COVID-19 TRANSMISSION

Grupo Coordenador Local do Programa de Prevenção e Controlo de Infeções e de Resistência aos Antimicrobianos (GCL-PPCIRA)

Why can pathogenic droplets depending on room temperature and humidity, reach distances of 7-8 meters?

When we sneeze, we emit two types of droplets: large and small. The large ones fall to the ground faster than they evaporate, while the smaller ones are airborne and evaporate faster than they fall, forming a cloud in the environment. Currently, it is known that small droplets, when transited from respiratory system’s hot and humid conditions, to a cooler and drier environment, evaporate and form aerosols.

Recent investigation has shown that coughing and sneezing produce multiphase clouds of turbulent gas that enters the environment and carries clusters of droplets. The inside of the cloud remains hotter longer, allowing the droplets to escape evaporation for a longer period, increasing its life span and contagion.

Due to the advanced momentum of the cloud, the pathogenic droplets are propelled much further, and are able to travel 7-8 meters, depending on air temperature and humidity.

How long so the SARS-CoV 2 aerosols remain in the air?

On average they remain viable for 30 min.

Can objects (via fomites) effectively be a source of transmission?

A fomite is any inanimate object or substance capable of absorbing, retaining and transporting infectious organisms from one individual to another, after contact with aerosols or droplets.

Smooth (non-porous) surfaces transmit bacteria and viruses better than porous materials, as they absorb and trap the contagious agent, making it more difficult to contract through touch.

Examples of fomites: contaminated shoes, laryngoscopes, computer keyboard, mobile phone, cutlery, door handles, floor and walls.

What are the transmission routes of  SARS-CoV 2?

Respiratory secretions, feces and cases of sexual transmission (semen) have also been reported.

Is the viral load the same throughout the respiratory system?

The highest buildup of COVID-19 is found in the sputum and secretions of the upper airway.  

Hand hygiene, saves lives!

Always. But today more than ever …

Grupo Coordenador Local do Programa de Prevenção e Controlo de Infeções e de Resistência aos Antimicrobianos (GCL-PPCIRA)

Every year, on the 5th of May - World Hand Hygiene Day - is celebrated by the GCL-PPCIRA of the HPA Health Group.  We began with minimum local initiatives to raise awareness among professionals on the importance of hand hygiene, where we would welcome and reward the department that adhered most to this practice and, more recently, with further initiatives aimed at the community.

However, this year will be different. The world is different. Our units are different. We are all different. But the importance of hand hygiene in the prevention of infection has not changed. Perhaps what has changed is the way we all view its effectiveness. Now, we look at hand hygiene as a powerful and truly effective way in the prevention of cross-transmission. Now and always we realize the importance of continued hand hygiene. 

We know and feel how much anguish and uncertainty this pandemic has caused to us all. However, we also recognize that it has brought us something that for years the World Health Organization, the National Health Department, the Regional Coordinating Groups of PPCIRA, the Local Coordinating Groups of PPCIRA, tried, but never succeeded: real awareness of the importance of hand hygiene. Today we are all aware that WASHING HANDS SAVES LIVES!

Some patients with SARS-CoV-2 (COVID-19) have since the beginning of this pandemic, passed through our hospitals, fortunately not many. We believe that all the measures adopted by our professionals, of which we highlight hand hygiene, were essential in avoiding what could have been a catastrophe in our units: transmission of the virus to professionals or to other patients. Our SARS-CoV-2 cross infection rate is zero at the moment, and we are sure that good practices such as hand hygiene have contributed immensely towards this result.

These are some of the reasons why today we must emphasize the importance of this measure, that, being the simplest and the most economical, is also the most effective, in the prevention and control of infection.

Recomendations when leaving home confinement 

During the past few weeks we have had to learn to live differently.
A way of living that is likely to continue for a long time.

Do not neglect the advice that was requested of us from the first day: frequent and correct hand hygiene, breathing etiquette and social distancing.

When leaving home, add the following advice as well.

Make this a learning opportunity, we will all make a difference if we all take care.

