Threats Posed to Infection Preventionists and Others from Wuhan Coronavirus Still Being Calculated

Every week brings something new with the novel coronavirus first identified in Wuhan, China. Reporting on case counts seems futile as these numbers are changing daily. The World Health Organization (WHO) has provided a name for the disease though, COVID-19. “COVI” referring to coronavirus and “D” for disease, meaning that this is the name of the disease caused by the virus that will likely be called SARS-CoV-2. Similar to the naming aspects of HIV/AIDs, the COVID-19 refers to the illness and disease caused by the infectious agent, 2019-CoV (until it is officially given the taxonomy of SARS-CoV-2). 

While this will likely require communication with frontline healthcare workers to avoid confusion, hopefully this is a sign of more research and efforts to clarify things related to the virus and disease. This will be especially critical as personal protective equipment (PPE) shortages continue and infection preventionists will likely need to give guidance on the extended use and re-use of N95 masks. These are important topics to consider though, and now is the time for hospitals to engage in strategies or at least plan to potentially use/extend use of those N95s we’re struggling to acquire. 

As of Feb. 11, 2020, the CDC has not changed its guidelines on criteria to evaluate people who may have been infected by 2019-nCoV. If cases continue to spread outside of China though, this might change, or ultimately travel-related screening will cease to be effective. As our current guidance for screening is heavily reliant on travel to the affected area or exposure to a known/suspected case, widespread transmission beyond China will weaken such criteria. 

There are two critical pieces of research that were released within the last week. The first was a study evaluating the persistence of coronaviruses on inanimate objects and inactivation processes. While the authors evaluated research related to all coronaviruses that infect humans, they did find that across 22 studies, the virus can persist on inanimate objects (metal, glass, or plastic) for up to 9 days. Coronaviruses are enveloped viruses, meaning that they are easier to inactivate with disinfectants and that the use of EPA-registered hospital disinfectants is effective. The authors note that coronaviruses can be “efficiently inactivated by surface disinfection procedures with 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective.”

The second relevant piece of research that was recently published is a study in which the authors evaluated the clinical characteristics of 138 hospitalized patients with 2019-nCoV in Wuhan, China. Evaluation of these patients found two concerning pieces of information-26% required admission to an intensive care unit (ICU) and 41% of the 138 patients are believed to have acquired the disease through hospital transmission. 

These findings are concerning for a number of reasons. Firstly, patients in ICUs tend to require longer lengths of stay, which means more use of healthcare workers (infection preventionists among them) and other resources, and increases the patient’s risk for healthcare-associated infections (HAIs), but also the chance that 2019-nCoV could be transmitted. Secondly, the volume of HAIs is deeply worrisome as it shows, like SARS and MERS, hospitals easily act as amplifiers of these diseases during outbreaks. This further reinforces the need to continuously work with staff to rapidly identify, isolate, and inform, when potential patients are triaged. More importantly though, it emphasizes the need to focus on infection prevention efforts and how we can better avoid such transmission through the foundational efforts we teach on frequently.