FAQs FOR GLOBAL HEALTH WORKERS AND NGOs

This document summarizes WHO’s recommendations for the rational use of personal protective equipment (PPE) in health care and home care settings, as well as during the handling of cargo; it also assesses the current disruption of the global supply chain and considerations for decision making during severe shortages of PPE.

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This document provides guidelines for the continued provision of essential services and operations for dealing with long-standing health
problems during COVID-19. In order to continue to protect the lives of people with TB and other diseases or health conditions, the document covers the following questions, among other topics: 

• Are people with TB likely to be at increased risk of COVID-19 infection, illness and death?
• What should health authorities do to provide sustainability of essential TB services during the COVID-19 pandemic? What services can be leveraged across both diseases?
• What measures should be in place to protect staff working in TB laboratories and healthcare facilities, and community health workers, from COVID-19 infection?
• Etc.

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Disinfecting with bleach guidance

According to many sources

Studies in China:

According to the Zhou, et al. (2020) lancet journal ‘Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study‘  The article reported that 32 patients required invasive mechanical ventilation, of whom 31 (97%) died. 

According to Wang et al (2020) Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. The article reported that 26% of patients required admission to the intensive care unit (ICU) and 4.3% died, but a number of patients were still hospitalized at the time. 

According to Huang et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China  The article reported that out of 41 admitted hospital patients, 13 (32%) patients were admitted to an ICU and six (15%) died.   

According to Cao et al (2020) Clinical features and short-term outcomes of 18 patients with corona virus disease 2019 in intensive care unit – The article reported that 102 patients was studied.   Of 18 admitted to ICU, 17 died.  Only one third were ventilated as others had septic shock or were non-compliant with mechanical ventilation.  

Study in UK

According to ICNARC report on COVID-19 in critical care (UK), Intensive Care National Audit and Research Centre, 27 March 2020 The mortality rate in intensive care close 48%.  

Two interesting articles produced by the CSTS:

Psychological effects of quarantine during the coronavirus outbreak

Caring for patient’s mental Well-being during Coronavirus and other Emerging Infectious Disease: A Guide for Clinicians. 

Starting at midnight on Mar. 19, Hong Kong will put all arriving passengers under a two-week quarantine and medical surveillance in an attempt to prevent more spread of the COVID-19 disease.

Link: https://www.cnbc.com/2020/03/18/hong-kong-uses-electronic-wristbands-to-enforce-coronavirus-quarantine.html?__source=sharebar%7Clinkedin&par=sharebar&fbclid=IwAR3dyKnfIOA_RF7esTTmdaW6qg7UJfdevBFWpYY_tuUxk5FsWAdBjFKXzVo

Everyone can help stop stigma related to COVID-19 by knowing the facts and sharing them with others in your community. Communicators and public health officials can help counter stigma during the COVID-19 response.

Link: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/reducing-stigma.html

Generally, pregnant women do not appear to be more likely to be severely unwell than other healthy adults if they develop the new coronavirus. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

Link: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

For further Articles and Journal Articles on COVID-19 and pregnancy, CLICK HERE

Since January when the World Health Organization (WHO) determined the outbreak of the novel coronavirus disease, COVID-19, to be a “public health emergency of international concern”, stress levels everywhere have continued to mount.

Link: https://news.un.org/en/story/2020/03/1059542

Link: https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf

According to Medical News Today, According to the authors, people with type A blood might be more at risk than those with other blood types.

Link: https://www.medicalnewstoday.com/articles/is-blood-type-linked-to-covid-19-risk

According to Health24 news, Researchers say the average incubation period for the Covid-19 period is about five days, confirming that the 14-day quarantine period being used by most health authorities cross the globe is “appropriate”.

Link: https://www.health24.com/Medical/Infectious-diseases/Coronavirus/coronavirus-why-the-14-day-quarantine-period-20200311-3

According to the New Humanitarian, the WHO had, as of 1 February, estimated new global spending requirements of $675 million for three months of “priority public health measures”. It set out planning assumptions in a 28-page document, adding international measures, including research needs. The bulk of it, $640 million, was for countries to prepare and respond.

Link: https://www.thenewhumanitarian.org/news/2020/03/12/Coronavirus-emergency-aid-funding

According to the CNN, potential coronavirus second wave has China on high alert. As the number of novel coronavirus cases slows to a trickle within China but continues to soar outside, Chinese authorities are stepping up measures to prevent a surge in cross-border infections.