Mandatory and correct use of surgical masks

The use of surgical masks in health units has become mandatory for everyone.  DGS also calls for people over the age of 65, with chronic diseases and / or immunosuppressive conditions  to wear surgical masks whenever they leave home.

Therefore, it is important to know their effectiveness and correct use.

Be rational in their consumption and be prudent in their use.

Learn how to protect yourself and others.

Masks and protection

Masks vary depending on their protective barrier both for the wearer and also for others.

Surgical masks cover the mouth and nose and act as a barrier minimizing the direct transmission of infectious agents between the wearer and others. The main purpose is to protect the health of others, while at the same time safeguarding the user.

Respirators or respiratory masks (Filtering Face Piece, FFP) are personal protective equipment for health professionals. They are commonly classified as P1, P2 and P3 (FFP1, FFP2 and FFP3) according to their filtration capacity.

Social masks have become common use in this context of the current pandemic, as they have become mandatory use in a community context. They are made from a textile material and must ensure at least 70% filtration. Manufacturers of this type of mask must provide detailed information on their reuse (washing, drying, conservation and maintenance), as well as the number of possible uses. 

How should a surgical mask be used  

• Before putting on your mask, wash your hands with soap and water or sanitize with an alcohol-based solution.
• Place the white part towards the face and the colored part facing out.
• Cover the mouth and nose with the mask and make sure that there are no spaces between the face and the mask, especially near the chin.
• The outer part of the mask is considered to be contaminated. Whenever you touch this area, wash your hands immediately.
• Your mask must be replaced as soon as it becomes wet; single-use masks are not to be reused.
• To remove your mask use the support straps or elastics; dispose of immediately in a suitable container (waste container) and wash your hands with soap and water or sanitize with an alcohol-based solution. Never remove the mask by holding it in the front part.
• NEVER USE YOUR MASK HANGING ON YOUR NECK. NEVER PULL OFF TO TALK. NEVER PLACE ON TABLES OR COUNTERTOPS.      

Regardless of which mask one can or should use, a mask will always be a complementary measure to the other preventive and crucial measures in the fight against transmission: meticulous hand hygiene (40-60 seconds with soap and water or 20-30 seconds with alcohol- based solution); respiratory etiquette (covering the mouth and nose with a tissue when coughing, or doing it on your forearm) as well as social distancing.

Guidelines on nutrition during covid-19

Dr.ª Soraia Santos

In the time of pandemic and confinement that we are all going through, it is important to maintain a varied and balanced diet, rich in fibers and vitamins, essentially vitamin C and E, and some minerals such as zinc and selenium, which help to strengthen the immune system.

Some foods contribute to improving our immunity, such as yogurts, which have a probiotic action due to the presence of bacteria that help regulate intestinal flora, onions and garlic act as anti-inflammatory agents, ginger and mushrooms, more specifically the shitake mushroom, for their beneficial properties.

During confinement it is inevitably that we use less energy than usual and, naturally, combating a sedentary lifestyle and weight gain become a difficult task. It is recommended, in addition to a healthy diet, to maintain physical exercise, with daily exercise classes at home and /or hiking or running outdoors.

Do not forget that drinking water regularly is essential for the for the correct functioning of our bodily functions. At least 1 ½ liters of liquids per day is recommended, can be plain water, flavored water, tea or herbal infusions without sugar.

From a planning point of view, when buying food, especially vegetables, preference should be given to frozen products that have greater durability, but at the same time, fresh products and fruit, such as orange, lemon, kiwi, pineapple and red fruits are a must.

One should take advantage of these moments which mean spending more time at home with the children. Invite them to participate in the elaboration some healthy recipes, such as natural yogurt ice cream or natural fruit jelly. Likewise instilling in them the habit of eating more vegetables  by using your imagination in the ways presentation, by grating, slicing, cutting into cubes or making  “spaghetti” vegetables.

On a final note, it is important to stress that this is not the time for very restrictive diets, a balanced diet and maintaining a good body weight, is already great!

