Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
January 21, 2020

DEPARTMENT MEMORANDUM
No. 2020 - _____________

FOR : ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;

CENTERS FOR HEALTH DEVELOPMENT (CHD) AND BUREAU
DIRECTORS; MINISTER OF HEALTH - BANGSAMORO
AUTONOMOUS REGION IN MUSLIM MINDANAO (MOH-BARMM);
SPECIAL AND SPECIALTY HOSPITAL DIRECTORS; CHIEFS OF
MEDICAL CENTERS, HOSPITALS AND SANITARIA; AND OTHER
CONCERNED

SUBJECT : Interim Guidelines on the Preparedness and Response to Novel

Coronavirus (2019-nCoV) from Wuhan, China (as of Jan 21, 2020)

I. BACKGROUND

On December 31, 2019, a clustering of pneumonia cases of unknown etiology was reported in Wuhan
City, Hubei Province of China. Cases were identified between December 8, 2019 and January 2, 2020.
As of January 5, 2020, there were 59 cases identified with remaining seven (7) severely ill.

On January 9, 2020 Chinese health authorities reported that the cause of this viral pneumonia was
preliminarily identified as a novel (or new) type of coronavirus (2019-nCoV), which is different from
any other human coronaviruses discovered so far. To date, there are a total of 139 2019-nCoV cases in
China, especially in Wuhan, Beijing, and Shenzhen. Thailand, Japan and South Korea reported
confirmed cases outside of China. Initially, the said disease was thought to be transmitted through animal
contact but recent reports of health workers infected with the 2019-nCoV suggest human-to-human
transmission.

The Department of Health hereby issues these interim guidelines to provide guidance to all national
health security partners and stakeholders so as to take necessary precautions, prevent and immediately
act in the event of entry of potential cases of 2019-nCoV into the country. Being a novel or new
pathogen never experienced by humans, it is considered an emerging infectious disease and is currently
being monitored and the details of the pathogen investigated. This point stated, WHO guidelines are
closely followed and implemented and member states may adjust recommendations as per their
respective context.

II. IMPLEMENTING GUIDELINES

A. 2019- nCoV - novel coronavirus

Coronaviruses are a large family of viruses, some causing illness in people and others that
circulate among animals, including camels, cats and bats. Rarely, animal coronaviruses can
evolve and infect people and then spread between people such as has been seen with MERS
and SARS.

Current available information show that most patients present with fever, fatigue, little sputum
and small number of patients with difficulty breathing. Chest X-ray finding of pneumonia
described as infiltrative lung disease. The virus is mild in presentation as compared to SARS
and MersCoV but have been 4 deaths declared in persons with other co-morbidities aside from
the pneumonia.

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ● Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ● URL: http://www.doh.gov.ph; e-mail: [email protected]
 The preparedness and response framework of the Department of Health, Philippines against
the 2019 Novel Coronavirus is embodied in the Emerging and re-emerging Infectious Disease
Manual of Operations and Procedures.

Each of the partners and stakeholders, are part of the work force with their corresponding roles
and responsibilities. Please see the link:

https://mail.google.com/mail/u/0?ui=2&ik=784518f27c&attid=0.1&permmsgid=msg-
f:1650775572605504542&th=16e8bba3190b0c1e&view=att&disp=safe&realattid=f_k382v8
l50

B. Surveillance
Person Under Investigation (PUI) should meet and evaluated following the table below:

Note:
1. *NPS/OPS collection must be collected on admission followed after 24 to 48 hours after
admission
2. The decision to admit the patient must be based on the assessment of the attending
physician on the health condition of the patient
3. This Decision Tool shall be treated as an interim guide as for health personnel in the
assessment of person under investigation an new knowledge on the disease is uncovered

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A checklist could be developed by hospital/offices using the above tool. For case definition see
ANNEX 1: Surveillance case definitions for human infection with novel coronavirus (nCoV)

For close contact criteria and evaluation see ANNEX 2.

