Handbook of COVID-19 Prevention. What is a virus?

Transcription

1 1 What is a virus? Viruses are essentially invisible particles of nucleic acids and the proteins that envelop them. The core of viral amplification in the infected cells is the replication of its genetic material, nucleic acid molecules. The so-called replication refers to a nucleic acid as a template to produce a new nucleic acid which is identical to the original one. Independent viruses can not complete any vital process or show any life features. But the virus will show active life features immediately after invading the cells and they will use the host cell system for replication and amplification, and the new generation of viruses will be born. In this process, the host cells will be damaged to some extent. 1

2 2 How do viruses affect the human body? Viruses can invade the human body individually or in groups. Viruses may invade the tissue cells and SARS-CoV-2 mainly invades the lung tissue cells, which are medically called lung epithelial cells. There are hundreds of millions of epithelial cells in lung tissue. Once the virus invades the pulmonary epithelial cells, it starts to multiply (the core is RNA replication). Many new virus particles are formed in the cells, leading to cell death and the release of new virus particles and then infecting the surrounding pulmonary epithelial cells. If the body s immune system is defective, the infection process can break out in a very short time, leading to serious lung tissue damage and individual death. But under normal circumstances, our immune systems will work to prevent the virus from invading. Immunity is divided into inborn immunity (or innate immunity medically) and mixed immunity (acquired immunity medically), which can suppress and eliminate the invading viruses at many levels. 2

3 3 What is an infectious pneumonia? The infectious pneumonia refers to the inflammation of the lungs mainly caused by different pathogenic microorganisms. Infectious pneumonia pathogens include bacteria, viruses, fungi, mycoplasma, chlamydia and so on. Winter and spring are seasons with the high incidence of respiratory infections and viral pneumonia. The main clinical symptoms of viral pneumonia are fever, cough or chest tightness, dyspnea and so on. 3

4 4 What is a coronavirus? Coronavirus is named because its form is similar to the crown under electron microscope. Its transmission history can be described as notoriety. It is not only one of the main pathogens of the common cold, but also the cause of several serious epidemics. Coronavirus, a class of RNA viruses with envelope and linear single-strand positive-strand genome, are widely distributed in nature. The virus genome has a methylation cap at the 5 end, a poly(a) tail at the 3 end and a length of kb (kb is short for kilobase, which is a unit of length describing polynucleotide chains, equivalent to 1,000 bases in a single strand of nucleic acid), is a RNA virus with the largest genome up to now. Coronavirus only infects vertebrates and is related to many diseases of humans and animals, such as diseases in respiratory tract, digestive tract and nervous system. 4

5 5 What are the physical and chemical characteristics of the coronavirus? Human coronavirus is sensitive to heat. It is moderately stable at 4 and can be kept at -60 for several years. However, its resistance will decrease as the temperature increases. For example, HCoV-229E (a less pathogenic coronavirus that generally causes respiratory symptoms like the common cold) can lose the infectivity at 56 for 10 minutes or 37 for several hours. Human coronavirus is intolerant to acid and alkali. The optimal ph (Pondus Hydrogenii) for virus replication is 7.2. Human coronavirus is sensitive to organic solvents and disinfectants, so it can be inactivated by 75% alcohol, ether, chloroform, formaldehyde, chlorinated disinfectants, peracetic acid and ultraviolet light. Chlorhexidine is not effective in inactivating the virus. 5

6 6 The epidemiological investigation of coronavirus. Globally, 10% ~ 30% of the upper respiratory tract infections are caused by coronaviruses such as HCOV-229E, HcoV-OC43, HCoV-NL63, and HCOV- HKU1, which are the second leading cause of the common cold, only second to rhinoviruses. The infection is seasonal, with high incidence in spring and winter. It usually has an incubation period and the population is generally susceptible. The main route of transmission is contact transmission. 6

7 7 What are animal coronaviruses? Animal coronaviruses include mammalian coronaviruses and avian coronaviruses. Mammalian coronaviruses are mainly α and β coronaviruses, which can infect bats, pigs, dogs, cats, rats, cattle, horses and other mammals. Avian coronaviruses are mainly γ and δ coronaviruses, which can infect chickens, sparrows, ducks, gooses, pigeons and many other kinds of birds. Many wild animals may carry pathogens and become the media for certain infectious diseases. For example, civet cats, bats, bamboo rats, and badgers are the common hosts of coronavirus. Since the evolutionary neighbors and extrasensory groups of SARS-CoV-2 are found in a variety of bats, it is speculated that the natural host of SARS-CoV-2 might be bats. Therefore, do not eat unquarantined wild animals, fresh and other food. Avoid taking the risk just for the purpose of trying out new specialties. 7

8 8 What are the coronaviruses that can infect people? So far, in addition to SARS-CoV-2 that causes the viral pneumonia outbreak, there are another six kinds of coronaviruses (HCoV-229E, HCoV-OC43, SARS- CoV, HCoV-NL63, HCoV-HKU1 and MERS-CoV). 8

9 9 How coronaviruses are transmitted from animals to humans? Bats are the natural host of many coronaviruses. It is likely that the bat is a native host of the SARS-CoV-2. After mutating, the virus will infect intermediate hosts and then humans. However, there may be more intermediate hosts from bats to humans that have not yet been identified. The coronaviruses are mainly spread from animal to human and from human to human through droplet transmission and contact transmission. 9

10 10 What is the pathogenicity of coronavirus? Coronavirus mainly infects adults or the relatively older children, causing the common cold and pharyngitis. Some strains can also cause adult diarrhea. The virus is spread by droplets transmission and fecal-oral transmission. And the incidence is always high in spring and winter. The essence of virus infecting human beings is a process of mutual struggle between virus and our immune system. During this process, the transmissible virus mutates through replication in the infected cells after it infects people and the highly virulent virus will be recognized and destroyed by the immune system under the immune surveillance. Therefore, from a longer window phase, the virulence and pathogenicity of this transmissible virus will not be stronger but be weaker. 10

11 11 What is a SARS-CoV-2? SARS-CoV-2 is a kind of coronavirus that has not been found in humans previously. The antigenic variation of coronavirus resulted in the born of SARS- CoV-2 and the population lacked immunity to the variant virus strains, which caused the epidemic of COVID-19. On January 27, 2020, the National Pathogenic Microorganism Resource Bank has released some important authoritative information and provided the shared services related to the Chinese and English name, number (NPRC ) information and its electron microscope photos, SARS-CoV-2 nucleic acid detection primer and probe sequence of the first strain of SARS-CoV-2 isolated from environmental samples by the China Center for Disease Control and Prevention. 11

12 12 What are the characteristics of SARS-CoV-2? SARS-CoV-2 is a coronavirus of the genus β, which has an envelope and is round or oval in shape. It is often polymorphic. It is always 60 to 140nm in size. Its genetic characteristics are significantly different from those of SAESr-CoV and MERSr-CoV. The current study shows that the homology between bat-sl- CoVZC45 and SARS-CoV-2 is more than 85%. In vitro culture, SARS-CoV-2 can be found in epithelial cells of human respiratory tract within 96 hours, whereas it takes about 6 days to isolate and culture it in VEROE6 and Huh-7 cell lines. Much of the understanding of the physical and chemical properties of SARS- CoV-2 comes from studies of SARSr-CoV and MERSr-CoV. The virus is sensitive to ultraviolet radiation and heat. 75% ethanol, chlorine-containing disinfectants, Peracetic acid, chloroform and many other fat-solvent can inactivate the virus. Chlorhexidine is not effective in inactivating the virus. 12

13 13 Can SARS-CoV-2 be transmitted from person to person? At present, the main source of infection is the infected patients. But the asymptomatic infected people may also become a source of infection through respiratory droplets transmission and contact transmission, which leads to the human-to-human transmission. In a relatively closed environment, the possibility of aerosol transmission exists if people are exposed to high concentration aerosol for a long time. Other transmission routes are not yet clear. 13

