NOVAL CORONA VIRUS 2019

1. DRSHAWKY ELEMAM
MEDICAL SPECIALIST (GIT &LIVER)
CBIC AMERICAN BOARD
BAISH HOSPITAL
COVID19
(SARS-CoV-2)

2. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬‫بسم‬
”‫العليم‬ ‫أنت‬ ‫إنك‬ ‫علمتنا‬ ‫ما‬ ‫إال‬ ‫لنا‬ ‫علم‬ ‫ال‬‫سبحانك‬
‫الحكيم‬”‫اآلية‬ ‫البقرة‬ ‫سورة‬32

3. * Contents
1. Introduction.
2.Case definition
3. Contact precautions (1,2,3,4).
4. Air borne precautions.
5. Clinical Manifestation
6. Investigations
7. Treatment
8. Prevention

4. Introduction
*Coronaviruses (CoV) are a large family of RNA
viruses that cause illnesses ranging from the common
cold to more severe diseases such as Middle East
Respiratory Syndrome (MERS-CoV) and Severe Acute
Respiratory Syndrome (SARS-CoV).
*The new strain of coronavirus identified in December
2019 in Wuhan city, Hubei province of China, has
been named by the International Committee on
Taxonomy of Viruses (ICTV) as Severe Acute
Respiratory Syndrome Corona Virus-2 (SARS-CoV-2).
The ICTV have determined that SARS-CoV-2 is the
same species as SARS-CoV but a different strain.

12. Ensure that health care workers refrain
from touching their eyes, nose, or mouth
with potentially contaminated gloved or
ungloved hands .
Avoid contaminating environmental
surfaces that are not directly related to
patient care (e.g. door handles and light
switches) . Routinely clean and disinfect
surfaces which the patient is in contact.
3- CONTACT PRECAUTIONS

13. Ensure adequate room ventilation .
Use single rooms, or cohort
patients with the same diagnosis .
Minimize movement or
transport of patients .
Perform hand hygiene.
4-Contact precautions

14. Some procedures such as aspiration or open
suctioning of respiratory tract specimens,
noninvasive ventilation, high flow oxygen
therapy, delivery of nebulizers, intubation,
cardiopulmonary resuscitation, and
bronchoscopy can generate aerosols (called
aerosol-generating procedures). These are
associated with increased risk of transmission of
nCoV. Healthcare workers need to take the
following airborne precautions when
performing these.
1- Airborne Precautions

15. Airborne Precautions 2--
*Use PPE, including gloves, long-sleeved gowns,
eye protection, and particulate respirators (N95
or equivalent, or higher level of protection).
•*Use adequately ventilated single rooms
when performing aerosol-generating
procedures .
•This means negative pressure rooms with
minimum of 12 air changes per hour or at
least 160 litres/second/patient in facilities
with natural ventilation. Ask all people not

16. Signs and symptoms
As with other coronavirus infections, early
signs and symptoms in more severe infections
are likely:
Fever , Chills , Cough and Shortness of breath .
Rapid progression to severe
pneumonia and Respiratory failure usually
happens within the first week.

17. Life-threatening manifestations of
respiratory infection include:
* Severe pneumonia.
* Acute respiratory distress syndrome
* Early recognition of these clinical
syndromes allows for timely initiation of
prevention and control (IPC) as well as
supportive therapeutics .

18. * Supportive therapy
Although there is often no specific cure for emerging
respiratory virus infection, the following 3 supportive
therapies may counteract the symptoms and increase
chances of survival
1. Antimicrobials: suitable for likely pathogens,
including
pneumonia or health care associated
pneumonia (if infection was acquired in
health care setting) and sepsis
©

19. Oxygen: people with severe nCoV with signs of
respiratory distress, reduced blood oxygen levels
(hypoxaemia), or shock should be given
supplemental oxygen therapy immediately.
3. Specific treatment for underlying conditions such
as diabetes, kidney failure
• With coronavirus infections, many people with
severe cases of infection have underlying
conditions and this group are at greatest risk
of
dying.

20. Intensive supportive care*
* Severe respiratory distress:
not responding to escalating supplemental
oxygen therapy requires advanced respiratory
interventions including:
* High flow oxygen
* Non-invasive ventilation
* Invasive ventilation

21. Intensive supportive care
Septic shock: treat with intravenous
fluid therapy and vasopressors to
improve
targets of perfusion.
* These approaches generate aerosols so
the airborne precautions outlined in this
unit must be followed

22. Therapeutics research – 1
Compounds already licensed or in
development for other diseases
may need to be repurposed for
emerging respiratory virus
infection.

23. Management of people with
(Asymptomatic infection)
Contacts of confirmed cases may identify people
who test positive but have no symptoms. Until
more is known, people who are found to be positive
on RT-PCR testing, should be:
* Isolated,
* Followed up daily for symptoms, and
* Tested at least weekly – or earlier, if symptoms
develop.

24. Isolation should continue until two
consecutive upper respiratory
tract
samples (e.g. nasopharyngeal and/or
oropharyngeal swabs)
taken at least 24
hours apart test negative on RT-PCR

25. Contact:
IPC: Dr April Baller- ballera@who.int
Clinical management: Dr Janet Diaz - diazj@who.int
Guidance documents and tools
Infection prevention and control during healthcare when nCoV is
suspected :
https://www.who.int/publications-detail/infection-prevention-and-
control-duringhealth-
care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
Clinical Management of acute respiratory infection when nCoV is
suspected:
https://www.who.int/publications-detail/clinical-management-of-
severe-acuterespiratory-
infection-when-novel-coronavirus-(ncov)-infection-is-suspected

27. SARS COV2
Dr. SHAWKY El-EMAM
CBIC AMERICAN BOARD
BAISH G HOSPITAL
TSH