COVID-19 College Notes PDF

COVID-19 Pandemic declaration On March 11, 2020, the World Health Organization (WHO) characterized COVID-19 as a pandemic. It has caused severe illness and death. It features sustained person-to-person spread worldwide. It poses an especially high risk for the elderly (60 or older),...

COVID-19 Pandemic declaration On March 11, 2020, the World Health Organization (WHO) characterized COVID-19 as a pandemic. It has caused severe illness and death. It features sustained person-to-person spread worldwide. It poses an especially high risk for the elderly (60 or older), people with pre- existing health conditions such as high blood pressure, heart disease, lung disease, diabetes, autoimmune 2 disorders, and certain workers. What is SARS-CoV-2? SARS-CoV-2 is the virus that causes coronavirus disease 2019 (COVID-19) SARS = severe acute respiratory distress syndrome Spreads easily person-to- person Little if any immunity in humans Detailed information: https://www.cdc.gov/coronavirus/2019-ncov/in dex.html 3 Human coronaviruses were first identified in the mid-1960s. The seven coronaviruses that can infect people are: Common human coronaviruses 1.229E (alpha coronavirus) 2.NL63 (alpha coronavirus) 3.OC43 (beta coronavirus) 4.HKU1 (beta coronavirus) Other human coronaviruses 5.MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS) 6.SARS-CoV (the beta coronavirus that causes severe acute respiratory syndrome, or SARS) 7.SARS-CoV-2 (the novel coronavirus that causes coronavirus disease 2019, or CO VID-19 ) Corona virussen People around the world commonly get infected with human coronaviruses 229E, NL63, OC43, and HKU1. Sometimes coronaviruses that infect animals can evolve (antigenic shift!) and become a new (potentially dangerous) human coronavirus. Three recent examples of this are 2019-nCoV, SARS- CoV, and MERS-CoV. Recently evolved Human Corona viruses MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS) SARS-CoV (the beta coronavirus that causes severe acute respiratory syndrome, or SARS) SARS-CoV-2 (the novel coronavirus that causes coronavir us disease 2019, or COVID-19 )  Corona virussen (+)ssRNA : Single strand positive sense RNA (is tegelijkertijd mRNA). Ribosomen in het cytoplasma van de gastheercel produceren de eiwitten die dit mRNA coderen. Virussen gebruiken dus de gastheercel-organen om te repliceren. The virus gets its genetic material inside and hijacks its host's cellular machinery to help it reproduce by multiplying the virus' genetic material and proteins Transmission COVID-19 is spread Droplet - respiratory secretions from person to from coughing or sneezing person mainly landing on mucosal surfaces (nose, mouth, and eyes) through coughing, Aerosol - a solid particle or sneezing, and liquid droplet suspended in talking and air breathing. Contact -Touching something with SARS-2 virus on it and then touching mouth, nose or eyes Other possible routes: Through fecal matter 9 Respirators Respirators are needed when there is a potential for aerosol transmission. An N95 respirator is the minimum level of protection to prevent inhaling coronavirus. 10 Respirators (continued) Surgical masks are not respirators! Surgical masks do not: Fit tightly against the skin to form a seal Filter tiny particles, such as viruses or bacteria that are in the air But they do limit transmission in not highly contaminated areas! 11 Incubation period The incubation period is the time between exposure to a virus and the onset of symptoms. With COVID-19, symptoms may show 2-14 days after exposure. CDC indicates that people are most contagious when they are the symptomatic. Several studies show people may be contagious already 2 days before developing symptoms. 12 COVID-19 can cause mild to severe symptoms Other symptoms may include: Most common symptoms Sore throat include: Runny or stuffy nose Fever Body aches Cough Headache (Severe) shortness of Chills Fatigue breath Gastrointestinal: diarrhea, nausea Loss of smell and taste 13  Severe symptoms – emergency warning signs for COVID-19 Most people will have mild symptoms and should recover at home and NOT go to the hospital or emergency room. Get medical attention immediately if you have: Difficulty breathing or shortness of breath. Persistent pain or pressure in the chest. New confusion or inability to arouse. Bluish lips or face. 14 What is a person under investigation? A person who has both consistent signs or symptoms and risk factors as follows: A potential exposure within 14 days before Suspect the onset of symptoms. Case Symptoms, including cough, fever, and shortness of breath. 15 Confirmed case A confirmed case is a suspect case with laboratory-confirmed diagnostic evidence of SARS-CoV-2 virus infection. (a PCR or antigen test of a swab) U.S. Centers for Disease Control and Prevention via AP 16 Suriname (in de piekfase van de pandemie) Keuze om: Suspected cases individueel te isoleren tot de diagnose bevestigd is, of de quarantaineperiode is afgelopen Confirmed mild or asymptomatic cases in cohort isolatie te plaatsen Severe cases in cohort ziekenhuisfaciliteiten te plaatsen  How long does SARS-CoV-2 survive outside of the body? It is not clear yet how long the coronavirus can live on surfaces, but it seems to behave like other coronaviruses. Virus may persist on surfaces for a few hours or up to several days, depending on conditions and the type of surface. It is likely that it can be killed with a simple disinfectant There are ongoing investigations to learn more. 18 Increased risk of severe illness COVID-19 poses a greater risk for severe illness for people with underlying health conditions: Heart disease Lung disease such as asthma Diabetes Suppressed immune systems The elderly have higher rates of severe illness from COVID-19. Children and younger adults have had less severe illness and death. Because COVID-19 is new, there are a lot of scientific unknowns such as the impact on pregnant women and their fetuses. 