How to Prepare for COVID-19 Pandemic

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#COVID19
HOW TO PREPARE OUR CITIZENS FOR
THE PANDEMIC
Dr. Madhur Verma MD
Assistant Professor of Community and Family Medicine
All India Institute of Medical Sciences Bathinda, Punjab.
Email: drmadhurverma@gmail.com
*Disclaimer: The views are of the presenter and do not represent the policy of the institution. However, data has been adapted from reputed national and international sources.

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Objectives of today’s session
1. To know about the disease in terms of its nature, routes of transmission,
signs and symptoms, diagnosis and available treatment options
2. To know methods of protecting oneself and family members and what to do
in case a family member becomes infected
3. To know how to maintain a healthy lifestyle during lockdown
4. To differentiate between prevalent myths and facts

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Phases of epidemic
1. The first stage: cases of an infection are imported into a country which
was not the source of the infection.
2. The second stage: when there are cases of local transmission in the
country. In this stage, the trajectory of the virus can be identified from
the source to all the infected individuals.
3. Third stage: Community transmission starts. It becomes hard to track the
chain of transmission of the virus in a large number of cases.
4. Fourth stage of an outbreak is when an infection becomes endemic and
keeps resurfacing round the year, like malaria and dengue in India.

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Corona virus
Coronaviruses are a related group of viruses that cause diseases in mammals
and birds.
The name "coronavirus" is derived from Latin corona, meaning "crown".
The name refers to the characteristic appearance of the virus, which have
a large surface projections creating an image that resembles a crown.

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IS IT A NEW VIRUS???
Coronaviruses were first discovered in the 1930s in an acute respiratory
infection of domesticated chickens.
Human coronaviruses were discovered in the 1960s.
Past Outbreaks of coronavirus diseases
• Severe acute respiratory syndrome (SARS)-2003
• Middle East respiratory syndrome (MERS)-2012.
This time it’s the new strain of Coronavirus that was discovered in 2019 and
has not been previously identified in humans.

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COVID-19
The name of the disease is Corona Virus Disease – discovered in 2019 -
COVID-19.
The name of the organism that causes the disease is SARS-CoV-2.
• This stands for Severe (because it is serious) Acute Respiratory
Syndrome- Coronavirus (the name of the family of viruses) 2.

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Is the coronavirus disease more severe
than the flu?
COVID-19 causes more severe disease than seasonal influenza and is 10 times
more deadly than the swine flu.
While many people globally have built up immunity to seasonal flu strains,
COVID-19 is a new virus to which no one has immunity.
That means more people are susceptible to infection, and some will suffer
severe disease.

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COVID 19
The incubation period of COVID 19 (time between getting the infection and
showing symptoms) is 2 to 14 days.
Some people with the infection, but without any serious symptoms can also
spread the disease.

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How do you get infected ?
The virus travels through the respiratory droplets of an infected person.
When the person sneezes or coughs, the virus is deposited on the person’s
hand if the hand covers the mouth, or droplets fall on a surface when the
mouth/nose is not covered.
From the surface/hand, the virus will get transferred to an uninfected person’s
hand and when that hand comes in touch with the nostril, eyes or mouth the
virus gets inside the body.

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How does COVID-19 spread?
 Transmission can happen in two ways:
• Direct close contact: one can get the infection by being in close contact with COVID-19
patients (within one Metre of the infected person), especially if they do not cover their
face when coughing or sneezing.
• Indirect contact: the droplets survive on surfaces and clothes for many days. Therefore,
touching any such infected surface or cloth and then touching one’s mouth, nose or eyes
can transmit the disease.

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MODES OF TRANSMISSION
SNEEZE/ COUGH
BY INFECTED PERSON
INFECTED DROPLETS
GET ON YOUR HAND
AND WHEN TOUCH
ANY SURFACE OR PERSON
VIRUS
TRANSFERRED!!
SNEEZE/ COUGH
BY INFECTED PERSON INFECTED DROPLETS
INFECTED DROPLETS
GET ON YOUR HAND
VIRUS
TRANSFERRED!!
INFECTED DROPLETS
07

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Definition of a COVID 19 Suspect
Let us remember that the suspect needs to have any one of the 5 things:
1. Any kind of fever, cough or a difficulty in breathing.
2. If the person has travelled from any place which has been an outbreak area
for COVID in the last 14 days.
3. If the person has been in close contact of another person who is positive for
COVID
4. A person who has tested but has not got the results
5. A person who may not have the symptoms but the lab reports come as
positive.

