COVID-19

Question 1

Common animals infected with coronaviruses

Answer 1

Pigs, humans, bats

Question 2

Coronavirus (crown of spike proteins) structure

Answer 2

+RNA: Same as messenger RNA in our cells
Enveloped: Stolen from previously infected cells (Spike proteins and others on surface)

Question 3

Cold causing coronaviruses

Answer 3

-Infect upper airways (Coughing, Malaise, Sneezing)
-Low(ish) infectivity
-Low mortality
-4 known

Question 4

SARS-CoV-1 (SARS Classic) Origin

Answer 4

Bat (intermediate civet cat)

Question 5

Uses ACE2 to infect cells

Answer 5

SARS-CoV-1(SARS Classic) and SARS-CoV-2 (PANDEMIC CORONAVIRUS)

Question 6

ACE2

Answer 6

Protein on many cell types
◦ Lung
◦ Cardiac
◦ GI tract
◦ Kidneys

Question 7

SARS-CoV-1 Symptoms

Answer 7

-Fever
-Malaise
-Difficulty breathing
-GI distress
-Infectious when symptomatic
-Causes lower respiratory tract infections
◦ Pneumonia
◦ Ground glass opacity

Question 8

SARS meaning

Answer 8

Severe Acute Respiratory Syndrome

Question 9

SARS-CoV-1 Infection

Answer 9

Causes severe disease often
◦ Not many asymptomatic cases
◦ Most cases needed medical intervention
◦ 30% need ventilation

Question 10

Fatality rate for SARS-CoV-1 or SARS Classic is

Answer 10

Fatality rate is about 10%
◦ lots of variance depending on age/underlying health
◦ Roughly 50% mortality in > 75 years old

Question 11

SARS-CoV-1 or SARS Classic Transmission

Answer 11

Spread by respiratory droplets
◦ Fomites?
◦ Fecal transmission?
◦ Poo cloud or “toilet plume” (little evidence, mostly theory)

Question 12

SARS outbreak

Answer 12

November 2002 cluster of viral pneumonia cases

Question 13

SARS outbreak started in

Answer 13

Open air markets Guangdong province (Wet markets)

Question 14

First coronavirus that caused severe disease in people

Answer 14

The SARS Outbreak; identified March 21st coronavirus found by multiple agencies

Question 15

SARS outbreak containment

Answer 15

Contained by aggressive containment measures
◦ Testing (thermal scanning)
◦ Contact tracing
◦Quarantine
◦ Social distancing
Hasn’t been seen since 2005!

Question 16

MERS-CoV origin

Answer 16

Bat (intermediate dromedary camels)

Question 17

MERS-CoV transmission

Answer 17

Lower transmissibility between people
◦ Droplet spread
◦ Fomites
◦ Many cases/outbreaks involve direct contact with camels

Question 18

MERS stands for

Answer 18

Middle Eastern Respiratory Syndrome

Question 19

MERS Infection

Answer 19

-Some asymptomatic and mild cases
-Severe cases present with viral pneumonia
◦ Ventilation needed in high percentage
-Roughly 35% mortality rate
◦ Most cases had underlying medical conditions

Question 20

MERS outbreaks (Very often associated with healthcare spread)

Answer 20

Small cluster outbreaks (2012-2015)
◦ Saudi Arabia
◦Jordan
◦ Korea
◦ UK

Question 21

SARS-CoV-2 (PANDEMIC CORONAVIRUS) Receptor

Answer 21

Uses ACE2 to gain entry in to host cells, but likely does not entirely rely on it and has an alternative receptor.

Question 22

Virus amplification

Answer 22

Most rise in viral load

Question 23

SARS-CoV-2 Infection

Answer 23

-The virus gets in your mouth, eyes, nose
-Symptom onset: Decline in viral load after about 1 week

Question 24

The Disease caused by SARS-COV-2

Answer 24

COVID-19

Question 25

How do you become infected with COVID-19?

