COVID-19 ; Know Your Enemy And Save Lives | Doctor Tawasol

COVID-19 ; Know Your Enemy And Save Lives | Doctor Tawasol

COVID-19 ; Know Your Enemy And Save Lives.. here is a full guide to doctors to deal with COVID-19 known as coronavrus .. made by IMHOTEP RESEARCH CLINIC.

Valuable facts about COVID-19

  • The median incubation period is 5 to 6 days (ranged from 0 to 14 days).
  • The median age of the confirmed cases is around 59 years.
  • Initial data indicated that more than 80% of patients have asymptomatic or mild disease and recovered.
  • About 15% may get a severe disease including pneumonia, and around 5% become critically unwell with septic shock and/or multi-organ and respiratory failure.
  • The case fatality rate is estimated at approximately 2% overall, but ranges from 0.2% in people under 50 to 14.8% in those over 80, and is higher among those with chronic comorbid conditions.
  • Like influenza, touching a surface can sweep up millions of viral particles in just a few seconds. However, COVID-19 survives on plastic and stainless steel surfaces for around 3 days, and can be detected in aerosols up to 3 hours post aerosolization.

Transmission in pre-symptomatic stage of infection

  • The proportion of pre-symptomatic transmission was estimated to be around 48% and 62%, regarding shorter serial interval of COVID-19 (4.0 to 4.6 days) than the mean incubation period (5 days).
  • Indicating that many secondary transmissions would have already occurred at the time when symptomatic cases are detected and isolated.

The virus is transmitted in respiratory droplets and can be spread by coughing, sneezing, or touching infected surfaces. Coronaviruses have also been detected in blood, faeces, and urine.

Clinical Symptoms

The most commonly reported symptoms in laboratory-confirmed cases are:

  • fever (88%),
  • followed by dry cough (68%),
  • fatigue (38%), sputum production (33%),
  • dyspnea (19%),
  • sore throat (14%),
  • headache (14%), and
  • myalgia or arthralgia (15%).

Less common symptoms are diarrhea (4%) and vomiting (5%).

When to suspect COVID-19 ?

Anyone who has either had (a) a contact with someone with confirmed covid-19 infection or returned from a (b) high risk country in the 14 days before the onset of symptoms if they present with any of the major symptoms.

Clinicians should be alert to the possibility of atypical presentations in (c) vulnerable groups of patients.

A.A contact is defined as:

  • Living in the same household as a person with a confirmed infection
  • Direct contact with someone who has a confirmed infection, or their body fluids, without appropriate personal protective equipment
  • Face-to-face contact with a person with a confirmed infection, for any length of time
  • Being within two meters of a person with a confirmed infection for longer than 15 minutes
  • Being advised by a public health agency that contact with a confirmed case has occurred.

B. Which countries are considered high risk?

Europe has now become the epicenter of the COVID-19 pandemic, says the World Health Organization (WHO), 13 March 2020. Italy has the largest outbreak in Europe.

As of 2 March 2020, category 1 areas (highest risk) included Wuhan city and Hubei Province in China, Daegu or Cheongdo in Republic of Korea, Italian towns under containment measures, and Islamic Republic of Iran.

Category 2 (high risk) countries included China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia, Macau, Italy, Cambodia, Laos, Myanmar, and Vietnam.

C. Vulnerable groups

  • People Above 60 Years Of Age
  • Males Showing Higher Risk
  • People With Underlying Chronic Conditions Such As Hypertension, Diabetes, Cardiovascular Disease, Chronic Respiratory Disease And Cancer.
  • Higher Ace Gene Expression May Be Linked To Higher Susceptibility To SARS-COV-2. It Has Been Shown That ACE 2 Expression In Lung Tissues Increases With Age, Tobacco-use And With Some Hypertensive Treatment.
  • Smokers In Particular Are Identified As A Potential Vulnerable Group.

Currently Available Information Indicates That Children Are As Likely To Be Infected As Adults; However They Experience Milder Clinical Manifestations.

Special Groups

Pregnancy and COVID-19

Pregnant women appear to experience similar clinical manifestations as non-pregnant adult patients with COVID-19 pneumonia.

There is no evidence of severe adverse outcomes in neonates due to maternal COVID-19 pneumonia, and the virus has not been found in breast-milk.

Warning about elderly

Evidence from epidemiological investigations suggests that, in China, COVID-19 poses a disproportionately high threat to those aged 70 or above. While these numbers call for older adults to protect themselves as much as possible, misinformation can undermine recommended protective behaviors prescribed by health agencies.

The relationship between age and misinformation has been extensively explored by psychologists generating nuanced and, at times, competing insights. However, a 2014 meta-analysis of ageing and the misinformation effect revealed that older adults, especially those over 65, are more vulnerable to misinformation as compared to other groups.

How to deal with suspected COVID-19 patient?

How to respond during a phone consultation?

At first; ask screening questions to patients:

  1. Do you have a high temperature or cough or breathlessness?
  2. Have you been in close contact with someone with coronavirus infection?
  3. Have you been to any of the following areas (see list above) in the last 14 days?

Assess whether they are clinically stable and not critically unwell. If the patient is critically unwell and requires urgent transfer to hospital, call 123 and inform the ambulance call handler of a suspected case of COVID-19.

Avoid a face-to-face assessment in primary care. Advise the patient to call 105 ; hotline of the Egyptian ministry of health.

