COVID-19 frequently asked inpatient questions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]Nuha Al-Howthi, MD[3]Gurmandeep Singh Sandhu,M.B.B.S.[4]

• Preliminary evidence from a UK-based randomized clinical trial (The recovery trial) suggests dexamethasone reduced mortality for patients on ventilators by about 33% and by 20% in patients requiring oxygen support. The study showed no benefit in patients with milder disease, there were also no preventive benefits.
• Currently, dexamethasone is not routinely used in COVID-19 patients except there are specific indications, i.e COPD exacerbation.
• Dexamethasone may be used cautiously on a case-by-case bases in patients who are severely ill and are on ventilation or oxygen support.

Eligible patients were randomly allocated between several treatment arms. Dexamethasone was administered as an oral (liquid or tablets) or intravenous preparation, at a dose of 6 mg once daily for ten days, in one of the arms.

In pregnancy or breastfeeding women, patients were randomized to prednisolone (a milder corticosteroid) 40 mg administered by mouth.^[1]

• Currently, hydroxychloroquine is not recommended for use outside of clinical trials due to its potential for toxicity and lack of documented benefits. The Emergency use authorization of hydroxychloroquine and chloroquine was revoked by the US FDA on JUNE 15th 2020, as the known potential benefits do not outweigh the potential risks and toxicity.^[2]

• Not all patients with COVID-19 require hospital admission.
• Patients whose clinical presentation warrants in-patient clinical management for supportive medical care should be admitted to the hospital under appropriate isolation precautions.

• Some patients with an initially mild clinical presentation may worsen in the second week of illness.
• The decision to monitor these patients in the inpatient or outpatient setting should be made on a case-by-case basis. This decision will depend not only on the clinical presentation, but also on the patient’s ability to engage in self-monitoring, the feasibility of safe isolation at home, and the risk of transmission in the patient’s home environment.

• Currently there are no FDA-approved medicines specifically approved for the treatment or prevention of COVID-19.
• During public health emergencies, the FDA may authorize the use of unapproved drugs or unapproved uses of approved drugs for life-threatening conditions when there are no adequate, approved, and available options and other conditions are met. This is called an Emergency Use Authorization (EUA).
• The FDA has issued EUAs for some medicines to be used for certain patients hospitalized with COVID-19. Researchers are studying new drugs, and medicines that are already approved for other health conditions, as possible treatments for COVID-19.
• The FDA created the Coronavirus Treatment Acceleration Program (CTAP) to use every available method to move new treatments to patients.
• Additionally, the FDA is working with the National Institutes of Health, drug manufacturers, researchers, and other partners to accelerate the development process for COVID-19 treatments.
• FDA’s Sentinel System is being used to monitor the use of drugs, describe the course of illness among hospitalized patients, and evaluate the treatment impact of therapies actively being used under real-world conditions.

• No. Remdesivir is an investigational antiviral drug. It is not currently FDA-approved to treat or prevent any diseases, including COVID-19. Because remdesivir may possibly help very sick patients, the FDA is allowing this drug to be provided to hospitalized patients with severe COVID-19 under an Emergency Use Authorization (EUA) issued May 1, 2020.
• Under the EUA, health care providers and patients are provided with information about the risks of remdesivir. However, final data from clinical trials included in an FDA application for approval are necessary for us to determine whether the drug is safe and effective in treating COVID-19.

• Several patients with COVID-19 have been reported to present with concurrent community-acquired bacterial pneumonia.
• Decisions to administer antibiotics to COVID-19 patients should be based on the likelihood of bacterial infection. (community-acquired or hospital-acquired), illness severity, and antimicrobial stewardship issues.

• There are no drugs or other therapeutics presently approved by the U.S. Food and Drug Administration (FDA) to prevent or treat COVID-19.
• Current clinical management includes infection prevention and control measures and supportive care, including supplemental oxygen and mechanical ventilatory support when indicated. There are many ongoing clinical trials in the US and around the world for the treatment of COVID-19.

• No. While there are approved uses for ivermectin in people and animals, it is not approved for the prevention or treatment of COVID-19.
• One should not take any medicine to treat or prevent COVID-19 unless it has been prescribed by a health care provider and acquired from a legitimate source.
• A recently released research article described the effect of ivermectin on SARS-CoV-2 in a laboratory setting. These types of laboratory studies are commonly used at an early stage of drug development. Additional testing is needed to determine whether ivermectin might be appropriate to prevent or treat coronavirus or COVID-19.

• CDC is currently not aware of scientific evidence establishing a link between NSAIDs (e.g., ibuprofen, naproxen) and worsening of COVID‑19.
• FDA external, the European Medicines, the World Health Organization, and CDC are continuing to monitor the situation and will review new information on the effects of NSAIDs and COVID-19 disease as it becomes available.
• For those who wish to use treatment options other than NSAIDs, there are other over-the-counter and prescription medications approved for pain relief and fever reduction.
• Patients who rely on NSAIDs to treat chronic conditions and have additional questions should speak to their healthcare provider for individualized management.
• Patients should use NSAIDs, and all medications, according to the product labels and advice of their healthcare professional.

• At this time there is no vaccine to prevent COVID-19.
• The FDA is working with the vaccine developers and other researchers and manufacturers to help expedite the development and availability of medical products such as vaccines, antibodies, and drugs to prevent COVID-19.

• Convalescent plasma is the liquid part of blood that is collected from patients who have recovered from the novel coronavirus disease, COVID-19, caused by the virus SARS-CoV-2.
• COVID-19 patients develop antibodies in the blood against the virus. Antibodies are proteins that might help fight the infection.
• Convalescent plasma is being investigated for the treatment of COVID-19 because there is no approved treatment for this disease and there is some information that suggests it might help some patients recover from COVID-19. Further investigation is still necessary to determine if convalescent plasma might shorten the duration of illness, reduce morbidity, or prevent death associated with COVID-19.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]Nuha Al-Howthi, MD[3]Gurmandeep Singh Sandhu,M.B.B.S.[4]

• COVID-19 is a new disease and there is limited information regarding risk factors for severe illness. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.^[1]
• Based on what we know now, those at high-risk for severe illness from COVID-19 are:
  • People 65 years and older
  • People who live in a nursing home or long-term care facility
• People of all ages with underlying medical conditions, particularly if not well controlled, including:
  • People with chronic lung disease or moderate to severe asthma
  • People who have serious heart conditions
  • People who are immunocompromised
    • Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
  • People with severe obesity (body mass index [BMI] of 40 or higher)
  • People with diabetes
  • People with chronic kidney disease undergoing dialysis
  • People with liver disease

• Information on COVID-19 evolves daily. Current known risk factors include but are not limited to underlying chronic conditions such as; lung disease, moderate to severe asthma, cardiac disease with complications, diabetes, or immunocompromising conditions.
• Lymphocytopenia, increase in circulating neutrophils, increased AST, ALT, LDH, elevated C-reactive protein, and increased ferritin levels may all be associated with severe illness/disease from COVID-19^[2].

