Corona Slides for orientation and other purposes . Information is fast changing so will have to be changed accordingly in some places

1. COMMUNITY AWARENESS ON CORONA
VIRUS
(COVID-19 PANDEMIC)
DR. RISHABH KUMAR RANA
ASSISTANT PROFESSOR
DEPT. OF PSM
PMC , DHNABAD
Mob – 9852737954
E.Mail :bakwasandsony@gmail.com

3. What is Coronavirus?
• Coronaviruses ,a large family of viruses known to cause
illness ranging from the common cold to more severe
diseases such as
• Severe Acute Respiratory Syndrome (SARS) - from civet cats, China
(2002)
• Middle East Respiratory Syndrome (MERS) - from dromedary
camels, Saudi Arabia(2012)
• A new Coronavirus emerged in Wuhan City, Hubei
Province in China is called as 2019-nCoV

4. Emerging Respiratory InfectiousDiseases
• 2002: Severe Acute Respiratory Syndrome
Coronavirus (SARS CoV)
• 2009: A H1N1 influenza
• 2012: Middle East Respiratory Syndrome Coronavirus
(MERS CoV)
• 2019: Novel Coronavirus (COVID-19) – Has so far
affected 118 countries including India. WHO
declared it as a Global Public Health Emergency.

5. Where do coronavirus come from?
• 2019-nCoV suspected to be from sea food market
at Wuhan
• Several known coronaviruses are circulating
in animals that have not yet infected humans
• A spill-over event is when a virus that is circulating in
an animal species is found to have been transmitted to
humans.

6. Current Global Scenario WHO COVID 19
https://www.who.int/

7. https://www.mohfw.gov.in/

8. Current Status of Novel coronavirus(COVID-19)
Global 184976 Confirmed
7529 Death
159 Country Affected
India
Samples Tested --
Confirmed 147
Deaths 3
Jharkhand
Samples Tested 22 ( Zero In Dhanbad )
Confirmed 0

9. Current
Scenario of
the Virus
Spread its
various peaks
across the
Globe

10. Corona itself is telling us to take precautions –
• C - Clean your hands
• O - Off from gathering
• R - Raise your immunity
• O - Offer hand wash to poor people
• N - No to handshake
• A - Avoid rumors

11. Recent News from Medical College Sree Chitra Tirunal Insitutute for
Medical Sciences and Technology

12. Increased Risk in following conditions

13. Risk Assessment
• 20 % are reported to be severe
• Overall Case Fatality Ratio of 2.3 percent which
is considerably lower than that was reported
during
• SARS (15%) and
• MERS-CoV outbreaks (37%)

14. Human Corona Virus has 7 strains
1. Human CoV 229 E
2. Human CoV OC43
3. SARS-CoV (2003 Outbreak)
4. Human CoV NL63
5. Human CoV HKU 1
6. MERS-CoV (2012 Outbreak)
7. Nobel CoV( 2019-nCoV)

15. Viral Causes of Common Cold: (>200 viral types)
S. No Virus
1 Rhinovirus
2 Corona Virus
3 Influenza Virus
4 Adenovirus
5 Respiratory Syncytial Virus
6 Para Influenza Virus
7 Metapneumovirus

16. Symptoms
• Mild to severe respiratory illness with symptoms of
• Fever
• Cough
• shortness of breath
• Upper respiratory tract symptoms like sore throat, rhinorrhea, and
gastrointestinal symptoms like diarrhea and nausea/ vomiting are
seen in about 20% of cases
• Symptoms of 2019-nCoV may appear as early as 2 days or as
long as 14 days after exposure.

17. Mode of Spread
• Through hands – more than 80 percent
• After touching the infected surfaces like
immigration counter, ticket counter, door handles,
handrails of staircases or elevators etc, touching the
face, eyes, nose without washing hands
• Airborne direct transmission – less than 20percent
• when a nearby person sneezes or coughs

18. Case definitions – Suspected case
• A patient with acute respiratory illness AND history of travel to or
residence in a country/area or territory reporting local transmission of
COVID-19 disease during the 14 days prior to symptom onset;
OR
• A patient/Health care worker with any acute respiratory illness AND having
been in contact with a confirmed COVID-19 case in the last 14 days prior to
onset of symptoms;
OR
• A patient with severe acute respiratory infection with no other etiology
that fully explains the clinical presentation;
OR
• A case for whom testing for COVID-19 is inconclusive.

