Novel Coronavirus Disease 2019
(COVID‐19)
Infection Prevention Handbook
for the General Public［Version 2.2］

Published: February 25, 2020
Revised: April 20, 2020
This handbook was created based on information
current as of April 24, 2020.

Infection Prevention Handbook

Introduction

A pneumonia of unknown cause detected in Wuhan, China was firstreported to the WHO Country Office in China on 31 December 2019.
The outbreak was declared a Public Health Emergency of International
Concern on 30 January 2020. Then, WHO characterized COVID-19 as apandemic on 11 March 2020.
There are many things still not understood about the novel coronavirus
and the disease it causes. Although some human-to-human transmission
has been confirmed, it is not clear how far it will spread.
This handbook was written with the goal of providing everyone with acorrect understanding of infectious disease prevention so that you can go
about your lives with peace of mind. I hope that this will help prevent
respiratory infections, including COVID-19, at home．
This handbook was written based on information current as of March
2020. It may be revised in the future as new information becomes
available.
March 16, 2020
Mitsuo Kaku
Professor, Division of Infectious Diseases and Infection Control
Faculty of Medicine, Tohoku Medical and Pharmaceutical University
Emeritus Professor, Tohoku University Graduate School of Medicine

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INDEX
What is the novel coronavirus?

3

Which countries and regions are affected by COVID-19?

4

What are the symptoms of COVID-19?

5

How does the virus spread?

6

What should I do if I develop noticeable symptoms?

8

Thoroughly Prevent the Spread of Infection

9

Follow Cough Etiquette︕

10

Wash Your Hands︕

12

Environment Disinfecting・Ventilation

14

Infection Prevention FAQ

16

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What is the novel
coronavirus (SARS-CoV-2)︖
 Coronaviruses are viruses that mainly infect animals, includingbats and camels, but they can also infect humans.
 The Middle East Respiratory Syndrome (MERS) reported in 2012
in Saudi Arabia and the Severe Acute Respiratory Syndrome(SARS) that spread from China in 2002-2003 are both from thesame group of coronaviruses.
 The exact source of the novel coronavirus SARS-CoV-2 is not yet
known.
At the end of December 2019, people who developed
pneumonia from unexplained causes were reported in the city of
Wuhan. Because many people who developed symptoms had
visited a wet market in the city that handled seafood and animal
meat, it is thought that an animal sold there may be related.
(This market was closed on January 1, 2020.)
 The novel coronavirus SARS-CoV-2 is spread from person-toperson. The World Health Organization (WHO) states that one
infected person infects about two people, which is slightly lower
than seasonal flu.
 Currently, there is no vaccine or special treatment for the novel
coronavirus, so current treatment methods focus on treating
symptoms.
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Which countries and regions are affected by
the novel coronavirus disease（COVID-19）?
 The disease appeared in Wuhan City, Hubei Province, China in
December 2019, but as of April 23, 2020, there are over
2,500,000 infected people reported around the world.
 Infections have been reported in 213 countries, including China,
Japan, Singapore, Thailand, the United States, Australia, Canada,
France, and more.

Global Outbreaks (April 24, 2020)
Source: World Health Organization

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What are the symptoms of the novel
coronavirus disease (COVID-19)?
 The main symptoms are fever, dry cough, headache, andmalaise (fatigue and tiredness) .This appears similar to thecommon cold, but the symptoms tend to prolong.
 Some people become infected but do not develop any symptoms
and do not feel unwell.
 Around 1 out of every 6 people who gets COVID-19 becomes
seriously ill and develops difficulty breathing.
 Older people, and those with underlying medical problems likehigh blood pressure, heart problems, or diabetes, are more likely
to develop serious illness.
 The incubation period* is said to be 2-12.5 days.
*The “incubation period” means the time between catching thevirus and beginning to have symptoms of the disease.

