NCA

CHN
COVID-19
◦ Coronavirus disease (COVID-19) is an infectious disease caused by the
SARS-CoV-2 virus (Severe acute respiratory syndrome coronavirus 2)
◦ Coronaviruses-are a large family of viruses that cause illness like severe acute
respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
◦ Novel coronavirus (nCoV) is a new strain that has not been previously
identified in humans. The new virus was subsequently named the “COVID-19
virus
◦ Corona- spike proteins that attaches to a human cell to infect it, allowing it to
replicate inside of the cell and spread to other cells. Some antibodies can
protect you from SARS-CoV-2 by targeting these spike proteins.
◦ 30 January 2020- Dr Tedros Adhanom Ghebreyesus, WHO Director-General
declared the novel coronavirus outbreak a public health emergency of
international concern. At that time there were 98 cases and no deaths in 18
countries outside China.
◦ 11 March 2020- the rapid increase in the number of cases outside China led the
WHO Director-General to announce that the outbreak could be characterized
as a pandemic. By then more than 118 000 cases had been reported in 114
countries, and 4291 deaths had been recorded.
◦ Mid-March 2020- the WHO European Region had become the epicentre of the
epidemic, reporting over 40% of globally confirmed cases.
At Risks of COVID-19

◦Elderly
◦With comorbidities-with underlying medical conditions
like cardiovascular disease, diabetes, chronic respiratory
disease, or cancer
Mode of Transmission
The virus can spread from an infected person’s mouth or
nose in small liquid particles when they cough, sneeze,
speak, sing or breathe. These particles range from larger
respiratory droplets to smaller aerosols
Inhalation
Deposition of virus on exposed mucous membrane
Touching mucous membranes with contaminated hands
Incubation Period
◦The incubation period is the number of days from exposure to
the appearance of symptoms. This is used to decide how long
people need to stay away from others during an outbreak.
◦Original variant-2-14 days; average of 5-6 days
◦SARS-CoV-2 B.1.1.529; average; average (Omicron) Variant-3
days
◦Delta variant ( B.1.617.2 ) average- 4 days
Preventions
◦Mask
◦Social distancing of at least 1 meter
◦Hand hygiene: washing your hands or using an alcohol-based
rub frequently
◦Vaccination
◦Respiratory etiquette: Cover your mouth and nose when coughing or
sneezing, coughing into a flexed elbow
◦Stay home and self-isolation
◦Choose open, well-ventilated spaces over closed ones. Open a window if
indoors.
Diagnostic Tests
CDC recommends fully vaccinated people get tested 5-7 days after close contact
with a person with suspected or confirmed COVID-19.
◦ Rapid antigen tests (RAT)-detect viral proteins (outer surface of the virus)
known as antigens - use to initiate contact tracing, epidemiological surveillance
and clinical management.
◦ RT-PCR –standard diagnostic test by testing the nucleic acid of the virus
◦ Influenza SARS-CoV-2 (Flu SC2) Multiplex Assay- detects presence of
SARS-CoV-2, influenza A, and influenza B nucleic acid in a patient specimen.
Signs and Symptoms
On average it takes 5–6 days from exposure when someone is infected with the
virus for symptoms to show, however it can take up to 14 days.
Most common symptoms:

◦ Cough
◦ fever
◦ tiredness
◦ loss of taste or smell.
Less common symptoms:
◦sore throat
◦headache
◦aches and pains
◦diarrhoea
◦a rash on skin, or discolouration of fingers or toes
◦red or irritated eyes.
Serious Symptoms:
◦ difficulty breathing or shortness of breath
◦ loss of speech or mobility, or confusion
◦ chest pain.
Epidemiologic investigation
◦ an inquiry to the incidence, prevalence, extent, source, mode of transmission,
causation of, and other information pertinent to a disease occurrence;
◦ Attack rate - also known as ‘incidence proportion’, is the proportion of an initially
disease-free population that develops disease, during a specific period of time. The
attack rate is calculated as the number of people who contract the disease divided
by the number of people at risk for the disease/population.
◦ 2. Case fatality rate - An estimate of the risk of mortality/deaths of the disease.
Calculated as total number of deaths among cases divided numberoftotal cases,
multiplied by 100 in a given time period
◦ 3. Doubling time - measures speed of outbreak. The amountoftime it takes for
a value to double itself at a consistent rate of growth. In COVID-19, it is a
model which allows health authorities to quantitatively forecast the time
evolution of infections and fatalities during the pandemic wave
◦ 4. Positivity rate - Refers to the percentage of patients who have positive tests.
This is an indicator used to track the spread of disease or calculate the
contagiousness of a disease. It can be calculated by dividing the numberoftotal
cases who tested positive by the total numberof individuals tested, multiplied
by 100.
◦ 5. Recovery rate - Refers to the percentage of patients who recovered from
COVID-19 based on the recovery classification. It can be calculated by
dividing the numberof recovered patients from the total cumulative number of
COVID-19 cases in a specific period of time, multiplied by 100.
◦ Cluster - an unusual aggregation, real or perceived, of health events that are
grouped together as to time and space and that is reported to a public health
department.
◦ it is further defined as two or more confirmed cases from the same area over a period of
14 days.
Criteria :
◦ i. Geographical boundary (purok, barangay, zone) - 2 confirmed cases from 2 different
households.
◦ ii. Residential building - 2 confirmed cases from 2 different housing units.
◦ iii. Workplace - 2 confirmed cases regardless if same or different office space.
◦ iv. Health care facilities and other closed settings (jail, detention centers, long-term care
facility, etc.) - 2 confirmed cases regardless if from the same location in said closed
setting.
◦ Close Contact - a person who has experienced any one of the following
exposures during the 2 days before and the 14 days after the onset of symptoms
of a probable or confirmed case:
◦ 1. Face-to face contact with a probably or confirmed case within 1 meter and
for at least 15 minutes
◦ 2. Direct physical contact with a probable or confirmed case
◦ 3. Direct care for a patient with probable or confirmed COVID-19 disease
without using recommended personal protective equipment OR
◦4. Other situations as indicated by local risk assessments Close contacts
can be classified further into first-, second-, and third-generation close
contacts:
◦1. First-generation close contacts - close contacts of a probable, or
confirmed case
◦2. Second-generation close contacts - close contact of a first generation
close contact.
◦3. Third-generation close contacts - close contact of a second generation
close contact.
What is the difference between quarantine
and isolation?
◦Quarantine- is used to an exposed individuals. It is a strategy used to
prevent transmission of COVID-19 by keeping people who have been
in close contact with someone with COVID-19 apart from others.
◦The date of exposure starts on day 0. Day 1 is the first full day after last
contact with a person who has had COVID-19.
Stay home and away from other people for at least 5 days.

