International departures and arrivals across the world have increased significantly in just 10 years, contributing to the rapid spread of coronavirus globally OVERVIEW OF coronavirus Epidemiology CoVs: COVID-19 Transmission COVID-19 Distribution SARS-CoV-2 Strain

1. G L O B A L T R A V E L A N D S P R E A D O F C O V I D 1 9 :
C U R R E N T E P I D E M I O L O G I C A L S T A T U S
P R E S E N T E D B Y :
C H A N D R A N I G O S W A M I
R E G N N O . : 2 0 1 9 - V D K - 3 4
D E P A R T M E N T O F V E T E R I N A R Y P U B L I C H E A L T H
MA JOR CREDIT SEMINAR

2. INTRODUCTION
 1.5 billion international tourist arrivals
were recorded in 2019, globally
(UNWTO,2020)
 International departures and arrivals
across the world have increased
significantly in just 10 years, contributing
to the rapid spread of coronavirus
globally (ToI report, 2020)
(ToI report, 2020)

3. (ToI report, 2020)
 In 2008, just before swine flu, there were 5.3
million arrivals in India (UNWTO,2009)
 Arrivals in India from abroad increased 3 times
in 10 years (UNWTO,2020)
 About 40% of these arrivals were NRIs.
 Unlike foreign tourists who are more likely to
visit popular spots and business districts,
 NRIs are more likely to visit their villages and
cities that may not be on tourism maps
(thus spread accompanying diseases) (ToI
report, 2020)
 In 2019, 11 million foreigners and 7 million
NRIs visited India, mostly from Europe and
North America (UNWTO,2020)

4. 4 GENUS OF CORONA VIRUS (COVS):
Alpha “α” and Beta “β” - CoVs”
originated from bat and rodents.
1. Alpha (α – CoV) 2. Beta (β – CoV)
Gamma “γ” and Delta “δ” - CoVs”
originated from avian and birds.
3. Gamma (γ – CoV) 4. Delta (δ – Cov)
OVERVIEW OF
CORONAVIRUSCoronavirus
Corona= “Crown” in Latin
Family = Coronaviridae
Order = Nidovirales
Positive sense. Single stranded
RNA viruses (+)
 Commonly cause mild but occasionally more
severe community acquired acute respiratory
infections in humans.
 CoVs also infect a wide variety of animals
 People who are “YOPI” are more prone

5. Beta (β) Coronaviruses
Lineage A Lineage B Lineage C
SARS- CoV
Expelled from human population (July 2003)
Discovered in 2002/2003
Guangdong Province, China (16th Nov,2002)
Transmitted from bats to civets to human
MERS- CoV
Discovered in 2012
Saudi Arabia
Saudi Arabia, South Korea
Middle East Respiratory Syndrome
(MERS)
More than 2400
cases
858 deaths
Fatality Rate: 35%
Severe Acute Respiratory Syndrome
(SARS)
More than 8000 cases
774 deaths
Fatality Rate: 9.6%
Coronavirus Disease 2019
(COVID-19)
SARS- CoV-
2
Wuhan, Hubei Province of China
Discovered in 2019
Worldwide Pandemic (Feb/Mar 2020)
More than 16 M cases
>661K deaths
Fatality Rate: ~3%
Majority have severe symptoms
Fever, cough, chills, Myalgia, ARDS
Basic Reproduction no.: 0.7-3
Asymptomatic Severe/ Fatal
Fever, cough, dyspnea, ARDS
Basic Reproduction no.: 2-3
Asymptomatic Severe/ Fatal
Fever, cough, dyspnea, AKI, ARDS
Epidemiology CoVs:
Basic Reproduction no.: 0.3-0.8

6. 1.No cases reported: Countries/territories/areas with no confirmed cases
2. Sporadic cases.: small number of cases that are either imported or that are detected locally
3. Clusters of cases: refers to cases that are clustered in time, geographic location and or by a
common exposure
4. Community transmission: inability to relate confirmed cases through chains of transmission
for a large number of cases
Four levels of COVID-19 transmission (WHO, April, 2020)
COVID-19 Transmission
 Droplet transmission: occurs when a person is in close contact (within 1 m) with
someone who has respiratory symptoms (e.g. coughing or sneezing)
 Droplet transmission through fomites: immediate environment around the
infected person (Ong et. al., 2020)
 Airborne transmission may be possible in specific circumstances and settings in
procedures that generate aerosols are performed (i.e. endotracheal intubation,
bronchoscopy, open suctioning etc. (WHO, 2020)
 COVID-19 infection may lead to intestinal infection and be present in faeces. One
study has cultured the COVID-19 virus from a single stool specimen (Zang et. al.,
2020)

