Introduction

Novel Coronavirus disease (COVID-19) is a recently reported infectious disease caused by severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 viruses. It primarily manifests as an acute respiratory illness with interstitial and alveolar pneumonia, but it can affect multiple organs such as the heart, kidney, digestive tract, and nervous system [1]. The disease was first identified in 2019 in Wuhan, China, and has since spread globally, resulting in the 2019-20 coronavirus pandemic [2]. As of September 25th, 2020, 32,029,704 cases of COVID-19 have been reported worldwide in more than 200 countries, with 979,212 deaths [3]. The infection typically spreads from one person to another via respiratory droplets produced during coughing and sneezing [4,5]. Time from exposure to onset of symptoms is generally between 2 and 14 days, with an average of 5 days [6,7]. The standard method of testing is reverse transcription-polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab. Transmission within healthcare centres to healthcare workers has been documented [8,9]. Almost 3000 healthcare staff has been infected in China, and at least 22 died. Transmission to family members was reported. Although transmission occurs mostly via symptomatic individuals, there are reports of asymptomatic individuals who transmitted the disease to multiple family members [10]. These reports demonstrate the need for prevention of cross-infection. Evidence related to transmissibility and mortality should increase awareness among the clinical community of the importance of vigilance, preparation, active management, and protection. The widespread use of protective equipment (such as masks, gloves, gowns, and eyewear) in the care of patients with respiratory symptoms must be prioritized. However asymptomatic and undiagnosed patients in emergency departments, outpatient offices, homes, and other settings, represent a real challenge. Therefore, ensuring routine droplet barrier precautions, environmental hygiene, and overall sound infection prevention practice is warranted.

Protection is achievable even without N95 masks. In a study of outpatient health care staff in diverse ambulatory practices, face masks applied to both caregiver and patients provided effectively similar protection as N95 face masks in the incidence of laboratoryconfirmed influenza among caregivers who were routinely exposed to patients with respiratory viruses [11]. Adherence to guidelines for masks, hand hygiene, and environmental hygiene enhanced the safety of health care workers. Strategies should be implemented to prepare the medical practice for this pandemic to optimize patient care. These include space management, staff education, and supplies maintenance. Also, infection prevention measures need to be implemented to prevent the spread of infection. As a group of physicians, we developed infection outbreak response measures in the outpatient settings. The two goals were to facilitate the care of patients with known or suspected COVID-19 who needed medical attention and to reduce the risk of viral transmission to healthcare workers and other patients in the clinical office. This review article aims to describe the measures that need to be taken to address these goals, including identification of suspected cases, modification of workflow and processes, management of staff, and even using telehealth [12-14].

General Information and Literature Review

• Medical staff carrying the virus (ascertained) must avoid work until cleared by the infection specialist team. • The working team consisting of physicians and nursing staff should receive training in updated clinical practice and management of COVID-19, performing nasopharyngeal swabs for PCR COVID-19 with adequate protection, assessing infection risk, utilizing epidemic prevention tools, and acquiring guidelines from the government, academic societies and delivering them to all medical care personnel as needed, preferably online. • Information on travel, occupation, contacts, and cluster history of each medical staff, patient, family members, residents of the same household, and colleagues at work should be reported and updated regularly. • Members of the medical-nursing staff must self-monitor their health and immediately inform the director if either they or their family members have developed symptoms suggestive of COVID- 19 infection. • Proactively contact at-risk patients and risk-stratify patients according to their risk for morbidity and mortality if they contract the infection. Arrange for pharmacy delivery if they require medications.