Covid Flashcards
Characteristics of SARS-CoV-2
Enveloped, positive-sense, single-stranded RNA viruses
What does Corona Virus commonly cause in man?
Common causes of upper respiratory tract infections in man*
Family of Alpha Corona virus
HCoV-229E, HCoV-NL63
Family of Beta Corona virus
1) HCoV-HKU1, HCoV-OC43
2) SARS-CoV
3) MERS-CoV
4) SARS-CoV-2
What is the type of vector for Gamma and Delta corona virus?
Avian
% of URI in adults with Corona Virus
5-10% of upper respiratory infections in adults, up to 33% in outbreaks.
What other symptoms may associated with Corona virus?
diarrhea and otitis media.
True and False
Corona Virus has low pathogenicity in healthy infants and children.
True
Re-infection with Corona virus is common due to?
antigenic variation in the species.
T/F
SARS, MERS, and COVID-19 are zoonoses.
True
Fatality rate in 2002-2003 w/ SARS
9.6% case fatality rate
Fertility rate in old and young patients with SARS
43% fatal in patients over 60, 13% in younger patients, none in children.
How does SARS( SARS-CoV) transmit? Animals
Horseshoe bats (reservoir) –> Palm civets (intermediate host) –>Human Beings (incidental host) –>Person to Person spread.
SARS: Incubation period?
2-10 days
SARS: Transmission via which modes
Spread by droplet, possibly fecal-oral, airborne, and fomite routes.
SARS: Clinical feature. Prodrome
prolonged prodrome lasting 3-7 days, with fever, headache, myalgias, and no respiratory symptoms.
SARS: symtoms
The prodrome is followed by an acute respiratory illness with a nonproductive cough, dyspnea, with respiratory failure (25% requiring mechanical ventilation).
*SARS: Prodrome
The low infectivity of patients during the prodrome allowed for early isolation; peak viral shedding occurs 6-11 days after the onset of illness.
SARS: how to binds
The virus uses the receptor-binding domain of its spike protein to bind to the host receptor, angiotensin-converting enzyme 2 (ACE2), to gain cell entry.
SARS: Diagnoses
By PCR from the respiratory tract (32% positive 3 days after symptom onset, 68% positive at day 14), or from stool or serum.
If PCR is negative, must repeat in 5-7 days.
Also need acute and convalescent serologic testing (mean time for seroconversion is 19-20 days).
SARS: Treatment
Supportive care
Possibly remdesivir
SARS: Candidate Vaccines
Large number of candidate vaccines, but have not undergone trials in human subjects
Some vaccines given to animals have been paradoxically associated with severe disease on subsequent exposure to the natural virus
MERS: Reservoir
Bats are the reservoir, and camels are the intermediate host for the virus, MERS-CoV .
MERS: Transmission
Cases have occurred in human beings by contact with camels and from human-to human spread, including nosocomial spread.
The largest known outbreak of MERS in other country?
South Korea, 2015 by traveling from Arabian Peninsula
MERS Incubation period?
2-14 days (median: 5.2 days)
MERS Symptoms?
Asymptomatic to severe pneumonitis may be seen
Fever, chills, cough, dyspnea are all common at times with diarrhea and renal injury
MERS fertility rate
34.5% (894 death among 2591 patients)
How MERS transmitted?
Close camel contact or droplets spread from infected person
MERS in person to person
more frequent in health care settings than home
T/F
There is an evidence for sustained human to human transmission of MERS in the community
False
MERS receptor name and location
DPP4
in the upper respiratory system of camels
lower in the human
T/F
DPP4-R are increased in smokers and COPD patients
True
T/F
PCR of lower respiratory tract specimens is less sensitive than upper one because it located deeper in the respiratory system
False
Upper- 93%
Lower- 48%
How long is the serum PCR is positive with MERS
8 days
Other MERS diagnosis tools
ELISA, IFA with microneutralhzation for confirmation
T/F
Neutralizing antibody develops with moderate to severe disease, not in the patient without symptoms or with mild illness. MERS
True
T/F there is no treatment for MERS to be definitely beneficial
True
T/F Ramdesivil has shown moderate therapeutic efficacy with upper respiratory infection with MERS
False- there is no vaccine in human yet
PHEIC?
