Coronavirus FAQs

General

The most common symptoms of COVID-19 are fever, cough, or shortness of breath. Some people may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell.

Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air.

Evidence-Based Guidelines

Dedicated medical equipment (e.g., ventilator) should be used when caring for patients with known or suspected COVID-19. If dedication is not feasible, all non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.

According to the World Health Organization (WHO), there are no special procedures for the management of bodies of persons who have died from COVID-19. Local authorities and medical facilities should proceed with their existing policies and regulations that guide post-mortem management of persons who died from infectious diseases.

COVID-19 is an emerging disease and it is still under studied; thus, the Joint Commission International (JCI) is updating the COVID-19 website with latest resources and information.

For any emergency preparedness plan, the facility emergency or disaster preparedness team/committee should conduct an assessment using the hazard and vulnerability assessment (HVA) tool to assess a facility or community's vulnerability to certain type of mass casualty events and determine elements to be included in the plan.

The Joint Commission International Standards do not specify outbreak investigation steps. The health care facilities shall define elements of the basic program, the response to infectious disease outbreaks, and any reporting requirements, based on the local laws and regulations.

The Joint Commission International Standard PCI 8. 2 covers an emergency preparedness program to respond to the presentation of global communicable diseases (including COVID-19).

There is no recommendation from the Joint Commission International list of actions and procedures. The facility should determine the list of actions and procedures, based on the available resources.

If emergency surgery is indicated for a patient with COVID-19:

  1. Schedule the patient as the last surgical case to provide maximum time for adequate air changes per hour (ACH).
  2. Operating room personnel should use NIOSH-approved N95 respirators without exhalation valves.
  3. Keep the operating room door closed after the patient is intubated, and allow adequate time for sufficient ACH to remove 99% of airborne particles:
    • After the patient is intubated and particularly if intubation produces coughing.
    • If the door to the operating suite must be opened, and intubation induces coughing in the patient; or
    • After the patient is extubated and suctioned (unless a closed suctioning system is present).
  4. Extubate the patient in the operating room or allow the patient to recover in Airborne Infection Isolation Room (AIIR) rather than in the regular open recovery facilities.
  5. Temporary use of a portable, industrial grade HEPA filter may expedite removal of airborne contaminants (fresh-air exchange requirements for proper ventilation must still be met).
  6. Breathing circuit filters with 0.1–0.2 μm pore size can be used as an adjunct infection prevention and control measure.

Current World Health Organization (WHO) guidance for HCW caring for suspected or confirmed COVID-19 patients recommends the use of contact and droplet precautions, in addition to standard precautions which should always be used by all healthcare personnel for all patients. Respirators (e.g. N95) are required for aerosol generating procedures. However, when this is not feasible (e.g., when patient’s life is at stake) and if exposure occurs, the monitoring (i.e., self-monitoring, active monitoring or self-monitoring with delegated supervision) should be based the exposure risk category.

Please refer to Table 1 in below link for Epidemiologic Risk Classification1 for Asymptomatic Healthcare Personnel Following Exposure to Patients with Coronavirus Disease (COVID-19) or their Secretions/Excretions in a Healthcare Setting, and their Associated Monitoring and Work Restriction Recommendations.

Visit the CDC website

Environmental cleaning in healthcare facilities housing patients with suspected or confirmed COVID-19 should use disinfectants that are active against enveloped viruses, such as COVID-19 and other coronaviruses. There are many disinfectants, including commonly used hospital disinfectants, that are active against enveloped viruses. Currently WHO recommendations include the use of:

  • 70% Ethyl alcohol to disinfect reusable dedicated equipment (e.g., thermometers) between uses.
  • Sodium hypochlorite at 0.5% (equivalent 5000ppm) for disinfection of frequently touched surfaces in health care facilities.

Clinical Environment, Diagnostic, and Personal Protective Equipment

Environmental cleaning in health care facilities housing patients with suspected or confirmed COVID-19 should use disinfectants that are active against enveloped viruses, such as SARS-CoV-2 and other coronaviruses. There are many disinfectants, including commonly used hospital disinfectants, that are active against enveloped viruses. Currently WHO recommendations include the use of:

  • 70% Ethyl alcohol to disinfect reusable dedicated equipment (e.g., thermometers) between uses.
  • Sodium hypochlorite at 0.5% (equivalent 5000ppm) for disinfection of frequently touched surfaces in health care facilities.

