This presentation discusses COVID-19. It covers etiology, epidemiology, pathophysiology, clinical features, diagnosis, clinical management and treatment of COVID-19. It also discusses the effects of COVID-19 on pregnancy,how it manifests and how it is diagnosed and how it is managed. Hope this will help you.

1. COVID-19
Dr.Muhammad Zaid Shaukat

2. COVID-19
Coronaviruses belong to the
“Coronaviridae family”, which
causes various diseases,
from the common cold to SARS and
MERS. The coronavirus is naturally
prevalent in mammals
and birds. So far, six human-
transmitted coronaviruses have been
discovered. Severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-
2) was first reported in December
2019 in Wuhan, China.

3. COVID-19

4. EPIDEMIOLOGY
EPIDEMIOLOGY INDICATORS DESCRIPTION
AGE Increased risk with 60+
age.Cases range from 2 to 72
years. Elderly with morbid
conditions (Hypertension,
diabetes, chronic kidney
disease).
SEX Males mostly affected
MORTALITY High mortality from 60 to 80
years. Increased mortality in
60+ years of age.
INCUBATION PERIOD Symptoms may appear from
2 to 14 days after exposure.

5. PATHOPHYSIOLOGY
The S glycoprotein of the newly discovered SARS-CoV-2 is composed of two
subunits, S1 and S2, and is commonly represented as a sword-like spike.
Angiotensin-converting enzyme 2 (ACE2) receptors in mammalian lung
cells act as recipients of the S-spike protein, releasing endogenous viral
RNA genetic material into host cells. One of the crucial functions of
angiotensin-converting enzymes (ACE2) is to regulate the renin–
angiotensin system (RAS). In general, the angiotensin-converting enzyme 2
(ACE2) acts as a cell surface receptor and causes SARS-CoV-2 to enter host
cells and plasma and is expressed in organs such as the lungs, kidneys, and
heart. Moreover, one of the reasons for the development of COVID-19 is
the disturbance of the ACE/ACE2 balance and the activation of RAAS by
SARS-CoV-2, especially in patients with underlying cardiovascular disease
problems, hypertension, and diabetes.

7. ACE2 expression in alveolar epithelial cells types 1 and 2 in
the human lung is much higher than elsewhere in the
body.According to research, the level of ACE2 expressions
in men is much higher than in women in alveolar cells.
Moreover, in their alveolar cells, ACE2 expression levels in
Asians are much higher than in whites and African-
Americans. It is stated that Increasing ACE2 expression due
to SARS-CoV-2 virus binding via spike protein could lead to
alveolar cell damage and followed by systemic reactions
and even death.

8. CYTOKINE STORM
1)Infection of lung cells by
COVID-19.
2)Cytokine production through
virus detection by immune cells
(macrophages).
3)Creating a cycle of
inflammation in lung cells by
further uptake of immune cells
(white blood cells) through the
cytokine phenomenon.
4)Fibrin formation and further
damage.
5)Filling of the lung cavities due
to the infiltration of fluids into
the weak blood vessels, followed
by respiratory damage.

10. CLINICAL FEATURES
Symptoms of COVID-19 disease vary from patient to
patient. Sometimes it may be asymptomatic. Typically, in
the early stages of COVID-19 infection, the most common
infection symptoms can be fever, dry cough, and tiredness.
Less common symptoms are nausea or vomiting, muscle
or joint pain, sore throat, loss of sense of smell or taste or
both, nasal congestion, conjunctivitis, headache, different
types of skin rashes, diarrhea, shivering, and dizziness. In
the disease’s progression stages, the patient will face
severe shortness of breath, decdecreased blood oxygen
(hypoxia), destruction of the lungs,and several organs
dysfunction. More severe and rare neurological
complications such as stroke, encephalitis, delirium, and
nerve damage are other complications of COVID-19.