• Smoking cigarettes can leave you more vulnerable to respiratory illnesses, such as COVID-19. For example, smoking is known to cause lung disease and people with underlying lung problems may have increased risk for serious complications from COVID-19, a disease that primarily attacks the lungs. Smoking cigarettes can also cause inflammation and cell damage throughout the body and can weaken your immune system, making it less able to fight off disease.

• Although research for COVID-19 is still ongoing, scientists have found extra-pulmonary manifestations in several other systems. It is thought that the virus instigates a “cytokine storm” where the body responds massively, leading to widespread cytokine release, cellular, tissue, and organ damage. Extra-pulmonary manifestations include but are not limited to;^[3]
  • Heart Inflammation
  • Neurological manifestations
  • Renal disease
  • Liver and digestive tract compromise
  • Venous thromboembolism.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD Rinky Agnes Botleroo, M.B.B.S.Gurmandeep Singh Sandhu,M.B.B.S.[2] Aisha Adigun, B.Sc., M.D.[3]

• No. The American Heart Association, the Heart Failure Society of America and the American College of Cardiology recommend continuing ACE-I or ARB medications for all patients already prescribed those medications for indications such as heart failure, hypertension, or ischemic heart disease.
• At this time, the available evidence demonstrates no indication of COVID-specific harm from these agents. Several randomized controlled trials are underway to better answer this important clinical question.
• Cardiovascular disease patients diagnosed with COVID-19 should be fully evaluated by a healthcare professional before adding or removing any treatments, and any changes to their treatment should be based on the latest scientific evidence. Patients who rely on ACE-Is or ARBs to treat chronic conditions and have additional questions should speak to their healthcare provider for individualized management.

• The selection of therapeutic options through the guideline-recommended treatment of asthma exacerbation has not been affected by what we currently know about COVID-19.
• Systemic corticosteroids should be used to treat an asthma exacerbation per national asthma guidelines and current standards of care, even if it is caused by COVID-19.
• Short-term use of systemic corticosteroids to treat asthma exacerbation should be continued. There is currently no evidence to suggest that short-term use of systemic corticosteroids to treat asthma exacerbation increases the risk of developing severe COVID-19, whereas there is an abundance of data to support the use of systemic steroids for moderate or severe asthma exacerbation.
• Patients with asthma but without symptoms or a diagnosis of COVID-19 should continue any required nebulizer for treatments, as recommended by national professional organizations.
• If healthcare providers need to be present during nebulizer use among patients who have either symptoms or a diagnosis of COVID-19, they should use recommended precautions when performing aerosol-generating procedures (AGPs).
• If clinicians are concerned that an asthma exacerbation is related to an underlying infection with COVID-19, clinicians can access laboratory testing for COVID-19 through a network of state and local public health laboratories across the country.

• If patients with asthma who have symptoms or a diagnosis of COVID-19 need to use nebulizer at home, it is recommended by national professional organizations that they should use the nebulizer in a location that minimizes and preferably avoids exposure to any other members of the household, and preferably a location where the air is not recirculated into the home (like a porch, patio, or garage). Limiting the number of people in the room or location where the nebulizer is used is also recommended. Nebulizers should be used and cleaned according to the manufacturer’s instructions.^[1]
• If nebulizer use in a healthcare setting is necessary for patients who have either symptoms or a diagnosis of COVID-19, they must use recommended precautions when performing aerosol-generating procedures (AGPs).

• Yes, you must go to all your dialysis treatments. Missing even one treatment can make you very sick or lead to death. Dialysis centers have been given strict guidelines on how to keep you safe from COVID-19. The Centers for Disease Control has issued interim guidance for patients on dialysis who have COVID-19 and all centers should be following these guidelines.
  • Everyone, including all patients receiving treatment at the center, home dialysis patients, staff, and visitors who may have been exposed to the coronavirus, and people who currently have symptoms of COVID-19 should be asked if they:
    • have had any fevers or any breathing or respiratory (lung) symptoms
    • live in an area with confirmed COVID-19 cases
    • had contact with someone who is being checked for COVID-19, or if they have recently been in another country where COVID-19 has spread
  • Centers should take patients’ temperatures at check-in.
  • Have separate waiting areas for sick patients that are at least six feet from other patients (some centers allow healthy patients to wait outside or in their cars until it’s their turn to be seen)
  • Patients with respiratory symptoms should be given wear masks to wear and they should be dialyzing six feet away in all directions from healthy patients. In some centers, patients with respiratory symptoms may be dialyzed in a separate area.
  • Visitors with signs/symptoms of infection should not be permitted to enter the dialysis center
  • Use cleaning procedures that kill the coronavirus, along with all routine cleaning and disinfection procedures.^[2]

• No. People who are on dialysis and who have also contracted COVID-19 are considered to be at high-risk. If there is availability, these patients may even be admitted to a hospital.
• In the event your symptoms are mild, you should be able to go to your dialysis center for your scheduled treatments. If you have a confirmed case of COVID-19, or have symptoms of COVID-19, or believe you may have been exposed to the coronavirus, then call your dialysis center prior to your scheduled appointment as there may be new procedures they would like you to follow.^[2]

• Patients receiving dialysis in their own room or an isolation room do not need to wear a mask if the dialysis staff is working from outside the room.
• If the dialysis staff is in the room with the patient, the patient should wear a facemask if tolerated.
• Dialysis staff in the room should use all recommended PPE (Personal Protective Equipment).
• When patients with confirmed COVID-19 are being dialyzed in the acute dialysis unit, the patient should wear a facemask for the duration of treatment.
• Dialysis staff in the room should adhere to appropriate transmission-based Precautions and use all recommended PPE.

