Coronaviruses are an extremely common cause of colds and other upper respiratory infections.
COVID-19, short for “coronavirus disease 2019,” is the official name given by the World Health Organization to the disease caused by this newly identified coronavirus.
Human coronaviruses are common throughout the world. The name corona refers to a crown because these viruses have crown-like spikes on their surface when viewed under an electron microscope. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans. Some coronaviruses such as 229E, NL63, OC43 and HKU1 are common causes of illness, including respiratory illness, in humans throughout the world. Sometimes coronaviruses infecting animals can evolve to cause disease in humans and become a new (novel) coronavirus for humans. Examples of this are the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), first reported from Saudi Arabia in 2012, and the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), first recognized in China in 2002. On 7 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the causative agent of coronavirus disease 2019 (COVID-19).
The numbers are changing rapidly.
The most up-to-date information is available from the World Health Organization, the US Centers for Disease Control and Prevention (CDC), and Johns Hopkins University.
It has spread so rapidly and to so many countries that the World Health Organization has declared it a pandemic (a term indicating that it has affected a large population, region, country, or continent).
Currently, patients are being suspected of having coronavirus if they fulfil the following criteria and contact their health care provider who will then decide if testing is necessary. The criteria are found at http://www.nicd.ac.za/diseases-a-z-index/covid-19/,
Currently this includes:
Persons with acute respiratory illness with sudden onset of at least one of the following: cough, sore throat, shortness of breath or fever [≥ 38°C (measured) or history of fever (subjective)] irrespective of admission status AND
In the 14 days prior to onset of symptoms, met at least one of the following epidemiological criteria:
- Were in close contact 1) with a confirmed 2) or probable 3) case of SARS-CoV-2 infection;
- History of travel to areas with presumed ongoing community transmission of SARS-CoV-2
- Worked in, or attended a health care facility where patients with SARS-CoV-2 infections were being treated
- Admitted with severe pneumonia of unknown aetiology.
Please watch for updates as this might change.
NASO/OROPHARYNGEAL SWABS and respiratory samples are used to identify the corona virus. Full details of specimens and how to collect and transport are found at http://www.nicd.ac.za/wp-content/uploads/2020/03/COVID-19-Quick-reference-v7-10.03.2020-Final-clean.pdf
These are currently being processed at the national Institute for Communicable diseases
Not too much is known about this presently and as more research is done on the cases, more information will become available. The main spread of the virus is thought to be droplet spread via coughing and sneezing secretions, but it has been established that the virus can be present in faecal material and hence oro-faecal spread is possible. Standard precaution must always be followed when working with specimens, together with good hand hygiene. Any other specific control sin the workplace need to be based on specific risks at the particular laboratory.
If a health care worker suspects a possible COVID 19 infection, the health care worker should discuss the case with the doctor on call at the National Institute for Communicable diseases before collecting sample at NICD hotline – 0828839920|0665624021 and further information will be given to the health care worker on specimen collection and transport if warranted.
Employees at laboratory setting are encouraged to follow the same standard infection prevention precautions as they usually do when working with infectious material and this should be based on the risk assessment done in their workplace.
You’re right to be concerned about the flu. Fortunately, the same measures that help prevent the spread of the COVID-19 virus — frequent and thorough handwashing, not touching your face, coughing and sneezing into a tissue or your elbow, avoiding people who are sick, and staying away from people if you’re sick — also help to protect against spread of the flu.
In addition, most people older than six months can and should get the flu vaccine to help prevent the flu. However, the flu vaccine will not protect you against this coronavirus.
If you do get sick with the flu, your doctor can prescribe an antiviral drug that can reduce the severity of your illness and shorten its duration. There are currently no antiviral drugs available to treat COVID-19.
An antiviral drug must be able to target the specific part of a virus’s life cycle that is necessary for it to reproduce. In addition, an antiviral drug must be able to kill a virus without killing the human cell it occupies. And viruses are highly adaptive. Because they reproduce so rapidly, they have plenty of opportunity to mutate (change their genetic information) with each new generation, developing resistance to whatever drugs or vaccines we develop.
Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with cough, sore throat, shortness of breath or fever [≥ 38°C (measured) or history of fever (subjective). Reported illnesses have ranged from infected people with little to no symptoms to people being severely ill and dying.
Because this coronavirus has just been discovered, the time from exposure to symptom onset (known as the incubation period) for most people has yet to be determined. Based on current information, symptoms could appear as soon as two days after exposure to as long as 14 days later.
The coronavirus is thought to spread mainly from person to person. This can happen between people who are in close contact with one another. Droplets that are produced when an infected person coughs or sneezes may land in the mouths or noses of people who are nearby, or possibly be inhaled into their lungs.
Coronavirus can also spread from contact with contaminated surfaces or objects. For example, a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.
People are thought to be most contagious when they are most symptomatic. However, there have been reports of coronavirus spreading before people show symptoms. Preliminary research of individuals who developed mild disease also suggests that they could be contagious early in the course of their illness, even before they have experienced symptoms or are only experiencing mild symptoms.
