Wuhan Coronavirus(2019-nCoV) by Facts, Concerns and Prevention by Dr Junaid Ahmad Assistant Professor Department of Clinical Microbiology and Hospital Infection Control

1. Dr Junaid Ahmad
Assistant Professor
Department of Clinical Microbiology and Hospital Infection Control
Wuhan Coronavirus(2019-nCoV)
Facts, Concerns and Prevention
2/4/2020Dr JunaidAhmad1

2. How it all started ?
 In late December, 2019, patients presenting with viral pneumonia
due to an unidentified microbial agent were reported in Wuhan,
China.
 A novel coronavirus was subsequently identified as the causative
pathogen, provisionally named 2019 novel coronavirus (2019-
nCoV) ,2019 nCoV Acute Respiratory Disease.
 As of Feb 2, 2020, 14642 cases of 2019-nCoV infection have been
confirmed, with 304 deaths in China and 1 in Phillipiens most of
which involved people living in or visiting Wuhan, and human-to-
human transmission has been confirmed.
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6. Ministry of health and family welfare GOI
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7. Structure and Types
 Coronaviruses are named for the crown-like spikes on their
surface. There are 4 main sub-groupings of coronavirus, known as
alpha, beta, gamma and delta.
 Human coronavirus were first identified in the mid-1960s. The 7
CoV that can infect people are:
 229E alpha coronavirus
 NL63 alpha coronavirus
 OC43 beta coronavirus
 HKU1 beta coronavirus
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8. Structure and Types cont…..
 MERS-CoV beta CoV causing Middle East Respiratory Syndrome
(MERS)
 SARS-CoV beta CoV causing Severe Acute Respiratory Syndrome
(SARS)
 2019 Novel CoV (nCoV)
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9. What is 2019- n CoV ?
 The virus appears to be a never-before-seen strain of
coronavirus -a large family of viruses that can cause illnesses
ranging from a cold to more severe diseases.Typically, symptoms
include a fever, fatigue, sore throat and dry cough, and may
later develop into breathing difficulties.
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10. Why New Viral Infections Emerging
 New viral diseases typically emerge
because of human activity that brings
people into contact with wildlife, such
as road building, hunting and
agriculture expansion, About 75
percent of emerging diseases in people
come from animals, according to Eco
HealthAlliance.
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11. Symptoms of Corona viruses
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12. Symptoms of 2019-nCoV
CDC believes at this time that
symptoms of 2019-nCoV may
appear in few as 2 days or as
long as 14 days after exposure.
This has been based on what
has been seen previously as the
incubation period of MERS
viruses.
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13. Transmission
 Much is unknown about how 2019- nCoV spreads. Athough it is
zoonotic , Current knowledge is based upon on what is known
about similar corona virus.
 Person to person among close contacts i.e 6 feet
 Respiratory droplets
 Unclear whether it can spread by touching the surface that has a
virus (CDC).
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14. Possible source of Infection
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15.  Specimen Collection,Packaging andTransport Guidelines
for 2019 Novel Coronavirus (2019-nCoV)
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16. SURVEILLANCE CASE DEFINITIONS –
WHO(1)
 A person with Severe Acute Respiratory Infection (SARI), with history of fever and cough
requiring admission to hospital, with no other etiology that fully explains the clinical
presentation
 AND any of the following
 A. A history of travel to Wuhan, Hubei Province China in the 14 days prior to
symptom onset.
 b. the disease occurs in a health care worker who has been working in an
environment where patients with severe acute respiratory infections are being
cared for, without regard to place of residence or history of travel.
 c. the person develops an unusual or unexpected clinical course, especially sudden
deterioration despite appropriate treatment, without regard to place of residence
or history of travel, even if another etiology has been identified that fully explains
the clinical presentation.
