This document discusses COVID-19, caused by SARS-CoV-2. It defines the virus and outlines its origin in Wuhan, China in December 2019. Clinical features include fever, cough and dyspnea. Diagnosis involves travel history screening and PCR testing of respiratory samples. Management involves supportive care, with oxygen and ventilation for severe cases. Specific antivirals like remdesivir are under investigation but no vaccine currently exists. Prognosis is best for non-critical cases without comorbidities, with a overall fatality rate of 2.3%.

1. Etiology, Clinical features
&
Management of COVID-19
Dr.S.Sesha Sai
Assistant Professor
Dept. of Pulmonary Medicine
East Point College of Medical Sciences

2. WHO Situation Report as of 4/3/2020

3. Definitions
• Coronavirus disease 2019 (COVID-19) is a
severe acute respiratory infection caused
by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2/previously
called as 2019-nCoV)
• The virus was identified as the cause of
an outbreak of pneumonia of unknown
cause in Wuhan City, Hubei Province,
China, in December 2019

4. Etiology
SARS-CoV-2 is a previously
unknown betacoronavirus
Discovered in BAL samples
taken from clusters of
patients who presented
with pneumonia of
unknown cause in Wuhan
City, Hubei Province, China,
in December 2019
SARS-CoV-2 - Sarbecovirus
subgenus of the
Coronaviridae family, 7th
coronavirus known to
infect humans.
A majority of patients in
the initial stages of this
outbreak reported a link to
the Huanan South China
Seafood Market, a live
animal or "wet" market,
suggesting a zoonotic origin
of the virus

5. Etiology
• Animal reservoir and intermediary host(s) - unknown
• Recombinant virus between the bat coronavirus and an
origin-unknown coronavirus
• Person-to-person spread has been confirmed in
community and healthcare settings in China and other
countries.
• Perinatal transmission or transmission via
breastfeeding – Possible but unlikely (based on data
from SARS,MERS outbreaks)
• No evidence for intrauterine infection caused by
vertical transmission in women who develop the
infection late in pregnancy.

6. Risk Factors
• Diagnosis should be suspected in patients with
fever and/or signs/symptoms of lower respiratory
illness (e.g., cough, dyspnea) who reside in, or
have traveled to a country/area or territory
reporting local transmission of COVID-19 in the 14
days prior to symptom onset
• Close contact with infected individual

7. History & Clinical Features
• Travel history is key.
• Illness
– Mild 80%
– Severe 14%
– Critical 5%
• Severe in Older age and Underlying Co
morbidities
• Incubation period varies from 2-14 days(New
reports suggesting more than 20 days)
• Most cases deteriorates in 2nd week of illness

8. History & Clinical Features
• Fever (83% to 98%) – Children may not present with fever
• Cough (59% to 82%) – Usually dry
• Dyspnea (31% to 55%) – Symptom onset to dyspnea takes 5-8 days
(2nd week of illness)
• GI Symptoms – Nausea, Vomiting, Diarrhea
• Common
– Fatigue(44-69%), Myalgia(11-44%), Anorexia(40%), Sputum
Production(26-28%), Sore throat(5-17%)
• Bronchial breath sounds, Tachypnea, Tachycardia, Cyanosis,
Crepitations in acute respiratory disease
• Uncommon
– Confusion, Dizziness, Headache, Hemoptysis, Rhinorrhea,
Chest pain

9. Diagnostic Criteria
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
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
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

10. Diagnostic Tests
Test Result
Pulse Oximetry Low saturation
ABG Low pO2
CBC Leukopenia,lymphopenia,thrombocytopenia
Coagulation Profile Elevated D-dimer, Prolonged PT
Metabolic panel Elevated liver enzymes, decreased albumin, renal
impairment
Procalcitonin, CRP, LDH, Creatine kinase,
Troponin
Elevated
Blood and Sputum Cultures Negative for bacteria
RT-PCR (upper and lower resp tract
specimens, blood, urine, stool)
+ve for SARS-CoV-2 viral RNA
Chest X-ray U/L(25%) or B/L(75%) lung infiltrates
CT Chest Primary imaging modality in China. Bilateral
ground glass opacity or consolidation.
Cavity, nodules, pleural effusions,
lymphadenopathy were absent

11. Management
• No specific treatments are known to be
effective for COVID-19
• Mainstay of management is optimized
supportive care to relieve symptoms and to
support organ function in more severe illness.
• Isolation
• Infection prevention and control procedures.
• Reporting

12. Management
With Pneumonia/Comorbities
• 23-32% require ICU
• Supportive therapy – O2, Fluids, Symptom relief,
Antimicrobials
• Monitor for clinical deterioration such as respiratory
failure, sepsis
• Mechanical ventilation for Hypoxemic respiratory
failure and ARDS
– Low tidal volume(4-8ml/kg PBW) and lower
plateau pressures(<30cm H2o), Prone ventilation
– Use of in-line suction catheters for suctioning
• Corticosteroids – found to be ineffective

13. Management
Without Pneumonia or Comorbidities
• Home care can be considered on case-by-case
basis.
• Mild symptoms, No warning signs, No
comorbids.

14. Specific Anti Virals
• Remdesivir was considered the most promising
candidate based on the broad antiviral spectrum,
the in vitro and in-vivo data available for its use
against coronaviruses and the extensive clinical
safety database.
• Among the repurposed drugs, the investigation of
the antiretroviral medicine (HIV protease
inhibitors), lopinavir/ritonavir, either alone or in
combination with IFNbeta1b, was considered a
suitable second option for rapid implementation
in clinical trials.

15. Complications
• ARDS
• Acute Cardiac injury
• Arrythmias
• Secondary infection
• Acute Resp failure
• AKI
• Septic Shock
• DIC

16. SARS-CoV-2
Prevention
16

17. Regularly and thoroughly clean your hands with an alcohol-
based hand rub or wash them with soap and water.
17

18. Make sure you, and the people around you,
follow good respiratory hygiene.
18

19. Maintain at least 1 meter (3 feet) distance between yourself
and anyone who is coughing or sneezing.
19

20. Avoid touching eyes, nose and mouth without washing hands
20

21. Use Mask and personal protective equipment
21

22. Stay home if you feel unwell.
If you have a fever, cough and difficulty breathing, seek medical attention.
22

23. Prevention

24. Vaccine
• No vaccine available.
• Vaccines are in development, but it may take
up to 12 months before a vaccine is available.
• 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, with an estimated start date of
6 March 2020.

25. Prognosis
• The natural course of infection and prognosis are unknown at this
time.
• Based on a large case series of patients in China (72,314 reported
cases from 31 December 2019 to 11 February 2020), the overall
case fatality rate is 2.3%.
• The majority of deaths have been in patients aged 60 years and
older and/or those who have pre-existing underlying health
conditions (e.g., hypertension, diabetes, cardiovascular disease).
• Highest among critical cases (49%).
• Higher in patients
– aged 80 years and older (15%)
– males (2.8% versus 1.7% for females)
– with comorbidities (10.5% for cardiovascular disease, 7.3% for
diabetes, 6.3% for chronic respiratory disease, 6% for hypertension,
and 5.6% for cancer).

26. References
• Guidelines on Clinical management of severe acute
respiratory illness (SARI) in suspect/confirmed novel
coronavirus (nCoV) cases. MOHFW, India.
• BMJ Best Practice COVID-19, 2nd March,2020
• Clinical management of severe acute respiratory
infection when novel coronavirus (nCoV) infection is
suspected, WHO, Jan 2020
• Home care for patients with suspected novel
coronavirus (nCoV) infection presenting with mild
symptoms and management of contacts, WHO, Feb
2020