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Hospitals, nursing homes prep as COVID-19 cases climb in New York

Don't panic if one or more people in Western New York test positive for the novel coronavirus.

“The nice thing about a coronavirus is they’re easy to kill” on hands and other surfaces outside the body, Charlene Ludlow said.

Inside the body, not always so much. That’s why Ludlow – who leads infectious control efforts for Erie County Medical Center and Kaleida Health – stressed in an interview how important preventing the virus will be to what unfolds in the region.

Older people and those with compromised immune systems are most at risk. Those 60 and older are most likely to need treatment and those 80 and older are at the highest risk of death, said U.S. Surgeon General Jerome Adams. He encourages older people to reconsider flying and avoid cruise travel.

Meanwhile, Ludlow and Adams urge everyone to take steps to contain the virus, stressing that those who are sick stay home and contact their primary care providers if their flu-like symptoms worsen.

Public health and infectious control specialists have learned much during the past generation from similar new airborne diseases, as well as how COVID-19 has spread through other nations before the first case in the U.S. was diagnosed Jan. 20 in the Pacific Northwest.

Hospitals and nursing homes across the region are required by the federal Centers for Disease Control and Prevention to have plans in place if the virus is discovered and intensifies, said Ludlow, a registered nurse and certified infection control specialist.

She answered the following questions, which have been condensed and edited.

Q: Is it possible that the COVID-19 is already here and spreading among people who have easily defeated it without being tested? 

A: There are people that could have it and don't know. The number from the CDC is that 80% of the cases have been mild. We're seeing the more aggressive disease in the adults with chronic disease and that's when the testing is happening.

Q: How are things normally handled when it comes to preventing the spread of viruses and infections from spreading in a hospital?

A: We are still just pushing people to make sure they're doing the basics under standard precautions: washing their hands, making sure they're using personal protective equipment when appropriate. These are standard precautions that we've been using for years. We use droplet precautions for the seasonal influenza that we see. We tell people when they go into a patient room they have to be wearing gloves, wearing masks. With a novel virus like COVID-19, it's a changing situation. We don't know enough about the virus yet, so we’ve stepped up a bit to airborne precautions. We're going to use a higher level of respiratory protection for our employees, an N95 respirator mask. Now we use N95 respirators if we have to rule out a tuberculosis case, so these are not foreign pieces of equipment.

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Q: How are virus screenings changing?

A: We have to have early identification of these cases. That's the key, so we're starting with early triage questions. We’re asking “Have you traveled?” When it was Ebola, we were looking for travel to Africa. Now we're looking for travel to China, to Italy, to Iran. As COVID-19 continues to progress, the travel questions will be going out the window. And now that we have cases New York State, are we going to start doing quarantine for people that were down in New York City? The answer is no.

That’s why questions are changing each day right now. We're doing things like respiratory screens as they come in. With influenza, it's much more fever and upper respiratory. This is lower respiratory, also still the fever. Chest X-rays are showing some specific findings that are leading down the road that it could be the coronavirus. If we have chest X-rays that are positive, then they may go forward and be doing more of the COVID-19 screening.

Q: How should people react if, and when, the first positive test result is reported in Western New York?

A: First of all, don't panic. It's one case. Yes, it can grow. But if people are taking care of themselves, being mindful of hand-washing and not putting others at risk, that helps prevent the spread.

Q: Do you have any sense yet how this might compare to past incidents involving swine flu, SARS or Ebola?

A: Ebola is a bloodborne pathogen. SARS was airborne and the novel coronavirus is also. It’s just a different strain so it may be sort of similar. Influenza is a totally different virus. One of the differences I see in the United States is that we do a little better with spacing. When you get into countries where population density is really high, and you've got a lot of people in smaller spaces, you're less likely to be able to keep that arm's length from people … 3 to 6 feet.

(Erie County)

Q: Has any of the staff been tested for COVID-19? Are there plans to do so?

A: Not at ECMC. [Few people in WNY have been tested.] Nobody's been positive. We don't test people that are asymptomatic. That's in the CDC guidelines [which could change as more test kits become available.]

 Q: What protocol would be used by front-line staff working with patients who test positive for COVID-19?

A: We will continue to follow the transmission-based precautions. That's that protective barrier that we use all the time. The staff are required to wear the appropriate personal protective equipment going into that room. In addition, it's not just personal protective equipment, hand-washing on the way in, hand-washing on the way out is essential.

Q: Would that patient then automatically be put into a negative pressure [isolation] room where air from the room doesn’t circulate through other parts of the hospital?

A: We have 18 negative pressure rooms at ECMC. They're scattered throughout the hospital in key locations. We have some for critical care and some for general medical care. We work closely with Kaleida Health and they also have negative pressure rooms [as do Catholic Health hospitals]. And they will be able to handle several patients as well. The other part of that is if we do run out of negative pressure rooms, the CDC has given us guidance on how to manage people in private rooms as well. That's not the preferred method. But there's a way to do that so that we decrease the risk to others.

In a clinical setting where they don't have negative pressure rooms, if a patient comes in and they're symptomatic, we would put a mask on the patient as they arrive, then we would take them into the private room and keep the mask on the patient for the duration. Then you have containment. As the health care worker goes into that room, they too will put a mask on. And again, barrier for the health care worker, barrier on the patient, decrease the spread. [Some Kaleida hospitals have clusters of rooms that can be converted with the flip of a switch.]

Q: Is it a given that Western New York will have cases? There are two provinces in China where most of the cases have been reported and now, in the U.S., many of the most serious cases have been in Seattle. What are the chances that this is going to spread like wildfire across the U.S. or maybe hit as it has in China and other countries in pockets of those nations?

A: We have to look optimistically at this and say if we continue with our preparedness efforts, if we have barriers, if we're teaching people how to handle things so that they're not going to be spreading the virus itself, we have a much better chance of decreasing those numbers than if we just sat back and said, “Oh, look what's happening!” We've got to give it a fighting chance.

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