Waheed Shouman was informed on December 31, 2019 of 44 cases of pneumonia in Wuhan, China with no known cause. Most patients reported a link to a seafood market. By January 1, 2020 person-to-person spread was occurring, including among healthcare workers. As of March 5, 2020 there were over 82 countries affected globally.

1. Waheed Shouman
Professor of Chest Medicine
Zagazig University

6. was informed of 44 cases of pneumonia of unknown
microbial etiology associated with Wuhan City,
Hubei Province, China on 31 December 2019. Most
of the patients in the outbreak reported a link to a
large seafood and live animal market (Huanan South
China Seafood Market)

7.  55% (before Jan,1st 2020) were linked to the
Huanan South China Seafood Market
 8.6% only (after Jan, 1st, 2020) were linked to the
Huanan South China Seafood Market
 This confirms that person-to-person spread
occurred among close contacts since the middle
of December 2019, including infections in
healthcare workers

8.  At least have reported local
transmission (as of 1 March 2020)
 Number of countries affected on March 5th, 82
 Number of countries affected on March 5th, 102

9. CDC, 5-3-2020 (1 PM, CLT)(82 countries)

10. 7-3-2020 (1 PM, CLT)(102 countries)

11. March 5th, 2020 (1 PM, CLT)

12. March 8th, 2020 (1 AM, CLT)

13. March 8th, 2020 (1 AM, CLT)

14. March 5th, 2020 (1 PM, CLT)
12 Hours Later

15. March7th, 2020 (1 AM, CLT)
1 day Later

16. March 6th, 2020 (1 AM, CLT)

17. March 8th, 2020 (1 AM, CLT)

18. March 8th, 2020 (1 AM, CLT)

19. "an overabundance of information — some
accurate and some not — that makes it hard
for people to find trustworthy sources and
reliable guidance when they need it."

20. “an epidemic occurring worldwide, or over a
very wide area, crossing international
boundaries and usually affecting a large
number of people”
Doshi P. The elusive definition of pandemic influenza. Bull World Health Org 2011; 89: 532-
538
 This is an elusive definition
 It contains nothing about: population immunity,
virology, or disease severity

21. WHO epidemic phases

22. WHO epidemic phases

25.  Geographic location (MERS-spanish)
 People names (Chagas)
 species of animal or food (Swine, Bird)
 cultural, population or occupational group
(Legionnaires)
 Undue fear (epidemic, Fatal, unknown)

26.  The disease: CoViD-19
 The virus: SARS-2 virus

27.  Alphacoronaviruses: 229E virus and NL63
virus
 Betacoronaviruses: , SARS-2 virus
, SARS-CoV , MERS-CoV ,
OC43 virus and HKU1 virus

30.  Respiratory droplets (speaking, coughing, sneezing) (direct
and indirect)
 Fecal transmission is possible
 Blood, Vomits and Saliva?
 Urine, Breast milk and Semen, vaginal delivery (unknown)
 No evidence of intrauterine infection
 Some people can act as superspreaders early in the course
of their infection. It is not just viral load, but also
behavioral and environmental factors

31.  Some people can act as superspreaders early in
the course of their infection.
 It is not just viral load, but also behavioral and
environmental factors
 No evidence of pet transmission

32.  1-14 days
 5 days median
 Reports for 24-27 days (WHO: Incomplete
cure or re-infection)
 Patients are infectious in incubation period

34.  Currently unknown
 It bind to the angiotensin-converting enzyme-2
(ACE2) receptor in humans, which suggests
 That it may have a similar pathogenesis to SARS
 A unique structural feature of the spike
glycoprotein receptor binding domain of SARS-
CoV-2 (which is responsible for the entry of the
virus into host cells) confers potentially higher
binding affinity for ACE2 on host cells compared
to SARS-CoV.

41.  Fever (83-93)
 Cough (59-82)
 Dyspnea (31-55)
 Myalgia (11-44)
 Fatigue (44-69)

42.  Anorexia (40)
 Sputum production (26-28)
 Sore throat (5-17)
 Confusion (9)
 Dizziness (9)
 Headache (6-8)
 Rhinorrhea (4)
 Chest pain (2-5)
 Hemoptysis (5)
 Diarrhea, Nausea/vomiting, Abdominal pain (1-10%)

44.  Leukopenia, Leukocytosis, Neutrophilia
 Lymphopenia
 Thrombocytopenia
 Anemia
 Low albumin
 Elevated liver enzymes
 Renal Impairment
 High CRP

45.  CXR in patients suspect to have pneumonia
 75% bilateral disease, while 25% have
Unilateral disease
 CT chest:
 Bilateral multiple lobular and subsegmntal
consolidation
 GGO

56. Radiology conclusions:
 Up to approximately of patients with COVID-19 infection may have
normal CT scans after onset of flu-like symptoms from
COVID-19
 COVID-19 RT-PCR sensitivity may be as low as ; therefore
patients with pneumonia due to COVID-19 may have lung abnormalities
on chest CT but an initially negative RT-PCR
 Lung abnormalities during the early course of COVID-19 infection
usually are peripheral focal or multifocal ground-glass opacities
affecting both lungs in approximately of patients.
 As the disease progresses, crazy paving and consolidation become the
dominant CT findings, peaking around followed by slow
clearing at approximately and beyond.

