An Introduction of

COVID-19

Dr. E. Hagni Wardoyo, Sp.MK

Bagian Mikrobiologi FK Universitas Mataram
PAMKI cab Bali-Nusra
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NTB, 20 Maret 2020 https://corona.ntbprov.go.id/
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Media Indonesia, 16 Mar
MI, 16
Mar
Kompas,
17 Maret 2020
Kebijakan pembatasan transportasi umum
diberlakukan senin, 16 Maret 2020

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ditiadakan, saran penggunaan kendaraan pribadi diberlakukan
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2019-nCoV
• Taxonomy: Group IV ((+)ssRNA); Coronaviridae;
Coronavirinae; Betacoronavirus; Wuhan seafood
market pneumonia virus
• Virion: enveloped, spherical, 60-140 nm in
diameter with spikes of about 9-12 nm
• Genome: ~30 kb positive-sense, single-stranded
RNA
• RNA Transcript: 5' cap, 3' poly-A tail
• Proteome: 10 proteins
• Phylogeny: More closely related to bat-SL-
CoVZC45 and bat-SL-CoVZXC21 than SARS
https://www.viprbrc.org/brc/home.spg?decorator=corona_ncov
https://www.viprbrc.org/brc/home.spg?decorator=corona_ncov
https://www.viprbrc.org/brc/home.spg?decorator=corona_ncov
Genome 2019-nCoV
De Wit, et al, Nature Reviews Microbiology, 2016
Persyaratan lab pemeriksaan: BSL-3
Urgent perihal penguatan kapasitas
lab menggunakan Rapid test
1. Covid 19 adalah virus zoonosis yang ditemukan December 2019
2. Virologi nya di pelajari dan di teliti bulan Desember , pengembangan diagnostik Januari 2020
serta uji coba Februari 2020 dengan berbagai penyempurnaan yg masih terus berlangsung
3. Virus ini ber mutasi ber evolusi dan memberi karakter klinis yg tidak menetap dan pola yg
berbeda.
4. Pemeriksaan yg valid dan dalam proses pengembangan yaitu PCR dengan harapan spesifitas dan
sensitivitas yang tinggi .
5. Diagnostic kit harus teruji di lab rujukan untuk 5 positif dan 10 negatif yang berguna
menghindari false positive dan false negative
6. Sangat berbahaya jika rapid test sebagai diagnostic konfirmasi
7. Perkuat kapasitas labkesda dengan PCR dan rujukan tertinggi Balitbangkes
8. Virus berakibat penyakit , disisi lain menjadi alat untuk stigmatisasi , diskriminasi dan persekusi
sosial dan fisik,,,
• The Lancet: Kasus positif COVID-
19 dengan gejala DHF
• Alasan kenapa detection nya hrs
PCR sequencing bukan serology.
Klinis mirip dengue dg IgM
antiden (+), smnta PCR Den (-),
bgtu PCR seq Covid (+)
Diagnostic: solely molecular
identification
• Virus RNA  Reverse transcriptase  cDNA
• cDNA  Real Time PCR  tercopy cDNA
Davin HE Setiamarga, MI,
16 Maret 2020
Laboratorium
diagnostik di
Indonesia
(KMK HK.01.07/Menkes/182/2020)
Pemeriksaan COVID-19 di
Litbangkes
• Menggunakan 2 protokol
1. US CDC: rRT-PCR
2. Cara konvensional menggunakan 2 target gen:
• Gen N (nucleocapsid)
• Gen RdRp (RNA-dependent RNA polymerase)
Prinsip Penularan 2019-nCoV
• Udara melalui bersin dan batuk
• Kontak erat, bersentuhan atau bersalaman
• Menyentuh permukaan dimana virus berada dan kemudian
menyentuh mulut, hidung atau mata sebelum mencuci tangan
• Jarang, melalui kontaminasi fecal

https://www.cdc.gov/coronavirus/about/transmission.html
Human to human transmission
Mother to child transmission

• A mother with the deadly virus gave birth to the child at the Wuhan Children
Hospital in Hubei province on 2 February, China's state broadcaster CCTV reported.
• The newborn was given a test 30 hours later and was confirmed to have
coronavirus, doctors said.
https://www.nytimes.com/interactive/2020/world/asia/china-c
oronavirus-contain.html
 https://www.nytimes.com/interactive/2020/world/asia/china-c
Average case-fatality rates and transmission numbers are shown. Estimates of oronavirus-contain.html

case-fatality rates can vary, and numbers for the Wuhan coronavirus are
preliminary estimates.
 https://www.nytimes.com/interactive/2020/world/asia/china-c
oronavirus-contain.html

The official World Health Organization case count for SARS was delayed at the beginning of the outbreak. Some cases were suspected but not
confirmed; SARS is a diagnosis of exclusion, so previously reported cases may have been discarded after further investigation. Wuhan coronavirus data
as of 11:30 p.m. E.T., Jan. 30.
Map shows passenger volume from October to https://www.nytimes.com/interactive/2020/world/asia/china-c
oronavirus-contain.html
November 2019, the most recent data available.
Destinations with fewer than 1,000 passengers are
not shown
Contact transmission
• Cuci tangan menggunakan air mengalir dan sabun sesering mungkin
• Menggunakan sarung tangan dan apron jika merawat orang sakit
Droplet transmission
• Cuci tangan menggunakan air mengalir dan sabun sesering mungkin
• Menggunakan masker bedah jika merasa sakit
Droplets vs. Droplet Nuclei
(Droplet vs Airborne Precautions)
Size (μm) Velocity time Time to fall 1 Distance to
to settling m (time) touchdown
(m/s) (m)
1 3.50E-05 7.9 h 240
5 7.80E-04 21 m 11
10 2.90E-03 5.7 m 2.9
50 2.90E-03 13 s 0.11
100 1.70E-01 5.9 s 0.049

