Clinical presentation of Covid 19, Sars-Cov-2, Corona & Treatment

1. COVID-19
CLINICAL PRESENTATION OF COVID-19
PREPARED BY:
Ms. Shubhangi R. Vinchurkar.
M.Pharm, First year,
KYDSCT’s College of Pharmacy, Sakegaon,
Jalgaon.

2. Presentation by
2014-2018: B. Pharmacy
KVPS, Institute of Pharmaceutical Education, Boradi
(KVPSIPE), Dhule
2019: M.Pharm First yr.
KYDSCT”s College of Pharmacy, Sakegaon, Jalgaon.
Ms Shubhangi R. Vinchurkar
Ms. Shubhangi R. vinchurkar.
shubhangi27897@gmail.com

3. Content
Etiology
01
Introduction
02
Diagnosis
03
Precaution & Treatment
04

4. Etiology
 As of February 7, 2020, 31,000 human infections with a novel coronavirus
(2019-nCoV) have been confirmed in China with at least 630 reported deaths
and reports continue to increase.
 Additional cases have been confirmed in multiple countries including the
United state.
 Public health officials and healthcare providers should consider 2019-nCoV
infection as a potential etiology among travelers returning from Wuhan City,
China who present with an acute fever and respiratory illness, particularly if
there was any close contact with a suspected or laboratory confirmed Covid-
19 sick patient.

5. Etiology
 On 25 January 2020, the WHO confirmed that the virus was
spread via human‐to‐human transmission.
 Some studies shows that it is transmitted through respiratory
droplets & vertical transmission is rare observed.
 At the close day on 11th May 2020 the infected people worldwide
was 4,197,459 with the highest number of 1,367,963 patient in
America, 264,663 in Spain and then 219,070 in Italy. Whereas
highest number 80,787 of people died in America.
 Taxonomy of Viruses has proposed SARS-CoV-2 as the name of
the virus that causes COVID-19.

6. Covid-19 cases
Median cases with lower mortality rate.
High cases with higher mortality rate.
China
92,918
Iran
1,07603
France
1,76,970
Brazil
1,66,99
UK
2,19,183
USA
13,67,963
India
67,259
Italy
2,19,070
Spain
2,64,633

7. COVID-19
 In December 2019, the Centers for Disease Control and Prevention (CDC)
started monitoring the outbreak of a new coronavirus, SARS-CoV-2, which
causes the respiratory illness now recognized as COVID-19 (Corona Virus
Disease 2019).
 The first person infected with Covid-19 first identified in Wuhan city of
China.
 More than 74,000 people have infected with the virus in China.

8. COVID-19
 Health authorities have identified many other people with COVID-19 around
the world, including many in the United States.
 On January 31, 2020, the virus passed from one person to another in the
America.
 On March 11, 2020 WHO declared Covid-19 as
a Pandemic.

9. INTRODUCTION
Though Covid-19 spread overall countries in the world, it was first detected
in Wuhan City, the capital of Hubei Province, with a population of 11 million.
The origin of the virus remains unknown, and the virus‐host is suspected to
be a species of bat.
COVID-19 disease, is seem to be the largest pandemic since the 1918 H1N1
influenza outbreak.
 Similar to severe acute respiratory syndrome coronavirus (SARS-Cov) and
Middle East respiratory syndrome coronavirus (MERS-Cov) infections,
patients exhibited symptoms of viral pneumonia including fever and difficulty
breathing.

10. SARS-COV-2
Corona virus is a single stranded RNA virus belongs to the β Corona virus.
Corona virus belong to the subfamily Coronavirinae in the family Coronaviridae.

11. continued
Scientist identified seven type of Corona virus which are infected human
beings and four are most common:
 𝜶 Corona virus (229E).
 𝜶 Corona virus (Nl63).
 β Corona virus (OC43).
 β Corona virus (HKU1).

12. Structure & Genome sequence
• The morphology of coronavirus includes spherical or polymorphic.
• The genome of the coronavirus consists of 6 and 7 open reading frames
(ORFs).
• The ORF 1a and 1b encompass two-third of the viral genome which encodes
the non-structural poly-proteins and the other four ORFs on the
downstream side encode for the structural proteins such as
 Envelope protein (E),
 Spike protein (S),
 Nucleocapsid protein (N), and
 Membrane protein (M).

