Content developed by Clarity Informatics, providers of online solutions to support the nursing community through appraisals and revalidation.
First published 18 February 2020
Updated 18 May 2020
The COVID-19 pandemic is dominating the news, our practice and all our thoughts at present, and during the crisis it is important to have access to accurate information so that we understand the context for both Government announcements and reports in the media.
This resource will help you to understand:
This resource is provided at an intermediate level by Clarity Informatics. Read the article and answer the self-assessment questions, and reflect on what you have learned.
Complete the resource to obtain a certificate to include in your revalidation portfolio. You should record the time spent on this resource in your CPD log.
On 11 March the WHO advised that the situation was now a pandemic.1
Previous recent novel disease outbreaks have followed different patterns, but the following table provides a comparison with COVID-19, so far.
SARS, severe acute respiratory syndrome; MERS, Middle East respiratory syndrome-related coronavirus
*Mortality varied according to the region, but an estimated 205,000 died of H1N1-related illnesses2
In the last 100 years there have been four significant pandemics:
A typical flu season causes in the region of 400,000 deaths.
WHAT IS CORONAVIRUS?
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new betacoronavirus. Genetic analysis suggests that bats may be the original host of this virus. It is also thought that an animal from the seafood market in Wuhan could be the intermediate host, leading to the emergence of the virus in humans.
WHAT IS THE SCALE OF THE PROBLEM?
The number of confirmed cases of COVID-19 is increasing daily. This topic will be updated regularly to provide new information as it becomes available in a rapidly changing landscape.
However, Johns Hopkins University have provided an interactive map of the spread of this disease on this publically available site. Coronavirus COVID-19 Global Cases4
At the date of publication there were over 873,767 cases world wide, over 43,288 deaths, and over 184,770 people who had been identified as recovered.
Mortality rates appear to be around 2-3%, with more physically vulnerable people more likely to die from the disease.
The initial outbreak was in mainland China but transmission is now worldwide, with large outbreaks in South Korea, Italy, Iran and the US with varying rates of infection and mortality.
As of 18 May, there were 246,406 confirmed cases in the UK, and 34,796 deaths.
Public Health England has provided a similar interactive map with UK data5
WHAT HAVE BEEN THE PUBLIC HEALTH RESPONSES?
In China extensive efforts aiming to contain the virus have included lock-down of entire cities, with self-quarantine of suspected infected individuals, restrictions on travel and monitoring large swathes of the population.
Beyond the boarders of China, the WHO has coordinated and advised the following measures:
WHAT ARE THE SYMPTOMS AND SIGNS OF COVID-19?
COVID-19 has a predilection for the upper and lower respiratory tract alveolar cells and is spread by droplets from sneezing and coughing.
The prodrome (pre-illness phase) lasts between 2-10 days. The reason for isolation of 14 days was to ensure a safe return to society to circumvent a slightly longer potential prodrome phase.
In a study of the first 99 patients diagnosed with COVID-19 in China it was found that the majority of people had fever or cough (83%) and a third of patients had shortness of breath.
Other symptoms included muscle ache, headache, confusion, chest pain, and vomiting and diarrhoea (3% and 5%).
Many patients presented with organ function damage, including 17 (17%) with ARDS, eight (8%) with acute respiratory injury, three (3%) with acute kidney injury, four (4%) with sepsis, and one (1%) with ventilator-associated pneumonia.7,8
WHAT IS THE ADVICE FOR PREGNANT WOMEN?
For women who are pregnant and well the advice is to socially distance themselves.
For women who have been exposed to COVID-19 or who have symptoms which are suggestive of COVID-19 the advice is to self-isolate. Now the guidance recommends
WHAT IS THE ADVICE FOR PEOPLE WITH IMMUNOSUPPRESSION?
Public Health England9 has issued guidance for people with immunosuppression to undertake self isolation. PHE defines people in the following groups to be at high risk.
Those aged over 70 years of age, or
Aged under the age of 70
and with one of the following conditions
WHAT ARE YOUR RESPONSIBILITIES?
As a healthcare worker it is important that you can access and understand the latest advice from Public Health England
Currently the advice given is to:
Patients are advised to use the 111 online coronavirus service at https://111.nhs.uk/service/covid-19
WHAT IF A PATIENT ARRIVES AT THE PRACTICE WITH POSSIBLE COVID-19?
NHS England has published a standard operating procedure, which can be found here10
Current advice from Public Health England is as follows:
WHAT ARE YOUR RESPONSIBILITIES IN GENERAL PRACTICE?
When a telephone interview is being conducted with a patient located elsewhere and it determined that COVID-19 is possible (based on the PHE criteria for a possible case).
WHAT ARE YOUR ORGANISATION’S RESPONSIBILITIES?
