COVID-19 Flashcards
Covid 19 presentation ranges from what to what?
Mild common cold-like illness to severe viral pneumonia leading to ARDS
What are characteristic symptoms of covid-19?
Fever
Cough
SoB
Altered sense of taste/smell
Some patients may be asymptomatic
What is the cough of covid-19 normally like?
Usually dry
What are strong risk factors for developing covid-19?
Residence in/travel to location reporting community transmission
Close contact with confirmed case
Old age
Residence in a long-term care facility
Male sex
BAME (black, Asian and ethnic minority)
Presence of co-morbidities (HTN, CV disease, DM, obesity, CKD, malignancy)
What are the BAME group at increased risk of?
Higher risk of infection and worse outcomes
What conditions predispose to a more severe illness with covid-19?
CV disease HTN DM Chronic respiratory disease CKD Malignancy Sickle cell disease Solid organ transplant Smoking Chronic liver disease Pregnancy
What kind of viruses are coronaviruses?
Enveloped RNA viruses
What kind of animals do coronaviruses tend to circulate amongst?
Birds and mammals
How many subtypes of coronavirus have been discovered?
2 (L and S)
How is covid-19 spread?
Direct, indirect or close contact with infected people through infected secretions, e.g. saliva or respiratory droplets which are expelled during coughing/sneezing etc.
What is R0?
The reproductive number = the number of people who acquire the infection from an infected person
From what group of people is the virus mostly spread?
Symptomatic people
What is the incubation period of covid-19?
1 to 14 days (usually 5-6 days)
How is it thought that covid-19 acts in the body?
Binds to angiotensin converting enzyme 2 receptor and downregulates ACE2 leading to toxic overaccumulation of angiotensin-2
What is the WHO categories of covid-19?
Mild - symptomatic without evidence of hypoxia/pneumonia
Moderate - clinical signs of pneumonia but no severe pneumonia, SpO2 90+%
Severe - clinical signs of pneumonia + 1 of: RR>30, severe resp distress, SpO2 <90% on room air
Critical - ARDS, sepsis, septic shock, other complications (PE, coronary syndrome, acute stroke, delirium)
What is the national institute of health’s clinical classification of covid-19?
Asymptomatic/presymptomatic - positive test, no symptoms
Mild - signs and symptoms, but no SoB, dyspnoea, or abnormal imaging
Moderate - evidence of lower resp disease by clinical assessment + SpO2 >93% on air
Severe - RR >30, SpO2<=93% on air, lung infiltrates >50%
Critical - resp failure, septic shock and/or multiple organ dsyfunction
Who should you suspect a diagnosis of covid-19 in?
Those with an acute resp illness (fever + 1 of resp symptoms e.g. cough, SoB) + hx travel to/residence in location reporting community transmission of covid in the last 14 days or been in contact with confirmed/probable case in last 14 days
Which groups of patients are more likely to present with covid-19 atypically?
Elderly/immunocompromised
What bacteria most commonly cause co-infections in covid-19 patients?
Mycoplasma pneumoniae
Pseudomonas aeruginosa
H. influenzae
Klebsiella pneumoniae
What signs may those in respiratory distress exhibit?
Tachycardia Tachypnoea Cyanosis Hypoxia Low O2 sats
What initial lab investigations should be done in suspected covid-19?
ABG FBC Metabolic panel BG Coagulation screen Inflammatory markers (e.g. CRP, ESR...) Cardiac biomarkers Serum CK
What other investigations might you do for those with severe/critical covid-19?
Blood/sputum specimens
What test is required to confirm the diagnosis of covid-19?
Molecular testing (NAAT (e.g. real time reverse transcription polymerase chain reaction for SARS-CoV-2)
Do on upper resp specimens (e.g. nasopharyngeal/oropharyngeal swab or wash) or lower resp specimens (e.g. BAL) in those with severe resp disease
Consider collecting additional clinical specimens, e.g. blood stool or urine
In the UK who should be tested for covid-19?
Those with symptoms of a new continuous cough, high temperate or altered sense of taste/smell
What is found in most CXRs of covid-19 patients?
Bilateral infiltrates
What are differentials for covid-19?
CAP Influenza Common cold Other viral/bacterial resp infections Aspiration pneumonia PJP
What investigations should be done in someone with suspected covid-19?
Pulse oximetry ABG FBC Comprehensive metabolic panel BG Coagulation screen Inflammatory markers - - CR, ESR, lactate dehydrogenase, IL-6, ferritin, amyloid A Serum CK Blood + sputum cultures Real-time reverse transcription polymerase chain reaction CXR
Who is considered a contact?
Anyone who has experienced either of the following during 2 days before and 14 days after onset of symptoms of a confirmed/probably case -
- Face to face contact within 1m for >15m
- Direct physical contact
- Direct care
What things should be done in covid-19 management?
Isolation
Infection prevention and control
Symptom management
Supportive care
Where is mild/moderate covid-19 managed?
Can be managed at home, community facility or healthcare facility
Where should severe covid-19 be managed?
Hospital
Where should critical covid-19 be managed?
ITU/critical care
What things are advised for symptom management in covid-19?
Fever/pain - paracetamol/ibruprofen
Cough - avoid lying on back
Olfactory dysfunction - treat after 2 weeks if persists
Advise patients re nutrition and rehydration
What should be given to patients with covid-19 and suspected bacterial co-infection?
Empirical antibiotics
Define severe covid-19 in children
Clinical signs of pneumonia + 1 of:
- Central cyanosis or SpO2 <90%
- Severe resp distress
- General danger sign
- Inability to breastfeed or drink, lethargy, unconsciousness or convulsions
What can be given to patients with moderate-severe breathlessness causing distress?
Oxygen
Opioid and benzo combination
What covid-19 patients should be given VTE prophylaxis?
Acutely ill hospitalised adults and adolescents with covid-19
What drug should you consider giving to a covid-19 patient in hospital who requires oxygen/ventilation?
Low dose dexamethasone
What experimental therapies may be used in the treatment of covid-19 infection?
Remdesivir
Hydroxychloroquine
Lopinavir/ritonavir
Plasma therapy
THESE SHOULD ONLY BE ADMINISTERED IN THE CONTEXT OF A CLINICAL TRIAL
How should those with mild acute respiratory distress be managed?
Non-invasive ventilation (e.g. CPAP or BiPAP) or high flow nasal oxygen
Consider endotracheal intubation + mechanical ventilation in patients with acutely deteriorating patients despite the above measure
What might you trial in patients with severe ARDS and hypoxaemia despite optimising ventilation?
Inhaled pulmonary vasodilator
What VTE prophylaxis is recommended first line?
LMWH
What complications are associated with covid-19?
VTE CV complications (e.g. myocarditis, heart failure, arrhythmias) AKI Acute liver injury Neurological complications Cytokine release syndrome Acute respiratory failure Septic shock
What is the global case fatality rate?
4.4%
