ALL U WANTED TO KNOW ABOUT CORONA AND COVID-19

Coronavirus are the large family of viruses that are known to cause illness in human and animals. A new human corona virus was discovered in Qatar and Saudi Arabia in 2012. The new virus ia a new strain of beta coronavirus, named as novel coronavirus(ncov). This was mostly seen in middle east countries causing middle east respiratory Syndrome (MERS). An outbreak of respiratory illness caused by a novel(new) coronavirus(named 2019 –ncov”) that was first detected in wuhan city, China and which continues to expand.

How is the novel coronavirus spread?

Novel coronavirus experts think that it is originated in an animal species (including camels, cattle, cats, and bats), rarely, animal coronavirus can infect people and then spread between people such as Like MERS (middle east respiratory syndrome) and SARS (severe acute respiratory syndrome). Corona virus can spread by airosals/airborn. Incubation period is 2 to 7 days and Infectivity is 7 to 10 days

Source and spread of virus

Person to person spread of the novel corona virus is reported between (those cases involved close contact, family members, co-workers, fellow patients and healthcare workers). It spreads through direct contact, droplets (coughing, sneezing) infection and through fomites (contaminated cloth, hand, table, chair and cot)

Epedimology – New Coronavirus

China,US, Canada, Japan, South Korea, Taiwan, Vietnam, Combodia, Singapore, Malaysia, Australia, Srilanka, Thailand, UAE, Nepal, Germany, France, Finland. As on February 10th, around 40K people in China mainland have confirmed cases and around 900 dead. In India, only 3 confirmed cases till today from Kerala, who all returned from Wuhan.

Symptoms of Novel Corona Virus

  • Fever
  • Running nose
  • Cough
  • Throat pain
  • Shortness of breath
  • Pneumonia
  • Severe pneumonia ARDS
  • Vomiting
  • Diarrhorea
  • Renal failure
  • Coronavirus primarily infect the upper respiratory and gastrointestinal tract of humans. Causes mild respiratory illness
  • Most people who got infected with the novel corona virus developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath.

Treatment

There is no specific treatment now. Supportive medical care is provided to help relieve the acuteness of the symptoms and control complications

Is there a vaccine for the new corona virus?

So far there is no vaccine

Prevention

  1. Keep away from someone with cold/ cough/ sneezing
  2. Who are having above symptoms compulsory use of Face mask, 3 layer surgical mask/ N-95 mask
  3. Who are not having symptoms also can prevent infection by using mask
  4. Use a tissue to cover nose/ mouth when coughing, sneezing, wiping and blowing noses
  5. If tissue isn’t available, cough or sneeze into the inner elbow rather than the hand
  6. Avoid direct hand contact with eyes, mouth and nose
  7. Frequent hand wash with water and soap or clean with alcohol based sanitizer.
  8. Adhering to food safety and hygiene rules such as avoiding under-cooked meats, raw fruits and vegetables unless they have been peeled or unsafe water
  9. Disinfect common surfaces as frequently as possible
  10. Wash hands or use a sanitizer when in contact with common surfaces like door handles
  11. PPE (masks, gloves) and appropriate hand hygiene also help reduce the spread of infection.

“Together we can prevent coronavirus”

Avoid contact with Infected or suspected person

Corona viruses are a large family of viruses which may cause illness in animals (camels, cattle, cats, and bats) or humans. In humans, several corona viruses are known to cause infections of the respiratory tract. It may range from common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

There are 7 different strains of corona virus.

The most recently discovered corona virus causes Corona Virus Disease or COVID-19.

SARS-CoV-2 is the novel coronavirus that causes COVID-19

COVID-19 is the infectious disease caused by the most recently discovered corona virus SARS-CoV-2. This new virus and disease were unknown before the outbreak in China .

Towards December 2019, this novel corona virus was identified as a cause of upper and lower respiratory tract infections in Wuhan, a city in the Hubei Province of China.

Sometimes corona virus from animals infect people and spread further via human to human transmission.

