Guidance for Corona virus Disease 2019 Prevention,control,diagnosis and management

1. Guidance for Corona
Virus Disease 2019
Prevention, Control, Diagnosis and
Management
By : Dr. Rana Nabeel Mazhar

2. Edited By :
National Health Commission and National Administration of Traditional Chinese
Medicine of the PRC
Compiled and
Translated by :
Chinese
Preventive
Medicine
Association

3. Unexplained Pneumonia in China
Dec 29,2019: Hospital in Wuhan, Hubei Province China reported severe
unexplained pneumina cases
Jan 30,2020 : WHO declared it Public Health Emergency
Feb 12,2020: Virus officially named SARS-CoV-2 and disease as
COVID19

4. Pathogenic
Characteristics
Genus beta
Enveloped, round to elliptical in shape
60 to 140 nm in diameter
Sensitive to : UV ray, heat upto 56 degree Celsius
for 30 min, Ethanol 75 percent, Chlorine
containing disinfectants but not to chlorhexidine

5. Epidemiological Characteristics
Source: Patients and
asymtomatic carriers
Route of Transmission:
Droplet,contact,aerosol
if prolonged exposure
Susceptible
Individuals: People of
all ages but more in
immunocompromised

6. Clinical
Characteristics
Incubation period from 1 to 14 days
Fever,fatigue and dry cough
Mild cases without manifestation of
pneumonia
Elderly people with chronic underlying
diseases usually have poor prognosis

7. Laboratory Examination
In early stage a normal or decreased WBC count and a decreased lymphocyte count can be
seen
In addition : raised Liver enzymes,LDH,Muscle enzymes, myoglobin and troponin in
critically ill patients
Raised CRP and ESR
Nucleic acid ( RNA ) of coronavirus can be detected in biological specimens like
nasophyrangeal swabs,blood and feces.

8. Chest Imaging
Early stage: small
patchy shadows and
interstitial changes
especially in lungs
periphery
As disease
progress: multiple
ground glass shadows
and infiltration
shadows
In severe cases: lung
consolidation

9. Diagnostic Criteria
Suspected Cases: Considering both epidemiological and clinical
manifestation. One of epidemiological exposure history and two of
clinical manifestation OR no definitive epidemiological history but
three clinical manifestations
Confirmed Cases: A suspected case with positive PCR

10. Clinical Classification
Mild Cases: Mild symptoms ,no pneumonia
Ordinary Cases: Respiratory symptoms and pneumonia on imaging
Severe Cases: Meeting any of following RR > OR EQUAL 30 b/min , SpO2 <93 percent, PaO2
/FiO2 <300 mmHg ,>50 percent progression on pulmonary imaging in 24 to 48 hours
Critical Cases: Respiratory failure, shock or any organ failure requiring ICU care

11. Differential
Diagnosis
COVID19 infection should be
differentiated from
Other mild manifestations of
viral respiratory infections
Other viral pneumonias
like influenza, adenovirus or RSV
and mycoplasma pneumonia

12. Case Identification and Report
Immediate isolation and treatment of
suspected cases in a single room
Suspected cases should be
transferred to hospital
immediately

13. TREATMENT
General Treatment:
Bed Rest
Adequate nutrition
Water and electrolyte balance
Close monitoring of vitals especially oxygen
saturation
Baseline labs including CBC, Urine RE,CRP,
Coagulation profile, ABGs and chest imaging

14. Antiviral
Treatment
Undertrial Medicines
Alpha interferon nebulization 5 million units per day
Lopinavir/ritonavir 200mg/50mg two capsule BD for<10 days
Ribavirin 500mg inj. 2 to 3 times per day for <10 days
Arbidol (Umifenovir) 200mg BD for <10 days
Chloroquine phosphate 500mg BD <10 days
No effective antiviral treatment is currently confirmed

15. Traditional
Chinese Medicine
Medical Observation Period: Fatigue and gastrointestinal
upset (Huoxianghenqi cap), fatigue and fever (Jinhua Qinggan
granules)
Clinical Treatment Period: Lung clearing and detoxification soup
containing herba ephedrae,radix glycyrrhizae,raw gypsum
fibrosum,rhizoma alismatis
Severe Cases: injections including Xiyanping 100mg BD, Reduning
20 mL, Tanreqing 40 mg BD
In Fever with Consciousness disturbance: inj Xingnao 20 mL
In SIRS or MODS: inj Xuebijing 100 mL

16. Treatment
of Severe
and Critical
Cases
Principles:
Symptomatic treatment
Prevent complications
Prevent secondary infections
Oxygen Therapy: inhalational oxygen with facemask or nasal catheter. If
condition does not improve within 1 to 2 hours endotracheal intubation and
invasive ventilation should be done
Lung protective ventilation: small tidal volume (4 to 8 ml/kg) and low
inspiratory pressure (<30 cmH2O) to reduce lung injury

17. Salvage
Treatment
In severe ARDS perform lung
expansion by
Prone position ventilation for >12
hours per day
In poor prone position ventilation
Extra Corporeal Membrane
Oxygenation (ECMO) cardiopulmonary
bypass should be done

18. Other
Treatments
Convalescent Plasma Therapy: Suitable
for treating rapidly developing cases
Glucocorticoids: can be used for short
term period
Plasma exchange,adsorption,blood/plasma
filtration,and other extracorporeal blood
purification techniques are considered in
severe inflammatory reactions

19. Discharge
Standards
Normal body temp for >3 days
Significantly recovered respiratory symptoms
Lung imaging showing obvious absorption
Negative PCR RESULTS FOR CONSECUTIVE TWO
TIMES (sampling interval at leaste one day)
Recommended to monitor health for 14 days,
wear face mask and stay in a single ventilated
room.

