Coronavirus

Coronaviruses (CoV) are a large family of viruses that are common and are typically associated with mild illnesses, similar to the common cold.

A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. The severe diseases have included:

• Middle East Respiratory Syndrome (MERS-CoV) (first reported in 2012, all cases have been linked to countries in or near the Arabian Peninsula)
• Severe Acute Respiratory Syndrome (SARS-CoV)

Currently a new coronavirus has been identified in China (Wuhan City), and was initially known as 2019 Novel Coronavirus (2019-nCoV). It has been now formally named COVID-19. The case was reported on December 31st, 2019, and confirmation of the coronavirus identification occurred on January 7th, 2020.

This document will discuss general precautions a workplace can take to help lower the spread of coronaviruses. For updates on the 2019-n-CoV/COVID-19 situation, please see:

• In Canada: Government of Canada (Public Health Agency of Canada) - 2019 Novel Coronavirus infection (Wuhan, China): Outbreak update
• In the USA: Center for Disease Control and Prevention (CDC) - 2019 Novel Coronavirus, Wuhan, China
• For world reports: World Health Organization - Novel Coronavirus (2019-nCoV)

Workplaces should have a policy in place that outlines their requirements when people may be sick or absent to care for others. This policy should indicate how to notify the workplace, and if there is a requirement for a doctor's note and when.

Monitor the situation by visiting the organizations listed above for more information.

Workplaces can help by having an infection control plan which may include details such as:

• Providing clean hand washing facilities.
• Offering alcohol-based hand sanitizers when regular facilities are not available (or to people on the road).
• Cleaning objects that are touched frequently, such as doorknobs, handles, railings, kettles, etc. more often with regular disinfectants or soap and water
• Providing boxes of tissues and encourage their use.
• Reminding staff to not share cups, glasses, dishes and cutlery. Be sure dishes are washed in soap and water after use.
• Removing magazines and papers from waiting areas or common rooms (such as tea rooms and kitchens).
• Making sure ventilation systems are working properly.
• Cleaning a person's workstation or other areas where they have been if a person has been suspected or identified with an infection
• Using social distancing techniques, such as using telephone, video conferencing, or the internet to conduct as much business as possible (including within the same building), allow employees to work from home, or to work flexible hours to avoid peak public transportation times or crowding the workplace.

Coronaviruses are zoonotic, meaning they usually begin in animals.  While rare, coronaviruses can evolve to infect people.  For example, investigations found that SARS-CoV was transmitted from civet cats to humans, and MERS-CoV was transmitted from dromedary camels to humans.

In some cases, the coronavirus can evolve further and spread from person-to-person. The route of transmission is not always known, but the viruses are generally thought to spread by respiratory droplets when people are in close contact.

Generally speaking, examples of close contact include:

• Having cared for or lived with a person known to have the virus, including being within 2 metres (6 feet) or within the room or care area of a patient with the virus without wearing personal protective equipment
• Direct contact with droplets from coughing or sneezing by someone affected by the virus
• When a person touches a surface contaminated with infectious fluids and then touches their mouth, nose, or eyes

Each coronavirus will vary in the severity of infection it causes.  Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, respiratory issues, kidney failure, and sometimes death.

2019-nCoV presents with fever and symptoms of lower respiratory illness (e.g., cough or difficulty breathing).  Fever may not be present in all patients.  Identification of 2019-nCoV is made through tests as well as patient history (especially recent travel).

People caring for individuals with a coronavirus are at the greatest risk for contracting the disease such as health care workers in acute care hospitals, rehabilitation hospitals, mental health hospitals, long term care facilities, emergency departments, and others who work close to their clients or patients.

Persons living with individuals with a severe coronavirus may also be at risk for contracting the disease.

Standard recommendations from the World Health Organization to the public to prevent the spread of infection include:

• Frequently clean hands by using alcohol-based hand rub or soap and water
• When coughing and sneezing cover mouth and nose with flexed elbow or tissue – throw tissue away immediately and wash hands
• Avoid close contact with anyone who has a fever and cough
• If you have fever, cough and difficulty breathing, seek medical care early and share previous travel history with your health care provider
• When visiting live markets in areas currently experiencing cases of novel coronavirus, avoid direct unprotected contact with live animals and surfaces that have been in contact with animals
• The consumption of raw or undercooked animal products should be avoided. Raw meat, milk or animal organs should be handled with care to avoid cross-contamination with uncooked foods, as per good food safety practices

The general guidelines for public and most workplaces (non-healthcare) are outlined in the following documents:

• Hand Washing: Reducing the Risk of Common Infections
• Good Hygiene Practices - Reducing the Spread of Infections and Viruses

For health care workplaces, the following precautions should help prevent transmission. In addition, check with organizations such as Health Canada, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) who will be monitoring any new situation, and will include specific infection control guidance for workers at risk as the information becomes available.

