Hello Kolkata HEALTH DESK
PROF. DR. PRASANTA KUMAR
BHATTACHARYYA,
CONSULTANT PLASTIC SURGEON, KPCMCH KOLKATA.
What is a corona virus?
Corona
viruses are a large family of viruses which may cause illness in animals or humans. In humans, several corona viruses are known
to cause respiratory infections ranging from the common cold to more severe
diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute
Respiratory Syndrome (SARS). The most recently discovered coronavirus causes
coronavirus disease COVID-19.
What is COVID-19?
COVID-19 is
the infectious disease caused by the most recently discovered coronavirus. This
new virus and disease were unknown before the outbreak began in Wuhan, China,
in December 2019. COVID-19 is now a pandemic affecting many countries globally.
What are the symptoms of COVID-19?
The most
common symptoms of COVID-19 are fever, dry cough, and tiredness. Other symptoms
that are less common and may affect some patients include aches and pains,
nasal congestion, headache, conjunctivitis, sore throat, diarrhea, loss of
taste or smell or a rash on skin or discoloration of fingers or toes. These
symptoms are usually mild and begin gradually. Some people become infected but
only have very mild symptoms.
Most people
(about 80%) recover from the disease without needing hospital treatment. Around
1 out of every 5 people who gets COVID-19 becomes seriously ill and develops
difficulty breathing. Older people, and those with underlying medical problems
like high blood pressure, heart and lung problems, diabetes, or cancer, are at
higher risk of developing serious illness.
However, anyone can catch COVID-19 and become seriously ill. People of all ages who experience fever
and/or cough associated withdifficulty
breathing/shortness of breath, chest pain/pressure, or loss of speech or
movement should seek medical attention immediately. If possible, it is
recommended to call the health care provider or facility first, so the patient
can be directed to the right clinic.
What should I do if I have COVID-19 symptoms and when
should I seek medical care?
If you have
minor symptoms, such as a slight cough or a mild fever, there is generally no
need to seek medical care. Stay at home, self-isolate and monitor your
symptoms. Follow national guidance on self-isolation.
However, if
you live in an area with malaria or dengue fever it is important that you do
not ignore symptoms of fever. Seek
medical help. When you attend the health
facility wear a mask if possible, keep at least 1 metre distance from other
people and do not touch surfaces with your hands. If it is a child who is sick
help the child stick to this advice.
Seek
immediate medical care if you have difficulty breathing or pain/pressure in the
chest. If possible, call your health care provider in advance, so he/she can
direct you to the right health facility.
How does COVID-19 spread?
People can
catch COVID-19 from others who have the virus. The disease spreads primarily
from person to person through small droplets from the nose or mouth, which are
expelled when a person with COVID-19 coughs, sneezes, or speaks. These droplets
are relatively heavy, do not travel far and quickly sink to the ground. People
can catch COVID-19 if they breathe in these droplets from a person infected
with the virus. This is why it is
important to stay at least 1 meter) away from others. These droplets can land
on objects and surfaces around the person such as tables, doorknobs and handrails. People can become infected by touching these
objects or surfaces, then touching their eyes, nose or mouth. This is why it is important to wash your
hands regularly with soap and water or clean with alcohol-based hand rub.
Can COVID-19 be caught from a person who has no
symptoms?
COVID-19 is
mainly spread through respiratory droplets expelled by someone who is coughing
or has other symptoms such as fever or tiredness. Many people with COVID-19
experience only mild symptoms. This is particularly true in the early stages of
the disease. It is possible to catch COVID-19 from someone who has just a mild
cough and does not feel ill.
Some reports
have indicated that people with no symptoms can transmit the virus. It is not
yet known how often it happens.
How can we protect others and ourselves if we don't
know who is infected?
Practicing
hand and respiratory hygiene is important at ALL times and is the best way to
protect others and yourself.
When
possible maintain at least a 1 meter distance between yourself and others. This
is especially important if you are standing by someone who is coughing or
sneezing. Since some infected persons
may not yet be exhibiting symptoms or their symptoms may be mild, maintaining a
physical distance with everyone is a good idea if you are in an area where COVID-19
is circulating.
What should I do if I have come in close contact with
someone who has COVID-19?
If you have
been in close contact with someone with COVID-19, you may be infected.
Close
contact means that you live with or have been in settings of less than 1 metre
from those who have the disease. In these cases, it is best to stay at home.
