PART 4. CORONAVIRUS.So, like SARS and MERS — other coronaviruses — before it, the Wuhan coronavirus is spreading in hospitals.”

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PART 4

“A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

it means that nearly half of the initial infections in this hospital appear to have been spread within the hospital itself…

So, like SARS and MERS — other coronaviruses — before it, the Wuhan coronavirus is spreading in hospitals.”

“Five health care workers at Good Samaritan Hospital in San Jose were exposed to the new coronavirus while treating a patient there and have been sent home and told to remain isolated until Feb. 11, according to Santa Clara County public health officials…

The workers are being kept at home “to protect the public’s health and limit any potential spread of the virus,” Santa Clara County public health officials said in a statement.” (A)

“During SARS, patients were sent to nine hospitals all over Hong Kong so that no one hospital had to bear the full burden of the outbreak. Despite this effort to spread the load, the outbreak overwhelmed the city’s health-care system. The Tuen Mun public hospital in the northwest of the city was one of the treatment facilities. The toll on the hospital was steep. Staff had to work long hours with the threat of a deadly virus looming over them. Non-emergency patients were turned away. Entire wards were turned into isolation zones. And the first of many casualties among health-care workers in Hong Kong occurred at Tuen Mun on April 26, 2003…

During SARS much of the spread was happening in hospitals. Once that became clear, public health officials put in place rigid infection control measures in medical settings; the outbreaks in Hong Kong, China, Toronto and elsewhere were brought under control. Cowling says transmission of this new coronavirus is quite different from SARS…

Public health officials don’t yet know what it will take to stop the new Wuhan coronavirus, but Seto says fanatically enforcing hand washing — at home and in hospitals — will probably be one of the keys.” (B)

“Most transmission appears to be occurring in the community,” he says. “We’ve seen a small number of infections of health-care workers, but nothing like SARS where one third of the cases were health-care workers. For the new coronavirus it’s a much smaller fraction in hospitals, and probably most transmission occurring in the general community. And that’s much, much more difficult for public health measures to deal with.”

Infectious disease specialists and scientists say the new coronavirus that’s shuttering companies across mainland China may be more contagious than current data shows.

Emerging in Wuhan, China, about a month ago, the virus has spread from about 300 people as of Jan. 21 to close to 21,000 and killed more than 420 — with the number of new cases growing by the thousands every day.

“The rapid acceleration of cases is of concern,” Dr. Mike Ryan, executive director of the World Health Organization’s emergencies program, said at a news conference last week before the agency declared a global health emergency.

Chinese scientists worry the respiratory illness, which world health officials say likely came from a fish market, has mutated to adapt to its new human hosts far more quickly than SARS. Data on the virus is changing by the day, and some infectious disease specialists say it will take weeks before they can see just how contagious it is. What they’re seeing so far is concerning and leading U.S. and international scientists to believe the virus is more contagious than the current data shows, according to interviews with epidemiologists, scientists and infectious disease specialists.” (C)

“The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe, according to many of the world’s leading infectious disease experts.

The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease.” (D)

“When the H1N1 flu began spreading a decade ago, U.S. hospitals were flooded with patients. The pandemic, which was declared over in 2010, left nearly 275,000 hospitalized, as health officials fretted whether they would have enough beds, enough medical supplies, or enough protective gear…

Hospitals across the country are convening near-daily meetings to check in on their emergency preparedness plans. And they’ve called all hands on deck. Nearly everyone — from physicians and nurses to public affairs representatives and the employees responsible for ordering supplies and keeping the hospital clean — is involved in making sure a hospital’s existing emergency plans are up to date.

 “But as we project outward with the potential for this to be a much longer situation, one of the things that we’re actively working on is projecting the long-term needs for our health care system,” Dr. Nancy Messonnier, director of Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, told reporters on Wednesday…

Much of that work revolves around hospitals planning for what Biddinger called the “four S’s” of a surge in patients amid an outbreak: supplies, staff, space, and the system that governs all of them.