Pearson ML, Basics of airborne infection control. CDC

doi:10.1016/j.jinf.2010.11.010
• Figure 1 The changing size scale of particle sizes and demarcations of particle size. This schematic
indicates the size range of expelled from individuals prior to and after 1979. The black arrow
refers to the size range identified from healthy and infected individuals. The red dashed line
refers to the size range identified from individuals with known bacterial infections. The yellow
dashed line refers to the size range identified from individuals with known viral infections.
Patient placement during
airborne infection
outbreak
Cohorting
• If patient with acute respiratory infections (ARI) cannot be
accommodated in single occupancy rooms,  separate from
asymptomatic patients.
• These efforts may include placing patients in multi-occupancy rooms,
or designating patient care areas or contiguous sections within a
facility for patient cohorts
• Protect those who don’t have an ARI

Key Infection Control Recommendations. CDC

Patient/Resident Cohorting
• The placement and care of individuals who are infected or colonized
with the same microorganism in the same room
• This means lab confirmation!!
• This does NOT mean you can cohort everyone together that has general acute
respiratory infection symptoms
• This does NOT mean you can cohort VRE with MRSA or influenza with RSV
• Placing those who have been exposed together to limit risk of further
transmission
Staff Cohorting
• Assigning specified HCW to care only for patients/residents known to
be colonized or infected with the same microorganism.
• Can be used in addition to patient/resident and geographical
cohorting by assigning dedicated staff to care for either those
patients/residents who are infected or colonized, or those who are
not.
• Can be used during outbreaks to reduce the potential for cross-
infection between patients/residents by limiting the number of staff
interacting with patients/residents.
Patient surge using HEPA filter

Minnesota Dept of Health. Airborne Infection Disease Management

Isolation room
Type of Isolation room
• Used to reduce the spread of airborne infectious disease (TB) from the patient in
Airborne Infection Isolation the AIIR to the rest of hospital
Rooms (AIIRs) • Most common type seen in hospital

• Used to protect the patient (immunosuppressed) in the protective environment

Protective Isolation/Environment from common enviromental airborne infectious disease
room (PE) • Less common than AIIRs

• Rooms that can be converted from AIIR (negative) to PE (positive pressure)

Convertible isolation room • Out of the concept – not allowed by ASHRAE standard 170

• Used for immunocompromised patient who has an infectious disease

Combination AIIR/PE • Protect both patient and the rest of hospital
Type of Isolation room
• Used to reduce the spread of airborne infectious disease (TB) from the patient in
Airborne Infection Isolation the AIIR to the rest of hospital
Rooms (AIIRs) • Most common type seen in hospital

• Used to protect the patient (immunosuppressed) in the protective environment

Protective Isolation/Environment from common enviromental airborne infectious disease
room (PE) • Less common than AIIRs

• Rooms that can be converted from AIIR (negative) to PE (positive pressure)

Convertible isolation room • Out of the concept – not allowed by ASHRAE standard 170

• Used for immunocompromised patient who has an infectious disease

Combination AIIR/PE • Protect both patient and the rest of hospital
Negative pressure
• Controlable and measurable one direction airflow
• Airborne pathogen containment (HEPA filter)
• Recirculatable air
• Pressure= corridor > anteroom =/> isolation room > toilet
• Slightly difference= 2,5 Pa = 2,5x10 -5 atm
Airborne Infectious Isolation Room
Architectural Design Considerations
• AII room constructed to minimize leakage
areas and allow for room pressurization
• Self-closing doors (swing out for negatively
pressurized spaces; swing in for positively
pressurized spaces) with door sweeps
• Finishes should be smooth and cleanable
Airborne Infectious Isolation Room
Architectural Design Considerations
• Ante room should be negative
pressure to corridor
• Ante room airflow: 10 ACH
• CDC 2003: Supply above patient,
exhaust low on wall
• the difference between
exhaust and supply should
create a pressure differential of
about 0.01 inch water gauge (in.
w.g.) or 2.5 Pascals (Pa)
 Relation between
airflow and distance
of contaminant’s
source

WHO. Hazard Prevention and Control in the Work Environment: Airborne Dust, WHO/SDE/OEH/99.14 p.107
AIIRs with curtain
• The area around the bed can be “sealed off”
by attaching fire-rated
plastic sheeting to the curtain track along with
duct tape to attach the plastic to the floor
• The area around the bed can be “sealed
off” by attaching fire-rated plastic sheeting

• The intake must be within the plastic

enclosure and the output must be outside
the plastic enclosure
Pasien menolak dirawat? UU RI No 4
tahun 1984 ttg Wabah Penyakit
Menular
UU no 6 tahun 2018 tentang
Kekarantinaan Kesehatan
• Pasal 5
• Pemerintah Pusat (PP) bertanggung jawab menyelenggarakan
kekarantinaan kesehatan di Pintu Masuk dan wilayah secara terpadu
• Dalam menyelenggarakan Kekarantinaan Kesehatan sebagaimana
dimaksud pada ayat (1), PP dapat melibatkan Pemerintah Daerah (PD)
• Pasal 6
• PP dan PD bertanggung jawab terhadap ketersediaan sumber daya
yang diperlukan dalam penyelenggaraan Kekarantinaan Kesehatan
• Pasal 19
March 17, 2020
DOI: 10.1056/NEJMc2004973
JawaPos, 13 Maret 2020
Tetap semangat
Thank you
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