To date there is no epidemiological information to suggest that contact with goods, products, or supplies have been the source of COVID-19 in humans. For these reasons, there is no disinfection recommendations for any goods, products, or supplies given that there is no available evidence that these products pose a risk to public health. The World Health Organization will continue to closely monitor the evolution of COVID-19, and will update the recommendations as needed.

Disposable N95 masks are intended for a single use only. After use they should be removed using appropriate techniques (i.e. do no touch the front, remove by pulling the elastic ear straps or laces from behind) and disposed of immediately in an infectious waste bin with a lid, followed by hand hygiene. For reprocessing or decontamination procedure of reusable respirators, the facilities should always comply with manufacturer's instructions for use (IFU).

A key consideration for safe extended use is that the respirator must maintain its fit and function. Thus, the maximum length of continuous use in non-dusty health care facilities is typically dictated by hygienic concerns (e.g., the respirator was discarded because it became contaminated) or practical considerations (e.g., need to use the restroom, meal breaks, etc.), rather than a pre-determined number of hours.

Please refer to the Centers for Disease Control and Prevention (CDC) website for Strategies for Optimizing the Supply of PPE.

Visit the CDC

These strategies are also available in the Joint Commission International (JCI) COVID-19 webpage.

Visit the COVID-19 webpage

Disposable medical face masks are intended for a single use only. After use they should be removed using appropriate techniques (i.e. do no touch the front, remove by pulling the elastic ear straps or laces from behind) and disposed of immediately in an infectious waste bin with a lid, followed by hand hygiene.

COVID-19 is mainly transmitted through respiratory droplets and contact. If droplet exposure is anticipated, masks should be worn.

The World Health Organization (WHO) does not recommend that asymptomatic individuals (i.e., who do not have respiratory symptoms) to wear masks, as currently there is no evidence that routine use of masks by healthy individuals prevents COVID-19 transmission. Masks are recommended to be used by symptomatic persons . Misuse and overuse of medical masks may cause serious issues of shortage of stocks and lack of mask availability for those who actually need to wear them.

To reduce the chances of decreased protection caused by a loss of respirator functionality, the facility respiratory protection program managers should consult with the respirator manufacturers regarding the maximum number of donnings or uses they recommend for the N95 respirator model(s) used in that facility. If no manufacturer guidance is available, it is recommended to limiting the number of reuses to no more than five uses per device to ensure an adequate safety margin.

Current World Health Organization (WHO) guidance for healthcare personnel caring for suspected or confirmed COVID-19 patients recommends the use of contact and droplet precautions, in addition to standard precautions which should always be used by all healthcare personnel for all patients. In terms of personal protective equipment, contact and droplet precautions include wearing disposable gloves to protect hands, and clean, non-sterile, long-sleeve gown to protect clothes from contamination, medical masks to protect nose and mouth, and eye protection (e.g., goggles, face shield), before entering the room where suspected or confirmed COVID-19 patients are admitted. Respirators (e.g. N95) are only required for aerosol generating procedures.

  • As a measure to limit healthcare personnel exposure and conserve personal protective equipment, the Centers for Disease Control and Prevention (CDC) recommends designating entire units within the facility, with dedicated healthcare personnel, to care for known or suspected COVID-19 patients. Dedicated means that healthcare personnel are assigned to care only for these patients during their shift. The World Health Organization (WHO) also recommends Dedicated COVID-19 patient care areas within health facility for sporadic cases (e.g. infectious disease ward, isolation rooms in emergency or ICU wards).
  • Ideally, suspected and confirmed COVID-19 patients should be isolated in single rooms. However, when this is not feasible (e.g., limited number of single rooms), cohorting is an acceptable option. Some patients with suspected COVID-19 may actually have other respiratory illnesses, hence they must be cohorted separately from patients with confirmed COVID-19. A minimum of 1-meter distance between beds should be maintained at all times. Healthcare personnel should strictly follow basic infection prevention and control practices between patients (e.g., hand hygiene, cleaning and disinfecting shared equipment).

If the health care personnel are not exposed during the procedure, there is no recommendation for work restriction. If exposure occurs, the monitoring (i.e., self-monitoring, active monitoring or self-monitoring with delegated supervision) should be based the exposure risk category.

Please refer to Table 1 in below link for Epidemiologic Risk Classification1 for Asymptomatic Healthcare Personnel Following Exposure to Patients with Coronavirus Disease (COVID-19) or their Secretions/Excretions in a Healthcare Setting, and their Associated Monitoring and Work Restriction Recommendations.

