Frequently Asked

The following FAQ has been sourced from various resources including the MoHFW, WHO and ICMR.

You can log into the Co-WIN portal using the link and click on the “Register/Sign In yourself” tab to register for COVID-19 vaccination.
There is no authorised mobile app for registering for vaccination in India except Aarogya Setu. You need to log into the Co-WIN portal. Alternatively, you can also register for vaccination through the Aarogya Setu App.
All citizens aged 18 years and above can register for vaccination.
Vaccination Centres provide for a limited number of on-spot registration slots every day. Citizens aged 45 years and above can schedule appointments online or walk-in to vaccination centres. However, citizens aged 18-44 years should mandatorily register themselves and schedule appointments online before going to the vaccination centre. In general, all citizens are recommended to register online and schedule vaccination in advance for a hassle-free vaccination experience.
Up to 4 people can be registered for vaccination using the same mobile number.
Up to 4 people can be registered for vaccination using the same mobile number. Citizens can take help from friends or family for online registration.
Yes, you can register on Co-WIN portal using any of the following ID proofs:
  • Aadhaar card
  • Driving License
  • PAN card
  • Passport
  • Pension Passbook
  • NPR Smart Card
  • Voter ID (EPIC)
No. There is no registration charge.
No. Currently, vaccination is free at Government hospitals and charged at INR 250 in Private hospitals for citizens aged 45 years and above. From 1st May onwards, the Vaccination for people of 45 years or more will continue to be free at the Government facilities. For people between 18 to 44 years the States will announce the policy relating to payment. Vaccination will be priced by private facilities and you can see the price of each vaccine at the time of booking.
Yes. The System will show the price of the vaccine below the name of the vaccination centre at the time of scheduling an appointment.
System will show the vaccine being administered in each vaccination centre at the time of scheduling an appointment. Citizens can choose the vaccination centre as per their choice of vaccine being administered However, the choice will not be available at the Government facilities.
The Vaccination Centres have been directed to ensure that if a citizen is being vaccinated with 2nd dose, they should confirm that the first dose vaccination was done with the same vaccine as is being offered at the time of second dose and that the first dose was administered more than 28 days ago. You should share the correct information about the vaccine type and the date of 1st dose vaccination with the vaccinator. You should carry your vaccine certificate issued after the first dose.
Yes, you can get vaccinated in any State/District. The only restriction is that you will be able to get vaccinated only on those centres which are offering the same vaccine as was administered to you on your first dose.
You should carry your identity proof specified by you at the time of registration on the Co-WIN portal and a printout/screenshot of your appointment slip.
Yes, it is possible that no facility near your place has published their vaccination program as yet. You may wait for some time till vaccination facilities near your place are boarded on the Co-Win platform, become active and start their services.
  • One type of vaccine will be provided at such sessions that are conducted at the Work Places. This is necessary to avoid mixing of vaccine types in 1st and 2nd dose of a beneficiary.
  • Beneficiaries at the Workplace who have already received one dose of a vaccine different from the one being administered at the WorkPlace CVC shall not be vaccinated at session in the WorkPlace CVC. They are expected to get the second dose of the same vaccine at an appropriate COVID vaccination centre. However, those who have received same a vaccine as first dose may be provided as the second dose at the WorkPlace CVC.
  • The full list of beneficiaries, as available in Co-WIN, will be visible to all verifiers and vaccinators, option of on-the-spot registration will also be available.
  • Verification will be done by Verifier (Vaccination Officer-1) preferably using Aadhar.
  • In case Aadhar authentication is not possible for any reason, the Verifier will verify the identity and eligibility of the beneficiary from the photo ID Card indicated by the beneficiary at the time of registration.
  • Apart from Aadhar, other IDs approved by the MoHFW are:
    • EPIC,
    • Passport,
    • Driving license,
    • PAN Card,
    • Smart Card issued by RGI under NPR,
    • Pension Document with Photograph.
  • If the identity and eligibility of a beneficiary is established upon verification, the beneficiary will be vaccinated and his/her vaccination status will be updated, else the the beneficiary will not be vaccinated.
  • All Vaccination must be recorded in real time through the Co-WIN Vaccinator Module on the same day.
  • The digital vaccination certificate of the beneficiary will be generated through Co-WIN, Workplace CVC Nodal Person will be responsible for providing a printed copy of the vaccination certificate, both after 1st and 2nd doses, to the beneficiary, on site after vaccination.
  • Operational guidelines and standard operating procedure for COVID-19 vaccination should be referred for detailed planning and operationalization.
    These are available at
  • COVID 19 vaccination at government Workplace organized by district health authorities will be free of cost.
  • COVID 19 vaccination organized by private CVC would be on payment basis and will be at same rate as of vaccination at private health facilities.
  • Service charge subject to a ceiling of INR 100 /- per person per dose,
  • Vaccine cost INR 150/- per person per dose.
  • Hence, the financial ceiling of the total amount recoverable by private health facility is INR 250/- per person per dose.
  • • The Private health facility that will be organizing vaccination at the private sector Workplace.will deposit the cost of vaccines upfront in the bank account designated by the National HealthAuthority. The hospitals will provide proof of payments to the DIO in-charge of the concerned district. The payment gateway on the NHA portal will be used by the private CVC for this purpose.
  • The District Task Force (DTF) chaired by District Magistrate and Urban Task Force (UTF) chaired by Municipal Commissioner will identify such government and private Workplaces after due deliberations with relevant employers and / or Head of offices.
