BACKGROUND
- It is an infectious disease caused by the SARS -Cov 2 ( severe acute Respiratory syndrome- Corona virus 2)
- Corona virus derive their name from the Latin word “corona” meaning crown
- The name refers to the unique appearance of the virus under an electron microscope as round particles with a rim of projections resembling the solar corona
- They are enveloped , positive sense, single stranded RNA viruses which were first isolated from humans in 1965.
- Corona virus belongs to the family coronaviridae which is known to produce mild respiratory disease in humans.
Variants
- In the last 2 years, we have seen 5 variants of concerns- Alpha, Beta, Gama, Delta and Omicron
- WHO has said that omicron won’t be the last variant .
- SARS-Cov 2 is the seventh known corona virus to infect people after 229E, NL63, OC43, HKUI, MERS-Cov and the original SARS- Cov
EPIDEMIOLOGY
- On 31 Dec 2019, WHO was informed of cases of Pneumonia of unknown cause in Wuhan city, China.
- A novel coronavirus was identified as the cause by chinese authorities on 7 jan 2020 and was temporarily named “2019-nCov”.
- Recently, there have been 3 major corona virus leading to disease outbreaks, beginning with the (SARS- COV) in 2002, followed by the Middle east respiratory syndrome coronavirus (MERS-Cov) in 2012 , and now the SARS- Cov 2
- Since the initial report from china, the disease spread rapidly, and the number of causes increased exponentially.
- On Jan 11, the 1st case was reported outside mainland china in Thailand, within months the disease spread to all the continents except Antarctica.
- India reported its 1st case of COVID-19 on Jan 30, 2020. This rose to 3 cases by Feb 3 2020, by mid march. The number of infected cases started to increase. The first COVID 19 related to death in India was reported on March 12, 2020.
INCUBATION PERIOD
- The mean or median incubation period of disease ranges from 5 to 6 days
- The median duration of virus shedding was 20 days , mild cases tend to clear the viruses early, while severe cases can have prolonged viral shedding.
MODE OF TRANSMISSION
- Commonly through droplets/ Airborne transmission
- Sometimes by surface/fomite transmission
CLINICAL MANIFESTATIONS
COVID 19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover without hospitalization.
Most common symptoms:
- Fever
- Cold
- Cough
- Sorethroat
- Headache
- Body pains
- Tiredness
- Loss of taste or smell
Less common symptoms
- Diarrhoea
- Skin rash
- Conjuctivitis
Serious symptoms:
seen in small proprtions of patients
- Difficulty breathing or shortness of breath
- Chest pain
People with mild symptoms should manage their symptoms at home. On average it takes 5-6 days from when someone is infected with the virus for symptoms to show, however it can take upto 14 days.
DIAGNOSTIC TESTS
Rapid antigen test -Nasal /Throat swab
Less sensitive, more specific
RT PCR – Nasal /Throat swab
Less sensitive, more specific
HRCT scan – Helps in diagnosis and also in assessing severity of the disease
More sensitive and specific
Timing is important
Routine blood tests
- CBC
- RFT
- Blood sugars etc
Inflammatory markers: Helps to assess severity and to monitor treatment
- CRP
- D- Dimer
- LDH
- IL-6 –Can be sent in rapidly detoriating patients
TREATMENT
Mild disease: Fever, upper respiratory tract symptoms without SOB or Hypoxia
Symptomatic management- Hydration
Paracetamol
Anti tussives
Monitor vitals regularly
Moderate disease
If SOB is present, Tachypnea present or SPO2 < 94% room air
- Low dose steroids (Dexamethasone/ Methylprednisolone)
- Anticoagulant prophylaxis : If there is no contraindication or high risk of bleeding
(eg. Enoxaparin 0.5mg/kg/day subcutaneous route)
- Antiviral
Inj. Remdesivir 200mg for 1st day followed by 100mg for 5 days
- Oxygen supplementation and other supportive medication
Severe disease
If SOB is present, severe tachypnea or SPO2 < 94% room air
Need ICU admission
- Parenteral steroids -should ruleout sepsis
- Anticoagulants – If there is no contraindication or high risk of bleeding
- Anti viaral
Inj .Remdesivir for 5 days
- Oxygen supplementation or NIV or Invasive ventilation depending on patient clinical condition
Red flags
- Pulmonary embolism is a complication during and after Covid which can cause rapid deterioration of patient condition
- Mucormycosis or other fungal infections can occur during or after Covid
Pearls
Monoclonal antibodies: Different combinations of monoclonal antibodies are being tried for treatment of infection with different strains
PREVENTION
Protect yourself and those around you:
- Get vaccinated as soon as it’s your turn and follow local guidance on vaccination.
- Keep physical distance of at least 1 metre from others, even if they don’t appear to be sick. Avoid crowds and close contact.
- Wear a properly fitted mask when physical distancing is not possible and in poorly ventilated settings.
- Clean your hands frequently with alcohol-based hand rub or soap and water.
- Cover your mouth and nose with a bent elbow or tissue when you cough or sneeze. Dispose of used tissues immediately and clean hands regularly.
- If you develop symptoms or test positive for COVID-19, self-isolate until you recover.
To properly wear your mask:
- Make sure your mask covers your nose, mouth and chin.
- Clean your hands before you put your mask on, before and after you take it off, and after you touch it at any time.
- When you take off your mask, store it in a clean plastic bag, and every day either wash it if it’s a fabric mask or dispose of it in a trash bin if it’s a medical mask.
- Don’t use masks with valves.
Submitted by
P.Bharathi