Question

1. COVID-19 overview
2. Diagnosing, treatment, and prevention of COVID-19 (using evidenced-based information)
3. COVID-19 screening site addresses, phone numbers, and contact information.
4. Resources for individuals who do not have health insurance and/or low income to obtain COVID-19 screening.

Answer 1

There is a new world health crisis threatening the public with spread of COVID-19 (Coronavirus Disease-2019) . Since

December 2019, when Covid-19 emerged in Hunan seafood market at Wuhan, South China and rapidly spread through-

out the world, the virus outbreak has been declared a public health emergency of International concern by World

Health Organization (WHO). We here summarize the current clinical characteristics data to guide potential COVID-19

about Prevention, Diagnosis, Treatments and Prevention of COVID-19. In this review, we extracted data from various Re-

search Report, WHO guidelines and other articles. It is important to caution the readers that new data updating nearly

every hour regarding clinical characteristics, diagnosis, treatment strategies, and outcomes COVID-19.

Throughout the world the disease has caused varying degrees of illness. Patient shows various symptoms usually fever,

cough, sore throat, breathlessness, fatigue, and malaise among others. The disease is being cured through general

treatment, symptomatic treatment, by using antiviral drugs, oxygen therapy and by the immune system. It is neces-

sary to identify the potential cases as soon as possible and isolate the suspected people from the confirmed cases of

COVID-19, to prevent the potential transmission of infection to other patients and health care staff bcCoronaviruses are a large family of viruses which may

cause disease in animals or humans.[1] Seven corona-

viruses can produce infection in people around the world

but commonly people get infected with these four human

coronaviruses: 229E, NL63, OC43, and HKU1. They usually

cause a respiratory infection ranging from the common

cold to more severe diseases such as Middle East Respi-

ratory Syndrome (MERS) and Severe Acute Respiratory

Syndrome (SARS) and the most recently discovered coro-

navirus (COVID-19) causes infectious disease.[1] This zoo-

notic disease caused by severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2). The WHO originally called this

infectious disease Novel Coronavirus-Infected Pneumonia

(NCIP) and the virus had been named 2019 novel corona-

virus (2019-nCoV). On 11th Feb 2020, the (WHO) officially

renamed the clinical condition COVID-19 (a shortening of

Corona Virus Disease-19), which was announced in a tweet.

An outbreak of COVID-19 caused by the 2019 novel coro-

navirus (SARS-CoV-2) began in Wuhan, Hubei Province,

China in December 2019, the current outbreak is officially

a pandemic.[2] Since knowledge about this virus is rapidly

evolving, readers are urged to update themselves regularly

(Fig. 1).[3]

The virus is typically rapidly spread from one person to an-

other via respiratory droplets produced during coughingand sneezing. It is considered most contagious when peo-

ple are symptomatic, although transmission may be possi-

ble before symptoms show in patients. Time from exposure

and symptom onset is generally between two and 14 days,

with an average of five days. Common symptoms include

fever, cough, sneezing and shortness of breath. Complica-

tions may include pneumonia, throat pain and acute re-

spiratory distress syndrome. Currently, there is no specific

antiviral treatment or vaccine; efforts consist of symptom

abolition supportive therapy. Recommended preventive

measures include washing your hands with soap, covering

the mouth when coughing, maintaining 1-meter distance

from other people and monitoring and self-isolation for

fourteen days for people who suspect they are infected.[4]

The standard tool of diagnosis is by reverse transcription-

polymerase chain reaction (rRT-PCR) from a throat swab or

nasopharyngeal swab. The infection can also be diagnosed

from a combination of symptoms, risk factors and a chest

CT scan showing features of pneumonia.[5]

Epidemiology

As of 15 April 2020, 210 Countries and Territories around

the world have reported over 1.998.111 confirmed cases

and 126.604 deaths of COVID-19 and show the presence in

six continents.

According to the medical journal hosted by Johns Hop-

kins University. Though the proportion of confirmed cas-

es outside China is steadily increasing.[2, 6] Most infected

countries data of COVID-19 are summarised in the below

chart Figure 2.