11. SYMPTOMS
Cough Fever Shortness
Of Breath
Sore Throat
MOST COMMON SYMPTOMS LESS COMMON SYMPTOMS SEVERE SYMPTOMS
•DRY COUGH
•FEVER
•TIREDENESS
•GASTROINTESTINAL
PROBLEMS
•NAUSEA & DIARRHEA
•SORE THROAT
•HEART ATTACK
•SHORTNESS OF
BREATH
•CEREBRAL
HEMORRHAGE

13. COVID-19
MODES
OF
TRANSMISSION

14. Close contact and respiratory droplets are
one of the main ways of transmission.
Therefore, the relevant experts strongly
advised maintaining social distance and
using a mask. Touching the face’s T-zone
after contact with contaminated surfaces is
also a mode of transmission that
emphasizes the need for hand hygiene and
handwashing. Other routes of transmission
are through contaminated surfaces as well
as airborne, fecal-oral transmission.
MODES OF
TRANSMISSION

17. PREVENTION
Social
Distancing
2m
Indoors: prevent
close contact with
sick people and
maintain a distance
of 6 feet
Outdoors: Maintain a
6-foot distance
between yourself
and people.

18. PREVENTION
FACE MASK
Prevent the high prevalence and infection of
the virus by masks.Due to the transmission
of COVID-19 disease to others even if there
are no symptoms.The necessity of wearing
masks in public areas and around people in
society due to the difficulty of observing
social distancing.
2m
SOCIAL DISTANCING
Maintain distance of 6ft(2m).
CLEAN & DISINFECT
Do NOT touch contaminated surfaces AND
regularly clean, and disinfect surfaces that
are frequently touched, such as telephones,
keyboards, light switches, handles, faucets,
sinks, toilets, tables, door buttons, and
countertops.
HAND SANITIZER
Washing hands for at least 60 s with soap
and water.Before and after touching
face.When leave a public place.After
coughing, blowing your nose, and sneezing

20. DIAGNOSIS
1. RT-PCR METHOD
One of the most important ways
to detect the SARS-CoV-2 virus in
upper and lower respiratory
specimens is the Real-Time
Reverse Transcriptase (RT)–PCR
Diagnostic Panel. The basis of the
PCR is copying the RNA and DNA
structure of the sample, which
can diagnose infectious origin and
various genetic and blood
diseases.

21. Position the patient in a
comfortable position.
3.3.3 Tilt the patient’s head back
at a 70-degree angle.
Rotate the swab gently through
180 degrees to make sure
adequate specimen is obtained.
Leave the swab in place for 2-3
seconds to ensure absorbance of
secretions.
NASOPHARYNGEAL SWAB <15 min OROPHARYNGEAL SWAB
Press the outer two-thirds of the tongue
down with a tongue depressor,
making the tonsils and the posterior wall of
the throat visible.
3.4.3 Insert swab, avoiding touching the
teeth, tongue, or the depressor.
3.4.4 Rub the swab over both tonsillar
pillars and posterior oropharynx. This will
cause the patient to gag briefl

22. 2.CT SCAN
Computed tomography (CT) is a
suitable diagnostic method that
sheds light on several stages of
disease diagnosis and
development.CT imaging can help
to reveal the abnormalities caused
by COVID-19.
In about 85% of patients with
superimposed irregular lines and
interfaces, Chest CT in
COVID-19 pneumonia cases
shows bilateral, peripheral, and
basal predominant ground glass
opacities (GGOs) and/or
consolidation.
CT SCAN FOR COVID POSTIVE(TOP) AND FOR NON-
COVID(BOTTOM)

23. CLINICAL
MANAGEMENT &
TREATMENT

24. Supportive care
The mainstay of management for COVID-19 is oxygen therapy via nasal cannula or face mask.
If available high flow oxygen can also be used to maintain saturation. All patients with low
saturations should be placed in the prone position. For those not intubated, voluntary awake
prone positioning should be encouraged for as long as the patient can manage. For patients on
the ventilator, 12 to 15 hours of prone positioning should be attempted.
Specific Therapy
Steroids
All patients requiring oxygen should be started on steroids. The steroids recommended include
dexamethasone or methylprednisone. The choice of steroid used is at the discretion of the clinician.
However, dexamethasone is cheaper, easier to use in the outpatient setting and has more potent
glucocorticoid (anti-inflammatory) activity). On the other hand, methylprednisonemay be superior in
patients in shock due to its mineralocorticoid activity. In patients with severe and critical disease,
intravenous steroids are preferred. Treatment should continue for 5 days. However, this may be
prolonged in case of prolonged hypoxia.Dose: 6mg per day of dexamethasone (oral or intravenous)
0.5 to 1 mg/kg/d of methylprednisone

