Corona Virus Update

CORONA VIRUS
UPDATE
DR ANAND SINGH
ASSOCIATE CONSULTANT NEONATOLOGY
(DCH, DNB, FNNF)

Order - Nidovirales (viruses that replicate using a nested set of mRNAs) ("nido-" for "nest").
Subfamily is further classified into four genera: alpha, beta, gamma, and delta coronaviruses.
HCoV are in two of these genera:
Alpha coronaviruses (HCoV-229E and HCoV-NL63)
Beta coronaviruses (HCoV-HKU1, HCoV-OC43, Middle East respiratory syndrome coronavirus [MERS-CoV] and the
severe acute respiratory syndrome coronavirus [SARS-CoV]

 Medium-sized enveloped positive-stranded RNA viruses.
 Crown-like appearance in electron micrographs.
 Length of 27 to 32 kb.
 The host-derived membrane is studded with glycoprotein spikes and surrounds the genome,
which is encased in a nucleocapsid that is helical in its relaxed form but assumes a roughly
spherical shape in the virus particle.
 The genome encodes four or five structural proteins, S, M, N, HE, and E.

Seasonality
 Community-acquired coronaviruses are ubiquitous, wherever investigators have looked, they have
been detected.
 Coronavirus respiratory infections occur primarily in the Winter, although smaller peaks are sometimes
seen in the fall or spring, and infections can occur at any time of the year.
(Gaunt ER, Hardie A, Claas EC, et al. Epidemiology and clinical presentations of the four human coronaviruses 229E, HKU1, NL63, and OC43 detected
over 3 years using a novel multiplex real-time PCR method. J Clin Microbiol 2010; 48:2940)
 A seven-year study of hospitalized children in Guangzhou, China, described the seasonality in a
subtropical region, with outbreaks at almost any time of year but predominantly in the spring and fall.
(Zeng ZQ, Chen DH, Tan WP, et al. Epidemiology and clinical characteristics of human coronaviruses OC43, 229E, NL63, and HKU1: a study of
hospitalized children with acute respiratory tract infection in Guangzhou, China. Eur J Clin Microbiol Infect Dis 2018; 37:363)

 A large PCR based study of viruses in adults and children with acute respiratory illness was performed
in Scotland, with sampling in over 44,000 episodes over nine years & found that HCoV infections
were most common in the winter, were distributed across all age groups, coinfections were relatively
common, particularly in young children.
(Nickbakhsh S, Thorburn F, VON Wissmann B, et al. Extensive multiplex PCR diagnostics reveal new insights into the epidemiology of viral respiratory
infections. Epidemiol Infect 2016; 144:2064)

 Via direct contact with infected secretions or large aerosol droplets.
 Immunity develops soon after infection but wanes gradually over time.
 Reinfection is common, presumably because of waning immunity but possibly because of antigenic
variation within species.
 In hospital settings, spread among pediatric patients probably occurs through shedding by their
infected caretakers.
 Outbreaks are common in long-term care facilities for older adults.

Respiratory
 HCoV probably account for 5 to 10 percent of all acute upper respiratory tract infections in adults, with
outbreaks during which 25 – 35 % of respiratory infections can be attributed to a single species.
( Monto AS. Medical reviews. Coronaviruses. Yale J Biol Med 1974; 47:234 )
 HCoV-229 E and HCoV-OC43 have been proven to have pathogenicity in humans.
 HCoV-OC43 may have greater clinical impact as compared to HCoV-229E.
 Study in 3104 adults in Europe spanning two and a half years, patients with lower respiratory tract
infection (which included community- acquired pneumonia as well as cough without evidence of
pneumonia) were sampled. HCoV was the third most common virus detected (after rhinovirus and
influenza virus).
(Leven M, Coenen S, Loens K, et al. Aetiology of lower respiratory tract infection in adults in primary care: a prospective study in 11 European countries.
Microbiol Infect 2018; 24:1158 )

