Covid 19 by Dr akbar safi

Nangarhar University Teaching
Hospital
Department Of General Surgery
Dr. Akbar Khan Safi
PGY1
Topic : COVID-19
Guider teacher Prof. Dr Abdul baser Mangal Neuro Surgeon.
Dr Mustafa safi

• Corona viruses (cov) are a larger family of viruses that cusses a
wide range of illness form the common cold to more severe
disease i.e Middle east respiratory syndrome (MERS) and severe
acute respiratory syndrome (SARS).
• A novel Corona Viruses (n Cov) is a new strain that has not be
previously identified in humans.
• On 31 December 2019, the WHO Chania Country office was
informed of pneumonia case of unknown cause in Wuhan city,
Hubei province of Chania. A novel Corona Virus ( COVID 19) was
isolated and identified as the causative virus by Chinese
authorities on 7 January.

• Nearly 143000 causes and of to 4000 deaths have been reported in
china ( as of 16 Mar 2020). The majority of cases are in Hubei
province.
• Cases outside of china at least ( 168826 ) cases and ( 6492 )
deaths have been reported in the following ( 157 ) countries
outside of china (as of 16 Mar 2020).

• Incubation period – 1 – 12.5 days (median 5-6 days). Estimates will
be refined as more date become available.
• More information needed to determine whether transmission can
occur from asymptomatic individuals or during the incubation
perion.
• Mode of transmission: droplets sprayed by affected individuals,
contact with patient respiratory secretions, contaminated
surfaces, fomites and equipment.
• Airborne spread is NOT documented so far.

Symptoms
• Early stage: fever (> 38C) AND Respiratory symptoms: Cough,
shortness of breath, Runny nose, Weakness, Malaise,
Nausea/vomiting Diarrhea, Headache.
• Advanced Stage: all of the earlier symptoms plus pneumonia,
bronchitis.
• The people most at risk of infection are those are who are in close
contact with a COVID-19 patient or who care for COVID-19
patients.

Primary Prevention
• General preventions:
• The only way to prevent infection to avoid exposure to the virus
and people should be advised to:
• Wash hands often with soap and water or an alcohol- based hand
sanitiser and avoid touching the eyes, nose and mouth with
unwashed hands.
• Avoid close contact with people (i.e., maintain a distance of at
least 1 meter [3feet], particularly those who have a fever or are
coughing or sneezing,

Cont..
• Practice respiratory hygiene (i.e., cover mouth and nose when coughing
or sneezing, disease tissue immediately in a closed bin, and wash
hands).
• Seek medical care early if they have a fever, cough and difficulty
breathing and share their previous travel and contact history with their
healthcare provider.
• Avoid direct unprotected contact with live animals and surfaces in
contact with live animals when visiting live markets in affected areas.
• Avoid the consumption of raw or undercooked animal products, and
handle raw meat, milk, or animal organs with care as per usual good
food safety practices.

Medical Masks
• The (WHO) dose not recommend that people wear a medical mask
in community settings if they do not have respiratory symptoms as
there is no evidence available on tis usefulness to protect people
who are not ill.
• However, mask may be worn in some countries according to local
cultural habits, individuals with fever and/or respiratory
symptoms are advised to were a mask, particularly in endemic
areas.
• It is mandatory to wear a medical mask in public in certain areas
of china, and local guidance should be consulted for more
information.

Screening and quarantine
• People travelling from areas with a high risk of infection may be
screened using questionnaires about their travel, contact with ill
persons, symptoms of infection, and/or measurement of their
temperature.
• Combined screening of airline passengers on exit from an affected area
and on arrival elsewhere has been relatively ineffective when used for
other infections such as Ebola virus infection, and has been modelled to
miss up to 50% of cases of COVID-19, particularly those with no
symptoms during an incubation period, which may exceed 10 days.
• Symptom – based screening processes have been reported to be
ineffective in detecting SARS-CoV-2 in a throat swab.

• Enforced quarantine has been used in some countries to isolate
easily identifiable cohorts of people at potential risk of recent
exposure (e.g., groups evacuated by airplane from affected areas,
or groups on cruise ships with infected people on board).
• The psychosocial effects of enforced quarantine may have long-
lasting repercussions.

Screening
• Management of contacts:
People who may have been exposed to individuals with suspected
COVID-19 (including healthcare workers) should be advised to
monitor their health for 14 days from the last day of possible
contact and seek immediate medical attention if they develop any
symptoms, particularly fever, respiratory symptoms such as
coughing or shortness of breath, or diarrhea. Some people may be
put into voluntary or compulsory quarantine depending on the
guidance from local health authorities.

• Screening of travelers:
Exit and entry screening may be recommended in some countries,
particular when repatriating nationals from affected areas.
Travelers returning from affected areas should self-monitor fro
symptoms for 14 days and follow local protocols of the receiving
country.
Some countries may require returning travelers to enter quarantine.
Travelers who develop symptoms are advised to contact their local
health care provider, preferably by phone.