Death Rate Varies by Age, Health and Sex

World Health Organizations Director-General, Tedros Ad-

hanom Ghebreyesus, said that globally, about 3.4% of

reported Covid-19 cases have died. Matt Hancock Health

Secretary of UK governments said a very best assessment

was that the fatality rate was "2% or, likely, lower". However,

it varies on a range of factors such as general health, age,

sex, and the health system you are living in. In the first hugeanalysis of more than 44.000 cases from China, the death

rate was ten times higher in the very elderly compared to

the middle-aged.

The death rates were lowest for under the 30s there have

been eight deaths in 4.500 cases. And deaths were at least

five times more common among individuals with diabetes,

high blood pressure or heart or breathing problems. There

was even a rather higher number of deaths among men

compared to women.[7]

COVID-19 death Rate by Age Group: Death Rate = Num-

ber of deaths/Number of cases = Probability of dying if in-

fected by the virus (%)

Many studies increasingly clear that death rate increases

with age Children under 9 years of age seem to be largely

unaffected, either with no or mild symptoms or none have

died due to COVID-19 infection. While people over the age

of Eighty years and those with chronic diseases are the

most vulnerable. For those cross 80, approximately 14.80%

of those infected dies. Data show in Figure 3.

The fatality rate starts to increase for those over 50 years of

age. Those under 50 years who are infected have a death

rate of 0.40%, while for those 50-59 years it's 1.3%. For those

60-69 years it's 3.60%, for 70 to 79-year-olds it's 8.00% and

for those over 80 years of age, it is 14.8%.[8, 9]

Covid-19 death Rate by Sex Ratio: As the worldwide

death toll from the COVID-19 increase, the evidence is

growing that more men are becoming seriously ill or dyingfrom the coronavirus than women. yet its numbers slightly

vary country to country. it doesn’t necessarily reflect differ-

ences in biology. Scientists are still not completely sure but

maybe on average, men more involve in health-damaging

habits such as drinking and smoking than women (Fig. 4.)

Show fatality sex difference.[8]

COVID-19 death Rate by Health Conditions: Information

made by Centres for Disease Control and Prevention (CDC)

and lots of other studies increasingly clear that risk of se-

vere illness and death increases with age. Adults who are

both older and not have better medical conditions have a

greater risk to become infected. Among adults age 60 or

older, more than half also have a serious medical condition

rising to nearly two-thirds of people age 80 and older.[2, 10]

Older age people and younger adults with serious illness,

such as diabetes, heart disease, and lungs disease, have

a greater risk of becoming severely ill if they get infected

with the coronavirus. The death rate for those who not

have pre-existing conditions is approximately 1%. Cen-

tres for Disease Control and Prevention has issued specific

guidance for people who fall into these categories.[10]

For those with cardiovascular (heart) disease the death

rate is 10.5%, for diabetes death rate is 7.3%, for Chronic

respiratory disease (such as asthma and chronic obstruc-

tive pulmonary disease) it is 6.3%, for hypertension (high

blood pressure) it's 6.0% and the cancer death rate is 5.6%

data summarised in. (8,9) Figure 5.

Origin and Transmission of COVID-19

The first cases of coronaviruses in human found in 1965 by

Tyrrell and Bynoe. They observed that they could passage

a virus named B814. It was observed in human embryonic

tracheal organ cultures obtained from the respiratory tract

of an adult with a common cold symptom. The first cases

were seen in Wuhan City of Hubei Province China in De-

cember 2019, and have been linked to the Huanan Seafood

Market (South China) and the infection has spread to sev-

eral countries around the world.[2]

The novel coronavirus originated from the Hunan seafood

market at Wuhan, South China where raccoon dogs, bats,

snakes, palm civets, and other animals are sold, and rapidly

spread up to 109 countries. The zoonotic source of SARS-

CoV-2 is not confirmed, however, the sequence-based

analysis suggested bats as the main reservoir. The recom-

bination of DNA was found to be involved at spike glyco-

protein which assorted SARS-CoV (CoVZXC21 or CoVZC45)

with the RBD of another Beta CoV, thus could be the reason

for cross-species transmission and rapid infection.[7]