Link: https://edition.cnn.com/videos/world/2020/03/20/coronavirus-outbreak-pandemic-china-high-alert-second-wave-culver-pkg-intl-ldn-vpx.cnn/video/playlists/coronavirus-intl/

According to the WHO Interim guidance ‘Clinical Management of severe acute respiratory infection (SARI) when COVID 19 disease is suspected. (13/03/20) 

Management of mild COVID-19: symptomatic treatment and monitoring  

• Patients with mild disease do not require hospital interventions, but isolation is necessary to contain virus transmission and will depend on national strategy and resources. 
• Provide patients with mild COVID-19 with symptomatic treatment such as antipyretics for fever. 
• Counsel patients with mild COVID-19 about signs and symptoms of complicated disease. If they develop any of these symptoms, they should seek urgent care through national referral systems. 

Management of severe COVID-19: oxygen therapy and monitoring  

• Give supplemental oxygen therapy immediately to patients with SARI and respiratory distress, hypoxaemia or shock and target SpO2 > 94%.  
• Closely monitor patients with COVID-19 for signs of clinical deterioration, such as rapidly progressive respiratory failure and sepsis and respond immediately with supportive care interventions. 
• Understand the patient’s co-morbid condition(s) to tailor the management of critical illness.
• Use conservative fluid management in patients with SARI when there is no evidence of shock. 

Management of severe COVID-19: treatment of co-infections  

• Give empiric antimicrobials to treat all likely pathogens causing SARI and sepsis as soon as possible, within 1 hour of initial assessment for patients with sepsis.  
• Empiric therapy should be de-escalated on the basis of microbiology results and clinical judgment. 

Management of critical COVID-19: acute respiratory distress syndrome (ARDS)  

• Recognize severe hypoxemic respiratory failure when a patient with respiratory distress is failing to respond to standard oxygen therapy and prepare to provide advanced oxygen/ventilatory support.  
• Endotracheal intubation should be performed by a trained and experienced provider using airborne precautions.  

The following recommendations pertain to mechanically ventilated adults and paediatric patients with ARDS. Implement mechanical ventilation using lower tidal volumes (4–8 mL/kg predicted body weight, PBW) and lower inspiratory pressures (plateau pressure < 30 cmH2O).  

• In adult patients with severe ARDS, prone ventilation for 12–16 hours per day is recommended.
• Use a conservative fluid management strategy for ARDS patients without tissue hypoperfusion. 
• In patients with moderate or severe ARDS, higher PEEP instead of lower PEEP is suggested.   
• In patients with moderate-severe ARDS (PaO2/FiO2 < 150), neuromuscular blockade by continuous infusion should not be routinely used.  
• Avoid disconnecting the patient from the ventilator, which results in loss of PEEP and atelectasis. 
• Use in-line catheters for airway suctioning and clamp endotracheal tube when disconnection is required (for example, transfer to a transport ventilator).  

The following recommendations pertain to adult and paediatric patients with ARDS who are treated with non-invasive or high-flow oxygen systems.  

• High-flow nasal oxygen (HFNO) should be used only in selected patients with hypoxemic respiratory failure. Non-invasive ventilation (NIV) should be used only in selected patients with hypoxemic respiratory failure. Patients treated with either HFNO or NIV should be closely monitored for clinical deterioration.  

The following recommendations pertain to adult and paediatric patients with ARDS in whom lung protective ventilation strategy fails.  

• In settings with access to expertise in extracorporeal membrane oxygenation (ECMO), consider referral of patients who have refractory hypoxemia despite lung protective ventilation.  

Link: https://webcache.googleusercontent.com/search?q=cache:ozsyhpBq5D8J:https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf%3Fsfvrsn%3Dbc7da517_10%26download%3Dtrue+&cd=4&hl=en&ct=clnk&gl=th 

The virus that causes coronavirus disease 2019 (COVID-19) is stable for several hours to days in aerosols and on surfaces, according to a new study from National Institutes of Health, CDC, UCLA and Princeton University scientists in The New England Journal of Medicine.