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Now, a Contact is:
1. Someone who is providing direct care to a person who is confirmed to be
positive for COVID
2. Someone who has stayed together with a person who has been tested as
positive for COVID
3. Someone who has travelled together for more than 6 hours in close space
with a person who later becomes positive for COVID

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Contact of COVID 19
The types of contacts can then be further divided into contact who are at a high
risk and those who are at low risk
1. The high risk ones are those who have directly been in touch with the patient or
any body fluids while taking care during home quarantine, travelled with a
patient, been in the same room/house and shared utensils, etc. with the patient.
2. A low risk contact is someone who would have been in the same place but well
outside the range of one meter, may have travelled in the same bus or train or
flight but sat atleast 1 meter away from the person who tested positive.

ADVISORY FOR CONTACTS
1.If symptoms develop (fever, cough, difficulty
in breathing), use mask, self-isolate and
immediately inform designated health
workers by telephone
1. Home quarantine for at least 28 days after
the last exposure with the case.
2. Initiate self-health monitoring for
development of fever or cough and maintain
a list of contacts on daily basis.
3. Active monitoring (eg. Daily visits or
telephone calls) for 28 days after the last
exposure shall be done by designated
health workers
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Source: Ministry of Health and Family Welfare, Governemnt of India. Avaialble at: https://www.mohfw.gov.in/pdf/2COVID19PPT_25MarchPPTWithAnimation.pdf

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Clinical profile of COVID-19
The Symptoms Of Covid-19
Are Fever, Cough, and Difficulty
in Breathing

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Signs & Symptoms:
Appear 2-14 days after coming in contact with a
case
In the initial stages:
• High fever
• Dry Cough
• Shortness of breath
With increasing severity:
• Diarrhoea
• Severe respiratory distress
• Lack of oxygenation will cause bluish discolouration of lips
In some cases with severe co-morbidities, the disease can cause:
• Signs of kidney failure
• Respiratory failure
• Death

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Signs & Symptoms:
Caution:
These symptoms and signs are not exclusive for COVID-19
These may be present in other respiratory illnesses also
So, there is high suspicion if along with these symptoms there is :
travel from an affected area
contact with a known case
Having a patient of COVID-19 at home
History of visit to a crowded area without precaution

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Diagnosis and treatment of COVID19

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• At present tests are available in laboratories only
• For the sake of quality, tests should be carried out in ICMR recommended labs only
• Point of care tests are not available yet
Diagnosis of COVID19

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COVID-19 testing - when and how?
All individuals need not be tested, because Disease is primarily reported in
Individuals with travel history to the affected areas or close contacts of positive
cases.
The guidelines for testing are being revised continuously, keeping in view the
current case load, availability of the test kits and other logistics.

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WHOM TO TEST
ALL symptomatic people who
• Had come in contact of confirmed cases
• Have history of travel to areas with confirmed cases in last 14 days
• Are healthcare workers
• Are hospitalized patients with Severe Acute Respiratory Illness (SARI) or Influenza Like
Illness (ILI) or severe pneumonia.
Asymptomatic direct and high-risk contacts of confirmed cases should be tested once
between day 5 and day 14 of coming in his/her contact.
List of labs (Govt. & Private) can be accessed at: icmr.nic.in

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• At present there are no medicines that can cure a person of the disease
• PREVENTION IS THE ONLY SOLUTION TO THIS DISEASE AT PRESENT !
• But, spontaneous recovery is the rule, as only 2-3% diseased persons have died so far
• Supportive treatment helps speedy recovery
• But treatment can be given in medical supervision only
Treatment of COVID19

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Key messages for prevention of COVID-19

