Current status of COVID-19 in

Pakistan; Etiology, Pathology,

Prevention
By Tuzuk-e-Ahtsham
Note:All information is based on information updated till 10/4/2020 and
references and links to all scientific articles are given at the end.
Origin:
It was first discovered on December 31 in Wuhan, China.
Coronaviruses (CoV) are a massive family of viruses that inflict illness ranging from the common
cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and
Severe Acute Respiratory Syndrome (SARS-CoV). Coronavirus disease (COVID-19) caused by
SARS-COV2 is the new strain that was discovered in 2019 but had not been previously
identified in humans. Coronaviruses are zoonotic viruses, which means they are transmitted
between animals and humans. It is believed that COVID-19 was transmitted from a pangolin to
humans.
Thw virus is most likely a mutations and natural selection besides recombination case. The
viruses evolved into two significant types (designated L and S. The L type (∼70%) is more
prevalent than the S type (∼30%) which is the predecessor. The L type was more prominent in
the early phases of the outbreak in Wuhan but its occurrence decreased after January 2020.
The particle size is 0.3micron.

Symptoms:
98% of patients show fever.
86% of patients are originally asymptomatic.
76% of patients show coughing.
Shortness of birth is a symptom which takes 5-8 days for development.
Bluish lips or face is also a symptom
30% patients also show loss of senses such as hyposmia and anosmia and 89% show this
characteristic in the asymptomatic phase.
In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome,
kidney failure and even death.
Incubation period is of 1 to 2 weeks most commonly 5 days.
It can be transmitted feco-orally.
It cannot be spread from cats and dogs.

Pathology
It is an air borne viral infection that is also spread feco-orally If not in aerosol form. It is
extremely contagious 10x more than SARS and it causes pneumonia like symptoms.
Acute respiratory distress syndrome is caused by the virus and it causes fluid traversing into the
interstitial space in lungs causing diffuse alveolar damage hypoxia and hence the need for a
ventilator and likeness of the illness to pneumonia and tuberculosis.

Epidemiology:
It has a 2.3% mortality rate however recent data suggests that the real Case Fatality Rate
(CFR) for covid-19 is closer to 0.4% that of this number due to untested corona positive cases
Total 44896 tests have been done in Pakistan.
Total cases are 4414 at the time of writing of this article.

Susceptible individuals:
A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory
disease, e.g., cough, shortness of breath) and a history of travel to or residence in a location
reporting community transmission of COVID-19 disease during the 14 days prior to symptom
onset.
A patient with any acute respiratory illness AND having been in contact with a confirmed or
probable COVID-19 case (see definition of contact) in the last 14 days prior to onset of
symptoms.
A patient with severe acute respiratory illness (fever and at least one sign/symptom of
respiratory disease, e.g. cough, shortness of breath; AND requiring hospitalization)
A contact is a person who experienced any one of the following exposures during the 2 days
before and the 14 days after the onset of symptoms of a probable or confirmed case:
Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15
minutes
Direct physical contact with a probable or confirmed case
Direct care for a patient with probable or confirmed COVID-19 disease without using proper
personal protective equipment
There are household members who may be at increased risk of complications from COVID19
infection (e.g., people >65 years old, young children, pregnant women, people who are
immunocompromised or who have chronic heart, lung, or kidney conditions).

Precautions:
Avoid big gatherings and crowded places, especially when in closed spaces.
Super-spreading events are inevitable, and could overwhelm the contact tracing system, leading
to the need for broader-scale social distancing interventions.
CFR increases sharply with age and is higher in people with COVID-19 and underlying
comorbidities. Targeted social distancing for these groups could be the most effective way to
reduce morbidity and concomitant mortality.
Pro-active or reactive school day closures can be exercised.
Maintain sleep for better immunity

Wash your hands frequently with soap and water for 40-60 seconds.

If soap and water are not available, rub your hands for 20-30 seconds with an alcohol-based hand
sanitizer that contains 60-80% alcohol.

Avoid touching your eyes, nose, and mouth.

Cover your cough or sneeze in the bend of elbow or a tissue, then throw the tissue in the bin.

Clean and disinfect frequently touched objects and surfaces within home e.g. door handles, switch
boards etc. (Separate Guidelines on Surface Disinfection)

Do not give your mobile to any of the household member. In case there is a need to share it someone,
clean it with a disinfectant.

Stay informed about the local outbreak situation.

Avoid having any unnecessary visitors. take vitamin c and d3 to maintain strong immunity

Hot and cold therapy and the use of saunas can improve immunity against SARS and so is considered
favorable to improve immunity against covid-19 and is currently under research.

Avoid gatherings with friends and family within the home premises. Avoid having any unnecessary
visitors.

Avoid unnecessary use of public transport.

Work from home using digital media sources.

