Covid19

Outline
• Terms Pandemic , Endemic , Epidemic
• Investigating an Outbreak
• Epidemiology of Covid19
• Viral Structure
• Infectivity and its role in Pandemicity
• Case definition
• Pathophysiology
• RTPCR
• Treatment Options
• Remdesivir
• Infection Prevention Control (IPC)
• Masks
• Bio Medical Waste Management

EPIDEMIC
• [Epi (upon), demos (people)]. The occurrence in a community or region of cases
of an illness, specific health related behaviour, or other health-related events
clearly in excess of normal expectancy. The community or region and the period
in which the cases occur must be specified precisely. The number of cases
indicating the presence of an epidemic varies according to the agent, size, and
type of population exposed: previous experience or lack of exposure to the
disease; and time and place of occurrence.
• Epidemicity is thus relative to usual frequency of the disease in the same area,
among the specified population, at the same season of the year.
• A single case of a communicable disease long absent from a population or first
invasion by a disease not previously recognized in that area requires immediate
reporting and full field investigation; two cases of such disease associated in time
and place may be sufficient evidence to be considered an epidemic.
Park 25th Edition page 101

ENDEMIC
• (En=in; demos=people). It refers to the constant presence of a disease or
infectious agent within a given geographic area or population group, without
importation from outside; may also refer to the "usual" or expected frequency of
the disease within such area or population group.
• For instance, common cold is endemic because somebody always has one.
“Hyperendemic" expresses that the disease is constantly present at a high incidence
and/or prevalence rate and affects all age groups equally; .
“Holoendemic" a high level of infection beginning early in life and affecting most of
the child population, leading to a state of equilibrium such that the adult population
shows evidence of the disease much less commonly than do the children, as in the
case of malaria.
• An endemic disease when conditions are favorable may burst into an epidemic
(e.g., hepatitis A, typhoid fever).

SPORADIC
• The word sporadic means scattered about. The cases occur
irregularly, haphazardly from time to time, and generally infrequently.
• The cases are so few and separated widely in space and time that
they show little or no connection with each other. nor a recognizable
common source of infection, e.g. , tetanus, herpes-zoster and
meningococcal meningitis.
• A sporadic disease may be the starting point of an epidemic when
conditions are favourable for its spread.
• Many zoonotic diseases are characterised by sporadic transmission to
man.

PANDEMIC
• An epidemic occurring over a very wide area, crossing international
boundaries, and usually affecting a large number of people.
• Pandemics are, therefore, identified by their geographic scale rather than
the severity of illness.
• For example, in contrast to annual seasonal influenza epidemics, pandemic
influenza is defined as “when a new influenza virus emerges and spreads
around the world, and most people do not have immunity” (WHO 2010).
• Only some pandemics cause severe disease in some individuals or at a
population level.
• Characteristics of an infectious agent influencing the causation of a
pandemic include : the agent must be able to infect humans, to cause
disease in humans and to spread easily from human to human.

Shortcomings in managing Pandemics
• The 2003 severe acute respiratory syndrome (SARS) pandemic and growing
concerns about the threat posed by avian influenza led many countries to devise
pandemic plans. IHR was the result with more funding and research
• Despite these improvements, significant gaps and challenges exist in global
pandemic preparedness. Progress toward meeting the IHR has been uneven, and
many countries have been unable to meet basic requirements for compliance
(Fischer and Katz 2013; WHO2014).
• Multiple outbreaks, notably the 2014 West Africa Ebola epidemic, have exposed
gaps related to the timely detection of disease, availability of basic care, tracing
of contacts, quarantine and isolation procedures, and preparedness outside the
health sector, including global coordination and response mobilization (Moon and
others 2015; Pathmanathan and others 2014).
• These gaps are especially evident in resource- limited settings and have posed
challenges during relatively localized epidemics, with dire implications for what
may happen during a full-fledged global pandemic.
Madhav N, Oppenheim B, Gallivan M, et al. Pandemics: Risks, Impacts, and Mitigation. In: Jamison DT, Gelband H, Horton S, et al., editors. Disease Control Priorities:
Improving Health and Reducing Poverty. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 27.
Chapter 17. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525302/ doi: 10.1596/978-1-4648-0527-1_ch17

