Office of Continuing Medical Education and Professional Development. COVID-19: Clinical Updates Webinar 02/04/2020 This material is for individual use only and not to be used for further dissemination. 1 COVID-19 and SARS-CoV-2 Infection Prevention and Control J Conly Faculty/Presenter Disclosure • Financial disclosure affiliations – John Conly : • Honoraria: None • Speakers' Bureaux, advisory boards: Received funding to attend a meeting on HAI from the CDC and bioMerieux • Grants/Clinical Trials: Local PI for the STRIVE S. aureus vaccine trial spinal surgery (Pfizer) and holds grants from CIHR, AI-HS, PHAC, AH, AHS, EDT. • Patents, royalties: None • Investments in health organizations: None • Other influential affiliations: Member of committees with PHAC, WHO and CIHR 26 Environmental specimens • 585 samples collected from 2 batches of South China Seafood City (sampling on 1/1/20): PCR tests showed that 33 samples + for SARS-CoV-2 nucleic acid N-CoV was successfully isolated from + environmental specimens as well (ProMed) Patient specimens BAL samples (Zhu NEJM) + viral isolation Nasopharyngeal/oropharyngeal (NP/OP) swabs + multiple studies Serum (Lancet 2020) + one patient and Stool RNA in the of infected patients (ProMed, Holshue NEJM 2020) and 1/3 of patients in the WHO –China Joint Mission Exact duration of shedding not known with certainty Healthcare workers (HCWs) • 7% HCW infections reported in a series of 425 Chinese patients from Wuhan (Li, NEJM) • Vast majority before outbreak recognized and most transmissions were at home • Multiple HCWs reported confirmed cases inside and outside of China • In a single-center series n= 138 hospitalized cases in Wuhan, China, presumed hospital-related transmission of SARS-CoV-2 was suspected in 41% of patients (Wang, JAMA). • Recent paper Wuhan ( CID March 2020) single highest RR was poor HH/poor adherence to technique despite full PPE use State of the art SARS-CoV-2 25 26 27
Transcript
Office of Continuing Medical Education and Professional Development. COVID-19: Clinical Updates Webinar
02/04/2020
This material is for individual use only and not to be used for further dissemination. 1
COVID-19 and SARS-CoV-2 Infection Prevention and Control
J Conly
Faculty/Presenter Disclosure
• Financial disclosure affiliations – John Conly :• Honoraria: None• Speakers' Bureaux, advisory boards: Received funding to attend a meeting on HAI from the
CDC and bioMerieux• Grants/Clinical Trials: Local PI for the STRIVE S. aureus vaccine trial spinal surgery (Pfizer) and
holds grants from CIHR, AI-HS, PHAC, AH, AHS, EDT. • Patents, royalties: None• Investments in health organizations: None• Other influential affiliations: Member of committees with PHAC, WHO and CIHR
26
Environmental specimens• 585 samples collected from 2 batches of South China Seafood City (sampling on 1/1/20):
PCR tests showed that 33 samples + for SARS-CoV-2 nucleic acid N-CoV was successfully isolated from + environmental specimens as well (ProMed)
Patient specimens BAL samples (Zhu NEJM) + viral isolation Nasopharyngeal/oropharyngeal (NP/OP) swabs + multiple studies Serum (Lancet 2020) + one patient and Stool RNA in the of infected patients (ProMed, Holshue NEJM 2020) and 1/3 of patients in the WHO
–China Joint Mission Exact duration of shedding not known with certainty
Healthcare workers (HCWs)• 7% HCW infections reported in a series of 425 Chinese patients from Wuhan (Li, NEJM)• Vast majority before outbreak recognized and most transmissions were at home • Multiple HCWs reported confirmed cases inside and outside of China• In a single-center series n= 138 hospitalized cases in Wuhan, China, presumed hospital-related
transmission of SARS-CoV-2 was suspected in 41% of patients (Wang, JAMA).• Recent paper Wuhan ( CID March 2020) single highest RR was poor HH/poor adherence to
technique despite full PPE use
State of the art SARS-CoV-2
25
26
27
Office of Continuing Medical Education and Professional Development. COVID-19: Clinical Updates Webinar
02/04/2020
This material is for individual use only and not to be used for further dissemination. 2
Wolfel et al Nature Med Apr 1 2020
Virus wasreadily isolated during the first week of symptoms from a considerablefraction of samples (16.66% in swabs, 83.33% in sputum samples)
No isolates of virus were obtained from samples taken after day 8 in spite of ongoing high viral loads by RT-PCR
How COVID-19 spread compares
Source: Knvul Sheikh, Derek Watkins, Jin Wu and Mika Gröndahl, How Bad Will the Coronavirus Outbreak Get? Feb 1 2020. The New York Times
Liu, Gayle, Wilder-Smith & Rocklov. The reproductive number of COVID-19 is higher compared to SARS coronavirus. Journal of Travel Medicine. February 13, 2020
Range R01.96-6.47
Basic reproductive number (R0)
the average number of individuals infected by a case over the infectious
period, in a fully susceptible population.
