Coronavirus disease (COVID-19)

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases,The World Health Organization has announced that COVID-19 is a pandemic.

Seminar Prepared by :-
Mohammed Musa (M.B.Ch.B)

Azadi Teaching Hospital - Kirkuk

1. COVID-19 Mohammed Musa M.B.Ch.B Azadi Teaching Hospital - Kirkuk

2. Coronavirus: Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.

3. COVID-19 or SARS-CoV-2 SARS-CoV-2 refers to severe acute respiratory syndrome coronavirus 2 which was announced by ICTV (International Committee on Taxonomy of Viruses) as the name of the new virus on 11 February 2020. This name was chosen because the virus is genetically related to the coronavirus responsible for the SARS outbreak of 2003. While related, the two viruses are different. COVID-19 is the name of this new disease announced on 11 February 2020, following guidelines previously developed with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO).

4. Clinical Features: Incubation period : 1-27 days Recovery time : 3 weeks to 6 weeks Frequently reported signs and symptoms of patients include: fever (77–98%) cough (46%–82%) myalgia or fatigue (11–52%) shortness of breath (3-31%) less commonly reported respiratory symptoms include sore throat, headache, cough with sputum production and/or hemoptysis .

5. Diagnosis: Travel history to endemic countries like (China, Iran & Italy) CBC (leukopenia, seen in 30% to 45% of patients, and lymphocytopenia, seen in 85% of the patients) Chest X-Ray (cheaper & easier with 60% sensitivity) PCR (30%-70% sensitivity) Chest CT Scan (95% sensitivity, low specificity) IgM/IgG combo test for COVID-19

6. Chest X-Ray vs Chest CT scan:

7. Chest CT Scan findings:

8. IgM/IgG combo test

9. Specimen Collection: Combined nasopharyngeal/oropharyngeal swab If positive repeat every 3 days till negative If negative repeat second test after 24 hours If 2 consecutive negative isolation can be discontinued Lower respiratory specimen is preferred when applicable Airborne and contact isolation is recommended for further information contact your infection control practitioner.

10. Classification: Symptoms were categorized as follows: Mild cases: The majority (81%) of these coronavirus disease cases were mild cases include all patients without pneumonia or cases of mild pneumonia. Severe cases: This includes patients who suffered from shortness of breath, respiratory frequency ≥ 30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300,30 and/or lung infiltrates >50% within 24–48 hours. Critical cases: Include patients who suffered respiratory failure, septic shock, and/or multiple organ dysfunction or failure.

11. Risk of Infection: The Case fertility rate (CFR) was 0.9% for those without a preexisting health condition & for young ages. The CFR was 10% for those with underlying health conditions & for old ages. Fulminant myocarditis has also been reported in patients with Covid-19 which is caused by virus. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%–70%. Physicians should pay attention not only to the symptoms of respiratory dysfunction but also the symptoms of cardiac injury.

12. Management: No specific treatment for COVID-19 is currently available. There are currently no antiviral drugs licensed by the U.S. Food and Drug Administration (FDA) to treat patients with COVID-19. Clinical management includes prompt implementation of recommended infection prevention and control measures and supportive management of complications, including advanced organ support if indicated. Corticosteroids should be avoided, because of the potential for prolonging viral replication as observed in MERS-CoV patients, unless indicated for other reasons. For example, for a COPD exacerbation or for septic shock per Surviving Sepsis guidelines.

13. Treatment: Mild cases: Supportive treatments (Antihistamine & Analgesics) Moderate cases: Oseltamivir (150 mg BID for 5 days) Hydroxychloroquine, Chloroquine (500 mg BID for 14 days) or Ribavirin (for 5 days) Severe cases: Oseltamivir (150 mg BID for 5 days) Kaletra (Lopinavir/Ritonavir) (for 5 days) Hydroxychloroquine, Chloroquine (500 mg BID for 14 days) or Ribavirin (for 5 days) Critical cases: Oseltamivir (150 mg BID for 5 days) Kaletra (Lopinavir/Ritonavir) (for 5 days) Ribavirin (for 5 days) Hydroxychloroquine or Chloroquine (for 14 days) Investigational therapies: Favilavir (Favipiravir) Remdesivir Teicoplanin Tocilizumab

14. Prevention: People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick.

15. Prevention: If someone sneezes with it, it takes about 10 feet before it drops to the ground and is no longer airborne. If it drops on a metal surface it will live for at least 12 hours - so if you come into contact with any metal surface - wash your hands as soon as you can with a bacterial soap. On fabric, it can survive for 6-12 hours. normal laundry detergent will kill it. Washing hands frequently as the virus can only live on hands for 5-10 minutes, but a lot can happen during that time - you can rub your eyes, pick your nose unwittingly and so on.

16. References: Iraqi ministry of health COVID-19 guidelines https://www.who.int/health-topics/coronavirus https://forum.facmedicine.com/threads/breaking-news-favilavir-approved-as-experimental-coronavirus-drug.47832/ https://www.medscape.com/ https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html https://h5.clewm.net/?url=qr61.cn%2FoVMOYl%2FqhrjB3p&hasredirect=1