Major Epidemics /Pandemics
Madhav N, Oppenheim B, Gallivan M, et al. Pandemics: Risks, Impacts, and Mitigation. In: Jamison DT, Gelband H, Horton S, et al., editors. Disease Control Priorities:
Improving Health and Reducing Poverty. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 27.
Chapter 17. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525302/ doi: 10.1596/978-1-4648-0527-1_ch17

Major Epidemics /Pandemics
Madhav N, Oppenheim B, Gallivan M, et al. Pandemics: Risks, Impacts, and Mitigation. In: Jamison DT, Gelband H, Horton S, et al., editors. Disease Control
Priorities: Improving Health and Reducing Poverty. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World
Bank; 2017 Nov 27. Chapter 17. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525302/ doi: 10.1596/978-1-4648-0527-1_ch17

Investigating an Epidemic
How it All Starts
• 1st Case in India of SARS CoV -2 30th Jan
• What to do???
• Was it an outbreak or was it an epidemic ??
• Who did what and why ???
• Is there any team for that ???
Park 25th Edition page 163 ,
https://www.slideshare.net/rishabhkrana/rrt-covid19

General Phases of an Outbreak
Investigation
Descriptive Explanatory Response
Dr Rishabh Kumar Rana Asst. Prof. , Deptt. of PSM , PMCH
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Descriptive Phase
1. Prepare for fieldwork
2. Establish the existence of an outbreak
3. Verify the diagnosis
4. Construct a case definition
5. Identify cases and collect information
6. Perform descriptive epidemiology
Descriptive
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1. Verification of
Diagnosis
2. Confirmation
of the existence of
the epidemic
3. Defining the
Population at risk
4. Rapid search
for all cases and their
characteristic
5. Data Analysis

Explanatory Phase
7. Develop hypotheses
8. Evaluate hypotheses epidemiologically
9. Reconcile epidemiology with laboratory and
environmental findings
10. Conduct additional studies as necessary
Explanatory
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6. Formulate
the
Hypothesis
7. Testing the
hypothesis
8.Evaluation
of Ecological
Factors
9.Further
investigation
of population
at risk

Response Phase
11. Implement and evaluate prevention and control
measures
12. Initiative or maintain surveillance
13. Communicate findings
Response
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10. Writing the
Report

Descriptive Phase
Descriptive
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1. Verification of
Diagnosis
2. Confirmation
of the existence of
the epidemic
3. Defining the
Population at risk
4. Rapid search
for all cases and their
characteristic
5. Data Analysis

Tasks to Prepare For Fieldwork
• Form a team
• Learn about the disease
• Make necessary administrative,
personnel, and logistical
arrangements
• Coordinate with partner
agencies and local contacts
Descriptive
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Form a Team
Team Leader
Interviewers Regulators
Epidemiologist Lab Technician
Environmental
Health Specialist
Clinicians
Descriptive
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Descriptive Phase
Descriptive
DescriptiveDescriptive
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More than expected?
The occurrence of more cases of a disease than
expected for a particular place and time
“Usual”, “Expected”
No.CasesofaDisease
Time
“More than expected”
= “Outbreak”
Descriptive
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Descriptive Phase
Descriptive
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Evaluate the Clues to
Verify the Diagnosis
 Signs and symptoms
 Laboratory findings
 Disease onset
 Duration of symptoms
 Suspected exposure
 Suspected virus, bacteria, or
toxin
Descriptive
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Descriptive Phase
Descriptive
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Descriptive Phase
Descriptive
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Find Cases Systematically,
Develop Line List
Signs/Symptoms Labs Demographics
Case
#
Date of
Symptom
Onset Diarrhea Vomiting
Fever
>37oC
Positive
stool
culture Age Gender
1 22/10/14 Y Y
Not
done
Y 19 M
2 25/10/14 N Y N N 17 M
3 22/10/14 N Y N Y 23 F
4 27/10/14 Y ? ? Pending 18 ?
5 23/10/14 N Y N Y 21 M
6 21/10/14 Y Y Y
Not
submitted
18 F
Descriptive
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Descriptive Phase
Descriptive
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Descriptive Epidemiology
•Describe and orient data
•Person
•Place
•Time
Descriptive
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Perform Descriptive
Epidemiology
• Time (epidemic curve)
• Ideally: when were they infected?
• More practically: when did they become ill?
• Place (spot map, shaded map)
• Ideally: where were they infected?
• More commonly: where do they live, work?
• Person (tables)
• Who was infected?
• Numerators and denominators
• What do the cases have in common?
Descriptive
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With title
0
2
4
6
8
10
12
14
16
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NumberofCases
September 2014
Date of Onset
Number of Cases of Disease X
by Date of Onset, District Y, September2014
Descriptive
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Explanatory Phase
9. Reconcile epidemiology with laboratory
and environmental findings
Explanatory
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6. Formulate the
Hypothesis
7. Testing the
hypothesis
8.Evaluation of
Ecological
Factors
9.Further
investigation of
population at
risk