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DO
DO
NOT
• Do not hold events where people have to gather (even if it is
a corner meeting with three or four friends, or an evening
chat on the chaupal)
• Do not go to crowded places likemarkets, shopping,
melas, and parties
• Do not use publictransport
PREVENTION: SOCIAL DISTANCING
SOCIAL Distancing: deliberately increasing the physical space between people to avoid spreading
illness.
• Stay at home unlessabsolutely
necessary
• Keep a distance of atleast one meter
between yourself and another person

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Practice good hygiene
Wash your hands frequently using soap and water:
• After coming home from outside or meeting other people especially if they are ill.
• After having touched your face, coughing or sneezing.
• Before preparing food, eating or feeding children.
• Before and after using toilet, cleaning etc.

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Correct Technique
of Hand Washing:

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Coughing and sneezing etiquettes
While coughing or sneezing cover your nose and mouth with handkerchief.
 Wash the handkerchief at least daily
It is preferable to cough/sneeze into your bent elbow rather than your palms.
Never use the saree pallu or gamcha for sneezing into as you may use these for
wiping your hands and the germs will get transferred from your hand to your nose,
mouth or eyes.
Practice good respiratory hygiene

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Do not Spit or shout in public places to avoid the spread of droplets.
Do not touch your eyes, nose and mouth with unclean hands.
Ensure that the surfaces and objects are regularly cleaned.
Practice good hygiene

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Practice food safety
Use different chopping
boards and knives for
raw meat and cooked
foods
Wash your hands
between handling
raw and cooked food

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Sick animals and
animals that have
died of diseases
should not be
eaten

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Even in areas experiencing
outbreaks, meat products
can be safely consumed if
these items are cooked
thoroughly and properly
handled during food
preparation

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PREVENTION: HIGH RISK GROUPS
High risk groups are people who are at a higher risk from severe illness
if they get covid-19. They includes:
PREGNANT WOMEN
(As we do not know the
impact of the disease on
pregnancy as of yet, it is
better to take care)
OLDER ADULTS PEOPLE WHO HAVE UNDERLYING
MEDICAL CONDITIONS LIKE:
▪On Cancer Medication
▪Heart Disease
▪Diabetes
▪Lung Disease
▪Kidney Disease

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Be SAFE from #coronavirus
if you are 60+ or if you have an underlying
condition like:
Cardiovascular disease
Respiratory condition
Diabetes
Avoid crowded areas or places where you
might interact with people who are sick.

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#Coronavirus #COVID19
Other adults and people with
underlying conditions
Keep regular routines and schedules
as much as possible or help create
new ones in a new environment,
including regular exercising, cleaning,
daily chores, singing, painting or
other activities.

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People with underlying conditions
If you have an underlying health
conditions, make sure to have access
to any medications that you are
currently using.
Activate your social contacts to
provide you with assistance, if
needed.

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Make sure you have up to 2 weeks of
all your regular medicines that you
may require.

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Be prepared and know in advance
where and how to get practical help if
needed, like calling a taxi, having
food delivered and requesting
medical care.

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Obligations of a responsible citizen of India during Lockdown

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#MentalHealth #COVID19 #coronavirus
Be INFORMED
Be PREPARED
Be SMART
Be SAFE
Be READY to fight
#COVID19

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Choose a limited time each day
when you will check #COVID19
updates.
Constantly listening to media
coverage about #coronavirus can
make you more anxious and
upset.

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Seek information only from
trusted sources and mainly to
take practical steps to
prepare your plans and
protect yourself and loved
ones.

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COVID-19 has and is likely to affect
people from many countries. Do not
attach it to any ethnicity or nationality.
Be empathetic to all those who are
affected, in and from any country –
they deserve our support, compassion
and kindness.

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Honor caretakers and healthcare
workers supporting people affected
with COVID-19 in your community.
Acknowledge the role they play to
save lives and keep your loved ones
safe.