7. COVID-19 Distribution
World Cases:
>17M
Deaths:
>667K
Recovered:
>9.96M
India Cases (3rd):
>1.58M
Deaths:
>34,968
Recovered:
>1.02M**Corona cases are toped by USA followed by Brazil
Countries that have not reported any cases of the coronavirus so far:
Kiribati, Marshall Islands, Micronesia, Nauru, North Korea, Palau, Samoa, Solomon
Islands, Tonga, Turkmenistan, Tuvalu, Vanuatu
WHO Situation report, 30 July 2020

8. SARS-CoV-2 Strain
 Researchers from Peking University in Beijing, China, described two distinct lineages of SARS-CoV-2,
which they termed “S” and “L” strains. (National Science Review, April 2020)
 The virus from Wuhan is L-strain and it is more deadly
 S-strain emerged from mutation of L-strain but it is less deadly
 Patients in Kerala came from Dubai found to be infected with S-strain
 Gujarat, more number of people coming from America, where there is L-strain
 All strains circulating in Assam were L-strain
Statements released by
labs of respective states
Case Study (Thangaraj et.al., May, 2020)
 A cluster of SARS-CoV-2 infection occurred among Italian tourists visiting India.
 Group of 23 Italian tourists reached New Delhi, on Feb 21, 2020 and along with 3 Indians visited
Rajasthan.
 By March 3, 2020, 17 of the 26 tested positive for SARS-CoV-2
 Of these 17 patients, 9 = symptomatic, 8 = asymptomatic
 Two patients died
 It was inferred, they could have picked up the infection from Italy and later transmitted the infection to
co-tourists.

9. Noted cases:
 SARS-CoV-2 infects cat populations in Wuhan during the COVID-19 outbreak, under natural condition upon contact
with COVID-19 patients and develops antibody response (Zhang et. al., 2020)
 Detected in the feces and vomit of an infected pet cat with COVID-19 in Belgium indicating active replication of the
virus (Thompson et. al., 2020)
 Two pet dogs from Hong Kong and another from North Italy have been infected with the infection, without
symptoms (Loeb et. al., 2020)
 A Malayan tiger at Bronx Zoo, USA has been tested positive for COVID-19 as the first case of animal infection in USA
getting with contact with an infected employee (WCS et. al., 2020)
 First case of a domestic cat testing positive for COVID-19 in the U.K. (CBC News, 28 July 2020)
 On the contrary, chickens, ducks, and pigs are not susceptible to SARS-CoV-2 infection (Shi et. al., 2020)
COVID-19 cases in
animals
 Although the virus is believed to spread almost exclusively by human-to-human transmission, there are
concerns that some animal species may contribute to the ongoing SARS-CoV-2 pandemic
epidemiology (McNamara et. al., 2020).
 To date, sporadic cases of SARS-CoV-2 infection have been reported in dogs and cats.

10. Case Study (Patterson et. al., 2020)
 Performed a large-scale study to assess SARS-CoV-2 infection in 817 companion animals (cats
and dogs) living in northern Italy, sampled at a time of frequent human infection from March to
May 2020
 Most studies of companion animals are small in nature, likely because of an inevitable research
focus on human disease
 Wide scale testing of susceptible species is needed to assess the extent of animal infection
under more natural conditions of husbandry.
 In another study, sero-positivity rates in animals comparable to those of humans via community
sampling at a similar time in European countries (Pollan, et.al., 2020) suggests that infection in
companion animals is not unusual.
 No animals tested RT-PCR positive.
 3.4% of dogs and 3.9% of cats had measurable SARS-CoV-2 neutralizing antibody titers
 All animals tested negative by PCR, including those animals living in households with confirmed
COVID-19 human infection and those with and without respiratory symptoms suggesting pet
animals can seroconvert, they may shed virus for relatively short periods of time.
 Stated both cats and dogs can seroconvert under the normal conditions of pet ownership, and
where the burdens of disease are highest in humans.

