This is a new virus that causes a respiratory illness in people and animals and can spread from person-to person through sneezing and coughing droplets. This virus has signs and symptoms similar to the common cold but is dangerous and if not reported early and managed by Health Workers it can cause severe illnesses in humans and can lead to death.

There are ongoing studies on the origins of Coronavirus. However, the current outbreak started in a large animal and seafood market in China, in a city called Wuhan.

Coronavirus is spread from human-to-human when an infected person’s sneeze or cough droplets come into contact with others. It can also spread when a person touches a contaminated surface, e.g. desk, chair, door handle etc. then touches their eyes, nose and/or mouth.

Everyone is at risk. However, severe symptoms and death appear more frequently among older people. People with underlying health conditions
such as lung or heart diseases, renal failure or weak immune systems are noted to be at a higher risk of infection.



Most patients who have been seen so far present with:
- Fever

- Cough

- Sore throat

- Running nose

- Difficulty breathing


There are simple everyday actions that can help prevent the spread of the virus:
- Avoid close contact with people who are visibly sick with flu-like symptoms (fever, cough, sneezing).

- Avoid touching your eyes, nose, and mouth with unwashed hands.

- Wash your hands often with soap and running water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.

- Stay home when you experience these symptoms to avoid spreading illness to others.

- The sick are encouraged to use a facemask to cover their nose and mouth.

- Cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the dustbin and wash your hands thoroughly with soap and running water.

- Regularly clean and disinfect frequently touched objects and surfaces such as door handles and phones.


There is currently no vaccine to protect against Coronavirus. The best way to prevent infection is to avoid being exposed to the virus or to those infected with the virus.

There is no specific antiviral treatment. However, people who have been infected should immediately, seek medical care to help relieve symptoms and manage complications.

The best place to manage a sick person with Coronavirus is in the hospital. However, if the patient is still managed at home you should:
- Place the patient in a well-ventilated single room and provide the patient with a facemask.

- Limit the number of caretakers of the patient to only one person who is in good health.

- Wash your hands with running water and soap following all contact with sick persons or their immediate environment.

- Avoid direct contact with body fluids, particularly oral or respiratory secretions or stool of the patient.

- Avoid sharing toothbrushes, eating utensils, dishes, drinks, towels, washcloths or bed linen with the sick person.

- Regularly clean and disinfect frequently touched surfaces such as doorknobs/handles, bedside tables, bedframes, and other bedroom furniture daily with regular household disinfectant or soap.

- Clean and disinfect bathroom and toilet surfaces at least once a day with regular household disinfectant or soap.

- Persons with symptoms should remain at home until their symptoms are resolved based on either clinical and/or laboratory findings.

- All household members should be considered contacts and their health should be monitored.

- If a household member develops symptoms of acute respiratory infection, including fever, cough, sore throat and difficulty breathing, follow the steps above.


#### Key messages
- Be on the lookout and avoid close contact with persons who show flu-like symptoms.

- Cover your mouth and nose when sneezing or coughing.

- Regularly wash your hands with soap and running water.

- Whenever possible avoid handling cash and try to use alternative payment methods such as mobile money or debit/credit cards. Ensure you wash your hands thoroughly with soap and running water after handling cash.

- Thoroughly cook meat and eggs.

- Avoid unprotected contact with live wild or farm animals


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Coronavirus (COVID-19): What you need to know and learn

Testing for SARS-CoV-2 in practice can inform individual patient care, and testing at a population level helps determine what interventions may need to be put in place to control the spread of disease within a community.

#### Who should be tested for SARS-CoV-2 infection?
- Patients with symptoms consistent with COVID-19

- Patients who were in close contact with a person with confirmed or probable SARS-CoV-2 infection

#### Patients with symptoms consistent with COVID-19
Testing should be considered with any of the following symptoms:

- Fever or chills

- Cough

- Congestion or runny nose

- Loss of taste or smell

- Shortness of breath or difficulty breathing

- Body aches

- Fatigue or headache

- Sore throat

- Nausea, vomiting, or diarrhea

The decision to test does not differ by the age of the child, although some symptoms such as body aches, shortness of breath, and loss of taste/smell are more prevalent in young adults than in school-aged children.

