PPT on Corona Virus

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COVID-19: GUIDANCE
•R K Karna

2. Update
• Named SARS CoV-2 by International Committee on Taxonomy of Viruses
• Disease caused is called coronavirus disease 2019 (COVID-19)
• Declared pandemic on 11th March, 2020
• Merely 5 nucleotide difference between SARS and SARS CoV-2
• Also transmitted through tears, saliva, stool (Alfonso J. Rodriguez-Morales, D. Katterine
Bonilla-Aldana, Ruchi Tiwari, Ranjit Sah, Ali A. Rabaan, Kuldeep Dhama, COVID-19, an Emerging
Coronavirus Infection: Current Scenario and Recent Developments – An Overview, J. Pure Appl.
Microbiol., 2020; 14(1)
• Can survive on both hot and humid as well as cold and dry climate (WHO)

3. Case definitions for surveillance(WHO)
Suspected case:
A) a patient with acute respiratory illness AND with no other etiology
that fully explains the clinical presentation AND
a history of travel to or residence in a country, area or territory that has
reported local transmission of COVID-19 disease during the 14 days
prior to symptom onset
OR
B) patient with any acute respiratory illness AND who has been a
contact of a confirmed or probable case of COVID-19 disease during the
14 days prior to the onset of symptoms OR

4. Contd…
C) a patient with severe acute respiratory infection
• AND who requires hospitalization
• AND who has no other etiology that fully explains the clinical
presentation
Probable case
• suspected case for whom the report from laboratory testing for the
COVID-19 virus is inconclusive
Confirmed case
• person with laboratory confirmation of infection with the COVID-19
virus, irrespective of clinical signs and symptoms

5. Definition of contact (WHO)
• Providing direct care for patients with COVID-19 disease without
using proper PPE
• Staying in the same close environment as a COVID-19 patient
• Travelling in close proximity with (less than 1 m separation from) a
COVID-19 patient in any kind of conveyance

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Personal Protective Equipment (PPE)
 Gloves
 Mask or Respirators
 Goggles or face shield
 Gown
 Apron

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PPE : Donning
Hand hygiene
Gown
Mask/respirator
Goggles/face shield
Gloves

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PPE: Doffing
Gloves
Goggles/face shield
Gown
Mask/respirator
Hand hygiene

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PPE: Doffing
Gown and Gloves
Goggles/face shield
Mask/respirator
Hand hygiene

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PPE: Safe Work Practices
Donning of PPE
 Keep hands away from face
 Limit surfaces touched
 Change gloves when torn or heavily contaminated
Doffing of PPE
 Perform hand hygiene:
- between steps if hands become contaminated
- immediately after removing all PPE

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PPE Recommendations by WHO
Healthcare
facilities
Target person Activity Type of PPE
Inpatient room
Healthcare workers
Providing direct
care
Mask, gown, gloves, eye
protection
Aerosol generating
procedures
Respirator, gown, gloves,
eye protection, apron
Cleaners Entering in room
Mask,gown,gloves,boots,eye
protection if risk of splash
Visitors Entering in room Mask,gown,gloves
Triage
Healthcare workers Screening not
involving direct
contact
Maintain spatial distance of at
least 1m, No PPE required
Patients with respiratory
symptoms Any
Maintain spatial distance of at
least 1m, mask if tolerated
Patients without
respiratory symptoms Any
No PPE required
Laboratory Lab technician
Manipulation of
respiratory samples
Mask,gown,gloves,eye
protection if risk of splash

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Outpatient facilities Target person Activity Type of PPE
Consultation room
Healthcare workers
Physical examination of
patients with respiratory
symptoms
Mask,gown,gloves,eye
protection
Physical examination of
patients without
respiratory symptoms
PPE according to
standard precautions
Patients with respiratory
symptoms
Any Provide mask
Patients without
respiratory symptoms
Any No PPE required
Cleaners
After/between
consultations with
patients with respiratory
symptoms
Mask, gown, gloves, eye
protection(if risk of
splash)
Waiting room
Patients with respiratory
symptoms
Any Provide mask if
tolerated, immediately
move to separate or
isolation room
Triage Healthcare workers Preliminary screening
not involving direct
contact
Maintain spatial distance
of at least 1m, provide
mask

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Points of entry Target person Activity Type of PPE
Screening area Staff
Not involving direct contact Maintain distance of at least
1m, no PPE required
Interviewing suspects Mask, gloves
Temporary isolation
area
Staff
Entering but not providing
direct assistance
Maintain distance of at least
1m, mask,gloves
Staff,healthcare
workers
Assisting suspects to
healthcare facility
Mask,gown,gloves,eye
protection
Ambulance or
transfer vehicle
Healthcare workers Transporting patients Mask,gowns,gloves,
eye protection
Driver
No direct contact, driver
compartment is separated
from patient
Maintain spatial distance of at
least 1m,no PPE required
Assisting in loading and
unloading patients
Mask,gowns,gloves,eye
protection
No direct contact but no
separate driver compartment
Mask
Cleaners
Cleaning screening/isolation
area and transfer vehicle
Mask,gowns,gloves,boots,eye
protection(if risk of splash)