  • Workplace management will designate one of their senior staff to work as “Nodal Officer'' to coordinate with district health authorities/ private COVID Vaccination Centres (CVCs) and support vaccination activities.
  • The Nodal Officer will oversee and facilitate all aspects of vaccination at Work Place CVC like registration of beneficiaries, availability of physical and IT infrastructure and oversight to vaccination etc.
  • Only employees of WorkPlace aged 45 years or more will be eligible for vaccination at Work Place, no outsiders including eligible family members will be allowed for vaccination at "CVC at Work Place".
  • Beneficiaries must be registered in the Co-WIN portal prior to vaccination. CVC Nodal Officer will ensure registration of all targeted beneficiaries and facility of on-the spot registration will also be available but only to employees of the workplace.
A COVID Vaccine Certificate (CVC) issued by the government offers an assurance to the beneficiary on the vaccination, type of vaccine used, and the provisional certificate also provides the next vaccination due. It also is an evidence for the citizen to prove to any entities which may require proof of vaccination especially in case of travel. Vaccination not only protects individuals from disease, but also reduces their risk of spreading the virus. Therefore, there could be a requirement in future to produce certificates for certain kinds of social interactions and international travel. In this context the certificate issued by Co-WIN has built in security features to guarantee genuineness of the certificate which can be digitally verified using approved utilities which are provided in Co-WIN portal.
The Vaccination Centre is responsible for generating your certificate and for providing a printed copy post vaccination on the day of vaccination itself. Please do insist on receiving the certificate at the Centre. For Private Hospitals, the charges for providing a printed copy of the certificate are included in the service charge for vaccination.
You can download a vaccination certificate from the Co-WIN portal ( or the Aarogya Setu app or through Digi-Locker by following the simple steps. You may do so by using the mobile number used at the time of registration.
You can contact on any of the following details:
  • Helpline Number: +91-11-23978046 (Toll free- 1075)
  • Technical Helpline Number: 0120-4473222
  • Helpline Email Id:
You may also contact the Vaccination Centre where you took vaccination, for advice.
First detected in India, the Delta variant of Covid-19 is 60% more transmissible than the Alpha variant, which was first detected in the United Kingdom’s Kent. The estimates for doubling rate (time taken for the number of infections to double) of infection for the Delta is also relatively high, with doubling time ranging from 4.5 days to 11.5 days.
It has been called a ‘variant of concern’ by the US CDC. WHO has said that it has spread to over 80 countries.
The Delta variant of Covid-19 is 60% more transmissible than the Alpha variant, which was first detected in the United Kingdom’s Kent. The estimates for doubling rate (time taken for the number of infections to double) of infection for the Delta is also relatively high, with doubling time ranging from 4.5 days to 11.5 days.
Considering the rapid mutation of the original Sars-CoV-2 virus, which led to the spread of the coronavirus disease, it is very important now to get yourself vaccinated. The second wave of the pandemic, led by the Delta variant, showed how rapidly the infection was spreading. It also caused a high number of fatalities.
While the Delta variant is more infectious, research released by the Public Health England shows that the two doses of the Pfizer/BioNTech vaccine prevent hospitalisation in 96% of cases, and two doses of the AstraZeneca/Oxford one in 92% of the cases. The vaccines, according to earlier research by PHE, were found to be 88% and 60% effective in preventing infection after two doses (and 33% effective in preventing it after one).
Researchers at Pune’s Indian Council of Medical Research-National Institute of Virology (ICMR-NIV) Bharat Biotech’s Covaxin is also effective in neutralising the Delta and Beta variants of Sars-CoV-2.
However, a study conducted by Delhi's All India Institute of Medical Sciences (AIIMS) said that the Delta variant can infect vaccinated people, though the infection does not become severe. This makes it even more important to take the jab as soon as possible. .
The scientists in India have said that they have found a mutated variant of the predominant B.1.617.2, which is wreaking havoc across the world. Called 'AY.1' or 'Delta plus', the new variant is resistant to the monoclonal antibody cocktail treatment for Covid-19 recently authorised in India.
Vinod Scaria, clinician and scientist at Delhi’s CSIR-Institute of Genomics and Integrative Biology (IGIB), said on Twitter that the new mutation is characterised by the acquisition of K417N mutation. It is the spike protein of Sars-CoV-2, which helps the virus enter and infect the human cells, he added.
According to Public Health England, 63 genomes of Delta variant with the new K417N mutation have been identified so far on the global science initiative GISAID. However, in India, its incidence is still low.
Research suggests that immunity against Sars-CoV-2 virus can last a year, and that infected people who received at least one dose of the vaccine developed strong immunity even against the variants of concern. Those infected by the virus develop memory plasma cells which typically offer long-lasting immunity against the virus.
Therefore, one can assume that there would be some immunological benefit for those who suffered the disease with a symptomatic infection.
A few media reports have claimed that it would be better to shorten the gap between two doses of Covishield vaccine, in light of the variants in circulation. But on Monday, Dr V K Paul, member (Health) at Niti Aayog, said there is a need to balance such concerns.
He said at a press conference that there is no need to panic. "We must remember that when we increased the gap, we had to consider the risk posed by the virus to those who have received only one dose. But the counterpoint was that more people will then be able to get the first dose, thereby giving a reasonable degree of immunity to more people."
In case you get fever, cough, muscle pain without shortness of breath, call your doctor and seek advice on the phone. You need to stay at home (at least for 14 days) and avoid close contact with other family members and maintain hand hygiene and correctly wear a medical mask. If there is shortness of breath or worsening symptoms like excessive fatigue call/visit your doctor (further advice will depend on advice of your physician).
