2019-nCOV Update and Country

Preparedness and Responses

Health Emergency Operation Center

Ministry of Health and Population

About the Coronavirus • Coronaviruses (CoV) are a large family of Zoonotic viruses

– SARS-CoV was transmitted from civet cats

– MERS-CoV from dromedary camels

• Several known coronaviruses are circulating in animals that have not yet infected humans.

• A total of 7 CoV are circulating in Human globally including the new one

• Cause illness ranging from the common cold to Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

• A novel coronavirus (nCoV) is a new strain: not previously identified in humans.

Coronavirus • On 31 December 2019, cases of

pneumonia of unknown etiology reported in Wuhan City, Hubei Province of China

• On 7 January confirmed as a novel coronavirus (2019-nCoV) as the causative virus of the condition

2019-nCoV

• main clinical signs and symptoms reported – fever, difficulty in breathing, and chest

radiographs showing bilateral lung infiltrates.

• Not enough is known about the epidemiology of 2019-nCoV to draw definitive conclusions about the full clinical features

• the intensity of the human-to-human transmission, and the original source of the outbreak.

2019-nCoV

• New epidemiological information reinforces the evidence that the 2019-nCoV can be transmitted from one individual to another.

• During previous outbreaks due to other coronavirus (MERS and SARS), human to human transmission occurred through droplets, contact and fomites, suggesting that the transmission mode of the 2019-nCoV can be similar.

Situation update: As of 26 January 2020 • a total of 2014 confirmed cases have been reported 2019-nCoV

with 56 deaths reported and 324 cases severely ill

• Cases reported from: China (1985), Thailand (5), Japan(3), Republic of Korea(2), Vietnam (2), Republic of Singapore (4), USA(2), Australia (4), Nepal (1), French Republic (3)and Malasiya (3)

• Of these 29 confirmed cases, 26 had travel history to Wuhan City, China; 2 cases in Australia had direct contact with a confirmed case from Wuhan while in China; and one confirmed case in Viet Nam had no travel history to any part of China

• Suggests and instance of Human-to-human transmission is occurring

• But the extent of human-to-human transmission is still not clear.

Source: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200124-sitrep-5-2019-ncov.pdf?sfvrsn=9272d086_2

Distribution of Reported Cases of 2019-nCov, 25 January

Country Context

• Nepali Citizen from Wuhan City returned on 9th Jan 2020

• 13th Jan 2020, visited Teku Hospital and all possible suspected tests performed : -ve

• the throat swab taken and sent to University of Hongkong, School of Public Health for nCOV testing

• Confirmed on 23rd

• Case now not exhibiting any symptoms and under surveillance

WHO Emergency Committee

• Convened

– Wednesday, 22 January 2020, and

– Thursday, 23 January 2020

• PHEIC not declared yet but intermediate level of alertness was recommended

• International traffic: no restrictions recommended

• measures to limit the risk of exportation or importation should be implemented, without unnecessary restrictions of international traffic.

WHO Risk Assessment as of 24th Jan 2020

–very high in China,

–high at the regional level and

–moderate at the global level

–Nepal is at High level

Advice to Other Countries including Nepal

• all countries should be prepared for containment,

– including active surveillance,

– early detection,

– isolation and case management,

– contact tracing and prevention of onward spread

• share information with WHO according to the IHR within 24 hrs

Advice for the public

• Frequently clean hands

• Respiratory ettiquette

• Avoid close contact with anyone who has fever and cough;

• seek medical care early

• When visiting live markets avoid direct unprotected contact with live animals and surfaces in contact with animals;

• Avoid the consumption of raw or undercooked animal products

Advice for International Traffic as of 24th Jan 2020

• practice usual precautions as transmission potential and modes of transmission remain unclear.

• avoiding close contact with people suffering from acute respiratory infections;

• frequent hand-washing, especially after direct contact with ill people or their environment;

• avoiding close contact with live or dead farm or wild animals

• should practice cough etiquette

• provide information to travelers to reduce the general risk at points of entry

Advice for screening and POE

At points of Exit:

• Suggest only for China

At points of Entry:

• temperature screening associated with

– early detection of symptomatic passengers and

– their referral for medical follow up

– dissemination of risk communication messages

• Counties implementing temperature screening are encouraged to establish proper mechanism for data collection and analysis based on the national capacity

Advice for screening and POE

• Public health authorities should reinforce collaboration with airlines operators for case management on board aircraft and reporting, should a traveler with respiratory disease symptoms is detected, in accordance with the IATA guidance for cabin crew to manage suspected communicable disease on board an aircraft.

