a seminar covering coronavirus microbiology, epidemiology, sign and symptoms of infection, and management algorithm of Novel coronavirus COVID-19

2. Morphology
Genome: SS linear, non segmented, positive sense
RNA. Largest among RNA viruses.
Electron Microscopy: enveloped, carrying petal or
club shaped or crown like peplomer spikes giving
appearance of solar corona
Large (120-160nm) spherical viruses having a helical
symmetry.

3. SOLAR CORONA

4. (N)

5. Electron microscopic structure

6.  The viral envelope consists of a lipid bilaye where the
membrane (M), envelope (E) and spike (S) structural
proteins are anchored.
 A subset of coronaviruses (specifically the members
of betacoronavirus subgroup A) also have a shorter
spike-like surface protein called hemagglutinin
esterase (HE).
 Inside the envelope, there is the nucleocapsid, which
is formed from multiple copies of the nucleocapsid
(N) protein, which are bound to the positive-sense
single-stranded RNA genome in a continuous beads-
on-a-string type conformation.
 The lipid bilayer envelope, membrane proteins, and
nucleocapsid protect the virus when it is outside the
host cell.

7. Classification
Coronaviridae family contains two sub families:
Coronavirinae and Torovirinae
 There are four main sub-groupings of
coronaviruses, known as alpha, beta, gamma,
and delta.
 Human coronaviruses were first identified in the
mid-1960s
Common human coronaviruses infections
1. 229E (alpha coronavirus)
2. NL63 (alpha coronavirus)
3. OC43 (beta coronavirus)
4. HKU1 (beta coronavirus)

8.  Other human coronaviruses (not common)
1. MERS-CoV (the beta coronavirus that causes Middle
East Respiratory Syndrome, or MERS)
2. SARS-CoV (the beta coronavirus that causes severe
acute respiratory syndrome, or SARS)
3. SARS-CoV2 (the novel coronavirus that cause disease
2019, or COVID 19)
 People around the world commonly get infected with
human coronaviruses 229E, NL63, OC43, and HKU1.
 Sometimes coronaviruses that infect animals can evolve
and make people sick and become a new human
coronavirus. Three recent examples of this are 2019-
nCoV, SARS-CoV, and MERS-CoV.

9. Transmission
Human coronaviruses spread by coughing, sneezing
and close personal contact, such as touching
mouth, nose or eyes or shaking hands.
SARS-CoV can also spread via droplets and rarely
through the air

10. Clinical Manifestations
 Coronaviruses invade the respiratory tract via the nose.
 After an incubation period of about 3 days, they cause
the symptoms of a common cold, including nasal
obstruction, sneezing, runny nose, and occasionally
cough .
 The disease resolves in a few days, during which virus is
shed in nasal secretions.
 There is some evidence that the respiratory
coronaviruses can cause disease of the lower airways.
 On rare occasions, gastrointestinal coronavirus infection
has been associated with outbreaks of diarrhoea in
children

11. Epidemiology
 Waves of infection pass through communities
during the winter months, and often cause
small outbreaks in families, schools, etc.
 Immunity does not persist, and subjects may
be re-infected, sometimes within a year.
 The pattern thus differs from that of rhinovirus
infections, which peak in the fall and spring
and generally elicit long-lasting immunity.
 About one in five colds is due to coronaviruses.

12. History: First recognized in China in 2003 by WHO
Epidemiology: during 2003 outbreak it spreads from
Asia to various regions of world causing nearly
8098 cases in 29 countries with 774 deaths.
However, India remained free from infection
Source: animals, including monkeys, himalayan
civets, cats, dogs, rodents etc
Clinical manifestations: severe lower respiratory tract
infection, muscle pain, headache, sore throat, fever,
cough, dyspnea, pneumonia
Since 2004, no case have been reported in the world.

13. Epidemiology: first reported in Saudi Arabia in 2012,
about 858 people died
In May2015, outbreak occurred in Korea
Not reported from India yet
Source: Camels and bats. Also known as Camel flu
Clinical Manifestation: I.P. 2-14 days
Severe acute respiratory symptoms such as fever,
cough, shortness of breath
Sometimes diarrhea, nausea and vomiting
Complications like pneumonia, kidney failure etc

14.  On 31December, WHO was alerted to several cases of
pneumonia in Wuhan City, China
 On 7 January 2020, Chinese authorities confirmed
that they had identified a new virus
 This new virus was temporarily called as “2019-
nCoV” and now named as COVID 19.
 Since its emergence, disease rapidly spread to
neighboring province of China as well as to other 182
countries.
 Currently, India has witnessed cases most related to
travel and local transmission from imported cases to
their immediate contacts
 No community transmission has still documented

15. • Some link to a large seafood and animal market, suggesting animal-
to-person spread.
• However, a growing number of patients reportedly have not had
exposure to animal markets, suggesting person-to person spread is
occurring

16. Upto 8 hours.

18. SUSPECTCASE:
A. Patient with severe acute respiratory infection (fever, cough, and
requiring admission to hospital), AND with no other etiology that
fully explains the clinical presentation AND a history of travel to or
residence inChina during the 14 days prior to symptom onset
OR
B. Patient with any acute respiratory illnessAND at least one of the
following during the 14 days prior tosymptom onset:
a)contact with a confirmed or probable caseof COVID 19 infection, or
b)worked in or attended a health care facility where patients with
confirmed or probableCOVID 19 acute respiratory disease patients
were being treated

19. PROBABLE CASE:
 A suspect case for whom testing for SARS-
CoV-2 is inconclusive or for whom testing
was positive on a pan-coronavirus assay.
CONFIRMED CASE:
 A person who tests positive to a validated
specific SARS-CoV-2 nucleic acid test or has
the virus identified by electron microscopy
or viral culture, at a reference laboratory.

20. 1. All asymptomatic individuals who have undertaken
international travel in last 14 days
 They should stay in home quarantine for 14 days
 They should be tested only if they become symptomatic
 All family members living with a confirmed case should
be quarantined
2. All symptomatic contacts of laboratory confirmed cases
3. All symptomatic health care workers
4. All hospitalized patients with Severe Acute Respiratory
illness
5. Asymptomatic direct and high risk contacts of confirmed
case should be tested once between day 5 and day 14 of
coming in his/her contact

21. • Collect specimens from
BOTH the upper
respiratory tract AND
lower respiratory tract
for COVID 19 testing by
RT-PCR.
• Serology for diagnostic
purposesis
recommended only when
RT-PCR isnot available.
NASAL
SWAB /
THROAT
SWAB
ET
ASPIRATEBAL
SPUTU
M

26.  Triage
 Immediate implementation of infection prevention and
control (IPC) measures
 Early supportive therapy and monitoring
 Collection of specimens
 Management of ARDS
 Prevention of complications

27.  Recognize and sort all pts with severe acute respiratory
infection (SARI) at first point of contact (emergency dept)
 ARI with fever (>38°C)
 History of travel
 Unusual or unexpected clinical course
 Close physical contact

28.  Medical mask
 Single rooms or group together
 When providing care use eye protection
 Limit pt movement within hospital and ensure that pts
wear mask when outside rooms

29.  Mask, goggles, gloves, gown
 Use Personal protective equipment (PPE) when
entering and remove PPE while leaving
 Equipments –clean and disinfect between each pt
use
 Health care worker (HCW) -refrain from touching
their eyes, nose, mouth with gloved or ungloved
hands
 Avoid contaminating environmental surfaces
 Perform hand hygiene