Covid-19

MERS

Middle East respiratory syndrome

Dealing with the COVID-19 disease requires prompt detection of new cases, continued monitoring and tracking of the disease spread, effective triage and isolation of infected patients, and the protection of the community and healthcare workers. The following CDC interim guidelines for minimizing the risk of exposure to this virus are recommended.

1. Assess and triage patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a mask on the patient and isolating them in an Airborne Infection Isolation Room (AIIR), if available. 2. Use Standard Precautions, Contact Precautions, Airborne Precautions and eye protection when caring for patients with confirmed or possible COVID-19. 3. Perform hand hygiene with alcohol-based hand sanitizer before and after all patient contact, contact with potentially infectious material, and before putting on personal protective equipment (PPE), including gloves. Use soap and water if hands are visibly soiled. 4. Practice how to properly don, use, and doff PPE in a manner to prevent self-contamination. 5. Perform aerosol-generating procedures, including collection of diagnostic respiratory specimens, in an AIIR, while following appropriate IPC practices, including use of appropriate PPE (7, 16, 21).

Currently, individuals can help prevent the transmission of the SARS-CoV-2 by following the interim U.S. guidelines recommended by the CDC. These include the following:

1. Avoid close contact with individuals who are sick. 2. Cover coughing and sneezing with a tissue. Cover your nose and mouth with a flexed elbow if tissues are unavailable and dispose of the tissue. 3. Refrain from touching your mouth and nose. 4. Wash your hands with soap and water for at least 20 seconds, after going to the bathroom, before eating, after coughing and sneezing, after blowing your nose, or when coming in contact with potentially infected items or dirty surfaces. If soap and water are not available, use a hand sanitizer that contains at least 60-95% alcohol. 5. Always wash your hands with soap and water if they are visibly dirty. 6. Clean and disinfect surfaces or items you touch often. This may include cell phones, computer keyboards and other work surfaces. 7. The CDC doesn't recommend that healthy people wear a facemask to protect themselves from respiratory illnesses. Only wear a mask if a healthcare provider tells you to do so. A facemask is not required if exhibiting no symptoms, as there is no evidence that wearing a mask protects non-sick persons. 8. Remain at home if you are sick except to get medical care. Do not go to work, school or public areas. Avoid using public transportation or ride-sharing. 9. Call ahead before visiting your doctor. 10. The World Health Organization (WHO) recommends that you avoid eating raw or undercooked meat or animal organs and to avoid contact with live animals and surfaces they may have touched if you're visiting live markets in areas that have recently had new coronavirus cases (18, 22).

What is considered a fever?

100.4 or greater without any antipyretics on board

People around the world commonly get infected with these four human coronaviruses

229E, NL63, OC43, and HKU1

Quarantine

A period of isolation to control the spread of infectious disease

What are additional symptoms the 4 coronavirus cause?

Additional symptoms can occur and include bronchiolitis and pneumonia.

HCoV-229E HCoV-NL63

Alpha Coronaviruses - Infections may be asymptomatic or associated with mild to moderate upper respiratory tract illness; signs/symptoms include general malaise, a sore throat, headache, sneezing, coughing, fever, and/or nasal discharge.

Healthcare providers should contact their local/state health department immediately to notify them of a person under investigation.

Are we supposed to report PUI ??? Who do we report to???

Time-since-illness-onset and time-since-recovery strategy (non-test-based strategy)*Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions:

At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, At least 7 days have passed since symptoms first appeared. (at least 10 days put in own words)

HCoV-OC43 HCoV-HKU1

Beta Coronaviruses - Infections are often asymptomatic; may be associated with mild to moderate upper respiratory tract illness; considered the second most common cause of the common cold. Common manifestations of the HCoV-HKU1 infection include dyspnea, cough, and rhinorrhea.

To date, there is no vaccine or drug available to prevent the disease.

