China coronavirus: cases surge as official admits human to human transmissionBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m236 (Published 20 January 2020) Cite this as: BMJ 2020;368:m236
All rapid responses
Dynamics on Transmission of COVID-19 - Take home message for Health Care providers and Policy Makers
Currently there is no known cure identified for clinical management of COVID-19; in this condition the next ultimate goal of health care providers (HCP) is to focus on preventive measures. The scientific outcome elaborates that human coronaviruses can survive up to nine days in the pathogenic form after expulsion. The average expected reproductive number of virus spread by individual was considered to be 2.2, which indicates that each infected case has a high possibility of transmission to another two people .
Regulatory authorities emphasize more the use of N95 respirator masks in preventing droplet infection but the efficiency (300nm as recommended)  of such masks is under potential threat due to its limitation in filtering aerosol viral particles between 80-120 nm . Masks for toddlers and children below 5 years old have not been approved. On the other hand, proper education on personal protective equipment (PPE) has to be imparted to the general public, including the geriatric population who are at high risk of exposure and infection.
Contaminated N95 mask is considered to be potential medical waste hence a proper biomedical waste management program has to be adopted to prevent the recurrent spread of virus through surface contamination. Engagement of dedicated resources in the process of knowledge sharing on safe usage and disposal of N-95 masks in clinics will in turn reduce the incidence of new infection. Policy makers may think of placing exclusive mask disposable hoods fitted with HEPA filters, which can logically perform well in reducing the contamination.
Fecal oral contamination - Apart from aerosol droplet infection, viral transmission is also achieved effectively through fecal oral contamination . Studies indicate a paradigm shift of swab viral load from oral positive (earlier phase) to anal positive (later phase) in infected patients. In this context, contamination may be controlled by maintaining a proper level of sanitation and with disinfection procedures. Research has proven that a combination of ethanol and hydrogen peroxide or sodium hypochlorite can effectively degrade the viral proteins.
Temperature and humidity favors the life span of atmospheric virons. Studies have proven that a decrease in air temperature increases spreadability . Demography data issued by the WHO between 22 January to 20 February 2020 indicates that total infected cases have shown a huge marginal increase from 278 to 74,675 in China and 314 to 75,748 globally . It might also be one of the reasons that the temperature in the severely affected regions helped in transmission between Jan to Feb 2020. Hospitals may think of propagating hot water hand sanitation programs along with conventional sterilization. Warm air blowers and heaters in rooms may also considerably reduce the viral load.
Doctor’ stress – A potential risk factor
Managing the stress level of health care workers is equally import in providing the quality of care to patients. Nurses priorities top the stress level scale among other health care providers: it seems like 39% of those in intensive care exhibit posttraumatic stress disorder . Extended work hours, continuous clinical interventions, restlessness, inadequate quality time with family members make clinicians and professionals of healthcare sectors more prone to the condition called burnout--a kind of emotional exhaustion with reduced interest and attention towards work. Deep breath meditation and periodic counselling led by a psychologist may help to manage the stress related burnouts and also minimize the chances of medication and decision making errors [8,9].
Take home message for Clinicians and other HCPs
1. Impart knowledge to the public on proper usage and safe disposal of face masks
2. Implementation of programs that regulate good biomedical waste management practice
3. Effective management of professional stress related burnout for dynamic decision making
4. Fruitful coordination with other health care professionals in providing quality care to infected patients
5. CME discussion among medical team to enrich the recent updated on therapeutic management of COVID-19
6. Sharing success stories with other clinicians to boost confidence level
Take home message for Policy Makers (health monitoring authorities)
It's highly appreciated if health monitoring authorities frame specific guidelines on emergency basis to address the following:
1. Facilitating mobile medicare units for handling the patients resident in homes
2. Installation of HEPA cabinet protected waste bins for mask and medical waste disposal
3. High standard on sanitation programs to avoid other possible routes of viral transmission (fecal oral)
4. Educating people on seeking medical care at earlier stage of disease
5. Promotion of medical textile policies in designing and manufacturing masks exclusively for toddlers and children of age less than 5 years
6. Development of a unique strategy to control infection rate and mortality index
In conclusion, services offered by clinicians and other health care professionals in managing historic crisis like COVID-19 seem remarkable as they risking their life in saving thousands of infected individuals. Hence at this stage a helping hand from paramedical staff, allied health professionals, general public, researchers and policy makers is likely to widen the scope of disease control and prevention.
The authors would like to thank the Indian Council of Medical Research (ICMR), Government of India, New Delhi, India.
Competing interests: The authors declare no competing interests.
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Competing interests: No competing interests