Co-infection or different pathogen with similar presentation. Testing for SARS-CoV-2 is suggested along with testing for other suspected or test-proven causes of acute illness that share symptoms consistent with COVID-19 (eg, influenza, respiratory syncytial virus [RSV], etc), depending on local epidemiology. Testing for SARS-CoV-2 infection should be guided by clinician judgment in accordance with the prevalence of COVID-19 in a given community. Testing for SARS-CoV-2 infection in the clinic setting is not recommended routinely in the context of other illnesses that lack shared symptoms (eg, cellulitis, urinary tract infection, etc.) but may be performed for children being hospitalized to allow for additional isolation precautions if a child is SARS-CoV-2 positive, unrelated to the admission diagnosis.

#### Patients in close contact with an individual with confirmed or probable SARS-CoV-2 infection

“Close contact” is defined as a distance of less than 6 feet for a cumulative total of at least 15 minutes over a 24 hour period from a person with laboratory-confirmed or probable SARS-CoV-2 infection starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated. Wearing a mask or cloth covering is presently not considered sufficient to alleviate the risk of transmission if close contact conditions are met. However, for those who are fully immunized, current CDC guidance allows for both indoor and outdoor activities without masks or face coverings, although local health department guidelines may differ. Testing for active SARS-CoV-2 infection may be considered for exposures of shorter duration or greater distance on a case-by-case basis. Testing for active SARS-CoV-2 infection is not necessary if there is exposure to a close contact of an individual with laboratory-confirmed SARS-CoV-2 infection and not the infected person himself/herself, unless the close contact is symptomatic or other criteria are met. Testing household contacts of newly infected persons for active SARS-CoV-2 infection using a nucleic acid amplification test (NAAT) or antigen test (see below) can be considered but may be falsely reassuring if negative, because continued contact with the infected household member may delay the onset of active infection for up to 14 days following the last exposure.

#### Patients requiring screening in the absence of symptoms or known close contact

Uganda is now requiring SARS-CoV-2 testing for incoming international travelers. Hospitals recommend that children receive testing for active SARS-CoV-2 infection prior to medical procedures such as elective surgery. These decisions should be made on the basis of local recommendations and institutional policies.

#### What is the optimal timing for testing? Are there reasons to defer or not to test?
**Immediate testing.** Patients with symptoms consistent with COVID-19 should be tested without delay using either a NAAT (including polymerase chain reaction [PCR]) or antigen tests (see below). Testing these patients in a timely fashion is important especially if participating in school, sports, or work so local groups can begin contact tracing, outlining school/work closures, and notifying families to begin home quarantines until test results are received.

**Delayed testing**. Asymptomatic patients with close contact exposure to infected persons should not be tested until at least 4 days after exposure. With faster diagnosis of infected persons using rapid SARS-CoV-2 antigen testing, there are pressures to have close contacts immediately tested. However, it is important for pediatricians to advise exposed patients to quarantine and wait to test until at least day 4 in order to limit early false-negative results and to limit the need for sequential testing. The probability of a false-negative result in an infected person decreases substantially over the first 4 days after exposure. Because symptoms develop 2 to 14 days following exposure and most commonly between 5 and 6 days, further testing after a negative test result should be guided by symptomatology. The appropriate test for delayed testing of asymptomatic patients is the PCR and not the rapid antigen.

**No testing**. Testing is not generally recommended for indirect exposure such as exposure to a close contact and not directly with the infected person, unless the close contact subsequently tests positive or develops symptoms. Testing is also not generally recommended for asymptomatic patients who have previously tested positive within the past 3 months or who are fully vaccinated against SARS-CoV-2 (see “What are the recommendations for testing after previous infection or after COVID-19 vaccination?” below).

A negative test result should not be necessary for return to school/work clearance if the patient has recently tested positive but meets current CDC criteria for return to school/work. Patients may have low levels of virus in their bodies and can continue to test positive without risk of spreading the disease to others.