Currently, individuals can help prevent the transmission of the SARS-CoV-2 by following the interim U.S. guidelines recommended by the CDC. These include the following:

brief interactions

Examples of include: briefly entering the patient room without having direct contact with the patient or their secretions/excretions, brief conversation at a triage desk with a patient who was not wearing a facemask. See Table 1 for more detailed information. Risk stratification can be made in consultation with public health authorities.

HCP PPE: None

Exposure category: Medium Recommended Monitoring for COVID-19 (until 14 days after last potential exposure) Active Work Restrictions for Asymptomatic HCPExclude from work for 14 days after last exposure

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care. Considerations for care at home include whether: The patient is stable enough to receive care at home. Appropriate caregivers are available at home. There is a separate bedroom where the patient can recover without sharing immediate space with others. Resources for access to food and other necessities are available. The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves and facemask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene); There are household members who may be at increased risk of complications from COVID-19 infection (.e.g., people >65 years old, young children, pregnant women, people who are immunocompromised or who have chronic heart, lung, or kidney conditions).

Close contacts should also follow these recommendations:

Make sure that you understand and can help the patient follow their healthcare provider's instructions for medication(s) and care. *You should help the patient with basic needs in the home and provide support for getting groceries, prescriptions, and other personal needs. *Monitor the patient's symptoms. If the patient is getting sicker, call his or her healthcare provider and tell them that the patient has laboratory-confirmed COVID-19. *This will help the healthcare provider's office take steps to keep other people in the office or waiting room from getting infected. *Ask the healthcare provider to call the local or state health department for additional guidance. *If the patient has a medical emergency and you need to call 911, notify the dispatch personnel that the patient has, or is being evaluated for COVID-19. *Household members should stay in another room or be separated from the patient as much as possible. *Household members should use a separate bedroom and bathroom, if available. *Prohibit visitors who do not have an essential need to be in the home. *Household members should care for any pets in the home. Do not handle pets or other animals while sick. For more information, see COVID-19 and Animals. *Make sure that shared spaces in the home have good air flow, such as by an air conditioner or an opened window, weather permitting. *Perform hand hygiene frequently. Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty. *Avoid touching your eyes, nose, and mouth with unwashed hands. *The patient should wear a facemask when you are around other people. If the patient is not able to wear a facemask (for example, because it causes trouble breathing), you, as the caregiver, should wear a mask when you are in the same room as the patient. *Wear a disposable facemask and gloves when you touch or have contact with the patient's blood, stool, or body fluids, such as saliva, sputum, nasal mucus, vomit, urine.Throw out disposable facemasks and gloves after using them. Do not reuse. When removing personal protective equipment, first remove and dispose of gloves. Then, immediately clean your hands with soap and water or alcohol-based hand sanitizer. Next, remove and dispose of facemask, and immediately clean your hands again with soap and water or alcohol-based hand sanitizer. *Avoid sharing household items with the patient. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. After the patient uses these items, you should wash them thoroughly (see below "Wash laundry thoroughly"). *Clean all "high-touch" surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day. Also, clean any surfaces that may have blood, stool, or body fluids on them. *Use a household cleaning spray or wipe, according to the label instructions. *Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product. Wash laundry thoroughly. **Immediately remove and wash clothes or bedding that have blood, stool, or body fluids on them. **Wear disposable gloves while handling soiled items and keep soiled items away from your body. **Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after removing your gloves. **Read and follow directions on labels of laundry or clothing items and detergent. **In general, using a normal laundry detergent according to washing machine instructions and dry thoroughly using the warmest temperatures recommended on the clothing label. *Place all used disposable gloves, facemasks, and other contaminated items in a lined container before disposing of them with other household waste. *Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after handling these items. Soap and water should be used preferentially if hands are visibly dirty. *Discuss any additional questions with your state or local health department or healthcare provider. Check available hours when contacting your local health department.

Persons who have COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions:

Resolution of fever without the use of fever-reducing medications and Improvement in respiratory symptoms (e.g., cough, shortness of breath) and Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart** (total of two negative specimens). *See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for 2019 Novel Coronavirus (2019-nCoV)for specimen collection guidance.