19. Case definitions – Laboratory confirmed case
• A person with laboratory confirmation of COVID-19 infection, irrespective of
clinical signs and symptoms.

20. Definition of Contact
A contact is a person that is involved in any of the following:
• Providing direct care without proper personal protective equipment (PPE)
for COVID-19 patients
• Staying in the same close environment of a COVID-19 patient (including
workplace, classroom, household, gatherings).
• Traveling together in close proximity (1 m) with a symptomatic person
who later tested positive for COVID-19.

21. Key considerations – Surveillance
• Surveillance period is for 28 days – (14 days quarantine at home or
hospital or a designated facility and next 14 days is for self reporting).
• Testing –
• All high risk contacts to be tracked, quarantined and lab-tested as per the
protocol.
• For low risk contacts – lab-test only when the person under surveillance
develops symptoms.

22. What Samples to be collected
• Essential samples:
- Throat swab (oropharyngeal swab)
- Nasal swab (Nasopharyngeal swab)
• Other preferred samples:
- Bronchoalveolar lavage
- Tracheal aspirate Wide mouth sterile plastic containers
- Sputum
• In lab confirmed patients:
- Blood - Vacutainer
- Stool and urine - Wide mouth sterile plastic containers

23. Collection of OP and NP swabs
• Optimal timing:
- Within 3 days of symptom onset and no later than 7 days.
- Preferably prior to initiation of antimicrobial chemoprophylaxis or therapy.

24. Types of Tests
• No validated serological tests
• Only molecular diagnosis
- PCR based test aims at detection of the virus.
• Real time PCR platform is required.

25. 52 VRDLs doing SARS-CoV-2 testing 57 VRDLs as collection sites

26. Pre Emotive Interventions

27. Environmental cleaning, disinfection and
bio-medical waste management

28. Environmental Decontamination (1)
General Principles
• Healthcare environment contains a diverse population of microorganisms, but only few
are significant pathogens
• Microbiologically contaminated surfaces can serve as reservoirs of potential pathogens
• Contaminated surfaces not directly associated with transmission of infections to either
staff or patients
• Transfer of microorganisms from environmental surfaces to patients is mostly via hand
contact with the surface
• Hand hygiene is important to minimize the impact of this transfer
• Cleaning and disinfecting environmental surfaces is fundamental in reducing healthcare-
associated infections

29. Environmental Decontamination (2)
• COVID-19 virus can potentially survive in the environment for several
hours/days
• Premises and areas potentially contaminated with the virus to be
cleaned before their re-use
• Products containing antimicrobial agents known to be effective
against coronaviruses may be used

30. Cleaning/disinfection of medical equipment (4)
Area/Items Inputs Process Method/ procedure
Stethoscope Alcohol-based rub/Spirit
swab
Cleaning o Should be cleaned with detergent and water
o Should be wiped with alcohol based rub/spirit swab before each
patient contact
BP cuffs & covers Detergent Hot water Washing o Cuffs should be wiped with alcohol- based disinfectant and regular
laundering is recommended for the cover
Thermometer Detergent and water
Alcohol rub
Individual thermometer
holder
Cleaning o Should be stored dry in individual holder
o Clean with detergent and tepid water and wipe with alcohol rub in
between patient use
o Store in individual holder inverted
o Preferably one thermometer for each patient
Injection and
dressing trolley
Detergent and water
Duster
Disinfectant (70% alcohol)
Cleaning o To be cleaned daily with detergent and water
o After each use should be wiped with disinfectant

31. • Ambulance Decontamination – By 1% Sodium hypochlorite solution
using Knapsack sprayer ( Involved personnel must to wear PPE)

32. Cleaning and disinfection of occupied patient rooms
• Designate specific well-trained staff for cleaning environmental surfaces
• Cleaning personnel should wear PPE and must be trained on proper use
of PPE and hand hygiene
• Use a checklist to promote accountability for cleaning responsibilities
• Keep cleaning supplies outside the patient room

