The document summarizes the systemic involvement of the novel coronavirus (COVID-19). It discusses how COVID-19 can affect multiple organ systems beyond just the respiratory system. It outlines how the virus can cause pneumonia and ARDS in the lungs. It also explains how COVID-19 has been found to impact the cardiovascular, gastrointestinal, renal, central nervous, musculoskeletal, and hematological systems. The document emphasizes that the virus causes a cytokine storm that leads to multi-organ damage and failure in severe cases. It provides recommendations for treatment and supportive care for patients depending on which organ systems are involved.

1. Systemic involvement of Novel
Corona Virus (COVID 19)
Samaresh Das
Consultant, Anaesthetics and Critical care
Yeovil Hospital, NHS, England

4. • Covid19 outbreak has caused a pandemonium in modern world & introduced new
terminologies: ‘social distancing’, ‘lock-down’, ‘stay safe’, ‘key workers’, ‘self-quarantine’,
‘work-from-home’ & so on
• Started from Wuhan & has caused thousands of deaths, serious illness, & disruption of
global economy never seen since the 2nd world war
• New virus, limited epidemiology & mainly the Tt for symptomatic patients is supportive
• However, Covid19 not only attacks the respiratory system, rather it involve other systems
from the beginning or subsequent to respiratory infection
Introduction

5. Respiratory System
• Majority: mild, cold-like symptoms. S/s may appear 2-14 days from the initial
exposure and present with cough (mostly dry but at times with copious sputum
production), fever, sore throat, runny nose, SOB
• Hospital admissions: pneumonia like symptoms with SOB & desaturation
• ~15% develop mod. to sev. Illness, oxygen support, further 5%- ICU & organ
supportive therapies including intubation and ventilation
• Pneumonia: the most common complication/ARDS

6. Imaging

7. Blood gas & Imaging

8. • Prevalence of cardiovascular diseases (CVD) are substantial in general population and the
probability Covid19 infection is particularly high in this subset of people
• Acute cardiac injury ( ~8–12%) due to viral involvement of cardiomyocytes & SIRS
• Common complications includes tachy & brady arrhythmias
• Until now, no study describes ST elevation or acute MI secondary to Covid19
• Only one Chinese study reported heart failure in Covid19 patients
• It is too early to assess the long- term implications of the consequences of Covid19
affection on cardiovascular system
Cardiovascular System

9. • Data from Wuhan: ~79% diarrhea, decreased appetite, nausea, vomiting, abdominal pain
and gastrointestinal bleeding during the onset and subsequently
• Adult and young children can present only with GI symptoms
• Studies from the China: Anorexia most frequent in adults (39.9%‐50.2%), Diarrhea in adults
and children (2%‐49.5%) & vomiting in children
• GI bleeding was found only in few ventilated patients in ICU
• Recently Virus reported for the first time in stool samples in USA
Gastrointestinal System

10. • long‐term hypoxemia, cell necrosis GI mucosa leads to ulceration and bleeding + IV
corticosteroids, NSAIDs, physiological challenging to trace the real cause
• Liver disfunction: Hepatitis, microvascular steatosis, elevated aminotransferases, high
bilirubin, hypoproteinemia, and prolonged PT, activation of coagulative & fibrinolytic
pathways, relatively depressed platelets, climbing neutrophils, increased neutrophil:
lymphocyte, & high ferritin levels
• Drug-induced liver injury is a possible contributing factor
Gastrointestinal System

11. • Incidence of AKI was directly proportional to the baseline serum creatinine
• The severity of AKI positively associated with older age, higher body mass index, diabetes
mellitus, history of heart failure, higher peak airway pressure and higher SOFA score
• The potential mechanisms of kidney involvement in these patients can be didactically
divided into three aspects: cytokine damage, organ crosstalk and systemic effects
Renal System

12. Central Nervous System
Entry of Covid19 in the CNS

13. • Involvement may occur either during initial or late phase
• Early: fever, loss of smell, taste, headache, visual impairment, dizziness, ataxia and
convulsions
• Neurological S/s could be a combination of hypoxia, respiratory & metabolic acidosis at
advanced stage
• Patients with neurological symptoms would require more specific and aggressive
treatments
• Recently a case report has been published Wuhan describing a patient presented with acute
symmetrical ascending weakness resembling GBS
Central Nervous System

14. • Generalized muscle pain and fatigue are common
• Clinicians should consider the diagnosis of rhabdomyolysis when patients have focal
muscle pain and fatigue
• CK, myoglobin are important indexes for rhabdomyolysis & should be tested earlier to
avoid ARF from rhabdomyolysis
• Prolonged ventilation are prone for muscle atrophy & weakness during recovery
Musculoskeletal System

15. • Microvascular thrombosis & reduced platelets count, prolongation of the PT/INR,
PTT, elevation of D-dimer, and reduced fibrinogen levels
• Platelets transfusion if the platelet count <50 x 109/L, FFP- if INR >1.8 & fibrinogen
concentrate (4 grams) or cryoprecipitate (10 units) fibrinogen level <1.5 g/L
• In patients already on anticoagulation for VTE or atrial fibrillation, therapeutic
doses of anticoagulant therapy should continue but may need to be withheld if
platelet count is less than 50 x 109/L
Hematological System

16. • Prophylactic LMWH to all hospitalized patients despite abnormal coagulation
(absence of active bleeding, platelet <25, or fibrinogen <0.5 g/L)
• Abnormal PT/INR or PTT is not a contraindication for pharmacological
thromboprophylaxis
• Mechanical thromboprophylaxis when pharmacological thromboprophylaxis is
contraindicated
Hematological System

17. • COVID patients who spend significant time in the hospital are more vulnerable to
delirium; irrespective of ICU admission and regardless of the severity of illness
• There are reported case of mental and social health problems even among front-
line health care workers
Psychological aspects

18. Systemic manifestation

19. Messages for the general population:
• Be empathetic to those infected with the virus. They all deserve support, compassion
& kindness
• Minimize watching, reading or listening to news about COVID-19 that cause anxious
or distressed; seek information only from trusted sources
• Protect yourself and be supportive to others
• Find opportunities to amplify positive and hopeful stories and positive images of
local people who have experienced COVID-19
• Honor careers healthcare workers and supporting people
Important message

20. Messages for the Health Care Workers:
• Managing mental health and psychosocial well-being is as important as managing
physical health
• Sufficient rest during work or between shifts, healthy food, physical activity, and stay in
contact with family and friends
• Avoid use of tobacco, alcohol or other drugs
• If possible, staying connected with your loved ones, including through digital methods (is
one way to maintain contact
Important message

21. Any questions?
Feedback: drsamareshdas@gmail.com
+447960532682