LNC Krug

Legal Nurse Consultant Sandra Krug

Autism (ASD): The Most Eye-opening Fundamentals to Know

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Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior.

 

Although autism can be diagnosed at any age, it is said to be a “developmental disorder” because symptoms generally appear in the first two years of life.

 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association used to diagnose mental disorders, people with ASD have:

• Difficulty with communication and interaction with other people
• Restricted interests and repetitive behaviors
• Symptoms decreasing the person’s ability to function well in school, work, and other areas of life

 

Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience.

ASD occurs in all ethnic, racial, and economic groups. Although ASD can be a lifelong disorder, treatments, and services can improve a person’s symptoms and ability to function. The American Academy of Pediatrics recommends that all children be screened for autism. All caregivers should talk to their doctor about ASD screening or evaluation.

 

Signs and Symptoms of ASD

 
People with ASD have difficulty with social communication and interaction, restricted interests, and repetitive behaviors. The list below gives some examples of the types of behaviors that are seen in people diagnosed with ASD. Not all people with ASD will show all behaviors, but most will show several.
 

Social communication / interaction behaviors may include:

• Making little or inconsistent eye contact
• Tending not to look at or listen to people
• Rarely sharing enjoyment of objects or activities by pointing or showing things to others
• Failing to, or being slow to, respond to someone calling their name or to other verbal attempts to gain attention
• Having difficulties with the back and forth of conversation
• Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
• Having facial expressions, movements, and gestures that do not match what is being said
• Having an unusual tone of voice that may sound sing-song or flat and robot-like
• Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions

 

Restrictive / repetitive behaviors may include:

• Repeating certain behaviors or having unusual behaviors. For example, repeating words or phrases, a behavior called echolalia
• Having a lasting intense interest in certain topics, such as numbers, details, or facts
• Having overly focused interests, such as with moving objects or parts of objects
• Getting upset by slight changes in a routine
• Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature
 
People with ASD may also experience sleep problems and irritability. Although people with ASD experience many challenges, they may also have many strengths, including:

• Being able to learn things in detail and remember information for long periods of time
• Being strong visual and auditory learners
• Excelling in math, science, music, or art

 

Causes and Risk Factors

 
While scientists don’t know the exact causes of ASD, research suggests that genes can act together with influences from the environment to affect development in ways that lead to ASD. Although scientists are still trying to understand why some people develop ASD and others don’t, some risk factors include:

• Having a sibling with ASD
• Having older parents
• Having certain genetic conditions—people with conditions such as Down syndrome, fragile X syndrome, and Rett syndrome are more likely than others to have ASD
• Very low birth weight

 

Diagnosing ASD

 
Doctors diagnose ASD by looking at a person’s behavior and development. ASD can usually be reliably diagnosed by the age of two. It is important for those with concerns to seek out assessment as soon as possible so that a diagnosis can be made, and treatment can begin.

 

Diagnosis in Young Children

 

Diagnosis in young children is often a two-stage process.

 
Stage 1: General Developmental Screening During Well-Child Checkups

Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children be screened for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits and specifically for autism at their 18- and 24-month well-child visits. Additional screening might be needed if a child is at high risk for ASD or developmental problems.

Those at high risk include children who have a family member with ASD, have some ASD behaviors, have older parents, have certain genetic conditions, or who were born at very low birth weights.

Parents’ experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the child’s behaviors and combine those answers with information from ASD screening tools, and with his or her observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention (CDC) website.

Children who show developmental problems during this screening process will be referred for the second stage of evaluation.

 

Stage 2: Additional Evaluation

This second evaluation is with a team of doctors and other health professionals who are experienced in diagnosing ASD.

This team may include:

• A developmental pediatrician—a doctor who has special training in child development
• A child psychologist and/or child psychiatrist—a doctor who has specialized training in brain development and behavior
• A neuropsychologist—a doctor who focuses on evaluating, diagnosing, and treating neurological, medical, and neurodevelopmental disorders
• A speech-language pathologist—a health professional who has special training in communication difficulties
 
The evaluation may assess:

• Cognitive level or thinking skills
• Language abilities
• Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting
 
Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:

• Blood tests
• Hearing test

The outcome of the evaluation will result in a formal diagnosis and recommendations for treatment.

 

Diagnosis in older children and adolescents

 
ASD symptoms in older children and adolescents who attend school are often first recognized by parents and teachers and then evaluated by the school’s special education team. The school’s team may perform an initial evaluation and then recommend these children visit their primary health care doctor or doctors who specialize in ASD for additional testing.

