Dr (Brig) Rakesh GuptaDirector

Government Institute of Medical Sciences

➢Major Public Health problem

➢GB Nagar is a Hot spot - Large no of cases

➢Need to complement you all - Noida 1st Spot-→ 5th Spot

➢Lock down has controlled the disease, temporarily,

but no guarantee for future . It has given enough time

for preparedness. We must act

➢ We have to live with covid-19 as the virus is going to

stay

➢ Concern for infection for HCW

➢Noida has huge potential – infrastructure, no of

hospitals (Public/Private/Medical college)

➢To fight the Covid effectively & Efficiently

WITHOUT compromising with Patient

Care and WITHOUT compromising the

interest of Health care professionals

(Prevention of infection in HCW)

We all have to work together as a Team

COVID-19

•Corona virus is a common microorganism which causes infections of Resp system.

•Enveloped RNA viruses which are distributed among human, animals as well as birds.

•Four types Alpha, Beta, Gamma, Delta.

•2019-nCoV (Now called COVID-19) which falls into genus Beta coronavirus.

•On December 31, 2019 China reported a cluster of cases of Pneumonia from Wuhan associated with seafood.

Covid is not New

Mortality in India is 0.7 Deaths per million population

All age groups are at risk

At High risk : Older persons

Persons with pre-existing medical conditions (High blood pressure, Heart disease, Lung disease, Cancer or Diabetes

VIABILITY PERIOD OF VIRUSES(REF:March 17, 2020, at NEJM.org)

SURFACE VIABILITY PERIOD

Aerosols 3 hours

Copper 4 hours

Cardboard 24 hours

Stainless steel 48 hours

Plastics 72 hours

Water and Sewage Weeks

❑ People 65 years and older

❑ People of all ages with underlying medical conditions, particularly if not well controlled, including:

Chronic lung disease (Asthma,Cystic Fibrosis,COPD)

Chronic Heart Diseases

Immunocompromised Individuals

Malignancy

Diabetes,Chronic smokers,Drug abusers

Severe obesity (body mass index [BMI] of 40 or higher)

People with chronic kidney disease undergoing dialysis

People with chronic liver diseases

REF:National centre for Immunization and Respiratory diseases(NCIRD),CDC

CLINICAL FEATURES

• Incubation period -2-14 days.

•About 25% patients with COVID -19 may remain asymptomatic , however they may be carrier and may spread the disease to others.

• Symptomatic patients present with mild symptoms(81%),moderate to severe symptoms(14%) and with critical illness(5%)

•MOHFW has recently introduced the term Severe Acute Respiratory Illness (SARI),which has been defined as

• “An ARI with history of fever or measured temperature ≥38 C° and cough onset within the last ~10 days; and requiring hospitalization.”

Complications Of COVID-19 Infection

•Respiratory Complications:❖ Acute Respiratory Distress Syndrome❖ Pneumonia

•Non-Respiratory Complications:❖ Septic Shock❖ Acute Kidney Injury❖ Disseminated Intravascular Coagulation❖ Rhabdomyolysis❖ Acute Cardiac Injury: Fulminant Myocarditis and

ArrythmiaNEJM-Feb;2020: Clinical Characteristics Of CoronaVirus disease 2019,China

DIAGNOSIS

• Nasopharygeal/oropharyngeal swab

• Sputum

•Broncho alveolar lavage (BAL)

(BAL should be restricted to mechanically ventilated patients as BAL sample remains positive for extended period)

•Sample storage: The samples require storage at 2-80 C

SOURCE: JAMA

TIMELINE OF COVID 19 INFECTION(LAB WISE)

• Day 0: infected

• Upto Day 5: Onset of symptoms

• Day 7: IgM positive (D7- D 21)

• Day 14: IgG positive

• Days 1-28: SARS CoV2 RNA & Antigens will be positive

• Day 21: IgM disappears

• Day 28: SARS CoV2 RNA & Antigens disappear

• D0 - D5: ASYPMPTOMATIC PHASE

• D0 -D7: WINDOW PERIOD (ONLY PCR IS POSITIVE IN THIS PHASE)

• D 14- D21: DECLINE PHASE (STILL INFECTIVE)

• D 21- D28: CONVALESCENCE PHASE (may be STILL INFECTIVE)

➢ All Hospital must assist in Covid care

➢ Hospital check List of 114 points

➢ Flu corner ( Cough/Fever OPD)

➢ Strict screening protocol

➢ Micromanagement of emergency

➢ Isolation of suspected cases and Immediate

testing

➢ Barrier nursing - Physical barriers / Face shields

/ Social distancing

➢ If Positive – Transfer to Covid care center

➢ Availability of PPE and protective equipments

➢ Training at all levels / PPEs

➢ Hospital Management

➢ Infection control & Prevention policy

➢ Housekeeping policy

➢ Dead body protocol

➢ Contingency plan

➢ Procurement Policy

➢ BMW management policy

➢ Discharge policy

➢ Sample collection & Testing Policy

➢ Blood Transfusion & Biosafety

Flu Corner

Quarantine versus Isolation • Isolation refers to separation of individuals who are ill and suspected

or confirmed to have COVID-19 infection.

• Quarantine refers to separation of individuals who are not yet ill but have been exposed to COVID-19 and therefore have a potential to become ill.

• Quarantine should be done for 2 weeks(Institutional/Home)

Purpose of quarantine is to reduce transmission by

• Separating contacts of COVID-19 patients from community

• Monitoring contacts for development of sign and symptoms of COVID-19

• Segregation of COVID-19 suspects, as early as possible from among other quarantined persons

➢ Social distancing

➢ Masking

➢ Hand washing and hygiene

➢ Respiratory hygiene and cough etiquettes

➢ Self Discipline

➢ Arogya Setu app

➢ Telemedicine

➢ Soft skills/ communication, while dealing with

patients

Priority I- Hospitalized patients ( Covid+ / suspect covid)

and symptomatic health care workers / Moderately

symptomatic patients (ILI/SARI)

Priority II- People at high risk of complications who also

have symptoms, including people in long-term care facilities,

people ages 65 and older, people with underlying conditions

/Imminent surgery/Pregnancy in labour

Priority III – First / immediate contacts ( close family

members) /quarantine ( Day 5to 14)

Priority IV- Critical infrastructure workers, health care

workers and first responders without symptoms

Patient (Flue OPD/Contact / Hotspot)

Asymptomatic Symptomatic

Send to GalgotiaUniv (900) Eng college(300)

Home Quarantine Isolation beds for COVID 19+

GIMS (20)/Sharda(150)SSPH (20)- if child

Mild Moderate Severe

KailashIsolation ward for Covid suspect

District Hospital (100) Negative PositivePositive

Positive

Home Quarantine

Negative

Negative

Home Quarantine

Sampling

Patient Flow Algorithm

District Health Society

• District Magistrate

• CMO

• Helpline Contact No:

Thank you