Updates on Corona virus by Dr. Rameshwar Naik

Updates on
Corona Virus
Introduction, Precautions,
Symptoms and Remedy
By
Dr. Rameshwar Naik
M.D. (Medicine)
Lifeline Hospital, Parbhani

01Introduction
02Genera
03History
04Etiologic Agent
UpdatesonCoronaVirus|Dr.RameshwarNaik

05Coronovirus
06Epidemiology
07Pathogenesis
08Symptoms

Common viral infections caused by 6 of
the major groups of respiratory viruses:
❖ Influenza viruses
❖ Rhinoviruses
❖ Coronaviruses
❖ Respiratory syncytial viruses
❖ Metapneumoviruses
❖ Adenoviruses
Introduction

❖ Family coronaviridae contains two genera
❖ Coronavirusus
❖ Toroviruses
❖ Coronaviruses usually causes respiratory and sometimes viral diarrheas
❖ SARS CoV: During winter of 2002-03, SARS CoV has outbreak from southern Peoples Republic of China
following transmission from palm civets (intermediate host) to humans originating from Chinese
horseshoe bats.
❖ MERS-CoV : At the end of November 2019, a total of 2494 confirmer cases of middle east respiratory
syndrome (MERS), including 858 deaths were reported globally.
❖ Majority were from Saudi Arabia, MERS-CoV transmitted from dromedary camels to humans.
❖ Toroviruses are exclusively enteric pathogens in animals also.
Genera

History
❖ In 1965, Tyrrell and Bynoe cultured a virus from respiratory track of a boy by
passage in Human Embryonic tracheal organ cultures.
❖ Similarly, Hamre and Procknow recovered the same and named as 229E
❖ McIntosh reported the same virus called ‘OC43’ (Organ Culture)
❖ Sequencing an antigenicity studies, were divided into three groups
❖ Group No. 1, HCoV-229E and animal viruses
❖ Group No. 2, HCoV-OC43 and bovine, mouse hepatitis virus
❖ Group No. 3, Avian Virus

ETIOLOGIC AGENT
❖ Coronaviruses are pleomorphic, single-stranded RNA viruses that measure 100–160 nm in diameter.
❖ The name derives from the crown- like appearance produced by the club-shaped projections that stud
the viral envelope.
❖ RNA measures 30Kb in length, positive sense, single stranded and infectious.
❖ Major structural protein is surface hemagglutinin esterase protein, play role in attachment and release.
❖ Surface glycoprotein, petal shaped surface projection, responsible for attachment.
❖ Small envelope protein, membrane glycoprotein and nucleocapsid proteins.
❖ It develops in cytoplasm of infected cells.

CORONAVIRUS
Electron Microscope image

EPIDEMIOLOGY
India,
34

EPIDEMIOLOGY
❖ Human coronavirus infections are present throughout the world.
❖ Overall, coronaviruses account for 10–35% of common colds.
❖ It appears to be prevalent in late fall, winter, and early spring—times.
❖ SARS occurred in 2002–2003. It began in southern China and resulted in 8096 recognized cases in 28 countries.
❖ The natural reservoir of SARS-CoV appeared to be the horseshoe bat, and the outbreak may have originated from
human contact with infected semidomesticated animals such as the palm civet. In most cases, however, the
infection was transmitted from human to human.
❖ Case–fatality rates are ~9.5%.
❖ The mechanisms of transmission of SARS are incompletely under- stood.
❖ Clusters of cases suggest that spread may occur via both large- and small-droplet aerosols and perhaps via the
fecal–oral route as well.
❖ MERS-CoV : At the end of November 2019, a total of 2494 confirmer cases of middle east respiratory syndrome
(MERS), including 858 deaths were reported globally.
❖ Majority were from Saudi Arabia, MERS-CoV transmitted from dromedary camels to humans.

