Coronavirus Pandemic Dr Julia Turner Senior Medical Technical

Coronavirus Pandemic Dr Julia Turner Senior Medical Technical Adviser: Care and Treatment 2 April 2020

Coronavirus family of viruses - SARS - MERS SARS: Severe acute respiratory syndrome SARS Co. V 2 virus COVID-19 disease 2

World Stats Source: worldometer, www. worldometers. info/coronavirus/#co untries Ø 1. 3 million cases Ø 74 000 deaths Ø 170 countries Wuhan, China 3

World Stats For todays stats check: worldometer: www. worldometers. info/ coronavirus/#countries 4% case fatality rate 4

South Africa 1655 cases 11 deaths

6 13 -Apr 12 -Apr 11 -Apr 10 -Apr 09 -Apr 08 -Apr 07 -Apr 06 -Apr 05 -Apr 04 -Apr 03 -Apr 02 -Apr 01 -Apr 31 -Mar 30 -Mar http: //www. nicd. ac. za/disea ses-a-z-index/covid-19/covid -19 -situational-reports/ For daily SA stats visit the NICD website: 29 -Mar 28 -Mar 27 -Mar 26 -Mar 25 -Mar 24 -Mar 23 -Mar 22 -Mar 21 -Mar 20 -Mar 19 -Mar 18 -Mar South Africa Cases South Africa

How can you get coronavirus? Dr Julia Turner Senior Medical Technical Adviser: Care and Treatment 2 April 2020

How does SARS-Co. V 2 spread? coughs sneezes Respiratory droplets speaks The virus can transmit even when someone does not have symptoms Faecal oral transmission? 8 Mother to child

9

How many people can be infected by 1 person? 10

How quickly do you get sick? 2 days 5 days 14 days Self-quarantine for 14 days 11 27 days

How do you know if you have coronavirus? Dr Julia Turner Senior Medical Technical Adviser: Care and Treatment 2 April 2020

What symptoms to look out for? 44 -98% 46 -82% 3 -31% May also have: body aches & fatigue (11 -52%), loss of appetite (40%), sputum production (27%), headache, sore throat or diarrhea https: //www. hopkinsmedicine. org/health/conditions-and-diseases/coronavirus-facts-infographic https: //www. cdc. gov/coronavirus/2019 -ncov/hcp/clinical-guidance-management-patients. html 13

TASTE SMELL 14

What is a fever? https: //www. hopkinsmedicine. org/health/conditions-anddiseases/coronavirus-facts-infographic https: //www. cdc. gov/coronavirus/2019 -ncov/hcp/clinical-guidance-managementpatients. html 15

Upper Respiratory tract Upper and Lower Respiratory tract cold Blocked/ runny nose Sneezing Sore throat flu COVID 19 Cough Difficulty breathing SMELL TASTE 16

WARNING 17

How do they test? nasopharyngeal swab oropharyngeal swab Sputum sample Blood test 18

Who should be tested in SA? Symptoms: cough, fever, difficulty breathing etc. ? + In the last 14 days: • A known contact OR • travel OR • Health care worker OR • In hospital with severe pneumonia 19

What is the definition of a contact? Work closely together Live together Cared for someone without PPE Travelled together 15 min within 1 m from someone 20

What happens if you test positive for Coronavirus? Dr Julia Turner Senior Medical Technical Adviser: Care and Treatment 2 April 2020

What happens to the person with COVID-19 Isolation Home Hospital

100 people with COVID-19

40%

40%

40% 15%

40% 15% 5%

WARNING 28

Who are most likely to die from Coronavirus Dr Julia Turner Senior Medical Technical Adviser: Care and Treatment 2 April 2020

Who gets more severely ill? Mortality by age, Wuhan, China. (11 Feb 2020) (among 44, 672 confirmed cases) 1 in 500 1 in 250 Much higher risk of dying if > 50 years old 1 in 76 1 in 27 1 in 12 1 in 6 30

Who gets more severely ill? UNDERLYING MEDICAL CONDITIONS Hypertension OF TB COVID-19 IN CHINA HIV malnutrition Diabetes Heart Immuno. Lung disease Liver Kidney deficiency disease 19230 Confirmed cases with detailed epidemiological investigation information 31 China CDC/NHC 2020

HIV and COVID-19 in South Africa 7. 7 mill people with HIV 5 mill people on ARVs 2. 7 mill people not on ARVs Clinic VL<50 and CD 4 increasing Most likely no increased risk of severe COVID-19 VL>1000 and CD 4 low Test Do not know they have HIV Restart Stopped taking their ARVs Get flu vaccine Risk of severe COVID-19

