COVID-19 FAQs for health professionals
Updated Nov. 24, 2020

The most current evidence shows the virus transmits easily between people, most often through droplets generated by coughs and sneezes. Part of the idea of social distancing is that droplets can generally carry for only 5 to 6 feet. If you’re farther than that, your chances of getting the virus are generally lower.

There continues to be debate about how far the virus can travel in the air. Based upon UC Davis Health evidence and peer-reviewed research, UC Davis Health believes the virus can be spread through the air by coughing, sneezing, or through aerosol generating procedures (AGPs), such as intubation, which create small droplet spread. UC Davis Health does not believe the virus is truly airborne, like measles, where persons in adjacent rooms or floors above or below may become infected. While droplets can be detected in the air farther than 6 feet, it does not appear these particles contain enough active virus to deliver an infection-causing dose.

COVID-19 may also be spread by people who are not showing symptoms (i.e., “asymptomatic”). The disease might be transmitted when people touch, or cough on, a surface or object and then touch their face, nose or mouth or eyes. However, this is not thought to be the main way the virus spreads. Current data and information also suggest that the risk of COVID-19 spreading from pets to people is low as well.

Receiving an infection-causing level of virus appears to be dependent upon several factors, including amount of virus transmitted as determined by a combination of ventilation level in the area, time spent being exposed to the virus, and level of PPE used by both people involved.

Many healthy people who become infected with COVID-19 have no symptoms or have mild symptoms. However, there have been healthy people who have progressed to severe disease. We must be vigilant regardless of age and underlying illness. People who have underlying illness and who are older are at higher risk for getting severe disease, but they’re not the only ones at risk.

Overall mortality statistics for COVID-19 continue show those at the highest risk are age 65 or over and/or reside in group living facilities. Overall, 80% of COVID-19 deaths to date have been in the 65+ age group. Deaths age 55 and over make up over 91% of all COVID-19 in the US to date.

Procedures that release upper and lower respiratory tract specimens into the air are at higher risk for releasing airborne particulates by aerosolization. These procedures include intubation, BiPAP, high-flow nasal cannula, nebulizing medications, CPR and resuscitation and bronchoscopy. During these aerosol-generating procedures, providers should wear PAPR or an N95 mask as well as eye protection, a gown, and gloves. If available, it is preferred that the procedure be conducted in an airborne isolation room or private room, and personnel should be limited.

Visit the CDC website for return-to-work information.

Contact droplet is the predominant route of COVID-19 transmission. Using appropriate contact droplet precautions, and in the circumstance where the patient can be masked, you increase the potential protection. If aerosolization is expected, then you should upgrade to N95 or PAPR-level protection. Since surfaces are lower risk but not zero risk of virus transmission, good hand hygiene, as well as keeping hands away from your face and appropriate housekeeping within the health care facility are still the best ways to protect against COVID-19 transmission.

In every location, all employees need to either maintain at least 6 feet of distance from other people at all times and wear a mask for additional protection. In clinical areas where 6 feet of space between people cannot be maintained, clinical masks (ear loop/procedure masks) need to be worn. In non-clinical areas, employees should stay 6 feet apart at all times, or there should be a barrier in place (example: cubicle walls), or a face covering needs to be worn. In non-clinical areas, these masks can be cloth or homemade (with no logos).

This is in alignment with California Gov. Gavin Newsom’s direction on April 14 to ensure our actions are aligned to achieve the following:

• Ensure our ability to care for the sick within our hospitals;
• Prevent infection in people who are at high risk for severe disease;
• Build the capacity to protect the health and well-being of the public; and
• Reduce social, emotional and economic disruptions

Health care professionals should be aware that Cal-OSHA believes N95 masks should be the standard for use for COVID-19 patients, based upon their regulatory perception of occupational risk.

There have been no employee infections from patients at UC Davis Health when proper personal protective equipment (PPE) was worn. Transmission of infection from patients to employees have resulted from not properly wearing a face mask, face shield or improper hand hygiene (or, not wearing higher level protection during aerosol-generating procedures (AGPs) for COVID-positive patients In addition, UC Davis Health’s Stuart Cohen published a paper as a co-author on this topic:

“In all 8 cases, the staff had close contact with the index patients without sufficient PPE. Importantly, despite multiple aerosol generating procedures, there was no evidence of airborne transmission.

“These observations suggest that, at least in a health care setting, a majority of SARS-CoV-2 transmission is likely to take place during close contact with infected patients through respiratory droplets, rather than by long-distance airborne transmission.”

Evidence shows wearing a face shield along with a mask provides more protection from COVID-19. Face shields are required for all providers managed by UC Davis Health during patient encounters (inpatient and outpatient), and they're recommended by the CDC. The primary protection from a face shield is in close environments, when droplets can be sprayed (via speaking, sneezing, coughing) from person to person. Secondary protection comes from a reduction in the wearer’s hands touching the eyes or areas around the eye, which can transfer the virus and cause an infection. Face shields should cover the forehead, extend below the chin, and wrap around the side of the face, according to CDC guidelines.

For patients where no aerosol-generating procedures are expected, use contact and droplet precautions. Providers should use a surgical mask, eye protection (e.g. face shield), gown, and gloves.

Health care professionals should be aware that Cal-OSHA believes N95 masks should be the standard for use for COVID-19 patients, based upon their regulatory perception of occupational risk.