However, if
you live in an area with malaria or dengue fever it is important that you do
not ignore symptoms of fever. Seek medical help. When you attend the health
facility wear a mask if possible, keep at least 1 metre distant from other
people and do not touch surfaces with your hands. If it is a child who is sick
help the child stick to this advice.
If you do
not live in an area with malaria or dengue fever please do the following:
1. If you
become ill, even with very mild symptoms you must self-isolate
2. Even if
you don’t think you have been exposed to COVID-19 but develop symptoms, then
self-isolate and monitor yourself
3. You are
more likely to infect others in the early stages of the disease when you just
have mild symptoms, therefore early self-isolation is very important.
4. If you do
not have symptoms, but have been exposed to an infected person, self-quarantine
for 14 days.
5. If you
have definitely had COVID-19 (confirmed by a test) self-isolate for 14 days
even after symptoms have disappeared as a precautionary measure – it is not yet
known exactly how long people remain infectious after they have recovered.
Follow national advice on self-isolation.
What does it mean to self-isolate?
Self-isolation
is an important measure taken by those who have COVID-19 symptoms to avoid
infecting others in the community, including family members.
Self-isolation
is when a person who is experiencing fever, cough or other COVID-19 symptoms
stays at home and does not go to work, school or public places. This can be
voluntarily or based on his/her health care provider’s recommendation. However,
if you live in an area with malaria or dengue fever it is important that you do
not ignore symptoms of fever. Seek medical help. When you attend the health
facility wear a mask if possible, keep at least 1 metre distant from other
people and do not touch surfaces with your hands. If it is a child who is sick
help the child stick to this advice.
If you do
not live in an area with malaria or dengue fever please do the following:
- If a person is in self-isolation, it is
because he/she is ill but not severely ill (requiring medical attention)
have a
large, well-ventilated with hand-hygiene and toilet facilities
If this is
not possible, place beds at least 1 metre apart
Keep at
least 1 metre from others, even from your family members
Monitor your
symptoms daily
Isolate for
14 days, even if you feel healthy
If you
develop difficulty breathing, contact your healthcare provider immediately –
call them first if possible
Stay
positive and energized by keeping in touch with loved ones by phone or online,
and by exercising yourself at home.
What should I do if I have no symptoms, but I think I
have been exposed to COVID-19? What does it mean to self-quarantine?
To
self-quarantine means to separate yourself from others because you have been
exposed to someone with COVID-19 even though you, yourself, do not have
symptoms.During self-quarantine you monitor yourself for symptoms. The goal of the self-quarantine is to prevent
transmission. Since people who become
ill with COVID-19 can infect people immediately self-quarantine can prevent
some infections from happening. .
In this
case:
Have a
large, well-ventilated single room with hand hygiene and toilet facilities
If this is
not available place beds at least 1 metre apart.
Keep at
least 1-metre distance from others, even from your family members.
Monitor your
symptoms daily
Self-quarantine
for 14 days, even if you feel healthy
If you
develop difficulty breathing, contact your healthcare provider immediately –
call them first if possible.
Stay
positive and energized by keeping in touch with loved ones by phone or online,
and by exercising yourself at home.
However, if
you live in an area with malaria or dengue fever it is important that you do
not ignore symptoms of fever. Seek medical help. When you attend the health
facility wear a mask if possible, keep at least 1 metre distant from other
people and do not touch surfaces with your hands. If it is a child who is sick
help the child stick to this advice.
What can I do to protect myself and prevent the
spread of disease?
Stay aware
of the latest information on the COVID-19 outbreak, available on the WHO website
and through your national and local public health authority. Most countries
around the world have seen cases of COVID-19 and many are experiencing
outbreaks. Authorities in China and some other countries have succeeded in
slowing their outbreaks. However, the situation is unpredictable so check
regularly for the latest news.
You can
reduce your chances of being infected or spreading COVID-19 by taking some
simple precautions:
Regularly
and thoroughly clean your hands with an alcohol-based hand rub or wash them
with soap and water. Why? Washing your hands with soap and water or using
alcohol-based hand rub kills viruses that may be on your hands.
Maintain at
least 1 metre distance between yourself and others. Why? When someone coughs,
sneezes, or speaks they spray small liquid droplets from their nose or mouth
which may contain virus. If you are too close, you can breathe in the droplets,
including the COVID-19 virus if the person has the disease.
Avoid going
to crowded places. Why? Where people come together in crowds, you are more
likely to come into close contact with someone that has COVID-19 and it is more
difficult to maintain physical distance of 1 metre.
Avoid
touching eyes, nose and mouth. Why? Hands touch many surfaces and can pick up
viruses. Once contaminated, hands can transfer the virus to your eyes, nose or
mouth. From there, the virus can enter your body and infect you.