They need to review their inventory of supplies, including ventilators, oxygen tanks, and the respirator masks that health workers might need to wear to care for infected patients. They need to plan for how to protect other patients in the hospital, particularly those with weak immune systems. They need to review screening procedures and the proper way to put on protective gear. And they need to educate everyone — from the front desk employees in the ER to the workers who take out the trash in patient rooms — in those protocols.” (E)

“Given the unknowns about 2019-nCoV, in the coming days and weeks, we’re in for some twists and turns. For now, many experts believe this outbreak could get a lot worse: burdening the Chinese health system, spreading in poorer countries with weaker health systems, and sickening and killing thousands more people along the way. Alternatively, it could get much better, with new cases and deaths steadily dropping. Here are the key factors that will determine which way it goes.

4 ways this outbreak could take a turn for the worse

1) China can’t contain the new coronavirus

2) The new coronavirus spreads in countries with weak health systems

3) The virus is actually deadlier than it seems right now

4) Travel bans isolate countries, spread xenophobia — and exacerbate outbreaks

4 things that could unfold that would prevent a pandemic

1) China contains the virus

2) Local clusters of the disease in other countries don’t grow

3) The virus can’t spread in poorer countries with hotter climates

4) We learn the virus is not as deadly as it seems (F)

“Princess Cruises late Tuesday said nine passengers and a crew member on one of its ships in Japan had tested positive for the new coronavirus from China, prompting local authorities to order a multiweek quarantine of the vessel.

The Santa Clarita, California-based line said more than 2,600 passengers and 1,044 crew on the Diamond Princess would remain quarantined on the ship for at least 14 days.

The 10 people who have tested positive for the virus are being taken off the ship, which is in the harbor of Yokohama, Japan — the port for Tokyo. They’ll be transferred to local hospitals…

Early Wednesday, another cruise vessel arriving in a major Asian port was quarantined until passengers could undergo screening for coronavirus. The quarantine of the 3,376-passenger World Dream, in Hong Kong, was ordered after three passengers from a previous sailing tested positive for the virus. World Dream is operated by Dream Cruises, an Asia-based cruise company that caters to Asian travelers.//

Princess said Diamond Princess would head out to sea to perform normal marine operations including, but not limited to, the production of fresh water and ballast operations, before returning to Yokohama and docking at the city’s port. Food and other supplies needed for the extended quarantine of the vessel will be brought onboard.

Passengers have been confined to their cabins for the duration of the quarantine, and many shipboard services have been shut down. Food is being delivered to cabins at regular intervals. Passengers have access to complimentary internet and telephone service to stay in contact with their families and other loved ones.”  (G)

“A southern New Jersey military installation is on a list of potential coronavirus quarantine locations should the need arise.

The Department of Health and Human Services has requested the support of the Department of Defense to provide space if primary and secondary facilities become full.

The Department of Defense identified 11 locations near major airports, including Joint Base McGuire-Dix-Lakehurst, which spans through portions of Burlington and Ocean counties, according to a news release issued Thursday.

The military involvement would be limited to providing housing support for up to 20 people as they undergo a period of quarantined observation, the Department of Defense release said. Military personnel will not be in direct contact with quarantined people and will minimize contact with personnel supporting the evacuees, officials said…

There are currently 12 confirmed cases in the United States, CNN reported Thursday. The news network report said that “planeloads” of Americans fleeing the outbreak in China are arriving at military bases across the United States.” (H)

“Current efforts to contain the coronavirus differ in many ways from those inflicted on lepers in the past century. Americans who may have been exposed to the virus in China are quarantined for 14 days and are not sentenced to life in isolation. The medical treatment is significantly improved and the chances of recovery are good. However, the corona virus is far more contagious than leprosy, against which 95% of people are naturally immune. Precautions are certainly useful.