Some types of painkillers(called NSAIDs) like Ibuprofen are found to worsen theCOVID-19. Such drugs are known to be harmful to heart failure patients and may increase your risk of kidney damage. Avoid NSAIDs or take them only when prescribed by your doctor. Paracetamol is one of the safest pain killers to use if needed. Control blood pressure (BP), blood sugar and do regular physical activity It is also important to control your risk factor levels – Avoid smoking and alcohol, have your BP and blood sugar levels under control and have some form of regular physical activity (However, please modify your out-door activities according to the norms of social-distancing.). Follow the diet and salt restriction as advised. If you are a non-vegetarian, you can continue to be so. Increasing the fibre and protein content of the diet and more vegetables and fruits in the diet is advisable.
Management of COVID-19 patients with mild disease. (Upper respiratory tract symptoms (&/or fever) WITHOUT shortness of breath or hypoxia)
  • Physical distancing, indoor mask use, strict hand hygiene.
  • Symptomatic management (hydration, antipyretics, antitussive, multivitamins).
  • Stay in contact with a treating physician.
  • Monitor temperature and oxygen saturation (by applying a SpO2 probe to fingers). Seek immediate medical attention if:
  • Difficulty in breathing
  • High grade fever/severe cough, particularly if lasting for >5 days
  • A low threshold to be kept for those with any of the high-risk features*
    Therapies based on low certainty of evidence
  • Tab Ivermectin (200 mcg/kg once a day for 3 days). Avoid for pregnant and lactating women.
  • Tab HCQ (400 mg BD for 1 day f/b 400 mg OD for 4 days) unless contraindicated. Inhalational Budesonide (given via Metered dose inhaler/ Dry powder inhaler) at a dose of 800 mcg BD for 5 days) to be given if symptoms (fever and/or cough) are persistent beyond 5 days of disease onset.
The asymptomatic cases are laboratory confirmed cases not experiencing any symptoms and having oxygen saturation at room air of more than 94%. Clinically assigned mild cases are patients with upper respiratory tract symptoms (&/or fever) without shortness of breath and having oxygen saturation at room air of more than 94%.
Patients eligible for home isolation
  • The patient should be clinically assigned as mild/ asymptomatic case by the treating Medical Officer.
  • Such cases should have the requisite facility at their residence for self-isolation and for quarantining the family contacts.
  • A care giver should be available to provide care on 24 x7 basis. A communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation.
  • Elderly patients aged more than 60 years and those with co-morbid conditions such as Hypertension, Diabetes, Heart disease, Chronic lung/liver/ kidney disease, Cerebro-vascular disease etc shall only be allowed home isolation after proper evaluation by the treating medical officer.
  • Patients suffering from immune compromised status (HIV, Transplant recipients, Cancer therapy etc.) are not recommended for home isolation and shall only be allowed home isolation after proper evaluation by the treating medical officer.
  • The care giver and all close contacts of such cases should take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating medical officer.
  • In addition, the guidelines on home-quarantine for other members available at:
  •, shall be also followed.
Instructions for the patient
  • Patient must isolate himself from other household members, stay in the identified room and away from other people in home, especially elderlies and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease etc.
  • The patient should be kept in a well-ventilated room with cross ventilation and windows should be kept open to allow fresh air to come in.
  • Patient should at all times use triple layer medical mask. Discard mask after 8 hours of use or earlier if they become wet or visibly soiled. In the event of care giver entering the room, both care giver and patient may consider using N 95 mask.
  • Mask should be discarded only after disinfecting it with 1% Sodium Hypochlorite.
  • Patient must take rest and drink lot of fluids to maintain adequate hydration.
  • Follow respiratory etiquettes at all times.
  • Frequent hand washing with soap and water for at least 40 seconds or clean with alcohol-based sanitizer.
  • Don’t share personal items with other people in the household.
  • Ensure cleaning of surfaces in the room that are touched often (tabletops, doorknobs, handles, etc.) with 1% hypochlorite solution.
  • Self-monitoring of blood oxygen saturation with a pulse oximeter is strongly advised.
  • The patient will self-monitor his/her health with daily temperature monitoring and report promptly if any deterioration of symptom as given below is noticed.
Instructions for caregivers
  • Mask:
  • The caregiver should wear a triple layer medical mask. N95 mask may be considered when in the same room with the ill person.
  • Front portion of the mask should not be touched or handled during use.
  • If the mask gets wet or dirty with secretions, it must be changed immediately.
  • Discard the mask after use and perform hand hygiene after disposal of the mask.
  • He/she should avoid touching own face, nose or mouth.
  • Hand hygiene
  • Hand hygiene must be ensured following contact with ill person or his immediate environment.
  • Hand hygiene should also be practiced before and after preparing food, before eating, after using the toilet, and whenever hands look dirty.
  • Use soap and water for hand washing at least for 40 seconds. Alcohol-based hand rub can be used, if hands are not visibly soiled.
  • After using soap and water, use of disposable paper towels to dry hands is desirable. If not available, use dedicated clean cloth towels and replace them when they become wet.
  • Perform hand hygiene before and after removing gloves.
  • Exposure to patient/patient’s environment
  • Avoid direct contact with body fluids of the patient, particularly oral or respiratory secretions. Use disposable gloves while handling the patient.
  • Avoid exposure to potentially contaminated items in his immediate environment (e.g. avoid sharing cigarettes, eating utensils, dishes, drinks, used towels or bed linen).
  • Food must be provided to the patient in his room. Utensils and dishes used by the patient should be cleaned with soap/detergent and water wearing gloves. The utensils and dishes may be re-used.
