COVID-19 An Overview APPRECIATION

• Dr. Larry Fontanilla, Thurston County MPD • Thurston County Fire Agencies • Dr. Tom Rea, King County MPD • Dr. Michael Sayre, Medical Director Seattle Fire Department • Staff at King County Public Health • Centers for Disease Control and Prevention OBJECTIVES

• Background • Epidemiology • Patient Screening • PPE • Treatment • Transportation • Decontamination • Exposure BACKGROUND

• City • Population: 11 million • Capital city of province • City Flower: Plum Blossom

• Hubei Province • Population: 58.5 million • POI: , , and Hubei University • Hubei = “north of the lake” Betacoronaviruses • SARS-CoV-2 (which causes COVID-19) ORIGIN STORY • MERS-CoV • SARS-CoV

Where do we get our information? Spectrum of disease (N = 44 415) • Mild: 81% (36 160 cases) • Severe: 14% (6168 cases) • Critical: 5% (2087 cases)

Age distribution (N = 44 672) • ≥80 years: 3% (1408 cases) • 30-79 years: 87% (38 680 cases) • 20-29 years: 8% (3619 cases) • 10-19 years: 1% (549 cases) • <10 years: 1% (416 cases) EPIDEMIOLOGY Initial Overall Case Fatality Rate = 2.3% IMPORTANT <1% mortality in MORTALITY those without STATISTIC comorbidities CASE FATALITY vs. TRANSMISSION TRANSMISSION Fever = 83-98%

Dry Cough = 76-82% CLINICAL PRESENTATION Fatigue and myalgias = 11-44%

Headache Other symptoms Sore Throat reported: Abdominal Pain Diarrhea PATIENT IDENTIFICATION (SCREENING)

COVID-19 Identification Algorithm

Clinical Features & Epidemiologic Risk

Fever* and symptoms of AND In the last 14 days before symptom onset, a history of lower respiratory illness travel outside of the US. (e.g., cough, difficulty – or – breathing) In the last 14 days before symptom onset, contact with a *>100.5 °F person who is under investigation or confirmed infection for COVID-19. TCOMM NOTIFICATION Positive screenings by TCOMM will be notified to providers in the following manner: • The positive screen will be placed in the MDT feed for the incident AND • The positive screen will be indicated over the air via the following phrase:

“CD Precautions Advised” PPE •Mask •Eyewear •Gloves •Gown Until Otherwise Notified, N95 Masks shall be single patient use under the N95 MASKS following conditions: • The patient has screened positively for potentially having COVID-19 • The patient is presenting with fever or respiratory symptoms, but has screened negative for COVID-19 PATIENT CONTACT AND TRANSPORT FLOW CHART • One gurney LIMIT EQUIPMENT • One transport unit • Consider necessity of AED, ALS monitor, jump bags, drug kits, etc. LIMIT PERSONNEL

SEE PDF FLOWCHART FOR PATIENT CONTACT AND TRANSPORT

TREATMENT DOs • Hand a surgical mask to any patient you suspect of having an infectious disease of respiratory origin

• For those patients you suspect of having COVID-19, administer supportive O2 therapy via NRB mask

• Limit therapies to those that are absolutely necessary

• If advanced interventions are necessary for respiratory support, consider iGel placement if clinically appropriate. Do not withhold life saving interventions when appropriate. Ultimately, use good judgement HIGH RISK TREATMENTS Consider the risk of aerosol generating procedures such as: • INTUBATIONS • NON-INVASIVE VENTILATION (BiPAP®) • SUCTIONING • ADMINISTRATION OF NEBULIZED MEDICATIONS THESE ARE CONSIDERED HIGH RISK PROCEDURES TRANSPORTATION

Only ONE transporting unit is to be used for any positively screened potential COVID- 19 patient. Run vents/exhaust fans during transportation

Driver should maintain N95 Mask TRANSPORTATION and eyewear

When parked and on scene, open rear doors in the event the patient needs an aerosolizing procedure performed and weather permits Products approved for use: • Cavi Wipes • Stryker Wipes • Cetylcide Spray • Bleach Solutions • Lysol • Other agents approved for disinfection of DECONTAMINATION “coronaviruses” NON-TRANSPORTING UNIT

PPE disposal after patient contact • Proper disposal of PPE • Use alcohol-based hand sanitizer • Change clothing • Wash hands when available TRANSPORTING UNIT

• Decontaminate surface areas and equipment with approved cleaning agents • Use alcohol-based hand sanitizer • Change clothing • Wash hands when available What is an exposure? QUARANTINE • Asymptomatic • Lower risk of transmission • “Self-quarantine” at home How to • Monitor with Thurston County Public Health and Social Services (TC-PHSS) for symptoms differentiate • Report signs and symptoms immediately to TC-PHSS between ISOLATION quarantine • Symptomatic and isolation? • High risk of transmission • “Self-isolate” at home pending public health investigation • Current guidance from CDC and DOH are that patients must have 2 negative tests to be removed from isolation If you are wearing appropriate PPE (N95 mask, eyewear, gloves, and gown), you are not exposed EXPOSURE

LOW RISK HIGH RISK • ≥ 6 feet from the patient • ≤ 6 feet from the patient • Gown failure • Eyewear failure • Glove failure • N95 mask failure • Broken elastic band that resulted in removal • Involuntary removal within 6 feet of patient These do not constitute the need for quarantine

These do constitute the need for quarantine In the event that appropriate PPE is not worn and a “high risk” exposure is experienced:

Notify patient’s destination NOTIFICATION hospital that a provider exposure has occurred

Following hospital notification, immediately notify your command The provider will be placed in quarantine until one of the following occurs:

• The hospital will run tests on any pathogens that are able to be identified (i.e. influenzas, QUARANTINE pneumonias, other strains of the coronavirus, etc.) – NOT SARS-CoV-2 (COVID-19)…see next (PART 1) slide. • If any test returns positive, quarantine is no longer warranted • Provider is authorized to immediately return to work • Thurston County Public Health and Social Services, along with the DOH, will authorize testing of the exposed provider QUARANTINE • If the SARS-CoV-2 (COVID-19) test comes back negative, quarantine is no longer warranted (PART 2) • Providers that return negative results will immediately be authorized to return to work • Providers should continue to monitor for signs/symptoms over the next 10 days Command should be contacted for any questions or reports related to exposures QUESTIONS The on-call duty officer with public health can be reached through TCOMM by requesting a callback from the “on-call public health duty officer” – be prepared to provide TCOMM with a callback phone number