COVID 19

Question 1

What is a coronavirus?

Answer 1

A group of RNA viruses that cause disease in mammals and birds.
They are an enveloped virus with characteristic spike proteins on their surface which leads to their name.
They cause respiratory tract infections which can range from mild to severe.

Question 2

What variants of coronavirus can cause severe illness in humans?

Answer 2

• SARS-cov1 (severe acute respiratory virus)
• MERS-cov (middle eastern respiratory virus)
• SARS-cov2 (severe acute respiratory virus 2- covid 19 pandemic)

Question 3

How does the coronavirus 19/SARS-cov2 cause infection in humans?

Answer 3

Spike proteins on the surface of the virus attach to ACE2 receptors on epithelial cells of the lung. This facilitates entry of the viral RNA into the host cell and replication via the host replication pathway.
Release of the virus allows haematogenous spread and binding to ACE2-R throughout the body, notably heart, liver bowel.
Transmission to another host is via aerosol, droplets and fomites.

Question 4

How does SARS-cov2 infection present?

Answer 4

Around a third of those infected remain asymptomatic.
Of those with symptoms and following an initial incubation period typical symptoms include:
Systemic:
- fever
- lethargy

Respiratory:

• sore throat
• dry cough
• breathlessness and hypoxia

Ex-pulmonary:

• diarrhoea
• headaches
• heart failure
• deranged LFTs

Question 5

How would you manage a patient with SARS-cov2 infection?

Answer 5

• Infection control and prevention measures - staff donning of PPE and isolation of patient
• ABCDE approach
• Administration of oxygen therapy relative to extent of hypoxia and work of breathing (HFNO2, CPAP, IPPV)
• nasal and throat swabs sent early along with extended respiratory viral panel
• CXR
• serology including blood cultures
• urinary antigens for pneumococcal and legionella
• consider CTPA and assessment for DVT if CXR unremarkable.
• cardiac investigations for myocarditis (trop, BNP, echo).
• Specific therapies:
• dexamethasone (mortality benefit)
• remdesivir (reduces recovery time in those not on respiratory support)
• IL6 antagonists (mortality and organ support free days)
• CPAP
• SARS-Cov2 antibodies
• enhanced VTE prophylaxis
• ventilatory strategies and ECMO