Covid-19

There is currently no known difference between the clinical manifestations of COVID-19 or risk of severe illness or foetal compromise for pregnant and non-pregnant women or adults of reproductive age.  Pregnant and recently pregnant women with suspected or confirmed COVID-19 should be treated with supportive and management therapies, considering the immunologic and physiologic adaptations during and after pregnancy which may overlap with COVID-19 symptoms.  Data are limited but, until the evidence base provides clearer information, special consideration should be given to pregnant women with concomitant medical illnesses who could be infected with COVID-19. There are no reported deaths in pregnant women at time of publishing this information however, COVID-19 testing of symptomatic pregnant women may need to be prioritized to enable access to specialized care.  All recently pregnant women with COVID-19 or who have recovered from COVID-19 should be provided with information and counselling on safe infant feeding and appropriate IPC measures to prevent COVID-19 virus transmission.

With confirmed disease or under investigation, management is similar to non-pregnant women, with appropriate isolation of confirmed or under investigation.  Obstetric facilities must be notified and prepared, noting that each infant born to any mother with confirmed COVID-19 should be considered a ‘person under investigation’ and should be isolated according to the IPC guidance.  Currently, it is unknown whether newborns with COVID-19 are at increased risk for severe complications.

It is important to assure continuous access to essential HIV prevention, testing and treatment services also where measurements of confinement are implemented within the public health response to the COVID-19 pandemic. While access to essential services should be maintained, adapted and evidence-based measures to reduce possible transmission should be considered and implemented.  These include:

• Applying standard precautions for all patients (including ensuring that all patients cover their nose and mouth with a tissue or elbow when coughing or sneezing, offering a medical mask to patients with suspected COVID-19 infection while they are in waiting in the service, perform hand hygiene etc.)
• Health care and outreach workers, as well as peer educators and clients should apply adapted hand hygiene measures
• Ensuring triage, early recognition, and source control (isolating patients with suspected COVID-19 infection)
• Ensure there is adequate ventilation in all areas in the healthcare facility
• Spatial separation of at least 1 metre should ideally be maintained between all patients within all types of services
• Cleaning and disinfection procedures should be followed consistently and correctly
• Dispensing medicines (for treatment of HIV, TB and other chronic conditions such as opioid dependence) for longer periods allowing reduced frequency of patient visits
• Consider reduction of services to the most critical ones (provision of essential treatment and prevention services; services such as counselling sessions may be reduced or adapted)

Generally, vulnerable populations, including members of key populations, as well as homeless and/or displaced people may be at increased risk of infection – because of additional comorbidities impacting on their immune system, reduced ability to apply measures of confinement and social distancing, as well as generally limited access to health services.  It is critical that services that reach these populations such as community-based services, drop-in centres and outreach services can continue providing life-saving prevention (distribution of condoms, needles and syringes), testing and treatment while securing safety of staff and clients. Services can be adapted according to above considerations where applicable.

People living with HIV with advanced disease, those with low CD4 and high viral load and those who are not taking antiretroviral treatment have an increased risk of infections and related complications in general.  It is unknown if the immunosuppression of HIV will put a person at greater risk for COVID-19, thus, until more is known, additional precautions for all people with advanced HIV or poorly controlled HIV, should be employed.

At present there is no evidence that the risk of infection or complications of COVID-19 is different among people living with HIV who are clinically and immunologically stable on antiretroviral treatment when compared with the general population.  Some people living with HIV may have known risk factors for COVID-19 complications, such as diabetes, hypertension and other noncommunicable diseases and as such may have increased risk of COVID-19 unrelated to HIV.  We know that during the SARS and MERS outbreaks there were only a few case reports of mild disease among people living with HIV.