  • Clean hands after taking off gloves or handling used items. Use triple layer medical mask and disposable gloves while cleaning or handling surfaces, clothing or linen used by the patient.
  • Perform hand hygiene before and after removing gloves.
  • Biomedical Waste disposal
  • Effective waste disposal shall be ensured so as to prevent further spread of infection within household. The waste (masks, disposable items, food packets etc.) should be disposed of as per CPCB guidelines (available at:
    • Patients must be in communication with a treating physician and promptly report in case of any deterioration.
    • Continue the medications for other co-morbid illness after consulting the treating physician.
    • Patients to follow symptomatic management for fever, running nose and cough, as warranted.
    • Patients may perform warm water gargles or take steam inhalation twice a day.
    • If fever is not controlled with a maximum dose of Tab. Paracetamol 650mg four times a day, consult the treating doctor who may consider advising other drugs like non-steroidal anti-inflammatory drug (NSAID) (ex: Tab. Naproxen 250 mg twice a day).
    • The decision to administer Remdesivir or any other investigational therapy must be taken by a medical professional and administered only in a hospital setting. Do not attempt to procure or administer Remdesivir at home.
    • Systemic oral steroids not indicated in mild disease. If symptoms persist beyond 7 days (persistent fever, worsening cough etc.) consult the treating doctor for treatment with low dose oral steroids.
    • In case of falling oxygen saturation or shortness of breath, the person should require hospital admission and seek immediate consultation of their treating physician/surveillance team.
  • Patient / Care giver will keep monitoring their health. Immediate medical attention must be sought if serious signs or symptoms develop. These could includei. Difficulty in breathing,
  • Dip in oxygen saturation (SpO2 < 94% on room air)
  • Persistent pain/pressure in the chest,
  • Mental confusion or inability to arouse,
Patient under home isolation will stand discharged and end isolation after at least 10 days have passed from onset of symptoms (or from date of sampling for asymptomatic cases) and no fever for 3 days. There is no need for testing after the home isolation period is over.
  • States/ Districts should monitor all cases under home isolation.
  • The health status of those under home isolation should be monitored by the field staff/surveillance teams through personal visit along with a dedicated call centre to follow up the patients on daily basis.
  • The clinical status of each case shall be recorded by the field staff/call centre (body temperature, pulse rate and oxygen saturation). The field staff will guide the patient on measuring these parameters and provide the instructions (for patients and their care givers). This mechanism to daily monitor those under home isolation shall be strictly adhered to.
  • Details about patients under home isolation should also be updated on COVID-19 portal and facility app (with DSO as user). Senior State and District officials should monitor the records updation. v. A mechanism to shift patient in case of violation or need for treatment has to be established and implemented. Sufficient dedicated ambulances for the same shall be organised. Wide publicity for the same shall also be given to the community.
  • All family members and close contacts shall be monitored and tested as per protocol by the field staff.
  • Patient on home isolation will be discharged from treatment as indicate above. These discharge guidelines shall be strictly adhered to.
PRONING is the process of turning a patient with precise, safe motions, from their back onto their abdomen (stomach), so the individual is lying face down. Proning is a medically accepted position to improves breathing, comfort and oxygenation. It is extremely beneficial in COVID-19 patients with compromised breathing comfort, especially during home isolation.
Prone positioning improves ventilation, keeps alveolar units open and breathing easy. Proning is required only when the patient feels difficulty in breathing and the SpO2 decreases below 94 (less than 94). Regular monitoring of SpO2, along with other signs like temperature, blood pressure and blood sugar, is important during home isolation. Missing out on hypoxia (compromised Oxygen circulation) may lead to worsening of complications. Timely proning and maintaining good ventilation could save many lives.
One pillow below the neck One or two pillows below the chest through upper thighs Two pillows below the shins You will need 4-5 Pillows. Regular alterations in lying position Best is to not spend more than 30 minutes in each position. Read more..
Avoid proning for an hour after meals Maintain proning for only as much times as easily tolerable One may prone for up to 16 hours a day, in multiple cycles, as felt comfortable Pillows may be adjusted slightly to alter pressure areas and for comfort Keep a track of any pressure sores or injuries, especially ,around bony prominences Avoid Proning in conditions like:
  • Pregnancy
  • Deep venous thrombosis (Treated in less than 48 hours)
  • Major cardiac conditions
Non self-pronating
  • Using a flat sheet, pull the patient to one side of the bed.
  • Place the flat sheet around the arm that will pull through (the side you are turning toward).
  • A second flat sheet is placed on the bed and tucked under the patient. This sheet will pull through as you are turning the patient.
  • Using the sheet, turn the patient over and position the patient prone. The arm and sheet will pull across the bed.
  • Pull and center the patient. Discard the sheet that was used to place the patient in the supine position. Straighten lines and tubes.
It is well documented that children are less commonly affected with this infection and majority of them are asymptomatic or mildly symptomatic. A small proportion (<10%- 20%) of symptomatic children may need hospitalization and 1% to 3% of symptomatic children may have severe illness requiring intensive care admission. Direct person to person transmission occurs through close contact, mainly through respiratory droplets that are released when the infected person coughs, sneezes or talks. These droplets may also land on surfaces where the virus remains viable. Median incubation period is 5.1 days (range 2 to 14 days). As per current evidence, the period of infectivity starts 2 days prior to onset of symptoms and lasts up-to 8 days.
A person/ child with laboratory confirmation of Covid – 19 infection irrespective of clinical signs and symptoms.