But this recent outbreak raises questions similar to the health authorities that struggled with decades ago. Are quarantine and isolation the most effective way to contain a disease? Do you hesitate to identify yourself as a potential victim?

“It fails because people are headed for the hills,” said Wendy Parmet, a professor of health law at Northeastern University, Rob Stein from the NPR. “People don’t call and look for medical care … and medical care providers are afraid to treat patients because they don’t want to be quarantined.”

There are other questions as well.

Will the US decision to close its borders for foreigners who have recently visited China do more harm than good? The World Health Organization believes that such travel bans may and warns of panic and anxiety measures.

Perhaps more importantly, how are those who are believed to be potential carriers of the virus treated by those around them? NPR’s Maria Godoy reports that some Asian Americans are already experiencing a setback. A student was told to leave a cafe and “take the corona virus with her.”” (I)

“The Centers for Disease Control and Prevention has shipped the diagnostic test for the novel coronavirus to more than 100 public health labs nationwide, allowing states to test for coronavirus cases themselves and receive results quicker.

Why it matters: The FDA bypassed usual regulatory channels to distribute the test under an Emergency Use Authorization, which has been used in life-threatening situations like MERS, Ebola and the Zika virus.

Before, specimens from all over the country had to be shipped to Atlanta to have their suspected cases validated.

“This continues to be an evolving situation and the ability to distribute this diagnostic test to qualified labs is a critical step forward in protecting the public health,” FDA Commissioner Stephen Hahn said.” (J)

“CDC created this interim guidance to provide US public health authorities and other partners with a framework for assessing and managing risk of potential exposures to 2019-nCoV and implementing public health actions based on a person’s risk level and clinical presentation. Public health actions may include active monitoring or supervision of self-monitoring by public health authorities, or the application of movement restrictions, including isolation and quarantine, when needed to prevent the possible spread of 2019-nCoV in US communities. The recommendations in this guidance apply to US-bound travelers and people located in the United States who may have been exposed to 2019-nCoV. CDC acknowledges that state and local jurisdictions may make risk management decisions that differ from those recommended here. However, a harmonized national approach will facilitate smooth coordination and minimize confusion. The guidance may be updated based on the evolving circumstances of the outbreak.” (K)

“Infection control procedures including administrative rules and engineering controls, environmental hygiene, correct work practices, and appropriate use of personal protective equipment (PPE) are all necessary to prevent infections from spreading during healthcare delivery. Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility. All healthcare facilities must ensure that their personnel are correctly trained and capable of implementing infection control procedures; individual healthcare personnel should ensure they understand and can adhere to infection control requirements.

This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration. This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States. This guidance is applicable to all U.S. healthcare settings. This guidance is not intended for non-healthcare settings (e.g., schools) OR to persons outside of healthcare settings. For recommendations regarding clinical management, air or ground medical transport, or laboratory settings, refer to the main CDC 2019-nCoV website.” (L)

“Whether it’s an influx of coronavirus carriers or another Superstorm Sandy, a new nonprofit report finds New Jersey is in a relatively good position to handle the next public health emergency.

An annual survey released Wednesday by The Trust for America’s Health shows that New Jersey is among a top tier of 17 states considered to have the best health care and emergency response systems, along with the training and capacity to protect residents against communicable diseases, natural disasters and other calamities.

Officials at the Trust — a national research and advocacy group focused on public health and injury prevention — said the Garden State has ranked in the top third of states for the last several years, a significant improvement from 2013, when it came in as one of the seven lowest-scoring states.” (M)

“Gov. Phil Murphy on Monday launched a task force to make sure New Jersey is prepared for any threat from the surging coronavirus.

Murphy also noted that Newark Liberty International Airport is one of 11 major U.S. airports that receive flights from China requiring enhanced screening for the virus.

There are no confirmed cases of coronavirus in New Jersey, but Murphy said it’s “critical” the state has “strong preparedness protocols in place.”

