COVID-19: Diagnosis and Management - Part II E-Book
44,81 €
Mehr erfahren.
- Herausgeber: Bentham Science Publishers
- Kategorie: Fachliteratur
- Sprache: Englisch
The coronavirus disease 2019 (COVID-19) outbreak has spread throughout the globe and much time has passed since it was declared as a pandemic by the World Health Organization (WHO). COVID-19: Diagnosis and Management provides clinicians and scholars all the information on this disease in 2 volumes. Readers will find a concise and visual reference for this viral disease and will be equipped with the knowledge to assess and manage Sar-Cov-2 infection cases in clinical settings.
This book is divided into two parts (I and II). Part I provides comprehensive information about 1) History of Coronaviruses, 2) Epidemiology of COVID-19, 3) Clinical presentation of this viral disease and 4) COVID-19 diagnosis. Part II covers broader topics about this communicable disease including 1) the prevention and treatment methodology, 2) mortality and long-term complications, 3) COVID-19 vaccines and future perspectives.
Key Features:
Covers all the aspects of COVID-19 making this a perfect textbook for virology and medical students
Chapter wise description and segregation of topics from pathophysiology to diagnosis and management of COVID-19.
Six chapters in the first part which focus on clinical basics of COVID-19.
Six chapters in the second part which cover broader topics for practical infection control.
Multiple tables and figures which summarize and highlight important points.
Presents a summary of the current standards for the evaluation and diagnosis of COVID-19.
Features a detailed list of references, abbreviations, and symbols.
This book is an essential textbook reference for medical students, scientists (virologists, pulmonologists) and public health officials who are required to understand COVDI-19 diagnosis and management as part of their clinical training or professional work.
Das E-Book können Sie in Legimi-Apps oder einer beliebigen App lesen, die das folgende Format unterstützen:
Seitenzahl: 411
Veröffentlichungsjahr: 2021
Ähnliche
BENTHAM SCIENCE PUBLISHERS LTD.
End User License Agreement (for non-institutional, personal use)
This is an agreement between you and Bentham Science Publishers Ltd. Please read this License Agreement carefully before using the ebook/echapter/ejournal (“Work”). Your use of the Work constitutes your agreement to the terms and conditions set forth in this License Agreement. If you do not agree to these terms and conditions then you should not use the Work.
Bentham Science Publishers agrees to grant you a non-exclusive, non-transferable limited license to use the Work subject to and in accordance with the following terms and conditions. This License Agreement is for non-library, personal use only. For a library / institutional / multi user license in respect of the Work, please contact: [email protected].
Usage Rules:
All rights reserved: The Work is 1. the subject of copyright and Bentham Science Publishers either owns the Work (and the copyright in it) or is licensed to distribute the Work. You shall not copy, reproduce, modify, remove, delete, augment, add to, publish, transmit, sell, resell, create derivative works from, or in any way exploit the Work or make the Work available for others to do any of the same, in any form or by any means, in whole or in part, in each case without the prior written permission of Bentham Science Publishers, unless stated otherwise in this License Agreement.You may download a copy of the Work on one occasion to one personal computer (including tablet, laptop, desktop, or other such devices). You may make one back-up copy of the Work to avoid losing it.The unauthorised use or distribution of copyrighted or other proprietary content is illegal and could subject you to liability for substantial money damages. You will be liable for any damage resulting from your misuse of the Work or any violation of this License Agreement, including any infringement by you of copyrights or proprietary rights.Disclaimer:
Bentham Science Publishers does not guarantee that the information in the Work is error-free, or warrant that it will meet your requirements or that access to the Work will be uninterrupted or error-free. The Work is provided "as is" without warranty of any kind, either express or implied or statutory, including, without limitation, implied warranties of merchantability and fitness for a particular purpose. The entire risk as to the results and performance of the Work is assumed by you. No responsibility is assumed by Bentham Science Publishers, its staff, editors and/or authors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products instruction, advertisements or ideas contained in the Work.
