Coronavirus Disease 2019 (COVID-19)

(Presentation adapted from slides prepared by WHO colleagues)

Dr N. Paranietharan
WHO Representative to Indonesia

Humanitarian Country Team meeting

12 February 2020

Disclaimer: Information presented is valid as of 10 February and may change with time
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Epidemiology
• Coronaviruses can infect both animals and humans.
• Human coronaviruses can cause mild disease similar to a
common cold or severe disease (such as MERS - Middle East
Respiratory Syndrome and SARS – Severe Acute Respiratory
Syndrome).
• Some coronaviruses found in animals can infect humans –
zoonotic
• Based on current information, an animal source seems the most
likely primary source of this outbreak
• There is clear evidence of human-to-human transmission.
• Incubation period can be from 1 day, up to 14 days
• More epidemiological data still required to understand the full
extent of this transmission.
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Clinical features
• Patients present with fever, cough, shortness of
breath, myalgia, confusion, headache
• Severity ranges from mild to severe disease resulting
in death
• Most cases reported to date have been milder;
about 14% appear to progress to severe cases
• Chinese authorities report 2 - 4% of people infected
with the virus have died
• True case-fatality ratio difficult to assess,
denominator (number of infections) unknown
• Continued analysis of information on both current
and any new cases is critical.
• There is No known effective antiviral therapy for
2019-nCoV and NO Vaccines so far
• People of all ages can be infected
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Characteristics of 2019-nCoV compared to other major viruses
Source: Slide 7, EPI-WIN Update #7 11.02.2020
Virus Total # reported Deaths reported Crude fatality Countries RO
cases ratio reporting

Seasonal influenza 3-5 million 290,000- 0.1% Global 1.28

(1) (severe 650,000
cases)
Ebola 2014 28,600 11,325 50% 6 countries ±1
(average)
H5N1 Bird Flu 861 455 53% 17 countries n/a
(human infections)
Nipah 265 105 40-75% 4 countries 0.33
SARS 8098 774 9.5% 26 countries 2.2-3.7
MERS (2) 2494 858 35% 27 countries <1
(average)
H7N9 Bird Flu (3) 1568 At least 615 39% 3 countries n/a
2019-nCoV (4) 40,554 909 2% 25 countries 1.4-4.9

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Evolution of the 2019-nCoV outbreak (31 December 2019 – 4 February 2020)
Dec 31, 2019
Cluster of 27 pneumonia Jan 29, 2020
cases of unknown origin with 7 First confirmed cases in
severe cases reported to China UAE, Finland and Italy
Jan 11, 2020 Jan 30, 2020
National Health Commission
First fatal case in China
Jan 28, 2020 1st Member States
Jan 19, 2020 briefing
Jan 7, 2020 First confirmed case in
First confirmed Jan 23, 2020
Novel coronavirus Germany
case in First confirmed 2nd Emergency
isolated
Jan 13, 2020 Republic of case in Singapore Jan 26, 2020 Committee – WHO Feb 3, 2020
First confirmed Korea First confirmed declares a PHEIC Daily WHO
case in Shutdown of case in Canada Health Security
Nepal Wuhan City First confirmed cases in Council put in
India and Philippines place

Jan 25, Jan 31, 2020

Jan 8, 2020 Jan 14, 2020
2020 First confirmed
First confirmed First confirmed
Jan 22-23, 2020 First cases in Russia,
case in case in Feb 4, 2020
1st Emergency confirmed Spain, Sweden
Thailand Japan 2nd Member
Committee cases in and UK
Jan 20, 2020 States briefing
Jan 1, 2020 Australia
Infection in health-care workers
Huanan Seafood Wholesale and
caring for 2019-nCoV Jan 27, 2020 Feb 2, 2020
market closed Malaysia
Patients First confirmed cases in First fatal
Jan 12, 2020 Jan 24, 2020
Cambodia and Sri Lanka case outside
Named as 2019-nCoV; First confirmed
First confirmed case in USA China
Whole genome sequence cases in France
WHO Director General in
shared with WHO and Viet Nam
China confirms human to human China
transmission HEALTH
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Confirmed cases of 2019-n CoV reported to WHO as of 10 February
Outside China-319
confirmed cases
Globally-40 554
Deaths- 910 SEAR – 37 cases
• Thailand - 32
• Nepal - 1
• Sri Lanka -1
China * • India -3
Confirmed -40235 WPR (Excluding China)
Severe – 6484 • 147 cases in 8 MS
70 cases in
Deaths- 909 •
international
conveyance –Japan
*Hong-Kong-36 EUR
(1 death) • 39 cases in 9 MS
*Macao -10 PAHO/Region of
*Taipei- 18 Americas
• 19 cases in 2 MS
EMRO
WHO Dashboard is active now http://who.maps.arcgis.com/apps/opsdashboard/index.h • 7 cases in 1 MS
Please log on for new updates tml#/c88e37cfc43b4ed3baf977d77e4a0667 Travel history to china -157