As stated by the Government of Canada:

“In addition to the consistent application of routine practices, follow contact and droplet precautions. This [procedure] includes the appropriate selection and use of personal protective equipment:

• Gloves; AND
• A long-sleeved gown; AND
• Facial protection: Surgical/procedural mask and eye protection, face shield, or surgical/procedural mask with visor attachment.
• An N95 respirator (plus eye protection) should be used when performing aerosol-generating medical procedures (AGMPs) on a person under investigation (PUI) for 2019-nCoV infection.

Hand hygiene should be performed whenever indicated, paying particularly attention to during and after removal of PPE, and after leaving the patient care environment.”

Note that no single respirator or any type of personal protective equipment (PPE) can be expected to provide protection against all types of hazards. Be sure you are wearing the correct PPE for the task.  If PPE is used, it should be managed as part of a complete PPE program which will include selection, fitting, training, inspection, use, cleaning, maintenance, and storage as appropriate.

The following are practices that can be used in healthcare or similar workplaces.  In all cases, follow the recommendations of your workplace as there may be considerations specific to a situation that require other practices.

Hand Hygiene

Use of alcohol-based hand rub at the point-of-care as the preferred method for hand hygiene in all healthcare settings unless certain exceptions apply.  Hands must be cleaned before and after contact with a patient, after contact with body fluids, and after contact with items known to be contaminated with respiratory secretions.

Disposable Gloves

Gloves should be used as an additional measure, not as a substitute for hand washing. Gloves must be put on before contact with the patient and they should be removed and hands washed before leaving the patient's room.

Gowns

Long sleeved gowns should be worn by all health care workers if direct contact with the patient is anticipated.

Respirators / Masks

Respirators used in health care settings should be selected according to the efficiency of respirator filters in its ability to filter aerosols and according to the type of procedure to be carried out.

As stated in the Canadian Biosafety Handbook, Second Edition, "Where applicable, respiratory protection should conform to standard CSA Z94.4, Selection, Use and Care of Respirators" and "Using the wrong respirator or misusing one can be as dangerous as not wearing one at all."

A common respirator used in health care facilities is the N95 disposable respirator. N95 filters belong to a group of respirators that contain air purifying particulate filters.  N95 type respirators are recommended by the Government of Canada and the U.S. Centers for Disease Control and Prevention (CDC) for use by health care workers in contact with patients with infections that are transmitted from inhaling airborne droplets (e.g., tuberculosis (TB), and are also recommended for health care staff working with patients having or suspected of having a severe coronavirus).

In comparison, surgical masks, while not a respirator by definition, can be effective barriers for retaining large droplets which can be released from the wearer through talking, coughing, or sneezing. The mask must cover the user's mouth and nose. However, surgical masks are not designed to protect the wearer by filtering or blocking very small particles in the air.  

It is important to understand the benefits and limitations of each type or respirator or mask.  Respirators must be fitted to the face appropriately for a good seal to be effective.  For more information, please see:

• Respirators – Respirator Selection
• Respirators – Respirators vs. Surgical Masks
• Respiratory Protection Against Airborne Infectious Agents for Health Care Workers
• Respirators – Wearing a Respirator

After handling a used respirator or mask, wash your hands immediately.

Eye / Face Protection

Eye protection, face shields (with safety glasses or goggles), and/or visors are recommended for health care workers where there is a potential for splattering or spraying of blood or other body fluids.

Footwear

If recommended at your workplace, dispose of used shoe covers in appropriate waste bin.  Do not reuse shoe covers.

Cleaning and Disinfecting

In many cases, regular detergents or cleaning solutions can be used to clean the items, utensils, bedding and clothing that have been in contact with an infected patient.   Items that are regularly touched such as doorknobs, handles, and bed rails should be cleaned more often.