Resources for COVID19

The Office Bearers of PBSA appreciate the efforts and resilience of all healthcare workers, doctors, nurses, paramedic staff, lab technologists and medical technologists who are striving in finding a cure for COVID19. Reference material that will be useful for all and will also help in ensuring better preparation has been uploaded. Among these, we have included the Bioprism manual – the training manual used by the organization during biosafety and biosecurity trainings. This manual has been made available to all, so that they may better protect themselves during these troubled times.

On behalf of National Institute of Health (NIH) we are also uploading the National Guidelines Infection Prevention and Control 2020. These are so that all members are working in coordination with the national standard, and all can create response systems using these same established formats.

PBSA Bioprism Manual (English)

PBSA Bioprism Manual (URDU)

National Guidelines Infection Prevention and Control 2020

We will continually update this section with new information as and when it arrives. Keep returning to this section to see more updates.


Frequently Asked Questions about SARS-CoV-2 and COVID-19

Questions about PPE and prevention methods:

Masks 

Q: Should healthy people wear masks?

A: The source indicates the face mask use recommendations by different health authorities.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118603/#box1

Q: Can homemade or cloth masks offer protection from SARS-CoV2 and could cloth masks be a substitute for surgical masks?

A: CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain. The general public can use cloth masks to protect those around them. The cloth face coverings recommended are not surgical masks or N-95 respirators.  Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

Q: For how long can a normal surgical mask or N95 mask be worn?

A: The normal suggested time for wearing an N95 mask is 8 hours, however in a relatively clean atmosphere this can usually be extended. You can also consider wearing an “over mask” to extend the longevity of N95 masks. Please see pages 6-7 of Dr. Philippe Stroot’s document. http://www.xibios.eu/20200408_COVID-19_Masks_Options.pdf

Q: Can N95 masks be sterilized and reused?

A: For N95, details pertaining to reuse are still being researched. CDC has some information to consider.

If N95 and surgical masks are to be reused take the following into consideration: 70C /158F heating in an oven (not your home oven) for 30min, or hot water vapor from boiling water for 10 min, are additional effective decontamination methods. Dr. Philippe Stroot has put together a comprehensive guidance document about the reuse of N95 masks given shortages of PPE which can be found here:

https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

https://stanfordmedicine.app.box.com/v/covid19-PPE-1-1

http://www.xibios.eu/20200408_COVID-19_Masks_Options.pdf

A recent study conducted at the US National Institutes of Health also provides some guidance.

The study investigators are with NIH’s Rocky Mountain Laboratories (RML) in Hamilton, Montana, part of the National Institute of Allergy and Infectious Diseases (NIAID). With collaborators from the University of California, Los Angeles, they tested the decontamination of small sections of N95 filter fabric that had been exposed to SARS-CoV-2, the virus that causes COVID-19.  Decontamination methods tested included vaporized hydrogen peroxide (VHP), 70-degree Celsius dry heat, ultraviolet light, and 70% ethanol spray. All four methods eliminated detectable viable virus from the N95 fabric test samples. The investigators then treated fully intact, clean respirators with the same decontamination methods to test their reuse durability. Volunteer RML employees wore the masks for two hours to determine if they maintained a proper fit and seal over the face; decontamination was repeated three times with each mask using the same procedure. The scientists found that ethanol spray damaged the integrity of the respirator’s fit and seal after two decontamination sessions and therefore do not recommend it for decontaminating N95 respirators.  UV and heat-treated respirators began showing fit and seal problems after three decontaminations-suggesting these respirators potentially could be re-used twice. The VHP-treated masks experienced no failures, suggesting they potentially could be re-used three times. The authors concluded that VHP was the most effective decontamination method, because no virus could be detected after only a 10-minute treatment. UV and dry heat were acceptable decontamination procedures as long as the methods are applied for at least 60 minutes. The authors urge anyone decontaminating an N95 respirator to check the fit and seal over the face before each re-use.

https://www.medrxiv.org/content/10.1101/2020.04.11.20062018v1

Q: Do regular surgical masks offer protection from COVID-19?

A: In laboratory experiments, the masks significantly reduced the amounts of various airborne viruses coming from infected patients University of Maryland. “Wearing surgical masks in public could help slow COVID-19 pandemic’s advance: Masks may limit the spread of diseases including influenza, rhinoviruses and coronaviruses.” ScienceDaily, 3 April 2020. <www.sciencedaily.com/releases/2020/04/200403132345.htm>.

Q: What are the alternatives to N95 masks?