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17. SURVEILLANCE CASE DEFINITIONS –
WHO(2)
2. Individuals with acute respiratory illness (ARI)/ ILI of any
degree of severity who, within 14 days before onset of illness,
had any of the following exposures:
 a. close physical contact with a confirmed case of nCoV infection, while that
patient was symptomatic;
 b. healthcare facility in a country where hospital associated nCoV infections
have been reported;
 c. direct contact with animals (if animal source is identified) in countries
where the nCoV is known to be circulating in animal populations or where
human infections have occurred as a result of presumed zoonotic
transmission.
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18. Criteria for Sample collection
Health care
providers/Subjects
District Surveillance
team/
Clinicians
Patients with fever
and lower
respiratory illness
who travelled to
Wuhan, China
within 14 days of
symptom onsetClinical Features & Epidemiologic Risk
Fever and symptoms
of lower respiratory
illness (e.g., cough,
difficulty breathing)
and In the last 14 days before
symptom onset, a history
of travel fromWuhan City,
China.– or –
In the last 14 days before
symptom onset, close
contact
2
with a person
who is under investigation
for 2019-nCoV while that
person was ill.
Feveror symptoms of
lower respiratory
illness (e.g., cough,
difficulty breathing)
and In the last 14 days, close
contact with an ill
laboratory-confirmed
2019-nCoV patient.
Notify State health
authority
Decide for Isolation and
sample collection
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19. Specimen collection details:
Adapted from the WHO guidelines on 2019-nCoV
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20. Specimen labelling and processing
 Personal protective equipment (apron, hand gloves, face shield,
N95 Masks etc.) need to be used and all biosafety precautions
should be followed so as to protect individuals and the
environment.
 Proper labelling (name/age/gender/specimen ID) need to be
done on specimen container and other details of sender
(name/address/phone number) on the outer container by
mentioning “To be tested for 2019-nCoV”
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21. Personnel Protective Equipment (PPE)
Hand hygiene (7 STEPS OF HANDWASHING)
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22. Personnel Protective Equipment (PPE)
• Cuts and abrasions should be covered prior to entry
to the ward/laboratory
• Gloves should be:
- Suitable for the procedure
- Chemically compatible
- Changed regularly when working with hazardous
agents
•Gowns and Coverall suits:
-Disposable gowns should be worn
-Should be fastened correctly
-Should have close fitting cuffs
-Should be single use
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23. Personnel Protective Equipment (PPE)
Mucosal membranes (eyes)
• Safety glasses
• Goggles
• Full face visor
Face masks
• N95 respirator is the most common of
particulate filtering face piece
respirators.
• This product filters at least 95% of
airborne particles
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25. Personnel Protective Equipment (PPE)
PPE Disposal
Autoclave
or
Incinerate
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26.  For any queries, u can contact the nodal officer from ICMR-NIV
Pune
 DrYogesh K. Gurav, Scientist E
 Phone 020-26006290/ 26006390.
 Email:gurav.yk@gmail.com/gurav.yk@gov.in
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27. Requirements for Clinical Samples
Collection, Packaging and Transport
Sample vials andVirusTransport Medium (VTM)
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28. Adsorbent material (cotton, tissue paper),paraffin, scissor, cello tape.
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29. A leak-proof secondary container (e.g., ziplock pouch, cryobox, 50
mL centrifuge tube, plastic container)
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30. Hard-frozen Gel Packs
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31. A suitable outer container (e.g., thermocol box, ice-box, hard-board
box) (minimum dimensions: 10 x 10 x 10 cm)
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32. Procedure for Specimen Packaging and
Transport
Use PPE while handling specimen
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33. Seal the neck of the sample vials using parafilm
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34. Cover the sample vials using absorbent material
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35. Arrange primary container (vial) in secondary container
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36. Placing the centrifuge tube inside a zip-lock pouch
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37. Placing the zip-lock pouch inside a sturdy plastic
container and seal the neck of the container
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38. Using a thermocol box as an outer container and placing
the secondary container within it, surrounded by
hardfrozen gel packs
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39. Using a hard card-board box as an outer container and
placing the secondary container and the gel packs
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40. Placing the completed Specimen Referral Form (available on
www.niv.co.in) and request letter inside a leak-proof, zip-lock pouch
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41. Securing the zip-lock pouch with the Specimen Referral Form
on the outer container
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42. Attaching the labels
• Senders’ address, contact number; Consignee’s
address /contact number;
• Biological substance- Category B;
• UN 3373’; Orientation label, Handle with care
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43. Documents to accompany:
1) Packaging list/proforma Invoice.
