Sars Covid by Dr.Manoj.pptx
Download as PPTX, PDF0 likes45 views
At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread globally, resulting in an ongoing pandemic. Coronaviruses can cause illnesses ranging from common cold to more severe respiratory diseases. This particular virus is designated SARS-CoV-2 and causes the disease COVID-19. Symptoms include fever, cough and shortness of breath. Diagnosis is made through PCR testing of respiratory samples. Treatment is supportive and includes oxygen supplementation. Several investigational agents are being studied but no proven treatments currently exist.
![ Viral RNA levels appear to be higher soon after symptom onset compared
with later in the illness [15]; this raises the possibility that transmission
might be more likely in the earlier stage of infection, but additional data
are needed to confirm this hypothesis.](https://image.slidesharecdn.com/sarscovidbydr-220919162940-2397b7bc/85/Sars-Covid-by-Dr-Manoj-pptx-10-320.jpg)
![ Residence in or travel to areas where widespread community transmission
has been reported (eg, China, South Korea, most of Europe [including
Italy], Iran, Japan).
●Potential exposure through attendance at events or spending time in
specific settings where COVID-19 cases have been reported](https://image.slidesharecdn.com/sarscovidbydr-220919162940-2397b7bc/85/Sars-Covid-by-Dr-Manoj-pptx-28-320.jpg)
![ In the United States, the CDC recommends collection of a nasopharyngeal
swab specimen to test for SARS-CoV-2 [64]. An oropharyngeal swab can
be collected but is not essential; if collected, it should be placed in the
same container as the nasopharyngeal specimen. Sputum should only be
collected from patients with productive cough; induction of sputum is not
indicated.](https://image.slidesharecdn.com/sarscovidbydr-220919162940-2397b7bc/85/Sars-Covid-by-Dr-Manoj-pptx-29-320.jpg)
![ Chloroquine/hydroxychloroquine – Both chloroquine and
hydroxychloroquine inhibit SARS-CoV-2 in vitro, although
hydroxychloroquine appears to have more potent antiviral activity [78]. A
number of clinical trials are underway in China to evaluate the use of
chloroquine or hydroxychloroquine for COVID-19](https://image.slidesharecdn.com/sarscovidbydr-220919162940-2397b7bc/85/Sars-Covid-by-Dr-Manoj-pptx-40-320.jpg)
Sars Covid by Dr.Manoj.pptx
- 1. THE 2019 NOVEL CORONAVIRUS OUTBREAK DR.MANOJ ARYAL RESIDENT INTERNAL MEDICINE
- 2. Coronaviruses are important human and animal pathogens that can cause diseases ranging from the common cold to more severe and even fetal respiratory infections. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread, resulting in an epidemic throughout China, followed by an increasing number of cases in other countries throughout the world.
- 3. Evidence indicates that substantial similarities exits between severe acute respiratory syndrome and covid-19.A recent study reported a 79.5% genome sequence identity between SARS-cov-2 and SARS COV-1.
- 4. Correct slide Coronavirus Cases: 230,718 view by country Deaths: 9,390 Recovered: 86,261
- 6. In February 2020, the World Health Organization designated the disease COVID-19, which stands for coronavirus disease 2019 . The virus that causes COVID-19 is designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); previously, it was referred to as 2019-nCoV.
- 7. EPIDEMIOLOGY Geographic distribution — Since the first reports of cases from Wuhan, a city in the Hubei Province of China, at the end of 2019, more than 80,000 COVID-19 cases have been reported in China. Increasing numbers of cases have also been reported in other countries across all continents except Antarctica, and the rate of new cases outside of China has outpaced the rate in China. These cases initially occurred mainly among travelers from China and those who have had contact with travelers from China . However, ongoing local transmission has driven smaller outbreaks in some locations outside of China, including South Korea, Italy, Iran, and Japan, and infections elsewhere have been identified in travelers from those countries .
- 8. Transmission Person-to-person spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur mainly via respiratory droplets, resembling the spread of influenza.
