What are the clinical features of the disease in Corona Virus Infection (Covid-19)? 

Respiratory symptoms such as fever, cough and shortness of breath are present. If the disease worsens: pneumonia, severe respiratory failure, renal failure may occur. People can carry viruses in their respiratory tract without any symptoms. 

Are pregnant women more prone to Covid-19 infection? 

Physiological and immunological changes of pregnancy make pregnant women more susceptible to viral infections. For this reason, the risk of severe illness and death during pregnancy may be higher in such infections than in normal population members. Our information is limited, as there has not been extensive research on the possible side effects of Covid-19 on pregnant women. However, SARS and MERS infections, which have been seen in previous years, guide us. 

How is the infection? 

Contamination enters the body through the mouth, nose, eyes and throat as a result of close contact (< 2 meters) or long-term contact (for 1-2 minutes) with the droplet breath and secretions of the coughing patient. Transmission through the skin from infected surfaces is not yet clear, but caution should be exercised. 

Who are considered close contacts? 

Persons who provide direct care to a definite or potential patient without taking preventive measures for droplet infection, who work with healthcare professionals infected with Covid-19, who stay in the same closed environment as the patient concerned, or who visit patients, who are likely to be infected, usually associated with a healthcare centre, Persons who work closely in the same environment or share the same class before school, have front, back and side friends in school children, teachers, people traveling with the patient, living in the same house with the patient, working in the same office are considered close contacts. 

How is it recognized? How is it reported? 

Respiratory samples should be evaluated for Covid-19. Even if the first sample is negative, a second sample must be given. As a respiratory tract swab, 2-3 ml of tracheal aspirate, bronchoscopic sample or sputum are taken into viral transport medium or sterile, screw capped containers and immediately stored in the refrigerator (2-8 degrees) and transported to the laboratory immediately. (The Virology Reference Laboratory of the General Directorate of Public Health in our country is authorized in this regard. As soon as a possible case is identified, the Infectious Diseases Unit of the Provincial Health Directorate is informed. The management of the case is carried out under the coordination of the Provincial Health Directorate.) 

Is the prognosis of mother and baby worse if Covid-19 infection is passed during pregnancy? 

The data are insufficient for now, but we know that the rates of abortion, premature and stillbirth have increased in previous similar epidemics. Long-term effects are still unclear. However, exposure to high fever in the first trimester of pregnancy can increase birth defects. 

Does Covid-19 pass to the fetus during pregnancy and to the baby at birth? 

Not yet known. However, the virus has not been found in the amniotic fluids and breast milk of pregnant women. In previous outbreaks, direct transmission to the baby has not been demonstrated. 

What risks do pregnant healthcare professionals face when examining and treating a Covid-19 patient? How should it be protected? 

The risk of transmission is higher in the hospital setting. For this reason, patients with suspected infections should wear masks, be isolated in single rooms if necessary, stay in their rooms for a short time, avoid direct contact, and approach such patients by wearing special masks and wearing special clothing and equipment. (Medical mask, gloves, gown:-non-sterile, preferably liquid-impermeable and long-sleeved, as well as glasses/visors, liquid soap, alcohol-based hand sanitizer…) If the equipment used (e.g. stethoscope, thermometer) is used on more than one patient, each patient should be cleaned and disinfected after use. Access to the patient’s room should be limited, and only the personnel who are responsible for the patient’s care and whose entrance is required should be allowed to enter the room. If possible, the same personnel should be provided with care. Patient visitors should be prohibited and the companion should be limited to a single person if necessary, personal protective equipment should be kept ready at the entrance of the patient room at the entrance to the patient room. It should be ensured that the door is closed during the process, the door should not be kept open for a while, including the entrance and exit, and the related procedures should be carried out in rooms with natural air flow and, if possible, negative pressure. Personal protective equipment should be kept ready in ambulances, and personal protective equipment should be used until the patient is delivered to the first responder health institution and the ambulance is cleaned. 

How should personal protection be? 

There is no vaccine yet. It should not be in crowded and closed environments. Travel to risky areas should not be planned. Do not come into direct contact with sick people. When sick, one should stay at home, rooms, toilets and belongings should be separated from other individuals, should not go out in public, and if going out, a mask should be worn. The face, eyes and mouth should not be touched. While coughing or sneezing, hands should not be protected, disposable wipes should be used, and the touched items and materials should be disinfected. Hands should be washed with soap for at least 20 seconds or wiped with 60% alcohol. 

What should be considered in patients followed at home? 

The movement of the contact inside the home should be limited; Common areas such as toilets and bathrooms should be well ventilated, personal items (such as glasses, plates, towels) should not be shared, if necessary, these items should be washed thoroughly with soap and water, possibly infected clothes should be washed with normal detergent at 60-90°C, and toilets should be cleaned at least once a day with diluted bleach (1:100 sodium hypochlorite at normal dilution). 

How to follow up if the suspect is not found to have a virus? 

These people are followed up daily for 14 days after their last unprotected contact, especially for fever and respiratory symptoms. If other symptoms such as chills, body aches, sore throat, headache, diarrhea, nausea/vomiting and runny nose occur in these people, a home visit is made and the examinations are repeated. 