Answer 25

Droplet spread: “The wetness of our coughs and sneezes”

Question 26

Symptoms of COVID-19

Answer 26

Typical: ◦ Fever ◦ Dry cough ◦ Malaise ◦ GI upset ◦ Loss of taste or smell

Question 27

COVID-19 completely asymptomatic usually is simply

Answer 27

Pre-symptomatic

Question 28

Mild disease COVID-19

Answer 28

Common cold ~ 3 days

Question 29

Moderate disease COVID-19

Answer 29

Bad flu-like illness

Question 30

COVID-19 Severe disease

Answer 30

Hospitalization (not all equal) ◦ As little as just needing fluid therapy or Remdesivir therapy ◦Oxygen in a tube ◦ Full oxygen mask ◦Intubation (In dire cases only; mortality is high in these cases)

Question 31

COVID-19 Higher risk factors

Answer 31

-Age -Smoking -Obesity -Heart disease (Lots of ACE2) -Pregnancy -Diabetes (Slightly delays immune response maybe)

Question 32

COVID-19 Post infection issues

Answer 32

◦ Thrombotic problems ◦ Bacterial infection ◦ Tail phase “Long haulers” ◦ Brain fog ◦Inflammatory skin disease

Question 33

Can reinfection of COVID-19 occur?

Answer 33

Yes, but probably not right away in most people (3 months)

Question 34

Reinfection of COVID-19, why?

Answer 34

High levels of neutralizing antibodies ◦ (Also non-neutralizing antibodies) ◦ Plateau after a few months ◦ Memory B cells persist ◦ Plasma cells have perished ◦ T cell activation ◦ To clear infection ◦ Memory T cells persist

Question 35

RT-PCR tests

Answer 35

Reverse transcriptase PCR (Used to determine if RNA is present)

Question 36

RT-PCR tests use

Answer 36

Enzyme that compliments RNA in to cDNA ◦ cDNA denotes the original RNA template ◦ Doesn’t exist in cellular life

Question 37

RT-PCR tests results +

Answer 37

Viral RNA present (Currently infectious?)

Question 38

RT-PCR tests results -

Answer 38

No viral RNA present (can still become +)

Question 39

Limits of RT-PCR tests

Answer 39

Viral RNA present ◦ 1 day – 5 weeks ◦ Viral RNA load Good for clinical diagnosis of symptomatic patient

Question 40

Antigen tests

Answer 40

Rapid kit-based kits ◦ Nasal swab ◦ Positive band means virus protein binding

Question 41

Antigen tests good

Answer 41

Could be as little as $1 (they aren’t currently that cheap), Fast results – 15 minutes

Question 42

Antigen tests Bad

Answer 42

Less sensitivity, Might miss some + cases, (Does it matter?)

Question 43

When/why to test

Answer 43

When feeling poorly (Rapid antigen or RT-PCR), When traveling or going to an event (Rapid antigen, RT-PCR might be too sensitive)

Question 44

Viral phase

Answer 44

in first week

Question 45

Inflammatory phases

Answer 45

After first week

Question 46

Paxlovid – antiviral drug

Answer 46

Inhibits SARS-CoV-2 protease ◦ Enzyme that cleaves large, non-functional amino acid blob in to multiple, functional proteins ◦ Given 0-5 days after symptom onset (earlier the better)

Question 47

Remdesivir – antiviral drug

Answer 47

◦Effects RDRP of SARS-CoV-2 ◦ Given early in infection

Question 48

Monoclonal antibody therapy

Answer 48

Laboratory derived ◦ Uses monoclonal antibody from a lab (or combo of monoclonal antibodies) ◦ Neutralize virus ◦ Late vs early use? (Early) ◦ Works against variants? (Not as of now)

Question 49

Dexamethasone (and other corticosteroids) to suppress the immune response

Answer 49

Good: Reduces inflammation, short duration, can reduce mortality by 30% in critical cases Bad: Broad – suppresses immune system, open for infection of other types

Question 50

COVID19 Vaccines Measuring efficacy

Answer 50

What are the endpoints? ◦ Any symptomatic disease? ◦ Severe disease (Hospitalization) ◦ Death?

Question 51

Vaccine Development

Answer 51

When you can use other people’s money to not risk your own. (Operation WARP Speed) No steps in vaccine development were skipped.

Question 52

Real world data

Answer 52

Once you start vaccinating millions, the numbers can change (no such thing as 100% in real life) Also variants can change the picture. Agencies track data and report (Getting more complicated now)

Question 53

How many do you need?

Answer 53

Many vaccines are 2 doses or 3 doses

Question 54

Pfizer

Answer 54

Comirnaty

Question 55

Moderna

Answer 55

Spikevax

Question 56

To boost or not to boost?

Answer 56

-Lab experiments show increase in neutralizing antibodies -no adverse reactions