Several coronaviruses can infect humans, the globally endemic human coronaviruses HCoV-229E, HCoV-NL63, HCoV-HKU1 and HCoV-OC43 that tend to cause mild respiratory disease, and the zoonotic Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) that have a higher case fatality rate. COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019.
Case definitions for surveillance
The case definitions are based on the current information available and will be revised.
Suspect case 1. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness of breath), AND with no other aetiology that fully explains the clinical presentation AND a history of travel to or residence in a country/area or territory reporting local transmission (See situation report).of COVID-19 disease during the 14 days prior to symptom onset
Suspect case 2. 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
Suspect case 3. A patient with severe acute respiratory infection (fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness breath) AND requiring hospitalization AND with no other aetiology that fully explains the clinical presentation
A suspect case for whom testing for COVID-19 is inconclusive
A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.
The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don’t feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention.
The following clinical syndromes associated with 2019-nCoV infection:
• Uncomplicated illness
• Mild pneumonia
• Severe pneumonia
• Acute Respiratory Distress Syndrome
• Cytokines storm
• Additional viral and bacterial infections
Details can be accessed at WHO reference number: WHO/nCoV/Clinical/2020.3
People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick. Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air
Reduce chances of being infected or spreading COVID-19 by taking some simple precautions:
• Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water
Why? Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands
• Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing
Why? When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease
• Avoid touching eyes, nose and mouth
Why? Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick
• Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
Why? Droplets spread virus. By following good respiratory hygiene, you protect the people around you from viruses such as cold, flu and COVID-19
• Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention
• Keep up to date on the latest COVID-19 hotspots (cities or local areas where COVID-19 is spreading widely). If possible, avoid traveling to places – especially if you are an older person or have diabetes, heart or lung disease.
Why? You have a higher chance of catching COVID-19 in one of these areas.
• Advice to download and use Aarogya Setu app
Follow the guidance outlined above (Protection measures for everyone)
• Self-isolate by staying at home if you begin to feel unwell, even with mild symptoms such as headache, low grade fever (37.3 C or above) and slight runny nose, until you recover. If it is essential for you to have someone bring you supplies or to go out, e.g. to buy food, then wear a mask to avoid infecting other people
Why? Avoiding contact with others and visits to medical facilities will allow these facilities to operate more effectively and help protect you and others from possible COVID-19 and other viruses
• If you develop fever, cough and difficulty breathing, seek medical advice promptly as this may be due to a respiratory infection or other serious condition
Medical masks are recommended in health care settings.
There are two types of masks which are recommended for various categories of personnel working in hospital or community settings, depending upon the work environment:
1. Triple layer medical mask
2. N-95 Respirator mask
A triple layer medical mask is a disposable mask, fluid-resistant, provide protection to the wearer from droplets of infectious material, An N-95 respirator mask is a respiratory protective device with high filtration efficiency to airborne particles.
However, it is important to remember that the use of masks should be combined with other key infection prevention and control measures such as hand hygiene and physical distancing, as they do not serve all purposes to protect against COVID-19.
Remember, a mask should only be used by health workers, care takers, and individuals with respiratory symptoms, such as fever and cough
• Before touching the mask, clean hands with an alcohol-based hand rub or soap and water
• Take the mask and inspect it for tears or holes
• Orient which side is the top side (where the metal strip is)
• Ensure the proper side of the mask faces outwards (the coloured side)
• Place the mask to your face. Pinch the stiff edge of the mask so it moulds to the shape of your nose
• Pull down the mask’s bottom so it covers your mouth and your chin
• After use, take off the mask; remove the elastic loops from behind the ears while keeping the mask away from your face and clothes, to avoid touching potentially contaminated surfaces of the mask
• Discard the mask in a closed bin immediately after use
• Perform hand hygiene after touching or discarding the mask – Use alcohol-based hand rub or, if visibly soiled, wash your hands with soap and water
For those presenting with mild illness, hospitalization may not be required unless there is concern about rapid deterioration
Patients with mild symptoms and without underlying chronic conditions − such as lung or heart disease, renal failure or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home.
A communication link with healthcare provider or public health personnel, or both, should be established for the duration of the home care period.
Patients and household members should be educated about personal hygiene, basic IPC measures and how to care for the member of the family suspected of having COVID-19 disease as safely as possible to prevent the infection from spreading to household contacts
According to a recent literature review, the most frequent laboratory abnormalities encountered in patients with COVID-19 encompass:
• Lymphopenia (35-83%)
• Thrombocytopenia (5-36%)
• Increased CRP (75-93%)
• Increased LDH (27-92%)
• Increased ESR (up to 85%)
• Increased D-dimer (36-43%)
• Decreased serum albumin (50-98%)
• Decreased Hb (41-50%).