 Among older adult patients, there is increasing evidence that coronaviruses are important causes of
influenza-like illness, acute exacerbations of chronic bronchitis and pneumonia.
(Kherad O, Kaiser L, Bridevaux PO, et al. Upper-respiratory viral infection, biomarkers, and COPD exacerbations. Chest 2010; 138:896)
 Coronaviruses have been found in 4 to 6 percent of adults with exacerbations of chronic obstructive
pulmonary disease (less frequent than rhinoviruses and respiratory syncytial virus, equally frequent or
somewhat less frequent than influenza, and more frequent than parainfluenza viruses, human
metapneumovirus, and adenoviruses).
(Zwaans WA, Mallia P, van Winden ME, Rohde GG. The relevance of respiratory viral infections in the exacerbations of chronic obstructive pulmonary disease—a
systematic review. J Clin Virol 2014; 61:181)

 In children hospitalized in New York City with HCoV infection and respiratory disease, a majority were under
five years of age and had some underlying condition such as heart disease, chronic lung disease, or
congenital abnormalities.
(Varghese L, Zachariah P, Vargas C, et al. Epidemiology and Clinical Features of Human Coronaviruses in the Pediatric Population. J Pediatric Infect Dis Soc 2018;
7:151)
 They have been temporally linked to acute asthma attacks in both children and adults.
(McIntosh K, Ellis EF, Hoffman LS, et al. The association of viral and bacterial respiratory infections with exacerbations of wheezing in young asthmatic children. J
Pediatr 1973; 82:578)
 They have been found in variable proportions, ranging from 2 to 8 % of neonates, infants, and young children
hospitalized with community-acquired pneumonia, and have been identified even more frequently in lower
respiratory tract disease in outpatients.
(Talbot HK, Shepherd BE, Crowe JE Jr, et al. The pediatric burden of human coronaviruses evaluated for twenty years. Pediatr Infect Dis J 2009; 28:682)

 They are also an important cause of nosocomial infections in neonatal intensive care units.
(Sizun J, Soupre D, Legrand MC, et al. Neonatal nosocomial respiratory infection with coronavirus: a prospective study in a neonatal intensive care unit.
Acta Paediatr 1995; 84:617)
 One of the more recently discovered human coronaviruses, HCoV-NL63, has been associated with
croup in children.
(Varghese L, Zachariah P, Vargas C, et al. Epidemiology and Clinical Features of Human Coronaviruses in the Pediatric Population. J Pediatric Infect Dis
Soc 2018; 7:151).
 Coronaviruses can be detected in middle ear effusions and have been implicated as important viral
causes of acute otitis media in children.
(Chonmaitree T, Revai K, Grady JJ, et al. Viral upper respiratory tract infection and otitis media complication in young children. Clin Infect Dis 2008;
46:815)

 Coronaviruses also probably cause pneumonia in immunocompromised hosts, including adults with HIV
infection.
 28 HCoV infected hematopoietic cell transplant (HCT) recipients were compared with published series of
similar HCT patients with influenza virus, RSV, and parainfluenza virus infections from the same center. All
viruses were detected in BAL specimens. No differences in survival were seen between the HCoV-infected
patients and those infected with the other respiratory viruses.
(Ogimi C, Waghmare AA, Kuypers JM, et al. Clinical Significance of Human Coronavirus in Bronchoalveolar Lavage Samples From Hematopoietic Cell Transplant
Recipients and Patients With Hematologic Malignancies. Clin Infect Dis 2017; 64:1532)
 Some evidence of an association between coronavirus infection and acute rejection and bronchiolitis
obliterans syndrome in lung transplant recipients, although the association is less clear than for other
respiratory viruses.

ENTERIC
 The idea that coronaviruses produce diarrhea in humans is intriguing because of their clear intestinal
pathogenicity in animals.
 Early human studies depended on finding "coronavirus-like particles" (CVLPs) by electron microscopy in
stool samples.
 The most convincing studies showed a strong association between the presence of CVLPs and diarrhea in
infants or necrotizing enterocolitis in newborns.
(Chany C, Moscovici O, Lebon P, Rousset S. Association of coronavirus infection with neonatal necrotizing enterocolitis. Pediatrics 1982; 69:209)
 In several studies, CVLPs have been purified that appear to be antigenically related to HCoV-OC43.
(Gerna G, Passarani N, Battaglia M, Rondanelli EG. Human enteric coronaviruses: antigenic relatedness to human coronavirus OC43 and
possible etiologic role in viral gastroenteritis. J Infect Dis 1985; 151:796)

