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Coronavirus: Guidelines Have Been Slow to Reach the Public, Hospitals

The new coronavirus is an enveloped virus and not that hard to deactivate, but even hospitals aren’t disinfecting adequately, says Gavin Macgregor-Skinner, and nurses on the front lines are concerned and want more information.

With the number of coronavirus infections multiplying, the United States has catching up to do when it comes to surveillance of the spread of the COVID-19 disease and education of how to prevent that spread — and that includes in hospitals.

“It’s happening now, but gosh we were so slow,” said Gavin Macgregor-Skinner, director of strategic partnerships in disaster medicine at Beth Israel Deaconess Medical Center. Macgregor-Skinner recently returned from an 18-day official deployment to Hong Kong in relation to the new coronavirus.

In Hong Kong he was training and observing, and some of what he observed there he’s seen here in the United States as well — hospitals not understanding how to clean up after the virus.

“Nearly every hospital I’ve been to does a clean and shine, they don’t do a clean and disinfect, both in the U.S. and overseas,” Macgregor-Skinner said. He spent some of those 18 days in Hong Kong educating people there on how to disinfect and he also took part in contact tracing teams that go out and trace who has had contact with an infected person. Back in the U.S., he has been educating hospitals and others on how to disinfect and deactivate the virus.

The coronavirus is an enveloped virus, one that has an outer wrapping or envelope. Macgregor-Skinner called it the easiest of all the pathogens we deal with to inactivate.

Disinfecting with any number of products — the EPA has published a list — will do the trick but it must be done thoroughly. “In the last week, no one I’ve seen in any hospital is allowing enough wet contact time for the chemistry of the product in the disinfectant to inactivate the virus,” he said. “When we look at whether we’re using chlorine dioxide or other products, they all have a wet contact time that’s required to break down that envelope and deactivate the virus,” he said.

Catherine Kennedy, a registered nurse in Roseville, Calif., and a secretary of the California Nurses Association, said nurses on the front lines are concerned. “We are absolutely concerned that the nurses are not getting relevant information in a timely manner,” she told The Guardian this week. “A lot of hospitals state that they have a plan, but the plan has never been disseminated to the nurses,” she said.

“Every institution ought to be re-educating everybody about appropriate respiratory precautions,” William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University told the same publication.

Macgregor-Skinner said hospitals will bear an incredible weight as more people are hospitalized with the virus if it continues to spread. He observed very sick people with severe pneumonia in Hong Kong and that coincided with a huge amount of medical waste. “They required breathing support for four to six weeks easily and even when they were not symptomatic and were discharged, they were not doing very well.”

He said none was sneezing, but the virus was everywhere — cups, plates, knives, utensils, clothes. “We know the virus doesn’t last long on fabric, but in some environmental samples they were getting virus up to five days on hard, nonporous surfaces,” he said.

Treating just one person sick with the virus will take health-care workers off the front lines at a hospital so tracking, surveillance, diagnosing and isolating people is critical.

The American College of Emergency Physicians (ACEP) yesterday published a set of policy changes it deems necessary to mitigate the impact and spread of the virus. The recommendations have three main objectives: providing access to care for those infected or suspected of being infected; securing an adequate health-care workforce; and ensuring adequate resource allocation.

The recommendations are:

•    Implementing alternative testing centers for faster, more cost-effective testing while freeing up hospital capacity for those who need it most and allowing those who test positive to self-quarantine.
•    Ensuring full coverage of testing and diagnoses by payers without patient cost-sharing.
•    Prioritizing available personnel responding to the outbreak.
•    Ensuring the production of medications and supplies relevant to COVID-19 is prioritized and that they are distributed directly to needed sites of care.
•    Increasing transparency of the supply chain for these products to better identify and proactively address potential shortages.

Testing also got off to a slow start in the U.S. because the CDC insisted on developing the lead diagnostic test kit, according to Macgregor-Skinner. “And we’ve seen in the media that the manufacturing laboratory had a contamination issue and what the CDC has said now is that they’ve taken that test away from that lab and given it to another.”

He said there were other sources of reliable lab tests that the U.S. could have been using. And U.S. labs could have started developing their own diagnostic tests.
“It wasn’t allowed,” he said.

Macgregor-Skinner said more training is necessary and it could start in schools. “I’d like to see a national school program right now.”

He said people from FEMA, CDC or HHS could develop a curriculum in a day and that a 30-minute program for every teacher in the U.S. could be administered on how to protect against the virus and include behavioral actions and social distancing.

“A national curriculum could be taught this week and evaluated next week,” he said. “Within two weeks we’ve got data and metrics to show if people understood and could actually do what we’re telling them to do.

But what we’re not seeing is implementation of all sectors of the community being involved. You go back to California with their earthquake curriculum and copy that approach and methodology and apply it with different messaging.”