The precautions and steps to be taken remain same as before. It is essential to mask yourself properly, take both doses of vaccines (if not yet vaccinated), maintain social distancing and maintain good ventilation to the maximum possible.

While, there is no evidence to suggest that existing vaccines do not work on Omicron, some of the mutations reported on Spike gene may decrease the efficacy of existing vaccines. However, vaccine protection is also by antibodies as well as by cellular immunity, which is expected to be relatively better preserved. Hence vaccines are expected to still offer protection against severe disease and, vaccination with the available vaccines is crucial. If eligible, but not vaccinated, one should get vaccinated.

1. Identify separate, well-ventilated room
2. Use triple layer mask and discard in a paper bag after 72 hours
3. Maintain adequate hydration
4. Following respiratory etiquettes
5. Follow hand hygiene
6. Don't share personal items with others
7. Clean frequently touched surfaces with soap/detergent and water
8. Monitor bloody oxygen and temperature regularly
9. Report promptly in case of deterioration

1. Identify separate, well-ventilated room
2. Use triple layer mask and discard in a paper bag after 72 hours
3. Maintain adequate hydration
4. Following respiratory etiquettes
5. Follow hand hygiene
6. Use gloves
7. Avoid direct contact with body fluids of patient
8. Avoid exposure to contaminated items
9. Ensure effective waste disposal

The following are the latest government of India guidelines drawn up by AIIMS/ ICMR-COVID-19 National Task Force/ Joint Monitoring Group for the Ministry of Health:

Home isolation and care

MUST Dos

• Physical distancing, indoor mask
• Use, strict hand hygiene.
• Symptomatic management (hydration, anti-pyretics, antitussive, multivitamins).
• Stay in contact with treating physician.
• Monitor temperature and oxygen saturation (by applying a SpO2 probe to fingers).

Seek immediate medical attention if:

1. Difficulty in breathing
2. High grade fever/severe cough, particularly if lasting for >5 days

Admit In Ward

1. Oxygen Support: Target SpO2: 92-96% (88-92% in patients with COPD). Preferred devices for oxygenation: non-rebreathing face mask.
2. Awake proning encouraged in all patients requiring supplemental oxygen therapy (sequential position changes every 2 hours).

Anti-inflammatory or immunomodulatory therapy

1. Inj. Methylprednisolone 0.5 to 1 mg/kg in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration of 5 to 10 days.
2. Patients may be initiated or switched to oral route if stable and/or improving.

Anticoagulation

1. Conventional dose prophylactic unfractionated heparin or Low Molecular Weight Heparin (weight based e.g., enoxaparin 0.5mg/kg per day SC). There should be no contraindication or high risk of bleeding.

Monitoring

1. Clinical Monitoring: Work of breathing, Hemodynamic instability, Change in oxygen requirement.
2. Serial CXR; HRCT chest to be done ONLY If there is worsening.
3. Lab monitoring: CRP and D-dimer 48 to 72 hrly; CBC, KFT, LFT 24 to 48 hrly; IL-6 levels to be done if deteriorating (subject to availability

Admit In ICU

Respiratory support

1. Consider use of NIV (Helmet or face mask interface depending on availability) in patients with increasing oxygen requirement, if work of breathing is LOW.
2. Consider use of HFNC in patients with increasing oxygen requirement.
3. Intubation should be prioritized in patients with high work of breathing /if NIV is not tolerated.
4. Use conventional ARDSnet protocol for ventilatory management.

Anti-inflammatory or immunomodulatory therapyy

1. Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration 5 to 10 days.

Anticoagulation

1. Weight based intermediate dose prophylactic unfractionated heparin or Low Molecular Weight Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD). There should be no contraindication or high risk of bleeding.

Supportive measures

1. Maintain euvolemia (if available, use dynamic measures for assessing fluid responsiveness).
2. If sepsis/septic shock: manage as per existing protocol and local antibiogram. Monitoring
3. Serial CXR; HRCT chest to be done ONLY if there is worsening.
4. Lab monitoring: CRP and D-dimer 24-48 hourly; CBC, KFT, LFT daily; IL-6 to be done if deteriorating (subject to availability).