It rapidly spread, resulting in an epidemic throughout China . It gradually started spreading to other parts of the world in pandemic proportions. It has affected almost every continent in this world, except Antarctica. In February 2020, the World Health Organization(WHO) designated the disease as COVID-19, which stands for corona virus disease 2019.

At the beginning of the outbreak, investigation in Wuhan identified an initial association with a seafood market where most patients had worked or visited.

The seafood market also sold live rabbits, snakes,dogs and other animals. The initial concept was that the virus originated from snakes. Later, studies proved that it had more similarity with bats.

However, as the outbreak progressed, person-to-person transmission through droplets and fomites became the primary mode of transmission.

The main mode of transmission of this dreaded virus is by Droplet transmission.

The virus gets released in the respiratory secretions when an infected person talks coughs or sneezes. These droplets can infect others if they make direct contact with the mucous membranes.

Infection can also spread by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.

Droplets typically do not travel more than 6 feet (about 2meters) and do not linger in the air.

One study suggested that the virus may also be present in feces and could contaminate places like toilet cumode and bathroom sinks.

Patients are thought to be most contagious when they are symptomatic .Some spread might be possible before symptoms appear, but this is not thought to be a common occurrence

COVID-19 virus can persist on inanimate surfaces like metal, glass or plastic for upto 9 days, but can be efficiently inactivated by surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute.  Other biocidal agents such as 0.02% chlorhexidine digluconate or 0.05–0.2% benzalkonium chloride are less effective. Hence terminal disinfection becomes very important.

These symptoms are usually mild and begin gradually .Some people become infected but may not develop any symptoms.

The most common clinical features at the onset of illness are :

  • Fever in 88%
  • Dry cough in 67%
  • Fatigue in 38%
  • Dyspnea in 18.7%
  • Myalgias in 14.9%

Pneumonia appears to be the most common and severe manifestation of this viral infection.

Acute respiratory distress syndrome developed in 3.4% of patients.

Other symptoms  include

  • Headache
  • Sore throat
  • Rhinorrhea
  • Gastrointestinal symptoms like  Nausea , Vomiting , Diarrhea

About 80% of confirmed COVID-19 cases suffer from only mild to moderate disease and nearly 13% have severe disease . Critical illness (respiratory failure, septic shock, and/or multiple organ dysfunction/failure) is noted in only in less than 6% of cases.

It is presumed to be between 2 to 14 days after exposure, with most cases occurring within 5 days after exposure.

  • Mostly middle aged (>30 years) and elderly.
  • Older persons and persons with pre-existing medical conditions such as diabetes mellitus ,high blood pressure or ischemic heart disease appear to develop serious illness more often.
  • Symptomatic infection in children appears to be uncommon, and when it occurs, it is usually mild

The initial diagnosis is based on typical symptoms .

The current recommended diagnostic modality for Covid-19

  • SARS-CoV-2 RNA is detected by polymerase chain reaction (RT-PCR)
  • Results of this test are available within a few hours to 2 days
  • A single positive test should be confirmed by a second RT-PCR assay. This test targets different SARS-CoV-2 gene
  • If initial testing is negative but COVID-19 infection is highly suspected, the WHO recommends re-sampling and testing from multiple sites in the respiratory tract.
  • For safety reasons, specimens from a patient with suspected or documented    COVID-19 should not be submitted for viral culture.
  • Samples should also be tested for other viral/bacterial pathogens.

COVID 19- RAPID TESTS

COVID-19 Rapid Test qualitatively detects IgG and IgM antibodies to SARS-CoV-2 in human whole blood, serum and plasma samples.

The IgM-IgG combined assay has better sensitivity and utility as compared to single IgM or IgG test. It can be used for the rapid screening of SARS-CoV-2 carriers, symptomatic or asymptomatic patients  in clinics , hospitals and laboratories.

Despite the promise, there is no definitive evidence regarding the utility of rapid kits for testing respiratory/serum samples of COVID 19 suspected patients.