14 14 Who is susceptible to SARS-CoV-2? All age groups are generally susceptible. COVID-19 can occur in both immunocompromised and immunocompetent individuals. 14

15 15 What are the symptoms of the SARS-CoV-2 infection? The main symptoms are fever, fatigue, and dry cough. A small number of patients may have some other symptoms such as nasal obstruction, runny nose, sore throat, and diarrhea. Those severe cases often have dyspnea or hypoxemia after one week of onset and the conditions can even be worsened and transformed rapidly into acute respiratory distress syndrome, septic shock, intractable metabolic acidosis, coagulation dysfunction and multiple organ failure. It should be noted that the course of severe and critical patients can be moderate to low fever, or even no obvious fever. Some mild patients may only have the mild symptoms like low fever, slight fatigue and no sign of pneumonia. From the current cases, most patients have a good prognosis and only a few patients are critically ill. The prognosis of the elderly and those with chronic basic disease is relatively poor. And the symptoms in children are relatively mild. 15

16 16 Who are the suspicious exposures? Suspicious exposures are people who are exposed to the SARS-CoV-2 positive patients, suspicious wildlife, contaminated objects and the environment without any effective preventive measures. 16

17 17 How to define the suspected cases? Comprehensive analysis based on epidemiological history and clinical manifestations: (1) Epidemiological history: 1 History of travel to or residence in Wuhan and its surrounding areas, or in other communities where cases have been reported within 14 days prior to the onset of the disease; 2 In contact with SARS-CoV-2 infected people (with positive results for the nucleic acid test) within 14 days prior to the onset of the disease; 3 In contact with patients who have fever or respiratory symptoms from Wuhan and its surrounding area, or from communities where confirmed cases have been reported within 14 days before the onset of the disease; (2) Clinical manifestations: 1 Fever and / or respiratory symptoms; 2 The aforementioned imaging characteristics of COVID-19; 3 Normal or decreased WBC count, normal or decreased lymphocyte count in the early stage of onset. A suspected case has any of the epidemiological history plus any two clinical manifestations or all three clinical manifestations if there is no clear epidemiological history. 17

18 18 What are the asymptomatic infected people? At present, during the observation of close contacts of the cases, it is found that some people do not show any relevant symptoms, but they have the positive nucleic acid test in SARS-CoV-2 and certain virus transmission power. Those groups of people are called asymptomatic infected people. 18

19 19 What is a super spreader? The World Health Organization proposes that patients who have transmitted the virus to more than ten people are called super spreaders. 19

20 20 What symptoms can mean that you should see a doctor? The main symptoms are fever, fatigue, and dry cough. A small number of patients may have some other symptoms such as nasal obstruction, runny nose, sore throat, and diarrhea. Those severe cases often have dyspnea after one week of onset and the conditions can even be worsened and transformed rapidly into acute respiratory distress syndrome, septic shock, intractable metabolic acidosis and coagulation dysfunction. If there are respiratory problems, fever, chills, fatigue, diarrhea, conjunctival congestion and other symptoms, you should seek medical treatment in time. 20

21 21 If fever and other symptoms occur, does it mean that you ve been infected? As the fever symptoms may occur in many respiratory diseases, whether you are infected with SARS-CoV-2 requires the doctors comprehensive judgment based on the epidemiological history, clinical manifestations and laboratory test results. If fever symptoms occur, don t be panic. You should take personal protection in time and go to the relevant medical institution for medical examination and treatment. 21

22 22 What is the difference between a dry cough and a cough? The main difference between a dry cough and a cough lies in the presence of sputum. A dry cough is a cough that has no or little sputum when you cough. A common cold and acute bronchitis can result in a dry cough. And some respiratory infections such as acute sinusitis, acute rhinitis, acute tonsillitis, acute pharyngitis and acute episodes of chronic bronchitis can also cause a dry cough. In addition, acute dry cough may also be induced by inhaling some irritating gases and dust. A cough is a protective response mechanism of the respiratory tract. Some respiratory secretions and harmful factors can be removed by coughing. Sputum is formed when respiratory secretions or harmful factors are expelled from the body when coughing. A cough or coughing of phlegm usually means that the respiratory tract is stimulated or has some diseases. 22

23 23 By which ways may people be infected with SARS-CoV-2? The main transmission route is respiratory droplet transmission, plus contact transmission. There is also a possibility of aerosol transmission when people are exposed to high concentrations of aerosol for a long time in a relatively closed area. Other transmission routes are yet to be determined. The main ways of transmission in daily life are as follows: (1) Respiratory droplets spread through the air when people are coughing or sneezing. (2) Close contact with the infected patient without taking effective precautions. (3) Touching mouth, nose or eyes with contaminated hands which have touched the surfaces of some contaminated objects. 23

24 24 What can you do if you suspect yourself being infected? If you suspect yourself being infected, please avoid crowed places first. Then, wear a medical mask and keep a distance from your family members; keep proper indoor ventilation; pay attention to personal hygiene and go to the designated hospital nearby. Avoid using public transport when going to the hospital and tell the truth of the places you ve been and the history of close contact with people to cooperate with doctors. 24

25 25 How should the fever clinic do when receiving patients? If the patients want to have a treatment in the hospital, they should wear masks first, and the infrared scanner installed at the entrance of the outpatient department will monitor their temperature when they arrive at the hospital. If someone has a fever, he will be guided by a medical staff to the pre-examination clinic where the patient will be investigated the epidemiological history. Once the fever patient with an epidemiological history is found, he will be guided to the fever clinic; while the fever patient without an epidemiological history will be guided to the emergency respiratory clinic for diagnosis and treatment. If someone has a fever in the midnight, when he arrives at the emergency department with a medical mask, he will be guided to the emergency triage to have a pre-examination after being scanned by the infrared scanner. Then, the fever patient with an epidemiological history will be guided to the fever clinic while those with no epidemiological history will be guided to the emergency respiratory clinic. 25

26 26 How to avoid cross infection in hospital? It is necessary for the hospital to improve the isolation and treatment process of fever patients in the outpatient area to ensure an effective operation of the preexamination triage and fever clinic. Those well-equipped medical institutions can provide online or telephone consultation services. For eligible patients with chronic and elderly diseases, the prescription dosage can be appropriately increased to reduce the frequency of clinical visits. For those patients who have been scheduled to be hospitalized after the Spring Festival, the hospitalization time can be postponed appropriately according to the situation. Non-emergency surgery can also be postponed after discussing with patients. 26

27 27 How to confirm COVID-19? On the basis of meeting the criteria for suspected cases, if the real-time fluorescent RT-PCR of respiratory specimens or blood specimens is positive for SARS-CoV-2 nucleic acids, and genetic sequencing of respiratory specimens or blood specimens is highly homologous with SARS-CoV-2, and based on the history and clinical manifestations of suspected cases as well as the results of nucleic acid testing or viral gene sequencing, it is determined to be a confirmed case of COVID

28 28 Are there specific medicines or vaccines for COVID-19? At present, there are no specific medicines yet, and only symptomatic supportive treatment is available. Research and development of medicines and vaccines against COVID-19 are underway. Meanwhile, China is also conducting observational research on some traditional Chinese medicines. 28

29 29 How to avoid missed diagnosis for atypical patients without fever and cough? According to the Recognition and Protection of COVID-19 Patients- Attaching Importance to the First Symptoms of the Non-Respiratory System, published by the Research Group of Wuhan University People s Hospital on January 23, 2020, some patients have non-respiratory symptoms as the first symptom. Some patients may have the first symptoms in digestive system, such as mild loss of appetite, fatigue, poor mentality, nausea, vomiting and diarrhea; some may have the first symptoms in nervous system, such as palpitation, chest tightness, etc.; some patients first symptoms may occur in the cardiovascular system, such as palpitation and chest distress; some patients may have ophthalmic symptoms like conjunctivitis; and even some others only feel mild sore in limbs or lower back muscles. The patients mentioned above should be referred to relevant departments (such as digestive medicine, neurology, cardiovascular medicine, etc.) to avoid misdiagnosis and missed diagnosis. 29