How was the virus was transmitted outside the city of Wuhan, China

The virus was transmitted outside the city of Wuhan by people travelling on planes, trains, and ships.

Who do these 4 coronavirus appear & what do they cause?

These four coronaviruses continually circulate in the human population and are the second most common cause of the "common cold".

Who is at risk for complications of the 4 coronavirus's?

These usually occur in immunocompromised adults, infants, and older adults.

zoonotic virus can be found in what animals?

These viruses can be found in camels, cattle, bats, cats, rats, mice, dogs, turkeys, horses and pigs.

What symptoms do these 4 coronavirus cause?

They cause upper and lower respiratory tract infections which are usually asymptomatic or associated with mild to moderate upper respiratory tract illness.

A report was generated from these meetings and was referred to as the "Report of WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)." The final report of the Joint Mission was submitted on February 28, 2020. The report identified the following signs and symptoms of the COVID-19 based on 55,924 laboratory confirmed cases.

Typical signs and symptoms included: fever (87.9), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgia or arthralgia (14.8%), chills (11.4%), nausea or vomiting (5%), nasal congestion (4.8%) and diarrhea (3.7%).

zoonotic

Viruses that can be transmitted between animals and humans.

Novel Coronavirus

a new strain of coronavirus that has not previously been identified in humans

World Health Organization (WHO)

a specialized agency of the United Nations that is concerned with world public health. WHO's primary role is to direct international health within the United Nations' system and to lead partners in global health responses.

Outbreak

a sudden increase in the number of cases of a disease in a particular place and time

Close contact is defined as—

a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a COVID-19 case - or - b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on).

Risk factors for COVID-19 are thought to be:

age (higher prevalence in adults aged 60-65 or older); individuals with pre-existing diseases/co-morbidities such as cardiovascular disease, diabetes, chronic respiratory diseases, renal disease and hypertension; gender (higher prevalence in men); and individuals living in areas, traveling to, or in close contact with individuals infected with the virus (3).

Pandemic

an epidemic that has spread over several countries or continents, usually affecting a large number of people

Epidemic

an increase, usually sudden, in the number of cases of a disease above what is normally expected in that population in that area

Coronaviruses (CoVs)

are a large family of viruses that can infect humans and animals around the world.

Respiratory symptoms consistent with COVID-19

are cough, shortness of breath, and sore throat. Medical evaluation may be recommended for lower temperatures (<100.0oF) or other symptoms (e.g., muscle aches, nausea, vomiting, diarrhea, abdominal pain headache, runny nose, fatigue) based on assessment by public health authorities.

Asymptomatic transmission

asymptomatic carriers of the virus who show no signs of being sick but have the virus and can spread it to others

Individuals with laboratory-confirmed COVID-19 who have not had any symptoms may discontinue home isolation when

at least 7 days have passed since the date of their first positive COVID-19 diagnostic test and have had no subsequent illness.(? but what about incubation period)

SARS-CoV and MERS-CoV are thought to have originated from what animals/mammals?

camels & or bats

Everyone will need to play a part in

decreasing and stopping the spread of the infection.

Symptoms of Covid-19

fever, cough, shortness of breath

A human coronavirus (HCoV)

found in the nasal discharge of patients with a common cold, was discovered by scientists in the 1960's.

Medium-risk exposures for HCP

generally include HCP who had prolonged close contact with patients with COVID-19 who were wearing a facemask while HCP nose and mouth were exposed to material potentially infectious with the virus causing COVID-19. Some low-risk exposures are considered medium-risk depending on the type of care activity performed. For example, HCP who were wearing a gown, gloves, eye protection and a facemask (instead of a respirator) during an aerosol-generating procedure would be considered to have a medium-risk exposure. If an aerosol-generating procedure had not been performed, they would have been considered low-risk. See Table 1 for additional examples.

