Dr. Joe P Bryan_04-10- 2020

Coronavirus Infections

Joe P. Bryan, MD
Fellow, Infectious Diseases Society of America

Number and Types of Influenza Virus Lab Test
Positive, 2019-2020, USA

Outpatient Influenza-Like Activity, week ending
Feb. 29 and Mar 21, 2020 reflecting COVID19 visits

Influenza, Oklahoma Hospitalizations
2019-2020 - Blaine 10*
- Caddo 39*
Week ending 4 April - Custer 13
2020 - Canadian 94
- Beckham
• Influenza Hospitalization – 3455
• Hospitalizations last week - 17 *>100/100,000
• Deaths from Influenza - 83

Influenza Vaccine Coverage

Influenza Vaccine Coverage by Age, IHS, 2010-18

Human Coronavirus Infections/Outbreaks

• Long considered inconsequential, a cause of common cold
• 2002 Coronavirus Severe Acute Respiratory Syndrome (SARS-CoV)

• 8098 individuals were infected and 774 died world-wide.
• Pandemic cost the global economy an estimated $30 billion to $100 billion.
• SARS-CoV demonstrated that animal CoVs (bats and civet cats) could jump the

species barrier

• 2012 Middle East Respiratory Syndrome coronavirus (MERS-CoV)

• By November 2019, MERS-CoV has caused a total of 2494 cases and 858
deaths, the majority in Saudi Arabia.

• Bats are reservoir but camels may be involved

• 2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, China

JAMA. Published online January 23, 2020. doi:10.1001/jama.2020.07

International Spread of SARS CoV, 2002-2003

• Severe atypical pneumonia described in Guangdong Province, China,
causing worldwide concern as disease spread via international travel to
more than 2 dozen countries.

• 90% of Cases were reported from China, Taiwan, Hong Kong, Singapore, and Toronto,
Canada

• Human-to-human transmission was documented, mostly in health care
settings.

• Predominant human receptor for the SARS is found primarily in the lower
respiratory tract, rather than in the upper airway.

• Peak shedding of virus is 10 days into illness
• Intubations and other aerosolizing procedures put health care workers at

risk

JAMA. Published online January 23, 2020. doi:10.1001/jama.2020.07

Chain of Transmission from Hotel Metropole
SARS-CoV, 2003

MMWR March 28, 2003 / 52(12);241-248

N -51 MMWR March 28, 2003 / 52(12);241-248

Severe Acute Respiratory Syndrome, Toronto,
2003

Case distribution and Case fatality by Age
Group, SARS, Toronto, 2003

Medical Professionals Who Died of SARS

• At least 39 medical professionals died of SARS in 2003 Worldwide
• The first was Carlo Urbani of WHO who was investigating the

outbreak in Hanoi, Vietnam, March 23, 2003
• The last was a family physician in Toronto, Canada who died of

complications of SARS in August 2003.

Lessons Learned from 2002-2003 SARS (and
anthrax attacks of 2001)

• The US Quarantine systems, which had been depleted from over 50 sites to
8 because it was thought the era of Infectious Diseases had passed

• Quarantine system for air, sea and land was strengthened to 20 sites

• 2005 International Health Regulations

• World Health Organization developed agreement/document

• Previously, countries only had to report plague and cholera
• Now have to report any outbreak of potential international concern
• Each country has an IHR contact: For US, it is Director of CDC, Robert Redfield

• National Public Health Lab System developed with over 50 labs capable of
specialized diagnostics

• Strategic National Stockpile system developed with warehouses (secret)
strategically placed

• Current name dates from March 2003

2019-nCoV

• December 31, 2019, Chinese authorities reported a cluster of atypical
pneumonia cases in Wuhan, China,

• most patients reported exposure to a large seafood market selling many
species of live animals.

• January 10, 2020, researchers from the Shanghai Public Health
Clinical Center & School of Public Health and their collaborators
released a full genomic sequence of 2019-nCoV to public databases

• Human-to-human transmission of 2019-nCoV occurs, as evidenced by
the infection of 15 health care practitioners in a Wuhan hospital.

