National Nurses United Response To Covid-19

SARS-CoV-2 is a novel coronavirus that causes the disease, Covid-19. Coronaviruses are a large family of viruses that can infect animals and humans. SARS-CoV-2 is similar to the viruses that cause SARS-CoV-1 (Severe Acute Respiratory Syndrome 1) and MERS-CoV (Middle East Respiratory Syndrome). Coronaviruses, named for the crown-like spikes protruding from their surfaces, circulate among animals such as pigs, camels, bats, and cats. SARS-CoV-2 is thought to have originated in bats and likely infected an intermediate host before transmitting to a human. [1] This is known as a spillover event, defined as the event in which a virus is transmitted from one species to another.
 
[1] Lau S, Luk H, Wong A, et al. Possible Bat Origin of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(7):1542-1547.

Symptoms

Covid-19 has wide-ranging clinical manifestations from asymptomatic infection to life-threatening respiratory failure and multi-organ dysfunction. Some of the common symptoms reported are

• Fever
• Cough
• Muscle soreness
• Fatigue
• Diarrhea
• Headache
• Shortness of breath
• Sore throat
• Chills
• Sudden loss of taste or smell

Other clinical manifestations of Covid-19 can also include blood clots, strokes, inability to wake or stay awake, new confusion, bluish lips or face, encephalopathy, acute hypoxemic, sepsis and septic shock, and delirium.
 
Long-lasting Covid-19 symptoms have also been reported. Recent research indicates damage to lung, cardiac, and neurological function can persist for months after infection with SARS-CoV-2.[1,2]

The serious and disparate impacts of Covid-19 can be attributed to the angiotensin-converting enzyme 2 or ACE2 mechanism that pervades the whole body. SARS-CoV-2 uses the ACE2 receptor to facilitate viral entry into human cells, enabling the virus to infect many organs throughout the body.[3] At this time, it is unclear whether these impacts are temporary or permanent.

[1] Zhao et al., Follow-up study of the pulmonary function and related physiological characteristics of Covid-19 survivors three months after recovery. The Lancet EClinical Medicine, 2020.
[2] Carfi et al., Persistent Symptoms in Patients After Acute Covid-19, JAMA, 2020;324(6):603-605.
[3] Gheblawi et al., Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System, Circulation Research, 2020;126:1456–1474

SARS-CoV-2 spreads easily from person to person. Overwhelming scientific evidence points to aerosol transmission as the significant and predominant mode. Aerosols, which are particles suspended in air, can be emitted by an infected person through breathing, talking, singing, coughing, and sneezing.[1] Asymptomatic individuals, for instance, can spread infectious SARS-CoV-2 aerosols during breathing and speaking, without coughing or other respiratory symptoms. Aerosols can also be generated during medical procedures such as intubation and bronchoscopy.

Respiratory particles vary in size; larger aerosol particles can remain suspended in the air for several minutes, while smaller or lighter ones can linger in the air for hours and travel through the room and ventilation systems. Perfume spray or cigarette smoke demonstrates the extent of aerosol plume distribution as it can be smelled from a distance for quite some time as the particles disperse throughout the room.
 
Studies about SARS-CoV-2 satisfy the criteria for classifying an infectious disease as airborne – the virus must be transmitted via aerosol particles less than 5 µm in diameter and be capable of causing infection. A recent study has found that SARS-CoV-2 can survive and remain infectious for at least 16 hours suspended in aerosols.[2] Researchers have also recovered infectious SARS-CoV-2 in the air from hospital rooms with Covid-19 patients, collected at nearly 16 feet away. Airborne SARS-CoV-2 particles were less than 5 µm in diameter and were detected in the absence of a cough or aerosol generating procedures.[3,4]

[1] Jones, R.M. and L.M. Brosseau, Aerosol transmission of infectious disease. Journal of Occupational and Environmental Medicine, 2015. 57(5): p. 501-8.
[2] Fears, Alyssa C. et al., Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 in Aerosol Suspensions, Emerging Infectious Diseases, 2020;26(9):2168-2171.
[3] Santarpia et al., The Infectious Nature of Patient-Generated SARS-CoV-2 Aerosol, medRxiv, 2020.
[4] Lednicky et al., Viable SARS-CoV-2 in the air of a hospital room with Covid-19 patients. International Journal of Infectious Diseases, 2020.

Droplet vs. Airborne:
How is SARS-CoV-2 Transmitted?