Secondary prevention
• Early recognition of new cases is the cornerstone of prevention of
transmission. Immediately isolate all suspected and confirmed
cases and implement recommended infection prevention and
control procedures according to local protocols, including
standard precautions at all times, and contact, droplet, and
airborne precautions while the patient is symptomatic.
• Report all suspected and confirmed cases to your local health
authorities.
• Additional precautions are required by healthcare workers to
protect themselves and prevent transmissions in the healthcare
setting.

• Precautions to be implemented by healthcare workers caring for patients
with COVID-19 disease include using personal protective equipment
(PPE) appropriately ; this involves selecting the proper PPE and being
trained in how to put on, remove and dispose of it.
• (PPE) includes gloves, medical mask, goggles or a face shield and gowns,
as well as for specific procedures, respirators (i.e., N95 masks) and
apron.
Note:
• Patients presenting with URTI symptoms should be advised to self –
quarantine for 14 days and seek medical advice only if they develop any
signs of severity.

• Isolation and testing facilities are available in Government
hospital.

When to suspect
Any patient with acute respiratory illness with:
• A history of travel to or residence in china in the 14 days prior to
symptom onset, or
• Close contact with a confirmed / suspected case of 2019-nCoV in
the 14 days prior to symptom onset, or
• Healthcare worker taking care of confirmed/suspected patients of
2019-nCoV.
Or history of travel from herat ,iran and other infected place

Case Definition of 2019-nCoV
Suspected case:
• Patients with acute respiratory infection (sudden onset of at least one of the following: cough,
sore throat, shortness of breath) requiring hospitalization or not.
AND:
In the 14 days prior to onset of symptoms, met at least one of the following epidemiological
criteria:
• Were in close contact with a confirmed or probable case of 2019-nCoV infection;
OR
• Had a history of travel to areas of china with ongoing community transmission of 2019-nCoV;
OR
• Worked in or attended a health care facility where patient with 2019-nCoV infections were
being treated.

Close contact
Close contact is defined as:
• Healthcare associated exposure, visiting or staying in the same
close environment as a nCoV patient.
• Working together in close proximity or living in the same
household with a nCoV patient.
• Travelling together with a nCoV patient in any kind of conveyance.
The epidemiological link may have occurred within a 14-days period
before or after the onset of illness in the case under consideration.

Probable Case
• A suspected case for whom testing for 2019-nCoV is inconclusive
(the result of the test reported by the laboratory) or for whom
testing was positive on a pan coronavirus assay.
Confirmed case:
• A person with laboratory confirmation of 2019-nCoV infection,
irrespective of clinical signs and symptoms.

Clinical Features
The clinical and radiological manifestations of 2019-nCoV include:
• Fever
• Cough
• Shortness of breath
• Sore throat
• Rhinorrhea
• Diarrhea
• bilateral pneumonia on imaging
• ARDS

Laboratory Diagnosis
Whom to test:
• A) for persons with travel history to the Wuhan province in China
after 15th January 2020, respiratory samples (nasopharyngeal
swab, oropharyngeal swab) and blood samples should be collected
for all persons whether symptomatic or asymptomatic.
• B) for travel history to rest of China, respiratory and blood
samples will be collected only from symptomatic cases.
• *All suspected cases to be mandatorily reported to the district &
state surveillance officers.

IPC strategies to prevent or limit infection transmission in health-care setting include the
following:
1. Standard Precautions:
1.1 Hand hygiene.
1.2 Respiratory hygiene.
1.3 Personal protective equipment (PPE)
2. Additional precautions.
3. Bio Medical waste management.
4. Laundry management.
5. Sample collection, storage and transportation.
6. Monitor health of HCWs providing care to cases of 2019-nCoV Acute Respiratory Disease.
7. Hospital Disinfection (Environmental).

• Sample to be collected:
• Nasopharyngeal /nasal swab from floor .
• Throat swab from over the tonsillar area and posterior pharyngeal
area.
• Care it at the same day .
• If test( +) repeat every 3 days still negative.
• If test( _) repeat second test after 24 hours
• If 2 consecutive negative isolation can be dis continued

Protocol for treatment of confirmed COVID-
19 infection: CDC MICC
• 1. upper respiratory tract infections PCR+ :
• Chloroquine phosphate PO 500mg BID 5 days +
• Oseltamivir PO 150mg BID 5 days
• 2. covid 19 pneumonia treatment
• Chloroquine phosphate PO 500mg BID 10 days +
• Darunavir 800mg/Cobicistant 150mg (Rezolsta) PO ,OD -2week or
• Atazanavir(reyataz) PO 400mg OD +Oseltamivir PO 150mg BID ±
• Corticosteroid IV __ Methyl prednisolone 40mg /12h for 5 days

Diluting your household bleach:
• 5 table spoone (1/3 rd cup) bleach per gallon of water or
• 4 tea spoons bleach per quart of water .
• Alcohol solution for hands hygiene is 70%
• Call for more info Afghanistan MOPH (166) and Dr ajeer Rahman
• (0775358493) for nangarhar province

Reference
• Update WHO
• WUHAN CITY( Hubei province) Hospital
• CNN,BBC
• WEB

Covid 19 by Dr akbar safi

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