Explanatory Phase
Explanatory
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6. Formulate the
Hypothesis
7. Testing the
hypothesis
8.Evaluation of
Ecological
Factors
9.Further
investigation of
population at
risk

Explanatory Phase
Explanatory
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6. Formulate the
Hypothesis
7. Testing the
hypothesis
8.Evaluation of
Ecological
Factors
9.Further
investigation of
population at
risk

Response Phase
measures
Response
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10. Writing the
Report

Prevention and Control
Measures
• Immediate control measures
• Long-term control measures
Response
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Chain of Transmission
Susceptible Host
(via portal of entry)
Route of
TransmissionReservoir
Agent
Response
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Conduct Surveillance
measures
Response
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Communicate Findings
During the investigation
• Among team members
• To the public
• To health professionals
• To public health officials/policy makers
At the end of the investigation
• Oral briefing
• Written report
Response
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Epidemiology of COVID19
• WHO names the disease condition as novel coronavirus disease
(COVID-19).
• The virus is SARS-CoV-2..
• The SARS-CoV-2 is a beta-coronavirus belonging to the family
of Coronaviridae. Essentially a zoonotic disease, the first human
coronavirus outbreak was recorded in 1965 - HCoV-229E, followed by
two outbreaks of similar capacity - SARS-CoV and MERS-CoV in 2003
and 2012, respectively.

The Viral Genome
• Meta-genomic sequencing of RNA samples isolated from the
bronchoalveolar lavage (BAL) fluid of patients suffering from severe acute
respiratory illness (SARI) in the city of Wuhan identified a novel RNA virus
as the causative pathogen.
• 11 complete genome sequences of SARS-CoV-2 isolates are available. Six of
the whole genome-sequenced SARS-CoV-2 were isolated from different
parts of China and five were isolated from Japan.
• Genome sequences of different isolates are highly similar and showed
more than 99 per cent sequence identity.
• The genome of SARS-CoV-2 harbours 10 coding sequences (CDS), which
encode polyprotein, surface glycoprotein, membrane glycoprotein and
nucleocapsid phosphoprotein
Chatterjee, P., Nagi, N., Agarwal, A., Das, B., Banerjee, S., Sarkar, S., Gupta, N., & Gangakhedkar, R. R. (2020). The 2019 novel coronavirus disease (COVID-19) pandemic:
A review of the current evidence. The Indian journal of medical research, 151(2 & 3), 147–159. https://doi.org/10.4103/ijmr.IJMR_519_20

• Phylogenetic analysis using complete genome sequence of SARS-CoV-2
revealed that its genome sequences are very similar (~90%) to the
SARS-like CoVs.
• Cell binding happens via the viral S protein to the host receptor
angiotensin-converting enzyme 2 (ACE2) is required for infection.

