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January 29, 2020

Are US hospitals ready for a coronavirus outbreak?

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    In recent weeks, hospitals across the country have been preparing to screen and treat patients for the new coronavirus that's been rapidly spreading throughout China and other countries. However, Betsy McCaughey, chair of the Committee to Reduce Infection Deaths, in a Wall Street Journal opinion piece questions whether the preparations will be enough to contain the virus in the United States.

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    About the new coronavirus

    Reports of the new coronavirus first surfaced in early December 2019 among people in Wuhan, which is the capital of China's Hubei province. According to the World Health Organization (WHO), the main symptoms of infection from the Wuhan coronavirus, called 2019-nCoV, are fever and lesions in both lungs. Some patients also have reported difficulty breathing, WHO said.

    Officials in China said there have been 132 reported deaths, all occurring in China, linked to the virus. As of Wednesday, China's National Health Commission had reported 5,974 confirmed cases of the virus. Reported cases involve patients in Australia, Cambodia, Canada, China, France, Germany, Japan, Korea, Macau, Malaysia, Nepal, Singapore, South Korea, Sri Lanka, Taiwan, Thailand, Vietnam, and the United States. In the United States, officials have confirmed five cases of the new coronavirus, and CDC is monitoring 110 people across 26 states for possible infection.

    HHS Secretary Alex Azar on Tuesday said he has not declared a public health emergency in the United States over the virus, because risk of the virus' spread in the country is low. Still, Azar said federal officials are "monitoring" the virus and "working hard to keep [Americans] safe, preparing for the possibility this could worsen."

    How US hospitals are preparing

    CDC has released a series of recommendations to help hospitals prepare for patients who may be infected with the coronavirus. The recommendations include ensuring that negative-pressure isolation rooms are available and functioning properly, and ensuring that personal protective equipment and other supplies for infection prevention and control are readily available.

    CDC also has urged hospitals to ask patients with respiratory symptoms about their travel histories and whether they might have come in contact with individuals who recently traveled to areas affected by the coronavirus outbreak.

    Many hospitals have taken quick action to prepare for and screen potential patients for the new virus.

    For example, Vanderbilt University Medical Center (VUMC) last week announced that it changed its electronic prompts to ensure all patients who enter the hospital, ED, or clinics with a fever or respiratory symptoms are asked whether they recently have been to China or have been in contact with someone else who has.

    Health care workers at Emory University and UCLA hospitals also have been asking patients questions about their travel histories, and other hospitals have incorporated coronavirus-specific questions into their EHR systems.

    Hospitals also are taking steps to contain the virus' potential spread and protect immunocompromised patients who are more susceptible to contracting coronaviruses, and some have established routines to help safely guide suspected coronavirus patients through facilities and avoid transmitting the virus.

    For example, John Lynch, an infectious disease specialist at Harborview Medical Center, said if the hospital encounters a patient with a suspected case of the new coronavirus, staff would "get a surgical mask on [the patient] and then get them out of waiting rooms into some other space—that's really the most important step."

    At the University of California, San Francisco (UCSF), patients who providers suspect are infected with the virus would be isolated in a room specifically designed for people with an emerging pathogen—which the facility established in light of the 2014-2016 West African Ebola outbreak.

    Are those preparations enough to contain the virus?

    But McCaughey in her opinion piece argues that it's unlikely every hospital in the United States is as prepared as it should be to handle a contagion like the new coronavirus, citing research and issues with how hospitals in Canada handled the SARS outbreak in 2003.

    McCaughey notes that two patients with undiagnosed SARS infection sought treatment at Canadian hospitals on March 7, 2003—one in Vancouver and one in Toronto. In Vancouver, providers took the patient away from the ED and isolated the patient within five minutes after they discovered he was feeling sick after a trip to Asia. McCaughey writes that the disease didn't spread to others at the hospital, thanks to "a robust worker safety and infection control culture," according to a final report from the SARS Commission.

    In contrast, the Toronto SARS patient sat in the ED for 16 hours before being admitted to a hospital room, and it took an additional five hours for providers to isolate the patient. Ultimately, the patient's infection spread to a number of other patients and hospital staff who hadn't followed proper infection protocols, leading to a SARS outbreak in the region that ultimately killed 44 people within two months. "In short, SARS started as a travel infection but rapidly became a hospital infection because of lax infection-control standards," McCaughey writes.

    This is not a problem unique to Canada, McCaughey writes. She notes that a literature review published in June 2017 that focused on EDs in the United States found "a lack of adequate distance between patients, use of contaminated equipment, failure to use shields to protect health care workers who are intubating patients, and failure to ask coughing patients to wear masks."

    Similarly, CDC conducted "mystery patient" drills at 49 EDs in New York City by sending in 95 patients who pretended to have symptoms of measles and MERS infections. CDC found that, in 78% of cases, the patients were given masks and isolated immediately. However, just 36% of providers involved with treating the patients washed their hands. Overall, CDC said it found "suboptimal adherence to key infection control practices."

    Further, McCaughey notes that health care workers often risk taking pathogens home with them, as evidenced during the Toronto SARS outbreak, when the virus spread to health care workers' families who had not visited the hospital. McCaughey writes that providers often wear their uniforms after work at home or even in restaurants.

    McCaughey writes that, overall, "[t]his latest coronavirus should be a red flag for American hospitals, which need to get serious about infection control." She concludes, "Even if luck holds, and the new virus doesn't spread further, better infection control will still save tens of thousands of lives a year. It's a no-brainer" (McCaughey, Wall Street Journal, 1/25; Bannow, Modern Healthcare, 1/21; Chakradhar/Joseph, STAT News, 1/24; New York Times, 1/29; Nebehay, Reuters, 1/29; Crossley, Reuters, 1/27; Morse, Healthcare Finance News, 1/28).

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