Fauci et al JAMA. Published online January 23, 2020. doi:10.1001/jama.2020.07

Persons at High Risk for Severe Disease

• Persons ≥ 65 year of age
• Persons in nursing homes and long-term care facilities
• People of all ages with underlying medical conditions, particularly if not well controlled, including:
• People with chronic lung disease or moderate to severe asthma
• People who have serious heart conditions
• People who are immunocompromised

• Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking,
bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged
use of corticosteroids and other immune weakening medications

• People with severe obesity (body mass index [BMI] of 40 or higher)
• People with diabetes
• People with chronic kidney disease undergoing dialysis
• People with liver disease

States Reporting Cases of COVID-19 April 9,
2020

16 States with >5000 cases

COVID-19 Cases by Indian Health Service by
Area (April 8)

CoVID-19 OK 9 April

Preventive Measures

• Avoid becoming a contact of infectious persons

• Stay home, Avoid Public transport and taxis
• Stay apart at least 6 feet to avoid respiratory droplets from others
• Wash hands frequently with soap for 20 seconds; if not available use alcohol

gel for 15 seconds with at least 60% alcohol
• Clean and disinfect surfaces, including eating utensils
• Avoid touching face, especially eyes, nose and mouth
• Do not visit hospitals or clinics or ill persons unneccesarily
• If you are out, wear a simple mask to catch droplets and virus that may come

out when you are breathing, talking, singing

CDC. Steps to help Prevent the spread of COVID-10 if you are sick

Preventing spread to others if you are ill

• How to prevent spread to others if you are infectious (pre-
symptomatic, mildly symptomatic, ill

• Same as above, but wear a mask to prevent spread of droplets
• Sneeze or cough into sleeve or into tissue, then dispose
• Monitor your symptoms and stay in touch with your doctor

• If you develop emergency warning signs, get medical help immediately

• Trouble Breathing
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

https://www.cdc.gov/coronavirus/2019-ncov/pCrDevCe. nStt-egpetsttinogh-seilcpk/Pcrleevaennintgt-hdeissipnrfeecatdi of COVID-10 if you are sick

Clean and Disinfect

• Cleaning refers to the removal of germs, dirt, and impurities from surfaces. It
does not kill germs, but lowers their numbers and the risk of spreading infection.

• Clean all “high-touch” surfaces every day (door knobs, light switches, remote
• Disinfecting refers to using chemicals, for example, EPA-registered disinfectants,

to kill germs on surfaces. This process does not necessarily clean dirty surfaces or
remove germs, but by killing germs on a surface after cleaning, it can further
lower the risk of spreading infection.
• Environmental Protection Agency lists 126 products labeled to inactivate human
coronaviruses https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
• Make a simple disinfecting solution carefully mixing 1/3 cup of household bleach
in one gallon of water; or 4 teaspoons of bleach/quart of water

• Leave wet for 5 minutes

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html

Laundry

• Wear disposable gloves, or immediately wash hands after handling
• Do not shake dirty laundry
• Launder items according to manufacturers instructions using the

warmest appropriate water setting.
• Dry completely
• Dirty laundry from an infected person can be washed with other

clothing
• Clean the laundry hamper (Wash if cloth; Clean and disinfect if other

CDC.gov

Discontinuation of home isolation if ill

• If you will not have a lab test for COVID-19

• No fever for 72 hours without use of meds for fever
• Other symptoms have improved
• At least 7 days have passed since your symptoms began

• If you will be tested to determine if you are still contagious

• You no longer have a fever without the use of medicines to reduce fevers
• Other symptoms have improved (cough, shortness of breath)
• Two negative tests in a row, 24 hours apart

• Do in concert with your local health care provider and local and state
health authorities

• They will want to change your health status of outbreak

CDC. Steps to help Prevent the spread of COVID-10 if you are sick

Twelve things to do to avoid Respiratory Tract
Infections

• Don’t smoke tobacco or other substances nor abuse alcohol
• Loose weight if obese
• Control diabetes
• Control hypertension
• Avoid crowds of more than 10 people, nursing homes, cruise ships, hospitals
• Maintain at least 6 feet from others
• Wash your hands frequently
• Eat a balanced nutritious diet
• Stay hydrated so respiratory mucosa can best protect us
• Clean and wipe down then disinfect surfaces
• Get sufficient rest to maintain your immune system
• Get your influenza vaccine every year and your pneumococcal vaccine as indicated

The Future

• Over 400 clinical trials for therapies now listed at
www.clinicaltrials.gov

• Vaccine trials starting including here in Oklahoma
• Let’s keep working to eliminate to get to Zero as in 2003 for SARS and

for Ebola in West Africa in 2015