COVID-19: What Should you know?

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Introduction


Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV)[1] and Severe Acute Respiratory Syndrome (SARS-CoV)[2]. A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.

On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization declared the outbreak a “public health emergency of international concern external icon” (PHEIC)[3]. The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).


Healthcare personnel (HCP) have an increased risk of exposure to the Coronavirus as we are on the front lines of caring for the patients with confirmed or possible coronavirus disease 2019 (COVID-19) infection. There is a very real chance that we may have to look after somebody with suspected COVID-19 over the coming weeks and months. In order to best protect ourselves, we have to minimize the risk of exposure when caring for confirmed or possible COVID-19 patients by following CDC infection prevention and control guidelines, including use of recommended personal protective equipment (PPE).


We must be aware the COVID -19/Corona Virus situation is changing from day to day and our internal contingency plans are updated accordingly.


Symptoms of coronavirus

Image source: NewYork Times


COVID-19 can take up to 14 days for symptoms to appear. The most common symptoms of coronavirus are:

o Headache

o Sore throat

o Runny nose

o Cough

o Fever

o A general feeling of being unwell


Read the lastest COVID-19 Updates here


Case Definition

Possible case

Patients with severe acute respiratory infection requiring admission to hospital with clinical or radiological evidence of pneumonia or acute respiratory distress syndrome [4].


OR


Patients with acute respiratory infection of any degree of severity including at least one of the following: fever, cough, shortness of breath


OR


Fever of unknown cause with no other symptoms


AND


In the 14 days prior to onset of symptoms, met at least one of the following epidemiological criteria:

  • Were in close contact with a case of COVID-19 infection;

OR

OR

  • Worked in or attended a health care facility where patients with COVID-19 infections were being treated.


As clinicians, we must always be alert to the possibility of atypical presentations in immunocompromised patients .


Probable case

A possible case for whom testing for SARS-CoV-2 virus (COVID-19 infection) is inconclusive (the result of the test reported by the laboratory) or for whom testing was positive on a pan-coronavirus assay [4].


Confirmed case

A person with laboratory confirmation of SARS-CoV-2 virus (COVID-19 infection), irrespective of clinical signs and symptoms.


Close contact

Any individual who has had greater than 15 minutes face-to-face (<2 metres distance) contact with a laboratory confirmed case, in any setting [4].


According to the Irish Health Protection Surveillance Center website [4], Healthcare workers, including laboratory workers, who have not worn appropriate PPE or had a breach in PPE during the following exposures to the confirmed case:

  • Direct contact with the case their body fluids or their laboratory specimen

  • Present in the same room when an aerosol generating procedure is undertaken on the case

For those contacts who have shared a closed space with a confirmed case for longer than two hours, a risk assessment should be undertaken taking into consideration the size of the room, ventilation and the distance from the case.

  • This may include office and school settings and any sort of conveyance.

  • A contact in an aircraft sitting within two seats (in any direction) of the COVID-19 case, travel companions or persons providing care, and crew members serving in the section of the aircraft where the index case was seated (if severity of symptoms or movement of the case indicate more extensive exposure, passengers seated in the entire section or all passengers on the aircraft may be considered close contacts)

  • An assessment for other respiratory pathogens e.g. influenza, RSV and also for avian influenza risk factors should also be carried out for every individual that has travelled to China in the 10 days prior to onset of fever and lower respiratory tract symptoms.


COVID-19 transmission

Image source: alliance/dpa/C. Klose


Coronavirus is spread in sneeze or cough droplets.

One could get the virus if [5]:

  • He/she comes into close contact with someone who has the virus and is coughing or sneezing

  • He/she touches surfaces that someone who has the virus has coughed or sneezed on.

As it's a new illness, we do not know how easily the virus spreads from person to person. Spread is most likely from those who have symptoms [6].


The virus may only survive a few hours if someone who has it coughs or sneezes on a surface. Simple household disinfectants can kill the virus on surfaces. Clean the surface first and then use a disinfectant.


Person-to-person spread

  • The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet).

  • Through respiratory droplets produced when an infected person coughs or sneezes.

  • These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.


Can someone spread the virus without being sick?

  • People are thought to be most contagious when they are most symptomatic (the sickest).

  • Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.


Spread from contact with infected surfaces or objects

  • It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.


How easily the virus spreads?

  • How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily.

  • Another factor is whether the spread is sustained, spreading continually without stopping.

  • The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas.

  • One case which is community acquired is currently in hospital in Cork University Hospital in Ireland. The patient had not travelled abroad [7].


When you may need to be tested for coronavirus?

You will need to be tested for coronavirus if you have symptoms and have in the last 14 days been:


Packages from affected countries

  • There is no evidence that one can get coronavirus from packages or food that has come from China or elsewhere.


