COVID 19

COVID-19, A GLOBAL NIGHTMARE KEY THINGS TO KNOW ABOUT THE CORONAVIRUS.

Points for discussion: Topics an ghlights How COVID started Important data Signs'ofinfection How to stay safe to do if inféCted 't VI-and more important points KEY THINGS TO KNOW ABOUT THE CORONAVIRUS in vaccine COVID-19, A GLOBAL NIGHTMARE.

How it started. About OV • Coronavirus (COV) also called (SARS-CoV-2 and COVID-19) • Derived from the Latin word 'coronal meaning 'crown'. • Single-stranded big, enveloped RNA viruses • Causes various gastrointestinal, neurological and respiratory tract infections in humans, ranging from a moderate cold to severe respiratory distress syndrome. • The most prevalent coronaviruses are 229E, OC43, NL63, and HKUI, which often induce common cold symptoms in immunocompetent patients. • The first coronavirus that caused serious disease was SARS, which was considered to have originated in Foshan, China, and culminated in the 2002-2003 SARS-CoV pandemic. • The second was the coronavirus-caused Middle East respirat rydisease (MERS), which emerged in 2012 from the Arabian Peninsula. • SARS-CoV-2 is the third coronavirus to produce serious sick ess in people during the last two decades and it began in Wuhan, China in December 2019. • SARS-CoV-2 include the delta and omicron variant. • Resulted in nearly 3 million fatalities worldwide (Umakantha et al., 2019). KEY THINGS TO KNOW ABOUT THE CORONAVIRUS COVID-19, A GLOBAL NIGHTMARE.

How the virus spreads • Zoonotic origin (bats, pangolins, and minks) but in other animals such as dogs, cats, chickens, cattle, pigs, and birds. • Predominantly propagated via human-to-human transmission • Transmission mechanisms include o coughing, o sneezing, o droplet inhalation o contact with oral, nasal, and ocular mucous membranes (Zhang et al., 2021; Shi et al., 2020; Wiersinga et al., 2020) KEY THINGS TO KNOW ABOUT THE CORONAVIRUS Land on Surface Noø. Finally Get in to Mouth 00 COVID-19, A GLOBAL NIGHTMARE.

Human respiratory system Non neutralizing Ciliated lung epitheleal cells antibodies could cause IL-6, TNFa IL-IO.IL-IB • and GMCSF ADE Raptured capillaries with protein exudates Obstructed airways due to COVID 19/ pneumonia 999999 9 SARS-CoV-2 ACE2 receptor SARS-CoV-2 infection leads to pyroptosis of lun e itheleal cells glass opacity N protein of SARS-CoV-2 activates complement leading to a cytokine storm Defective Alveolus gaseous exchange FCNI • inflammatory Alveolar Macrophages Carbondioxide Oxygen in Alveolar macrophages PMN infiltration Alveolus KEY THINGS TO KNOW ABOUT THE CORONAVIRUS • Delay Type 1 Interferon release • Fail to phagocytose virus infected cells • Secrete inflammatory cytokines leading to cytokine storm • Defficient antigen processing and T cell help • Fail to resolve inflammation and repair alveolar barrier • CD4• T cells secrete low levels IFNv •Chronic T cell activation and Pathophysiology of Covid- 19 Unclear but resembles SaRs pathophysiology The cytol<ine storm is a major contributor to both ARDS and extra-pulmonary organ failure (Shi et al., 2020 COVID-19, A GLOBAL NIGHTMARE.

Pathophysiology of Covid- SARS-CoV-2 ACE2 Host cells KEY THINGS TO KNOW ABOUT THE CORONAVIRUS Innate immunity Acquired immunity —•i)AMP-PRR— Th re MODS Cytokine storm protease, ROS, RNS Immunosuppre ssion-• seconda infection COVID-19, A GLOBAL NIGHTMARE.

Pathophysiology of Covid- Fever. Headache kegpiratory droplets containi SARS-CoV-2 Circulation system Blood Pressure Prefusion Acute respiratory distress syndrome Multi-organ falure SARS-CoV-2 Fluid accumulation Diffculity in breathing Host rOosmto RUA Conoescgnt SARS-CoV-2 APN-OI ACE Polypeptide chairz opnawr Kaletra Retndesivir. Avigan • Geoi ACE2 Nafarnostat TWRSS2 Alveolar cells Neurofil SepsWseptjc Shock MLX-organ ttoba.jrnao Deam Corticosteroids Anti-inflammato Replicase and RNA repbcaton Viral stradure Viral ao,ag KEY THINGS TO KNOW ABOUT THE CORONAVIRUS COVID-19, A GLOBAL NIGHTMARE.

