As there is no vaccine available for prevention at the moment, the best way of protecting oneself is by minimizing exposure to the virus. Protection guidelines are the established, are for all respiratory diseases and are as follows:
- Avoid contact with people who are ill as much as possible.
- Stay at home when you are ill to avoid spreading the virus to others.
- Don’t touch your face with contaminated hands. Viruses can easily gain access into your system via mucosa such as your eyes, mouth, and nostrils.
- Disinfection of household objects should be carried out routinely especially if there is a sick person in the home.
- Cover your sneeze or cough with a tissue and discard that tissue afterwards to avoid reintroducing the shed viruses into your body system.
- Hand washing with soap or an alcohol-based hand sanitizer as frequently as possible and especially after using the bathroom or before eating. Hand sanitizers should be used when water and soap aren’t readily available. But hand washing remains the preferred means of hand hygiene.
- Wearing of face mask is only recommended for people who are manifesting symptoms of COVID-19.
Wearing of face masks by people who are otherwise well has not been shown to have much benefits but rather, may have a paradoxical effect. Face masks are not meant to be worn on a long term basis, and definitely not meant to be re-used. Doing this may predispose one to a respiratory infection arising from a cocktail of trapped dust and nasal mucus secretions, humid and warm air which creates a favourable medium for growth of microorganisms. Falling sick would then further reduce the individual’s immunity to the coronavirus.
Healthy people don’t need to wear facemasks for prevention, even in an area where coronavirus is prevalent. Following general measures like avoiding exposure, hand washing, maintenance of respiratory hygiene is more important than wearing a facemask to reduce transmission of disease. Also, healthy individuals who are taking care of coronavirus infected persons should wear a facemask when in the same room with them.
Even for countries where the risk of infection is low, there is need for every person to take necessary precautionary measures on their side to prevent this public health threat. Some of these measures are listed below:
- With approach of the flu season, everyone should get the flu vaccine and take other hygienic measures to minimize the spread of illness. They may also consider taking antiviral flu medications if the doctor prescribes them. These drugs have been shown to not only reduce the severity of disease, but also shorten its duration.
- Healthcare providers should be vigilant and aware enough to protect themselves while treating coronavirus infected patients. Healthcare providers should be able to able to identify a person who has a specific history (travel to china, fever, respiratory symptoms) and take appropriate steps as needed.
- If a person has travelled to China recently or has in some way been exposed to coronavirus infected patients, they should limit their activities and movement. Specific instructions and guidelines should be followed to ensure that they play their role in preventing the transmission of disease. If they develop COVID-19 symptoms, then they should notify the relevant health authorities and ask for medical assistance.
1. Pregnant women
Women undergo immunological and physiological changes during pregnancy that might make them more vulnerable to infections, including COVID 19. The evidence of COVID 19 causing severe illness in pregnant women is not present, but it is supported by the fact that other forms of coronavirus (Severe acute respiratory syndrome coronavirus [SARS-CoV], and Middle East respiratory syndrome coronavirus [MERS-CoV] cause more severe illness in pregnant women as compared to the general population. Pregnant women are advised to follow the general health guidelines to reduce the risk of infection.
Many viral infections can cause adverse fetal outcomes as reported in influenza, SARS-CoV-1, and MERS-CoV infection. It may therefore be deduced that COVID-19 infections during pregnancy may be involved in adverse fetal outcomes due to the similarities in makep. Pregnant women with COVID-19 infections experience less adverse maternal and fetal complications as compared to pregnant women with SARS-CoV-1 infection however.
Even though there have been two cases of neonatal COVID 19 so far, these have occurred in the presence of close contact with infected persons and there is still a lack of sufficient evidence to support a vertical transmission of the SARS-CoV-2 virus which is transmission occurring from mother to child through the placenta during pregnancy, perinatally through contact with the mother’s body fluids during delivery, or through the breast milk during breastfeeding.
Precautions for pregnant women :
- Pregnant women should be considered a high-risk population for coronavirus infection.
- Health education and screening facilities should be made readily available for women.
- Newborns with suspected or confirmed infection should be isolated, and should not be breastfed.
- Following the WHO general guidelines like hand washing, avoiding contact exposure, avoiding exposure with dead animals, etc.
2. School Children
The number of children affected by the COVID 19 infections is few as compared to adults. The reason is unknown, but it may be due to a difference in the immune system of age groups. Parents and teachers should encourage children to follow hygienic measures to protect themselves from the disease.
Some parents have opted to keep their children at home while many schools in China especially in the Hubei province of Wuhan have remained closed even with the end of the holiday season.
3. International Travel and Health
If a person is planning to travel, they should check the travel advisories. Consult your doctor before traveling if you are suffering from any health conditions which make you more vulnerable to respiratory infections.
The CDC recommends avoiding non-essential travel to China, and if you must travel:
- Avoid close contact with people who are sick.
- Avoid coming in close contact with animals whether alive or dead. Also keep away from animal markets and wild farms and their products.
