COVID-19 Overview Dr. Michael Parry Director of Infectious Diseases and Microbiology Stamford Health March 2020 - Town of New Canaan
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COVID-19
Overview
Dr. Michael Parry
Director of Infectious Diseases and Microbiology
Stamford Health
March 2020
1
Put this in perspective
• We’ve been here before….
– SARS in 2003
– Pandemic H1N1 Influenza in 2009
– Ebola in 2013
– COVID-19 in 2020
2
Put this in perspective
• Influenza in US
– 30-50 million cases per year
– 300,000 hospitalizations per year
– 30,000 to 60,000 deaths per year
• Influenza in Stamford
– 1000 cases per year (SH lab)
– Peaks at 80-100 per week
– 100-200 hospitalizations/yr
– Generally accepted CFR is 1/1000
3
Respiratory Infections in Stamford
Influenza Testing Stamford 2019-2020
60
50
number of tests performed
40
30
20
10
0
Positive A Positive B Negative Tests
Week ending 3/8: 45 flu cases, 5 rhinovirus, 4 coronavirus NL63, 2 metapneumovirus
CT DOH data from preceding week: 200 flu admissions and 7 flu deaths
No COVID-19 in Stamford; 2 cases in CT (out of 54 patients tested by the State DOH) 4
US Data 3/10/2020
5
Initial reports…. Date: 1 Jan 2020 UNDIAGNOSED PNEUMONIA - CHINA (HUBEI) (01): WILDLIFE SALES, MARKET CLOSED – REQUEST FOR MORE INFORMATION ****************************************************************** A ProMED-mail post. http://www.promedmail.org. International Society for Infectious Diseases. Source: South China Morning Post The World Health Organisation said it is in ongoing contact with authorities in China over an unidentified outbreak of viral pneumonia in the central city of Wuhan, amid concern it may have been transmitted from animals. Wuhan health authorities on Tuesday [31 Dec 2019] said 27 people - most of them stallholders at the Huanan Seafood Wholesale Market - had been treated in hospital, with 7 said to be in serious condition. Pathology tests were under way to try and identify the virus, officials said…. There continue to be social media reports on twitter and Weibo (the Chinese social media) on this outbreak.
What is Coronavirus?
• Large RNA virus, respiratory infection (like influenza, enterovirus, etc)
• Named for the corona-like protein receptor spikes on the surface
• Receptor-binding domain on spikes mediate attachment of the virus to its
cellular receptor, angiotensin-converting enzyme-2; host specific
• Animal kingdom wide distribution – especially birds and bats
• Evidence of evolution over thousands of years from animal to man
• Human “common” coronavirus
– HKU1, NL63, OC43, 229E
– Both upper and lower respiratory illness; flu-like illness
– Significant proportion of all common colds in adults and children.
– Fever, sore throat and lymphadenopathy
– Viral bronchitis and pneumonia
• SARS (severe acute respiratory syndrome)
• MERS (middle-eastern respiratory syndrome)
• COVID-19
– Infection due to 2019 SARS-CoV-2 7
Case numbers 3/10/2020
COVID-19 overview
• Symptoms
– Fever, cough, shortness of breath
– Symptoms can appear 2-14 days after exposure
– Many cases of mild illness which may go undiagnosed
– Asymptomatic illness
• Transmission
– Risk probably persists while symptomatic (14 day cutoff)
– Droplet spread – close contact (less than 6 feet)
– Hands contaminated with virus
• Testing
– Nose and throat swabs, sputum
– State DOH
– Quest, Labcorp
– Local labs?
• Treatment
– Supportive care at present
– Future research potential
• Antiviral agents
• Vaccine
Characteristics of Coronavirus Disease 2019 (COVID-19) Outbreak in China --
Summary of a Report of 72 ,314 Cases From the Chinese CDC.
Zunyou, W and McGoogan, JM: JAMA February 24, 2020;
• 72 ,314 Cases (as of February 11, 2020)
• Age distribution (N = 44 672)
– ≥80 years: 3% (1408 cases)
– 30-79 years: 87% (38 680 cases)
– 20-29 years: 8% (3619 cases)
– 10-19 years: 1% (549 cases)
–How contagious is it?
• First 12 travel related cases in US
– 445 close contacts identified
• 19 household contacts
• 104 community close contacts (>10 minutes atAsymptomatic cases - clues from the Diamond Princess
12
https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_on_cruise_ships#Diamond_Princess accessed 3/8/2013
What have we done?
Infection Prevention / Patient/staff safety
• Daily tracking of CDC, WHO, DOH directives since January 2020
• Communication plan
• Algorithm for clinical staff to handle potential cases
• Signage and scripting created for staff
• Web Posting (internet and intranet)
• Incident command activation
• Regular meetings established with physician State and local DOH
• New isolation signs created
– Contact + Airborne + Eye Protection
• Isolation room (negative-pressure room)
• PPE stockpile
• Live drills
• Traffic restrictions – visitors, families, staff
• Employee health policies staff screening & quarantine
• Testing process established
14Infectious Diseases Travel Alerts
Travel Restrictions https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
Clinical Guidance for testing coronavirus PUI 3/8/2020
17Signage
1819
Scripting
Infection Prevention Measures
• Avoid close contact with people who are sick
– Social distancing
– Travel restrictions
– 6 foot zone of safety
• Stay home when you are sick
• Avoid touching your eyes, nose, and mouth
– Hand to mucous membrane is most common
mode of transmission
• Cover your cough
– Sleeve, not hands
– Use a facemask if you are symptomatic
• Hand Hygiene
– Purell or soap and water
– “Fist bump” or “Elbow bump”
• Surface cleaning
• Proper use of PPE for patient contact
– Gown, mask, eye protection, gloves
Same actions used to prevent the spread of influenzaWeb Resources for COVID-19 Information
23Questions?
24
https://www.cdc.gov/coronavirus/2019-ncov/communication/factsheets.htmlYou can also read
