COVID-19(2019 NCO-V)
SARI (SEVERE ACUTE RESPIRATORY INFECTION)
David Jay Weber, M.D., M.P.H., FSHEA, FIDSA, FRSM (London)Professor of Medicine, Pediatrics, EpidemiologyAssociate Chief Medical Officer, UNC Hospitals
Medical Director, Hospital EpidemiologyUniversity of North Carolina at Chapel Hill
CORONAVIRUSES
Size and shape: 120-160 nm, pleomorphic Genome: Single-stranded, linear, positive-
sense RNA Enveloped: Yes Reservoirs: Humans, multiple animal
species Syndromes
Common colds: Account for up to 50% of upper respiratory tract infections
Gastroenteritis SARS, MERS, SARI (nCo-V)
S glycoproteinM glycoprotein
E protein
N-nucleocapsid protein
Genomic RNA
Lipid Envelope
HelicalNucleocapsid
HE glycoprotein
NON-EPIDEMIC, HUMAN CO-VS: EPIDEMIOLOGY
Epidemiology Worldwide; winter and spring in temperate climates Exposure common in early childhood Droplet, contact, and indirect contact Symptoms and viral loads high first few days of illness Incubation period 2–5 days
Symptoms Most often associated with upper respiratory tract infections in children Lower tract infections in immunocompromised individuals and older adults May play a role in exacerbations of underlying respiratory diseases
https://www.bbc.com/new s/world-51235105
Symptoms of COVID-19
• Uncomplicated upper respiratory infection:
• Fever• Cough• Sore throat• Nasal congestion• Malaise• Headache• Myalgias• Shortness of breath
• Complications for infection:• Mild to severe pneumonia• Acute Respiratory Distress
Syndrome• Sepsis• Septic shock
THE RISK OF INFLUENZA VS COVID-19
Burden of influenza, US, 2018-19 35,000,000 illnesses 16,500,000 medical visits 490,000 hospitalizations 34,200 deaths
Burden of COVID-19 (as of 2/29)
Total cases: 85,403 China: 79,394
Total deaths: 2, 924 China: 2,838
COVID-19: Confirmed and Presumptive Positive Cases in the United States*
Confirmed Presumptive + Confirmed and presumptive +
Travel related 12 1 13
Person to person 3 6 9
Total cases 15 7 22
Total tested 472 NA 472
Deaths 0 1 1
* It does not include people who returned to the U.S. via State Department-chartered flights.
https://www.bbc.com/news/world-51235105
COVID-19: WHAT WE KNOW
Initial cases likely represented animal-to-human transmission(likely reservoir is bats)
Person-to-person transmission documented (US also) to closecontacts
Transmission droplet/contact Infectivity 2.2-2.8 High attack rate in confined quarters (cruise ships)
Super-spreaders reported Transmit infection to > 10 persons
COVID-19: WHAT WE KNOW
Sustained numbers of healthcare personnel (HCP) infected: 1,700 in China Based on other coronaviruses: Any FDA-approved antiseptic will inactivate and any EPA-registered
disinfectant with a coronavirus claim will inactivate CDC sent out defective diagnostic test kits to >25 countries and US health departments Economic consequences include a shortage of PPE (masks), increase price of basic commodities in
hardest hit areas of China and closure of some factories outside of China that use Chinese parts Symptoms are typical of a respiratory tract infection:
Fever, cough, shortness of breath (fever may be absent)
Older adults and person with co-morbidities may be at higher risk for severe disease
Some patients may present with GI symptoms (nausea, vomiting, diarrhea)
COVID-19: WHAT WE DO NOT KNOW
Transmission: Unknown whether virus can be transmitted by the airborne route (i.e., >6 feet) or by indirect contact (likely based on SARS –CoV and MERS-CoV)
Morbidity and mortality (biases could result in under or over estimates)How frequently asymptomatic but infected persons can transmit infectionWhether persons before becoming symptomatic can transmit infection Frequency of super-spreaders When the outbreak will peak and number of countries that will be affected Impact of the outbreak and travel curtailment on goods and supplies from China:
High likelihood of shortages of drugs and PPE
IMPACT OF A SINGLE SUPERSPEADER
A single traveler to Republic of Korea led to an outbreak in thatcountry
COVID-19: WHAT WE DO NOT KNOW
When the outbreak will peak and the number of countries that will be affectedMethod of acquisition by HCP:
In community Failure to promptly identify and isolate cases in the healthcare facility Adequate PPE Improper donning and doffing of PPE OR Failure of properly donned and doffed PPE
Possibility of transmission by contact or aerosolization of feces: COVID-19 detected in stool, patients may have nausea and vomiting
PREVENTION FOR THE GENERAL PUBLIC, CDC
Recommendations to prevent transmission of ALL viral respiratory pathogens Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer
that contains at least 60% alcohol if soap and water are not available Avoid touching your eyes, nose, and mouth with unwashed hands Avoid close contact with people who are sick Stay home when you are sick Cover your cough or sneeze with a tissue, then throw the tissue in the trash Clean and disinfect frequently touched objects and surfaces
NCDHHS2/28/20
Case Investigation and Testing Clinicians are encouraged to screen for possible infection by the virus that causes COVID-19 by asking:
Does the person have fever OR Symptoms of lower respiratory illness, such as cough or shortness of breath?
AND Has the patient traveled to an affected geographic area within 14 days of symptom onset?
OR Has the patient had close contact with a person with COVID-19?
Patients who meet the following criteria should be evaluated as a Patient Under Investigation (PUI) in association with the outbreak of COVID-19: Fever OR signs/symptoms of lower respiratory illness (e.g., cough, shortness of breath) in any person,
including healthcare workers, who has had close contact with a laboratory-confirmed COVID-19 patient within 14 of symptom onset.
LONG TERM CARE FACILITY GUIDANCE
Diligence with respiratory hygiene/cough etiquette AND Standard precautionsAdvise staff, other caregivers and volunteers with symptoms of an acute
respiratory infection not to come to work and report their symptoms to infection prevention.
Consider posting signs at entry to the building for anyone entering the LTCF (i.e., visitors, staff, volunteers) to self-identify if they have relevant symptoms and travel history/exposure: including
Screening of new resident admissions, re-admissions. Staff education regarding coronavirus transmission/prevention.
Adhering to standard infection preventions practices such as hand hygiene, respiratory hygiene/cough etiquette and environmental cleaning are essential in reducing risk of transmission