C. Laboratory Testing

Rapid collection and testing of appropriate specimens from suspected cases is a priority.
Respiratory material* (nasopharyngeal and oropharyngeal swab) shall be collected in
ambulatory patients and sputum (if produced) and/or endotracheal aspirate in patients with more
severe respiratory disease). Serum for serological testing, acute sample and convalescent
sample, shall be collected as well (this is additional to respiratory materials and can support the
identification of the true agent, once serologic assay is available). Other specimens to consider
in unresolved cases: blood for culture, urine for Legionella and pneumococcal antigen detection

For Samples to be collected see ANNEX 3 and for Safety procedures during sample collection and
transport see ANNEX 4 & 5.

D. Clinical Management of PUI in a Health Facility

This is intended for clinicians taking care of hospitalized adult and pediatric patient classified as PUI;

1. Triage: Recognize and sort all patients with Severe Acute Respiratory Infection (SARI) at first point
of contact. Consider nCOV as a possible etiology of SARI based on surveillance criteria. Triage patients
and start emergency treatments based on disease severity.

2. Immediate implementation of appropriate infection prevention and control (IPC) measure.

Activate your institutions’ IPC committee. The Health Facility Development
Bureau provides manuals and protocols on health facility IPC.

3. Early supportive therapy and monitoring; As there is still ongoing investigation on the details of the
pathogen and precise mode of transmission of the virus, there are no prescribed medicines, vaccines and
protocol for exact pathogen. Supportive therapy and management of concomitant co morbidities or other
infections are advised

See ANNEX 6 for additional clinical management criteria and procedures

E. Risk Communication and Community Engagement (RCCE)

One of the most important and effective interventions in public health response to the nCoV is to
proactively communicate what is known, what is unknown and what is being done to get more information
with the objective of saving lives and minimizing adverse consequences.

RCCE should be initiated to help prevent infodemics (the spread of misinformation), builds trust in the
response and increases the probability that health advice is followed. It minimizes and manages false
rumors and misunderstanding that undermine response and may lead to further disease spread.

Community engagement strategies should start to involve communities in the response and develops
acceptable yet effective interventions to stop further amplification of the outbreak and for individual and
group protective measures.

See ANNEX 9 for detailed WHO recommendations on Risk Communication and Community
Engagement

F. Infection Prevention and Control

1. Early recognition and immediate placement of patients in separate area from other patients is critical
measure for rapid identification and appropriate care for suspected nCoV cases.
2. Ensure Standard Precautions are observed, including hand and respiratory hygiene, and use of
personal protective equipment.

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 3. Implement empiric additional precautions for suspected nCoV infections, especially
contact and droplet precautions, and airborne precautions for aerosol-generating
procedures see ANNEX 7
4. Individual and community engagement is vital in stopping the virus circulation see
ANNEX 8

Health human resources have been trained and are experienced to handle MERS-Cov and other
SARI. There is Rapid Response Team created by each CHD which is composed of the EREID
coordinator, HEMs Manager, HEPOs and RESUs.

Logistics supplies include PPE sets, N95 masks, surgical masks, gloves and Oseltamivir for
Influenza virus which are available at the central office and CHDs.

Further guidelines will be provided as new information evolves.

For information and guidance of all concerned.

By authority of the Secretary of Health,

ROLANDO ENRIQUE D. DOMINGO, MD, DPBO

Undersecretary of Health
Office of the Chief of Staff/Health Regulation Team

Office PHST-Usec FICT-Usec

Name

Myrna C. Cabotaje, MD, MPH, Gerardo V. Bayugo, MD, MPH,

CESO III CESO III
Undersecretary of Health Undersecretary of Health

Date

Keywords Novel Coronavirus in China

Related
Issuances

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ANNEX 1.

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ANNEX 2

The criteria are intended to serve as guidance for evaluation. Patients should be evaluated and
discussed with public health departments on a case-by-case basis if their clinical presentation or
exposure history is equivocal (e.g., uncertain travel or exposure).

Close contact is defined as:

1. Persons visiting patients or staying in the same close environment of a nCoV patient.

a) being within approximately 6 feet (2 meters), or within the room or care area, of a
novel coronavirus case for a prolonged period of time while not wearing
recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-
certified disposable N95 respirator, eye protection); close contact can include caring
for, living with, visiting, or sharing a health care waiting area or room with a novel
coronavirus case.– or –

b) having direct contact with infectious secretions of a novel coronavirus case (e.g.,
being coughed on) while not wearing recommended personal protective equipment.

