everything regarding the pandemic,COVID-19 ;to help health care professionals based on WHO,CHC,ICMR website info, till 25.3.2020.For a quick read.

1. COVID-19
#lets fight
Dr.Shreyas.K
PG in ENT
JJMMC, Davangere,
Karnataka.

2. CORONA VIRUS
• cause illness in animals or humans.
• In humans coronaviruses are known to cause
respiratory infections
• ranging from the common cold to more severe diseases
such as Middle East Respiratory Syndrome (MERS) and
Severe Acute Respiratory Syndrome (SARS).
• The most recently discovered coronavirus causes
coronavirus disease COVID-19.

3. SARS-COV 2
• Severe acute respiratory syndrome corona virus 2
• New strain of corona virus
• Unknown before outbreak in Wuhan,China in December 2019
• Previously called 2019 novel coronavirus.
• ICTV(International Committee on Taxonomy of Viruses) announced
SARS-CoV-2 as the name of the new virus on 11 February 2020.
• This name was chosen because the virus is genetically related to the
coronavirus responsible for the SARS outbreak of 2003. While
related, the two viruses are different.

4. COVID -19
• COrona Virus Disease 2019
• WHO announced “COVID-19” as the name of this new disease on 11
February 2020.
• Incubation period- not confirmed.
• 1-14 days as suggested by WHO.
• From 5 days to as long as 28 days as seen in various patients.

5. DISEASE TRANSMISSION
• People can catch COVID-19 from others who have the virus.
• droplets spread- when a person with COVID-19 coughs or exhales.
• touching these objects or surfaces contaminated with droplets, then
touching their eyes, nose or mouth.
• if they breathe in droplets from a person with COVID-19 who coughs
out or exhales droplets.
• This is why it is important to stay more than 1 meter (3 feet) away
from a person who is sick.
• How long the virus stays on surfaces is also not confirmed.(WHO)

6. PRESENTING SYMPTOMS:
• fever, tiredness, and dry cough.
• aches and pains.
• nasal congestion, runny nose, sore throat.
• diarrhea.
• Anosmia may appear early in these individuals.
• Difficulty in breathing at later stages.
• symptoms are usually mild and begin gradually.
• Most people (about 80%) recover from the disease without needing
special treatment.

7. AT RISK PATIENTS:
• Around 1 out of every 6 people who gets COVID-19 becomes seriously
ill and develops difficulty breathing .
• Elderly and children
• Hypertensive
• Diabetic
• Cardiac patients
• Asthma
• Immunosuppressed/immunocompromised

8. COMPLICATIONS:
• Pneumonia(8-9days)
• ARDS(8-9 days)
• cardiac injury, arrhythmia.
• Secondary infection,septic shock .
• liver dysfunction,
• acute kidney injury,
• and multi-organ failure.

9. MYTHS – REALITY CHECK!
• Affects only elderly.
• Hot and humid climate kills the virus
• Snow and cold climate kills the virus
• Hot water bath is the solution.
• Mosquito bite transmits the disease.
• Pets transmit the disease.
• ayurvedic/herbal medicine is effective.
• Saline nasal wash is going to reduce
transmission
• Antibiotics will kill the virus.
• UV rays,hand dryers kill the virus

10. PREVENTIVE MEASURES:
• Regularly and thoroughly clean your hands with an
alcohol-based hand rub or wash them with soap
and water.
• Maintain at least 1 metre (3 feet) distance between
yourself and anyone who is coughing or sneezing.
• Avoid touching eyes, nose and mouth.
• follow good respiratory hygiene
• cover your mouth and nose with your bent elbow
or tissue when you cough or sneeze.
• dispose of the used tissue immediately.

11. FOR PATIENTS WITH TRAVEL HISTORY
• 14 days to 1 month travel history should be enquired.
• Self-isolation and home quarantine. Avoid contact.
• mild symptoms such as headache, low grade fever (37.3 C or above) and slight
runny nose-wait and watch.
• medical mask should be used; worn for as long as possible, if it can be tolerated,
and changed at least once daily.
• Persons who cannot tolerate a medical mask should rigorously apply respiratory
hygiene .
• Improve airflow in their living space by opening windows and doors as much as
possible.
• If symptoms worsen- patient develops fever, cough and difficulty breathing,
medical help needed.

12. COVID-19 and PREGNANCY
• No evidence to say pregnant ladies are at higher risk.
• To be tested only if symptoms are present.
• WHO advice is that caesarean sections should only be performed when
medically justified in a pregnant COVID-19 patient.
• The mode of birth should be individualized and based on a woman’s
preferences alongside obstetric indications.
• Can and should breastfeed the baby; adequate precautions like hand-
hygiene should be maintained.
• If too unwell to breastfeed the baby due to COVID-19 :
provide baby with breastmilk in a way possible, available, and acceptable
to the mother. (Expressing milk/Relactation/Donor human milk)

13. WHO guidelines on PPE for
healthcare workers:
• wear disposable gloves to protect hands,
• clean, long-sleeve gown to protect clothes from contamination.
• medical masks to protect nose and mouth,
• and eye protection (e.g., goggles, face shield),
• before entering the room where suspected or confirmed 2019-nCoV
acute respiratory disease patients are admitted.
• Respirators (e.g. N95) are only required for aerosol generating
procedures.

