SARS-CoV2, the cause of Covid-19, is arguably the most significant viral infection of the last century, causing unprecedented disruption of the global healthcare system.

1. SARS-CoV 2 , Covid 19
Reidwaan Ally

4. OUTLINE
• Epidemiology
• Biology of the SARS-CoV 2
• Immunopathology
• Clinical Presentations
• Diagnosis
• Management

5. EPIDEMIOLOGY

13. BIOLOGY

17. IMMUNOPATHOLOGY

30. CLINICAL

33. • NIH Treatment Guidelines
• Endothelial Disease
• Respiratory
• Cardiovascular
• Renal
• Obesity , Diabetes , Hypertension

35. NIH
• 1) Asymptomatic/Presymtomatic
• 2) Mild - 80 %
• 3) Moderate - 20 % - Res Ds but SpO2 > 94%
• 4) Severe - - > 30 B/m , SpO2 < 94 %
PaO2/FiO2 < 300 mmHg
Radiology
• 5) Critical - - Respiratory Failure, MOF , SS

41. Respiratory

57. Cardiovascular

77. Renal

82. Obesity,Diabetes ,Hypertension

89. Coagulation

93. DIAGNOSIS

94. • Screening
• PCR Antigen Test
• Antibody Test

95. MANAGEMENT

98. Drug Therapy
• A) Anti viral therapy
• B) Immune Based therapies
• C) Adjuvant
• D ) Critically ill patient

99. Antiviral Therapies
• 1) Remdesivir – ACTT ( NEJM ) - YES
• 2)Kaletra , Alluvia , Ribavirin , Interferon - NO
• 3) HydroxyChloroquin , Chloroquin - NO

100. Immune Based Therapies
• Anti IL 6 - Tocilizumab - NO
• Anti IL 1 - Anakinra - NO
• Polygam - YES
• Convalescent Plasma – YES
• JAK Inhibitors - ?????

101. Steroids
• 1) Without ARDS – no benefit
With ARDS - ??
Organizing Pneumonia - ??
• 2) Mechanically Ventilated – RECOVERY TRIAL
Dexamethazone

103. OTHERS
• Antithrombotic Therapies - YES
• Statins - ?????
• Antioxidants – Vit C , Vit D , Nicotinic Acid , Zinc - YES
• ECMO – if available

104. Critically ill
• 1) Infection Control
• 2) Haemodynamic – Balanced Crystalloids , Nor Ad
• 3) Ventilation – HFNC , NIPPV ( CPAP ) , Pronation
• 4) AKI - RRT
• 5) Antithrombotic Therapy
• 6) Co Morbid Indications

110. SUMMARY
• South Africa
• we had flatten the curve – to allow…
• Next 8 weeks – reduce community spread/vulnerable/
Use of Antioxidents
• Majority cases – mild disease
Only hospitalised patients require specific therapies
• Vaccination program

111. Patient 1- 72 yr male
Dry cough , SOB , chills , palpitations
Was Hypertensive on treatment , Obese
MACU : In addition – ECHO – Myocarditis
Don’t have Remdesivir
Antibiotics , ended up needing MV , Inotrope (
Dobutamine ) , Steroids, Anticoagulation , RRT
Died

112. Patient 2 – 57 yr male
• Dry cough , SOB , Myalgia
• CXR – “ typical Covid “, SpO2 – 90 room air
• Rapid Ag test – negative , also – standard swab ….
• PIWR( PUI ) – CRP 425 , d- DIMERS – 13 ,5 , CXR –
• Swab – positive ….Triaged to Covid
• 2 weeks - initially – HFNO , Prone , Anticoagulated , Polygam , Dexamethazone , Antibiotics – Pneumonia (CT)
• Discharged