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2. • Mr D.T is a 54 year old man known hypertensive who is a Nurse and
reside at J.K Town. He was admitted on 5/5/21 at S.M Hospital with
c/o cough, fever, difficulty in breathing and diarrhea. He just
recently returned from India to visit his son
• Physical examination revealed pt in resp. distress, dehydrated with
Temp 38c, RR 36cpm,PR 100bpm, BP 150/90mmHg and Spo2
85%.
• He was immediately placed on oxygen and I.V fluids and was
isolated by the Casualty Officer in charge
CASE SCENARIO

3. • Investigations requested includes FBC, EUCR, Sputum GeneXpert,
CXR, ECG, Abd Uss, Stool Culture, Covid PCR
• Investigations results revealed normal results with positive COVID
19 PCR and CXR showing diffuse ground glass appearance
• He was placed on Zinc, Vitamin C, Azithromycin, Remdisivir and
Paracetamol, Antihypertensives and continued on oxygen
CASE SCENARIO

4. I n t r o d u c t i o n
E p i d e m i o l o g y
Ae t i o p a t h o g e n e s i s
C l i n i c a l p r e s e n t a t i o n
1
2
3
4
CONTENTS
5
6
7
P r e ve n t i o n
M a n a g e m e n t
C o n c l u s i o n

5. Introduction

6. T h e N e w
C o r o n a v i r
u s
The New Coronavirus
• Coronaviruses are a large family of RNA viruses that infect birds and
many mammals including humans
• Coronavirus disease 2019 (COVID-19) is an illness caused by severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
• An emerging strain, the virus was first identified as the cause of an
outbreak of pneumonia of unknown aetiology in China
• Little is known about the virus, we continue to learn more as data
emerges and researches ongoing

7. Epidemiology

8. • The disease was first reported in December 2019 from Wuhan, Hubei
province, China and has since spread throughout the world.
• The W.H.O declared a global pandemic on March 11, 2020
• In the U.S, confirmed cases as of March 17, 2022 is nearly 80 million
with over 968,000 deaths
• In Nigeria the total number of cases on 17 March, 2022 is about
255,000 with total number of 3,142 deaths
Epidemiology

9. • First case in Nigeria was reported on 27th February, 2020 in Lagos-
NCDC
• CFR in Nigeria 1.12%
• Gombe State recorded 3,307 number of cases with 66 deaths
Epidemiology

10. Aetiology

11. • SARS CoV-2 is a highly infectious zoonotic virus belongs to family
coronavirdae
• It has been established that SARS-CoV-2 shares sequence homology
with the SARS-CoV, MERS-CoV and BatCoV
• Despite its similarity to SARS-CoV, its transmission efficiency and
pathophysiology are rather different.
• The distinguishing factor is probably due to the changes in the spike
(S) protein
Aetiology

12. Microbiology

13. Coronaviridae
Alpha, Beta, Gamma, Delta and
recently Omicron and Ihu
• ssRNA virus
• It has 4 structural proteins and 16 non
structural proteins
The structural proteins are:
• S - Spike glycoprotein
• E - Envelope
• M - Membrane
• N - Nucleocapsid
• The replication of the virus is by RdRp

14. Pathogenesis

15. Respiratory droplets
When the carrier coughs or
sneezes, droplets or aerosols
with pathogens are formed, and
the susceptible person gets an
infection when inhaled.
Contact spread
For example, rubbing the eyes
and nose with contaminated
hands, the virus can enter the
body through the mucous
membranes.
Pathogenesis

16. Pathogenesis
• Angiotensin-converting enzyme , used by the virus to
enter type II pneumocytes in the lung
• Infection is characterized by an initial cytokine storm that can result
in marked inflammation and macrophage activation
• Interstitial mononuclear inflammatory infiltrates and edema
followed by hyaline membrane formation occurs leading to
• Further injury to the endothelial tissues results in microthrombi
formation and can lead to thrombotic complications

17. T h e N e w
C o r o n a v i r
u s
T h e N e w
C o r o n a v i r
u s
• Secondary sepsis in
these individuals
further contributes
to the severity of the
illness and death
• Disease more severe
in elderly -
immunosenescence
Pathogenesis

18. Clinical Presentation

19. • The typical incubation period of
COVID-19 ranges from 1 to 14
days, with an average of 3-7
days
• History of close contact with
COVID-19 or was part of a family
cluster of cases
Clinical Presentation

