Overview of COVID-19

OUTLINE
• Introduction
• Epidemiology
• Aetiology
• Clinical features
• Diagnosis
• Treatment
• Infection prevention
• Conclusion
• References

INTRODUCTION
• Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory
illness caused by a novel coronavirus, Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2)
• First identified following an outbreak of respiratory illnesses in Wuhan,
China.
• Reported to WHO on 30/12/19, WHO declared it a global health emergency
on 30/01/20 and a global pandemic on 11/03/20.

EPIDEMIOLOGY 1
• As at today, coronavirus has being confirmed in:
• 10 million individuals worldwide, with over 507,000 deaths
• About 188 countries have reported laboratory confirmed cases
• The united states has the highest number of infections and deaths, followed
closely by Brazil.
• In Africa, South Africa has the highest number of reported infections, while
Egypt has the highest number of deaths.

EPIDEMIOLOGY 2
Nigeria recorded its first case on 27th February, 2020 after an Italian citizen,
resident in Lagos returned to the country from Italy.
Infections have been reported in 35 states and the FCT
• Total no of infections - 25,133
• Total no of recoveries - 9,402
• Total no of deaths - 573
• Lagos state has the highest no of infections and deaths

EPIDEMIOLOGY 3
• Among the first 32 cases in Nigeria
• 53% of them were 40 years and above
• 66% were male
• 94% had history of recent travel or contact with a confirmed case.
• 75% presented with moderate to severe symptoms
• 16% were asymptomatic
• 59% had fever
• 44% had dry cough

0.0
5.0
10.0
15.0
20.0
25.0
30.0
(N%)
DISEASE
Most common comorbidities observed in coronavirus (COVID-19) deceased patients
in Italy as of May 2020

Aetiology
• The on-going pandemic started in late December, 2019, when several
patients presented with viral pneumonia in Wuhan, China and were
epidemiologically traced to the Huanan seafood market in Wuhan, where
non-aquatic animals were sold.
• A novel, human-infecting, rapid human-to-human transmitting severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) provisionally named
2019 novel corona virus (2019-nCoV), was identified and has been
renamed as Coronavirus disease 2019 (COVID-19)

• Corona viruses are enveloped, single-
stranded, positive-sense RNA viruses of
the Coronaviridae family with genome
ranging from 26 to 32kb in length.
• They have been identified in bats,
mice, rats, chickens, turkeys, masked
palm civets, swine, dogs, cats, rabbits,
horses, cattle and humans, are known to
cause a wide range of disease
conditions that can vary from mild to
severe.

TRANSMISSION CHAIN
How a virus spreads: The 6 Links In The Chain
Of Infection; Liam Palmer, nurses.co.UK

PATHOPHYSIOLOGY 2
• The virus enters the mucosa of the nose and throat, attaches to a cell-surface
receptor called angiotensin-converting enzyme 2 (ACE2).
• Once inside, the virus hijacks the cell’s machinery, making myriad copies of itself and
invading new cells. If the immune system doesn’t beat back SARS-CoV-2 during this
initial phase, the virus then marches down the windpipe to attack the lungs.
• As the immune system wars with this invader, there is disruption of healthy oxygen
transfer- this explains the reduced oxygen saturation in affected patients.
• Front-line white blood cells (lymphocytes and neutrophils) release inflammatory
molecules called chemokines, causes the immune defenses to overshoot, resulting in a
"cytokine storm."

PATHOPHYSIOLOGY 3
• The cytokine storm ultimately causes high fever, excessive leakiness of blood
vessels, blood clotting inside the body, extremely low blood pressure, lack of
oxygen and excess acidity of the blood, and pleural effusion
• White blood cells are misdirected to attack and inflame even healthy tissue,
leading to failure of the lungs, heart, liver, intestines, kidneys, and genitals
(Multiple Organ Dysfunction Syndrome, MODS). This may worsen and
shutdown the lungs (Acute Respiratory Distress Syndrome, ARDS)

Most common symptoms:
• Fever
• Dry cough
• Tiredness
Serious symptoms:
• Difficulty breathing or shortness
of breath
• Chest pain or pressure
• Loss of speech or movement
Less common symptoms:
• Aches and pains
• Sore throat
• Diarrhea
• Conjunctivitis
• Headache
• Loss of taste or smell
• A rash on skin, or
discoloration of fingers or
toes

DIAGNOSIS 1
• Real-time reverse transcriptase-
polymerase chain reaction (RT-PCR)
to detect the positive nucleic acid of
SARS-CoV-2 in sputum, throat swabs,
and secretions of the lower respiratory
tract sample is the gold standard.
• Discussions around rapid test and
antibody test are still not conclusive.

