covid Flashcards
What are the origins of SARS-COV2?
What is its structure like?
What corona virus number does it cause?
What are the 4 main structural proteins that make up SARS-COV2?
What do mutations in spike proteins cause?
What is a current circulating variant of concern?
- The Origins of SARS-COV2 are likely from natural virus entry from a bat, via intermediate.
- Its structure is a single-stranded RNA virus.
- SARS-COV2 causes Coronavirus number 7.
4 major structural proteins that make up SARS-COV2 (NMES)
1) Nucleocapsid
2) Membrane
3) Envelope
4) Spike
Mutations in spike proteins lead to inevitable variants with different structure, function, and enhanced overall fitness
A current circulating variant of concern is Omicron (WHO label)
What are the 2 main methods SARS-COV2 enters cells?
2 main methods SARS-COV2 enters cells:
1) Endocytosis
2) TMPRSS2 (Transmembrane serine protease 2
What are 12 possible symptoms of Covid?
What are 4 of the most common symptoms?
What may be the only symptom?
Possible symptoms of Covid:
1) Fever or chills
2) Cough
3) Malaise (a general feeling of discomfort, illness, or unease whose exact cause is difficult to identify)
4) Shortness of breath or difficulty breathing
5) Fatigue
6) Myalgia (Muscle or body aches)
7) Headache
8) New loss of taste or smell
9) Sore throat
10) Congestion or runny nose
11) Nausea or vomiting
12) Diarrhoea
4 of the most common symptoms:
1) Fever
2) Cough
3) Malaise
4) SOB
Patients may only present with diarrhoea and vomiting, or present with no symptoms at all
What are 5 overt (obvious) signs of covid that can be seen on examination/tests?
5 Overt (obvious) signs of covid that can be seen on examination/tests:
1) Pneumonia or bronchial breathing
2) Frequently signs on chest – bilateral signs (fine crepitations on exam/CXR)
* Crackles orexplosive sounds heard on auscilitation
3) Respiratory failure
4) Acute kidney injury
5) Delirium
What are 4 prognostic biomarkers of covid?
What are 3 severity markers of covid?
What pneumonic can be used for risk factors for covid?
4 prognostic biomarkers of covid:
1) lymphopenia (<1.0) – low white blood cells
2) Elevated Ferritin
3) Elevated LDH
4) Elevated D-dimer (>1000ng/ml)
3 severity markers of covid:
1) SOFA
2) qSOFA
3) lactate >4 mmol/l
Pneumonic for risk factors of covid (SO AFRAID):
1) S – Sex
2) O – Obesity
3) A – Age (>60)
4) F – Frailty
5) R – respiratory disease
6) A- cArdiovascular disease
7) I – Immunosuppression
8) D - Diabetes
What is ISARIC?
What were 3 findings from ISARIC studies in the UK on covid?
ISARIC is a global federation of clinical research networks, providing a proficient, coordinated, and agile research response to outbreak-prone infectious diseases.
Findings from ISARIC studies in the UK on covid:
1) Covid was more common in men in the study
2) The greater the age, the greater the number of risks that come with having covid
3) Cough, fever, SOB, fatigue were the most common symptoms on presentation in the hospital
How does acute covid present?
How long is the pre-symptomatic stage?
What 3 things do we need to consider with acute covid?
A majority of patients with acute covid have low or minimal symptoms of infection
We also have to note the pre-symptomatic stage, which is about 3 days
3 things we need to consider with acute covid:
1) Mild illness (self-resolving) vs acute disease (subtype, severity)
2) Urgent/immediate treatment priorities
3) Ceiling of care
* Refers to the maximum level of care which the patient is set to receive,
* This is often a complex and sensitive decision reached between the patient, their family and the healthcare team responsible for the patient.
How is suspected/mild covid treated different based on presence of (in picture – other comorbidities):
* Mild illness?
* Pneumonia?
* ARDS (acute respiratory distress syndrome)?
* Sepsis (severe sepsis/septic shock)?
what are 5 ways to diagnose covid?
