COVID-19 Healthcare Worker Training

Dr. Wangulu Collins (MBChB, MMed-Path, MPH)

Pathologist – AAR Healthcare (K)

OVERVIEW ON COVID-19

COVID-19 HCW Training

 OUTLINE
• Introduction
• Etiology
• Epidemiology
• Transmission
• Clinical Presentation
• Diagnosis
• Treatment & Prevention

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 INTRODUCTION

• They are a group of viruses referred to as “coronaviruses”

• The more common human coronaviruses (HCoV-NL63,
HCoV-229E, HCoV-OC43 and HKU1) cause mild upper
respiratory diseases in persons with normal immunity.
• Others have caused pandemics; include SARS-COV,
Middle East respiratory syndrome coronavirus (MERS-
CoV), SARS-COV -2.
• The current discussion is the pandemic causing COVID-
19 which is just one of them.

COVID-19 HCW Training

Has their been Coronavirus pandemics before ?
• Severe acute respiratory syndrome (SARS) ( SARS
COV) in 2002 and 2003 in Guangdong province, China
• Middle East Respiratory Syndrome coronavirus (MERS-
CoV) emerged in Middle Eastern countries 2012.
• Notably SARS-CoV and MERS-CoV were transmitted
directly to humans from market civets and dromedary
camels, respectively and both viruses are thought to have
originated in bats.

COVID-19 HCW Training

Etiology

• It is a virus
• Scientific name SARS- COV 2
• Microscopic
• Estimated size is 125 nanometers
(0.125 microns) in diameter.
• The size of biological aerosols
from coughing and sneezing range
in size from 0.5-3 Micron

COVID-19 HCW Training

Seven coronaviruses that can infect humans
– Common human CoVs
Common colds and self-limiting URTI in
• HCoV-229E (alpha)
immunocompetent individuals. May cause
• HCoV-OC43 (alpha) LRTI in immunocompromised subjects and the
• HCoV-NL63 (beta) elderly
• HCoV-HKU1 (beta)
– Other CoVs
• SARS-CoV (beta)
Highly pathogenic causing variable
• MERS-CoV (beta) respiratory and extra-respiratory
• SARS-CoV-2 manifestations

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• SARS-COV-2
– BetaCoV
– 60–140 nm
– Like other CoVs, it is sensitive to ultraviolet rays and heat.
– Inactivated by lipid solvents including ether (75%), ethanol and
chlorine-containing disinfectant
– Probably evolved from a strain found in bats.
– Amplifying mammalian host, intermediate between bats and humans,
is, however, not known.
– Since the mutation in the original strain could have directly triggered
virulence towards humans, it is not certain that this intermediary
exists

COVID-19 HCW Training

 Historical flow of events
• Viral diseases continue to emerge posing a serious public health issue-
(WHO).
• Epidemics in the last 20 years
– SARS-COV – 2002/2003
– H1N1 influenza - 2009
– MERS-COV-2012
• Dec 31 2019-epidemic of cases with unexplained LRTI was detected in
Wuhan, China.
• Initially classified as "pneumonia of unknown etiology.“
• The Chinese CDC and other CDCs organized an intensive outbreak
investigation program.
• The etiology of this illness is now attributed to a novel virus belonging to
the coronavirus (CoV) family.
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NAME DATE WORLD POP SUBTYPE REPRODUCTIO DEATHS CASE
N RATE WORLDWID FATALIT
E Y

Spanish Flu 1918-1920 1.80b H1N1 1.47-2.27 20-100M 10%

Asian Flu 1957-1958 2.9B N2N2 1.53-1.7 1-4M <0.2%

Hong Kong 1968-1969 3.53 H3N2 1.56- 1-4M <0.2%

Flu

Swine Flu 2009-2010 6.85 H1N1 1.3-1.7 151700- 0.03%

575400

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 Historical Perspective

• SARS-CoV (Severe Acute Respiratory Syndrome)

– Coronavirus Viral respiratory illness)
• First recognized in November 2002 in China
• 2002-2003 global outbreak – 8,098 probable cases
– 774 deaths
• No known human cases since 2004
• Spread by close person-to-person contact
• Symptoms often include:
– Fever, chills, and body aches progressing to pneumonia