Risk factors associated with higher odds of in-hospital death were:
• D-dimer levels greater than 1 μg/mL
• Higher SOFA score on admission
Elevated levels of blood IL-6, high-sensitivity cardiac troponin I, lactate dehydrogenase, ALT and ferritin & lymphopenia were more commonly seen in severe COVID-19 illness.
Lymphopenia is one of the hallmarks of COVID-19 and is also an unfavourable prognostic indicator. In general, counts of peripheral CD4 and CD8 T cells are found to be substantially reduced. CD8 T cells are also found to contain a considerable number of cytotoxic granules.
Increased high-sensitivity cardiac troponin I during hospitalisation was found in more than half of those who died.
SGOT, SGPT are increased and indicate liver injury or wide spread organ damage, and elevated creatinine which indicates kidney injury.
Although less than 20% of COVID-19 patients present with increased procalcitonin, results of a recent meta-analysis suggest that serial procalcitonin measurement may play a role for predicting evolution towards a more severe form of disease and for defining the risk of developing severe bacterial co-infections. Increased procalcitonin values are associated with a nearly 5-fold risk of more severe forms of COVID-19.
In patients with severe COVID-19, histological examination of lung tissue shows diffuse alveolar damage characterized by the presence of cellular fibromyxoid exudates, desquamation of pneumocytes and hyaline membrane formation. This is consistent with ARDS.
Chest radiographs may show bilateral infiltrates. The most common patterns on chest CT were found to be ground-glass opacity (56.4%) and bilateral patchy shadowing (51.8%).
The age distribution of infected patients is as follows (data from 44,672 patients laboratory confirmed cases):
<10 years: <1%
10-19 years: 1%
20-29 years: 8%
30-79 years: 87%
≥ 80 years: 3%
Receiving the patient: Give suspect patient a medical mask and direct patient to separate area, an isolation room if available. Keep at least 1meter distance between suspected patients and other patients. Instruct all patients to cover nose and mouth during coughing or sneezing with tissue or flexed elbow for others. Perform hand hygiene after contact with respiratory secretions
Apply droplet precautions: Use a medical mask if working within 1-2 metres of the patient. When providing care in close contact with a patient with respiratory symptoms (e.g. coughing or sneezing), use eye protection (face-mask or goggles), because sprays of secretions may occur
Apply contact precautions: Use PPE (medical mask, eye protection, gloves and gown) when entering room and remove PPE when leaving. If possible, use either disposable or dedicated equipment Ensure that health care workers refrain from touching their eyes, nose, and mouth with potentially contaminated gloved or ungloved hands
Apply airborne precautions when performing an aerosol generating procedure: Ensure that healthcare workers performing aerosol-generating procedures (i.e. open suctioning of respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation) use PPE, including gloves, long-sleeved gowns, eye protection, and fit-tested particulate respirators (N95 or equivalent, or higher level of protection)
Suburban Diagnostics is amongst the very first list of 4 labs approved by ICMR on March 22,2020 for Covid-19 testing across the country.
Suburban Diagnostics has Exclusive collection centres and drive thru collection points.
No. As per the latest revised discharge policy, there is no need for testing prior to discharge all presymptomatic/very mild/mild confirmed cases of COVID-19 after 10 days of symptom onset and no fever for 3 days. Therefore, it stands to reason, that no testing is also needed for patients undergoing home isolation (pre-symptomatic/very mild/mild confirmed cases) after the home isolation period is over.
For mild/very mild/pre-symptomatic cases
• Patient can be discharged after 10 days of symptom onset and no fever for 3 days
• No need for testing prior to discharge
• Patient will be advised to isolate himself/herself at home & self-monitor his/her health for further 7 days
For moderate cases
• Patient can be discharged (a) if asymptomatic for 3 days and (b) after 10 days of symptom onset
• No need for testing prior to discharge
• Patient will be advised to isolate himself/herself at home & self-monitor his/her health for further 7 days
For severe cases
• Clinical recovery
• Patient tested negative once by RT-PCR (after resolution of symptoms)
WHO website, https://www.who.int/news-room/q-a-detail/q-a-coronaviruses,
WHO reference number: WHO/COVID-19/laboratory/2020.4
WHO reference number: WHO/nCoV/Clinical/2020.3
WHO reference number: WHO/nCov/IPC/HomeCare/2020.2
Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA [Internet]. 2020 Feb 24 [cited 2020 Mar 13]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2762130
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28;NEJMoa2002032.
Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med CCLM [Internet]. 2020 Mar 3;0(0). Available from: http://www.degruyter.com/view/j/cclm.ahead-of-print/cclm-2020-0198/cclm-2020-0198.xml
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020 Mar;S0140673620305663.
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020 Feb;S221326002030076X.
Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta. 2020 Jun;505:190–1.
Elsevier. Novel Coronavirus Information Center [Internet]. Elsevier Connect. Available from: https://www.elsevier.com/connect/coronavirus-information-center
Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected [Internet]. Available from: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125