Coronavirus Infection – Symptoms, Diagnosis, Treatment

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Coronavirus Infection/Coronavirus (CoV) are a large family of viruses 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). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.

Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

In one of the first reports on the disease, Huang et al. illustrated that patients suffered from fever, malaise, dry cough, and dyspnea.

Causes of Coronavirus Infection

Humans first get a coronavirus from contact with animals. Then, it can spread from human to human. Health officials do not know what animal caused COVID-19.

  • The COVID-19 virus can be spread through contact with certain bodily fluids, such as droplets in a cough. It might also be caused by touching something an infected person has touched and then touching your hand to your mouth, nose, or eyes.
  • The virus can cause pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases, there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against the flu will not work. Recovery depends on the strength of the immune system. Many of those who have died were already in poor health.

How COVID-19 Spreads

  • COVID-19 is a new disease and we are still learning how it spreads, the severity of illness it causes, and to what extent it may spread in the United States.

Person-to-person spread

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet).
  • Respiratory droplets produced when an infected person coughs or sneezes.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Can someone spread the virus without being sick?

  • People are thought to be most contagious when they are most symptomatic (the sickest).
  • Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.

Spread from contact with contaminated surfaces or objects

  • 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.

How easily the virus spreads

  • How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, spreading continually without stopping.
  • The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas.
  • Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

Symptoms of Coronavirus Infection

Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases.

The following symptoms may appear 2-14 days after exposure.[rx]

Symptoms of coronavirus infections include

Symptoms of COVID-19 are usually milder than those of SARS and MERS.

The symptoms of COVID-19 include

  • Fever
  • Cough
  • Shortness of breath
  • Itchy eyes? Runny nose? You probably have allergies — or a garden variety cold – The issue with seasonal allergies is that they affect the nose and eye. They tend to be nasal, and most symptoms are localized to the head unless you also experience a rash.
  • Coronavirus and flu symptoms tend to be more systemic – That is, they affect the whole body. The flu and the novel coronavirus, these affect other systems and the lower respiratory tract. You probably won’t have a runny nose, but what you might have is a sore throat, a cough, a fever or shortness of breath. So it’s a subtly different clinical diagnosis. Pay attention to your temperature, Poland says it’s very unlikely that allergies would result in a fever. They usually don’t cause shortness of breath either, unless you have a preexisting condition like asthma.
  • Allergy symptoms are regularly occurring, and usually mild – if you’ve had the same symptoms around the same time, year after year, you’re probably experiencing seasonal allergies. In that case, over the counter medication and other regular health precautions will help you feel better.
  • Coronavirus and flu symptoms can put you out of commission – If you have an acute case of coronavirus or flu, you will feel so tired, so achy, you’d basically be driven to bed. Everybody would see the difference, Allergies may make you feel tired, but they’re not going to cause severe muscle or joint ache.”
  • Cold and mild flu symptoms usually resolve themselves – With normal illnesses, you’ll start feeling better with rest and proper care within a few days (unless you are elderly or have other health conditions, in which case even mild illnesses may take longer to pass).
  • Coronavirus and acute flu symptoms could get worse over time – If you have a nasty case of the flu or coronavirus, you may get worse when you expect to get better. This is a sure sign to seek medical care.
  • Early symptoms of allergies, colds, flu, and coronavirus could be similar – Unfortunately, the initial stages of colds, flu, and the coronavirus can be very similar, and some coronavirus and flu cases can be so mild they don’t raise any red flags. That’s why you have to pay attention to see if your symptoms persist, especially if you are in an at-risk group.

If you have symptoms and have not traveled to areas where infection rates have been high or been exposed to someone who has, it’s highly unlikely that you have one of these new coronaviruses. You may have another type of virus, such as the flu. The flu is much more common in the United States than the new coronaviruses.

Monitor your symptoms

  • Seek medical attention – to seek prompt medical attention if your illness is worsening (e.g., difficulty breathing).
  • Call your doctor – Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, COVID-19.
  • Wear a facemask when sick – Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed.
  • Alert health department – Ask your healthcare provider to call the local or state health department. Persons who are placed under active monitoring or facilitated self-monitoring should follow instructions provided by their local health department or occupational health professionals, as appropriate.

Diagnosis of Coronavirus Infection

  • The clinical spectrum of COVID-19 varies from asymptomatic or paucisymptomatic forms to clinical conditions characterized by respiratory failure that necessitates mechanical ventilation and support in an intensive care unit (ICU), to multiorgan and systemic manifestations in terms of sepsis, septic shock, and multiple organ dysfunction syndromes (MODS).