Clinical Features:

Majority of children with covid infection may be asymptomatic or mildly symptomatic. Common symptoms include- fever, cough, breathlessness/ shortness of breath, fatigue, myalgia, rhinorrhea, sore throat, diarrhea, loss of smell, loss of taste etc. Few children may present with gastrointestinal symptoms and atypical symptoms. A new syndrome with name of multi system inflammatory syndrome has been described in children. Such cases are characterized by: unremitting fever > 38oC, epidemiological linkage with SARS CoV – 2 and clinical features suggestive of Multi System Inflammatory Syndrome.
Management of children with Covid – 19 disease: Children with Covid 19 infection may be asymptomatic, mildly symptomatic, moderately sick or severe illness. Asymptomatic children are usually identified while screening, if family members are identified. Such children do not require any treatment except monitoring for development of symptoms and subsequent treatment according to assessed severity. Mild disease: Children with mild disease may present with sore throat, rhinorrhea, cough with no breathing difficulty. Few children may have gastrointestinal symptoms also. Such children do not need any investigations These children can be managed at home with home isolation and symptomatic treatment. For home isolation it is important to assess whether home isolation is feasible by following steps:
  • There is requisite facility for isolation at his/her residence and also for quarantining the family contacts
  • Parents or other care taker who can monitor and take care of child
  • If available, Arogya Setu App should be downloaded
  • The parents/care giver has agreed to monitor health of the child and regularly inform his/her health status to the Surveillance Officer/ doctor
  • The parents/ care giver has filled an undertaking on self-isolation and shall follow home isolation/quarantine guidelines
Children with underlying comorbid condition including: congenital heart disease, chronic lung diseases, chronic organ dysfunction, Obesity (BMI> 2SD) may also be managed at home, if they have features of mild disease and there is easy access to health facility in case of any deterioration. In case there is lack of proper arrangement to manage these children at home/ access to health facility is difficult, such children may be admitted.
A child with Covid-19 will be categorized as having moderate disease if he/ she has the following: Rapid respiration as follows Age: less than 2 months: respiratory rate >60/ min, Age: 2 to 12 months: respiratory rate >50/min, Age: 1 to 5 years: respiratory rate >40/min, Age: more than 5 years: respiratory rate >30/min. And oxygen saturations above 90%. Children with moderate Covid – 19 disease may be suffering from pneumonia which may not be clinically apparent. Investigations: No lab tests are required routinely unless indicated by associated co-morbid conditions. Treatment: Children with moderate Covid-19 disease should be admitted in Dedicated Covid Health Centre or Secondary level Healthcare Facility and monitored for clinical progress. Maintain fluid and electrolyte balance. Encourage oral feeds (breast feeds in infants); if oral intake is poor, intravenous fluid therapy should be initiated.

