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Coronavirus 2019
- 1. CORONAVIRUS (COVID-19/SARS-CoV-2) TECHNICAL JARGON BROKEN DOWN FOR NON-HEALTH/SCIENCE INDIVIDUALS TO COMPREHEND PRESENTED BY: DR. MICHELLE STAUFFER, PT, DPT
- 2. Disclosures/Disclaimer I have no disclosures. My company is not affiliated with this content. The information provided is meant solely as EDUCATIONAL. The information provided is NOT intended to replace seeking medical, professional care for individualized and specific healthcare needs. The information provided is based off one individual’s review of some, but not all, literature at the present time of presentation production. Research/evidence related to coronavirus is constantly evolving and information is subject to change.
- 3. Who am I? Doctor of physical therapy – since 2017 Graduate of University of Colorado Anschutz Medical Campus Ranked #13 in US Passionate about the cardiopulmonary system Work in subacute rehabilitation Aka skilled-nursing facility
- 4. Objectives Discuss background Discuss known transmission and protection Discuss virus entry and molecular effects of body Explain comorbidities at risk Generic treatment aides
- 5. Background Originated in Wuhan, China Suspected animal origin alpha, beta bats known for human illness gamma, delta avian/pig New suspicions lab origin Timeline of knowledge: First hospitalization in China 11/19’ WHO informed of “pneumonia of unknown etiology” 12/19’ Secretary of HHS declared “public health emergency” 1/31/20 First declared US case 2/26/20 WHO declared pandemic 3/11/20 Trump declared “National Emergency” 3/13/20
- 6. Transmission Respiratory/salivary droplets Cough Sneeze Spoken word Incubation 2-12 days Typical 2-3 before symptoms Shedding up to 37 days Self-protection: Contact precaution: Cover areas that may physically touch pathogen Droplet precaution: Cover areas that a drop may touch Airborne precaution: Cover areas open to air particles Smaller than droplet
- 7. Virus Entry to Body ACE2 receptor locations in humans: Oral and nasal mucosa Nasopharynx Lung Stomach Intestine Skin Lymph nodes Thymus Bone marrow Spleen Liver Kidney Brain ACE2 Receptor
- 8. Molecular Effects on Body
- 10. Comorbidities Increasing Risk INTERNAL: Older age DIABETES Cardiac issues Lung issues Kidney disease Liver disease Autoimmune diseases EXTERNAL: Low income/poverty Rural living Developing nation Social support Family/roommates
- 11. Treatment … Best option TBD No vaccine as of yet No “gold standard” test Clinical trials underway For mild cases: Vital monitoring (temp, HR) Hydration/electrolytes Light exercise (1MET or RPE 1-3/10) Adequate rest Anti-inflammatory diet Scrubbing of hands 15-20sec Fun fact: coronaviruses do not like *Heat and UV rays* hence the reason for “flu season” occurring in Winter not Summer.
- 12. Why Light Exercise v My Normal? Starting with elevated heart rate and likely impaired lung function Impaired oxygenation to body Abnormal heart rhythm Normal strength training (60-80% max effort) works to breakdown muscle systems Spreading work capacity to heal body Inc/restart inflammatory response Work lower extremity vs upper extremity Less HR and BP changes
- 13. QUESTIONS
- 14. Citations 1. Coronavirus | Human Coronavirus Types | CDC. https://www.cdc.gov/coronavirus/types.html. Published February 27, 2020. Accessed April 18, 2020. 2. Fehr AR, Perlman S. Coronaviruses: An Overview of Their Replication and Pathogenesis. Coronaviruses. 2015;1282:1-23. doi:10.1007/978-1-4939-2438-7_1 3. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. http://www.ncbi.nlm.nih.gov/books/NBK554776/. 4. Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak. The White House. https://www.whitehouse.gov/presidential-actions/proclamation-declaring-national-emergency-concerning-novel-coronavirus-disease-covid-19-outbreak/. Accessed April 18, 2020. 1. 5. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020. 1. 6. Coronavirus COVID-19 (SARS-CoV-2) | Johns Hopkins ABX Guide. https://www.hopkinsguides.com/hopkins/.//view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_?refer=true. Accessed April 18, 2020. 1. 7. Isolation Precautions | Guidelines Library | Infection Control | CDC. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html. Published July 22, 2019. Accessed April 18, 2020. 1. 8. Hamming I, Timens W, Bulthuis M, Lely A, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. The Journal of Pathology. 2004;203(2):631-637. doi:10.1002/path.15701. 