Year Zero: How COVID-19 Changed Everything

We can say that we didn’t see it coming, but we can’t say that we weren’t warned. Healthcare experts for decades have been telling us that it’s a question of when, not if, we’ll be hit with a worldwide pandemic. And though coronavirus disease 2019 (COVID-19) technically—as the name suggests—reared its spiky head in 2019, most of us didn’t know about it until 2020. Those who did know about it, could only guess what havoc SARS-CoV-2 would cause. As the timeline below of articles that appeared in Infection Control Today® in 2020 makes clear, even the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) were caught somewhat off-guard.

Here’s where things stand as of yesterday, December 22. There were about 195,000 new cases of COVID-19 reported in the United States, making the 7-day average about 215,000, according to Johns Hopkins University. Meanwhile, 3401 people died from the disease. That’s the second-highest number of deaths from the novel coronavirus in a single day.

According to the COVID Tracking Project, 117,777 people were hospitalized for COVID-19. Again, another record; the most hospitalizations for one day since the pandemic began. In addition, 22,213 Americans were in intensive care units and 7830 were on ventilators, according to the COVID Tracking Project.

More grim records will almost certainly be broken, according to President-elect Joe Biden. “Our darkest days in the battle against COVID are ahead of us, not behind us,” Biden told reporters.

And yet, though tough months lie ahead for infection preventionists and other healthcare professionals, hope remains that at some point in 2021 things will begin to settle down. Vaccines have been rolled into the battle, and the healthcare system in general has a better grasp of just what we’re dealing with and how to treat it. Many healthcare experts predict that infection rates, hospitalizations, and deaths will recede into a past that we’ll be all too happy to be done with. It might take until the end of the year, but it will happen.

In the end, it comes down to a simple formula: We win, COVID-19 loses.

January 21: CDC Officially Confirms First Case in the US

The patient had apparently researched the virus online, and upon developing symptoms reached out to his healthcare provider on January 19. The novel coronavirus was confirmed on January 20 using samples shipped overnight. Public health officials from Washington indicated that the patient was hospitalized out of precaution but in overall good condition.

January 23: WHO Says the Mysterious Coronavirus That Emerged in China Isn’t a Global Health Threat—Yet

But it may soon become one, warned Tedros Adhanom Ghebreyesus, PhD, director-general of the World Health Organization. The decision was made based on the fact that public health efforts are being implemented to try to contain the disease and a low number of case counts overall.

January 30: First Human-to-Human Coronavirus Transmission in US Confirmed

It occurred in the spouse of a Chicago woman who caught the virus when traveling to Wuhan. “In most patients, symptoms are milder, but approximately 1 in 5 individuals have experienced severe illness including severe pneumonia and respiratory failure.”

February 5: Infection Preventionists Are Critical Responders to Wuhan Coronavirus Outbreak

Responding to infectious disease outbreaks is not a novel part of infection prevention and control (IPC) work. In fact, many infection preventionists (IPs) are epidemiologists, trained in outbreak response. While IPs normally deal with outbreaks of drug-resistant organisms or norovirus, often emerging and novel infectious diseases occur that challenge our day-to-day activities.

February 6: FDA Fast-Tracks Distribution of Test That Can Quickly Diagnose Coronavirus

The FDA’s emergency use authorization (EUA) rolls the CDC’s 2019-nCoV Real-Time RT-PCR Diagnostic Panel into the battle against the coronavirus. The test had previously only been allowed to be used in CDC labs. It provides presumptive detection of 2019-nCoV (also known as the Wuhan coronavirus) from respiratory secretions, such as nasal or oral swabs

February 19: CDC Seeks to Test Some with Flu-Like Symptoms for COVID-19

Health officials say that this is a particularly bad year for an extended influenza season since flu symptoms and some of the symptoms of the novel coronavirus, COVID-19, are the same (fever, cough, shortness of breath).

February 26: CDC Wants Schools, Businesses, Citizens to Prepare for Possible US Coronavirus Onslaught

The US Centers for Disease Control and Prevention (CDC) has a more pessimistic view of just how disruptive the novel coronavirus COVID-19 can be than the World Health Organization (WHO). Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters yesterday that she expects the virus will soon begin to spread at the community level in the United States.