Children with moderate Covid – 19 disease should be administered:

  • For fever: Paracetamol 10-15 mg/kg/dose. May be repeated every 4-6 hourly. (temperature > 38oC, i.e. 100.4oF).
  • Amoxycillin to be administered, if there is evidence/ strong suspicion of bacterial infection.
  • For SpO2 below 94%, oxygen supplementation is required.
  • Corticosteriods may be administered in rapidly progressive disease. It is not required in all children with moderate illness, specifically during first few days of illness.
  • Supportive care for comorbid conditions, if any.
Management of Shock: If the child develops septic shock or myocardial dysfunction then he/ she may require:
  • Crystalloid bolus administration: 10 to 20 ml/kg over 30 to 60 minutes; be cautious if cardiac dysfunction is there.
  • Early inotrope support with monitoring of fluid overload like any other cause of shock.

A new syndrome with name of multisystem inflammatory syndrome as been described in children. Such cases are characterized by: unremitting fever > 380 C, epidemiological linkage with SARS CoV – 2 and clinical features suggestive of Multi System Inflammatory Syndrome.

Diagnostic criteria of MISC in Children (WHO criteria): a constellation of clinical and laboratory parameters has been suggested for diagnosis. These include:

Children and adolescents 0–19 years of age with fever ≥ 3 days

AND two of these:

  • Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet).
  • Hypotension or shock.
  • Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT- proBNP),
  • Evidence of coagulopathy (by PT, PTT, elevated d-Dimers).
  • Acute gastrointestinal problems (diarrhoea, vomiting, or abdominal pain). AND
  • Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin. AND
  • No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes.
  • Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19.
Investigations: as listed above in criteria and investigations to rule out common differential diagnoses.
COVID-19 is the disease caused by a new coronavirus called SARS-CoV-2. WHO first learned of this new virus on 31 December 2019, following a report of a cluster of cases of ‘viral pneumonia’ in Wuhan, People’s Republic of China.
The most common symptoms of COVID-19 are:
  • Fever
  • Dry cough
  • Fatigue
Other symptoms that are less common and may affect some patients include:
  • Loss of taste or smell,
  • Nasal congestion,
  • Conjunctivitis (also known as red eyes)
  • Sore throat,
  • Headache,
  • Muscle or joint pain,
  • Different types of skin rash,
  • Nausea or vomiting,
  • Diarrhea,
  • Chills or dizziness.
Symptoms of severe COVID‐19 disease include:
  • Shortness of breath,
  • Loss of appetite,
  • Confusion,
  • Persistent pain or pressure in the chest,
  • High temperature (above 38 °C).
Other less common symptoms are:
  • Irritability,
  • Confusion,
  • Reduced consciousness (sometimes associated with seizures),
  • Anxiety,
  • Depression,
  • Sleep disorders,
  • More severe and rare neurological complications such as strokes, brain inflammation, delirium and nerve damage.

People of all ages who experience fever and/or cough associated with difficulty breathing or shortness of breath, chest pain or pressure, or loss of speech or movement should seek medical care immediately. If possible, call your health care provider, hotline or health facility first, so you can be directed to the right clinic.