Way of diagnosing Covid:
1) Nose/throat swab RT-PCR
2) Genomics (‘WGS’ – whole genome sequencing)
3) Measure of viral presence (not disease, as they could be ill for other reasons but so happen to have or not have the virus)
4) Antibody testing
5) Imaging, such as CXR, then comparison to ECG
What are 3 pros and 4 cons of Nose/throat swab RT-PCR?
3 pros of Nose/throat swab RT-PCR:
1) Positive diagnosis (tells us virus is there, no discussion)
2) Clinically relevant
3) Rapid test (lab PCR 2-3h)
POCT (20mins) (points of care testing – LFT)
4 cons of Nose/throat swab RT-PCR:
1) Negative does NOT = no infection
2) Operator-dependent
3) Upper airway virus (may not swab virus)
4) Test failure/performance
Why is WGS (whole genome sequencing) used for covid?
When might urgent samples be sequenced?
WGS (whole genome sequencing) is used for covid as it allows scientists to classify a virus as a particular variant and determine its lineage.
Urgent samples come from cases where it is unclear how they might have been infected, or when additional evidence is needed to confirm which cluster they belong to
What is antibody testing not relevant for?
Do antibodies equate to immunity?
What is the host antibody response to covid?
What else we have to consider for antibody testing?
Antibody testing for covid is not relevant for acute COVID diagnosis, as they may have old antibodies from an old covid infection/vaccine
Antibodies do not equate to immunity
Host antibody immune response to covid is IgM (>10d), and later IgG (~6-12 months)
We also need to consider what is required for the antibody test, and constantly update this
E.g 2021: seronegative patients offered monoclonal antibody treatment (‘Ronapreve’)
2022: Ronapreve ineffective
Predominantly, what type of illness is covid?
How are CXRs used in covid?
What 3 things is a CXR sensitive to that can be related to covid?
Why is a normal CXR reassuring?
What % of people with covid have mild or moderate cases of covid?
What will moderate covid include on an x-ray?
What are the most commonly reported signs of covid on a CXR/CT scan?
What is bilateral interstitial pneumonia? What is ground-glass opacity (GGO)?
COVID-19 is predominantly a respiratory illness
CXR is a critical diagnostic/prognostic marker in COVID19, and provides the most cost-effective biomarker
3 things a CXR is sensitive to that can be related to covid:
1) Pneumonia
2) Heart failure
3) Early ARDS (acute respiratory distress syndrome
This makes a normal CXR reassuring (when compared with ECG) that major complications are not present
~80% will have mild (40%) to moderate (40%) disease, most will recover
Moderate disease will include a mild form of pneumonia on a CXR
Bilateral infiltrates and ground glass opacity are the most commonly reported signs on CXR and CT imaging
Bilateral interstitial pneumonia is a serious infection that can inflame and scar your lungs
Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs.
It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis, or a neoplastic process
What are 2 other diagnostic tools for covid?
1) Rapid molecular diagnostics
2) Machine learning and ‘Deep Neural Networks’ (DNN)
What are the 2 stages of Covid?
What medicine can be useful in each stage?
What is the most important in the treatment of covid?
2 stages of Covid:
1) Viral infection +/- viraemia
* Viremia is a medical term for viruses present in the bloodstream
* Anti-virals predicted to be useful in stage/phase 1
2) Pro-inflammatory cascade
* Anti-inflammatory or immunomodulatory therapy predicted useful in phase 2
Augmenting host responses > mitigating viral impact in the treatment of Covid
This is because we want our immune system to help us, not cause immunopathology, which is a lot of what this disease is
How is suspected/mild covid treated different based on presence of (in picture – other comorbidities):
* Mild illness?
* Pneumonia?
* ARDS (acute respiratory distress syndrome)?
* Sepsis (severe sepsis/septic shock)?
What 6 part pneumonic do we use in the acute management of covid?
What are ongoing trials for COVID?
What are 3 ways covid diagnostics are getting better?
How is STRAPP in acute management of covid developing (in picture)?
Ongoing trials for covid include REMAP-CAP and RECOVERY (biggest covid trial in the world)
3 ways covid diagnostics are getting better:
1) POCT will become easier (point of care testing)
2) Role in out-patients at risk
3) Markers in ICU