The progress from Bats to…… to humans !!!
• Phylogenetic analysis suggests that although bats may act as the original
reservoir for SARS-CoV-2, there is a possibility of yet another unidentified
intermediate host, which was likely being sold at the seafood market in
Wuhan before the outbreak.
• When the first cases emerged in December 2019, bats were likely in
hibernation, and if there was an intermediate host, it might have played a
role in continuing local transmission of the virus. Hence, despite there
being about 89 per cent similarity with the genomic sequence of bat-SL-
CoVZC45 and bat-SL-CoVZXC21, there still remain doubts regarding its
direct ancestors. It has been hypothesized that game animals, the
consumption of which is culturally acceptable in China, may also represent
a bridging host which instigated the spread of the virus from bats to human
beings

Understanding the COVID19
Pandemic – Factors
•Total Secondary Cases per
infected Case
•R0
Fundamental Driver
•Duration of Infectious Period
•Number of Infections per day
Influenced by • Resistance to the infection to
treatment
• Disease induced mortality rate
• Treatment of Infected People
• Co infections of the host
• Virulence
• Severity of Symptoms
• Quarantine of Infected persons
• Movement of hosts or vectors
• Host resistance to infection
• Population Density
Which in Turn
is influenced by
Dr Rishabh Kumar Rana , Assist. Prof., Deptt. of PSM, PMCH
,Dhanbad
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,Dhanbad
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Infectious !!!! Yes it is
• COVID-19 remains a highly infectious disease, with reproductive
number (R0) estimates ranging from 1.4 to 3.5. The early WHO
estimate of R0 was 1.4 to 2.5. Preliminary studies, conducted at the
beginning of the outbreak, reported higher estimates of R0, in the
range of 2.24-3.58. Two recent estimates place it in the range of 2.0-
3.1 and at 3.11 (95% CI 2.39-4.13). All the estimates of transmissibility
indicate that self-sustaining human-to-human transmission is the only
plausible explanation for the magnitude of the on-going outbreak.
The case fatality rate (CFR) of COVID-19 has been seen to be higher in
China (2.1%) than outside (0.5%).

Quarantine and Isolation for General Infectious diseases
and Covid19
Quarantine:
Quarantine refers to separation of individuals who are not yet ill
but have been exposed to COVID-19/ Diseased area or travel
history to affected countries / states and therefore have a
potential to become ill.
Isolation
Isolation refers to separation of individuals who are ill and
suspected or confirmed of COVID-19/Diseased area will be
hospitalized and kept in isolation in a designated facility till such
time they are tested negative.
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Incubation Period
The mean incubation period was 5.2 days (95% CI 4.1-7.0 days) in a study covering 425 cases, and the
median incubation period was 3.0 days (range 0-24 days) in another study based on 1,324 cases. It might be
possible that the single case, with an outlying incubation period of 24 days, was actually a second exposure,
rather than a single infection incubation period.
The incubation period for COVID-19 remains comparable to other recent epidemic viral diseases - SARS (2-
7 days)and MERS-CoV (2-14 days), but it is slightly longer than swine flu (1-4 days) and seasonal influenza
(1-4 days).

Case Definitions
• SARI - An acute respiratory infection with a history of fever or measured
temperature >38°C, and cough, onset within 10 days and requiring
hospitalization.
• Surveillance case definitions for SARS-CoV-2 - A person with SARI with no
other etiologies with one of the following: (i) History of travel to Endemic ,
region in the last 14 days; and (ii) Patient is a HCW who has been caring for
patients with SARI of unknown etiology.
• Patient with acute respiratory illness and at least one of the following: (I)
Close contact with a confirmed or probable case of SARS-CoV-2 in the 14
days before illness onset; and (ii) Worked or attended a health care facility
in the 14 days before onset of symptoms where patients with hospital-
associated SARS-CoV-2 infections were reported.

Case definitions of COVID-19
DEFINITIONS – SUSPECT
A person with acute respiratory illness (fever and at least one sign/symptom of
respiratory disease (eg. Cough, shortness of breath) AND history of travel to or
residence in a country/area or territory reporting local transmission of COVID-19
disease during the 14 days prior to symptom onset
OR
• A person with any acute respiratory illness AND having being in contact with a
confirmed COVID-19 case in the last 14 days prior to onset of symptoms
OR
• A person with severe acute respiratory infection {fever and at least one
sign/symptom of respiratory disease (eg., Cough, shortness of breath)} AND
requiring hospitalization AND with no other etiology that fully explains the clinical
presentation .
PROBABLE CASES
A case for whom testing for COVID-19 is inconclusive.
OR
B. A suspect case for whom testing could not be performed for any reason.
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Case definitions of COVID-19
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GoI recent Guidelines for Managing COVID19