 All four HCoV species have been found by reverse-transcriptase polymerase chain reaction (RT-PCR) in the
stools of a small proportion of infants and children hospitalized with diarrhea (often with respiratory
symptoms as well).
(Jevšnik M, Steyer A, Zrim T, et al. Detection of human coronaviruses in simultaneously collected stool samples and nasopharyngeal swabs from hospitalized
children with acute gastroenteritis. Virol J 2013; 10:46)
 In one study, all four species were found in stools from 2.5 percent of 878 children with diarrhea and
1.8 percent of 112 asymptomatic children by RT-PCR, However, in this and other surveys, most
diarrhea-associated coronavirus-positive stools also contained other known pathogens, such as
rotavirus or norovirus.
(Jevšnik M, Steyer A, Zrim T, et al. Detection of human coronaviruses in simultaneously collected stool samples and nasopharyngeal swabs from hospitalized
children with acute gastroenteritis. Virol J 2013; 10:46)
 In a study that used RT-PCR to investigate the frequency of coronaviruses in stool samples
from children and adults with gastrointestinal illness, CoV-HKU1 was found in 4 of 479
patients (0.8 percent), and no other HCoV species were found.
(Esper F, Ou Z, Huang YT. Human coronaviruses are uncommon in patients with gastrointestinal illness. J Clin Virol 2010; 48:131)

 A study assessed the association between gastrointestinal manifestations (diarrhea, vomiting, nausea,
and abdominal pain) in adults reporting to general practitioners with respiratory symptoms plus
systemic symptoms or signs (fever, chills, headache, or myalgia).
 Viruses were sought from respiratory and stool samples and bacteria from stool samples only.
 Gastrointestinal symptoms, which occurred in 57 percent of patients, were more likely to occur in
those with fever >102.2°F, headache, a gastrointestinal pathogen, or HCoV respiratory infection.
 Although a few HCoVs were found in stool samples, it was thought that these were likely swallowed
viruses. The pathogenetic mechanism of these gastrointestinal manifestations remains unclear.
(Minodier L, Masse S, Capai L, et al. Clinical and virological factors associated with gastrointestinal symptoms in patients with acute respiratory
infection: a two-year prospective study in general practice medicine. BMC Infect Dis 2017; 17:729)

 Community-acquired human coronaviruses (HCoVs) can infect neural cells in vitro.
(Arbour N, Ekandé S, Côté G, et al. Persistent infection of human oligodendrocytic and neuroglial cell lines by human coronavirus 229E. J Virol 1999;
73:3326)
 HCoV-OC43 RNA sequences have been detected in the cerebrospinal fluid of a 15-year-old boy with
acute demyelinating encephalomyelitis (ADEM).
(Yeh EA, Collins A, Cohen ME, et al. Detection of coronavirus in the central nervous system of a child with acute disseminated encephalomyelitis.
Pediatrics 2004; 113:e73)
 In another report, full-length HCoV-OC43 RNA was recovered from the brain, in an 11-month-old
boy with severe combined immunodeficiency and acute encephalitis following umbilical cord blood
transplantation.
(Morfopoulou S, Brown JR, Davies EG, et al. Human Coronavirus OC43 Associated with Fatal Encephalitis. N Engl J Med 2016; 375:497)
Neurologic disease

 RNA of the human coronaviruses (HCoV-OC43 and HCoV-229E) have been detected in brain tissue
from MS patients by reverse-transcriptase polymerase chain reaction.
(Arbour N, Day R, Newcombe J, Talbot PJ. Neuroinvasion by human respiratory coronaviruses. J Virol 2000; 74:8913)

 An association of coronavirus infection with Kawasaki disease was reported by one group of
investigators.
(Esper F, Shapiro ED, Weibel C, et al. Association between a novel human coronavirus and Kawasaki disease. J Infect Dis 2005; 191:499)
 Others failed to confirm this finding & at the present time, it is assumed that known coronaviruses
have no role in this disease.
(Dominguez SR, Anderson MS, Glodé MP, et al. Blinded case-control study of the relationship between human coronavirus NL63 and Kawasaki
syndrome. J Infect Dis 2006; 194:1697)
Kawasaki Disease

