- COVID-19 is caused by SARS-CoV-2 virus and has no specific approved treatment. The document summarizes the stages of COVID-19 infection and treatment approaches based on disease severity. For mild cases, symptomatic treatment is recommended. For moderate cases, hydroxychloroquine with or without azithromycin is recommended. Severe cases may require ICU care, lopinavir/ritonavir, tocilizumab for cytokine release syndrome, and consideration of remdesivir or interferons through clinical trials.
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases,The World Health Organization has announced that COVID-19 is a pandemic.
Seminar Prepared by :-
Mohammed Musa (M.B.Ch.B)
Azadi Teaching Hospital - Kirkuk
Coronavirus Disease, officially named as COVID-19, started as an epidemic in a live animal market in Wuhan, China, and spread throughout the world at an alarming rate. It was declared a pandemic by WHO on 11th March, 2020. The virus causing the disease was initially named 2019 Novel Coronavirus (2019-nCoV), but later officially renamed by WHO as Severe Acute Respiratory Syndrome- Coronavirus 2 (SARS-CoV-2). This virus is related to SARS-CoV and MERS-CoV that caused epidemics in China and Saudi Arabia in 2002 and 2012, respectively. The virus primarily affects the lungs, and causes death in a small proportion of patients due to Acute Respiratory Distress Syndrome (ARDS). The data on this new disease is very early, and might change as new data emerges.
Disclaimer: The images used in this presentation do not belong to me.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus that emerged in 2019 and causes coronavirus disease2019(COVID-19).1,2 SARS-CoV-2ishighlycontagious.Itdiffers from other respiratory viruses in that it appears that human-tohuman transmission occurs approximately 2 to 10 days prior to the individual becoming symptomatic.2–4 The virus is transmitted from person to person through respiratory secretions. Large droplets from coughing, sneezing or rhinorrhoea land on surfaces within 2 m of the infected person. SARS-CoV-2 remains viable for at least 24 hours on hard surfaces and up to 8 hours on soft surfaces.5 The virus is transferred to another person through hand contact on a contaminated surface followed by touching the mouth, nose or eyes. Aerosol airborne infected particles created during a sneeze or cough remain viable in the air for3 hours.5 These airborne particles of SARS-CoV2 can then be inhaled by another person or land on the mucosal membranes of the eyes.
Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser extent, related serovars paratyphi A, B, and C.
The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
A cardiologists perspective to current scenario in light of corona pandemic in india and world wide. cardiac procedures , heart disease , aceinhibitors , arni , heart failure , troponin, nt probnp
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases,The World Health Organization has announced that COVID-19 is a pandemic.
Seminar Prepared by :-
Mohammed Musa (M.B.Ch.B)
Azadi Teaching Hospital - Kirkuk
Coronavirus Disease, officially named as COVID-19, started as an epidemic in a live animal market in Wuhan, China, and spread throughout the world at an alarming rate. It was declared a pandemic by WHO on 11th March, 2020. The virus causing the disease was initially named 2019 Novel Coronavirus (2019-nCoV), but later officially renamed by WHO as Severe Acute Respiratory Syndrome- Coronavirus 2 (SARS-CoV-2). This virus is related to SARS-CoV and MERS-CoV that caused epidemics in China and Saudi Arabia in 2002 and 2012, respectively. The virus primarily affects the lungs, and causes death in a small proportion of patients due to Acute Respiratory Distress Syndrome (ARDS). The data on this new disease is very early, and might change as new data emerges.
Disclaimer: The images used in this presentation do not belong to me.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus that emerged in 2019 and causes coronavirus disease2019(COVID-19).1,2 SARS-CoV-2ishighlycontagious.Itdiffers from other respiratory viruses in that it appears that human-tohuman transmission occurs approximately 2 to 10 days prior to the individual becoming symptomatic.2–4 The virus is transmitted from person to person through respiratory secretions. Large droplets from coughing, sneezing or rhinorrhoea land on surfaces within 2 m of the infected person. SARS-CoV-2 remains viable for at least 24 hours on hard surfaces and up to 8 hours on soft surfaces.5 The virus is transferred to another person through hand contact on a contaminated surface followed by touching the mouth, nose or eyes. Aerosol airborne infected particles created during a sneeze or cough remain viable in the air for3 hours.5 These airborne particles of SARS-CoV2 can then be inhaled by another person or land on the mucosal membranes of the eyes.
Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser extent, related serovars paratyphi A, B, and C.
The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
A cardiologists perspective to current scenario in light of corona pandemic in india and world wide. cardiac procedures , heart disease , aceinhibitors , arni , heart failure , troponin, nt probnp
Brief presentation about COVID19 diagnosis ,management and discharge criteria from isolation. Short Discussion about guideline given by Nepal medical council and TUTH for management.
It is about detailed management of dengue and malaria in adults and children with brief review of clinical history and diagnosis.
reference:
-latest WHO and CDC guidelines
-Nelson 21st edition
-Ghai-Essential Paediatrics 9th edition
-Harrison
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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COVID 19- Diagnosis and Treatment
1. COVID 19 –Diagnosis & Treatment
Dr Rohit Kallukadavil
MBBS, MD, DNB, MRCP Sce (Resp)
Consultant Pulmonologist and Critical care specialist
HGM Hospital, Kottayam, Kerala.
2. Introduction
• COVID 19- caused by SARS CoV-2
• World wide 37L pts infected and 2.6L patients died
• Till now there is no specific treatment or vaccinations
available.
6. Stages of Infection
Stage I- Mild (Early Infection):
• Local symptoms-throat irritation, dry cough, fever etc. Many
asymptomatic. Pt vl be infective. 80% recover in few weeks.
• Lymphopenia & neutrophilia.
7. Stage II- Moderate Disease /Pulmonary phase:
• Viral multiplications, Infect lung- epithelial injury – DAD –
ARDS- hypoxemia.
• Blood- lymphopenia. Transminitis. Procal- Normal
• Need hospitalisation.
10. Lung phenotypes
Type L patient- Low elastance, Low V/Q, low lung weight, Low
recruitability
• severely hypoxic without significant dyspnoea(silent hypoxemia).
• Better response to O2, may not benefit from high PEEP.
Type H patient (30%) – High elastance, R-L shunt, high lung weight,
High recruitability-
• Histopathology- typical DAD
• May need Invasive ventilation
Ref: COVID-19 pneumonia: different respiratory treatments for different phenotypes? Luciano
Gattinoni, Intensive Care Medicine (2020)
11. Other organs
• Heart – elevated Trop/BNP- ? Left ventricular dysfunction,
myocarditis
• Kidney- 4.5% pts, ? Due to cardiac failure, sepsis, fluid
dysregulation, rhabdomyolysis etc
• Neurological- ? CVA.
12. Vascular Injury
• SARS CoV2 bind to ACE receptors in Endothelial cells of blood
vessels-injury and cytokine- thrombosis
• Resp failure not explained with ARDS alone- microvascular
thrombotic process also
• Strong association between D Dimer, disease progression and CT
features of venous thrombosis
• Autopsies showed thrombosis in multiple organs
• IL 6 elevation after 13 days of disease onset, but D –Dimer level 10
fold raised before that.
13. • Prophylactic and therapeutic
anticoagulation showed better
out comes
• CT – vessel enlargement near
areas of GGO-in 89% pts
• CTPA – 40% subsegmental
embolism
15. Children safe from Covid ?
• Less viral load
• ACE 2 expression is lower
• Poorly developed humoral and cellular immune system
• Recurrent antigenic stimuli from viruses cause more
inflammatory immune response in adults
17. Covid suspect:
• All symptomatic(fever, cough and Dyspnoea) individuals who have undertaken international travel in the
last 14 days
• or
• All symptomatic contacts of laboratory confirmed cases
• or
• All symptomatic healthcare personnel (HCP)
• or
• Hospitalized patients with fever AND cough and/or shortness of breath
• or
• Asymptomatic direct and high risk contacts of a confirmed case (should be tested once between day 5 and
day 14 after contact)
• Symptomatic pts in Hotspots/cluster (as per MoHFW) and in large migration gatherings/evacuees centres:
Confirmed case:
A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms
18. Samples for analysis
Specimen Positivity
BAL 93%
Sputum 72%
Nasopharyngeal swab 63%
Oropharyngeal swab 32%
Faeces 29%
Blood 1%
Urine 0%
Detection of SARS-CoV-2 in different types of clinical specimens. Wenling Wang, Yanli Xu.