2)Air way bill (for air transport)
3)Value equivalence document (for road/rail/sea transport)
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44. Routing of samples
 Clinical specimens, official documents and Specimen request
forms for testing of 2019-nCoV need to be sent to the ICMR-NIV
address
 The Director, ICMR-National Institute ofVirology, 20-
A, Dr Ambedkar Road,Pune, Maharashtra,
Pin:4110001).
 For shipment-related queries/information, kindly contact
 Dr Sumit Bharadwaj (Scientist B, Influenza Group) on
email: sumitduttbhardwaj@gmail.com, phone 020-
26006290/26006390
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45. Principles of infection prevention and
control strategies
1. EARLY RECOGNITION AND SOURCE CONTROL:
 Encourage HCWs to have a high level of clinical suspicion
 Institute screening questionnaire
 Awareness in public areas reminding symptomatic patients to alert
HCWs.
 Promotion of respiratory hygiene is an important preventive
measure.
 Suspected cases should be placed in an area separate from other
patients.
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46. 2. APPLICATION OF STANDARD PRECAUTIONS FOR ALL
PATIENTS:
 This includes hand and respiratory hygiene measures:
 medical mask to the suspected patients
 cover nose and mouth during coughing with tissue/flexed
elbow
 perform hand hygiene after contact with respiratory secretions.
 Use of personal protective equipment (PPE)
 Prevention of needle-stick or sharps injury
 Safe waste management
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47.  Environmental cleaning and sterilisation of patient-care
equipment and linen:
 thorough cleaning with water and detergent
 Applying hospital level disinfectants like sodium hypochlorite is
an effective and sufficient procedure
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48. 3.IMPLEMENTATION OF EMPIRIC ADDITIONAL
PRECAUTIONS FOR SUSPECTED nCoV INFECTIONS:
 All individuals including family members, visitors and HCWs
should apply contact and droplet precautions.
 Place patients in adequately ventilated single rooms.
 When single rooms aren’t available, cohort patients suspected of
nCoV infection together.
 Place patient beds at least 1m apart.
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49.  Use medical mask, eye/facial protection, clean non-sterile
long-sleeved fluid resistant gown, gloves.
 Use either single use disposable equipment or dedicated
equipment (stethoscopes, BP cuffs). If need to be shared
among patients clean and disinfect them.
 Avoid the movement of patients out of the room.
 Limit the number of HCWs, family members in contact with
the suspect.
 Maintain a record of all persons entering the room including
the staffs.
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50. Immediate implementation of appropriate
IPC measures
1. ATTRAIGE: give suspect a medical mask and direct them
to separate area.
2. APPLY DROPLET and CONTACT PRECAUTIONS:
3. APPLY AIR-BORNE PRECAUTIONSWHEN
PERFORMING AN AEROSOL GENERATING
PROCEDURE: ensure HCWs use PPE including gloves,
gowns, goggles before open suctioning for respiratory
tract, intubation, bronchoscopy, CPR.
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51. Testing at reference labs
1. Microscopy: Electron and Light
2. Culture: Gold standard but experienced staff and biosafety
implications.
3. Molecular Testing :Whole genome sequencing, NAAT, Real
time RTPCR
4. Serological Testing :Paired serum samples 2 to 4 weeks
apart.
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52. For the House
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53. Take home Message
 W Wash hands.
 U Use mask properly.
 H Have temperatures checked regularly.
 A Avoid large crowds.
 N Never touch your face with unclean hands.
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Program file made by
Dr Junaid Ahmad
Assistant Professor
Department of Clinical
Microbiology and Hospital
Infection Control Srinagar