What transplant programs and OPOs need to know about coronavirus
Tuesday, February 25, 2020
The 2019 novel coronavirus (2019-nCoV), officially named as COVID-19 by the World Health Organization (WHO), is spreading at a concerning pace. Healthcare professionals in a variety of specialties are readying their practices for the possibility of infection in their area. Many transplant programs, Organ Procurement Organizations (OPOs) and patients worry about the safety of organ transplantation during the outbreak, for example.
Fortunately, a number of organizations, such as the Centers for Disease Control and Prevention (CDC) and Organ Procurement and Transplantation Network (OPTN), are working to provide current information about COVID-19. The Centers for Disease Control and Prevention (CDC) continues to work closely with WHO to monitor COVID-19 and provide updated information on the virus. The CDC is also currently conducting entry screening of all passengers coming in on direct and connecting flights from Wuhan.
Officials in China reported an outbreak of pneumonia, later identified as a novel coronavirus, to WHO on Dec. 31, 2019. The infection appeared to have a zoonotic source in the early part of the outbreak, as the infected individuals seemed to have links to a large seafood and animal market.
As the outbreak progressed, it became clear that person-to-person transmission was possible, probably from respiratory droplets. Researchers are still working to determine the origin and mode of transmission of the novel coronavirus.
As of Feb. 25, the infection had spread to 35 countries, sickened over 80,000 and claimed the lives of approximately 2,700.
Infection with COVID-19 causes symptoms of lower respiratory disease, including:
- Shortness of breath
The incubation period appears to range from two to 14 days. Respiratory symptoms range from mild to severe. Immunosuppressed individuals may not develop a fever.
There is no FDA-approved antiviral medication or vaccine for COVID-19. Treatment is supportive, and the most effective preventive measure is to avoid exposure to the virus. Transplant professionals should use clinical judgment when evaluating transplant recipients who have been in contact with patients under investigation for infection with coronavirus, or who have symptoms and have traveled to an area with active infections.
Controlling Risk of Transmission for Donors and Recipients
Deceased and living donors
While there have been no reports of COVID-19 transmission through the transfusion of blood products, tissues, or organ transplantation, OPOs should continue to focus on epidemiologic risk factors, such as travel history to areas with documented COVID-19 infection or exposure to a potentially infected individual.
Potential living donors who have traveled to these areas or who have had contact with a patient under investigation for COVID-19 should consider a temporary delay in donation.
The risk of transmitting COVID-19 through solid organ transplantation is currently unknown. Like other infections, though, infection with this novel coronavirus may be more severe in recipients of solid organ transplants and other immunocompromised hosts. It may also be readily transmissible to others.
The CDC recommends all travelers avoid non-essential travel to Wuhan and other affected areas of Hubei Province. Travelers going to other parts of China should be aware of symptoms, avoid contact with those infected with the virus, practice good hand washing, and stay up to date on all vaccinations.
While there is a low risk of COVID-19 spread in the United States, it is always wise to use standard precautions against all respiratory viruses.
Precautions for Transplant Programs to Implement when Providing Care for Patient Under Investigation for COVID-19
While transmission dynamics are not yet determined, the CDC provides recommendations for the evaluation of a patient suspected of having COVID-19. These recommendations include:
- Masking the patient
- Moving the patient to a private room and keeping the door closed; placing the patient in an airborne infection isolation room whenever possible
- Using airborne and contact precautions, including the use of a face shield, when entering the patient room
- Reporting suspected COVID-19 infections to the local infection prevention personnel and local health department immediately
- Following updated guidelines from the CDC
COVID-19 is a rapidly evolving situation. Healthcare professionals in every field, including organ procurement and transplantation, should review their infection control guidelines.
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