COVID-19 PANDEMIC
The virus is responsible for affecting the respiratory
system both upper (nose, sinuses and pharynx) and lower (trachea, bronchus and
bronchioles) respiratory system.
The first outbreak was observed in Wuhan, China in early
December 2019.
After the outbreak WHO recognized it as SARS-COV-2; a type
of corona virus.
The spread of virus is common from person to person.
Disease range is seen from mild to moderate to severe.
Strains- Researchers have identified 2 strains L and S. L strain was most common in early stage of
outbreak.
Risk Factors:
SYMPTOMS:
People with mild to moderate disease tends to recover at
home without the need of hospitalization. The common symptoms:
·
Fever (99%)
·
Generalized weakness (70%)
·
Dry cough (59%)
Along with this person may develop symptoms like:
·
Loss of taste
·
Loss of smell
·
Body ache
·
Sore throat
·
Diarrhea
·
Nausea
·
New confusion
Severe Symptoms include:
·
Breathlessness
· Chest pain or pressure
Virus is responsible for development of pneumonia,
respiratory failure, septic shock and death.
Diagnostic Testing of COVID 19:
Detection of the Antigen of the virus is helpful. RT-PCR
test identifies the protein of the virus.
For the detection swab is introduced in the nostril or the
back of the mouth, and the sample is collected.
This sample is then tested in the laboratory, for the
detection of the virus. Rapid test is also introduced, which gives result in
few minutes, but there are chances of false negative.
Antibody testing (IgG), the test for knowing whether the
individual has been infected previously. The immunoglobulin (IgG), has role to
controls the infection. But as the virus is new it is difficult to predict, how
one will get re-infected. Yet, none of
these tests are 100% accurate.
Management:
For mild cases: Patient can be recovered
at home with adequate care and monitoring.
·
Should take proper rest.
·
Intake of fluid should be maximized.
·
Avoid going in crowded places. Better to stay
isolated for at least 14 days, so that spread of the virus can be decreased.
·
Constant monitoring of oxygen level through
pulse oximeter.
If, symptoms gets worse better to consult the physician
immediately.
In case, if the patient needs to be hospitalized, the management
guideline should be followed.
·
Oxygen therapy is required.
·
Recently, FDA has approved the benefits of
Favilavir, Antiviral for mild to moderate cases.
·
Hydroxychloroquine (200mg x 2 day or 3 day);
drug used in malaria, amebiasis and for other autoimmune, is being advised by
the Chinese National Guideline. But, there are lack of clear evidence, in the
COVID-19 infection.
·
Antibiotic: For community- acquired pneumonia
(CAP), third generation cephalosporin, clarithromycin or azithromycin or
alternatively fluoroquinolones can be administrated, with attention.
·
Tocilizumab, monoclonal antibody, is used in
severe cases. In afebrile patient the drug can be administrated for >72
hours and/or at least 7 days. In case, IL-6 is high, PLT <50,000 cell/mmc,
neutrophils <500 cells/mmc, sepsis, co-morbidities and worsening of the gas
exchange; tocilizumab should be put on hold.
·
Remdesivir(GS-5734): Broad spectrum antiviral nucleotide, its action is premature
termination of viral RNA- transcription. Remdesivir - 200 mg on day 1 then
100 mg/day for another 9 days in combination with chloroquine
500 mg, 1 × 2/day or hydroxychloroquine 200 mg, 1 × 2/day. If the
patient develops a BCRSS score 3 or MEWS ≥ 3, evaluate dexamethasone and/or
tocilizumab.
·
Methylprednisolone (20mg x 2/day) should be administrated
in case of:
Ø Severe
Hyoxia, i.e., Sp02<93%
Ø Respiratory
rate >30/min
Ø P/F
ratio <= 300mmHg
Ø HRCT
Thorax – s/o severe extensive, bilateral interstitial involvement with fibrotic
changes.
·
Sodic Enoxaparin:
Ø Low-intensity care COVID-19 wards:
100 U/Kg/day; 70 U/Kg × 2/day for obese patient (BMI > 30) or at
particularly high thrombotic risk.
Ø Intermediate/high-intensity care COVID-19
departments: 70 U/Kg × 2/day.
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