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COVID-19 of hospital policies and

Important public health procedures

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Department of pediatric

Ting-I Lin

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Introduction

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Coronaviruses

  • Single strand RNA virus：
    • Nidovirales
    • Coronaviridae
    • Orthocoronavirinae
  • Subgroup：α、β、γ、δ
  • Host：
    • Human
    • Bat、dog、pig、rat、bird、cow、whale、horse、goat、monkey
    • Disinfect：

56℃ 30 mins、ether、75% alcohol、Chlorine。

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Human-related coronavirus

  • Subgroup α：229E、NL63
  • Subgroup β：OC43、HKU1、MERS-CoV、SARS-CoV、

SARS-CoV-2(COVID-19)

❇Pneumonia related coronavirus：

    • HKU1
    • SARS-CoV
    • MERS-CoV
    • COVID-19

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Estimated R0

公佈日期

單位

R0預估值

2020/01/29

中國疾控中心

2.2(1.4-3.9)

2020/01/26

廣東疾控中心

2.90-2.92

2020/01/25

英國皇家學院

2.6(1.5-3.5)

2020/01/24

美國哈佛大學

2.0-3.3

2020/01/24

香港中文大學

3.3-5.47

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Disease

Transmission

R0

Measles

Airborne

12-18

Smallpox

Airborne droplet

5-7

Polio

Fecal-oral route

5-7

Rubella

Airborne droplet

5-7

Mumps

Airborne droplet

4-7

HIV/AIDS

Sexual contact

2-5

SARS-CoV

Airborne droplet

2-5

Influenza

(1918 pandemic strain)

Airborne droplet

2-3

2019-nCoV (Wuhan)

Airborne droplet (?)

1.4-2.5*

Ebola

(2014 Ebola outbreak)

Bodily fluids

1.5-2.5

* WHO Estimate. 23 Jan. 2020

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R0 of COVID-19 variant

  • Alpha variant: 4
  • Delta variant: 5-8
  • Beta variant: 3.75

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Symptoms of COVID-19

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Signs and symptoms among 291 pediatric (age <18 years) and 10,944 adult (age 18-64 years) patients* with laboratory-confirmed COVID-19 in the US from February 12, 2020, to April 2, 2020.

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Diagnosis of COVID-19

  • RT-PCR
  • Antigen test
  • Antibody test (serum IgM, IgG)

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Variants of COVID-19

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Published: 12 July 2021

Emerging SARS-CoV-2 variants of concern and potential intervention approaches

Jasmin Khateeb, Yuchong Li & Haibo Zhang 

Critical Care volume 25

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資料來源：報導者 COVID-19病毒變身全解析

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July 21, 2021, at NEJM.org.

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July 28, 2021, at NEJM.org.

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Breakthrough infection: 0.4%

Most with mild symptoms

Long S/S(>6 wks) : 19%

NO secondary infection

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88 health care workers

ChAdOx1 nCoV-19 vaccine 9 to 12 weeks earlier

37 🡪 ChAdOx1 nCoV-19 vaccine

51 🡪 heterologous boost with mRNA-1273 (Moderna)

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This letter was published on July 14, 2021, at NEJM.org.

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  • https://youtu.be/K3odScka55A

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Adverse reaction

Injection site pain

Fatigue

Headache

Muscle pain

Chills

Arthragia

Fever (>38ºC)

Moderna

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  • possibility of very rare cases of blood clots combined with low levels of blood platelets occurring within 2 weeks of vaccination.
  • most of the cases reported have occurred in women under 60 years of age within 2 weeks.
  • blood clots occurred in veins in the brain (cerebral venous sinus thrombosis, CVST) and the abdomen (splanchnic vein thrombosis) and in arteries, together with low levels of blood platelets and sometimes bleeding.

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  • 62 cases of cerebral venous sinus thrombosis and 24 cases of splanchnic vein thrombosis reported in the EU drug safety database (EudraVigilance) as of 22 March 2021, 18 of which were fatal.
  • One plausible explanation for the combination of blood clots and low blood platelets is an immune response.

