Care of the COVID-19 Patient

This guide is created for teams who care for COVID-19 patients in acute and long term care settings. The goal of this guide is to support unit-based education, develop COVID core competencies to care for patients with increasing acuity, and with a focus on key elements of a patient-centred plan of care.

It is important for each practitioner to remain up to date on their COVID-19 competencies in order to have the required knowledge, skills, and abilities to provide care within the unit they work in (i.e., acute COVID unit, critical care, RCU). This guide provides an overview of COVID-19, current treatments, key elements to be considered, and additional resources. This knowledge is important for all practitioners within an acute care COVID unit. It also provides knowledge and procedural skill videos that can be used to adjunct in person simulations. There is a section for practitioners who will care for higher acuity patients either within an Intermediate Care Unit (IMCU) or beginner practitioners within Critical Care environments. Please ensure you have reviewed content assigned by your Clinical Nurse Educator (CNE).

The introduction and overview information below and on the COVID-19 Patient Care page applies to all care areas. As care needs escalate, the level of care may change (e.g., transfer from COVID unit to critical care), and care interventions may change as appropriate. Please use the following COVID Education Plan as a guide to the required COVID competencies for staff. Please note the following course, Quick ICU Training for COVID-19, is accessible to practitioners who are new to ICU, as well as Critical Care for the Non-ICU Clinician, which is a free online course for non ICU practitioners produced by the Society of Critical Care Medicine.

Disclaimer: This information is consistent with evidence-informed research and standards of practice at the time of publication. However, in view of ongoing research, changes in public health/government regulations, and the constant flow of information relating to practice, team members should regularly consult clinical practice reference sources, including the COVID-19 Hub.

The content in this guide should not replace specific decisions for individual patients, nor substitute shared decision-making between patients/families and physicians/other health care professionals.

Brief Timeline of COVID-19

  • Late 2019 / early 2020: Novel coronavirus outbreak confirmed by China
  • March 11, 2020: Global pandemic declared by World Health Organization (WHO)
  • March 15, 2020: First 3 cases identified in Nova Scotia
  • March 22, 2020: Nova Scotia declared state of emergency
  • April 2020: Virus is all around us in the world: it has spread in Canada despite public health guidance of physical distancing, masking, hand hygiene, limiting social contacts, self-isolation, quarantine and closure of borders
  • May 2020: Known virus spread in NS with some facility/regional clusters of viral activity
  • May 2020 to early 2021: Virus activity comes in ‘waves’: Nova Scotia had first wave peak in May 2020, second wave of activity which began in fall 2020, peaked in Jan 2021, third wave is expected before herd immunity is achieved through immunization
  • December 16, 2020: First vaccinations began December 16, 2020 (Lycan-Lang, 2020)

(WHO, 2021; Government of Nova Scotia, 2021b)

Cause

Coronaviruses are a large family of viruses that usually cause mild to moderate upper respiratory illnesses, like  a common cold.

SARS coronavirus (SARS-CoV) occured in 2002, and caused Severe Acute Respiratory Syndrome (SARS). SARS virus disappeared in 2004.

Middle Eastern Respiratory Syndrome (MERS) appeared in 2012, and is caused by the MERS coronavirus (MERS-CoV) (National Institute of Allergy and Infectious Diseases, 2021).

The virus SARS-CoV-2 appeared in late 2019, and causes COVID-19 (WHO, 2021).

Genetic variations of a virus are common and expected. SARS-CoV2 will naturally develop mutations. There are a number of variants the Canadian government is monitoring. A variant is a concern when it affects:

Please review the following power point from Dr. Lisa Barrett on COVID variants. It contains significant information on how these variants are changing the course of this disease and in turn our ability to recognize and treat these viruses.

Transmission

COVID-19 spreads from an infected person to others via respiratory droplets or aerosols that are created when an infectious person coughs, sneezes, sings, shouts, or talks.

The infectiousness of droplets varies — droplets may come in direct contact with the mucous membranes (person’s nose, mouth, or eyes), or they may be inhaled via nose, mouth, airways, and lungs.