Most experts suggest it is falling into range of2.0 -2.3 , including
Lombardy
Droplet and contact – multiple studies demonstrated compliance with gloves, gowns and medical masks or N95s were adequate to prevent transmission for SARS; major risks exposure of eye and mucous membranes to resp secretions and AGMPs, ie intubation (opportunistic airborne); no association with contact with urine/stool
HCW spread - associated with inconsistent or improper PPE use for SARS/MERS-CoV outbreaks; Infections in HCWs: 22% and 25% for SARS and MERS, respectively
Risk factors for nosocomial spread of MERS-CoV in two large outbreaks in Saudi Arabia and South Korea found ER/Ward overcrowding and sub-optimal control of visitors were factors
Transmission of MERS-CoV was not documented in an investigation of mostly asymptomatic and pauci-symptomatic cases and their household contacts
Asymptomatic cases uncommon – one study of MERS cases found 80% of “asymptomatic” persons actually had symptoms on close questioning
State of the art - evidence from SARS-CoV andMERS-CoV relevant to IPC
Seto WH et al Lancet 2003;Raboud J et al Plos One 2010; Jefferson et al Cochrane Rev 2011; Oboho IK et a NEJM 2015;Kim SW CID 2017; Cheng VC et al Antiviral Res 2013; Van Kerkhove MD et al Sci Rep. 2019.
28
29
30
Office of Continuing Medical Education and Professional Development. COVID-19: Clinical Updates Webinar
02/04/2020
This material is for individual use only and not to be used for further dissemination. 3
Image: Dan Rowlands / SWNS.com
Image: STRINGER/EPA-EFE/REX
SARS-CoV-2Transmission Routes
Source: J.A. Otter et al. / Journal of Hospital Infection 92 (2016) 235e250
Ong SW et al Air, Surface Environmental, and Personal Protective Equipment Contamination by (SARS-CoV-2)From a Symptomatic Patients March 4 Online JAMA 2020
Van Doremalen et al Aerosol and surface stability of HCoV-19 (SARS-CoV-6 2) compared to SARS-CoV-1. NEJM online March 17 2020
- New publication released week of March 16, 2020. - Creating a stir on social media that COVID-19 is airborne- Used a 3 jet nebulizer /drum and 10 ml sample akin to a “bomb” of
of the virus and demonstrated dispersal- No correlation whatsoever to the clinical setting and does
not simulate coughing - a system used for bioterroism studies
31
32
33
Office of Continuing Medical Education and Professional Development. COVID-19: Clinical Updates Webinar
02/04/2020
This material is for individual use only and not to be used for further dissemination. 4
![Page 1: K ( ( ] } ( } v ] v µ ] v P D ] o µ ] } v v W } ( ] } v o À o } u v X Ks/ r í õ W ... · 2020. 4. 2. · ^ } t, o > v î ì ì ï VZ } µ : o W o } K v î ì í ì V : ( (](https://reader033.documents.pub/reader033/viewer/2022060915/60a8c3521fefe5678e533b1e/html5/thumbnails/1.jpg)