What is coronavirus testing?

Coronavirus testing looks for signs of coronavirus infection in nasal secretions, blood, or other body fluids. Coronaviruses are types of viruses that infect the respiratory system. They are found in both animals and people. Coronavirus infections in people are common throughout the world. They don’t usually cause serious illness.

Sometimes a coronavirus that infects animals will change and turn into a new coronavirus that can infect people. These coronaviruses can be more serious and sometimes lead to pneumonia. Pneumonia is a life-threatening condition in which fluid builds up in the lungs.

Three of these new coronaviruses have been discovered in recent years

  • SARS (severe acute respiratory syndrome) – a serious and sometimes fatal respiratory illness. It was first discovered in China in 2002 and spread around the world. An international effort helped quickly contain the spread of disease. There have been no new cases reported anywhere in the world since 2004.
  • MERS (Middle East respiratory syndrome) – a severe respiratory illness discovered in Saudi Arabia in 2012. The illness has spread to 27 countries. Only two cases have been reported in the United States. All cases have been linked to travel or residence in or around the Arabian Peninsula.
  • COVID-19 (coronavirus disease 2019) – It was discovered in late 2019 in Wuhan City, in the Hubei Province of China. Most infections have occurred in China or are related to travel from Hubei Province. There have been some cases reported in the United States. The outbreak is being closely monitored by the Centers for Disease Control (CDC) and the World Health Organization (WHO).
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Coronavirus testing is used to help diagnose infections and help prevent the spread of disease. You may need testing if you have symptoms of infection and have recently traveled to parts of the world where infection rates are high. You may also need testing if you have had close contact with someone who has traveled to one of those areas.

Chest computerized tomography (CT) scans showed pneumonia with abnormal findings in all cases. About a third of those (13, 32%) required ICU care, and there were 6 (15%) fatal cases.

What happens during coronavirus testing?

If your provider thinks you may have COVID-19, he or she will contact the CDC or your local health department for instructions on testing. You may be told to go to a special lab for your test. Only certain labs have been allowed to do tests for COVID-19.

There are a few ways that a lab may get a sample for testing.

  • Swab test – A health care provider will use a special swab to take a sample from your nose or throat.
  • Nasal aspirate – A health care provider will inject a saline solution into your nose, then remove the sample with gentle suction.
  • Tracheal aspirate – A health care provider will put a thin, lighted tube called a bronchoscope down your mouth and into your lungs, where a sample will be collected.
  • Sputum test – Sputum is a thick mucus that is coughed up from the lungs. You may be asked to cough up sputum into a special cup, or a special swab may be used to take a sample from your nose.
  • Blood – A health care professional will take a blood sample from a vein in your arm.

The FDA has approved more widespread use of a rapid test for COVID-19. The test, which was developed by the CDC, uses samples from the nose, throat, or lungs. It enables fast, accurate diagnosis of the virus. The test is now allowed to be used at any CDC-approved lab across the country.

Will I need to do anything to prepare for this test and risk?

  • Your health care provider may ask you to wear a facemask to your appointment. Your provider will let you know if you should take other steps to prevent the spread of infection.
  • You may feel a tickle or a gagging sensation when your nose or throat is swabbed. The nasal aspirate may feel uncomfortable. These effects are temporary.
  • There is a minor risk of bleeding or infection from a tracheal aspiration.
  • There is very little risk of having a blood test. You may have slight pain or bruise at the spot where the needle was put in, but most symptoms go away quickly.

Daily risk assessment on COVID-19, 9 March 2020

The risk associated with COVID-19 infection for people in the EU/EEA and UK is currently considered moderate to high

This assessment is based on the following factors

  • Most cases reported in the EU/EEA and the UK outside some regions in Italy have identified epidemiological links. However, there is an increasing number of cases without a defined chain of transmission. Extraordinary public health measures have been implemented in Italy and other EU/EEA countries and the UK, and strong efforts are being made to identify, isolate and test contacts in order to contain the outbreak. Despite contact tracing measures initiated to contain the further spread, there continue to be cases exported between EU/EEA countries, and an increasing number of sporadic cases across EU/EEA countries. The probability of further transmission in the EU/EEA and the UK is considered high. There is still a level of uncertainty regarding several unpredictable factors in a situation that is still evolving.
  • The possibility of new introductions from other countries outside China into the EU/EEA appears to be increasing as the number of countries reporting cases continues to rise.
  • The evidence from analyses of cases to date is that COVID-19 infection causes mild disease (i.e. non-pneumonia or mild pneumonia) in about 80% of cases and in most cases recover, 14 % have more severe disease and 6% experience critical illness. The great majority of the most severe illnesses, and deaths, have occurred among the elderly and those with other chronic underlying conditions. In addition to the public health impacts with substantial fatal outcomes in high-risk groups, COVID-19 outbreaks can cause huge economic and societal disruptions.

