2. HEALTH
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EMERGENCIES
Coronavirus
• Large, enveloped, positive-strand RNA viruses
• Human (H)CoVs cause 10-30% of URTIs in adults
• Subtypes:
Alphacoronavirus (HCoV-NL63, HCoV-229E)
Betacoronavirus (Hcov-OC43, HCoV-HKU1, SARS, MERS,
SARS-CoV2)
Gammacoronavirus
Delta coronavirus
• SARS-CoV, MERS-CoV & SARS-CoV2 can cause
severe human infections
4. HEALTH
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EMERGENCIES
Coronavirus
Key feature of coronaviruses which cause SARI:
• There is established human-human transmission, including
nosocomial (SARS-CoV-2 >MERS > SARS).
• Viral replication in the upper and lower respiratory tract.
• Aberrant host immune response (upregulation of pro-
inflammatory cytokines)
6. HEALTH
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EMERGENCIES
Virus and Disease
• There are different processes and purpose for naming viruses
and diseases
• Viruses are named based on their genetic structures to
facilitate the development of diagnostic tests, vaccines and
medicines, discussion on disease prevention, spread,
transmissibility, severity and treatment
• Done by virologist and scientist (International Committee on
taxonomy of Viruses (ICTV)) officially announced by WHO
7. HEALTH
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EMERGENCIES
COVID-2019 - CLINICAL FEATURES
• Symptoms at onset*:
• fever (83-98%), dry cough (59-82%),
• fatigue & myalgia (11-44%), sputum production (15-
28%), headache (8%), haemoptysis (5%),
• diarrhoea (3-10%)
• dyspnoea (31-55%)
Huang, C. et al Lancet 2020 China CDC 2020
Wang, D. et al JAMA 2020
Chen, D et al. Lancet 2020
9. HEALTH
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EMERGENCIES
Virus and Disease
• 2019 Novel Corona Virus (Previously)
• Corona Virus Disease (COVID-19)
• Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
• The virus is genetically related to the Coronavirus responsible for the SARI outbreak
in 2003
10. HEALTH
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EMERGENCIES
CASE DEFINITION FOR SURVEILLANCE OF COVID-19
IN SIERRA LEONE
1. SUSPECTED CASE
• A patient with acute respiratory illness (*fever and at least one sign/symptom of
respiratory disease, e.g., cough, shortness of breath).
• *Fever (≥37.5°C) or history of fever
•
1. PROBABLE CASE
• A suspect case for whom laboratory testing for COVID-19 is inconclusive
1. CONFIRMED CASE
• A person with laboratory confirmation of COVID-19 infection, irrespective of clinical
signs and symptoms.
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EMERGENCIES
CASE DEFINITION FOR SURVEILLANCE OF COVID-19 IN SIERRA LEONE
• COVID-19 death is defined for surveillance
purposes as a death resulting from a clinically
compatible illness in a probable or confirmed
COVID-19 case, unless there is a clear alternative
cause of death that cannot be related to COVID
disease (e.g. trauma). There should be no period
of complete recovery between the illness and
death.
12. HEALTH
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EMERGENCIES
COVID-2019 - TRANSMISSION
• Cluster of cases of pneumonia reported in Wuhan on 31 Dec
2019, with 1st case symptomatic on 8 Dec
• Initial cases associated with a market in Wuhan, animal
source remains to be identified
• Rapid spread within Wuhan and to many other Chinese
provinces and other countries
• Human-human transmission
• Nosocomial transmission to HCWs have occurred
• Spread is through droplets and contact
13. HEALTH
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EMERGENCIES
DEFINITION OF CONTACT
• A person who experienced any one of the following exposure during the
2 days before and the 14days after the onset of symptoms of a probable
or confirmed case:
I. Face to face contact with a probable or confirmed case within 1 meter
and for more than 15 minutes;
2. Direct Physical contact with a probable or confirmed case;
14. HEALTH
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EMERGENCIES
DEFINITION OF CONTACT
3. Direct care for a patient with probable or confirmed COVID-19 disease
without using proper personal protective equipment OR
4.Other situations as indicated by local risk assessments
• NOTE: for confirmed asymptomatic cases, the period of contact is
measured as the 2 days before through the 14 days after the date on
which the sample was taken which led to confirmation
15. HEALTH
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EMERGENCIES
China CDC Epidemiologic study
• N = 72,314 total
• N = 44, 672 confirmed
• 3,019 HCW infections
The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team.
