Everything you need to know about Corona Virus.

Corona Virus -CoviD-19
Everything you need to know
about
ü Diplomat American Board of Psychiatry and Neurology
ü Diplomat American Board of Clinical Psycho-Pharmacology
ü Diplomat American Board of Addiction Medicine
Tanveer A Padder MD
Medical Director TIME Organization
Baltimore MD

What is the Corona-COVID-19 virus?
ØThe COVID-19 virus belongs to a family of viruses known as coronaviruses; they
generally infect bats, pigs, small mammals, and on rare occasions, humans.
ØThis new coronavirus is called severe acute respiratory syndrome coronavirus
2(SARS-CoV-2 or COVID-19).
ØSeven strains are known to infect humans, including the COVID-19, causing
illnesses in the respiratory tract.
ØThe origin of the outbreak is reportedly due to the infected seafood and live
animal market in Wuhan, China.
ØOn January 7, 2020, Chinese authorities confirmed the identification of a new
coronavirus, and the Chinese government is still sharing findings with the
international scientific community.

What is the Corona Virus? Cont.…
ØThe virus has sparked a global panic and on January 30th,
was deemed to be a pandemic by the World Health
Organization.
ØThe current mortality rate of the COVID-19 virus is about
3.4%. However, other types of diseases, such as measles and
the Ebola virus, are much more dangerous.
ØMost cases of COVID-19 have been mild, with 20% of the
infected experiencing severe illness. The numbers are much
less than the common flu.

Origin of Corona Virus:
ØThe virus originated in bats, which are a host of
many illnesses such as Ebola, Rabies, and the
Marburg virus.
ØIt was transferred to other animals, specifically
pangolins, which are heavily trafficked mammals.
ØCOVID-19 first appeared on December 12 in
Wuhan, a large city in China. It is theorized that
someone bought contaminated meat, became
infected, and infected others, creating a worldwide
ripple effect.

Current Statistics World Wide
156112
5,829
73,922
Total Cases
Death Cases
Recovered Cases

Current Statistics-USA
2800Total Cases
Recover Cases
31
Death Cases 58
Ø As of March 13, there were at least 2800 confirmed cases of COVID-19 in the U.S.
Ø However, officials have warned that due to delays in testing, the number of infected individuals is likely much higher
Ø 58 deaths have been linked to the outbreak of COVID-19 at a long-term care facility, the Life Care Center, in Kirkland, Washington.

Current Statistics USA Cont.…

Global Pandemic
ØMarch 11, 2020, the World Health Organization (WHO) declared the COVID-19
outbreak a pandemic. This means the outbreak has now spread worldwide.
Ø Distribution of COVID-19 cases as of March 12, 2020

Global Pandemic Cont.…
ØAround the world, strict quarantine and lockdown measures have been put in
place to stop the spread of the virus.
ØMany countries have declared a state of emergency including the USA and
banned social gatherings, games, closed schools, restaurants and other public
places.
ØMany states are mandating the closure of schools for some time until the
outbreak is controlled.
ØIt seems that the U.S. is in for some trouble with the virus since tests for the
virus are hard to get. Many more may be infected than originally thought.

1. Tom Hanks and his wife
2. Justin Trodsus wife
3. Spanish PM’s wife
4. Brune Poirson, the French Secretary of State
5. Nadine Dorries - British junior health minister
6. Peter Dutton_ Australian Minister
7. Rudy Gobert-NBA star
8. Fabio Wajngarten, a public official in Brazil
9. Donovan Mitchell, NBA star
10.Daniele Rugani, Italian national soccer team star
11.Mikel Arteta, Arsenal's head coach
12.Callum Hudson-Odoi, Chelsea winger
Famous People Diagnosed with
Coronavirus

The Travel Industry in Distress:
ØAirlines, cruise lines, and hotels are facing problems as
thousands of people do not travel.
ØMany cruise ships have been quarantined with thousands of
people stuck on board.
ØDelta, United, and American Airlines have cancelled all flights
to China to contain the virus.
ØHotels are also removing cancellation fees in select locations,
specifically those in China or other affected areas.
ØMany countries are shutting down entirely, including malls,
grocery stores , resteraunts, and many more.

Transmission
ØIt spreads from person-to-person via respiratory droplets
that are emitted from an infected person into the air,
which is inhaled by other people.
ØThere is also a possible transmission through surfaces and
even feces.
ØThe virus has been identified in environmental samples in
a live animal market in Wuhan, China.