Clinical Feature of SARI when Novel coronavirus (2019-nCoV) infection is suspected

 Rapid techniques that can be used to detect coronaviruses from nasopharyngeal samples
include reverse-transcriptase polymerase chain reaction (RT-PCR) and immunofluorescence
antigen detection assays.
 Although broadly reacting pan-coronavirus primers have been developed, they are less
sensitive than primers designed for each of the four human strains. The sensitivity may be
further improved by using real-time RT-PCR.
(Gaunt ER, Hardie A, Claas EC, et al. Epidemiology and clinical presentations of the four human coronaviruses 229E, HKU1, NL63, and OC43 detected
over 3 years using a novel multiplex real-time PCR method. J Clin Microbiol 2010; 48:2940)
 Community-acquired coronaviruses are difficult to replicate in tissue culture.
 Serology for diagnostic purposes is recommended only when RT-PCR is not available.
(Antibodies are not detectable until 10 days after symptoms onset & may take 4 weeks for
IgGseroconversion)

WHO RECOOMENDATION ON SARI FOR SAMPLE COLLECTION Collect blood cultures for bacteria that cause pneumonia and sepsis, ideally before antimicrobial
therapy.
 Collect specimens from BOTH the upper respiratory tract (URT - nasopharyngeal and oropharyngeal)
AND lower respiratory tract (LRT - expectorated sputum, endotracheal aspirate, or bronchoalveolar
lavage) for 2019-nCoV testing by RT-PCR.
(When collecting URT samples, use viral swabs (sterile Dacron/rayon, not cotton) and viral transport
media.
Do not sample the nostrils or tonsils.)
 Clinicians may elect to collect only LRT samples when these are readily available (in mechanically
ventilated patients).
 In hospitalized patients with confirmed 2019-nCoV infection, Repeat URT and LRT samples should be
collected to demonstrate viral clearance. The frequency of specimen collection will depend on local
circumstances but should be at least every 2 to 4 days until there are two consecutive negative results

 There is currently no treatment recommended for coronavirus infections except for supportive care as
needed.
 Chloroquine, which has potent antiviral activity against the SARS-CoV has been shown to have similar
activity against HCoV-229E in cultured cells and against HCoV-OC43 both in cultured cells and in a mouse
model. However, there have been no studies of efficacy in humans.
(Kono M, Tatsumi K, Imai AM, et al. Inhibition of human coronavirus 229E infection in human epithelial lung cells (L132) by chloroquine:
involvement of p38 MAPK and ERK. Antiviral Res 2008; 77:150.
Keyaerts E, Li S, Vijgen L, et al. Antiviral activity of chloroquine against human coronavirus OC43 infection in newborn mice. Antimicrob Agents
Chemother 2009; 53:3416)
 Remdesivir which was developed for treatment of Ebola virus has helped 1 patient in nCoV2019 from
recovery. (Source- Media)
 Another Clinical trial, combination of two anti- HIV drugs (Lopinavir & Ritonavir) is also underway in
Chinese Hospitals. (Source- Media)

The following measures are not specifically recommended as 2019-nCoV remedies, as they are not
effective to protect yourself and can be even harmful: (WHO)
 Taking vitamin C
 Smoking
 Drinking tradition herbal teas
 Wearing multiple masks to maximize protection
 Taking self-medication such as antibiotics
 In any case, if you have fever, cough and difficulty breathing seek medical care early to reduce the risk
of developing a more severe infection and be sure to share your recent travel history with your health
care provider.

 Give supplemental oxygen therapy immediately to patients with SARI and respiratory distress,
hypoxaemia, or shock.
 Use conservative fluid management in patients with SARI when there is no evidence of shock.
(Aggressive fluid may worsen oxygenation)
 Give empiric antimicrobials to treat all likely pathogens causing SARI.
 (Empiric antibiotic acc to the clinical diagnosis or sepsis, local epidemiology and susceptibility data,
treatment guidelines. Empiric therapy includes a neuraminidase inhibitor for treatment of influenza
when there is local circulation or other risk factors, including travel history or exposure to animal
influenza viruses.
 Empiric therapy should be de-escalated on the basis of microbiology results and clinical judgment)
 Give antimicrobials within one hour of initial patient assessment for patients with sepsis.

