Critical Considerations in Nursing Care of Quarantined COVID-19 Patients

 

JXL, PhD

PG, PhD

 

Introduction

Since the end of 2019, the whole world has been concerned with the spreading of COVID-19,commonly known as the Corona virus disease. Not only does COVID-19 threaten people’s health, it also poses a great threat against societies’ economies and livelihood. An impending feeling of crisis can be found in a great number of countries,as mobility of persons is thought to be a risk increasing infection. For those infected and contagious, the application of proper quarantine measures is an important way to break the chain of infection transmission (Smeltzer et al., 2010, p. 2121). COVID-19 is active globally and thousands of caseshave been confirmed. The World Health Organization (WHO) declared the coronavirus outbreak as a pandemic on Wednesday the 11th of March 2020.

For health care professionals, it is good to prepare for the possibility of tough times to come and listen to the advice of those who have had direct experience in working with COVID-19. Recently, we have the honor to interview such a person, Associate Professor Dr. Chen Hui, a doctor working on the foremost frontline of epidemic prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan City, China. Professor Chen and colleagues have accumulated first-hand experience from the foremost frontline of control and prevention of the COVID-19. This blog will briefly discuss COVID-19 and its transmission, as well as how health care professionals shall tutor quarantined COVID-19 patients so as to avoid spreading virus to their family members and others. Quarantine is ordinarily compulsory in many countries but voluntary cooperation is encouraged. It involves both medical senses, breach of which brings about risks for others, and legal obligations, ignorance of which brings about punishments.The information given on this blog is based on information given by Professor Chen, the World Health Organization (WHO), The National Health CommissionNHC (China), The National Institute for Health and Welfare(Finland), and Centers for Disease Control and Prevention (US).

COVID-19 and its transmission

COVID-19 is the infectious disease caused by the most recently discovered coronavirus (WHO, 2020). Four of the most frequent symptoms of infected COVID-19 patients are fever, tiredness, dry cough and shortness of breath. Other symptoms can include aches and pains, nasal congestion, runny nose, sore throat, diarrhea, etc. (Chen, 2020; WHO, 2020; NHC, 2020b; THL, 2020; CDC, 2020).

Most people can recover from COVID-19 disease without special treatment. Prof. Chen witnessed firsthand however that it is possible to develop into a very serious illness for senior persons, and those with underlying medical problems like kidney disease, diabetes, and lung disease (Chen, 2020). From clinical experience, these people are the most likely to be infected and have the worst prognosis. People with some other diseases, such as high blood pressure and heart problems are also likely to develop serious illness. People with fever, cough, and shortness of breath as well as other difficult symptoms have been advised to seek medical treatment (WHO, 2020).

COVID-19 may spread from person-to-person when people are in close contact with one another, within about two meters, through respiratory droplets generated by coughs or sneezes (WHO, 2020; NHC, 2020b; Chen, 2020). Prof. Chen has added that face-to-face conversations within a short distance from one another can be a scenario for an infected person to transmit the virus to another person (Chen, 2020). Moreover, exhalation alone can also be a source for the virus to enter the air (WHO, 2020; NHC, 2020b). The latter scenario has been ignored by many people, as well as some professionals, when they have spoken about the spreading of the virus. Exhaling can generate droplets, even though they are smaller than when people are coughing or sneezing. With these droplets in the air, the nearby people can have these droplets land in their mouths or noses and then inhaled into the lungs.It is also possible for a person to get COVID-19 by touching a polluted surface or object and then touching their own mouth, nose, or eyes (WHO, 2020). Virus on a polluted surface may persist for a few hours or up to several days. Other possibilities of existence of the virus are in the feces of an infected person(CDC, 2020).

Usually, medical professionals consider people without symptoms not to be contagious even if they are bearers of the virus. For the case of COVID-19, it has however been revealed that, while it is true that people are thought to be most contagious when they are most symptomatic (the sickest), at the same time, there is a possibility that some spread might occur before people show symptoms (WHO, 2020; NHC, 2020b). The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some geographic areas, for examples of the city of Wuhan, China, the area of North Italy, a church in South Korea, the Nordrhein-Westfalen area of Germany and Tyrol in Austria.