The time from exposure to COVID-19 to the moment when symptoms begin is, on average, 5-6 days and can range from 1-14 days. This is why people who have been exposed to the virus are advised to remain at home and stay away from others, for 14 days, in order to prevent the spread of the virus, especially where testing is not easily available.
India has been hit by a devastating second wave COVID and there has been a lot of talk about a ‘double mutant’. Experts however warn against using that term. Officially called Variant B.1.617, it’s called ‘double mutant’ because it has two key mutations that cropped up in two other strains. However, the term is a misnomer since SARS-COV-2 keeps on mutating and the B.1.617 contains dozens of mutations, not just two. It contains a one mutation which was present in California and another which was first detected in South Africa and Brazil. These are two famous mutations which led to the naming. However, experts warn that there is no scientific evidence to suggests B.1.617 is more transmissible. Dr Ravi Gupta of Cambridge University urged people to stop using the term ‘double mutant’ and wrote on Twitter: “The combination of the two mutations gives a value of 4, in other words the two mutations DO NOT confer substantial antibody evasion and we can stop using the term 'Double Mutant'. This is reassuring and gives us good reason to believe that expanding vaccination in India will contribute to control of transmission as well as the severe effects of COVID-19. The data also help to explain why one significant sub lineage of B.1.617 appears to have lost E484Q.” So to sum up, while the term is a misnomer and vaccines work against. "The fact that case numbers fell in India during 2020 with limited social distancing makes me worry that the decline was related to reduced numbers of susceptible people," Gupta wrote, because so many Indians caught COVID-19 and became immune during the first wave. "And ... this [second] wave is driven by waning immunity + evasion, as suggested by B.1.1.7 and B.1.617 dominance."
Among those who develop symptoms, most (about 80%) recover from the disease without needing hospital treatment. About 15% become seriously ill and require oxygen and 5% become critically ill and need intensive care. Complications leading to death may include respiratory failure, acute respiratory distress syndrome (ARDS), sepsis and septic shock, thromboembolism, and/or multiorgan failure, including injury of the heart, liver or kidneys. In rare situations, children can develop a severe inflammatory syndrome a few weeks after infection.
People aged 60 years and over, and those with underlying medical problems like high blood pressure, heart and lung problems, diabetes, obesity or cancer, are at higher risk of developing serious illness. However, anyone can get sick with COVID-19 and become seriously ill or die at any age.
Some people who have had COVID-19, whether they have needed hospitalization or not, continue to experience symptoms, including fatigue, respiratory and neurological symptoms. WHO is working with our Global Technical Network for Clinical Management of COVID-19, researchers and patient groups around the world to design and carry out studies of patients beyond the initial acute course of illness to understand the proportion of patients who have long term effects, how long they persist, and why they occur. These studies will be used to develop further guidance for patient care.
Stay safe by taking some simple precautions, such as physical distancing, wearing a mask, especially when distancing cannot be maintained, keeping rooms well ventilated, avoiding crowds and close contact, regularly cleaning your hands, and coughing into a bent elbow or tissue. Check local advice where you live and work. Do it all!
Anyone with symptoms should be tested, wherever possible. People who do not have symptoms but have had close contact with someone who is, or may be, infected may also consider testing – contact your local health guidelines and follow their guidance. While a person is waiting for test results, they should remain isolated from others. Where testing capacity is limited, tests should first be done for those at higher risk of infection, such as health workers, and those at higher risk of severe illness such as older people, especially those living in seniors’ residences or long-term care facilities.
In most situations, a molecular test is used to detect SARS-CoV-2 and confirm infection. Polymerase chain reaction (PCR) is the most commonly used molecular test. Samples are collected from the nose and/or throat with a swab. Molecular tests detect virus in the sample by amplifying viral genetic material to detectable levels. For this reason, a molecular test is used to confirm an active infection, usually within a few days of exposure and around the time that symptoms may begin.
Antibody tests can tell us whether someone has had an infection in the past, even if they have not had symptoms. Also known as serological tests and usually done on a blood sample, these tests detect antibodies produced in response to an infection. In most people, antibodies start to develop after days to weeks and can indicate if a person has had past infection. Antibody tests cannot be used to diagnose COVID-19 in the early stages of infection or disease but can indicate whether or not someone has had the disease in the past. The time from exposure to COVID-19 to the moment when symptoms begin is, on average, 5-6 days and can range from 1-14 days. This is why people who have been exposed to the virus are advised to remain at home and stay away from others, for 14 days, in order to prevent the spread of the virus, especially where testing is not easily available.
SARS-CoV-2, the virus which causes the coronavirus disease (Covid-19), is predominantly transmitted through the air, according to a new study published in The Lancet journal. "There is consistent, strong evidence that SARS-CoV-2 spreads by airborne transmission. Although other routes can contribute, we believe that the airborne route is likely to be dominant. The public health community should act accordingly and without further delay,” according to the analysis by six experts from the UK, the US and Canada. The experts pointed out that superspreading events account for substantial SARS-CoV-2 transmission, saying “such events may be the pandemic's primary drivers.” “Detailed analyses of human behaviours and interactions, room sizes, ventilation, and other variables in choir concerts, cruise ships, slaughterhouses, care homes, and correctional facilities, among other settings, have shown patterns—eg, long-range transmission and overdispersion of the basic reproduction number (R0), discussed below—consistent with airborne spread of SARS-CoV-2 that cannot be adequately explained by droplets or fomites.”
Evidence suggests that one in five people infected will experience no symptoms and transmit to fewer people. However, there’s no clarity on the fact if asymptomatic people can be a ‘silent driver’. A white paper on COVID-19 published by Prof Narinder Mehra (Hon. Emeritus Scientist of Indian Council of Medical Research and Former Dean and National Chair, All India Institute of Medical Sciences, New Delhi) wrote in a white paper: “Briefly, to estimate the transmission potential and progression of the COVID-19 epidemic, R0 may not be the only factor. This is because not much information is available so far on the mechanism of transmission through asymptomatic carriers.” Ergo, the best option right now is to wear masks and get vaccinated when feasible.

Masks are a key measure to suppress transmission and save lives.