The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus
Diseases (COVID-19) – China, 2020. China CDC Weekly.
20. HEALTH
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EMERGENCIES
COVID-2019: newborns and pregnant women
• Small cohort of 9 COVID-2019 pregnant women and 10
neonates.
– All neonates tested negative by throat swab,
– Intrauterine fetal distress in 6 of 10 neonates,
– 4 full term, 6 premature, 1 died.
– Conclusion: no evidence of vertical transmission.
21. HEALTH
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EMERGENCIES
COVID-2019 - INVESTIGATIONS*
INVESTIGATIONS*:
• Blood: leucopenia (25%), lymphopenia (9-70%),
elevated AST (37%)
• ALT is more likely to be elevated than AST in Sierra
Leone
• Radiology - CT chest abnormalities in all patients
(bilateral in 98%); typically bilateral lobular & sub
segmental consolidation Huang, C. et al Lancet 2020
Wang, D. et al JAMA 2020
Chen, D et al. Lancet 2020
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EMERGENCIES
2019-nCoV – Natural history (China CDC)
• Pneumonia (100%)
• ARDS (17-29%)
• Viral RNA detected in blood (15%)
• Acute cardiac injury (7-12%)
• Secondary infection (5-10%)
• 5% admitted to ICU, 4-12% required mechanical ventilation
• 31-68% discharged, 4-15% dead, 17% remain in hospital.
Huang, C. et al Lancet 2020 De Chang, JAMA 2020
Wang, D. et al JAMA 2020
Chen, D et al. Lancet 2020
24. HEALTH
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EMERGENCIES
2019-nCoV – Natural history (China CDC)
• 81% mild illness:
– no complication
• 14% severe:
– SpO2 < 94%, progressive infiltrates
• 5% critically ill:
– Shock, acute respiratory failure, organ failure needing ICU
Huang, C. et al Lancet 2020 De
Chang, JAMA 2020
Wang, D. et al JAMA 2020
Chen, D et al. Lancet 2020
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EMERGENCIES
COVID-19 – CLINICAL MANAGEMENT
1. Triage and early recognition
2. Implement immediate strict IPC interventions.
3. Early diagnosis and alert of public health authorities.
4. Supportive and intensive care interventions for SARI and sepsis.
5. Antimicrobials therapy for co-infection (sepsis)
6. Prevention of complications .
7. Quality care and Ethics.
8. Clinical Research
Refer to WHO Case Management SOP (27th May 2020) and
version 2 of the Case Management SOP for Sierra Leone
28. HEALTH
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EMERGENCIES
2019-nCoV – WHO Website
• https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• https://www.who.int/blueprint/priority-diseases/key-action/novel-
coronavirus/en/
• https://www.who.int/emergencies/diseases/novel-coronavirus-
2019/technical-guidance
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EMERGENCIES
Summary
• In December 2019, a novel coronavirus (2019-nCoV) started
an outbreak of pneumonia in Wuhan, China
• COVID-19 is related to SARS-CoV and MERS-CoV.
• Initial origin was probably zoonotic but human-human
transmission is established.
• Number of cases is increasing rapidly, most patients have
mild illness, presenting with fever, cough, fatigue & myalgia.
• Management involves early recognition, strict IPC, supportive
care and oxygen therapy for severe cases.
Editor's Notes
Diameter varied from about 60 to 140 nm. Virus particles had quite distinctive spikes, about 9 to 12 nm, and gave virions the appearance of a solar corona. Extracellular free virus particles and inclusion bodies filled with virus particles in membranebound vesicles in cytoplasm were found in the human airway epithelial ultrathin sections. This observed morphology is consistent with the Coronaviridae family. To further characterize the virus, de novo se
SARS had more person-to-person transmission than MERS.