Person-to-Person Spread
ØThe COVID-19 virus spreads quickly due to
community spread, the spread of a disease in an
area of people.
ØSome viruses have been found to last as long as nine
days on many different materials.
ØCOVID-19 spreads very quickly, and currently, every
infected person transmits the virus to 2 to 3 others.
ØThese transmission rates are higher than the spread
of influenza.

What is the incubation period?
ØThe incubation period is the time it takes for
symptoms of an infection to appear.
ØPeople will become symptomatic between 2
and 14 days after infection; the average
incubation period is 5.2 days.

Symptoms
Fever
Chest Pain
Breathing
Difficulties
Pneumonia
Sore
Throat
Most Common symptoms:
ØFever (83–98%)
ØCough (76%–82%)
ØFatigue: 38%
ØCoughing up sputum,: 33%
ØShortness of breath: 19%
ØBone or joint pain: 15%
ØHeadache: 14%
ØSore throat: 14%
ØChills: 11%
ØNausea or vomiting: 5%
ØStuffy nose: 5%
ØDiarrhea: 4%

Clinical Course
ØPatients usually develop symptoms within the second week of
contracting the virus, including pnemonia, and about half develop
dyspnoea
ØSome reports describe asymptomatic infections.
ØIt can cause pneumonia, severe acute respiratory syndrome (SARS),
kidney failure, or even death in severe cases
ØIt is currently not clear how long an infected person is contagious
Among hospitalized patients:
■ 17–29% developed ARDS- Acute respiratory distress syndrome
■ 10% developed a secondary infection
■ ~23–32% required intensive care for respiratory support
■ 4–10% required mechanical ventilation
■ 3–5% required extracorporeal membrane oxygenation

Risk Assessment:
ØThe mortality rate increased from 2% to 3.4%. The exact rate
won't be known until the number of infected is known.
ØThe mortality rate may be much lower if the number of
asymptomatic cases is more significant. However, COVID-19 is
much deadlier than the seasonal flu.
ØCOVID-19 spreads more easily from person to person than SARS.
ØThe sustained person-to-person spread of COVID-19 will likely
continue to occur along with widespread transmission in the
U.S.
Ø
ØMillions of people can be effected putting the colossal burden
on the healthcare system and hospitals.

Who is at Highest Risk?
ØPeople of all ages have been infected, but the mortality rate
is much higher in people older than 80.
ØChildren can also become severely infected.
ØHighest risk:
ØHealthcare workers
Ø People in close contact with affected persons,
ØPeople traveling from affected locations
ØElderly people
ØPeople with diabetes, heart disease, or compromised immune
systems.

Risk in USA?
ØThe current risk to the U.S. population is on the rise.
ØCOVID-19 cases have been confirmed in 49 US states, Washington, D.C. &
Puerto Rico
ØCDC warned that the United States should brace for a domestic corona virus
outbreak.
ØNumerous states have announced bans on large gatherings and encouraged
companies to allow employees to telecommute if possible.

Impact on Pregnancy
ØAccording to the CDC, in the case of SARS and MERS,
pregnant women were more at risk for severe illness,
and some experienced miscarriage and stillbirth.
ØPregnancy could cause a woman to become more
susceptible.
ØSo far, only one infant in England has the virus.

Diagnosis
ØDiagnostics tests are the only way to confirm whether a person has the
coronavirus.
Ø In the U.S., testing is limited by a narrow testing criterion.
ØA blood test was recently licensed in China, which can also show immunity.
ØNew test kits were released to state public health laboratories. The CDC is
working with commercial labs to validate tests in the future to build testing
capacity.
ØDrive through testing has already started so that individuals can drive up
and be swabbed without having to leave their car.
ØThis week, cities in California, Colorado, Connecticut, Minnesota, New York,
Texas, and Washington, have opened drive-through coronavirus testing
stations and more cities are following suit.

Criteria for Diagnosis
Epidemiological criteria:
ØThose who have travelled to China, South Korea, Iran, Hong Kong,
Japan, Macau, Malaysia, Singapore, Taiwan, Thailand, Italy,
Cambodia, Laos, Myanmar or Vietnam in the last 14 days before the
onset of illness.
ØThose who have come into contact with confirmed cases of COVID-
19.
Clinical criteria:
ØPeople requiring admission to hospital, radiological evidence of
pneumonia, acute respiratory infection, or fever with no other
symptoms.
ØMust have at least one symptom.