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How does the virus spread?
The virus spreads from person to person.
 In Wuhan, China, many of the infected people had recently
visited a wet market in the city. This is why the infection sourceis thought to have been in the wet market. However, as of now,
the infection source remains unidentified.
 There are reports of infections through person-to-person spread.
Most cases reported around the world were infected
through close contact with family members, coworkers, orother people who were showing symptoms.
 “Close contact” is considered to be the following situations: Living with a sick person suspected to have a COVID-19
infection
 Having been in a confined space with a sick person
suspected to have a COVID-19 infection
 Having come in direct contact with bodily fluids from thecoughing, sneezing, runny nose, etc. of a sick person
suspected to have a COVID-19 infection※The droplets from sneezing or coughing can travel as far as
1.5 to 2 meters.
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How does the virus spread?
The virus spreads mainly from person to person via
droplets and contact.
What is droplet infection?
 It is the process of when a infected person sends droplets
containing the virus flying through coughing, sneezing, saliva,
mucus, etc., and someone else gets infected by breathing in
those spray droplets through their mouth or nose.
What is infection through physical contact?
 It is the process of infection when fingers contaminated with thevirus touch a personʼs eyes, mouth, or nose, allowing the virus
to enter the body through the mucous membranes.
 After an infected person covers a cough or a sneeze with theirhands, when they use those hands to touch doorknobs, lightswitches, handrails, and other places or objects around them,the virus is transferred to those surfaces. When other people
touch those places or objects, the virus contaminates theirhands. When they then use those hands to touch their eyes,mouth, or nose, the virus infects them through their mucous
membranes.

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What should I do if I develop
noticeable symptoms?
If you have traveled abroad in the past 14 days (including to China) or
had close contact with someone who has traveled abroad recently or wasdiagnosed as infected, and within the following 12 days developed
symptoms such as fever or cough that are lasting, we recommend thefollowing actions:（１）If you have symptoms such as a fever or cough, please avoid
going outside as much as possible. When you are with otherpeople or go outside, wear a mask and avoid crowded places.

（２）Check your temperature twice a day (morning, evening).
 If your temperature is 37.5°C (99.5°F) or higher, you have a severe
cough, or you have difficulty breathing, call your local health center
immediately.
 To avoid spreading the infection to other people, do NOT go directly
to a medical institution unless you are instructed to by the healthcenter.
（３）If someone in your family is sick, keep them in a separate roomfrom the healthy people as much as possible. Make sure theirroom is a room that can be ventilated with windows.
※More details will be explained on the countermeasure methods pages.
8Infection Prevention Handbook

Thoroughly Prevent the Spread of
Infection
The basic things you can do to fight infection is wash your hands
frequently, use face masks correctly, and stay home when you feelsick.

In order to protect from and to prevent the
spread of disease, it is important to combine
several countermeasures:
Hand Washing& Sanitizing
Ventilation
Cough
Environment
Etiquette
Disinfecting「Reduce the risk of infection as much as possible」
With this motto in mind,
letʼs make sure to do each method.

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Method 1.

Follow Cough Etiquette︕
Masks can prevent droplets and the viruses and pathogens in
those droplets from going flying when you cough or sneeze.
People with symptoms such as coughing and sneezing should
avoid going out as much as possible.

When you have to go out, make sure to use masks correctly.

When you cough or sneeze, cover your nose and mouth with ahandkerchief or tissue, turn your face away from other people,
and move at least one meter away.


Immediately throw away your used tissue(s) in the trash can
and wash your hands.



If you do not have tissues, cover your mouth and nose using
your sleeve.

When you are sick with a cough, wear a mask so that you
could avoid infecting other people.
Ask people who are coughing to please wear a mask.
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Method 1.

Follow Cough Etiquette︕
Practice Proper Cough Etiquette①Wear amask when
you have a
cough②Use a tissue
to cover yourmouth andnose when
you sneeze or
cough③Turn your faceaway from people
when you coughor sneeze; andmove 1+ metersaway④Immediately
throw away
your used
tissue in thetrash can*⑤Wash your handswith liquid soap
and running
water*︓Put a plastic bag in the trash can. Use a trash can for which you
can throw things away without touching the lid with your hands.

Use a Mask Correctly
How to put on a mask

Check the front
and back

Press the nosepiece tothe shape of your nose

Stretch out thepleats and adjust tocover your chin

How to take off a mask

Without touching themaskʼs front, grab the ear
straps to remove the mask

Holding the strap,
throw the mask
into the trash can

Wash or sanitize
your hands

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Method 2.