The following guidelines are provided by the Ministry of Health and Family Welfare and are the latest guidelines as of Sep 21:

EUA/Off label use (based on limited available evidence and only in specific circumstances):

Remdesivir (EUA) may be considered ONLY in patients with

1. Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN), AND
2. No renal or hepatic dysfunction (eGFR <30 ml/min/m2; AST/ALT>5 times ULN (Not an absolute contradiction), AND
3. Who are within 10 days of onset of symptom/s.
4. Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.
5. Not to be used in patients who are NOT on oxygen support or in home settings

Tocilizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET

1. Presence of severe disease (preferably within 24 to 48 hours of onset of severe disease/ICU admission).
2. Significantly raised inflammatory markers (CRP &/or IL-6).
3. Not improving despite use of steroids.
4. No active bacterial/fungal/tubercular infection.
5. Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.

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

COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019.

According to WHO, the most common symptoms of COVID-19 are:

• fever
• cough
• tiredness
• loss of taste or smell

• difficulty breathing or shortness of breath
• loss of speech or mobility, or confusion
• Seek immediate medical attention if you have serious symptoms. Always call before visiting your doctor or health facility.
• People with mild symptoms who are otherwise healthy should manage their symptoms at home.
• On average it takes 5–6 days from when someone is infected with the virus for symptoms to show, however it can take up to 14 days.

Omicron symptoms are remarkable similar to the common cold or influenza.

In all three cases of common cold, influenza, or a coronavirus disease (Covid-19) infection caused by Omicron, the symptoms include a sore throat, runny nose, body ache, and fever. The prime suspect, in almost all of these cases, is the common cold. It might also be tempting to consider influenza, which tends to peak in the middle of winter from early October to mid-February.

Professor Eskild Petersen, of the Aarhus University Hospital in Denmark, was quoted as saying by a media publication, “A common cold and Omicron is, in my view, impossible to distinguish.”

The point was also echoed by Dr Andrew Freedman, an infectious diseases specialist at Cardiff University in the UK. “A lot of people, particularly vaccinated people, are getting what would otherwise be thought of as the common cold.”

Here are a few general symptoms of Covid-19, influenza, and the common cold, arranged according to their frequency:

1. Dry cough: Covid-19 (frequent), flu (frequent), cold (occasionally)
2. Fever : Covid-19 (frequent), flu (frequent), cold (rare)
3. Stuffy nose : Covid-19 (rare), flu (sometimes), cold (frequent)
4. Sore throat : Covid-19 (sometimes), flu (sometimes), cold (frequent)
5. Shortness of breath : Covid-19 (sometimes), flu (not observed), cold (not observed)
6. Headache : Covid-19 (sometimes), flu (frequent), cold (not observed)
7. Body aches : Covid-19 (sometimes), flu (frequent), cold (frequent)
8. Sneezing : Covid-19 (not observed), flu (not observed), cold (frequent)
9. Exhaustion : Covid-19 (sometimes), flu (frequent), cold (sometimes)
10. Diarrhoea : Covid-19 (rare), flu (sometimes), cold (not observed)

People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick.

Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air. According to a news a new study, 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 main way the disease spreads is through respiratory droplets expelled by someone who is coughing.

The risk of catching COVID-19 from someone with no symptoms at all is low. However, many people with COVID-19 experience only mild symptoms. This is particularly true at the early stages of the disease. It is therefore possible to catch COVID-19 from someone who has, for example, just a mild cough and does not feel ill.

Protection measures for everyone

Stay aware of the latest information on the COVID-19 outbreak, available on the national,state and local public health authority. Many countries around the world have seen cases of COVID-19 and several have seen outbreaks.

You can reduce your chances of being infected or spreading COVID 19 by taking some simple precautions:

1. Regularly and thoroughly clean your hands with an alcohol based hand rub or wash them with soap and water. Why? Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands.
2. Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing. Why? When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease.
3. Avoid touching eyes, nose and mouth. Why? Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.
4. Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately. Why? Droplets spread viruses. By following good respiratory hygiene you protect the people around you from viruses such as cold, flu and COVID-19
5. Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority. Why? National and local authorities will have the most up to date information on the situation in your area. Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also protect you and help prevent spread of viruses and other infections
6. Keep up to date on the latest COVID-19 hotspots (cities or local areas where COVID-19 is spreading widely). If possible, avoid traveling to places – especially if you are an older person or have diabetes, heart or lung disease. Why? You have a higher chance of catching COVID-19 in one of these areas.