19 Seasonal flu vs. COVID-19 COVID-19 has the potential to cause more deaths and hospitalizations SARS-CoV-2 is much more infectious and spreads faster than the seasonal flu 20 Seasonal flu vs. COVID-19 So far, the case fatality rate (CFR) of COVID-19 is estimated to be at around 2%. The CFR of seasonal influenza is estimated to be around 0.1%, making SARS- CoV-2 about 20 times more deadly than the seasonal flu. An estimated 15-20% of infected individuals may suffer from severe symptoms that require medical attention, including pneumonia with shortness of breath and lowered blood oxygen saturation. No Treatment Immunity: unknown how long it will last post illness or vaccination. 21 Immunity post infection or post vaccination Zowel na vaccinatie als na infectie wordt de duur van de immuniteit (tegen ernstige symptomen) geschat op 3 – 6 maanden) Dat is de reden waarom er booster vaccinaties worden aanbevolen. Boostervaccinaties worden doorgaans zes maanden na de laatste infectie of vaccinatie gegeven. Pandemic influenza Experts have been recommending preparedness, warning about the likelihood of future pandemic influenza outbreaks for decades. Flu pandemic fatalities, worldwide, in the last century: 1918 – between 40 and 100 million 1957 – 2 million 1968 – 1 million COVID-19 6.64 million 23 STOP shaking hands! 24 Treatment There is no confirmed treatment available for CoVID-19! There are some options that modify disease: Fraxiparin for seriously ill patients (increased coagulation) Dexamethason (reduces inflammation) Convalescent serum ( conflicting results) Molnupiravir/Nirmatrelvir: if started within 5 days of infection and continued for 5 days, reduces the frequency of serious symptoms (Recommended only for people with high risk of progressing to serious illness) Vaccination! But why? Waarom een Covid-19 vaccin? Vatbaarheid van de populatie. Wachten op natuurlijke immuniteit van de populatie heeft onacceptabele maatschappelijke consequenties: Hoge (onaanvaardbare) case fatality rate onder kwetsbare populatie Disease burden heeft grote consequenties voor de gezondheidszorg: overmatige belasting van de ziekenhuiszorg en mede daardoor verwaarlozing van andere pathologie door ‘afschalen’ Bovendien: duur van bescherming door natuurlijk verworven immuniteit is beperkt.  Soorten vaccins Levende (verzwakte) micro-organismen (gele koorts) Geïnactiveerde (dode) vaccins (Hepatitis A, Polio, Rabies) Ex vivo gesynthetiseerde immunogene onderdelen van het pathogeen (Hepatitis B, middels recombinant DNA technieken geproduceerd in een schimmel) In vivo translatie van mRNA door: Toedienen van mRNA dat codeert voor het immunogene eiwit Toedienen van apathogene DNA virusssen waar de mRNA code voor translatie naar het immunogene eiwit in het virale DNA is ingebouwd.  Bekende Risico’s van vaccinatie Algemeen: locale ontstekingsreactie (pijn, zwelling roodheid), malaise, koorts, allergische reacties. Levend verzwakte virussen kunnen met name bij een verzwakte afweer leiden tot een infectie leiden (MMR, gele koorts) Geïnactiveerde vaccins geven doorgaans kortdurende bescherming Bij in ‘vivo translatie vaccins’ is er geen sprake van ‘genetische manipulatie’ daar het genetisch material niet in het humane genoom kan worden opgenomen.  Corona virussen (+)ssRNA : Single strand positive sense RNA (is tegelijkertijd mRNA). Ribosomen in het cytoplasma van de gastheercel produceren de eiwitten die dit mRNA coderen. Virussen gebruiken dus de gastheercel-organen om te repliceren. mRNA vaccins Bij het mRNA vaccin wordt echter niet het gehele genoom gebruikt, waardoor er niet een geheel virus kan worden gemaakt: slechts het deel dat de code voor het ‘spike protein’ bevat, wordt nagemaakt. Aan het mRNA worden Nanoparticles (lipiden, ter preventie van afbraak voor het in de cel terecht komt) en een adjuvans (om de immunogeniciteit te bevorderen) gekoppeld. Genetische manipulatie? Genetic manipulation is the direct manipulation of an organism's genes using biotechnology. Het is dus niet juist om bij mRNA vaccins van genetische manipulatie te spreken, want mRNA kan niet in het humane genoom worden opgenomen; het komt niet eens in de celkern terecht.  Wat doet het mRNA vaccin van Pfizer - Biontech? Induceert 3 – 6 maal hogere VNT, 7 dagen na 2e dosis (21 d) vergeleken met conconvalescent serum. Significante cytokine respons (IFNϒ, TNF, IL1ß, 2, 12) van CD4+ en CD8+ lymfocyten. Vaccinatie strategie: Wie als eerste? Sterfte reduceren?: Kwetsbare groepen eerst (ouderen, comorbiditeiten) Zorginfarct voorkomen?: Gezondheidswerkers Transmissie reduceren?: Mensen tussen 20 en 40 jaar Huidige stand van zaken Aantal infecties is sterk afgenomen door haard immuniteit en door vaccinatie. Ongevaccineerde risicogroepen lopen nog steeds risico op ernstige symptomen. Er worden nog sporadisc patienten opgenomen, Infectiepreventie is nog steeds de way to go Suriname heeft nog steeds een vaccinatie graad < 60%!  Take Home Messages Bestaande vaccins beschermen tegen ziekte, wat een impact kan hebben op sterfte en voorkomen daardoor ontwrichting van de gezondheidszorg. Geen redenen om aan te nemen dat de in vivo translatie vaccins (mRNA en DNA) ‘gevaarlijk’ zijn. Het is nog onduidelijk of vaccinatie een impact heeft op de transmissie van het virus. ‘Emerging strains’ vormen op termijn mogelijk een beperking voor de universele bruikbaarheid van de huidige vaccins.