Public Health Emergency International Concern
World wide Fertility rate of SARS-CO-V-2?
1.05%
U.S Fertility rate of SARS-CO-V-2?
1.10 %
T/F incidence of COVId is 10 times higher than reported rate
True
T/F All SARS- Co-V-2 , SARS CoV and MERS are alpha-corona virus
False- Beta-coronavirus
T/F The host receptor used for SARS-CoV-2 cell entry is the same as for SARS-CoV, the angiotensin-converting enzyme 2 (ACE2).
True
T/F
An animal intermediate host for Covid-19 has not been identified.
True
ACE-2 Receptor
ACE-2 is present in lungs, heart, kidneys, blood vessels, liver, GI tract, and epithelial cells of respiratory tract
ACE-2 breaks down angiotensin Ⅱ into molecules that counteract its harmful effects on tissues
How does SARS-CoV-2 transmit mainly?
Mainly by droplet spread, via respiratory particles within 2 meters (6 feet) of an infected person.
T/F Airborne spread of SARS-Cov-2 is not possible, especially with procedures generating an aerosol as it mainly spread by droplet
False- it is possible (e.g., endotracheal intubation)
T/F (Exam!)
SARS-CoV-2 transmission after 7-10 days still can be infectious
False- Transmission after 7-10 days of illness is unlikely. Viral RNA may be detected in the respiratory tract for a prolonged period after symptom resolution, but is not associated with infectivity.
T/F Many infected patients do not transmit the virus to anyone else. A minority of index cases may result in the majority of secondary cases.
True?
T/F It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then transferring virus to mucous membranes by touching his or her own mouth, nose, or possibly the eyes.
True ; but this is not the main way the virus spreads.
T/F The virus that causes COVID-19 spreads very easily, allowing for sustainably in the community (“community spread”) in many affected geographic areas.
TRUE
T/F The risk of transmission less likely effective with prolonged contact indoors, so secondary infections are common - Covid
False
The risk of transmission increases with prolonged contact indoors, so secondary infections are common
Features of SARS-Cov-2 Variants
Increase in transmissibility
Greater risk of severe disease
Significant reduction in neutralization by antibodies generated during previous infection or after vaccination
Reduced effectiveness of treatments or vaccines
How Covid-2 Variants are detected?
Variants are detected by viral sequencing or by multiplex PCR genotype testing, not by clinically available diagnostic tests.
“Variants of Concern”?
SARS-CoV-2 evolves over time, with those variants (having implications for transmission or severity of clinical illness) considered variants of concern.
Alpha SARS-CO-V-2
Identified in the United Kingdom in late 2020
Became dominant in the U.S. and elsewhere, then declined with the emergence of the Delta variant
Some studies suggested more transmissibility and disease severity than previous circulating lineages
Associated with a minimal reduction in neutralization by monoclonal antibodies
Beta SARS-Co-V-2
South Africa in late 2020, then other countries
Associated with reduced susceptibility to bamvanilimab/etesevimab, but not other monoclonal antibodies
Has declined in prevalence globally
Gamma SARS-Co-V-2
Japan in 4 travelers from Brazil, then in Brazil in December 2020, then in other countries including the U.S., but with subsequent decline in global prevalence
Associated with ** reduced susceptibility to bamvanilimab/etesevimab, but not other monoclonal antibodies
Delta SARS-Co-V-2
India in December 2020, became the most prevalent variant in India, U.K., U.S., and other countries
** Highly transmissible (more than Alpha)
** Associated with more hospitalizations and with higher risk for severe disease than Alpha
*** Vaccine effectiveness against severe disease and hospitalization remained high against Delta
T/F Delta SARS-Co-V-2 has higher transmission rate and
more associated wit hospitalization as it has more severity
True
Omicron SARS-CoV-2: Sublineages BA. 1 and BA. 1.1
Originated in Botswana and South Africa late November 2021
- Increased transmissibility compared to Delta, with less severe disease
Sotrovimab: Active;
Bebtelovimab: Active; Tixagevimab-cilgavimab: Reduced activity
Omicron SARS-CoV-2 : Sublineage BA.2
Increased transmissibility compared to BA.1, with similar disease severity
Bebtelovimab: Active;
Tixagevimab-cilgavimab: Active
Omicron SARS-CoV-2 : Sublineage BA. 4 and 5
Preliminary evidence suggests similar disease as with other Omicron sublineages
Uncertain impact on transmissibility.