30 30 Are senior people more susceptible to SARS- CoV-2? People aged 65 and above are generally defined as senior people in diagnostics. However, as people s physical conditions vary from each other, it is recommended that people over 60 years old raise awareness of their health and pay close attention to their own conditions. People at all ages are susceptible to various populations. But the senior people s immunity is relatively low and they usually have some basic diseases such as cardiovascular disease, so their symptoms are more severe and are more likely to quickly progress to severe illness or even death after being infected. Therefore, all people, especially the senior should pay attention to health and take preventive measures. 30

31 31 Why should close contacts be observed for 14 days? At present, it s necessary for close contacts to make relatively stricter medical observations and other preventive measures. This is a responsible action for public health and safety and a common practice in the international community. According to the latent period of diseases caused by other coronaviruses, combined with the relevant information of COVID-19 and the current actual situation of prevention and control, the medical observation period is set as 14 days and close contacts should be observed at home. As the virus is still contagious in the latent period within 1 to 14 days, whether people are infected will be judged after 14 days. 31

32 32 What are the differences between COVID-19 and common colds? In the Guidelines on the Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (5 th trial edition) issued by the National Health Commission of the People's Republic of China, the clinical indications of SARS-CoV-2 are listed as follows: the latent period is from 1 to 14 days and mostly 3 to 7 days based on the current epidemiological investigation. The main symptoms are fever, fatigue, and dry cough. A small number of patients may have some other symptoms such as nasal obstruction, runny nose, sore throat, and diarrhea. Those severe cases often have dyspnea or hypoxemia after one week of onset and the conditions can even be worsened and transformed rapidly into acute respiratory distress syndrome, septic shock, intractable metabolic acidosis and coagulation dysfunction. It should be noted that the course of severe and critical patients can have moderate to low fever, or even no obvious fever. Some patients may only have the mild symptoms like low fever, slight fatigue and not any sign of pneumonia. From the current cases, most patients have a good prognosis and only a few patients are critically ill. The prognosis of the elderly and those with chronic basic diseases is relatively poor. And the symptoms of pediatric patients are relatively mild. 32

33 Most common colds are caused by viral infection, and the other small part of them is due to the bacteria or mycoplasma infection. Common colds can occur throughout the year. The main symptoms are sore throat, coughing, sneezing and runny nose. Children and some adult patients may have fever sometimes, but the symptoms will not be very serious and they can generally recover within 5 to 7 days. 33

34 33 What are the differences between COVID-19 and influenza? Influenza, or flu for short, is an acute respiratory infectious disease caused by influenza A, B and C viruses. Influenza A viruses often appear in epidemic forms and can cause worldwide pandemic. Influenza B viruse always outbreaks locally. Influenza C virus mainly appears individually and is seldom being epidemic. A person may be infected with the same and / or different types of influenza viruses many times in their lifetime. Flu always outbreaks in a certain season featuring mild local symptoms yet severe systemic symptoms. 34

35 34 What are the differences between COVID-19 and SARS? Atypical pneumonia, also known as severe acute respiratory syndrome, or SARS for short, is a respiratory infectious disease caused by SARS coronavirus infection, featuring a high rate of infectivity and rapid disease progression. SARS-CoV-2 is homologous with SARS virus and they both belong to the coronavirus family, but their genetic structures are different. 35

36 35 Could pets spread SARS-CoV-2? At present, there is no evidence that pets like cats and dogs can be infected with SARS-CoV-2, but they may carry viruses on the surfaces of their bodies, thereby contaminating the surrounding environment. Therefore, washing hands with soap and running water after contacting with pets can reduce the risks of indirect contact infections caused by other common pathogenic microorganisms. 36

37 36 Why is seeing dentist during the epidemic period not recommended? At present, the transmission routes of SARS-CoV-2 have been determined as droplet transmission and contact transmission. At this time, if a patient in latent period goes to see a doctor unknowingly and receives the oral diagnosis and treatment, his doctor will be infected for close contact. Therefore, it is recommended to postpone oral treatment during the epidemic period unless it is acute pulpitis, maxillofacial space infection, maxillofacial trauma and other oral emergencies. On January 31, 2020, the Henan Provincial Health Committee issued a document requesting the outpatient departments and clinics of stomatology to stop all clinical examinations, the stomatological hospitals and the stomatology departments of secondary and higher-level medical care institutions to suspend all routine clinical examinations and treatments. And only the necessary stomatology emergencies will be retained to provide oral emergency medical services such as acute toothache, tooth trauma, oral and maxillofacial trauma and infection to help control the epidemic situation. 37

38 37 Can COVID-19 be cured? In clinical practice, some infected patients are tested negative for two consecutive respiratory pathogenic nucleic acid tests and the results of their chest radiographs, blood tests and other examinations are proved normal, which meet the standards of recovery and discharge. 38

39 38 What are the criteria of being released from isolation now? According to the latest Guidelines on the Novel Coronavirus-infected Pneumonia Diagnosis and Treatment (6th trial edition), the four requirements of the criteria of being released from isolation are as follows: (1) The body temperature has returned to normal for more than 3 days. (2) The respiratory symptoms have been improved significantly. (3) The acute exudative lesions have been obviously absorbed and improved in pulmonary imaging. (4) The nucleic acid detection of respiratory tract specimens was negative for two consecutive times. (Sampling interval is at least 1 day). 39

40 39 What are the precautions for discharged patients after being cured? Based on the current clinical practice, some cured patients may still have a fever and positive nucleic acid detection result after discharge from the hospital. According to the latest Guidelines on the Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (6th trial edition), precautions after discharge are as follows: (1) The designated hospitals should make close contact with the basic medical institutions where the patients live, share medical records and report the information of discharged patients to the patient's jurisdiction or the residential committee and basic medical institutions in time. (2) As people who have been just discharged from hospital usually have a low immunity in the recovery period, the risk of infection with other pathogens is relatively high. Therefore, it is recommended that these groups of people should continue to monitor the self-health status for 14 days and wear a mask. If permitted, they should live in a well-ventilated single room and eat separately to reduce the close contact with family members. They should keep hands clean and avoid going out. (3) It is recommended to have follow-up and subsequent visits in the second and fourth week after discharge. 40

41 40 Are discharged patients contagious? The patient is considered to be cured after two consecutive respiratory pathogenic nucleic acid test results show negative, and other examination results become normal, including the chest radiograph, routine blood tests and inflammatory indicators. They can be released from quarantine and return to normal life. There is no need to doubt whether a cured patient is contagious and feel afraid of the contact with a cured patient. The cured patients usually have antibodies in their bodies and the risk of secondary infection in the short term is low, so they can work, study and live as usual. 41

42 41 How to choose masks? Firstly, please choose disposable medical masks, surgical masks, medical protective masks or N95 masks made by legal manufacturers. Care masks, cotton masks, and sponge masks are not recommended. Guidelines on the Use of Masks to Prevent Pneumonia Caused by SARS-CoV-2 issued by the Bureau of Disease Control and Prevention of National Health Commission points out: Disposable medical masks: These masks are recommended to be used in non-crowed places. Surgical masks: Their protective effects are better than those of disposable medical masks. The suspected cases, workers of the public transportation, taxi drivers, sanitation workers and service staff are recommended to wear surgical masks during work. KN95 or N95 masks and higher-level particulate matter protective masks: Their protective effects are better than those of medical surgical masks and disposable medical masks. These masks are recommended for on-site survey, sampling and testing staff. The public can also wear this kind of masks in places with high concentration of people or in closed public places. Medical protective masks: It is recommended to wear them at the outpatient clinic or in the ward. And when the confirmed patients are being transferred, they can also wear medical protective masks. Patients with basic respiratory diseases should use them under the guidance of a doctor. To avoid suffocation, infants should never wear masks. 42