What to do if you suspect COVID-19 during a consultation?

Stop the consultation and leave the room, avoiding physical examination, direct physical contact, and exposure to respiratory secretions. Wash your hands thoroughly with soap and water.
Isolate the patient and reassure them that you are following precautionary guidelines and try to communicate with them through closed door to reassure them and provide updates.

Isolate individuals suspected to have COVID-19, their waste, and their belongings in a room with the door closed and window open (switch off any air conditioning). Ensure that they have a mobile phone or access to a telephone line and ask them to call 105 for advice.

Avoid entering the isolation room. If further clinical history needs to be obtained this should be done by phone

If the patient with suspected COVID-19 is accompanied by family members or friends, they should all be isolated if they are close contacts of the patient.

If entry to the isolation room or contact with the patient is unavoidable, wear protective clothing in line with the standard infection control precautions, such as gloves, apron, and a standard fluid resistant surgical mask, and keep exposure to a minimum. All protective clothing and equipment should be disposed of as clinical waste.

Once a possible case has been transferred from the primary care premises, the room where the patient was placed should not be used, the room door should remain shut, with windows opened and the air conditioning switched off, until it has been cleaned with detergent and disinfectant. Once this process has been completed, the room can be put back in use immediately.

Wiping the surfaces with either a combined detergent disinfectant solution at a dilution of 1000 parts per million available chlorine or a neutral purpose detergent followed by disinfection.

Self-isolation at home

Indicated for people suspected to have COVID-19 who are undergoing testing and are not critically ill.

Self-isolation means staying indoors for 14 days from the date of contact with a confirmed case or return from high risk areas, avoiding contact with other people, and separating themselves from the rest of the household

Patients who are self-isolating are advised to:

  • Stay in a well-ventilated room, use a separate bathroom if available.
  • Wash hands with soap and water before cooking and eating and after using the toilet
  • Have food, medication, and supplies delivered to you
  • Cover coughs and sneezes with a tissue and put it in a bin
  • Avoid going out except if advised to seek medical care and do not use public transport or taxis. Own vehicle may be used
  • Not to have visitors at home
  • Double bag and seal all waste.

Animals and COVID-19

As a general precaution, anyone visiting live animal markets, wet markets or animal product markets, should practice general hygiene measures.

Any contact with other animals possibly living in the market (e.g., stray cats and dogs, rodents, birds, bats) should be strictly avoided.
The consumption of raw or undercooked animal products should be avoided.

As a general recommendation, sick animals should never be slaughtered for consumption; dead animals should be safely buried or destroyed and contact with their body fluids should be avoided without protective clothes.

Recommendations and advice for the public

  • Avoiding close contact with people suffering from acute respiratory infections.
  • Frequent hand-washing, especially after direct contact with ill people or their environment.

Follow these five steps every time.

  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

You can use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

Washing hands with soap and water is the best way to get rid of germs in most situations.

  • Avoiding unprotected contact with farm or wild animals.
  • People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands).
  • WHO does not recommend any specific health measures for travellers. In case of symptoms suggestive of respiratory illness either during or after travel, travellers are encouraged to seek medical attention and share their travel history with their health care provider.
  • Face masks for the general public are not recommended.

References

1. Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., ... & Xing, X. (2020). Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. New England Journal of Medicine.

2. Wu, Z., & McGoogan, J. M. (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama.

3. Liu, T., Hu, J., Kang, M., Lin, L., Zhong, H., Xiao, J., ... & Deng, A. (2020). Transmission dynamics of 2019 novel coronavirus (2019-nCoV).

4. Backer, J. A., Klinkenberg, D., & Wallinga, J. (2020). Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Eurosurveillance, 25(5).

5. Razai, M. S., Doerholt, K., Ladhani, S., & Oakeshott, P. (2020). Coronavirus disease 2019 (covid-19): a guide for UK GPs. BMJ, 368.

6. Wylie, L. E., Patihis, L., & McCuller, L. L. (2014). Misinformation effect in older versus younger adults: A meta-analysis and review. In The elderly eyewitness in court (pp. 52-80). Psychology Press.

7. World Health Organization. Coronavirus disease 2019 (covid-19) Situation Report–29. 19 February 2020.

8. Public Health England. covid-19: epidemiology, virology and clinical features. 2020.https://www.gov.uk/government/publications/wuhan-novel-coronavirus-background-information/wuhan-novel-coronavirus-epidemiology-virology-and-clinical-features

9. World Health Organization. WHO Director-General’s remarks at the media briefing on COVID-2019 outbreak on 17 February 2020. 2020 https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-covid-2019-outbreak-on-17-february-2020.

10. Briefing NHS. Primary care providers and the coronavirus (covid-19). 2020. https://www.england.nhs.uk/wp-content/uploads/2020/02/coronavirus-primary-care-briefing.pdf

11. European Centre for Disease Prevention and Control Coronavirus latest: WHO says Europe now epicentre of pandemic

12. van Doremalen, N., Bushmaker, T., Morris, D., Holbrook, M., Gamble, A., Williamson, B., ... & Lloyd-Smith, J. (2020). Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. medRxiv.

13. Jacoby, L. L., & Rhodes, M. G. (2006). False remembering in the aged. Current Directions in Psychological Science, 15(2), 49-53.

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