Clinical Picture
• The most common symptoms at illness onset are fever (99%), fatigue
(70%), dry cough (60%), myalgia (44%) and dyspnea.
• Less common symptoms are headache, dizziness, diarrhoea, nausea and
vomiting. Symptoms such as pharyngeal pain, dyspnea, dizziness,
abdominal pain and anorexia are more likely to be present in patients with
severe illnesses.
• But In India - Integrated Disease Surveillance Programme (IDSP) portal
case investigation forms for COVID 19 (n=15,366), the details on the signs
and symptoms reported are (as on 11.06.2020), fever (27%), cough (21%),
sore throat (10%), breathlessness (8%), Weakness (7%), running nose (3%)
and others 24%.

Path- Physiology
• Most patients with COVID-19 predominantly have a respiratory tract
infection associated with SARS-CoV-2 infection. However, in a small
proportion of cases, they can progress to a more severe and systemic
disease characterized by the Acute Respiratory Distress Syndrome (ARDS),
sepsis and septic shock, multi organ failure, including acute kidney injury
and cardiac injury.
• Autopsy findings in China and European countries showed endothelial
damage of pulmonary vasculature, microvascular thrombosis and
hemorrhage linked to extensive alveolar and interstitial inflammation that
ultimately result in COVID-19 vasculo pathy, pulmonary intravascular
coagulopathy, hypercoagulability, ventilation perfusion mismatch, and
refractory ARDS. Hypoxemia, secondary to ARDS may also activate the
coagulation cascade.
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Clinical Complications
• The most common laboratory abnormalities among patients
hospitalized with COVID-19 are marked lymphopenia, prolonged
prothrombin time, elevated lactate dehydrogenase and elevated D-
dimer. These laboratory abnormalities are similar to the ones seen in
SARS-CoV and MERS-CoV infections. Bilateral patchy shadows and
ground-glass opacities are seen on chest imaging. The most common
complications of COVID-19 are acute respiratory distress syndrome,
arrhythmias, acute cardiac injury, shock and acute kidney injury

Investigations
• CBC, ESR
• RBS, S. Creatinine
• SGOT,SGPT, Bilirubin
• Chest X-ray: (Portable) Need Based
• S. Electrolyte (Need Based)
• ECG: Need Based
• PF/PV, Typhi Dot, Dengue serology: Need Based.
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Monitoring (To be documented)
• Temperature chart: 8 hourly/SOS
• GCS: Once daily and SOS
• Pulse Oximetry: 8 hourly and SOS
• Blood Pressure: Once daily and SOS
• Respiratory rate: Twice daily and SOS
• Chest Auscultation: Once daily and SOS
• Input Output Charting
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Diagnosis
• Preferred clinical samples for establishing the laboratory confirmation
of a suspected case include nasopharyngeal and oropharyngeal swabs
collected using Dacron swabs, expectorated sputum, BAL fluid,
endotracheal aspirate and tissue. The clinical sample is to be collected
in a sterile container with normal saline which covers the sample;
serum samples are collected in pairs in red cap vials (plain vials) with
clot activators during both the acute phase and the convalescent
phase of the illness .

Sample Collection
• Appropriately filling the laboratory request form is vital once a clinical
sample is collected from a suspected patient. Information regarding
the patient's demographic details, date, time and anatomical site of
the sample collection, tests required and the clinical history,
symptoms, and risk factors need to be mentioned to mitigate risks of
transmission if the sample turns out to be positive. The sample
package must be labelled with UN3373 for Category B Biological
Substances.

Samples
• While handling specimens of SARS-COV-2, one must ensure that
neither the sample nor the Health Care Worker(HCW) is
contaminated to minimize any risks and to ensure accuracy of
diagnosis. Isolation of SARS-COV-2 can be done in cells lines and the
diagnosis has to be confirmed by RT-PCR.
• Charité Berlin, from Germany, was the first to develop the assay and
standardize the protocol for real time RT-PCR.

