Detailed presentation for Covid 19

1. SARS-COV-2
Covid-19
Dr. Rajesh Shrivastava
Consultant Bariatric & Laparoscopic Surgeon
Asst. Professor – Vedanta Institute of Medical Sciences
Director - Shreeji Hospital Bhilad
Director Hernia Surgery – DHI Mumbai

2. INTRODUCTION
•Coronavirus disease 2019 (COVID-19) is an infectious
disease caused by SARS- CoV-2, a virus closely
related to the SARS (Severe Acute Respiratory
Syndrome)
•The disease is the cause of the 2019–20 coronavirus
outbreak.
•Started from “Wuhan City” of Mainland China
• It is primarily spread between people via
respiratory droplets from infected individuals when
they cough or sneeze.
•Time from exposure to onset of symptoms is generally
between 2 and 14 days.
•The mortality rate is around 2%.
•The WHO has declared the 2019–20 coronavirus
outbreak to be a Public Health Emergency of
International Concern (PHEIC).

3. The new coronavirus, first called 2019–nCoV and officially
renamed as SARS- CoV2 (the virus) and COVID-19 (the
disease), belongs to the family of coronavirus, the name to
crown-like spikes on their surface. Most described
coronavirus are found in birds or mammals, particularly
bats.
The new coronavirus is called SARS-CoV2 because its
genetic sequence is very similar to that of SARS, another
coronavirus that appeared for first (and only) time in 2002
and caused a pandemic with more than 8,000 infected
people and 800 deaths.

4. ABOUT
STRUCTURE
• They look like a tennis ball with all these spikes sticking out of it.
Depending on the type of spikes, it allows that virus to attach to
certain places. So some viruses, hey have this spike that attaches to
your nose. So basically you just get a common cold.
• But the SARS virus and this new virus that has the spike that allows it
to attach to the cells in your lung and when it attaches there, it puts in
information to make photocopies of itself
4

7. A person can contract COVID-19 if:
● They come in contact with another person
infected with the virus
● Someone infected coughs or sneezes directly to
them
● They touch any surface with little droplets from
infected people’s cough or sneezes and then
touch their eyes, nose or mouth
● Sometimes contact of body fluids
HOW DO YOU GET
COVID-19?

8. Clinical Features
The incubation period of COVID-19 is 1-14
days (mean duration of 5-7 days), with peak
viraemia occurring before the onset of
symptoms.
THE MOST COMMON PRESENTING
FEATURES OF COVID-19 INFECTION
ARE LISTED BELOW:
Symptoms (frequency in %)
Fever (80-90)
Cough (60-80)
Breathlessness (18-46)
Fatigue (38)
Body ache/joint pain (15)
Sore throat (11-14)
Headache (6-14)
Chills (12)
Running nose (5)
Nausea/vomiting (5)
Diarrhea (2-10)
Loss of smell & taste

9. Warning signs or red flag signs that can
assist in triage, indicating the need for
urgent care/hospitalization, are listed
below:
Warning signs
Fever and upper respiratory
symptoms lasting
for >5 days and any of the
following:
1. Breathlessness/respiratory
rate >24/min
2. Oxygen saturation (SpO2 )
lessthan 94%or fallby 4mm
after6minwalktest
3. 110/bpm heart rate or less
than 90 mm of Systolic blood
pressure
E M E R G E N C Y

10. COVID nucleic acid test positive.
Without any clinical symptoms but
the person can infect others.
HRCT imaging might shows GROUND
GLASS APPEARANCE
ASYMPTOMIC CONDITION

11. Categorization ofprobablecoronavirusdisease2019 (COVID-19) severity,testingandadmissionstrategy
Clinical category of
COVID-19
Features Testing strategy Level of care
MILD Fever with upper respiratory
symptoms Mild sore throat and
GI symptoms
Testing may be considered in select
individuals
individuals in the high-risk group
low priority HOME CARE
MODERATE
Breathlessness/respiratory rate >24/min
Oxygen saturation (SpO2) <95% in room
air Fatigue with heart rate of >110/bpm
Systolic blood pressure <90 mmHg
HIGH PRIORITY INPATIENT CARE
SEVERE
SpO2 <90% in room air
Hypotension requiring ionotropic support
ARDS/myocarditis
HIGH PRIORITY INTENSIVE CARE

12. THELIFE CYCLEOF SARS-COV-2 IN THE
HOST CELLS

13. 1. Travel history to endemic countries
2. CBC (leukopenia, seen in 30% to 45% of patients,
and lymphocytopenia, seen in 85% of the
patients)
3. Chest X-Ray (cheaper & easier with 60%
sensitivity)
4. RTPCR(65% sensitivity)
5. Chest CTScan (95% sensitivity, low specificity)
6. Antigen Test
7. IgM/IgG combo test for COVID-19
DIAGNOSIS

14. SUPPORTIVE BLOOD TESTS
• CBC
• CRP
• LDH
• FERRITIN
• D DIMER
• IL6
• TROPONIN I
• LIVER ENZYMES

16. CLINICAL
MANAGEMENT

18. CASE DEFINITION

19. MILD COVID-19 - MANAGEMENT
• Symptomatic treatment such as antipyretic
(Paracetamol) for fever and pain, antitussives for
cough
• Adequate nutrition and appropriate hydration to
ensured.
• Tab Hydroxychloroquine (HCQ) may be considered for
any of those having high risk features for severe
disease (such as age> 60 years; Hypertension,
diabetes, chronic lung/kidney/ liver disease,
Cerebrovascular disease and obesity) under strict
medical supervision, preferably after shifting to
DCHC/DCH.
• Avoid HCQ in patients with underlying cardiac
disease, history of unexplained syncope or QT
prolongation

20. MANAGEMENT OF MODERATE CASES
1. Symptomatic treatment such as antipyretic
(Paracetamol) for fever and pain, antitussives for
cough
2. Adequate hydration to be ensured
3. Oxygen Support : Target SpO2: 92-96% (88-92%
in patients with COPD)
4. The device for administering oxygen (nasal prongs,
mask, or masks with breathing / non-rebreathing
reservoir bag) depends upon the increasing
requirement of oxygen therapy.
5. If HFNC or simple nasal cannula is used, N95 mask
should be applied over it.
6. Awake proning may be used as a rescue therapy.