Healthy recipies

• Watercress soup without potato
• Light vegetable broth
• Crispy chicken steaks with cauliflower puree
• Courgette and grated carrot cakes with poached egg
• Hake medallions with coriander and steamed broccoli
• Lettuce, shrimp and avocado salad

• Quinoa salad with azuki beans and kale
• Mini muffins with tomato, spinach and shitake mushrooms
• Sugar-free jelly with chopped fresh fruit
• Plain yogurt ice cream, with chopped fresh fruit
• Baked oven roast apples with cinnamon
• Oatmeal and blueberry pancakes and hibiscus infusion

Tips on juices and teas to boost immunity

• Curcuma, ginger, lemon and cinnamon stick tea
• Fresh beet, orange, carrot and spinach juice
• Apple juice, cabbage leaf, parsley, lemon and ground flaxseed (1tbsp.)
• Varied infusions, eucalyptus leaves, thyme, rosemary, pennyroyal, star anise

Diagnostic tests for Covid-19

Any diagnostic test must guarantee its quality with regard to specificity (ability to correctly identify individuals who have the disease, that is, not to generate false positives) and sensitivity (ability of the test to correctly identify individuals who do not have the disease, that is, not originate false negatives) and, preferably, it should also be quick and accessible.

The test most commonly used for the diagnosis of COVID-19 infection is performed using nasopharyngeal swabs, for the detection of the virus's RNA (genome) by RT-PCR.

This test has a high specificity, that is, the results do not cause false positives. However, for sensitivity it appears that it can reach 30% false negatives. To eliminate this possibility, it is advisable to carry out more than one sample test on different days.

The analysis of RT-PCR requires differentiated and expensive technology, which is why rapid tests for the detection of COVID-19 antigens, similar to pregnancy tests, are being developed. It is expected that the percentage of false negatives from these tests may be even higher. However, it will also make it possible to treat individuals with a positive result early.

Parallel to the RT-PCR and antigen tests, tests that detect IgM and IgG antibodies against COVID-19 have now begun to appear, using the English ELISA technique (Enzyme Linked ImmunonoSorbent Assay, based on antigen-antibodies reactions detectable by enzymes), are cheaper and more accessible compared to RT-PCR.

There is, however, a drawback to antibody testing; in the early stages of infection results are negative. Physiologically the explanation lies in the fact that in the first few days of the individual being infected, it is his innate system that is asked to act, and it is only days later that the adaptive system is activated, including B cells, responsible for producing specific antibodies against COVID-19.

IgG and IgM tests are especially suitable when PCR tests are negative, but the patient presents the initial symptoms of pneumonia or persisting symptoms for over 10 days.

Managing potentially contaminated waste

(Source: (DGS, 2020)

With the potential and imminent presence of the new Coronavirus, all precautions must be redoubled when it comes to matters concerning hygiene, including those related to waste matter.

According to DGS (Direção Geral de Saude), waste such as handkerchiefs, food scraps or other household waste, from an individual who is in quarantine or isolation, should be treated with special care, including the waste produced by other cohabitants:

• In the bedroom / lounge where the individual is in quarantine or isolation, a trash container with a lid and pedal for opening must be made available, where a plastic bag has been placed. Only and exclusively in this bin should waste produced be placed.
• Never tamper with the waste or squeeze the bag to vent the air.
• The bag should only be filled up to 2/3, and closed with two tight knots, a zip tie or tape.
• This bag must be placed in a second bag and closed using the same procedure.
• To avoid the risk of contamination, the procedures for handling and closing the bags should be carried out with gloves, preferably single use gloves.
• Remove the gloves by rolling them from the inside out, that is, without ever touching the exterior which was in contact with the bags. Wrap them up and put them in the waste bag. Finish the procedure by washing your hands with soap and water for at least 20 seconds.
• Finally, place the bags in the communal undifferentiated waste container, taking care that they do not touch your clothes or body.
• This waste must not be separated for recycling, nor placed in the ecopoint.
• Always wash your hands for at least 20 seconds, after handling waste bags and waste containers.
• All household waste containers must be washed and disinfected: i) wash first with soap and water; ii) apply bleach, 1 measure of bleach to 9 of water; iii) let stand for 10 minutes and iv) rinse with hot water, allowing to air dry. This procedure should be performed preferably with gloves.
• The waste produced by cohabitants of the individual in quarantine or isolation, must follow the same procedure, but placed in a diferente waste container.