Testing Methods
• Antigen Testing ( Yet to be employed , having controversy etc. )
• RTPCR ( Gold Standard )
• True Nat

Real-time reverse-transcription Polymerase Chain
Reaction RTPCR
• First Samples are collected in the form of Oropharyngeal and nasal Swab
and transported in Viral Transport Medium within a temperature range of
2-6 Degree C for transport .
• Then after thawing the samples RNA is extracted using RNA extractor
Magna Pure 96 system .
• A 25 μL reaction contains 5 μL of RNA, 12.5 μL of 2 × reaction buffer
provided with the Superscript III one step RT-PCR system with Platinum Taq
Polymerase (Invitrogen, Darmstadt, Germany; containing 0.4 mM of each
deoxyribont triphosphates (dNTP) and 3.2 mM magnesium sulphate), 1 μL
of reverse transcriptase/Taq mixture , 0.4 μL of a 50 mM magnesium
sulphate solution (Invitrogen), and 1 μg of nonacetylatebovine serum
albumin (Roche) .
Corman Victor M, Landt Olfert, et al . Detection of 2019 novel coronavirus (2019-
nCoV) by real-time
RT-PCR. Euro Surveill. 2020;

A two step RT –PCR being employed
• Two-step RT-PCR
Two-step RT-PCR, as the name implies, occurs in two steps. First the
reverse transcription and then the PCR. This method is more
sensitive than the one-step method. Kits are also useful for two-step
RT-PCR. Just as for one-step, use only intact, high quality RNA for the
best results. The primer for two-step does not have to be sequence
specific.
Step one
• Combine template RNA, primer, dNTP mix, and nuclease-free
water in a PCR tube.
• Add RNase inhibitor and reverse transcriptase to the PCR tube.
• Place PCR tube in thermal cycler for one cycle that includes
annealing, extending and then inactivating reverse transcriptase.
• Proceed directly to PCR or store on ice until PCR can be
performed.
Step two
• Add a master mix (containing buffer, dNTP mix, MgCl2, Taq
polymerase and nuclease-free water) to each PCR tube.
• Add appropriate primer.
• Place PCR tubes in thermal cycler for 30 cycles of the
amplification program, which includes three steps: (1)
denaturation (2) annealing (3) elongation.
• The RT-PCR products can then be analyzed with gel
electrophoresis.
• For a routine workflow, the E gene assay as the first-line screening tool,
followed by confirmatory testing with the RdRp gene assay. Application of
the RdRp gene assay with dual colour technology can discriminate 2019-
nCoV (both probes positive) from SARS-CoV RNA if the latter is used as
positive control.
Alternatively, laboratories may choose to run the RdRp assay with only the
2019- nCoV-specific probe.

Pooling of samples during RTPCR
• Real-time PCR for COVID-19 by pooling 5 samples of TS/NS (200 µl/sample) is
feasible when the prevalence rates of infection are low. All individual samples in a
negative pool to be regarded as negative. Deconvoluted testing is recommended if
any of the pool is positive. Pooling of more than 5 samples is not recommended to
avoid the effect of dilution leading to false negatives.
• Use only in areas with low prevalence of COVID-19 (initially using proxy of low
positivity of 5% for COVID-19
• ln areas with positivity of 2-5 o/o, sample pooling for PCR screening may be
considered only in community survey or surveillance among asymptomatic
individuals, strictly excluding pooling samples of individuals with known contact
with confirmed cases, Health Care Workers (in direct contact with care of COVID-19
patients). Sample from such individuals should be directly tested without pooling .
• Pooling of sample is not recommended in areas or population with positivity rates
of >5% for COVID-19
Corman Victor M, Landt Olfert, et al . Detection of 2019 novel coronavirus (2019-
nCoV) by real-time
RT-PCR. Euro Surveill. 2020;

