Infection Prevention a

nd Control (IPC)
for COVID-19 Virus

Module 2: The COVID-19 Virus

Its epidemiology, risk factors, definitions and symptomology

WHO IPC Technical and Clinical Unit

What is a coronavirus?

• Coronaviruses (CoV) are a large family of

viruses that cause a wide range of illness
from the common cold to more severe
diseases
• i.e., Middle East Respiratory Syndrome [MERS]
and Severe Acute Respiratory Syndrome
[SARS]

• A novel coronavirus (nCoV) is a new strain

that has not been previously identified in
humans.
Countries affected (08-04-2020)

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
What we know about the COVID-19 virus
• Incubation period - current estimates of the incubation period of the virus
range: 1-12.5 days (median 5-6 days).
• Estimates will be refined as more data become available.
• More information needed to determine whether transmission can occur
from asymptomatic individuals or during the incubation period.
• Modes of transmission: droplets sprayed by affected individuals, contact with
patient respiratory secretions, contaminated surfaces and equipment.
• Transmission from animals and human-to-human.
• Currently no available treatment or vaccination, supportive measures only.
Mode of transmission – what is known to date
Primary modes of transmission of COVID-19:
• Droplet: Respiratory droplets (particles >5-10 μm in diameter) are
generated when an infected person coughs or sneezes. Any person who is
in close contact (within 1 m) with someone who has respiratory symptoms
(coughing, sneezing) is at risk of having his/her mucosae (mouth and nose)
or conjunctiva (eyes) exposed to potentially infective respiratory droplets
• Contact: direct contact with infected people and indirect contact with
surfaces in the immediate environment of or with objects used on the
infected person (e.g., stethoscope or thermometer) (droplets may land on
surfaces where the virus could remain viable).
Ø WHO Joint Mission COVID-19 to China, https://www.who.int/docs/default-source/coronaviruse/who-china-joint-
mission-on-covid-19-final-report.pdf
Ø Ran L, et al. CID 2020
Ø Moriarty LF, et al. MMWR 2020
Ø Jefferson T, et al. Medrix 2020
Airborne transmission – what is known to date
q Mainly limited to circumstances and settings in which aerosol generating procedures (AGPs): tracheal
intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before
intubation, bronchoscopy.
q Detection of COVID-19 RNA in air samples
• Experimental studies not reflecting human cough or clinical settings (e.g. van Doremalen N et al, NEJM
2020)
• Reports from settings where symptomatic COVID-19 patients have been admitted, in absence of AGPs
o Negative: Cheng V, et al. ICHE 2020; Ong SW, et al. JAMA 2020; Faridi S et al. Science of The
Total Environment 2020
o Positive air samples with fragments of the virus detected by RT-PCR in microdroplets: Liu Y et al,
2020, bioRxiv preprint; Santarpia JL et al, 2020, medRxiv preprint;
o RT-PCR positive respiratory droplet and aerosol samples for coronaviruses: Leung et al. Nature
Med 2020
• Detection of COVID-19 RNA in extremely low concentrations (well below what could be the infectious
inoculum)
• The detection of RNA in air samples based on PCR-based assays is not indicative of viable virus that
could be transmissible (Wölfel R, Nature 2020)
COVID-19 signs and symptoms

Illness seems to start

Case definitions – (as of 04-02-2020)
to be investigated and tested
Severe acute respiratory infection (SARI):
A. History of fever, cough, and requiring admission to hospital,
(with no other etiology that fully explains the clinical presentation)
AND
history of travel or residence in/to China in the 14 days prior
to symptom onset

OR
B. Patient with any acute respiratory illness AND at least one of the
following during the 14 days prior to symptom onset:
Contact with a confirmed or suspected case of COVID-19 infection
OR
worked in or attended a health care facility where patients with
confirmed or probable COVID-19 acute respiratory disease
patients were being treated