No. Antibiotics only work on bacterial infections and not on viral infections. COVID-19 is caused by a virus, so antibiotics do not work. Antibiotics should not be used as a means of prevention or treatment of COVID-19.

NOT YET. At the moment, the recommended strategies to deal with this dreaded viral infection are only supportive and preventive .These measures are  aimed at reducing transmission in the community.

To date, there is no vaccine and no specific antiviral medicine to prevent or treat COVID-2019 disease. However, those affected should receive symptomatic care. People with serious illness should be admitted in the hospital.

  • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected covid-19 infection.
  • You should wear a mask if you are coughing or sneezing.
  • Masks are effective only when used in combination with frequent hand-washing with alcohol-based hand rub or soap and water.
  • If you are wearing a mask, then you must know how to use it and dispose it properly.

If you are wearing a mask then it should cover mouth and nose and make sure there are no gaps between your face and the mask.

Surgical masks helps stopping the wearer from spreading their germs and infection when coughing , sneezing or talking . They’re designed to protect patients, not to protect the wearer.

There isn’t currently research available on the efficacy of surgical masks (or even respirators), for protecting wearers against the corona virus.

1.Asymptomatic individuals wearing masks of any type is not recommended

  1. Wearing masks when they are not indicated results in  unnecessary cost and a    procurement burden especially during the time of an epidemic/pandemic
  2. People with respiratory symptoms or who are taking care of COVID-19 patients at  home should receive triple layer surgical masks.
  3. Respirators(N95, FFP2 or equivalent standard) should be reserved for aerosol generating procedures (Tracheal intubation, non-invasive ventilation, tracheostomy, bronchoscopy and cardio pulmonary resuscitation) along with other personal protective equipments (PPE)
  4. Health care workers who are involved in direct care of COVID -19 patients should use    three layered surgical mask/ Respirator (only if available in sufficient quantity) and  other PPE  (eye protection, gloves and gowns/fluid resistant aprons)
  5. Medical and Nursing staff involved in Intensive care unit should use Respirators( N95/FFP2 or an equivalent)
  6. During the present pandemic situation respirators (e.g., N95, FFP2 )can be used for an extended time, especially while caring for multiple patients who have the same diagnosis without removing it. Evidence shows that respirators maintain their protection when it is been used for extended periods
  7. Always prioritize the use of N95 respirators for those personnel at the highest risk of    contracting infections.
  8. Most often an N95 mask can be used for up to 8hours on a continuous or intermittent    basis and ideally it needs to be removed after that.
  9. Avoid touching the inside of the respirator. If inadvertent contact is made with the    inside of the respirator, perform hand hygiene.
  10. Used mask should be considered as a potentially infected material and it should be    disposed separately in an infectious waste disposable bag.
  11. Health care system at every locality should adopt appropriate steps for disposal of used masks.
  1. Any person diagnosed with SARS CoV 2 infection by means of laboratory testing at   a government recommended testing laboratory.
  2. Anyone who has symptoms of fever and respiratory illness, and has a history of  close contact of a person who has either been diagnosed as COVID-19 or has a history of travel to a COVID affected region within the last 14 days.
  3. Any health care worker with symptoms of fever and respiratory illness who has been    involved directly in treating COVID- 19 patients or has close contact with persons  involved in treating COVID- 19 patients during the last 14 days.

Asymptomatic cases with exposure to Covid-19 positive patients can be quarantined  at their homes, but to be under strict surveillance by the government authorities

Suspected patient to be isolated in well ventilated, preferably separate rooms.