2. Working together in close proximity or sharing the same classroom environment with a
with nCoV patient
3. Traveling together with nCoV patient in any kind of conveyance
4. Living in the same household as a nCoV patient
5. Health care associated exposure, including providing direct care for nCov patients,
working with health care workers infected with nCov
6. Once the animal source is identified, exposure to the animals or animal products

The epidemiological link may have occurred within a 14‐day period before or after the onset of
illness in the case under consideration.

Healthcare providers should immediately notify both infection control personnel at their
healthcare facility and their local or state health department in the event of a PUI for 2019-
nCoV. Likewise, quarantine officers and community surveillance officers should alert the
Epidemiology Bureau, DOH immediately.

The surveillance of influenza-like illness (ILI) under the Philippine Integrated Disease
Surveillance and Response (PIDSR) will continue to be implemented. However, the event based
surveillance will be primarily used for this 2019-nCov event.

The laboratory-based ILI surveillance maintained by RITM shall be utilized to facilitate the
collection, storage and transport to RITM of specimens from suspected cases of nCoV.

The BOQ shall be responsible for the early screening and preliminary investigation of all
suspected nCoV cases identified in all points of entry. These cases shall be reported within 24
hours to the corresponding RESU.

Designated disease surveillance officers in hospitals and other facilities shall be responsible for
doing the preliminary assessment of suspected cases in their respective health facility.

Information obtained from above systems shall follow their usual reporting and feedback
mechanism.

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ANNEX 3

Specimens to be collected from symptomatic patients and asymptomatic contacts

Specimen type Collection Transport Storage till Comment

materials to testing
laboratory
Nasopharyngeal Dacron or 4 °C ≤5 days: 4 °C The nasopharyngeal and
and oropharyngeal polyester >5 days: -70 °C oropharyngeal swabs
swab flocked should be placed in the
swabs* same tube to increase the
viral load.
Bronchoalveolar sterile 4 °C ≤48 hours: 4 °C There may be some
lavage container * >48 hours: –70 dilution
°C of pathogen, but still a
worthwhile specimen
Tracheal aspirate, sterile 4 °C ≤48 hours: 4 °C
nasopharyngeal container * >48 hours: –70
aspirate or nasal °C
wash
Sputum sterile 4 °C ≤48 hours: 4 °C Ensure the material is
container >48 hours: –70 from the lower
°C respiratory tract
Tissue from biopsy sterile 4 °C ≤24 hours: 4 °C
or autopsy container with >24 hours: –70
including from saline °C
lung
Serum (2 samples Serum 4 °C ≤5 days: 4 °C Collect paired samples:
acute and separator >5 days: –70 °C • acute – first week
convalescent tubes (adults: of illness
possibly 2-4 weeks collect 3-5 ml • convalescent – 2
after acute phase) whole blood) to 3 weeks later
Whole blood collection tube 4 °C ≤5 days: 4 °C For antigen detection
>5 days: –70 °C particularly in the first
week of illness
Urine urine 4 °C ≤5 days: 4 °C
collection >5 days: –70 °C
container

*For transport of samples for viral detection, use VTM (viral transport medium) containing antifungal
and antibiotic supplements. For bacterial or fungal culture, transport dry or in a very small amount of
sterile water. Avoid repeated freezing and thawing of specimens.

Aside from specific collection materials indicated in the table also assure other materials and
equipment are available: e.g. transport containers and specimen collection bags and packaging, coolers
and cold packs or dry ice, sterile blood-drawing equipment (e.g. needles, syringes and tubes), labels
and permanent markers, PPE, materials for decontamination of surfaces.

Serum for serologic tests for the detection of nCoV antigen and/or antibodies against nCoV should
also be saved/extracted. For this, paired serum samples are required for confirmation of infection.
Single acute samples with high titers may also be of value for identifying probable cases. Paired serum
samples should ideally be collected 14-21 days apart, with the first being taken during the first week of

7
illness. If only a single sample can be collected, this should be done at least 14 days after the onset of
symptoms.

Laboratory testing for nCoV is performed by the Molecular Biology Laboratory of the Research
Institute for Tropical Medicine. The turn-around time is usually 48 hours upon receipt of the
specimen. All specimens sent to RITM shall be coordinated with the Surveillance Unit at (02) 994-
1887.