The virus that causes coronavirus disease 19 (COVID-19) is

a highly transmittable and pathogenic viral infection and

mainly transmitted through contact with respiratory drop-

lets rather than through the air.[7, 11] Primarily people can

catch coronavirus disease 19 (COVID-19) from others who

are infected. A single cough can circulate up to 3.000 drop-

lets. These droplets can land on other people, and covering

surfaces around them, however, several smaller particles

will stay within the air. the virus is also shed for extended

in faecal matter, thus anyone who not washing their hands

thoroughly after visiting the toilet, bathroom could con-

taminate anything they touch like many respiratory virus-

es, including flu, Covid-19 can be spread by close contact

with small droplets released from infected individuals' up-

per respiratory tract secretions,[12] e.g. sneezing, common

cold or coughing from the nose and mouth.[2] That is why

to stay more than 1 meter (3 feet) away from a person who

is sick. The virus can also be transmitted through surface

contamination when these droplets land on objects and

surfaces around the person and other individual touches

these objects or surfaces and further touching their eyes,

nose or mouth then these people catch COVID-19Replication

Infection begins when the virus enters the host cell, the vi-

rus particle is uncoated and the spike protein attaches to

its complementary host cell receptor. After attachment, a

proteolytic enzyme of the host cell cleaves and activates

the receptor-attached spike macromolecule. Depending

on the host cell proteolytic enzyme available, cleavage and

activation enable cell entry through endocytosis or direct

fusion of the viral envelope with the host membrane. (SA

16) The chemical structure of Coronavirus RNA consists of

5' methylated head and a 3' polyadenylated tail, through

which the RNA attaches to the free ribosomes of the host

cell. This lead to the process of translation and formation

of a long polypeptide chain. This protein has its enzyme

(Proteases) which break the polyprotein into multiple non-

structure proteins.

Coronaviruses (CoVs), are the family of viruses that have

pricky spikes that project from their surface. They have en-

veloped RNA viruses, are characterized by club-like spikes

that project from their surface, they have a unique replicat-

ing process. These viruses are the cause of many types of

diseases in mammals and birds leading to enteritis in cows

and pigs and upper respiratory infection in humans which

may be fatal. In the given review we have discussed a brief

introduction to coronaviruses detailing its replication and

pathogenic activity, preventive measures and treatment

strategies. We will elaborate the discussion on the out-

breaks of the highly pathogenic Severe Acute Respiratory

Syndrome Coronavirus (SARS-CoV) and the recently dis-

covered Middle Eastern Respiratory Syndrome Coronavirus

(MERS-CoV) (Fig. 7).[15]

Symptoms

Maximum of the patients infected with the virus will ex-

perience common cold and flu, while few of them remain

asymptomatic. 80% of patient will show mild symptoms of

the disease. Adults have the best immunity to fight against

the infection but the demerit is that they are more likely to

spread the infection

A recent study of nearly 140 patients at the Zhongnan

Hospital of Wuhan University identified different types of

symptom, which lead to a disease known as COVID-19. 99%

of the patients developed a fever with extremely high tem-

perature, while more than half experienced fatigue and a

dry cough. One-third of the patient developed a dry cough

and difficulty in breathing.[16]

Research from the Chinese CDC observes that around 80%

of coronavirus cases are mild, around 15% of patients have

infected severe cases, and 5% have become critically ill. A

day by day breakdown of coronavirus symptoms shows

how symptoms progress among typical patients, how the

disease, COVID-19, goes from bad to worse.[16]

Day 1: In the starting day of the symptom, the patient suf-

fers from fever along with fatigue, muscle pain, and a dry

cough. Few of them may experience nausea and diarrhoea

a few days before the arousal of symptoms.

Day 5: Patients may suffer from breathing problem espe-

cially if they are elderly or have some pre-existing health

condition.

Day 7: According to the Wuhan University study, these are

the symptoms of the patient that lead the patient to be ad-

mitted in the hospital.

Day 8: On the 8th day, patients (15%, according to the Chi-

nese CDC) develop acute respiratory distress syndrome

(ARDS), a condition where the fluid fills up in the lungs and

this is mostly fatal. This usually happens in severe cases.