◦Isolation- if sick and test positive.

◦Day 0 is the first day of symptoms or a positive viral test. Day 1 is the first
full day after symptoms developed or the test specimen was collected.
Isolate for at least 5 days.
◦Close Contact-someone who was less than 6 feet away from an
infected person for a cumulative total of 15 minutes or more over a
24-hour period (for example, three individual 5-minute exposures for
a total of 15 minutes).
◦An infected person can spread SARS-CoV-2 starting 2 days before they
have any symptoms (or, for asymptomatic people, 2 days before the
positive specimen collection date).
◦People who are exposed to someone with COVID-19 after they
completed at least 5 days of isolation are not considered close contacts.
◦Exposure- Contact with someone infected with SARS-CoV-2, the
virus that causes COVID-19, in a way that increases the likelihood of
getting infected with the virus.
◦General Contact - individuals who may have been exposed
to a confirmed case (such as those who were in the same
event, social gathering, or venue as the confirmed case) but
did not fulfill the case definition for a close contact (e.g.
were beyond one meter distance from the confirmed case
or did not have prolonged interaction or direct contact with
the confirmed case).
◦Case Investigation & Contact Tracing-Fundamental
activities that involve working with a person with
COVID-19 who has been diagnosed with an infectious
disease to identify and provide support to people who may
have been infected (close contacts) through exposure to
the person with COVID-19.
◦This process prevents further transmission of disease by
separating people who have (or may have) an infectious
disease from people who do not.
◦Contact Tracing - the identification, listing,
assessment, and monitoring of persons who
may have come into close contact with a
confirmed COVID-19 case. Contact tracing is
an important componentin containing
outbreaks of infectious diseases.
◦History of exposure to known probable and/or
confirmed COVID-19 case14 days before the onset
of signs and symptoms? Or if asymptomatic, 14
days before swabbing
◦ Epidemiological criteria:
1. Residing or working in an area with high risk of transmission of the virus: for
example, closed residential settings and humanitarian settings, such as camp and
camp-like settings for displaced persons, any time within the 14 days prior to
symptom onset; OR
2. Residing in or travel to an area with community transmission anytime within the
14 days prior to symptom onset; OR
3. Working in health setting, including within health facilities and within
households, anytime within the 14 days prior to symptom onset.
Considered fully vaccinated

◦2 weeks after their second dose in a 2-dose

series
Mutations
◦mutations – genetic and characteristic changes or changes to the spike
protein; the SARS-CoV-2 virus begins to form genetic lineages.
◦Scientists call the viruses with these changes “variants”.
◦They are still SARS-CoV-2, but may act differently.
◦Alpha ( B.1.1.7 )
◦Beta ( B.1.351 )
◦Gamma ( P.1 )
◦Delta variant ( B.1.617.2 )- detected in India
- highly contagious, more than 2x as contagious as previous variants.
◦SARS-CoV-2 B.1.1.529 (Omicron)-Multiple countries
Omicron was
first detected in
specimens
collected on
November 11,
2021, in
Botswana and on
November 14 in
South Africa
Terminating Isolation
◦ end isolation after 5 full days if you are fever-free for 24 hours without the use of
fever-reducing medication and your other symptoms have improved (Loss of taste and
smell may persist for weeks or months after recovery and need not delay the end of
isolation).
◦ If you test positive for COVID-19 and never develop symptoms, isolate for at least 5
days. You should continue to wear a well-fitting mask around others at home and in
public until day 10
◦ after testing positive, your 5-day isolation period should start over. Day 0 is your first
day of symptoms
◦ for people who were severely ill or immunocompromised - an isolation period of at
least 10 and up to 20 days.
DOH COVID- Vaccination
Vaccine Dosage
Pfizer Moderna Astrazeneca Janssen Sinovac

3 ml 0.5 ml 0.5 ml 0.5 ml 0.5 ml

Types of Medical Wastes
◦ https://doh.gov.ph/sites/default/files/health-update/dm2020-0439.pdf