A: For healthcare professionals, the alternatives are provided here.

http://www.xibios.eu/20200408_COVID-19_Masks_Options.pdf

https://multimedia.3m.com/mws/media/1791500O/comparison-ffp2-kn95-n95-filtering-facepiece-respirator-classes-tb.pdf

Q: Can an N95 mask be used without a Fit Test?

A: No. It will become a risk and portal of entry for the wearer. Always do fit test with N95 to ensure complete protection. This Link explains N95 fit test

https://www.youtube.com/watch?v=05wyH1-mLGk&feature=youtu.be

https://blogs.cdc.gov/niosh-science-blog/2020/03/16/n95-preparedness/

Q: Is it important to cover facial hair if one is close to a COVID-19 positive case?

A: Having a moustache or beard can affect the seal of the face filtering respirators

https://www.cdc.gov/niosh/npptl/pdfs/FacialHairWmask11282017-508.pdf

Q: What are minimum material requirements for PPE, especially coveralls for red zones for HCWs?

A: Nonsterile, disposable patient isolation gowns, which are used for routine patient care in healthcare settings, are appropriate for use by patients with suspected or confirmed COVID-19. While the transmissibility of COVID-19 is not fully understood, gowns are available that protect against microorganisms. The choice of gown should be made based on the level of risk of contamination. Certain areas of surgical and isolation gowns are defined as “critical zones” where direct contact with blood, body fluids, and/or other potentially infectious materials is most likely to occur. If there is a medium to high risk of contamination and need for a large critical zone, isolation gowns that claim moderate to high barrier protection can be used. For healthcare activities with low, medium, or high risk of contamination, surgical gowns (ANSI/AAMI PB70 Levels 1-4pdf icon) can be used. These gowns are intended to be worn by healthcare personnel during surgical procedures. If the risk of bodily fluid exposure is low or minimal, gowns that claim minimal or low levels of barrier protection can be used. These gowns should not be worn during surgical or invasive procedures, or for medium to high risk contamination patient care activities.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

Healthcare workers performing aerosol-generating procedures such as swabbing should wear the suggested PPE set for droplet, contact and airborne              transmission (gloves, goggles, gown and N95 or European equivalent FFP2/FFP3 respirator) If there is a            shortage of FFP2/FFP3 respirators, healthcare workers performing procedures in direct contact with a suspected or confirmed case (but not at risk for generating aerosol) can consider wearing a mask with the highest available filter level, such as a surgical mask, in addition to gloves, goggles and gown. If there is an insufficient stock of respirators, then staff engaged in environmental cleaning and waste management                 should wear a surgical mask, in addition to gloves, goggles and gown.

https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pd

https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-infection-prevention-and-control-healthcare-settings-march-2020.pdf

https://www.who.int/csr/bioriskreduction/infection_control/publication/en/.

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

Q: Is it necessary for the material used for PPE made locally to be certified and tested?

A: CDC’s guidance for Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids outlines the scientific evidence and information on national and international standards, test methods, and specifications for fluid-resistant and impermeable gowns and coveralls used in healthcare. Many organizations have published guidelines for the use of personal protective equipment (PPE) in medical settings. The American National Standards Institute (ANSI) and the Association of the Advancement of Medical Instrumentation (AAMI) describes the liquid barrier performance and a classification of surgical and isolation gowns for use in health care facilities. As with any type of PPE, the key to proper selection and use of protective clothing is to understand the hazards and the risk of exposure. Some of the factors important to assessing the risk of exposure in health facilities include source, modes of transmission, pressures and types of contact, and duration and type of tasks to be performed by the user of the PPE. (Technical Information Report (TIR) [AAMI 2005]).

For gowns, it is important to have sufficient overlap of the fabric so that it wraps around the       body to cover the back (ensuring that if the wearer squats or sits down, the gown still protects      the back area of the body).

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

https://www.cdc.gov/niosh/npptl/topics/protectiveclothing/

PPE made locally or internationally must meet certain criteria to provide enough protection against the biological agent we are working with. Testing and certification bodies check for those criteria against the product. So, it is definitely necessary for the organizations to meet those criteria and get their products certified.

Q: How does one properly dispose of COVID-19 used PPE?

