Overview of COVID-19

1. A Presentation on
COVID-19
By Team-D
Department of Family Medicine
Univeristy of Uyo Teaching Hospital

2. OUTLINE
• Introdution
• History
• Epidemiology
• Pathophysiology
• Clinical Features
• Post-acute Sequelae
• Case Definition
• Investigation
• Treatment
• Prevention
• Role of Family Physician
• Conclusion
• References

3. INTRODUCTION:
• Coronavirus disease 2019 (COVID-19) is a communicable
respiratory disease caused by a novel coronavirus called severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2;
formerly called 2019-nCoV)

4. HISTORY
• It was first identified amid an outbreak of respiratory illness cases in
Wuhan City, Hubei Province, China in December 2019
• On January 30, 2020, the WHO declared the COVID-19 outbreak a
global health emergency
• On February 11, 2020, it was classified under the taxonomy of severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
• The first confirmed case in Nigeria was announced on 27th February
2020.
• On March 11, 2020, the WHO declared COVID-19 a global pandemic

5. EPIDEMIOLOGY
• As of February 10, 2022 there were 'over' 404,550,122 confirmed
COVID-19 infections worldwide.
• Recovered cases 'over' 324, 460,614
• Deaths 5,798,707
Most - Elderly (>50 years) with comorbidities
Least - Children
• Locally:
Lagos - Epicenter >38% of confirmed cases
Kogi - Least number of cases, 0.002%
Akwa Ibom - 1.8% of confirmed cases

6. EPIDEMIOLOGY:
Globally case fatality rate 2.2, compared to that of SARS and MERS which
was 10% and 34% respectively.
Africa, as of 9TH February, 2022; 12:35 GMT
- 11,010,622 confirmed cases
- 242,165 confirmed deaths
Nigeria, as of 10TH February, 2022; 15:57 GMT
- 253,875 confirmed cases
- 230,221 recovered
- 3,139 deaths
Case fatality rate: 1.2

7. EPIDEMIOLOGY:
Increased mortality rates have also been noted in those with
underlying co-morbidities. The most common reported
include:
• Hypertension (66%)
• Type 2 diabetes (29.8%)
• Ischaemic Heart disease (27.6%)
• Chronic renal failure(20.2%)

8. EPIDEMIOLOGY:
Most critical respiratory comorbidities according to the CDC
are:
• Moderate or severe Asthma
• Pre-existing COPD
• Pulmonary fibrosis
• Cystic fibrosis

9. PATHOHYSIOLOGY:

10. PATHOPHYSIOLOGY
TRANSMISSION:
- It is thought to occur through close range contact (within 6 ft or 2m)
via respiratory droplets when an infected person coughs, sneezes or
talks, OTHERWISE transmitted via aerosolized particles, bodily fluids
and faecal shedding.
- Family clustering
- Community transmission

11. PATHOPHYSIOLOGY
SARS CoV-2 Spike gp + ACE2 Receptors/TMPRSS2
Release of DAMP (ATP, nucleic acids etc) triggers cytokine release
Inflammatory response by T-cell, monocytes and macrophages
Immune dysregulation
Cytokine storm syndrome
MODs-thrombocytopenia+leukopenia+anemia

12. PATHOPHYSIOLOGY
Predisposing Factors to Symptomatic Presentation:
• Age related increase in endothelial damage and changes in clotting
function.
• Higher ACE-2 receptor/TMPRSS-2 densisty, affinity and difference in
distribution.
• Immunosenescence/immunocompromised status
• Higher prevelance of comorbidities
• Lower levels of vitamin-D

13. CLINICAL FEATURES
Incubation period 1 to 14 days
• 40% aymptomatic or presymptomatic
• Less pronounced in children
• Generally most commonly presenting symptoms:
- Fever & cough
In people without prior ENT disorders, anosmia combined
with ageusia is associated with COVID-19 with a specificity of
95%
• Others: GIT related, diarrhea, abdominal pain and/or
vomiting

14. CLINICAL FEATURES
Predictors of Severe Disease:
• Dyspnea: RR >50c/m in children aged 1 - 12 months
>40c/m in children 1 to 5 years
>30c/m in older than 5 years
• Persistent high grade fever
• Lethargy, altered mental status or deteriorating
consciousness
• Younger than 3 months
• Extrapulmonary complications

15. POST-ACUTE SEQUELAE
• As the COVID-19 pandemic has matured, more patients have
reported long term, post infection sequelae such as fatigue,
dyspnoea, cough, joint pain, and chest pain lasting weeks to
months after the acute illness.
• The UK National Institute for Healthcare and Excellence
(NICE) define the syndrome as signs and symptoms that
develop during or after an infection consistent with COVID-
19, continue for more than 12 weeks and are not explained
by an alternative diagnosis.