- 9. With droplet transmission, virus released in the respiratory secretions when a person with infection coughs, sneezes, or talks can infect another person if it makes direct contact with the mucous membranes; infection can also occur if a person touches an infected surface and then touches his or her eyes, nose, or mouth. Droplets typically do not travel more than six feet (about two meters) and do not linger in the air
- 10. Viral RNA levels appear to be higher soon after symptom onset compared with later in the illness [15]; this raises the possibility that transmission might be more likely in the earlier stage of infection, but additional data are needed to confirm this hypothesis.
- 11. VIROLOGY Full-genome sequencing and phylogenic analysis indicated that the coronavirus that causes COVID-19 is a betacoronavirus in the same subgenus as the severe acute respiratory syndrome (SARS) virus (as well as several bat coronaviruses). Positive sense,single strandard RNA virus
- 12. The structure of the receptor-binding gene region is very similar to that of the SARS coronavirus, and the virus has been shown to use the same receptor, the angiotensin-converting enzyme 2 (ACE2), for cell entry . The Coronavirus Study Group of the International Committee on Taxonomy of Viruses has proposed that this virus be designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
- 13. Spectrum of illness severity In a study describing 138 patients with COVID-19 pneumonia in Wuhan Mild (no or mild pneumonia) was reported in 81 percent. Severe disease (eg, with dyspnea, hypoxia, or >50 percent lung involvement on imaging within 24 to 48 hours) was reported in 14 percent. Critical disease (eg, with respiratory failure, shock, or multiorgan dysfunction) was reported in 5 percent. The overall case fatality rate was 2.3 percent; no deaths were reported among noncritical cases.
- 14. Impact of Age In several cohorts of hospitalized patients with confirmed COVID-19, the median age ranged from 49 to 56 years . In a report from the Chinese Center for Disease Control and Prevention that included approximately 44,500 confirmed infections, 87 percent of patients were between 30 and 79 years old . Older age was also associated with increased mortality, with a case fatality rate of 8 and 15 percent among those aged 70 to 79 years and 80 years or older, respectively.
- 15. Clinical manifestations Initial presentation — Pneumonia appears to be the most frequent serious manifestation of infection, characterized primarily by fever, cough, dyspnea, and bilateral infiltrates on chest imaging . There are no specific clinical features that can yet reliably distinguish COVID-19 from other viral respiratory infections.
- 16. In a study describing 138 patients with COVID-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were Fever in 99 percent Fatigue in 70 percent Dry cough in 59 percent Anorexia in 40 percent Myalgias in 35 percent Dyspnea in 31 percent
- 17. Other, less common symptoms have included headache, sore throat, anosmia and rhinorrhea. In addition to respiratory symptoms, gastrointestinal symptoms (eg, nausea and diarrhea) have also been reported in some patients, but these are relatively uncommon.
- 19. Acute respiratory distress syndrome (ARDS) is a major complication in patients with severe disease. In the study of 138 patients described above, ARDS developed in 20 percent after a median of eight days, and mechanical ventilation was implemented in 12.3 percent . In another study of 201 hospitalized patients with COVID-19 in Wuhan, 41 percent developed ARDS; age greater than 65 years, diabetes mellitus, and hypertension were each associated with ARDS . Other complications have included arrhythmias, acute cardiac injury, and shock. In one study, these were reported in 17, 7, and 9 percent, respectively .
- 20. Laboratory findings In patients with COVID-19, the white blood cell count can vary. Leukopenia, leukocytosis, and lymphopenia have been reported, although lymphopenia appears most common . Elevated lactate dehydrogenase and ferritin levels are common, and elevated aminotransferase levels have also been described. High D-dimer levels and more severe lymphopenia have been associated with mortality
- 21. Imaging findings Chest CT in patients with COVID-19 most commonly demonstrates ground-glass opacification with or without consolidative abnormalities, consistent with viral pneumonia . Case series have suggested that chest CT abnormalities are more likely to be bilateral, have a peripheral distribution, and involve the lower lobes. Less common findings include pleural thickening, pleural effusion, and lymphadenopathy
- 22. 79-year-old woman who presented with fever, dry cough, and chest pain for 3 days. Her husband and daughter-in-law had been recently diagnosed with coronavirus disease 2019 (COVID-19). Patient expired 11 days after admission (Courtesy of Song F, Shanghai Public Health Clinical Center, Shanghai, China) A, Axial (A) and coronal (B) CT images show multiple patchy, peripheral, bilateral areas of ground-glass opacity.