33. Disposal of BMW
Category Type of bag/container Type of waste Treatment disposal options
Yellow Non chlorinated colour coded bags
in coloured bins
Separate collection system leading
to ETP
• Human anatomical waste
• Animal anatomical waste
• Soiled waste
• Expired or discarded medicines
• Chemical waste
• Micro, biotech & clinical lab waste
• Chemical liquid waste
Incineration/deep burial
Red Non chlorinated plastic bags in
coloured bins/ containers
Contaminated waste (recyclable) tubing, bottles,
urine bags, syringes (without needles) and gloves
Auto/micro/hydro and then sent to
recycling
White Translucent, puncture, leak & tamper
proof
Waste sharps including metals Auto/dry heat sterilization followed by
shredding /mutilation/encapsulation
Blue Water proof card board
boxes/containers
Glassware waste Disinfection or auto/micro /hydro then
sent to recycling
*Disposal by deep burial is permitted only in rural or remote areas where there is no access to common bio-medical waste treatment facility. This will
be carried out with prior approval from the prescribed authority

34. Infection Prevention & Control

35. Who is at risk of infection?
Everyone

36. • WHO2015 Safe & Quality Health Services Package
Benefits of IPC
Protecting yourself
Protecting your
family, community &
environment
Protecting your
patients

37. Personal protective equipment
WHO interim guidance document for Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19)

39. • Avoid close contact with people
suffering from acute respiratory
infections
• Frequent hand hygiene, especially
after direct contact with ill people or
their environment
• People with symptoms of acute
respiratory infection should practice
• respiratory etiquette (Shishtachar)
• wear a medical mask
• seek medical care for advice
General advice for
COVID-19

40. Hand hygiene: WHO 5 moments
• https://www.who.int/infection-prevention/tools/hand-hygiene/en/

41. • Use appropriate product and
technique
• An alcohol-based hand rub
product is preferable, if
hands are not visibly soiled
• Rub hands for 20–30
seconds!
• Soap, running water and
single use towel, when
visibly dirty or contaminated
with proteinaceous material
• Wash hands for 40–60
seconds!
Hand hygiene: Hand Wash – SUMAN K
https://www.who.int/infection-prevention/tools/hand-hygiene/en/

42. Respiratory hygiene/etiquette
Reduces the spread of microorganisms (germs) that
cause respiratory infections (colds, flu).
• Turn head away from others when
coughing/sneezing
• Cover the nose and mouth with a tissue paper.
• If tissues are used, discard immediately into the
trash
• Cough/sneeze into your sleeve if no tissue is
available
• Clean your hands with soap and water or alcohol
based products
• Do not spit here and there
Image source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

43. PPE for use in health care for COVID-19
Head cover
Head + hair
Goggle
EyesNose + mouth
Face Mask Face shield
Eyes + nose + mouth
Gloves
Hands
Apron
Body
Gown
Body
N95 Mask
Nose + mouth

44. Home care for patients with suspected COVID-19
infection with mild symptoms
• Place the patient in a well-ventilated single room (i.e., with open windows and an
open door).
• Limit the movement of the patient & minimize shared space
• Household members should stay in a different room or, if that is not possible,
maintain a distance of at least 1 m from the ill person (e.g., sleep in a separate
bed).
• Limit the number of caregivers (Family members or Paid helper)
• Visitors should not be allowed.
• Perform hand hygiene after contact with patients or their immediate
environment, before and after preparing food, before eating, after using the
toilet and whenever hands look dirty.
• Provide medical mask to the patient.