• For patients with suspected or confirmed COVID-19 requiring intermittent hemodialysis in the acute care setting, dialysis should ideally be performed in the patient’s hospital room with the door closed. This serves to limit the patient’s movement within the hospital.

• If the patient is to be dialyzed in the acute care dialysis unit, consider the following:

• Transporting the patient to the acute care dialysis unit:

When a patient with suspected or confirmed COVID-19 is being transported to the acute care dialysis unit, ensure HCP(Health Care Personnel) adhere to recommended infection control practices like using personal protective equipment. The patient should wear a facemask during transportation.

• • Dialyzing patient in an acute care dialysis unit isolation room:

If the acute care dialysis unit has an isolation room, hemodialysis should be performed in the isolation room with the door closed. Hepatitis B isolation rooms should only be used for dialysis patients with confirmed or suspected COVID-19 if:

1. The patient is hepatitis B surface antigen-positive or
2. The facility has no patients on the census with hepatitis B infection who would require treatment in the isolation room.

The isolation room should be terminally cleaned after the care of each patient with COVID-19.

• • Dialyzing several patients with confirmed COVID-19 in a shared room in the acute care dialysis unit:

In a situation where there are several patients with confirmed COVID-19 requiring hemodialysis (non-ICU), consider cohorting the patients on the same dialysis shift, preferably the last dialysis shift of the day to allow for terminal cleaning of the dialysis unit following treatment.

• • If possible, patients without COVID-19 should not receive dialysis during the same shift (in the same room); if patients without COVID-19 are dialyzed at the same time in the unit, they should be kept at least 6 feet away from the COVID-19 patients at all times. Patients with confirmed or suspected COVID-19 should continue to wear their facemask during treatment and adhere to appropriate respiratory hygiene and cough etiquette.

• High-risk patients, such as those on dialysis, may be at higher risk for severe disease from COVID-19.For severe cases, recovery may take 6 weeks or more. About 1% those infected will die from the disease.^[2]

• Because every case is unique, decisions on whether or not to postpone cancer treatment and care should be made on a patient-by-patient basis with the physician. Patients should contact their physician or health care providers’ office for any concerns they may have. ^[3]

• If you take medications that weaken your immune system, called immunosuppressant medications:

1. Do not change or stop taking medicines without talking to your doctor. Stopping or changing medicine can cause serious health problems.^[4]

• Among the biologicals, the theoretical risk of COVID‐19 infection seems to be higher with inhibitors of {{tumor necrosis factor-alpha{{ (TNF‐α) compared to interleukin (IL) inhibitors. Among the TNF‐α, the risk seems to be somewhat increased with infliximab and its biosimilars. In general, TNF‐α is not recommended during infectious diseases.

• Ustekinumab, risankizumab, ixekizumab, and brodalumab do not increase the risk of respiratory infections in general. However, the data should be interpreted with caution, since we do not have the data for COVID‐19 yet.

• There are reports on drug‐induced interstitial lung disease by infliximab adalimumab, and ustekinumab. Patients on these medications with pre-existent pulmonary problems have a higher risk for COVID‐19.

• Oseltamivir(branded as Tamiflu) is a drug approved for the treatment of influenza A and B. Oseltamivir targets the neuraminidase distributed on the surface of the influenza virus to inhibit the spread of the influenza virus in the human body. A study in Wuhan reported that no positive outcomes were observed after receiving antiviral treatment with oseltamivir.
• Several clinical trials are still evaluating the effectiveness of oseltamivir in treating SARS-CoV-2 infection. Oseltamivir is also used in clinical trials in several combinations, such as with chloroquine and favipiravir.

• There is no evidence that suggests that HIV patients who are on effective antiretroviral treatments and who have adequate CD4 counts are at increased risk of contracting COVID-19.^[5]
• Individuals with weakened immunity, i.e. HIV patients who are not on effective antiretroviral medication or those with low CD4 counts and have other comorbidities may be at increased risk of severe illness from COVID-19.^[5][6]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]Gurmandeep Singh Sandhu,M.B.B.S.[3]

• As long as a patient is stable and no longer symptomatic, they can be discharged.

• Based on data and experience with other viral infections, most persons recovered from COVID-19 who test persistently or recurrently positive by RT-PCR are likely no longer infectious. Additionally, the magnitude and persistence of the immune response following recovery may vary among individuals, with factors such as age potentially influencing protection.
• Based on limited available data, determinations must be made on a case-by-case basis as to whether recovered persons with persistently detectable SARS-CoV-2 RNA are potentially infectious to others and should continue to be in-home isolation and excluded from work, school, or other group settings. Such determinations are typically made in consultation with infectious disease specialists and public health officials, after reviewing available information (e.g., medical history, time from an initial positive test, RT-PCR Ct values, and presence of COVID-19 signs or symptoms).

• Yes, they should be isolated and retested.
• Persons who test positive for SARS-CoV-2 by RT-PCR come out of isolation after meeting the criteria for the symptom-based or test-based strategy.
• We do not know the degree to which previous COVID-19 illness protects against subsequent SARS-CoV-2 infection or for how long persons are protected.
• Currently, serologic testing cannot be used to determine if this person may be reinfected. A positive serologic test may be evidence of the prior infection, but it remains unknown to what degree persons with detectable anti-SARS-CoV-2 antibodies are immune to reinfection. Contact tracing for the second period of symptoms (new case investigation) may be warranted.

• COVID-19 convalescent plasma must only be collected from recovered individuals if they are eligible to donate blood.
• Individuals must have had a prior diagnosis of COVID-19 documented by a laboratory test and meet other laboratory criteria.
• Individuals must have fully recovered from COVID-19, with complete resolution of symptoms for at least 14 days before donation of convalescent plasma. You can ask your local blood center if there are options to donate convalescent plasma in your area.

• Yes, they should follow quarantine recommendations for contacts. We do not know to what degree or duration persons are protected against reinfection with SARS-CoV-2 following recovery from COVID illness.
• A positive serologic test may be evidence of prior infection, but it remains unknown whether persons with detectable anti-SARS-CoV-2 antibodies are immune to reinfection.

