JOURNAL CLUB

25-01-2020

Dr Nikhil Kumar
Junior resident
Internal medicine
 NOVEL CORONA VIRUS

 Timeline
 Surveillance
 Management
 Affect on Indians
 Time Line
 31st Dec 19, cases of pneumonia unknown aetiology detected in Wuhan City,
Hubei Province of China

 Chinese authorities identified a new type of coronavirus, which was isolated

on 7 January 2020
 On 11 and 12 January 2020, WHO received further detailed information from
the National Health Commission China that the outbreak is associated with
exposures in one seafood market in Wuhan City.

 On 13 January 2020, the Ministry of Public Health, Thailand reported the first
imported case of lab-confirmed novel coronavirus (2019-nCoV) from Wuhan
 Similarly, Japan, USA and Republic of Korea reported their first case of this
virus
 Till date 3 new confirmed cases also found in france
 Latest Update
• In china, more than 1000 confirmed cases of infection out of
which 41 have died

• Majority of deceased patients were older than 60 years with

pre-existing conditions but a young previously healthy male
died in wuhan, china on 24.01.2020

• Till now infection have been confirmed in France, south

Korea, japan, Thailand, Singapore, Vietnam,Taiwan and united
states
• 61 year old male was the first person to die from
nCoV 19 infection and was a regular shopper at
Huanan seafood market
• The Huanan sea food market use to sell civet cats,
wolves, snakes and poultry
• The sea food market has been shut down since 1 st
jan 2020
• Other places similar sea food market are in
Guangzhou, guangdoung and Shandong province of
china
 What is nCoV??

• Novel betacoronavirus
• Same family as SARS-CoV and MERS-CoV
• Characteristic crown morphology
• Possibly zoonotic transmission
• Limited data on human to human transmission
 Symptoms
MILD TO MODERATE
• Fever- low grade
• Runny nose
• Sore throat
• Cough
• Feeling of being unwell
• Headache

SEVERE
• Shortness of breath
• Difficulty in breathing
• Increased sputum production
• Altered mental status
• GI symptoms- vomiting and diarrhoea
 Surveillance
Suspect case
Acute respiratory illness and at least one of the following:

 close contact with a confirmed or probable case of 2019-nCoV in the

14 days prior to illness onset

 working in a live animal market in Wuhan

 worked or attended a health care facility in the 14 days prior to onset

of symptoms

WHO/2019-nCoV/SurveillanceGuidance/2020.3
 Surveillance

• Probable Case testing for 2019- nCoV inconclusive or

testing positive on a pan-coronavirus
assay

Laboratory confirmed case,

• Confirmed Case irrespective of symptoms

WHO/2019-nCoV/SurveillanceGuidance/2020.3
 Specimen collection and shipment
• Respiratory material: nasopharyngeal and
oropharyngeal swab or endotracheal aspirate
or bronchoalveolar lavage

• Serum for serological testing: acute sample

and convalescent sample
 Home care for patients with suspected
nCoV infection
• The patient should be placed in a well ventilated single room
• Limited number of caretakers of the patients, preferable in a
good health without risk condition.
• If possible the household members should stay in a different
room and maintain a distance of at least one metre from the
patient
• Hand hygiene and respiratory hygiene should be always
performed
• Persons with symptoms should remain at home until their
symptoms are resolved based on either clinical or laboratory
finding ( 2 negative RT-PCR atleast 24 hours apart)
• There should be limited patient movement and minimal
shared space such as kitchen, washroom
• Caregiver should wear a medical mask around the patient
• Hand washing with soap and water when hands are visibly
soiled
• Respiratory hygiene like covering the mouth and nose during
sneezing and coughing with medical masks, clothes masks,
tissue paper and flexed elbow
• Breastfeeding mother should continue breastfeeding as there
is benefit of breastfeeding and insignificant role of breast milk
in transmission of viruses
 Management of contacts
• Limited evidence of Human to human transmission of nCoV
• Monitor exposed persons for 14 days from the last exposure
• Contacts seeks immediate medical attention if they develop
symptoms
• These cases should be notified within 24-48 hrs
• Contacts should avoid public transportation
• Always perform hand and respiratory hygiene
 Clinical Management
• Triage: recognize and sort patients with SARI
• Immediate implementation of appropriate infection
prevention and control (IPC) measures
• Early supportive therapy and monitoring
• Collection of specimens for laboratory diagnosis
• Management of hypoxemic respiratory failure and acute
respiratory distress syndrome (ARDS)
• Management of septic shock
• Prevention of complications
• Specific anti-nCoV treatments
• Special considerations for pregnant patients
 Preparation of India

• Various surveillance centers:

Passengers arriving from china will be screened for the virus
(thermal screening) at various international airports like Delhi,
Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad and cochin and in
addition to the same 12 more airports where travel advisory will be
displayed.
• Two persons who returned from china have been kept under
observation at Mumbai hospital.
• Ten laboratories under ICMR are also equipped to test the samples
• An Indian nurse in Saudi Arabia has a different strain of corona virus and
is under the treatment.
THANK YOU