Experts share their views on what precautions need to be taken in an eventuality of an outbreak
Hospitals bracing themselves and acting towards being well prepared to treat CoronaVirus outbreak
The novel Coronavirus disease 2019 or COVID-19 as it is now called has for the last month and a half been the focus of everybody’s attention worldwide. It is a new virus whose behaviour is largely unknown but it is now known that it spreads quite an easily by person to person contact through droplets and from touching surfaces contaminated with the virus.
Jaslok Hospital has a Department of Infectious Disease and a very strong Infection Prevention Programme that is based on training, strict isolation guidelines and a system of monitoring of infection prevention practices with infection rates that are within international benchmarks.
The hospital has put together a task force comprising infectious disease specialists, respiratory medicine specialists, critical care specialists, microbiologist, emergency medicine specialist, nursing and administrative staff to take care of the important aspects of prevention, identifying infection in patients presenting to the hospital and containment of this infection.
Around a month ago, the hospital took the lead to prepare guidelines for its staff on identifying and handling suspected cases of COVID-19 infection and began intensive training for its entire staff.
The hospital has negative pressure rooms where suspected cases will be isolated until the diagnosis is clear. In this way, we intend to contain the spread.
Patient education guidelines are being played on screens in patient waiting areas to encourage people to follow basic health practices to keep themselves safe such as hand hygiene and the use of personal protective equipment such as masks whenever required.
Through communication at consultant meetings and our research bulletin, we keep our consultants updated on the recent developments of this infection and the public health advisory on it.
COVID-19 is a global public health challenge and at Jaslok Hospital by being prepared, we intend to play our part fully to prevent its spread.
Stay informed and avoid panic
The virus probably originally emerged from an animal source but now seems to be spreading from person-to-person, mainly via respiratory droplets produced when an infected person coughs or sneezes. It is currently unclear if 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 eyes.
The symptoms include mild to severe respiratory illness with fever, cough, difficulty in breathing and diarrhoea. Most of the serious cases (breathing failure, shock, kidney failure) occurred in patients with underlying medical co-morbidities. Symptoms occur two to 14 days after exposure to a case. A test is being done at multiple government-assigned labs, but only for selected cases based on travel and exposure history. However, there is no vaccine yet for this disease, and no specific anti-viral treatment, supportive care (fever reduction and breathing support).
For prevention, one must avoid close contact with people who are sick and touching eyes, nose and mouth with unwashed hands. Further, one should wash hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitiser. The helpline for India is 24×7 National Centre for Disease Control Call centre (+91-11-23978046)
If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after travel from China or other countries with active spread, you should call ahead to a doctor and mention your recent travel or close contact with known/suspected COVID-19 case.
Avoid travelling to countries with active spread of COVID-19 including China, Thailand, Japan, Singapore, etc. In Bengaluru, Rajiv Gandhi Institute of Chest Diseases is the main isolation and treatment centre. There is no reported case in the city.
Best to avoid consuming goods like processed meats
India has been actively screening passengers returning from China. To prevent the spread of Coronavirus to India, it had been decided to expand the universal screening for all the passengers arriving in the flights directly from Japan, South Korea, Singapore, besides the flights from China and Hong Kong.
The first of the few cases of Coronavirus in India was reported in Kerala and the patients are now reported to be stable.
It is best to avoid consuming goods like processed meats and live, consumable animals like poultry, donkey, sheep, pig, camel, fox, badgers, bamboo rats, hedgehogs and reptiles.
Currently, there is no vaccine for Coronavirus. Finding a vaccine and taking it from expectation to reality, tests and solutions will take at least a year. For now, precautions can be taken at a personal level to avoid by the following ways:
- Consume properly cooked meat
- Avoid consuming poultry and wild animals
- Avoid contact with infected people
- Avoid touching mouth and face with unwashed hands
- Wash hands thoroughly with soap
Prevention is the only way to contain this virus
Wearing a mask in public place or when exposed to a person who is having symptoms of cold, cough etc, is a must. Since the virus spreads through droplets and not through the air any mask is fine and it should not be necessarily N95 mask. Infected secretions in the form of respiratory droplets remain alive for at least 12 hours so it is advised to wash hands on a regular basis. The most common way of getting infected is by touching things in public places. The virus can only stay alive for 5-10 mins and a lot can happen in that duration. Since the disease is mainly zoonotic, it spreads from animals to humans faster. So it is advisable to avoid close contact with live or dead farm and wild animals.