43 42 How to wear a surgical mask correctly? (1) Choose a mask of the right size. (2) The colored side faces outward while the white side should touch your face. (3) The metal strip side is the upside of the mask. (4) After identifying the inside and outside and the upper and lower ends of the mask, wash your hands first and check whether the mask is placed correctly, then hang the two loops on your ears respectively. (5) After putting on the mask, you need to press the metal bars on both sides of the nose bridge with both hands to make the upper end of the mask close to the nose bridge, and then stretch the mask downwards so that the mask does not leave wrinkles and covers your nose and mouth. (6) Adjust the mask appropriately so that the mask and your face are in full contact with each other. (7) You d better replace your mask every 2 to 4 hours. If the mask gets wet, polluted or damaged, it should be replaced in time. Avoid sharing a mask with others. 43

44 43 How to deal with the used masks? (1) Masks used by healthy people should be discarded according to the requirements of domestic garbage classification. (2) Masks used by suspected cases and their caregivers are collected and disposed of as medical waste. (3) When removing the mask, try to make sure your hands do not touch the outside of your mask. You should grasp the loops on both sides to remove it and put it in the collection bag, and then throw it into the trash bin. After that, please wash or disinfect your hands immediately. 44

45 44 How to wash hands correctly? First, wet your hands under running water. Then take some liquid soap (you can also use soap or toilet soap) and smear your entire palm, back of the hands, fingers and seams evenly. Wash your hands carefully for at least 15 seconds in seven steps. The specific steps for washing hands are as follows: (1) Rub hands palm to palm; (2) Right palm over left dorsum with interlaced fingers and vice versa; (3) Palm to palm with fingers interlaced; (4) Backs of fingers to opposing palms with fingers interlocked; (5) Rotational rubbing of left thumb clasped in right palm and vice versa; (6) Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa; (7) Rotational rubbing and washing wrists. Finally, rinse your hands thoroughly with running water and wipe dry. Take some liquid soap for skin care. 45

46 45 How to take protective measures when going out and staying at home during the epidemic period? (1) Make fewer trips outside. Avoid going to the affected areas and reduce visits to relatives and friends or dinner together. Try to rest at home. Minimize the chance of going to the public occasion with heavy crowds, particularly the places where air circulation is poor, such as public baths, hot springs, cinemas, Internet cafes, KTVs, shopping malls, stations, airports, terminals, exhibition halls, etc. (2) Take preventive measures when going out. 1) Wear a mask. If you need to go out in special circumstances, you should wear a mask. You should wear the surgical mask, disposable medical mask, or N95 mask when going out to public places, seeing a doctor or taking public transport. 2) Keep your hands clean. Minimize contact with items in public places; wash your hands with liquid soap, soap or toilet soap under running water or wash with alcohol-free hand sanitizer when you return home from public places or after covering your cough with your hands, or before and after meals; avoid touching your mouth, nose, and eyes with your hands when you are not sure whether your hands are clean; cover your mouth and nose with your elbow clothes when you sneeze or cough. (3) Health monitoring and medical treatment. 46

47 1) Proactively monitor the health of individuals and family members and measure body temperature when you have a fever. If there is a child in your family, pay attention to observe whether the child has headache, decreased appetite, hypoactivity, irritability, crying and other abnormal manifestations. If there is any fever symptom, you should take his temperature. 2) If there are suspicious symptoms, you should take the initiative to wear a mask and seek medical treatment nearby. If there are suspicious symptoms of SARS-CoV-2 infection (including fever, cough, sore throat, chest tightness, dyspnea, mild loss of appetite, fatigue, low spirit, nausea, vomiting, diarrhea, headache, palpitation, conjunctivitis, mild soreness in limbs or lower back muscles, etc.), you should go to the medical institution in time according to the condition. Try to avoid taking subways, buses and other means of public transportation and avoid going to crowded places. When visiting a doctor, you should tell the truth of your travel and residence history in the affected area and the history of close contact with people since the onset of the disease to cooperate with the doctor to carry out related investigations. (4) Maintain good hygiene and health habits. 1) Open windows frequently to ventilate. 2) Separate the raw and cooked cutting boards and knives. Cook meat, poultry food and eggs thoroughly. 3) Family members should avoid sharing towels. Keep home and tableware clean. Dry clothes and quilts in the sun frequently. 4) Wash your hands before and after meals. Do not spit in public spaces. Wrap the mouth and nose secretions with paper towels and put them in a covered trash bin. 47

48 5) Pay attention to nutrition and exercise moderately. 6) Do not contact, purchase and eat wild animals; try to avoid going to markets that sell live animals (poultry, seafood, wild animals, etc.) 7) Pet-raising families should pay attention to the hygiene of pets. The management of pets should be strengthened to keep pets from contacting infected people. 8) During the epidemic period, people have to stay at home. Family members should show concern for each other and try to distract the over-concern of the epidemic by reading, exercising or doing housework. If there is a child in the family, parents and the child can play games, read books and do exercises together. 9) Thermometers, disposable medical masks, surgical masks or N95 masks and household disinfection supplies should be available at home. 48

49 46 What should you do when your family member has suspicious symptoms? (1) If your family member has suspicious symptoms relating to COVID-19, such as fever, cough, sore throat, chest tightness, dyspnea, mild loss of appetite, fatigue, low in spirit, nausea and vomiting, diarrhea, headache, palpitation, conjunctivitis and mild soreness in the limbs or lower back muscles, he should seek medical treatment in time according to the condition. (2) People with suspicious symptoms should avoid taking public transport such as subways and buses when going out for treatment and avoid going to crowded places. (3) When visiting a doctor, you should take the initiative to tell the doctor about your travel and residence history in the affected area and the history of close contact with people since the onset of the disease to cooperate with the doctor to carry out related investigations. (4) People with suspicious symptoms and their family members should wear masks. They should keep a distance from other asymptomatic family members to avoid close contact. (5) If someone in the family is diagnosed with COVID-19, other family members who are confirmed as close contacts should receive medical observation for 14 days. 49

50 47 How should you do if you suspect that someone around you is infected with SARS-CoV-2? If you suspect that someone around you is infected with SARS-CoV-2, you should take personal protective measures first and wear a mask to avoid close contact. At the same time, you should recommend him to wear a mask in time and go to the designated hospital nearby for treatment. 50

51 48 What should you do if you have the residence or travel history in the affected area? (1) Register in the village committee or community as soon as possible. Make fewer trips outside and especially avoid going to the public occasion with heavy crowds. (2) From the time of leaving the affected area, self-health monitoring was conducted twice a day for 14 consecutive days. If the conditions permit, try to live alone or in a well-ventilated single room and minimize close contact with family members. (6) If there are suspicious symptoms relating to COVID-19, such as fever, cough, sore throat, chest tightness, dyspnea, mild loss of appetite, fatigue, low in spirits, nausea and vomiting, diarrhea, headache, palpitation, conjunctivitis and mild soreness in the limbs or lower back muscles, you should seek medical treatment in time according to the condition. Specific suggestions during the process of seeking medical treatment: 1 On the way to the hospital, patients should wear surgical masks, disposable medical masks or N95 masks. 2 If possible, avoid taking public transportation to the hospital. 51

52 Driving private cars with windows open on the road. 3 Keep hands clean at all times. 4 Stay as far away as possible from others (at least 1 meter) on the road or in the hospital. 5 If the vehicle is contaminated on the way, it is recommended to use chlorine disinfectant or peracetic acid disinfectant to disinfect all surfaces contaminated with respiratory secretions or body fluids. 52

