There is no question that we have all been living in unprecedented times. The vast majority of us have been affected by the COVID-19 pandemic in some way. I was recently speaking with a nurse colleague of mine, who works in a large academic medical center. She lost her husband to COVID-19 in April 2020. He had been hospitalized for 1 month before dying from this disease. She herself had developed mild symptoms, which she described as shortness of breath when walking and a temperature elevation of no more than 99.7[degrees]F. At the time, the hospital would not test her for the COVID-19 virus. Her primary care physician did an antibody test on her in June 2020, and she was antibody positive for COVID-19. Despite having minimal symptoms when she contracted the virus, she has since developed an embolus and is being evaluated for cardiac problems secondary to the virus. As she relayed to me, "This is no virus to fool around with-it has devastating consequences in a lot of people."
COVID-19 is a novel (new) corona virus. The pandemic began in January 2020 in Wuhan, China; however, there are estimates that this virus may have started in the fall of 2019. This virus has had some devastating consequences. As of the writing of this column, the United States has over 548,000 reported deaths from this virus. As with any infectious disease, many individuals are asymptomatic, others have mild symptoms, others have more severe symptoms, and others die from this virus.
Nurses are on the front line in many types of service practices. Residential addiction treatment centers are one of those practice types. So, how does an administration keep both staff and patients safe from contracting COVID-19?
I am going to turn to my home state of New Jersey. At the height of this pandemic, New Jersey had the second largest number of COVID-19 cases in the nation. This was secondary to the close proximity of New Jersey to New York City, New York. The highest number of cases in New Jersey was in the northern counties that border New York City and some of the central counties as many individuals travel to work daily to New York City from those counties. I reside in the southern part of the state, and in that part of the state, we saw much less COVID-19 cases.
One upon a time in my career, I was director of an infection control program in an acute care hospital. From attending programs to learn infection control, I learned about the chain of infection, which includes six components: (a) an infectious agent (in the case of COVID-19, the infectious agent is a novel corona virus), (b) a reservoir (it is believed that corona viruses come from the animal kingdom, in the case of COVID-19, a bat in Wuhan, China), (c) a portal of exit (with COVID-19, it is believed to exit by an infected person talking, coughing, or sneezing), (d) a mode of transmission (it is felt that this virus is transmitted by droplet in the air or possibly by contact touch from a contaminated object), (e) a portal of entry (with this virus, it is the respiratory tract of a person who comes in contract with the virus, or from one's hand touching their face, mouth, or nose), and (f) a susceptible host (the older adults as well as patients with comorbidities, such as diabetes, heart disease, obesity, etc.). The first picture describes the chain of infection (see Figure 1).
PREVENTING COVID-19 INFECTION
The assumption needs to be made that every person has this virus. It needs to be treated in the same manner when universal precautions to prevent blood-borne illnesses were implemented.
It cannot be stated more clearly that the best way to prevent contact with COVID-19 is that everyone should wear a face mask. The way to keep treatment centers safe includes and is not limited to the following:
1. Staff and patients wear masks at all times.
2. Anyone entering the building has their temperature taken, and a survey questionnaire is completed (see sample survey questionnaire below). Temperature elevations greater than 99.5[degrees]F and/or any one positive answer to the questionnaire results in immediate quarantine and testing. An employee would be sent home to quarantine.
3. Newly admitted patients are quarantined in a single room, and a COVID-19 viral antigen test is performed on admission. The patient does not leave quarantine until the recommend CDC quarantine time has been completed.
4. Social distancing of a least 6 feet.
5. All staff get a viral COVID-19 antigen test weekly.
6. Excellent handwashing.
7. Telehealth for providers, especially providers, who are at a high risk of contracting the virus.
8. Telehealth and/or virtual group meetings for patients.
9. Now that the vaccines are available, every adult should get vaccinated with one of the COVID-19 vaccines that are available.
SAMPLE COVID-19 SCREEING QUESTIONNAIRE
BELOW ARE THE SAMPLE QUESTIONS FOR COVID-19 SCREENING:
1. Have you traveled outside the United States within the past month?
2. To your knowledge, have you been in close contact with someone who may have been exposed to COVID-19?
3. Have you experienced a loss of smell within the past 2 weeks?
4. Have you experienced a loss of taste within the past 2 weeks?
5. Have you experienced a fever, dry cough, shortness of breath, chest pain, vomiting, or diarrhea within the past 2 weeks?
6. Current temperature: ___________________________________
7. Have you been in quarantine? If the answer is yes, for how long?
8. Have you had a recent COVID-19 viral antigen (nasal swab) test? If yes, when? What were the results?
9. Have you been in quarantine? If yes, for how long?
Note that any one positive answer to symptom questions or elevated temperature equal to or greater than 99.5 F require further evaluation and quarantine (Arundio, 2020).
Those centers that have followed these guidelines have remained open and have had a minimum number of COVID-19 cases.
The problem is that these guidelines have not been implemented universally. Some treatment centers do not perform tests, do not quarantine, do not social distance, and do not have staff or patients wear masks. Practices such as these will place both staff and patients at a high risk for contracting COVID-19.
As healthcare providers, it is our duty and responsibility that we ensure the safest practices based on science and not emotion or personal beliefs to protect our staff and, most importantly, our patients.