Protection measures for persons who are in or have recently visited (past 14 days) areas where COVID-19 is spreading

1. Follow the guidance outlined above (Protection measures for everyone)
2. Self-isolate by staying at home if you begin to feel unwell, even with mild symptoms such as headache, low grade fever (37.3 C or above) and slight runny nose, until you recover. If it is essential for you to have someone bring you supplies or to go out, e.g. to buy food, then wear a mask to avoid infecting other people.
   Why? Avoiding contact with others and visits to medical facilities will allow these facilities to operate more effectively and help protect you and others from possible COVID-19 and other viruses.
3. If you develop fever, cough and difficulty breathing, seek medical advice promptly as this may be due to a respiratory infection or other serious condition. Call in advance and tell your provider of any recent travel or contact with travelers. Why? Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also help to prevent possible spread of COVID-19 and other viruses.

The risk depends on where you are - and more specifically, whether there is a COVID-19 outbreak unfolding there.

For most people in most locations the risk of catching COVID-19 is still low. However, there are now places around the world (cities or areas) where the disease is spreading. For people living in, or visiting, these areas the risk of catching COVID-19 is higher. Governments and health authorities are taking vigorous action every time a new case of COVID-19 is identified. Be sure to comply with any local restrictions on travel, movement or large gatherings. Cooperating with disease control efforts will reduce your risk of catching or spreading COVID-19.

COVID-19 outbreaks can be contained and transmission stopped, as has been shown in China and some other countries. Unfortunately, new outbreaks can emerge rapidly. It’s important to be aware of the situation where you are or intend to go.

Illness due to COVID-19 infection is generally mild, especially for children and young adults. However, it can cause serious illness: about 1 in every 5 people who catch it need hospital care. It is therefore quite normal for people to worry about how the COVID-19 outbreak will affect them and their loved ones.

We can channel our concerns into actions to protect ourselves, our loved ones and our communities. First and foremost among these actions is regular and thorough hand-washing and good respiratory hygiene. Secondly, keep informed and follow the advice of the local health authorities including any restrictions put in place on travel, movement and gatherings.

No. Antibiotics do not work against viruses, they only work on bacterial infections. COVID-19 is caused by a virus, so antibiotics do not work. Antibiotics should not be used as a means of prevention or treatment of COVID-19. They should only be used as directed by a physician to treat a bacterial infection.

While some western, traditional or home remedies may provide comfort and alleviate symptoms of COVID-19, there is no evidence that current medicine can prevent or cure the disease. We do not recommend self-medication with any medicines, including antibiotics, as a prevention or cure for COVID-19. However, there are several ongoing clinical trials that include both western and traditional medicines. We will continue to provide updated information as soon as clinical findings are available.

No. The virus that causes COVID-19 and the one that caused the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 are related to each other genetically, but the diseases they cause are quite different.

SARS was more deadly but much less infectious than COVID-19. There have been no outbreaks of SARS anywhere in the world since 2003.

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

Wearing well-fitted masks should be used as part of a comprehensive ‘Do it all!’ approach including maintaining physical distancing, avoiding crowded, closed and close-contact settings, ensuring good ventilation of indoor spaces, cleaning hands regularly, and covering sneezes and coughs with a tissue of bent elbow.

Depending on the type, masks can be used for either protection of healthy persons or to prevent onward transmission, or both.

There are three types of masks that WHO recommend for the public:

1. Reusable non-medical masks which comply with the ASTM F3502 standard or CEN Working Agreement 17553, or a non-medical mask meeting WHO essential parameters;
2. Disposable medical masks which comply with medical mask standards EN 14683 Type I, ASTM F2100 Level 1, YY/T 0969, YY 0469 (or equivalent);
3. Other types of well-fitting non-medical masks, including homemade multi-layered masks are an acceptable option, when other options are not available.

Disposable medical masks are also recommended for the following groups, because if infected, they are at a higher risk of becoming seriously ill with COVID-19 and dying:

1. People aged 60 or over.
2. People of any age with underlying health conditions, including chronic respiratory disease, cardiovascular disease, cancer, obesity, immunocompromised patients and diabetes mellitus.

Disposable medical masks are also recommended for:

1. Anyone who is feeling unwell, including people with mild symptoms, such as muscle aches, slight cough, sore throat or fatigue.
2. Anyone awaiting COVID-19 test results or who has recently tested positive.

A respirator or a medical mask should be worn by to caregivers at any setting where care is provided to patients with suspected or confirmed COVID-19, including home care, long-term care facilities and community care settings

In settings where there is community or cluster transmission of SARS-CoV-2, irrespective of vaccination status or history of prior infection, wearing a well-fitting mask that covers the nose and mouth is recommended for the public when interacting with individuals who are not members of their household:

1. in indoor settings where ventilation is known to be poor or cannot be assessed, or the ventilation system is not properly maintained, regardless of whether physical distancing of at least 1 metre can be maintained;
2. in indoor settings that have adequate ventilation if physical distancing of at least 1 metre cannot be maintained; or
3. in outdoor settings where physical distancing of at least 1 metre cannot be maintained.