Low-risk exposures for HCP

generally refer to brief interactions with patients with COVID-19 or prolonged close contact with patients who were wearing a facemask for source control while HCP were wearing a facemask or respirator. Use of eye protection, in addition to a facemask or respirator would further lower the risk of exposure.

Close contact

healthcare workers who are within approximately six feet of a person with COVID-19 for a prolonged period of time. Pending further investigation, anything longer than 1-2 minutes, should be considered prolonged.

Endemic

infectious agent in a population within a geographic area

Close contact for healthcare exposures

is defined as follows: a) being within approximately 6 feet (2 meters), of a person with COVID-19 for a prolonged period of time (such as caring for or visiting the patient; or sitting within 6 feet of the patient in a healthcare waiting area or room); or b) having unprotected direct contact with infectious secretions or excretions of the patient (e.g., being coughed on, touching used tissues with a bare hand).

Fever (HCP)

is either measured temperature >100.0oF or subjective fever. Note that fever may be intermittent or may not be present in some patients, such as those who are elderly, immunosuppressed, or taking certain medications (e.g., NSAIDs). Clinical judgement should be used to guide testing of patients in such situations.

CDC - Centers for Disease Control and Prevention

is one of the major operating components of the Department of Health and Human Services.

The mission of the CDC

is to protect America from health, safety and security threats, both foreign and in the United States.

Self-monitoring

means HCP should monitor themselves for fever by taking their temperature (> or =100 degrees F or subjective fever) twice a day and remain alert for respiratory symptoms (e.g., cough, shortness of breath, sore throat)*. Anyone on self-monitoring should be provided a plan for whom to contact if they develop fever or respiratory symptoms during the self-monitoring period to determine whether medical evaluation is needed.

Active monitoring

means that the state or local public health authority assumes responsibility for establishing regular communication with potentially exposed people to assess for the presence of fever or respiratory symptoms (e.g., cough, shortness of breath, sore throat)*. For HCP with high- or medium-risk exposures, CDC recommends this communication occurs at least once each day. The mode of communication can be determined by the state or local public health authority and may include telephone calls or any electronic or internet-based means of communication.

It was noted that symptoms of COVID-19 were non-specific and the disease presentation ranged from

no symptoms (asymptomatic) to severe pneumonia and death (20).

The outbreak of COVID-19 is a

rapidly evolving situation.

The first non-human coronavirus

was isolated in 1937. This was a virus that produced an infectious bronchitis in birds.

high-risk exposures for HCP

refer to HCP who have had prolonged close contact with patients with COVID-19 who were not wearing a facemask while HCP nose and mouth were exposed to material potentially infectious with the virus causing COVID-19. Being present in the room for procedures that generate aerosols or during which respiratory secretions are likely to be poorly controlled (e.g., cardiopulmonary resuscitation, intubation, extubation, bronchoscopy, nebulizer therapy, sputum induction) on patients with COVID-19 when the healthcare providers' eyes, nose, or mouth were not protected, is also considered high-risk.

SARS-CoV and MERS-CoV cause what symptoms?

resulted in cases of fatal respiratory diseases in humans.

How many current strains of coronavirus infect humans?

seven These include HCoV-NL63, HCoV-HKU1, HCoV-229E, HCoV-OC43, SARS-CoV, MERS-CoV, and SARS-CoV-2 (23).

SARS

severe acute respiratory syndrome

Social Distancing

social distancing includes minimizing exposure to infected individuals by avoiding large public gathering venues, adhering to spacing requirements in the workspace, and following proper personal hygiene practices.

Incubation period for Covid-19

thought to be 2-14 days

Zoonotic disease

zoonosis refers to an infectious disease caused by bacteria, viruses, fungi, or parasites that can be passed from animals to humans. These diseases are referred to as zoonotic diseases. Diseases such as the Ebola virus disease, rabies, malaria, Rocky Mountain spotted fever, and salmonella infections are examples of zoonotic diseases. Clinical manifestations of zoonotic diseases range from mild to severe, and some can be fatal.