Coronavirus

Question 1

Corona virus

modes of transmission

Answer 1

1. Fecal oral
2. respiratory droplets- can survive for 3 hours in the air –> which infect type 2 pneumocyte

Question 2

alveoli cells

Answer 2

type 1 pneumocyte responsible for gas exchange.
type 2 pneumocyte which produces surfactant to prevent alveolar collapse.
macrophage fight iinfection!

Question 3

type 2 pneumocyte

Answer 3

produces surfactant to prevent alveolar collapse.
it also has ACE 2 receptor, binds via S protein (spike protein)

Question 4

COVID RNA

Answer 4

positive sense RNA virus
meaning it can instantly take over host machinery.

Question 5

Pathophys of COVID

macrophages with covid infection

Answer 5

Type 2s burst open. Macrophages then send out cytokines (ILs 6,8,TFA). These are to initiate immune response. they make capilaries more permeable to allow WBCs to come in and fight infection.
this immune response mixed with lack of surfactant causes leading to alveolar collapse.

Question 6

Commonalities between MERS, SARS, CVD19

Answer 6

They’re all Coronaviruses
They’re all highly contagious
The Symptom pattern is the same - fever, cough, myalgia, fatigue and lower respiratory signs

Question 7

SARS COV1

Resevoir species and intermediate spp.

Answer 7

Origin was thought to be a horseshoe bat with the intermediate species being a palm civet.

Question 8

SARS COV1

Sx

Answer 8

** Fever – 100 percent
Cough – 66 percent**
Chills and/or rigors – 52 percent
Myalgias – 49 percent
Dyspnea – 46 percent
Headache – 39 percent

Question 9

SARS

prognosis

Answer 9

Started at 10% mortality in 2003

It is in the general nature of a virus to get less deadly time.

Question 10

SARS COV1

Dx

Answer 10

PCR Testing is the gold standard - Can be tested from Stool, Plasma, Sputum

Question 11

SARS COV!

Tx

Answer 11

Treatment Options - All that have been studied have shown little efficacy. These include Glucocorticoids, Ribavirin, Remdesivir (RNA Polymerase inhibitors).

Question 12

MERS

origin

Answer 12

In September of 2012, a case of novel coronavirus infection was reported involving a man in Saudi Arabia who was admitted to a hospital with pneumonia and AKI in June of 2012. Days later, a separate and identical case was detected in a patient in the UK. The man had previously traveled to Saudi Arabia.

Stay Away from Camels!

Question 13

MERS

mode of transmission

Answer 13

MERS binds the DPP4 Receptor (upper airway of camels, lower airway of humans).

What does DPP4 do? (This applies to diabetes as well).-cleaves GLP1. DPP4 found in lower resp tract of lungs (top of lungs for camels)

Respiratory Droplets, Direct Human Contact

Question 14

MERS

S/Sx

Answer 14

Most reported patients with MERS-CoV infection have been adults with severe pneumonia and acute respiratory distress syndrome, and some have had acute kidney injury.

Other clinical manifestations that have been reported are gastrointestinal symptoms (anorexia, nausea, vomiting, abdominal pain, diarrhea), pericarditis, and disseminated intravascular coagulation.

Fever (>38°C) – 46 patients (98 percent)
Fever with chills or rigors – 41 patients (87 percent)
Cough – 39 patients (83 percent)
Shortness of breath – 34 patients (72 percent)
Hemoptysis – 8 patients (17 percent)
Sore throat – 10 patients (21 percent)
Myalgias – 15 patients (32 percent)
Diarrhea – 12 patients (26 percent)
Vomiting – 10 patients (21 percent)
Abdominal pain – 8 patients (17 percent)
Abnormal chest radiograph – 47 patients (100 percent)

35% mortality accross all populations in middle east.
20% when it hit S korea (better health care)

Question 15

MERS

Testing and reporting

Answer 15

Lower respiratory tract specimens should be the first priority for collection and real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing, since rRT-PCR testing of lower respiratory specimens appears to be more sensitive for detection of Middle East respiratory syndrome coronavirus (MERS-CoV) than testing of upper respiratory tract specimens.

