Page 35 - Delaware Medical Journal - March/April 2020

PUBLIC HEALTH
EARLY ISOLATION
If screening is positive or uncertain, early isolation will reduce the risk of transmission to staff and other patients. A negative-pressure room is ideal; place a surgical mask on the patient
and escort the patient to the appropriate treatment area. If a negative-pressure or airborne-infection isolation room
is not available, consider any isolation room with three walls and a closed door, plus a surgical mask for the patient. Staff should follow contact (gloves/gown), droplet (eye protection such as a face shield), and airborne (fit- tested N95) precautions.
EARLY NOTIFICATION
Early notification will help connect
the facility with the subject-matter experts to guide staff through the process of evaluation — using the CDC Patient Under Investigation (PUI) case definition — and through the testing process. The Division of Public Health (DPH) must approve COVID-19 testing at the Delaware Public Health Lab (DPHL). Specimens will consist
of nasopharyngeal and oropharyngeal swabs (similar to influenza testing).
A formalized process that includes early screening, early isolation, and early notification can give providers, staff, patients, visitors, and the general public confidence in the ability to manage suspected cases of COVID-19. Providers and staff should limit close contact (less than 6 feet or 2 meters of separation) with the patients as much as possible unless acuity and condition require increased contact. Consider remote options of communication, such as phone or intercom, if the patient’s medical condition allows,
to gather the necessary information to assess the risk for COVID-19 (e.g.,
travel itinerary, symptoms with onset, sick contacts, etc.). Once a case is determined to be a suspected PUI, remember to protect others from risk of transmission. If the patient needs to be transferred to another facility, such as an emergency department, contact the receiving facility ahead of time to allow for preparation for the patient’s arrival, such as an airborne-infection isolation room, personal protective equipment, and separation from others during transport to the treatment area.
To contain any high-consequence infectious disease, teamwork among all stakeholders — such as the health care community, public health, and the general public — is necessary. The CDC recommends that anyone with medium risk of exposure should undergo self-monitoring of symptoms. Both the health care community and public health staff can educate those without symptoms but who are still considered at risk — due to their
exposure or travel history — to remain at home or in a comparable setting, avoid congregate settings, limit
public activity, and practice social distancing. Compliance to these non- pharmaceutical interventions can slow the spread of an emerging respiratory disease like COVID-19, especially when vaccines and drug treatments are not yet available.
Despite the worldwide impact of COVID-19, as of March 1, 2020, there are no confirmed cases or deaths related to COVID-19 in Delaware. However, other diseases are present that are directly affecting Delawareans. Seasonal influenza occurs every year, resulting in a large number of cases, including associated deaths. Last
year, in Delaware, there were 6,387
f lu-related cases, and 24 deaths. As
of February 27, 2020, the current influenza season includes 5,572
cases and 11 deaths so far. Other communicable diseases that DPH is
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