Day 10: The progression of the disease leads to worsening

of the symptom and at this point the patient is shifted to

ICU. Patients with milder symptoms probably have more

abdominal pain and loss of appetite. Only a small fraction

die. The current mortality rate is around 2%.

Day 17: On average, after two-and-a-half weeks patients

who recover are discharged from the hospital.

However, it's difficult to find out the symptoms in the ear-

lier days of the infection. This is usually seen after 5-6 days.

[16] Reported symptoms have ranged from mild to severe

illness and death for confirmed coronavirus disease 2019

cases.

Emergency warning signs of COVID-19 needs medical at-

tention immediately, continuous pain or pressure in the

chest, include trouble in breathing, confusion and bluish

lips or face. The progressed condition leads to Pneumonia[4,

17] and the incubation period is yet to be determined as

the virus is recently identified. As per the new information,

symptoms could appear as soon as three days after expo-

sure to as long as 13 days later. Recently published research

found that on average, the incubation period is about five

daysDiagnosis of COVID-19

Diagnosis allows suspected people to understand that

they are infected or not. Diagnosis can help them receive

the care they need and it can help them take measures to

cut back the probability of infecting others. People who

don't know they are infected may not occupy at home and

thereby risk infecting others. If the person develops symp-

toms of coronavirus disease 2019 and they have been ex-

posed to the virus, he should consult to doctor. The doctor

may decide whether to conduct tests for COVID-19 based

on individual signs and symptoms. The doctor may also

consider whether an individual had close contact with

someone diagnosed with COVID-19 or travelled to or lived

in any areas with ongoing community spread of COVID-19

within last 14 days.[18]

Coronavirus Disease-2019 tracking and diagnostic testing

are critical and also critical to understanding epidemiology,

informing case management, and to suppressing trans-

mission. The Coronavirus disease outbreak is additionally

typical to prevent virus community transmission, including

how testing might be rationalized when lack of reagents/

testing kit or testing capacity necessitates prioritization of

certain populations group or individuals for testing." (MA

3) To test for COVID-19, doctor or health practitioner may

take samples, including a sample of saliva (sputum), a nasal

swab and a throat swab, to send to a lab for testing or fol-

low the directions of your local health authority.[18]

Paper-Based Test COVID-19

As Covid-19 cases increase around all over the world so that

the requirement of fast diagnoses needs and easy to han-

dle diagnostic test procedure is becoming ever more press-

ing. A startup company spun out from MIT is now working

on a paper-based test that may deliver results in less than

half an hour. Early detection of covid19 is extremely useful

to prevent spreading covid19.

In this test a strip of paper is required that is coated with

antibodies this is bind to a particular (COVID19) protein.

A second antibody is attached to gold nanoparticles, and

therefore the patient's sample is added to a solution of

these particles. Then the test strip is dipped in this solu-

tion. If the viral protein is present in the sample, it will be

attaches to the antibodies on the paper strip as well as the

nanoparticle-bound antibodies, and a coloured spot ap-

pears on the strip within 20 minutes.

Currently, there are only two primary types of Covid-19 di-

agnostics method are available. First one is that test screens

patient blood samples for antibodies against the virus. The

drawback is that antibodies are often not detectable until

a few days after symptoms begin. The second type of test

looks for viral DNA in a sputum sample. It can detect the vi-

rus earlier in the infection, but they require polymerase chain

reaction (PCR), to perform this method take more times (sev-

eral hours) than screens patient blood test method.[20]

RNA Vaccines

The Cambridge-based biotech company Moderna pre-

pared an experimental vaccine to diagnose coronavirus.

That speedy turnaround is because of the unique advan-

tages of RNA vaccines, MIT professor of chemical engineer-

ing Daniel Anderson, says a key advantage of messenger

RNA is that the speed with which you can identify a new

sequence and use it to come up with a new vaccine.

Traditional vaccines consist of an inactivated form of a viral

protein that induces an immune response. Usually, these

vaccines take a longer time to manufacture, and they are

too risky for a few diseases. Vaccines that consist of mes-

senger RNA is an appealing alternative because they in-

duce host cells to produce many copies of the proteins

they encode, promoting a stronger immune response than

proteins delivered on their own.