Visit the CDC website

If the health care personnel are not exposed during the procedure, there is no recommendation for work restriction. If exposure occurs, the monitoring (i.e., self-monitoring, active monitoring or self-monitoring with delegated supervision) should be based the exposure risk category.

Please refer to Table 1 in below link for Epidemiologic Risk Classification1 for Asymptomatic Healthcare Personnel Following Exposure to Patients with Coronavirus Disease (COVID-19) or their Secretions/Excretions in a Healthcare Setting, and their Associated Monitoring and Work Restriction Recommendations.

Visit the CDC website

If exposure occurs, the monitoring (i.e., self-monitoring, active monitoring or self-monitoring with delegated supervision) should be based the exposure risk category.

Please refer to Table 1 in below link for Epidemiologic Risk Classification1 for Asymptomatic Healthcare Personnel Following Exposure to Patients with Coronavirus Disease (COVID-19) or their Secretions/Excretions in a Healthcare Setting, and their Associated Monitoring and Work Restriction Recommendations.

Visit the CDC website

The portable, industrial-grade high efficiency particulate air (HEPA) filter units can be used to provide the equivalent of additional air changes per hour (ACH), but it does not prevent COVID-19. Patients with COVID-19 undergoing aerosol-generating procedures (e.g., sputum induction, open suctioning of airways) should be placed in Airborne Infection Isolation Rooms (AIIRs).

There is still a lot that is unknown about the newly emerged COVID-19. While we don’t know for sure that this virus will behave the same way as SARS-CoV and MERS-CoV, we can use the information gained from both of these earlier coronaviruses to guide us. In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from patient records (i.e., paper) at ambient temperatures. However, it is recommended to keep the record in the same room or designate an area to place the records.

A patient with known or suspected COVID-19 should be placed in a single-person room with the door closed. The patient should have a dedicated bathroom. Airborne Infection Isolation Rooms (AIIRs) should be reserved for COVID-19 patients who will be undergoing aerosol-generating procedures (e.g., sputum induction, open suctioning of airways).

Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through respiratory droplets and contact. Airborne transmission may happen, during aerosol-generating procedures (e.g., tracheal intubation, bronchoscopy), thus WHO recommends airborne precautions for these procedures. Elective surgery on COVID-19 patients should be postponed until such patients have received adequate drug therapy. The use of general anesthesia in COVID-19 patients poses infection-control challenges because intubation can induce coughing, and the anesthesia breathing circuit apparatus potentially can become contaminated.

If emergency surgery is indicated for a patient with COVID-19:

  1. Schedule the patient as the last surgical case to provide maximum time for adequate air changes per hour (ACH).
  2. Operating room personnel should use NIOSH-approved N95 respirators without exhalation valves.
  3. Keep the operating room door closed after the patient is intubated, and allow adequate time for sufficient ACH to remove 99% of airborne particles:
    • After the patient is intubated and particularly if intubation produces coughing.
    • If the door to the operating suite must be opened, and intubation induces coughing in the patient; or
    • After the patient is extubated and suctioned (unless a closed suctioning system is present).
  4. Extubate the patient in the operating room or allow the patient to recover in Airborne Infection Isolation Room (AIIR) rather than in the regular open recovery facilities.
  5. Temporary use of a portable, industrial grade HEPA filter may expedite removal of airborne contaminants (fresh-air exchange requirements for proper ventilation must still be met).
  6. Breathing circuit filters with 0.1–0.2 μm pore size can be used as an adjunct infection prevention and control measure.

The World Health Organization (WHO) developed its rapid guidance based on the consensus of international experts who considered the currently available evidence on the modes of transmission of COVID-19. This evidence demonstrates viral transmission by droplets and contact with contaminated surfaces of equipment; it does not support routine airborne transmission. Airborne transmission may happen, as has been shown with other viral respiratory diseases, during aerosol-generating procedures (e.g., tracheal intubation, bronchoscopy), thus WHO recommends airborne precautions for these procedures.

The facility should conduct risk assessment and decision should be made by the key stakeholders, based on the result. However, you should always refer to the local/state regulations.

A patient with known or suspected COVID-19 should be placed in a single-person room with the door closed. The patient should have a dedicated bathroom. Airborne Infection Isolation Rooms (AIIRs) should be reserved for COVID-19 patients who will be undergoing aerosol-generating procedures (e.g., sputum induction, open suctioning of airways).

Information about Airborne Infection Isolation Rooms (AIIRs):

  • AIIRs are single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation).
  • Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation.
  • Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
  • Facilities should monitor and document the proper negative-pressure function of these rooms.
  • Anteroom is recommended but not required.