A: Handle laboratory waste from testing suspected or confirmed COVID-19 patient specimens as all other biohazardous waste in the laboratory. Currently, there is no evidence to suggest that this laboratory waste needs additional packaging or disinfection procedures.

https://www.cdc.gov/coronavirus/2019-ncov/lab/biosafety-faqs.html

Medical waste (trash) coming from healthcare facilities treating COVID-2019 patients is no different than waste coming from facilities without COVID-19 patients. CDC’s guidance states that management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures. There is no evidence to suggest that facility waste needs any additional disinfection.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html

PPE materials such as gowns, gloves and masks that are considered soiled by hospital policy would be thrown into a biohazard trash bag and disposed of as infectious medical waste

https://www.wpr.org/what-happens-used-personal-protective-equipment.

https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html#lab-waste

https://www.who.int/csr/resources/publications/biosafety/Biosafety7.pdf?ua=1

 

Hand Hygiene 

Q: Is it necessary for the general public to wear gloves? Is it necessary to wear hand gloves when we go to malls or is hand sanitizer enough?

A: The CDC only recommends wearing gloves if you are caring for someone who is sick or cleaning your home. In general, wearing gloves in public will not protect you from SARS-CoV-2 because gloves can easily become contaminated and create a false sense of security. Gloves are not a substitute for hand hygiene and sanitizers; , handwashing with soap is the best practice.

https://www.health.com/condition/infectious-diseases/coronavirus/should-you-wear-gloves-to-the-grocery-store

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

https://www.cdc.gov/handhygiene/providers/index.html

Q: Which is more effective, hand sanitizer or soap?

  1. CDC recommends washing hands with soap and water whenever possible because hand washing reduces the amounts of all types of germs and chemicals on hands. But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help you avoid getting sick and spreading germs to others. The guidance for effective hand washing and use of hand sanitizer in community settings was developed based on data from a number of studies. Hand sanitizers may not be as effective when hands are visibly dirty or greasy.

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html

Disinfection:

Q: Is Dettol an effective disinfectant against any viruses?

A: Specific Dettol products have demonstrated effectiveness (>99.9% inactivation) against coronaviruses, given the structural similarities of the COVID-19 virus to the coronavirus strains tested previously (SARS-CoV, MERS-CoV, Human Coronavirus), and based on the evidence, it is expected that Dettol would be effective against SARS-CoV-2.

https://www.dettol.co.uk/about-us/understanding-coronavirus/

Q: What are ways to disinfect cell phones and other electronics?

A: Consider the use of alcohol-based wipes or sprays containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html

Q: Which sanitizer is used in walk through gates?

A: Chlorine based disinfectants

Q: Will the sanitizing walk through gates help control the spread of coronavirus infection?

A: No. Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body. Spraying such substances can be harmful to clothes and mucous membranes (i.e., eyes, mouth). The use of these tunnels may give a false sense of security and may have adverse health effects as sodium hypochlorite have many harmful effects on the human body

https://www.who.int

Q: Can we use a chlorine-based spraying gate at entrance of some essential factories, grocery store and Hospital?

A: Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body. Spraying such substances can be harmful to clothes and mucous membranes (i.e. eyes, mouth). Be aware that both alcohol and chlorine can be useful to disinfect surfaces, but they need to be used under appropriate recommendations.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

Q: Is it recommended to clean the parcels with any disinfectant?

A: There is still a lot that is unknown about COVID-19 and how it spreads. This coronavirus is thought to be spread most often by respiratory droplets. Although the virus can survive for a short period on some surfaces, it is unlikely to be spread from products or packaging that are shipped over a period of days or weeks at ambient temperatures. Currently there is no evidence to support transmission of COVID-19 associated with imported goods and there have not been any cases of COVID-19 in the United States associated with imported goods. Information will be provided on the Coronavirus Disease 2019 (COVID-19) website as it becomes available.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How-COVID-19-Spreads

There is no evidence of human or animal food or food packaging being associated with transmission of the coronavirus that causes COVID-19.

https://www.fda.gov/news-events/fda-voices/fda-offers-assurance-about-food-safety-and-supply-people-and-animals-during-covid-19

Q: What can we use at home for disinfectant if hand sanitizer is not available?

A: Use Soap.

https://www.who.int/publications-detail/water-sanitation-hygiene-and-waste-management-for-covid-19 and https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html 

Q: What is the proper purge timing of hand sanitizers? How many seconds are needed to destroy the microorganism on skin?

  1. A. Twenty seconds at least. Make sure that your fingernails are cleaned as that is a portal for entry. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

https://www.who.int/gpsc/5may/Hand_Hygiene_When_and_How_Leaflet.pdf?ua=1

Q: How long does the virus survive on fruit and vegetables?

A: Coronaviruses are generally thought to be spread from person to person through respiratory droplets. Currently, there is no evidence to support transmission of COVID-19 associated with food. Before preparing or eating food it is important to always wash your hands with soap and water for at least 20 seconds for general food safety. Throughout the day use a tissue to cover your coughing or sneezing, and wash your hands after blowing your nose, coughing or sneezing, or going to the bathroom.