- Wash hands frequently, each session lasting at least 20 seconds and using soap and water. Alcohol-based hand sanitizers can be made use of in the absence of soap and water.
- Older adults and travellers with underlying health issues may be at risk for more severe disease.
On the 10th of January 2020, WHO issued the first report on travel advice concerning the outbreak of new coronavirus in China. According to the report, as the mode of transmission of the virus was not yet fully established, travellers were advised to adhere to general health practices to reduce the spread of respiratory infections.
Health providers are also enjoined to give health education to travellers about disease symptoms and prevention. If a traveller exhibits the signs and symptoms of respiratory disease, health authorities should be notified and the contact details of the traveller is taken for follow up. WHO did not recommend travel restrictions or specific health measures for the travellers. Also, screening at entry points was thought to offer a limited benefit while using up a lot of resources.
On the 27th of January 2020, WHO issued an updated report which confirmed human to human transmission of the disease. Measures were aimed at reducing the risk of importation and exportation of the disease without non-essential restrictions. General health measures to follow by travellers and country health authorities were the same as that of the previous report. Measures on entry and exit point screening were also given in the report.
On the 30th of January 2020, COVID-19 was declared a public health emergency of international concern (PHEIC) by the WHO. Countries were advised to be prepared for containment, screening, isolation, diagnosis, case management, contact tracing, and identification. Specific measures were issued related to repatriation and quarantine of travellers.
On the 4th of February 2020, CDC also issued a Level 3 warning to avoid non-essential travel to China. Transportation within and out of the affected province of China were also affected. The US Department of State also issued a Level 4 advisory asking people not to travel to China due to the coronavirus outbreak.
If someone must travel to China, they are to follow the preventive guidelines as stated earlier. Cancellation or postponement of travel to Hong Kong was not recommended by CDC. Travelers to Hong Kong are encouraged to practice the usual precautions.
4. Health Professionals
Specific guidelines were issued in order to guide healthcare facilities and health professionals on infection prevention and control measures in the management of suspected and confirmed cases of 2019-nCoV infection.
As the spectrum of disease is largely unknown, a criteria was devised to evaluate a patient. Healthcare providers are to obtain detailed information on the travel history of patients being evaluated for fever and acute respiratory illness. For severely ill individuals, testing can be considered when exposure history is equivocal (e.g., uncertain travel or exposure, or no known exposure) and another cause has not been otherwise identified.
Healthcare providers stand at great risk of acquiring the infection because of the frequent contact with infected patients. Healthcare providers should adhere to infection control and prevention strategies to protect themselves from acquiring the infection. It includes the appropriate use of engineering, administrative controls, and personal protective equipment (PPE). Guidance about the appropriate use of personal protective equipment has been issued by the CDC.
A healthcare provider should assess and triage the patients according to respiratory symptoms and risk factors for 2019-nCoV to minimize the chances of exposure, including placing a facemask on the patient and isolating them. Hand hygiene should be maintained using alcohol-based hand sanitizer before and after every patient contact, or contact with materials that could be potentially infectious, as well as before putting on and taking off protective equipment, gloves inclusive. Routine cleaning and disinfection procedures should be performed. Management of laundry, food service utensils and medical waste should also be performed per guidelines. A health care provider who has an unprotected exposure to a confirmed or possible case 2019-nCoV patient should quickly contact their supervisor or occupational health officer. If a health professional starts having symptoms consistent with COV 19 infection, they should not report to work but instead, should contact their occupational health services.
Guidelines for employers to use:
- Encouraging sick employees to stay home. Employees should notify their seniors and stay home if they are sick. Flexible policies that allow employees to remain home to care for ill family members should be encouraged.
- Sick employees should be kept away from others and wear a facemask. They should cover their faces while coughing and sneezing.
- Encouragement of hygienic practices like hand washing in offices.
- Health education.
- Notify the supervisor before traveling.
6. Persons infected With Coronavirus
If a person was in China in the preceding 14 days and feels sick with fever, cough, or difficulty in breathing, they should:
- Consult a medical doctor – They should call ahead before they go to a doctor’s office or emergency room and should reveal all relevant information.
- Not come in contact with other people.
- Cover their mouth and nose with a tissue when coughing or sneezing.
- Wash their hands with soap and water immediately after coughing, sneezing or blowing the nose. If soap and water are not available, sanitizer can be used. If hands are visibly soiled, washing them with soap is always preferred.
- Clean and disinfect contact surfaces.
If a person falls Ill, they should:
- stay at home and restrict movements except to seek medical care.
- Avoid the use of public transportation.
- isolate themselves. Contact with other people and animals during illness should be very minimal.
- Inform the doctor before visiting so that steps may be taken to prevent other people from getting exposed.
- wear a facemask when they come in contact with other people.
- cover their mouth and nose during coughing or sneezing.
- Refrain from sharing household personal items with other people
- practice handwashing with water and soap.
- avoid touching the eyes, mouth and nose with dirty hands.
- disinfect the touched surfaces and maintain a clean environment.
- Monitor their symptoms and seek medical care if symptoms get worse.