Take care of the emotional health of your household members, including yourself.
A simple cotton cloth mask can prevent infection by 71%.

Masks should be removed on being soiled or wet.

They should be untied from behind and not touched form the front.

If wearing both gloves and mask the mask should be taken off after the gloves are taken off.

Masks used should be disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution
(1%) and then disposed of either by burning or deep burial.
These masks can also be sterilized by heat.

For ordinary citizens distancing themselves and going outside a simply surgical mask can be enough
protection.

For medical staff having closer encounters a full protective suit with double gloves and an N95 mask is
necessary.

An N95 masks prevents 95% of the particles from entry.

MAINTAINANCE OF QUARANTINE OR
ISOLATION
Quarantine
Separation and restriction of movement of persons who are exposed to a patient with COVID-19
disease to see whether they developed the infection. Quarantine may be at home or in a facility.
 Isolation
Separation of patients infected with proven or suspected COVID-19 to prevent the spread of the
infection. Isolation may be at home or in the hospital.
Individuals should ensure that they have access to several weeks of medications and supplies
in case you need to stay home. In case of a preexisting underlying medical condition like
hypertension, cardiovascular disease, diabetes they should reach out to their medical care
provider to discuss the management
Home isolation (staying home) of sick persons can be ended if: They have had no fever for at
least 72 hours without the use medicine that reduces fevers. Or if other symptoms have
improved (for example, when their cough or shortness of breath has improved).
Citizens should take additional precautions for those at higher risk, particularly older adults and
those who have severe underlying health conditions
They should avoid sharing personal items like dishes, towels, and bedding.
If possible, they should use a separate washroom.
They should wear a facemask when they are around people.
The ill person in a house should eat/be fed in their room if possible.
Non-disposable food service items used should be handled with gloves and washed with hot
water or in a dishwasher. Clean hands after handling used food service items.
If possible a lined trash can should be dedicated for the ill person. Gloves should be used when
removing garbage bags, handling, and disposing of trash. Hands should be washed after
handling or disposing of trash.
Dirty laundry from an ill person can be washed with other people’s items
Disposable gloves should be worn when handling dirty laundry from an ill person and then
discarded after each use. If no gloves are used when handling dirty laundry hands should be
washed afterwards.
If possible we should not shake dirty laundry. This will minimize the possibility of dispersing
virus through the air.
We should take care of the emotional health of the other household members, including
ourselves.
If the person in isolation or quarantine is a housewife, she should avoid preparing, cooking and
serving food to other members of the family.
Only one healthy household member with no other health issue should be designated caregiver
of COVID-19 patient.
Entry of visitors is prohibited until the completion of quarantine period COVID-19 patients who
are mildly ill are able to recover at home.
Patients cannot leave their home, except to get medical care. They cannot visit public areas.
This includes mosques, parks and shops and using public transportation, ridesharing, or taxis.
Patients must stay in touch with a healthcare provided Patient must only go to a hospital which
is on the list of Government identified hospitals for COVID-19
The contact should avoid taking public transportation to the facility if possible; an ambulance
can be called, or the ill contact can be transported in a private vehicle with all windows open, if
possible.
Any surfaces that become soiled with respiratory secretions or other body fluids during transport
should be cleaned with soap or detergent and then disinfected with a regular household product
containing a 0.5% diluted bleach solution. All close contacts of that contact need to be home
quarantined for 14 days and followed up for an additional 14 days or until the report of such
cases is negative on lab testing.
People should wash clothes, bed clothes, bath and hand towels, using regular laundry detergent
and water or machine wash at 60-90°C with common household detergent and dry thoroughly.
Dustbins must be covered with lids and lined with plastic bags. Bags must be tied up before
being disposed.
Disposable facemasks and gloves must be disposed of in a covered bin after using them.
We should not reuse disposable facemasks and gloves.

Accommodation and supplies

Travelers should be provided with adequate food and water, appropriate accommodation
including sleeping arrangements and clothing, protection for baggage and other possessions,
appropriate medical treatment, means of necessary communication if possible, in a language
that they can understand and other appropriate assistance.
A medical mask is not required for those who are quarantined
Ventilators should not be shared

Communication
We should establish appropriate communication channels to avoid panic and to provide
appropriate health messaging so those quarantined can seek timely appropriate care when
developing symptoms.

Respect and Dignity

Travelers should be treated with respect for their dignity, human rights and fundamental
freedom and minimize any discomfort or distress associated with such measures.