53 49 What preventive measures should the staff in public spaces take? (1) Staff working in public places should monitor their health conditions. Stay home if one develops suspicious symptoms relating to COVID-19. (2) Staff working in public places should ask those with suspicious symptoms relating to COVID-19 to leave. (3) Clean and disinfect frequently touched objects and facilities in public places regularly. (4) Keep public places well-ventilated. Ensure the proper functioning of the air conditioners or extractor fans. Clean the filters of the air conditioners regularly and open windows frequently for better ventilation. (5) Prepare enough liquid soap in the restroom. Ensure water supply facilities like the taps function well. (6) Keep the environment clean and dispose of the waste in a timely manner. (7) People in the affected areas should avoid going out to public places, especially crowded places or those with poor ventilation. 53

54 50 How to choose the way to go to work? It is recommended to go to work by walking, bicycling or driving private car. Avoid taking public transport. Take personal protective measures if you have to take public transport. 54

55 51 How to do disinfection and other preventive measures for public transport? (1) Staff working on public transport in affected areas should wear surgical or N95 masks and have their health monitored on daily basis. (2) Thermometers and masks should be available on public transport. (3) Clean and disinfect public transport more frequently. Keep proper log sheets and labelling of the cleaning history. (4) Ensure the public transport is well-ventilated. (5) Keep the metro / bus / train stations and carriages clean and tidy and promptly dispose of waste. (6) Improve the work / rest schedules to make sure workers on public transport get enough rest. 55

56 52 What should be paid attention to when taking public transport? Wear a mask all the way on the public transport; avoid or reduce chats; keep a distance of more than 1 meter from others; cover your mouth and nose with disposable tissues or elbow clothes when you cough or sneeze; avoid touching the handles or other items on the vehicles; wash your hands with liquid soap, soap or toilet soap under running water or disinfect with alcohol-free hand sanitizer after getting off. 56

57 53 What protective measures should be taken before work? (1) Take a temperature consciously before going to work. If the temperature is normal, you can have the access to the factory, workshop, office, etc. (2) If you have suspicious symptoms relating to COVID-19 such as fever, fatigue, dry cough and chest tightness, you should take the initiative to wear a mask and go to the medical institution nearby for treatment. (3) You should take the initiative to tell the medical staff of pre-examination triage and the doctor about your travel and residence history in the affected area and the history of close contact with people since the onset of the disease to cooperate with them to carry out related investigations. 57

58 54 How to prevent from being infected by SARS- CoV-2 at the workplace? Pay special attention to take protective measures if you are in the elevator rooms, canteens, offices or meeting rooms where there are frequent crowds or crowds of people. Maintain indoor ventilation in the office; disinfect and clean public areas (elevator rooms, canteens, conference rooms, etc.) and public items (buttons, faucets, switches, telephones, copy fax machines, etc.). Keep a distance with others when being seated for business conversation or conference; wash your hands frequently. Do not spit in public areas. If you need to spit, you can spit on the paper towel and then throw it into a closed trash bin. When you cough or sneeze, cover your mouth and nose completely with disposable tissues and throw them into the trash bin immediately or cover your mouth and nose with the elbow or clothes. Avoid attending parties. Stay at home to quarantine yourself when you are not feeling well. 58

59 55 How to protect from being infected when taking an elevator? Wear a mask all the way on the elevator. It is recommended to press the buttons with disposable tissues and other items to avoid the direct contact with your hands. Wash your hands or disinfect your hands after leaving the elevator. 59

60 56 How to protect from being infected in the office? Keep the working area clean. It is recommended to ventilate the office 3 times a day for minutes each time and be sure to keep warm when ventilating. Keep a distance of more than 1 meter when talking with others and wear a mask if you are working in a multi-person office. Wash your hands frequently and drink more water. Wash your hands with the liquid soap, soap, toilet soap, and running water before eating and after going to the toilet. When receiving outsiders, please make sure that both of you wear masks. 60

61 57 How to protect from being infected when attending a meeting? It is recommended to wear a mask and wash your hands before entering the meeting room. Reduce the chance of group meetings and control the meeting time. If the meeting time is too long, please open the window to ventilate halfway. The distance between each seat should be kept at least one meter. If you need to drink during the meeting, it is recommended to drink bottled water or drink with your own glass and disposable paper cups. The venue, tables and chairs must be disinfected after the meeting. 61

62 58 How to protect from being infected if there are official visits? (1) Security personnel of enterprises should wear a mask when working. They should take the visitors temperature and ask them if there is any history of contact with the affected area and symptoms of fever, cough and poor breathing, and then register the conditions of visitors. (2) People with no above symptoms or contact history and with normal body temperature can have the access to enter. Once an abnormal condition occurs, please report it in a timely manner. (3) Both the receivers and the visitors should wear masks. 62

63 59 What preventive measures should the enterprises take? (1) Enterprises should clean and disinfect the factories, workshops and other public areas as well as the facilities, equipment and frequently used parts in elevators (if conditions permit, it is necessary to disinfect the elevator rooms, especially the button area frequently) and other crowed areas. (2) Pay attention to strengthen hygiene and ventilation. Maintain the air circulation and sanitation of indoor and outdoor environments. (3) If the fan coil unit of the central air-conditioning system is in normal use, the air supply outlets and return air inlets should be disinfected regularly. If the fresh air mode of central air-conditioning system is in normal use during the epidemic period, please do not stop the fan operation. You should close the exhaust branch pipe after the evacuation of personnel and keep the air-conditioner running. After a period of its operation, you should close the fresh air exhaust system and disinfected it at the same time (the disinfection should be conducted by professional air-conditioning maintenance staffs); for the all-air system with return air, the return air shall be completely closed to ensure the complete running of the fresh air mode. 63

64 60 What should you do when you go to the dining hall? It is advisable to bring your own lunch boxes and other tableware to eat separately. Avoid peak hours for dining and washing your hands before meals; avoid sitting face-to-face with others or talking during meals. 64

65 61 How to prevent from being infected after you return home from work? Take off your coat after you return home and put it in a fixed position. Remove your mask and do not touch the outer layer of the mask with your hands. Put the used mask in a garbage bag according to the requirements of garbage classification, then wash your hands and face immediately. You can wipe the phone, keys and other common items with disinfectant wipes or 75% alcohol. 65

66 62 How to prevent from being infected with SARS-CoV-2 at school? (1) For personal protection of students, please refer to 45. How to take protective measures when going out and staying at home during epidemic period. (2) Do not spit on the ground. If you need to spit, you can spit on the paper towel and then throw it into a closed trash bin. When you cough or sneeze, cover your mouth and nose completely with disposable tissues and throw them into the trash bin immediately to avoid the spread of viruses. Pay attention to maintain personal hygiene and wash your hands frequently. (3) Keep the school areas clean. Soap or alcohol-based hand sanitizer should be available in the school toilet. Public signs should be put on to remind students of washing their hands in time and not wiping their hands with dirty towels. (4) Sick students should rest at home. (5) Students should have a balanced diet, moderate exercise and adequate rest and avoid excessive fatigue. (6) The classrooms, student dormitories and dining halls should be ventilated 66

67 every day to keep the indoor air fresh. Ventilation should not be less than 2 hours per day. If there is poor natural ventilation, mechanical ventilation should be strengthened. Boarding school students should dry quilts in the sun, wash hands and change clothes frequently and avoid sharing towels. (7) If there are suspected cases, the schools should report them to the education administrative department as well as to the local health department and make sure that suspected cases be treated in a timely manner. The schools should organize the disinfection of the internal areas of the campus. For those key places and public items, the infection should mainly focus on their surfaces (wiping with chlorinecontaining disinfectant such as 1: 49 bleach and chlorine dioxide solution) and should be supplemented by air disinfection (peracetic acid, lactic acid, acetic acid spray or fumigation can be used if necessary). (8) If there are suspected cases, the schools should implement a daily morning examination system to measure the body temperature. Flu-like students or staff with body temperature of 37.3 or above should be persuaded to seek medical treatment and rest at home. If there is an abnormal increase in absenteeism/absence from school due to illness within a short period of time, the schools should report this situation to the education administrative department as well as to the local health department. (9) If there is an outbreak of flu-like cases in the school, the school reporters on infectious disease should report the situation to the local disease prevention and control institution in time and to the higher education authority at the same time. Medical personnel in the school infirmary should register and manage those flulike cases carefully, fill in the relevant information according to the flu-like case registration form, and assist doctors in disease control institutions in sampling and case-handling work. 67