“By establishing the Coronavirus Task Force, we are bringing together experts across state agencies, health officials, and federal partners to ensure that we are working collaboratively to protect the health and safety of all New Jerseyans,” the governor added.

According to an executive order Murphy signed Monday, the task force will coordinate all state efforts to “prepare for and respond to the public health hazard posed” by coronavirus.

The task force is chaired by state Health Commissioner Judith Persichilli and will include members of the state’s human services, law and public safety, education, and homeland security departments, as well as the State Police.” (N)

““I have to emphasize that the risk right now, certainly to the United States but definitely to the residents of New Jersey, is still low,” said state health commissioner Judith Persichilli, whom Murphy named as the chair of a new Coronavirus Task Force…

Authorities also said that Newark Liberty International Airport is one of 11 airports in the nation where flights from China will be allowed to land, and passengers on those flights will be screened and, if necessary, quarantined.

“We’ve been very proactive, we have teams in place ready to go,” Persichilli said. “There will be screening at the Newark Airport. We are prepared to handle quarantine of any person that comes in.”

Also represented on the task force are the State Police, the Office of Homeland Security, the attorney general and the Department of Education. The group will coordinate with hospitals and other health care facilities as well as federal authorities and the Port Authority, which runs Newark Airport.

Also Monday, Princeton University has told students who recently returned from China to “self-quarantine” for 14 days from the time they were last in China, a step the university said was being taken as a precaution. The number of students affected by the order is more than 100, according to various news reports.

The precaution matches a general advisory issued for travelers by state public health officials.

“If you’ve traveled to China and return from that travel, we would urge residents to monitor their symptoms for 14 days,” said Dr. Lisa McHugh, program coordinator for infectious disease epidemiology for the state health department. “If you develop symptoms, again we would urge you to contact your health care provider, and we’ll work through them to determine if the individual should be tested at the Centers for Disease Control.”” (O)

“China on Thursday finished building a second new hospital to isolate and treat patients of a virus that has killed more than 560 people and continues to spread, disrupting travel and people’s lives and fueling economic fears.

A first group of patients was expected to start testing a new antiviral drug, as China also moved people with milder symptoms into makeshift hospitals at sports centers, exhibition halls and other public spaces.

Other treatment centers had tight rows of simple cots lining cavernous rooms where patients with milder symptoms would be cared for. And Wuhan had another 132 quarantine sites with more than 12,500 beds, according to the official Xinhua News Agency.” (P)

“United States citizen died from the coronavirus in Wuhan, China, American officials said on Saturday. It was the first known American death from the illness, and was likely to add to diplomatic friction over Beijing’s response to the epidemic.” (Q)

“A study published Friday in the medical journal JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.

This is big news. In plain English, it means that nearly half of the initial infections in this hospital appear to have been spread within the hospital itself. This is called nosocomial transmission. (Doctors use big words to hide bad things: Nosocomial means caught it in the hospital.)

What’s more, most spread doesn’t appear to have been the result of a so-called “super-spreader event,” in which a single patient transmits infection to many other people. In these events, a procedure such as bronchoscopy — where a doctor inserts a tube into the patient’s lungs — can result in many infections.

This would be a concern, but not nearly as much as what appears to have happened: Many health care workers and many patients got infected in many parts of the hospital. What’s more, since there’s a broad spectrum of infection and only patients who were sick were tested, it’s quite likely that there was even more transmission in the hospital.

So, like SARS and MERS — other coronaviruses — before it, the Wuhan coronavirus is spreading in hospitals.” (R)

“The World Health Organization’s director-general cautioned Saturday that transmission of the new coronavirus outside of China may increase and countries should prepare for that possibility.

 “It’s slow now, but it may accelerate,” Tedros Adhanom Ghebreyesus said during a press conference in Geneva. “So while it’s still slow there is a window of opportunity that we should use to the maximum in order to have a better outcome, and further decrease the progress and stop it.”