Duration
Up to 14 days

Medical Research Findings

HIV inhibitors and NSAIDS have proven futile in treatment so shouldn’t be used.
Ibuprofen may even make symptoms more severe and WHO advises against its use.
In a preliminary clinical trial on a small cohort of COVID-19 patients it was seen that those
patients treated with hydroxychloroquine (600 mg per day, N=20 patients) had a significant
reduction in viral carriage. In addition, patients who received azithromycin for five days (for the
purposes of preventing bacterial super-infection) all (100%) were virologically cured at D6-post
inclusion.
It has been discovered that a treatment of chloroquinone plus zinc leads to improvement of
symptoms between 8-12hours

Workers in industrial zones:

Workers can protect themselves by using alcohol-based (70 percent) sanitizer or wipes at entry
and exit points
Discontinuing Biometric attendance
Covering cough or sneeze with tissue or a shoulder or elbow
Avoiding touching eyes, nose, or mouth.
Repeated and diligent handwashing least 20 seconds after every hour
Clothes of the workers and management shall be frequently disinfected, especially following
contact with any frequently-touched surfaces such as door handles, elevator buttons, machines,
handrails, drinking fountains, computers, telephones, fax machines keyboards, etc.
Workers should keep up-to-date on the latest information on COVID-19 (Federal & provincial
government health websites, WHO etc.)
if any worker starts to feel unwell they should seek health care and avoid contact with others
when unwell.
Workers should not attend work while unwell
Changes should be made in work policy or procedures to reduce or minimize exposure to a
hazard by the worker or employer.
All industrial zones must assess the risk in consultation with workers and implement control
measures to minimize the spread of the virus, these may include
Contact among workers, clients, and customers should be minimized and replaced by face-to-
face meetings with virtual communications and implementing telework if feasible
Administration should establish alternating days or extra shifts that reduce the total number of
employees in a facility at a given time, maintaining a full onsite work week
Employers should be responsible for providing information, instruction and training on
occupational safety and health
They should be providing workers with up-to-date education and training on COVID-19 risk
factors and protective behaviors.
Employers should provide tissues, no-touch trash cans, hand soap, alcohol-based hand rubs
containing 70 percent alcohol, disinfectants, and disposable towels for workers to clean their
work surfaces
They should be providing employees good quality masks, safety glasses, gauze caps and
gloves
They should be maintaining the record of all individuals and vehicles entering and exiting the
premise
They should determine areas to be disinfected and cordon off using signs and physical barriers
such as caution banner tape, safety cones, etc.
Workers should dedicate separate pairs of clothes for work within a unit or premise.
Disposable cups, glasses and plates for drinks and meals should be used.
Drivers must wear masks, head gear and gloves while traveling
Disinfection of transport vehicles of industries before boarding should be done.
Drivers should ensure washing of all transport vehicles leaving the industrial exit
All the supplies/deliveries products shall be properly sanitized and disinfected before exit
Windows are to be kept open while travelling
Cooling (air conditions), and heating systems of the transport vehicles shouldn’t be used.
Supply/delivery of items from geographic areas severely affected by COVID-19 may be
cancelled.

Cleaning:
Horizontal surfaces with infrequent hand contact like window sills and hard-surface flooring in
routine patient-care areas require cleaning on a regular basis, when soiling or spills occur, and
when a patient is discharged from the facility.
Most, if not all, housekeeping surfaces need to be cleaned only with soap and water or a
detergent/disinfectant, depending on the nature of the surface and the type and degree of
contamination.
There have been a total of 357 entries as of 8/4/2020 on the EPA American site of cleaning
products that are effective to combat Covid-19.

Protection in stores
The staff should wash hands with soap and water frequently or use an alcohol-based (70%)
hand sanitizer.
They should ensure the availability of alcohol-based hand sanitizer (at least 70% alcohol) at the
store entrance for the customers.
Each customer should sanitize their hands before entering the store and while leaving.
Staff should not allow the customer with cough and flu to enter the store or thermal guns can be
kept to prevent entry.
To ensure the space does not get crowded, people should be allowed to enter the shop only in
small groups.
Staff should disinfect the most frequently used surfaces by the customers such as shopping
trollies, door handles, cashier counter, product racks etc. with 0.5% diluted bleach or 60%-80%
dilute alcohol solution. They should disinfect the floor with bleach or alcohol-based surface
cleaner regularly at equal intervals. (Disinfectant formulations such as sodium hypochlorite with
concentration of 5000-6150 ppm to 500-615 ppm free chlorine are used for environmental
surface cleaning)
The ATM machines should be cleaned with alcohol swab after every customer use and make
available a hand sanitizer beside each machine.
The credit/debit card machine available at cashier counter should also be disinfected frequently.
Each salesperson and receptionist must ensure the use of gloves.
Customers should buy as per their need to prevent hoarding of products.
Staff should ensure queue control, maintaining the advised 6 feet distance, outside of shops
and other essential premises that remain open for example using stickers on the ground.
The store manager and staff must keep themselves updated with the updated instructions
issued by the government and show strict compliance to them.

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