 Do not routinely give systemic corticosteroids for treatment of viral pneumonia or ARDS outside of
clinical trials unless they are indicated for another reason (no survival benefit and possible harms like
avascular necrosis, psychosis, diabetes, and delayed viral clearance)
 Closely monitor patients with SARI for signs of clinical deterioration, such as rapidly progressive
respiratory failure and sepsis and apply supportive care interventions immediately.
(For SARI – WHO)

 Understand the patient’s co-morbid condition(s) to tailor the management of critical illness and
appreciate the prognosis.
 Communicate early with patient and family.
 Recognize severe hypoxemic respiratory failure when a patient with respiratory distress is failing
standard oxygen therapy.
 Application of timely, effective, and safe supportive therapies is the cornerstone of therapy.
 High-flow nasal oxygen (HFNO) or non-invasive ventilation (NIV) should only be used in selected
patients with hypoxemic respiratory failure.
 The risk of treatment failure is high in patients with MERS treated with NIV, and patients treated with
either HFNO or NIV should be closely monitored for clinical deterioration.
 (Patients receiving a trial of NIV should be in a monitored setting and cared for by experienced
personnel capable of endotracheal intubation in case the patient acutely deteriorates or does not
improve after a short trial (about 1 hr).
(For Management of hypoxemic respiratory failure and ARDS – WHO)

 Patients with hemodynamic instability, multiorgan failure or abnormal mental status should not
receive NIV.
 Recent publications suggest that newer HFNO and NIV systems with good interface fitting do not
create widespread dispersion of exhaled air and therefore should be associated with low risk of
airborne transmission)

 Endotracheal intubation should be performed by a trained and experienced provider using airborne
precautions.
 Patients with ARDS, especially young children or those who are obese or pregnant, may desaturate
quickly during intubation.
 Pre-oxygenate with 100% FiO2 for 5 minutes, via a face mask with reservoir bag, bag-valve mask,
HFNO, or NIV.
 Rapid sequence intubation is appropriate after an airway assessment that identifies no signs of
intubation)
 Implement mechanical ventilation using lower tidal volumes (4–8 ml/kg predicted body weight) and
lower inspiratory pressures (plateau pressure <30 cmH2O)
 High driving pressure (plateau pressure−PEEP) may more accurately predict increased mortality in
ARDS compared to high tidal volume or plateau pressure.

 In patients with severe ARDS, Prone ventilation for >12 hours per day is strongly recommended for
severe ARDS.
 Use a conservative fluid management strategy for ARDS patients without tissue hypoperfusion.
 Avoid disconnecting the patient from the ventilator, which results in loss of PEEP and atelectasis.
 Use in-line catheters for airway suctioning and clamp endotracheal tube when disconnection is required
(for example, transfer to a transport ventilator).

 In patients with moderate or severe ARDS, higher PEEP instead of lower PEEP is suggested.
 In patients with moderate-severe ARDS (PaO2/FiO2 <150), neuromuscular blockade by continuous infusion
should not be routinely used.
 This strategy improved survival in patients with severe ARDS (PaO2/FiO2 <150) without causing significant
weakness, but results of a recent larger trial found that use of neuromuscular blockage with high PEEP strategy
was not associated with survival when compared to a light sedation strategy without neuromuscular blockade.
 Continuous neuromuscular blockade may still be considered in patients with ARDS in certain situations:
dysnchrony despite sedation or refractory hypoxemia or hypercapnia.
 In settings with access to expertise in extracorporeal life support (ECLS), consider referral of patients with
refractory hypoxemia despite lung protective ventilation.