Sotrovimab: Unlikely to be active; Bebtelovimab: Active;
Tixagevimab-cilgavimab: Likely active
The most recent variant of Covid as of October 2022
Sub-lineage Q.1
Incubation period of Covid-19?
Incubation period is 2-14 days (mean 4-5 days, 3 for Omicron)
% of asymptomatic and infections with COV-2
33% of infections are asymptomatic (43% at time of positive test, with 73% remaining asymptomatic)
Other signs and symptoms associated with COVID-19
fever, myalgia, fatigue, cough, and dyspnea.
Sore throat has been reported in some patients early in the clinical course, as has altered sensation of taste and smell.
More common symptoms associated with Omicron?
Nasal congestion, sneezing, sore throat are more common with Omicron variants.
Other clinical manifestations of Covid-19
Nausea, vomiting, diarrhea, and abdominal pain may be seen.
Rash may develop, including red nodules of the distal digits in children.
How do you define severe Covid-19?
Severe disease is defined by an oxygen saturation <94% on room air or by the need for oxygen or ventilatory support.
% of most common symptoms
Cough 50%
Fever (temp >100.4) 43%
Myalgias 36%
Headache 34%
Dyspnea 29%
Sore throat 20%
In how many days worsening of the respiratory symptoms developed?
There may be worsening of the respiratory symptoms one week after onset. 1 week
Systemic disease associated with Covid -19
arrhythmias (abnormal heart electrical activity), acute coronary injury, deep venous thrombosis (venous clots), pulmonary embolism (life threatening clot in the pulmonary arteries), stroke, and renal disease can develop.
Systemic disease commonly associated with critical illness
Covid
Encephalopathy is common in the critically ill.
T/F Guillain-Barré has been reported associated with Covid-19
True
A multisystem inflammatory syndrome similar to ( ) can develop in some children, rarely in adults.
Kawasaki’s
Covid- 19 is not associated with diabetes
FALSE: Secondary bacterial infection can develop, usually in setting of diabetes and/or glucocorticoid therapy.
Post- Covid Syndromes
aka Long Covid
May include fatigue, dyspnea, chest pain, cough, psychological and/or cognitive issues.
T/F Children of all ages get infected with SARS-C0V-2 and the incidence is similar to that in adults.
True
T/F Going to school is commonly associated with SARS-CoV-2, because the inconsistent use of masks at school was associated with infection.
False
Children with COVID-19
2% had severe disease
0.08% (6) died
Common systemic underlying disease associated with Covid-19 in children under 21 age
75% of the 21 had underlying risk factors (most frequently reported were chronic lung disease, obesity, neurologic disorders, and cardiovascular disease).
CDC report of Child case as of October 2022
The CDC states there have been 15,795,714 cases among children 0-17, with 1843 deaths
MIS-C , Stands for?
Multisystem Inflammatory Syndrome of Children
MIS-C syndrome
Very much like Kawasaki’s Diseases and Toxic Shock Syndrome
Hypotension
GI symptoms
Rash
Myocarditis
Increase in inflammatory markers
Response to intravenous immunoglobulin
Most common in children 6-12 years of age
Risk factors for SEVERE Covid-19 in Adults
Advanced age (risk of death if >80 was 20x higher than if 50-59 in a UK study)
Cardiovascular disease
Diabetes mellitus
Chronic lung disease
Renal disease
Cancer
Presence of solid organ or stem cell transplantation
Hypertension
Smoking
Obesity
Social determinants of health (Blacks, Hispanics, American Indians, and Alaskan Natives are more likely to become infected and are at risk for more severe disease)
Risk factors for SEVERE Covid -19 in Children
Age<1 year
Medical complexity
Genetic disorders
Neurologic conditions
Metabolic disorders
Diabetes mellitus
Obesity
Congenital heart disease/cardiovascular disease
Asthma and other chronic pulmonary conditions
Sickle cell disease
Immunosuppression
Social determinants of health
T/F Chest CT should be followed by chest x-ray to differentiate the COVID-19 and pneumonia
False: A chest CT does not distinguish between COVID-19 and other causes of viral pneumonia.