21. MANAGEMENT OF MODERATE CASES…
6. Anticoagulation – LMWH or UFH (eg-
enoxaparin).
7. Corticosteroids – iv methylprednisolone /
Dexamethasone preferably within 48 hrs of
admission.
8. Tab HCQ 400 mg BD on day one followed by
200 mg BD for 4 days
9 . Antivirals – Remdesivir
10. Treatment of Co-morbid conditions
11 . Follow up Blood Tests & Monitoring

22. Hydroxychloroquine:
The 4-aminoquinolone, commonly used as an antimalarial and
anti-inflammatory agent, possesses broad antiviral activity. While
the exact mechanisms are unknown, it is considered to gain its
antiviral effects through alkalinization of the phagolysosome as
well as inhibition of viral entry by blocking receptor binding and
membrane fusion.
Remdesivir:
 It is an adenosine analogue and RNA polymerase blocker, is a
novel drug developed for the treatment of Ebola virus infection.
 Oseltamivir:
 Lopinavir…….
THE FOLLOWING DRUGS HAVE SHOWN SOME PROMISE FOR
THE MANAGEMENT OF COVID-19

23. Interleukin-6 (IL-6) inhibitors
 A subgroup of patients with COVID-19 develop severe cytokine
activation and secondary haemophagocytic lymphohistiocytosis
(HLH), leading to rapid-onset hypoxemia, shock and multiorgan
dysfunction. A higher neutrophil count and elevated C-reactive
protein may predict this subgroup of patients.
 Interleukin-6 (IL-6) is a key cytokine in the cytokine storm, and
tocilizumb, a humanized anti- IL-6 receptor antibody, is proposed
as a therapeutic agent in severe SARS-CoV-2 disease.
 Convalescent plasma from COVID-19 survivors
 Convalescent plasma plasma therapy was attempted with some benefit
in MERS, Ebola and H1N1 pandemic influenza49-51. A small case
series of patients with critically ill COVID-19 on mechanical
mechanical ventilation improving after receiving therapy on the third
week of illness is encouraging
Management

24. MANAGEMENT OF SEVERE CASES
• Continue the treatment as in moderate cases
• Management of hypoxemic respiratory failure
• Management of ARDS
• Management of Septic Shock
• Management of Multiorgan Failure

25. RETURN TO WORK CRITERIA FOR HCP
HCP with mild to moderate illness who are not severely
immunocompromised:
At least 10 days have passed since symptoms first appeared and At
least 24 hours have passed since
-last fever without the use of fever-reducing medications
-Symptoms (e.g., cough, shortness of breath) have improved Note:
HCP with severe to critical illness or who are severely
immunocompromised :
At least 20 days have passed since symptoms rst appeared At least
24 hours have passed since last fever without the use of fever-
reducing medications and Symptoms (e.g., cough, shortness of
breath) have improved

27. Cover your mouth and your
nose with your bent elbow or a
tissue when coughing
Seek medical attention
if you have difficulty
breathing and a high
fever
Follow the directions of
your national or local
health authorities
Wash your hands
with an alcohol-
based sanitizer or
with soap and water
Keep a distance of at
least 1 meter between
yourself and anyone
who coughs or
sneezes
Try your best not to
touch your eyes,
your nose and your
mouth
PROTECTING YOURSELF AND PREVENTING THE SPREAD OF
THE DISEASE

28. COVID-19 IN DIFFERENT SURFACES
SURFACE TIME
Sprayers 3 hours
Copper 4 hours
Plastic 2-3 days
SURFACE TIME
Cardboard 24 hours
Steel 2-3 days
Wood 4 days

29. ● Before wearing a mask, wash your hands with an
alcohol-based disinfectant or with soap and
water.
● Cover your mouth and nose with the mask
and make sure the mask is firmly pressed
against your face. Replace the mask as soon
as it gets wet and do not reuse disposable
masks.
● Remove the mask from behind (do not touch its
front side); throw it away in a closed container
and then wash your hands with an alcohol-based
disinfectant or with soap and water.
HOW TO USE A MASK

31. MASK ROTATION
• Acquire a set number of N95 masks (at least 5 per the CDC), and
rotate their use each day, allowing them to dry for long enough that
the virus is no longer viable (> 72 hours).
• Proper storage for this technique requires either hanging the
respirators to dry, or keeping them in a clean, breathable container
like a paper bag between uses.
• Make sure the masks do not touch each other, and that you do not
share your respirator with other people. A user seal check should be
performed before each use.

33. PERSONAL PROTECTIVE EQUIPMENT'S

34. FACE SHEILD

35. 8 WAYS TO PROTECT DOCTORS
CARING FOR PATIENTS WITH COVID-
19
• Minimize chance for exposure
• Adhere to precautions
• Manage visitor access and movement
• Implement engineering controls
• Monitor and manage health personnel
• Train and educate health professionals
• Implement environmental infection control
• Establish reporting to public health authorities