Wash Your Hands︕
How to avoid bringing infectious diseases home...
When you are out and about, it is likely that you are touching places thatmany other people have touched. You should wash your hands with soap
and water or sanitize them with alcohol when you come back home.

When should you wash your hands at home?
・

When you come back home・

When you have touched places many other people may havetouched・After you sneeze, cough, or blow your nose・After caring for a sick person

・Before cooking

・Before eating・

After handling family and animal body waste

・After going to the bathroom

This is the same whether you are at home or out and about.
When you do not have access to a sink or alcohol, or for smallchildren or elderly people with handicaps, thoroughly scrub
both hands with alcohol wet wipes.
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Method 2.

Wash Your Hands︕
Washing with soap & water①Wet your handswith water, putsoap in palms, andrub together well

⑤Use your palms togrip thumbs and twist②Rub the back ofboth hands with
fingers interlaced⑥Scrub your wrists③Wash fingertips andunder the nails well

④Thoroughly clean
between fingers⑦Rinse well withrunning water⑧Dry well with a paper
towel (Use the same
paper towel to turn off
faucet)Sanitizing hands with alcohol①Put an appropriate
amount of disinfectant
in your palm

④Use your palms
to grip thumbs
and twist②Rub the disinfectant
well into the front andback of your hands③Rub well into fingertips,
backs of fingers, andbetween fingers⑤Use your palms
to rub disinfectant
into your wrists⑥Continue to rub it in
until it dries

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Method 3.

Environment Disinfecting・Ventilation
When people use their hands to cover their nose or mouth when
they cough or sneeze, the virus gets on their hands. By using thosehands to touch handrails, tables, doorknobs, etc., the virus gets
onto surrounding surfaces. Then, other people unknowingly touch
those surfaces and infect themselves when they touch their mouth,
nose, or eyes.

<Surface and Environment Disinfecting>

Disinfect places that your family touches often (doorknobs, lightswitches, remote controls, washbasins/sinks, toilet handles,etc.)．



1-2 times a day, use diluted chlorine bleach (0.05％ sodium
hypochlorite solution) or a tissue wetted with alcohol to wipe
down doorknobs, tables, handrails, light switches, and otherplaces hands frequently touch.

※ After disinfecting an area with bleach (sodium hypochlorite
solution), wipe it again with water to prevent deterioration.

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Method 3.

Environment Disinfecting・Ventilation<Ventilation>

To prevent the spread of infectious disease, the room should bewell ventilated to reduce the amount of virus in the room. Keep
the air in the room fresh by opening windows and doors widefor 5-10 minutes every 1-2 hours throughout the day.

<Sharing Space with a Sick Person>To the extent possible, sick family members should stay in a
separate room from healthy ones. That room should be onethat can be ventilated with windows.

The sick person and the other people living with them should all
wash their hands with soap frequently. When they interact
within 1-2 meters of each other in the same room, everyone
should wear masks.

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Infection Prevention FAQ※ Because of the current lack of information about the novel
coronavirus disease infections, explanations will follow guidelines
for the Middle East Respiratory Syndrome (MERS), which belongs to
the same group of coronaviruses.
Q1. What should I be careful about when caring for someone
with a (suspected) coronavirus infection?
A. If possible, have sick family members stay in a separate roomfrom healthy ones, and make only one person the designatedcaregiver.
By limiting caregiving to one person as much as possible, therisk of contact with the infection is reduced.
When providing care, wear a mask and gloves. Put used masks
and gloves into a plastic bag, tie closed, and throw away. Wash
hands frequently.
The caregiver should check their own temperature twice a day,paying careful attention to whether or not they themselves
show symptoms of infection.

Sick Person
Wear a mask

Caregiver
Wear a mask and gloves
Wash or sanitize hands frequently

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Infection Prevention FAQ
Q2. What should I pay attention to about washing hands?
A.

Wash hands frequently. Wash with running water and soap.
After washing, use paper towels or tissue to dry your hands
completely. Avoid sharing towels with other family members.
Set up alcohol-based sanitizer in a spot so that you can sanitize
your hands anytime．

Q3. What should I be careful of at meals?
A.

