2019- n Coronavirus outbreak: Introduction,Infection Prevention & Control, Sample Collection

1. 2019- Novel
Coronavirus(2019-nCoV)
Outbreak
Preparedness: Introduction,
Infection Prevention and Control ,
Sample Collection
Dr. Sumi Nandwani

2. What is Coronavirus? How is the strain
causing outbreak different?
 Coronaviruses -large family of RNA
viruses
 Structure -petal shaped spikes
surrounding the virus and resembling the
‘solar corona’, hence the name.
 They mostly infect animals, including
camels, cattle, cats and bats.
 2019- Novel Coronavirus belongs to
group of newer Human Coronaviruses
including SARS, MERS which have evolved
and infect and spread amongst humans
usually causing severe respiratory illness
and outbreaks.

3. Current Outbreak: When and where did it
start?
 On 31st December 2019, WHO was alerted to several
cases of pneumonia in Wuhan City, Hubei Province of
China of unknown etiology
 31st Dec 2019 – 3rd Jan 2020: 44 cases with pneumonia
of unknown etiology in China
 7th Jan 2020 : China isolated a new type of coronavirus
 12th Jan 2020: China shared the genetic sequence of the
new coronavirus which did not match any other known
virus
 Temporarily named “2019-nCoV.” 2019- novel
coronavirus

5. Current Outbreak
Situation: ( WHO )
Countries 20.01.2020 25.01.2020 29.01.2020 30.01.2020
Japan 01 03 07 11
Korea 01 02 04 04
Thailand 02 04 14 14
Vietnam - 02 02 02
Singapore - 03 07 10
Australia - 03 07 07
Malaysia - - 04 07
Cambodia - - 01 01
Nepal - 01 01 01
Sri Lanka - - 01 01
USA - 02 05 05
France - 03 04 05
Canada - - 02 03
Germany - - 04 04
UAE - - 04 04
Philippines - 01
India 01
Finland 01
TOTAL 04 23 68 82
Statistics as
per WHO
20.01
.2020
25.01.
2020
29.01.
2020
30.01.
2020
Confirmed
cases
282 1,320 6,065 7,818
Deaths 06 41 132 170
China –
Confirmed
Cases
278 1,297 5,997 7,736
Outside
China-
Confirmed
Cases
04 23 68 82
No of
countries
other than
China
03 09 15 18
Hongkong - 05 08 10
Macau - 02 07 07
Taipei - 03 08 08

6. W.H.O.
RISK ASSESSMENT:
- Very High - China,
- High -Regional level
- High - Global level.

7. MODE OF SPREAD:
 Initially, many cases had some link to a
large seafood and animal market,
suggesting animal-to-person spread.
 However, now It is suggested that
person-to-person transmission might
be occurring
 The exact mode of human to human
transmission of the 2019-nCoV is not
known
 It is thought to be similar to
Influenza, SARS, MERS i.e. commonly
through respiratory droplets
produced when an infected person
coughs or sneezes

8. CLINICAL SIGNS AND SYMPTOMS
 For confirmed 2019-nCoV infections,
reported illnesses have ranged from
infected people with little to no
symptoms to people being severely ill
and dying.
 Symptoms can include: Fever, Cough,
Shortness of breath.
 In severe illness: Severe Acute
Respiratory illness, Pneumonia, Renal
failure, Death
 Symptoms of 2019-nCoV may appear in
as few as 2 to 14 days after exposure

9. PREVENTION
 There is currently no vaccine to prevent
2019-nCoV infection.
 The best way to prevent infection is to avoid
exposure and preventing transmission:
 Avoid all non essential travel to China.
 Observe good personal hygiene.
 Wash your hands often with soap and water
for at least 20 seconds. If soap and water are
not available, use an alcohol-based hand
sanitizer.
 Avoid touching your eyes, nose, and mouth
with unwashed hands.
 Avoid close contact with people who are sick.
 Stay home when you are sick.

10. Observe respiratory etiquettes-
 While coughing or sneezing
cover mouth and nose with
flexed elbow or tissue, then
throw the tissue in the trash.
 Clean and disinfect
frequently touched objects
and surfaces.

11. Food Safety
 Avoid direct unprotected contact
with live animals
 The consumption of raw or
undercooked animal products should
be avoided

12. IPC Measures in a Health Care Setup

13. Infection Prevention and Control Measures
Should be initiated at first point of contact with a
suspected patient
 All Standard precautions need to be undertaken:
HAND HYGIENE
USE OF PPE Personal Protective Equipment
SHARP INJURY
WASTE MANAGEMENT
DISINFECTION
 APPLY DROPLET PRECAUTIONS
 APPLY CONTACT PRECAUTIONS
 APPLY AIRBORNE PRECAUTIONS – when performing Aerosol
Generating Procedure

14. Words of Wisdom on Hand
Washing
Soap, water and
Common sense are still
the Best Antiseptics
William Osler

16. • The use of protective gears should be
made mandatory for all the personnel
if chances of close contact with
suspected or diagnosed patient is
anticipated/inevitable.
N-95 masks only to be used for people
who are likely to come in close
contact with the patient(One meter)
or while taking samples or doing
procedures which can generate
aerosols.
Make sure the mask fits properly( Do
a fit test)
Personnel Protective Equipment( PPE)

17. At TRIAGE
 Give suspect patient a medical mask
 Direct patient to a separate earmarked isolated area
 Keep atleast 1 meter distance between suspected and
other patients
 Instruct all patients to cover nose and mouth during
coughing/ sneezing
 Perform Hand Hygiene

18. DROPLET PRECAUTIONS
 Use medical Mask if working within 1-2 meters of
patient
 Place patients in single room or group in one room
if same etiological diagnosis with spatial
separation
 When providing patient care in close contact –
wear Mask

19. Airborne Borne Precautions
 When performing aerosol generating
procedures Use PPE
 Adequately ventilated isolated single rooms
 Avoid crowding or unnecessary personnel in
room.