ANNEX 4

Safety Procedure during Sample Collection

Infection prevention measurements for a novel coronavirus (route of transmission unknown but
suspected to be respiratory)

Ensure that Health Care workers (HCWs) who collect specimens follow the following guideline and
use the adequate PPE: Infection prevention and control during health care when novel coronavirus
(nCoV) infection is suspected, interim guidance, January 2020 (11) and other IPC guidance (10, 15-
17).

Ensure that HCWs performing aerosol-generating procedures (i.e. aspiration or open suctioning of
respiratory tract specimens, intubation, cardiopulmonary resuscitation, bronchoscopy) use additional
precautions (for details see detailed guidelines mentioned above).

Respirators (NIOSH-certified N95, EU FFP2 or equivalent, or higher level of protection).

When putting on a disposable particulate respirator, always check the seal/fitness. Be aware that the
presence of facial hair (e.g. beard) may prevent a proper respirator fit for the wearer.

Eye protection (i.e. goggles or a face shield).

Clean, non-sterile, long-sleeved gown and gloves. Note that some procedures require sterile
gloves. If gowns are not fluid resistant, a waterproof apron should be used for procedures
where it is expected that high fluid volumes might penetrate the gown

• Perform procedures in an adequately ventilated room: at a minimum natural ventilation with at least
160l/s/patient air flow, or negative pressure rooms with at least 12 air changes per hour and controlled
direction of air flow when using mechanical ventilation

• Limit the number of persons present in the room to the minimum required for the patient’s care and
support; and

• Follow guidance for steps of donning and doffing PPE. Perform hand hygiene before and after
contact with the patient and his or her surroundings and after PPE removal.

• Waste management and decontamination procedures:

Ensure that all materials used is disposed appropriately. Disinfection of work areas and
decontamination of possible spills of blood or infectious body fluids should follow validated
procedures, usually with chlorine-based solutions.

Specifics for transport of samples to laboratory:

• Ensure that personnel who transport specimens are trained in safe handling practices and spill
decontamination procedures.
• Follow the requirements in the national or international regulations for the transport of
dangerous goods (infectious substances) as applicable (14).
• Deliver all specimens by hand whenever possible. Do not use pneumatic-tube systems to
transport specimens. • State the full name, date of birth of the suspected SARI case clearly on

8
 the accompanying request form. Notify the laboratory as soon as possible that the specimen is
being transported.

Specifics for biosafety practices in the laboratory

Ensure that health laboratories adhere to appropriate biosafety practices. Any testing on clinical
specimens from patient meeting the case definition should be performed in appropriately equipped
laboratories by staff trained in the relevant technical and safety procedures. National guidelines on
the laboratory biosafety should be followed in all circumstances. General information on laboratory
biosafety guidelines, see the WHO Laboratory Biosafety Manual, 3rd edition (8).

It is recommended that all manipulations in laboratory settings of samples originating from suspected
or confirmed cases of novel coronaviruses can be conducted according to WHO recommendations
available at: https://www.who.int/csr/disease/coronavirus_infections/Biosafe
ty_InterimRecommendations_NovelCoronavirus2012_31Oct12. pdf?ua=1 Information on biosafety
levers for SARS, a Betacoronavirus that can cause severe respiratory disease can be consulted at
https://www.who.int/csr/sars/biosafety2003_04_25/en/.
and other guidance.

ANNEX 5

Packaging and shipment to another laboratory

Transport of specimens within national borders should comply with applicable national regulations.
International Transport Regulations. Novel coronavirus specimens should follow the UN Model
Regulations, and any other applicable regulations depending on the mode of transport being used.
More information may be found in the WHO Guidance on regulations for the Transport of Infectious
Substances 2019-2020 (Applicable as from 1 January 2019) (14). A summary on transport of
infectious substances can also be found in Toolbox 4 of the Managing epidemics handbook (1).

Patient specimens from suspected or confirmed cases should be transported as UN3373, “Biological
Substance, Category B”, when they are transported for diagnostic or investigational purposes. Viral
cultures or isolates should be transported as Category A, UN2814, “infectious substance, affecting
humans”. All specimens being transported (whether UN3373 or UN2814) should have appropriate
packaging, labelling and documentation, as described above.