JAMA.2020. Mar11
Preferred: Throat &
nasal swab
19.
20. Diagnostic Test
• RT- PCR(Reverse transcriptase polymerase chain reaction)
• Gold standard for diagnosis(100% specificity)
• Positive result in early phase, later can be –ve due to
immunity devlopment.
• Expensive, time consuming(6-8 Hr), low sensitivity(50-
70%)
21. Sample – treated with chemicals-
Extract RNA – Reverse transcribed
to DNA – Add a complimentary
DNA fragment to detect Corona
virus- If virus is present, it will
attach to the fragment- fluorescent
material also added for labelling—
RT PCR machine- each cycle
double the DNAA- 35 cycles
minimum- machine detect
florescence- in real time manor.
22. • If RT PCR is negative and suspicion is high – test should be
repeated- if possibly from lower resp tract
• Positivity rates >90% on Day 1-3 of ilnness, <80= at Day6,
<50% after day 14.
23. Rapid antibody tests
• ELIZA test- IgM(active infection) and IgG(Past infection)
• Can be used as a screen test
• Point of care test, rapid results
• cheaper
• Blood test
• Combined IgG+IgM – better utility
26. • Biosecurity precautions- collection of samples
• Only RT PCR(No conventional PCR or Antibody test)
• Positive samples- to be transported to ICMR- NIV
• Truenat machine – can also be used.
30. • All health care providers should take extra precautions –
Mask, gloves, PPEs etc
• Social distancing
• Avoiding unnecessary crowds in hospitals(amplifyng centre
for a pandemic)
• Isolate suspects and +ve pts in Covid care centres
• Only <20% require admission/ ICU care
• Ideal to have Neg pressure Isolation room
31. Categories
A Mild sore throat/ cough/ rhinitis/ diarrhea
B Fever and /or severe sore throat/ cough / diarrhea
or
Cat A + Any of the following
Cardiovascular disease
Uncontrolled DM, HTN, Cancer, HIV, lung, liver, renal or neurological diseases
On steroids/ immunosuppressants
Pregnancy
Age> 60 yrs
C Dyspnoea, chest pain, drowsy, low BP, cyanosis, haemoptysis
Children with ILI
Worsening of underlying chronic conditions
32. High risk patients
• age>60, With comorbidities
• spo2<93%, HR>125, RR>30, BP<90/60
• Altered sensorium
• CRP>100, CPK> two time upper limit
• Ferritin >300, LDH>245, D- dimer>1000, Trop T +ve
• MODS
33. Admission
• Covid care centre: Confirmed mild cases
• Covid Ward: High risk patients,
Category B pts
RR>24
Spo2<94%
• Covid ICU: Category C patients
Moderate – severe ARDS
MODS
Shock
34. Treatment
• A,B,C categories
• Only Paracetamol, avoid other NSAIDs
• All ILI- use oseltamivir till COVID result available
• Broad spectrum antibiotics
• Better avoid steroids
35. Treatment
A Symptomatic Rx
Reassess and categorize Q 28-48Hrs
B HCQ 400mcg BDx 1day, 200mg BD x4 days
Or
Chloroquine600mg then 300mg BD x 5 days
+
Tab Azithromycin 500mg OD x 5 days.
Oseltamivir 75mg BD x 5 days in all ILI until PCR reports
C All ILI- Oseltamivir
HCQ/Chloroquine + Inj Azithromycin
Tab Lopinavir/Ritonavir(400/100) x 14 days (If HCQ contraindicated/ on
compassionate use with consent, has to be started within 10 days of
symptom onset)
If ARDS /MODS- add Lopinavir/ ritonavir and stop Azithromycin(QTc monitor)
37. • Serum IL-6 is the marker, ferritin
• CRP- surrogate marker
• Grade 3& 4- use Tocilizumab 8mg/kg IV (max 800mg) over
60min, if no effect repeat x 2 more doses Q8H.
• If no response corticosteroids.
38. Steroids in COVID
• Better to avoid
• Delays viral clearance
• Use in
• Refractory shock, Macrophage activation syndrome,
cytokine release syndrome Grade 3/ 4
• 1-2mg/kg /day methylprednisolone equivalent x 3-5 days
39. Chloroquine/HCQ
• Change Ph of endosome and viral entry
• No renal or hepatic dose adjustement
• 400mg BDx 1, then 200mg BD x 4 days.