Testing
Ø As of the morning of March 15, 84 state and local public health laboratories
in 50 states, the District of Columbia, and are offering testing.
Ø CDC will coordinate with state authorities and providers to ship specimens
to public health labs
Ø Specimens needed for collection:
Ø Lower respiratory (Bronchoalveolar lavage, tracheal aspirate or sputum)
Ø Upper respiratory OR nasopharyngeal wash/aspirate or nasal aspirate)
Ø Serum (red top tube)
Ø Whole blood, stool, urine sample will also be accepted

How to Get Tested for Coronavirus
ØCall ahead to your doctor or a health care facility if you are
concerned and you want to be tested.
ØBased off your symptoms, they will decide if you need to
be evaluated in person and may confer with state
authorities about where and how to do the testing.
ØAnybody with a doctor's order should be able to access the
tests.
ØThey will give you instructions on how to arrive in a way
that limits exposure.
ØIt is important to make arrangements ahead of time to
protect everyone when coming in for a test.

ØAll states now have a public health lab testing for
coronavirus, and an increasing number of
commercial and academic labs are testing as well.
ØDuring the test, clinicians swab your throat, going
through both your mouth and your nose.
ØPeople with "wet" coughs may also be asked to
cough up sputum, a mixture of saliva and mucous.
ØJohn Hopkins developed in house test today which
can test at least 1000 people a day.
How to Get Tested for Coronavirus Cont.…

Treatment
ØThere are no current approved vaccinations or medications;
the CDC recommends taking preventative measures.
ØThere is currently no specific treatment for COVID-19.
ØThere are no scientifically approved drugs for COVID-19, but
several are in development.
ØVaccines are under development, Phase 1 trials in people
may occur within 1 to 2 months.
Ø CDC recommends taking pain and fever medications,
drinking plenty of liquids, and resting.

Treatment Cont.…
ØCOVID-19 DNA has been decoded and many laboratories in
China, Canada and Australia were able to grow the
coronavirus in cell culture successfully.
ØThis is potentially good news, because it may lead to a
vaccine.
ØInfection control must be initiated immediately to prevent
airborne pathogens from spreading.
ØChina may have a vaccine developed, but they need more
time to test it.

What to do if you think you have Coronavirus
ØCall ahead-call the healthcare provider and tell
them that you may have COVID-19. This will help
the healthcare provider to be prepared
beforehand.
ØWear a facemask. You should wear a facemask
when you are around other people or pets.
ØStay home: You should restrict activities outside
your home, except for getting medical care.
ØAvoid public areas: Do not go to work, school, or
public spaces.
ØAvoid public transportation: Avoid using public
transport, ride-sharing, or taxis.
Call ahead
Wear a facemask
Avoid public
Areas

What to do if you think you have Cont.….
ØStay away from others:, You should stay
away from other people in a specific room
ØSeek medical attention: Seek prompt
medical attention if your illness is worsening in
any way.
ØCall your doctor: Before seeking care, call
your healthcare provider and tell them that
want to be evaluated for, COVID-19.
ØAlert health department: Persons who are
placed under active monitoring or facilitated
self-monitoring should follow instructions
provided by their local health department or
occupational health professionals.
Medical Attention
Wear a facemask
Avoid public
areas

Prevention of Corona Virus
ØInform: If you have a fever, cough, and difficulty
breathing, informs medical personnel.
ØAvoid :Avoid close contact with affected individuals.
ØWash hands: Wash your hands often with soap
and water for at least 20 seconds, especially after
blowing your nose, coughing, or sneezing; going to the
bathroom; and before eating or preparing food.
ØHand sanitizer: If soap and water are not readily
available, use an alcohol-based hand sanitizer with at
least 60% alcohol, covering all surfaces of your hands
and rubbing them together until they feel dry.

Prevention of Corona Virus Cont…
ØAvoid touching: Avoid touching your eyes, nose,
and mouth with unwashed hands.
ØSocial distancing: maintain a distance of at least 6
feet from coughing or sneezing person, and stay
home when sick.
ØCover: Cover your cough or sneeze and wash
hands often.
ØDispose : Throw used tissues in a lined trash can.

Prevention of Corona Virus Cont…
Ø Facemask: Facemasks should be used by those who
show symptoms of COVID-19.
ØDisinfect: Clean and disinfect frequently touched
objects and surfaces.
ØAntivirals :As there's no available vaccine, the CDC
recommends taking antiviral pills.
ØDo not share: You should not share dishes, drinking
glasses, cups, eating utensils, towels, or bedding
with other people or pets in your home.

Prevention of Corona Virus Cont..
ØClean and disinfect: Practice routine cleaning of
high touch surfaces.
ØHigh touch surfaces: these include counters, table
tops, doorknobs, bathroom fixtures, toilets, phones,
keyboards, tablets, and bedside tables.
ØDisinfect : Disinfects areas with bodily fluids: Also,
clean any surfaces that may have blood, stool, or
body fluids on them.
ØHousehold cleaners: Use a household cleaning
spray or wipe, according to the label instructions.