Limitation of Liability:
In no event will Bentham Science Publishers, its staff, editors and/or authors, be liable for any damages, including, without limitation, special, incidental and/or consequential damages and/or damages for lost data and/or profits arising out of (whether directly or indirectly) the use or inability to use the Work. The entire liability of Bentham Science Publishers shall be limited to the amount actually paid by you for the Work.
General:
Any dispute or claim arising out of or in connection with this License Agreement or the Work (including non-contractual disputes or claims) will be governed by and construed in accordance with the laws of the U.A.E. as applied in the Emirate of Dubai. Each party agrees that the courts of the Emirate of Dubai shall have exclusive jurisdiction to settle any dispute or claim arising out of or in connection with this License Agreement or the Work (including non-contractual disputes or claims).Your rights under this License Agreement will automatically terminate without notice and without the need for a court order if at any point you breach any terms of this License Agreement. In no event will any delay or failure by Bentham Science Publishers in enforcing your compliance with this License Agreement constitute a waiver of any of its rights.You acknowledge that you have read this License Agreement, and agree to be bound by its terms and conditions. To the extent that any other terms and conditions presented on any website of Bentham Science Publishers conflict with, or are inconsistent with, the terms and conditions set out in this License Agreement, you acknowledge that the terms and conditions set out in this License Agreement shall prevail.Bentham Science Publishers Ltd. Executive Suite Y - 2 PO Box 7917, Saif Zone Sharjah, U.A.E. Email: [email protected]
FOREWORD
It is my proud privilege to introduce the book “Covid-19: Diagnosis and Management,” which is authored by a group from PGIMER, Chandigarh. The timing of this monograph is very apt as it has been about 9 months since the start of the COVID-19 pandemic, and it is now that we are starting to unravel the various mechanisms of disease pathogenesis and treatment modalities for this viral infection which has infected 29 million people, out of which about 1 million have died globally.
It has been the need of the hour to come up with a treatment for this pandemic disease. Moreover, it is of utmost importance that all the information related to COVID -19 should be compiled in one place, a goal which this book will fulfill.
Though the tests for diagnosis of the infection have been developed in the start of the pandemic, there are still some issues in diagnosis, including the sensitivity of the best test available, i.e., Real-Time Polymerase Chain Reaction.
The book is very well organized and has been divided into two parts; each part is comprised of 6 chapters and covers all the aspects of COVID-19 from the history to the treatment of the disease. Based on the best scientific studies available, the editors and authors have used their vast professional experience to discuss the all clinical aspects of COVID-19, including clinical presentation to diagnosis in the first part and treatment of COVID-19 in the second part, and I am very sure that this compendium will become the benchmark to refer to for any information required on COVID-19.
Whenever we write books, we must have in our minds, as clearly as possible, the affirmation of Carlyle Guerra de Macedo, who was the Director of Pan American Health Organization, relative to the responsibility of what is being published: “It must be remembered that behind each table, every report or material examined, there are lives, there are people, there is suffering, waiting for our efforts and human solidarity.” Both the parts of the book are very well organized, and the readers will get a mine of information available to date on COVID-19 in one place, and it would be helpful to both the clinicians and the lab professionals for day-to-day guidance in various matters. The monograph is comprehensive but is written in a lucid manner that is easy to grasp, and even complex topics are made simple for understanding.
I am also sure that as the knowledge of the virus evolves further, the authors will certainly keep updating the work from time to time, further adding to the importance of the book. I would like to congratulate the editors/authors for this tremendous effort, and I am very sure that this book will surely be of use to readers around the world and help them in the diagnosis and management of patients with COVID-19 and will also go a long way in the efforts to help fight the pandemic, which is being faced by the humanity now.
