COVID-19 frequently asked inpatient questions: Difference between revisions

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{{Frequently Asked Inpatient Questions}}
{{Frequently Asked Inpatient Questions}}
To go back to the COVID-19 project, click [[COVID-19 project|'''here''']].
'''To visit COVID-19 Project page, click [[COVID-19 project|here]]'''.<br>
'''To visit COVID-19 homepage, click [[COVID-19|here]]'''.<br>
{{CMG}}{{AE}}{{GDS}}{{Aisha}}{{HAR}}{{RAB}}{{Nuha}}{{IF}}}{{SaraH}}


{{CMG}}{{AE}}{{GDS}}{{Aisha}}{{HAR}}{{RAB}}{{Nuha}}{{IF}}}
{{SK}} Novel coronavirus, covid-19, COVID-19, SARS-CoV-2, Wuhan coronavirus, severe acute respiratory syndrome coronavirus 2, 2019-nCoV, COVID, coronavirus disease, novel coronavirus
==Treatment Based Questions==
====Following the retraction of the two articles that halted the use of hydroxychloroquine in COVID-19 patients, can I currently administer this medication to patients?====
====Is every patient with a positive COVID-19 test required to be admitted to the hospital?====
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 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.
'''Sources of content-''' [https://www.cdc.gov/coronavirus/2019-ncov/index.html CDC], [https://www.who.int/emergencies/diseases/novel-coronavirus-2019 WHO], and [https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19 FDA].


====What are the chances of recovery in a hospital admitted COVID-19 patient?====
====Are empirical antibiotics recommended for patients suspected with having 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.


====What anti-viral medications are available to treat COVID-19?====
==[[Treatment Based Questions]]==
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.
==[[Complications Based Questions]]==
 
==[[Co-Morbidity Based Questions]]==
 
==[[Hospital Discharge Related Questions]]==
==Complications Based Questions==
==[[Re-Infection Related Questions]]==
====What population is most at risk for severe disease from COVID-19?====
==[[Pregnancy Related Questions]]==
====What risk factors result in severe complications from COVID-19?====
==[[Pediatrics Related Questions]]==
====What systems other than the Respiratory system can be involved?====
==[[Visitors Related Questions]]==
====Does prolonged ventilation in hospitalized patients worsen the outcome of COVID-19?====
==[[General In-Patient Questions]]==
==Co-Morbidity Based Questions==
==[[Management of Dead Bodies from COVID-19]]==
 
==[[General Health Care Practitioner (HCP) Questions]]==
=== <u>Patients with Hypertension</u> ===
 
====Should ACE Inhibitors and ARBs be discontinued in patients on admission for COVID-19?====
Based on current studies, it is advisable to continue the current treatment of chronic disease conditions including hypertension with either ACEI or ARB during the COVID-19 pandemic,
 
=== <u>Patients with Asthma</u> ===
 
====Should an Asthma exacerbation be managed any differently to reduce the risk of COVID-19?====
 
Selection of therapeutic options through guideline-recommended treatment of asthma exacerbations 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 exacerbations should be continued. There is currently no evidence to suggest that short-term use of systemic corticosteroids to treat asthma exacerbations increases the risk of developing severe COVID-19, whereas there is an abundance of data to support use of systemic steroids for moderate or severe asthma exacerbations.
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.
 
==== Are any changes recommended to the treatment plan of an asthma patient with  COVID 19? ====
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 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.
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).
 
=== <u>Patients currently Undergoing Hemodialysis</u> ===
 
===Can patients continue receiving Hemodialysis in a hospital where other COVID-19 patients are treated?===
 
=== <u>Cancer Patients</u> ===
 
==== Can/Should Cancer surgery be delayed? What about radiation therapy? ====
 
==== Should immuno-suppresive treatments be discontinued or delayed? ====
 
==== Are support groups or activites still available in the hospital? ====
 
==== Should patients take an antiviral medication such as Tami flu for protection? ====
 