- 23. 79-year-old woman who presented with fever, dry cough, and chest pain for 3 days. Her husband and daughter-in-law had been recently diagnosed with coronavirus disease 2019 (COVID-19). Patient expired 11 days after admission (Courtesy of Song F, Shanghai Public Health Clinical Center, Shanghai, China) B, Axial (A) and coronal (B) CT images show multiple patchy, peripheral, bilateral
- 24. 47-year-old Chinese man with 2-day history of fever, chills, productive cough, sneezing, and fatigue who presented to emergency department. (Courtesy of Liu M, China-Japan Friendship Hospital, Beijing, China) A, Initial CT images obtained show small round areas of mixed ground-glass opacity and consolidation (rectangles) at at level of aortic arch (A) and ventricles (B) in right and left lower lobe posterior zones.
- 26. EVALUATION AND DIAGNOSIS At present, the possibility of COVID-19 should be considered primarily in patients with fever and/or respiratory tract symptoms (eg, cough, dyspnea) who have had any of the following in the prior 14 days:
- 27. Close contact with a confirmed or suspected case of COVID-19, including through work in health care settings. Close contact includes being within approximately six feet (about two meters) of a patient for a prolonged period of time while not wearing personal protective equipment or having direct contact with infectious secretions while not wearing personal protective equipment.
- 28. Residence in or travel to areas where widespread community transmission has been reported (eg, China, South Korea, most of Europe [including Italy], Iran, Japan). ●Potential exposure through attendance at events or spending time in specific settings where COVID-19 cases have been reported
- 29. In the United States, the CDC recommends collection of a nasopharyngeal swab specimen to test for SARS-CoV-2 [64]. An oropharyngeal swab can be collected but is not essential; if collected, it should be placed in the same container as the nasopharyngeal specimen. Sputum should only be collected from patients with productive cough; induction of sputum is not indicated.
- 30. SARS-CoV-2 RNA is detected by reverse-transcription polymerase chain reaction (RT-PCR). A positive test for SARS-CoV-2 confirms the diagnosis of COVID-19. If initial testing is negative but the suspicion for COVID-19 remains, the WHO recommends resampling and testing from multiple respiratory tract sites . The accuracy and predictive values of SARS-CoV-2 testing have not been systematically evaluated. Negative RT-PCR tests on oropharyngeal swabs despite CT findings suggestive of viral pneumonia have been reported in some patients who ultimately tested positive for SARS-CoV-2
- 32. Rapid diagnostic test Antigen/Antibody test.
- 33. MANAGEMENT Site of care Home care — Home management is appropriate for patients with mild infection who can be adequately isolated in the outpatient setting . Management of such patients should focus on prevention of transmission to others and monitoring for clinical deterioration, which should prompt hospitalization.
- 34. Hospital care — Some patients with suspected or documented COVID-19 have severe disease that warrants hospital care. Patients with severe disease often need oxygenation support. High-flow oxygen and noninvasive positive pressure ventilation have been used, but the safety these measures is uncertain, and they should be considered aerosol- generating procedures that warrant specific isolation precautions. Some patients may develop acute respiratory distress syndrome and warrant intubation with mechanical ventilation; extracorporeal membrane oxygenation may be indicated in patients with refractory hypoxia
- 35. Supportive therapy Vitals signs and oxygen saturation should be monited regularly,supportive treatment strengthened , sufficient calories provided, and the stability of the internal environment,such as water ,electrolyte and acid-base balance maintained.The intake and output volumes should be strictly balanced.