15. Specimen (WHO)
Upper respiratory specimens which can be either
• Nasopharyngeal and oropharyngeal swab
• Or wash in ambulatory patients
AND/OR lower respiratory specimens which can be either
• Sputum (if produced) and/or endotracheal aspirate
• Bronchoalveolar lavage in patients with more severe respiratory
disease

16. Sample for patient
Patient
Test Type of sample Timing
NAAT  LRT:
 Sputum
 Lavage
 Aspirate
 URT:
 Nasopharyngeal swab
 Oropharyngeal swab
 Nasopharyngeal wash or aspirate
 Consider stools, whole blood, urine, and if
diseased, material from autopsy
Collect on presentation
Serology Serum for serological
testing once validated and
available
Paired samples are
necessary for confirmation

17. Sample for contacts
Contact
Test Type of sample Timing
NAAT Nasopharyngeal and
oropharyngeal swabs
Within incubation period of
last documented contact
Serology Serum for serological
testing once validated and
available
Baseline serum taken as
early as possible within
incubation period of contact
and convalescent serum
taken 2-4 weeks after last
contact

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Collecting and Handling Specimens from
Suspected Patients
 HCWs collecting specimens should use appropriate PPE
 Collected under guidance of laboratory expert
 Transport specimens as per standard protocol
 Deliver by hand whenever possible
 Document patients full name, date of birth and potential
concerns
 Notify laboratory as soon as possible about specimen
transportation

20. Nasopharyngeal swab Oropharyngeal swab

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Viral Transport Medium (VTM)
 Transport medium 199
-Tissue culture medium 199 containing 0.5% bovine serum
albumin (BSA)
-Antimicrobials
 PBS-Glycerol transport medium
-Phosphate buffered saline
(NaCl,Kcl,Na2HPO4,KH2PO4)
-Antimicrobials

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Specimen Packing

23. Laboratory diagnosis
COVID-19 specific rapid diagnostic kits
• BioMedomics Rapid IgM-IgG Test
• detect IgG and IgM antibodies of the novel coronavirus in human
serum, plasma or whole
• Sensitivity-88.66%
• Specificity-90.63%

24. Contd…
Reverse transcriptional loop-mediated isothermal amplification(RT-
LAMP):
• Also called as iLACO
• Amplify a fragment of the ORF1ab gene using 6 primers
• Reverse transcription and amplification occurs simultaneously
• Positive result indication by color change from pink to yellow
• Result within 15-40 minutes

26. Advice on use of masks (Community setting)
Individuals without symptoms:
• Avoid agglomerations and frequency of closed crowded spaces
• Maintain distance of at least 1 meter from any individual with 2019-nCoV
respiratory symptoms
• Perform hand hygiene frequently
• Cover nose and mouth with flexed elbow or paper tissue when coughing
or sneezing
• Dispose of tissue immediately after use
• Refrain from touching mouth and nose
• Medical mask is not required

27. Contd…
Individuals with respiratory symptoms should:
• Wear a medical mask
• Seek medical care if experiencing fever, cough and difficulty in
breathing, as soon as possible or in accordance with to local protocols
• Follow the below advice regarding appropriate mask management

28. Home care setting
People with mild respiratory symptoms:
Perform hand hygiene frequently
 Keep distance from well individuals as much as possible
Use a medical mask
For individuals who cannot tolerate a medical mask, he/she should
rigorously apply respiratory hygiene
Improve airflow in living space by opening windows and door as
much as possible

29. Contd…
Relatives or caregivers:
• Perform hand hygiene frequently
• Keep distance from affected individual as much as possible
• Wear a medical mask when in the same room with the affected
individual
• Dispose of the material immediately after use
• Clean hands immediately after contact with respiratory secretions;
• Improve airflow in living space by opening windows as much as
possible.