PREFACE
The coronavirus disease 2019 (COVID-19) outbreak has spread throughout the globe and declared as a pandemic by the World Health Organization (WHO) on 11th March, 2020. Till date on 1st September 2020, there are more than 25,327,098 confirmed cases of COVID-19 worldwide and around 848,255 deaths have been reported. The clinicians and scientists across the globe need all the information on this pandemic disease on one platform. We have already discussed history, epidemiology, and diagnosis in part I of this book. Part II of the book “COVID-19: Diagnosis and Management” is a concise and visual reference for this viral disease. It will provide comprehensive knowledge that will cover all the aspects related to the prevention and treatment methodology of this communicable disease COVID-19.
Key Features:
Chapter vise description and segregation of all the areas of management of COVID-19.Six chapters cover prevention and treatment aspects of COVID-19.Multiple tables and figures summarize and highlight important points.Covering all the aspects of COVID-19 making this a perfect textbook for Virologist and medical students.A summary of the current standards for the evaluation and clinical management of COVID-19.A detailed list of references, abbreviations and symbols.This book is an essential reference for practicing and training virologists, pulmologists, medical students, scientists working in various research labs, pharmaceutical and biotechnology industries on COVID-19.
List of Contributors
Prevention of COVID-19: Facts to Overcome the Myths
Rajesh Kumar1,Mangesh Pradeep Kulkarni1,Sheetu Wadhwa1,Soundappan Kathirvel2,*Abstract
The entire world has slowed down since the outbreak of a highly contagious virus, i.e., Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Extensive efforts are being made to reduce disease transmission, optimize the management strategy to reduce deaths and to come up with a vaccine as a preventive measure. Though several scientists across the globe are working tirelessly for developing an effective vaccine, it may still take several months to launch it successfully in the market. The behavioural interventions like maintenance of physical distancing (at least one meter), hand hygiene and cough etiquette, and use of personal protective equipment (PPE) are the currently available effective strategies to break the chain of disease transmission. All these interventions have been implemented at the population and individual level with or without linking with regulations. Based on the risk of exposure, provision and use of appropriate PPE is the need of the hour. The healthcare professionals working in COVID-19 areas have been recommended to use full PPE, which includes gloves, N-95 face masks, face shields, goggles, full-body gowns, and shoe covers. The general population has been asked to use homemade or triple-layered surgical masks in addition to the maintenance of physical distancing and hand hygiene. There are other additional strategies or measures which may or may not prevent the COVID-19 transmission. This chapter attempts to clarify the important and effective measures for the prevention of COVID-19 at the individual and community levels. It also tried to demystify the myths related to COVID-19.
INTRODUCTION
As it has been well-said, “Prevention is better than cure”, the same applies to the pandemic situation of COVID-19 as the causative virus is novel, and there is no specific treatment available. In this situation, only the preventive measures applicable to the community and individual level will help control the spread of infection and its impact. There are several preventive measures, specifically behavioural interventions like use of face masks or personal protective equipment, maintaining hand hygiene and physical distancing, practicing cough etiquette and others to contain the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which have been discussed throughout this chapter (World Health Organization, 2020c). A thorough understanding of existing evidence on the mode of transmission of the infection is important to practice the preventive measures further.
The modes of transmission of coronavirus can be broadly categorized into two types. Direct transmission is characterized by close and direct contact of a healthy person with asymptomatic (less likely) or symptomatic COVID-19 patient, especially when a healthy individual comes into close contact (up to 2 meters) and has been exposed to the respiratory droplets (>5-10µm diameter) produced by sneezing, coughing, talking and other activities (Bai et al., 2020). Indirect transmission of infection happens through contact with fomites. It is generated during sneezing and coughing, which may deposit on clothes and even surfaces or objects, making it viable for transmission (Guo et al., 2020). However, the evidence on airborne transmission (through droplet nuclei-diameter <5µm) and transmission through the faeco-oral route is extremely limited. Though mother-to- child transmission is highly unlikely, the newborn baby is equally at risk of acquiring the disease like others for the person-to-person transmission through respiratory droplets or through contact with fomites (Sohrabi et al., 2020; World Health Organization, 2020b). Table 1 summarizes the myths and facts related to the transmission of COVID-19 (Fong, 2020).
