Since January 2020, news of the coronavirus outbreak in Wuhan, China has made headlines around the world (Reynolds, 2020). However, how many of us fully understand what the virus is and what the implications are for women and their families in our care?
Given the number of deaths in Wuhan and global spread of the virus, the World Health Organization (WHO) has been working with authorities both in China and around the world to learn more about it, how it affects people and how it can be treated (WHO, 2020a). Certainly, this virus appears to be rapidly spreading across the globe and as of 13 February 2020, there are nine confirmed cases of the coronavirus in the UK (Public Health England [PHE], 2020a; 2020b).
In the UK, clinical guidance for the detection and diagnosis of novel coronavirus (2019-nCov, now known as COVID-19), and infection prevention and control has been issued by the Department of Health and Social Care (2020a) and PHE (2020). In fact, the chief medical officer, medical director at PHE and medical director at NHSE have issued advice via a central alerting system that warns frontline staff to increase awareness of the situation (Department of Health and Social Care, 2020b; PHE, 2020). This article considers the current literature on this topic.
The coronavirus is a group of viruses which can pass between animals and humans; they are zoonotic. Within the coronavirus group, there are a few infectious agents that 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; , Zaki, 2012; WHO, 2020a). At the end of 2019, a new novel coronavirus, not previously seen in humans, was identified in Wuhan, China (PHE, 2020a; 2020b; WHO, 2020b). The COVID-19 is a beta coronavirus and its full genome has now been identified for vaccine development (BMJ Best Practice, 2020).
Transmission
The coronavirus is usually transmitted by droplets, such as those produced when coughing and sneezing, and by direct or indirect contact with secretions infected by the virus (PHE, 2020a; 2020c). The virus may also shed in blood, urine and faeces, and, therefore, there is potential for transmission through contact with a wide range of bodily fluids (PHE, 2020). Certainly, person-to-person spread has been confirmed in community and healthcare settings across Asia and into Europe (Phan et al, 2020; WHO, 2020c). There is also a possibility that asymptomatic carriers may be able to infect people (Rothe et al, 2020). PHE has classified the COVID-19 infection as an airborne, high consequence infectious disease (HCID) in the UK (PHE, 2020d).
The application of infection prevention and control (IPC) principles are already widely used by healthcare professionals within hospital and community settings to both prevent the spread of infections and to control outbreaks when they do occur. The WHO (2020a) has issued interim guidance regarding IPC when COVID-19 is suspected. This advice is echoed by guidance issued by PHE (2020).
PHE (2020) suggests the coronavirus may pose complications, such as illness pneumonia or severe acute respiratory infection. They also suggest that patients with long-term conditions or are immunocompromised are at risk of these complications (PHE, 2020). It is important that as first-line staff, midwives are also 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 COVID-19 (PHE, 2020).
Signs and symptoms
Typically, the coronavirus causes mild-to-moderate upper respiratory tract illnesses 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 (Smutts et al, 2008; Jartti et al, 2011; PHE, 2020). PHE (2020) suggest that the coronavirus may even lead to pneumonia or SARS.
Certainly, the severity of the infections ranges from mild symptoms of upper respiratory tract infection with or without fever to serious episodes of pneumonia requiring hospitalisation and assisted ventilation, and even leading to death (CMO, 2020).
Prevention of spread
Like many of the key strategies for management of a new virus, prevention and education are critical to reducing transmission (PHE, 2020). The crucial IPC strategies recommended by the WHO (2020a) and PHE (2020) in the management of suspected cases of COVID-19 are:
The use of standard IPC precautions, which include:
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The Department of Health and Social Care has launched a coronavirus public information campaign across the UK highlighting good hygiene advice, as evidenced in the table above (Department of Health and Social Care, 2020).
As of 26 February 2020, there have been over 2 760 fatalities due to the coronavirus (Worldometer, 2020). It is imperative that as healthcare workers, we consider additional measures to prevent transmission of this virus (PHE, 2020d).
These include training and provision of PPE, such as:
All staff involved with managing suspected or confirmed cases of COVID-19 should be properly trained in the use of provided PPE, including how to put it on and remove it safely (PHE, 2020). In addition, adequate IPC signage should be displayed and contact with patients suspected of having COVID-19 should be limited to essential staff and visitors should be restricted. There is currently no vaccine or specific treatment for COVID-19 although there is work currently underway in the development of a vaccine. However, this is likely to take several months to develop. Treatment of inpatient cases of COVID-19 are for supportive measures (WHO, 2020a).
The early recognition of symptoms and rapid diagnosis is therefore essential to prevent transmission (BMJ Best Practice, 2020; PHE, 2020). All patients should be triaged and isolated, and their diagnosis confirmed (BMJ Best Practice, 2020). The COVID-19 should be considered as a differential diagnosis for all patients who have a fever and/or symptoms of lower respiratory illness, and have travelled from China or any other affected areas within the last 14 days (WHO, 2020d). This is because the estimated incubation period range is 2–10 days (WHO, 2020d).
Management
The management of this virus includes early diagnosis and isolation of suspected cases, supportive therapies such as assisted ventilation, management of complications (namely pneumonia and sepsis) and monitoring for signs of deterioration (BMJ Best Practice, 2020). If a patient has a confirmed case of coronavirus, they will need to be cared for in isolation in a negative pressure isolation room or single room with ensuite bathroom facilities or commode (PHE, 2020). In addition, adequate IPC signage should be displayed and contact with patients suspected of having COVID-19 should be limited to essential staff and other visitors restricted (PHE, 2020d; WHO, 2020a).
Health Protection Scotland ([HPS], 2020) mirrors what is outlined in PHE (2020b) and the WHO (2020a). They suggest that in the absence of effective drugs or a vaccine the control of this disease relies on the appropriate management of cases such as isolation of probably or confirmed cases and their contacts. Our responsibility as nurses and midwives therefore includes:
| If you have recently returned from China, particularly Wuhan or Hubei Province, it is best you: |
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Summary
It is important to note that the current outbreak of novel coronavirus is rapidly changing, therefore, guidelines are likely to be updated as more data regarding COVID-19 becomes available (PHE, 2020; HPS, 2020). In the absence of any known treatment apart from supportive measures, healthcare professionals should keep up to date with the recommended guidelines in conjunction with local IPC guidance.