Tutoring COVID-19 patients

COVID-19 patients should be quarantined, except when they have necessity to get medical care (NHC, 2020a; CDC, 2020). Usually, quarantine can be implemented by the patients themselves. However, Public health quarantine and isolation enforced by legal authorities may sometimes be deemed compulsory. Breach of quarantine is a punishable offence in many countries and if deemed necessary, quarantine should be implemented forcibly for those who cannot abide by the order voluntarily.

During quarantine, COVID-19 patients should preferably be kept separated from other people, including family members and animals (NHC, 2020a; CDC, 2020). Quarantine should include if possible, avoiding the usage and sharing of the same living facilities and as well as driving in same car. Quarantine does not mean that the patients can only stay indoors. However, it should be born in mind that if patients go outdoors, they should keep sufficient distance from others. They should not enter closed public places, such as shops, schools, offices, markets, libraries, museums, theaters, bars, and restaurants. Neither should they take public transportation vehicles, such as buses, metros, trains and planes. Patients can visit some open-air public places, such as parks, but a sufficient distance to others should be kept. In this situation, protective masks should preferably be worn by the patients. Use of public toilets by the patients should also be prohibited.

When COVID-19 patients visit a health care center or hospital, a telephone call should be made in advance, and protective transportation and meeting place should be arranged so that no risk of infection should be caused to health care staff or the public. This rule has been implemented in many countries so as to avoid unnecessary contact between patients and the healthcare workers as well as the public and thus avoid increasing the risk for further spread of the disease.

Patients with COVID-19 have been advised, by some, to wear facemasks when they are exposed to the public (NHC, 2020a; CDC, 2020)as this is deemed as a way to contain the virus within the reach of the patients themselves but not causing it to escape and infect others. Considering the virus can be transmitted through droplets coughed, sneezed or exhaled out by the patients into the air, quarantine orderscould be extended in order to ensure separation of patients’ secretions from reaching others.

In all cases, when the patients cough and sneeze, their mouth and nose should be properly covered (NHC, 2020a; CDC, 2020). Tissue paper used to cover the coughs and sneezes should be disposed properly. In occasional cases when the patients cover coughs and sneezes by hands, they should avoid touching any publicly accessed objects, such as elevator buttons, computer mouse and keyboards, door handles, light switch button and so on. Deliberately ignoring such rules has the same nature as a breach of quarantine order.

Patients should wash their hands often, and when necessary, disinfect them. They should avoid using publicly accessed objects that are left not cleaned or disinfected. That way, the patient will help to stop spreading virus to their family members or others who are unaware of the existence of the contagion on those objects. In their places of quarantine, patients should avoid sharing personal household items, such as tableware, hygiene supplies, and even computers, telephones, remote controls, etc. In case a surface or an object is touched, they should be cleaned or even disinfected instantly (NHC, 2020a; CDC, 2020).

The symptoms of quarantined patients should be monitored closely (NHC, 2020a; CDC, 2020). For people under the age of fifty and without chronic diseases, usually the coronavirus is not as lethal as it is for the senior and physically weak population. However, the COVID-19 infection can develop fast and pose the same risks for people of all age groups. Close monitoring of symptoms will help patients to know when to seek emergency care or not. Once the health situation worsens, emergency care should be contacted and applied.

According to the NHC, the health condition of discharged patients should be followed for up to 14 days, during which they should refrain from participating in group activities, even reducing direct contact with family members. Checkups should be done for the first time in two weeks and for the second time in four weeks after their discharge (NHC, 2020a, p. 22).Prof. Chen mentioned that doctors and nurses must also pay attention to patient’s psychological health and not only their physical health. Most patients are living with families, but due to the contagious nature of the disease family members can only play a minimum role in taking care of their loved ones, which has resulted in a feeling of desperation for many patients. Therefore, doctors and nurses should pay attention to psychological care of the patients, and help patients channel their feelings of anxiety and despair.

