Letter: Strategies for Prevention and Control of 2019 Novel Coronavirus Infection Among Medical Staff

Abstract

the outbreak of the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) that originated in Wuhan, Hubei province has spread rapidly across China. Many hospitals in Wuhan are the epicenter of the outbreak. The first 14 staff members who were infected with SARS-Cov-2 were from our department. All of them recovered. In such an urgent and unexpected situation, our department began immediate and effective prevention and control strategies to stop the spread of the epidemic in the department. We believe that clinical departments, especially those related to noninfectious diseases in geographic areas of high risk for virus transmission, should take appropriate management and control measures to improve safety during this epidemic. For this purpose, we summarize and share our experiences which should help medical staff prepare in advance for a similar situation. These include the characteristics of SARS-Cov-2 infection, principles of prevention and control of infection, management of infected patients, and epidemic prevention in the outpatient department, ward, operating room, and medical staff.At the end of December 2019, several cases of pneumonia in Wuhan, China caused by an unknown virus were reported to the World Health Organization (WHO). The novel virus was initially identified as a coronavirus on January 7, 2020, and named "severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)" by WHO on February 11, 2020. The disease caused by SARS-CoV-2 is now known as coronavirus disease 2019 (COVID-19). According to the latest retrospective analysis, the median (range) incubation period of COVID-19 is 3 d, but incubation can be as long as 24 d. 1 The median age of patients is 47 yr, and adults are more susceptible than children and adolescents.There is no specific identifying symptom during the early stage of COVID-19 infection. Infected individuals may display weakness, cough, fever, or even no symptom, and yet they are already infectious. The accuracy of early diagnosis based on combined chest computed tomography and nucleic acid test can reach 97%. Expiratory dyspnea occurs in the late stages of infection, and respiratory distress syndrome, acute circulatory failure, or renal failure in severe cases. No specific effective therapeutic protocol in known. The current treatment methods are empiric based on symptoms, and consist of respiratory support (eg, oxygen, mechanical ventilation, or artificial lung technology), antibiotics, and antiviral drugs supplemented by immunoglobulin infusion. 1,2 The outbreak of COVID-19 in Wuhan occurred on the eve of the Chinese New Year (January 12, 2020). However, due to

Management Protocol for Emergency Aneurysm Craniotomy Clipping in Non-Major COVID-19 Epidemic Areas in Beijing, China

“…However, we should be vigilant for false negative CIVID-19 NAT and asymptomatic infections. It was reported that the positive detection rate of COVID-19 NAT was thought to be only 30-50% (13). And about 30-60% of COVID-19 asymptomatic infections may exist in the current population (22), and the virus load of asymptomatic infections is similar to that of symptomatic patients (23).…”

“…After the patient came to the emergency department, the emergency physicians prescribed CT/CTA and clinical presentations to con rm the diagnosis of aSAH. Emergency physicians protect themselves according to the second-level protection standards: work clothing, shoe covers, disposable working caps, N95 masks (replace every 4 hours or when it is wet or at any time if there is pollution), goggles, protective clothing or isolation clothes, latex gloves (6,13). Preliminary screening for COVID-19 in the emergency department included epidemiological history, admission axillary temperature, routine blood test, and lung CT (6).…”

“…We have dedicated patients transport channels, dedicated surgical teams and dedicated negative pressure OR. The surgical team should protect themselves according to the third-levels of protection standards: work clothing, protective boot covers, disposable working caps, N95 masks, goggles, medical protective masks (or positive pressure head covers), protective clothing, double-layer latex gloves (6,13). After the surgery, the patients would be sent to the COVID-19 isolation negative pressure ICU.…”

“…If the COVID-19 NAT was positive, the patients would be transferred to the COVID-19 designated hospital for further treatment after the intracranial condition stabilized. For screening negative, preliminary undetermined (1) and preliminary undetermined (2)/suspected/con rmed patients, paramedic adopts rst-level protection standards ( rstlayer work clothes [eg, scrubs], disposable working caps, surgical masks), second-level protection standards and third-level protection standards after operation, respectively (6,13). Family members of the patient are not allowed to accompany the patient in the ward during the hospitalization.…”

Experiences of practicing surgical neuro-oncology during the COVID-19 pandemic

“…For patients who are suspected of having COVID-19 but who require emergency surgery, or patients from a high risk area, the tertiary health care facility must be equipped to perform the surgery. Patients who are COVID-19 positive should be transferred to the designated hospitals for accepting COVID-19 positive patients, with the exception of emergency cases, in which case the operation should be carried out under level 3 precautions [3]. Besides appropriate PPE, a negative pressure operating room and corresponding intensive care unit (ICU) support are indispensable in the management of these patients.…”