COVID-19 Pneumonia Transmission PDF

COVID 19 PNEUMONIA - Clinical findings of MERS are similar to those of SARS - Causative agent: CORONAVIRUS under the family CORONAVIRIDAE CORONAVIRUS - Enveloped, helica...

COVID 19 PNEUMONIA - Clinical findings of MERS are similar to those of SARS - Causative agent: CORONAVIRUS under the family CORONAVIRIDAE CORONAVIRUS - Enveloped, helical - No segmented, (+) ssRNA - Prominent club shaped spikes from “corona” (halo) - Two serotypes: 229E and OC43 TRANSMISSION: Respiratory Droplets RESERVOIR: Horseshoe Bat Immediate Host: Civet Cat COMMON COLDS - Coronavirus is second to RHINOVIRUS as the BRIEF HISTORY most common cause of common colds - Covid 19 pandemic has exploded since cases were first reported in China in December 2019 2nd Disorder Caused by Coronavirus - Cases have been reported in more than 180 countries including the Philippines SEVERE ACUTE RESPIRATORY SYNDROME (SARS) - Incubation period: 2-10 days (mean, 5 days) BACKGROUND - Receptor for SARS-CoV on surface of cells is angiotensin-converting enzyme-2 (ACE-2) - The novel coronavirus, SARS CoV, first isolated in - Binding of the virus to ACE-2 on the surface of Wuhan City, Hubei Province in China last respiratory tract epithelium dysregulation of December 2019, has caused a global pandemic fluid balance alveolar edema with staggering speed. - Severe atypical pneumonia rapidly progressing to - The situation in the Philippines has also rapidly ARDS evolved, with a single case identified last January - Leukopenia and thrombocytopenia 20, 2020, to over 200 cases by March 16, 2020. - CXR: Interstitial “ground-glass” infiltrates that DO - As of July 2020, the country has more than NOT cavitate 60,000 reported cases with more than 1,000 deaths. MIDDLE EAST RESPIRATORY SYNDROME (MERS) - MERS-CoV binds to CD-26 on the respiratory mucosa (not ACE-2) DE LEON, RTRP 1  CLINICAL PRESENTATION ROUTES OF SARS-CoV TRANSMISSION - Estimated incubation period for COVID-19 is up - Transmission of SARS-CoV occurs primarily to 14 days from the time of exposure through RESPIRATORY SECRETIONS - Median incubation period of 4 to 5 days (RESPIRATORY DROPLETS), and to a lesser extent, contact with contaminated surfaces SYMPTOMS: - Fever - Cough PATHOGENESIS OF COVID-19 FROM A CELL BIOLOGY - Shortness of breath PERSPECTIVE - Muscle aches - Headaches OTHER REPORTED SYMPTOMS: - Diarrhea - Dizziness - Rhinorrhea - Anosmia - Dysgeusia - Sore throat - Abdominal pain - Anorexia - Vomiting TESTING OF SARS-CoV INFECTION CLINICAL MANIFESTATIONS 1. VIROLOGIC TESTING FOR SARS-COV INFECTION - Virologic testing (molecular diagnostic or antigen test to detect SARS-CoV-2) should be done in all persons with a syndrome consistent with COVID- 19 and in people with known high-risk exposures. - Most common symptom: FEVER DE LEON, RTRP 2 2. SEROLOGIC (OR ANTIBODY) TESTING FOR - Commercially available rapid antigen test report DIAGNOSIS OF SARS-COV a sensitivity of 87% (95% Cl 52.9 to 97.8) and a - Serologic tests are intended to identify persons specificity of 100% (95% Cl 96.8 to 100) based on with recent or prior SARS-CoV-2 infection a small study using direct nasal swabs from - It may take 21 days or longer after symptom nset sequentially enrolled patients compared to SARS for seroconversion or detection of IgM and/or CoV-2 extracted RT-PCR assay IgG antibodies to SARS-CoV-2 5. ANCILLARY TESTS - Complete blood count (CBC) - Metabolic panel: creatinine, LFTs, sodium, potassium, magnesium, calcium, albumin - Inflammatory markers: lactate dehydrogenase (LDH), Ferritin, C-reactive protein (CRP), and Procalcitonin - Prothrombin and D-Dimer - Arterial Blood Gas measurement (ABG) - Blood cultures if concominant bacterial infection is supected - Respiratory tract specimen for influenza testing - Sputum, endotracheal aspirate (ETA), or bronchoalveolar lavage fluid culture and sensitivity - chest x-ray 3. REAL-TIME REVERSE TRANSCRIPTION-POLYMERASE - high resolution chest CT scan plain CHAIN REACTION (RT-PCR) ASSAY - ECG - Currently recommended test to confirm COVID- 19 infection - SARS CoV-2 can be detected in nasal or pharyngeal samples, sputum, bronchoalvealar lavage fluid, and other bodily fluids, including feces and blood - In a study of 1078 specimens collected from 205 patients with confirmed COVID-19 infection, RT- PCR positivity was highest according to this manner ▪ Bronchoalveolar lavage specimens (93%) ▪ Sputum (72%) ▪ Nasal swab (63%) ▪ Pharyngeal swab (32%) ▪ Feces (29%) ▪ Blood (1%) 4. RAPID ANTIGEN SWAB TEST - Detects the presence of viral proteins (antigens) expressed by the COVID-19 virus in a sample from the respiratory tract of a person Absolute Lymphocyte Count: WBC count x 1000 x % lymphocyte in WBC DE LEON, RTRP 3 CHEST CT as a screening tool for COVID-19 in unrelated patients and asymptomatic subjcets without contact history is unjustified According to Wei Hong Liu et.al., - Chest CT to screen COVID-19 may not be sensitive. Initial reports have been focused on severe patients and reprted high chest CT positive rate. For milder cases. The chest CT positive rate will be much lower - “screening for COVID-19 should focus on the contact history, symptoms, pathogenic evidence, and early isolation for suspected cases.” - “There is no scientific evidence to recommed the use of chest CT as a screening tool for asymptomatic subjects without contact history.” Examples of Ct scan findings of COVID-19 Pneumonia: DE LEON, RTRP 4  TREAMENT SUPPORATIVE THERAPY - Give supplemental O2 therapy and target SpO2>92% - Use HFNC (high-flow nasal cannula at 40-60 lpm) overlapped with surgical mask and non-invasive positive pressure ventilation (NIPPV) should be given to a patient in a single negative pressure room with the healthcare worker wearing complete PPE. - Compute for ROX INDEX: (SpO2/FiO2)/RR - To maintain ROX Index at >4.88 – maintain O2 support ▪ Perform intubaton when ROX value: ▪