![Page 2: K ( ( ] } ( } v ] v µ ] v P D ] o µ ] } v v W } ( ] } v o À o } u v X Ks/ r í õ W ... · 2020. 4. 2. · ^ } t, o > v î ì ì ï VZ } µ : o W o } K v î ì í ì V : ( (](https://reader033.documents.pub/reader033/viewer/2022060915/60a8c3521fefe5678e533b1e/html5/thumbnails/2.jpg)
![Page 3: K ( ( ] } ( } v ] v µ ] v P D ] o µ ] } v v W } ( ] } v o À o } u v X Ks/ r í õ W ... · 2020. 4. 2. · ^ } t, o > v î ì ì ï VZ } µ : o W o } K v î ì í ì V : ( (](https://reader033.documents.pub/reader033/viewer/2022060915/60a8c3521fefe5678e533b1e/html5/thumbnails/3.jpg)
![Page 4: K ( ( ] } ( } v ] v µ ] v P D ] o µ ] } v v W } ( ] } v o À o } u v X Ks/ r í õ W ... · 2020. 4. 2. · ^ } t, o > v î ì ì ï VZ } µ : o W o } K v î ì í ì V : ( (](https://reader033.documents.pub/reader033/viewer/2022060915/60a8c3521fefe5678e533b1e/html5/thumbnails/4.jpg)
![Page 5: K ( ( ] } ( } v ] v µ ] v P D ] o µ ] } v v W } ( ] } v o À o } u v X Ks/ r í õ W ... · 2020. 4. 2. · ^ } t, o > v î ì ì ï VZ } µ : o W o } K v î ì í ì V : ( (](https://reader033.documents.pub/reader033/viewer/2022060915/60a8c3521fefe5678e533b1e/html5/thumbnails/5.jpg)
![d Z Z } o o ] v P ^ o ^ À ] } } DK > ð ì ì · ^ o ( r o ] P v ] v P } o o } Á ( } } v } ( Z o X í ì X í ì X K } v o s ] ] } v > ] ð X](https://static.documents.pub/doc/80x56/5b98146709d3f2fd558b7914/d-z-z-o-o-v-p-o-a-dk-d-i-i-o-r-o-p-v-v-p-o-o-.jpg)
![} U ' } o ' } Á Z v ] } À Ç ] v Z u ] } } W v ] } v : µ o Ç î ì î ì...^ Yy & ] v v ] o ^ u v ( } ( µ o o Á v ] ] v P ] o X ø : µ v í í U î ì î ì µ ] v } Æ ' }](https://static.documents.pub/doc/80x56/5f987da300d10336f248fb0a/-u-o-z-v-v-z-u-w-v-v-o-.jpg)
![v v ] } v o ^ Ç u } ] µ u } v D µ o ] ] ] o ] v Ç ^ µ ... · Z ] W d ] o µ Z } ^ l ò õ r ^ v o } v ' Ç r } Æ Z d & µ Ì Ì K À Ì l ] v < X U P Ì o ] l 7 X K À Ì](https://static.documents.pub/doc/80x56/5c02669c09d3f2ab198b65c2/v-v-v-o-c-u-u-v-d-o-o-v-c-z-w-d-o-.jpg)
![} u ] v / rK P v ] Ì ] } v o ~ o o W } i î X X ] î X X ......Z À ] Á ^ µ s À ] o o s Á i µ u v E s s } u o í X ì ì í X ì ì ì X ì ì í X ì ì í ì ì 9](https://static.documents.pub/doc/80x56/5ff3348c4673c51bd903a80a/-u-v-rk-p-v-oe-v-o-o-o-w-i-x-x-x-x-z-.jpg)
![D Ì î ì î ì v ] Z P Z o v OLHEH *HPHLQGHE UJHU /LHEH ... · D Ì î ì î ì v ] Z P Z o v Á v U } v v Á µ ( º v í ô X ñ X î ì î ì ] v µ ( v X](https://static.documents.pub/doc/80x56/5f082ece7e708231d420c034/d-oe-v-z-p-z-o-v-olheh-hphlqghe-ujhu-lheh-d-oe-v.jpg)
![o o ] v ( } t ^ Á Z ] v Z & } Ç ] o ô Z U î ì í ð · o ] v E u E o t P Ç v Z t^ Z ( v E µ u t^ r ì í ì r/Ed r r ì ì r ì ñ r ì ì ì ð r ì ì ï ô. ^ Z Á Z o o](https://static.documents.pub/doc/80x56/5ecaeae12366eb3186732f19/o-o-v-t-z-v-z-o-z-u-o-v-e-u-e-o-t-p-.jpg)
![NOMINATI 20-21 SETT GPS - istruzionetreviso.it · ] } À À ] } } v À } Ì ] } v } X v X ô ð ó õ o í ñ l ì õ l î ì î ì r } v ] v } u ] v ] ] o í õ l ì õ ] o î ì](https://static.documents.pub/doc/80x56/60aa65e64d76694d6300a7cf/nominati-20-21-sett-gps-v-oe-v-x-v-x-o.jpg)
