Overview of COVID-19

COVID-I9, Aetiology, Pathophysiology, Prevention and Control

1. COVID-19 PANDEMIC AN OVERVIEW

2. OUTLINE Introduction Epidemiology Aetiology Clinical features Diagnosis Treatment Infection prevention Conclusion References

3. INTRODUCTION Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory illness caused by a novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) First identified following an outbreak of respiratory illnesses in Wuhan, China. Reported to WHO on 30/12/19, WHO declared it a global health emergency on 30/01/20 and a global pandemic on 11/03/20.

4. EPIDEMIOLOGY 1 As at today, coronavirus has being confirmed in: 10 million individuals worldwide, with over 507,000 deaths About 188 countries have reported laboratory confirmed cases The united states has the highest number of infections and deaths, followed closely by Brazil. In Africa, South Africa has the highest number of reported infections, while Egypt has the highest number of deaths.

5. EPIDEMIOLOGY 2 Nigeria recorded its first case on 27 th February, 2020 after an Italian citizen, resident in Lagos returned to the country from Italy. Infections have been reported in 35 states and the FCT Total no of infections - 25,133 Total no of recoveries - 9,402 Total no of deaths - 573 Lagos state has the highest no of infections and deaths

6. EPIDEMIOLOGY 3 Among the first 32 cases in Nigeria 53% of them were 40 years and above 66% were male 94% had history of recent travel or contact with a confirmed case. 75% presented with moderate to severe symptoms 16% were asymptomatic 59% had fever 44% had dry cough

7. Open Source

8. Open source

9. Aetiology The on-going pandemic started in late December, 2019, when several patients presented with viral pneumonia in Wuhan, China and were epidemiologically traced to the Huanan seafood market in Wuhan, where non-aquatic animals were sold. A novel, human-infecting, rapid human-to-human transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provisionally named 2019 novel corona virus (2019-nCoV), was identified and has been renamed as Coronavirus disease 2019 (COVID-19)

10. Corona viruses are enveloped, single-stranded, positive-sense RNA viruses of the Coronaviridae family with genome ranging from 26 to 32kb in length. They have been identified in bats, mice, rats, chickens, turkeys, masked palm civets, swine, dogs, cats, rabbits, horses, cattle and humans, are known to cause a wide range of disease conditions that can vary from mild to severe.

11. TRANSMISSION CHAIN How a virus spreads: The 6 Links In The Chain Of Infection; Liam Palmer, nurses.co.UK

12. TRANSMISSION MODES

13. PATHOPHYSIOLOGY 1

14. PATHOPHYSIOLOGY 2 The virus enters the mucosa of the nose and throat, attaches to a cell-surface receptor called angiotensin-converting enzyme 2 (ACE2). Once inside, the virus hijacks the cell’s machinery, making myriad copies of itself and invading new cells. If the immune system doesn’t beat back SARS-CoV-2 during this initial phase, the virus then marches down the windpipe to attack the lungs. As the immune system wars with this invader, there is disruption of healthy oxygen transfer- this explains the reduced oxygen saturation in affected patients. Front-line white blood cells (lymphocytes and neutrophils) release inflammatory molecules called chemokines, causes the immune defenses to overshoot, resulting in a "cytokine storm."

15. PATHOPHYSIOLOGY 3 The cytokine storm ultimately causes high fever, excessive leakiness of blood vessels, blood clotting inside the body, extremely low blood pressure, lack of oxygen and excess acidity of the blood, and pleural effusion White blood cells are misdirected to attack and inflame even healthy tissue, leading to failure of the lungs, heart, liver, intestines, kidneys, and genitals (Multiple Organ Dysfunction Syndrome, MODS). This may worsen and shutdown the lungs (Acute Respiratory Distress Syndrome, ARDS)

16. Most common symptoms: Fever Dry cough Tiredness Serious symptoms: Difficulty breathing or shortness of breath Chest pain or pressure Loss of speech or movement Less common symptoms: Aches and pains Sore throat Diarrhea Conjunctivitis Headache Loss of taste or smell A rash on skin, or discoloration of fingers or toes

17. DIAGNOSIS 1 Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) to detect the positive nucleic acid of SARS-CoV-2 in sputum, throat swabs, and secretions of the lower respiratory tract sample is the gold standard. Discussions around rapid test and antibody test are still not conclusive.

