Training Center for Travel Medicine CDC.TAIWAN & NTUH

Coronavirus disease 2019 (COVID-19)

Introduction

• SARS-CoV-2 was initially identified in Wuhan, the capital of Hubei province, China,in December 2019 and had rapidly infected millions of people.
• Coronaviruses are enveloped RNA viruses that are spherical in shape and characterized by crown-like spikes on the surface under an electron microscope, hence the name.
• Taiwan CDC classified COVID-19 as a Category 5 communicable disease on January 15, 2020, to strengthen surveillance and containment of COVID-19.
• The International Committee on Taxonomy of Viruses(ICTV) then officially named 2019-nCoV as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)on February 11th, 2020, whereas the WHO officially named the disease caused by SARS-CoV-2 as Coronavirus Disease 2019 (COVID-19).

Epidemiology

• More than 3.04 million cases have now been reported worldwide (through April 27 at 2 a.m. CST); approximately 50% of these cases were reported in the past 10 days.
• Approximately 60% of deaths have come from European region and region of the Americas. The World Health Organization (WHO) risk assessment of COVID-19 reaches global level and is very high risk.

Transmission

• Most human coronaviruses are the result of infection by direct contact with secretions or droplets, such as from coughing or sneezing. Some infected animals also suffer from having diarrhea, and the virus present in the feces can cause further disease transmission.

Disease incubation period

• An incubation period of 2 to 12 days appears most common (7 days on average), with an upper range of 14 days.

What are the symptoms of SARS-CoV-2 infection? Are they serious?

• Coronavirus infection among humans primarily involves the respiratory tract, including symptoms of general upper respiratory infection like nasal congestion, rhinorrhea, cough, and fever. However, infections caused by SARS-CoV, MERS-CoV, and COVID-19 (SARS-CoV-2) tend to be more severe than other strains of human coronavirus, with some cases developing severe pneumonia and even respiratory failure.
• Symptoms of patients with COVID-19 are not easily distinguishable from other infections. Most patients develop symptoms of fever, dry cough, fatigue, with a third presenting with shortness of breath. Other symptoms include myalgia, headache, sore throat, and diarrhea. Some cases also report abnormal sense of smell (anosmia) and taste (dysgeusia).
• Current data suggest that most patients present with mild symptoms or are asymptomatic, but some of infected patients have severe symptoms which require hospitalization and oxygen therapy. In severe cases, the symptoms could progress to severe pneumonia, acute respiratory distress, or multiple organ failure, and shock.
• According to available epidemiological data reported so far, most patients eventually recover, but there are still some deaths. Most mortality cases had underlying diseases, such as diabetes mellitus, chronic liver disease, renal insufficiency, and cardiovascular disease, etc.

Recommendations for international travelers

• It is prudent for travelers who are sick to delay or avoid travel to affected areas, in particular for elderly travelers and people with chronic diseases or underlying health conditions.
• General recommendations for personal hygiene, cough etiquette and keeping a distance of at least one meter from persons showing symptoms remain particularly important for all travelers. These include:
• Perform hand hygiene frequently, particularly after contact with respiratory secretions. Hand hygiene includes either cleaning hands with soap and water or with an alcohol-based hand rub. Alcohol-based hand rubs are preferred if hands are not visibly soiled; wash hands with soap and water when they are visibly soiled.
• Cover your nose and mouth with a flexed elbow or paper tissue when coughing or sneezing and disposing immediately of the tissue and performing hand hygiene.
• Refrain from touching mouth and nose.
• If masks are to be worn, it is critical to follow best practices on how to wear, remove and dispose of them and on hand hygiene after removal.

Prevention

• There is no vaccine as yet to prevent COVID-19. Prevention is the same as for other respiratory infections including washing hands frequently, wearing masks and cleaning up secretion from the mouth and nose appropriately.
• Other measures include avoiding crowded places such as markets or local hospitals, avoiding contact with animals and dead animals and avoiding eating raw meat or eggs. Additionally, you should wear masks and attend medical attention immediately when flu-like symptoms occur (such as body temperature ≧38℃, and coughing, etc)

Treatment

• Currently, there is no targeted treatment for COVID-19. Current treatment aims at supportive care. The anti-viral medications used for SARS have not been proven to help with the novel coronavirus infection. There is no vaccine as yet to prevent the novel (new) coronavirus. Please seek medical attention immediately if you are unwell.

What steps have been taken by Taiwan CDC to prevent imported cases?

• In response to the COVID-19 epidemic which first originated from Wuhan, China, the Taiwan Central Epidemics Command Center (CECC) has been constantly strengthening international epidemic surveillance as well as border control measures.
• To minimize the risk of any community outbreaks, passengers presenting with fever at international and Mini Three Links ports of entry are required to clarify any travel history to Wuhan and undergo comprehensive health assessment to evaluate the need of on-the-spot compulsory transfer to hospital (medical evacuation).
• For inbound travelers with upper respiratory symptoms who do not meet the criteria of compulsory transfer to hospital, they are required to complete the “Communicable Disease Survey Form” and receive “Notification of Compulsory Quarantine for Arriving Passengers with Suspicious Symptoms.” This is aimed at strengthening quarantine measures at ports of entry and to improve understanding of COVID-19 among the general public, while protecting domestic security at once.

References:

1. COVID-19 Weekly Key Points (through April 20, 2020) Shoreland's Travax News Alert Service
2. Updated WHO recommendations for international traffic in relation to COVID-19 outbreak   World Health Organization(WHO) https://www.who.int/news-room/articles-detail/updated-who-recommendations-for-international-traffic-in-relation-to-covid-19-outbreak
3. Coronavirus disease (COVID-2019) situation reports – 90, 19 April 2020   World Health Organization(WHO) https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
4. Diseases & Conditions - COVID-19 Taiwan Centers for Disease Control https://www.cdc.gov.tw/Category/QAPage/LnqBFJsulw6fW3nswc04Yw