To date, there is a case report of a person living with HIV who had COVID-19 and recovered and a small study on risk factors and antiretrovirals used among people living with HIV with COVID-19 from China.  This study reported similar rates of COVID-19 disease as compared to the entire population and increased risk with older age, but not with low CD4, high viral load level or antiretroviral regimen. Current clinical data suggest the main mortality risk factors are linked to older age and other comorbidities including cardiovascular disease, diabetes, chronic respiratory disease, and hypertension. Some very healthy people have also developed severe disease from the coronavirus infection.

PLHIV are advised to take the same precautions as the general population:

• wash hands often
• cough etiquette
• physical distancing
• seek medical care if symptomatic
• self-isolation if in contact with someone with COVID-19 and
• other actions per the government response

People living with HIV who are taking antiretroviral drugs should ensure that they have at least 30 days and up to 6-month supply of medicines and ensure that their vaccinations are up to date (influenza and pneumococcal vaccines). Adequate supplies of medicines to treat co-infections and comorbidities and addiction should also be ensured.

The most important thing to know about coronavirus on surfaces is that they can easily be cleaned with common household disinfectants that will kill the virus. Studies have shown that the COVID-19 virus can survive for up to 72 hours on plastic and stainless steel, less than 4 hours on copper and less than 24 hours on cardboard.As, always clean your hands with an alcohol-based hand rub or wash them with soap and water. Avoid touching your eyes, mouth, or nose.

The time between exposure to COVID-19 and the moment when symptoms start is commonly around five to six days but can range from 1 – 14 days.

COVID-19 is mainly spread through respiratory droplets expelled by someone who is coughing or has other symptoms such as fever or tiredness. Many people with COVID-19 experience only mild symptoms. This is particularly true in the early stages of the disease. It is possible to catch COVID-19 from someone who has just a mild cough and does not feel ill.Some reports have indicated that people with no symptoms can transmit the virus. It is not yet known how often it happens. WHO is assessing ongoing research on the topic and will continue to share updated findings.

People can catch COVID-19 from others who have the virus. The disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes, or speaks. These droplets are relatively heavy, do not travel far and quickly sink to the ground. People can catch COVID-19 if they breathe in these droplets from a person infected with the virus. This is why it is important to stay at least 1 meter) away from others. These droplets can land on objects and surfaces around the person such as tables, doorknobs and handrails. People can become infected by touching these objects or surfaces, then touching their eyes, nose or mouth. This is why it is important to wash your hands regularly with soap and water or clean with alcohol-based hand rub. WHO is assessing ongoing research on the ways that COVID-19 is spread and will continue to share updated findings.

If you have minor symptoms, such as a slight cough or a mild fever, there is generally no need to seek medical care. Stay at home, self-isolate and monitor your symptoms. Follow national guidance on self-isolation.However, if you live in an area with malaria or dengue fever it is important that you do not ignore symptoms of fever. Seek medical help. When you attend the health facility wear a mask if possible, keep at least 1 metre distance from other people and do not touch surfaces with your hands. If it is a child who is sick help the child stick to this advice. Seek immediate medical care if you have difficulty breathing or pain/pressure in the chest. If possible, call your health care provider in advance, so he/she can direct you to the right health facility.

The most common symptoms of COVID-19 are fever, dry cough, and tiredness. Other symptoms that are less common and may affect some patients include aches and pains, nasal congestion, headache, conjunctivitis, sore throat, diarrhea, loss of taste or smell or a rash on skin or discoloration of fingers or toes. These symptoms are usually mild and begin gradually. Some people become infected but only have very mild symptoms.Most people (about 80%) recover from the disease without needing hospital treatment. Around 1 out of every 5 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart and lung problems, diabetes, or cancer, are at higher risk of developing serious illness. However, anyone can catch COVID-19 and become seriously ill. People of all ages who experience fever and/or cough associated withdifficulty breathing/shortness of breath, chest pain/pressure, or loss of speech or movement should seek medical attention immediately. If possible, it is recommended to call the health care provider or facility first, so the patient can be directed to the right clinic.

Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease COVID-19.