MEASURES TO PREVENT THE SPREAD, ASSOCIATED MYTHS AND FACTS
The preventive measures ranged from using a simple face mask to using a full set (from head to toe) of personal protective equipment. Similarly, the preventive measures work together and effectively prevent the transmission of the disease like the use of face mask, physical distancing, maintenance of hand hygiene and others. Further, most of the measures are related to changing the behaviour and practice, some of which are linked with regulations.
Personal Protective Equipment (PPE)
The PPE can act as a physical barrier, or it is something that protects a person from any lethal biological agent when used properly (World Health Organization, 2020d).
PPE can be divided into various components, such as:
Head Cap/coverFace ShieldMaskGogglesGlovesShoe CoverGowns or CoverallsAll the above-mentioned components together make a complete PPE, and a brief explanation on them, rationale of their use and the standards thereof are discussed below:
Head Covers
This works as a primary covering for the head and also the hair to prevent cross-contamination between the patients and healthcare providers.
Face Shield
Face shields are like the primary walls for the protection of the face, i.e., nose, eyes and mouth, which are vulnerable to getting infected by the droplet transmission that is generated as a result of sneezing or coughing or talking and protects the face from direct exposure to infectious droplets as well as refrains a person from touching the face (Gupta, 2020).
The standards and specification for face shields are following:
Must be made of a transparent plastic/polymer and provide clear visibility from either side and should be preferably fog-resistant.Should cover the sides and length of the face.An adjustable/elastic in nature band for its snug fitting to the forehead.May be disposable or preferably reusable after appropriate disinfection.Mask
A face mask is the most common PPE used by all groups of population based on the risk of exposure or type of setting, i.e., at the community or healthcare setting. It varies from simple homemade cloth mask or advanced masks like filtering facepiece (FFP) 3. As the cloth masks or non-medical masks are not fluid resistant and have low filtration efficiency, they are not considered to be a PPE. Further, masks can be disposable or reusable after adequate and appropriate disinfection.
Classification of Masks
Single-Use Masks
Usually with a single layer, and prevents larger dust particles. The filtration efficiency of this mask is 95% for particles above 3.0 microns.
Surgical Masks
It is usually triple-layered and the filtration efficiency up to 98% for particles above 0.1 microns. However, effectiveness in the prevention of infection is low in case of exposure with confirmed COVID-19 patient.
Respirator or FFP Masks
These are effective masks, especially in preventing the airborne transmission of infections and smaller particles. Further, it is available with or without an exhaling valve.
Non-respirator or Dust Masks
These are worn to prevent non-toxic nuisance dust generated from various activities. However, it will not provide adequate protection from hazardous dust or infectious agents (Robertson, 2020).
FFP (Filtering Face Piece) Classification
FFP is classified into three types based on the filtering capacity and total inward leakage of a mask. The lesser the inward leakage better is the protection offered (Bode Science Center, 2020).
FFP-1: Maximum of 22%FFP-2: Maximum of 8%. The N95 mask is a type of FFP2 mask.FFP-3: Maximum of 2%Masks used for Prevention of COVID-19 Transmission
Masks are of several types, but specifically, two types of masks are used in the present conditions of COVID-19, which are:
N-95 Mask
It is the best suiting mask for the present situation as it has good aerosol filtration percentage, i.e., 95% and it closely fits the face of one wearing it with a tighter and better seal than any other mask. These are available with and without an exhalation valve. The valve allows free movement of exhaled air and reduces the discomfort when worn. It is recommended in place of moderate to high risk of exposure to COVID-19.