• Yes. It is recommended that almost all persons wear cloth face coverings in public.^[1]
• The primary purpose of cloth face coverings is to limit transmission of SARS-CoV-2 from infected persons who may be infectious but do not have clinical symptoms of illness or may have early or mild symptoms that they do not recognize.
• Fabric face coverings may also offer the wearer some protection against re-exposure to SARS-CoV-2, provide reassurance to others in public settings, and act as a reminder of the need to maintain social distancing. However, cloth face coverings are not personal protective equipment (PPE) and should not be used instead of a respirator or a facemask to protect a healthcare worker.
• Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.^[1]

• After discharge, patients can resume work as soon as they feel well enough to. They should adhere to strict social distancing, frequent hand washing, face-covering, and other recommended safety measures

• Patients can use public places and transportation. However, they should adhere strictly to recommended safety measures or guidelines.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]Gurmandeep Singh Sandhu,M.B.B.S.[3] Aisha Adigun, B.Sc., M.D.[4]

• Currently, there is no evidence to suggest that individuals who have recovered from COVID-19 and have antibodies present in their blood are immune or protected from reinfection.^[1]
• The world’s first documented re-infection case was recorded on August 15, 2020, when a Hong Kong man returning from international travel re-tested positive four, and a half months after his initial infection^[2]. The patient was reported to have tested positive to a strain that was different from his prior infection^[2].

• There is currently no evidence to show that re-infection is worse than the initial infection.

• Most likely a reinfected individual will present with similar symptoms as the initial infection.

• Whether the presence of detectable but low concentrations of viral RNA after clinical recovery represents the presence of the potentially infectious virus is unknown.
  • Based on experience with other viruses, it is unlikely that such persons pose an infectious risk to others. However, whether this is true for SARS-CoV-2 infection has not been definitively established.
  • Typically, after the onset of illness, the detectable viral burden declines. After a week or more, anti-SARS-CoV-2 immunoglobulin becomes detectable, and antibody titers rise. Some of these antibodies may prevent the virus from infecting cells in cell culture. The decline in viral burden is associated with decreased ability to isolate the live virus.
  • Efforts to isolate live virus from upper respiratory tract specimens have been unsuccessful when specimens are collected more than 10 days after illness onset.
• Persons who have tested persistently or recurrently positive for SARS-CoV-2 RNA have shown stable or improving signs of illness. When viral isolation in tissue culture has been attempted in such persons in South Korea and the United States, live viruses were not isolated.
• In addition, there is no evidence that clinically recovered persons with persistent or recurrent detection of viral RNA have transmitted COVID-19 to others.
• Despite encouraging observations to date, it’s not possible to conclude that persons with persistent or recurrent detection of SARS-CoV-2 RNA are no longer infectious.
• There is no firm evidence yet that the antibodies that develop in response to infection are protective. If these antibodies are protective, it’s not known what antibody titers are associated with protection from reinfection.

Based on these data and experience with other viral infections, most persons recovered from COVID-19 who test persistently or recurrently positive by RT-PCR are likely no longer infectious. Additionally, the magnitude and persistence of the immune response following recovery may vary among individuals, with factors such as age potentially influencing protection.

• Based on limited available data, determinations must be made on a case-by-case basis as to whether recovered persons with persistently detectable SARS-CoV-2 RNA are potentially infectious to others and should continue to be in-home isolation and excluded from work, school, or other group settings. Such determinations are typically made in consultation with infectious disease specialists and public health officials, after reviewing available information (e.g., medical history, time from an initial positive test, RT-PCR Ct values, and presence of COVID-19 signs or symptoms).^[3]

• Prospectively collecting serial respiratory samples and attempting to isolate the live virus in tissue culture from multiple persons testing positive by RT-PCR following illness recovery is generally required. If repeated attempts to recover replication-competent virus in culture from such serial samples are unsuccessful that is considered sufficient evidence that infectious virus is absent, and that persons continuing to test positive do not pose an infectious risk to other people.^[3]

====If the infected person has clinically recovered using the symptom based strategy, do they need a test to show that they are not infectious?^[3]

• No. Symptom based strategy is intended to replace the repeat testing.

• Many recovered persons do not have detectable SARS-CoV-2 RNA in upper respiratory tract specimens. In others, viral RNA can be persistently detected by RT-PCR in respiratory tract samples after clinical recovery.
• In some persons, after testing negative by RT-PCR in two consecutive samples, later samples can test positive again. Whether persistent or recurrent, these repeated detections of viral RNA consistently are associated with higher cycle threshold (Ct) values (i.e., fewer RNA copies) than were found in earlier RT-PCR results in samples collected shortly or and during clinical illness.
• Studies that have looked at how long SARS-CoV-2 RNA can be detected in adults have demonstrated that in some persons it can be detected for weeks.^[3]

• No. Although attempts to culture virus from upper respiratory specimens have been largely unsuccessful when Ct values are in high but detectable ranges, Ct values are not a quantitative measure of viral burden. In addition, Ct values are not standardized by RT-PCR platform nor have they been approved by FDA for use in clinical management. CDC does not endorse or recommend use of Ct values to assess when a person is no longer infectious. However, serial Ct values may be useful in the context of the entire body of information available when assessing recovery and resolution of infection.

• Yes. It is recommended that all persons, with a few exceptions, wear cloth face coverings in public. The primary purpose of cloth face coverings is to limit transmission of SARS-CoV-2 from infected persons who may be infectious but do not have clinical symptoms of illness or may have early or mild symptoms that they do not recognize. Cloth face coverings may provide reassurance to others in public settings and be a reminder of the need to maintain social distancing. However, cloth face coverings are not personal protective equipment (PPE) and should not be used instead of a respirator or a face mask to protect a healthcare worker.
• Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.