Advice for screening and POE

• If a traveller on board has signs and symptoms indicative of ARI, use

– the model of Maritime declaration of health (Annex 8 of IHR) or

– the health part of the aircraft general declaration (Annex 9 of IHR)

• to register the health information onboard and submit to POE health authorities

Countries Shall Ensure at POE • trained staff,

• appropriate space and

• stockpile of adequate equipment in place at for assessing and managing ill travellers

• procedures and means for communication of between conveyances and POE as well as between POE and national health authorities;

• safe transportation of symptomatic travellers to designated hospitals

• a functional public health emergency contingency plan at points of entry

Containment Responses

International Travel Arrangement at TIA

• routine measures,

– Health Desk in operation with 8 persons in the Leadership of MD , 3 medical officer, 1 paramedic and 3 nurses deputed at TIA for 24/7

– appropriate space (arranged and being customized)

– stockpile of adequate equipment in place at points of entry

• PPE teku 5 set

• Airport 5 set

• Additional 105 stock on hand

• Infrared thermal monitor 5

International Travel Arrangements at TIA

• procedures and means are in place at TIA

– to communicate information on ill travelers between conveyances and POE as well as between POE and Hospitals, EDCD and HEOC

• Safe transportation of symptomatic travelers to hospitals or designated facilities

– Exit route planned

– Provisioning of Designated Ambulance from NAS, Norvik and KMC

• a functional public health emergency contingency plan at points of entry

– protocol of TIA engaging Health Desk (EDCD), KMC and HEOC

Other Interventions

Isolation Arrangement:

• Teku Hospital

• Patan Hospital

• other hospitals....?

Laboratory: • Testing at Designated WHO collaborating center via

NPHL

• Working to ensure national capacity for in-country testing

Follow on Health Sector Interventions Case Management:

• transferring the case patient from TIA to hospital

• Hospital readiness (isolation facilities) to be ensured (inform team members)

• the team of multidisciplinary team members managing the case patient in the hospital

• nCorona case management plan of Patan hospital and teku hsopital ready

Other Interventions...

Risk communication:

• Identify the focal points for managing the press (Technical issues: IHR NFP Director EDCD and General issues: MoHP spokesperson)

• Regular and Press Release as and when required through MOHP

• IEC materials developed and being disseminated.

Other Interventions...

• Meeting with TIA Authorities for Customization of Health Desk

– Identification of site and customization

– on board notification arrangement by TIA

– Orientation planned for TIA

• Media Briefing, Jan 24, 2020

• Reporting to WHO

Algorithm to suspect Novel Corona Virus (nCov) infection based on the WHO Surveillance Case Definition

25 1/27/2020

• Available in the EDCD website

• Circulated in the existing networks viz.

1) Early Warning and Reporting System

(EWARS) network

2) National Influenza surveillance

Network

Key Actions to be taken when case(s) of nCoV infection is/are suspected

26 1/27/2020

• Available in the EDCD website

• Circulated in the existing networks

viz.

1) Early Warning and Reporting

System (EWARS) network

2) National Influenza surveillance

Network (NISN)

Public Health Awareness Messages

27 1/27/2020

• Information, Education and Communication

(IEC) material;

Public health awareness message for

Novel Coronavirus developed in nepali

language and circulated in web domain

targeting social media which audiences

regularly use.

Frequently Asked Questions (FAQs)

28 1/27/2020

• Information, Education and Communication

(IEC) material;

Frequently Asked Question (FAQs)

regarding Novel Coronavirus developed

in nepali language and circulated in

web domain targeting social media

which audiences regularly use.

Interim reporting form for suspected cases of 2019 Novel Coronavirus (2019-nCoV) - 3 pages

29 1/27/2020

Reporting form

standardized, circulated in

the EWARS network and

made available in the

EDCD website

(http://www.edcd.gov.np/

Standee at Port of Entry (PoE) at Tribhuvan International Airport (TIA)

30 1/27/2020

• Standee developed and displayed at

Port of Entry (PoE) at Tribhuvan

International Airport (TIA)