16. CASE DEFINITION:
Suspected Case
Any person presenting with fever, cough or difficulty in
breathing
AND
1. History of travel to any high risk country with widespread
community transmission
2. Close contact with a confirmed case
3.Exposure to health facility where COVID-19 cases have been
reported

17. CASE DEFINITION:
Probable case
Any suspected case
1. For whom COVID-19 is indeterminate
2. For whom testing was positive on a pan-coronavirus assay
3. Where samples were not collected before the demise of a
suspect case

18. CASE DEFINITION:
Confirmed case
Any person with laboratory confirmation of SARS-CoV-2
infection with or without signs or symptoms.

19. INVESTIGATIONS:
Viral nucleic acid tests via NAAT (PCR) GOLD STANDARD!
• In September 2020, WHO announced the emergency used
authorisation (EUA) of two antigen based rapid diagnostic
tests. Data showed both to have a sensitivity of >80% and
specificity of >97%.
• In the case where a person with symptoms or a high risk
contact of a positive case has a negative result, a PCR
confirmatory test should should follow to rule out COVID-19

20. INVESTIGATIONS:
Sputum/Throat swab M/C/S
FBC
CXR (Chest CT)
Others: Informed by clinical assessment

21. INVESTIGATIONS:
Predictors of severe disease:
- Cytopenias
- Elevated liver and cardiac enzymes
- Elevated LDH
- Metabolic acidosis
- Bilateral or multilobar infiltration, pleural effusion or
rapid progressive changes in a short time on CXR/Chest
CT.

22. TREATMENT
In general, adults with SARS-CoV-2 infection can grouped into
the following severity of illness categories which helps in
guiding treatment:
1. Asymptomatic or presymptomatic infection
2. Mild Illness
3. Moderate illness
4. Severe illness
5. Critical illness

23. TREATMENT
I. Asymptomatic patients or those with mild to
moderate disease without risk factors for poor
outcome may not require hospitalization and can
self isolate at home
II. In areas with endemic infections that cause fever
(such as malaria, dengue) febrile patients should
be tested and treated as they could be co-infected
III. Antipyretics for fever and pain

24. TREATMENT
IV. Adequate nutrition
V. Appropriate rehydration
VI. Close monitoring for any signs or symptoms of
deterioration in their health status by a trained health
worker.
VII. Patient should be counselled about signs and
symptoms of complications that should prompt urgent
care.

25. TREATMENT
• Same as for mild infection
• For patients at high risk for deterioration, isolation in hospital is
preferred
• Antibiotics should not be prescribed unless there is clinical
suspicion of a bacterial infection. However, empiric antibiotic may
be considered in older people especially those in long term care
facilities and in children <5years of age.
• Close monitoring of patients for signs and symptoms of disease
progression
• Provision of mechanisms for close follow up in case of escalation of
medical care should be available.

26. TREATMENT
SEVERE AND CRITICAL ILLNESSES:
• Management should be in the critical care unit
• Multidisciplinary approach
• High flow oxygen administration.
• Airway management and mechanical ventilation
• Extracorporeal membrane oxygenation
• Continuous monitoring of vital signs
• Cautious IVF administration
• Management of complications as they arise.

27. TREATMENT
Early in the course of the infection, COVID-19 is thought to be
primarily driven by replication of severe acute respiratory syndrome
SARS-CoV-2.
Later in the course of infection, the disease is driven by an
exaggerated immune/inflammatory response that leads to tissue
damage.
Based on this understanding , it is anticipated that antiviral
therapies would have the greatest effect early in the course of the
disease, while immunosuppressive/anti-inflammatory therapies are
likely to be more beneficial in the later stages of COVID-19

28. TREATMENT
MEDICATIONS :
• *Remdesivir, only approved
• Dexamethazone
• Ivermectin
• Azithromycin
• Lopinavir/ritonavir (Alluvia)
• Hydroxychloroquine/chloroquine

29. TREATMENT
However, published data by FDA and WHO found both to
have little or no effect on hospitalized patients with COVID-
19, as indicated by overall mortality, initiation of ventilation
and duration of hospital stay.

30. TREATMENT
Adjuvants:
• Antithrombotics
• Vitamin C
• Vitamin D
• Zinc Supplementation

31. TREATMENT
Discharge criteria
• Symptomatic
10 days after symptom onset, plus at least 3 days without
symptoms
• Asymptomatic
14 days after the initial positive result
The above is based on the premise that viral RNA detected
beyond 10 days is no longer infectious as there are not
viable.

