Information and recommendations for COVID-19 infection

Management of the risk of infection and the development of an epidemic process
All aspects of the newly emerging infectious disease are studied globally – etiology, epidemiology, pathogenesis, clinical manifestation, treatment, vaccines, etc. In the Republic of Bulgaria at the moment – 03.03.2020, the virus has not been isolated, therefore, there is no epidemic situation / epidemic – manifestation of a group of diseases of the same nature, quantitatively above the normal level, with the cases related by place, time and mode of transmission.
A crisis headquarters by distinguished experts has been formed, and is providing daily information. Impressive anti-epidemic measures have been taken in order to prevent the import of the infection in the country – searching for people with symptoms of respiratory infection arriving from geographical regions with registered coronavirus infections. The established cases are immediately isolated in infectious disease wards and tested for COVID-19. Their contacts are traced and quarantined for 14 days (maximum incubation period). People arriving from Italy and China are also put under quarantine.
Prevention recommendations at the Medical University – Plovdiv
In this regard, the brief epidemiological data known at this stage regarding COVID-19 infection includes:
– The virus is unstable in the external environment.
– Virus circulation peaks around the second month.
– A sick person is a source of infection (the animal reservoirs is being studied) and can infect 2-3 healthy ones.
– Mode of transmission: air-borne with aerosol droplets released from the contaminated during coughing, sneezing, having runny nose, etc. catarrhal events, in the most dangerous area – up to 2 meters.
– Incubation period: 2-14 days.
– Fatality rate: about 2% in 40-50 year olds and up to 18% in 80+ year olds with comorbidities.
– Age-related differences in morbidity, high in adults/elderly and very low in children.
– In the country, incl. in Plovdiv, a second epidemic wave of the flu, etiologically associated with the influenza B virus, is currently observed (it is difficult to clinically distinguish the influenza infection from the coronavirus infection).
– Virological test are performed on two groups of persons: the first group are the ones with symptoms of respiratory infection resided in areas with registered COVID-19, and the second group are the contacts of patients.
– There is no specific etiological treatment to reduce the epidemiological significance of patients as a source of infection
Recommendations for students, faculty members and other staff:
1. Face masks (basic to specialized) are to be worn by persons with respiratory infections (sneezing, coughing, fever, fatigue, etc.) and staff providing medical care. They need to cover the nose and be well adhered to the face, and have to be changed when moistened (1-2 hours). The mask should be removed without any touching of the front surface, and afterwards the hands should be immedualty washed with water and soap.
Why? – To keep healthy people safe. But do we do it???
It is an epidemiologically significant fact that in young, healthy people, flu-like illnesses tend to be less severe – “on foot”, and therefore we call them moving “springs of contagion”.
Healthy immunocompromised persons can wear masks while staying in overcrowded rooms to reduce the risk of infection during the period of epidemic rise in the circulation of respiratory viruses.
2. Frequent hygienic hand washing with soap for at least 20 seconds, with emphasis: fingertips, fingers, anatomic folds of the palm.
3. In the absence of this possibility, hand hygiene is to be performed with skin antiseptics from the alcohol group.
4. Do not touch eyes, nose and mouth – the “front doors” for viruses.
5. Avoid sneezing and coughing in hands. It is recommended to use the crease of the elbow. If immediate hygiene washing or disinfection of the hands is impossible, avoid touching any surfaces.
6. Avoid handshakes and hugs.
7. Avoid using public transport.
Concerning the external environment in the Auditorium and Departments:
1. Frequent ventilation.
2. Decontamination of surfaces – mechanical cleaning and chemical disinfection.
3. Risk of contamination of hands when touching door handles, elevator buttons, stair railing, etc.
It is not recommended for students and academic personnel to travel to/visit Italy, where there is an avalanche of cases, as well as other countries with registered COVID-19 cases. The same was recommended in a letter from the MES.

Professor Y. Stoilova, MD, PhD
Head of the Department of Epidemiology and DM