HIV and COVID-19 in South Africa • Maybe some good news? • Report from Dr Josep Llibre in Spain • In Spain, we have sadly surpassed 100, 000 cases of COVID-19 at the time of this writing (April 1, 2020), with a mortality rate of 8. 9% among those diagnosed. Quite unexpectedly, we have seen that PLWH are not at increased risk of acquiring COVID-19 or of progressing to acute respiratory distress syndrome (ARDS) once infected, even if they have unsuppressed viral loads or low CD 4 count. For reasons that are as yet unknown, it appears that their risk may even be lower than that of the general population. • This is a report , not a study so we need more data • But we can be cautiously hopeful • Still make sure that all our HIV patients are well controlled • In SA we are in a position to generate the data

TB and COVID-19 in South Africa +/- 250 000 people get TB every year (higher chance if HIV+) If you have a TB contact, cough, fever, night sweats, loss of appetite, loss of weight, come to the clinic If you are HIV+ and haven’t had TB prevention treatment, come to the clinic to start TPT.

People with chronic illnesses Get your sugar and BP stable Take your medicine Take precautions

Pregnant women and babies No increased maternal mortality No mother to child transmission

WARNING 37

What should South Africans do to protect themselves from coronavirus? 2 April 2020 Dr Julia Turner Senior Medical Technical Adviser: Care and Treatment

Prevention? coughs Stay away from people, especially people with Respiratory droplets cough or fever sneezes speaks Clean surfaces you have to touch Wash hands regularly Don’t share utensils

Hand Washing 20 seconds Or hand sanitizer – 70% alcohol

Masks

Medical Masks • Global shortage of Medical Masks • Need to save them for health care workers • WHO has said that only sick patients who are coughing (and health care workers) should wear medical masks • N 95 masks are only used by health care workers performing aerosol generating procedures (e. g. taking nasopharyngeal and oropharyngeal swabs to test for COVID-19)

How long should a mask be used? • This is very controversial and dependent on the supply of masks. • When masks are in short supply we do wear them for longer than ideal. • Medical/surgical masks can be worn till the end of a shift unless damp, torn or contaminated • N 95 masks up to 1 week unless damaged, wet or soiled To Note:

N 95

Gloves

Gloves • • Not recommended for general public Viruses stick to gloves and can still be carried to mouth nose eyes Can still get dirty and transmit spread from one surface to another Generally only recommended for health care workers in certain settings. They have to be changed in between patients and hands must be washed as they are not 100% protective

Physical Distancing 1. 5 m

Physical distancing flattens the curve

Graphic from Washington Post: https: //www. washingtonpost. com/health/2020/03/10/social-distancing-coronavirus/. Data from: Hatchett RJ, Mecher CE, Lipsitch M. Proc Natl Acad Sci U S A. 2007 May 1; 104(18): 7582 -7

Vaccines and Treatment

Health Care in South Africa • Government • NICD: National Institute of Communicable diseases • Department of Health

Stigma • Seems to be a South African phenomenon like HIV • Seen as rich white persons disease • Two approaches – secrecy – Public messages • Will need to start with both approaches • Need to try and do testing privately if violence is a possibility • We need to have a big public campaign to destigmatise it

• • Practice physical distancing Look after your own health Protect the elderly and people with other illnesses Take all preventative measures to decrease transmission by washing hands and surfaces, and staying away from other people as much as possible If you develop a fever or a cough, stay at home, don’t panic, call the national hotline number to advise you whether you need to go to the clinic for testing or not. If you become short of breath or are having any trouble breathing, come to your nearest hospital immediately Support one another, be positive, kind and caring. Share accurate information from reliable health organisations such as department of health, WHO, CDC and USAID

Together we can do this SA National Tollfree hotline: 0800 029 999 • www. sacoronavirus. co. za • http: //www. nicd. ac. za/what-is-the-coronavirus/ • www. who. int/emergencies/diseases/novelcoronavirus-2019/advice-for-public

Acknowledgements • • • • President Cyril Ramaphosa South African National Department of Health NICD including Lynn Morris Dr Anthony Fauci, NIH Dr Brooks, CDC Caveat: New information is being Dr Roberto Cosentini published all the time, I have done my Right to Care best to assess the data available at the WHO moment, however there is always a USAID possibility that I may have missed some PEPFAR new data. John Hopkins Ferguson, N. M. et al www. worldometers. info/coronavirus/#countries Tomas Pueyo and Journal of the American Medical Association Chinese Handbook for COVID-19 All the health care workers in SA