What manifestations observed from the x-ray and CT scan Covid
Ground-glass opacities are commonly seen in the lower lung fields bilaterally.
Ground-glass changes are common, usually bilateral, peripheral, and in the lower lung fields.
A tool used for Diagnosis of Covid -19
nasopharyngeal secretions obtained properly with a viral swab is the gold standard for diagnosis.
T/F The yield of PCR from sputum can have positive result although it has lower yield rate.
True
T/F Nasopharyngeal secretion is the gold standard for diagnosis as it has higher yield than oropharyngeal or sputum
True
T/F Antigen tests are quite specific, but they are not as sensitive as the RT-PCR.
True
T/F Serology is a diagnosis tool to determine the exposure and immunity
False Serology is used only to determine exposure, not immunity.
which immunoglobulin developed after the exposure and in how many days? (COVID)
It takes up to three weeks for IgG to develop (positivity approaches 100 % by 16-20 days).
Most patients have detectable IgG up to 8 months after infection.
T/F Serologic also indicated protective immunity to SARS-COv2 especially with IgG.
Serologic correlates of protective immunity have not been defined. Only determines the exposure
Mechanism of Covid-19 Vaccine
Vaccination induces the production of anti-spike antibodies.
What is the key factor that determine the infection from serology from vaccinated patients?
Anti-nucleocapsid antibodies
Serologic tests to determine infection in those who have been vaccinated must detect anti-nucleocapsid antibodies, but those very antibodies are less likely to develop in those who become infected after having been vaccinated.
Oral protease inhibitor to use to treat Covid-19?
Nirmatrelvir/Ritonavir (Paxlovid)
How Nirmatrelvir/Ritonavir (Paxlovid) treat Covid -19?
Nirmatrelvir inhibits the SARS-C0V-2-3CL protease and is given with low-dose ritonavir to slow its metabolism
A prodrug of the nucleoside derivative
N4-hydroxycytidine, and as a nucleoside analogue, causes copying errors during viral RNA replication.
Molnupiravir (Lagevrio)
How Molnupiravir (Lagevrio) treat Covid-19?
It is a prodrug of the nucleoside derivative N4-hydroxycytidine, and as a nucleoside analogue, causes copying errors during viral RNA replication.
** Medications Not Recommended for Treatment of SARS-C0V-2 Infection
Ivermectin
Hydroxychloroquine
Chloroquine
Favipiravir
Interferons
Azithromycin
Lopinavir/ritonavir
Nirmatrelvir/ritonavir (Paxlovid) Is given to patients who are:
> 65 years of age
immunosuppressed adults
any age with multiple risk factors for severe disease
adults > 50 who have not been vaccinated
Give as soon as possible, but within 5 days of symptom onset
If cannot give Paxlovid, what should be considered?
Bebtelovimab
Remdesivir (Veklury)
Convalescent high-titer plasma
Molunupiravir
Bebtelovimab
Monoclonal antibody, given as 175 mg IV x 1 dose within 7 days
Only monoclonal in available in the US with activity against current Omicron sublineages
Remdesivir (Veklury)
200mg IV first day, then 100 mg daily x 2d
Give within 7 days
Reduces risk of hospitalization in those with risk factors
Convalescent high-titer plasma
Difficult to obtain
Give within 8 days
May reduce the risk of hospitalization in those with risk factors for severe disease
Treatment of the Hospitalized Patient with COVID-19 (in hospital)
Respiratory support (oxygen, with ventilation as needed)
Avoidance of nebulization for administration of medications (to avoid risk of aerosolization)
Prophylaxis against thrombotic events for all patients with COVID-19 who are hospitalized. Full anticoagulation for documented clots.