The risk of acquiring the disease for people from the EU/EEA and the UK traveling/resident in areas with no cases, or multiple imported cases, or limited local transmission, is currently considered low to moderate

  • This is assuming surveillance in the area is activated, tests are carried out on suspected cases and that there is sufficient testing capacity in the area. If these surveillance and case detection conditions are not met, the risk is considered moderate to high, but with a high level of uncertainty.

The risk for people from the EU/EEA and the UK traveling/resident in areas with the more widespread local transmission is currently considered to be high

This assessment is based on the following factors:

  • The overall number of reported cases in areas with the more widespread local transmission is high or increasing. However, there are significant uncertainties regarding transmissibility and under-detection, particularly among mild or asymptomatic cases.
  • The evidence from analyses of cases to date is that COVID-19 infection causes mild disease (i.e. non-pneumonia or mild pneumonia) in about 80% of cases and in most cases recover, 14 % have more severe disease and 6% experience critical illness. The great majority of the most severe illnesses and deaths have occurred among the elderly and those with other chronic underlying conditions. The areas with local transmission are also likely to increase as importations in unaffected areas keep occurring.

The risk of the occurrence of clusters associated with COVID-19 in other countries in the EU/EEA and the UK is currently considered moderate to high

This assessment is based on the following factors:

  • The current event in Italy indicates that local transmission may have resulted in several clusters. The accumulated evidence from clusters reported in the EU/EEA and the UK indicates that once imported, the virus causing COVID-19 can be transmitted rapidly. It is plausible that a proportion of transmissions occur from cases with mild symptoms that do not provoke healthcare-seeking behavior. The increase in case numbers and the number of countries outside China reporting those cases increases the potential routes of importation of the infection into the EU/EEA and the UK. Importations from other European countries have already occurred.
  • The impact of such clusters in the EU/EEA would be high, especially if hospitals were affected and a large number of healthcare workers had to be isolated. The impact on vulnerable groups in the affected hospitals or healthcare facilities would be severe, in particular for the elderly.
  • The rigorous public health measures that were implemented immediately after identifying the Italian COVID-19 cases will reduce but not exclude the probability of further spread.

The risk of widespread and sustained transmission of COVID-19 in the EU/EEA and the UK in the coming weeks is moderate to high with more countries reporting more cases and clusters

This assessment is based on the following factors:

  • There is an increasing number of countries with local or widespread local transmission around the world and in Europe that are exporting cases to unaffected areas. These exportations have caused transmission in previously unaffected areas. The control measures have up to now been able to only slow the further spread, but not to stop it.
  • Cases with mild symptoms are numerous and able to transmit the infection. Cases with mild symptoms are not always aware of their potential infectivity and have sought medical care, infecting healthcare workers.
  • Previously unaffected areas are reporting cases with travel history to a country that did not appear to have widespread local transmission.
  • The WHO increased its assessment of the risk of spread and the risk of the impact of COVID-19 to very high at a global level.

The risk for healthcare system capacity in the EU/EEA and the UK in the coming weeks is considered moderate to high.

This assessment is based on the following factors:

  • As the number of reported COVID-19 cases in the EU/EEA and the UK is increasing, the probability of widespread infection is increasing from low to moderate.
  • The majority of countries reported widespread influenza activity for week 8/2020, but the proportion of specimens tested positive in sentinel surveillance is slightly decreasing; some EU/EEA countries might have already moved past the peak period of high influenza circulation.
  • If there is a significant increase in COVID-19 cases in the coming weeks, the potential impact on public health and overall healthcare systems would be high. Increasing numbers of imported cases and local transmission chains would require additional resources for case management, surveillance, and contact tracing. Risk communication to concerned members of the public and healthcare professionals would tie up further resources. Further increased transmission could result in a significant increase in hospital admissions at a time when healthcare systems are may already be under pressure from the current influenza season. This would be exacerbated if substantial numbers of healthcare workers became infected. Specimens for COVID-19 could, therefore, lead to bottlenecks not only in healthcare but also in a diagnostic capacity. Containment measures intended to slow down the spread of the virus in the population are therefore extremely important as outlined below in the ‘Options for response’ and recent ECDC guidance documents.