The standards that a N-95 mask should meet are:
High filtration capacity with good breathability with or without expiratory valve.Ensuring shape that does not collapse easily and is reliable. It should be compliant or equivalent to the following standards: National Institute of Occupational Safety and Health (NIOSH) N95, EN 149 FFP2, andFluid resistant at a minimum of 80 mmHg based on the guideline of American Society for Testing & Materials (ASTM) F1862, International Organization of Standardization (ISO) 22609 or equivalent (US Food and Drug Administration, 2020).Triple-layered Medical Mask
As the name itself suggests, it is a triple-layered mask which is fluid-resistant and thus provides protection from the droplets and is disposable too. A triple-layered mask must be non-woven with a nose pin and ISI compliant with a filtering efficiency of 99% for 3-micron and larger particle size. It is recommended in low risk of exposure to COVID-19 or people working in non-COVID-19 areas/settings.
Goggles
They form an integral part of the protective equipment for face and should have a flexible frame making it fit tightly to the face and not allowing any particulate matter or droplets to enter the eyes (World Health Organization, 2020d). Usually, people working in high-risk area or exposure to COVID-19 need to wear goggles along with N95 masks.
The specifications and standards to be ensured for a mask include:
Should have a good seal, transparent, made up of strong polymeric material, covering all sides with a good fitting.Preferably fog and scratch-resistant.An adjustable band that can firmly secure the position and does not lose out during the clinical activity.Should have an indirect vent to reduce fogging.It should preferably be reusable after adequate disinfection.Gloves
The major source of getting infected after the droplet transmission is by physical contact, which is majorly through hands. Anybody who is dealing with moderate to high-risk areas (the areas where the infected or one with high risk are dealt with) has to ensure wearing gloves and also their proper disposal after use or else, they may also become a mode of transmission. However, maintenance of hand hygiene and PPE cannot be ignored even if someone is using gloves (alone) since the person may touch his face or other places after wearing the gloves.
Certain specifications and standards for gloves (non-sterile) include:
Made up of Nitrile rubber (better resistance to chemicals than latex).Must be powder-free.Outer gloves should reach the mid-forearm (at least 280 mm total length).Available in different sizes.Shoe Covers
The shoe covers are made of an impermeable material to cover the footwear and for personal protection which must be made of the same material as that of coverall and must cover the entire shoe and reach above the ankle. Shoe covers are recommended to people working in the high-risk areas or exposure to COVID-19.
Gowns or Coveralls
These are the full-body coverings generally made of polymers that ensure the safety of the body of the healthcare workers and provide a barrier to reduce or even eliminate the droplet contamination. It generally covers the whole body from head to feet and ensures complete protection if appropriately used. However, there might be some gaps at the backside of the gowns or coveralls, which may also cause contamination but ensuring a proper covering and doffing can minimize this risk. They can basically protect a person from the biologically contaminated particulate matter or solid (World Health Organization, 2020a).
The specification and standards for the coveralls and gowns include:
Single-use and preferably light in colour to detect the contamination.Must be impermeable to blood and other body fluids and has an impermeability pressure of at least 40 mmHg.Thumb/finger loops for anchoring the sleeves.Must be equivalent, exceed or complaint with the following standard:
ISO 16603 Class-3 Exposure Pressure
The rationale of the use of PPEs as per the guidelines by Ministry of Health and Family Welfare, Government of India & World Health Organization, are stated below in Table 2 (EMR Division Ministry of Health and Family Welfare (Government of India), 2020b, 2020a; World Health Organization, 2020d, 2020c).
SANITIZATION AND DISINFECTION
Hand Hygiene
The coronavirus pandemic is known for transmission through two major modes which include the droplet transmission or through contact. Transmission through contact occurs when a healthy person comes in contact, i.e., touches an infected person, surfaces, etc., with his hands and may carry the virus which may further enter in the body through nose, mouth or eyes while performing the day to day activities. To prevent this possibility of getting infected, one must always maintain the hands clean (Lotfinejad et al., 2020; World Health Organization, 2020b).