It’s not always easy to determine the quality of ventilation. If you have any doubts, it’s safer to simply wear a mask. While wearing a mask, you should continue to maintain physical distance from others as much as possible. Wearing a mask does not mean you can have close contact with people.

The “incubation period” means the time between catching the virus and beginning to have symptoms of the disease. Most estimates of the incubation period for COVID-19 range from 1-14 days, most commonly around five days. These estimates will be updated as more data become available.

Coronaviruses are a large family of viruses that are common in animals. Occasionally, people get infected with these viruses which

may then spread to other people. For example, SARS-CoV was associated with civet cats and MERS-CoV is transmitted by dromedary camels. Possible animal sources of COVID-19 have not yet been confirmed.

To protect yourself, such as when visiting live animal markets, avoid direct contact with animals and surfaces in contact with animals. Ensure good food safety practices at all times. Handle raw meat, milk or animal organs with care to avoid contamination of uncooked foods and avoid consuming raw or undercooked animal products.

The most recent advice from the WHO3 is that current evidence indicates that COVID-19 virus is transmitted during close contact through respiratory droplets (formed on coughing or sneezing) and by fomites. 4-10 The virus can spread directly from person-to-person when a COVID-19 case coughs or sneezes, producing droplets that reach the nose,mouth, or eyes of another person. Alternatively, as the respiratory droplets are too heavy to be airborne, they land on objects and surfaces surrounding the infected person.

It is possible that someone may become infected by touching a contaminated surface, object, or the hand of an infected person and then touching their own mouth, nose, or eyes.

This can happen, for instance, when touching door knobs or shaking hands and then touching the face. Recent research evaluated the survival of the COVID-19 virus on different surfaces and reported that the virus can remain viable for up to 72 hours on plastic and stainless steel, up to four hours on copper, and up to 24 hours on cardboard.

This research was conducted under laboratory conditions (controlled relative humidity and temperature) and should be interpreted with caution in the real-life environment.

Yes. The likelihood of an infected person contaminating commercial goods is low and the risk of catching the virus that causes COVID-19 from a package that has been moved, travelled, and exposed to different conditions and temperature is also low.

No, people with hypertension, diabetes or heart diseases are at no greater risk of getting the infection than anyone else.

The majority (80%) of people diagnosed with COVID-19 will have mild symptoms of a respiratory infection (fever, sore throat, cough) and make full recovery. Some of the people with diabetes, hypertension and heart diseases including Heart Failure (weak heart) may develop more severe symptoms and complications. Therefore extra care is advised for these patients.

In general, you know that people with uncontrolled diabetes are at increased risk of all infections. People with diabetes are not at higher risk for acquiring the infection, but some individuals are prone to more severe disease and poorer outcomes once infected. Hence, follow your diet and exercise routine (to the extent possible), take your medications regularly and test your sugar levels frequently so as to keep your diabetes under control. When diabetic patients become sick, they may require frequent monitoring of blood glucose and adjustment of drugs including insulin, small frequent meals and adequate fluids.

Some tips for those with diabetes, hypertension and heart disease:

Take your medicines regularly - It is very important Make sure that you take all medications prescribed regularly as before even if you are mildly symptomatic. Don’t stop any medication unless advised by your doctor. Continue with your blood pressure, diabetes and heart disease medications in case you are unable to visit your doctor. Medications to control cholesterol (statins) should be continued.

Social distancing – Very important .

1. Avoid contact with someone who shows symptoms of possible COVID-19 - anyone having a cold or cough or fever.
2. Avoid non-essential travel and use of public transport.
3. Avoid public places, crowds and large families get togethers. Keep in touch with friends and relatives using phone, internet, and social media.
4. Avoid routine visits to hospitals / Labs. for minor problems, contact hospital or HF clinic by phone or helpline number if possible. If you are regularly checking INR and adjusting blood thinning medicines, please contact the doctor over phone if possible and try to avoid a hospital as much as possible.

Hand hygiene

1. Avoid handshakes and touching face with hands
2. Wash your hands with soap and water frequently – do this for at least 20-30 seconds and systematically to clean all parts of the hand
3. Alcohol based hand-sanitisers are also useful.
4. Avoid touching possibly contaminated areas/objects – Public toilet doors, door handles etc.