March 5: PPE Shortages Hamper COVID-19 Containment, Endanger Healthcare Workers

There’s a dwindling supply of personal protective equipment (PPE) available for infection preventionists and other healthcare workers that hampers their ability to contain COVID-19, warns Tedros Adhanom Ghebreyesus, PhD, the director-general of the World Health Organization (WHO).

March 9: Hospitals Slammed for Not Doing Enough to Protect Nurses from COVID-19

National Nurses United wants hospitals to establish protocols in which nurses are immediately notified when a patient who might have COVID-19 is admitted.

March 10: Infection Preventionists Might Perform COVID-19 Risk Assessments on Healthcare Workers

Connie Steed, MSN, RN, CIC, FAPIC, the president of the Association for Professionals in Infection Control and Epidemiology (APIC) told Infection Control Today® that the IPs would be functioning under the Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel (HCP) with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19). The guidance was modified on March 7 by the US Centers for Disease Control and Prevention (CDC) as part of its response to COVID-19.

March 17: Asymptomatic Carriers of COVID-19 Make It Tough to Target

SARS-CoV-2 stays active in or on aerosols for up to 3 hours, copper for up to 4 hours, cardboard for up to 24 hours, and plastic and stainless steel for up to 2 to 3 days.

March 20: Fight COVID-19 With Telemedicine

One of the barriers that has been addressed in recent years was just how providers are to be paid for using telemedicine.

March 23: 7 Things Infection Preventionists Need to Know When Dealing with COVID-19

We asked Linda Spaulding, RN, CIC, BC, CHEC, CHOP, to list what infection preventionists need to know to get through this suddenly thrusted upon us Era of COVID-19.

April 1: Expect Huge Surge in Demand for Personal Protective Equipment in COVID-19 Hotspots

More data to underscore a problem that infection preventionists and other healthcare workers battling the new coronavirus know too well: quickly depleting stores of personal protective equipment (PPE).

April 6: Resources Infection Preventionists Need to Battle COVID-19

In efforts to prepare your healthcare facilities for potential COVID-19 patients, it often feels like there is an onslaught of information. Below are resources which, as an infection preventionist, I found helpful in establishing plans, training methods, and more.

April 14: Quantity Not the Only Concern About N95 Masks; Quality Also Matters

Most of the news about N95 respirators deals with quantity: There’s a shortage, and too many healthcare workers enter the battle against COVID-19 unarmed. That shortage still exists but, thanks to recent rulings by the US Food and Drug Administration (FDA) that approves decontamination processes for the masks, quantity will hopefully become less of a pressing problem as the battle against COVID-19 moves forward and the curve flattens.

April 19: Q&A: Even COVID-19 Might Not Be Enough to Improve Infection Control’s Standing

Michael L. Millenson: “As we emerge from the COVID-19 crisis, it’s very important for infection control professionals to think, ‘How do we take this crisis and use it as a lever to cause the change that we care about so much?’”

April 22: Insight into Community Transmission of COVID-19 (Note: Hospitals Are Communities)

Look to our own practices in hospitals. Are meetings occurring with lots of people for a prolonged period of time without PPE? Breakroom clusters of staff to eat? Exposure is not limited to the patient-caregiver interaction.

April 25: Cloth Masks Are Useless Against COVID-19

Lisa Brosseau, ScD: “What we’re seeing is a lot of magical thinking. A lot of wishful thinking. Cloth masks are wishful thinking.”

April 29: Major Federal Project Pushes Development of COVID-19 Vaccine

“Operation Warp Speed,” a federal project that some are likening to the Manhattan Project that developed the atomic bombs that ended World War II, seeks to develop and disburse 100 million doses of a COVID-19 vaccine to the public by the end of the year.

May 5: COVID-19 Highlights Crucial Role of Infection Preventionists

Mary Jean Ricci, MSN, RN-BC: “Now we’re looking at [infection prevention] from a global perspective. Every patient needs to be educated because this is a novel virus and it is unknown.”