Now the question is, what and how can someone achieve or maintain this hand hygiene? Well, it’s quite simple, but certain considerations have to be ensured to stay safe such as:
For Public
One can wash his hands with soap and water for a minimum of 20-30 seconds ensuring the proper scrubbing of all the areas of palm, fingers, nails and crevices is recommended till the wrist, and then the soap is properly washed with water and ensure that the hands are dry.One can also consider the use of hand sanitizers, which should contain not less than 70% of isopropyl alcohol when cleaning with soap and water is not possible or hands are not visibly soiled. A person allergic to alcohol-based hand rub can maintain hand hygiene using soap and water.Everybody must consider washing hands or sanitizing them at regular intervals, especially during the following activities, namely:
Before preparing and eating food.Before and after coming in contact with any person outside the house.After visiting a public place like an office, hospital, sports complexes etc.Before and after treating a wound or cut.After using public devices, others’ phones and also touching surfaces such as lift buttons, doorknobs, public transport etc. (Fathizadeh et al., 2020).After coughing or sneezing or vomiting.Before touching the face while outdoors.Prevention of COVID-19 Among Frontline Healthcare Workers
As the frontline working force including the healthcare professionals, sanitization workers, law enforcement departments etc. are more susceptible to acquire the infection being in direct contact with the infected or in contact with a lot of people every day. Hence, it is very necessary for them to take care of hand hygiene importantly (Lotfinejad et al., 2020). This can be done by the use of disposable hand gloves and repeatedly sanitizing the hands with a recommended sanitizer that has the alcohol content not less than 70%. Frontline workers not only have to take care of their hands but should also consider disinfecting their clothes and whole body once they relieve from their everyday duty to ensure maximum safety (World Health Organization, 2020a).
Cleaning of Vegetables-Fruits
Vegetables and fruits are an essential part of daily life and are very necessary to be consumed for maintaining sound health. But, in pandemic situations like COVID-19, there are chances of contamination of the fruits and vegetable surfaces as well, and to overcome this, certain steps have to be followed, such as:
One should wash his hands efficiently before and after handling fruits/vegetablesInitially, they can be classified into two types, i.e., 1) Raw fruits & vegetables, and 2) Green leafy vegetablesFor the fruits and vegetables whose outer covering is removed before consumption, they can be soaked in clean water with some amount of salt or baking soda or potassium permanganate added to it and cleaned properly followed by washing them under a tap of clean running water with the application of a mild scrub or a brush for this activity, wherever applicable.In case of the green leafy vegetables, soaking them for 15 minutes in one part of vinegar and three parts of water or water added with a spoon of salt followed by thorough washing under running water is recommended.Note:
One should not use detergents or any disinfectants to clean edible substances as their consumption be harmful to our body.Purchase only fresh fruits and vegetables.Purchase prepacked fruits and vegetables, preferably which may have less contact with human hands or secretions.Avoid eating uncooked vegetables or improperly cleaned fruits and vegetables.Consumption of raw or stale meat must be avoided.Safe Handling of Currency and Paper Documents
The paper currency notes tend to carry several microorganisms as they go hand by hand to several individuals and places, making them a potential carrier for bacteria and viruses. Hence, one must ensure proper hand hygiene as discussed above before and after handling currency, as there are possibilities of carrying the droplets over them (Oosterhoff and Palmer, 2020). Shifting towards cashless payment methods wherever possible is advised to reduce the chance of exposure.
Recently, a laboratory of Defense Research Development Organization (DRDO), India has developed a device which can sanitize items like paper currency, mobile phones, wallets, laptops etc. with the help of UV-C rays (predominantly 254 nm) which is an effective method to be adopted (Roza et al., 1985). Few countries which have polymer-based water-proof currency have an additional advantage of the ease of sanitizing them, making it safer for use (IANS, 2020). Further, all the routine office procedures could be shifted to digital mode to reduce the handling of paper surfaces which moves between people and risk the exposure. Besides, the movement towards digital method further increases the efficiency, timeliness and transparency.
Cough or Respiratory Etiquettes
Individual responsibility plays a major role in efficient handling of such dreadful pandemic and containing the spread of disease, especially in practicing the cough or respiratory etiquettes.