• Withing 3 months of recovery: A person who has clinically recovered from COVID-19 and then is identified as a contact of a new case does not need to be quarantined or retested for SARS-CoV-2.
• After 3 months: If a person is identified as a contact of a new case, they should follow quarantine recommendations for contacts.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]Nuha Al-Howthi, MD[3]

• No. Healthcare practitioners and hospitals are committed to making sure that mothers and babies are safe during this pandemic. All necessary precautions are being taken against exposure to COVID-19in the majority of hospitals. Pregnant women and their health care providers should discuss the mother’s concerns. ^[1]

• Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Fever is the most commonly reported sign; most patients with confirmed COVID-19 have developed a fever and/or symptoms of acute respiratory illness (cough, difficulty breathing).^[2]
• Data regarding COVID-19 in pregnancy are limited; according to current information, presenting signs and symptoms are expected to be similar to those for non-pregnant patients, including the presence of fever.

Other considerations that may guide testing are epidemiologic factors such as the occurrence of local community transmission of COVID-19 infections. As part of the evaluation, clinicians are strongly encouraged to test for other causes of respiratory illness and peripartum fever.^[2]

• With COVID-19 being due to a novel virus, there is limited evidence regarding how it affects pregnancy. Current/recent studies, however, show no evidence of mothers diagnosed with COVID-19 in the third trimester, passing the virus to their babies while in the uterus.^[3]

• According to the CDC “HCP in labor and delivery healthcare settings should follow the same infection prevention and control recommendations and personal protective equipment recommendations as all other HCP. If HCP are exposed to patients with COVID-19 infection, guidance is available for HCP and healthcare facilities on steps to take.”^[2]

• It is advised that all pregnant health care personnel should follow established risk assessment and infection control guidelines when exposed to all patients with or suspected of having COVID-19. Because the literature and information on pregnancy and COVID-19 are still being investigated, facilities can consider limiting the exposure of their pregnant health care personnel to patients with COVID-19 when possible.^[4]

• Yes, scheduled cesarean delivery and induction of labor can be performed as indicated despite the pandemic. Pregnant women can communicate with their providers on any concerns that they may have.^[5]

• According to recommendations by the American College of Obstetricians and Gynecologists,^[5]
  • “Due to the well-established benefit of antenatal corticosteroids administration with reduced neonatal morbidity and mortality, corticosteroids should continue to be administered in pregnant patients with suspected or confirmed COVID-19 who are between 24 0/7 weeks and 33 6/7 weeks of gestation and at increased risk of preterm birth within 7 days“. It is advised that modifications to care should be individualized based on the neonatal benefits of antenatal corticosteroid with the risks of potential harm to the pregnant patient.
  • “The benefits of antenatal corticosteroids in the late preterm period are more modest. As such, and weighing this against any potential harm to the pregnant patient, antenatal corticosteroids should not be offered to pregnant patients with suspected or confirmed COVID-19 who are between 34 0/7 weeks and 36 6/7 weeks of gestation and at risk of preterm birth within 7 days“. It is advised that modifications to care should be individualized based on the neonatal benefits of antenatal corticosteroid with the risks of potential harm to the pregnant patient.

• Literature and previous studies have shown that pregnant women are at increased risk of adverse outcomes when exposed to respiratory infections. With COVID-19 being a novel virus, the literature and evidence available are limited. Current evidence however does not indicate that pregnant women are at increase risk of infection or severe morbidity. The same cannot be said for pregnant women with underlying comorbidities hence, all pregnant women should adhere strictly to already established social distancing and sanitation guidelines.^[5]

• With guidance from infection control specialists and other organizations, most hospitals, will begin testing all women arriving at Labor and Delivery. This means that some patients who have no symptoms will be identified as COVID positive. It is believed that this will allow all necessary precautions to be put in place and the best possible care of all the mothers and babies.^[6]

• In the limited studies available, COVID-19 has not been found in breast milk. However, babies can get the virus from contact with mothers or other caregivers. The CDC recommends breastfeeding or feeding expressed breast milk to babies while taking precautions to avoid spreading the virus. Breast milk protects babies from getting sick and is the best source of nutrition for most babies. Breastfeeding helps strengthen the baby’s immune system because breast milk contains antibodies and other important components.

• If a person sick or experiencing symptoms, they should take all possible precautions to protect the baby, including washing hands before and wearing a facemask prior to touching the baby. Patients may breastfeed directly or express breast milk for a healthy caregiver to feed to the baby.

• The CDC has advised hospitals to limit the number of people allowed in hospitals, including visitors and non-essential staff to reduce exposure of patients and health care workers, to COVID-19. During labor, hospitals have generally made exceptions to allow a support person as long as they are not experiencing symptoms associated with COVID-19.

• Patients can talk to their facilities or health care provider about their policies and question if facilities are allowing any exceptions on a case-by-case basis. Primary support persons should be decided in advance and a second person should be identified in case the primary support person is experiencing symptoms of COVID-19. Plans can also be made with providers about connecting with additional support-people through platforms such as FaceTime, Google Hangouts, or Zoom.

• CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the birth hospitalization is within the mother’s room. Temporary separation of the newborn from a mother with suspected or confirmed COVID-19 should be considered to reduce the risk of spreading the virus to the newborn. The risks and benefits of temporary separation of the mother from her newborn should be discussed with the mother by her healthcare team. Decisions about temporary separation should be made with respect to the mother’s wishes. If the mother chooses a temporary separation to reduce the risk of spreading the virus and would like to breastfeed, she should express breast milk and have a healthy caregiver who is not at high-risk for severe illness from COVID-19 bottle-feed the newborn the expressed breast milk if possible.

• If the mother with suspected or confirmed COVID-19 does not choose temporary separation in the hospital, she should take precautions to avoid spreading the virus to the newborn, including washing her hands and wearing a cloth face covering when within 6 feet of her newborn. The newborn should be kept ≥6 feet away from the mother, as much as possible, including the use of physical barriers (e.g., placing the newborn in an incubator).

• The limited studies on breastfeeding women with COVID-19 have not found the virus in breast milk. The main concern is the parent or caregiver infecting the baby through respiratory droplets. Precautions should be taken to keep your baby healthy, including washing hands before touching and feeding your baby and wearing a face mask if you are experiencing symptoms or confirmed positive with COVID-19.

• Mothers may choose to continue to separate from the newborn at home to reduce the risk of spreading the virus if a healthy caregiver is available. If a healthy caregiver is not available, a mother with COVID-19 can still care for her infant if she is well enough while using precautions (for example, hand washing, wearing a cloth face covering).