Make sure
you, and the people around you, follow good respiratory hygiene. This means
covering your mouth and nose with your bent elbow or tissue when you cough or
sneeze. Then dispose of the used tissue immediately and wash your hands. Why?
Droplets spread virus. By following good respiratory hygiene, you protect the
people around you from viruses such as cold, flu and COVID-19.
Stay home
and self-isolate even with minor symptoms such as cough, headache, mild fever,
until you recover. Have someone bring you supplies. If you need to leave your
house, wear a mask to avoid infecting others. Why? Avoiding contact with others
will protect them from possible COVID-19 and other viruses.
If you have
a fever, cough and difficulty breathing, seek medical attention, but call by
telephone in advance if possible and follow the directions of your local health
authority. Why? National and local authorities will have the most up to date
information on the situation in your area. Calling in advance will allow your
health care provider to quickly direct you to the right health facility. This
will also protect you and help prevent spread of viruses and other infections.
Keep up to
date on the latest information from trusted sources, such as WHO or your local
and national health authorities. Why? Local and national authorities are best
placed to advise on what people in your area should be doing to protect
themselves.
How to properly wear a medical mask?
If you
choose to wear a mask:
Before
touching the mask, clean hands with an alcohol-based hand rub or soap and water
Take the
mask and inspect it for tears or holes.
Orient which
side is the top side (where the metal strip is).
Ensure the
proper side of the mask faces outwards (the coloured side).
Place the
mask to your face. Pinch the metal strip or stiff edge of the mask so it moulds
to the shape of your nose.
Pull down
the mask’s bottom so it covers your mouth and your chin.
Do not touch
the mask while you are wearing it for protection.
After use,
take off the mask with clean hands; remove the elastic loops from behind the
ears while keeping the mask away from your face and clothes, to avoid touching
potentially contaminated surfaces of the mask.
Discard the
mask in a closed bin immediately after use. Do not reuse the mask.
Perform hand
hygiene after touching or discarding the mask – Use alcohol-based hand rub or,
if visibly soiled, wash your hands with soap and water.
Be aware
that there is a global shortage of medical masks (both surgical masks and N95
masks). These should be reserved as much as possible for health care workers.
Remember
that masks are not a substitute for
other, more effective ways to protect yourself and others against COVID-19 such
as frequently washing your hands, covering your cough with the bend of elbow or
tissue and maintain a distance of at least 1 meter from others. See basic
protective measures against the new coronavirus for more information.
Follow the
advice of your national health authority on the use of masks.
What is the difference between self-isolation,
self-quarantine and distancing?
-Quarantine
means restricting activities or separating people who are not ill themselves
but may have been exposed to COVID-19. The goal is to prevent spread of the
disease at the time when people just develop symptoms..
-Isolation
means separating people who are ill with symptoms of COVID-19 and may be
infectious to prevent the spread of the disease.
-Physical
distancing means being physically apart. WHO recommends keeping at least
1-metre distance from others. This is a general measure that everyone should
take even if they are well with no known exposure to COVID-19.
Can I catch COVID-19 from my pet or other animals?
Several dogs
and cats (domestic cats and tigers) in contact with infected humans have tested
positive for COVID-19. In addition, ferrets appear to be susceptible to the
infection. In experimental conditions, both cats and ferrets were able to
transmit infection to other animals of the same species. However, there is no
evidence that these animals can transmit the disease to humans and spread
COVID-19. COVID-19 is mainly spread through droplets produced when an infected
person coughs, sneezes, or speaks.
Minks raised
in farms have also been detected with the virus. Most likely, they have been
infected by farm workers. In a few instances, the minks that were infected by
humans have transmitted the virus to other people. These are the first reported
cases of animal-to-human transmission.
It is still
recommended that people who are sick with COVID-19 and people who are at risk
limit contact with companion and other animals. When handling and caring for
animals, basic hygiene measures should always be implemented. This includes
hand washing after handling animals, their food or supplies, as well as
avoiding kissing, licking or sharing food.
Can I catch COVID-19 from the faeces of someone with
the disease?
While
initial investigations suggest the virus may be present in faeces in some
cases, to date, there have not been reports of faecal-oral transmission of
COVID-19. Additionally, there is no evidence to date on the survival of the
COVID-19 virus in water or sewage.
Updated recommendation
Within the
Clinical Management of COVID-19 interim guidance published on 27 May 2020. WHO
updated the criteria for discharge from isolation as part of the clinical care
pathway of a COVID-19 patient. These criteria apply to all COVID-19 cases
regardless of isolation location or disease severity.