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ANNEX 6:

CLINICAL MANAGEMENT

The nCoV may present with mild, moderate, or severe illness; the latter includes severe pneumonia,
ARDS, sepsis and septic shock. Early recognition of suspected patients allows for timely initiation of
IPC. Early identification of those with severe manifestations allows for immediate optimized
supportive care treatments and safe, rapid admission (or referral) to intensive care unit according to
institutional or national protocols. For those with mild illness, hospitalization may not be required
unless there is concern for rapid deterioration. All patients discharged home should be instructed to
return to hospital if they develop any worsening of illness.

There is no current evidence from RCTs to recommend any specific anti-nCoV treatment for
patients with suspected or confirmed nCoV.

https://www.who.int/docs/default-source/coronaviruse/clinical- management-of-novel-
cov.pdf?sfvrsn=bc7da517_2

Clinical syndromes associated with nCoV infection

Uncomplicated Patients with uncomplicated upper respiratory tract viral infection, may have non-
illness specific symptoms such as fever, cough, sore throat, nasal congestion, malaise,
headache, muscle pain or malaise. The elderly and immunosuppressed may present
with atypical symptoms. These patients do not have any signs of dehydration, sepsis or
shortness of breath.
Mild Patient with pneumonia and no signs of severe pneumonia.
pneumonia Child with non-severe pneumonia has cough or difficulty breathing + fast breathing: fast
breathing (in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40 and no
signs of severe pneumonia.
Severe
Pneumonia Adolescent or adult: fever or suspected respiratory infection, plus one of respiratory
rate >30
breaths/min, severe respiratory distress, or SpO2 <90% on room air.
Child with cough or difficulty in breathing, plus at least one of the following:
central cyanosis or SpO2 <90%; severe respiratory distress (e.g. grunting, very
severe chest in drawing); signs of pneumonia with a general danger sign:
inability to breastfeed or drink, lethargy or unconsciousness, or convulsions.
Other signs of pneumonia may be present: chest in drawing, fast breathing (in
breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40.2 The
diagnosis is clinical; chest imaging can exclude complications.

Supportive Therapy

 Give supplemental oxygen therapy immediately to patients with SARI and respiratory
distress, hypoxemia, or shock
 Use conservative fluid management in patients with SARI when there is no evidence
of shock.
 Give empiric antimicrobials to treat all likely pathogens causing SARI. Give
antimicrobials within one hour of initial patient assessment for patients with sepsis.
 Do not routinely give systemic corticosteroids for treatment of viral pneumonia or
Acute Respiratory Distress Syndrome (ARDS) outside of clinical trials unless they
are indicated for another reason.

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  Closely monitor patients with SARI for signs of clinical deterioration, such as rapidly
progressive respiratory failure and sepsis, and apply supportive care interventions
immediately.
 Understand the patient’s co-morbid condition(s) to tailor the management of critical
illness and appreciate the prognosis. Communicate early with patient and family.

Management of hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS)

 Recognize severe hypoxemic respiratory failure when a patient with respiratory

distress is failing standard oxygen therapy.
 High-flow nasal oxygen (HFNO) or non-invasive ventilation (NIV) should only be
used in selected patients with hypoxemic respiratory failure. The risk of treatment
failure is high in patients with MERS treated with NIV, and patients treated with
either HFNO or NIV should be closely monitored for clinical deterioration.
 Endotracheal intubation should be performed by a trained and experienced provider
using airborne precautions.
 Implement mechanical ventilation using lower tidal volumes (4–8 ml/kg predicted
body weight, PBW) and lower inspiratory pressures (plateau pressure <30 cmH2O).
 In patients with severe ARDS, prone ventilation for >12 hours per day is
recommended
 Use a conservative fluid management strategy for ARDS patients without tissue
hypoperfusion.
 In patients with moderate or severe ARDS, higher PEEP instead of lower PEEP is
suggested.
 In patients with moderate-severe ARDS (PaO2/FiO2 <150), neuromuscular
blockade by continuous infusion should not be routinely used.
 In settings with access to expertise in extracorporeal life support (ECLS), consider
referral of patients with refractory hypoxemia despite lung protective ventilation

Avoid disconnecting the patient from the ventilator, which results in loss of PEEP and atelectasis. Use
in-line catheters for airway suctioning and clamp endotracheal tube when disconnection is required
(for example, transfer to a transport ventilator).