30. Recommendation for implementation of
Quarantine (WHO)
Appropriate quarantine setting and adequate provisions for the
quarantine period:
• Spacious single rooms, with ensuite toilet
• If single rooms are not available, beds should be placed at least 1
meter apart
• Suitable environmental infection controls
• Maintenance of social distancing of the persons quarantined
• Accommodation with an appropriate level of comfort

31. Contd…
Minimum infection prevention and control measures
• Any person in quarantine who develops febrile illness or respiratory
symptoms, at any point during the quarantine period, should be
treated and managed as a suspect COVID-19 case
• Apply standard precautions for all persons quarantined and
quarantine personnel
Minimum requirements for health monitoring of quarantined
persons during the quarantine period

32. Environmental controls of quarantine site
• Clean and disinfect frequently touched surfaces daily with diluted
bleach solution
• For surfaces that do not tolerate bleach, 70% ethanol can be used
• Clean and disinfect bathroom and toilet surfaces at least once daily
with diluted bleach solution
• Clean clothes using regular laundry soap and water or machine wash
at 60–90 °C with common laundry detergent and dry thoroughly
• Waste is disposed of in a sanitary landfill
• Cleaning personnel should wear disposable gloves when cleaning or
handling surfaces, clothing or linen soiled with body fluids

33. WASH in healthcare settings
Hand hygiene practices
Sanitation
Separate latrine for COVID patients
• If not possible, it should be cleaned and disinfected at least twice
daily by a trained cleaner wearing PPE
• If the patient is unable to use a latrine, excreta should be collected in
either a diaper or a clean bedpan and immediately and carefully
disposed of into a separate toilet

34. Guidelines for Infants born to COVID-19
infected mother or PUI (CDC)
• Infants born to mothers with confirmed COVID-19 should be
considered PUIs
• A separate isolation room should be available for the infant while
they remain a PUI
• If colocation of the newborn with ill mother in the same hospital
room occurs:
 Physical barriers like curtains
Keep the newborn ≥6 feet away from the ill mother

35. Contd…
• Breastfeeding:
Encouraged to express breast milk
If possible, breast pump should be provided
Expressed breast milk should be fed by a healthy caregiver
If a mother wishes to feed at the breast, she should put on a facemask and
practice hand hygiene

36. Traffic Control Bundling
Aims:
• To decline availability of HCW due to anxiety and fear
• To curtail potential rise of nosocomial infection
• To strengthen HCW safety and trust in institution
(Schwartz J, King CC, Yen MY. Protecting HCWs during COVID-19 coronavirus outbreak- Lessons from
Taiwan SARS response. 2020)

38. Disinfectants
Approved by World Health Organization Approved by Environmental Protection Agency
0.1% Sodium hypochlorite (surface disinfection) Quaternary ammonium compound
1% Sodium hypochlorite (disinfection of blood
spills)
Peroxyacetic acid
Octanoic acid
62-71% ethanol Ethanol
Isopropanol
0.5% hydrogen peroxide Hydrogen peroxide
Quaternary ammonium compounds Quaternary ammonium compounds
Phenolic compounds Phenolic compounds

39. Homemade Sanitizer
•98% of spirit
+
•2% glycerine
- For flavor, add lemon juice or rose water

40. No cases Sporadic cases Cluster of cases Community transmission
Transmission
scenario
No reported cases One or more cases,
imported or
locally acquired
Most cases of local
transmission linked to
chains of transmission
Outbreaks with the inability
to relate confirmed cases
through chains of
transmission for a large
number of cases,
or by increasing positive tests
through
sentinel samples
Aim Stop transmission
and prevent spread
Stop transmission and
prevent
spread
Stop transmission and
prevent
spread
Slow transmission, reduce
case numbers, end
community outbreaks
Case finding,
Contact tracing
and
management
Conduct active
case finding,
contact tracing and
monitoring;
quarantine of
contacts and
isolation
of cases.
Enhance active case
finding, contact
tracing and
monitoring;
quarantine of
contacts and isolation
of cases.
Intensify case finding,
contact
tracing, monitoring,
quarantine of
contacts, and isolation of
cases.
Continue contact tracing
where possible,
especially in newly infected
areas,
quarantine of contacts, &
isolation of
cases; apply self-initiated
isolation for
symptomatic individuals.
Surveillance Consider testing
for COVID-19

41. No cases Sporadic cases Cluster of cases Community of cases
Surveillance Consider testing for
COVID-19 using
existing respiratory
disease surveillance
systems and hospital-
based surveillance
Implement COVID-19
surveillance using
existing respiratory
disease surveillance
systems and hospital
based surveillance
Expand COVID-19
surveillance using
existing respiratory
disease surveillance
systems and hospital
based surveillance
Adapt existing
surveillance systems
to monitor disease
activity (e.g. through
sentinel sites)
Public health
measures
Hand hygiene,
respiratory etiquette,
practice social
distancing
Hand hygiene,
respiratory etiquette,
practice social
distancing
Hand hygiene,
respiratory etiquette,
practice social
distancing
Hand hygiene,
respiratory etiquette,
practice social
distancing
Infection prevention
control
Hand hygiene,
respiratory etiquette,
practice social
distancing
Hand hygiene,
respiratory etiquette,
practice social
distancing
Hand hygiene,
respiratory etiquette,
practice social
distancing
Hand hygiene,
respiratory etiquette,
practice social
distancing