11. TRAVEL RELATED RISK FACTORS FOR
DISEASE OCCURRENCE
(WHO, 2010)
 Mode of transport  Behavior of the travelers  Duration and season of
travel
 Destination Purpose of travel
(UNWTO, 2019)
 Underlying health of thetravelers;
standards
of accommodation and food hygiene

12. AIR TRAVEL &
ASSOCIATED RISKS In 2016, there were a staggering 3.8 billion air travelers, a number it
predicts will balloon to 7.2 billion passengers by 2035 (International
Air Transport Association , 2017)
 WHO estimates that 6.5 passengers per million traveled on commercial
flights originating from regions of active transmission while symptomatic
with probable SARS during the height of the outbreak.
 The aircraft cabin environment: During flight, the aircraft cabin is
a ventilated, enclosed environment that exposes passengers to
hypoxia, dry humidity, and close proximity to fellow
passengers.
 Auxiliary Air Unit and Quality of Aircraft cabin air
(recirculated air)
 Dirty surfaces in terminals and boarding in unventilated jetways
are also risk-factors, among others

13. SEA TRAVEL &
ASSOCIATED RISKS In 2017, a record 25.8 million passengers cruised globally.
(UNWTO, 2018)
 More than 700 people on board the Diamond Princess and
Ruby Princess cruise ship in Japan and Australia respectively
has recorded Covid-19 cases. (The Guardian, May 2020)
Factors:
 Presence of a vast cohort of individuals in semi-confined settings is
accompanied by an increase in the risk of particular infections.
 Environment where the infection is acquired is often the risk factor
that leads to the acquisition of the infection or the pathogenic
organism.
 Respiratory illnesses such as CoV or influenza can occur at any time
of the year.

14. GLOBAL
RESPONSE
Global Outbreak Alert and Response Network (GOA
International Health Regulations (IHR), 2005

15. Global Outbreak Alert and Response Network (GOARN), 2000
 GOARN works closely with and under the WHO. Have over 600 partners in the form of public health
institutions, networks, labs, and NGOs
 Played role in containing the 2003 SARS outbreak.
 During outbreaks, the network ensures that the right technical expertise and skills are on the
ground where and when they are needed most.
 Countries are also being supported by experts, deployed around the world by GOARN
Aarogya Setu is a part of GOARN initiative
 GOARN COVID-19 Research Response: ensures network
partners and in-country stakeholders have technical guidance,
capabilities, and tools needed to:
 characterize COVID-19 within their local or regional context
 draw from the latest evidence to implement better response
 evaluate their response and mitigate secondary impacts
 The IATA along with GOARN, has established guidelines for the aviation industry for operations
during pandemic influenza outbreaks.
These include:
 Risk communication to the traveling public,
 Establishment of national passenger exit screening from outbreak regions, and
 Increasing airline preparedness (aircraft cleaning and procedures in case of in-flight illness)

16.  Came into force on15th June 2007. Represent an agreement between 196 countries including all
WHO Member States to work together for global health security.
Their main objectives are to ensure:
(1)Routine, preventive measures (e.g. at ports and airports) and the use by all countries of
internationally approved documents (e.g. vaccination certificates);
(2)To notify WHO of all events that may constitute a public health emergency of
international concern
International Health Regulations (IHR), 2005
 The IHR regulations contains routine requirements for :
 Disease surveillance and control activities at international airports, seaports, and border
crossings
 Specifies that states shall establish programs to control vectors that may transport a public
health risk in the immediate vicinity of international ports, airports, and ground crossings.
 Aircraft disinsection was made mandatory by the IHR
 Provides world standards for ships and port sanitation, as well as surveillance and response for
infectious diseases aboard conveyances, including cruise ships
 Make recommendations for the use of interventions to mitigate the community impact of
pandemic coronavirus and other novel infectious agents with pandemic potential.

17. Steps by IHR regarding COVID-19 pandemic:
Coordination, planning, and monitoring
Risk communication and community engagement
Surveillance
Health Workers safety
Food Security
Research and development
International Health Regulations (IHR), 2005
 Travel and Trade
 Continue working with countries and partners to enable essential travel needed for
pandemic response, humanitarian relief, and cargo operations.
 Develop strategic guidance with partners for the gradual return to normal operations of
passenger travel in a coordinated manner
 Update recommendations on appropriate travel measures and analyze their effects on
international transmission of COVID-19,
 Consider balance between benefits and unintended consequences, including entry and exit
screening, education of travelers on responsible travel behavior etc.