It may be possible that a person can get COVID-19 by touching a surface or object, like a packaging container, that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from food products or packaging.

Based on information about this novel coronavirus thus far, it seems unlikely that COVID-19 can be transmitted through food – additional investigation is needed.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How-COVID-19-Spreads

Corona virus does not seem to spread through exposure to food. Still, it’s a good idea to wash fruits and vegetables under running water before you eat them. Perform hand hygiene after visiting supermarket and before entering your home.

https://www.webmd.com/lung/how-long-covid-19-lives-on-surfaces

Questions about transmission dynamics:

Q: What is the chance of humans passing this on to animals or birds? Can SARS-CoV2 be transmitted from pets or wild animals to patients?

A: Coronaviruses are a large family of viruses that are common in animals. Occasionally, people get infected with these viruses which may then spread to other people. For example, SARS-CoV was associated with civet cats and MERS-CoV is transmitted by dromedary camels. Possible animal sources of COVID-19 have not yet been confirmed.  To protect yourself, such as when visiting live animal markets, avoid direct contact with animals and surfaces in contact with animals. Ensure good food safety practices at all times. Handle raw meat, milk or animal organs with care to avoid contamination of uncooked foods and avoid consuming raw or undercooked animal products. WHO is aware of instances of animals and pets of COVID-19 patients being infected with the diseaseAs the intergovernmental body responsible for improving animal health worldwide, the World Organization for Animal Health (OIE) has been developing technical guidance on specialized topics related to animal health, dedicated to veterinary services and technical experts (including on testing and quarantine);There is a possibility for some animals to become infected through close contact with infected humans. Further evidence is needed to understand if animals and pets can spread the disease; Based on current evidence, human to human transmission remains the main driver; It is still too early to say whether cats could be the intermediate host in the transmission of the COVID-19.

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

Q: If a person is infected (both symptomatically or asymptomatically) and they smoke a cigarette, is it possible to pass it to people nearby through secondhand smoke?

A: Coronavirus is thought to mainly spread through person-to-person contact when an infected person coughs, sneezes or speaks, producing respiratory droplets which land in the mouths or noses of those nearby. While we were unable to find information directly on the topic of smoking, it is likely that these respiratory droplets are also produced when an infected person exhales smoke. Therefore, coronavirus could be passed by smokers not through secondhand smoke but through respiratory droplets.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Coronavirus-Disease-2019-Basics

Q: What are the chances of vertical transmission (mother to child)?

A: We still do not know if a pregnant woman with COVID-19 can pass the virus to her foetus or baby during pregnancy or delivery. To date, the virus has not been found in samples of amniotic fluid or breast milk. Mother-to-child transmission of coronavirus during pregnancy is unlikely, but after birth a newborn is susceptible to person-to-person spread.

 https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-pregnancy-childbirth-and-breastfeeding

https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30191-2/fulltext

Q: Is it right to keep a large number of beds in one big hall designated as a Quarantine center?

A: Page 4 of the document found at this link gives recommended guidelines for quarantine centers. Rooms should be well ventilated and each bed should be separated by  1-2 meters on all sides. https://ncdc.gov.in/WriteReadData/l892s/90542653311584546120.pdf

Q: Do severe/critical case patients pose more risks than patients with milder symptoms in Isolation ward with > 1 patient? Is it safe for a suspected person, coming for testing, to wait in open air with proper distancing?

A: Critically ill patients in ICU if on Ventilatory support or on suction are also generating aerosols. HCW needs to handle them more often thus critical patients can transmit the disease more easily than healthy patients in isolation wards. Secondly, Yes, it is safe to keep testing patients in open rather than in room. Reason is simply dilution of viruses in air and less chance of transmission. Indus Hospital is doing the same. Solution for Pollution is dilution.

Q: Is it possible to aerosolize the virus by flushing a toilet and transmitting it that way?

