Coronavirus has spread to 177 countries or territories, including Uganda, and claimed more than 34,000 lives.

Coronavirus comprises of a large family of viruses that are common in human beings as

well animals (camels, cattle, cats, and bats). There are seven different strains of corona

virus.

229E (alpha coronavirus)

NL63 (alpha coronavirus)

OC43 (beta coronavirus)

HKU1 (beta coronavirus)

MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or

MERS)

SARS-CoV (the beta coronavirus that causes a severe acute respiratory syndrome, or

SARS)

SARS-CoV-2 (the novel coronavirus that causes coronavirus disease in 2019, or

COVID-19)

Sometimes coronavirus from animals infect people and spread further via human to human transmission such as with MERS-CoV, SARS-CoV, and now with this COVID 19 (Corona disease 2019). The virus that causes COVID-19 is designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); 

This novel coronavirus was identified as a cause of upper and lower respiratory tract infections in Wuhan, a city in the Hubei Province of China. It rapidly spread, resulting in an epidemic throughout China and then gradually spreading to other parts of the world in pandemic proportions. It has affected almost every continent in this world, except Antarctica. In February 2020, the World Health Organization designated the disease COVID-19, which stands for coronavirus disease in 2019.

TRANSMISSION

Our understanding of the mode of transmission is currently incomplete. Epidemiologic

investigation in Wuhan at the beginning of the outbreak identified an initial association with a seafood market where most patients had worked or visited. The seafood market also sold live rabbits, snakes and other animals. The initial concept was that the virus originated from snakes, however, later studies proved that it had more similarity with bats. However, as the outbreak progressed, person-to-person transmission through droplets and fomites became the primary mode of transmission.

How does Person-to-person transmission occur?

Droplet transmission

The virus is released in the respiratory secretions when an infected person coughs, sneezes or talks. These droplets can infect others if they make direct contact with the mucous membranes. Infection can also occur by touching an infected surface and followed by eyes, nose or mouth. Droplets typically do not travel more than six feet (about two meters) and do not linger in the air. However, given the current uncertainty regarding transmission mechanisms, airborne precautions are recommended routinely in some countries and in the setting of specific high-risk procedures. Patients are thought to be most contagious when they have symptoms. Some spread might be possible before symptoms appear, but this is not thought to be a common occurrence.

Other possible modes of transmission

It may be possible that a person can get COVID-19 by touching a surface or object that has

the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is

not thought to be the main way the virus spreads.

One study suggested that the virus may also be present in faeces and could contaminate

places like toilet bowls and bathroom sinks. But the researchers noted the possibility

of this being a mode of transmission needs more research.

In February a Chinese newborn was diagnosed with the new coronavirus just 30 hours after birth. The baby’s mother tested positive before she gave birth. It is unclear how the disease was transmitted – in the womb, or after birth. Recently in London, another newborn was tested positive for the coronavirus, marking what appears to be the second such case as the pandemic worsens.

CLINICAL FEATURES

Incubation period

The exact incubation period is not known. It is presumed to be between 2 to 14 days after

exposure, with most cases occurring within 5 days after exposure.

The spectrum of illness severity

Most infections are self-limiting. COVID-19 tends to cause more severe illness in the elderly

population or in patients with underlying medical problems. As per the report from Chinese centre for disease control and prevention that included approximately 44,500 confirmed Infections with an estimation of disease severity.

• The mild illness was reported in 81% of patients
• Severe illness in 14%
• Critical Disease (Respiratory failure, shock, multi-organ dysfunction syndrome) was

reported in 5%.

• The overall case fatality rate was between 2.3 to 5%

COVID 19 in the pediatric population (children)

In this outbreak, compared with adult cases, there are relatively fewer cases of children,

milder symptoms and better prognosis. Also, children are less frequently exposed to the

main sources of transmission. Most infected children recover one to two weeks after the

onset of symptoms, and no deaths had been reported by February 2020. 

According to the recent report of the China-WHO Joint Mission Expert Group, the current domestic case data show that children under 18 years of age account for 2.4% of all reported cases, and no deaths have been reported.

