Infection Control
againstCovid -19Autumn 2020
Illustrated & Written byMasataka Shimotsuma MD
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Contents
What is coronavirus disease 2019 (Covid-19) ?

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Three infection patterns of Covid-19

P.4"Five situations" that increase the risk of infection

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Mechanism of infection, and symptoms of Covid-19

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Infection control against Covid-19

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Why is universal masking necessary ?

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When you can't keep a distance, wear a mask

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Clean hands when touching nose, eyes or mouth

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Fingertips are important when cleaning hands

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When a family member is infected …

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Gargle just after you get home, and also before going to bed
When you get home, wash your hands, gargle, and wash your face.
Before going to bed, gargle to reduce the virus in your mouth.

2What is coronavirus disease 2019 (Covid-19) ?

Coronavirus disease 2019 is thought to have occurred around November
2019, when a coronavirus of the bats began to infect humans.

The first case in Japan was confirmed in January 2020.
Of the 3713 passengers aboard the Diamond Princess (a cruise ship) that came toYokohama Port in February, 712 (about 20%) were infected.
There were many findings by analyzing and investigating the infection on this cruise ship.

3Three infection patterns of Covid-19③ Aerosol infection① Droplet
infection

When speaking loudly, aerosols (very small
droplets that are less than 1/100 mm) are
spread. They float in the air for approximately
20 minutes. If you inhale them, you may get
infected.

② Contact
infection
Wash hands to prevent
contact infections

Wear a mask

Closed space is dangerous!
Ventilate to blow out aerosols.
※ Aerosols are more widespreadthan droplets.

4Common points that are found among clusters ...
The infection risk is not so high, when just walking around in the city or shopping,as long as everyone is wearing a mask.（ Dr. Shigeru Omi ）Avoid the 3 Cs!

Do notSpeakloudlyConfined spaces
Crowded places
Close contact

Follow theinfection
controlmeasures

These three are the points ofcountermeasures
Lecture at the Japanese Societyof Infectious Diseases
on August 20, 2020

Chairman of novel coronavirus control subcommitteeby the government

When speaking in a loud voice,both droplets and aerosols spread out.

Be careful not to
get Covid-19!

Aerosols

Droplets
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In the locker roomof a fitness gym

“Five situations” that increase the risk of infection
Conversation without a mask, in cars and buses

Let's wear amask

Let's ventilate

Social gatherings with drinking alcohol6

Conversations without masks, andkaraoke

Living with room mates in a small roomsuch as in a dormitory

Break time in the staff room, changing
time in the locker room, and smoking inthe smoking room

"Five scenes" of the infection risk
① Social gatherings with drinking alcohol② Long feasts in large groups③ Conversation without a mask
④ Living together in a small limited space⑤ Switching locations
Ministry of Health, Labor and Welfare,
October 23, 20207

Mechanism and symptoms of novel coronavirus
The Covid-19 virus enters the body by binding to special receptors on
the mucous membranes. This receptor is for regulating blood pressure,
however the virus happens to stick to it.

②①Invades into the body

Bind to the receptor

Receptors on the facial
mucosa are on the nasal
mucosa, eye conjunctiva,
oral mucosa, and thesurface of the tongue.
As the skin has no
mucous membranes,
there are no receptors.

smelldisordertastedisorder

The skin is a naturalbarrier8Symptoms ofCovid-19

Cerebral infarction(cerebral thrombosis)

Fever
Cough

Runny nose / Smell disorder
Taste disorder

Pneumonia
Pulmonary embolus

Sore throat
Myocardial infarction
Kidney failure
Diarrhea

Lower Limb
Deep Vein Thrombosis※As inflammation progresses,
blood tends to clot in the bloodvessels throughout the body,resulting in secondary
symptoms such as shown in
red letters.

Children are less susceptible
to infection due to the smaller
number of receptors.

Children may be infected when they are
exposed to large number of virusus in ashort time, even though they have fewer
receptors.

9Infection control against Covid-19
Basic Precaution
Always wear a Mask andWash your Hands“Hand washing beforemeals” has always
been important, fromlong long ago.

Droplet Infection

Mask

Wear a mask when you can't
keep a distance from people

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Aerosol Infection

Ventilation

Aerosols generated by a loud voice can stay in the air for a long time in poorly ventilated
space. In such space, there is a risk of infection even for people who are sitting far away.
Ventilate the room well to blow out these aerosols.