13. continued
• In some coronaviruses, the hemagglutininesterase (HE) gene is present in
the region between ORF 1b and S.
• These structural proteins are folded and entered into the endoplasmic
reticulum (ER) and transported to the Golgi transitional slot.
• During the replication of coronavirus, substantial amounts of structural
proteins are synthesized to assemble the progeny virions.

14. continued
Structure of corona virus and Genome sequence of corona virus.

15. Origin
The first cases were linked to the Huanan
seafood market in Wuhan city of China.
It has been reported that environmental samples
obtained from the marketplace have come back
positive for the SARS-CoV-2, but the specific
animal has not been identified.
More recently, several studies have suggested
that bats could also be the potential natural host
of SARS-CoV-2

16. The SARS-CoV-2 can be
transmitted between humans via
respiratory droplets when an
infected person coughs or sneezes.
It may be possible that a person
can infected with SARS-Cov-2 by
touching a surface or object that
has the virus on it and then
touching their own mouth, nose or
possibly their eyes.

17. SARS-COV-2
Cardboard/
paper
Copper Aerosol
0.7
Hr
1.2
Hr
3.46
Hr
6.8
Hr
Stainless
steel
5.6
Hr
Plastic
Life period of SARS-Cov-2 outside the body.

18. “Replication
Cycle”

19. Pathogenesis
COVID-19
 Binding of the SARS-CoV to the ACE-2 receptors in the
type II pneumocytes in the lungs triggers a cascade of
inflammation in the lower respiratory tract.
 These spike and ACE-2 complex proteolytically processed
by adjacent type 2 transmembrane protease TMPRSS2
leading to cleavage of ACE-2 and activation of the spike
protein.
 Viral entry and cell infection trigger the host’s immune
response, and the inflammatory cascade by the presence
of antigen, the immune system releasing interleukin 12 to
suppress antigen which are already targeted any cell.

20. Clinical Manifestation
PANDEMIC (COVID-19)
Cough Fever
Shortness
Of Breath
Sore
Throat
Thrombocyto
-penia
01%
Fever
67%
Cough
66%
Dyspnea
07%
Sore
throat
07%
Fatigue
07%
Myalgia
06
Viral pneumonia is an important cause of morbidity and
mortality among human being.

21. Diagnosis Criteria
Physical examination
Computed tomography
Rapid diagnostic test
Plasma Test

22. Physical Examination
Patients with mild symptoms may not present
positive signs of symptoms.
Patients in severe condition may have shortness of
breath, abnormal rattling sound in lungs, and
increased or decreased tactile speech tremor.

23. Computed Tomography
Computed Tomography (CT) is often found to be
positive when patients with SARS-CoV-2 develop a
persistent cough, fever, and unexplained fatigue.
Typical CT of COVID-19 patients shown bilateral
pulmonary parenchymal ground-glass opacity,
pulmonary consolidation, and nodules, bilateral
diffuse distribution, sometimes with a rounded
morphology, and a peripheral lung distribution.

24. Rapid Diagnostic Test
RDT is further classified in two types.
 RDT based on antigen test
 RDT based on antibody test

25. RDT based on antigen test
RDT is based on antigen detection test.
RDT detects the presence of viral proteins (antigens) expressed by
the COVID-19 virus in a sample from the respiratory tract of a
person.
Antigen(s) will bind to specific antibodies fixed to a paper strip
enclosed in a plastic casing and generate a visually detectable signal,
typically within 30 minutes.
The antigen(s) detected are expressed only when the virus is actively
replicating; therefore, such tests are best used to identify acute or
early infection

26. RDT based on antibody test
It is another type of rapid detection test based on antibodies
detection in blood of patient supposed to have been infected
with Covid-19.
For clinical diagnosis, however, such tests have limited utility
because they cannot quickly diagnose acute infection to inform
actions needed to determine the course of treatment.