 Recognize septic shock in children with any hypotension (systolic blood pressure [SBP] <5th centile or >2
SD below normal for age) or 2-3 of the following: altered mental state; tachycardia or bradycardia (HR
bpm or >160 bpm in infants and HR <70 bpm or >150 bpm in children); prolonged capillary refill (>2 sec)
or warm vasodilation with bounding pulses; tachypnea; mottled skin or petechial or purpuric rash;
lactate; oliguria; hyperthermia or hypothermia.
 In resuscitation from septic shock in children in well-resourced settings, give 20 ml/kg as a rapid bolus and
up to 40-60 ml/kg in the first 1 hr.
 Administer vasopressors when shock persists during or after fluid resuscitation. The initial blood pressure
target is MAP ≥65 mmHg in adults and age-appropriate targets in children.
For Management of septic shock -

Basic protective measures against the new coronavirus (WHO)

 Wash your hands frequently with an alcohol-based hand rub or soap and water.
 When coughing and sneezing, cover mouth and nose with flexed elbow or tissue – discard tissue immediately
into a closed bin and clean your hands with alcohol-based hand rub or soap and water.
 Maintain at least 1 metre (3 feet) distance between yourself and other people, particularly those who are
coughing, sneezing and have a fever.
 If you touch your eyes, nose or mouth with your contaminated hands, you can transfer the virus from the
surface to yourself.
 Tell your health care provider if you have traveled in an area in China where 2019-nCoV has been reported, or
if you have been in close contact with someone with who has traveled from China and has respiratory
symptoms.

 If you have mild respiratory symptoms and no travel history to or within China, carefully practice basic
respiratory and hand hygiene and stay home until you are recovered, if possible.
 Ensure regular hand washing with soap and potable water after touching animals and animal products.
 Avoid touching eyes, nose or mouth with hands and avoid contact with sick animals or spoiled animal products.
 Strictly avoid any contact with other animals in the market (e.g stray cats and dogs, rodents, birds, bats).
 Avoid contact with potentially contaminated animal waste or fluids on the soil or structures of shops and market
facilities.
 Handle raw meat, milk or animal organs with care, to avoid cross-contamination with uncooked foods, as per
good food safety practices.

Infection prevention and control measures for patients with suspected or confirmed nCoV

 At Triage
Give suspected patient a medical mask and direct patient to separate area
An isolation room if available.
Keep at least 1meter distance between suspected patients and other patients.
Instruct all patients to cover nose and mouth during coughing or sneezing with
tissue or flexed elbow for others.
Perform hand hygiene after contact with respiratory secretions

 Apply Droplet Precautions
Droplet precautions prevent large droplet transmission of respiratory viruses.
Use a medical mask if working within 1-2 metres of the patient.
Place patients in single rooms or group together those with the same etiological diagnosis.
If an etiological diagnosis is not possible, group patients with similar clinical diagnosis and based on
epidemiological risk factors, with a spatial separation.
When providing care in close contact with a patient with respiratory symptoms (e.g. coughing or
sneezing), use eye protection (face-mask or goggles), because sprays of secretions may occur.
Limit patient movement within the institution and ensure that patients wear medical masks when
outside their rooms.

 Apply contact precautions
Droplet and contact precautions prevent direct or indirect transmission from contact with contaminated
surfaces or equipment (i.e. contact with contaminated oxygen tubing/interfaces).
Use PPE (medical mask, eye protection, gloves and gown) when entering room and remove PPE when
If possible, use either disposable or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and
thermometers).
If equipment needs to be shared among patients, clean and disinfect between each patient use.
Ensure that health care workers refrain from touching their eyes, nose, and mouth with potentially
contaminated gloved or ungloved hands.
Avoid contaminating environmental surfaces that are not directly related to patient care (e.g. door handles
light switches).
Ensure adequate room ventilation.
Avoid movement of patients or transport.
Perform hand hygiene.

 Apply airborne precautions when performing an aerosol generating procedure
Ensure that healthcare workers performing aerosol-generating procedures (i.e. open suctioning of
respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation) use PPE, including gloves,
long-sleeved gowns, eye protection, and fit-tested particulate respirators (N95 or equivalent, or higher
level of protection).
Whenever possible, use adequately ventilated single rooms when performing aerosol-generating
procedures, meaning negative pressure rooms with minimum of 12 air changes per hour or at least 160
litres/second/patient in facilities with natural ventilation.
Avoid the presence of unnecessary individuals in the room.
Care for the patient in the same type of room after mechanical ventilation commences.

