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COVID-19 Wiki
During emergencies, organisations involved in the emergency response will often use 'wiki' pages to gather and summarise knowledge and experience as it emerges. These pages are dedicated to clinically relevant information relating to COVID-19. Whilst the information is aimed at healthcare staff working in maternity services, much of the information is generic and broadly applicable across healthcare settings.
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The purpose of a Wiki is to allow multiple people to submit and curate the relevant information. If you have:
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Information that you think should be added
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Comments on the current information
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SUMMARY & LATEST UPDATES
CONTENTS
CLINICAL INFORMATION
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General principles of care for COVID-19 positive patients (WHO)
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Perimortem Caesarean Section
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Key research papers & clinical guidance from professional bodies
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MIDWIFERY AND NEONATAL GUIDANCE
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BACKGROUND INFORMATION
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Origins, clinical features, & transmission of COVID-19
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Epidemiology of COVID-19 in Pregnancy ​(links to UK Cohort data - BMJ)
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Translated COVID-19 patient information leaflets (from Doctors of the World)
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INFECTION CONTROL
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Personal Protective Equipment (PPE)
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'Donning and Doffing' (putting on & taking off)
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Handwashing guidance
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Transferring Patients with COVID-19 (suspected and confirmed)
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Equipment: Point of Care tests (FBS / BM)
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STAFF WELLBEING RESOURCES
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BACKGROUND INFORMATION
WHAT IS COVID-19?
COVID-19 stands for ‘coronavirus disease 2019’ and is an infectious disease caused by the RNA virus ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2). COVID-19 is a zoonosis (a disease transmitted from humans to animals). It was initially thought that the disease came from bats, however in February 2020, a virus sample obtained from a sunda pangolin was discovered with a viral nucleic acid sequence "99% identical" to SARS-CoV-2. Although Pangolins are protected under Chinese law, they are thought to be the most illegally trafficked mammal in the world and are widely poached for human consumption and use in traditional medicines. They are one of the species known to have been available in the Wuhan ‘wet market’ where COVID-19 first infected humans. COVID-19 was first transmitted to humans in November or December 2019, and the primary source of infection became human-to-human transmission by early January 2020.
WHAT ARE THE SYMPTOMS OF COVID-19?
There are no specific clinical features that can yet reliably distinguish COVID-19 from other viral respiratory infections. In a study of 138 hospitalised patients with COVID-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were:
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Fever in 99 percent
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Fatigue in 70 percent
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Dry cough in 59 percent
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Anorexia (loss of appetite) in 40 percent
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Myalgia (muscle pain) in 35 percent
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Dyspnoea (shortness of breath) in 31 percent
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Sputum production in 27 percent
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The dyspnoea developed after a median of five days. Acute respiratory distress syndrome developed in 20 percent, and mechanical ventilation was required in 12.3 percent.
Less common symptoms included headache, sore throat, and rhinorrhoea (runny nose). Gastrointestinal symptoms (eg, nausea and diarrheoa) have also been reported but are rare.
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When fever presents, it may be of varying severity so healthcare professionals should maintain a high index of suspicion even when the temperature is <38°C. In a study of 1099 patients from Wuhan and other areas in China, a temperature over 37.5°C was present in only 44 percent of patients on admission but was ultimately noted in 89 percent during the hospitalisation.
HOW SEVERE IS COVID-19?
Pneumonia is the most frequent serious manifestation of COVID-19 infection, characterised by fever, cough, dyspnoea, and bilateral infiltrates on chest imaging.
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Although COVID-19 has a higher mortality than seasonal influenza, most infections are not severe. In a report from the Chinese Center for Disease Control and Prevention that included approximately 44,500 confirmed infections with an estimation of disease severity:
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Mild symptoms (no or mild pneumonia) were reported in 81 percent.
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Severe disease (eg, with dyspnoea, hypoxia, or >50 percent lung involvement on imaging within 24 to 48 hours) was reported in 14 percent.
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Critical disease (eg, with respiratory failure, shock, or multi-organ dysfunction) was reported in 5 percent.
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The overall case fatality rate was 2.3 percent; no deaths were reported among noncritical cases.
Current estimates for overall mortality range from between 1-5%. It is likely that the mortality will be towards the lower ends of the estimates due to the large number of mild cases that will not be counted in the pool of confirmed cases. Most of the fatal cases have occurred in patients with advanced age and/or underlying medical co-morbidities.
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Unlike other infectious diseases, children are thought to be at lower risk from severe morbidity / mortality from COVID-19. No deaths have been reported in the under-9 age group.
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No deaths have been recorded in pregnant women. However, as the graph opposite shows, medical co-morbidities are a key contributor to mortality with COVID-19 infection. People with cardiovascular disease and diabetes are at particular risk. Importantly, women with complex medical co-morbidities form an increasingly large proportion of the pregnant population so are at theoretically higher risk of developing severe disease in the context of COVID-19.
HOW IS COVID-19 TRANSMITTED?
PERSON-TO-PERSON SPREAD:
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This is thought to occur mainly via respiratory droplets, resembling the spread of influenza.
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With droplet transmission, virus is released in the respiratory secretions when a person with infection coughs, sneezes, or talks. This can infect another person if the secretions make direct contact with the mucous membranes such as the eyes, nose and mouth.
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Droplets typically do not travel more than six feet (about two meters) and do not linger in the air.
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Viral RNA levels appear to be higher soon after symptom onset compared with later in the illness; this raises the possibility that transmission might be more likely in the earlier stage of infection.
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Transmission from asymptomatic individuals (or individuals within the incubation period) has also been described but the extent to which this occurs remains unknown.
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COVID-19 has also been detected in blood and stool but it is unclear if faecal-oral transmission is a significant factor in the spread of infection.
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SPREAD VIA INFECTED SURFACES:
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Infection can also occur if a person touches an infected surface and then touches his or her eyes, nose, or mouth
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A recent study has found that the virus remains active on surfaces for a lengthy period: up to 24 hours on cardboard to up to two or three days on plastic and stainless steel.
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It also remained viable in aerosols—attached to particles that stay aloft in the air—for up to three hours. All of this is similar to the stability of SARS, the coronavirus that caused an outbreak in the early 2000s.
COVID-19 in PREGNANCY
HANDWASHING TO REDUCE TRANSMISSION OF COVID-19
HANDWASHING
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Sars-CoV-2, and indeed most viruses are self-assembled nanoparticle in which the weakest link is the lipid (fatty) bilayer. Soap dissolves the fat membrane and denatures (kills) the virus. This is why handwashing remains one of the most effective ways to reduce your risk of infection / transmission. Simple soaps, including (washing up liquid) are considered effective for handwashing.
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Alcohol-based products, which contain a high-percentage alcohol solution (typically 60-80% ethanol) and kill viruses in a similar fashion to soap.
Washing with soap is arguably the superior method because only a fairly small amount of soapy water, can cover your entire hand easily. With alcohol, the virus needs to be soaked for a brief moment and rubbing gel on the hands does not guarantee that every corner of the skin is covered.
PERSONAL PROTECTIVE EQUIPMENT (PPE) GUIDANCE