• HCQ is more potent antiviral than chloroquire
• Side effect: QT prolongation, ventricular arrhythmias
• Contraindications: QTc>500msec, Porphyria, Myasthenia,
Retinopathy, Epilepsy
40. Evidence
• Cause Increase Ph of endosome and prevents virus entry,
transport and post entry events ?
• invitro action- chloroquine/ hcq against viruses- corona/
influenzea
• No peer reviewed publications/ well conducted RCT.
• Unpublished study from China and France(HCQ+
Azithromycin) – showed better viral clearance.
41. Conclusion –
This study therefore recommends that COVID-19 patients be treated with hydroxychloroquine and
azithromycin to cure their infection and to limit the transmission of the virus to other people,
Figure - Percentage of patients with PCR-positive nasopharyngeal samples from inclusion to day6 post-inclusion in COVID-19 patients treated with
hydroxychloroquine only, in COVID-19 patients treated with hydroxychloroquine and azithomycin combination, and in COVID-19 control patients
Ref –
Int J Antimicrob Agents. 2020 Mar 20 : 105949
Biosci Trends. 2020 Apr 5. doi: 10.5582/bst.2020.03058.
42. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80
COVID-19 patients with at least a six-day follow up: an observational study
• In 80 in-patients receiving a combination of
hydroxychloroquine and azithromycin
• A rapid fall of nasopharyngeal viral load tested by qPCR was
noted, with 83% negative at Day 7, and 93% at Day 8.
• Virus cultures from patient respiratory samples were
negative in 97.5% patients at Day 5.
• This allowed patients to rapidly discharge from highly
contagious wards with a mean length of stay of five days.
43. Remdesivir
• In vitro activity against SARS Cov2
• Premature termination of RNA transcription
• Only for compassionate use
• Interim analysis of RCT in US- faster recovery
• Chinese study- No significant recovery or mortality benefits
• 200mg IV then 100mg IV OD x 9 days
• Side effects: GI intolerance/ hepatotoxicity.
45. Lopinavir/Ritonavir
• WHO – drug can be tried
• CYP3A4 inhibitor- monitor drug interactions
• QT prolongation, hepatotoxicity.
Interferons
• IFN-2a, IFN-2b orIFN-1a
• Side effect: Flu like syndrome
48. Convalescent plasma
• Plasma from recovered pts
• Efficiency not known
• One study- improved viral clearance and oxygenation by 12
days after transfusion
• Another- 5/6 pt died within 3 days despite viral clearance
• Dose: 10-15mL/kg
• Need high titre of neutralizing antibody
• Lack of infectious particles
• ABO and Rh compatible
49. Side effects:
• Infections
• Volume overload
• Febrile and allergic reactions
• Anaphylaxis(In IgA deficiency)
• TRALI
50. Ivermectin
• Antiparasite drug
• Inhibit entry of viral protein into nucleus of cell
• In vitro studies-Australia showed : single treatment able to
effect 5000 fold reduction in virus at 48 hour in cell culture.
51. ? Traditional
Chinese Medicines
• TCM- used for long time
• Effective component- unknown or vague
• Chinese studies- WM+TCM Vs WM: symptomatic
worsening= 7.4% Vs 46.2%, Mortality 8.8%Vs39%
52. Supportive therapy
• Supplemental oxygen- in hypoxia or shock
• Target SpO2 ≥90% , pregnant ≥92-95 %
• Conservative fluid- in SARI without shock, aggressive fluid
Mx can worsen oxygenation
• Antimicrobial within 1 hr of identification of sepsis
53. Hypoxia
• If supplemental oxygen cannot alleviate
symptoms- use NIV/HFNO.
• NIV – proper interface and PPE reduce chance
of transmission
• Intubation produce more aerosol and chance
of viral transmission
54. Mechanical ventilation
• Severe resp failure- intubate and ventilate
• Use new tubings and viral filtres
• Low tidal volume, high PEEP strategy
• Prone ventilation/ ECMO
55. Septic shock Mx
• Use crystalloids (NS/RL) with caution
• If no response to fluid vasopressor
• Central line or peripheral line
• Target MAP >65, urine out put > 0.5ml/kg/hr
56. Prone positioning
Awake proning:
• Adjunct to use of NIV- as a rescue therapy
before intubation
• Based of perfusion redistribution
• Benefits are short lived
• Consider- if pt can communicate & co operate
if pt able to rotate and adjust position
• Pt should switch positons every 30min to 2 hours
Proning after intubation- follow standard protocols.