The answer depends on whether you’re looking at the fatality rate (the risk of death among those who are infected) or the total number of deaths. So far, influenza has caused far more deaths this flu season, both in the US and worldwide, than COVID-19. This is why you may have heard it said that the flu is a bigger threat.
Regarding the fatality rate, it appears that the risk of death after coronavirus infection (estimated at 3% to 4%) is less than it was for SARS (11%) and MERS (35%), but may be higher than the risk from seasonal flu (0.1%). However, the numbers circulating right now for this new coronavirus are likely to be adjusted over time as more people are tested and reporting becomes more consistent. For example, testing has been limited at the start of the outbreak, which could result in fewer identified cases, making it seem as though a larger percentage of infections are fatal.
Older people, and those with underlying medical problems like chronic bronchitis, emphysema, heart failure, immunocompromised or diabetes, are more likely to develop serious illness.
As of 16 March, 2020, face masks are not recommended for the general public or workers that are not directly exposed.
If you have respiratory symptoms like coughing or sneezing, experts recommend wearing a mask to protect others. This may help contain droplets containing any type of virus, including the flu, and protect anyone within three to six feet of the infected person.
The CDC offers more information about masks. The WHO offers videos and illustrations on when and how to use a mask.
No vaccine is available, although scientists will be starting human testing on a vaccine very soon. However, it may be a year or more before we even know if we have a vaccine that works.
While we don’t know the answer yet, most people would likely develop at least short-term immunity to the specific coronavirus that causes COVID-19. However, you would still be susceptible to a different Coronavirus infection. Or, this particular virus could mutate, just like the influenza virus does each year. Often these mutations change the virus enough to make you susceptible, because your immune system thinks it is an infection that it has never seen before.
Evidence in peer-reviewed literature does not support the use of thermal scanning as an efficient measure for detecting fever in travellers or individuals requiring access to workplaces (1-4).
Studies have shown that many travellers that have passed the temperature- based screening had subsequently tested positive for COVID-19 using the reverse transcription polymerase chain reaction (RT-PCR) (5-7). A study by Quilty et al., (2020) demonstrated that approximately 46% of travellers would not be detected by airport thermal scanners (8).
The reasons for this include:
- The individual may not have symptoms as yet i.e. they are still in the incubation period.
- The individual may be on antipyretic medication to suppress a fever.
- It may yield a false positive result (fever due to another cause).
The accuracy of the thermal scanner is variable and requires close up face imaging (<50cm) which leads to an unnecessary risk for droplet spread of COVID-19.
The NIOH recommends that a broader strategy be used to identify possible COVID -19 cases. This includes a brief screening questionnaire assessing the risk of exposure either from travel within the last 14 days or a close contact with a positive COVID-19 patient and a symptom checklist.
A screening questionnaire can be found at http://www.nioh.ac.za/wp-content/uploads/2020/03/self-declaration-questionnaire.pdf
A specific job risk assessment needs to be conducted to determine which PPE are required.
Surgical masks are not tight fitting respirators. Therefore, if the concern is exposure to COVID-19, then a tight fitting respirator such as FFP2 or N95 should be considered since the use of the surgical mask may allow droplets to n enter through the sides, top and bottom of the mask.
Due to the shortage of stock, unnecessary use of PPE should be discouraged. In general, masks should only be usedor if you have symptoms such as sneezing or coughing. You need to know how to use it and dispose of it properly.
Gloves require frequent changing. Thus every time one touches a potential contaminated surface, their nose, mouth and eyes, the gloves need to be changed. If not changed, this may result in cross contamination. This is not feasible with the current stock shortages.
There is currently a worldwide shortage of N95 respirators, thus they need to be supplied to workers that are at high risk of exposure such as health workers in contact with COVID-19. Workers who are required to wear respirators should be to be fit tested to confirm fit prior to use.
PPE includes gloves, surgical masks, goggles or face shield, gowns, aprons and in specific circumstances respirators such as N95 or FFP2 standard or equivalent.
But it must be emphasised that the use of PPE should be minimised.
The decision for employees to wear PPE should be based on the outcome of the risk assessment. These employees should include those are likely to be exposed to suspected cases, symptomatic and those likely to perform aerosol generating procedures.
These workers include:
- Airline operations (e.g. airline cabin crew, aircraft cleaners, mechanics)
- Boarder control (e.g. security officials, and other boarder officials)
- Health care (e.g. paramedics, nurses, doctors, other medical staff)
- Laboratories (e.g. medical technologists, scientists, laboratory aids and researchers)
- Pathology and funeral services (e.g. mortuary attendants, autopsy technicians and funeral directors)
- Solid waste and wastewater management (e.g. waste pickers, water treatment plant
In addition, if a person/ worker is symptomatic they need to wear a surgical mask to prevent transmission.
For more information on use of PPE please see https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf
Employers should consider applying the hierarchy of controls in terms of implementing the controls prior to using the of PPE. Appropriate use of PPE involves proper selection and training and information on how to put on, remove and dispose of it.
As of 16 March, 2020, face masks are not recommended for the general public or workers that are not directly exposed.
If you have respiratory symptoms like coughing or sneezing, experts recommend wearing a surgical mask to protect others. This may help contain droplets containing any type of virus, including the flu, and protect anyone within three to six feet of the infected person.