Messenger RNA can encode the viral antigens, but to work,

we seek out the simplest way to deliver these antigens to

a particular part of the body so that they generate an im-

mune response. It also makes sure that the vaccine causes

appropriate immune stimulation to get a strong response.

RNA vaccines can also be quickly target to different viral

proteins, as long as the sequence encoding the protein is

understood. The main object to developing such vaccines

is that finding effective and safe ways to deliver them the

site of action. The recent study showed that packing such

vaccines into a special type of lipid nanoparticles can en-

hance the immune response that they produce.[20]

Molecular Assays to Diagnose 2019-nCoV

Currently, several assays that detect the 2019-nCoV both

in-house and commercially have been prepared or under

development. Some assays may detect only the novel virus

and a few can also detect other strains (e.g. SARS-CoV) that

are genetically similar.[19]

In-House Developed Molecular Assays

Some groups shared their protocols which are summarized

in the below table. In some cases, the groups will be will-

ing to send reagents or reagent mixers prepared in their

laboratories, with or without associated fees. It is strongly

recommended to contact the scientist. The list summarized

below is not exhaustive and is being updated from time to

time (Table 1).[19]

Treatment Strategyof COVID 19

We here summarize the current data to guide potential CO-

VID-19 treatment options. It is important to caution read-

ers that new data updating nearly every hour regarding

clinical characteristics, diagnose, treatment options, and

outcomes for COVID-19. But optimized supportive care

remains the backbone of therapy and the clinical efficacy

for the subsequent agents is still under investigation or inclinical trials.[21] Most standing clinical and preclinical data

on antiviral therapy is taken from other viruses, including

SARS-CoV-1,[22] Middle East Respiratory Syndrome,[23] and

non-coronaviruses (Ebola).[24, 11]

General Treatment

A confirmed patient of COVID 19 needs complete bed

rest and supportive treatment, ensuring adequate calorie

and water intake to reduce the risk of dehydration. Water

electrolyte balance and homeostasis need to maintain

along with the of monitoring vital signs and oxygen satura-

tion; keeping respiratory tract unobstructed and inhaling

oxygen in more severe cases; measuring blood count, C-

reactive protein, urine test, and other blood biochemical

indexes including liver and kidney function, myocardial en-

zyme spectrum, and coagulation function according to pa-

tient's conditions. Chest imaging should be continuously

re-examined and blood gas analysis should be performed

when required.

Symptomatic Treatment

Control measures are needed for patients with a high fever.

Antipyretic drug treatment should be performed in case

the temperature exceeds 38.5 °C. Warm water bath and an-

tipyretic patches are preferred as a preventive measure to

lower the temperature. Common drugs include ibuprofen

orally, 5–10 mg/kg every time; acetaminophen orally, 10–

15 mg/kg every time. Need to administer sedative arises in

case the child suffers from convulsions or seizure.

Oxygen Therapy

The chances of hypoxia are increased as the virus targets

the lungs. Nasal catheter, mask oxygen should be imme-

diately provided to the patient. In emergency conditions,

Non-invasive or invasive mechanical ventilation should be

provided to the patient.[26]

Antiviral Drugs

Group of antiviral drugs including interferon α (IFN-α), lopi-

navir/ritonavir, chloroquine phosphate, ribavirin, and arbidol

are therapeutically useful for the Prevention, Diagnosis, and

Treatment of Novel Coronavirus-induced Pneumonia by the

National Health Commission (NHC) of the People's Republic

of China for tentative treatment of COVID-19 (Table 2).

IFN-α is administered in the form of vapour inhalation at a

dose of 5 million U (and 2 mL of sterile water for injection)

for adults, 2 times/day. The dosage of lopinavir/ritonavir is

400 mg/100 mg for adults, 2 times/day. Ribavirin should be

administered via intravenous infusion at a dose of 500 mg

for adults, 2 to 3 times/day in combination with IFN-α or

lopinavir/ritonavir. Chloroquine phosphate is orally admin-

istered at a dose of 500 mg (300 mg for chloroquine) for

adults, 2 times/day. Arbidol is orally administered at a dose

of 200 mg for adults, 3 times/day. The duration of treat-

ment is no more than 10 days.