• As always, before touching the baby the hands should be thoroughly washed with soap and running water for 2o seconds or more. If the mother has tested positive or suspects she has COVID-19, she should wear a face mask and wash hands before each feeding.

• If you are sick or choose to express breast milk to feed your baby, you can do so with hand expression or a breast pump (manual or electric). Be sure to use proper hand washing before touching any pump or bottle parts and before expressing breast milk. Follow recommendations for proper pump cleaning after each use and thoroughly clean all parts that come into contact with breast milk. Clean the pump after each pumping session according to the pump manufacturer’s instructions.
• If possible, or if you are too sick to feed your baby, have another healthy person feed your expressed milk to your baby. Be sure everyone feeding your baby follows proper hand hygiene and wears a face mask if experiencing symptoms. To establish and keep your milk supply, it is important to express your milk from the breast as often as your baby eats every day, typically 8-12 times a day for newborns or every 1.5 to 3 hours.

• Plastic face shields for newborns and infants are NOT recommended. There is no data supporting the use of infant face shields for protection against COVID-19 or other respiratory illnesses.
• An infant face shield could increase the risk of sudden infant death syndrome (SIDS) or accidental suffocation and strangulation.
• Infants, including newborns, move frequently, which could increase the possibility of their nose and mouth becoming blocked by the plastic face shield or foam components. The baby’s movement could also cause the face shield to become displaced, resulting in strangulation from the strap.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

• A study published in the Journal of the American Heart Association investigated the effects of COVID-17 in the pediatric and adolescent population with congenital heart disease(CHD).^[1] The results found that patients with CHD are more susceptible to being infected with COVID-19 and may in fact have worse outcomes and complications due to the disease. This is as a result of their already disturbed physiologic states as well as other co-morbidities associated with congenital heart diseases.^[1] For these individuals, primary prevention and infection control processes are especially crucial.

• Almost all children infected with COVID-19 have excellent outcomes. However of those hospitalized due to the disease, the majority are children under the age of 1,^[2][3] and those with underlying conditions. The most commonly reported conditions include:^{[2] [4]}
  • pulmonary diseases i.e; asthma
  • congenital heart disease and other cardiovascular conditions
  • Immunosuppression due to cancer or any of its treatment therapies, high dose of glucocorticoids, e.t.c

• Kawasaki disease, also known as lymph node syndrome, mucocutaneous node disease, infantile polyarteritis, and Kawasaki syndrome, is a poorly understood self-limited vasculitis that affects many organs, including the skin, mucous membranes, lymph nodes, blood vessel walls, and the heart.^[5] The emergence of COVID-19 has seen new presentations of known medical conditions for the first time.^[6] Numerous reports have shown a spike in new/concurrent cases of Kawasaki disease in COVID-19 positive patients. Information regarding the novel COVID-19 is still being gathered and although an exact association hasn’t been established between Kawasaki disease and COVID-19, more research and investigations are still being conducted.^[7]

• As described in the Health Advisory, “Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19),”^[8] the case definition for MIS-C is^[9]:
  • An individual aged <21 years presenting with fever(>38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours), laboratory evidence of inflammation (Including, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes, and low albumin), and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
  • No alternative plausible diagnoses; AND
  • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or exposure to a suspected or confirmed COVID-19 case within the 4 weeks prior to the onset of symptoms.

• There have been very few cases of death reported in hospitalized patients.^[9]

• The best-known way to prevent MIS-C is primary prevention against COVID-19.^[10] Individuals should follow already established social-distancing and sanitation guidelines.

• At each patient visit, it is important to access the vaccination status of children and adolescents. As long as there are no specific contraindications to vaccination at that time, all due and over-due immunizations should be administered at that visit.^[11]
  • According to the CDC;^[12] Routine vaccinations are an essential preventive care service for children and adolescents and should not be delayed because of the COVID-19 pandemic.^[11]

• In order to prevent the transmission of HBV in exposed infants, prompt administration of hepatitis B immune globulin at birth, and the completion of the hepatitis B vaccine series and post-vaccination serologic testing is warranted.This should not be delayed even during the COVID-19 pandemic.^[11]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

• For the safety of the general public, visitors to healthcare facilities are limited due to the coronavirus pandemic. Depending on certain factors, a limited number of visitors are allowed for certain patients. In such a setting, the following precautions are advised as per recommendations by the CDC;
  • A visitor specific entrance should be designated for visitors only.
  • Visitors who are observed by healthcare facility staff to have a fever or other symptoms of acute respiratory illness (e.g., cough or shortness of breath) should be instructed to leave the facility immediately and seek care if needed.
  • All visitors or encouraged to be aware of signs and symptoms of acute respiratory illness and to desist from entering healthcare facilities if they have those symptoms.
  • Visual alerts, such as signs and posters, should be placed at facility entrances and other strategic areas instructing visitors not to enter as a visitor if they have a fever or other respiratory symptoms.
  • Signage should include signs and symptoms of COVID-19 and who to notify if visitors have symptoms.
  • Visitors are strongly discouraged from visiting patients who are at high risk for severe illness from COVID-19, including patients who are older adults or with an underlying medical condition. If visitors are allowed, facilities should follow national policies regarding the use of medical masks or face covers (e.g., homemade masks) by healthy visitors.
  • Facilities should apply alternatives for direct interaction between visitors and patients, including setting up remote communications (e.g., telephone or internet connection) in the isolation area to allow for video or audio calls.
  • Facilities should have staff members who are able to provide training and education to visitors. All visitors allowed to visit patients should be educated on:
  • Signs and symptoms of COVID-19 including instructions on who to notify if they develop symptoms.
  • Performing hand hygiene by washing hands with soap and water for at least 40 seconds or by using an alcohol-based hand rub with at least 60% ethanol or 70% isopropanol for at least 20 seconds. Facilities should provide adequate supplies for visitors to perform hand hygiene.
  • Following respiratory hygiene and cough etiquette (e.g., covering mouth and nose with a disposable tissue when coughing or sneezing) in the event an individual develops respiratory symptoms while visiting the facility. Facilities should provide adequate supplies for visitors to perform respiratory hygiene and should instruct visitors with cough or other respiratory symptoms to immediately leave the facility and seek care if needed.

