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What You Need to Know About the Corona Virus (COVID-19)

Updated April 5, 2020

Hysteria is building throughout Florida about the Corona Virus (COVID-19) right now.  We know there are a lot of unanswered questions and concerns from our community.  Your children were hearing rumors at school, on TV, or even from other friends and family about what Corona Virus (Covid-19) is and how it will affect your family.  With the information below, you can have an educated conversation with your children.  We are sharing with you how it may impact you and your family; what we know about how Corona Virus is spread and what to do if you suspect you or a loved one has the Corona Virus (COVID-19).

At Night Lite Pediatrics Urgent Care, we are taking extra precautions so we can care for your children during this stressful time.

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WHAT IS CORONA VIRUS (COVID-19)?

Coronaviruses are large, enveloped, positive-strand RNA viruses.  Corona means crown in Latin because proteins surrounding make it look like a crown. Human coronaviruses (HCoVs) are RNA viruses that have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people. However, in the 21st century, 2 highly pathogenic HCoVs—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality. In December 2019, yet another pathogenic HCoV, 2019 novel coronavirus (2019-nCoV or COVID-19), was recognized in Wuhan, China and has caused serious illness and death. The ultimate scope and effect of this outbreak is unclear at present as the situation is rapidly evolving (adapted from JAMA).

WHERE DO CORONA VIRUSES (COVID-19) THRIVE?

Viruses attach themselves to places where they have receptors; receptors for Novel Corona Virus (COVID-19) are in the respiratory tract especially the lower respiratory tract (lungs). Therefore, the virus can cause severe lung disease.

WHERE CAN’T CORONA VIRUSES(COVID-19) SURVIVE OR WHAT KILLS THEM?

RNA enveloped viruses are more sensitive to and easily inactivated by environmental agents such as disinfectants, heat, and alcohol with greater than 60 to 65% alcohol. Coronavirus can’t survive in an acid medium; hence, they can’t survive in the stomach.

HOW IS CORONA VIRUSES(COVID-19) SPREAD?

Person-to-person spread of Corona Virus (COVID-19) is thought to occur mainly via respiratory droplets because of their large size, resembling the spread of influenza. The virus does not settle in the air but is grounded, so it is not transmitted by air (airborne). There is a new thinking and models that show that the droplets can travel up to 4 feet in the air and infect others. The virus particles (droplets) fall on surfaces such as hands, counter tops and doorknobs from which others can contact it. This contrasts with smaller viruses such as Measles or bacteria such as Tuberculosis that can float and survive in the air for periods of time.

SHOULD MASKS BE USED?

Initially, CDC (Center for Disease Control and Prevention) did not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including Corona Virus (COVID-19). It was initially stated that you should only wear a mask if a healthcare professional recommends it. A facemask should be used by people who have Corona Virus (COVID-19) and are showing symptoms. This is to protect others from the risk of getting infected. The use of facemasks also is crucial for health workers and other people who are taking care of someone infected with Corona Virus (COVID-19)  in close settings (at home or in a health care facility. Adapted from CDC).

WHAT CHANGED ABOUT WEARING A FACEMASK IN PUBLIC?

  • It has become obvious that 20% of people with Corona virus (COVID 19) infection do not have any symptom of the disease and they are going to public places like grocery stores where social distancing cannot be maintained.
  • It therefore stands to reason that wearing a mask in public may protect other people who come into contact with the unknowing individual. Indeed, there is evidence that this worked in South Korea and Czech Republic and this is the basis of the new CDC recommendation to wear masks in public.
  • The mask need not be professional grade to offer some benefit.
  • The CDC recommends constructing your own cloth mask and there are more detailed directions on how to do that on the CDC website.
  • It is important to note that the facemask can be soiled hence the need to dispose or maintain cleanliness of the mask.

HOW CAN SPREAD OF CORONA VIRUSES (COVID-19) BE PREVENTED?

