Managing a new Virus
The role of the nurse/midwife in the treatment and management of a novel virus. By Debbie Duncan and Gillian Lyall.
Coronaviruses are a group of viruses which can pass between animals and humans; they are zoonotic. Several coronaviruses are endemic to humans; such as the common cold. However, there are novel strains of coronavirus that can cause more severe illnesses; such as Severe Acute Respiratory Syndrome (SARS) identified in 2003 and Middle East Respiratory Syndrome (MERS) identified in 2012, (Holmes, 2003; WHO, 2020, Zaki, 2012).
At the end of 2019, a new novel coronavirus, not previously been seen in humans, was identified in Wuhan, China. This has obviously happened before but has raised concerns because of the speed of transmission.
Typically, coronaviruses cause mild to moderate upper respiratory tract illnesses (URTI) with symptoms such as fever, cough, shortness of breath, headache and feeling generally unwell. However, they can cause more severe illness, especially in individuals who have co-morbidities such as infants and the elderly, ( Jartti et al, 2011).
Since the virus was identified, the World Health Organization (WHO) has been working with authorities in China and around the world to learn more about the virus, how it affects people and how it can be treated (WHO, 2020).
Coronaviruses are usually transmitted by droplets, such as those produced when coughing and sneezing, and by direct or indirect contact with secretions infected by the virus. The virus may also shed in blood, urine and faeces, therefore, there is potential for transmission through contact with a wide range of bodily fluids. The application of infection prevention and control (IPC) principles are already widely used by health care professionals within hospital and community settings to both prevent the spread of infections and to control outbreaks when they do occur. The WHO has issued interim guidance regarding IPC when WN-CoV is suspected (WHO, 2020). This advice is echoed by guidance issued by Public Health England (PHE) (PHE, 2020).
PHE (2020) suggest that as the Wuhan novel coronavirus (WN-CoV) may complications such as illness pneumonia or severe acute respiratory infection, so patients could potentially present to primary care. It is important for nursing teams to ensure they are familiar with the recommended IPC principles and measures and ensure they have the appropriate personal protective equipment (PPE) when caring for a patient with suspected WN-CoV, (PHE, 2020).
The key IPC strategies recommended by WHO (2020) and PHE (2020) in the management of suspected cases of WN-CoV are:
- Triage, early identification and control of the source
- Front line staff should be appropriately trained have a high clinical suspicion,
- Adequate PPE should be available at triage points,
- Use of signage to advise symptomatic patients to alert staff
The use of Standard IPC precautions which include:
- Hand hygiene is key in preventing the spread of disease.
- clinical waste should be secured in leak proof containers.
- laundry should be classified as infectious.
- all specimens should be double bagged, and hand delivered to the labs.
Patients should be encouraged to cover their mouth and nose with a tissue when coughing/sneezing/blowing nose, promptly dispose of correctly, and have good hand hygiene. Other measures of infection control to prevent transmission of this virus are:
- use single use FFP3 respirators when entering the patient’s room.
- use long sleeve fluid repellent gowns.
- Use of disposable gloves.
- The use eye protection.
If a patient has a confirmed case of Corona Virus, they will need to be cared for in Isolation in a negative pressure isolation room or single room with ensuite bathroom facilities or commode. In addition, adequate IPC signage should be displayed and contact with patients suspected of having WN-CoV should be limited to essential staff and visitors should be restricted.
It is important to note that the current outbreak of novel coronavirus is rapidly changing, therefore, guidance is likely to updated as more data regarding WN-CoV becomes
- Health care professionals should keep up to date with the recommended guidance, in conjunction with local IPC guidance. As of 26 February 2020 there are no confirmed cases in NI although the PHE website is updated at 2pm every day, (PHE, 2020b)
Holmes, K. V. (2003). SARS-associated coronavirus. New England Journal of Medicine, 348(20), 1948-1951.
Jartti, L., Langen, H., Söderlund-Venermo, M., Vuorinen, T., Ruuskanen, O., & Jartti, T. (2011). New respiratory viruses and the elderly. The open respiratory medicine journal, 5, 61.
Public Health England. (2020). Wuhan novel coronavirus (WN-CoV) infection prevention and control guidance. Online. [Accessed 25 Jan 2020]. Available at: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/wuhan-novel-coronavirus-wn-cov-infection-prevention-and-control-guidance
Public Health England (2020b). Wuhan novel coronavirus: information for the public. Information on Wuhan novel coronavirus, including assessment and management of suspected UK cases.[Accessed 27 Jan 2020].
Smuts, H., Workman, L., & Zar, H. J. (2008). Role of human metapneumovirus, human coronavirus NL63 and human bocavirus in infants and young children with acute wheezing. Journal of medical virology, 80(5), 906-912.
World Health Organization. (2020). Infection prevention and control during health care when novel coronovirus (nCoV) infection is suspected. Online. [Accessed 25 Jan 2020]. Available at: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
Zaki A . (2012). Novel coronavirus—Saudi Arabia: human isolate. Int. Soc. Infect. Dis. ProMED-mail. http://www.promedmail.org/direct.php?id=20120920.1302733.