Symptomatic  COVID- 19 positive patients should be hospitalized in isolation room  and also should be monitored adequately by medical team

  • Ensure that appropriate hand washing facilities and hand-hygiene supplies are available.
  • Stock the sink area with suitable supplies for hand washing and with alcohol-based hand rub, near the point of care and the room door.
  • Ensure adequate ventilation of the room.
  • Post signs on the door indicating that the space is an isolation area.
  • All visitors should consult the health-care worker in charge before being allowed into the isolation areas.
  • Remove all non-essential furniture and ensure that the remaining furniture is easy to clean.
  • Stock the PPE supply and linen outside the isolation room or area (e.g. in the change room). Setup a trolley outside the door to hold PPE(Personal Protective Equipment). A checklist may be useful to ensure that everything required is available.
  • Place appropriate waste bags in a bin. If possible, use a touch-free bin. Ensure that    used (i.e. dirty) bins remain inside the isolation rooms.
  • Place containers for disposal of sharps inside the isolation room or area.
  • Keep the patient’s personal belongings to a minimum.
  • Dedicate non-critical patient-care equipment (e.g. blood pressure cuff , sphygmomanometer, thermometer and stethoscope) to the patient, if possible. Thoroughly clean and disinfect patient-care equipment every time before using in next patient.
  • Adequate equipment required for cleaning or disinfection inside the isolation room    should be kept and room should be cleaned on a daily basis
  • Set up a telephone or other means of communication in the isolation room or area  to enable patients, family members or visitors to communicate with health-care workers.This may reduce the number of times the workers need to don the PPE to  enter the room or the area.

Before entering the isolation room or area

  • Collect all necessary items
  • Ensure to perform hand hygiene with an alcohol-based hand rub or soap and water
  • Use PPE in the order that ensures adequate placement of PPE items and prevents  self-contamination and self-inoculation while using and taking off PPE

Either remove PPE in the anteroom or, if there is no anteroom, make sure that the PPE   will not contaminate either the environment outside the isolation room or area, or other people.

Remove PPE in a way in such a manner that prevents self-contamination or self-inoculation with contaminated PPE or hands.

General principles are:

  • Remove the most contaminated PPE items first
  • Perform hand hygiene immediately after removing gloves
  • Remove the mask or particulate respirator last by grasping the ties and discarding in a rubbish bin
  • Discard disposable items in a closed rubbish bin
  • Put reusable items in a dry (e.g. without any disinfectant solution) closed container;an example of the order in which to take off PPE when all PPE items are needed is  gloves (if the gown is disposable, gloves can be peeled off together with gown upon  removal), hand hygiene, gown, eye protection, mask or respirator, and hand hygiene
  • Perform hand hygiene with an alcohol-based hand rub (preferably) or soap and water whenever ungloved hands touch contaminated PPE items.
  • Preferably wear face mask as much as time possible in a day
  • Restrict movement of patient for chest X-rays ,CT scans and labs as this lead to dissemination of infection to other places
  • Attached urinals and wash room facility in all isolation rooms
  • Separate portable X-ray,CT units,USG machines and stethoscopes should be dedicated for patients suffering from COVID-19
  • Patient needs to be kept in isolation till his both respiratory samples turns out to be negative.

 

Severe Disease (14%)

  • Respiratory rate > 30/min
  • Oxygen Saturation in room air  <93%
  • Lung infiltrates >50% (on Chest x-ray) within 24- 48 hours

Critically ill (5%)

  • Respiratory failure (need of mechanical ventilation)
  • Septic shock
  • MODS ( Multiple Organ Dysfunction Syndrome)

No drug of choice to treat

The following supportive therapy are followed at present

  • Oxygen support
  • Oxygen saturation to be maintained above 90%
  • Conservative fluid management
  • High dependency / ICU care when needed

No anti-viral therapy has been proven to work for COVID-19 in humans.

The vast majority of patients will do fine without any therapy, so in most cases  there’s no need for antiviral therapy. However, waiting until patients are severely ill before initiating therapy could cause us to miss an early treatment window, during which the disease course is more modifiable.

A focus is placed on lopinavir/ritonavir and chloroquine since these agents are   currently available.