Special considerations for pregnant patients

 Pregnant women with suspected or confirmed 2019-nCoV infection should be treated with
supportive therapies as described above, taking into account the physiologic adaptations of
pregnancy.
 The use of investigational therapeutic agents outside of a research study should be guided by
individual risk-benefit analysis based on potential benefit for mother and safety to fetus, with
consultation from an obstetric specialist and ethics committee.
 Emergency delivery and pregnancy termination decisions are challenging and based on many factors:
gestational age, maternal condition, and fetal stability.
 Consultations with obstetric, neonatal, and intensive care specialists (depending on the condition of
the mother) are essential.

Can humans become infected with the 2019-nCoV from an animal source?
 SARS-CoV was transmitted from Cats to humans in China in 2002 and MERS-CoV from camels to
in Saudi Arabia in 2012.
 Several known coronaviruses are circulating in animals that have not yet infected humans. As
improves around the world, more coronaviruses are likely to be identified
 The animal source of the 2019-nCoV has not yet been identified.
 It’s likely that an animal source from a live animal market in China was responsible for some of the first
reported human infections.
 To protect yourself, when visiting live animal markets, avoid direct unprotected contact with live animals
and surfaces in contact with animals.
 The consumption of raw or undercooked animal products should be avoided. Raw meat, milk or animal
organs should be handled with care, to avoid cross-contamination with uncooked foods, as per good
safety practices.

Can I catch 2019-nCoV from my pet ?
No, at present there is no evidence that companion animals or pets such as cats and dogs have been
infected or have spread 2019-nCoV.

Should I wear a mask to protect myself?
 Wearing a medical mask can help limit the spread of some respiratory disease. However, using a
mask alone is not guaranteed to stop infections and should be combined with other prevention
measures.
 WHO advises on rational use of medical masks thus avoiding unnecessary wastage of precious
resources and potential mis-use of masks.
 Use masks only if you have respiratory symptoms (coughing or sneezing), have suspected 2019-
nCoV infection with mild symptoms or are caring for someone with suspected 2019-nCoV
 A suspected 2019-nCoV infection is linked to travel in an area in China where 2019-nCoV has been
reported or close contact with someone who has travelled from China and has respiratory
symptoms.

Instruction for use of Mask
 Place mask carefully to cover mouth and nose and tie securely to minimise any gaps between the
face and the mask.
 While in use, avoid touching the mask.
 Remove the mask by using appropriate technique (i.e. do not touch the front but remove the lace
from behind)
 After removal or whenever you inadvertently touch a used mask, clean hands by using an alcohol-
based hand rub or soap and water if visibly soiled.
 Replace masks with a new clean, dry mask as soon as they become damp/humid.
 Do not re-use single-use masks.
 Discard single-use masks after each use and dispose of them immediately upon removal.
 Cloth (e.g. cotton or gauze) masks are not recommended under any circumstance.
(WHO)

How long does the virus survive on surfaces?
 It is still not known how long the 2019-nCoV virus survives on surfaces.
 Although preliminary information suggests the virus may survive a few hours.
 Simple disinfectants can kill the virus making it no longer possible to infect people.

What's the difference between illness caused by 2019-nCoV infection, the flu or a cold?
 People with 2019-nCoV infection, the flu, or a cold typically develop respiratory symptoms such as
fever, cough and runny nose.
 Because of their similarities, it can be difficult to identify the disease based on symptoms alone.
That’s why laboratory tests are required to confirm if someone has 2019-nCoV.
 WHO recommends that people who have cough, fever and difficulty breathing should seek medical
care early.
 Patients should inform health care providers if they have travelled in the 14 days before they
developed symptoms or if they have been in close contact with someone with who has been sick
with respiratory symptoms.

Can 2019-nCoV be caught from a person who presents no symptoms?
 Understanding the time when infected patients may spread the virus to others is critical for control
 Detailed medical information from people infected is needed to determine the infectious period of
nCoV.
 According to recent reports, it may be possible that people infected with 2019-nCoV may be infectious
before showing significant symptoms.
 However based on currently available data, the people who have symptoms are causing the majority of
virus spread.

Corona Virus Update

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