CORONA VIRUS DISEASE (COVID-19)

CORONA VIRUS DISEASE (COVID-19)

INTRODUCTION

                                    

Corona virus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic. As of 27 April 2020, more than 2.97 million cases have been reported across 185 countries and territories, resulting in more than 206,000 deaths. More than 868,000 people have recovered.

Corona viruses (CoV) are a large family of viruses transmitting between animals and people that cause illness ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV).

The virus is primarily spread between people during close contact, often via small droplets produced by coughing, sneezing, or talking. The droplets usually fall to the ground or onto surfaces rather than remaining in the air over long distances. People may also become infected by touching a contaminated surface and then touching their face. In experimental settings, the virus may survive on surfaces for up to 72 hours. It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease

SIGN & SYMPTOMS: -

                                                   

Common symptoms include fever, cough, fatigue, shortness of breath and loss of smell. While the majority of cases result in mild symptoms, some progress to viral pneumonia, multi-organ failure, or cytokine storm. More concerning symptoms include difficulty breathing, persistent chest pain, confusion, difficulty waking, and bluish skin. The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days.

DECLARATION BY HEALTH CARE AGENCIES: -

                             

The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 and a pandemic on 11 March 2020. Local transmission of the disease has occurred in most countries across all six WHO regions.

Currently, there is no vaccine or specific antiviral treatment for COVID-19. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures. The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 and a pandemic on 11 March 2020. Local transmission of the disease has occurred in India and cases gradually increasing.

MODE OF TRANSMISSION

1.The virus is primarily spread between people during close contact.

2. Small droplets produced by coughing, sneezing, or talking. 

3.The droplets usually fall to the ground or onto surfaces rather than remaining in the air over long distances. 

4.People may also become infected by touching a contaminated surface and then touching their face. In experimental settings, the virus may survive on surfaces for up to 72 hours.

5.It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease.

PATHOPHYSIOLOGY

                                   

The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested that decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective and these hypotheses need to be tested. As the alveolar disease progresses, respiratory failure might develop and death may follow.

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

DIAGNOSIS

As seen in hospitalized COVID‑19 patients to cough into a sterile container, thus producing a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has the potential of being quicker than a swab and involving less risk to health care workers (collection at home or in the car)

                               

1.Along with laboratory testing samples.

2.The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (RRT-PCR) from a nasopharyngeal swab.

3.Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using it for routine screening.

MANAGEMENT

Currently, there is no vaccine or specific antiviral treatment for COVID-19.

 Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

                                      

Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

People are managed with supportive care, which may include fluid therapy, oxygen support, and supporting other affected vital organs.

The CDC recommends that those who suspect they carry the virus wear a simple face mask. Extra corporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration. Personal hygiene and a healthy lifestyle and diet.

The CDC also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose, coughing or sneezing. It further recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available.

For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises

From ethanol or Isoproponoal  Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". 

Medications: -

Some medical Professionals, recommend Paracetamol (acetaminophen) over Ibrofen for first-line use. The WHO and NIH do not oppose the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for symptoms, and the FDA says currently there is no evidence that NSAIDs worsen COVID‑19 symptoms.

 ACE inhibitors and angiotensin receptor blockers, these are not sufficient to justify stopping these medications Steroids, such as methylprednisolone, are not recommended unless the disease is complicated by acute respiratory distress syndrome.

Medications to prevent blood clotting have been suggested for treatment, and anticoagulant therapy with low molecular weight heparin appears to be associated with better outcomes in severe COVID‐19 showing signs of coagulopathy.

RECOMMENDED PREVENTIVE MEASURES

1.Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms)

2.covering coughs, and keeping unwashed hands away from the face.

3.The use of a face covering is recommended for those who suspect they have the virus and their caregivers.

4.Recommendations for face covering use by the general public vary, with some authorities recommending against their use, some recommending their use, and others requiring their use.

5.Currently, there is not enough evidence for or against the use of masks (medical or other) in healthy individuals in the wider community. Also masks purchased by the public may impact availability for health care providers.

COMMON PREVENTIVE MEASURES

Protect yourself and others around you by knowing the facts and taking appropriate precautions. Follow advice provided by your local public health agency.

To prevent the spread of COVID-19:

1.Clean your hands often. Use soap and water, or an alcohol-based hand rub.

2.Maintain a safe distance from anyone who is coughing or sneezing.

3.Don’t touch your eyes, nose or mouth.

4.Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.

5.Stay home if you feel unwell.

6.If you have a fever, a cough, and difficulty breathing, seek medical attention. Call in advance.

7.Follow the directions of your local health authority.

8.Avoiding unneeded visits to medical facilities allows healthcare systems to operate more effectively, therefore protecting you and others.

WHO RECOMMENDATIONS: -

WHEN TO USE MASK?

1.Before putting on a mask, clean hands with alcohol-based hand rub or soap and water.

2.Cover mouth and nose with mask and make sure there are no gaps between your face and the mask.

3.Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water.

4.Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.

5.To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.

                      

       

WHEN AND HOW TO WEAR MEDICAL MASK TO PROTECT AGAINST CORONA VIRUS??

1.If you are healthy, you only need to wear a mask if you are taking care of a person with COVID-19.

2.Wear a mask if you are coughing or sneezing.

3.Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.

4.If you wear a mask, then you must know how to use it and dispose of it properly.

WHAT IS THE CORRECT METHOD TO DISPOSE THE MASK??

Different germs can survive on a used mask for different duration's. Experts feel that viruses, when left exposed, can survive between a few hours and a few days. My earnest request to all of you is not to throw the used mask indiscriminately in lifts, parks, workplaces, homes, open dust bins as it can pose a potential health hazard to people who come in contact with such masks. Also, some people are picking them up for re-use and hence putting their life in danger. The infected masks have respiratory secretions on them and can be dispersed and transmitted through the air. So, please be sensitive. Always wash your hands before and after taking off the mask.

Cloth mask (Wash) – Should be washed properly and frequently and left to hang and air dry.

Surgical mask (Fold, tie, wrap) – It should be removed chin upwards and please take care to remove it from the strings and be careful not to touch the front portion while taking off the mask. After taking the mask off, please fold it half inwards, such that droplets from mouth and nose are not exposed. Then, fold the mask into another half, until it looks like a roll. The mask can also be wrapped with its ear loops so that it will not unravel. Then wrap the mask in a tissue paper or polythene bag and immediately discard it in the yellow waste bag. Keep the things handy before disposing it off.

N-95 respirator – When removing the mask, hold the edge of the straps attached to take of the N-95 mask. Don’t touch the inside part of the respirator. Wash hands before and after it. Gently remove the mask so as not to disseminate contaminants on the mask. Place the mask in a plastic bag or zip-lock bag. You can also store them in a breathable container such as a paper bag between uses. Secure the bag tightly. Place the plastic bag into garbage can or biomedical waste disposal unit. Never put on a new mask until you have properly washed your hands.

                   

  Written By:

  Priyanka Massey

 Certified Infection Control Nurse & Professional Trainer.

 Ingenious Health Care Consultants Pvt.Ltd.