A: The virus that causes COVID-19 has been detected in the feces of some patients diagnosed with COVID-19. The amount of virus released from the body (shed) in stool, how long the virus is shed, and whether the virus in stool is infectious is not known. The risk of transmission of the virus that causes COVID-19 from the feces of an infected person is also unknown. However, the risk is expected to be low based on data from previous outbreaks of related coronaviruses, such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). There has been no confirmed fecal-oral transmission of COVID-19 to date. CDC is reviewing all data on COVID-19 transmission as information becomes available. At this time, the risk of transmission of the virus that causes COVID-19 through sewerage systems is thought to be low. Although transmission of the virus that causes COVID-19 through sewage may be possible, there is no evidence to date that this has occurred.  The World Health Organization has indicated that “there is no evidence to date that COVID-19 virus has been transmitted via sewerage systems, with or without wastewater treatment.”

https://www.cdc.gov/coronavirus/2019-ncov/php/water.html

https://www.epa.gov/coronavirus/can-i-get-covid-19-wastewater-or-sewage

There have been no reports of fecal−oral transmission of the COVID-19 virus.

file:///C:/Users/USER/Downloads/WHO-2019-nCoV-IPC_WASH-2020.2-eng.pdf

Q: Do food animals (*presumably animals used for food) have receptors for this virus like feline and canine families do?

A: We don’t know for sure which animals can be infected with the virus that causes COVID-19. CDC is aware of a very small number of pets, including dogs and cats, outside the United States reported to be infected with the virus that causes COVID-19 after close contact with people with COVID-19. A tiger at a zoo in New York has also tested positive for the virus.

Recent research shows that ferrets, cats, and golden Syrian hamsters can be experimentally infected with the virus and can spread the infection to other animals of the same species in laboratory settings. Pigs, chickens, and ducks did not become infected or spread the infection based on results from these studies. Data from one study suggested dogs are not as likely to become infected with the virus as cats and ferrets. These findings were based on data from a small number of animals, and do not indicate whether animals can spread infection to people.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Symptoms-&-Testing

There is no evidence for any such transfer from companion animals and animal products.

https://www.oie.int/scientific-expertise/specific-information-and-recommendations/questions-and-answers-on-2019novel-coronavirus/

Q: Is SARS-COV 2 an airborne disease?

A:  COVID-19 is mainly transmitted through droplets generated when an infected person coughs, sneezes, or speaks. These droplets are too heavy to hang in the air. They quickly fall on floors or surfaces. Airborne precautions must be taken in settings where aerosol generating procedures and support treatment are being performed

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

Q: What are aerosol producing procedures in labs and in hospitals?

A: The procedures or support treatments that generate aerosols include; i.e., endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation.

https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

Q: Is there any evidence of transmission of COVID-19 through blood transfusion?

A: According to Canadian Blood Services, “viruses rely on ‘binding sites’ on their host cells, proteins which allow them to attach and invade the host immune system. The binding sites for COVID-19 are located in the lungs and the intestines. “There is no evidence this new coronavirus targets blood cells, or even uses plasma to move around and invade other organs,”

http://www.rfi.fr/en/science-and-technology/20200413-can-covid-19-be-transferred-through-blood-donations

There’s no evidence the respiratory virus can be transmitted by blood. COVID-19 is primarily a respiratory virus, with potential to infect the digestive system as well. People can get infected when they inhale or ingest the virus, but not via a blood transfusion.(Canadian Blood Services) According to the US Food and Drug Administration, “respiratory viruses are not known to be transmitted by blood transfusion, and there have been no reported cases of transfusion-transmitted coronavirus.”

https://blood.ca/en/stories/why-you-wont-get-covid-19-from-a-blood-transfusion

Q: Can flies and other insects transfer COVID from secretions / excretions of patients to healthy persons?

A: At this time, CDC has no data to suggest that this new coronavirus or other similar coronaviruses are spread by mosquitoes or ticks. The main way that COVID-19 spreads is from person to person. See How Coronavirus Spreads for more information.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How-COVID-19-Spreads

To date there has been no information nor evidence to suggest that the new coronavirus could be transmitted by mosquitoes.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

Questions about the virus: 

 Q: Is it possible the virus was designed artificially through synthetic biology?  Why did it come so suddenly? Wouldn’t we expect a longer duration of reported cases rather than so many clusters of cases in a short period of time? Can this be the case with a slowly evolving virus?

  1. No. Evidence suggest that the virus is a naturally evolved disease-causing agent. It was not developed through synthetic biology. It was first identified in Wuhan, China as a result of an animal-to-human transfer.

https://www.nature.com/articles/s41564-020-0695-z. As far as pandemic aspects of COVID19 are concerned, we refer to the following article.

https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1733440#aHR0cHM6Ly93d3cudGFuZGZvbmxpbmUuY29tL2RvaS9wZGYvMTAuMTA4MC8yMjIyMTc1MS4yMDIwLjE3MzM0NDA/bmVlZEFjY2Vzcz10cnVlQEBAMA==

Q: Does temperature affect COVID19?