20. SPECIMEN COLLECTION
 Samples should be collected as soon as possible.
 Wear proper PPE including N95 Mask
Samples acceptable:
 Oropharyngeal swab
 Nasopharyngeal swab
 Nasal aspirate
 combined nasopharyngeal swab with oropharyngeal swab
 For patients who are intubated, an endotracheal
aspirate/Bronchoalveolar lavage (BAL)
 Sputum specimens are also acceptable but not preferred.
 Tissue Biopsy
 Serum samples( paired serum sample Acute/ Convalescent
phase 4 weeks apart)

21. Collection of Oropharyngeal swab
Instructions for collection:
 Adequate view of the throat should be ensured
by good lighting.
 Disposable wooden spatula should be used to pull
outwards and to depress the tongue.
 Swab: Dacron coated sterile swab on a stick
 Swab should be rubbed with rotation over one
tonsillar area, arch of soft palate and uvula, the
other tonsillar area and finally the posterior
pharyngeal wall.

22. Nasopharyngeal swab
 Tilt head backwards Insert flexible fine- shafted
polyester swab into nostril and back to
nasopharynx
 Leave in place a few seconds
 Withdraw slowly; rotating motion
Nasal swab
 A nasal swab is taken to detect healthy carriers
Nasopharyngeal aspirate
Tilt head slightly backward Instill 1-1.5 ml of
VTM/sterile normal saline into one nostril
 Use aspiration mucus trap Insert silicon catheter in
nostril and aspirate the secretion gently by suction
in each nostril

23. PACKAGING AND TRANSPORT
 The heads of swabs are broken of into tubes of viral
transport medium (VTM).
 Three layer packing to be done as per guidelines
 Use ice packs in a sealed box for transport
 Labelling and fill referral form as per NIV pune
 Transport as soon as possible.
 Courier service number as provided by NIV pune.
 Pre inform State nodal officer and Nodal officer NIV
Pune contact details as provided on their website
 If delay for ˃24 hrs., refrigerate at 4°C
 The swab should be replaced in its tube with care
not to soil the rim
 If Delay in transport can be kept at 4°C for 72 hrs.
or at -20°C no longer than 4 days.

24. FAQs
 Q: Has anyone in India gotten infected?
 A One case declared today(31.01.2020) in Kerala and some suspected cases
have been isolated and are under observation to confirm diagnosis.
 Q:Am I at risk for 2019-nCoV infection in the India?
 A: This is a rapidly evolving situation and the risk assessment may change
daily. Currently WHO has declared all counties to be at high risk.
 Q: How can I help protect myself?
 A: Refer to Steps for prevention of exposure .
 Q: Is it safe to travel to Wuhan, China or other countries where 2019-nCoV
2019 cases have occurred?
 A: Travel to China especially affected areas is avoidable. The situation is evolving.
 Ministry of Health, India has issued Travel advisory to travelers visiting China
‘Updated Travel advisory for travelers visiting China (to replace previous travel
advisory)’
 https://mohfw.gov.in/diseasealerts/novel-corona-virus

25.  Q: What if I recently traveled to Wuhan, China and got sick?
 A: If you were in Wuhan and feel sick with fever, cough, or
difficulty breathing, within 14 days after you left Wuhan, you
should
 Immediately call Helpline number (011- 23978046) by MOH Govt
of India
 Seek medical care right away. Before you go to a doctor’s office
or emergency room, call ahead and tell them about your recent
travel and your symptoms.
 Avoid contact with others.
 Not travel while sick.
 Cover your mouth and nose with a tissue or your sleeve (not your
hands) when coughing or sneezing.
 Wash hands often with soap and water for at least 20 seconds to
avoid spreading the virus to others. Use an alcohol-based hand
sanitizer if soap and water are not available.
 Refer to detailed ‘Updated Travel advisory for travelers visiting
China’ by MOH( enclosed)
https://mohfw.gov.in/diseasealerts/novel-corona-virus

28. TREATMENT
 There is no specific antiviral treatment recommended
for 2019-nCoV infection.
 People infected with 2019-nCoV should receive supportive
care to help relieve symptoms.
 For severe cases, treatment should include care to
support vital organ functions.

29. Dr. SUMI NANDWANI
PROFESSOR cum CHIEF CONSULTANT & HOD, Microbiology,
Sub-Dean
Superspeciality Paediatric hospital and PostgraduateTeaching
Institute,Noida,UP, INDIA
(An Autonomous Institute under GOVERNMENTOF UTTAR PRADESH)
E Mail: suminandwani@gmail.com
THANK YOU