27. Plasma test
02 03 04
01
80 µL plasma
sample was
added into 240
µL of Trizol LS
in the
Biosafety Level
3 laboratory.
Total RNA
was
extracted by
Direct-zol
RNA Miniprep
kit
& 50 µL
elution was
obtained for
sample.
RNA was used
for real-time
RT-PCR, which
targeted the
NP
(Nucleocapsid
protein) gene
using AgPath-
ID One-Step
RT-PCR
Reagent.
RNAaemia was
defined as a
positive result
for real-time
RT-PCR in the
plasma sample.
Real-time RT-PCR was performed using the following conditions: 50°C for 15 min and 95°C for
3 min, 50 cycles of amplification at 95°C for 10 s and 60°C for 45 s.

28. Prevention of infection
Hand washing with soap and water for at least 20 seconds. If soap
and water are not available, use an alcohol-based hand sanitizer.
Avoid touching eyes, nose, and mouth with unwashed hands.
Avoid close contact with people who are sick.
Seek medical attention if you believe you have been exposed and
have symptoms.
Adding sesame oil into the nostrils can prevent the spread of SARS-
CoV-2.
Cover a cough or sneeze with a tissue, then discard the tissue in a
contained trash.
Clean and disinfect frequently touched objects and surfaces.
2
m

29. TREATMENT
GENERAL TREATMENT
ANTIVIRALTREATMENT
PLASMA THERAPY

30. General Treatment
General treatment includes bed rest and
supportive treatments, securing sufficient
energy intake, maintaining a constant internal
environment (water, electrolytes, and other
internal environment factors) and monitoring
vital signs (heart rate, pulse, blood pressure,
oxygen saturation, respiratory rate).

31. Antiviral treatment
Besides this, with antiviral and medication, the treatment mainly focused on pneumonia caused by Covid-19.
Interferon α
IFNα belonging to І interferon family
suppresses viral infection by directly
interfering with the replication of the
virus and by promoting both innate and
adaptive immune responses.
Lopinavir/Ritonavir
It’s a protease inhibitor & suggests
that they exert an antiviral effect
by inhibiting protein synthesis of
SARS-CoV-2
Ribavirin
It can prevent the replication of RNA
and DNA viruses by suppressing the
activity of inosine monophosphate
dehydrogenase. Ribavirin was widely
used to treat SARS patients.
Chloroquine
It is a widely used antimalarial drug.
Chloroquine phosphate has shown
distinct efficacy in the treatment
of COVID-19 with combination
therapy.
Arbidol
Is an antiviral drug widely used
against influenza infection. Arbidol
mesylate were shown to have a potent
inhibitory effect in reducing the
reproduction of SARS-CoV-2 in vitro.
Remedisivir
It’s a nucleoside analogue & reported
that, the first case of SARS-CoV2
infection in the USA was treated
with IV remdesivir.

32. In a certain study, it is observed that developed antibodies which
are present in already cured Covid-19 patient can utilize to treat
another Covid-19 patient.
The convalescent antibodies present in immune plasma moderate
their therapeutic effect through a variety of mechanisms.
They may bind to the virus and neutralizing their infectivity or may
phagocytic to virus to show therapeutic effect.
But plasma therapy is still objectionable.
Plasma therapy

33. PRACTICE POINTS FROM AN INDIAN PERSPECTIVE
Healthcare providers should take travel history of all patients with
respiratory symptoms, and any international travel within the past 2
weeks .
They & patients ought to use surgical masks themselves while examining
such patients and practice hand hygiene frequently.
Suspected cases should be brought up by government-designated
centers for isolation and testing.
Patients admitted with severe pneumonia and acute respiratory distress
syndrome should be evaluated for travel history and placed under
contact and droplet isolation.

34. Continued
They ought to be tested for etiology using multiplex PCR panels if
logistics permit and if no pathogen is identified, refer the samples
for testing for SARS-CoV-2.
Non-essential international travel should be avoided at this time.
People should stop spreading myths and false information about
the disease and check out to allay the panic and anxiety of the
general public

35. THANK YOU
P.S.G.V.P. Mandal’s College of Pharmacy, Shahada, Dist: Nandurbar