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Emergency Physicians Monthly

Spreading facts among an outbreak of fears and rumors.

Everyone’s talking about – and wondering about – Coronavirus (COVID-19). Here are the answers to some common assertions, to better educate your patients, families and colleagues.

Coronavirus is a family of viruses, which COVID-19 is a strain that typically causes the common cold and upper respiratory symptoms. It is a common human virus similar to rhinovirus, RSV and parainfluenza, It is spread mainly through respiratory droplets, coughing and sneezing, though can spread by face touching (particularly eye) with a recently exposed hand. The time of onset of the virus is 2-14 days from exposure, with most patients exhibiting little to no symptoms.

With so many fears from the general public, your EDs might get flooded by well-meaning, but ill-informed patients dreading the worst about the COVID-19. The EPM board crafted a list of myths people are spreading faster than the virus along with the reality of this strain and its impact.

MYTH 1: COVID-19 is going to kill me!

TRUTH: COVID-19 is a type of coronavirus, much like SARS and MERS but with a much lower fatality rate (≈3% vs. 10% vs. 35% respectively). COVID-19 is more highly transmissible, but not as deadly. You have higher rates of dying from influenza.

As of Feb. 15, 2020 CDC estimates INFLUENZA 29 million patients, 13 million physician visits, 280,000 hospitalizations and 16K deaths (105 peds death compared to COVID-19 as of Feb. 24, 2020 75,569 cases in china (14 cases in US), 2,239 deaths in China, (few deaths in US)

  • While COVID-19 does not seem to be infecting the pediatric population as much as adults, INFLUENZA in 2019-20 season seems to particularly severe with very high peds hospitalizations and death rates compared to seasons past. —> TAKE HOME: keep these numbers in perspective and get your flu shot.

MYTH 2: We’re all at risk of serious illness

TRUTH: Elderly patients, particularly with lung comorbidities, and adult smokers, seem to be at significant risk of severe or critical illness, but children and healthy younger adults seem to have a milder course.

MYTH 3: Masks will help protect average people from contracting the disease

TRUTH: Masks are to prevent suspected individuals from spreading the disease. While masks are now ubiquitous in public in China,Taiwan and the Philippines, they’re not designed to protect the wearer but rather, to trap the wearer’s respiratory droplets. Their effectiveness is largely unknown. WHO is recommending surgical masks because N-95 respirators are not generally available around the world.

MYTH 4: N-95 respirators will help protect average people from contracting the disease

TRUTH: The CDC is recommending people NOT wear N-95 respirators in public. It’s true that a properly fitted N-95 mask, sealed around the chin, mouth and nose can block about 95% of airborne particles from being inhaled. That’s probably going to cut down on COVID transmissions in controlled, limited healthcare encounters. But fitting and sealing the mask properly takes work. Breathing in and out through the thick N95 respirator is also work. Staff needs to take breaks and take the mask off frequently. Wearing a respirator for long periods of time, and frequently adjusting the respirator with one’s fingers, may well negate any protective effect.

MYTH 5: I have to shave my beard now to take care of COVID patients

TRUTH: PAPR (powered air-purifying respirator) ought to be available to you in your ED — a lot of hospitals stocked up during the Ebola epidemic of 2014. The sequence to secure the rechargeable battery to your person, then properly donning the head covering, is more elaborate than an N95 respiratory and the level of protection is actually higher (PAPRs’ HEPA is capable of filtering 99.97% of 3 micron diameter particles).

MYTH 6: I should stockpile masks and take antibiotics

TRUTH: Neither of these actions will help. Antibiotics have no effect on viruses.

  • Prevention is important. Wash your hands. Cough or sneeze into your arm (not your hands). Avoid touching your eyes, nose and mouth, which makes it more likely to spread germs. Avoid contact with other sick people. Clean objects before touching them (like shopping cart handles and computer keyboards).
  • Preparation is also important. Consider what you would do in the event of a large scale shutdown. Consider certain areas of Italy that have banned gatherings at most public places – including museums, schools, bars and restaurants – to avoid transmission of the virus. How would you get by if stores were all closed? The CDC has a checklist of emergency preparedness supplies that may be wise to review. Recommendations include at least three days of food and water for each person, medical supplies and medications, basic tools, batteries/phone chargers, extra clothing and rain gear.

MYTH 7: It isn’t safe to go to spaces where people with coronavirus have occupied

TRUTH: While we still don’t know how long it takes for coronavirus to clear from the air in a room, CDC studies on other pathogens show that clearance rate of airborne pathogens from the air in a room is, in part, determined by air flow rate — or how many “air changes per hour” occur in that room. The more ventilation that occurs, the less time it takes to remove airborne pathogens. For 99% of an airborne contaminant to be removed from a room, it takes 28 minutes of ventilation if there is the equivalent of 10 air changes in the room per hour. It takes more than two hours (138 minutes) to remove 99% of airborne pathogens if there are only two air changes in the room per hour. Keep this in mind when you’re sitting in the ED waiting room … or riding the subway.

MYTH 8: I can catch coronavirus from my dog

TRUTH: Probably not. The World Health Organization and – if you’re into tabloid news – experts interviewed by People magazine say that there isn’t any evidence of animal to human transmission of coronavirus. However, a Chinese scientist and epidemiologist working on the coronavirus said that mammal to mammal transmission is possible. In addition, the first confirmed case of coronavirus was recently documented in a Pomeranian dog from Hong Kong. Just to be on the safe side, don’t go kissing your animals on the lips. Oh, and vets recommend against masks for dogs, even though puppy PPE is becoming commonplace in China.

MYTH 9: We should avoid using Chinese products to minimize the chance of catching COVID-19
TRUTH: On the chance that you’re still a little concerned that Chinese-manufactured products may pose a risk for developing a COVID-19 infection, you’ll need to stop taking many medications. According to an article in Politico, a vast majority of US imports of ibuprofen, hydrocortisone and acetaminophen are from China and 80 percent of all the antibiotics used in the United States are produced… in China. China is a main world supplier of active ingredients used in formulating medications and is reportedly the sole supplier of ingredients used to make vancomycin.

What else can we do as EM physicians?

  • Know that hospitals have been working on infectious disease-related surge capacity issues for 20 years. It’s time to involve your hospital administration, dust off the playbook, making sure there’s a way to prioritize your negative pressure rooms and discuss resource allocation.
  • Get to know your county and state public health officials. They can help divert patients, provide appropriate discharge instructions, and facilitate protocol development.
  • Protect your staff. Make sure everyone knows how to don/doff properly. *Please reference the CDC link below for guidance on the donning and doffing process and share it with your teams.

Other resources on Corona Virus:

(FLOW CHART for patient workup)