References: 

1-Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases 21.2.2020 

2-Interim Guidance: Get Your Household Ready for Coronavirus Disease 2019 (COVID-19) 

Centers for Disease Control and Prevention (CDC)1.3.2020 

3-Covid-19 (2019-nCoV Disease) Guide TR Ministry of Health General Directorate of Public Health. 25.2.2020 

Questions&Answers for Pregnant women 

 
Q: Are pregnant women more susceptible to infection, or at increased risk for severe illness, morbidity, or mortality with COVID-19, çomarda with the general public? 
A: We do not have information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population as observed in Pregnant women cases of other related coronavirus infections [including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)] and other viral respiratory infections, such as influenza, during pregnancy. 
Though person-to-person spread of the virus that causes COVID-19 has been observed in the United States among close contacts, this virus is not currently spreading among persons in the community in the United States and the immediate risk to the general public is low. Pregnant women should engage in usual preventive actions to avoid infection like washing hands often and avoiding people who are sick. 
Q: Are pregnant women with COVID-19 at increased risk for adverse pregnancy outcomes? 
A: We do not have information on adverse pregnancy outcomes in pregnant women with COVID-19. Pregnancy loss, including miscarriage and stillbirth, has been observed in cases of infection with other related coronaviruses [SARS-CoV and MERS-CoV] during pregnancy. High fevers during the first trimester of pregnancy can increase the risk of certain birth defects. 
Q: Are pregnant healthcare personnel at increased risk for adverse outcomes if they care for patients with COVID-19? 
A: Pregnant healthcare personnel (HCP) should follow risk assessment and infection control guidelines for HCP exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy is very limited; facilities may want to consider limiting exposure of pregnant HCP to patients with confirmed or suspected COVID-19, especially during higher risk procedures (e.g., aerosol-generating procedures) if feasible based on staffing availability. 
Transmission during pregnancy or during delivery 
Q: Can pregnant women with COVID-19 pass the virus to their fetus or newborn (i.e. vertical transmission)? 
A: The virus that causes COVID-19 is thought to spread mainly by close contact with an infected person through respiratory droplets. Whether a pregnant woman with COVID-19 can transmit the virus that causes COVID-19 to her fetus or neonate by other routes of vertical transmission (before, during, or after delivery) is still unknown. However, in limited recent case series of infants born to mothers with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for the virus that causes COVID-19. Additionally, virus was not detected in samples of amniotic fluid or breastmilk. 
Limited information is available about vertical transmission for other coronaviruses (MERS-CoV and SARS-CoV) but vertical transmission has not been reported for these infections. 
Infants 
Q: Are infants born to mothers with COVID-19 during pregnancy at increased risk for adverse outcomes? 
A: Based on limited case reports, adverse infant outcomes (e.g., preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, it is not clear that these outcomes were related to maternal infection, and at this time the risk of adverse infant outcomes is not known. Given the limited data available related to COVID-19 during pregnancy, knowledge of adverse outcomes from other respiratory viral infections may provide some information. For example, other respiratory viral infections during pregnancy, such as influenza, have been associated with adverse neonatal outcomes, including low birth weight and preterm birth. Additionally, having a cold or influenza with high fever early in pregnancy may increase the risk of certain birth defects. Infants have been born preterm and/or small for gestational age to mothers with other coronavirus infections, SARS-CoV and MERS-CoV, during pregnancy. 
Q: Is there a risk that COVID-19 in a pregnant woman or neonate could have long-term effects on infant health and development that may require clinical support beyond infancy? 
A: At this time, there is no information on long-term health effects on infants either with COVID-19, or those exposed to the virus that causes COVID-19 in utero. In general, prematurity and low birth weight are associated with adverse long-term health effects. 
Transmission through breast milk 
Q: Is maternal illness with COVID-19 during lactation associated with potential risk to a breastfeeding infant? 
A: Human-to-human transmission by close contact with a person with confirmed COVID-19 has been reported and is thought to occur mainly via respiratory droplets produced when a person with infection coughs or sneezes. 
In limited case series reported to date, no evidence of virus has been found in the breast milk of women with COVID-19. No information is available on the transmission of the virus that causes COVID-19 through breast milk (i.e., whether infectious virus is present in the breast milk of an infected woman). 
In limited reports of lactating women infected with SARS-CoV, virus has not been detected in breast milk; however, antibodies against SARS-CoV were detected in at least one sample. 

 
How COVID-19 Spreads

Current understanding about how the virus that causes coronavirus disease 2019 (COVID-19) spreads is largely based on what is known about similar coronaviruses. COVID-19 is a new disease and there is more to learn about how it spreads, the severity of illness it causes, and to what extent it may spread in the United States. 
Person-to-person spread 
The virus is thought to spread mainly from person-to-person. 
•    Between people who are in close contact with one another (within about 6 feet). 
•    Through respiratory droplets produced when an infected person coughs or sneezes. 
These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. 
Spread from contact with infected surfaces or objects 
It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. 
Can someone spread the virus without being sick? 
•    People are thought to be most contagious when they are most symptomatic (the sickest). 
•    Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads. 

How easily does the virus spread? 

How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained. 
The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected. 
International Areas with Sustained (Ongoing) Transmission 
Last updated February 28, 2020 
•    China (Level 3 Travel Health Notice) 
•    Iran (Level 3 Travel Health Notice) 
•    Italy (Level 3 Travel Health Notice) 
•    Japan (Level 2 Travel Health Notice) 
•    South Korea (Level 3 Travel Health Notice)