Non specific symptoms Symptoms may appear 2-14 days after exposure to the virus. Some infected patients are asymptomatic Fever • Cough • Myalgia • Sore throat • Headache • Chills • Nausea • Vomiting • Diarrhoea • Ageusia • Conjunctival congestion KEY THINGS TO KNOW ABOUT THE CORONAVIRUS (Wiersinga et al., 2020) COVID-19, A GLOBAL NIGHTMARE.

Specific symptoms Critical COVID-19 Defined by the criteria for acute respiratory distress syndrome (ARDS), sepsis, septic shock, or other conditions that normally require life- sustaining therapies such as mechanical ventilation (invasive or non- invasive) or vasopressor therapy. Severe COVID-19 Defined by any of the oxygen saturation < 90% on room air; severe pneumonia; and signs of severe respiratory distress (in adults, accessory muscle use, inability to complete full sentences, respiratory rate > 30 breaths per minute; and, in children, very severe chest wall in- drawing, grunting, central cyanosis, or presence of any other general danger signs including an inability to breastfeed or drink, lethargy, convulsions or reduced level of consciousness). Non-severe COVID-19 Defined as the absence of any criteria for severe or critical COVID-19. (Wiersinga et al., KEY THINGS TO KNOW ABOUT THE CORONAVIRUS 2020) COVID-19, A GLOBAL NIGHTMARE.

Total cases in the world Total OH KEY THINGS TO KNOW ABOUT THE CORONAVIRUS ases Total vaccine administered As of March 7 2023 (WHO, 2023 COVID-19, A GLOBAL NIGHTMARE.

Total cases in the world Situation by WHO Region Weeny Deaths Europe Western Pacific Americas South-East Asia Eastern Mediterranean Africa may Oy ce 273,666,626 201,522,015 190,682,244 60,770,940 23,265,472 9,500,642 CORONAVIRUS 30 Se30 31 30 2020 2020 202 ' KEY THINGS TO KNOW ABOUT THE .1 Se 30 MY 3' 30 S" 30 202 ' 202 ' 2022 COVID-19, A GLOBAL NIGHTMARE.

Total cases in the world confirmed cases 30 2020 6,866,434 30 deaths S--OV*. day ce wee My 21 21 21 202 ' 202' s.0 30 202 t 202' 202 202 ' 20 20 20 20 2022 2022 KEY THINGS TO KNOW ABOUT THE CORONAVIRUS COVID-19, A GLOBAL NIGHTMARE.

Risk factors • Smoking, • Hypertension • Diabetes, • Cardiovascular disease • Chronic obstructive pulmonary disorder • Old age KEY THINGS TO KNOW ABOUT THE CORONAVIRUS COVID-19, A GLOBAL NIGHTMARE.

SARS-CoV-2 COVID-19 Tests collecti«t Serological test: NAAT•. EUSA •soy KEY THINGS TO KNOW ABOUT THE CORONAVIRUS Viral Tests NAAT, e.g. reverse transcription and real-time PCR of nasopharyngeal or oropharyngeal swabs Serological Tests Serological tests, e.g. ELISA and antibody detection of nasopharyngeal or oropharyngeal swabs Other test: Other Tests Imaging studies e.g. CT scan, MRI, chest x-ray Sensor e.g. temperature COVID-19, A GLOBAL NIGHTMARE.

COVID-19 Management The CARE Pathway by WHO Recording and reporting All COVID-19 treatments should be prescribed, completed or stopped under guidance of a health care professional. Adverse events (AE) should be reported through local or national reporting systems. KEY THINGS TO KNOW ABOUT THE CORONAVIRUS COVID-19, A GLOBAL NIGHTMARE.

Confirm Ensure prompt diagnosis of SARS-CoV-2 infection using a molecular (NAAT/PCR) or antigen-detection test (Ag-RDT). KEY THINGS TO KNOW ABOUT THE CORONAVIRUS COVID-19, A GLOBAL NIGHTMARE.