If a person with a possible case of COVID-19 has been in a primary care building then a specific approach to cleaning must be undertaken. This includes:
before entering the room, perform hand hygiene then put on a disposable plastic apron and gloves
On entering the room
Cleaning and disinfection of reusable equipment
Carpeted flooring and soft furnishings
If carpeted floors or item cannot withstand chlorine-releasing agents, consult the manufacturer’s instructions for a suitable alternative to use, following or combined with detergent cleaning.
On leaving the room
Cleaning of communal areas
If a suspected case spent time in a communal area, for example, a waiting area or toilet facilities, then these areas should be cleaned with detergent and disinfectant (as above) as soon as practicably possible, unless there has been a blood/body fluid spill which should be dealt with immediately. Once cleaning and disinfection have been completed, the area can be put back in use.11
WHAT ARE THE WIDER NHS RESPONSIBILITIES?
The NHS as an organisation has a responsibility to coordinate the response to the potential service changes to accommodate any cases or outbreak of COVID-19 in the UK.
The NHS also has a responsibility to collect, learn from and disseminate the most up to date information and learning across primary, secondary, pre-hospital emergency services and tertiary care.
The NHS also has a responsibility to provide guidance on how to improve outcomes and care for patients.
The NHS has an additional responsibility to report statistics for all services.
What are the Government’s responsibilities?
In a time of national need the Government’s first duty is to strive to protect the population.
In doing this, the government has a responsibility to deploy all resources at its disposal, including clinical, technical, financial, organisational and infrastructural.
It will utilise national contingency planning, if needed, in order to coordinate a response which involves elements of containment, monitoring, active treatment, mass communication, research and, if needed, mitigation.
There is currently no specific treatment for coronavirus. Antibiotics do no work against viruses, and there are no specific antiviral medicines that are effective against this virus. Treatment aims to relieve the symptoms of COVID-19 while the body fights the infection: this may involve ventilation or other respiratory support measures in severe cases.
A number of existing agents are being investigated for use in patients with COVID-19, including
There have been some reports stating that non-steroidal anti-inflammatory drugs (NSAIDs) exacerbate symptoms in COVID-19 patients, but a systematic review found no published evidence for or against their use. There is some evidence that early use of corticosteroids may be beneficial, but this approach is not currently supported by the WHO.14
WHAT MIGHT HAPPEN NEXT?
A global pandemic was declared by WHO on 11 March. Extensive monitoring is being conducted worldwide and disease pattern modelling undertaken by several centres. Many countries have moved to a wide scale lock-down.
The current total is 99.78 cases per million globally but this is still rising.
The current total of death is 4.78 per million, again rising.
In terms of prevention the most useful measures are social distancing for asymptomatic people, isolation for those with symptoms and simple hygiene approaches to coughs and sneezes, including the use of disposable tissues and frequent hand washing.
Paper surgical masks although popular, do not appear to be effective in the prevention of coronavirus dissemination.
WHERE CAN YOU GO FOR MORE HELP AND ADVICE?
The NHS provides a wide range of information and advice on the potential risk of coronavirus for clinicians, administrators, patients and carers.
Public Health England has detailed advice on their website for clinicians, for concerned individuals and travellers.
Clarity https://elearning.clarity.co.uk has further modules on pandemic influenza and the disposal of clinical waste. Clarity can also provide an extensive literature search on request.
This module will be updated regularly to reflect any changes in the evidence base.
1. World Health Organization. Coronavirus; 2019 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
2. Our World in Data https://ourworldindata.org/coronavirus
3. European Centre for Disease Prevention and Control https://www.ecdc.europa.eu/en/novel-coronavirus-china
4. National Institute of Allergy and Infectious Diseases Rocky Mountain Laboratories https://www.niaid.nih.gov/about/rocky-mountain-overview
5. Public Health England https://www.gov.uk/government/news/phe-reaches-crucial-step-in-fully-sequencing-novel-coronavirus
6. WHO Joint Missions Report on Coronavirus Disease https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
7. Chen N, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507-513 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext
8. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648 https://jamanetwork.com/journals/jama/fullarticle/2762130
9. Department of Health and Social Care https://www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public
10. NHS England COVID 19 Standard Operating Procedure https://www.england.nhs.uk/wp-content/uploads/2020/02/20200305-COVID-19-PRIMARY-CARE-SOP-GP-PUBLICATION-V1.1.pdf
11. Health and Safety Executive https://www.hse.gov.uk/news/coronavirus.htm
12. Lancet COVID-19 Resource Centre https://www.thelancet.com/coronavirus?dgcid=kr_pop-up_tlcoronavirus20
13. Mahase E. Covid-19: what treatments are being investigated? BMJ 2020;368:m1252 https://www.bmj.com/content/368/bmj.m1252
14. Russell E, Moss C, Rigg A, Van Hemelrijck M. COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting? ecancer 2020;14:1023 https://ecancer.org/en/journal/article/1023-covid-19-and-treatment-with-nsaids-and-corticosteroids-should-we-be-limiting-their-use-in-the-clinical-setting