![K v Á ^ } } u P ] Z o v ^ Z o v D î ì î î r î ì î ó K v } v Ì } l...P ] v î ^ } } u P ] Z o v ^ Z o v D î ì î î r î ì î ó K v } v Ì } l í ñ l ì õ l î ì t](https://static.documents.pub/doc/80x56/6075b4dbb0c0a25702570644/k-v-u-p-z-o-v-z-o-v-d-r-k-v-v-oe-l-.jpg)
![o v - OECD€¦ · / o v K ] P ] v o í ó r í î r î ì ì ï í ó r í î r î ì ì ð í î } v À v ] } v Á v Z Z µ o ] } ( / o v v Z / o ] v Z µ o ]](https://static.documents.pub/doc/80x56/5f1981f669ff5869de0c804c/o-v-o-v-k-p-v-o-r-r-r-r-.jpg)
![^ /D^ D v µ o D X/D^ X ì ì ì ì í r ì í í · D X/D^ X ì ì ì ì í r ì í í E u s o ] ] } v W Ç W o o ] } v < ZZ s o ] î ñ l ì ð l î ì í õ s ] ( ] Ç W v v ]](https://static.documents.pub/doc/80x56/5e6b120b2868a730a95c7c3b/-d-d-v-o-d-xd-x-r-d-xd-x-r-.jpg)
![u ] v < v v o o µ î ì î ì E ] } v o P ] o ] Ç Z u ] } v Z ] &/E ......2019/12/18 · u ] v < v v o o µ î ì î ì E ] } v o P ] o ] Ç Z u ] } v Z ] &/E > > ]](https://static.documents.pub/doc/80x56/5f8c184a54e5124e7437a327/u-v-v-v-o-o-e-v-o-p-o-z-u-v-z-e-.jpg)
![v ] o ] P v } ] } ( ] Ì Ì ] v µ ] v P s ] µ o v o o d Diagnosis.pdf · v ] o ] P v } ] } ( ] Ì Ì ] v µ ] v P s ] µ o v o o d ... ð ò](https://static.documents.pub/doc/80x56/5f8690f22daff8762a684168/v-o-p-v-oe-oe-v-v-p-s-o-v-o-o-d-diagnosispdf-v-o.jpg)
![v ] o l o Ç s// v } l Ì Á ] Ì v ] Ì i ' Á Ì l } o U i X í ...sp108.edu.pl/wp-content/uploads/2020/03/ZADANIA_KL_VIIA-jp.pdf · v ] /// n E } Á ] Ì P } u Ì } v Ç Z ] v](https://static.documents.pub/doc/80x56/5f377aef99d83719b20187fd/v-o-l-o-s-v-l-oe-oe-v-oe-i-oe-l-o-u-i-x-sp108eduplwp-contentuploads202003zadaniaklviia-jppdf.jpg)
![' u ] v P E ÁD ] v v } ' u o ] v P } v } o } Gaming News, October, November, December î ì 20 î ì î ì > P ] o } v](https://static.documents.pub/doc/80x56/61255bcd660d0b5c0765fc8d/-u-v-p-e-d-v-v-u-o-v-p-v-o-gaming-news-october-november-december.jpg)
![2018 HC Points for PDF 2018-08-13-1425...^ } v o W o Ç } ( ( v v } v î ì í ô r ì ñ r ì òd ì ì W ì ì W ì ì X ì ì ì } } v } o ò õ µ } ò v ( } u o ] v P õ ] v u,](https://static.documents.pub/doc/80x56/5f0cf19c7e708231d437e69e/2018-hc-points-for-pdf-2018-08-13-1425-v-o-w-o-v-v-v-.jpg)
![] o ] u… · 2020. 9. 21. · í ó l ì ï l î ì î ì v Ç À ] Á } v ] v ] v Z ] µ o ] } v } v } v ] o Ç v Z À ] Á } ( í ó l ì ï l î ì î ì ð K À À ] Á î ì](https://static.documents.pub/doc/80x56/60f8dd66ae7a7704e365c0c6/-o-u-2020-9-21-l-l-v-v-v-v-z.jpg)
![v v o µ ] W o v î ì î ì r î í l î ì î î r î ... · / v v o µ ] W o v î ì î ì r î í l î ì î î r î ï ( / v v o µ ] W o v î ì î ì r î í l î ì î î](https://static.documents.pub/doc/80x56/600570084499ff768d735382/v-v-o-w-o-v-r-l-r-v-v-o-w-o-v-.jpg)
![] o o ] v P W } À/ ^ À ] ] ] Z ] u u · 2018. 5. 4. · ì ì ô ì ì õ ô í ó D v o , o Z rW Ç Z } o } P Ç , ] o o } } µ P Z ¨ ì X ì ì ì ì ô ì ì õ ô í ô D v](https://static.documents.pub/doc/80x56/5fcff21319338404f02a86e2/-o-o-v-p-w-z-u-u-2018-5-4-.jpg)