 

Evaluation and consideration of influence on healthcare professionals

We asked Prof. Chen the following question “What special aspects should healthcare workers work in quarantined environment consider for themselves?” and this was the advice she gave based on his experience from the treating COVID-19 patients in China:

First of all, considering the rapid development of the epidemic, many healthcare workers have been overworked and experienced heavy physical exertion. At the same time, they have been unable to return home for a long time, and have experienced colleagues and friends becoming infected, all of which will have a huge impact on their psychology. Therefore, it is important healthcare workers should seek psychological assistance in a timely manner and arrange appropriate rotations if the epidemic prevention and control permits, as this will not only reduce their stress, but also avoid the risk of infection during high-intensity work.

Secondly, in the face of ineffective treatment of patients, the psychological impact on healthcare workers is very great. During this time healthcare workers should pay attention to adjusting their physical and psychological status, isolating themselves from negative news, and properly finding opportunities to release stress. Crying is a way for healthcare workers to release extreme emotions.

Thirdly, healthcare workers need to reduce the occurrence of psychological problems that may lead to post-traumatic stress disorder. This can be done by paying attention to talking to, communicating with and supporting each other, or by seeking help from professional psychologists before leaving their posts.

Finally, healthcare workers should avoid skin damage caused by frequent use of wearing a mask. From her experience, Prof. Chen emphasized that damage to local skin and subcutaneous tissues can be caused by wearing a mask for a long time. This kind of medical device-related pressure damage, mainly occurs in places that are under pressure for a long time, such as on the nose, cheeks, around the mouth or behind the ears. Healthcare workers should, if possible, choose a more suitable mask, such as a wide-sided mask with less local pressure or a lace-up style instead of an ear-hook style, and the pressure will be less.

 

Concluding remarks

Even though it is critical for health care workers to intervene in breaking the chain of infection transmission, patients themselves play a core role in the process. Their cooperation in upholding quarantine is both needed and expected, as it will benefit themselves, their families and the community. Tutoring patients about correct quarantine procedures will have a positive impact on reducing disease transmission. This means that social resources invested into quarantine can be kept at the lowest level, and no punishment measures will be needed to enforce quarantine orders. COVID-19 is at the moment and will continue, for the unforeseeable future, to be a burden on health care systems. It is therefore important to take in to consideration the physical, and psychological wellbeing of nurses as well as think about sustainable technical solutions for work so that they will not exhaust themselves as this will endanger even more people.

 

 

References

Centers for Disease Control and Prevention (CDC), 2020. Coronavirus Disease 2019. Available at: <https://www.cdc.gov/coronavirus/2019-ncov/index.html> [Accessed 10.3.2020].

 

Chen, Hui, 2020, March 5 & March 9. Personal Interview.

 

National Health Commission of the People’s Republic of China (NHC), 2020a. Diagnosis and Treatment Plan for COVID-19 (Seventh Edition)

 

National Health Commission of the People’s Republic of China (NHC), 2020b. Prevention and Control Plan for CIVIC-19 (Sixth Edition).

 

Smeltzer, S., Bare, B., Hinkle, J. L., Cheever, K. H., 2010. Brunner &Suddarth’s Textbook of Medical-Surgical Nursing. Philadelphia, PA: Wolters Kluwer Health / Lippincott Williams & Wilkins.

 

Terveyden ja Hyvinvoinnin Laitos (THL). 2020. Koronavirus COVID-19. Available at: <https://thl.fi/fi/web/infektiotaudit-ja-rokotukset/taudit-ja-torjunta/taudit-ja-taudinaiheuttajat-a-o/koronavirus-covid-19>[Accessed 10.3.2020]

 

World Health Organization (WHO), 2020. Q&A on Coronaviruses (COVID-19). Available at: <https://www.who.int/news-room/q-a-detail/q-a-coronaviruses> [Accessed 10.3.2020].