Precautions to be Taken While Coughing/Sneezing or Any Physical Contact
It is strictly advisable that a person should cover the mouth and nose with a mask always. Irrespective of use of mask, it is advisable to cover the mouth with his elbow while sneezing or coughing and to sanitize the hands after it with an alcohol-based sanitizer.
Spitting or Littering in Public
Spitting in public areas or on roads is strictly unadvisable as well as prohibited in several places or punishable under law. Spitting in places can increase the risk of infection as the virus may remain in an open area for a longer period of time (PTI, 2020).
Disinfection of Public Places
Disinfection and sanitization of public places is another measure that has to be performed effectively to check the spread of coronavirus. There are certain standard procedures and chemicals that have to be used for the disinfection of these surfaces to ensure no viable form of virus stays there to spread the infection (Oosterhoff and Palmer, 2020).
Certain guidelines for effective disinfection of surfaces are given below:
The surfaces of offices, rooms, hospitals must be mopped using phenol or 1% sodium hypochlorite solution or a bleaching agent at least twice daily.The frequently touched areas such as the tables, chairs, machines etc., must be cleaned using the same solution as mentioned in Table 3 below.Metallic surfaces such as lifts, doors knobs, handles, locks, and keys must be cleaned using 70% alcohol because using a bleaching agent or so could result in the rusting of these items.All the used products and disposable wastes must also be treated with 1% sodium hypochlorite solution preferably.Extra care must be taken for the cleaning of restrooms and all its surfaces and must be done at regular intervals with the aid of soaps, phenolic solutions, 1% sodium hypochlorite solution or using a bleaching agent (Xiao and Torok, 2020).There should be arrangements for disinfection of toilet seats present in public places. Closed flushing of the toilets must be practiced avoiding the generation of aerosols.Disposal and Disinfection of PPEs
As the PPEs are used as a barrier from the virus and is used when the risk is high; thus, the chances of them getting contaminated by the virus are also high. These contaminated kits cannot be disposed of as such and are needed to be treated with a disinfectant before disposal. For the disinfection, any phenolic solution or 1% sodium hypochlorite solution can be used.
Donning of PPE kits is recommended after proper sanitization of hands followed by the stepwise wearing of all the coverings from head to toe sequentially. Doffing of PPE kits requires utmost care and attention as there is a huge risk of contracting the virus. The steps for removal of PPE kits are shown in Fig. (1) below (World Health Organization, 2007).
WATER TREATMENT AND WASTE MANAGEMENT
Management of Water and Faecal Waste
Till date, there has been no significant evidence that the virus can be transmitted through sewage water, but studies have found viral fragments in the human excreta. Efficient wastewater treatment and disposal are essential to ensure that it will not pose any threat to nature or human beings. The general water treatment measures include the retention method, which is carried out for days (20 days), if sufficient and a final disinfection step may be considered to ensure better safety. Considering the safety requirements for the staff working in the respective water treatment plants, use of PPEs like heavy-duty gloves, masks, face shields, boots, goggles etc. must be practiced (World Health Organization, 2020e).
Fig. (1)) Steps to doffing or removal of personal protective equipment.Safety of Water Supplies
The basic measures that are taken for the treatment of water are enough to destroy coronavirus as they have sensitivity towards chlorination and the amount of residual chlorine ≥ 0.5 mg/L with 30 minutes of contact time at a pH of < 8 (World Health Organization, 2020e). Ultraviolet irradiation can also add up as a feature of extra safety to eradicate the chance of any viable form of virus remaining in water to render it unfit for consumption.
SOCIAL MEASURES
Physical Distancing
Through physical distancing (or also known as social distancing), i.e., maintaining a possible safe distance and avoiding the large gatherings, the contact of an infected person and susceptible person is minimized. Hence, it lowers the chances of the spread of infection. It can also be called a non-technical infection control and preventive measure to check on the spread of the virus (Kissler et al., 2020).