Parents may talk with these specialists about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers.

 

Diagnosis in adults

 
Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).

Adults who notice the signs and symptoms of ASD should talk with a doctor and ask for a referral for an ASD evaluation. While testing for ASD in adults is still being refined, adults can be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about concerns, such as:

• Social interaction and communication challenges
• Sensory issues
• Repetitive behaviors
• Restricted interests

Information about the adult’s developmental history will help in making an accurate diagnosis, so an ASD evaluation may include talking with parents or other family members.

Getting a correct diagnosis of ASD as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help. Studies are now underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of transition-age youth and adults with ASD.

 

Changes to the diagnosis of ASD

 
In 2013, a revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released. This revision changed the way autism is classified and diagnosed. Using the previous version of the DSM, people could be diagnosed with one of several separate conditions:

• Autistic disorder
• Asperger’s’ syndrome
• Pervasive developmental disorder not otherwise specified (PDD-NOS)

In the current revised version of the DSM (the DSM-5), these separate conditions have been combined into one diagnosis called “autism spectrum disorder.” Using the DSM-5, for example, people who were previously diagnosed as having Asperger’s syndrome would now be diagnosed as having autism spectrum disorder. Although the “official” diagnosis of ASD has changed, there is nothing wrong with continuing to use terms such as Asperger’s syndrome to describe oneself or to identify with a peer group.

 

Treatments and Therapies

 
Treatment for ASD should begin as soon as possible after diagnosis. Early treatment for ASD is important as proper care can reduce individuals’ difficulties while helping them learn new skills and make the most of their strengths.

The wide range of issues facing people with ASD means that there is no single best treatment for ASD. Working closely with a doctor or health care professional is an important part of finding the right treatment program.

 

Medication

 
A doctor may use medication to treat some symptoms that are common with ASD. With medication, a person with ASD may have fewer problems with:

• Irritability
• Aggression
• Repetitive behavior
• Hyperactivity
• Attention problems
• Anxiety and depression

Read more about the latest news and information on medication warnings, patient medication guides, or newly approved medications at the Food and Drug Administration’s (FDA) website at https://www.fda.gov/.

Behavioral, psychological, and educational therapy

 
People with ASD may be referred to doctors who specialize in providing behavioral, psychological, educational, or skill-building interventions. These programs are typically highly structured and intensive and may involve parents, siblings, and other family members. Programs may help people with ASD:

• Learn life-skills necessary to live independently
• Reduce challenging behaviors
• Increase or build upon strengths
• Learn social, communication, and language skills

 

Other resources

 
There are many social services programs and other resources that can help people with ASD. Here are some tips for finding these additional services:

• Contact your doctor, local health department, school, or autism advocacy group to learn about special programs or local resources.
• Find an autism support group. Sharing information and experiences can help individuals with ASD and/or their caregivers learn about treatment options and ASD-related programs.
• Record conversations and meetings with health care providers and teachers. This information helps when it’s time to make decisions about which programs might best meet an individual’s needs.
• Keep copies of doctors’ reports and evaluations. This information may help an individual qualify for special programs.

 

Autism Parenting Magazine is designed to help parents with Autistic children. They are currently giving away a bonus issue to anyone that visits their website.

https://www.autismparentingmagazine.com/autism-resources-parents/

 

Updated 11/27/2020:
 
An extensive guide on Modifying Your Backyard for Special Needs Children which has super-helpful information and tips on how to modify your backyard to accommodate children with special needs was just published.
 
You can see it here: https://bbqwork.com/backyard-modification/

Symptoms of COVID-19 – important to know it all

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Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with fever, cough, and difficulty breathing.

 

If you develop symptoms such as fever, cough, and/or difficulty breathing, and have been in close contact with a person known to have COVID-19 or have recently traveled from an area with the ongoing spread of COVID-19, stay home and call your healthcare provider.

 

Older patients and individuals who have severe underlying medical conditions or are immunocompromised should contact their healthcare provider early, even if their illness is mild. If you have severe symptoms, such as persistent pain or pressure in the chest, new confusion or inability to arouse, or bluish lips or face, contact your healthcare provider or emergency room and seek care immediately. Your doctor will determine if you have signs and symptoms of COVID-19 and whether you should be tested.

 

Using the CDC-developed diagnostic test, a negative result means that the virus that causes COVID-19 was not found in the person’s sample. In the early stages of infection, it is possible the virus will not be detected.
For COVID-19, a negative test result for a sample collected while a person has symptoms likely means that the COVID-19 virus is not causing their current illness.