 Management of septic shock

 Prevention of complications
 Specific anti-nCoV treatments

Special considerations for pregnant patients

Pregnant women with suspected or confirmed nCoV should be treated with supportive therapies as
described above, taking into account the physiologic adaptations of pregnancy.

The use of investigational therapeutic agents outside of a research study should be guided by individual
risk-benefit analysis based on potential benefit for mother and safety to fetus, with consultation from an
obstetric specialist and ethics committee.

Emergency delivery and pregnancy termination decisions are challenging and based on many factors:
gestational age, maternal condition, and fetal stability. Consultations with obstetric, neonatal, and
intensive care specialists (depending on the condition of the mother) are essential.

How to implement infection prevention and control measures for patients with suspected or
confirmed nCoV infection
At triage Give suspect patient a medical mask and direct patient to separate area, an
isolation room if available. Keep at least 1meter distance between suspected
patients and other patients. Instruct all patients to cover nose and mouth during

11
 coughing or sneezing with tissue or flexed elbow for others. Perform hand
hygiene after contact with respiratory secretions
Apply droplet precautions Droplet precautions prevent large droplet transmission of respiratory
viruses. Use a medical mask if working within 1-2 metre s of the patient. Place
patients in single rooms, or group together those with the same etiological
diagnosis. If an etiological diagnosis is not possible, group patients with similar
clinical diagnosis and based on epidemiological risk factors, with a spatial
separation. When providing care in close contact with a patient with respiratory
symptoms (e.g. coughing or sneezing), use eye protection (face-mask or
goggles), because sprays of secretions may occur. Limit patient movement
within the institution and ensure that patients wear medical masks when outside
their rooms.

Apply contact precautions Droplet and contact precautions prevent direct or indirect
transmission from contact with contaminated surfaces or equipment (i.e.
contact with contaminated oxygen tubing/interfaces). Use PPE (medical mask,
eye protection, gloves and gown) when entering room and remove PPE when
leaving. If possible, use either disposable or dedicated equipment (e.g.
stethoscopes, blood pressure cuffs and thermometers). If equipment needs to be
shared among patients, clean and disinfect between each patient use. Ensure
that health care workers refrain from touching their eyes, nose, and mouth with
potentially contaminated gloved or ungloved hands. Avoid contaminating
environmental surfaces that are not directly related to patient care (e.g. door
handles and light switches). Ensure adequate room ventilation. Avoid
movement of patients or transport. Perform hand hygiene.

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ANNEX 7

IPC is a critical and integral part of clinical management of patients and should be initiated at the
point of entry of the patient to hospital (typically the Emergency Department). Standard precautions
should always be routinely applied in all areas of health care facilities. Standard precautions include
hand hygiene; use of PPE to avoid direct contact with patients’ blood, body fluids, secretions
(including respiratory secretions) and non-intact skin. Standard precautions also include prevention of
needle-stick or sharps injury; safe waste management; cleaning and disinfection of equipment; and
cleaning of the environment.

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14
15
ANNEX 8

General Public Health Prevention Measures

DOH is recommending these measures for the following:

 Caregivers and household members of a person confirmed to have, or being evaluated for,
2019-nCoV infection
 Other people who have had close contact with a person confirmed to have, or being evaluated
for, 2019-nCoV infection

Prevention Steps for People who may have 2019-nCoV Infection

If you are feeling sick and are confirmed to have, or being evaluated for, 2019-nCoV infection you
should follow the prevention steps below until a healthcare provider or local or state health
department says you can return to your normal activities.

Stay home except to get medical care

You should restrict activities outside your home, except for getting medical care. Do not go to
work, school, or public areas, and do not use public transportation or taxis.

Separate yourself from other people in your home

As much as possible, you should stay in a different room from other people in your home. Also,
you should use a separate bathroom, if available.

Call ahead before visiting your doctor

Before your medical appointment, call the healthcare provider and tell them that you have, or are
being evaluated for, 2019-nCoV infection. This will help the healthcare provider’s office take
steps to keep other people from getting infected.