Current Scenario…
•All these cases
were clinically
stable during the
period of
hospitalization
and discharged
as per the
discharge policy.
Status
•In India, three
travel related
cases (from
Hubei province,
China), were
reported (all
from Kerala).
26th
February,
2020
• A total of 81109
confirmed cases of
COVID-19 worldwide
including 78191
confirmed cases and
2718 deaths
reported from China.
• Besides China, 2918
confirmed cases and
44 deaths have been
reported from 37
countries.
26th
February,
2020
• The disease has
affected all the
provinces of China
and 40 other
countries.
Infection
• Renamed by WHO
as SARS-CoV-2 and
the disease caused
by it as COVID-19.
SARS-CoV-2
& COVID-19
• Chinese
authorities
identified a new
strain of
Coronavirus as the
causative agent
for the disease.
7th January
2020
•WHO, China
informed of
cases of
pneumonia of
unknown
detected virus
31st
December
2019
Updates on Corona Virus | Dr. Rameshwar Naik

KEY NUMBERS(To Date)
103,168Total Confirmed cases
3,507Deaths
34Cases in India

PATHOLOGY
Damage to cell leads
to the release of
chemokines & IL.
Replication
Ciliated epithelium of
nasopharynx
Attachment
Encephalitis,
Demyelination
Brain
Direct renal injury
Kidneys
Septicaemia
Sceptic Shock

PATHOGENESIS
❖ Coronaviruses causing the common cold (e.g., strains HCoV-229E and HCoV-OC43) infect ciliated
epithelial cells in the nasopharynx via the aminopeptidase N receptor (group 1) or a sialic acid receptor
(group 2).
❖ Viral replication damages of ciliated cells and induction of chemokines and interleukins, with consequent
common-cold symptoms similar to rhinoviruses.
❖ SARS-CoV infects cells of the respiratory tract via the angiotensin- converting enzyme 2 receptor.
❖ It results in a systemic illness in which virus is also found in the bloodstream, urine, and stool.
❖ Virus persists in the respiratory tract for 2–3 weeks, and titers peak ~10 days after the onset of systemic
illness.
❖ Pulmonary pathology consists of hyaline membrane formation, desquamation of pneumocytes in
alveolar spaces, and an interstitial infiltrate made up of lymphocytes and mononuclear cells.
❖ Giant cells are frequently seen, and coronavirus particles have been detected in type II pneumocytes.
❖ Elevated levels of proinflammatory cytokines and chemokines have been detected in sera from patients
with SARS.
❖ Because MERS-CoV was so recently detected, little is known at present about its pathogenesis.

SYMPTOMS OF THE DISEASE
Encephalitis &
Demyelination
Brain
Pneumonia, ARDS
Lungs
Diarrhoea
GIT
Common Cold
Throat
Hepatitis
Liver

CLINICAL MANIFESTATIONS
❖ Incubation period that generally lasts 2–7 days (range, 1–14 days).
❖ SARS usually begins by the onset of fever, which is accompanied by malaise, headache, and myalgias
and is followed in 1–2 days by a nonproductive cough and dyspnea.
❖ Some patients have diarrhea.
❖ Chest x-rays can show a variety of infiltrates, including patchy areas of consolidation—most frequently in
peripheral and lower lung fields—or interstitial infiltrates, which can progress to diffuse involvement.
❖ In severe cases, respiratory function may worsen during the second week of illness and progress to frank
ARDS & MODS.
❖ Risk factors include an age of >50 years and comorbidities such as cardiovascular disease, diabetes, and
hepatitis.
❖ Illness in pregnant women may be particularly severe, but SARS-CoV infection appears to be milder in
children than in adults. I
❖ The clinical features of common colds caused by human coronaviruses are similar to those of illness
caused by rhinoviruses.

DIAGNOSIS
CBC
Lymphopenia,
Thrombocytopenia
RTPCR
Throat Swab, Urine and
Stool.
Vero E6 Cultures
To see cytopathic effects
on culture
Biochemistry
Raised level of
SGOT/SGPT, LDH
Elisa, IF
Detection of Serum
Antibodies
Viral Isolation

DIAGNOSIS
❖ Lab findings of SARS include lymphopenia.
❖ TLC counts are normal or slightly low, and thrombocytopenia may develop as the illness progresses.
❖ Elevated levels of SGPT/OT, creatine kinase, and LDH have been reported.
❖ A rapid diagnosis of SARS-CoV infection can be made by RT-PCR of respiratory tract samples as earliest
and of urine and stool later.
❖ SARS-CoV can also be grown from respiratory tract samples by inoculation into Vero E6 tissue culture
cells, in which a cytopathic effect is seen within days.
❖ Serum antibodies can be detected by ELISA or immunofluorescence, and nearly all patients develop
detectable serum antibodies within 28 days after the onset of illness.

