Prevention

Since at this time there are no approved treatments for this infection, prevention is crucial. Several properties of this virus make prevention difficult namely, non-specific features of the disease, the infectivity even before onset of symptoms in the incubation period, transmission from asymptomatic people, long incubation period, tropism for mucosal surfaces such as the conjunctiva, prolonged duration of the illness and transmission even after clinical recovery.

The WHO and other agencies such as CDC have published protective measures to mitigate the spread of COVID-19. This involves frequent hand washing with hand wash containing 60% of alcohol and soap for at least 20 seconds. Another important measure is avoiding close contact with sick people and keeping a social distance of 1 meter always to everyone who is coughing or sneezing. Staying at home is recommended for those who are sick, and wearing a facial mask is advised when going out among people. Furthermore, it is recommended to clean and sterilize touched surfaces such as phones and doorknobs on daily basis. Staying at home as much as possible is advisable for those who are at higher risk of exposure to COVID-19 during outbreaks.

Isolation of confirmed or suspected cases with mild illness at home is recommended. The ventilation at home should be good with sunlight to allow for destruction of virus. Patients should be asked to wear a simple surgical mask and practice cough hygiene. Caregivers should be asked to wear a surgical mask when in the same room as patient and use hand hygiene every 15-20 minutes.

The greatest risk in COVID-19 is transmission to healthcare workers. In the SARS outbreak of 2002, 21% of those affected were healthcare workers. Till date, almost 1500 healthcare workers in China have been infected with 6 deaths. The doctor who first warned about the virus has died too. It is important to protect healthcare workers to ensure continuity of care and to prevent transmission of infection to other patients. While COVID-19 transmits as a droplet pathogen and is placed in Category B of infectious agents (highly pathogenic H5N1 and SARS), by the China National Health Commission, infection control measures recommended are those for Category A agents (cholera, plague). Patients should be placed in separate rooms or cohosted together. Negative pressure rooms are not generally needed. The rooms and surfaces and equipment should undergo regular decontamination preferably with sodium hydro chlorite. Health care workers should be provided with fit tested N95 respirators and protective suits and goggles. Airborne transmission precautions should be taken during aerosol generating procedures such as intubation, suction and tracheostomies. All contacts including healthcare workers should be monitored for development of symptoms of COVID-19. Patients can be discharged from isolation once they are afebrile for at least 3 days and have two consecutive negative molecular tests at 1-day sampling interval. This recommendation is different from pandemic flu where patients were asked to resume work/school once afebrile for 24 hours or by day 7 of illness. Negative molecular tests were not a prerequisite for discharge.

At the community level, people should be asked to avoid crowded areas and postpone non-essential travel to places with ongoing transmission. They should be asked to practice cough hygiene by coughing in sleeve/tissue rather than hands and practice hand hygiene frequently after 15-20 minutes. Patients with respiratory symptoms should be asked to used surgical masks. The use of mask by healthy people in public places has not shown to protect against respiratory viral infections and is currently not recommended by WHO. However, in China, the public has been asked to wear masks in public and especially in crowded places and large scale gatherings are prohibited (entertainment parks etc). China is also considering introducing legislation to prohibit selling and trading of wild animals.

The international response has been dramatic. Initially, there were massive travel restrictions to China and people returning from China/ evacuated from China are being evaluated for clinical symptoms, isolated and tested for COVID-19 for two weeks even if asymptomatic. However, now with rapid world wide spread of the virus these travel restrictions have extended to other countries.