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Instructions for the travelers

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Avoid travel if you have
a fever and cough
If you have a fever, cough and
difficulty breathing seek medical
care early and share previous
travel history with your health
care provider

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Insert local logo
Avoid close contact
with people suffering
from a fever and cough
Frequently clean hands by
using alcohol-based
hand rub or soap and water
Avoid touching eyes,
nose or mouth
Insert local logo
Avoid close contact
with people suffering
from a fever and cough
Frequently clean hands by
using alcohol-based
hand rub or soap and water
Avoid touching eyes,
nose or mouth

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Insert local logo
When coughing or sneezing
cover mouth and nose with
flexed elbow or tissue - throw
tissue away immediately and
wash hands
If you choose to wear a mask, be
sure to cover mouth and nose –
avoid touching mask once it’s on
Immediately discard single-use mask
after each use and wash hands after
removing masks

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Insert local logo
If you become sick
while travelling,
inform crew and seek
medical care
early
If you seek medical
attention, share travel
history with your health
care provider

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Insert local logo
Eat only well-
cooked food
Avoid spitting in public
Avoid close contact
and travel with
animals that are sick

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Instructions for Home Quarantine

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Suggestions for a Healthy Lock-Down!!!

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Stay healthy during lock down!!!
Online exercise
classes
#BeActive #HealthyAtHome
Dancing
Playing active
Video games Jumping rope
Muscle
strength
and
balance
training

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Be active at home during
#COVID19 outbreak
Looking after yourself, your family and
friends is important through these
stressful times.
WHO encourages everyone at home to
do simple and fun physical activities to
stay healthy and active.

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Be active at home during
#COVID19 outbreak
Doing any activity around the home is
better than none at all.
Be active during #COVID19 outbreak to
maintain your heart health, muscle
strength and flexibility.
It is good for your mental health too!

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#COVID19
March 2020
minutes
moderate
intensity
weekly
minutes
vigorous
intensity
weekly
Make more moments active
This guidance is intended for non-symptomatic people.
It does not replace any medical guidance in case of any health condition.
Continue indoor
exercise routine
Perform
household
chores
Read, draw,
play music
Meditate and do
something relaxing
Tips to stay active at home during
#COVID19 outbreak

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Tips to stay active at home
during #COVID19 outbreak
Regularly check your sitting
posture while working from
home
Break up your sitting and stand
up while working, on the phone,
or watching TV
WOKING FROM HOME IS
CHALLENGING, I NEED
TO REGULARLY STAND
UP AND STRETCH…

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#COVID19
March 2020
BOOST YOUR
IMMUNE SYSTEM
Good nutrition and healthy diet are essential to maintain
optimal health, boost your immune system and prevent
communicable and non-communicable diseases
Eat a variety
of foods
Eat plenty of
vegetables
and fruit
Eat less salt
and sugars
Eat moderate
amounts of
fats and oils

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SAY NO TO TOBACCO
IN THE TIME OF COVID-19...
AND ALWAYS!
Increased risk of
serious illness due
to unhealthy lungs
Higher chance of
transmission from
hand to mouth
Smoking makes you more vulnerable to COVID-19.
So, stop smoking and give your lungs a chance!
#COVID19
March 2020

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Mental health during a lockdown

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It is normal to
feel fearful and
anxious during
this time.
Talking about
your feelings will
lessen your
distress.

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#COVID19 #coronavirus
The stress and adversity
during this time can
increase the risk for
depression.
If you are feeling sad,
hopeless and having
thoughts of harming
yourself, talk to a mental
health professional or
someone you trust about
your feelings. It will help.
#MentalHealth

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#MentalHealth #coronavirus
If someone you know is feeling hopeless and having
thoughts of harming themselves because of #COVID19 -
talk to them.
Talking about suicide will not increase the risk and can
help people in crisis process their feelings and relieve the
stress.

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Quarantine can lead to
loneliness – especially for
older people or people who
live alone.
Loneliness can contribute
to poor physical and mental
wellbeing. Connect with
other people, through social
media, telephone, and
online communities, and
maintain #MentalHealth.

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#mentalhealth #coronavirus
#COVID19 can be difficult for
children to understand.
Talk kindly to them using words
they can understand and
encourage them to practice
healthy habits through
activities such as songs and
dances.
This will help them feel more
secure.

