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How to handle potential cases of infection with the new Coronavirus


Attention! The information in this document may be modified periodically, depending on the news related to the pathology.

The new COVID-19 strain of coronavirus that has generated this latest wave of diseases is part of the Coronoviridae Family, common zoonotic viruses among animals, but which can also spread to humans. However, pets are not considered sources of disease, at the moment.

Among the common symptoms of the new Coronavirus strain infection there are:

  • High fever
  • Coughing
  • Breathing difficulties
  • Stuffy nose
  • Rhinorrhea (runny nose)
  • Throat aches
  • Head aches
  • Fatigue

As in the case of influenza, the clinical evolution can be aggravated by the patient's immunity status: age, immunosuppressed patients or patients suffering from conditions that affect their immunity.

Infection is transmitted:

  • By air (inhalation of infectious micro-particles emitted by coughing, sneezing or perhaps even when discussing with the infected person)
  • By unprotected personal contact with an infected person (touching, shaking hands)
  • By contact with contaminated surfaces, then touching the nose or mouth with infected hands
  • By kissing

The following categories of people are considered suspected of infection with the new coronavirus:

  • People showing signs of severe respiratory infection, associated with high fever (over 38 degrees C), coughing and respiratory difficulties

and

  • People who have traveled to areas with epidemic risk during the last 14 days or who have come into contact with a person diagnosed / suspected of being infected with COVID-19

Testing is necessary for people:

  • With a fever of at least 38 degrees C or history of fever and coughing and dyspnea, requiring overnight admission and without other etiology to fully explain the clinical overview
  • With an acute respiratory disease with any degree of severity, who within 14 days before the onset have had close physical contact with a confirmed case of infection with COVID-19, if the patient is symptomatic or has had a history of travelling to areas with extended community transmission within 14 days before the onset of symptoms in at least one of the:
    • 4 provinces in China affected so far (Hubei - Wuhan City, Guangdong Sheng, Beijing Shi, Shanghai Shi)
    • Italy: the whole country
    • South Korea: Cheongdo County (Daegu City) and other areas of South Korea
    • Iran - the whole country
    • Germany: Heinsberg district of North Rhine-Westphalia, Baden Wurttemberg region, Bayern region
    • France: Hauts de France region, Ile de France region, Grand Est region, Bourgogne France Comte region, Auvergne Rhones Alpes region
    • Spain: Madrid region

The sampling for testing is performed only in the infectious disease hospital designated by the Ministry of Health (Institute for Infectious Diseases "Matei Bals"), where the suspected cases are isolated.

The first suspected cases - managed by “Matei Bals” Institute for Infectious Diseases

According to the methodology of managing the suspected cases, because the first 10 suspected cases detected in Romania will be isolated at the "Prof. Dr. Matei Bals" Institute for Infectious Diseases, the samples collected from them will be investigated in the molecular biology laboratory within this institute, for detecting COVID-19. The required level of biosecurity is BSL 2. Subsequent cases will be directed to one of the hospitals for infectious diseases designated by the Ministry of Health, and the samples will be investigated in the hospital's laboratory. For this purpose, the laboratory must be equipped with the necessary reagents.

The laboratory personnel must strictly observe the precautions necessary to prevent diseases with COVID-19.

People with symptoms similar to the infection with the new coronavirus, who have traveled during the last 14 days to areas with outbreaks of infection, should go to the infectious diseases hospitals designated by the commission of the Ministry of Health to receive and provide care to patients with suspected / probable/ confirmed infection with COVID-19: "Prof. Dr. Matei Bals" Institute for Infectious Diseases in Bucharest, „Victor Babes” Clinical Hospital for Infectious and Tropical Diseases  in Bucharest, Clinical Hospital for Infectious Diseases in Cluj, Clinical Hospital for Infectious Diseases in Constanta, Clinical Hospital for Infectious Diseases in Iasi, Clinical Hospital for Infectious Diseases and Pneumophtisiology in Timisoara.

When a person becomes symptomatic and goes to the doctor (primary care doctors), his/hers obligation, if he/she has a suspected case, is to immediately isolate the patient and apply a mask on his nose and mouth and send him/her immediately, by ambulance, to the nearest infectious diseases hospital designated by the commission of the Ministry of Health to receive and provide care to patients with suspected / probable/ confirmed infection with COVID-19 (see the above list). 

People suspected of being infected with the new coronavirus, who have traveled to regions with outbreaks of infection, are encouraged to get in touch with their family doctor within the first 24 hours after the start of the isolation period, to obtain medical leave for that period.