Assess symptoms, risk factors and severity Provide early clinical assessment and evaluation to determine if the patient has symptoms, emergency signs or risk factors that may warrant treatment, clinical referral or admission to hospital care. DISEASE SEVERITY Patients with Non-severe confrimed COVID-19 Absence of signs of severe or critical disease KEY THINGS TO KNOW ABOUT THE CORONAVIRUS Severe Oxygen saturation on room air Signs of pneumonia Signs of severe respiratory distress Critical Reguires life sustaining treatment Acute respiratory distress syndrome Sepsis Septic shock.

Respond with appropriate care and treatment Treatment selection is determined by severity of disease and risk factors. Non-severe (mild and moderate) without risk factors • Symptom management and supportive care • Monitoring (at home, or in the community) Non-severe(mild and moderate) with risk factors • Nimatrelvir/ritonavir (oral) or • Molnupiravir (oral, contraindicated in pregnant or breastfeeding women and children) • Remdesivir (intravenous) Moderate COVID-19 who do not require emergency interventions, consider intensified monitoring in case they deteriorate. This may include home pulse oximetry, telemedicine, and community outreach teams. KEY THINGS TO KNOW ABOUT THE CORONAVIRUS Remember the FIVE RIGHTS of drug administration: sc Oral RIGHT COVID-19, A GLOBAL NIGHTMARE.

Respond with appropriate care and treatment Treatment selection is determined by severity of disease and risk factors. Severe or critical • Symptom management and supportive care • Oxygen therapy in hypoxaemic patients • Corticosteroids (oral or intravenous) • Venous thromboembolism prophylaxis • Antiviral medication, ideally in combination: • Interleukin-6 receptor blocker (tocilizumab OR sarilumab) • Janus Kinase (JNK) Inhibitor (baricitinib) In severe (but not in critical) COVID-19, consider the use of remdesivir. Specific considerations in older people with COVID-19 should be: Reviewing medication prescriptions to minimize polypharmacy and potential for drug-drug interactions. Ensuring multidisciplinary collaboration to address multimorbidity functional decline. KEY THINGS TO KNOW ABOUT THE CORONAVIRUS the and Remember the FIVE RIGHTS of drug administration: sc Oral RIGHT COVID-19, A GLOBAL NIGHTMARE.

Evaluate clinical response and recovery All patients receiving COVID-19 treatment require clinical monitoring and follow up by a health care professional throughout their illness and recovery, including those who develop post-COVID-19 condition. Immediate medical re-evaluation if • emergency signs are present • sp02 Urgent medical re-evaluation if • sp02 falls to 90-94% • Symptoms worsen • Side-effects occur • Other concerns arise If being treated at home, patients and caregivers should be counselled on important signs and symptoms (including chest pain, fast or difficult breathing, fast heart rate, palpitations, confusion). If present or worsening, instruct patient or caregivers to call for emergency help according to national protocols. KEY THINGS TO KNOW ABOUT THE CORONAVIRUS COVID-19, A GLOBAL NIGHTMARE.

Infectious period and de-isolation • Check if you have the symptoms. • Stay home and get in touch with a doctor. • Self-isolate and take precautions and recommendations from your doctor. • Monitor your symptoms. • Stay away from others, especially those with higher risk of getting infected by COVID-19. 10 days of isolation for individuals who are symptomatic due to SARS-CoV-2 infection is recommended 5 days of isolation for individuals who are asymptomatic with SARS-CoV-2 infection is recommended KEY THINGS TO KNOW ABOUT THE CORONAVIRUS COVID-19, A GLOBAL NIGHTMARE.

Preventio n Vaccination remains the only effective measures Antimicrob als can be used for prophylaxis Hand hygiene Use soap and water or a hand sanitizer containing at least 60% alcohol. Social distance Avoid close contact with people maintaining a distance of at least 6 feet from people around you. Personal protective Wear a mask and face shield Protect others Cover your mouth when coughing and sneezing. Throw away used tissues and wash your hands immediately. Stay at home if sick KEY THINGS TO KNOW ABOUT THE CORONAVIRUS Isolate and treat infected persons COVID-19, A GLOBAL NIGHTMARE.