57.  Required to confirm the diagnosis
 Perform real-time reverse-transcription polymerase chain
reaction (RT-PCR) assays for SARS-CoV-2 in all patients
with suspected infection

58. • Collect lower respiratory tract specimens (sputum, endotracheal
aspirate, bronchoalveolar lavage) where possible and depending upon the
patient’s condition
• Upper respiratory tract specimens (nasopharyngeal aspirate or
combined nasopharyngeal and oropharyngeal swabs) may be used if
lower respiratory tract specimens cannot be collected
• If initial testing is negative in a patient who is strongly suspected to have
COVID-19, recollect specimens from multiple respiratory tract sites (nose,
sputum, endotracheal aspirate) and retest

59.  Blood, urine, and stool specimens may also be
used to monitor for the presence of the virus;
however, sensitivity of diagnoses at these sites is
uncertain.
 Rule out infection with other respiratory
pathogens (e.g., influenza, atypical pathogens).
Collect nasopharyngeal swabs for testing.
 Serologic testing is not available
 Assays are in development

60. 1: suspect
A. Patients with acute respiratory illness (i.e., fever and at least one sign/symptom
of respiratory disease such as cough or shortness of breath) AND with no other
etiology that fully explains the clinical presentation AND a history of travel to or
residence in a country/area or territory reporting local transmission of COVID-19
disease during the 14 days prior to symptom onset;
OR
• B. Patients with any acute respiratory illness AND having been in contact with a
confirmed or probable COVID-19 case in the last 14 days prior to onset of
symptoms;
OR
• C. Patients with severe acute respiratory infection (i.e., fever and at least one
sign/symptom of respiratory disease such as cough or shortness of breath) AND
requiring hospitalization AND with no other etiology that fully explains the clinical
presentation.
Cofirmed:
A case with positive PCR irrespective of symptoms and signs

61.  A total of 72,314 patient records:
 44,672 (61.8%) confirmed cases,
 16,186 (22.4%) suspected cases,
 10,567 (14.6%) clinically diagnosed cases (Hubei
Province only),
 and 889 asymptomatic cases (1.2%)
 All COVID-19 cases reported through February 11,
2020 were extracted from China’s Infectious
Disease Information System

62.  86.6% were 30-79 years old
 80.9% mild cases
 2.3 case fatality rate
 1716 (2.37%) health workers were infected,
5 died (0.3%)

66.  The ≥80 age group had the highest case fatality
rate of all age groups at 14.8%
 Case fatality rate for males was 2.8% and for
females was 1.7%
 No comorbid conditions had a case fatality rate of
0.9%
 10.5% for those with cardiovascular disease
 7.3% for diabetes
 6.3% for chronic respiratory disease
 5.6% for cancer
 49% case fatality rate for critical cases

68.  MERS-CoV, SARS
 Influenza
 Avian Flu
 Common cold (Differentiating COVID-19 from community-acquired
respiratory tract infections is not possible from signs and symptoms.
However, early reports suggest that coryza and sore throat are less common
in COVID-19)
 Other pneumonias (CAP)
 Tuberculosis

69.  No specific treatments are known to be effective for
COVID-19 yet
 Remdesivir shows in vitro activity agains SARS-CoV-2 and
has been used to treat patients in China and USA
 Oseltamivir, lopinavir/ritonavir, ganciclovir, favipiravir,
baloxavir marboxil, umifenovir, interferon alfa, all tried but
no data to support their use.
 IVIG ---- tried, no support
 Chloroquine shows in vitro activity against SARS-CoV-2

70.  No available vaccine
 Vaccines are in development
 An mRNA vaccine (mRNA-1273) has been
shipped to the National Institute of Allergy
and Infectious Diseases for phase I clinical
trials in the US

71. The only way to prevent infection is to avoid exposure to the
virus
often with soap and water or an alcohol-
based hand sanitizer and avoid touching the eyes, nose,
and mouth with unwashed hands
with people (i.e., maintain a distance
of at least 3 feet [1 meter]), particularly those who have a
fever or are coughing or sneezing
(i.e., cover mouth and nose
when coughing or sneezing, discard tissue immediately in
a closed bin, and wash hands)

72. if they have a fever, cough, and
difficulty breathing, and share their previous travel and
contact history with their healthcare provider
and
surfaces in contact with live animals when visiting live
markets in affected areas
animal
products, and handle raw meat, milk, or animal organs with
care as per usual good food safety practices