#### What are the recommendations for testing after previous infection or after COVID-19 vaccination?
Testing for active SARS-CoV-2 infection using NAATs or antigen-based tests is not generally recommended for asymptomatic patients who have previously tested positive within the past 3 months. Variant SARS-CoV-2 strains with mutations in the spike protein have been reported from many locations in the world. The available data suggest that the newer strains identified to date are unlikely to cause symptomatic infection in those previously infected by SARS-CoV-2 or in those currently immunized with vaccines that create immunity to spike protein (Pfizer, Moderna, Janssen). Ongoing assessment of level of protection by current vaccines against each of the newly emergent strains is occurring to be able to quantify that risk of infection and of contagiousness represented by each new strain. Some SARS-CoV-2 variants may cause reinfections or infection after vaccination, but symptoms are generally mild and in adults, not associated with hospitalization or death, with similar outcomes expected for children. Therefore, in a child with known exposure and compatible symptoms, it may be reasonable to retest within the 3-month window. Results of such testing should be interpreted in the context of the knowledge that NAATs (particularly PCRs) may continue to yield positive results for weeks or months after initial infection, so a positive test result within that 3-month period may reflect prior infection.

**Receipt of SARS-CoV-2 vaccine does not result in positive NAAT or antigen test results**. Antibody (serology) tests that detect responses to the spike (not nucleocapsid) protein may become positive following vaccination. **bold text**

#### Which type of test should I use? How do I evaluate which test is best?
There are 3 main types of tests currently available for individuals who may have SARS-CoV-2 infection: nucleic acid amplification tests (NAATs), antigen tests, and antibody tests. Each of these has advantages and disadvantages, and decisions about which test to use depend on the specific clinical situation, local availability of testing, and local health department guidance. At minimum, the AAP recommends the use of tests that have received approval or Emergency Use Authorization (EUA) from the US Food and Drug Administration (FDA).

**NAATs** include PCR tests as well as strategies for isothermal amplification of nucleic acid, such as loop-mediated isothermal amplification (LAMP) and nicking enzyme amplification reaction (NEAR). A PCR test that has received FDA authorization or approval is the “gold standard” for testing an individual child for acute SARS-CoV-2 infection. These tests are generally performed on respiratory tract samples, most often nasal or nasopharyngeal swab specimens, and more recently, saliva samples. Some LAMP- and NEAR-based tests have received Emergency Use Authorization for point-of-care use. Despite LAMP and NEAR tests being molecular NAAT tests, preliminary data show that these tests should not be a replacement for PCR testing, especially for exposures and other clearance testing. Specific guidance for the use of these newer tests will require more data on their performance in children.

**Antigen tests** are generally performed on nasal or oral swab specimens. Some antigen tests are approved for point-of-care use and deliver rapid results, and others require shipment of samples to a central laboratory. Antigen tests generally have lower sensitivity than molecular tests, particularly in later stages of COVID-19. The utility of a positive or negative result depends on non-test factors, including the pretest probability of the patient having COVID-19 (based on symptoms, exposure, and local epidemiology). In patients with symptoms compatible with COVID-19 or with known exposures (ie, with high pretest probability of disease), positive antigen test results are generally reliable, although false-positive antigen tests have been reported, and negative test results may be false-negative results. In individuals without symptoms or known exposures, negative antigen tests are likely to be accurate, whereas positive antigen test results should generally be confirmed by another method (eg, PCR). Antigen tests are best used on patients with symptoms who are in settings where timing is important to notify others in efforts to contain disease (eg, in-person school, daycare, etc) and for whom a follow-up PCR test can be performed if needed. For purposes of clearance for a specific setting such as return to school, however, a negative antigen test result does not suffice.

**Antibody (serologic) tests** can provide evidence of previous infection with SARS-CoV-2 but are not useful for the diagnosis of acute infection. A positive antibody test result does not prove that a patient has protection against SARS-CoV-2, although the FDA and vaccine companies use serologic testing as a marker for immunogenicity and protection from SARS-CoV-2 infection. Thus, these tests should not be used to make decisions on grouping people in classrooms or other facilities at this time, and individuals with positive antibody tests should continue to adhere to guidelines about masking, physical distancing, and other preventive measures. Antibody testing is not recommended to determine immunity to COVID-19 following vaccination or to assess the need for vaccination. Population-level data from immunization programs suggest a very high level of response in all vaccines, regardless of the presence or lack of symptoms following immunization.

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#### Should I be testing in my office/practice?
A practice’s choice to test in office, collect specimens in office, or refer all patients out for collection and testing depends on multiple factors:

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Coronavirus (COVID-19): What you need to know and learn

COVID-19 Testing Guidance