Coronavirus : One year on, Preventative Measures, PART 3 OF 4
One year on, from the start of Covid, We look at what Prevention Strategies have been employed or recommended and why that is important in Managing the pandemic.
Prevention
Preventive measures are the current strategy to limit the spread of cases. Because an epidemic will increase as long as R0 is greater than 1 (COVID-19 is 2.2), control measures must focus on reducing the value to less than 1.
Preventive strategies are focused on the isolation of patients and careful infection control, including appropriate measures to be adopted during the diagnosis and the provision of clinical care to an infected patient.
Droplet, contact, and airborne precautions should be adopted during specimen collection, and sputum induction should be avoided.
The WHO and other organizations have issued the following general recommendations:
Avoid close contact with subjects suffering from acute respiratory infections.
Wash your hands frequently, especially after contact with infected people or their environment.
Avoid unprotected contact with farm or wild animals.
People with symptoms of acute airway infection should keep their distance, cover coughs or sneezes with disposable tissues or clothes and wash their hands.
Strengthen, in particular, in emergency medicine departments, the application of strict hygiene measures for the prevention and control of infections.
Individuals that are immunocompromised should avoid public gatherings.
The most important strategy is to frequently wash the hands and use portable hand sanitizer and avoid contact with their face and mouth after interacting with a possibly contaminated environment.
Isolation and contact tracing alone represent insufficient measures to control the spread of the disease. Nevertheless, their efficacy increases with the distancing. To this regard, a modelling study with data from over 40,000 participants in the UK, demonstrated that the combination of isolation and contact tracing with physical distancing measures can be effective for reducing the accounting of cases that would need to self-isolate and of contacts that would need to be traced, controlling in turn, the disease transmission. [54]
Healthcare workers caring for infected individuals should utilize contact and airborne precautions to include PPE such as N95 or FFP3 masks, eye protection, gowns, and gloves to prevent transmission of the pathogen.
Prognosis Preliminary data suggests the reported death rate ranges from <1% depending on the study and country. The majority of the fatalities have occurred in patients over 50 years of age. Young children appear to be mildly infected but may serve as a vector for additional transmission.
Deterrence and Patient Education Patients and families should receive instruction to maintain good social distance measures
Strict personal hygiene measures
Avoid close contact with subjects suffering from acute respiratory infections.
People with symptoms of acute airway infection should keep their distance, cover coughs or sneezes with disposable tissues or clothes, and wash their hands.
Immunocompromised patients should avoid public exposure and public gatherings.
Anecdotal Evidence From Those treating Coronavirus Patients.
The following pearls have been provided by health professionals in Italy, the UK, and the U.S. and are based on anecdotal experience.
The disease is not a 'typical' adult respiratory distress syndrome (ARDS).
Microvascular thrombosis in the pulmonary circulation can lead to an increased dead space. Pulmonary thrombosis has been associated with wedge-shaped infarcts in the lungs on imaging, without the evidence of deep vein thrombosis.
Early pulmonary fibrosis following the disease has been reported from Italy. This could be oxygen-related or inflammation-related.
In both NIV and MIV, prone positioning of the patient can be essential and should be done early. This procedure should be done more than once a day. Keep a lower threshold for proning even if the usual threshold is a PF ratio of 130. The benefit of proning lasts less than 4 hours in the early phase, but as the disease advances into ARDS, the beneficial effects become long-lasting. Prone positioning in MIV should be followed by HNFO or NIV (preferably in the prone position) if the saturation is not maintained. There should be a low threshold for intubation if NIV fails for more than an hour.
Many centers use inhaled nitric oxide and prostacyclin with good effect. Tachyphylaxis with nitric oxide is usually seen after 4-5 days.
Maintain euvolemia. There is a high risk of acute kidney injury with hypovolemia.
Extubation should be delayed more than usual, especially if the inflammatory markers are remaining high. Always perform a leak test before extubation.
The vast array of Medical information which has come to light throughout the course of the year, has dramatically reduced the death rate, from Covid infection.
As we continue measures to improve our medical knowledge from ongoing studies, treatment and vaccine development, it is important that we stay up to date with this information.