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Deaths outside china- Philippines – 1 EMERGENCIES
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 EPI-WIN (WHO Information Network for Epidemics)
Managing ‘infodemics’ - week of Feb 3
• Objective #1 - Balance the actual risk of nCoV vs the perceived risk globally

• Objective #2 - Decrease public concern of contracting nCov from asymptomatic

• Focus on HCW materials (FAQs on IPC and Clinical Care)

• Partners coordination beginning (UNICEF, IFRC, & many others)

EPI-WIN sector calls (World Economic Forum partnership)

• Travel & Trade ~ 20 companies (Lufthansa, Hilton, Airbnb, etc.)

• Business - ~ 50 fortune 500 companies (Edelman, etc.)

• Food and agriculture - ~35 companies (PepsiCo, Unilever, etc.)

Myth-busting & consistent messages sent globally

• nCoV and pets, garlic, olive oil, packages from China, antibiotics, etc.

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04/02/2020
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Following courses available on the open learning platform:
Emerging respiratory viruses, including 2019-nCoV: methods for detection,
prevention, response and control:
https://openwho.org/courses/introduction-to-ncov
• Provides a general introduction to 2019-nCoV and emerging respiratory viruses
• Intended for public health professionals, incident managers and personnel working for the United Nations,
international organizations and NGOs

Critical Care Severe Acute Respiratory Infection course:

https://openwho.org/courses/severe-acuterespiratory-infection
• Includes content on clinical management of patients with a severe acute respiratory infection.
• Intended for clinicians who are working in
• intensive care units in low- and middle-income countries
• managing adult and pediatric patients with severe forms of Severe Acute Respiratory Infection
including severe pneumonia, acute respiratory distress syndrome, sepsis and septic shock.
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International Health Regulations (2005)

– Legally binding treaty

– 196 States Parties
– In force 15 June 2007

Member States must report,

respond and cooperate

WHO coordinates
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Public Health Emergency of International Concern (PHEIC) is declared by WHO
Director-General upon the advice of the Emergency Committee
• Temporary recommendations – significant political and practical force.
• Protective for affected country(ies) when other countries take additional
measures beyond evidence-based recommendations.
• PHEIC determination reflects the global situation and not the individual country
• The main reason for the declaration is not for what’s happening in China but
because:
• H2H transmission in other countries
• Countries implementing travel and other restrictions exceeding
recommendations
• Concerns for countries with weak health system.
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 PHEIC declared on 30 Jan 2020
• The committee made a set of recommendations that are evidence-based
and commensurate with public health risks –to:
• Support countries with weaker health systems
• Accelerate the development of vaccines, therapeutics and diagnostics
• Combat the spread of rumours and misinformation
• Work together in spirit of solidarity and cooperation.