,Dhanbad
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• Remdesivir has been shown to inhibit replication of other human
coronaviruses associated with high morbidity in tissue cultures, including
severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 and
Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012.
• Remdesivir is administered via an intravenous injection (IV) with a loading
dose on day 1 (200 mg in adults, adjusted for body weight in pediatric
patients) followed by a daily maintenance dose (100 mg in adults) for up to
10 days. GoI mandates only 5 days .
• Remdesivir’s antiviral activity, sterically interacting with the viral RdRp to
induce delayed chain termination, has been demonstrated in vitro against
multiple coronaviruses (SARS, MERS, contemporary human CoV and bat-
CoVs)
Eastman, R. T., Roth, J. S., Brimacombe, K. R., Simeonov, A., Shen, M., Patnaik, S., & Hall, M. D. (2020). Remdesivir: A Review of Its Discovery and Development Leading to
Emergency Use Authorization for Treatment of COVID-19. ACS central science, 6(5), 672–683. https://doi.org/10.1021/acscentsci.0c00489
REMDESIVIR /GS5734 - nucleoside analog
prodrug by GILEAD and US CDC

Prevention Strategies
• Infection Prevention Control (IPC) Measures
• Social Distancing
• Using Masks
• Frequent Hand Hygiene
• Extra caution for Health Care Workers ( all )
• Using five moments of Hand Hygiene
• Using Appropriate PPE kit
• Boosting up the Individuals Immunity
• Right testing , timely identification of SARI and ILI Cases
• Timely treatment of SARI ,ILI and Covid 19 cases.
• IEC , BCC
• Checking the information Source
• Discipline

• WHO2015 Safe & Quality Health Services Package
Benefits of IPC
Protecting yourself
Protecting your
family, community &
environment
Protecting your
patients

Elements of Standard Precautions
1. Hand hygiene
2. Respiratory hygiene (etiquette)
3. PPE according to the risk
4. Safe injection practices, sharps
management and injury prevention
5. Safe handling, cleaning and disinfection of
patient care equipment
6. Environmental cleaning
7. Safe handling and cleaning of soiled linen
8. Waste management

Hand hygiene: WHO 5 moments
• https://www.who.int/infection-prevention/tools/hand-hygiene/en/

• SUMAN K
HAND HYGIENE
https://www.who.int/infection-prevention/tools/hand-hygiene/en/

PPE for use in health care for COVID-19
Head cover
Head + hair
Goggle
EyesNose + mouth
Face Mask Face shield
Eyes + nose + mouth
Gloves
Hands
Apron
Body
Gown
Body
N95 Mask
Nose + mouth

• Always clean your hands before and after wearing PPE
• PPE should be available where and when it is indicated
• in the correct size
• select according to risk or per transmission based precautions
• Always put on before contact with the patient
• Always remove immediately after completing the task and/or
leaving the patient care area
• NEVER reuse disposable PPE
• Clean and disinfect reusable PPE between each use
• Donning – Process of Putting on PPE while Doffing – process of
Taking out the PPE . Which one is more infectious ???
Principles for using PPE (1)

• Change PPE immediately if it becomes contaminated or
damaged
• PPE should not be adjusted or touched during patient care;
specifically
• never touch your face while wearing PPE
• if there is concern and/or breach of these practices, leave
the patient care area when safe to do so and properly
remove and change the PPE
• Always remove carefully to avoid self-contamination (from
dirtiest to cleanest areas)
Principles for using PPE (2)

Use of Mask : Community setting
• Individuals without respiratory symptoms
• Avoid closed crowded spaces
• Maintain distance – 1m
• Practice hand and respiratory hygiene
• Refrain from touching face, nose, mouth
• No need of mask
• Individuals with respiratory symptoms
• Wear a medical mask
• Seek medical care
• Learn mask management

Use of Mask : Home care
• Individuals with suspected infection with mild respiratory symptoms
• Relatives or caregivers
Along with
• hand hygiene
• keep distance from affected individual as much as possible (at least 1
meter)
• improve airflow in living space by opening windows as much as
possible
• Mask management

Use of Mask : Health Care Settings
Individuals with respiratory symptoms should:
• wear a medical mask while waiting in triage or waiting areas or during
transportation within the facility;
• wear a medical mask when staying in cohorting areas dedicated to
suspected or confirmed cases;
Health care workers should:
• wear a medical mask while providing care to the patient
• Use a particulate respirator N95 (NIOSH certified) , FFP2 (EU
standard), or equivalent, when performing aerosol generating
procedures (tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual
ventilation before intubation, and bronchoscopy.