32. TREATMENT
However, here in Akwa Ibom State, a
negative PCR test is required for discharge
from the COVID-19 pathway for all cases

33. OTHER VARIANTS OF INTEREST
WHO Label First Identified
Epsilon US
Delta India
Gamma Japan
Lota US
Kappa India
Zeta Brasil
Eta UK/Nigeria
Omicron South Africa

34. PREVENTION
VACCINATION:
• Pfizer-BioNTech: First COVID-19 vaccine to be authorised and cleared for
regular use. It has been shown to be 52% effective after the 1st dose and
over 90% effective after the 2nd dose.
• Moderna: The vaccine can provide 80.2% protection after one dose
compared to 95.6% after the second.
• Oxford-AstraZeneca: Efficacy stands at 64.1% after at least one standard
dose and 70.4% after two doses.
• Johnson and Johnson vaccine: A dose regimen is said to be 66% effective
in preventing symptomatic COVID-19 with an 85% efficacy in preventing
severe COVID-19

35. PREVENTION
Other Available Vaccines:
• Sputnik V
• SinoPharm
• Sinovac

36. PREVENTION
Vaccine Coverage:
• Globally over 10 billion doses given
• In Nigeria as at 10th February at least 20,617,588 (5.1% of
population) vacinnated.
• Independent Allocation of Vaccines Group (IAVG) of WHO advocates
70% coverage in all countries.

37. PREVENTION
Personal preventive measures
• Physical distancing
• Wearing of appropriate sized and well fitted facemasks
• Diligent hand-washing
• Respiratory hygiene
• Cleaning and disinfecting objects and surfaces that are frequently
touched

38. PREVENTION
Other public health measures:
• Aggressive case identification and isolation
• Contact tracing and quarantine
• Lock down, (partial or total)
• Travel restrictions with exit and/or entry screening

39. PREVENTION
Infection Control in the Healthcare Setting
• Screen and triage everyone entering a healthcare facility for signs and
symptoms of COVID-19.
• Wearing of facemask at all times by both patients, visitors and
healthcare workers
• Limiting visitors to only those essential for the patient’s physical and
emotional well being/care.
• Encourage and emphasize on physical distancing at all times

40. PREVENTION
Infection Control in the Healthcare Setting
• Implement universal use of personal protective equipment especially
in high risk situations like aerosol generating procedures
• Create a process of responding to SARS-CoV-2 exposures among
healthcare providers
• Encourage the use, whenever possible, of non-physical interface with
patients e.g. telemedicine
• Environmental disinfection

41. ROLE OF FAMILY PHYSICIAN
Most people with COVID-19 develop mild or uncomplicated illness that can be managed at
the primary care level; roles of the family physician may involve
• Identifying and triaging possible COVID-19 cases
• Making an early diagnosis
• Provision of home-based care where feasible
• Helping vulnerable people cope with their anxiety about the virus
• Reducing the demand for hospital services
• Advocacy for better policy advancing the fight against an evolving disease, COVID-19
(Provision of PPEs, Hand sanitizers, RDT kits at local level etc)
• Health promotion (Personal prevention measures)
• Public enlightment/awareness

42. ROLE OF FAMILY PHYSICIAN
The Main Principles of Primary Care in the COVID-19 Response are:
1. Maintain delivery of essential health services;
2. Identify and manage potential cases as soon as possible;
3. Avert the risk of transmission of infection to contacts and health-care
workers;
4. Enhance existing surveillance systems;
5. Strengthen risk communication and community Engagement; and
6. Support provision of vaccination services against SARS-CoV-2, the virus
that causes COVID-19.

43. CONCLUSION
Covid-19 is an evolving pandemic with spirally effects beyond health to
economic related challenges resulting in reccessions.
First line of management is prevention by observing basic hygiene
measures and VACCINATION.
The family physician must be armed with up-to-date measures in
rolling back the pandemic being among the foremost health care
service providers.

44. REFERENCES
• World Health Organization, United Nations Children's Fund. Guidance
on developing a national deployment and vaccination plan for COVID-
19 vaccines: interim guidance, 16 November 2020. Geneva: World
Health Organization; 2020.
(https://apps.who.int/iris/handle/10665/336603)
• National Centre for Disease Control. National Interim Guidelines for
Clinical Management of COVID-19. 2020.
Available@www.covid19.ncdc.gov.ng/media/files/. Accessed on
10/02/22
• Coronavirus Disease 2019
https://emedicine.medscape.com/article/25000114

45. THANK YOU