When eating a meal with someone who may be infected, avoid
sharing dishes. After using dishes, wash them well with dishsoap. If you are concerned, soak them in boiling water ordisinfectant for at least 10 minutes before washing as usual;then anyone can use those dishes.

Serve meals on separate dishes
Do not serve yourself from a shared serving dishAfter disinfecting and washing used dishes normally,other people can use them17Infection Prevention Handbook

Infection Prevention FAQ
Q4. What should I do for clothing and bedding?
A. Avoid sharing. If there is a possibility that body fluids such as
diarrhea and vomit may be present on clothes, futons andpillowcases, disinfect them in boiling water at 80°C (176°F) forat least 10 minutes, and then wash normally. If you are worried,
wash them separately from other peopleʼs clothes. If
discoloration is not a concern, soaking in diluted sodium
hypochlorite solution (used at 0.1%) is also effective.

Put clothes in a bucket of
80°C (176°F) hot water,and soak for 10 minutes

After disinfecting in hot
water, wash normally

Q5. How should I be careful when I throw away trash?
A.

When you want to throw away tissues used to wipe saliva or
phlegm from a sick person, or throw away used items fromcaregiving, put a plastic bag in the trash bin beforehand anddiscard them in there. Tie the bag shut and be careful thatyour hands will not touch the discarded items.

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Infection Prevention FAQ
Q6. What should I make sure to do regarding the toilet?
A. For toilets with lids, put down the lid before flushing. When apotentially-infected person uses the toilet, closing the lid
prevents the virus from going flying during flushing.
Make sure the bathroom is well-ventilated.
After a potentially-infected person uses the bathroom, use atissue or cleaning cloth soaked with disinfectant to wipe down
the areas where hands touch, such as the toilet bowl, toilet seat,door knobs, light switches, and the toiletʼs flush handle, with atissue or cleaning cloth soaked in a disinfectant solution.

Cleaning and Ventilating the Bathroom

After using the toilet, use a cloth soaked in disinfectant
to wipe down the toilet bowel, toilet seat, doorknobs, light switches, toilet
handle, and other places that hands may touch.
Disinfectant: Alcohol, or sodium hypochlorite (bleach) solution diluted to
0.05%

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Infection Prevention FAQ
Q7. How should I clean the room?
A. Use alcohol disinfectant at least once a day to sanitize places
that hands often touch, such as tables, doorknobs, toilets, etc.
If it is visibly soiled with bodily fluids or excrement, wipe it withdisposable paper towels, etc. soaked in a disinfectant (diluted
sodium hypochlorite solution [bleach]). If bleach is used, themetal may rust, so wipe with water after disinfecting. Alcoholbased disinfectant is also effective.
Itʼs easy if you use a plastic bottle.
One capful is about 5mL.

NOTE

How to Make Disinfectant(diluted sodium hypochlorite solution)

Disinfectant
Concentration

Original Liquid
Concentration*

How to Make It

What to Use It For

0.1%

5%

Put 10mL (2 capfuls) oforiginal liquid into a
500mL bottle of water

Cleaning vomit and feces

0.05%

5%

Put 5mL (1 capful) oforiginal liquid into a
500mL bottle of water

Disinfecting cookware,bathroom doorknobs, toilet
seats, floors, clothing, etc.

＊Please check the label because the concentration ofchlorine in chlorine bleach varies depending on the product.
CAUTION!

When using sodium hypochlorite:

・ When disinfecting, ventilate well.
・ The effectiveness of diluted products decreases over time. Use it all up every time.
・ To avoid accidentally drinking it, do not make it ahead of time.
・ Do not use it to sanitize hands.
・ Store it out of the reach of children, etc., because it is dangerous.

20◆ When using this document for printing and distributing,please cite the source.
◆ Modifications, additions, partial quotations, translations,use for commercial purposes (including paid videos), etc. of
the contents of the handbook are prohibited.
◆ We do not accept inquiries by phone or e-mail about the
handbook.

Editor︓
Authors︓

Mitsuo Kaku
Professor, Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
Emeritus Professor, Tohoku University Graduate School of Medicine
Department of Infection Control, Tohoku Medical and Pharmaceutical University Hospital
Department of Infectious Diseases, Tohoku University Graduate School of Medicine
Sendai East Infection Control Team (SEICT)