9. The Renin-Angiotensin-Aldosterone-System - Renin Release - Angiotensin II Production. TeachMePhysiology. https://teachmephysiology.com/urinary- system/regulation/the-renin-angiotensin-aldosterone-system/. Accessed April 18, 2020. 1. 10. Twig Interactive L http://www twiginteractive com. Programs. Tarix Orphan. http://www.tarixorphan.com/programs/. Accessed April 18, 2020. 11. (422) Vital Signs, Oxygen, & Exercise Prescription. How are these impacted by COVID-19 By Ellen Hillegass - YouTube. https://www.youtube.com/watch?v=lj716KWNcig. Accessed April 18, 2020. 1. 12. Papinska AM, Soto M, Meeks CJ, Rodgers KE. Long-term administration of angiotensin (1-7) prevents heart and lung dysfunction in a mouse model of type 2 diabetes (db/db) by reducing oxidative stress, inflammation and pathological remodeling. Pharmacol Res. 2016;107:372-380. doi:10.1016/j.phrs.2016.02.0261. 13. Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD. Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. New England Journal of Medicine. 2020;0(0):null. doi:10.1056/NEJMsr2005760
Editor's Notes
- The current COVID-19 is a beta. Newest information is showing no bats within 30 miles of suspected transmission site of animal to human.
- COVID-19 demonstrated to be small enough in size to be passed through respiratory droplets while talking. Incubation = infectious period Shedding = production of virus within body Contact precautions: gloves and gown Droplet precautions: gloves, gown, eye protection, and surgical mask Airborne precautions: full body coverage + n95 mask (filters smaller particles)
- ACE2 receptors are the key on COVID-19 and the lock is all the receptors also found within the body, thus allowing it entry to many organs
- Down-regulation of ACE2 (angiotension converting enzyme 2) from COVID19. If you minimize function of ACE2 you get excess inflammation, water retention, fibrosis of tissues, etc.. Many MAS receptors are located in lungs, brain, heart, bone marrow, muscle
- ACE2 down regulation therefore begins to affect multiple organs and shuts off the gate keeper mentality of the RAAS system. This is why you hear of “multi-organ failure” Shortness of breath/cough/inc respiratory rate/pneumonia/dec oxygenation due to ACE2 attacking the respiratory cells of the lung and essentially inactivating them. Renal failure due to dec renal perfusion and therefore acute kidney injury begins to cause failure from continued inhibition and no release of renin Diarrhea due to ACE2 receptors located in intestine, inc inflammation/dilation/water retention in intestine thus loose stool Myalgia due to ACE2 receptors located in bone marrow and muscle Fever/headache due to ACE2 receptors located in brain/vessel smooth muscle and the rapid cascade of inflammatory proteins
- Peak function of the body in all its components without external variables is 25-35 years of age. Therefore as you age, natural processes takes course and the body begins to not work at full optimal capacity. Diabetes is directly related to the RAAS system and therefore poses the largest risk for individuals. Any disease or poor function of the organs involved with the RAAS system are therefore at a risk. Autoimmune diseases are malfunction of the immune system thereby dec ability to fight off infection. Lack of money to afford safe living, medical care, access to news/information on health. Rural living might have similar issues and/or lack of expertise to treat diagnoses. Social support needed for mental health and well-being. Family/roommates pose health risk as they may be symptomatic or asymptomatic carriers.
- 3 METS = walking up flight of stairs RPE scale: 1- rest 3- carry on conversation 5- breath halfway thru sentence 7- difficult to say more than a word a breath 10- gassed out/maximal effort Check wrist pulse: put thumb and ring finger together then bend wrist palm toward arm, find tendons just under wrist crease, move just outside tendons (under thumb) and press lightly with fingertips. Check pulse for 20-30sec duration to ensure no abnormal rhythm. (60-80 normal for healthy mid-aged adult)
- If you are perfectly healthy your body spends 100% time to keep it that way. Now you have an illness. 50% time to fighting illness, 50% time to normal function of body. Now add intense exercise breaking down muscle to rebuild: 30% time on building muscle, 30% fighting illness, 30% normal function of body. Now add comorbidities (smoker, hypertension, anemic, etc.) You get the picture… Normal breathing: inhale 1 sec, exhale 2 sec Breathing exercise: sitting tall, inhale thru nose for 1 sec, hold for 3-5 sec, exhale thru mouth as if to blow out a candle for as long as possible