20. Prevention
and Control
Plan for
COVID19
Aims:
Timely detect and
report cases
Regulate close
contacts
Provide guides to
public and specific
groups for personal
protection
Strictly disinfect
specific places
Improve
intercommunication
and cooperation
among depts
Conduct regular
consultation

21. Responsibility
of CDC
Responsibilities of CDC includes:
Organizing
Supervising
Evaluating surveillance
Collecting
Anazyling
Reporting and providing feedback
Conducting training of field investigations

22. Responsibility
of Medical Institutions
Medical institutions are responsible for:
Case detection
Reporting
Isolation
Diagnosis
Treatment
Training medical staff

23. Surveillance
Plan of COVID19
To detect and
report cases
Cluster
outbreak cases
To know
epidemic
characteristics
To judge and
predict
developing
trends

24. Epidemiological Investigation Plan
Aims:
To investigate the
incidence and treatment,
clinical characteristics, risk
factors and exposure
history
To identify and manage
close contacts

25. Investigation Questionnaire

26. Investigation Questionnaire

27. Management
Plan for Close
Contacts
• Medical observation by health dept
and relevant depts together
• Contacts that refuse to comply should
be took compulsory isolation
measures by local public security
organizations
• Centralized isolation
• Home based isolation if centralized not
possible

28. Guidelines for Defining Close Contacts in
Vehicles
Aircraft: All
passengers in same
row and within
three rows and flight
attendants
1
Train: All passengers
in fully enclosed
train otherwise all in
same soft bedroom
or hard seat
2
Car: All passengers in
a closed car but
passengers in three
rows of ventilated
bus and drivers
3
Ship: Everyone in
same cabin and who
served
4

29. Guidelines
for
Laboratory
Examination
Requirements:
Biosafety training
PPE
Types of samples:
Upper and lower respiratory tract
Blood samples
Serum sample for antibodies
Eyes conjunctival samples
Stool samlpes
Specimen packing in class B Biosafety lab
Real Time flourescence RT-PCR
Primer and probes targeting ORF1ab and N gene region of nCoV

30. Guide to Prevent
and Control for
Specific
Populations
For
Elderly
For
Children
For Work
Place
For Public
Transport

31. Prevention and Control Guidelines for the Elderly
1. Ensure that the elderly acquire awareness of personal protective measures, hand hygiene requirements
2. When the elderly have suspicious symptoms such as fever, cough, sore throat, chest tightness, dyspnea:
Self-quarantine
Health status should be assessed by medical staff
Reduce unnecessary gatherings
If any elderly person with suspicious symptoms is diagnosed COVID-19, those who are in close contact should receive
medical observation for 14 days

32. Prevention and Control Guidelines for Children
Do not go
Do not go to
crowded places,
and do not
attend parties.
Wear
Wear a mask
when going out,
and remember to
remind your
parents and
grandparents to
do so.
Maintain
Maintain a
regular schedule
and healthy diet.
Wash your
hands carefully
before meals and
after defecation.
Take more
exercises at
home with your
parents.
Cover
Cover your
mouth and nose
with a paper
towel or by
elbow
when sneezing or
coughing.
Listen
Listen to your
parents and seek
immediate
medical care if
you have a fever
or get sic

33. Prevention and Control Guidelines for Work Places
1. Staff is advised to monitor their
own health
2. Staff with suspicious symptoms
should be required to leave
work place
3. Public goods should be cleaned
and disinfected regularly
4. Maintain air circulation in
office spaces. Ensure all
ventilating facilities work
efficiently. Air conditioner filters
should be cleaned regularly and
ventilation by window opening
should be strengthened
5. Washrooms should be
equipped with enough hand
sanitizers and ensure the normal
operation of water facilities
including faucets
6. Keep the environment clean
and tidy, and clean up garbage in
time

34. Prevention and Control Guidelines for Public
Transports
1. Staff of public transports
in epidemic areas should
wear surgical masks or N95
masks and conduct daily
health monitoring
2. It is recommended to
equip with thermometers,
masks and other items in
vehicles
3. Increase the frequency
of cleaning and disinfection
of vehicles, and make
records and signs of
cleaning and disinfection.
4. Keep the vehicles well
ventilated
5. Keep the stations and
the compartments clean
and tidy, and clean
up garbage in time
6. Arrange rotated days off
for the staff to have
enough rest

35. Together we can save
this world by following
precautionary measures and
taking care of each other...
Thanks!