Masks management
• place mask carefully to cover mouth and nose and tie securely to minimise any
gaps between the face and the mask
• while in use, avoid touching the mask
• remove the mask by using appropriate technique (i.e. do not touch the front but
remove the lace from behind)
• after removal or whenever you inadvertently touch a used mask, clean hands by
using an alcohol-based hand rub or soap and water if visibly soiled
• replace masks with a new clean, dry mask as soon as they become damp/humid
• do not re-use single-use masks
• discard single-use masks after each use and dispose of them immediately upon
removal

Bio-Medical Waste Management
Rules 2016, amended 2018 & 2019
• Environment (Protection) Act, 1986
• Apply to all persons who generate, collect, receive, store, transport,
treat, dispose, or handle any bio-medical waste
• "Occupier" means a person having administrative control over the
institution and the premises generating bio-medical waste
• Responsibility of every occupier – safe and proper identification,
handling, storage and disposal of biomedical waste from laboratories
and related facilities

Segregation, packaging, transportation and
storage
• Untreated bio-medical waste should not be mixed with
other wastes
• Bio-medical waste shall be segregated into containers or
bags at point of generation (as per BMWM Rules 2016)
• Bio-medical waste containers or bags should be
prominently labelled with biohazard symbol (and other
details as per Rules)
• Untreated bio-medical waste must not be stored >48 hrs
• Ensure no spillage occurs during handling and transit of
bio-medical waste

Yellow bag
• Anatomical waste – human, animal body parts & tissue
• Soiled waste – items contaminated with blood or body fluids – like
dressings, cotton swabs and bags containing residual blood/blood
components
• Chemical waste – chemicals used in production of biologicals
• Microbiology, biotechnology and other clinical laboratory waste (to be
pre-treated by autoclaving before discarding):
• Blood bags
• Laboratory cultures
• Stocks or specimens of microorganisms
• Live or attenuated vaccines
• Human and animal cell cultures
• Discarded linen contaminated with blood or body fluid including mask
and gown

Red Bag
• Contaminated recyclable waste
• Waste from disposable items:
• Tubing and bottles
• Intravenous tubes and sets
• Catheters and urine bags
• Syringes (without needles), vacutainers
• Gloves
• Plastic petri-plates containing infectious material to be pre-
treated by autoclaving and discarded in red bags

Translucent white box
• Puncture, leak and tamper proof
• Sharps waste (used, discarded and contaminated metal sharps)
• Needles
• Syringes with fixed needles
• Needles from needle tip cutter or burner
• Scalpels
• Blades
• Any other contaminated sharps

Blue box
• Or containers with blue coloured marking
• Puncture and leak proof boxes
• Glassware
• Broken or discarded glass including medicine vials & ampoules (except those
contaminated with cytotoxic waste)
• Broken or discarded contaminated glass

Labelling of BMW bags
Label should be non-washable and prominently visible

Disposal of BMW
Category Type of bag/container Type of waste Treatment disposal options
Yellow Non chlorinated colour
coded bags in coloured
bins
Separate collection system
leading to ETP
• Human anatomical waste
• Animal anatomical waste
• Soiled waste
• Expired or discarded medicines
• Chemical waste
• Micro, biotech & clinical lab waste
• Chemical liquid waste
Incineration/deep burial
Red Non chlorinated plastic
bags in coloured bins/
containers
Contaminated waste (recyclable)
tubing, bottles, urine bags, syringes
(without needles) and gloves
Auto/micro/hydro and then
sent to recycling
White Translucent, puncture, leak
& tamper proof
Waste sharps including metals Auto/dry heat sterilization
followed by shredding
/mutilation/encapsulation
Blue Water proof card board
boxes/containers
Glassware waste Disinfection or auto/micro
/hydro then sent to recycling
*Disposal by deep burial is permitted only in rural or remote areas where there is no access to common bio-
medical waste treatment facility. This will be carried out with prior approval from the prescribed authority

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