• The Committee does not recommend any travel and trade restrictions

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Recommendations
a) To the People’s Republic of China:
“Continue to: implement a comprehensive risk communication strategy; ensure public
health measures for containment….”

a) To All countries
“should be prepared for containment, including active surveillance, early detection,
isolation and case management, contact tracing and prevention of onward spread of
2019-nCoVinfection, and to share full data with WHO”
“The Committee does not recommend any travel or trade restriction based on the current
information available”
“…are cautioned against actions that promote stigma or discrimination, in line with the
principles of Article 3 of the IHR.
https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-
health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)

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 2019-nCoV available WHO guidelines
• Surveillance Case definitions
• Laboratory guidance
• Clinical management
• Infection prevention and control
• Risk communications
• Home care for patients with suspected nCoV
• Country Readiness checklist
• Disease commodity package
• Reducing transmission from animals to humans
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/indonesia/news/novel-coronavirus

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 Advice for public: Basic Protective measures
• Wash your hands frequently with an alcohol-based hand rub or soap and water.
• Practice respiratory hygiene
When coughing and sneezing, cover mouth and nose with flexed elbow or tissue – discard tissue immediately
into a closed bin and clean your hands with alcohol-based hand rub or soap and water.

• Maintain social distancing

at least 1 metre (3 feet) distance between yourself and other people, , particularly those who are coughing,
sneezing and have a fever.

• Avoid touching eyes, nose and mouth

• If you have fever, cough and difficulty breathing, seek medical care early
• Avoiding unprotected contact with farm or wild animals.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
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Reduce your risk of coronavirus infection:
Frequently clean hands by
using alcohol-based hand
rub or soap and water. When coughing and sneezing
cover mouth and nose with flexed
elbow or tissue – throw tissue away
Thoroughly cook meat immediately and wash hands.
and eggs

Avoid close contact with anyone

that has fever and cough
Avoid unprotected
contact with live wild or
farm animals

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Protect yourself and others from getting sick
Wash your hands
 after coughing or sneezing
 when caring for the sick
 before, during and after you prepare food
 before eating
 after toilet use
 when hands are visibly dirty
 after handling animals or animal waste

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 Current guidance on Masks
 Masks to be used by:
- People with respiratory symptoms, e.g. cough or difficulty breathing. Including when seeking
medical attention;
- People providing care to individuals with respiratory symptoms;
- Health workers, when entering a room with patients or treating an individual with
respiratory symptom
 A medical mask is not required for members of the general public who do
not have respiratory symptoms
- However, masks might be worn in some countries according to local cultural habits. If masks
are used, best practices should be followed on how to wear, remove, and dispose of them
and on hand hygiene action after removal.
https://www.who.int/docs/default-source/coronaviruse/advice-on-the-use-of-masks-2019-ncov.pdf

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When you need to wear a mask and how to use it
Wash hands with alcohol-based hand rub
or soap and water

Cover mouth and nose and make sure

there are no gaps

Avoid touching the mask while using it

Do not re-use single-use masks

Remove it from behind (do not touch the

front of mask); discard immediately in a
closed bin; wash hands with alcohol-
based hand rub or soap and water
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While Travelling
Avoid travel if Avoid close contact
you have a with people suffering from a
fever and fever and cough
cough

If you have a fever, cough and difficulty

breathing seek medical care early and share
previous travel history with your health care Frequently clean hands by using
provider alcohol-based
hand rub or soap and water

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While Travelling
If you become sick while
travelling, inform crew
and seek medical care
early

If you seek medical attention, share

travel history with your health care
provider

Avoid touching
eyes,
nose or Avoid close contact and
mouth travel with animals that
are sick

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While Travelling
When coughing or sneezing cover
mouth and nose with flexed elbow
or tissue - throw tissue away
immediately and wash hands

Avoid spitting
in public

Immediately discard single-use If you choose to wear a mask, be

mask after each use and wash hands sure to cover mouth and nose –
after removing masks avoid touching mask once it’s on

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 2019-nCoV Strategic Preparedness and Response Plan
• Scope: Public health strategy to support countries to
prepare and respond to nCoV-2019

• Goal: To stop further transmission of 2019-nCoV

within China and to other countries, and to mitigate
the impact of the outbreak in all countries

• Strategic objectives:
• Limit human-to-human transmission
• Identify, isolate and care for patients early
• Identify and reduce transmission from the animal source
• Address crucial unknowns
• Communicate critical risk and event information
• Minimize social and economic impact
www.who.int/docs/default-source/coronaviruse/srp-04022020.pdf

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 THANK YOU

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Medical staff members carry a patient into the Jinyintan hospital, where patients infected by a mysterious SARS-like
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virus are being treated, in Wuhan in China's central Hubei province on January 18, 2020. (AFP photo)