Age affected

• Mostly middle-aged (>30 years) and the elderly.
• Symptomatic infection in children appears to be uncommon, and when it occurs, it is

usually mild.

Clinical Presentation

In a study describing 1099 patients with COVID-19 pneumonia in Wuhan, the most

common clinical features at the onset of illness were: 

• Fever in 88%
• Fatigue in 38%
• Dry cough in 67%
• Muscle aches in 14.9%
• Difficulty in breathing in 18.7%

Pneumonia appears to be the most common and severe manifestation of infection. In this

group of patients breathing difficulty developed after a median of five days of illness. 

 

Other symptoms

• Headache
• Sore throat
• Running nose
• Gastrointestinal symptoms4D

DIAGNOSIS

CASE DEFINITIONS  (As per WHO-China joint commission report)

Suspected case

Based on the epidemiologic characteristics observed so far in China, everyone is assumed

to be susceptible, although there may be risk factors increase susceptibility to infection.

A patient with acute respiratory tract infection (sudden onset of at least one of the

following: cough, fever, shortness of breath) AND with no other aetiology that fully

explains the clinical presentation AND with a history of travel or residence in a country/area reporting local or community transmission* during the 14 days prior to symptom onset;

OR

A patient with an acute respiratory illness AND having been in close contact with a

confirmed or probable COVID-19 case in the last 14 days prior to the onset of symptoms;

OR

A patient with a severe acute respiratory infection (fever and at least one sign/symptom

of respiratory disease (e.g., cough, fever, shortness breath)) AND requiring hospitalization AND with no other aetiology that fully explains the clinical presentation.

Probable Case

A suspected case for whom testing for the virus causing COVID-19 is inconclusive (according

to the test results reported by the laboratory) or for whom testing was positive on a

pan-coronavirus assay.

Confirmed Case

A person with laboratory confirmation of virus causing COVID-19 infection, irrespective of clinical signs and symptoms

Close Contacts

Close contact of a probable or confirmed case is defined as

• A person living in the same household as a COVID-19 case;
• A person having had direct physical contact with a COVID-19 case (e.g. shaking

hands);

• A person having unprotected direct contact with infectious secretions of a COVID-19

case (e.g. being coughed on, touching used paper tissues with a bare hand);

• A person having had face-to-face contact with a COVID-19 case within 2 metres and

> 15 minutes;5B

• A person who was in a closed environment (e.g. classroom, meeting room, hospital

waiting room, etc.) with a COVID-19 case for 15 minutes or more and at a distance

of less than 2 metres;

• A healthcare worker (HCW) or other person providing direct care for a COVID-19

case, or laboratory workers handling specimens from a COVID-19 case without

recommended personal protective equipment (PPE) or with a possible breach of

PPE;

• A contact in an aircraft sitting within two seats (in any direction) of the COVID-19

case, travel companions or persons providing care, and crew members serving in

the section of the aircraft where the index case was seated (if severity of symptoms

or movement of the case indicate more extensive exposure, passengers seated in the

entire section or all passengers on the aircraft may be considered close contacts).

Recommendations for sample collection

• Collection of specimens to test for SARS-CoV-2 from the upper respiratory tract

(nasopharyngeal and oropharyngeal swab) is the preferred method for diagnosis

• Induction of sputum collection is not recommended
• Bronchoscopy being an aerosol generating procedure has got the potential to trans

mit infection to others. In view of this preferably avoid performing it and limit its

usage clearing secretions/mucous plugs in intubated patients 

• All respiratory specimen collection procedures should be done in negative pressure

rooms

• Additional specimens (eg: Blood, stool, urine) can also be collected to rule out alter

native/supportive diagnosis.

Current recommended diagnostic modality for COVID 19

• SARS-CoV-2 RNA is detected by polymerase chain reaction (RT-PCR)
• Results are generally available within a few hours to 2 days
• A single positive test should be confirmed by a second RT-PCR assay targeting a

different SARS-CoV-2 gene

• If initial testing is negative but the suspicion for COVID-19 remains, the WHO recommends re-sampling and testing from multiple respiratory tract sites
• For safety reasons, specimens from a patient with suspected or documented

COVID-19 should not be submitted for viral culture.

• Samples should also be tested for other viral/bacterial pathogens.