Favipiravir is a new drug that is under clinical trial for treat-

ing COVID-19. On February 15, 2020, China approved it

to be a useful drug for treating Novel Influenza. It acts by

inhibiting the enzyme RNA dependent RNA Polymerase.

Apart from being effective for anti-influenza virus, the drug

is capable of blocking the replication of flavi-, alpha-, filo-,

bunya-, arena-, noro-, and other RNA viruses. Favipiravir is

converted into an active phosphoribosylated form (favipi-

ravir-RTP) in cells and is recognized as a substrate by viralRNA polymerase, thus inhibiting RNA polymerase activity.

Therefore, favipiravir may have potential antiviral action on

SARS-CoV-2, which is an RNA virus.

Remdesivir is another investigational drug under clinical

trial for the treatment of COVID-19. Remdesivir is a nucleo-

side analogue and a broad-spectrum antiviral. Animal ex-

periments indicated that remdesivir can effectively reduce

the viral load in lung tissue of mice infected with MERS-CoV,

improve lung function, and alleviate pathological damage

to lung tissue.

A team of researchers from Shanghai Institute of Mate-

ria Medica and Shanghai Tech University performed drug

screening in silicon and an enzyme activity test, and they

reported 30 agents with potential antiviral activity against

SARS-CoV-2 on January 25, 2020. These agents are indina-

vir, saquinavir, lopinavir, carfilzomib, ritonavir, remdesivir,

atazanavir, darunavir, tipranavir, fosamprenavir, enzaplato-

vir, presatovir, abacavir, bortezomib, elvitegravir, maribavir,

raltegravir, montelukast, deoxyrhapontin, polydatin, chal-

cone, disulfiram, carmofur, shikonin, ebselen, tideglusib,

PX-12, TDZD-8, cyclosporin A, and cinanserin. Certain Chi-

nese herbal medicines such as RhizomaPolygoniCuspidati

and Radix SophoraeTonkinensis were also found to con-

tain certain active constituents that were effective against

SARS-COV-2.[27]

Recently, Wang and colleagues (Wang et al., 2020) evalu-

ated in vitrofive FDA-approved drugs and two broad-spec-

trum antivirals against a clinical isolate of SARS-CoV-2. One

of their conclusions was that"chloroquine is highly effec-

tive in the control of 2019-nCoV infection in vitro" and that

its "safety track record suggests that it should be assessed

in human patients suffering from the novel coronavirus dis-

ease".

At least 16 different trials for SARS-CoV-2 already registered

in the Chinese Clinical Trial Registry (ChiCTR2000029939,

ChiCTR2000029935, ChiCTR2000029899, ChiC-

TR2000029898, ChiCTR2000029868, ChiCTR2000029837,

ChiCTR2000029826, ChiCTR2000029803, ChiC-

TR2000029762, ChiCTR2000029761, ChiCTR2000029760,

ChiCTR2000029741, ChiCTR2000029740, ChiC-

TR2000029609, ChiCTR2000029559, ChiCTR2000029542)

propose to use chloroquine or hydroxychloroquine in the

treatment of COVID-19 ("Chinese Clinical Trial Register"

(ChiCTR)). In a recent publication Gao and colleagues eval-

uated that, "According to the new survey it is discovered

that Chloroquine Phosphate is more effective in control

treatment in inhibiting the progression of pneumonia, im-

proving lung imaging findings, promoting a virus-negative

conversion, and shortening the disease course". This anti-

malarial molecule would represent to be a successful drug

and good news in the treatment of acute viral infection

since the drug is quite cheap and easily available. However,

still, a large number of research data needs to be collected

before drawing any conclusion.[28]

Boost Your Immune System

On top of basic illness prevention and real defense against

disease is a strong immune system. People body is better

able to fight off disease when the immune system is hum-

ming and people should put to get their perfect body

shape. This is a time to focus on all the health habits people

may have been putting off, Dr. Tom Moorcroft, an osteo-

pathic doctor who specializes in infectious disease says,

start daily activities and food choices that support people's

health and turn them into habits that will lead to life-long

improvements in health. During this critical situation, get

adequate sleep and some fresh air and sunlight daily.

