Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness wellcast. I'm Shaina Farfel with Occupational Health. We are speaking with Vicki Brinsko Maddox, Director of the Department of Infection Prevention here at the Vanderbilt University Medical Center. Thanks for being with us today, Vicki.
Vicki Maddox: Thank you.
Shaina Farfel: I want to discuss what seems to be on everyone's mind these days and these past few months and that is the novel coronavirus or COVID-19. As we start to see more cases here in the U.S. , I wanted to address just some basic questions about the disease to provide further clarity and insight during a time when some of us are feeling increasingly fearful and confused. So, just to begin, what is the novel coronavirus or COVID-19?
Vicki Maddox: Well, there are seven different strains of common human coronaviruses and four of them circulate every year causing cold and flu-like symptoms. They are viruses that have spikes on their surfaces, so when you see them under the electron microscope, the virus looks like it is wearing a crown. Thus, they called it “coronavirus.” So, the symptoms of these four common strains are usually caused by mild to moderate upper respiratory tract illnesses like the common cold. Most people get infected with one or more of these viruses at some points in their lives. So, the novel coronavirus is a new coronavirus that's not been previously identified. We have this happen every once in a while. Remember back in 2003 when we had SARS, it emerged in Asia, causing severe acute respiratory syndrome, and MERS, or the Middle East Respiratory syndrome, emerged in Saudi Arabia in 2012, and often these new viruses reveal themselves when the virus jumps from animals to humans. So, a diagnosis with coronavirus in these four common strains is not the same as COVID-19 diagnosis. So, if your patient tests positive for one of these common coronavirus strains, they are placed on droplet precautions and patients with COVID-19 will be evaluated and cared for differently than patients with common coronavirus diagnoses.
Shaina Farfel: I know some of this is still sort of being figured out, but what are the signs and symptoms that we are seeing in some of these patients that have COVID-19?
Vicki Maddox: Well, the clinical spectrum of COVID-19 ranges from mild disease with nonspecific signs and symptoms of acute respiratory illness, like fever, respiratory flu-like symptoms to severe pneumonia with respiratory failure and septic shock. There has also been reports of asymptomatic infection with COVID-19. So, the available data are currently insufficient to identify risk factors for severe clinical outcomes, but from the limited data that are available for COVID-19-infected patients, like all those patients in China, and for data from related coronaviruses like SARS-CoV or MERS-CoV, it is possible that older adults and persons who have underlying chronic medical conditions, like immunocompromising conditions, may be at higher risk for more severe outcomes.
Shaina Farfel: Sure, and how do we believe the virus is transmitted?
Vicki Maddox: So, this is a new virus, and we are still learning about how it spreads. We do know that the virus is thought to be spread mainly from person to person between people who are in very close contact with one another, within about six feet, through respiratory droplets produced when an infected person coughs or sneezes, and these droplets can land in the mouths or noses of people who are nearby and possibly be inhaled into the lungs. So, people are thought to be most contagious when they are most symptomatic, like the sickest. Some spread might be possible before people show symptoms. There have been reports of this occurring with this new coronavirus, but it is not thought to be the main way the virus spreads. So, the onset and duration of viral shedding and period of infectiousness with COVID-19 are not quite known. It is an evolving situation and it is possible that SARS-CoV-2 RNA, which is the official name for the COVID-19 virus, may be detectable in the upper and lower respiratory tract for weeks after the illness onset, and that is similar to what we saw in MERS Co-V and SARS Co-V; however, detection of viral RNA does not necessarily mean that the infectious virus is present. Asymptomatic infection with the virus that causes COVID-19 has been reported, but it is not yet known what roles a symptomatic infection plays in transmission. Similarly, the role of presymptomatic transmissions or infections detected during the incubation period prior to illness onset is really unknown. So, we keep track with the existing literature and other coronaviruses, and it suggests that the incubation period may range for COVID-19 for about 2-14 days.
Shaina Farfel: How can we best protect ourselves right now? How can we try to prevent the spread of the disease if an outbreak were to occur kind of closer to home?
Vicki Maddox: So, you want to follow what the CDC recommends for really every single flu season. Avoid close contact with people who are sick. Don't touch your eyes, nose and mouth. Stay home when you're sick. Most importantly, wash your hands, wash your hands, wash your hands. Cover your cough or sneeze into a tissue. Then, throw that tissue into the trash. If you don't have a tissue, use the bends in your elbow. Clean and disinfect frequently-touched items, like surfaces you use every day. Think about your cell phone. Think about cleaning that on a regular basis. So, follow the CDC's recommendations for using a face mask. The CDC doesn't recommend that people who are well use a face mask to protect themselves from respiratory diseases, including COVID-19, but when you start to show symptoms of a respiratory illness, face masks should be used by those to prevent the spread of the disease to others, and the use of face masks is also crucial for healthcare workers and people who are taking care of someone in close settings, like at home or healthcare facilities. And I can't emphasize enough to wash your hands with soap and water. The alcohol-based hand rubs that we use kills the coronavirus strains, so very important - wash your hands.
Shaina Farfel: Yeah, okay. So, good to know. So, the face masks and the general public ... if you're not sick, we are saving those for the healthcare provider.
Vicki Maddox: Exactly. Exactly.
Shaina Farfel: What is Vanderbilt doing, specifically, to protect its employees from COVID-19?
Vicki Maddox: So, as many of you are aware, there is a lot of preparation work going on throughout VUMC related to COVID-19. The Emergency Operation Command Center is open and multiple workstreams are in place to prepare for potential threats and for potential patients. So, QSRP has Chad Fitzgerald leading the Command Center and the Chief Hospital Epidemiologist, Dr. Tom Talbot, are all over there leading our efforts. Our Infection and Prevention Team is hard at work fielding inquiries and providing expertise in developing educational plans. These are pushed out. Please know that the situation is very fluid and communications from VUMC are coming out regularly in MyVUMC. A special website had been launched and it's right off of our main website, www.vumc.org\coronavirus\information, employees and patients, so you can go there to get all the information you could possibly think of. Of course, we have our own Infection Control website at www.vumc.org\infectioncontrol (it's updated in real-time), and of course, we have our IP pager 24/7. That's (615) 835-1205. So, remember - wash your hands and check MyVUMC for regular updates.
Shaina Farfel: Perfect. And also, the CDC and World Health Organization are just good general resources, too, right?
Vicki Maddox: Absolutely. Absolutely.
Shaina Farfel: Wonderful. Well, we encourage everyone to use all those resources to stay abreast of the rapidly-developing situation, and Vicki, thank you so much for being with us today. We thank you for your hard work in keeping Vanderbilt employees informed and safe.
Vicki Maddox: Thanks.
Shaina Farfel: Thank you.
Vicki Maddox: Thank you!
Shaina Farfel: Thanks for listening. If you have a story suggestion, you can use the "Contact Us" page on our website at www.vumc.org/health-wellness.