18. DIAGNOSIS 2 Chest X-Ray Findings : The most frequent findings are bilateral, peripheral, and lower lung zone airspace opacities, described as consolidation Chest CT-Scan Findings: G round-glass opacities : bilateral, subpleural, peripheral Crazy paving appearance  Air space consolidation Broncho-vascular thickening in the lesion Traction bronchiectasis

19. DIAGNOSIS 3 Blood Tests Findings: Lymphopenia Increased prothrombin time (PT) Increased lactate dehydrogenase Mild elevated inflammatory markers (CRP and ESR) Elevated D- dimer Mildly deranged liver function test Deranged Kidney function test

20. TREATMENT No drugs have been approved for the prevention or treatment of COVID-19 globally. Some drugs like remdesivir, hydroxychloroquine, Azithromycin,  lopinavir and ritonavir, ribavarin, and interferon-1-beta  are being tried. Numerous other antiviral agents, immunotherapies, and vaccines continue to be investigated and developed as potential therapies. Current treatment is mainly symptomatic and supportive Recently steroids have been shown to help critically ill patients

21. PREVENTION

22. CONTROL

23. PREVENTION IN HEALTH CARE SETTING Ensure triage, early recognition, and source control (isolating patients with suspected COVID-19) Apply standard precautions for all patients Implement empiric additional precautions ( droplet and contact and, whenever applicable, airborne precautions ) for suspected cases of COVID-19 Implement administrative controls Use environmental and engineering controls

24. TRIAGING PROTOCOL All hospitals must have a closed entry manned by trained security or front desk personnel Facilities should have a screening questionnaire for all entry into the facility; both staff and patients You must communicate clearly to the patients and staff about your protocols Patients can be screened in their cars or a screening tent A written notice also helps to communicate with the patient Difficult cases should be escalated to the management www.fppt.com

25. Fever >37.5 ° axillary or > 38.0 ° core . Does the person have Cough (Dry/Wet) Difficulty in breathing Anosmia/Dysgeusia Gastrointestinal symptoms Note that travel history is no longer important as there is evidence of sustained community transmission Malaise/fatigue www.fppt.com

26. REDUCE UNNECESSARY CONTACT WITH PATIENTS Telemedicine (telephone consults and Whatsapp calls should be encouraged) Clinic visits should be based on appointments which must be well spaced to prevent overcrowding Drug refills should be done without clinic visits Walk ins should be reduced to the barest minimum Cashless policy should be encouraged Only one visitor should be allowed per patient into the facility Emergencies should be attended to using standard precaution s

27. CONCLUSION Coronavirus is an ongoing public health concern with attendant constraints on health care delivery. Patients with cancer are at high risk of dying if they contract the disease. However, their care has being impacted during the pandemic Therefore, it is expedient to adopt ways to manage patients with cancer during this pandemic.

28. REFERENCES World Health Organization. infection prevention and control during care when COVID-19 is suspected: interim guidance(19 march 2020) World Health Organization. Consideration of quarantine individuals in the context of containment for coronavirus disease: interim guidance(19 march, 2020) World Health Organization. Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortage: interim guidance J.O Bamidele, O J Daniel Epidemiology of coronavirus disease in Nigeria: annals of health researchvol.6 NO.2(2020) Max Roser , Hannah Ritchie, Esteban Ortiz-Ospina and Joe Hasell (2020) - "Coronavirus Pandemic (COVID-19)". Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/coronavirus' [Online Resource]