Based on the above, we are advised not to shake hands, avoid touching our eyes, nose and mouth with your hands which may be contaminated with the virus, and practice respiratory hygiene by covering your mouth and nose with a bent elbow or tissue rather that the hands. Most importantly, wash your hands frequently and thoroughly and keep an alcohol sterilizer in your pocket.

These are the precautions to take:

  • NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
  • Use ONLY your knuckle to touch light switches. elevator buttons, etc.
  • Lift the gasoline dispenser with a paper towel or use a disposable glove.
  • Open doors with your closed fist or hip – do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors (use a disposable towel to open the door if needed.)
  • Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
  • Wash your hands with soap for 20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
  • Keep a bottle of sanitizer available at each of your home’s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.
  • If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

Other relevant preventive measures are social distancing by keeping 6 feet from someone who is coughing or sneezing.  Practice appropriate food safety (sick animals, those who have died or come from questionable sources) should not be consumed.

DIFFERENCES BETWEEN ADULTS AND CHILDREN WITH CORONA VIRUS COVID-19 INFECTION:

Recent reports suggest that the disease is less severe in children and adolescents. This is good as young children, elderly and those with underlying chronic conditions are typically at high risk for severe viral illnesses. The drawback is that asymptomatic individuals (or individuals within the incubation period) especially adolescents may be nonchalant and careless about following precautions hence serve as sources for transmission

The extent to which this occurs remains unknown, so we need to maintain meticulous hygiene with children as they may have only mild cold symptoms and are unlikely to be tested. This may be the rationale for closure of schools and day care centers.

Recent reports out of China and Italy indicate that infants had higher rates of serious illness when compared with older children.

WHO NEEDS TO BE SCREENED OR TESTED?

Currently, there is no commercial test available for hospitals, physician practices or other outpatient facilities. All tests are sent to the Centers for Disease Control and Prevention and the Department of Health in the state where the test was conducted and some diagnostic laboratories such as Quest Diagnostic and LabCorp.

At present, the possibility of Corona Virus (COVID-19) should be considered primarily in patients with fever and/or lower respiratory tract symptoms who:

  • Reside in or have recently (within the prior 14 days) traveled to areas where community transmission has been reported (e.g., China, South Korea, Europe, Iran, Japan, Northern California, Seattle WA, Westchester NY but this is fast becoming anyone any form of travel even between states in the USA)

or

  • Have had recent (within the prior 14 days) close contact with a confirmed or suspected case of Corona Virus (COVID-19), including through work in health care settings.

Close contact includes being within approximately six feet of a patient for a prolonged period (1 hour) while not wearing personal protective equipment (PPE) or having direct contact with infectious secretions while not wearing PPE.

The possibility of Corona Virus (COVID-19) should also be considered in patients with severe lower respiratory tract illness when an alternative etiology cannot be identified, even if there has been no clear exposure.

Where possible, patients who do not need emergent care should be encouraged to call prior to presenting to a health care facility for evaluation so that infection control measures can be arranged and implemented before their arrival and public health officials notified.

WHAT DO YOU DO IF YOUR CHILD HAS SPECIAL HEATH CARE NEEDS?

Corona Virus (COVID 19) infections may have increased adverse consequences in children with special health care needs. This includes children with chronic conditions, disabilities, and those with medically complex conditions.

Caretakers of such children should bear the following in mind:

  • Meticulous handwashing for at least 20 seconds before anyone enters the child or youngster’s room is of utmost importance.
  • Limiting the number of contacts may be beneficial.
  • Communicate with physicians, therapists and home health care agencies in a timely fashion to create and adjust appointments, treatment plans and emergency action plans.
  • Inquire about the availability of telehealth services.
  • Create contingency plans for supplies, special nutritional needs and durable medical equipment with the responsible physician and / or care coordinator. In collaboration with your child’s provider(s}, You may need to navigate the logistics of getting refills for medications or supplies that require monthly approvals from the insurance company.
  • Link up with peer support groups to share experiences and brainstorm solutions.