May 12: Keeping the Supply Chain Intact in the Age of COVID-19

For those working in healthcare, the relationship with the supply chain department was an increasingly important one. Between daily mask utilization and supply reporting to scrambling to find more supplies, those working in healthcare supply chains were working exceedingly hard to keep our heads above water.

May 14: Q&A: Everybody’s Looking to Infection Preventionists for Answers These Days

Brooke Decker, MD: “Keep in mind that right now you’re generating those stories that you’re going to be telling junior colleagues for decades to come.”

May 20: Q&A: COVID-19 Will Affect How Environmental Service Teams Operate

Charles Gerba, PhD: Environmental services plays a crucial-and often unsung-role in infection prevention. “Unfortunately, we don’t honor people enough for things they prevented or that never happened.”

May 21: CDC Recommends Resumption of Non-COVID Related Elective Surgeries

While starting to perform elective surgeries, hospitals should also keep an eye on COVID-19 in their communities and have the resources available to respond to a surge in COVID patients without having to resort to a crisis standard of care.

May 27: Why the Public Should Wear Masks During the COVID-19 Pandemic

Over 100 prominent healthcare experts have sent a letter to the United States’ governors to recommend that the public wear fabric masks, and combined with other measures, the epidemic’s R0 can be driven below 1, halting the spread of the virus. And over 100 countries now recommend the wearing of cloth masks by the public.

May 28: Q&A: Reopening After COVID-19: Proceed With Caution

Kevin Kavangh, MD: “What worries me the most about reopening is that people are going to say, ‘Oh, it’s over with’ and not do any sort of protection, whether it’s social distancing, wearing masks, not gathering in crowds. I really think that people will think, ‘Well, we got this beat.’”

June 3: Answering Your Infection Prevention Questions Regarding COVID Reopening

Sharon Ward-Fore: “Rather than reusing gowns, consider bundling patient care activities to conserve gowns. Donning a gown that has already been used can be tricky, and a source of contamination to the user.”

June 4: Q&A: Infection Preventionist Role Will Expand Because of COVID-19

Rebecca Leach, RN, BSN, MPH, CIC: “Infection preventionists had to work very closely with our supply chain and look at all of our options and really keep track of it. I also think working with lab more closely will be important in the future, to understand testing modalities, understanding our abilities to test and interpreting those tests.”

June 9: FDA COVID-19 Ruling: Not All N95 Respirators Eligible for Decontamination and Reuse

Decontaminated respirators should only be resorted to when unused devices are not available, but that happened a lot in the last few months.

June 10: COVID-19 Forced Hospitals to Build Negative Pressure Rooms Fast

A portable anteroom can be used as an extra layer of protection between the isolation space and the rest of the hospital. A positively pressured anteroom, for instance, lets staff don PPE in a protected environment.

June 10: Infection Preventionists, Environmental Services Need to Work More Closely Together

Sharon Ward-Fore, MS, MT(ASCP), CIC: “It is a collaboration, and I think the most successful environmental services department has an infection preventionist who really enjoys working with EVS.”

June 15: New Method Needed to Determine Infection Preventionist Staffing Levels

The common method used to determine IP staffing-using a ratio of IPs to the number of beds or the number of patients-might not be the best way of determining just how many IPs an institution needs.

June 17: Infection Preventionists Prepare to Ride the Second Wave of COVID

Those of us in healthcare and infection prevention must focus on sustainable efforts to combat COVID-19. How do we maintain readiness and response without burnout? There’s no solid answer to this, but a big piece really goes into the establishment of plans and education.

June 19: Q&A: States Need to Mandate That Infection Preventionists be Certified

Ann Marie Pettis, RN, BSN, CIC, FAPIC, president-elect of the Association for Professionals in Infection Control and Epidemiology (APIC): “If indeed flu comes at the same time a second wave of COVID comes, that’s going to be difficult—unbelievably difficult because the symptoms obviously are somewhat similar. We’ll be trying to rule both of those things out. It will create more of a risk for a surge, and it will put more taxing on our PPE supplies.”