20. • The clinical presentation is that of a respiratory infection with a
symptom severity ranging from a mild common cold-like illness, to a
severe pneumonia that is potentially fatal.
• There may be extra pulmonary manifestation
• May be asymptomatic
Clinical Presentation

21. (48.5%)
(41.5%)
(34.7%)
• Fatigue (9.8%)
• Sore throat (7.3%)
• Nasal congestion (7.1%)
• Chest pain (6.6%)
• Headache (5.2%)
• Vomiting (4.9%)
• Diarrhea (2.5%)
Clinical Presentation

22. • On examination, patients may be febrile (with or without chills/rigors)
and respiratory distress.
• Patients with respiratory distress may have tachycardia, tachypnoea,
or cyanosis accompanying hypoxia
• Chest examination in keeping with pneumonia
Clinical Presentation

23. Complications

24. • DIC
• Sepsis
• Septic shock
• DVT
• AKI
• Seizure
• Multiple organ failure
• Death
Complications

25. • Adenovirus infection
• Bacterial pneumonia
• Influenza
• Parainfluenza virus infection
• Rhinovirus infection
Differentials

26. Management

27. • Case definition
• Triage
• Isolate
• Clincal Assessment
• Sample Collection
• Initiate Treatment
Approach

28. Investigations

29. • Have a high index of clinical suspicion for COVID-19 in all suspected
patients
• Diagnosis requires clinical findings supported by laboratory features
• A minimum of 1 nasal and 1 nasopharyngeal sample is required for
PCR
• Rapid Antigen Test are now available
Investigation

30. • RT PCR
• ABG
• LFT
• Coagulation screen
• Metabolic
• CXR
• FBC
Investigation

31. Investigation

32. Treatment

33. Due to limited knowledge about the virus, there is no approved therapeutic
drug. Treatment generally supportive
• Among the recommendations are bed rest and ensuring sufficient
calorie and fluid intake
• Oxygen therapy is recommended for patients with hypoxia ( RR > 30 or
Spo2 < 92%)
• Avoid antibiotics unless with indication
• Give psychological support
Treatment

34. Drug trials
a) Antivirals : Remdesivir, Lopinivir, Favipiravir
b) Antiparasitic : Ivermectin
c) Antibody-directed therapy : Bamlanivimab, Casirivimab and Sotrovimab
d) Steroids : Dexamethasone
d) Azithromycin and HcQ
e) Vitamin C and Zinc
f) Covalesent plasma
Treatment

35. • At least 3 days without symptoms (fever and respiratory symptoms)
• SpO2 ≥ 95% in room air for 3 days
• A patient should be discharged from the COVID-19 pathway 14 days
after the initial positive result
Discharge criteria

36. Prevention

37. T h e N e w
C o r o n a v i r
u s
Suscept ible people

38. • Vaccines are safe and effective!
• They have relatively clear
mechanism of action
• However, vaccine development
and uptake faces difficulties auch
as timeliness, viral mutation, lack
of trust and politics
Vaccine

39. T h e N e w
C o r o n a v i r
u s
Prevention
Reduce exposure: Avoid going to high-risk
areas and avoid gatherings
Wash your hands frequently
Wear facemask
01
02
03
04
Vaccine
Minimise contact with wild animals
Boost immune system
06
05

40. • Isolate
• Maintain sanitary isolation environment
• Observe IPC measures
• Use of appropriate PPE
• Safe burial and evacuation team
Vaccine
Recommendation for Health Workers

41. Prognosis

42. • Overall, current data continue to support the fact that whereas
children are infected with SARS-CoV-2 similar to adults, they are more
likely to be asymptomatic or to have less severe disease.
• An association was observed between severe COVID-19 and having 1
or more chronic conditions versus having none.
• According to CDC report of among 151 deaths, 75% had an underlying
medical condition.
Prognosis

43. Surveillance
• Reporting system
• Real time Data Management
• Contact tracing
• The Media

44. Conclusion

45. • COVID-19 is a new coronavirus
strain found in humans in 2019
• Symptoms of the virus are fever,
fatigue, dry cough, and dyspnea.
In severe cases, ARDS, septic
shock and coagulopathy
• Importance of clinical research
cannot be over emphasised
Conclusion

46. • Nigeria Center for Disease Control. National Interim Guidelines for
Clinical Management of COVID-19. Version 3, June 2020.
• World Health Organisation (WHO). Fact Sheets on COVID 19. November,
2021 67427889.1
• www.ncbi.com/covid19newsroom/77827ygws
References

47. T h a n k Y o u
f o r
L i s t e n i n g