COVID 19- rapid tests

COVID-19 Rapid Test qualitatively detects antibodies to SARS-CoV-2 in human whole blood, serum and plasma samples. 

It can be used for the rapid screening of SARS-CoV-2 carriers, symptomatic or asymptomatic, in hospitals, clinics, and test laboratories. Despite the promise, there is no definitive evidence regarding the utility of rapid kits for testing COVID 19 suspected patients respiratory/serum.

PREVENTION

Who is a contact?

• A contact is a person that is involved in any of the following: 
• Providing direct care without proper personal protective equipment (PPE)2 for

COVID-19 patients

• Staying in the same close environment of a COVID-19patient (including workplace, classroom, household, gatherings).
• Traveling together in close proximity (1 m) with a COVID-19 patient in any kind of conveyance within a 14_day period after the onset of symptoms in the case under consideration

Can the virus stay on inanimate surfaces?

• COVID-19 virus can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. 
• Hence terminal disinfection is important even after the patient getting discharged.

What should include ideal personal protective equipment (PPE)?

• • Gloves
  • N95 masks for health workers
  • Can Surgical Masks Filter the Corona virus?

 

• Surgical masks help to stop the wearer from spreading germsused masks. [63]

 

What can you do to reduce risk?

Social Distancing

Novel coronavirus are spread by people who have the virus coming in to contact with people who are not infected. The more you come in to contact with infected people, the more likely you are to catch the infection. Social distancing is infection control action that can be taken by public health officials to stop or slow down the spread of a highly contagious disease.

In addition to social distancing measures taken by governments, we can ourselves choose to reduce physical exposure to potentially sick people, for example:

• Exploring the option to work from home if your job allows for it.
• Avoiding large public gatherings such as sporting events. Or situations where you
• may come in to contact with crowds of people, for example in busy shopping malls.
• Interacting with people over the phone/video calls, instead of in person.

These types of steps may be an impediment to normal life. However the intention is that these will be a short term measure (not forever!).

Regular hand washing

The CDC recommends regular hand washing with soap and water for at least 20seconds. Prioritize washing prior to eating and after being out. Regular hand washing dries the hands, which at an extreme, may make them vulnerable to infection. To mitigate this, regularly use a glycerin based moisturizer with pump or squeeze mechanism. The CDC recommend that if soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol. Leave to air dry.

Sanitize your phone

Given how often we use our phones, this seems like the next logical priority to be sanitized. Using antibacterial wipes or alcohol swabs (typically 70% alcohol) to clean your phone and other items is a good option; other items to disinfect may include: 

• Computer keyboard and mouse
• House and car keys
• Re-usable water bottles
• Car steering wheel
• Clothing pockets
• Door handles

 

Keep your immune system healthy

Examples of actions you can take to maintain a healthy immune system

Sleep – Get adequate, high quality sleep. 

Exercise – Exercise regularly, but don’t overdo it. 9H

Vaccines for SARS cov 2

• Altimmune’s intranasal coronavirusvaccine
• INO-4800 by InovioPharmaceuticals
• mRNA-1273 vaccine byModerna
• Avian Corona virus Infectious Bronchitis Virus (IBV) vaccine by MIGAL and many

more

All vaccines are in developing stage only

Important steps for preventing transmission in the community

• Diligent hand washing, particularly after touching surfaces in public. Use of hand

sanitizer that contains at least 60 percent alcohol is a reasonable alternative if the

hands are not visibly dirty.

• Respiratory hygiene (e.g.: covering the cough or sneeze).
• Use triple layer disposable surgical mask if you have any Respiratory symptoms.
• Avoiding crowds (particularly in poorly ventilated spaces) if possible and avoiding

close contact with ill individuals. Also try to maintain a safe distance of 1 metre.

• Avoid handshakes, hugs and kisses
• Avoid non essential travels/gatherings
• Avoid holding on railings of steps
• May use pens for switching on lights in common areas, lift buttons
• At hospitals, avoid keeping patients files on the bed
• Use gloves
• Used mask and other personal protective equipment should be considered as a

potentially infected material and it should be disposed separately in an infectious

waste disposable bag.