Treatment of Coronavirus Infection

There is currently no specific treatment for coronavirus.

  • Antibiotics do not help, as they do not work against viruses.
  • Treatment aims to relieve the symptoms while your body fights the illness. You’ll need to stay in isolation away from other people until you’ve recovered.
  • There is currently no vaccine or treatment for COVID-19. Symptoms of a coronavirus usually go away on their own. If symptoms feel worse than a common cold, contact your doctor. He or she may prescribe pain or fever medication.
  • As with a cold or the flu, drink fluids and get plenty of rest. If you are having trouble breathing, seek immediate medical care.
  • When possible, avoid contact with others when you are sick. If you have COVID-19, wear a facemask to prevent spreading the virus to others. The CDC does not recommend wearing a mask if you do not have COVID-19.

Normal drugs that can be taken

1. Azithromycin 500mg (0+0+1)…………………….7 Days

2. Hydroxychloroquine 200 mg (1+0+1)………………….7 Days

3.Tramadol 50 mg (1+0+1)……………………………….7 days

Antioxidants, vitamin E, Vitamin C can be taken to improve the immunity system.

On  22 March 2020, the WHO released a document summarizing WHO guidelines and scientific evidence derived from the treatment of previous epidemics from HCoVs. This document addresses measures for recognizing and sorting patients with severe acute respiratory disease; strategies for infection prevention and control; early supportive therapy and monitoring; a guideline for laboratory diagnosis; management of respiratory failure and ARDS; management of septic shock; prevention of complications; treatments; and considerations for pregnant patients.

Among these recommendations, we report the strategies for addressing respiratory failure, including protective mechanical ventilation and high-flow nasal oxygen (HFNO) or non-invasive ventilation (NIV).

Intubation and protective mechanical ventilation

Special precautions are necessary during intubation. The procedure should be executed by an expert operator who uses personal protective equipment (PPE) such as FFP3 or N95 mask, protective goggles, disposable gown long sleeve raincoat, disposable double socks, and gloves. If possible, rapid sequence intubation (RSI) should be performed. Preoxygenation (100% O2 for 5 minutes) should be performed via the continuous positive airway pressure (CPAP) method. Heat and moisture exchanger (HME) must be positioned between the mask and the circuit of the fan or between the mask and the ventilation balloon.

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Mechanical ventilation should be with lower tidal volumes (4 to 6 ml/kg predicted body weight, PBW) and lower inspiratory pressures, reaching a plateau pressure (Pplat) < 28 to 30 cm H2O. PEEP must be as high as possible to maintain the driving pressure (Pplat-PEEP) as low as possible (< 14 cmH2O). Moreover, disconnections from the ventilator must be avoided for preventing loss of PEEP and atelectasis. Finally, the use of paralytics is not recommended unless PaO2/FiO2 < 150 mmHg. The prone ventilation for > 12 hours per day, and the use of a conservative fluid management strategy for ARDS patients without tissue hypoperfusion (strong recommendation) are emphasized.

Non-invasive ventilation

Concerning HFNO or non-invasive ventilation (NIV), the experts’ panel, points out that these approaches performed by systems with good interface fitting do not create widespread dispersion of exhaled air, and their use can be considered at low risk of airborne transmission. Practically, non-invasive techniques can be used in non-severe forms of respiratory failure. However, if the scenario does not improve or even worsen within a short period of time (1–2 hours) the mechanical ventilation must be preferred.

Other therapies

Among other therapeutic strategies, systemic corticosteroids for the treatment of viral pneumonia or acute respiratory distress syndrome (ARDS) are not recommended. Moreover, unselective or inappropriate administration of antibiotics should be avoided. Although no antiviral treatments have been approved, alpha-interferon (e.g., 5 million units by aerosol inhalation twice per day), and lopinavir/ritonavir have been suggested. Preclinical studies suggested that remdesivir (GS5734) — an inhibitor of RNA polymerase with in vitro activity against multiple RNA viruses, including Ebola — could be effective for both prophylaxis and therapy of HCV infections. This drug was positively tested in a rhesus macaque model of MERS-CoV infection.