45. Home care for patients with suspected COVID-19 infection with
mild symptoms – cont..
• Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene
• Caregivers should wear a tightly fitted medical mask that covers their mouth and nose
when in the same room as the patient
• Avoid direct contact with body fluids. Use disposable gloves and a mask when providing
oral or respiratory care and when handling stool, urine and other waste. Perform hand
hygiene before and after removing gloves and the mask.
• Use dedicated linen and eating utensils for the patient; these items should be cleaned with
soap and water after use and may be re-used instead of being discarded.
• Clean and disinfect daily surfaces that are frequently touched in the room where the
patient is being cared for (Household soap or detergent should be used first for cleaning,
and then, after rinsing, regular household disinfectant-sodium hypochlorite)
• Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap
and water or machine wash at 60–90 °C with common household detergent, and dry
thoroughly

46. Use of Mask : Home care
• Individuals with suspected infection with mild respiratory symptoms
• Relatives or caregivers
Along with
• hand hygiene
• keep distance from affected individual as much as possible (at least 1
meter)
• improve airflow in living space by opening windows as much as
possible
• Mask management

47. Use of Mask : Community setting
• Individuals without respiratory symptoms
• Avoid closed crowded spaces
• Maintain distance – 1m
• Practice hand and respiratory hygiene
• Refrain from touching face, nose, mouth
• No need of mask
• Individuals with respiratory symptoms
• Wear a medical mask
• Seek medical care
• Learn mask management

48. Donning Sequence of PPE
HAND
WASHING-
S- Sidha
U - Ulta
M - Muthi
A - Angutha
N - Nakhoon
K - Kalai

49. Sequence of Doffing of PPE

50. Everyday Preventive Actions for Everyone
Hand Hygiene Coughing and Sneezing
Hygiene Practice Food
safety
Avoid spitting in
Public places

51. Everyday Preventive Actions for Everyone
Seeking care
Avoid touching your eyes, nose,
andmouth with unwashed
hands
Avoid close contact with
symptomatic cases
Namaste instead of
Handshakes

52. Management of Contacts
• The contacts should be advised to monitor
their health for 28 days from the last day of
possible contact
• Should seek immediate medical attention if they
develop any symptoms, particularly fever,
respiratory symptoms such as coughing or
shortness of breath

53. TREATMENT
• No antiviral treatment for the coronavirus infection has been effective
BUT
• Studies among SARS-CoV patients show that the combination of lopinavir and
ritonavir was associated with possible clinical benefit.
• Based on this research, ICMR has obtained approval to use this combination
therapy as part of a public health emergency within a research framework and
restricted use.
• Only Symptomatic (81% of cases are mild,14% require Hospitalization & 5%
require Ventilator support)

54. Strategic Approach
• Travel related cases report in India
• Local Transmission of CONID-19
• Community Transmission of COVID-19 Diseases
• India become Endemic for COVID-19

55. CLUSTER CONTAINMENT
• What is cluster
• Containment zone is 3 KM
• Buffer zone is 7 KM

59. SOCIAL DISTANCING

60. An elevator with social distancing from
Thailand

62. ICMR Initiatives

63. ICMR Initiatives

64. ICMR Initiatives

67. Self care for Health Professionals /

70. Newer Drugs and Vaccines being tried Upon
• First Vaccine CoVID -19 in China Inovio Pahrmaceuticals
• Remdesivir – Drug by Gilead
• Favilivir – Anti viral Drug Clinical Trial being done in Shenzen ,
Guandong
• Intranasal Vaccine CoVID 19 US based Altimmune Being tested on Animals
• INO -4800 Inovio Beijing Advaccine Bitotechnology Pre Clinical Testing
being done .
• NP-120 ( Ifenprodil ) Algernon Pharmaceuticals a N-Methyl d- Aspartate
receptor glutamate receptor antagonist Brand Name ( Cerocal )

71. • mRNA-1273 Vaccine by Moderna and Vaccine Research Centre
Targeting the Spike (S) Protiein of the corona virus
• TNX -1800 BY Tonix Pharmaceuticals
• Clover Pharmaceuticals vaccine Trimeric S Protein (S- Trimer ) Pre
clinical Stages
• Linear DNA vaccine by Applied DNA Sciences
• Some drugs Like BXT -25 are targeting to treat ARDS Bioxytran
Efficiently transporting oxygen as its 5000 times smaller than RBCs
•

72. • INO 4700 ( GLS -5300) Invoio Gene One Life Sciences for MeRS –CoV
• BCX 4430 Galidesivir Broad spectrum activity against Coronavirus
Nucleioside RNA polymerase inhibitor disrupting viral replication .