Link: https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces

Resources can be found in the link below:

Link: https://www.theguardian.com/commentisfree/2020/mar/17/scientists-age-groups-covid-19-workplaces-shops-restaurants?CMP=Share_AndroidApp_Gmail

Checklist below for hospitals preparing for the reception and care of coronavirus 2019 (COVID-19) patients

https://www.ecdc.europa.eu/en/publications-data/checklist-hospitals-preparing-reception-and-care-coronavirus-2019-covid-19

Resources can be found here

Link: https://www.ecdc.europa.eu/en/publications-data/guidance-wearing-and-removing-personal-protective-equipment-healthcare-settings

Resource estimation for contact tracing, quarantine and monitoring activities for COVID-19 cases in the EU/EEA

https://www.ecdc.europa.eu/en/publications-data/resource-estimation-contact-tracing-quarantine-and-monitoring-activities-covid-19

Resource: Public health management of persons, including health care workers, having had contact with COVID-19 cases in the European Union:

https://www.ecdc.europa.eu/en/publications-data/public-health-management-persons-including-health-care-workers-having-had-contact

We can share the current data. According to WHO Global Statistics: 

• Nine new countries/territories/areas (African Region [7], European Region [1] and Region of Americas [1]) in have reported cases of COVID-19 in the past 24 hours. (Valid from March 16, 2020)
• A WHO high-level technical mission concluded a visit to Iraq to support the Iraqi Ministry of Health in their COVID-19 prevention and containment measures. WHO is working around the clock to establish 3 negative-pressure [contagious respiratory disease isolation] rooms in Baghdad, Erbil and Basra to accommodate patients who might require more sophisticated medical treatment

Link: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ 

According to WHO Africa:  

“As of 11 March 2020, a total of 47 confirmed COVID-19 cases, with no deaths, have been reported across nine countries in the region: Algeria (20), South Africa (13), Senegal (5), Nigeria (2), Cameroon (2), Burkina Faso (2), Cote d’Ivoire (1), Democratic Republic of the Congo (1), and Togo (1). Figures 1 and 2 show the temporal and geographical distribution of cases, respectively. In the rest of the African continent, a total of 66 confirmed COVID-19 cases were reported from three countries: Egypt (59), Tunisia (5), and Morocco (2)”  

Link: https://www.afro.who.int/health-topics/coronavirus-covid-19 

Another interesting source of information is Our World in Data which shows the location against how long it took for number of total confirmed cases to double.  

Link: https://ourworldindata.org/coronavirus 

According to the Health Protection Surveillance Centre: 

The guidance document for funeral directors has stated it “is possible that the act of moving a recently deceased individual might be sufficient to expel a very small amount of air and viral droplet from the lungs and thereby present a minor risk.  

After death, the human body does not generally create a serious health hazard for COVID-19 infection.  

In the interests of infection control, all staff should use Standard Precautions as a matter of course, treating all human remains as though potentially infected.”  

Link: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/funeraldirectorsguidance/ 

According to Wisconsin State Laboratory of Hygiene – test results will be available within 1-2 days of receipt of the specimen.  

Link: http://www.slh.wisc.edu/clinical/diseases/covid-19/ 

For initial diagnostic testing for COVID-19, CDC recommends collecting and testing upper respiratory tract specimens (nasopharyngeal swab). CDC also recommends testing lower respiratory tract specimens, if available.  

For patients who develop a productive cough, sputum should be collected and tested for COVID-19. The induction of sputum is not recommended. For patients for whom it is clinically indicated (e.g., those receiving invasive mechanical ventilation), a lower respiratory tract aspirate or bronchoalveolar lavage sample should be collected and tested as a lower respiratory tract specimen. Specimens should be collected as soon as possible once a PUI is identified, regardless of the time of symptom onset. 

Link: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fclinical-criteria.html 

2. In African countries:  South Africa, Senegal  

   In Asian countries: China, Hong Kong, Japan, Singapore, Thailand, India 

   In Middle Eastern countries: Unknown.  

   Link: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance 

Chan, K.H., et al 2011 published an article on the “Effects of Temperature and Relative Humidity on the Viability of the SARS Coronavirus” which studied the stability of the virus at different temperatures and relative humidity on smooth surfaces. “The dried virus on smooth surfaces retained its viability for over 5 days at temperatures of 22–25°C and relative humidity of 40–50%, that is, typical air-conditioned environments. However, virus viability was rapidly lost (>3 log10) at higher temperatures and higher relative humidity (e.g., 38°C, and relative humidity of >95%).”  

“The better stability of SARS coronavirus at low temperature and low humidity environment may facilitate its transmission in community in subtropical area (such as Hong Kong) during the spring and in air-conditioned environments. It may also explain why some Asian countries in tropical area (such as Malaysia, Indonesia or Thailand) with high temperature and high relative humidity environment did not have major community outbreaks of SARS.”  

Link: https://www.hindawi.com/journals/av/2011/734690/