 

CDC does not have any evidence to suggest that imported animals or animal products pose a risk for spreading COVID-19 in the United States. This is a rapidly evolving situation and information will be updated as it becomes available.

 

The U.S. Centers for Disease Control and Prevention (CDC), the U. S. Department of Agriculture (USDA), and the U.S. Fish and Wildlife Service (FWS) play distinct but complementary roles in regulating the importation of live animals and animal products into the United States.

 

CDC regulates animals and animal products that pose a threat to human health, USDA regulates animals and animal products that pose a threat to agriculture; and FWS regulates the importation of endangered species and wildlife that can harm the health and welfare of humans, the interests of agriculture, horticulture, or forestry, and the welfare and survival of wildlife resources.

Social Distancing, isolation, quarantine – the reason why is to be protected

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Physical/Social Distancing, Isolation, and Quarantine

 

COVID-19 is a new disease and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.
 
Based upon available information to date, those at high-risk for severe illness from COVID-19 include:
• People aged 65 years and older
• People who live in a nursing home or long-term care facility
• Other high-risk conditions could include:
o People with chronic lung disease or moderate to severe asthma
o People who have heart disease with complications
o People who are immunocompromised including cancer treatment
o People of any age with severe obesity (body mass index [(BM]I)≥40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
• People who are pregnant should be monitored since they are known to be at risk with a severe viral illness, however, to date data on COVID-19 has not shown an increased risk

 

There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19).

 

The best way to prevent illness is to avoid being exposed to this virus.

 
The virus is thought to spread mainly from person-to-person.
• Between people who are in close contact with one another (within about 6 feet).
• Respiratory droplets produced when an infected person coughs or sneezes.
• These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
 

physical - social distancing
Physical/Social Distancing

 

Social distancing is the practice of increasing the space between individuals and decreasing the frequency of contact to reduce the risk of spreading a disease.

 

Please practice Social distancing by increasing the space between yourself and other individuals and decreasing the frequency of contact with others to reduce the risk of spreading disease (ideally to maintain at least 6 feet between all individuals, even those who are asymptomatic).
 
Social distancing strategies can be applied on an individual level (e.g., avoiding physical contact), a group level (e.g., canceling group activities where individuals will be in close contact), and an operational level (e.g., rearranging chairs in the dining hall to increase the distance between them).
 
Although social distancing is challenging to practice, it is a cornerstone of reducing transmission of respiratory diseases such as COVID-19.

 

Avoid close contact

 
Social distancing avoids close contact with people who are sick.
Close contact is defined as—
a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a COVID-19 case
– or –
b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on).

Put six feet of Social distancing between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick.

 

Based on available information, adults aged 65 years and older and people of any age with underlying medical conditions included on the above list are at higher risk for severe illness and poorer outcomes from COVID-19.

 
The CDC is collecting and analyzing data regularly and will update the list when they learn more. People with underlying medical conditions not on the list might also be at higher risk and should consult with their healthcare provider if they are concerned.

 

We at Lessons for Legal Nurses encourage all people to practice social distancing, and regardless of risk, to:
• Take steps to protect yourself and others.
• Call your healthcare provider if you are sick with a fever, cough, or shortness of breath.
• Follow CDC travel guidelines and the recommendations of your state and local health officials.

 

isolation
Isolation

 

Isolation is defined as the separation or restriction of activities of an ill person with a contagious disease from those who are well.

At home

Patients with COVID-19 should be evaluated as to the need for hospitalization. If hospitalization is not medically necessary, home care is preferable if the individual’s situation allows.
 
In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care.
 
Considerations for care at home include whether:
• The patient is stable enough to receive care at home.
• Appropriate caregivers are available at home.
• There is a separate bedroom where the patient can recover without sharing immediate space with others.
• Resources for access to food and other necessities are available.
• The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves, and facemask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene);
• There are household members who may be at increased risk of complications from COVID-19 infection (.e.g., people >65 years old, young children, pregnant women, people who are immunocompromised or who have chronic heart, lung, or kidney conditions).
 
Household members, intimate partners, and caregivers in a nonhealthcare setting may have close contact with a person with symptomatic, laboratory-confirmed COVID-19 or a person under investigation.
 