68 63 How to protect from being infected with SARS- CoV-2 in the hospital? (1) Wear a mask when going to the hospital to see a doctor or a patient, especially when going to the fever clinic or respiratory department of the hospital. (2) Avoid close contact with people with respiratory disease symptoms (such as fever, cough or sneezing, etc.) as much as possible. (3) Keep a good personal hygiene habit and do not spit on the ground. If you need to spit, you can spit on the paper towel and then throw it into a closed trash bin. When you cough or sneeze, cover your mouth and nose completely with disposable tissues and throw them into the trash bin immediately to avoid the spread of viruses. (4) Wash hands with liquid soap (or soap, toilet soap) under running water, or with alcohol-based antibacterial hand sanitizer. Avoid touching your mouth, eyes and nose with contaminated hands. (5) If there are suspicious symptoms relating to COVID-19, such as fever, cough, sore throat, chest tightness, dyspnea, mild loss of appetite, fatigue, low in spirit, nausea and vomiting, diarrhea, headache, palpitation, conjunctivitis and mild soreness in the limbs or lower back muscles, you should seek medical treatment in time according to the condition. 68

69 64 What should you do when visiting a doctor for other diseases during the epidemic period? (1) Minimize or avoid the frequency of going to the hospital unless you have an urgent or critical disease and need to seek medical treatment immediately. If you have to seek medical treatment, you should choose the medical institution nearby which can meet your demand and have a small number of outpatients; only do the necessary or urgent medical examinations and operations while other examinations and operations should be supplemented as soon as possible; if you can choose the visiting department, avoid choosing the fever clinics and emergency clinics. (2) If you need to go to the hospital, you should know the situation of the hospital you would like to go in advance through internet or telephone as much as possible. Make appointment and preparations such as being familiar with the layout of hospital departments and the process to reduce the clinic time as much as possible. (3) Patients and the accompanying family members should wear surgical masks or N95 masks when they are on the way to the hospital or in the hospital. Replace masks in time if they are contaminated. (4) If possible, avoid taking public transport to the hospital. (5) Maintain hand hygiene at all times and a portable alcohol-free hand sanitizer 69

70 should be available. Keep a distance of at least 1 meter between people when you are on the road and in the hospital. (6) If the vehicle is contaminated on the road, it is recommended to use chlorine disinfectant and peracetic acid disinfectant to disinfect all surfaces contaminated with respiratory secretions or body fluids. (7) Avoid touching your mouth, eyes, and nose with your hands. Cover your mouth and nose with disposable tissues or elbow clothes when you sneeze or cough. (8) Clean your hands after touching items in the hospital such as hospital door handles, curtains and doctor's white coats. If you cannot clean your hands in time, do not touch your mouth, eyes, or nose with your hands. Minimize your stay in the hospital during your visit if possible. (9) After returning home, change your clothes immediately, wash your hands carefully with liquid soap, soap or toilet soap under running water, and wash the clothes as soon as possible. (10) If there are suspicious symptoms, such as fever, cough, sore throat, chest tightness, dyspnea, fatigue, nausea and vomiting, diarrhea, conjunctivitis and muscle soreness, consult the doctor in time according to the condition, and inform the doctor of your activity history of the past two weeks. 70

71 65 Under what circumstances should you receive a homebased medical observation? Close contacts or suspicious exposures should be medically observed. The medical observations include home-based isolation and centralized isolation. Homebased medical observations should be performed in accordance with the local medical observation management regulations. The isolation observation period is 14 days and starts from the day of your last contact with or exposure to the cases. After two-week observation, if there are no signs of being infected, you can resume normal study, work and life. 71

72 66 What should the close contacts do when receiving home-based medical observations? Close contacts of the confirmed cases of COVID-19 should be medically observed for 14 days from their last contact with the cases. It is necessary to keep in touch with medical observers during the home-based isolation period and grasp the key points of medical observation and nursing. It s also necessary to master the protective measures of hand washing, ventilation, protection and disinfection at home. Specific suggestions are as follows: (1) Choose rooms with better ventilation to perform the home-based medical observation and open windows for ventilation frequently; keep the door closed at any time and open the window first if you need to open the door that communicates with other family members or roommates. (2) You do not need to wear a mask when you are in the isolation room, but if you need to leave the isolation room, please wear a surgical mask first. Wash hands in time before and after wearing new surgical masks or after disposing the used masks. (3) If you have to leave the isolation room, please wear a surgical mask and wash or disinfect hands before going out. Avoid leaving the isolation room randomly. 72

73 (4) Minimize contacts with other family members. Keep a distance of more than 1 meter in particular cases and stay in the downwind direction as much as possible. (5) Separate articles of daily use from other family members or roommates to avoid cross-contamination. (6) Avoid using central air-conditioning. (7) Maintain adequate rest time and nutrition. It is suggested to eat and drink in isolated rooms. Try not to share the bathroom. If you family condition is limited, please avoid the peak periods. Ventilate the bathroom and disinfect the surface of those objects within reach with alcohol and other disinfectants after using. (8) Pay attention to the cough etiquette. Cover your mouth and nose with tissues when you are coughing. Do not spit on the ground. The used paper towels and masks should be thrown into the covered trash bin. (9) Clean and disinfect the used items in a timely manner. (10) According to the notice of home-based medical observation, take your body temperature every morning and afternoon and measure and record it at any time when you feel fever. If there are acute respiratory symptoms such as fever, cough and shortness of breath, contact the observer at the isolation spot in time. 73

74 67 What protective measures should the elderly, children and other special groups take? The population is generally susceptible to SARS-CoV-2, especially the elderly and children whose immunity is weaker than those in other age groups and self-protection ability is relatively low, so they should take more daily protective measures. Try to avoid going out and wear appropriate disposable medical masks if you have to go out; wash your hands frequently and develop good personal hygiene habits; keep warm while ventilating your room; maintain balanced nutrition and pay attention to the diet hygiene; take moderate exercises, work and rest regularly and maintain a peaceful mood. If you have chronic diseases, please pay attention to monitoring blood pressure and blood glucose level and follow the doctor's advice to maintain a sound self-management of your chronic diseases. If emergencies occur, please seek medical treatment immediately. The body temperature and physical conditions of the elderly and children should be monitored every day. If there are abnormal symptoms, perform a self-quarantine immediately and report to the local community. Wear a mask and avoid using public transport when seeing a doctor. People who look after infants should wash hands frequently and young children should avoid close contact with outsiders. Attention should be paid to those children who wear masks due to illness to make sure that they have no discomforts like breathing difficulties. 74

75 68 How to undertake disinfection for common families? During the epidemic period, wash your hands with liquid soap, soap or toilet soap under running water or disinfect your hands with alcohol-free hand sanitizer or with disinfectant every time when you return home. The surfaces of objects such as tables and chairs should be cleaned every day and disinfected regularly. If guests with unknown physical conditions come to visit, disinfect the surfaces of related objects in the room with legal and effective disinfectant or disinfection wipes after they leave. Open the windows to ventilate or use mechanical ventilation. Pay attention to keep warm to avoid having a cold due to the large difference between indoor and outdoor temperatures when opening windows for ventilation in winter. Surfaces of the objects: for those commonly-used objects such as countertop, door handles, telephones, switches, kettle handles, wash basins and western type toilets, you should use the chlorine-containing disinfectant (effective chlorine concentration 500 mg / L) to infect their surfaces for 30 minutes and then wipe them with clean water. You can use the 0.5% iodophor disinfectant or 75% alcohol disinfectant to wipe your hands for 1 to 3 minutes for hand disinfection. If there is contamination visible to naked eyes, use liquid soap to wash hands under running water first, and then disinfect your hands. If your skin is contaminated, the pollutants should be removed immediately and wiped with a disposable absorbent material dipped in 0.5% iodophor disinfectant or hydrogen peroxide disinfectant for more than 3 minutes to disinfect, and then wash it with water. 75