Continue ACE inhibitors, ARB’s, statins, and aspirin if on these
Rule out and treat for influenza during influenza outbreaks
Daily monitoring with CBC, CMP, CK, CRP; every other day PT, PTT, fibrinogen, D-dimer; baseline and as needed, LDH, troponin, EKG
Treatment of the Hospitalized Patient with COVID-19
Remdesivir
Monoclonal antibodies directed against SAR-C0V-2
Baricitinib
Tocilizumab
Remdesivir with hospitalized patients
A nucleotide analogue that has activity in vitro against SARS-CoV-2 by inhibiting RNA polymerase
Data is best for patients with risk factors for severe disease and without the need for oxygen or if on low flow oxygen.
Monoclonal antibodies directed against SAR-COV-2
may be given
1) if the patient is hospitalized for a reason not related to COVID-19, found to have the virus,
2) and if the patient meets the EUA criteria used for outpatients with COVID-19 for whom the antibodies are indicated.
The monoclonal must have been shown to be effective against the likely variant involved.
Immunosuppressed hospitalized COVID-19 patients may also be candidates for monoclonal antibody therapy.
Baricitinib
Janus kinase (JK) inhibitor used to treat rheumatoid arthritis. It is an immunomodulator that may also interfere with viral entry. It is given if the patient is on low flow oxygen or noninvasive ventilation and has rising inflammatory markers despite dexamethasone. It is given as 4 mg orally for up to 14 days, with renal dose adjustment needed.
Tocilizumab
An IL-6 pathway inhibitor. IL-6 is a proinflammatory cytokine that may be elevated in COVID-19. Tocilizumab is given as 8 mg/kg IV x 1 dose for patients on low flow oxygen with progressive inflammation despite dexamethasone and if on high flow oxygen or on higher ventilatory support.
If on no oxygen and hospitalized because of COVID-19?
No dexamethasone
Remdesivir (may improve time to recovery)
If on no oxygen and hospitalized for a non-COVID reason ?
Manage as do an outpatient with COVID
If on low-flow oxygen ?
Low dose dexamethasone and remdesivir
Add baricitinib or tocilizumab if have rising oxygen requirements or rising inflammatory markers
If on high flow oxygen or non-invasive ventilation ?
Dexamethasone, remdesivir, and baricitinib or tocilizumab
If on ventilator or ECMO(Extracorporeal membrane oxygenation)
Dexamethasone and baricitinib or tocilizumab, but no remdesivir
Covid-19 Pregnant Patient
C-section in the COVID-19 patient is associated with an increased risk of clinical deterioration in the patient (22% vs 5%) after delivery.
The mom can breastfeed and handle her infant, but should wear a mask and should perform careful hand hygiene. The risk to the infant is minimal.
The infant should be checked for SARS-CoV-2 at 24 h of age and, if negative, at 48 h.
T/F Pregnancy does not increase the risk of acquisition of SARS-CoV-2 infection.
True
T/F There is an increased risk of preterm labor in the pregnant patient with SARS-CoV-2 infection.
True
T/F There is evidence that the virus is transmitted in utero to any significant degree.
False: There is no evidence that the virus is transmitted in utero to any significant degree.
( ) can be given for pregnant patients
Dexamethasone
T/F Vaccination should be delayed -after the labor
False- Vaccination to prevent SARS-CoV-2 infection may be given and can be given at same time as TdaP or the influenza vaccine (both indicated during pregnancy).
COVID
Patients develop ( ) and ( ) after infection, with the durations uncertain.
Patients develop neutralizing antibody and T-cell mediated immunity after infection, with the durations uncertain.
T/F Reinfection in the 6-8 months after initial infection is common, with the severity of disease attenuated.
False - Reinfection in the 6-8 months after initial infection is not common, with the severity of disease attenuated.
Operation Warp Speed
Operation Warp Speed (OWS) was a partnership between the Departments of Health and Human Services (HHS) and Defense (DOD) and pharmaceutical companies aimed to help accelerate the development of a COVID-19 vaccine.
OWS selected vaccine candidates using different mechanisms to stimulate an immune response , and vaccine companies started large-scale manufacturing during clinical trials.
Vaccine Platform Technologies Supported by Operation Warp Speed as of January 1, 2021
How vaccine prevent from Covid-19
All vaccines to date have as the antigenic target the spike protein, thus preventing attachment to the host cell and neutralizing the virus.