People also, stay hydrated, minimize overly processed

foods and make sure to eat enough micronutrients when

they can try their best with what they can find at grocery

stores right now.[29]

Prevention & Precaution of COVID-19

People should stay aware of the latest information on the

COVID-19 outbreak provided by WHO and Follow the di-

rections of your local health authority and prevent second-

ary infections, interrupt human-to-human transmission to

your close contacts, health care workers and prevent fur-

ther international spread. most of the people who infected,

experience mild illness and recover it, but its infection can

be more severe for other individuals. To take care of your

health and protect others take the subsequent steps:[30, 31]

Take steps to protect yourself

• Wash your hands regularly and thoroughly with soap

and water for at least 20 seconds or with an alcohol-

based hand rub (hand sanitizer that contains at least

60% alcohol) completely cover your hands and rub

them together until they do not dry especially after you

have been visited a public place, or after blowing your

nose, sneezing or coughing.

• Hands touch many surfaces and pick up viruses and

these contaminated hands, can transfer the virus to

your nose, eyes or mouth So, avoid touching these or-

gans with unwashed hands. Because from there, the

virus can enter the body and may cause persons to sick.

• Maintain social distancing (maintain at least 1 metre or

3 feet distance between yourself and anyone) and avoid

close contact with people who are sick (who is cough-

ing or sneezing). When infected individuals cough or

sneezes, they spray small droplets from their nose or

mouth which may contain COVID-19 virus. The person

can breathe in these droplets.[31, 32]

• Avoid large events and mass gatherings

Take steps to protect others

• Stay home if you are feeling unwell, unless you're going

to get medical care.

• If you have a cough, fever and difficulty breathing, seekmedical attention consult online to your doctor.

• If you're sick avoid taking public transportation.

• Whenever you cough or sneeze cover your mouth and

nose with a tissue paper.

• Throw used tissues in the trash and wash your hands

immediately with antiseptic soap and water.

• If possible, stay isolated in a separate room from fam-

ily and pets and wear a facemask when you are around

other people (e.g., sharing a room or vehicle). If you are

unable to wear a facemask (due to its causes trouble

breathing or other reason) then you should cover your

coughs and sneezes, and but when the people who

are caring for you enter your room they should wear a

facemask (Facemasks may be in short supply and they

should be saved for caregivers).

• Stay home for a duration of time and follow your doc-

tor's instructions.

• If you're sick, avoid sharing bedding, dishes, glasses and

other household items

• If possible, use a separate bathroom and toilets from

the family.

• If surfaces are dirty, clean them, and use detergent or

antiseptic soap & water before disinfection apply,

• Apply disinfectant daily on frequently touched surfaces.

This includes desks, phones, keyboards, toilets, faucets,

tables, doorknobs, light switches, countertops, handles,

and sinks.[32, 33]

• Identify and Isolate Suspected Cases

• Before clinical care is started, Identify the potential cas-

es as soon as possible and isolate the suspected people

separately from those who confirmed cases of the virus

COVID-19, to Prevent the potential transmission of in-

fection to other patients and health care staff.

• Avoid direct physical contact (including physical exami-

nation and exposure) to respiratory and other body se-

cretions. For instance, move potentially infectious peo-

ple to isolation rooms and close the doors. In a working

place, make the distance in workers, customers, and

other visitors, especially from potentially infectious in-

dividuals’ location

• In case of need to isolate a patient or patient group,

pharmacies should designate and prepare a suitable

space

• Most patients presenting in community pharmacies are

unlikely to have COVID-19. If they have coughs, colds or

flu-like symptoms but not relevant to COVID-19, travel

or contact history, pharmacies should proceed in line

with their best practice and routine management of the

cross-infection risks to staff and other patients.

• Restrict the number of individuals entering isolation ar-

eas, including the room of a patient with suspected and

confirmed COVID-19.

• For safe work practice, protect workers to close contact

with the infected person by using additional engineering and administrative control

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