Tedros’s warning came after health authorities in Singapore announced they had diagnosed the infection in a man with no travel history to China and no known link to other cases in Singapore…

Infectious diseases expert Michael Osterholm warned that it is unwise to conclude that just because the world hasn’t yet seen outbreaks in other countries they won’t happen. It takes several generations of transmission — an imported case passed on to two others, who then infect two others and so on — before an outbreak takes off, he said.”

“What we’re watching is the public health community trying to catch up to the speed of the virus,” said Osterholm, who is the director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.” (S)

“With an intense flu season in full swing, hundreds of thousands of coughing and feverish patients have already overwhelmed emergency rooms around the United States. Now, hospitals are bracing for the potential spread of coronavirus that could bring another surge of patients.

So far, only a dozen people in the United States have become infected with the novel coronavirus, but an outbreak could severely strain the nation’s hospitals.

“We’re talking about the possibility of a double flu pandemic,” where a second wave starts before the first is over, said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security.

Public health experts are also closely watching reserves of vital medical supplies and medications, many of which are made in China. Some hospitals in the United States are already “critically low” on respirator masks, according to Premier Inc., which secures medical supplies and equipment on behalf of hospitals and health systems. And China is the dominant supplier of the raw ingredients needed for penicillin, ibuprofen and even aspirin — drugs taken daily by millions of Americans and dispensed routinely to hospital patients.

“All the hospitals are taxed with a large flu season and other bugs,” said Dr. Mark Jarrett, the chief quality officer for Northwell Health, which operates 23 hospitals across Long Island and elsewhere in New York. About 400 patients are coming to its emergency rooms each day with flulike symptoms.

“Everybody is at maximum capacity,” Dr. Jarrett said…

“Many of us are holding our breath to see the downstream effect on pharmaceuticals and other medical supplies because of this outbreak in China,” said Dr. Paul Biddinger, who helps oversee emergency preparedness for Partners Healthcare, the Boston hospital group that includes Massachusetts General.

Experts like Dr. Toner say supplies could easily become depleted, especially at smaller hospitals that tend to have less inventory of basic items like masks, gowns and gloves. Hospitals have long struggled with shortages of injectable medications and staples like saline. In 2017, Hurricane Maria knocked out power to several pharmaceutical factories in Puerto Rico, leading to a shortage of saline bags…

Because the nature of the virus is still unknown, public health officials said it’s unclear what future challenges hospitals will face if the coronavirus spreads into an epidemic in the United States. While the current government guidelines call for patients to be treated in specialized isolation rooms, experts say it is unlikely that there will be enough isolation rooms at individual facilities.” (T)

“The number of deaths from novel coronavirus in mainland China increased to 811 Sunday, health officials with China’s National Health Commission said.

This exceeds the number of deaths reported from the SARS outbreak in 2003, which killed 774 people, according to the World Health Organization.

Outside of China, two people died from the disease in the last two week, one in the Philippines and one in Hong Kong, bringing total number of global deaths to at least 813.

As of Sunday, more than 37,198 confirmed cases have been reported on mainland China…

Six more people aboard a cruise ship quarantined in Japan have tested positive for novel coronavirus, bringing the total on the Diamond Princess to 70, Japan’s health ministry said Sunday.

The ministry said one of the six confirmed cases is a woman in her 70s who has Hong Kong residency, but is also a U.S. citizen. That brings the total number of American passengers who were confirmed to have the virus to 14.” (U)

“Four passengers on Friday were taken to a hospital after their cruise ship arrived in New Jersey for evaluation of coronavirus..

The CDC has confirmed just 12 cases in the United States, mostly in California; there have been no cases in New Jersey or New York

Four passengers traveling on a cruise ship that returned to New Jersey have tested negative for the new virus that has sickened tens of thousands in mainland China and killed more than 800.

Governor Phil Murphy said all passengers tested negative and “New Jersey currently has no confirmed cases of novel coronavirus and the risk to residents remains low.” (V)

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