COVID-19

Question 1

What is the pathophysiology of COVID-19?

Answer 1

• Lymphocytic pneumonitis
• Pulmonary microvascular thrombosis
• Angiogenesis
• Viral inclusion endothelialitis

Question 2

List the different medications available for acute COVID-19 treatment.

Answer 2

• steroids - dexamethasone 6mg
• anticoagulation -
• remdesivir 200mg stat
• JK inhibitor - baricitinib 4mg
• IL-6 inhibitors - tocilizumab 8mg/kg or sarilumab 400mg
• nMAbs - not currently used (Oct ‘22)
• ronapreve

Question 3

What is Ronapreve? Who is/was it used to treat in COVID-19?

Answer 3

Anti-spike protein mAbs combination of casirivimab and imdevimab
Indications:
* high risk COVID +ve patients without antibodies

Question 4

When would you consider IL-6 inhibitors in COVID-19?

Answer 4

Indications:
* severely unwell with COVID-19 i.e. CRP >75, low O2, on respiratory support
* AND high oxygen requirement

NB: Sarilumab C/I if platelets <150x10^9

Question 5

What are the indications for steroid use in COVID-19?

Answer 5

Indication: All patients requiring oxygen therapy to maintain sats >94% and RR<30

Dose: dexamethasone 6mg/day for max 10days or until discharge (oral or IV)

Question 6

What are the indications for remdesivir in COVID-19?

Answer 6

Indications: all patients presenting within 10days of symptom onset AND not on invasive ventilation

Dose: 200mg stat then 100mg OD for 4 days.

Question 7

What are the indications for baricitinib in COVID-19?

Answer 7

Indications: all patients requiring oxygen to maintain sats and receiving steroids

NB: given alongside IL-6 inhibitors

Question 8

Which COVID-19 drug may cause increase in ALT?

Answer 8

Remdesivir - most common SE

Question 9

What medications may be used in non-acute COVID-19 treatment?

NB: this is only available for high risk patients who are symptomatic bu

Answer 9

One of:
2. Paxlovid (ritonavir) - 5 days
2. Remdesivir - 5 days
2. Sotrovimab (once)

Remdesivir over Paxlovid if low GFR <30

Question 10

How does CAP differ from COVID-19?

Answer 10

Question 11

What are the complications of severe COVID-19?

Answer 11

• multi-organ failure
• septic shock
• VTE
• AKI
• DIC
• CRS
• PIMS (paediatric)
• long-COVID

Many others.

Question 12

What is the prognosis with COVID-19?

Answer 12

The leading cause of death is respiratory failure from ARDS (39% die)
Prognosis depends on age and undelying medical conditions.