How to care for critically ill coronavirus patients: Take 5 extra precautions to prevent transmission

A physician in scrubs in a hospital hallway
Doctors and other healthcare workers need to take extra precautions in treating critically ill coronavirus patients to prevent transmission. (Getty/NanoStockk)

Doctors and other healthcare staff need to take some extra precautions when it comes to treating critically ill coronavirus patients, according to three health professionals.

Those treating patients with coronavirus or COVID-19 should make some modifications to the usual critical care they provide to patients hospitalized with acute respiratory distress, according to the authors of a clinical update published in JAMA.

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Managing severe coronavirus is not different from managing most viral pneumonia causing respiratory failure, they said, but it is critical to reducing the risk of spreading the virus to other patients and healthcare workers.

The authors—Srinivas Murthy, M.D., of the University of British Columbia in Vancouver, Canada; Charles D. Gomersall, MBBS, of the Chinese University of Hong Kong; and Robert A. Fowler, M.D., of Sunnybrook Hospital and the University of Toronto—recommend the following five additional precautions:

  • Admit patients suspected of having coronavirus to private rooms when possible.
     
  • Use medical face masks for symptomatic patients during assessment and transfer.
     
  • Keep patients with suspected or confirmed cases at least two meters apart.
     
  • Use caution when using high-flow nasal oxygen or noninvasive ventilation due to the risk of dispersion of aerosolized virus in the healthcare environment with poorly fitting masks.
     
  • Use additional airborne precautions, including N95 respirators and eye protection, if clinicians are involved with aerosol-generating procedures such as endotracheal intubation and diagnostic testing using bronchoscopy.

Coronavirus is spreading rapidly, and the World Health Organization (WHO) Wednesday declared the outbreak a pandemic.

Coronavirus has been reported in 114 countries, and in the past two weeks the number of cases outside China, where the outbreak began, has increased 13-fold with the number of affected countries tripling, according to WHO’s director-general. There are now more than 118,000 cases worldwide, with 4,291 deaths and thousands more fighting for their lives in hospitals, according to WHO.

Initial reports suggest coronavirus results in severe disease that requires intensive care in approximately 5% of cases, the JAMA authors said. The rapid increase in the number of cases in Wuhan, China, is a warning of how quickly health systems can be challenged to provide adequate care, they said.

Hospitals must ensure staff have updated training in standard, contact and droplet infection prevention and control, including personal protective equipment, they said.

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Facilities should also plan at the local and regional levels for a potential surge in the need for critical care resources.

The authors said critical care units in some regions may not have ventilators or not enough to care for all the patients. Hospitals should have clear resource allocation policies in place to help make decisions if access to lifesaving interventions, from having enough hospital beds to access to renal replacement therapy, becomes limited.

Since there are no proven therapies to treat COVID-19, healthcare professionals should ask patients to participate in clinical trials of supportive or targeted therapies.

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