In the case of acute respiratory infection, one should practice cough etiquette (maintain distance, cover cough and sneezes with disposable tissues or clothing and wash hands). While visiting a live animal market, a wet market or any animal product market, general hygiene like regular hand washing with soap and potable water after touching animals and animal products, should be practised. Consuming raw or undercooked animal products should be avoided and care should be taken while handling raw meat and milk. Since there is no vaccine available for this virus, prevention is the only way to contain this virus.
Preparedness is the key to handle any outbreak
Dec 2019 witnessed the emergence of a new virus from the Chinese city of Wuhan. Initially, the epidemic started with clustering of eight severe pneumonia cases, who had a history of visiting the seafood market in Wuhan. This is a betacorononavirus coming from bats. It is different from flu and causes high-grade fever and cough with sudden development of pneumonia. Throat pain and myalgia which are prominent flu symptoms are markedly absent. It is affecting elder males who mostly have other comorbidities.
Why did this virus spread like fire?
The initial anxiety about a possible outbreak was downplayed and finally, when public health people perceived impending an outbreak, there was already a great delay in relaying information to the competent authorities. The consequences were evident as unsuspecting healthcare workers developed infections and clustering of cases started happening. Super spreaders continued to move around giving rise to the epidemic doubling time of around 6.4 days. Unlike previous epidemics, many asymptomatic patients transmitted infections to their contacts.
This particular virus has very high transmissibility compared to SARS and MERS. The common route of transmission is by droplet and contact and suspected faecal-oral route of transmission in very few cases. A sustained human to human transmission was quickly established in these cases. Delay in announcing an outbreak helped people continue to move and travel which helped the epidemic to gain momentum.
- Healthcare workers should be always careful in identifying outbreaks and competent authorities should be immediately notified even with slightest suspicion.
- Hospital infection control is the most important preparedness for handling any outbreak.
- Normally health care workers in critical areas and specialized units have access to standard PPE, other healthcare workers may remain ignorant of the use of PPE and standard precautions. All healthcare workers should be trained in handling a possible outbreak like situation. Regular drills in response to emerging global infectious diseases are helpful.
- Dealing with Mask Psychosis- using mask everywhere by asymptomatic people doesn’t help in controlling the outbreak. The more important prevention measures are hand hygiene and practising basic respiratory etiquettes.
Both the general public and healthcare workers need to be educated and trained in basic infection prevention
Limiting the spread of virus and other infections which are either droplet borne (Influenza, SARS etc.) or Airborne (Tuberculosis, Chickenpox) or contact with body fluids from sick patients (Nipah, Ebola etc.) – all of them require meticulous attention to basic infection control principles; to the extent that it can be called basic hygiene. This requires hospitals, governments and individuals to focus upon the following three core aspects.
Infrastructure – Overcrowding and an HVAC system that does not facilitate ventilation and access to sunlight are common features in most of our healthcare facilities. These remain one of the major risk factors for many illnesses like TB, H1N1 and the novel CoV; also infections like Ebola and Nipah. We need Labs that can detect pathogens of importance rapidly and accurately at an affordable cost.
Knowledge and training – Both the general public and healthcare workers need to be educated and trained in basic infection prevention practices like hand hygiene and cough etiquette. Unfortunately, infection prevention practices like an appropriate use of personal protective equipment – PPE (like masks/gloves) and hand washing techniques are not a part of the medical curriculum. We need to introduce these basic aspects of hygiene and infection prevention training in schools/colleges for the general public and as an essential part of the medical curriculum for healthcare workers. The usual trend is that we do not use any PPE when indicated during the ‘routine’ care and during outbreaks like these – we overdo and use unnecessary PPE.
Behavioural changes – With the improved infrastructure, followed by education and training — the success of preventive programmes will be dependent on how as a society or organisation, we promote good behaviour and dissuade negative behaviour.
People of all ages are requested to take steps to protect themselves from the virus
Patients with 2019-nCoV have a respiratory illness like any virus infection, with symptoms of fever, cough, shortness of breath. Patients can get pneumonia in both the lungs. People of all ages can be infected by the virus. Older people and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus. People of all ages are requested to take steps to protect themselves from the virus, for example by following good hand hygiene and good respiratory hygiene. So far, children below 15 years have not been reported as affected by the virus but as new cases emerge every day this scenario may change. The most important preventive measure would be to ensure adequate hand and respiratory hygiene while attending school. The most reliable source is the World Health Organisation (WHO) website which has a world map with daily updates of confirmed cases.