COVID-19 HCW Training

• MERS-CoV [Middle East Respiratory Syndrome Coronavirus
(MERS)]
– Viral respiratory illness
– First reported in 2012 in Saudi Arabia
• Human illnesses in dozens of countries (in or near Arabian
Peninsula)
– As of October 3, 2019
• >2400 lab-confirmed cases
• >850 deaths

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 COVID 19
• Jan 30, 2020 Public Health Emergency of International Concern
(PHEIC) declared an outbreak as it had spread to 18 countries
with four countries reporting human-to-human transmission
• Feb 11, 2020 disease described as "COVID-19,“Initially, the
new virus was called 2019-nCoV.
• Subsequently, the task of experts of the International Committee
on Taxonomy of Viruses (ICTV) termed it the SARS-CoV-2
virus as it is very similar to the one that caused the SARS
outbreak (SARS-CoVs).

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EPIDEMIOLOGY

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 TRANSMISSION
• COVs are known to be zoonotic and can cross species barriers
causing mild to severe diseases in humans.
• These viruses that caused SARS and MERS probably originated
from bats and moved into other mammalian hosts — the
Himalayan palm civet for SARS-CoV, and the dromedary camel
for MERS-CoV — before jumping to humans.
• The dynamics of SARS-Cov-2 are currently unknown, but there
is speculation that it also has an animal origin

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 Zoonotic diseases and human spread

Zoonotic transmission Amplification

1. Transmission 2. Transmission from 3.Transmission between

between animal hosts animal host to humans humans

01/31/20
22

COVID-19 HCW Training

• The COVID 19 viral particles are covered in mucus and
saliva in the mouth, nose, throat, airways and lungs.
• They are released into the environment when an infected
person talks, breathe, cough or sneeze.
• The large droplets are directly sprayed onto conjunctiva or
mucous membranes (inside of the mouth, nose, throat) of a
susceptible host (an uninfected person).
• When these droplets are on surfaces and are touched by an
uninfected person, self-inoculation can occur by
contaminated hands.

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• A single cough is said to produce up to 3,000 droplets.
• These droplets not only land on the individuals around the
infected patient but will also land on surfaces.
• The Virus is viable (infectious) for a certain number of hours
on such surfaces
• COVID 19 is NOT transmitted through: Food, Human
Waste, Blood Transfusion.
• The risk of infection is notably greater in individuals with
pre-existing medical conditions such as asthma, hypertension,
diabetes, old age.

COVID-19 HCW Training

COVID-19 HCW Training
 Transmission contd..
– 1st cases of the CoVID-19 linked to direct exposure to the
Huanan Seafood (animal-to-human )
– Subsequent cases not associated with this exposure
mechanism.(human-to-human)
– Symptomatic people are the most frequent source of
COVID-19 spread.
– Transmission from asymptomatic people less frequent but
can not be excluded
– Basic reproduction number (R0 - R naught) is 2.2. In other
words, on average, each patient transmits the infection to an
additional 2.2 individuals 
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Symptomatology Pattern in Kenya

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 Pathogenesis

• Viral attachment to Respiratory epithelial receptor

(Angiotensin Converting Enzyme Receptor)
• Receptor mediated endocytosis
• Uncoating with release of contents into the cytoplasm
• Translocation of nuclear contents into the nucleus
• Viral RNA replication (Viral RNA synthesis)
• Viral mRNA translation (Viral Protein synthesis)
• Protein assembly
• Release by budding.

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 Structural Protein Functional Protein
Coronavirus
Nucleocapsid Protein (N) • Bound to RNA genome to
make up nucleocapsid
Spike Protein (S) • Critical for binding of host cell
receptors to facilitate entry of
host cell

Envelope Protein (E) • Interacts with M to form viral

envelope
Membrane Protein (M) • Central organizer of CoV
assembly
• Determines shape of viral
envelope
NOTE: Some CoV’s do not need to have the full ensemble of
structural proteins to make virions, highlighting that certain
proteins may be dispensable or compensated by the function
of non-structural proteins.

COVID-19 HCW Training

 Studies postulate that the viral infection is capable of producing an excessive immune reaction in the
host

Transmission through
respiratory droplets or contact
ACE2 receptors are
broadly expressed in
several human organs Mild viremia
Mild symptoms(cough, fever,
Upper respiratory infection pharyngeal erythema ) OR
asymptomatic

Overreactive immune response

Cytokine
syndrome

ARDS Death
 COVID 19 & Age

• Risk for severe illness from COVID-19 increases with age.