A thumb rule to ensure physical distancing is to maintain a distance of at least 1 meter (preferably 2 meters) from any individual. However, the more is the distance, and the lower are the chances of contracting the virus (Greenstone and Nigam, 2020). One can take advantage of technology to stay connected with their social groups, even while practicing physical distancing.
Application of door/home delivery, wherever possible, must be encouraged for the purchase of groceries, medications etc. If an individual is visiting any shop or a store, they must practice physical distancing.
Encouraging work from home can be another solution to avoid closed group gatherings and risk of exposures. Meetings and teaching must be conducted via video conferencing, or other online modes which can prevent large gatherings and yet fulfil the needs (Center for Disease Control, 2020; Ministry of Health and Family Welfare (Government of India), 2020a). The myths and facts related to social preventive measures during COVID-19 is described in Table 4.
Quarantine and Isolation
Quarantine is a practice of restricting the movement of an individual or a group of individuals for a particular period at a particular place who are potentially exposed to infection. This ensures early detection of infection among exposed individuals and reduces the chances of transmission through restricting the contact of a susceptible person with exposed person. Isolation can be simply termed as the separation of an infected patient from healthy/susceptible population to prevent further transmission of infection. Quarantine is traditionally employed among people who have a travel history from a place which is a hotspot for the disease or has come in contact with a person who has been diagnosed with the disease. This is basically done to break the chain of transmission (Nussbaumer-Streit et al., 2020). This can be broadly classified into two types, i.e., home quarantine and institutional quarantine, which is decided by the authorities dealing with the situation at the point taking several factors into consideration.
Home Quarantine
It is nothing but the restriction of movement of a person at his home itself for a period of 14 days (incubation period of the virus is 2-14 days) and taking care of necessary precautions like:
Staying in a separate room and isolated from other family members especially the elderly, children and the ones with comorbidities.Avoid sharing of household items with other people at home.Using a mask all the time and also take proper care of its disposal like treating it with disinfectants before discarding.Only one person (caretaker) of the family is advised to serve the quarantined person with necessities, and that too without direct physical contact with practicing all the necessary precautions and visitors should never be allowed.If any symptoms of the disease are observed, then it must be immediately brought to the notice of responsible authorities.All the surfaces, including the objects used, must be disinfected or adequately and appropriately cleaned.Everyone in the house must practice hand hygiene measures and try to practice physical distancing as much as possible.They have to regularly update the health workers or in the given mobile application regarding their health status and presence of new symptoms.Institutional Quarantine
Institutional quarantine is practiced especially for individuals who don’t have adequate facilities like a separate room in their house and other amenities for practicing quarantine (Hu et al., 2020). There are certain considerations needed to be taken care of for the efficient and purposeful functioning of a quarantine centre like:
Infrastructural Facilities
The institute must be well maintained, has proper water supply, drainage facility and electricity.Well maintained beds with a distance of at least 2 meters from each other with a proper washroom facility.Basic amenities like fans, lights etc. must be ensured.Staff Guidelines
The entry into the institute must be restricted and strictly monitored, and also a logbook should be maintained for the movement of staff in and out of the facilityAn active medical team must evaluate all the individuals residing in the facility for any symptoms periodically (daily or twice daily)The staff dealing with the institutional tasks must ensure wearing proper personal protective equipment and its disposalUtility Guidelines
Basic needs such as food, water, housekeeping and laundry must be taken care of efficientlyDisinfection of surfaces and washrooms must be done regularlyUsed clothes, masks or other daily use items must be washed/ disinfected/disposed efficientlyThe myths and facts related to quarantine are given in Table 5.
Lockdown and Travel Restrictions
A lockdown can be explained as a seizure of several non-essential and everyday activities in a particular area, state or country ensuring people stay at their home, thus resulting in better physical distancing, lesser gatherings and movements which will help to control the spread of the disease to an appreciable extent. As of now, to stop the spread of novel coronavirus, lockdowns and travel bans have become the frontline measures for the public and also containment of the disease.