TREATMENT
01 02 03 04
No Specific
Treatment
Supportive Care Maintaining Vitals
Ribavirin,
Lopinavir and
Glucocorticoids

TREATMENT
❖ There is no specific therapy for SARS with established efficacy.
❖ Although ribavirin has frequently been used, it has little if any activity against SARS-CoV in vitro, and no beneficial
effect on the course of illness has been demonstrated.
❖ Because of suggestions that immunopathology may contribute to the disease, glucocorticoids have also been
widely used, but their benefit, if any, likewise remains to be established.
❖ Supportive care to maintain pulmonary and other organ-system functions remains the mainstay of therapy.
❖ Similarly, there is no established antiviral therapy for MERS. Interferon α2b and ribavirin have displayed activity
against MERS-CoV in vitro and in a rhesus macaque model, but data are not available on its use in human cases of
MERS.
❖ The approach to the treatment of common colds caused by coronaviruses is similar to that discussed above for
rhinovirus-induced illnesses.
❖ Certain Protease inhibitors, in particular lopinavir, ritonavir have activity against SARS-CoV in-vitro.

Risk Assessment
❖ The risk for spread has been assessed by WHO (as on 26th February, 2020) it is very high for China.
❖ WHO on 30th January, 2020 declared the current novel coronavirus outbreak as a Public Health
Emergency of International Concern (PHEIC).
❖ According to WHO, “all countries should be prepared for containment, including active surveillance, early
detection, isolation and case management, contact tracing and prevention of onward spread of SARS-
CoV-2 infection.

Personal Protective Equipment
❖ Before initiating collection of sample a full
❖ complement of PPE should be worn. This
❖ includes :
Masks (N-95)
Gloves
Protective eye wear (goggles)
Hair covers
Boot or shoe covers
Protective clothing (gown or apron)

Vaccination
Containment of
Outbreak
PREVENTION
Hospital Infection
Control

PREVENTION
Updates on Corona Virus | Dr. Rameshwar Naik

RECOMMENDATIONS
▪ Frequent hand-washing,
especially after direct contact
with ill people or their
environment.
▪ People with symptoms of acute
respiratory infection should
practice cough etiquette
(maintain distance, cover
coughs and sneezes with
disposable tissues or clothing,
and wash hands).
▪ Within health care facilities,
enhance standard infection
prevention and control practices
in hospitals, especially in
emergency departments.
▪ Avoiding close contact with
people suffering from acute
respiratory infections.
▪ Avoiding unprotected contact
with farm or wild animals.
DOS DON’TS

Recommendations
❖ Limit human-to-human transmission including reducing secondary infections among close contacts and
health care workers, preventing transmission amplification events, and preventing further international
spread from China.
❖ Identify, isolate and care for patients early, including providing optimized care for infected patients
❖ Identify and reduce transmission from the animal source
❖ Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment
options, and accelerate the development of diagnostics, therapeutics and vaccines
❖ Communicate critical risk and event information to all communities and counter misinformation
❖ Minimize social and economic impact through multisectoral partnerships.
❖ Rapid identification, diagnosis and management of the cases, identification and follow up of the
contacts, infection prevention and control in health care settings, implementation of health measures for
travelers, awareness-raising in the population and risk communication

Hand Hygiene
is important!

CONCLUSION
Don’t Worry
Be Careful!

Thank you!
Acknowledgements
▪ WHO Websites
▪ Textbook of Principles and Practice of
Infectious Disease by Mandell.
▪ Harrison’s Principle of Internal
Medicine.
▪ Template by

Updates on Corona virus by Dr. Rameshwar Naik

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