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  • The reported combination of blood clots and low blood platelets is very rare, and the overall benefits of the vaccine in preventing COVID-19 outweigh the risks of side effects.

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  • Patients should seek medical assistance immediately if they have the following symptoms
  • shortness of breath
  • chest pain
  • swelling in your leg
  • persistent abdominal (belly) pain
  • neurological symptoms, including severe and persistent headaches or blurred vision
  • tiny blood spots under the skin beyond the site of injection

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Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination

  • Since April 2021, there have been more than a thousand reports to the Vaccine Adverse Event Reporting System (VAERS) of cases of inflammation of the heart—called myocarditis and pericarditis—happening after mRNA COVID-19 vaccination (i.e., Pfizer-BioNTech, Moderna) in the United States.

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  • CDC and FDA have confirmed 699 reports of myocarditis or pericarditis

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  • Confirmed cases have occurred:
    • Mostly in male adolescents and young adults age 16 years or older
    • More often after getting the second dose than after the first dose of one of these two mRNA COVID-19 vaccines
    • Typically within several days after COVID-19 vaccination
  • Patients can usually return to their normal daily activities after their symptoms improve.

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Hospital policies

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Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19

  • Source control measures
  • Hand hygiene practice
  • Limit and monitor points of entry to the facility

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Implement Universal Source Control Measures

  • Source control and personal protection
  • HCP should remove their respirator or facemask, perform hand hygiene, and put on their community source control when leaving the facility at the end of their shift.

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Encourage Physical Distancing

  • physical distancing (maintaining at least 6 feet/1.5 meter between people) is an important strategy to prevent SARS-CoV-2 transmission.

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Implement Universal Use of Personal Protective Equipment

  • FIT face mask

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HCP working in facilities located in areas with moderate to substantial community transmission

  • HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis.
  • Ex: N95

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Consider Performing Targeted SARS-CoV-2 Testing of Patients Without Signs or Symptoms of COVID-19

  • used to identify those with asymptomatic or pre-symptomatic SARS-CoV-2 infection.
  • Screen test with nucleic acid or antigen detection assays

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Consider if elective procedures, surgeries, and non-urgent outpatient visits should be postponed in certain circumstances.

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Optimize the Use of Engineering Controls and Indoor Air Quality

  • Physical barriers and dedicated pathways to guide symptomatic patients through triage areas.

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  • If climate permits, outdoor assessment and triage stations for patients with respiratory symptoms.

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Explore options, in consultation with facility engineers, to improve indoor air quality in all shared spaces.��

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Create a Process to Respond to SARS-CoV-2 Exposures Among HCP and Others

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Exposure definition (Taiwan)

  • Index case 2 days before symptoms onset
  • No proper protection (ex. No face mask)
  • Close contact (<2 meters) more than 15 minutes
  • Perform aerosol generating procedures(AGP) for confirmed case without proper protection

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Recommended infection prevention and control (IPC) practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection

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Patient Placement

  • Mild symptoms/asymptom 🡪 home care
  • If admitted, place a patient with suspected or confirmed SARS-CoV-2 infection in a single-person room with the door closed(should have a dedicated bathroom).
  • Airborne Infection Isolation Rooms (AIIRs) should be prioritized for patients who will be undergoing aerosol generating procedures 
  • Personnel entering the room should use PPE

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  • Designating entire units within the facility, with dedicated HCP, to care for patients with suspected or confirmed SARS-CoV-2 infection. 
  • It might not be possible to distinguish patients who have COVID-19 from patients with other respiratory viruses. As such, patients with different respiratory pathogens might be cohorted on the same unit.
  • Limit transport and movement of the patient outside of the room to medically essential purposes.

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Personal Protective Equipment

  • Respirator – N95 or higher
  • Eye Protection
  • Gloves
  • Gowns

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  • Remove PPE before leaving the room. (unless reuse of face mask or goggles)
  • Hand hygiene after removing PPE

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Meeting in E-Da hospital

  • < 50 persons
  • Social distance
  • DO NOT EAT during meeting

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Any Question?