  • Patient has to be classified as mild/severe/critical
  • Decide whether he/she requires only home isolation
  • Assess oxygenation on room air
  • Consider referral to a nodal center if requiring admission
  • Home care advise in mild/asymptomatic cases

Social Distancing :

Novel coronavirus are spread by people who have the virus and when they come in contact with people who are not infected. The more you come in to contact with infected people, the more likely you are to catch the infection from them .

Social distancing is an infection control action that can be taken by public health officials to stop or slow down the spread of a highly contagious disease.

In addition to social distancing measures taken by governments, we can ourselves choose to reduce physical exposure to potentially sick people, for example:  Exploring the option to work from home if your job allows for it , avoiding large public gatherings such as marriages, conferences ,sporting events or situations where you  may come in to contact with crowds of people, for example in busy shopping malls.

These can be supplemented by interaction over the phone and video calls, instead of in person.

These types of steps may be an impediment to normal life. However the intention is that these will be a short term measures (not forever!)

A risk with a pandemic is that the initial spread is so quick that it overwhelms the health services. A key aim for any country should be to avoid this initial rapid spread and social distancing can help to achieve this goal.

 

 

Regular Hand washing :

Regular hand washing with soap and water for at least 20 seconds may help to reduce the risk of transmission.

Prioritize hand washing prior and after eating. Regular hand washing dries the hands, which at an extreme, may make them vulnerable to infection. To mitigate this, use of a Glycerin based moisturizer with pump or squeeze mechanism or an Alcohol based hand Sanitizer (if soap and water are not available) can be used. Please ensure that the alcohol-based hand sanitizer has at least 60% alcohol in it. Leave to air dry.

Sanitize your Phone :

Given the frequency in which we use our mobile phones ,this seems like the next logical priority to be sanitized. Using antibacterial wipes or alcohol swabs (typically 70% alcohol) to clean your phone and other items is a good option. If the antibacterial wipes claim to be able to kill the flu virus (H1N1) – that’s a good sign they may be able to do similar for the corona virus. Once finished wiping, leave to air dry.

Sanitize other items you touch regularly :

  • Computer keyboard and mouse
  • House and car keys
  • Re-usable water bottles
  • Car steering wheel
  • Clothing pockets
  • Door handles

Keep your immune system healthy :

Sleep – Get adequate, high quality sleep. For most people ‘adequate’ means 7-8 hours. It’s no coincidence that “burning the candle at both ends” increases risk of illness. A literature review concluded that “sleep deprivation has a considerable impact on the immune response” and “should be considered a vital part of the  immune system”

Exercise – Exercise regularly, but don’t overdo it. To quote a  study on exercise  and the immune system – “moderate exercise” seems to exert a protective effect, whereas repeated bouts of strenuous exercise can result in immune dysfunction

Diligent hand washing, particularly after touching surfaces in public. Use of hand  sanitizer that contains at least 60 percent alcohol is a reasonable alternative if the hands are not visibly dirty.

  • Respiratory hygiene (e.g.: covering the cough or sneeze).
  • Use triple layer disposable surgical mask if you have any respiratory symptoms.
  • Avoiding crowds (particularly in poorly ventilated spaces) if possible and avoiding    close contact with ill individuals. Also try to maintain a safe distance of 1 metres.
  • Avoid handshakes, hugs and kisses
  • Avoid non essential travels/gatherings
  • Avoid holding on railings of steps
  • May use pens for switching on lights in common areas, lift buttons
  • At hospitals, avoid keeping patients files on the bed
  • Use gloves
  • Used mask and other personal protective equipments should be considered as a  potentially infected material and it should be disposed separately in an infectious  waste disposable bag.
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NOTE : COVID-19 IS A LIFE THREATENING DISEASE

It has spread to all continents except Antarctica  

Elderly persons with co-morbidities are more affected

It spreads mainly via Respiratory droplets

Pneumonia is the most common complication

Severe cases have a mortality rate of  2.3 to 5%

Presently there is no standardized treatment or vaccine available for COVID-10

Containment and prevention is the best option

 

TOGETHER WE CAN !