Prevention
Wash Hands
Keep Social
Distance
Don’t touch
your Nose,
Mouth, Eyes
Seek
medical
attention if
sick
Follow the
CDC
Guidelines
Cover mouth
When
coughing

What Disinfectants to Use?
ØHousehold bleach solutions, alcohol solutions with at least 70% alcohol, and
most common EPA-registered household disinfectants should be sufficient.
List of Registered Disinfectants:
ØClorox Multi-Surface Cleaner + Bleach
ØClorox Disinfecting Wipes
ØClorox Commercial Solutions® Clorox® Disinfecting Spray
ØLysol brand Heavy-Duty Cleaner Disinfectant Concentrate
ØLysol Disinfectant Max Cover Mist
ØLysol brand Clean & Fresh Multi-Surface Cleaner
ØPurell Professional Surface Disinfectant Wipes
ØSani-Prime Germicidal Spray

Role of Facemasks
ØOnly properly used N95 respirator masks can
guard you from the virus.
Ø The paper or polyurethane foam masks do not
filter out the smaller particles of the virus.
However, they may prevent the spread.
ØThe coronavirus can survive for up to 3 days on
a surface, depending on conditions.
ØIt is essential to change or clean masks
regularly and to wash your hands after.

Quarantine
ØQuarantine: The intentional separation of possible carriers of a disease to prevent
the healthy from becoming infected
ØHome quarantine is preferred- and Americans have been asked to self-quarantine.
ØTravellers from affected countries are being screened and evaluated.
ØAsymptomatic persons are monitored closely, the level of monitoring depends on
the origin of travel.
ØMany designated quarantine facilities will house people with a high likelihood of
exposure
ØIt is recommended to keep a minimum of a 6-foot space between oneself and
other people
ØMany cities have closed schools, colleges, concerts, mass gatherings, restaurants,
and malls.

CDC Guidelines
ØThe new CDC guidance recommends against holding any events or
group gatherings of 50 or more people across the U.S. for at least
the next eight weeks
ØSharing accurate information during such a time of concern is
critical as it negates the spread of misinformation.
ØDo not stigmatize people in quarantine.
ØDo not make assumptions about someone's health status based on
their ethnicity, race, or national origin.
ØThe CDC recommends getting a flu vaccine, taking everyday
preventive actions, and taking flu antivirals if prescribed

CDC Guidelines Cont.
ØOlder people and those with chronic immunological conditions should
take special precautions.
ØHealthcare providers: Be aware of people who recently travelled from
China or another affected area and who have symptoms associated with
COVID-19
ØIf you are a healthcare provider or a public health responder caring for a
COVID-19 patient, please follow the recommended infection control
procedures.
ØIf exposed to someone with COVID-19, and develop symptoms of COVID-
19, call your healthcare provider and explain the symptoms and possible
exposures.
ØCooperate with rules and limitations if you have recently travelled to
China or other affected countries.

Travel Advisory
ØVisit this website
Øhttps://wwwnc.cdc.gov/travel/destinations/list
ØOn January 30, China's travel advisory increased to level
4, recommending that Americans do not go there.
ØLevel 3 advisory in South Korea and a level 2 advisory in
Japan, Italy, and Iran.
ØLevel 1 advisory in Hong Kong.
ØTravellers are advised to reconsider trips to Asia.

Travel Advisory Cont.…
ØForeign nationals who traveled to China, Iran within the past 14 days
have been banned.
ØOn March 11, govt. restricts travel to the United States from foreign
nationals who have recently been in certain European countries.
Ø This does not apply to U.S. citizens or legal permanent residents.
ØU.S. citizens and lawful permanent residents will be permitted to return
from the European countries.
ØMany countries have banned all foreign national to their country
including IND for a month

Frequently Asked Questions-FAQ
What are good sources of information?
The Centers for Disease Control and Prevention website https://www.cdc.gov/coronavirus/2019-
ncov/index.html
Johns Hopkins website is http://coronavirus.jhu.edu
Should I be worried?
Ø Recent data suggests that most people only become mildly ill, ranging from fever, coughing, and aches
to minor pneumonia.
Ø Of 44,672 cases in China, 81% had mild symptoms, 13.8% were severely ill, and 4.7% were critically ill.
Ø The mortality rate is around 3-4%
Ø The virus may mutate, becoming more dangerous as it infects more people, which is why its
containment is vital.