WHAT DO WE DO AT NIGHT-LITE PEDIATRICS TO SAFEGUARD YOU?

At Night Lite Pediatrics, we are committed to keeping our communities healthy, safe and informed.  During this Corona Virus (COVID-19) outbreak, our staff is taking extra precautions during our cleaning processes.  All offices are using sanitary measures to deep clean all rooms.  At NLP Urgent Care we have implemented Corona Virus (COVID-19) protocols in each office:

During the Clinic hours Night Lite Pediatric staff are to perform environmental cleaning procedures EVERY OTHER HOUR of the following areas (SANITIZED):

  • Front door that leads outside of the building
  • Lobby counter
  • Lobby door that leads to the back office
  • Nurses station counter
  • Lab counters
  • Pens/clipboards
  • After every patient the following areas need to be SANITIZED:
    • Exam table
    • Counter/Sink Knobs
    • Soap Dispenser/Paper Towel Dispenser
    • Patient chairs and stool
    • Door Knobs
    • Light Switches
    • Triage Equipment
  • Gloves are to be worn by staff member performing the cleaning. Hands are to be washed after removing the gloves.
  • Every employee is to wash their hands before touching anything in the kitchen
  • RCP to instruct all parents to sanitize hands before signing in. Hand sanitizer to be kept at front desk.

WHAT DO WE DO AT NIGHT-LITE PEDIATRICS IF YOUR CHILD WERE POTENTIALLY EXPOSED TO SOMEONE WITH CORONA VIRUS (COVID-19)?

This is rapidly evolving hence subject to updates.

  • Patient is first encouraged to start their visit through call when they get to the clinic and register on-line. Either way we triage them for cough, fever and if positive they must stay in the car to complete their registration and for further instructions unless they have shortness of breath,  The idea is to avoid having anyone with fever and cough sit in our waiting room.
  • ALL parents and patients are to sanitize their hands before signing in, regardless of the reason for the visit. Anyone presenting with cough, fever (greater than 100°F) who walks in without telephone triage must wear a surgical face mask. Person Under Investigation (PUI) cannot be in our office without a face mask. Anyone accompanying these patients need also to be masked.
  • The patient who meets the above criteria now will have priority to be moved from the lobby. Patient would be placed in designated Corona Virus (COVID-19) exam room. Parent can fill out registration paperwork in the exam room. If designated Corona Virus (COVID-19) room is occupied have the patient/parent wait in their car.
  • Those that go back to their car are called to go through the questionnaire with NLP staff to classify their risk category and called back once the room is ready.
  • We allow only one parent or guardian to go to the exam room with the patient(s)
  • The patient will be evaluated by Provider wearing N95 masks and PPE, not surgical masks.
  • As an alternative, A healthcare provider dons PPE and goes to the car to collect vital signs of pulse ox heart rate and temperature, listens to lungs, checks for lymphadenopathy, etc. and collects the flu test. If the flu test is negative, we refer to a referral center for collection of the Corona Virus COVID-19 test. If the patient needs to come inside for additional evaluation, we have them place a mask and go to a designated (Corona Virus COVID-19) sick room.
  • No MA/RN is to perform triage. Triage should be performed in exam room by the provider using designated back up triage equipment. Providers are to perform any/all diagnostic tests for PUI.
  • NLP to contact local Health Department to report possible PUI.
  • Patient when discharged will be given age appropriate isolation instructions and encouraged to go to the hospital if their condition worsens and not return to NLP. If we determine that the patient needs a COIVD-19 test our medical staff has to call the local DOH and the DOH will tell our medical personal where the patient needs to go. This way Marlene can easily track and follow up with patients and obtain the lab results.
  • NLP Staff will perform Environmental Cleaning of Exam Room and Office.
  • NLP is working actively on incorporating telemedicine triage and follow-up and possibly drive through care into the process.

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