• Older adults at highest risk; Severe illness means that the
person with COVID-19 may require hospitalization,
• For example, people in their 50s are at higher risk for
severe illness than people in their 40s.
• Similarly, people in their 60s or 70s are, in general, at
higher risk for severe illness than people in their 50s.
• The greatest risk for severe illness from COVID-19 is
among those aged 85 or older.

COVID-19 HCW Training

Pattern in Kenya

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 COVID 19 & Co-Morbidities

• People of any age with certain underlying medical conditions are at

increased risk for severe illness from COVID-19
 Chronic kidney disease
 COPD (chronic obstructive pulmonary disease)
 Immunocompromised state (weakened immune system)
 Obesity (body mass index [BMI] of 30 or higher)
 Serious heart conditions, e.g. heart failure, coronary artery disease, or
cardiomyopathies
 Sickle Cell Disease
 Type 2 diabetes mellitus

COVID-19 HCW Training

• Might be at increased risk
 Asthma (moderate-to-severe)
 Cerebrovascular disease (affects blood vessels and blood supply to the
brain)
 Hypertension or high blood pressure
 Neurologic conditions, such as dementia
 Liver disease
 Pregnancy
 Pulmonary fibrosis (having damaged or scarred lung tissues)
 Smoking
 Type 1 diabetes mellitus

COVID-19 HCW Training

 LABORATORY TESTING
• Sampling done through Nasopharyngeal Swab and or Oropharyngeal swab
• Molecular Testing (PCR; Polymerase Chain reaction) where two or more
components of the virus are detected from samples.
• RESULTS
An infected person “ SARS-COV 2 – “ Positive or Detected”
Non-Infected Person “ SARS- COV 2 – “ Negative or Not Detected ”

Can Blood Be used for Diagnostic Testing?

• Currently No
• Blood tests (Antibody Testing) signify exposure and one cannot tell whether
there is active infection

COVID-19 HCW Training

What happens when one Tests Positive?

• Isolation to prevent further spread

• Homebased isolation if one meets pre-set criteria
• Hospital based isolation if one is symptomatic or at
risk of severe complications e.g. the elderly, those
with comorbidities.
What happens to contacts?
• Testing.
• Institution and country guidelines varied as per need.

COVID-19 HCW Training

 TREATMENT
• Multiple drugs have been subjected to clinical trials in order to
attempt to find a pharmaceutical intervention for COVID-19.
• Hydroxychloroquine there is limited data on the efficacy and
associated adverse events. Do not self medicate with
Hydroxychloroquine.
• Antiviral Remdesivir: the clinical and antiviral efficacy of
remdesivir in COVID-19 remains to be established.
• No Vaccine has been approved for use.
• Supportive Treatment: Antihistamine, Steroids like
dexamethasone, organ monitoring.

COVID-19 HCW Training

Non-Pharmaceutical Intervention
• Social/physical distancing is promising in minimizing spread
of COVID-19, the a reasonable distance (1.5m) is maintained
between an infected person and a host (infected person).
• Hand washing with soap + water or use of sanitizers prevents
self-inoculation from contaminated surfaces.
• Regular/Interval cleaning on surfaces with alcohol based
solutions (e.g. tables, Supermarket Trolleys) minimizes
transmission from surfaces
• Use of face masks by the general public
• Restricted movement of persons
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COVID-19 HCW Training

I have Flu-like symptoms (Common Cold), should I be worried?

• Presents: nasal stuffiness and discharge, sneezing, sore throat, cough and hoarse voice.
• Occasional symptoms: chills and at times fever.
• Caused by Viral infections: Rhinovirus (>70%), Respiratory Syncytial Virus (main
infection in children), Parainfluenza (5%), Influenza (5%), Coronaviruses (7%),
Adenovirus
• Colds are usually self-limiting to previously healthy individuals
• For Nasal congestion and dry cough: consider allergic cause if there’s previous history.
• However: If there’s history of known contact with COVID-19 diagnosed persons
COVID-19 needs to be ruled out.
What is it with one Laboratory Testing Positive
and the other Negative on the same person?

• Expedited release of testing reagents by FDA

• The usual process would take months to years with numerous
sample populations
• With time some of the tests in the market may be dropped off
or be given strong recommendation.
• There are issues around adequacy of patient sampling and
patient viral load at the time of testing.
• A positive result should however NOT be ignored
• Repeated testing; 2 negative results 24 hours apart renders a
previously positive person as negative.