57. Prevention of the transmission of infection
• droplet precaution (e.g. wearing mask & PPE), contact precaution (e.g. hand
washing or wearing gloves and gown) and airborne precaution (e.g. isolation
room with negative pressure)
• The use of clinical triage for the early identification of patients with ARI
• Isolation or cohorting of patients to prevent the transmission
• Use of PPE and adequately ventilated single rooms when performing aerosol
generating procedures
‘One Health’ approach communication and collaboration between countries
to build trust and academics
IPC, infection prevention and control; ARI - acute respiratory Infection; PPE, Personal Protective Equipment
Park S, Park J, Song Y, How S, Jung K. Respirology. 2019;24(6):590-7.
58. Prevention of complications- critically ill pts
• Use weaning protocols – daily
• Daily interruption of continuous sedation
• Semi recumbent position
• Closed suctioning
• New ventilator circuit for each pt
• DVT prophylaxis
• Turn pt Q2Hr to reduce bed sores
• Early enteral nutrition
• Ulcer prophylaxis
• Mobilize of limb physiotherapy
59. Outcomes
Variable Number %
Total 305
Median Hosp days 8.5
O2 76%
NIV 3.6%
HFNO 22%
ICU 39%
Median ICU days 8
MV 30%
RRT 7.5%
Inotrope 27.5%
Death 17%
Characteristics and Clinical Outcomes of Adult
Patients Hospitalized with COVID-19 — Georgia,
March 2020
New york April 14
60.
61. Viral clearance
• Repeat RT PCR should be done every 2 to 4 days- until 2 consecutive results are
negative (URT samples) – 24 Hr apart.
• Symptomatic pts- after the resolution of symptoms, samples should be collected
at least seven days after the onset or after > 3 days without fever.
• Asymptomatic infected persons, the tests should be done at a minimum of 14
days after the initial positive test.
• Virus can persist 7-12 days in moderate & 2 wks in severe cases
• Prolonged viral shedding in some, > 2 wks to months in PCR, but cultures –
negative
• Wuhan study Mean duration of viral shedding- 20 days, longest : 37 days
• 50% pts show viral shedding even after symptom resolution
The life cycle of SARS-CoV-2 in host cells; begins its life cycle when S protein binds to the cellular receptor ACE2. After receptor binding, the conformation change in the S protein facilitates viral envelope fusion with the cell membrane through the endosomal pathway. Then SARS-CoV-2 releases RNA into the host cell. Genome RNA is translated into viral replicase polyproteins pp1a and 1ab, which are then cleaved into small products by viral proteinases. The polymerase produces a series of subgenomic mRNAs by discontinuous transcription and finally translated into relevant viral proteins. Viral proteins and genome RNA are subsequently assembled into virions in the ER and Golgi and then transported via vesicles and released out of the cell. ACE2, angiotensin-converting enzyme 2; ER, endoplasmic reticulum; ERGIC, ER–Golgi intermediate compartment.
Viral particle- attach to ACE II in epithelial and endothelial cells- replicate and many virions realeases- the infected cells undergo apoptosis and release numerous toxins. Virus vill be presented to T cells with APC. CD4 cells – relase neumerous IL and cytokine storm- B cells get activated and produce antibody. If immunity is well virus is contained and neutralised in initial stages. But in 20 % significant viral load caue cytokine storm.
II a without hyoxia
Chest CT images in 51-year-old male (A) Day 7 after onset of symptoms: CT demonstrates bilateral ground glass opacities (GGOs) and early vascular enlargement. (B) Day 10: Rapid progression of GGOs with vascular thickening and interstitial pulmonary edema
Cooler box with ice packs.
Reasses A and B every 24- 48 hours
France study
Helmet based NIV- CPAP
Reference:
Park S, Park J, Song Y, How S, Jung K. Emerging respiratory infections threatening public health in the Asia‐Pacific region: A position paper of the Asian Pacific Society of Respirology. Respirology. 2019;24(6):590-597. doi:10.1111/resp.13558