- 36. Limited role of glucocorticoids The WHO and CDC recommend glucocorticoids not be used in patients with COVID-19 pneumonia unless there are other indications (eg, exacerbation of chronic obstructive pulmonary disease) . Glucocorticoids have been associated with an increased risk for mortality in patients with influenza and delayed viral clearance in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Although they were widely used in management of severe acute respiratory syndrome (SARS), there was no good evidence for benefit, and there was persuasive evidence of adverse short- and long-term harm
- 37. Investigational agents A number of investigational agents are being explored for antiviral treatment of COVID-19
- 38. Remdesivir – Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 . Remdesivir is a novel nucleotide analogue that has activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies Any clinical impact of remdesivir on COVID-19 remains unknown.
- 39. Compassionate Use of Remdesivir for Patients with Severe Covid-19 In this cohort of 61 patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.)
- 40. Chloroquine/hydroxychloroquine – Both chloroquine and hydroxychloroquine inhibit SARS-CoV-2 in vitro, although hydroxychloroquine appears to have more potent antiviral activity [78]. A number of clinical trials are underway in China to evaluate the use of chloroquine or hydroxychloroquine for COVID-19
- 41. Lopinavir-ritonavir – This combined protease inhibitor, which has primarily been used for HIV infection, has in vitro activity against the SARS-CoV and appears to have some activity against MERS-CoV in animal studies . The use of this agent for treatment of COVID-19 has been described in case reports , but its efficacy is unclear. In one report of five patients who were treated with lopinavir-ritonavir, three improved and two had clinical deterioration; four had gastrointestinal side effects. It is being evaluated in larger randomized trials.
- 42. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19 In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit
- 43. Tocilizumab – Treatment guidelines from China's National Health Commission include the IL-6 inhibitor tocilizumab for patients with severe COVID-19 and elevated IL-6 levels; the agent is being evaluated in a clinical trial
- 44. Outcomes in Patients with COVID-19 Infection Taking ACEI/ARB
- 45. Convalescent plasma transfusion for the treatment of COVID-19: Systematic review.
- 46. Coronavirus in Singapore,Hong kong and Japan Lessons from highly functioning health system Rapid adaptation of surveillance system; rapid test Selective use of travel restriction Early effective inter-governmentalcordination Shifted costs of treatment to government Develped lans for sustaining health care system Actively managed supply chain Emphasized infection prevention and protection HCW.
- 47. Preventing exposure in the community — The following general measures are recommended to reduce transmission of infection: Diligent hand washing, particularly after touching surfaces in public. Use of hand sanitizer that contains at least 60 percent alcohol is a reasonable alternative if the hands are not visibly dirty. Respiratory hygiene (eg, covering the cough or sneeze).
- 48. ●Avoiding touching the face (in particular eyes, nose, and mouth). ●Avoiding crowds (particularly in poorly ventilated spaces) if possible and avoiding close contact with ill individuals. ●Cleaning and disinfecting objects and surfaces that are frequently touched.
- 49. REFERENCES Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, Chi . Information for Healthcare Professionals. https://www.cdc.gov/coronavirus/2019 nCoV/hcp/index.html (Accessed on February 14, 2020). World Health Organization. Novel Coronavirus (2019-nCoV) technical guidance. tps://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guida nce (Accessed on February 14, 2020). Gorbalenya AE, Baker SC, Baric RS, et al. Severe acute respiratory syndrome-relat coronavirus: The species and its viruses – a statement of the Coronavirus Study G oup. bioRxiv 2020. https://www.biorxiv.org/content/10.1101/2020.02.07.937862v1 ( Accessed on February 12, 2020). Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382:727. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395:565. ACE Inhibitors and ARBs During the COVID-19 Pandemic Convalescent plasma as a potential therapy for COVID-19 Long Chen,Jing Xiong,Lei Bao,Yuan Shi
- 50. THANK YOU