Covid-19 Vaccine platforms that have been developed for study include
1) Live attenuated vaccines
Inactivated vaccines
2) Recombinant protein vaccines (Novavax vaccine, NVX-CoV2373)
2) Replication competent vector vaccines (Johnson & Johnson/Janssen Pharmaceuticals vaccine, Ad26.COV2.S)
3) Replication-incompetent vector vaccines (University of Oxford/ AstraZeneca vaccine, CHAdOx1 nCoV-19/AZD 1222)
4) Inactivated virus vector vaccines
mRNA vaccines (Pfizer/BioNTech BNT162b2 vaccine, Moderna mRNA-1273 vaccine and their bivalent booster vaccines)
T/F It is currently recommended that individuals with a history of SARS-CoV-2 infection still be vaccinated unless there is a history of MIS (multisystem inflammatory disorder).
True
Vaccination should be delayed for ( ) days after receipt of monoclonal antibodies or convalescent plasma.
90 days
T/F Pregnancy is not a contraindication to vaccination.
True
T/F Individuals with a history of heparin-induced thrombocytopenia should NOT receive an mRNA vaccine, but an adenovirus vector vaccine.
False- Individuals with a history of heparin-induced thrombocytopenia should receive an mRNA vaccine, not an adenovirus vector vaccine.
Novavax vaccine (NVX-CoV2373)
a recombinant vaccine which contains modified spike protein made using moth cells and an adjuvant made from tree bark.
Novavax vaccine made of?
The spike protein genes are placed in a baculovirus, an insect virus which infects moth cells, allowing the production of spike protein, purified for use.
Matrix-M, an adjuvant based on saponin extracted from the soapbark tree, is then added to increase the immune response.
Efficacy rate of Novavax
90.4 % in preventing symptomatic COVID-19 infection in the U.S
mRNA SARS-CoV-2 Vaccines- features
mRNA is modified by incorporating N1-methyl-pseudouridine in place of uridine, with a 10x increase in translation and avoidance of excessive inflammation
Placement of mRNA in lipid nanoparticles for delivery into cells and to protect from degradation by ribonucleases
The mRNA in the vaccine is degraded within a few days.
mRNA COVID Vaccines
Pfizer-BioNTech COVID-19 Vaccine, BNT162b2
Pfizer-BioNTech COVID-19 Vaccine, Bivalent
Moderna Covid-19 Vaccine (mRNA-1273)
Moderna Covid-19 Vaccine, Bivalent
AstraZeneca vaccine, CHAdOx1 nCoV-19
The vaccine uses an Adenovirus that ordinarily infects chimpanzees, genetically modified so it cannot replicate in man and containing the gene coding for spike protein.
Stored refrigerated
Given as 2 doses 4-12 weeks apart
Pfizer-BioNTech COVID-19 Vaccine, BNT162b2
Monovalent vaccine
FDA approved for persons 12 years of age and older and granted EUA for children 6 months-11 years of age
Primary series: 2 doses 3-8 weeks apart, 3rd dose 28 days after 2nd dose if immunosuppressed
Pfizer-BioNTech COVID-19 Vaccine, Bivalent
Original vaccine + Omicron BA.4/BA.5 (bivalent)
Granted EUA as booster for ages > 12
Moderna Covid-19 Vaccine (mRNA-1273)
Monovalent
Primary series: 2 doses 4-8 weeks apart, with 3rd dose one month later if immunosuppressed
FDA approved for ages > 18
Granted EUA for ages 6 months-17 years
Moderna Covid-19 Vaccine, Bivalent
Original vaccine + Omicron BA.4/BA.5 (bivalent)
Granted EUA for ages > 18 years of age
Johnson & Johnson/Janssen Pharmaceuticals vaccine, Ad26.COV2.S
Developed from a weakened adenovirus expressing SARS-CoV-2 spike protein
FDA currently has granted an EUA for individuals 18 and older if unable to take an mRNA Covid vaccine
Stored refrigerated
BNT162b2, Pfizer
95% efficacy in preventing symptomatic COVID-19 after primary series, declining to 90% between 2-4 months, and to 84% from 4-6 months
mRNA-1273, Moderna
94.1% efficacy in preventing symptomatic COVID-19 after the primary series, 93.2% after 5.2 months, with 98.2% efficacy in preventing severe disease
Ad26.COV2.S, J & J
66.9% efficacy in preventing moderate to severe COVID after one dose. With two doses two months apart, efficacy against symptomatic and severe COVID was found to be 75% and 100%, respectively.