June 21: Just-in-Time Fit Testing Allows for Rapid Response During Pandemics Like COVID-19

Just-in-time (JIT) fit testing allows a healthcare organization to offer evaluation, training, and fitting of healthcare professionals during rapid intervals, as needed, based on specific patient care assignments.

June 23: COVID-19 Reveals Fatal Infection Prevention Flaws at Long-Term Care Facilities

Many healthcare facilities, not only LTCFs, have turned to online training for staff and then designate the employee as competent to do their job. Online training does not prove competency; it provides training.

June 28: Telehealth in the Time of COVID-19: A 20-Year Overnight Success

The Infectious Diseases Society of America updated its position statement to educate its membership on the use of telemedicine and telehealth technologies to provide “evidence-based, cost-effective, subspecialty care.”

July 6: Environmental Services During COVID-19: No Longer ‘Unsung’ Heroes

The swiftness and severity of the COVID-19 spread meant some hospitals were scrambling to adjust. Environmental services often led the way.

July 16: Hand Hygiene in the Post-COVID-19 Era

To enact social change such as better hand hygiene, only about 25% of a group needs to adopt the change and move the rest of the group forward.

July 24: National Reporting System for All Dangerous Pathogens Needed

After decades of reluctance to implement a national reporting system, when COVID-19 came along we witnessed almost overnight the formulation of case definitions and comprehensive national reporting from all healthcare facilities.

August 7: How to Build Cost-Effective Infection Prevention Programs at Long-Term Care Facilities

Infection control at LTCFs needs to be a balanced approach that addresses the risk of infection, and not just the treatment of infection. Money is saved when this approach is used.

August 14: Handwashing: Is a New Normal Possible?

Professional development educators and infection control specialists need to design educational programs that create a lasting behavior change when it comes to hand hygiene.

August 22: Navigating the New Normal in Infection Prevention

It will also be necessary to again train other professionals the way IPs have historically trained them about infection prevention, because a lot of the old rules had to be set aside when COVID-19 surged.

August 27: IPs Must Ensure the Supply of PPE for COVID-19’s Second Wave

Supply chain issues are a larger, more systemic aspect of healthcare and national preparedness. Although IPs may not be able to fix them individually, there are ways we can ensure the safety of our hospitals.

September 3: Q&A: COVID Presents Unique Challenges to NICUs

Jenny Hayes, MSN, RN, CIC: “Asking the patient to wear a mask, which is something that we do in our facility, can be challenging at that point, especially as labor progresses, and you’re to the point of pushing. That right there offers a set of unique challenges for both the patient and the staff in the room.”

September 8: HAIs Didn’t Go Away When COVID-19 Came Along

As the pandemic seems not to abate, patients will start to present to the hospital after delaying crucial primary and preventive care visits, meaning sicker non–COVID-19 infected patients, with the potential for increased CLABSI and CAUTI rates.

September 16:Revamp Standard Precautions for Infection Preventionists

Many factors make the isolation precautions for diseases like COVID-19 more complex than typical droplet or airborne definitions.

September 20: Continuously Active Disinfectants Can Keep COVID at Bay

Charles P. Gerba, PhD: “Unfortunately, standard procedures for testing and registration by regulatory agencies of CADs (continuously active sanitizers or disinfectants) as disinfectants useful in preventing exposure to disease causing microorganism transmission has only taken place in recent years.”

September 23:During COVID, Telehealth Can Be an Infection Preventionist's Friend

A telework-ready infection preventionist is an IP who continues to support their facility if they also end up in quarantine. Teleworking like so many other aspects of nursing is something we just needed to jump into. No training, no guidebook, no manual.

September 27: Contact Tracing for COVID-19? Infection Preventionists Can Get it Done

As the COVID-19 pandemic continues to surge, it is unlikely that contact tracing within healthcare will become anything less than critical.

October 5: Infection Preventionists Might be Needed in Schools

Infection preventionists are of utmost importance to work with school systems and provide the safest strategies and environmental modifications which can suppress the transmission of the SARS-CoV-2 virus.