76 69 If a family member is infected, how should you undertake disinfection? After the patient leaves (such as hospitalization, release from quarantine, death, etc.), final disinfection should be done in your house. The objects which need to be disinfected finally include the room floors, walls, the surfaces of tables, chairs and other furniture, door handles, patient tableware, clothes, bedding and other daily necessities, toys and toilets. Final disinfection is usually done by a professional staff, so you can contact the local Center for Disease Control and Prevention (CDC). As other family members are close contacts, they should receive a 14-day medical observation. 76

77 70 How to regulate your life and strengthen immunity during the epidemic period? (1) Keep calm and always be in a peaceful mood. (2) Have a light diet and eat fresh fruits and vegetables appropriately. Minimize or avoid fried, smoked or spicy and greasy food. Stop smoking and limit alcohol. (3) Maintain good hygiene habits. Wash your hands frequently and wear a mask. (4) Maintain a daily routine and avoid staying up late. (5) Open the window frequently to ventilate. Keep a moderate room temperature and humid air indoor. (6) Take moderate exercises. You can do aerobic exercises appropriately to avoid consuming your strength due to the excessive sweating. 77

78 71 Emotional management during the epidemic period Excessive psychological stress can disturb the normal functions of multiple immune organs throughout our body and may also cause physical, emotional and cognitive symptoms such as poor appetite, nausea, light sleep, early awakening and anxiety. Do not suppress your negative emotions. You can choose a family member or a friend you trust to share your thoughts and feelings or you can distract your attention by doing what you like. Obtain information from authoritative and reliable media. If you know your own minds, you will feel relieved and be optimistic. Excessive stress can be relieved through mindfulness therapy, meditation, yoga, respiratory training and progressive relaxation therapy. 78

79 72 Stretching exercises at home The following actions are recommended to maintain 10 to 30 seconds and repeat 3 times respectively; and you can practice them 3 to 5 days a week according to personal situations. (1) Triceps surae stretching: Flex your foreleg and straighten the hind leg to stretch the calf muscles of the hind leg. Pay attention not to leave the heels of the hind leg off the ground. (2) Quadriceps femoris stretching: Bend one knee to lift the calf, hold the raised foot on the same side and hold the other hand against the wall to keep balance. 79

80 (3) Hamstring muscles stretching: In the supine position, bend your leg to right angle and hold the distal end of the hip flexed leg with both hands. Then, extend the knee until you feel a stretch on the back of the thigh. (4) Hip stretching: Hold one knee firmly with both hands, lift up against your abdomen and lift your toes. (5) Shoulder muscles stretching: 1) Flex your shoulder to 90, retract your shoulder joint horizontally and the opposite hand exerts force at the elbow joint to help stretch. 2) Hold the towel in both hands as illustrated and the hand on the upper side pulls up strongly. 80

81 3) Chest muscle group stretching: Stand against the wall, put your hand up next to the door frame and pull your body close to the door frame slowly to help stretch. 4) Kneeling back stretching: Extend your arms forward with hips seated on heels. 5) Cat-style stretching: Push down with both hands on your knees; lower your head, arch your upper back and exhale; raise your head, sink down your chest and inhale. 6) Neck muscle group stretching: In sitting position, flex your head to one side, put the hand on the same side on your head and press your head appropriately to help stretch. 81

82 73 Respiratory training Place one hand on the chest and the other hand on the abdomen in a supine position and feel the movement of the chest and abdomen with both hands when breathing. Keep your chest still and feel the hand on your abdomen slightly raised when inhaling. 82

83 74 Misunderstanding 1 SARS-CoV-2 is the same as SARS virus. SARS-CoV-2 is a coronavirus of the genus β, which has an envelope and is round or oval in shape. It is often polymorphic. It is always 60 to 140nm in size. Its genetic characteristics are significantly different from SARS and MERS coronaviruses. I am neither SARS nor MERS. 83

84 75 Misunderstanding 2 The elderly is susceptible to SARS-CoV-2. SARS-CoV-2 is a newly discovered virus which all age groups are susceptible to. The susceptible population refers to the group of people who have not been infected or have no resistance and no immune substances in their body or lack specific immunity to the pathogens of infectious diseases. Elderly people, people with poor resistance and people with underlying diseases are among the susceptible population, so they are more likely to become severe cases after infection. Is the elderly more susceptible to SARS-CoV-2? 84

85 76 Misunderstanding 3 You are infected if you have the clinical symptoms like fever, tiredness and dry cough. The symptoms like fever, fatigue and dry cough may occur in many respiratory diseases as well as common cold and flu. Whether you are diagnosed as COVID-19 or not is first analyzed according to the epidemiological history and clinical manifestations, and then confirmed according to the nucleic acid detection or the viral gene sequencing. If you are not feeling well, you can go to a community hospital first or go to a higher-level hospital according to the advice of the community doctor. Be sure to wear a mask and take protected measures when you visit a doctor and try to avoid using public transport. 85

86 77 Misunderstanding 4 Taking antibiotics can prevent the infection of SARS-CoV-2. The pathogens of SARS-CoV-2 are viruses while what the antibiotics can resist are bacteria. Therefore, taking antibiotics cannot prevent the infection of SARS- CoV-2; misusing antibiotics for the purpose of the so-called prevention can induce and aggravate the resistance of antibiotics. 86

87 78 Misunderstanding 5 Taking Vitamin C can improve immunity. Vitamin C can help the body maintain normal immune functions, but it has no effect on improving immunity and resisting to viruses. A proper vitamin C intake is usually only a supplementary treatment. 87

88 79 Misunderstanding 6 Taking Banlangen (Radix Isatidis) granules can prevent the infection of SARS-CoV-2. Banlangen (Radix Isatidis) granules are effective in treating hot syndromes such as wind-heat common cold, but it is not effective in preventing the infection of SARS-CoV-2. Many medicines can cause side effects. If you are healthy originally, taking medicines blindly may lead to diseases. Banlangen (Radix Isatidis) granules 88

89 80 Misunderstanding 7 Drinking spirits can resist the infection of SARS-CoV-2. The spirits you ve drunk can only be absorbed and then metabolized and it will never act on viruses. Medical alcohol is totally different from the usual wine. SARS-CoV-2 is inactivated by alcohol and 75% alcohol can kill viruses means that disinfection can be achieved by wiping with medical alcohol but not by drinking spirits. SARS-CoV-2 is sensitive to heat and can be killed by heating at 56 for 30 minutes. In addition, fat-solvent such as diethyl ether, 75% alcohol, chlorinecontaining disinfectants, peracetic acid and chloroform can inactivate viruses effectively. Spirits 89

90 81 Misunderstanding 8 Eating Garlic can prevent the infection of SARS- CoV-2. The claim that eating garlic can prevent the infection of SARS-CoV-2 lacks scientific evidence and clinical experimental evidence. Actually, there is no use in preventing the infection whether you eat it directly, drink it from juice or cook it. The antibacterial and other pharmacological effects of garlic extract are only in vitro experiments and the effects between garlic and garlic extract are very different. In addition, there is no clinical trial data to prove that garlic has an antiviral effect. 90

91 82 Misunderstanding 9 The used masks should be burned, boiled or cut before being discarded. (1) 在医疗机构使用后的口罩 目前, 医疗机构将使用过的一次性医用口罩作为 医疗废物 管理, 所以如在医疗机构场所内丢弃口罩时必须投进黄色的垃圾箱 ( 袋 ) 内 (2) 居民日常使用后的口罩 根据谨慎原则, 从最大限度保护人民的生命和健康角度出发, 建议把用过的一次性口罩单独放在塑料袋等密封袋里, 然后把密封袋投入到 其他垃圾 桶里 (3) 居家观察或集中隔离的群众使用后的口罩 在就诊或接受隔离时, 可以将使用过的口罩放置于密封袋中交给相关工作人员, 由工作人员代为处理 处理完口罩后, 记得及时用肥皂和流水洗手 91

