DUBAI: As coronavirus spreads rapidly and rising casualty numbers make screaming headlines globally, there are some elementary questions people around the world are asking as they go about their daily lives.
The most pressing among them perhaps is that given the fact that the common flu is so common, how we can be sure it’s not a coronavirus infection?
Aren’t many of their symptoms similar to begin with?
When the symptoms are mild enough and one is yet to visit the doctor, is there a protocol for home care?
After all, every unconfirmed coronavirus patient poses a huge risk, not just to his or her own well-being, but also to that of family members, colleagues and anyone else they may come into contact with?
Answering these questions going by the global experience so far, Dr Jacques Malan, Consultant Emergency Physician and Head of Department at the Mediclinic City Hospital in Dubai, told Gulf News, “If a person has symptoms and has been in close contact with a person that is confirmed to have COVID-19, they will need to be seen by a health care practitioner to exclude nCOV. Most patients will be isolated until the swabs are confirmed negative. This could mean admission to hospital in 24-48 hours.”
Who is at risk?
He said, “At present people that have been in close contact with a person who has confirmed nCoV infection or has travelled to China is at main risk for contracting the disease, but as we know, it has spread worldwide with cases reported around the globe. The DHA is updating the criteria on a daily basis as more information becomes available.”
From what is known so far, he said, “There are currently seven coronavirus strains. Human coronaviruses were first identified in the mid-1960s. All of them cause respiratory symptoms and are spread through infected droplets from human to human, although the initial origin is believed to be animal-based. The Chinese authorities identified the novel coronavirus (COVID-19) which was isolated on January 7 this year.”
About the similarity of symptoms with the common flu, Dr Malan said, “Yes, like any of the viruses in this family, the COVID-19 symptoms are “flu-like”, comprising fever, cough, runny nose, general body ache and breathing complaints. People at higher risk for developing severe symptoms and disease progression if they at the extremes of age and have other respiratory or immune diseases.”
He said most patients as with any of the flu virus will recover completely
Asked at what stage a patient with mild flu symptoms should visit the doctor, Dr Malan said, “If you develop respiratory symptoms and have travelled from China / Singapore / Hong Kong / Italy / Iran / Japan in the past 14 days or have had contact with a confirmed case, you must be tested for nCOV. The incubation period for most coronaviruses, including nCoV, is two-14 days, with the peak onset of symptoms being five to seven days.”
While the guidelines are being continuously evaluated and a doctor’s visit is a must to establish whether a patient is suffering from the common flu or COVID-19, following good home care is critical.
Protocol for home care
The World Health Organisation (WHO) has laid out a detailed protocol for home care of patients with suspected nCoV infection presenting with mild symptoms and without underlying chronic conditions. The recommendations are both for patients and caregivers who refer to parents, spouses, other family members or friends, without formal healthcare training.
According to WHO, the patient and family should adhere to some simple measures to stay on top of the game.
To begin with, the patient must be kept in a well-ventilated single room (i.e. open window and open door). The movement of the patient should be limited and shared space minimised. Shared spaces (e.g. kitchen, bathroom) should also be well-ventilated
Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 metre from the ill person (they should sleep on a separate bed).
The number of caregivers of the patient should also be limited. “Ideally, assign one person who is in a good health without underlying chronic conditions or immunocompromised conditions,” recommends WHO.
No visitors please
It goes without saying that visitors should not be allowed, until the patient has completely recovered from signs and symptoms
Hand hygiene following any type of contact with patients or their immediate environment is of course an absolute must. “Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet and whenever hands look dirty. If hands are not visibly soiled, alcohol-based hand rub can be used. For visibly soiled hands perform hand hygiene using soap and water,” says WHO.
“When washing hands with soap and water, the use of disposable paper towels to dry hands is desirable. If not available, use clean cloth towels and replace them when they become wet,” it adds.
To contain respiratory secretions, a medical mask should be provided to the patient and worn as much as possible. “For individuals who cannot tolerate a medical mask, he/she should rigorously apply respiratory hygiene, i.e. cover mouth and nose when coughing or sneezing with disposable paper tissue. Discard or appropriately clean materials used to cover the mouth and nose after use (wash handkerchiefs using regular soap or detergent and water),” the recommendations state.
As for the caregiver, he or she should wear a tightly fitted medical mask that covers the mouth and nose when in the same room with the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty with secretions, it must be replaced immediately with a new, clean, dry mask. “Remove the mask by using appropriate technique (do not touch the front but remove the lace from behind). Discard the mask immediately after use and perform hand hygiene,” says WHO.
Direct contact with body fluids, particularly oral or respiratory secretions and stool, must be avoided. Disposable gloves and masks should be used to provide oral or respiratory care and when handling stool, urine and waste. Hand hygiene before and after removing gloves and mask is a must again. The masks or gloves cannot be reused.
WHO recommends the use of dedicated linen and eating utensils for the patient. These items should be cleaned with soap and water after use and may be re-used instead of being discarded.
“Clean and disinfect daily the frequently touched surfaces throughout the patient’s care area such as bedside tables, bedframes and other bedroom furniture. Regular household soap or detergent should be used for cleaning first and then, after rinsing, regular household disinfectant containing 0.5 per cent sodium should be applied,” says WHO.
Other recommendations include cleaning and disinfecting bathroom and toilet surfaces at least once daily. The patient’s clothes, bedclothes, bath and hand towels, etc. should be cleaned using regular laundry soap and water or machine wash at 60–90 °C with common household detergent and dried thoroughly.
“Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid direct contact of the skin and clothes with contaminated materials.” Protective clothing
WHO recommends the use of gloves and protective clothing (plastic aprons) when cleaning or handling surfaces, clothing or linen soiled with body fluids. Depending on the context either utility or single use gloves can be used. Utility gloves should be cleaned with soap and water and decontaminated with 0.5 per cent of sodium hypochlorite after use. Single-use gloves (nitrile or latex or nitrile) should be discard after each use. Perform hand hygiene before and after removing gloves.
“Gloves, masks and other waste generated during the health care of patient at home should be placed in a waste bin with lid in the patient’s room before disposal as infection waste. Avoid other types of exposure to contaminated items from the immediate environment of the patient (e.g. no sharing of toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen),” the recommendations add.