October 12: Practicing Infection Prevention in Isolated Populations: How the Navajo Nation Took on COVID-19

Much of the care for the spread-out and isolated patient population is home care. The hospital has a 3-person HIV team and about 6 public health nurses who visit patients in their homes. They all speak Navajo. (COVID-19 is Diko Ntsaaígíí-Náhást’éíts’áadah.)

October 16: Why a COVID-19 Vaccine Might Not Be the Answer We’re Hoping For

One example of a way that IPs can collaborate with other departments to implement a vaccination program is to work with occupational health and emergency response departments to have a mass vaccination drill.

October 21: Infection Preventionist Guide for Dealing with Flu and COVID-19

If you see something, say something. Let coworkers know when they may have breached infection control practices such as forgetting to wash their hands, not wearing PPE properly, or missed opportunities to clean high-touch surfaces.

October 26: Infection Preventionists Need to Monitor PPE Use

Sharon Ward-Fore, MS, MT(ASCP), CIC: “Practices drift. You can become complacent and maybe your level of awareness has decreased…. So, infection preventionists need to be really aware of what’s happening in the areas they cover as far as PPE usage is concerned.”

October 30: How This Vascular Access Nurse Relies on an Infection Preventionist

Although both vascular access and infection prevention have their own focus, our commonality is in ensuring patients get the care they need while minimizing their chances of nosocomial infections.

November 3: Q&A: IPs Need to Get More Involved in Endoscope Disinfection

Melinda Benedict, MS, CIC, CFER: “I think for infection preventionists: If you’re not already involved in your endoscopy department or you haven’t been invited in, see if you can get in and just continue to check it out and see what’s going on, especially if the reprocessing and cleaning of the scope is actually done within that clinic.”

November 7: When It Comes to COVID-19 Disinfectants: Use with Care

Infection preventionists should know that these technologies are available to add to their toolboxes of best cleaning and disinfection practices when they need them but be aware of the caveats for their use.

November 11: Novel Initiative Keeps Nursing Home Residents Safe From COVID-19

Cedric Steiner: “We had to address the ability to say good-bye to loved ones. A big guy, with tears in his eyes. He was so thankful that they had a place to go for their mother, because at the hospital they couldn’t see her. He wanted to give me a bear hug, but we did the ‘elbow thing’ instead.”

November 14: Moderna COVID-19 Vaccine mRNA-1273 Reports 94.5% Efficacy in Early Data

Data show none of the treated volunteers to develop COVID-19 experienced a severe form of the disease, versus 11 given placebo.

November 16: Infection Preventionists Must Be Included on COVID Taskforce

IPs have not only that frontline experience, but also the ability to pivot and evolve with recommendations. In fact, our very jobs are about translating continuously evolving evidence and guidance into practice.

November 17: Taking Aim at Antibiotic-Resistant Bacteria During COVID

Patients afflicted with COVID-19 have an increased susceptibility to antibiotic resistant infections both from prolonged hospitalizations and the use of immunocompromising agents such as dexamethasone.

November 21: Tracking of Healthcare-Acquired Infections Continues to Evolve

COVID-19 possibly hindered the prevention of healthcare-acquired infections (HAIs) because infection preventionists have less time to do rounding and focus on the elements that contribute to HAIs.

November 23: Innovations Needed for Personal Protective Equipment

Perhaps now is the time that innovation begins to rely more heavily on infection preventionists and our valuable insight into the world of healthcare PPE. The changes we help guide now, can help make healthcare safer and infection prevention easier.

November 24: Next Course? COVID ‘Surge Superimposed Upon a Surge’

The CDC warns that it’s possible that the number of hospitalizations due to COVID-19 are likely to rise every day for the next 4 to 10 weeks, further straining an already strained healthcare system.

November 30: Moderna Submits COVID-19 Vaccine for FDA Approval

Efficacy against severe COVID-19 is 100%—based on the benchmark of 30 total severe cases, all in the placebo group. Consistent efficacy was seen across patient age, race and ethnicity groups, as well as gender demographics.