Close contacts should monitor their health; they should call their healthcare provider right away if they develop symptoms suggestive of COVID-19 (e.g., fever, cough, shortness of breath)

 
Close contacts should also follow these recommendations:

• Make sure that you understand and can help the patient follow their healthcare provider’s instructions for the medication(s) and care. You should help the patient with basic needs in the home and provide support for getting groceries, prescriptions, and other personal needs.

• Monitor the patient’s symptoms. If the patient is getting sicker, call his or her healthcare provider and tell them that the patient has laboratory-confirmed COVID-19. This will help the healthcare provider’s office take steps to keep other people in the office or waiting room from getting infected. Ask the healthcare provider to call the local or state health department for additional guidance. If the patient has a medical emergency and you need to call 911, notify the dispatch personnel that the patient has, or is being evaluated for COVID-19.

• Household members should stay in another room or be separated from the patient as much as possible. Household members should use a separate bedroom and bathroom, if available.

• Prohibit visitors who do not have an essential need to be in the home.

• Household members should care for any pets in the home. Do not handle pets or other animals while sick.

• Make sure that shared spaces in the home have good airflows, such as by an air conditioner or an opened window, weather permitting.

• Perform hand hygiene frequently. Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.

• Avoid touching your eyes, nose, and mouth with unwashed hands.

• The patient should wear a facemask when you are around other people. If the patient is not able to wear a facemask (for example, because it causes trouble breathing), you, as the caregiver, should wear a mask when you are in the same room as the patient.

• Wear a disposable facemask and gloves when you touch or have contact with the patient’s blood, stool, or body fluids, such as saliva, sputum, nasal mucus, vomit, urine.
o Throw out disposable facemasks and gloves after using them. Do not reuse it.
o When removing personal protective equipment, first remove and dispose of gloves. Then, immediately clean your hands with soap and water or alcohol-based hand sanitizer. Next, remove and dispose of facemask, and immediately clean your hands again with soap and water or alcohol-based hand sanitizer.

• Avoid sharing household items with the patient. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. After the patient uses these items, you should wash them thoroughly (see below “Wash laundry thoroughly”).

• Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day. Also, clean any surfaces that may have blood, stool, or body fluids on them.
o Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during the use of the product.

• Wash laundry thoroughly.
o Immediately remove and wash clothes or bedding that have blood, stool, or body fluids on them.
o Wear disposable gloves while handling soiled items and keep soiled items away from your body. Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after removing your gloves.
o Read and follow directions on labels of laundry or clothing items and detergent. In general, using a normal laundry detergent according to washing machine instructions and dry thoroughly using the warmest temperatures recommended on the clothing label.

• Place all used disposable gloves, facemasks, and other contaminated items in a lined container before disposing of them with other household waste. Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after handling these items. Soap and water should be used preferentially if hands are visibly dirty.

• Discuss any additional questions with your state or local health department or healthcare provider. Check available hours when contacting your local health department.

 

In hospital settings:

 
Hospitals will ensure rapid safe triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough). They will set up separate, well-ventilated triage areas, place patients with suspected or confirmed COVID-19 in private rooms with the door closed and private bathroom (as possible), prioritize Airborne Infection Isolation Rooms (AIIRs) for patients undergoing aerosol-generating procedures.
 
All visitors should perform frequent hand hygiene and follow respiratory hygiene and cough etiquette precautions while in the facility, especially in common areas.
 
Hospitals will implement mechanisms and policies that promote situational awareness for facility staff including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff about known or suspected COVID-19 patients and facility plans for response.

 

quarantine
Quarantine

 

Quarantine refers to the practice of confining individuals to determine whether they develop symptoms of disease.

 

Persons who are close contacts of a confirmed or suspected COVID-19 case should be placed under quarantine for 14 days.

 

If an individual is quarantined due to contact with a suspected case who is subsequently tested for COVID-19 and receives a negative result, the quarantined individual should be released from quarantine restrictions.

 

If the person in quarantine develops symptoms during the 14-day period, the individual should be placed under medical isolation and evaluated for COVID-19. If symptoms do not develop, movement restrictions can be lifted, and the individual can return to their previous activities.

 

Keep a quarantined individual’s movement outside the quarantine space to an absolute minimum.
• Provide medical evaluation and care inside or near the quarantine space when possible.
• Serve meals inside the quarantine space.
• Exclude the quarantined individual from all group activities.
• Assign the quarantined individual a dedicated bathroom when possible.
 
As a measure to limit health care personnel exposure and conserve personal protective equipment, facilities could consider designating entire units within the facility, with dedicated health care personnel, to care for known COVID-19 patients. Dedicated means that health care personnel are assigned to care only for these patients during their shift.
 