Criteria for
discharging patients from isolation (i.e., discontinuing transmission-based
precautions) without requiring retesting:
For
symptomatic patients: 10 days after symptom onset, plus at least 3 additional
days without symptoms (including without fever
and without respiratory symptoms)
For
asymptomatic cases[4]: 10 days after positive test for SARS-CoV-2
For example,
if a patient had symptoms for two days, then the patient could be released from
isolation after 10 days + 3 = 13 days from date of symptom onset; for a patient
with symptoms for 14 days, the patient can be discharged (14 days + 3 days =)
17 days after date of symptom onset; for a patient with symptoms for 30 days,
the patient can be discharged (30+3=) 33 days after symptom onset).
*Countries
may choose to continue to use testing as part of the release criteria. If so, the initial recommendation of two
negative PCR tests at least 24 hours apart can be used.
What is the reason for the change?
In
consultations with global expert networks and Member States, WHO has received
feedback that applying the initial recommendation of two negative RT-PCR tests
at least 24 hours apart, in light of limited laboratory supplies, equipment,
and personnel in areas with intense transmission, has been extremely difficult,
especially outside hospital settings.
With
widespread community transmission, these initial criteria for SARS-CoV-2 posed
several challenges:
Long periods
of isolation for individuals with prolonged viral RNA detection after
resolution of symptoms, affecting individual well-being, society ,and access to
healthcare.
Insufficient
testing capacity to comply with initial discharge criteria in many parts of the
world.
Prolonged
viral shedding around the limit of detection, having negative results followed
by positive results, which unnecessarily challenges trust in the laboratory
system.
These
challenges and newly available data on the risk of viral transmission over the
course of the COVID-19 illness provided the framework for updating WHO’s
position on the timing of discharging recovered patients from isolation in and
outside health care facilities. WHO continuously reviews scientific literature
on COVID-19 through its Science Division and its COVID-19 technical teams. All
aspects of clinical management of COVID-19 patients and laboratory testing
strategies are discussed within WHO and with Member States and WHO’s global
expert networks of public health professionals, clinicians, and academics
around the world. These expert networks and the Strategic and Technical
Advisory Group for Infectious Hazards (STAG-IH)7 considered the challenges and
reviewed the available data in the decision process to change the initial
recommendation.
The updated
criteria for discharge from isolation balances risks and benefits; however, no
criteria that can be practically implemented are without risk. There is a minimal residual risk that
transmission could occur with these non–test-based criteria. There can be situations in which a minimal
residual risk is unacceptable, for example, in individuals at high risk of
transmitting the virus to vulnerable groups or those in high-risk situations or
environments. In these situations, and in patients who are symptomatic for
prolonged periods of time, a laboratory-based approach can still be useful.
WHO
encourages the scientific community to compile additional evidence to further
improve isolation discharge criteria and establish the conditions under which
isolation can be abbreviated or where the possible risks of the current
discharge criteria require further adaptation. Better understanding of
transmission risk among individuals with different clinical presentations or
comorbidities and in different settings will aid further refinement of these
criteria. For situations that might still require a laboratory-based approach,
we encourage the further optimization of such a laboratory algorithm. WHO
encourages countries to continue testing patients, if they have the capacity to
do so, for systematic data collection that will enhance understanding and
better guide decisions about infection prevention and control measures,
especially among patients with prolonged illness or those who are
immunocompromised.
Current understanding of transmission risk
Infection
with the virus causing COVID-19 (SARS-CoV-2) is confirmed by the presence of
viral RNA detected by molecular testing, usually RT-PCR. Detection of viral RNA does not necessarily
mean that a person is infectious and able to transmit the virus to another
person. Factors that determine transmission risk include whether a virus is
still replication-competent, whether the patient has symptoms, such as a cough,
which can spread infectious droplets, and the behavior and environmental
factors associated with the infected individual. Usually 5-10 days after
infection with SARS-CoV-2, the infected individual starts to gradually produce
neutralizing antibodies. Binding of these neutralizing antibodies to the virus
is expected to reduce the risk of virus transmission.
SARS-CoV-2
RNA has been detected in patients 1-3 days before symptom onset, and viral load
in the upper respiratory tract peaks within the first week of infection,
followed by a gradual decline over time.
In the feces and lower respiratory tract,
this viral load seems to peak in the second week of illness.19 Viral RNA has
been detected in upper respiratory tract (URT) and lower respiratory tract
(LRT) and feces, regardless of severity of disease.19 There seems to be a trend
in longer detection of viral RNA in more severely ill patients.