• During a pandemic such as this, it is normal to feel helpless and anxious. There is so much that one can do to help others as research shows that volunteering can help one feel happier and healthier, helps relieve stress, help boost immunity, and even help anxiety. Individuals can help others in the following ways;^[1][2]
  • Take care of ones own physical and mental health first.
  • Practice social distancing and sanitation recommendations.
  • Check on your neighbors.
  • Make donations.
  • Volunteer at facilities where your expertise is required while practicing safety precautions.
  • Donate blood, food, and other essentials.
  • Combat misinformation online.
  • Share positive news with your family and members of your community.

• Hospitals are currently restricting visitors. Check your local health care facilities for their guidelines and recommendations on hospital visits specific to your situation.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Haddadi, M.D.[2]Nuha Al-Howthi, MD[3]Rinky Agnes Botleroo, M.B.B.S.{GDS}

• Getting the right amount of nutritious food like plenty of fruits and vegetables, lean protein, and whole grains is important for health.

• Dietary supplements aren’t meant to treat or prevent COVID-19. Certain vitamins and minerals (e.g., Vitamins C and D, zinc) may have effects on how our immune system works to fight off infections, as well as inflammation and swelling.

• The best way to obtain these nutrients is through foods: Vitamin C in fruits and vegetables, Vitamin D in low-fat milk, fortified milk alternatives, and seafood, and zinc in lean meat, seafood, legumes, nuts, and seeds ^[1].

• Patients can be discharged from the healthcare facility whenever clinically indicated. Isolation should be maintained at home if the patient returns home before the time period recommended for discontinuation of hospital transmission-based Precautions.

• Decisions to discontinue transmission-based Precautions or in-home isolation can be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health authorities based upon multiple factors, including disease severity, illness signs and symptoms, and results of laboratory testing for COVID-19 in respiratory specimens.

• There is no evidence that coronaviruses are transmissible by blood transfusion. Furthermore, pre-donation screening procedures are designed to prevent donations from people with symptoms of respiratory illnesses.

• Place visual alerts, such as signs and posters in appropriate languages, at entrances and in strategic places for hand hygiene, respiratory hygiene (including the use of cloth face coverings), and cough etiquette (Stop the Spread of Germspdf icon).
• Maintain physical distance as much as possible:
  • Use video conferencing and increase workstation spacing.
  • Reduce the number of individuals allowed in common areas such as breakrooms and on elevators.
• Limit visitors to the facility to only those essential for the patient’s physical or emotional well-being and care.
  • Assess visitors for fever and other COVID-19 symptoms before entry to the facility.
  • Instruct all visitors to wear a facemask or cloth face covering while in the facility, perform frequent hand hygiene, and restrict their visit to the patient’s room or other areas designated by the facility.
• Report hospital capacity, patients, supplies and staffing availability, and COVID-19 cases to the National Healthcare Safety Network (NHSN) COVID-19 module.^[2].
  
  • Hospitals can report daily counts of patients with suspected or confirmed COVID-19, current use and availability of hospital beds and mechanical ventilators, HCP staffing, and supply status and availability.
  • NHSN provides state health departments access to COVID-19 data for hospitals in their jurisdictions.

• Wastewater workers should use standard practices including basic hygiene precautions and wear the recommended PPE( Personal Protective Equipment) like goggles, protective face mask or splash-proof face shield,liquid-repellent coveralls, waterproof gloves, rubber boots as prescribed for their current work tasks when handling untreated waste. Basic Hygiene precautions include:
• Washing hands with soap and water immediately after handling human waste or sewage.
  • Avoid touching face, mouth, eyes, nose, or open sores and cuts while handling human waste or sewage.
  • After handling human waste or sewage, wash hands with soap and water before eating or drinking.
  • After handling human waste or sewage, wash hands with soap and water before and after using the toilet.
  • Removing soiled work clothes before eating food and eating in designated areas away from human waste and sewage-handling activities.
  • Not smoking or chewing tobacco or gum while handling human waste or sewage.
  • Keeping open sores, cuts, and wounds covered with clean, dry bandages.
  • Gently flushing eyes with safe water if human waste or sewage contacts eyes.
  • Using waterproof gloves to prevent cuts and contact with human waste or sewage.
  • Wearing rubber boots at the worksite and during transport of human waste or sewage.
  • Removing rubber boots and work clothes before leaving the work site.
  • Cleaning contaminated work clothing daily with 0.05% chlorine solution (1-part household bleach to 100-parts water).

• In general, only essential personnel should enter the room of patients with SARS-CoV-2 infection. Healthcare facilities should consider assigning daily cleaning and disinfection of high-touch surfaces to nursing personnel who will already be in the room providing care to the patient. If this responsibility is assigned to EVS personnel, they should wear all recommended PPE when in the room. PPE should be removed upon leaving the room, immediately followed by performance of hand hygiene.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Gurmandeep Singh Sandhu,M.B.B.S.[2]

• The health worker attending to the dead body should perform hand hygiene, ensure proper use of PPE (water-resistant apron, goggles, N95 mask, gloves).
• Plug Oral, nasal orifices of the dead body to prevent leakage of body fluids. If the family of the patient wishes to view the body at the time of removal from the isolation room or area, they may be allowed to do so with the application of standard precautions.
• Place the dead body in a leak-proof plastic body bag.
• The exterior of the body bag can be decontaminated with 1% hypochlorite. The body bag can be wrapped with a mortuary sheet or sheet provided by the family members.
• All used/ soiled linen should be handled with standard precautions, put in a biohazard bag and the outer surface of the bag disinfected with hypochlorite

solution.

• Used equipment should be autoclaved or decontaminated with disinfectant solutions in accordance with established infection prevention control

practices.

• All medical waste must be handled and disposed of in accordance with Biomedical waste management rules.^[1]

^[2]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]Gurmandeep Singh Sandhu,M.B.B.S.[3]Sara Haddadi, M.D.[4] Aisha Adigun, B.Sc., M.D.[5]

Sources of content- CDC, WHO, and FDA.

Is post-exposure prophylaxis currently available, and when can it be used?