Patients with known COVID-19 should be housed in the same room for the duration of their stay in the facility (e.g., minimize room transfers).

 
Patients should wear a facemask to contain secretions during transport. If patients cannot tolerate a facemask or one is not available, they should use tissues to cover their mouth and nose.
 
Restriction of all visitors is implemented. However, facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional well-being and care.

 

In Review

 
Physical/social distancing – In the context of COVID-19, an individual is considered a close contact if they have been within approximately 6 feet of another person.
 
Medical Isolation – Medical isolation refers to confining a confirmed or suspected COVID-19 case, to prevent contact with others and to reduce the risk of transmission.
 
Quarantine – Quarantine refers to the practice of confining individuals who have had close contact with a COVID-19 case to determine whether they develop symptoms of the disease. Quarantine for COVID-19 should last for a period of 14 days.

 
 

My friend Chou Xiong, a visual brand designer, has written a blog about social distancing: Social Distance & What You Can Do to Grow Your Business. Please go take a look.

Spotlight on the COVID-19 and world travel

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Global Health Advisory Level 4 – Do Not Travel

 

The Department of State advises U.S. citizens to avoid all international travel due to the global impact of COVID-19. In countries where commercial departure options remain available, U.S. citizens who live in the United States should arrange for an immediate return to the United States, unless they are prepared to remain abroad for an indefinite period. U.S. citizens who live abroad should avoid all international travel.

 

Many countries are experiencing COVID-19 outbreaks and implementing travel restrictions and mandatory quarantines, closing borders, and prohibiting non-citizens from the entry with little advance notice.

 

Airlines have canceled many international flights and several cruise operators have suspended operations or canceled trips. If you choose to travel internationally, your travel plans may be severely disrupted, and you may be forced to remain outside of the United States for an indefinite timeframe.

 

On March 14, the Department of State authorized the departure of U.S. personnel and family members from any diplomatic or consular post in the world who have determined they are at higher risk of a poor outcome if exposed to COVID-19 or who have requested departure based on a commensurate justification. These departures may limit the ability of U.S. Embassies and consulates to provide services to U.S. citizens.

 

For the latest information regarding COVID-19, please visit the Centers for Disease Control and Prevention’s (CDC) website.

 

You are encouraged to visit travel.state.gov to view individual Travel Advisories for the most urgent threats to safety and security. Please also visit the website of the relevant U.S. embassy or consulate to see information on entry restrictions, foreign quarantine policies, and urgent health information provided by local governments.

 

Travelers are urged to enroll in the Smart Traveler Enrollment Program (STEP) to receive Alerts and make it easier to locate you in an emergency. The Department uses these Alerts to convey information about terrorist threats, security incidents, planned demonstrations, natural disasters, etc.

 

In an emergency, please contact the nearest U.S. Embassy or Consulate or call the following numbers: 1(888) 407-4747 (toll-free in the United States and Canada) or 1 (202) 501-4444 from other countries or jurisdictions.

 

If you decide to travel abroad or are already outside the United States:

 
• Consider returning to your country of residence immediately using whatever commercial means are available.
• Have a travel plan that does not rely on the U.S. Government for assistance.
• Review and follow the CDC’s guidelines for the prevention of coronavirus.
• Check with your airline, cruise lines, or travel operators regarding any updated information about your travel plans and/or restrictions.
• Visit travel.state.gov to view individual Travel Advisories for the most urgent threats to safety and security.
• Visit our Embassy webpages on COVID-19 for information on conditions in each country or jurisdiction.
• Visit the Department of Homeland Security’s website on the latest travel restrictions to the United States

Alert: What is this COVID-19 thing, really?

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Coronavirus (COVID – 19)

 

Beginning December 2019, we have been hearing about a family of viruses known as coronaviruses. There are 69 known species of these coronaviruses. Seven of them can affect humans. The others of this virus species are contracted by animals, mostly pigs, bats, and other small mammals.

 

History

 
Healthcare providers have known about these viruses since the 1960s. From 2002 to 2003, the general population began to hear of them due to an outbreak of one of a new strain of coronavirus that occurred in China. Eventually, this virus was called Severe Acute Respiratory Syndrome (SARS). The epidemic spread to twenty-four countries around the world. According to the World Health Organization, roughly 8,000 cases were reported. The mortality rate was between 9.5 to 10 percent.
 
