CORONA VIRUS DISEASE

CORONA VIRUS DISEASE 

Corona virus was originated in Wuhan, China in December 2019 . The genetic sequence shows this is closely related to SARS Virus

This is SINGLE STRANDED RNA VIRUS With Crown like appearance with diameter of 60-140 nm

This is sensitive to

. Uv rays

. Lipid solvent like ether

. Ethanol

. Chlorine disinfectant

Corona virus replication decreases at high temperatures.

GLOBAL SCENARIO :

Disease originated from China spread over 200 country in the world and was declared as pandemic on 11 th March 2020 by WHO 

In December 2020 new strain of virus was detected in UK which has 70 % more Transmission  and was highly contagious . Various strains in different part of world are been established

As on 19th February 11.08 crore cases where been reported with 24,53,582 deaths all over world . Almost 8 crore recovered with the recovery rate of 77.4%

MODE OF TRANSMISSION:

SARS-COV-2 Transmission occurs through secretion of infected person that might be saliva or respiratory droplets via talking, sneezing, coughing

Droplets are more than 5-10 micron in diameter if less than 5 micron it is aerosol

Droplets spread when person is in close contact with infected person within 1 metre distance (hence social distancing is important) 

Air borne Transmission is possible that is aerosol of small size remains suspended in air for long period

Fomite Transmission is also possible as secretions of infected person remains on object table and may spread to healthy person

PERIOD OF COMMUNICABILITY:

Usually viral load can be detected 1-3 days before symptoms appear byRT-PCR TEST

RTPCR can detect SARS-COV-2 upto 1-2 week in asymptomatic case and 3 weeks in mild to moderate symptomatic

Incubation period = 2-14 days

RISK FACTORS:

1.Age more than 60

2.Non communicable disease like

    Hypertension. 

    Diabetes Mellitus

    Cardiac disease

    Cancer

    Immunosuppression disease

3.Smoking 

CLINICAL PRESENTATION:

1.Fever (83-99%

2.Cough(50%) 

3.Fatigue

4.Anorexia

5.Shortness of breath

6.Nausea vomiting

7.Diarrhea

8.Aisomnia (loss of smell) 

9.Loss of taste (Aguesia ) 

IN MODERATE CASES - PNEUMONIA

IN SEVERE CASE- SEVERE PNEUMONIA

IN CRITICAL CASE - ACUTE RESPIRATORY DISTRESS

 As disease progress spO2 level in blood starts to fall which is a serious threat

DIAGNOSIS:

Diagnosis can be done by

1. MOLECULAR TEST 

Respiratory sample collection:

1.Bronchoalveolar lavage, Sputum, Tracheal aspirate

2.Nasopharyngeal swab

3.oropharyngeal swab

Molecular test that we do

a. NAAT (Nucleic acid amplification technique) 

b. Antigen testing

C. Antibodies detection

2.IMAGING :

1.chest xray

2.CT chest

3.lung ultrasound

3.LAB INVESTIGATION:

 -D dimer levels increased

-Increased Neutrophil to lymphocyte ratio

-In early stage wbc may be normal or decreased

-LDH level and c reactive protein (crp) is increased

PREVENTION:

1.Wearing mask

2.Social distancing(atleast 1 m apart) 

3.Avoid unnecessary gathering

4.Use of PPE kit by health personnel

5.Vaccination

TREATMENT OF COVID:

Mild case:

Means only fever and uncomplicated disease without dysapnea(breathlessness) , hypoxemia

-Admission to COVID care centre

-Strict hand hygiene

-Adequate hydration

-vit. C tablet

Refer 

DCHC/DCH if Resp. Rate more than 24 and spO2 less than 94

Moderate case:

Means Pneumonia with no severe disease

Resp rate more than 24 and spO2 less than 94 at room air

-Admit to DCHC( dedicated COVID healthcare center) 

1.oxygen support

Target spO2- 92-96%

Preferred device for oxygenation- 

"NON BREATHING FACE MASK"

If hypoxemia continue despite of more than 4L/min than do awake proning(if no contraindications) 

2.Anticoagulants

Low molecular weight heparins can be used  (prophylactic dose) 

3.Corticosteriods

I. V PREDNISOLONE 0.5-1 mg/kg

OR

IV DEXAMETHASONE 0.1-0.2mg/kg 

For 3-5 days

4.Antiviral treatment should be consider

Severe case:

Means respiratory distress requiring mechanical ventilation

SpO2 less than 90% and Resp rate more than 30 

Admit to DCHC 

1. Oxygen support

If work of breathing is

   Low - caution trail of cPAP

    High- Intubation

Lung protective  ventilation strategy according to ARDS Net protocol

In case of refractory hypoxemia consider prone ventilation

2.Anticoagulant

High doses of low molecular weight heparin

3.corticosteriod

IV PREDNISOLONE 1-2 mg/kg

OR

IV DEXAMETHASONE 0.2-0.4mg/kg

For 5-7 days

 

 THANK YOU🤗 if u like the blog please do share and follow

For more visit Ujmedicalblogger