Wear a facemask

You should wear a facemask when you are in the same room with other people and when you visit
a healthcare provider. If you cannot wear a facemask, the people who live with you should wear
one while they are in the same room with you.

Cover your coughs and sneezes

Cover your mouth and nose with a tissue when you cough or sneeze, or you can cough or sneeze
into your sleeve. Throw used tissues in a lined trash can, and immediately wash your hands with
soap and water for at least 20 seconds.

Wash your hands

Wash your hands often and thoroughly with soap and water for at least 20 seconds. You can use an
alcohol-based hand sanitizer if soap and water are not available and if your hands are not visibly
dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing household items

You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other
items with other people in your home. After using these items, you should wash them thoroughly
with soap and water.
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Monitor your symptoms

Seek prompt medical attention if your illness is worsening (e.g., difficulty breathing). Before
going to your medical appointment, call the healthcare provider and tell them that you have, or are
being evaluated for, 2019-nCoV infection. This will help the healthcare provider’s office take
steps to keep other people from getting infected. Ask your healthcare provider to call the local or
city/provincial health department.

Prevention Steps for Caregivers and Household Members

If you live with, or provide care at home for, a person confirmed to have, or being evaluated for,
2019-nCoV infection, you should:

 Make sure that you understand and can help the person follow the healthcare provider’s
instructions for medication and care. You should help the person with basic needs in the home
and provide support for getting groceries, prescriptions, and other personal needs.
 Have only people in the home who are essential for providing care for the person.
o Other household members should stay in another home or place of residence. If this is
not possible, they should stay in another room, or be separated from the person as
much as possible. Use a separate bathroom, if available.
o Restrict visitors who do not have an essential need to be in the home.
o Keep elderly people and those who have compromised immune systems or chronic
health conditions away from the person. This includes people with chronic heart, lung
or kidney conditions, and diabetes.
 Make sure that shared spaces in the home have good air flow, such as by an air conditioner or
an opened window, weather permitting.
 Wash your hands often and thoroughly with soap and water for at least 20 seconds. You can
use an alcohol-based hand sanitizer if soap and water are not available and if your hands are
not visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.
 Wear a disposable facemask, gown, and gloves when you touch or have contact with the
person’s blood, body fluids and/or secretions, such as sweat, saliva, sputum, nasal mucus,
vomit, urine, or diarrhea.
o Throw out disposable facemasks, gowns, and gloves after using them. Do not reuse.
o Wash your hands immediately after removing your facemask, gown, and gloves.
 Avoid sharing household items. You should not share dishes, drinking glasses, cups, eating
utensils, towels, bedding, or other items with a person who is confirmed to have, or being
evaluated for, 2019-nCoV infection. After the person uses these items, you should wash them
thoroughly (see below “Wash laundry thoroughly”).
 Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures,
toilets, phones, keyboards, tablets, and bedside tables, every day. Also, clean any surfaces that
may have blood, body fluids and/or secretions or excretions on them.
o Read label of cleaning products and follow recommendations provided on product
labels. Labels contain instructions for safe and effective use of the cleaning product
including precautions you should take when applying the product, such as wearing
gloves or aprons and making sure you have good ventilation during use of the product.
o Use a diluted bleach solution or a household disinfectant with a label that says “EPA-
approved.” To make a bleach solution at home, add 1 tablespoon of bleach to 1 quart
(4 cups) of water. For a larger supply, add ¼ cup of bleach to 1 gallon (16 cups) of
water.
 Wash laundry thoroughly.
o Immediately remove and wash clothes or bedding that have blood, body fluids and/or
secretions or excretions on them.
o Wear disposable gloves while handling soiled items. Wash your hands immediately
after removing your gloves.
o Read and follow directions on labels of laundry or clothing items and detergent. In
general, wash and dry with the warmest temperatures recommended on the clothing
label.

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  Place all used disposable gloves, gowns, facemasks, and other contaminated items in a lined
container before disposing them with other household waste. Wash your hands immediately
after handling these items.
 Monitor the person’s symptoms. If they are getting sicker, call his or her medical provider and
tell them that the person has, or is being evaluated for, 2019-nCoV infection. This will help the
healthcare provider’s office take steps to keep other people from getting infected. Ask the
healthcare provider to call the local or city/ provincial health department.