Call your Health Departments

State and local health departments must still submit all CDC MERS-CoV rRT-PCR assay test results (e.g., negative, positive, equivocal) via the LRN. Any MERS case detected in the U.S., and any PUI with equivocal or positive MERS test results must still be immediately reported to CDC as currently recommended.

Question 16

MERS

precautions

Answer 16

Minimize chance for exposures
Adherence to standard, contact, airborne precautions
Manage vistor access

Question 17

COVID 19

Origin story

Answer 17

Li Wenliang (李文亮), MD, was an ophthalmologist in Wuhan, China, who warned several of his colleagues about the appearance of a new SARS-like virus in December 2019, at the very beginning of the global COVID-19 pandemic. Initially reprimanded by a hospital administrator and formally admonished by the local authorities in Wuhan, he was later exonerated by the Supreme People’s Court of the People’s Republic of China and, after his untimely death, honored by the central government of China as a “martyr” — one of the highest honors given to a private citizen in China.

Question 18

COVID2019

S/Sx

Answer 18

incubation is 5 days

There are no specific clinical features that can reliably distinguish COVID-19 from other viral respiratory infections.

Loss of taste and smell, dyspnea - should warrant suspicion, however….

You should have a very low index of suspicion for this virus as it is worldwide at this point.

Question 19

COVID19

Dx

Answer 19

Nasopharyngeal swabs

NAAT and Antigen testing - What’s the difference?

When to test? The time to detectable ribonucleic acid (RNA) following exposure is unknown, so the optimal time to test for COVID-19 following exposure is uncertain. The Centers for Disease Control and Prevention (CDC) recommends testing once five days have passed since the last exposure.

Question 20

COVID19

radiological features

Answer 20

Most common signs - Ground Glass Opacities, Nodular Shadowing, and Consolidation

usually in periphery not typically central

(ARDS case on the right- on vent)

Question 21

COVID

Answer 21

Nodular Shadowing

Question 22

COVID19

Answer 22

pulm consolidation

Question 23

COVID19

Tx

Answer 23

Treatment - (Recommended in Certain individuals) - Nirmatrelvir/ritonavir, Remdesivir, High Titer Convalescent Plasma

Treatments of Uncertain or Limited Efficacy - Molnupiravir (Nucleoside Analogue), Inhaled Glucorticoids, Moncolonal Antibodies, Peglyated Interferon Lambda

Not Recommended - Ivermectin, Hydroxychloroquine, Azithromycin, Fluvoxamine, Systemic Glucocorticoids

Question 24

COVID19

who to treat

Answer 24

65+
immunocompromised

Question 25

A 68-year old man was transferred to our center presenting with 5 days of coughing, shortness of breath, and general weakness on May 20, 2015. The patient was relatively healthy, except for well- controlled hypertension. He returned to Korea after visiting Bahrain and Saudi Arabia for approximately 3 weeks and developed fever, myalgia, and general weakness 1 week after returning home.

Questions - How do you test this patient? What precautions would you use?

Answer 25

RT PCR lower airway
Standard air

Question 26

A 60 year old physician reports to the emergency room with an SpO2 of 88%. Covid 19 testing via viral antigen tests was negative. Patient reports fever, myalgia, and dyspnea. Symptoms have been occurring for 2 days. CBC reveals Leukoctyosis, CMP reveals at Creatinine of 1.7 with a BUN to Creatinine Ratio of 30:1. Evaluation of Chest CT reveals ground glass opacities on the periphery.

Question - What is the differential diagnosis? What other questions do you want to ask this patient?

Answer 26

COVID, CLL, FLU,

dehydrated (30:1)

recent travel, similar sx,