December 2: Q&A: ‘Arguing’ Before the Supreme Court

Kevin Kavanagh, MD: “I would tell the Supreme Court that it’s very important that all high-risk venues are treated equally, but the remedy isn’t opening up one high-risk venue, the remedy should be closing down all high-risk venues.”

December 2: Hospital Fights COVID, Superbug CRAB at Same Time

When an 850-bed urban hospital fought off COVID-19 in part by having to relax infection prevention protocols, the opportunistic and deadly carbapenem-resistant Acinetobacter baumannii (CRAB) struck.

December 3: Infection Preventionist: ‘We On the Frontlines Have to be Strong’

Rebecca Leach: “I think the biggest thing is just having support, whoever it is. If it’s a fellow infection preventionist…. It really is that emotional support of being able to talk to each other about your experiences and really process your feelings.”

December 8: Time to Update Personal Protective Equipment Protocols?

Compare transmission data for patients on contact precautions using the recommended full complement of PPE versus transmissions for patients on contact precautions when PPE was being utilized differently or not at all.

December 9: Bracing for ‘Logistical Nightmare’ of COVD Vaccine Distribution

Sharon Ward-Fore, MS, MT(ASCP), CIC: “If it were my institution, I would make sure that infection preventionists are educated on everything they need to know about the COVID vaccine, as well as the flu vaccine side effects.”

December 11: How to Train Environmental Services Teams

Infection preventionists can work with environmental services (EVS) leadership to implement a routine practice for quality assurance checks that EVS leadership can follow. These metrics can then be reviewed as an aggregate with the IP department to target whether further education may be beneficial.

December 14: Truckloads of COVID-19 Vaccine Rolling to US Distribution Sites

Angela Rasmussen, PhD: “Even if you are in the first group to get the [Pfizer/BioNTech] vaccine, even if the vaccine becomes available widely beyond the first groups that are going to get it, we still need to be wearing masks, social distancing, thinking about ventilation, and avoiding large gatherings for some time to come.”

December 14: Infection Preventionists to Play Crucial Role in COVID Vaccinations

How will the COVID vaccine be handled at each facility? Will it be mandatory? Will it be given annually? Will it be a condition of employment? These are all questions that will need to be addressed.

December 15: Swiss Cheese Model—How Infection Prevention Really Works

In essence, infection prevention and control isn’t just one measure, like personal protective equipment (PPE), but all of these layers. Each layer is imperfect but plays a critical role in reducing risk.

December 17: Q&A: ‘Are You Going to Get the Vaccine?’

Bruce Y. Lee, MD, MBA: “I would like to see data for a longer period of time to make sure that we have a better handle in terms of efficacy and the safety of the vaccine.”

December 18: COVID Proved the Importance of Airflow in Buildings

Officials at the Children’s Hospital of Philadelphia have the ability to convert several floors into airborne infection isolation rooms, or more commonly termed negative pressure rooms, with the flip of a switch.

December 21: Moderna’s COVID-19 Approved by FDA

Unlike traditional forms, Moderna’s mRNA-1273 vaccine does not put weakened or inactivated germs inside the body. Rather, it teaches cells to make proteins that will trigger an immune response by injecting ribonucleic acid into cells which gives them instructions.

December 21: As Vaccines Roll Out, New COVID Strain Rolls In

Healthcare experts around the world worry that the COVID-19 mutation—called VUI–202012/01—might be 70% more infectious than the standard SARS-CoV-2 strain. There are no indications yet that it may also be more lethal or that vaccines can’t neutralize it.

December 22: How COVID-19 Vaccination Effort Should Proceed

When it comes to COVID-19 vaccinations, it’s important to consider ancillary staff. Employees in environmental services, lab, respiratory therapy, physical therapy, and food services who have been working in high-risk areas.

December 22: Vaccines Should Work Against New COVID-19 Strain

We must treat this strain with the respect it deserves, but we must not panic. There is no doubt that increased infectivity equates with increases in deaths, but it does not mean the vaccines will not work.