemed medically and socially appropriate. Pending transfer or discharge, place a facemask on the patient and isolate him/her in an examination room with the door closed.7 Ideally, the patient should not be placed in any room where room exhaust is recirculated within the building without HEPA filtration.
Once in an AIIR, the patient’s facemask may be removed. Limit transport and movement of the patient outside of the AIIR to medically-essential purposes. When not in an AIIR (e.g., during transport or if an AIIR is not available), patients should wear a facemask to contain secretions.7
Personnel entering the room should use PPE, including respiratory protection. Only essential personnel should enter the room. Implement staffing policies to minimize the number of HCP who enter the room. Facilities should consider caring for these patients with dedicated HCP to reduce the risk of transmission and exposure to other patients and other HCP.
Use dedicated or disposable noncritical patient-care equipment (e.g., blood pressure cuffs). If equipment will be used for more than one patient, clean and disinfect such equipment before use on another patient according to manufacturer’s instructions.7
HCP entering the room soon after a patient vacates the room should use respiratory protection. Standard practice for pathogens spread by the airborne route (e.g., measles, tuberculosis) is to restrict unprotected individuals, including HCP, from entering a vacated room until sufficient time has elapsed for enough air changes to remove potentially infectious particles.7
Follow contact and airborne PPE requirements. Respiratory protection should be, at a minimum, a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator.7
If reusable respirators are used, they must be cleaned and disinfected according to the manufacturer’s reprocessing instructions prior to re-use.
Use Caution When Performing Aerosol-Generating Procedures7
Until information is available regarding viral shedding after clinical improvement, discontinuation of isolation precautions should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities.7 Things to consider include7:
Establish procedures for monitoring, managing, and training visitors. Restrict visitors from entering the room of known or suspected COVID-19 patients.7
Consider alternative mechanisms for patient and visitor interactions, such as video-call applications on cell phones or tablets. Facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional well-being and care.
Consider designing and installing engineering controls to reduce or eliminate exposures by shielding HCP and other patients from infected individuals.7 Examples of engineering controls include7:
Facilities and organizations providing healthcare should implement sick leave policies for HCP that are non-punitive, flexible, and consistent with public health guidance.
Provide HCP with job- or task-specific education and training on preventing transmission of infectious agents, including refresher training.7
HCP must be medically cleared, trained, and fit-tested for respiratory protection device use (e.g., N95 filtering facepiece respirators), or medically cleared and trained in the use of an alternative respiratory protection device (e.g., Powered Air-Purifying Respirator, PAPR) whenever respirators are required.
Ensure that HCP are educated, trained, and have practiced the appropriate use of PPE prior to caring for a patient, including attention to the correct use of PPE and prevention of contamination of clothing, skin, and environment during the process of removing such equipment.
Dedicated medical equipment should be used for patient care. All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to the manufacturer’s instructions and facility policies.
Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly. Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are necessary for COVID-19 in healthcare settings. Products with EPA-approved emerging viral pathogens claims are recommended for use against COVID-19.7 If there are no available EPA-registered products that have an approved emerging viral pathogen claim for COVID-19, products with label claims against human coronaviruses should be used according to label instructions.7
Implement mechanisms and policies that promptly alert key facility staff, including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff about known or suspected COVID-19 patients.
Promptly notify state or local public health authorities of patients with known or suspected COVID-19. Facilities should designate specific persons within the healthcare facility who are responsible for communication with public health officials and dissemination of information to HCP.7
Below are the most recent guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19)8
This interim guidance is for staff at local and state health departments, infection prevention and control professionals, and healthcare personnel who are coordinating the home care and isolation of people with confirmed or suspected COVID-19 infection, including persons under investigation (see Criteria to Guide Evaluation of Persons Under Investigation (PUI) for COVID-19).
This guidance includes patients evaluated in an outpatient setting who do not require hospitalization (i.e., patients who are medically stable and can receive care at home) or patients who are discharged home following hospitalization with confirmed COVID-19 infection.
In general, people should adhere to home isolation until the risk of secondary transmission is thought to be of low risk. Visit the Preventing the Spread of Coronavirus Disease 2019 in Homes and Residential Communities page for more information.
Preventing COVID-19 from Spreading in Homes and Communities: Interim guidance that may help prevent COVID-19 from spreading among people in homes and communities.
For interim healthcare infection prevention and control recommendations, see Interim Infection Prevention and Control Recommendations for Patients with Known or Persons Under Investigation for Coronavirus Disease 2019 (COVID-19) in a Healthcare Setting. CDC will update this interim guidance as needed and as more information becomes available.
In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care. Considerations for care at home include whether:
A healthcare professional should:
John enters the ER with a complaint of cough and fever for four days. The clerk asks John to put on a mask and set in the waiting room alcove. The clerk notifies the triage nurse, who immediately triages John. John traveled to mainland China last week. The triage nurse puts John in a private room and implements contact and airborne precautions.
Had the clerk not identified John as someone needing a mask and location in the alcove instead of the main waiting room, people in the ER waiting room would have been exposed. Had the triage nurse not immediately triaged and isolated John, more people would have been exposed.
After diagnosis, John was found to have the flu. He was discharged home. The actions to prevent exposure of people and staff were time-consuming but warranted. The actions prevented the spread of the flu and possibly something more serious.