When the disease results in complex clinical pictures of MOD, organ function support in addition to respiratory support, is mandatory. Extracorporeal membrane oxygenation (ECMO) for patients with refractory hypoxemia despite lung-protective ventilation should merit consideration after a case-by-case analysis. It can be suggested for those with poor results to prone position ventilation.

Alternative Treatments of Coronavirus Infection

The Centers for Disease Control and Prevention (CDC) also recommends everyday preventive actions to help prevent the spread of this and other respiratory viruses, including the following:

  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Stay home when you are sick, and keep children home from school when they are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

If you feel sick with fever, cough, or difficulty breathing, and have traveled to high-risk countries or regions or were in close contact with someone with COVID-19 in the 14 days before you began to feel sick, seek medical care. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel or exposure and your symptoms

Prevention of Coronavirus Infection

Although there is no vaccine available to prevent infection with the new coronavirus, you can take steps to reduce your risk of infection. WHO and CDC recommend following the standard precautions for avoiding respiratory viruses:

  • Wash your hands often with soap and water, or use an alcohol-based hand sanitizer.
  • Cover your mouth and nose with your elbow or tissue when you cough or sneeze.
  • Avoid touching your eyes, nose, and mouth if your hands aren’t clean.
  • Avoid close contact with anyone who is sick.
  • Avoid sharing dishes, glasses, bedding and other household items if you’re sick.
  • Clean and disinfect surfaces you often touch.
  • Stay home from work, school, and public areas if you’re sick.

CDC doesn’t recommend that healthy people wear a facemask to protect themselves from respiratory illnesses, including COVID- 19. Only wear a mask if a health care provider tells you to do so.

WHO also recommends that you

  • Avoid eating raw or undercooked meat or animal organs.
  • Avoid contact with live animals and surfaces they may have touched if you’re visiting live markets in areas that have recently had new coronavirus cases.

Travel

If you’re planning to travel internationally, first check the CDC and WHO websites for updates and advice. Also, look for any health advisories that may be in the place where you plan to travel. You may also want to talk with your doctor if you have health conditions that make you more susceptible to respiratory infections and complications.

Steps to Prevent Illness

There is currently no vaccine to prevent coronavirus disease in 2019 (COVID-19).
The best way to prevent illness is to avoid being exposed to this virus.

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet).
  • Respiratory droplets produced when an infected person coughs or sneezes.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Take steps to protect yourself

Illustration: washing hands with soap and water

Clean your hands often

  • Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.

Illustration: Woman quarantined to her home

Avoid close contact

Take steps to protect others

man in bed

Stay home if you’re sick

  • Stay home if you are sick, except to get medical care. Learn what to do if you are sick.

woman covering their mouth when coughing

Cover coughs and sneezes

  • Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.
  • Throw used tissues in the trash.
  • Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.

man wearing a mask

Wear a facemask if you are sick

  • If you are sick – You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. [rx]
  • If you are NOT sick – You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.

cleaning a counter

Clean and disinfect

  • Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
  • If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection.

To disinfect

Most common EPA-registered household disinfectants will work. Use disinfectants appropriate for the surface.

Options include:

  • Diluting your household bleach – To make a bleach solution, mix:
  • 5 tablespoons (1/3rd cup) bleach per gallon of water
    OR
  • 4 teaspoons bleach per quart of water. Follow the manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.
  • Alcohol solutions – Ensure the solution has at least 70% alcohol.
  • Other common EPA-registered household disinfectants.
    Products with EPA-approved emerging viral pathogens pdf icon[7 pages]external icon claims are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).

Environmental Cleaning and Disinfection Recommendations

Interim Recommendations for US Households with Suspected/Confirmed Coronavirus Disease 2019

There is much to learn about the novel coronavirus that causes coronavirus disease 2019 (COVID-19). Based on what is currently known about the novel coronavirus and similar coronaviruses that cause SARS and MERS, spread from person-to-person with these viruses happens most frequently among close contacts (within about 6 feet). This type of transmission occurs via respiratory droplets. On the other hand, the transmission of novel coronavirus to persons from surfaces contaminated with the virus has not been documented. Transmission of coronavirus occurs much more commonly through respiratory droplets than through fomites. Current evidence suggests that novel coronavirus may remain viable for hours to days on surfaces made from a variety of materials. Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for the prevention of COVID-19 and other viral respiratory illnesses in households and community settings.