Studies of
viral RNA detection in immunocompromised patients are limited, but one study
suggested prolonged detection of viral RNA in renal transplant patients.Some
studies analyzed the risk of transmission related to symptom of onset, and the
estimated risk of transmission was highest at or around the time of symptom
onset and in the first 5 days of illness.
The ability
of the virus to replicate in cultured cells serves as a surrogate marker of
infectivity but requires special laboratory capabilities and may not be as
sensitive as PCR. Animal models can aid understanding of transmission risk. In
a study by Sia, et al., hamsters infected with SARS-CoV-2 were housed with
healthy hamsters on either day 1 or day 6 after infection. Transmission to
healthy hamsters occurred in the day 1 group, but not in those exposed 6 days
after inoculation. In this model, the timing of transmission correlated with
the detection of virus using cell culture, but not with detection of viral RNA
in donor nasal washes.
Studies
using viral culture of patient samples to assess the presence of infectious
SARS-CoV-2 are limited.
Viable virus
has been isolated from an asymptomatic case. A study of 9 COVID-19 patients with mild to moderate
disease found no SARS-CoV-2 virus able to be cultured from respiratory samples
after day 8 of symptom onset.10 Three studies of patients with undisclosed or
variable degree of illness showed an inability to culture virus after days 7-9
of symptom onset.
Patients who
were RT-PCR positive on retesting after an initial negative RT-PCR on discharge
from isolation were also studied, and none of these patients yielded positive
viral cultures.One possible outlier is a case report of a patient with mild
COVID-19 who remained PCR-positive for 63 days after symptom onset. In this
patient, viral cultures were positive from upper respiratory tract specimens
only on the day of symptom onset, but were culture-positive from sputum samples
until day .It is unclear whether this posed a transmission risk as the patient
had no respiratory symptoms. In a hospital-based study of 129 patients severely
or critically ill with COVID-19, 23
patients yielded at least one positive viral culture. This study included 30 patients
who were immunocompromised. The median duration of viral shedding as measured
by culture was 8 days post onset, the interquartile range was 5-11, and the
range was 0-20 days.11 The probability of detecting virus in culture dropped
below 5% after 15.2 days after of symptoms.
Although viral RNA can be detected by PCR even after the resolution of
symptoms, the amount of detected viral RNA is substantially reduced over time
and generally below the threshold where replication competent virus can be isolated.
Therefore, the combination of time after onset of symptoms and the clearance of
symptoms seems to be a generally safe approach based on current data.
Based on
evidence showing the rarity of virus that can be cultured in respiratory samples
after 9 days after symptom onset, especially in patients with mild disease,
usually accompanied by rising levels of neutralizing antibodies and a
resolution of symptoms, it appears safe to release patients from isolation
based on clinical criteria that require a minimum time in isolation of 13 days,
rather than strictly on repeated PCR results. It is important to note that the
clinical criteria require that patients’ symptoms have been resolved for at
least three days before release from isolation, with a minimum time in
isolation of 13 days since symptom onset.
Summary-
COVID-19 affects
different people in different ways. Most infected people will develop mild to
moderate illness and recover without hospitalization.
Most common symptoms:
1. Fever
2. Dry cough
3. Tiredness
Less common symptoms:
1. Aches and
pains
2. Sore
throat
3. Diarrhoea
4.
Conjunctivitis
5. Headache
6. Loss of
taste or smell
7. A rash on
skin, or discolouration of fingers or toes
PREVENTION:
Protect
yourself and others around you by knowing the facts and taking appropriate
precautions. Follow advice provided by your local health authority.
To prevent
the spread of COVID-19:
Clean your
hands often. Use soap and water, or an alcohol-based hand rub.
Maintain a
safe distance from anyone who is coughing or sneezing.
Wear a mask
when physical distancing is not possible.
Don’t touch
your eyes, nose or mouth.
Cover your
nose and mouth with your bent elbow or a tissue when you cough or sneeze.
Stay home if
you feel unwell.
If you have
a fever, cough and difficulty breathing, seek medical attention.
Calling in
advance allows your healthcare provider to quickly direct you to the right
health facility. This protects you, and prevents the spread of viruses and
other infections.
Masks:
Masks can
help prevent the spread of the virus from the person wearing the mask to
others. Masks alone do not protect against COVID-19, and should be combined
with physical distancing and hand hygiene. Follow the advice provided by your
local health authority.
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