A: Generally, coronaviruses survive for shorter periods at higher temperatures and humidity than in cooler or drier environments. However, we don’t have direct data for this virus, nor do we have direct data for a temperature-based cutoff for inactivation at this point. The necessary temperature would also be based on the materials of the surface, the environment, etc. Regardless of temperature please follow CDC’s guidance for cleaning and disinfection.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How-COVID-19-Spreads

Outside body: If virus is outside the body and is on any surface, researchers have demonstrated that it deactivates earlier at higher temperatures. Inside Body: Our body follow a homeostasis mechanism and slight rise in temperature (as in fever) will not have effect of killing the virus.

The COVID-19 virus can be transmitted in ALL AREAS, including areas with hot and humid weather and in areas with cold weather. The normal human body temperature remains around 36.5°C to 37°C, regardless of the external temperature or weather.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

Questions about treatment: 

Q: Do you suggest the use of hyperimmune serum to treat COVID-19 patients?

A: It is too early to suggest these treatments. Many types of treatments and vaccines are under trial and we have to wait until we get scientific evidence.

Several studies are in process of using hyperimmune serum of recovered patients for treatment of confirmed patients.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-encourages-recovered-patients-donate-plasma-development-blood

Q: Could drinking hot water would be helpful to denature SARS-CoV2 proteins which is present in a patient’s body?

A: There is no scientific evidence to this theory till now. Once the virus is inside the body of a human, drinking hot water will not kill the virus.

https://www.jhsph.edu/covid-19/articles/coronavirus-facts-vs-myths.html

https://www.forbes.com/sites/ericmack/2020/03/23/a-hot-bath-wont-protect-against-coronavirus-and-other-myths-busted-by-the-who/#69c3c8b57194

Q: Are antimalarial, anti-influenza, and drugs against HIV drugs effective in treating patients with COVID-19?

A: Some drugs have shown an in vitro effect to treat the COVID-19, but any drug has to pass human trials before it gets approved. Likewise, some drugs were found effective against COVID-19 but required a dose which was toxic to human cells. Therefore, It is too early to say if these are effective to treat COVID-19 inside a human body. We have to wait until clinical trials show evidence of their effectiveness.

Studies are being carried out but no confirmed treatment is finalized by WHO yet. WHO has launched the mega trial of four drugs as well.

https://www.sciencemag.org/news/2020/03/who-launches-global-megatrial-four-most-promising-coronavirus-treatments

https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-hiv-and-antiretrovirals

https://www.thelancet.com/pb-assets/Lancet/pdfs/coronavirus/S0140673620303172.pdf

Q: Can you use one ventilator to support multiple patients at the same time to meet the disaster surge? Is it safe?

A: No, it should not be used, but several studies are under process.  The US Public Health Department suggests occasional use of a single ventilator (If all other alternatives are exhausted, care providers could consider ventilation of two patients on a single ventilator for short-term use, although there are significant limitations to this strategy. Alternatively, manual bag-valve-mask ventilation done by ancillary providers can be considered as a bridging option to mechanical ventilation)

https://www.hhs.gov/sites/default/files/optimizing-ventilator-use-during-covid19-pandemic.pdf

https://www.ncbi.nlm.nih.gov/pubmed/16885402

Questions from researchers

Q: What precautions are important if serum separation of Positive COVID blood sample is done in BSL 2 level labs?

A: Unless a country decides otherwise, taking into account the newly acquired knowledge and effective preventive measures described above, viral isolation on clinical specimens from patients who are suspected or confirmed to be infected with novel corona virus               should be performed only in laboratories capable of meeting the following additional essential (minimal) containment requirements: • A controlled ventilation system which maintains directional airflow into the laboratory room.

  • Exhaust air from the laboratory room is not recirculated to other areas within the building. Air should be HEPA filtered, if reconditioned and recirculated within the laboratory. When exhaust air from the laboratory is discharged to the outdoors, it must be dispersed away from occupied buildings and air intakes. This air may be discharged through HEPA filters.
  • All manipulations of infectious or potentially infectious materials must be performed in appropriately maintained and validated Biological Safety Cabinet (BSC)
  • Access to the laboratory is restricted when work is in progress.
  • Practices recommended for containment laboratories — Biosafety Level 3 in the WHO Laboratory biosafety manual, 3rd edition, are rigorously followed.
  • Laboratory workers should wear protective equipment, including disposable gloves, solid front or wrap-around gowns, scrub suits, or coveralls with sleeves that fully cover the forearms, head coverings, shoe covers or dedicated shoes, eye protection (goggles or face shield), and respiratory protection (fit-tested particulate respirator, e.g. EU FFP2, US 6 NIOSH-certified N95 or equivalent, or higher protection), because of the risk of aerosol or droplet exposure.
  • A dedicated hand-wash sink should be available in the laboratory.
  • Centrifugation of specimens should be performed using sealed centrifuge rotors or sample cups. These rotors or cups should be loaded and unloaded in a BSC.
  • All materials transported within and between laboratories should be placed in a secondary container to minimize the potential for breakage or a spill. An example includes transfer of materials from the biological safety cabinet to an incubator and vice versa. Specimens leaving the BSC should be surface decontaminated.