Hand washingand Disinfection

Contact
Infection

Disinfect the parts
where everyone
touches often
Let's clean
our hands

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Why is universal masking necessary ?
One among three people infectedwith Covid-19 had no symptoms
33
nosymptoms

43
mildly ill

28
severely ill

104 definitely PCR-positive patients (Diamond Princess cruise ship)
Average age 68 years (47-75 years)(reported by the Self-Defense Forces Central Hospital)

We have no way of knowing who is spreading Covid-19!

When you can’t keep distance(1 to 2m), wear a mask

1ｍ1ｍ

Keep a sufficient distancewhen you are without a mask

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The peak of the viral
shedding of Covid-19,
is before the onset ofthe symptoms

Infected

2 daysbefore onset

Onset

10 days after the onset

Wear a mask even if you have no cough2 Daysbeforeonset

Onset
No symptoms

It is said the period to time that Covid-19 patients may
spread the infection to others is from 2 days before, to 7 to
10 days after the onset of the symptoms.
13When can't keep a distance, wear a mask

BeforeWhen you have a cough, wear a mask
① Mask

② Cover your mouthand nose with soft paper③ Cover your mouthand nose with sleeves

3 ways to ‘cover your cough’
Regardless ofcoughing

Now

When you can't keep a distance from others,
wear a mask

Hey, you two are too close.
Wear masks, please!

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When you can't keepa distance from others,
wear a maskregardless coughing

Universal-kun is giving masks to everyone.
※ Also called “Universal Masking"Surgical Mask（ Non-woven cloth ）Cloth Mask (cotton, gauze, etc.)

Nose wire

Absorbsmoisture fromexhaled breath

Cloth masks may
make you feel easier
to breathe, but they
may pass small
droplets when you
speak loudly.

Catches virus byattaching particles
Blocks droplets

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Clean hands when touching nose, eyes or mouth

The skin is okay!
But my nose isitchy ...

Oh
this feel goodAt this very moment ...

Covid-19 virus binds toreceptors on the
mucous membrane of
the nose, and invades
into the body16What to do against
the floating viruses

The Covid-19 virus cannot infect you while it is on your hands.
Wear “Glasses for hay fever" and “Mask" to prevent the virus
from binding to the receptors !

@ crowd of people

It is important to fit the mask snugly on theface, and make sure that there are no open
space around the nose and cheeks.

Disinfect or wash off the virusthat may be on your hands
before touching nose, eyesand mouth

The fingertips carry
the Covid-19 virus tothe nasal receptors

17fingertips are important when cleaning hands

First, sterilize yourfingertips in a poolof alcohol based
hand rub

Hand washwith soap and running water

Disinfect hands with alcohol based hand rub

In order not to hurt the surface of your skin ...
Foam the soap well. Do not scrub strongly.
Gently wash on the skin.
Do not wipe strongly. Moisturize well.

①③

Foam well and wash both hands②

Wash by twisting around yourthumb

Wash your fingertips④

Wash the base of your nails

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The correct way to disinfect hands① Use enough alcohol based hand rub to disinfect your entire hand

② At first disinfect your fingertips, nails, and thumbs,
that are most likely to be forgotten, but are very important③ Then rub both hands thoroughly until they are completely dry

1① Make a “Big Pool"on the palm of your hand

“Big Pool"
ofalcohol based hand rub

2③ When the right hand is finished,
move the liquid to the right hand palm
to disinfect the left hand by adding onepush② Put your fingertips in thepool and disinfect your nails.

3④ Disinfect the thumb,between the fingers, palm,
back of the hand, and wrist⑤ Disinfect thoroughly until
both hands dry up completely

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When a family member is infected …
UnwellIsolation

Influenza ？

Covid-19？
Covid-19 infection

Influenza infection

The initial symptoms may be similar to the flu
and the common cold.
The main symptoms arefever, cough, malaise, and respiratory distress.
Diarrhea (10%),
Taste disorder (17%)
Smell disorder (15%)

Onset with a sudden feverof 38-39°C or higher.
In addition to respiratory symptoms,
it is often accompanied by systemic symptoms
such as headache, lumbago pain, muscle pain,
arthralgia, and general malaise.

No one can tell if it is Covid-19 or influenza
Call a local clinic or hospital

Production Members✚ Japanese Red Cross Toyota College of Nursing
Masataka SHIMOTSUMA, MD, Ph.D.
（Infection Control Doctor）

Naotsune HOSONO, Ph.D.

Ver.1: 26 November 2020
Ver.2: 17 December 2020

(English Translator)

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