COVID-19 - CAV Flashcards
What increases the risk of severe or critical disease?
65+
Long-term care residents
Chronic medical conditions
Unvaccinated
Pregnancy
Smokers
Post-transplant
How is COVID transmitted?
Primarily through respiratory droplets
Also fecal-oral route
Less so: contaminated surfaces and aerosols
Incubation period?
up to 12-14 days
Mean = 5
What is the pathophys of COVID
Viral RNA invades cells and replicates - target endothelial cells in the alveoli
Alveolar walls thicken, become inflamed, collapse, and fluid leaks into them
-no gas exchange
-ARDS
Cytokines attack the virus as part of the immune system “cytokine storm”
What are common symptoms?
HA
rhinorrhea
pharyngitis
anosmia
ageusia
F/C
Dry cough
SOB
N/V/D
myalgias
extreme fatigue
What is often found on physical exam?
Fever
tachycardia
hypotension
+/- hypoxia
wheezing
rales
Derm findings:
-maculopapular rash, discolored lesions of fingers/toes, hives
What is the recommended diagnostic test for COVID
Reverse transcriptase polymerase chain reaction (RT-PCR)
AKA nucleic acid amplification test
What are the faster options for COVID diagnosis?
Rapid antigen tests
nasopharyngeal tests
What are some labs/imaging used to diagnose COVID?
CBC/CMP
Inflammatory markers (d-dimer, ferritin, ESR, CRP)
Procalcitonin
CXR - diffuse bilateral opacities
CTA chest - ground glass lung opacities
What are non-antiviral options for treatment?
Symptomatic/supportive
Oxygen therapy
Steroids - dexamethasone
When should Paxlovid be used for antiviral treatment?
Paxlovid (nirmatrelvir/ritonavir)
-first line
-13+ (>88 pounds)
-many drug interactions
When should Veklury be used for antiviral treatment?
IV infusion
28 days + and weigh at least 27 pounds
have symptoms
at high risk
When should Lagevrio be used for antiviral treatment?
18+
with symptoms
high risk
no other treatment options available
What meds were used at first but are no longer recommended?
Monoclonal antibodies
+/- Convalescent plasma
What age are vaccinations indicated?
6 months +
What options are mRNA vaccines?
Pfizer-BioNTech
Moderna
Enters muscle cells and instructs them to create spike protein
What type of vaccine is Novavax?
protein subunit vaccine
contains spike proteins of the actual virus plus adjuvants
What are common side effects of the vaccine?
sore arm
site reaction
milk headache
fatigue
nausea
24-48 hours
What are uncommon but more severe vaccine side effects?
fevers
chills
myalgias
headache
extreme fatigue
nausea
What is an option for PRE exposure prophylaxis?
Pemivibart (pemgarda)
for moderately/severly immunocompromised
Is breastfeeding a risk to spread?
No
What are acute complications of COVID
Pneumonia
ARDS
Sepsis
Hypercoagulable state/vasculitis
Restrictive lung disease/diffusing capacity and fibrosis
cardiac, derm, heme, hepatic, neuro, renal, etc
Children - multisystem inflammatory syndrome - MIS-C
What are symptoms of post-acute COVID-19 syndrome
ongoing pulmonary sx
Fatigue
skin rashes
chest pain/palpitations
diarrhea/GI pain
changes in menses
myalgias/arthralgias
psych changes
“brain fog”
What populations are more at risk for “long covid”
more severe COVID-19 illness
underlying health conditions prior to covid
unvaccinated
women
MIS during or after COVID-19 illness