https://www.who.int/csr/disease/ coronavirus_infections / Biosafety_Interim Recommendations  Novel Coronavirus_19Feb13.pdf

Q: Is it possible to transmit the virus through aerosols while processing biological fluids (blood, serum or urine) in lab?

A: There are still many things unknown about transmission of the virus. For procedures with a high likelihood to generate aerosols or droplets, use either a certified Class II Biological Safety Cabinet (BSC) or additional precautions to provide a barrier between the specimen and personnel. Examples of these additional precautions include personal protective equipment (PPE), such as a surgical mask or face shield, or other physical barriers, like a splash shield; centrifuge safety cups; and sealed centrifuge rotors to reduce the risk of exposure to laboratory personnel.

Site- and activity-specific biosafety risk assessments should be performed to determine if additional biosafety precautions are warranted based on situational needs, such as high testing volumes, and the likelihood to generate infectious droplets and aerosols.

https://www.cdc.gov/coronavirus/2019-nCoV/lab/lab-biosafety-guidelines.html#procedures

Q: What would you recommend as the minimum requirements of lab design, infrastructure and equipment to start molecular testing of Covid19 testing in a Lab?

A: Routine laboratory procedures, including diagnostic work and PCR analysis on clinical specimens from patients who are suspected or confirmed to be infected with novel coronavirus should be conducted adopting practices and procedures described for basic laboratory — Biosafety Level 2 (BSL-2), as detailed in the WHO Laboratory biosafety manual, 3rd edition.

https://www.who.int/csr/disease/coronavirus_infections/Biosafety_InterimRecommendations_NovelCoronavirus_19Feb13.pdf

Q: Which BSL level is required for working with SARS COV 2?

A: Routine diagnostic testing of patient specimens, such as the following activities, can be handled in a BSL-2 laboratory using Standard Precautions:

  • Using automated instruments and analyzers
  • Staining and microscopic analysis of fixed smears
  • Examination of bacterial cultures
  • Pathologic examination and processing of formalin-fixed or otherwise inactivated tissues
  • Molecular analysis of extracted nucleic acid preparations
  • Final packaging of specimens for transport to diagnostic laboratories for additional testing. Specimens should already be in a sealed, decontaminated primary container
  • Using inactivated specimens, such as specimens in nucleic acid extraction buffer
  • Electron microscopic studies with glutaraldehyde-fixed grids

https://www.cdc.gov/coronavirus/2019-ncov/lab/biosafety-faqs.html

Q: Reasons for high rate of false positive or false negative results during corona PCR testing?

A:  In the case of real-time RT-PCR negative result with clinical features suspicion for COVID-19, especially when only upper respiratory tract samples were tested,     multiple sample types in different time points, including from the lower respiratory tract if possible, should be tested. Importantly, combination of real time RT-PCR and clinical features especially CT image could facilitate disease management. Proper sampling procedures, good laboratory practice standard, and using high quality extraction and real-time RT-PCR kit could improve the approach and reduce inaccurate results

https://www.nih.org.pk/wp-content/uploads/2020/04/Laboratory-TestingRecommendations-for-COVID-

https://www.advisory.com/daily-briefing/2020/04/06/false-negative

https://www.tandfonline.com/doi/full/10.1080/14737159.2020.1757437

https://www.the-scientist.com/news-opinion/false-negatives-in-quick-covid-19-test-near-15-percent-study-67451

Q: Given the 40% false negative rate from the NF antigen test, what can be done? E.g. multiple tests and/or combining it with AB testing, reconsidering reliability of testing asymptomatic etc

A: Doctors need better training and information on how to administer the tests, and when. People with serious symptoms who test negative need multiple tests, in order to ensure their diagnosis is certain. And most importantly, patients with symptoms that are consistent with COVID should still behave as though they are infected, no matter what their lab results suggest

https://slate.com/technology/2020/04/coronavirus-testing-false-negatives.html

https://www.sciencemediacentre.org/expert-comments-on-different-types-of-test-for-covid-19/

Questions for hospitals and healthcare workers

Q: What recommendations are there for health workers to prevent them from infecting their families when they go home after treating COVID-19 patients?