Another new strain of coronavirus emerged in Saudi Arabia about ten years later, with an extremely high mortality rate of 35 percent. That epidemic spread to twenty-one countries before it was contained. Two thousand four hundred people were affected. Eight hundred people died. This virus was called Middle East Respiratory Syndrome (MERS).
 
The next new strain of coronavirus emerged in December 2019. The first reports emerged, once again in China, specifically in Wuhan province. The virus has been referred to as SARS Covid-2, and the disease as COVID-19 (Coronavirus disease, 2019).
 
There have been rumors that this coronavirus has mutated. No mutation has been recognized by healthcare officials.

 

Proliferation

 
Since December 2019, this COVID-19 has spread to over 115 nations. As of March 11, there have been more than 126,300 reported cases. Of these, 68,285 patients have recovered fully. There are 53,382 cases considered active. Of the active cases, 89 percent have minor conditions, and the rest are in severe or critical conditions. More than 4,633 people have died.

 

Transmition

 
Transmission occurs via small droplets of liquid from coughs and/or sneezes. It can also be transmitted by touching objects these droplets have touched. The virus enters through the mucosa in the mouth, nose, or eyes. The incubation period has been estimated to be between two and fourteen days.
 
The coronavirus can live outside the body from several hours to several days. Viruses are microscopic organisms that live inside cells. They only live as long as the cell they inhabit is alive. If the surface the virus is located on is wet it may remain alive for several days. If the surface is dry, the virus may die within hours.
 
It is estimated that an infected patient will transmit the virus to 2.6 people on average. Most cases of COVID-19 have been reported in someone who has been in contact with others infected by the virus. However, there have been cases where the disease appeared without any contact with someone infected.
 
The closer someone is to the infected person, the greater the risk of being infected. The Centers for Disease Control and Prevention (CDC) considers “close contact” to be about six feet away from another person.

 

Symptoms

 
Twenty percent of patients never develop symptoms. The common symptoms are fever, cough, muscle aches, headache, vomiting, and diarrhea. These symptoms are similar to those of influenza.
 
Symptoms remain mild in 85 to 89 percent of cases, but 11 to 15 percent of cases progress to severe or critical symptoms. These patients will have respiratory distress, pneumonia, and even hypotension or septic shock.

 

Prevention

 
The most important preventative measure is frequent hand washing. Hand sanitizer can also be used.
 

For medical personnel who handle cases of COVID-19, the use of gloves, gowns, and goggles are recommended.

 
It is also recommended that, until this epidemic is considered to be under control, we minimize physical contact with other people (examples: shaking hands, hugging, kissing, and so on).
 
If you are planning to travel to a country where the number of cases has increased, the recommendation is to not travel until the coronavirus pandemic has been contained.
 
This week Italy has declared a total quarantine. A few hours ago Italy closed most shops and restaurants, with the exception of pharmacies and supermarkets.

The state of California suspended all meetings of more than a thousand people, and these measures are likely to be tightened in the immediate future.

President Donald Trump decreed a few hours ago the suspension of all flights from Europe.

 

Mortality

 
The average mortality rate of COVID-19 is around 3.4 percent. The highest mortality rate was reported in Italy, estimated at 6 percent. The lowest mortality rate was reported in South Korea, estimated at 0.7 percent.
 
It is important to note that the mortality rate of this novel COVID-19 is not comparable to the two coronaviruses mentioned above. In reality, the mortality of this pandemic will probably be lower than reported, since up to 20 percent of patients remain completely asymptomatic, which means they will remain undiagnosed.
 
The highest-risk patients are those older than sixty years of age and those who suffer from a chronic disease, either respiratory or others such as diabetes mellitus or renal failure.
 
The mortality rate may end up 1 percent or less, according to an article in the New England Journal of Medicine. The common flu in the U.S. has a mortality rate of approximately 0.1 percent. The CDC (Center for Disease Control) in Atlanta estimates that in the current flu season, between 20,000 and 50,000 people will die in the U.S.

 

Alarm

 
The worldwide alarm over COVID-19 is due to the number of infected patients, not the mortality rate. The increasing number of patients makes the number of deaths from this virus potentially very high.
 
Millions of people will be affected by COVID-19 by the time this pandemic ends. This could produce hundreds of thousands of deaths unless we develop a vaccine or some kind of treatment quickly.
 
Most experts say we will not have a vaccine before the next 12 to 18 months. Antivirals are being tested, but there is currently no official recommendation for these drugs.