DIAGNOSIS 2
• Chest X-Ray Findings: The most frequent findings are bilateral, peripheral,
and lower lung zone airspace opacities, described as consolidation
• Chest CT-Scan Findings:
• Ground-glass opacities : bilateral, subpleural, peripheral
• Crazy paving appearance
• Air space consolidation
• Broncho-vascular thickening in the lesion
• Traction bronchiectasis

DIAGNOSIS 3
• Blood Tests Findings:
• Lymphopenia
• Increased prothrombin time (PT)
• Increased lactate dehydrogenase
• Mild elevated inflammatory markers (CRP and ESR)
• Elevated D-dimer
• Mildly deranged liver function test
• Deranged Kidney function test

TREATMENT
• No drugs have been approved for the prevention or treatment of
COVID-19 globally.
• Some drugs like remdesivir, hydroxychloroquine,
Azithromycin, lopinavir and ritonavir, ribavarin, and interferon-1-
beta are being tried.
• Numerous other antiviral agents, immunotherapies, and vaccines
continue to be investigated and developed as potential therapies.
• Current treatment is mainly symptomatic and supportive
• Recently steroids have been shown to help critically ill patients

PREVENTION IN HEALTH CARE SETTING
•Ensure triage, early recognition, and source control
(isolating patients with suspected COVID-19)
•Apply standard precautions for all patients
•Implement empiric additional precautions (droplet and contact
and, whenever applicable, airborne precautions) for suspected cases of
COVID-19
•Implement administrative controls
•Use environmental and engineering controls

TRIAGING PROTOCOL
All hospitals must have a closed entry manned by trained security or
front desk personnel
Facilities should have a screening questionnaire for all entry into the
facility; both staff and patients
You must communicate clearly to the patients and staff about your
protocols
Patients can be screened in their cars or a screening tent
A written notice also helps to communicate with the patient
Difficult cases should be escalated to the management
www.fppt.com

Fever >37.5° axillary or >38.0°
core.
Does the person have
Cough (Dry/Wet)
Difficulty in breathing
Anosmia/Dysgeusia
Gastrointestinal symptoms
Note that travel history is no longer important as
there is evidence of sustained community
transmission
Malaise/fatigue
www.fppt.com

REDUCE UNNECESSARY CONTACT
WITH PATIENTS
• Telemedicine (telephone consults and Whatsapp calls
should be encouraged)
• Clinic visits should be based on appointments which must
be well spaced to prevent overcrowding
• Drug refills should be done without clinic visits
• Walk ins should be reduced to the barest minimum
• Cashless policy should be encouraged
• Only one visitor should be allowed per patient into the
facility

CONCLUSION
• Coronavirus is an ongoing public health concern with attendant
constraints on health care delivery.
• Patients with cancer are at high risk of dying if they contract the
disease. However, their care has being impacted during the pandemic
• Therefore, it is expedient to adopt ways to manage patients with
cancer during this pandemic.

REFERENCES
• World Health Organization. infection prevention and control during care when
COVID-19 is suspected: interim guidance(19 march 2020)
• World Health Organization. Consideration of quarantine individuals in the
context of containment for coronavirus disease: interim guidance(19 march,
2020)
• World Health Organization. Rational use of personal protective equipment for
coronavirus disease (COVID-19) and considerations during severe shortage:
interim guidance
• J.O Bamidele, O J Daniel Epidemiology of coronavirus disease in Nigeria:
annals of health researchvol.6 NO.2(2020)
• Max Roser, Hannah Ritchie, Esteban Ortiz-Ospina and Joe Hasell (2020) -
"Coronavirus Pandemic (COVID-19)". Published online at
OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/coronavirus'
[Online Resource]

Overview of COVID-19

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