92 83 Misunderstanding 10 Wearing multi-layer disposable medical masks can prevent the infection of SARS-CoV-2. Wearing multi-layer disposable medical masks can not provide a better prevention but can affect the tightness of the masks and cause a poor breathing. Therefore, wearing a single disposable medical mask or surgical properly is enough in daily life. 92

93 84 Misunderstanding 11 It does not matter whether the masks are worn correctly or reversely. All masks must be worn correctly for best protection. If the disposable medical masks are worn reversely, its protective function will be reduced greatly and the comforts will be affected. The correct way of wearing a mask is to make sure that the colored side faces outward while the white side touches your face, and the metal strip side is on the upper side. Press the metal strips on both sides of the nose bridge with your hands to make the upper end of the mask close to the bridge. 93

94 85 Misunderstanding 12 Masks can be worn in the reverse direction after using the front side. It is very dangerous to wear a mask in the reverse direction after using the front side (after obviously feeling wet). In addition, some people may wear the front side of a mask when they are not sick and wearing the reverse side when they are sick. It is also dangerous because the outside of the mask is a contaminated side, wearing it reversely may lead to the infection with bacteria and viruses. 94

95 86 Misunderstanding 13 The masks don t need to be replaced and can be worn for a long period. It is recommended to replace the disposable medical masks and surgical masks every 2 to 4 hours. The two types of masks are for single use, but if there are no symptoms like fever or runny nose, sneezing and stuffy nose, you can reuse the mask slightly and put it in a fixed position after each use. If the mask becomes wet or contaminated with secretions, you should replace it immediately. The N95 mask is for personal use only and you should discard it if it is damaged, deformed, wet, dirty or contaminated. 95

96 87 Misunderstanding 14 Masks with breather valves are useless. Don t worry if there is a breathing valve on your mask. The air flow of the breathing valve is unidirectional and does not affect its effects of protection. However, for those people who have symptoms, it is advised not to use the mask with a breathing valve because it cannot stop the virus droplets from overflowing. 96

97 88 Misunderstanding 15 People need to wear goggles for daily protection. Wearing goggles is a protective suggestion for medical personnel who have direct contact with patients. It s unnecessary for ordinary people to wear goggles when going out, so you do not need to rush to purchase goggles. Experts remind that the conjunctival infection is mainly spread through the hand, therefore, you can not be infected by looking others from a distance. An important way to prevent the infection is to wash your hands frequently. If you have close contacts with feverish patients in the hospital, remember to disinfect and clean your phone and glasses. Ordinary people don t need to wear goggles when going out. 97

98 89 Misunderstanding 16 Smoking can prevent the infection of SARS-CoV-2. Rumors that smoking can prevent viral infections have existed since the SARS period. Actually, smoking not only fails to prevent the infection of SARS-CoV-2, but also irritates the respiratory tract. Smoking can cause an increase of the nicotine content in your blood, which may lead to vasospasm, thereby resulting in temporary hypoxia in local organs, especially in the respiratory tract and internal organs. Therefore, smoking is likely to reduce the body's resistance to disease and increase the risk of infection and the risk of severe illness after infection. In addition, you cannot wear a mask and your hands may touch your nose and mouth when smoking, so the risk of viral infection is increased. Therefore, it is recommended to quit smoking as soon as possible. 98

99 90 Misunderstanding 17 Fumigating with vinegar can disinfect the air and prevent the infection of SARS-CoV-2. Fumigating with vinegar can never prevent the infection of SARS-CoV-2. The maximum amount of acetic acid in a bottle of vinegar is only 5%. The method of evaporating acetic acid in vinegar into the air has a limited effect on increasing the acidity of the air, which cannot achieve the effect of disinfection. In addition, the acetic acid evaporated into the room may stimulate the respiratory tract mucosa, causing a throat discomfort, nausea and dyspnea. For children, the elderly whose respiratory tracts are sensitive and those people with a history of asthma, fumigating with vinegar are likely to cause respiratory diseases. 99

100 91 Misunderstanding 18 Gargling with the saline solution can inactivate SARS-CoV-2. There is no evidence that gargling with the saline solution can inactivate SARS- CoV-2. Gargling with the saline solution can help us clean the mouth and throat and relieve a sore throat. However, the position invaded by SARS-CoV-2 is in the respiratory tract and gargling cannot clean the respiratory tract. Gargling with saline solution 100

101 92 Misunderstanding 19 Dropping sesame oil in the nostrils can prevent the infection of SARS-CoV-2. Dripping sesame oil into the nostrils can neither prevent the virus from entering nor inhibit the virus from multiplying. It has no other effect except to make the body smell of sesame oil. It s no use wiping the nostrils with me to prevent the infection of SARS-CoV-2. sesame oil 101

102 93 Misunderstanding 20 Coats with a fur collar or fleece is more likely to be contaminated viruses easily. It seems that the virus prefers a smooth and nonporous surface according to the nature of the influenza virus. The virus is transmitted through droplets and it does not permeate in the air but may stay on clothing of any material. Therefore, wash hands immediately when you return home. Avoid touching the mouth, eyes and nose with your hands. Dry your coats in the sun frequently. 102

103 94 Misunderstanding 21 Taking a hot bath with 56 c water can prevent SARS-CoV-2. Our body temperature is relatively constant. Taking a hot bath will neither raise the body temperature nor prevent viral infections, and it may be life threatening. The inactivation of SARS-CoV-2 requires being in the temperature of 56 C at least 30 minutes. If people take a bath with 56 water for 30 minutes, they may get heat radiation disease, which may be threatening to their lives. Taking a hot bath with 56 C water for 30 minutes cannot prevent SARS-CoV

104 95 Misunderstanding 22 Sauna and steaming can prevent the infection of SARS-CoV-2. The temperature in the sauna room is high indeed, but your body temperature is relatively constant, so it cannot prevent the virus. And the ventilation is poor in the sauna and the steaming place and there are always many people in it, which increases the risk of the disease transmission. In addition, some symptoms like dehydration and even shock may occur after a long-term sauna and sweating. 104

105 96 Misunderstanding 23 The used masks can be disinfected by heating them in the microwave oven. The used masks should never be infected by heating in the microwave ovens, electric ovens and steamers. On the one hand, the internal structures of the masks will be damaged, so the masks cannot be used; on the other hand, the microwave ovens, electric ovens and steamers cannot continue to heat food due to the disposing of medical waste. 105

106 97 Misunderstanding 24 Spraying alcohol all over the body can have the effect of disinfection. The virus is not resistant to the outside world and 75% alcohol can have the effect of disinfection. However, the disinfection mainly focuses on those objects that are likely to be contaminated but not on common people at home. People contact with objects outside mainly through hands, so washing hands with soap under running water is an important measure. 75% alcohol is flammable, so pay attention not to spraying it in the confined space. 106

107 98 Misunderstanding 25 The higher the alcohol concentration is, the better the disinfection effect will be. 75% alcohol is an effective antiviral agent for SARS-CoV-2. Alcohol with higher concentrations, such as 95% alcohol, is unlikely to mutate the basic substances and proteins contained in the virus for the absence of water. 画重点 :75% 107

108 99 Misunderstanding 26 Sunbathing can kill SARS-CoV-2. The irradiation temperature of the sun can not reach 56, and the sunshine ultraviolet rays can not reach the intensity of ultraviolet ray disinfection lamps, which can not meet the requirements of killing viruses from any angle. If you want to bask in the sunshine, you still need to wear a mask and take necessary protective measures. 太阳公公对新型冠状病毒也没招 108