Systemic Involvement of COVID 19

1. Systemic involvement of Novel
Corona Virus (COVID 19)
Samaresh Das
Consultant, Anaesthetics and Critical care
Yeovil Hospital, NHS, England

4. • Covid19 outbreak has caused a pandemonium in modern world & introduced new
terminologies: ‘social distancing’, ‘lock-down’, ‘stay safe’, ‘key workers’, ‘self-quarantine’,
‘work-from-home’ & so on
• Started from Wuhan & has caused thousands of deaths, serious illness, & disruption of
global economy never seen since the 2nd world war
• New virus, limited epidemiology & mainly the Tt for symptomatic patients is supportive
• However, Covid19 not only attacks the respiratory system, rather it involve other systems
from the beginning or subsequent to respiratory infection
Introduction

5. Respiratory System
• Majority: mild, cold-like symptoms. S/s may appear 2-14 days from the initial
exposure and present with cough (mostly dry but at times with copious sputum
production), fever, sore throat, runny nose, SOB
• Hospital admissions: pneumonia like symptoms with SOB & desaturation
• ~15% develop mod. to sev. Illness, oxygen support, further 5%- ICU & organ
supportive therapies including intubation and ventilation
• Pneumonia: the most common complication/ARDS

6. Imaging

7. Blood gas & Imaging

8. • Prevalence of cardiovascular diseases (CVD) are substantial in general population and the
probability Covid19 infection is particularly high in this subset of people
• Acute cardiac injury ( ~8–12%) due to viral involvement of cardiomyocytes & SIRS
• Common complications includes tachy & brady arrhythmias
• Until now, no study describes ST elevation or acute MI secondary to Covid19
• Only one Chinese study reported heart failure in Covid19 patients
• It is too early to assess the long- term implications of the consequences of Covid19
affection on cardiovascular system
Cardiovascular System

9. • Data from Wuhan: ~79% diarrhea, decreased appetite, nausea, vomiting, abdominal pain
and gastrointestinal bleeding during the onset and subsequently
• Adult and young children can present only with GI symptoms
• Studies from the China: Anorexia most frequent in adults (39.9%‐50.2%), Diarrhea in adults
and children (2%‐49.5%) & vomiting in children
• GI bleeding was found only in few ventilated patients in ICU
• Recently Virus reported for the first time in stool samples in USA
Gastrointestinal System

10. • long‐term hypoxemia, cell necrosis GI mucosa leads to ulceration and bleeding + IV
corticosteroids, NSAIDs, physiological challenging to trace the real cause
• Liver disfunction: Hepatitis, microvascular steatosis, elevated aminotransferases, high
bilirubin, hypoproteinemia, and prolonged PT, activation of coagulative & fibrinolytic
pathways, relatively depressed platelets, climbing neutrophils, increased neutrophil:
lymphocyte, & high ferritin levels
• Drug-induced liver injury is a possible contributing factor
Gastrointestinal System

11. • Incidence of AKI was directly proportional to the baseline serum creatinine
• The severity of AKI positively associated with older age, higher body mass index, diabetes
mellitus, history of heart failure, higher peak airway pressure and higher SOFA score
• The potential mechanisms of kidney involvement in these patients can be didactically
divided into three aspects: cytokine damage, organ crosstalk and systemic effects
Renal System

12. Central Nervous System
Entry of Covid19 in the CNS

13. • Involvement may occur either during initial or late phase
• Early: fever, loss of smell, taste, headache, visual impairment, dizziness, ataxia and
convulsions
• Neurological S/s could be a combination of hypoxia, respiratory & metabolic acidosis at
advanced stage
• Patients with neurological symptoms would require more specific and aggressive
treatments
• Recently a case report has been published Wuhan describing a patient presented with acute
symmetrical ascending weakness resembling GBS
Central Nervous System

14. • Generalized muscle pain and fatigue are common
• Clinicians should consider the diagnosis of rhabdomyolysis when patients have focal
muscle pain and fatigue
• CK, myoglobin are important indexes for rhabdomyolysis & should be tested earlier to
avoid ARF from rhabdomyolysis
• Prolonged ventilation are prone for muscle atrophy & weakness during recovery
Musculoskeletal System

15. • Microvascular thrombosis & reduced platelets count, prolongation of the PT/INR,
PTT, elevation of D-dimer, and reduced fibrinogen levels
• Platelets transfusion if the platelet count <50 x 109/L, FFP- if INR >1.8 & fibrinogen
concentrate (4 grams) or cryoprecipitate (10 units) fibrinogen level <1.5 g/L
• In patients already on anticoagulation for VTE or atrial fibrillation, therapeutic
doses of anticoagulant therapy should continue but may need to be withheld if
platelet count is less than 50 x 109/L
Hematological System

16. • Prophylactic LMWH to all hospitalized patients despite abnormal coagulation
(absence of active bleeding, platelet <25, or fibrinogen <0.5 g/L)
• Abnormal PT/INR or PTT is not a contraindication for pharmacological
thromboprophylaxis
• Mechanical thromboprophylaxis when pharmacological thromboprophylaxis is
contraindicated
Hematological System

17. • COVID patients who spend significant time in the hospital are more vulnerable to
delirium; irrespective of ICU admission and regardless of the severity of illness
• There are reported case of mental and social health problems even among front-
line health care workers
Psychological aspects

18. Systemic manifestation

19. Messages for the general population:
• Be empathetic to those infected with the virus. They all deserve support, compassion
& kindness
• Minimize watching, reading or listening to news about COVID-19 that cause anxious
or distressed; seek information only from trusted sources
• Protect yourself and be supportive to others
• Find opportunities to amplify positive and hopeful stories and positive images of
local people who have experienced COVID-19
• Honor careers healthcare workers and supporting people
Important message

20. Messages for the Health Care Workers:
• Managing mental health and psychosocial well-being is as important as managing
physical health
• Sufficient rest during work or between shifts, healthy food, physical activity, and stay in
contact with family and friends
• Avoid use of tobacco, alcohol or other drugs
• If possible, staying connected with your loved ones, including through digital methods (is
one way to maintain contact
Important message

21. Any questions?
Feedback: drsamareshdas@gmail.com
+447960532682