Decontamination

Beginning in March 2020, many hospitals and other healthcare employers have turned to decontaminating single-use N95 respirators to be reused multiple times, given reports of PPE shortages. Several states have now begun reopening but have not taken substantial action to increase PPE production. Instead states and employers are relying on potentially dangerous decontamination methods. NNU has evaluated the available evidence on decontamination methods and determined NO METHOD IS BOTH SAFE AND EFFECTIVE. Please click on the following link to find out more about these unsafe and unproven methods.

• All NNU Statements and Materials On PPE Decontamination

World Health Organization (WHO)’s Dashboard

The situation is evolving rapidly. Please visit the World Health Organization's Dashboard for the most up-to-date information.

View the full National Nurses United Covid-19 Bibliography here

• August 26, 2020 - Nurses Condemn Trump Administration Attack On Public Safety in New CDC Testing Guidelines
• August 24, 2020 - Nurses seek OSHA sanctions on HCA
• August 7, 2020 - Nurses Deliver Half A Million Signatures to Congress, Calling on Congress to Protect Nurses During COVID-19 Pandemic
• August 3, 2020 - Thousands of Nurses Hold National Day of Action Aug. 5 to Save Lives During COVID-19 and Beyond

• July 28, 2020 - National nurse survey reveals devastating impact of reopening too soon
• July 27, 2020 - National Nurses United on Senate Republicans’ stimulus proposal: 'Senate Republicans have abandoned nurses and patients'
• July 25, 2020 - National Nurses United on Trump’s Dispatch of Federal Troops: Send Aid Instead for Confronting Virus, Economic Crisis
• July 14, 2020 - Nurses Call For Postponing In-person Learning, Citing Record Infections
• July 2, 2020 - Nurses Support Mandatory Cloth Face Covering Policies as One Measure Among Many to Protect Public Health
• July 1, 2020 - Letter to House Select Subcommittee on the Coronavirus Crisis

• June 25, 2020 - Nurses demand states close again until COVID-19 protection, testing, tracking measures in place
• June 16, 2020 - MNA and NNU Renew Call for Halt of COVID-19 Mask Decontamination Processes After UMass Scientist Questions Safety of Re-Used Masks Due to Lack of Rigorous Testing
• June 2, 2020 - Nurses Join Forces Nationally to Warn Against Early Reopening

• May 20, 2020 - New survey of nurses provides frontline proof of widespread employer, government disregard for nurse and patient safety, mainly through lack of optimal PPE
• May 8, 2020 - National Nurses United demands optimal COVID-19 protections, honors fallen nurses during national Nurses Week
• May 4, 2020 - Letter to Speaker of the House Nancy Pelosi to reconvene the U.S. House of Representatives
• May 4, 2020 - NNU calls on legislators to pass a mandate for an emergency temporary OSHA standard and increased production of PPE

• April 28, 2020 - California Nurses Association/National Nurses Organizing Committee/National Nurses United statement on reopening the country
• April 17, 2020 - Nurses Applaud Introduction of Emergency COVID-19 Bill to Protect RNs, First Responders, and Health Care Workers
• April 10, 2020 - Nurses Call for More Data, Action to Address Racial Disparities During COVID-19 Crisis
• April 6, 2020 - Nurses: Reuse, decontamination of masks endangers health care workers
• April 3, 2020 - Letter to Centers for Disease Control and Prevention on N95 Decontamination as Unsafe Practice

• March 27, 2020 - National Nurses United is Stepping Up Pressure On Hospital Employers Across the United States to Provide Safer Facilities
• March 26, 2020 - Nation’s Nurses United condemns congressional inaction on protecting nurses, other health care workers from COVID-19
• March 23, 2020 - Nurses Send Petition to Congress Demanding Immediate Protections During COVID-19 Outbreak
• March 17, 2020 - Petition to Congress for Proper Nurses Protection During COVID-19
• March 11, 2020 - Letter to Committee on Homeland Security
• March 5, 2020 - Survey of Nation’s Frontline Registered Nurses Shows Hospitals Unprepared For COVID-19
• March 4, 2020 - Letter to Centers for Disease Control and Prevention
• March 4, 2020 - Letter to Secretary of Labor and Federal OSHA
• March 2, 2020 - National Nurses United Urges Administration, Congress to Protect Health Care Workers and Fully Fund Coronavirus Response
• March 2, 2020 - General Statement - California Nurses Association/National Nurses United Monitoring Coronavirus
• March 2, 2020 - Letter to Office of the Vice-President, Coronavirus Response Coordinator, Members of United States Senate and House of Representative

• Feb 28, 2020 - Nation’s hospitals unprepared for COVID-19
• Feb 19, 2020 - Letter to National Center for Immunization and Respiratory Disease
• Feb 19, 2020 - Letter to California Department of Public Health

• Jan 30, 2020 - Letter to the World Health Organization