MORE SO THAN EVER IS IT IMPORTANT TO KNOW HOW TO MANAGE WASTE.

Plan the  food you need to store for a period of social isolation

(Source: DGS, 2020)

Preventive or prophylactic isolation requires more planning as far as food is concerned, as trips to the supermarket must be restricted. 

Therefore, we must all follow two recommendations: ensure that food balance requirements are met and be responsible with your purchases, that is, buy the necessary quantities without exaggeration, so as not to cause stock outages in supermarkets.

Other advice includes:

• Firstly check what you have in stock, draw up a shopping list with what you will need to buy according to the meals you have planned to prepare for the period;
• Buy food with a longer durability;
• Choose food with high nutritional value instead of food with high energy density;
• Don't forget to buy fresh products - vegetables and fruits - in an adequate quantity and with greater durability;
• Vegetables with a longer durability include: carrots, onion, zucchini, pumpkin, broccoli, cauliflower, green beans. Consider purchasing frozen vegetables (depending on the capacity of your freezer);
• Fruit with a longer durability are apples, pears, oranges and tangerines; 
• Finally, respect the behavior to be adopted in order to minimization contagion: handle only the products you are going to buy; comply with the safety distance (at least 1 meter); do not touch the eyes, nose and mouth with your hands;  wash your hands properly before and after going shopping, adopt measures of respiratory etiquette (do not cough or sneeze into your hands, use a tissue or forearm).

Your shopping basket for 14 days should include the following food and quantities: 

1. CEREALS AND DERIVATIVES, TUBERCULES
1.1 Breakfast and snacks

OR

1.2 Main meals 

2. VEGETABLES

3. FRUIT

4. DAIRY PRODUCTS 

5. MEAT, FISH AND EGGS

6. LEGUMES

7. OILS 

8. OTHER FOODS 

* Estimated average daily nutritional needs for the Portuguese population: 2000 kcal, 20% protein, 50% carbohydrates and 30% lipids. Adjust the quantities according to your household..

KNOW THE DIFFERENCE BETWEEN QUARANTINE AND ISOLATION 

Quarantine and isolation are both ways of social distancing to protect individuals and the population in general from an epidemic.

Quarantine 

Those who are believed to be healthy are placed in quarantine but that might have come into contact with a patient who has been confirmed to be infected. If you are placed in quarantine be aware of possible symptoms, by measuring your temperature twice daily.

The preventative measures must continue to be observed: In addition to social distancing, maintain respiratory etiquette and wash hands frequently

Isolation

Isolation is the measure adopted for people that are ill, to avoid others from becoming infected.

See how a patient in isolation at home should behave, as well as the other members of the family residing in the same home. 

Whether in quarantine or in isolation, the individual must comply scrupulously with the period indicated, even when no symptoms are present.

Home Isolation Measures
  

Avoid taking the virus home!
  

HOW DO NEW VIRUSES EMERGE?

Human health, animal health and the ecosystems are intimately connected.
We now know that 70-80% of emerging infectious diseases including the reemerging ones are of zoonotic origin. That is, they can be transmitted between humans and animals. 

Population growth, climatic changes, urban growth, travel facilities, and successive international migration, increase the risk pathogenic respiratory dissemination agents.

The new Coronavirus COVID-19 is an exemple of an emergent virus, belonging to an extensive family of viruses. 

The Ccoronavirus causes diseases of varying severity: the manifestation of a simple flu, to more serious conditions, such as Middle East Respiratory Syndrome (MERS), which occurred in 2012, or a Severe Acute Respiratory Syndrome (SARS) in 2002.