Dr (Brig) Rakesh Gupta - gims.ac.in overview.GB Nagar.pdf · Major Public Health problem GB Nagar...
Transcript of Dr (Brig) Rakesh Gupta - gims.ac.in overview.GB Nagar.pdf · Major Public Health problem GB Nagar...
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Dr (Brig) Rakesh GuptaDirector
Government Institute of Medical Sciences
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➢Major Public Health problem
➢GB Nagar is a Hot spot - Large no of cases
➢Need to complement you all - Noida 1st Spot-→ 5th Spot
➢Lock down has controlled the disease, temporarily,
but no guarantee for future . It has given enough time
for preparedness. We must act
➢ We have to live with covid-19 as the virus is going to
stay
➢ Concern for infection for HCW
➢Noida has huge potential – infrastructure, no of
hospitals (Public/Private/Medical college)
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➢To fight the Covid effectively & Efficiently
WITHOUT compromising with Patient
Care and WITHOUT compromising the
interest of Health care professionals
(Prevention of infection in HCW)
We all have to work together as a Team
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COVID-19
•Corona virus is a common microorganism which causes infections of Resp system.
•Enveloped RNA viruses which are distributed among human, animals as well as birds.
•Four types Alpha, Beta, Gamma, Delta.
•2019-nCoV (Now called COVID-19) which falls into genus Beta coronavirus.
•On December 31, 2019 China reported a cluster of cases of Pneumonia from Wuhan associated with seafood.
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Covid is not New
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Mortality in India is 0.7 Deaths per million population
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All age groups are at risk
At High risk : Older persons
Persons with pre-existing medical conditions (High blood pressure, Heart disease, Lung disease, Cancer or Diabetes
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VIABILITY PERIOD OF VIRUSES(REF:March 17, 2020, at NEJM.org)
SURFACE VIABILITY PERIOD
Aerosols 3 hours
Copper 4 hours
Cardboard 24 hours
Stainless steel 48 hours
Plastics 72 hours
Water and Sewage Weeks
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❑ People 65 years and older
❑ People of all ages with underlying medical conditions, particularly if not well controlled, including:
Chronic lung disease (Asthma,Cystic Fibrosis,COPD)
Chronic Heart Diseases
Immunocompromised Individuals
Malignancy
Diabetes,Chronic smokers,Drug abusers
Severe obesity (body mass index [BMI] of 40 or higher)
People with chronic kidney disease undergoing dialysis
People with chronic liver diseases
REF:National centre for Immunization and Respiratory diseases(NCIRD),CDC
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CLINICAL FEATURES
• Incubation period -2-14 days.
•About 25% patients with COVID -19 may remain asymptomatic , however they may be carrier and may spread the disease to others.
• Symptomatic patients present with mild symptoms(81%),moderate to severe symptoms(14%) and with critical illness(5%)
•MOHFW has recently introduced the term Severe Acute Respiratory Illness (SARI),which has been defined as
• “An ARI with history of fever or measured temperature ≥38 C° and cough onset within the last ~10 days; and requiring hospitalization.”
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Complications Of COVID-19 Infection
•Respiratory Complications:❖ Acute Respiratory Distress Syndrome❖ Pneumonia
•Non-Respiratory Complications:❖ Septic Shock❖ Acute Kidney Injury❖ Disseminated Intravascular Coagulation❖ Rhabdomyolysis❖ Acute Cardiac Injury: Fulminant Myocarditis and
ArrythmiaNEJM-Feb;2020: Clinical Characteristics Of CoronaVirus disease 2019,China
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DIAGNOSIS
• Nasopharygeal/oropharyngeal swab
• Sputum
•Broncho alveolar lavage (BAL)
(BAL should be restricted to mechanically ventilated patients as BAL sample remains positive for extended period)
•Sample storage: The samples require storage at 2-80 C
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SOURCE: JAMA
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TIMELINE OF COVID 19 INFECTION(LAB WISE)
• Day 0: infected
• Upto Day 5: Onset of symptoms
• Day 7: IgM positive (D7- D 21)
• Day 14: IgG positive
• Days 1-28: SARS CoV2 RNA & Antigens will be positive
• Day 21: IgM disappears
• Day 28: SARS CoV2 RNA & Antigens disappear
• D0 - D5: ASYPMPTOMATIC PHASE
• D0 -D7: WINDOW PERIOD (ONLY PCR IS POSITIVE IN THIS PHASE)
• D 14- D21: DECLINE PHASE (STILL INFECTIVE)
• D 21- D28: CONVALESCENCE PHASE (may be STILL INFECTIVE)
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➢ All Hospital must assist in Covid care
➢ Hospital check List of 114 points
➢ Flu corner ( Cough/Fever OPD)
➢ Strict screening protocol
➢ Micromanagement of emergency
➢ Isolation of suspected cases and Immediate
testing
➢ Barrier nursing - Physical barriers / Face shields
/ Social distancing
➢ If Positive – Transfer to Covid care center
➢ Availability of PPE and protective equipments
➢ Training at all levels / PPEs
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➢ Hospital Management
➢ Infection control & Prevention policy
➢ Housekeeping policy
➢ Dead body protocol
➢ Contingency plan
➢ Procurement Policy
➢ BMW management policy
➢ Discharge policy
➢ Sample collection & Testing Policy
➢ Blood Transfusion & Biosafety
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Flu Corner
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Quarantine versus Isolation • Isolation refers to separation of individuals who are ill and suspected
or confirmed to have COVID-19 infection.
• Quarantine refers to separation of individuals who are not yet ill but have been exposed to COVID-19 and therefore have a potential to become ill.
• Quarantine should be done for 2 weeks(Institutional/Home)
Purpose of quarantine is to reduce transmission by
• Separating contacts of COVID-19 patients from community
• Monitoring contacts for development of sign and symptoms of COVID-19
• Segregation of COVID-19 suspects, as early as possible from among other quarantined persons
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➢ Social distancing
➢ Masking
➢ Hand washing and hygiene
➢ Respiratory hygiene and cough etiquettes
➢ Self Discipline
➢ Arogya Setu app
➢ Telemedicine
➢ Soft skills/ communication, while dealing with
patients
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Priority I- Hospitalized patients ( Covid+ / suspect covid)
and symptomatic health care workers / Moderately
symptomatic patients (ILI/SARI)
Priority II- People at high risk of complications who also
have symptoms, including people in long-term care facilities,
people ages 65 and older, people with underlying conditions
/Imminent surgery/Pregnancy in labour
Priority III – First / immediate contacts ( close family
members) /quarantine ( Day 5to 14)
Priority IV- Critical infrastructure workers, health care
workers and first responders without symptoms
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Patient (Flue OPD/Contact / Hotspot)
Asymptomatic Symptomatic
Send to GalgotiaUniv (900) Eng college(300)
Home Quarantine Isolation beds for COVID 19+
GIMS (20)/Sharda(150)SSPH (20)- if child
Mild Moderate Severe
KailashIsolation ward for Covid suspect
District Hospital (100) Negative PositivePositive
Positive
Home Quarantine
Negative
Negative
Home Quarantine
Sampling
Patient Flow Algorithm
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District Health Society
• District Magistrate
• CMO
• Helpline Contact No:
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Thank you