A:  They take off all of the scrubs from work. They put them directly into the washing machine. Shoes stay in a nearby plastic container. Walking into the house, they go directly to the shower. Only after a hot shower does he (or she) return to begin the laundry.

Q: What is the recommended approach to regular testing of asymptomatic medical staff given the increased hospital workload?

A:  Asymptomatic Casual Contacts Can remain at Work.

https://www.inmo.ie/tempDocs/Interim%20Guidance%20for%20Coronavirus%20HCW%20Mgt%20by%20Occupational%20Health%20WHWU%20Version%206.pdf

Q: Is there a need of blood sample for corona PCR testing?

A: For RT_PCR, the specimen is usually collected from the upper respiratory tract using the nasopharyngeal swab and/or oropharyngeal swab technique ;  a sample is gathered from the throat behind the nose, containing a mixture of mucous and saliva.

https://www.nejm.org/doi/full/10.1056/NEJMvcm2010260

https://www.aljazeera.com/news/2020/03/coronavirus-testing-methods-200330142718434.html

Q: How reliable is serological testing for COVID-19?

A: FDA still expects tests to be validated even under the emergency  revised policy for tests. However, the EUA process or an evaluation by NIH supports greater confidence in test performance.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-serological-test-validation-and-education-efforts

Q: What are the appropriate diagnostic tests for corona testing?

A: PCR is gold standard for COVID-19 testing.

Nucleic acid amplification tests (NAAT) for COVID-19 virus, Serological testing, viral sequencing

https://apps.who.int/iris/bitstream/handle/10665/331329/WHO-COVID-19-laboratory-2020.4-eng.pdf

Q: What is the body’s own interferon release level in response to COVID-19?

A: Interferons have been shown to possess a crucial role in the defense against coronavirus diseases. The virus can impede the interferon induction in humans. Moreover, STAT1, a key protein in the interferon mediated immune response, is antagonized by the virus. This could explain the increased response threshold of immune cells to IFNs during CoV infections. A vivid correlation between the innate immune response threshold and the fatality rates in COVID-19 can be found.

https://www.researchgate.net/publication/339910612_Therapeutic_Approaches_for_COVID-19_Based_on_the_Dynamics_of_Interferon-mediated_Immune_Responses

Q: Can you get COVID-19 again? After how long?

A: CDC and partners are investigating to determine if you can get sick with COVID-19 more than once. At this time, we are not sure if you can become re-infected. Until we know more, continue to take steps to protect yourself and others.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How-COVID-19-Spreads

We know that for similar coronaviruses, infected people are unlikely to be re-infected shortly after they recover. However, because the immune response to COVID-19 is not yet understood, it is not yet known whether similar immune protection will be observed for patients who have recovered from COVID-19

https://www.un.org/en/coronavirus/covid-19-faqs

Q: When a patient or person spends 14 days in quarantine, will he/she be completely free of virus or can he still shed virus?

A: Quarantine means separating a person or group of people who have been exposed to a contagious disease but have not developed illness (symptoms) from others who have not been exposed, in order to prevent the possible spread of that disease. Quarantine is usually established for the incubation period of the communicable disease, which is the span of time           during which people have developed illness after exposure. For COVID-19, the period of quarantine is 14 days from the last date of exposure because the incubation period for this virus is 2 to 14 days. Someone who has been released from COVID-19 quarantine is not considered a risk for spreading the virus to others because they have not developed illness during the incubation period.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How-COVID-19-Spreads

Yes, provided quarantine is done properly a person can be declared virus free.

https://www.who.int/publications-detail/considerations-for-quarantine-of-individuals-in-the-context-of-containment-for-coronavirus-disease-(covid-19)

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html

Q: What could be the best ways to tackle anxiety arising out of spread of mis-information?

A: First of all, read valid information sources instead of media. Use Meditation to soothe yourself. One must not rely totally on social and electronic media for information. Look at reliable resources of information;

National Action Plan for Preparedness and Response to COVID-19 Pakistan, https://www.nih.org.pk/novel-coranavirus-2019-ncov,

The Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/index.html,

The World Health Organization, https://www.who.int/docs/default source/coronaviruse/situation-reports/20200216-sitrep-27-covid-19.pdf

NIH: US National Library of Medicine (MedinePlus), https://medlineplus.gov/coronavirusinfections.html, Elsevier Coronavirus Information Center https://www.elsevier.com/connect/coronavirus-information-center

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