Masks are a key measure to suppress transmission and save lives. Masks should be used as part of a comprehensive ‘Do it all!’ approach including physical distancing, avoiding crowded, closed and close-contact settings, good ventilation, cleaning hands, covering sneezes and coughs, and more. Depending on the type, masks can be used for either protection of healthy persons or to prevent onward transmission.
Medical masks are recommended for:
  • Health workers in clinical settings. See WHO guidance for more information on the use of personal protective equipment by health care workers
  • Anyone who is feeling unwell, including people with mild symptoms, such as muscle aches, slight cough, sore throat or fatigue.
  • Anyone awaiting COVID-19 test results or who has tested positive.
  • People caring for someone who is a suspected or confirmed case of COVID-19 outside of health facilities.
Medical masks are also recommended for the following groups, because they are at a higher risk of becoming seriously ill with COVID-19 and dying:
  • People aged 60 or over.
  • People of any age with underlying health conditions, including chronic respiratory disease, cardiovascular disease, cancer, obesity, immunocompromised patients and diabetes mellitus.
Non-medical, fabric masks can be used by the general public under the age of 60 and who do not have underlying health conditions.
In areas where the virus is circulating, masks should be worn when you’re in crowded settings, where you can’t be at least 1 metre from others, and in rooms with poor or unknown ventilation. It’s not always easy to determine the quality of ventilation, which depends on the rate of air change, recirculation and outdoor fresh air. So if you have any doubts, it’s safer to simply wear a mask. You should always clean your hands before and after using a mask, and before touching it while wearing it. While wearing a mask, you should still keep physical distance from others as much as possible. Wearing a mask does not mean you can have close contact with people. For indoor public settings such as busy shopping centres, religious buildings, restaurants, schools and public transport, you should wear a mask if you cannot maintain physical distance from others. If a visitor comes to your home who is not a member of the household, wear a mask if you cannot maintain a physical distance or the ventilation is poor. When outside, wear a mask if you cannot maintain physical distance from others. Some examples are busy markets, crowded streets and bus stops.
Even when you’re in an area of COVID-19 transmission, masks should not be worn during vigorous physical activity because of the risk of reducing your breathing capacity. No matter how intensely you exercise, keep at least 1 metre away from others, and if you’re indoors, make sure there is adequate ventilation.
Check for filtration, breathability and fit when choosing a fabric mask. It should be held in place comfortably with little adjustment using elastic bands or ties. There are different mask shapes such as flat-fold or duckbill – find the one that fits closely over your nose, cheeks and chin. When the edges of the mask are not close to the face and shift, such as when speaking, air penetrates through the edges of the mask rather than being filtered through the fabric. Masks with vents or exhalation valves are not advised because they allow unfiltered breath to escape the mask. Fabric masks should be made of three layers of fabric:
  • Inner layer of absorbent material, such as cotton.
  • Middle layer of non-woven non-absorbent material, such as polypropylene.
  • Outer layer of non-absorbent material, such as polyester or polyester blend.
If purchasing a fabric mask from a store, check to make sure it meets national performance standards.
  • Clean your hands before taking off the mask.
  • Take off the mask by removing it from the ear loops, without touching the front of the mask.
  • If your fabric mask is not dirty or wet and you plan to reuse it, put it in a clean plastic, resealable bag. If you need to use it again, hold the mask at the elastic loops when removing it from the bag. Clean your mask once a day.
  • Clean your hands after removing the mask.
  • Wash fabric masks in soap or detergent and preferably hot water (at least 60 degrees Centigrade/140 degrees Fahrenheit) at least once a day.
  • If it is not possible to wash the mask in hot water, then wash it in soap/detergent and room temperature water, followed by boiling the mask for 1 minute.
  • Make sure to clean your hands before touching your mask.
  • Make sure you have your own mask and do not share it with others.
  • Resist the temptation to pull down your mask to your chin or take if off when speaking to other people.
  • Do not store your mask around your arm or wrist or pull it down to rest around your chin or neck. Instead, store it in a clean plastic bag.
Medical masks (also known as surgical masks) are:
  • composed of 3 layers of synthetic nonwoven materials
  • configured to have filtration layers sandwiched in the middle
  • available in different thicknesses
  • have various levels of fluid-resistance and filtration
Respirators (also known as filtering facepiece respirators – FFP) are available at different performance levels such as FFP2, FFP3, N95, N99. Medical masks and respirator masks are similar in their protection value. However, respirators are specific for certain procedures and instances because they have a tightly fitted component to them. Respirator masks are designed to protect healthcare workers who provide care to COVID-19 patients in settings and areas where aerosol generating procedures are undertaken. Healthcare workers should be fit tested before using a respirator to ensure that they are wearing the correct size. Wearing a loose-fitting respirator will not offer the same protection to the wearer and may allow small particles to get inside the mask through the sides.
No, WHO does not advise using masks or respirators with exhalation valves. These masks are intended for industrial workers to prevent dust and particles from being breathed in as the valve closes on inhale. However, the valve opens on exhale, making it easier to breathe but also allowing any virus to pass through the valve opening. This makes the mask ineffective at preventing the spread of COVID-19 or any other respiratory virus.
No, WHO does not advise using gloves by people in the community. Instead, WHO encourages the installation of public hand hygiene stations at the entrance and exit of public places, such as supermarkets or public/private buildings. This helps reduce germs brought in by people’s hands. By widely improving hand hygiene practices, countries can help prevent the spread of the COVID-19 virus and other infections.
Health workers are the most likely to be exposed to COVID-19 because they are in close contact with patients with suspected, probable or confirmed COVID-19. In areas of community or cluster transmission, health workers, caregivers and visitors should wear a mask at all times when in the health facility, even if physical distancing can be maintained. Masks should be worn throughout their shifts, apart from when eating, drinking or needing to change the mask for specific reasons:
  • Health workers and caregivers include: doctors, nurses, midwives, medical attendants, cleaners, community health workers, and any others working in clinical areas.
  • Health workers must remember to combine hand hygiene with any time they touch their mask or face, before and after putting on and removing their masks, as well as before they touch them to readjust them.
In areas with sporadic spread of COVID-19, health workers in clinical areas should wear medical masks throughout their shift apart from when eating, drinking or needing to change the mask for specific reasons. Health workers should continue to physically distance and avoid unnecessary close contact with colleagues and others in the facility when not providing patient care. Respirator masks are recommended for use where aerosol generating procedures are in place for a suspect/confirmed COVID-19 patient. In these settings, WHO recommends the use of airborne and contact precautions. As health workers have been infected with COVID-19 outside of health facilities, it is critical that health workers, as all people, follow the guidance to protect themselves from infection when outside of a health facility.