A Courageous Nurse and Coronavirus

Aloha Colleagues,

As you know, right now the media is full of reports on the novel coronavirus, 2019-NCoV.

As you also know, the situation is evolving, yet I want to share what I have learned with you. This blog includes information released through 2/1/20 intended to be helpful & informative.

Coronavirus (CoV) is a big ‘family’ of viruses that involve a single strand of rna wrapped in a protein coat. Because they have such a simple structure, they mutate readily. Coronaviruses are ‘zoonotic’ (meaning they are transmissable across species) and cause illness ranging from the common cold to sometimes- fatal pneumonia. Two related coronaviruses with which you may be familiar are the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

A novel coronavirus that has been dubbed 2019-nCoV was first reported in Wuhan City in Hubei Province, China in November of 2019. At that time, we were told that a cluster of pneumonia cases were identified in people who had visited a market selling live fish and other animals for consumption, a so-called “wet-market”. While wet-markets provide fresh meat, they are known to be reservoirs of contagious disease due to close proximity of a variety of animals (both living and dead) to humans. 

SARS, which has a mortality rate of 15%, is believed to have made the jump from civet cat to humans at a wet market in China back in 2007. MERS-CoV, which has a mortality rate of 34%, is thought to have moved from bats or dromedary camels to humans in Saudi Arabia in 2012. It is possible that the novel (new) corona virus, N 2019 CoV, which has our attention now may have jumped from a bat or a cobra to human hosts. Several known corona viruses are circulating in animals that have not yet infected humans. 

In 2019 CoV has now been found to spread between humans via droplet, direct contact, and fomite. The incubation period of the novel corona virus is unknown but is estimated to be 2-14 days, during which time virons are thought to be shed by the host. Signs of the N 2019CoV infection include respiratory symptoms, fever, cough, shortness of breath and respiratory distress. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and death. 

Standard recommendations for infection control include regular hand washing, covering the mouth and nose when coughing and sneezing, as well as thoroughly cooking meat and eggs. The N-95 respirator mask provides some protection until it becomes moist and then should be replaced. We are always mindful that virons will adhere to the front of the mask. Because people are advised to avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing, it is best to avoid close contact (<3 feet) and large public places. Air travel can be particularly risky and should be avoided if possible. British Airways has cancelled its twice-daily service to China until March and other airlines followed suit as the World Health Organization (WHO) declared a global state of emergency on January 31.

Initial reports indicated a low R0 of 1.5 to 2 (“R- zero” or “R-naught” the number of persons to whom a single infected individual can pass the disease) a thousand or so cases in China and a handful in other countries. We now know that the preliminary reports were grossly understated and authorities are now responding to this information.

On January 23, a brave nurse from Wuhan appeared in a YouTube video warning us that there had been 90,000 cases diagnosed there and an acute shortage of personal protective equipment. At that time, the official case count was fewer than 2000. Her courage is underscored by the fact that YouTube (Like Facebook & Google/social media platforms) is illegal in the People’s Republic of China’s (PRC) and penalties are severe. As a result of her brave actions to make the truth known, media-outlets recognized and reported the greatly minimized official figures released by the PRC. 

What is the truth?

On January 27, 2020, China reported a total of 82 deaths from this outbreak, and estimated fewer than 2000 cases world-wide. Yet, 50 million people in the area around Wuhan were under strict quarantine at that time. Wuhan’s high tech industries and factories have closed. Wuhan is a major shipping port under quarantine, resulting in global financial market instability. Retail businesses including Starbucks, McDonalds & Shanghai Disney are closed. Two new hospitals with a total of 2500 beds are being quickly constructed in Hubei province. This, for an illness that most commonly presents as the common cold, with an R0 of 1.5 -2 and less than 2% mortality? The response was obviously disproportionate to the reported data, supporting the Wuhan nurse’s message.

On Wednesday, January 29, authorities in the US and abroad had corroborated the brave message of our nurse colleague. She risked death and imprisonment to inform us about the novel coronavirus. The PRCs mistakes in initially ignoring the outbreak, then imposing a belated quarantine are a recipe for disaster. At this writing, the PRC reports a total of an additional 24 documented cases and one fatality.

What can we do?

As nurses, we need to remain vigilant and educate others. The novel corona-virus is documented to have spread between human hosts outside of China. Individuals need to be assessed and screened with alacrity. A huge body of research informs us that the immune system is supported by individuals’ healthy behavior: 6 servings of fruit or veg every day, 8 hours of sleep at night, 80 ounces of water and 30 minutes of physical activity every day, elimination or effective management of stressors, elimination of tobacco, and fewer than 2 servings of alcohol daily. Reinforcement of healthy lifestyle and good hygiene practices is never wasted. It is important whether or not we are aware of pathogens in the environment. The importance of supportive care must be emphasized.

A patient with viral illness needs to stay in bed for 24 to 48 hours AFTER their temperature has returned to normal, while staying well-hydrated. (The people who were able to follow this advice survived the H1N1 influenza epidemic of 1918).

DNA testing for the novel coronavirus is available from CDC. I refer you to guidelines attached. (They request multiple sources from each suspected patient). Testing takes only 6 hours but the high demand & time for transport makes turn-around time much longer.

Personal Protective equipment needs to be sourced and sent to Wuhan. Local support is being organized for this initiative by the Hawaii Mainland Chinese Overseas Association (HMCOA). For more information, please contact Tan by emailing Hapica@yahoo.com.

It should be noted that N-95 respirators are in short supply on Oahu. Longs/CVS, Walgreens, Target & Home Depot were sold-out on January 28 and staff did not know when they would receive more. The same product is sold as a dusk mask in Lowe’s, & City Mill where they were still available at that time.

We are grateful to our brave colleague in Wohan. We are smart and we are strong!

Mahalo for All You Do!

Leslie

Reference links

https://m.youtube.com/watch?v=NVHFmVccWns

https://www.cdc.gov/media/releases/2020/s0126-coronavirus-new-cases.htmlhttps://www.dco.uscg.mil/Portals/9/DCO%20Documents/5p/MSIB/2020/MSIB-01-20-Novel-Coronavirus-Precautions-USCG.pdf?ver=2020-01-24-192641-323

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200125-sitrep-5-2019-ncov.pdf

https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fguidance-hcp.html