SARS-CoV2 virus may also spread when a person touches a surface or object (fomite) that has the virus on it and then touches their mouth, nose, or eyes with unwashed hands.

Transmission may occur from individuals who do not have signs or symptoms of infection (pre-symptomatic or asymptomatic).


(Government of Canada, 2021b, 2021d)

Risk Factors

Risks of getting COVID-19 remains high for all Canadians, so they should avoid settings and situations where there is increased risk, including:

  • closed spaces,
  • crowded spaces,
  • close contact settings where you cannot maintain physical distancing of 2 metres apart, and
  • settings where there is singing, shouting, or heavy breathing (Government of Canada, 2021b).

Health care workers who are in direct contact or providing care in areas with patients who have COVID-19 have an increased risk for contracting COVID-19. Initial Canadian case data reported health care workers formed 20% of all infections. This has reduced to less than 10% (Canadian Institute for Healthcare Improvement, 2021).

Prevention

Vaccinations and following public health guidance and following IPAC guidance are the best strategies to prevent the spread of COVID-19 (Government of Canada, 2021b).

Vaccinations

Several vaccines have been approved by Health Canada to prevent COVID-19. Read more information regarding Canadian vaccines (Government of Canada, 2021b).

Health care workers who have direct contact with patients who have COVID-19, or are under investigation for COVID-19, are being prioritized to receive a vaccination. Public health guidance and IPAC guidance continue once you are vaccinated; you implement these measures to prevent the spread of COVID-19 to others. Please note vaccination does not negate the health care provider or public's responsibility to maintain all IPAC principles, and strict adherence to public health measured (masking, social and physical distancing, hand washing etc).

Public Health Guidance

Public health guidance in Nova Scotia to avoid COVID-19 infection includes:

  • social distancing,
  • hand hygiene,
  • cough and sneeze etiquette,
  • cleaning and disinfecting,
  • shopping and food safety,
  • wearing a non-medical mask, and
  • being prepared for emergencies.

Monitoring for COVID-19

Health care workers must:

Canadian Institute for Healthcare Improvement. (2021). COVID-19 cases and deaths in health care workers in Canada — infographic. https://www.cihi.ca/en/covid-19-cases-and-deaths-in-health-care-workers-in-canada-infographic

Government of Canada. (2021a). Coronavirus disease (COVID-19): Outbreak update. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

Government of Canada. (2021b). Coronavirus disease (COVID-19): Prevention and risks.https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks.html

Government of Canada. (2021c). Hospitalizations, intensive care unit (ICU), mechanical ventilation and deaths. Retrieved March 3, 2021 from https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html#a7

Government of Canada. (2021d). Infection prevention and control for COVID-19: Interim guidance for acute healthcare settings. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/infection-prevention-control-covid-19-second-interim-guidance.html

Government of Nova Scotia. (2021a). Coronavirus (COVID-19): Avoiding infection. https://novascotia.ca/coronavirus/avoiding-infection/

Government of Nova Scotia. (2021b). Coronavirus (COVID-19): Case data. https://novascotia.ca/coronavirus/data/#overview

Lycan-Lang, E. (2020). Nova Scotia’s first COVID-19 vaccinations begin today. Halifax Examiner. https://www.halifaxexaminer.ca/featured/nova-scotias-first-covid-19-vaccinations-begin-today/

National Institute of Allergy and Infectious Disease. (2020). Coronaviruses. https://www.niaid.nih.gov/diseases-conditions/coronaviruses

Nova Scotia Health. (2020a). COVID-19 symptom monitoring for inpatients in acute care. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=77460

Nova Scotia Health. (2020b). COVID-19 symptom monitoring for residents in LTC. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=80537

Nova Scotia Health. (2020c). Novel coronavirus COVID-2019 - Overview and personal protective equipment requirements. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=76267

Nova Scotia Health. (2020d). Point of care risk assessment. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=76565

Nova Scotia Health. (2020e). Universal pandemic precautions. COVID-19 Hub. http://policy.nshealth.ca/Site_Published/covid19/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=83021

World Health Organization. (2021). Timeline: WHO’s COVID-19 response. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline#event-5