By: David M. Higgins II
Coronaviruses are a large family of viruses, some causing illness in people and others that circulate among animals, including camels, cats, and bats. Rarely, animal coronaviruses can evolve, infect, and spread among people, such as MERS and SARS.
Past MERS and SARS outbreaks have been complex, requiring comprehensive public health responses. Many of the patients in the outbreak in Wuhan, China, have reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, suggesting limited person-to-person spread is occurring. Although the exact mode of transmission is unclear, the virus could move via direct contact with an infected individual or by droplet and airborne particles expired when an infected patient breathes, coughs, or sneezes.
Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on the characteristics of the virus, including whether and how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications).
From a memo sent to all Maryland EMS Clinicians by State EMS Medical Director Tomithy Chizmar, MD, FACEP, he stated,” An outbreak of pneumonia associated with a novel coronavirus in Wuhan City, China was reported to the World Health Organization on December 31, 2019. The situation is dynamic, but since then, there have been several hundred confirmed infections in China, with scattered cases in other Asian countries, as well as one confirmed case in the State of Washington. Currently, there is limited information available to describe the degree to which the virus can be transmitted from person-to-person or the severity of the illness. Most patients with this illness have been reported to have a fever, cough, and difficulty breathing. Care is supportive. There is no vaccine or specific treatment for this infection. ”
He has laid out a plan for all EMS, following a CDC recommendation:
Based on recommendations from the CDC and Maryland Department of Health, we recommend the following:
1. Ask all patients about recent travel, particularly those with fever and respiratory illness
2. Identify patients under investigation (PUis) using the following criteria:
- a. Fever and symptoms of lower respiratory illness ( cough, shortness of breath) and one of the following:
- i. History of travel to Wuhan City, China within 14 days of symptom onset,
- or ii. Close contact with a person who is being evaluated for 2019-nCo V while that person was ill
- b. Fever or symptoms of lower respiratory illness ( cough, shortness of breath) and close contact with an ill laboratory-confirmed 2019-nCoV patient within the last 14 days
If you identify a PUI, please take the following steps:
1. EMS clinicians should use gown, gloves, eye protection, and airborne respiratory protection (fit-tested N-95 level or higher respirator)
2. Place a surgical (simple) mask on the patient
3. Contact the receiving hospital via EMRC prior to initiating transport, utilizing the term “PUI” during the consultation
- a. Transport directly to a Special Pathogen Assessment Hospital unless transport time is 45 minutes or more than transport time to a Frontline Hospital ED (closest hospital-based ED)
- b. Special Pathogen Assessment Hospitals: Anne Arundel Medical Center, Frederick Health Hospital, Holy Cross Hospital, Medstar Southern Maryland Hospital Center, Peninsula Regional Medical Center, The Johns Hopkins Hospital
- c. Special Pathogen Treatment Hospital: The Johns Hopkins Hospital
4, Decontaminate ambulance according to attached recommendations