At-risk groups and coronavirus

There is little evidence on which groups are most at risk of complications if they catch coronavirus. Surely, below groups have been reported to be high risk:

  • 60 years of age and over

  • Long-term medical condition – for example, heart disease, lung disease, high blood pressure, diabetes or cancer

  • Pregnant women


Kindly should follow the advice on how to protect yourself and others from coronavirus and other infections like flu.


Pets and coronavirus

  • There is no evidence that pets such as cats and dogs can catch or spread coronavirus.


Prevention


Face Mask

Image source: Khaleej Times


  • Facemasks help limit the spread of germs.

  • In the community, face masks can be helpful in preventing people who have coronavirus disease from spreading it to others.

  • Well people do not need to wear a surgical mask as there is little evidence supporting the widespread use of surgical masks in healthy people to prevent transmission in public.

  • Patients can consider wearing a face mask when they are sick with a cough or sneezing illness (with or without fever) and they expect to be around other people.

  • The face mask will help protect others from catching their illness. Healthcare settings have specific rules for when people should wear face masks [9].


Find out more in the WHO page about the use of surgical masks. [10]


There are some good videos of how to put on and remove PPE for different healthcare situations here: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/infectionpreventionandcontrolguidance/


Hand Hygiene

It is strongly advised to practise good hygiene to protect against infections. Good hygiene includes:

  • Washing your hands often with soap and water

  • Using a tissue and cover your mouth when you cough or sneeze

  • Avoiding close contact with others, such as touching


Read more about protective measures against coronavirus on the World Health Organization website.



How to isolate yourself

  • If you have a confirmed case, you need to isolate yourself to prevent it spreading to other people

  • Do not go to public places, such as work, school, shopping centres, childcare or university.

  • If possible, ask other people to get food and other necessities for you and leave them at your front door.

  • Only people who usually live with you should be in your home. Do not let in visitors.

  • You do not need to wear a mask in your home.

  • If you need to leave home to seek medical attention, wear a surgical mask (if you have one) to protect others.


Treatment for coronavirus

  • No specific treatment for coronavirus so far.

  • The treatment remains symptomatic and supportive (oxygen).

  • Life support can be used in extreme cases.

  • There is no place for antibiotics against coronavirus or any viruses. They only work against bacterial infections.

  • If you have been diagnosed with coronavirus, isolate yourself in your home.


The process to follow when assessing a possible COVID patient is here:

https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/algorithms/


Vaccine

  • Currently, there is no vaccine to treat or protect against coronavirus.

  • While the flu vaccine is used to protect against Flu, it does not protect against coronavirus.


Read the progress on vaccine here


Mortality rate

According to the World Health Organization briefing of last week, the mortality rate of COVID-19 can differ, ranging from 0.7% to up to 4%, depending on the quality of the health-care system where it's treated. Initially, scientists estimated the death rate around 2.3% but today, globally, about 3.4% of reported COVID-19 cases have died," WHO Director-General Tedros Adhanom Ghebreyesus said during a press briefing at the agency's headquarters in Geneva [11]. In comparison, seasonal flu generally kills far fewer than 1% of those infected, he said.


See also: Death Rate by Age and Sex of COVID-19 patients


More information

  1. COVID-19 Live updates 

  2. COVID-19 situation summary - how the world is responding to the global spread of coronavirus

  3. Updated travel information and advice- General travel advice

  4. Information for health professionals- What Healthcare Personnel Should Know about Caring for Patients with Confirmed or Possible COVID-19 Infection

  5. COVID-19: Drugs &Vaccine- A detailed guide to the coronavirus drugs and vaccines in development

  6. New Cases In Your Country- An up-to-date number of new cases in your area

  7. Death Rate by Age and Sex of COVID-19 patients- The most up-to-date mortality rate globally

  8. Updated case counts in English can be found on these websites :


References

[1]https://www.who.int/emergencies/mers-cov/en/ [2]https://www.who.int/csr/sars/en/ [3] https://www.cdc.gov/coronavirus/2019-ncov/summary.html [4] https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casedefinitions/ [5] https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html [6] https://www2.hse.ie/conditions/coronavirus/coronavirus.html [7] http://www.redfm.ie/news/cork/confirmed-7-new-coronavirus-cases-in-ireland-including-one-in-cork/ [8] https://www.uptodate.com/contents/general-travel-advice-beyond-the-basics [9]https://www.sfcdcp.org/communicable-disease/healthy-habits/how-to-put-on-and-remove-a-face-mask/ [10] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

[11] www.worldometers.info/coronavirus/coronavirus-death-rate/


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