• Contains message in English and

Chinese language

Traveller Public Health Declaration Form

31 1/27/2020

Meeting Minute: 2019-nCoV Nepal Preparedness update 24 Jan 2020

Meeting Minute: 2019-nCoV Nepal Preparedness update 25 Jan 2020

Meeting Minute: 2019-nCoV Nepal Preparedness update 26 Jan 2020

Available Documents

1. Infection prevention and control during health care when novel coronavirus (2019-nCov) infection is suspected

2. Algorithm to suspect Novel Corona Virus (2019-nCoV) infection based on the WHO surveillance case definition

3. Novel Corona Virus(2019-nCoV) Operational support and logistics Disease Commodity Packages (DCP)

4. Novel Corona Virus(2019-nCoV): Frequently Asked Questions (FAQs)

5. Novel Corona Virus(2019-nCoV): Awareness Message for public

6. Key Actions to be taken when case(s) of NCoV infection is/are suspected

7. Interim reporting form for suspected cases of 2019-nCoV

8. Risk Communication and Community engagement readiness and initial response for nCoV

*Note: All the documents are available on MoHP/HEOC and EDCD Web Portals

Proposed next steps: • In each province or key town / tourist spot (esp focus on places frequented by Chinese tourists) an hospital

with isolation facilities may be identified and to be instructed to admit and manage cases in consultation with provinces.

• Guidance notes; case forms; IPC rapid assessment checklists etc to be shared

• At least one facility per province with dedicated ICU including ventilator support to be identified and readied for managing severe cases

• Teams for investigation of suspected cases, including identification of the potential contacts of such cases to be identified and constituted in Kathmandu valley and each of the provinces - provincial RRTs, faculty trained in EPPR; those who were engaged in the investigation of the first confirmed case of Influenza A - H5N1 in Nepal (list available with WHO/EDCD) would be highly suited for the investigation. Clinician, PHO, Lab personnel.

• In coordination with EDCD, the HEOC network may develop and deploy mechanisms and teams at the central and provincial levels for contact tracing and follow up of health status of identified contacts (PHO and Data Manager/ IT personnel)

• NPHL with EDCD to ensure that samples are collected from all suspected cases, admitted anywhere in the Kathmandu valley and outside in coordination with the case investigation team and arrange for sample transport to NPHL

• NPHL may liaise with labs such as WARUN and others to ensure adequate surge capacity sample collection, transportation, processing, preliminary investigation of confirmatory diagnosis including the use of an effective existing mechanism for sending samples to a recognized lab outside of the country for confirmatory diagnosis in addition to mechanism available through WHO

• Procurement of the needed primers and probes, reagents, sample collection tools, consumables/ PPEs, medication for symptomatic treatment and needed equipment and supplies for the treatment of mild, moderate and severe cases

• All hospitals with isolation and ICU facilities assisted to develop a hospital contingency plan for the management of 2019-NCov cases and case surge in line with the template available with Patan hospital and adapted for Sukraj hospital

Proposed next steps: • All hospital beyond the surveillance network to report ILI and SARI cases on a daily basis to EDCD

• Entry screening at TIA to be maintained at the scale and mechanism for data management in addition to patient transfer and management to be streamlined; Arrangement to be readied for exit screening at TIA as soon as the human- human transmission is confirmed in Nepal which will be signaled by health care workers / close contacts of cases becoming infected

• Decision to be taken on exit and entry screening at selected, if not all ground crossings

• Risk Communication to be scaled up by NHEICC supported with the national Risk Communication working group which included UNICEF, FAO, and others. The MOU between MOHP and Ncell may be effectively used for the wide dissemination of multimedia risk communication messages

• Training as needed for rapid response team for case investigation, contact tracing team, PoE staff, Clinicians and hospital managers to be rolled up to the scale in all provinces with initial focus on areas with high tourist traffic

• Arrangement to be made for sharing of technical and general info including the status of progress of the emergency on all relevant website of the government and to WHO

• Adequate intersectoral; communication and engagement of MOHA and MOFA to handle the internal and external collaboration vision issues that would arise including the development of communication of appropriate advocacy meetings to ensure that there is minimal impact on Visit Nepal Initiative- The activation of the HEOC network may help manage this.

• In addition to mobilizing the domestic resources financial/human resources needed, MOHP to liaise with World Bank to put in place the arrangements needed to invoke the support from Pandemic Emergency Financial Facility and the CAT DDO in coordination with MOHA and MOF if needed.

• A note on sample collection: all labs engaged in ILI and SARI surveillance as part of National Influenza Surveillance Network have been trained with WHO support for collection for respiratory samples. The same personnel could be used for collection of sample to be tested for 2019-nCoV; around 80 laboratory staff across the country have been trained for IATA standard sample packaging and transportation. These trained personnel could be used for safe packaging and transportation. Most effective and fastest mechanism to be identified for transportation of the sample to the designated lab(s) for testing in the absence in a formal courier system in the country for undertaking this.

Thank you