Purpose

This guidance provides recommendations on the cleaning and disinfection of households where persons under investigation (PUI) or those with confirmed COVID-19 reside or maybe in self-isolation. It is aimed at limiting the survival of the virus in the environment. These recommendations will be updated if additional information becomes available.

These guidelines are focused on household settings and are meant for the general public.

  • Cleaning refers to the removal of germs, dirt, and impurities from surfaces. Cleaning does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.
  • Disinfecting refers to using chemicals to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.
General Recommendations for Routine Cleaning and Disinfection of Households

Community members can practice routine cleaning of frequently touched surfaces (for example tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks) with household cleaners and EPA-registered disinfectants that are appropriate for the surface, following label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during the use of the product. General Recommendations for Cleaning and Disinfection of Households with People Isolated in Home Care (e.g. Suspected/Confirmed to have COVID-19)

  • Household members should educate themselves about COVID-19 symptoms and preventing the spread of COVID-19 in homes.
  • Clean and disinfect high-touch surfaces daily in household common areas (e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks)
    • In the bedroom/bathroom dedicated to an ill person: consider reducing cleaning frequency to as-needed (e.g., soiled items and surfaces) to avoid unnecessary contact with the ill person.
      • As much as possible, an ill person should stay in a specific room and away from other people in their home, following home care guidance.
      • The caregiver can provide personal cleaning supplies for an ill person’s room and bathroom unless the room is occupied by a child or another person for whom such supplies would not be appropriate. These supplies include tissues, paper towels, cleaners and EPA-registered disinfectants (examples at this link pdf icon external icon).
      • If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person. If this is not possible, the caregiver should wait as long as practical after use by an ill person to clean and disinfect the high-touch surfaces.
  • Household members should follow home care guidance when interacting with persons with suspected/confirmed COVID-19 and their isolation rooms/bathrooms.
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How to clean and disinfect

Surfaces

  • Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated to cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection products used. Clean hands immediately after gloves are removed.
  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
  • For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective.
    • Diluted household bleach solutions can be used if appropriate for the surface. Follow the manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.
    • Prepare a bleach solution by mixing: 5 tablespoons (1/3rd cup) bleach per gallon of water or 4 teaspoons bleach per quart of water
    • Products with EPA-approved emerging viral pathogens claims pdf icon external icon is expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
  • For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:
    • Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely, or
      Use products with the EPA-approved emerging viral pathogens claims.

 Clothing, towels, linens and other items that go in the laundry

  • Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use. If using reusable gloves, those gloves should be dedicated to cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed.
    • If no gloves are used when handling dirty laundry, be sure to wash hands afterward.
    • If possible, do not shake dirty laundry. This will minimize the possibility of dispersing the virus through the air.
    • Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.
    • Clean and disinfect clothes hampers according to the guidance above for surfaces. If possible, consider placing a bag liner that is either disposable (can be thrown away) or can be laundered.

Hand hygiene and other preventive measures

  • Household members should clean hands often, including immediately after removing gloves and after contact with an ill person, by washing hands with soap and water for 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains at least 60% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water.
  • Household members should follow normal preventive actions while at work and home including recommended hand hygiene and avoiding touching eyes, nose, or mouth with unwashed hands.
    • Additional key times to clean hands include:
      • After blowing one’s nose, coughing, or sneezing
      • After using the restroom
      • Before eating or preparing food
      • After contact with animals or pets
      • Before and after providing routine care for another person who needs assistance (e.g. a child)

Other considerations

  • The ill person should eat/be fed in their room if possible. Non-disposable food service items used should be handled with gloves and washed with hot water or in a dishwasher. Clean hands after handling used food service items.
  • If possible, dedicate a lined trash can for the ill person. Use gloves when removing garbage bags, handling, and disposing of trash. Wash hands after handling or disposing of trash.
  • Consider consulting with your local health department about trash disposal guidance if available.

WHO Director-General’s opening remarks at the media briefing on COVID-19 – 9 March 2020

First, I’d like to start with a brief update on the Ebola epidemic in DRC. It’s now three weeks since the last case was reported, and a week since the last survivor left the treatment center. We are now in the countdown to the end of the outbreak.