Prevention Steps for Close Contacts

If you have had close contact with someone who is confirmed to have, or being evaluated for,
2019-nCoV infection, you should:

 Monitor your health starting from the day you first had close contact with the person and
continue for 14 days after you last had close contact with the person. Watch for these signs and
symptoms:
o Fever. Take your temperature twice a day.
o Coughing.
o Shortness of breath or difficulty breathing.
o Other early symptoms to watch for are chills, body aches, sore throat, headache,
diarrhea, nausea/vomiting, and runny nose.
 If you develop any of these symptoms, follow the prevention steps for caregivers and
household members described above, and call your healthcare provider as soon as possible.
Before going to your medical appointment, call the healthcare provider and tell them about
your close contact with someone who is confirmed to have, or being evaluated for, 2019-nCoV
infection. This will help the healthcare provider’s office take steps to keep other people from
getting infected. Ask your healthcare provider to call the local or city/provincial health
department.
 If you do not have any symptoms, you can continue with your daily activities, such as going to
work, school, or other public areas.

Reduce risk of transmission of emerging pathogens from animals to humans in live animal
markets

In light of available evidence and past experience, WHO makes the following general
recommendations:

 As a general precaution, anyone visiting live animal markets, wet markets or animal product
markets, should practice general hygiene measures, including regular hand washing with soap
and potable water after touching animals and animal products, avoiding touching eyes, nose or
mouth with hands, and avoiding contact with sick animals or spoiled animal products. Any
contact with other animals possibly living in the market (e.g., stray cats and dogs, rodents,
birds, bats) should be strictly avoided. Attention should also be taken to avoid contact with
potentially contaminated animal waste or fluids on the soil or structures of shops and market
facilities
 The consumption of raw or undercooked animal products should be avoided. Raw meat, milk
or animal organs should be handled with care, to avoid cross-contamination with uncooked
foods, as per good food safety practices.

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Recommendations for at-risk groups

 Until more is understood about the 2019-nCoV, people with underlying medical conditions are
considered at higher risk of severe disease. Therefore, individuals with these underlying
medical conditions should avoid contact with live animal markets, stray animals and wild
animals, should not eat animal raw meat. Such recommendations should also be disseminated
to travelers and tourists with underlying medical conditions.
 Slaughterhouse workers, veterinarians in charge of animal and food inspection in markets,
market workers, and those handling live animals and animal products should practice good
personal hygiene, including frequent hand washing after touching animals and animal
products. They should consider wearing protective gowns, gloves, masks while professionally
handling animals and fresh animal products. Equipment and working stations should be
disinfected frequently, at least once a day. Protective clothing should be removed after work
and washed daily. Workers should avoid exposing family members to soiled work clothing,
shoes, or other items that may have come into contact with potentially contaminated material.
It is therefore recommended that protective clothes and items remain at the workplace for daily
washing.
 Based on available information, it is not known if the 2019-nCoV has any impact on the health
of animals and no particular event has been reported in any species. As a general
recommendation, sick animals should never be slaughtered for consumption; dead animals
should be safely buried or destroyed and contact with their body fluids should be avoided
without protective clothes. Veterinarians should maintain a high level of vigilance and report
any unusual event detected in any animal species present in the markets to veterinary
authorities.

ANNEX 9

RCCE initial response checklist for countries where one or more cases have been identified

Goals

build and/or maintain trust with population through regular two way communication and engagement
that regularly addresses misunderstanding, misinformation, rumors
Encourage people to adopt protective behaviors

Action steps

Risk Communication Systems

processes that delay information

release and create confusion among affected populations

Internal and partner coordination

dissemination

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Public communication

ce the health threat early and often and update after a risk assessment and an analysis of risk

explain the degree to which information is uncertain (manage uncertainty), provide the public regular

for the audiences

Communication engagement with affected communities

Segment the audiences for the communication response (e.g. affected people, health care workers,
politica
Addressing uncertainty, perceptions and misinformation management

- explain degree to which uncertainty still

social media, hotlines, health care worker feedback from patients and community concerns and
continually apply feedback into adapted RCCE strategy Capacity building

leaders, responders and spokespeople on RCCE guidance as needed

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