HAdOx1 nCoV-19/AZD 1222: Astrigenca
76% efficacy in preventing symptomatic COVID-19 in study in U.S, Chile, Peru with 2 doses 4 weeks apart
NVX-CoV2373 , Novavax
89.7% effective in preventing symptomatic infection in a phase Ⅲ study in the United Kingdom among 14,000 participants
T/F
SARS is characterized by a prolonged prodrome lasting 3-7 days, with fever, headache, myalgias, and no respiratory symptoms.
True
Common side effects associated with mRNA vaccine?
Pain, injection site swelling and erythema, ipsilateral lymph node enlargement, fatigue, fever, headache are all common. Local and systemic side effects are more common in individuals with a history of SARS-CoV-2 infection
Other rare side effects associated with mRNA vaccine?
Anaphylaxis is rare.
Facial swelling in areas previously injected with cosmetic dermal fillers.
Myocarditis and pericarditis from mRNA vaccine
mainly in male adolescents and young adults
354,100,845 mRNA vaccines (JAMA)
-usually within one week after vaccine receipt
-usually mild, with fulminant myocarditis very rare
Adverse effects that associated with adenovirus vaccine
Thrombosis with thrombocytopenia
Guillain Barré syndrome
Which type of vaccine should be used with the Patient with history of Guillain Barré syndrome
mRNA vaccine should be used
T/F All SARS-Co-V are Zoonose
True
Definition of Prodrome
an early symptom indicating the onset of a disease or illness
Paradox response
Experience exacerbated immune response despite of vaccination
What is the key feature of SARS CoV1 and 2?
SARS- Cov1: Prodrome
Incubation rate of SARS is:
Incubation rate of MERS is:
SARS: 2-10 days
MERS: 2-14 days
T/F MERS more likely occurs from the healthcare settings
True
T/F MERS- The animal reservoir is a bat
True
T/F DPP4 receptor located in upper respiratory system in human
False- lower
T/F Omicron has less severity but more infectious
as the vaccination
True
T/F Omicron is associated with lower respiratory system as it mutated multiple times
False- more upper
Which Covid drug has lots interactions with the drugs?
Paxlovid
Paxlovid mostly interacted with what types of medication?
Hyperlipidemia mediation
Which vaccine cause the myocarditis?
mRNA-vaccine(Moderna) causese
Mryocardititis in males but mild way
Adenovirus vector vaccines
Adverse effects
Thrombosis with thrombocytopenia and
Guillain Barré syndrome
Deaths to date due to SARS-CoV, MERS-CoV, and SARS-CoV-2
SARS-CoV 9.6%
MERS-CoV 34.5%
SARS-CoV-2 1.10%
T/F
one of the most common adverse effects from mRNA vaccines is
anaphylaxis
False
T/F
mRNA virus can cause facial swelling in areas previously injected with cosmetic dermal fillers
True
T/F
Adenovirus vector vaccine cause the myocarditis mainly in male adolescents and young adults
False
mRNA vaccines
T/F
Nebulization must be used for administration of medications to avoid risk of aerosolization
False
should be avoided
T/F
Continue ACE inhibitors, ARB’s, statins, and aspirin is not recommended as the virus does not work these medications
False
should be used
Drug options for hospitalization patient with Covid
Remdesivir
Monoclonal antibodies directed against SAR-C0V-2
Baricitinib
Tocilizumab
Remdesivir
-A nucleotide analogue that has activity in vitro against SARS-CoV-2 by inhibiting RNA polymerase
-200 mg on day 1, then 100 mg daily x 5 days (can extend to 10 days if there is no clinical improvement)
-Data is best for patients with risk factors for severe disease and without the need for oxygen or if on low flow oxygen.
Monoclonal antibodies directed against SAR-C0V-2
may be given if the patient is hospitalized for a reason not related to COVID-19, found to have the virus, and if the patient meets the EUA criteria used for outpatients with COVID-19 for whom the antibodies are indicated. The monoclonal must have been shown to be effective against the likely variant involved. Immunosuppressed hospitalized COVID-19 patients may also be candidates for monoclonal antibody therapy.