25. Anticoagulation
As patients with COVID-19 may be hypercoagulable,
anticoagulation plays an important role in therapy. For all doses
mentioned below, adjustment will be required in case of renal
impairment or morbid obesity (BMI ≥ 40kg/m2
)If the patient was already on oral anticoagulation for another
indication (such as atrial fibrillation): • In moderate disease:
Continue same
• In severe/critical: Consider switching to parenteral therapy
If the patient was not on anticoagulation at the time of admission
• In moderate disease: Start standard DVT prophylaxis
(enoxaparin 40 mg once daily once
daily)
• If severe disease: Start aggressive prophylaxis (enoxaparin 40
mg every 12 hourly)
Indications for therapeutic anticoagulation (any of the following):
• Documented presence of thromboembolic disease (such as
ultrasound doppler or CT for
PE)
• Strong suspicion for thromboembolic disease when investigation
cannot be done
• D-Dimers over 3 times upper limit normal

26. Remdesivir
Indication:
Moderate and severe COVID
requiring
oxygen therapy regardless of
if CRS(CYTOKINE Release
Syndrome) is present. This
can also be given in critical
COVID, however, with the
available data, it is unlikely to
be of benefit in this patient
population.
Dose:
200 mg IV on day 1 followed
by then 100 mg IV daily on
days 2-5
Tocilizumab
Reserved for patients in whom worsening
occurs despite steroids or those who
present as
severe/critical disease in CRS. As
tocilizumab greatly increases the risk of
secondary infection,
only use in cases of confirmed CRS
Dose:
4 to 8 mg/kg iv. Not over 800mg
(maximum).
Can repeat in 12 hours once only
Contraindications:
Active TB
Zoster
Sepsis and positive blood culture
Suspected GI perforation
Multiple Sclerosis
Allergy to Tocilizumab
ALT > 5 times or Bilirubin > 2
ANC <2000 or Thrombocytopenia <50
Pregnancy (relative contraindication)

27. ANTIBIOTICS
Antibiotics should only be used in cases where a
bacterial infection is suspected, for example
in cases with an elevated white cell count (in the
absence of steroid) or procalcitonin. There is
no role of prophylactic antibiotics to prevent a secondary
infection.
VACCINE
A vaccine is a biological product that produces an acquired
active immunity against a specific microbial disease. Vaccines
are very vital to save the lives of millions of people every year.
The primary function of vaccines is to train and prepare the
immune system to identify and fight the target viruses and
bacteria.

29. EFFECTS OF COVID IN PREGNANCY
Due to the complications of COVID-19, pregnant women are expected to be at
risk of developing severe COVID-19 compared to non-pregnant women. It
should be noted that the easy spread of viral respiratory diseases, such as
influenza, during pregnancy indicates that pregnant women are more
vulnerable to COVID-19 and require more medical care. Generally, mechanical
and physiological changes in pregnancy gained susceptibility to COVID-19,
significantly when it affects cardiorespiratory and gravida, and it increases the
rate of progression in respiratory failure. Due to physiological changes in the
immune and cardiopulmonary system in pregnant women (e.g., improved
diaphragm, increased oxygen consumption and respiratory mucosal oedema),
they are very susceptible to respiratory pathogens severe
pneumonia.Additionally, pregnant people with COVID-19 might be at increased
risk of adverse pregnancy outcomes, such as preterm births.
A wide range of vaccines is routinely and safely administered during pregnancy. As
mentioned in the vaccine section, Pfizer-BioNTech vaccines are an effective vaccine
against COVID-19.

33. THANK YOU