Close contact is defined as the contact with: 

  • The person living in the same household with a patient with COVID-19;
  • The person who has had direct physical contact with a case of COVID-19 (e.g. hand shaking not followed by hand hygiene);
  • The person who has had unprotected direct contact with the infectious secretions of a case of COVID-19 (e.g. during coughing, touching handkerchiefs with an unprotected hand);
  • The person who has had face-to-face contact with a case of COVID-19 at a distance of less than 2 m and for a duration of over 15 minutes;
  • The person who has been in the same room (e.g. classroom, meeting room, hospital waiting room) with a case of COVID-19, for at least 15 minutes and at a distance of less than 2 m;
  • The person among the medical-sanitary personnel or another person who provides direct care to a patient with COVID-19 or a person among the laboratory personnel who handles samples collected from a patient with COVID-19, without the correct wearing of protective equipment; 
  • The person who has had contact in the plane with a case of COVID-19 and who has stayed on one of the 2 lines in any direction from the case: persons who have traveled with a patient or who have provided care in the plane, crew members who have served in the area where the patient was. If the severity of symptoms or the displacement of the case inside the plane indicates a larger exposure, close contacts will be considered all the passengers in the respective area of the plane or even all the passengers in the plane. 
  • Considering the new confirmed outbreaks, the above recommendation can also be applied for public transport (coaches / minibuses).

Measures for people receiving packages from the affected areas

Currently, there is limited information regarding the transmission and resistance in the environment of the new coronavirus. It is assumed that the virus is transmitted predominantly through drops of respiratory secretions (during sneezing, coughing). It has been observed that this virus requires close contact for inter-human transmission, but the possibility of transmission by contact with surfaces / objects that have been contaminated with respiratory secretions coming from an infected person is not excluded. However, given the low resistance of coronaviruses in the environment, as they are fragile viruses, it is assumed that, even in the case of the new coronavirus, it is very unlikely for it to be transmitted via international packages (via plane or by sea), taking into account the long processing and transport time.

Potential complications of the infection with the new coronavirus are:

  • Middle East Respiratory Syndrome (MERS-CoV)
  • Severe Acute Respiratory Syndrome (SARS-CoV);
  • Pneumonia - it does not respond to the standard antibiotic treatment
  • Premature birth, miscarriage, complications or death at birth.

What should people who suspect an infection with coronavirus do?

WHEN THERE IS A MEDICAL PROBLEM, WE ALWAYS MUST ADDRESS THE FAMILY DOCTOR. He / She has the competence to make a correct evaluation, after which the appropriate medical conduct will be established.

Currently, there is no specific treatment for the infection with the new coronavirus, the recommended treatment being only a symptomatic one. For this reason, prevention is the only way we can defend ourselves from the spread of the new coronavirus.

Prevention measures

Prevention measures against the infection with the new coronavirus and those that limit the spread of the virus should be taken by everyone, especially by the sick persons, whether they are diagnosed with this viral subtype or have clinical manifestations similar to the above. These protective measures are similar to those taken in the case of influenza, namely:

  • Avoiding urban agglomerations
  • Avoiding coughing and sneezing in the palms, preferring the bend of the elbow, and, if it is not possible, immediately performing hand hygiene, without touching the surfaces
  • Using a handkerchief for sneezing does not exclude hand washing after throwing it to the trash can
  • Avoiding the contact with people who show signs of infection
  • Avoiding outgoing in the community by the persons who show signs of disease
  • Proper ventilation of closed spaces (waiting rooms, classrooms, public transport, conference rooms, lounges, etc.)
  • Avoiding travelling to the affected areas
  • Proper ventilation of office buildings that have open space structure or common workspaces.
  • Proper wearing of protective mask during short intervals of time when there is a risk of contamination

PROTECTIVE MASKS ARE SINGLE-USE!

If you show respiratory symptoms and / or fever, for the proper wearing of mask you must follow the following instructions:

  • The mask must be applied by covering the airways, connected with the upper strings at the top of the head, and the lower strings near the cervical area
  • The metallic edge included in the upper part must be fixed as high as possible on the nose without obstructing the sight
  • The mask must be removed by undoing the strings and not by handling it by contact with the front part. As soon as it is removed, hand hygiene should be performed, by using water and soap.  
  • Protective masks with elastic instead of string will be removed by using the same technique.
  • Should wear masks people who have symptoms and people who provide medical care to sick people.

Additional and daily updated information may be found on the official website of the National Institute of Public Health in Romania at the web address http://www.cnscbt.ro/index.php/ncov.

Dr. Alexandra Constantin – Senior Doctor Care Specialist and Dr. Gabriel Gurguta – infectious diseases specialist

Sources:

www.ms.ro
www.cnscbt.ro
www.cdc.gov, Outbreak Notification 
www.who.int, 2019 Novel Coronavirus 
www.worldmeters.info (Novel Coronavirus situation reports 
National Health Commission (NHC) of the People’s Republic of China Novel coronavirus - Australian Government Department of Health)