Frequently Asked Questions-FAQ Cont…
What is the best course of action right now?
ØAs of March 13, 2020, the best way to deal with COVID-19 is to prevent the spread of the virus and
prevent its survival on surfaces.
ØTake any preventative actions necessary to keep you and those close to you safe and healthy.
How likely am I to catch COVID-19?
ØThe chance depends on where you are located and what people you are exposed to.
ØThe less you expose yourself to potentially infected people, the lower the chance.
ØIf immediate and drastic measures are not taken up to 40-50% of the population can
be affected since there is no vaccine yet.

Cont…
Is there anything I should not do?
Ø Be in contact with those infected with COVID-19
Ø Travel to heavily infected areas
Ø Touching your eyes, nose, and mouth
Ø Taking antibiotics
Ø Wearing multiple masks
Are there any places I should avoid?
ØTravelers should avoid travel to mainland China, South Korea, Italy, Japan, Iran, Spain, and other
affected countries.
Should I keep my child home from school?
ØIf your child is sick, you should keep them home to protect other kids. If they are not ill, then you
should monitor local closings and beware of potential infections.

Should I work from home?
ØYou should plan to work from home if possible and talk to employers about it
should the need arise. It is better to be prepared and stay cautious.
What should I do about my medications?
ØEnsure that you have a continuous supply of the medications to avoid running out.
What if I have to go to the doctor?
ØTalk to your doctor before making an appointment and, if possible, make a phone or
video appointment.
Frequently Asked Questions-FAQ Cont.…

Do I need a facemask?
ØYou should only wear a facemask if you are sick, or if a health professional
recommends it. Masks are in short supply and are needed by healthcare workers.
Do face masks or surgical masks protect against COVID-19?
ØMasks can reduce transmission especially droplets but they do better job of
protecting others from becoming infected like healthcare professionals.
If I don’t need a mask, how do I avoid getting sick?
ØThere is no vaccine, so you should avoid being exposed to the virus and keep yourself
clean and hygienic..

What if someone in my household thinks they have the virus?
ØThe person should get tested as soon as possible and be in self-quarantine.
How can you tell the difference between the coronavirus and a cold or influenza (flu)?
ØThe symptoms of the two viruses are very similar and can be confused. The best way is to get
tested.
Who is most at risk?
ØPeople who have been in close contact with a confirmed case of the virus are at risk,
travellers to infected areas, and the elderly.
Are people contagious before they develop symptoms?
ØYes, people can transmit the disease before symptoms occur, which is
why social distancing is essential.
Cont.…

What should people do if they think they have been infected?
Ø They should call a healthcare profession and explain the symptoms.
What can individuals do to protect themselves?
ØIndividuals should adopt healthy habits such as washing hands, avoid touching the face, and covering
the mouth and nose in the event of a sneeze or cough.
Will warmer weather result in fewer cases?
ØIt is too early to predict the impact of weather on the novel coronavirus.
Should people avoid products from China?
ØThe virus would likely not survive the trip, making goods safe to touch, especially if
hands are washed regularly.

Why did public health authorities declare an emergency, and what does that mean?
ØHealth officials wish to keep the risk factor of the virus low, and this means that a vaccine is in
production, making it a top priority of scientists and other healthcare workers.
What does pandemic mean?
ØA pandemic is a term used to describe the outbreak of a new virus that quickly and
efficiently spreads to other countries around the world.
How do outbreaks usually end?
ØOutbreaks can eventually be controlled through strict public cooperation and the
creation of an antiviral or vaccine.

What is the risk of my child becoming sick with COVID-19?
ØChildren are generally at the same risk of becoming infected as anyone else, although
handwashing should be encouraged.
Are the symptoms of COVID-19 different in children than in adults?
ØNo, the symptoms are very similar. Be sure to talk to your child about how they feel
and ask if anything has changed.
Should children wear masks?
ØIf they are healthy, no, but if they are ill, then wearing a mask is recommended to
prevent the spread of the virus.

What is the best way to wash your hands properly?
ØWet hands with warm running water
ØApply enough soap to cover wet hands
ØScrub all surfaces of the hands – including the back of hands, between fingers and
under nails – for at least 20 seconds.
ØRinse thoroughly with running water
ØDry hands with a clean cloth or single-use towel
What should I do if my child has symptoms of COVID-19?
ØSeek medical attention if necessary, but remember that it is flu season.

What's the most critical thing we can do to protect our kids?
ØMake sure that they understand handwashing is not optional. They need to know how
important it is, and they need to know the best way to wash their hands too.
What do we do if the school is cancelled?
ØMany parents and caregivers will scramble for child care, flexibility and empathy will
help you through this. Remain calm and make sure your child is safe.

56
Thank you
Any Other Questions ?
tpadder@gmail.comEmail:
Tanveer A Padder MD

Everything you need to know about Corona Virus.

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