CoronaVirus – Sign Symptoms, Causes, Prevention

Introduction:

Coronavirus constitutes the subfamily Orthogonality in the family Coronaviridae. They have enveloped viruses with a positive-sense single-stranded RNA genome. • The name coronavirus is derived from the Latin corona, meaning “crown” or “halo”, which refers to the characteristic appearance reminiscent of a crown when viewed under electron microscopy, due to the surface covering in club-shaped protein spikes.

Epidemiology:

Outbreaks of coronavirus types of relatively high mortality are as follows

Coronavirus disease 2019 (COVID-19):

• In December 2019, a pneumonia outbreak was reported in Wuhan city of China.
• On 31 December 2019, the outbreak was traced to a novel strain of coronavirus, which was given the interim name 2019-nCoV by the World Health Organization (WHO), later renamed SARS-CoV-2 by the International Committee on Taxonomy of Viruses.
• As of 15 March 2020, there have been at least 5,833 confirmed deaths and more than 156,396 confirmed cases in the coronavirus pneumonia pandemic.
• The Wuhan strain has been identified as a new strain of Beta coronavirus from group 2B with approximately 70% genetic similarity to the SARS- CoV.
• The virus has a 96% similarity to a bat coronavirus, so it is widely suspected to originate from bats as well. The pandemic has resulted in serious travel restrictions.

Causes of COVID – 19

• It is caused by SARS-CoV-2 is closely related to Severe Acute Respiratory Syndrome Corona Virus which was outbreaks in 2003.
• It is thought to have a zoonotic origin.

Mode of Transmission:

• The primary mode of transmission is via respiratory droplets that people exhale.
• Droplets only stay suspended in the air for a short time but may stay viable and contagious on metal, glass or plastic surface.
• Disinfection of surfaces is possible with substances such as 62–71% ethanol applied for one minute.

Incubation Period:

Ranges from one to fourteen days; it is most commonly for five days. In one case, it had an incubation period of 27 days.

Pathophysiology:

1. Host mechanism is decreased (Impaired gag and cough reflex or immunocompromized State)
2. Microorganisms enter the lower respiratory tract
3. The inflammatory reaction begins
4. Inflammatory reactions with WBC, neutrophils enter the alveoli and fill normally air containing spaces
5. Interfere exchange of O2 and CO2
6. Hypoxemia

Signs and Symptoms:

Symptoms of COVID-19 are non-specific and those infected may either be asymptomatic or develop flu-like symptoms such as

• Fever
• Cough
• Fatigue
• Shortness of breath
• Sore Tongue

Clinical Syndrome associated with COVID-19:

• Mild illness
• Pneumonia
• Severe Pneumonia
• Acute respiratory distress Syndrome
• Sepsis
• Septic Shock

Diagnosis:

Infection by the virus can be provisionally diagnosed on the basis of symptoms, though confirmation is ultimately by reverse transcription-polymerase chain reaction (rRT- PCR) of infected secretions (71% sensitivity) and CT imaging (98 % sensitivity).

• Viral testing: Reverse transcription-polymerase chain reaction (RRT-PCR) is done. The test can be done on respiratory or blood samples.
• Imaging: Radiographs and computed tomography. 

WHO Guidelines

WHO: Interim guidelines for the management of severe acute respiratory illness caused by the novel coronavirus.

• Recognition and sorting of all patients at the first point of contact with the healthcare system (e.g. Emergency Dept.)
• Recognize that nCoV is the possible etiology for SARI, which is based on the conditions outlined in Table 1.
• Immediate implementation of appropriate prevention and control (IPC) measures

Early supportive therapy and monitoring

• Supplemental oxygen therapy: SARI and respiratory distress, hypoxemia, or shock.
• If there’s no evidence of shock in patients with SARI, use conservative fluid management.
• Antimicrobials should be given to all patients with SARI to treat all likely pathogens causing SARI. Antimicrobials should be given within one hour of initial patient assessment for patients with sepsis. 

Early supportive

• Do NOT give routine corticosteroids for the treatment of viral pneumonia outside of clinical trials unless indicated for another reason.
• Early communication with patient and family is key for successful management

Collection of specimens for laboratory diagnosis

• Blood cultures for bacteria that cause pneumonia and sepsis should be collected, ideally, before microbial therapy. But DO NOT delay the antimicrobial therapy to collect blood cultures.
• Specimens should be collected from both the upper respiratory tract (URT) and the lower respiratory tract (LRT) for nCoV testing via RT-PCR.
• Serology as a diagnostic procedure is recommended only when RT-PCR is NOT available.

Caring for infants and mothers with COVID-19: IPC and breastfeeding

• Infants born to mothers with suspected, probable, or confirmed COVID-19 should be fed according to standard infant feeding guidelines while applying necessary precautions for IPC.
• Breastfeeding should be initiated within 1 hour of birth. Exclusive breastfeeding should continue for 6 months with timely introduction of adequate, safe and properly fed complementary foods at age 6 months while continuing breastfeeding up to 2 years of age or beyond.
• As with all confirmed or suspected COVID-19 cases, symptomatic mothers who are breastfeeding or practicing skin-to-skin contact or kangaroo mother care should practice respiratory hygiene, including during feeding (for example, use of a medical mask when near a child if the mother has respiratory symptoms), perform hand hygiene before and after contact with the child, and routinely clean and disinfect surfaces with which the symptomatic mother has been in contact.

PREVENTION:

• Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings ( Centers for Disease Control and Prevention)

• Minimize Chance for Exposures:
• Measures should be implemented before patient arrival, upon arrival, throughout the duration of the patient’s visit, and until the patient’s room is cleaned and disinfected.
• Before Arrival – When scheduling appointments for routine medical care (e.g., annual physical, elective surgery), instruct patients to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat, fever) on the day they are scheduled to be seen.
• Upon Arrival and During the Visit Take steps to ensure all persons with symptoms of COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, etc 

• Adhere to Standard and Transmission-Based Precautions:
• Hand Hygiene
• Personal Protective Equipment
• HAND WASHING: Hand washing is recommended to prevent the spread of the disease. The US Centers for Disease Control and Prevention (CDC) recommends that people wash hands often with soap and water for at least 20 seconds. 
• PERSONAL PROTECTIVE equipment: Respirator or Facemask Put on a respirator or facemask (if a respirator is not available) before entry into the patient room or care area. N95 respirators or respirators that offer a higher level of protection should be used instead of a facemask when performing or present for an aerosol-generating procedure.