• Any duration of exposure should be considered prolonged if the exposure occurred during a performance an aerosol-generating procedure.
• The time period that should be used for contact tracing after exposure to asymptomatic individuals who test positive for SARS-CoV-2 was shortened.
  • The time period was changed from 10 days before obtaining the specimen that tested positive for COVID-19 to 2 days to accommodate pragmatic and operational considerations for the implementation of case investigation and contact tracing programs.
  • Recent data suggest that asymptomatic persons may have a lower viral burden at diagnosis than symptomatic persons.  Thus, the longer contact elicitation window (10 days) may have a limited impact on identifying new COVID-19 cases.
  • The recommendation for the shorter contact elicitation window (2 days) will help focus case investigation and contact tracing resources toward activities most likely to interrupt ongoing transmission.
  • This time period is also now in alignment with recommendations from the World Health Organization, the European CDC, and Public Health Canada.

Can routine vaccinations still be administered to patients?

• Yes. Continue to administer these vaccines if an in-person visit must be scheduled for some other purpose and the clinical preventive service can be delivered during that visit with no additional risk, or an individual patient and their clinician believe that there is a compelling need to receive the service based on an assessment that the potential benefit outweighs the risk of exposure to SARS-CoV-2 virus

Should I use face mask/respirator while taking care of pregnant patients with known/suspected COVID-19 infection?

• When available, respirators (or face masks if a respirator is not available), eye protection, gloves, and gowns should be used for the care of pregnant patients with known or suspected COVID-19 infection.

I am a Health Care Practitioner living with someone who is at a higher risk of severe illness from COVID-19 infection. What precautions should I take?^[1][2]

• There are no additional precautions for the Health Care Practitioner. Some Health Care practitioners may choose to implement extra measures when arriving home from providing healthcare, such as removing any clothing worn during the delivery of healthcare, taking off shoes, washing clothing, and immediately showering. However, these are optional personal practices because there is insufficient evidence on whether they are effective. People at higher risk of severe illness from COVID-19 should take the general precautions recommended for them which include washing hands often, taking everyday precautions to keep space between them and others (stay 6 feet away, which is about two arm lengths), staying away from people who are sick, cleaning and disinfecting frequently touched services.

I am pregnant and a health care worker. Can I work with patients who are potentially infected with COVID-19?

• Information on COVID-19 in pregnancy is limited. Pregnant women are not currently considered at increased risk for severe illness from COVID-19. However, pregnant women have had a higher risk of severe illness when infected with viruses from the same family as COVID-19 and other viral respiratory infections, such as influenza.

Are there work restrictions recommended for HCP with underlying health conditions who may care for COVID-19 patients?

• Adherence to recommended infection prevention and control practices is an important part of protecting HCP and patients in healthcare settings. All HCP who care for confirmed or suspected COVID-19 patients should adhere to the standard and transmission-based precautions.
• To the extent feasible, healthcare facilities could consider prioritizing HCP who are not at higher risk of developing severe illness from COVID-19 or who are not pregnant to care for confirmed or suspected COVID-19 patients.
• If staffing shortages make this challenging, facilities could consider restricting HCP at higher risk for severe illness from COVID-19 or who are pregnant from being present for higher-risk procedures (e.g., aerosol-generating procedures) on COVID-19 patients.
• HCP who are concerned about their individual risk for severe illness from COVID-19 due to underlying medical conditions while caring for COVID-19 patients can discuss their concerns with their supervisor or occupational health services.
• People 65 years and older and people of all ages with serious underlying health conditions — like serious heart conditions, chronic lung disease, and diabetes — seem to be at higher risk of developing severe illness from COVID-19.

Whom should healthcare providers notify if they suspect a patient has COVID-19? Healthcare providers should immediately notify infection control personnel at their facility if they suspect COVID-19 in a patient. If a patient tests positive, providers should report positive results to their local/state health department.

If I have patients with asthma, do I need to make any changes to their daily asthma preventive management regimens to reduce their risk of getting sick with COVID-19?

• People with moderate to severe asthma, particularly if not well controlled, might be at higher risk of getting very sick from COVID-19.
• Based on what we currently know about COVID-19, the selection of therapeutic options through the guideline-recommended treatment of asthma has not been affected.
• Continuation of inhaled corticosteroids is particularly important for patients already using these medications because there is no evidence of increased risk of COVID-19 morbidity with the use of inhaled corticosteroids and an abundance of data showing reduced risk of asthma exacerbation with the maintenance of asthma controller therapy.
• Patients with asthma but without symptoms or a diagnosis of COVID-19 should continue any required nebulizer treatments.

What are the guidelines regarding face shields for HCP?

• CDC recommends that eye protection should be used in areas with moderate to substantial community transmission. For areas with minimal to no community transmission, eye protection is considered optional, unless otherwise indicated as part of standard precautions.
  

What is COVID-19 Surge?

• COVID-19Surge is a spreadsheet-based tool that hospital administrators and public health officials can use to estimate the surge in demand for hospital-based services during the COVID-19 pandemic. A user of COVID-19Surge can produce estimates of the number of COVID-19 patients that need to be hospitalized, the number requiring ICU care, and the number requiring ventilator support. The user can then compare those estimates with hospital capacity, using either existing capacity or estimates of expanded capacity.
  • Can COVID-19Surge be used to accurately estimate the impact of COVID-19?
    The numbers generated through COVID-19Surge are estimates. They DO NOT reflect what will actually occur during the pandemic. Rather, they are estimates for a given set of scenarios. COVID-19Surge should be used to plan and prepare a response to a surge in demand for hospital-based resources due to the COVID-19 pandemic.
  • Can users change the input variables?
    Yes. When you download and open the COVID-19Surge, all inputs are pre-populated with numbers and estimates based on published sources. Users can change the values in the tool that best illustrates the situation in their jurisdiction. Further, the CDC encourages users to change input values and explore the impact of various scenarios. Explanations are provided in the accompanying manual.

Are there any antibody tests for COVID-19?

• The FDA has approved COVID-19 blood tests to estimate the levels of antibodies in an individual’s blood^[3].
• The two tests, the ADVIA Centaur COV2G and Atellica IM COV2G were developed by Siemens Healthineers and have been reported to be 100% specific and 99.8% sensitive^[4].