14. CORRECT USE OF MEDICAL
MASKS:
• Place the mask carefully, ensuring it covers the mouth and nose, and tie it
securely to minimize any gaps between the face and the mask.
• Avoid touching the mask while wearing it.
• do not touch the front of the mask but untie it from behind.
• After removal or whenever a used mask is inadvertently touched, clean hands
using an alcohol-based hand rub or soap and water if hands are visibly dirty.
• Replace masks as soon as they become damp with a new clean, dry mask.
• Do not re-use single-use masks.
• Discard single-use masks after each use and dispose of them immediately upon
removal.
• Cloth (e.g. cotton or gauze) masks are not recommended under any
circumstances.

16. ISOLATION OF CASES:
• Prioritise the patient. Triage needed.
• All suspected cases to be isolated. Preferably with designated attached
washrooms.
• 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 to be shifted.
• If patients cannot tolerate a facemask or one is not available, they
should use tissues to cover their mouth and nose.
• Notify the authorities immediately

17. • Personnel entering the room should use PPE as described above.
• Ideally, suspected and confirmed 2019-nCoV acute respiratory
disease patients should be isolated in single rooms.
• However, when this is not feasible (e.g., limited number of single
rooms), cohorting is an acceptable option.
• A minimum of 1-meter distance between beds should be maintained
at all times.
• Once the patient has been discharged or transferred, should refrain
from entering the vacated room until sufficient time has elapsed for
enough air changes to remove potentially infectious particles.
• Time for reusing the room- not specified.

18. CURRENT TESTING STRATEGY:
(ICMR GUIDELINES)
• i) All asymptomatic people who have undertaken International
travel:
- They should stay in home quarantine for 14 days.
- They should be tested only if they become symptomatic (fever, cough,
difficulty in breathing etc.).
- If test result is positive, then they should be isolated and treated as
per the standard protocol.

19. • ii) All contacts of laboratory confirmed positive cases:
- They should stay in home quarantine for 14 days.
- They should be tested only if they become symptomatic (fever, cough,
difficulty in breathing etc.).
- If test result is positive, then they should be isolated and treated as
per the standard protocol.
• iii) Health care workers
- managing respiratory distress / Severe Acute Respiratory illness
should be tested when they are symptomatic.

20. HOW TO COLLECT NASAL/
OROPHARYNGEAL SWAB?
• Doctor should wear a clean, long-sleeve gown, a medical mask, eye
protection and gloves.
• Procedure should be conducted in a separate/isolation room
• request the patients to cover their mouth with a medical mask or
tissue.
• As the procedure has potential to induce fits of coughing from the
patient
• there is no currently available evidence that cough generated via
NP/OP specimen collection leads to increased risk of COVID-19
transmission via aerosols.

21. INVESTIGATIONS REVEALED:
(as per CDC)
 leukopenia (9–25%),
 leukocytosis (24–30%),
 lymphopenia (63%), and
 elevated alanine aminotransferase and aspartate aminotransferase
levels (37%).
 Multiple areas of consolidation and ground glass opacities are typical
findings on Xray or CT chest.

22. TESTING GUIDELINES-
ICMR RECOMMENDATION:
• Only real time PCR assays for
RNA viruses
• In govt approved centres
• And lab which has NABL
accreditation.
• Commercial kits should be US-
FDA approved or European –CE
certified or both –under
emergency use- only under
intimation to DCGI, MOH&FW.
NOT RECOMMENDED:
• Conventional PCR
• In-house real time PCR
• Ag-Ab tests

23. TREATMENT
• As per symptoms and general condition of the patient.
• Antibiotics-to prevent secondary infection.
• Corticosteroids contraindicated.
• No specific protocol advised.
• Intubation and ventilator support as and when required.
• No vaccines developed yet.

24. PROPHYLAXIS:

25. DISINFECTION:
• WHO recommendations include the use of:
• 70% Ethyl alcohol to disinfect reusable dedicated equipment
(e.g., thermometers) between uses
• Sodium hypochlorite at 0.5% (equivalent 5000ppm)
for disinfection of frequently touched surfaces.

26. BIOMEDICAL WASTE MANAGEMENT:
• According to National Health guidelines. (ICMR website)
• Disposal in a biohazard bag containing
2% Lyzol
or 55 freshly prepared sodium hypochlorite solution.
• Bag should be sealed and disposed according to guidelines.

27. CONTAMINATED SOILED LINEN
DISINFECTION:
• All individuals dealing with soiled bedding, towels and clothes from
patients with COVID-19 should wear appropriate personal protective
equipment.
• heavy duty gloves, mask, eye protection (face shield/goggles), long-sleeved
gown, apron (if gown is not fluid resistant), boots or closed shoes before
touching any soiled linen.
• Never carry soiled linen against body; place soiled linen in a clearly
labelled, leak-proof container (e.g. bag, bucket)
• If there is any solid excrement on the linen, scrape it off carefully with a
flat, firm object and put it in the designated toilet before putting linen in
the designated container.

28. • If the latrine is not in the same room as the patient, place soiled
excrement in covered bucket to dispose of in the toilet .
• Wash and disinfect linen: washing by machine with warm water (60-
90°C) and laundry detergent is recommended for cleaning and
disinfection of linens.
• If machine washing is not possible, linen can be soaked in hot water
and soap in a large drum, using a stick to stir, avoiding splashing.
• If hot water not available, soak linen in 0.05% chlorine for
approximately 30 minutes.
• Finally, rinse with clean water and let linen dry fully in the sunlight.

29. REFERENCES: as per information available on 25.3.2020.
• https://www.icmr.nic.in/
• https://www.who.int/
• https://www.cdc.gov/
• NOTE- Not based on whatsapp formats/news/protocols.
• Content is subjective to change daily.so KEEP UPDATED FROM THESE
SITES .
• #INDIA fights Corona.Let’s do our part!