  • We continue to investigate alerts and vaccinate contacts every day, and the security situation in North Kivu remains fragile.
  • In previous Ebola outbreaks, we have seen flare-ups even after the end of the outbreak, so we are continuing to provide follow-up care for more than 1100 survivors, and keeping teams on the ground to respond quickly to flare-ups if needed.

The outbreak may be ending – but our determination is not.

  • And nor is our commitment to combating the COVID-19 epidemic. As you know, over the weekend we crossed 100,000 reported cases of COVID-19 in 100 countries. It’s certainly troubling that so many people and countries have been affected, so quickly.
  • Now that the virus has a foothold in so many countries, the threat of a pandemic has become very real. But it would be the first pandemic in history that could be controlled.
  • The bottom line is: we are not at the mercy of this virus.

The great advantage we have is that the decisions we all make – as governments, businesses, communities, families and individuals – can influence the trajectory of this epidemic.

  • We need to remember that with decisive, early action, we can slow down the virus and prevent infections. Among those who are infected, most will recover. Of the 80,000 reported cases in China, more than 70% have recovered and been discharged. It’s also important to remember that looking only at the total number of reported cases and the total number of countries doesn’t tell the full story.
  • Of all the cases reported globally so far, 93% are from just four countries. This is an uneven epidemic at a global level. Different countries are in different scenarios, requiring a tailored response.

It’s not about containment or mitigation – which is a false dichotomy. It’s about both.

  • All countries must take a comprehensive blended strategy for controlling their epidemics and pushing this deadly virus back.
  • Countries that continue finding and testing cases and tracing their contacts not only protect their own people, they can also affect what happens in other countries and globally.
  • WHO has consolidated our guidance for countries in 4 categories: those with no cases; those with sporadic cases; those with clusters; and those with community transmission.
  • For all countries, the aim is the same: stop transmission and prevent the spread of the virus.
  • For the first three categories, countries must focus on finding, testing, treating and isolating individual cases, and following their contacts.
  • In areas with community spread, testing every suspected case and tracing their contacts becomes more challenging. Action must be taken to prevent transmission at the community level to reduce the epidemic to manageable clusters.
  • Depending on their context, countries with community transmission could consider closing schools, canceling mass gatherings and other measures to reduce exposure.

The fundamental elements of the response are the same for all countries:

  • Emergency response mechanisms;
  • Risk communications and public engagement;
  • Case finding and contact tracing;
  • Public health measures such as hand hygiene, respiratory etiquette, and social distancing;

China, Italy, Japan, the Republic of Korea, the United States of America and many others have activated emergency measures.

Singapore is a good example of an all-of-government approach – Prime Minister Lee Hsien Loong’s regular videos are helping to explain the risks and reassure people.

  • The Republic of Korea has increased efforts to identify all cases and contacts, including drive-through temperature testing to widen the net and catch cases that might otherwise be missed.
  • Nigeria, Senegal, and Ethiopia have strengthened surveillance and diagnostic capacity to find cases quickly.
  • Further details on specific actions countries should take in specific contexts are available on the WHO’s website.

WHO is continuing to support countries in all four scenarios.

  • We’re also working with our colleagues across the UN system to support countries to develop their preparedness and response plans, according to the 8 pillars. And we have set up a partner platform to match country needs with contributions from donors.
  • As you know, more funds are being made available for the response, and we’re very grateful to all countries and partners who have contributed. Just since Friday, Azerbaijan, China, the Republic of Korea, and the Kingdom of Saudi Arabia has announced contributions.
  • Almost 300 million U.S. dollars has now been pledged to WHO’s Strategic Preparedness and Response Plan.
  • We are encouraged by these signs of global solidarity. And we continue to call on all countries to take early and aggressive action to protect their people and save lives. For the moment, only a handful of countries have signs of sustained community transmission.
  • Most countries still have sporadic cases or defined clusters. We must all take heart from that.
  • As long as that’s the case, those countries have the opportunity to break the chains of transmission, prevent community transmission and reduce the burden on their health systems.
  • Of the four countries with the most cases, China is bringing its epidemic under control and there is now a decline in new cases being reported from the Republic of Korea. Both these countries demonstrate that it’s never too late to turn back the tide on this virus.

The rule of the game is – never give up.

We’re encouraged that Italy is taking aggressive measures to contain its epidemic, and we hope that those measures prove effective in the coming days.

  • Let hope be the antidote to fear.
  • Let solidarity be the antidote to blame.
  • Let our shared humanity be the antidote to our shared threat.

References

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