Interim Health advisory on the 2019 Novel Coronavirus (2019-nCoV)

The World Health Organization (WHO) says , ‘Not enough is known about 2019 Novel Coronavirus (2019-nCoV) to draw definitive conclusions about how it is transmitted, clinical features of disease, or the extent to which it has spread. The source also remains unknown’

The following information is based upon interim draft guidelines and is subject to change as and when newer recent information is received.

According to WHO, a new type of coronavirus (2019 novel coronavirus, nCoV) has been identified in China on 7 January 2020. The cluster of patients with pneumonia - like - illness was initially reported on 31 December 2019.

What is the nCoV ?

Coronaviruses are a family of respiratory viruses, named for the crown-like spikes on their surface. Coronaviruses can cause diseases ranging from the common cold to the Middle-East Respiratory Syndrome and the Severe Acute Respiratory Syndrome (SARS). The Novel coronavirus, nCoV is a new strain of coronavirus that has not been previously identified in humans. They are notorious for mutating quickly and acquiring new qualities.

What are the Symptoms and Signs of infection with Novel coronavirus, nCoV ?

The symptoms reported are mainly fever, with a few having difficulty in breathing. Chest Xrays are showing invasive pneumonic infiltrates in both lungs. This cannot be differentiated from other respiratory infections excepting a history of travel to affected geographical area.

What is the course of Illness ?

As of now, more than 41 cases with novel coronavirus infection have been preliminarily diagnosed in Wuhan City of China. Of the 41 cases reported, two deaths have been reported and at least one of the patient had other underlying health conditions. While seven are severely ill, six patients have been discharged from hospital. Cases have been identified in countries such as Japan , Thailand and USA .The risk of cases being reported form elsewhere is increased, especially considering heavy population movements during the Chinese New Year in the last week of January.

How is the infection transmitted ?

The transmission potential and modes of transmission as of now remain largely unclear. The evidence is highly suggestive that the outbreak is associated with exposures in one seafood market in Wuhan. Most of the cases affected worked at or were handlers and frequent visitors to the Huanan Seafood Wholesale Market. Preliminary epidemiology also suggests an animal source and thus a zoonotic disease .At this stage, there is no clear evidence but high suspicion of limited human to human transmission of infection. No case has been reported as yet among healthcare workers.

What are the criteria for Evaluation of Patients Under Investigation (PUI) for 2019-nCoV (Source- CDC 2020) ?

The transmission potential and modes of transmission as of now remain largely unclear. The evidence is highly suggestive that the outbreak is associated with exposures in one seafood market in Wuhan. Most of the cases affected worked at or were handlers and frequent visitors to the Huanan Seafood Wholesale Market. Preliminary epidemiology also suggests an animal source and thus a zoonotic disease .At this stage, there is no clear evidence but high suspicion of limited human to human transmission of infection. No case has been reported as yet among healthcare workers.

  1. Fever and symptoms of lower respiratory illness (e.g., cough, difficulty breathing) and in the last 14 days before symptom onset, a history of travel from Wuhan City, China
  2. In the last 14 days before symptom onset, close contact with a person who is under investigation for 2019-nCoV while that person was ill.
  3. Fever or symptoms of lower respiratory illness (e.g., cough, difficulty breathing) and in the last 14 days, close contact with an ill laboratory-confirmed 2019-nCoV patient.

Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to guide testing of patients in such situations.

Close contact is defined as—

  1. being within approximately 6 feet (2 meters), or within the room or care area, of a novel coronavirus case for a prolonged period of time while not wearing appropriate personal protective equipment (e.g., gowns, gloves, N95 respirator, eye protection). Close contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a novel coronavirus case or
  2. having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on) while not wearing appropriate personal protective equipment.
Travel Advisory

General preventive measures to be practiced while travelling in or from China:

  • Observe good personal hygiene
  • Namaste works best to avoid hand contact
  • Practice frequent hand washing with soap
  • Follow respiratory etiquette .The components of Respiratory Hygiene/Cough Etiquette are:
    • Practice frequent hand-hygiene at all times
    • Keep at arm’s length / Maintain a distance of minimum 3 feet from a person who is sneezing or coughing
    • Cough or sneeze into the inside of elbow or arms, not hands .
    • Whenever possible, use disposable tissues to cover your cough and cold.
    • Discard the used tissues immediately into an appropriate waste bin and practice hand hygiene .
    • Offer a surgical mask to person who is coughing or sneezing
  • Avoid close contact with people who are unwell or showing symptoms of illness, such as cough, runny nose etc.
  • Avoid contact with live animals and consumption of raw/undercooked meats M
  • Avoid travel to farms, live animal markets or where animals are slaughteredM
  • Wear a mask if you have respiratory symptoms such as cough or runny noseM
All travelers to China (in particular Wuhan city) to monitor their health closely.

If you feel sick and have fever and cough:

  • Cover your mouth while coughing or sneezing
  • Don’t plan travels if sick
  • Seek medical attention promptly

If you feel sick on the flight, while traveling back to India:

  • Inform the airlines crew about illness
  • Seek mask from the airlines crew
  • Avoid close contact with family members or fellow travelers
  • Follow the directions of airline crew while disembarking

If you feel sick on flight or at the time of disembarkation:

  • Report to airport health authorities/immigration.
  • Special counters are being opened in Delhi, Kolkata and Mumbai airports
  • Follow the direction of the airport health officer

If you feel sick with in a span of one month after return from China:

  • Report the illness to the nearest health facility and also inform the treating doctor regarding

your travel history

Treatment

There is no specific treatment for disease caused by the novel coronavirus. Treatment is mainly symptomatic and supportive, based on the patient’s clinical condition. As of now, there is no vaccine available.

Precautions for Household Members to patients with Suspected / Confirmed Patients with 2019-nCoV Infection/ Respiratory Symptoms
  1. Wash your hands often and thoroughly with soap and water for at least 20 seconds.
  2. Use an alcohol-based hand sanitizer if soap and water are not available and if your hands are not visibly dirty.
  3. Avoid touching your eyes, nose, and mouth with unwashed hands.
  4. For providing care at home, have only the essential people in the home .Other household members should stay in another home, if possible / another room / be separated from the person as much as possible
  5. Use a separate bathroom, if available.
  6. Restrict visitors who do not have an essential need to be in the home.
  7. Keep elderly people / those who have compromised immune systems /chronic health conditions - heart, lung or kidney conditions, and diabetes away from the person.
  8. Keep a window open or let the air conditioner be on
  9. Wear a disposable facemask, gown, when you touch or have contact with the person’s blood, body fluids and/or secretions - sweat, saliva, sputum, nasal mucus, vomit, urine, or diarrhea and gloves when required
  10. Discard used facemasks, gowns, and gloves after use and Wash hands immediately
  11. Do not share towels, eating utensils dishes, drinking glasses, cups, bedding, or other items with the suspected patient.
  12. Wash thoroughly with soap and water after use.
  13. Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day.
  14. Also, clean any surfaces that may have blood, body fluids and/or secretions or excretions on them.
  15. Use diluted bleach solution - To make a bleach solution at home, add 1 tablespoon of bleach to 4 cups of water or ¼ cup of bleach to 16 cups of water
  16. Monitor your health starting from the day you first had close contact with the person and continue for 14 days after you last had close contact with the person. Take your temperature twice a day. Be alert to Coughing, Shortness of breath ,chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose .

There is NO REASON TO PANIC. Please follow Indian National guidelines from NCDC or MOHFW, Govt. of India and State Government guidelines as and when they are available. Hand Hygiene and respiratory etiquette seem to be the containment strategy as of now.

References

References: 1. CDC https://www.cdc.gov/ncird/index.html 2020 2. MOHFW, Govt. of India Novel Corona Outbreak in China- Travel advisory for travelers visiting China https://mohfw.gov.in/media/disease-alerts Strictly restricted material, changing scenario of the outbreak, no references to be quoted, only readable i.e. WHO 2020