Baricitinib
a Janus kinase (JK) inhibitor used to treat rheumatoid arthritis. It is an immunomodulator that may also interfere with viral entry. It is given if the patient is on low flow oxygen or noninvasive ventilation and has rising inflammatory markers despite dexamethasone. It is given as 4 mg orally for up to 14 days, with renal dose adjustment needed.
Tocilizumab
an IL-6 pathway inhibitor. IL-6 is a proinflammatory cytokine that may be elevated in COVID-19. Tocilizumab is given as 8 mg/kg IV x 1 dose for patients on low flow oxygen with progressive inflammation despite dexamethasone and if on high flow oxygen or on higher ventilatory support.
Incubation period for Omicron
3 days
T/F
Covid highly associated with HIV
True
T/F
Metabolic disorders highly associated with COVID
True
Drug class of Nirmatrelvir/Ritonavir (Paxlovid) ?
Oral protease inhibitor,
T/F
Although individuals exposed to the Covid-v2, will not develop immunity permanently
True
Molnupiravir (Lagevrio)
Nucleoside analogue
It is a prodrug of the nucleoside derivative N4-hydroxycytidine, and as a nucleoside analogue, causes copying errors during viral RNA replication.
Remdesovir
Nucleotide inhibitor
inhibit RNA polymerize
Reduces risk of hospitalization in those with risk factors
Monoclonal antibodies
directed against covid2
only works in alpha covid 1
immunoesprrssant patient
Baricitinib
Janus Kinase inhibitor
treat rheumatoid arthritis
interfere viral entry
Tocillzumab
IL6 inhibitor
Bebtelovimab
monoclonal antibody
only monoclonal antibody in available in the US
Molnupiravir, contraindication/ toxic
Not indicated for pregnant women.
Toxic to bone and cartilage; not given to those < 18 years of age.
TREATMENT of COVID-19
1) Nirmatrelvir/Ritonavir (Paxlovid)
2) Molnupiravir (Lagevrio)
Treatment of Outpatients with COVID-19 When cannot give Paxlovid (Nirmatrelvir/Ritonavir)
Bebtelovimab- monocolonal antibody
Remdesivir (Veklury)
Convalescent high-titer plasma
Molunupiravir
Treatment of the Hospitalized Patient with COVID-19, continued
Remdesivir
Monoclonal antibodies directed against SAR-C0V-2
Baricitinib
Tocilizumab
T/F
Pregnancy increase the risk of acquisition of SARS-CoV-2 infection.
False
Pregnancy does not increase the risk of acquisition of SARS-CoV-2 infection.
T/F
There is an increased risk of preterm labor in the pregnant patient with SARS-CoV-2 infection.
True
T/F
There is recent evidence that the covid virus is transmitted in utero to any significant degree.
False
There is no evidence that the virus is transmitted in utero to any significant degree.
Which immunity are developed after COVIE infection
Patients develop neutralizing antibody and T-cell mediated immunity after infection, with the durations uncertain.
Vaccination to prevent SARS-CoV-2 infection
Evusheld (tixagevimab/cilgavimab)
may be given IM for immunocompromised patients preexposure to SARS-CoV-2
if the patient cannot be vaccinated or is expected to not respond to the vaccine and if the circulating variant is sensitive. It is given every 6 months.
Vaccines to Prevent SARS-CoV-2 Infection
1) Live attenuated vaccines
2) Inactivated vaccines
3) Recombinant protein vaccines (Novavax )
4) Replication competent vector vaccines (J& J)
5) Replication-incompetent vector vaccines (AstraZeneca)
5) Inactivated virus vector vaccines
6) mRNA vaccines Pfizer and moderna
Vaccines to Prevent SARS-CoV-2 Infection
1) Live attenuated vaccines
2) Inactivated vaccines
3) Recombinant protein vaccines (Novavax )
4) Replication competent vector vaccines (J& J)
5) Replication-incompetent vector vaccines (AstraZeneca)
5) Inactivated virus vector vaccines
6) mRNA vaccines Pfizer and moderna