Potential Complications of COVID-19 Complications Most people who develop COVID-19 recover, but current evidence suggests approximately 100/6-200/0 of people experience a variety of mid and long-term effects after they recover from their initial illness. These mid and long-term effects are collectively known as post-COVID-19 conditions or "long COVID. KEY THINGS TO KNOW ABOUT THE CORONAVIRUS Neurologic Cerebrovascular Disorders Corticospinal Damage • Meningitis/Encephalitis Encephalopathy • Cognitive + Motor Deficits Systemic Acute Liver Failure • Acute Kidney Injury Cytokine Storm Secondary Infection • Septic Shock • • MIS-C Vascular Vasculitis • Endothelialitis • Cutaneous Erythema Chilblain-like lesions Urticaria-like lesions • Vesicular lesions • Cardiac • MI (Types 1 & 11) • Heart Failure • Viral Myocarditis • Stress Cardiomyopathy Arrhythmia Respiratory Pneumonia Dyspnoea Hematologic • Coagulopathy - DVT - DIC - Organ Thromboembol - Arterial emboli • Thrombocytopenia Post Covid-19 Symptoms Fatigue Shortness of breath or difficulty breathing Memory, concentration or sleep problems Persistent cough • Chest pain Trouble speaking Muscle aches Loss of smell or taste Depression or anxiety Fever COVID-19, A GLOBAL NIGHTMARE.

References. CDC (2021). Long COVID or Post-COVID Conditions. [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Dhar Chowdhury, S. and Oommen, A.M. (2020). Epidemiology of COVID-19. Journal of Digestive Endoscopy, [online] 11(01), pp.03–07. doi:https://doi.org/10.1055/s-0040-1712187. Maia, R., Carvalho, V., Faria, B., Miranda, I., Catarino, S., Teixeira, S., Lima, R., Minas, G. and Ribeiro, J. (2022). Diagnosis Methods for COVID-19: A Systematic Review. Micromachines, [online] 13(8), p.1349. doi:https://doi.org/10.3390/mi13081349. Shi, Y., Wang, G., Cai, X., Deng, J., Zheng, L., Zhu, H., Zheng, M., Yang, B. and Chen, Z. (2020). An overview of COVID-19. Journal of Zhejiang University-SCIENCE B, [online] 21(5), pp.343–360. doi:https://doi.org/10.1631/jzus.b2000083. Umakanthan, S., Sahu, P., Ranade, A.V., Bukelo, M.M., Rao, J.S., Abrahao-Machado, L.F., Dahal, S., Kumar, H. and Dhananjaya, K. (2019). Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). BMJ journals. [online] doi:https://doi.org/10.1136/postgradmedj-2020-138234. WHO (2021). Coronavirus disease (COVID-19): Post COVID-19 condition. [online] www.who.int. Available at: https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-post-covid-19-condition?gclid=Cj0KCQiAgaGgBhC8ARIsAAAyLfFJXWCIX_sl1sCIU2rYU-NGrL0qPKxQqiot0COevq40g5NOAfVNDiMaAkWbEALw_wcB [Accessed 8 Mar. 2023]. WHO (2022). COVID-19 Clinical Care Pathway. [online] www.who.int. Available at: https://www.who.int/tools/covid-19-clinical-care-pathway. WHO (2023). Q&A Detail. [online] Who.int. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-%28covid-19%29-variants-of-sars-cov-2?gclid=Cj0KCQiAgaGgBhC8ARIsAAAyLfFH5ZNOLZaMgifAvgRz70efYtSlNw7vLqvLMjYOMm-fO7Nx_zo-tsIaAorgEALw_wcB [Accessed 8 Mar. 2023]. Wiersinga, W.J., Rhodes, A., Cheng, A.C., Peacock, S.J. and Prescott, H.C. (2020). Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA, [online] 324(8). doi:https://doi.org/10.1001/jama.2020.12839. Zhang, Y., Su, L., Chen, Y., Yu, S., Zhang, D., Mao, H. and Fang, L. (2021). Etiology and clinical characteristics of SARS-CoV-2 and other human coronaviruses among children in Zhejiang Province, China 2017–2019. Virology Journal, 18(1). doi:https://doi.org/10.1186/s12985-021-01562-8..

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