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Older people may find it difficult to stay connected
during a #COVID19 quarantine.
Loved ones should connect with them regularly through
telephone, messaging apps, and social media to help
them feel safe and secure.

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Care providers for older adults
Share simple facts about what is going on and how to
reduce risk of infection.
Use words that older people with or without cognitive
impairment can understand.

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#COVID19
Amplify hopeful stories and positive
images of local people who have
experienced COVID-19.
For example, stories of people who
have recovered or who have
supported a loved one and are willing
to share their experiences.
78

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Protect yourself and be supportive to others.
For example, check-in by phone on neighbours or elder
people in your community who may need extra assistance.
Working together as one community an help to create
solidarity in addressing COVID-19 together.

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Community resources - including civic groups,
neighborhood organizations and others - can help provide
psychosocial support for people living with mental health
conditions during this time.
We all have a role in maintaining our community's
#MentalHealth.

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• Fear of Falling ill and dying
• Fear of losing livelihoods, not being able to work during isolation, and of being dismissed
from work
• Fear of being socially excluded/placed in quarantine because of being associated with
the disease
• Feeling powerless in protecting loved ones and fear of losing loved ones because of the
virus or being separated during quarantine
• Feelings of boredom, loneliness and depression due to being isolated
In any epidemic, it is common for individuals to feel stressed and worried because they have:
WHAT IS STIGMA?

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The level of stigma associated with covid-19 is based on three main factors:
1. Covid-19 is a new disease about which many things are still being
discovered.
2. When something is unknown people are worried which leads to fear
3. Rumours or fake news give wrong information and spreads the fear.
Why is stigma associated with
#COVID19?

84
Makes people hide
their problems
Keeps people away from
accessing health services
and seeking help
Discourages them & may at
times prevent them from
adopting healthy behaviours
WHAT DOES STIGMA DO?

85
As a responsible citizen, we should:
• Inform that COVID 19 is a simple infection and 80% are mild cases.
• Inform that Covid-19 can happen to anyone.
• Comply with the LOCKDOWN and engage in relaxing activities.
• Ask people to stay away from watching negative things on the TV and also fake news
• Guide Whatsapp groups to help in giving hope and positive news to help people handle
stress.
• Use terms like people who have COVID-19 instead of “covid-19 cases” or “victims”.
• Make special efforts to reach out to high risk groups including senior citizens and children.
What can we do about stigma?
85

86
Work and lockdown during COVID 19
86

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#Coronavirus
Getting your workplace
ready for #COVID19
Surfaces (like desks,
tables) and objects
(like telephones,
keyboards) should be
wiped with
disinfectant regularly

88 #Coronavirus
ready for #COVID19
advise co-workers to avoid
public transport and
crowded places.
Promote regular
teleworking across your
organization.
Teleworking will help your
business keep operating
while your employees stay
safe.
88

89
#Coronavirus
ready for #COVID19
Your employees should
comply with any local
restrictions on travel,
movement or large
gatherings.
89

90
#Coronavirus
ready for #COVID19
• Keep workplaces
clean and hygienic
• Promote regular and
thorough hand
washing
• Promote good
respiratory hygiene
• Consult national
travel advice before
going on business
travel
• Advise those who are
sick to stay home
90

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All women have the right to a
safe and positive childbirth
experience, whether or not they
have a confirmed COVID-19
infection.
Respect and dignity
Clear communication
by maternity staff
A companion of choice
Pain relief strategies
Mobility in labour where possible
and birth position of choice

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Before, during and after
childbirth, all women have
the right to high quality
care. This includes:
Antenatal and
intrapartum
Newborn Postnatal Mental health

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I’m pregnant.
How can I protect myself
against COVID-19?
Wash your hands
frequently
Put space
between yourself
and others
Avoid touching your
eyes, nose and mouth
Cough or sneeze into
your bent elbow or a
tissue
If you have fever, cough or difficulty breathing, seek care early. Call
beforehand, and follow medical advice.

