COVID-19

Introduction

Coronavirus disease 2019 (COVID-19) is a potentially severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

SARS-CoV-2 has consistently mutated over the course of the pandemic, resulting in variants that are different from the original SARS-CoV-2 virus.

  • Alpha and Beta variants are ~50-60% more infectious than the original wide-type strain.
  • Delta variant is ~60% more infectious and transmissible than the alpha strain (and by extension, ~90% more infectious than the original wild-type strain).
  • Omicron ~2x as transmissible as Delta variant.



Transmission

Transmission is primarily droplet (for example from speaking, yelling, singing, coughing and sneezing) and less commonly airborne.
  • A modelling study suggested that infectiousness started 2.3 days prior to symptom onset, peaked 0.7 days before symptom onset and declined within 7 days; however, most patients were isolated following symptom onset, which would reduce the risk of transmission later in illness regardless of infectiousness.
  • Infectious virus unlikely to be isolated after the first week from onset of symptoms, falling to below 5% after 2 weeks.

The mean incubation time is estimated to be ~5 days after exposure (range 4.1-7.0 days, but as short as 36 hours).

The highest transmission rates are from close contacts and within households.



Symptoms

People with COVID-19 have had a wide range of symptoms reported - ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus.
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhoea

Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as Post-COVID Conditions (PCC) or Long COVID.



Management Based on Disease Severity

COVID HSO 2024 at Malaysia  Living with COVID-19  Face-masking is Encouraged

Due to the low mortality rate of COVID-19, the Ministry of Health (MOH) has updated the Home Surveillance Order (HSO) requirements and face mask guidelines, effective July 15, 2024.

  • COVID-19 positive cases will be treated similarly to those with other respiratory infections. They will no longer receive a 5-day HSO starting from the onset of their first symptoms.
  • Their COVID-19 status is no longer required to be reported in the MySejahtera app.

However, COVID-19 remains highly contagious.

  • Therefore, COVID-19 positive patients are encouraged to stay home, avoid close contact with others, and practice preventive measures (e.g., wearing a face mask and maintaining a physical distance of greater than 1 meter, handwashing and sanitising) if they must go out.
  • Wearing a face mask is recommended for the following groups:
    • COVID-19 positive patients
    • Symptomatic patients with cough and running nose
    • High-risk groups if in an areas that is crowded or with poor ventilation
    • Healthcare professionals who are on duty at healthcare facilities

Generally, supportive care with close clinical monitoring is recommended for COVID-19 positive patients (PCR or antigen) who are asymptomatic or have mild-to-moderate illness.

  • If symptoms persist or worsen, individuals should seek medical evaluation and treatment at a nearby health facility.

Antiviral therapy and/or monoclonal antibody (e.g. Paxlovid, remdesivir, molnupiravir) should be administered as early as possible (within 5-7 days) after symptom onset for patients with high risk of disease progression. Risk factors for development of severe disease include

  • Age >65 years
  • Immunocompromised state
  • Obesity
  • Diabetes mellitus
  • Chronic kidney disease



Prevention

Up-to-date vaccination.

Test if symptoms.

Practice social distancing, N95 respirators, surgical masks, eye protection, especially at high risk for severe illness.

Frequent handwashing (alcohol-based sanitizer and/or soap and water).

NOTE: More information on face mask is discussed separately.



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