18. WHAT ELSE CAN BE
DONE ?  Introduction of Travel
Health & Mass Gathering
Health in Public Health
Curriculum
 Pre-travel Medical Consultation
 Redefine responsibility
of thetravelers
 Medical Insurance
of travelers
 Strengthening of travel
industry and safety of
travelers

19. GENERAL PRECAUTIONS OF
COVID 191. Isolation / self quarantine.
2. Wash hands with
soap or disinfectant.
3. Do not touch the “T- Zone
[eye, nose, and mouth]”.
4. Decrease the travel
specially to the diseased area.
5. Avoid large crowding
Populations and stay
6 feet from susceptible
person.
6. Wear:
a) Mask {N95 mask}
b) Eye protection
c) Grown
d) Double gloves.

20. MEASURES TO REDUCE INFECTION RISK ON
PUBLIC TRANSPORT
Road:
 High levels of hygiene should be maintained in
Terminals, rest areas along motorways, parking, fueling
stations should maintain.
 At stations, passenger flow should be managed.
 Closing stops or stations should be considered.
Air Travel:
Ventilation should be strengthened, with hospital-grade air
filtering and vertical airflow.
Movement reduced (less cabin baggage, fewer interactions
with crew)
Management of Passenger flows
early arrival times at the airport;
prioritising electronic/self-check-in;
minimising contacts at baggage drop-offs

21. Rail:
 Frequency and capacity of trains should be increased
 Mandatory seat reservations on long-distance and
regional trains
 For short-distance trips, passengers should leave seats
empty between them, except for passengers from the
same household.
 Off-peak hour travel should be encouraged
Bus and coach:
Use of windows for ventilation
Seating should be organised where possible so that
,
families sit together
people not travelling together should be
separated
Passengers should handle the their own luggage

22. DIAGNOSIS/
INVESTIGATIONS:
 RT-PCR it takes times; is done by taking sample from
sputum, aspiration, and blood,
 Rapid Antibody Test
 Complete blood count (CBC): Lymphocytopenia (80%)
 Metabolic Panel:
A) Liver function test: ALT, AST, Bilirubin.
B) Renal test: Blood Urea Nitrogen ‘BUN’,
Creatinine
 Medical imaging:
1- Chest x-ray: Ground class opacity.
2- CT scan: Ground class opacity,
Consolidation (due to presence of
History Vital sign Sample collection
(Swabs)

23. MANAGEMENT OF COVID
19:
REMDESIVIR
IV Fluid (RL , NS) Antipyretic
VACCINE:
CHLOROQUINE RITONAVIR TOCILIZUMAB CORTICOSTEROIDS
 25 candidate vaccines in clinical evaluation (WHO, 29 July,
2020)
 6 candidate vaccine are in phase 3 (WHO, 29 July, 2020)
 Phase I human trials of Bharat Biotech’s Covaxin, India’s first
indigenous Covid-19 vaccine candidate is ongoing
 India's second COVID-19 vaccine candidate 'ZyCoV-D' to
start human trials

24.  “Due to globalisation, the intense mobility of human population and the relentless urbanisation, it
is likely that the next emerging virus will spread fast and far. It is impossible to predict the nature
of this virus or the source or where it will start spreading.” (WHO’s handbook, 2018)
 75% of emerging diseases of people are zoonotic or originated with animals (ILRI, 2016)
 Newly discovered diseases and the re-emergence of many long-established ones demand urgent
responses in all countries and planning and preparation of epidemic prevention and control
2019).
IMPORTANCE OF 'ONE HEALTH' APPROACH IN THE TIME OF
COVID-19 OUTBREAK
RESPONSE TO COVID-19
 WHO, OIE, FAO and countries are working together to:
 Identify the zoonotic source of the virus and the route of introduction to the human
population, including the possible role of intermediate hosts.
 Provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and
prevent the establishment of new zoonotic reservoirs.
 One Health approach is inevitable or else early signals of the emergence of such
viruses in animals or on the environment would be missed.
 Comprehensive approach to One Health is needed to deal with the complexities of
changing disease landscape (FAO, 2013).

25. CONCLUSION
 The importance of proper preparation prior to the travel requires to be
adequately informed by specialized healthcare professionals, and to receive
appropriate vaccinations and medications, when required is paramount.
 Need for further development of the branch of travel medicine and travel
health
 Research and development in discovery of managemental drug and early
vaccine production to mitigate the situation of current Pandemic.
 More robust, public awareness strategies to make the common people more
reactive and alert
 Wide scale testing of susceptible animal species is needed to assess the extent
of animal infection under more natural conditions .