95
Close contact and early, exclusive
breastfeeding helps a baby to thrive.
A woman with COVID-19 should
be supported to breastfeed safely, hold
her newborn skin-to-skin, and share a
room with her baby.

96
Women with COVID-19
can breastfeed if they wish to
do so. They should:
Practice respiratory
hygiene and wear a mask
Wash hands before and
after touching the baby
Routinely clean and
disinfect surfaces

97
If a woman with COVID-19 is too
unwell to breastfeed, she can be
supported to safely provide her
baby with breastmilk in other ways,
including by:
Expressing milk Relactation Donor human
milk

98
MASKS, MASKS AND MASKS…..

99Image downloaded from: shorturl.at/lwBR4.

101
The use of medical masks in the community may create a false sense of security, with
neglect of other essential measures, such as hand hygiene practices and physical distancing,
and may lead to touching the face under the masks and under the eyes, result in
unnecessary costs, and take masks away from those in health care who need them most,
especially when masks are in short supply.
When to use a mask
Further reading: WHO Advice on the use of masks in the context of COVID-19: interim guidance, 6 April 2020
https://apps.who.int/iris/bitstream/handle/10665/331693/WHO-2019-nCov-IPC_Masks-2020.3-
eng.pdf?sequence=1&isAllowed=y

102
When to use a mask
However, many states and union-territories of India have made the wearing of face masks
mandatory for people stepping out of their home.
This has been done due to the increasing no. of asymptomatic infections, and chances of
airborne transmission — in which the disease spreads in the much smaller particles from
exhaled air, known as aerosols (which is still debated)- cannot be ruled out.

106
Myths vs. reality for COVID-19

107
Myth Facts
The corona virus can be transmitted through
mosquitoes.
The corona virus CANNOT be transmitted through
mosquito bites.

108
Myth Facts
Only people with symptoms of COVID-19 can spread the
disease
Even people with the COVID-19 infection but no
symptoms can spread the disease.

109
Myth Facts
Eating garlic and drinking alcohol can prevent COVID 19 Garlic is a healthy food that has other benefits but does not
protect you against the coronavirus.
Eating garlic and drinking alcohol does not prevent COVID 19

110
Myth Facts
With the summers coming up, the coronavirus will be
killed
COVID-19 Has been detected in all areas, including areas
with hot and humid weather. The best way to protect
yourself against covid-19 is by frequently washing your
hands with soap and water, covering your coughs and
sneezes and avoiding crowded places.

111
Myth Facts
Having a bath with hot water will kill the virus The virus lives inside the body where the
temperature is maintained at 37ºc and is not
affected bya hot water bath that you have.

112
Myth Facts
Getting the pneumonia vaccine will protect
you against the virus
While vaccines for pneumonia will certainly
protect you against other organisms that
cause pneumonia, the vaccine for novel
coronavirus is under development.

113
Myth Facts
Spraying alcohol or disinfectant over
your body can prevent infection
Spraying with alcohol or sanitiser on clothes and
body will not prevent you from getting infection.
Infection spreads when the virus enters the body
through nose or mouth.
Cleaning and wiping hands with alcohol is to
prevent the germ from entering your system
through infected hands when you touch your
mouth or you eat food with infected hands.

114
Myth Facts
Regularly rinsing the nose with saline will
prevent the infection
Rinsing nose with saline has in few cases
helped in containing common cold, but has
no evidence to suggest it is effective against
the novel coronavirus infection

115
Myth Facts
Coronavirus can be passed through
chicken and meat
There is no such evidence of coronavirus
spreading through meat and poultry
products.
However it is always advised to have
properly cooked meat and chicken.

116
Myth Facts
A person with coronavirus can recover
fully and be no more infectious.
80% of the people have recovered from
the disease without needing special
treatment. But information on the virus
treatment is still being researched

117
Myth Facts
The virus can die easily once it is out of the
body
We do not know about this particular virus
as of now. similar viruses (SARS, MERS)
survive from 8 to 24 hours depending on
types of surfaces

118
For further information : Call at Ministry of Health, Govt. of
India’s 24X7 control room number +91-11-2397 8046

How to Prepare for COVID-19 Pandemic

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