==Hospital Discharge Related Questions==
====Can patients who are no longer symptomatic but still test positive for COVID-19 be discharged====
====If after discharge a patient shows new symptoms of COVID-19, should they be isolated and tested again?====
====If after discharge, close contacts of a patient test positive, should they self-isolate again?====
====After discharge, should patients continue to wear a face mask?====
====How soon after discharge can patients return to thier jobs?====
====Can discharged patients use public places and transportation?====
====What should be expected after leaving the hospital?====
 
==Re-Infection Related Questions==
====Do patients become immune after recovering from COVID-19?====
====Is re-infection worse than the initial infection?====
====Will a re-infected person show the same symptoms as the initial infection?====
====Are clinically recovered persons infectious to others if they test persistently or recurrently positive for SARS-COV-2 RNA?====
 
==Pregnancy Related Questions==
====Does hospital deliver increase the mother or baby's chances of contracting COVID-19?====
====Should intrapartum fever be considered as a possible sign of COVID-19 infection?====
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).
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.
====Are unborn babies of COVID-19 patients already infected with the virus?====
====What is the guidance available for labor and delivery Health Care Personnel with potential exposure in a healthcare setting to patients with COVID-19 infection?====
====Are Pregnant healthcare personnel at increased risk for adverse outcomes if they care for patients with COVID-19 infection?====
====Should patients proceed with a scheduled cesarean delivery if hospitalized with COVID-19?====
====Are glucocorticoids contraindicated in pregnant patients with COVID-19?====
====Are pregnant women more susceptible to infection or at increased risk for severe illness, morbidity, or mortality with COVID-19?====
====Are hospitals testing all women who arrive at the hospital in labor for COVID-19 even if they show no symptoms====
====Can nursing mothers with COVID-19 breastfeed their child?====
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.
 
====How many people can be present in the room during births?====
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.
 
====Can a baby stay with a COVID-19 infected mother after delivery?====
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).
 
====Can COVID-19 be transmitted via breastmilk?====
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.
 
====What should mothers do if they have been discharged, but have not med the criteria to discontinue self-isolation?====
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).
 
====What precautions can mothers take when directly breastfeeding a child?====
 
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.
====What precautions should mothers take when feeding expressed breast milk to a child?====
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.
 
====Should infants and new-borns wear face shields?====
Plastic face shields for newborns and infants are NOT recommended. There are 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.
 
==Pediatrics Related Questions==
====Are children with congenital heart diseases at increased risk of COVID-19?====
====Are children with underlying conditions at increased risk of hospitalization?====
====Is there and an association between KAWASAKI disease and COVID-19?====
====Is Multi-system Inflammatory Syndrome in Children (MIS-C) fatal? What precautions can be taken to avoid it?====
 
==== Should routinely-recommended Hepatitis A and B vaccines continue to be administered to children? ====
 
==== Should vaccinations for HBV exposed infants be continued during the COVID 19 pandemic? ====
 
==Visitors Related Questions==
====Can I have visitors while I’m in the hospital?====
====Is there anything I can to do to help others who have COVID-19?====
 
==== I would like to accompany my family member or friend for their procedure or appointments I am concerned they will need my support to cope or understand the information being shared with them by the healthcare team ====
 
==General In-Patient Questions==
====Does being hospitalized with other COVID-19 patients worsen my outcome?====
====What are the diet recommendations if I get hospitalized?====
====What can I expect while I’m in the hospital?====
====When can I leave the hospital?====
====Can you catch COVID-19 from a blood transfusion?====
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.
 
====Do wastewater & sewage workers need additional protection when handling untreated waste from hospitals with COVID-19 patients?====
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 worksite.
*Cleaning contaminated work clothing daily with 0.05% chlorine solution (1-part household bleach to 100-parts water).
 
==Management of Dead Bodies from COVID-19?==
====Do any special procedures exist for the management of bodies of persons who died from COVID-19?====
 
 
== General Health Care Practitioner (HCP) questions==
====I have underlying health conditions, are there work restrictions in place for me?====
====Is post-exposure prophylaxis currently available, and when can it be used?====
====Can routine vaccinations still be administered to patients?====
====Should I use face mask/respirator while taking care of pregnant patients with known/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?====
====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 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.
 
==Sources==

Latest revision as of 17:13, 7 July 2020