COVID (Final Exam) Flashcards
What does SARS-CoV-2 stand for
Severe-Acute Respiratory Syndrome Coronavirus 2
what are the four genera of coronavirus
alpha coronavirus
beta coronavirus
delta coronavirus
gamma coronavirus
which of the four genera of coronaviruses infect mammals
beta
what is the reservoir of COVID
Bats: infection believed to have spilled over to humans from live animal markets in Wuhan, China in late 2019
what are the 3 main routes of SARS-CoV2 transmission
- inhalation of small, fine droplets and aerosolized virus particles (greatest risk within 3-6 feet of infectious source)
- Deposition of virus in exhaled droplets and particles onto exposed mucus membranes (e.g. being coughed on)
- touching mucous membranes with soiled hands (virus on hands then touches eyes)
true or false: ventilation is key when it comes to spreading COVID
true - not as likely to spread covid outside than you would in a small house
what are the different types of vaccines available in Canada?
- mRNA
- viral vector (non-replicating)
- protein subunit
- virus-like particle (VLP)
this type of vaccine is currently the preferred recommended COVID-19 vaccines. these vaccines contain modified nucleotides that code for the SARS-CoV2 spike protein
mRNA vaccines
with mRNA vaccines, a ______ nanoparticle formulation delivers the mRNA into the recipients cell’s
lipid
true or false: once inside the nucleus of a cell, the mRNA provides instructions to the cell’s protein production machinery to produce the trans-membrane spike protein antigen. that becomes anchored on the cell’s external surface
false - mRNA doesn’t go to the nucleus, it stays in the cytoplasm
when an mRNA vaccine is administered, the immune system us engaged by both the transmembrane spike protein and immune receptors carrying spike antigens to induce ______ immune response
humoral and cellular immune
the mRNA, lipid nanoparticle, and spike protein are degraded or excreted with _____ to ______ (minutes to hours, hours to days, days to weeks or weeks to years)
days to weeks
true or false: mRNA are not live vaccines and cannot cause infection in the host
true
what are some examples of mRNA vaccines for COVID
- Moderna
- Pfizer/BioNTech
these COVID-19 vaccines use a modified virus to carry genes that encode SARS-CoV-2 spike proteins into the host cells. it is a type of adenovirus that has been modified to carry COVID-19 genes and to prevent replication of the adenovirus so that it does not cause disease
viral vector (non-replicating) vaccines
once inside the cells, the SARS-CoV-2 spike protein genes are transcribed into _____ (DNA/tRNA/mRNA/rRNA) in the nucleus and translated into proteins in the cytosol of the cell
mRNA
this specific viral vector vaccine uses a modified chimpanzee adenovirus vector (ChAd)
AstraZeneca
this type of COVID vaccine consists of a purified full-length SARS-CoV-2 recombinant spike protein nanoparticle administered as a co-formulation with the adjuvant Matrix-M
protein subunit vaccines
this is a novel saponin-based adjuvant that facilitates activation of the cells of the innate immune system, which enhances the magnitude of the spike protein-specific immune response
Matrix-M
what is an example of a protein subunit vaccine
Novavax
people over what age can be vaccinated for COVID-19
children over 6 months
what is the recommended dosing regimen of COVID-19 vaccines for those who are between 6 months and 5 years of age
2 doses of Moderna or 3 doses of Pfizer with an 8 week interval between doses (*For those who are moderately to severely immunocompromised, an additional dose is recommended)
what is the recommended dosing regimen for COVID-19 vaccines for those who are over the age of 5 years old
1 dose of Moderna or Pfizer (*For those who are moderately to severely immunocompromised, an additional dose is recommended)
when is it recommended to get the COVID-19 booster
NACI recommends a dose of the XBB.1.5-containing formulation of COVID-19 vaccine for individuals in the authorized age group if it has been at least 6 months since the previous COVID vaccine dose or known COVID-19 infection (whichever is later)
what populations are at an increased risk of COVID-19 infection or severe disease in which immunization for COVID-19 is particularly important
- adults 65 y/o and older
- residents of long-term care homes and other congregate living settings
- individuals with underlying medical conditions that place them at higher risk
- individuals who are pregnant
- individuals in or from First Nations, Metis, and Inuit communities
- members of racialized and other equity-deserving communities
- people who provide essential community services
true or false: booster doses in shorter intervals (3-less than 6 months) following previous vaccination or infection has been shown to pose a safety risk
false
true or false: evidence shows antibody response is higher with longer intervals between infection and vaccination, and with longer intervals between vaccine doses
true
what are some common s/e of mRNA, viral vector and protein subunit vaccines
pain, redness or swelling at the injection site
fatigue, h/a, muscle or joint pain, low fever & chills
what are some RARE adverse effects of mRNA vaccines
Myocarditis and Pericarditis (occurs more often after 2nd dose, usually within a week of vaccination)
!! most common in men under 30y !!
- symptoms include SOB, chest pain, sensation of rapid or abnormal heart rhythm
Pfizer only: reports of Bell palsy
what are RARE adverse effects of viral vector vaccines
serious blood clots (occurring 4-28 hours after vaccination), capillary leak syndrome, Guillian-Barre syndrome
when vaccination is not an option, some individuals may be eligible for this option:
- it is coadministration of 2 different neutralizing monoclonal antibodies
- targets SARS-CoV-2 spike protein preventing viral attachment and cell entry, decreasing viral replication and severity of illness
- not an urgent therapy as it requires ~ 29 days to reach maximum serum antibody concentration and is active for approximately 6 moons
-o- health Canada issued a warning that these monoclonal antibodies may not be effective against certain -2 omicron sub variants
pre-exposure prophylaxis
Tuxagevimab 150mg and cilgavimab 150mg are pre-exposure prophylaxis treatments that are sequentially administered by _____ for a total dose of 300mg
IM
who is eligible for pre-exposure prophylaxis
- for those who should not receive COVID-19 vaccination
- immunocompromised and are unlikely to mount an adequate immune response to the vaccine
when may people start to experience symptoms after exposure
1-14 days (typically appear between 3 and 7 days after exposure)
what are some of the commonly reported symptoms of COVID-19
- sore throat
- runny nose
- sneezing
- new or worsening cough
- fever
- chills
- fatigue or weakness
- new loss of smell or taste
- sob or double breathing
etc
what are some clinical manifestations associated with severe COVID-19 infections (often seen in hospital)
- myocarditis
- heart failure
- MI
- stroke
- clotting events
- AKI
- multiple organ failure
what are some RED FLAGS of a COVID-19 infection that require immediate medical care
- trouble breathing
- persistent pain or pressure in the chest
- confusion
- inability to wake or stay awake
- blue in face or lips
this ‘illness category’ of COVID-19 is described as individuals who test positive for SARS-CoV-2 but have no symptoms
asymptomatic or pre symptomatic
this ‘illness category’ of COVID-19 is described as individuals who have signs and symptoms (e.g.. fever, cough, sore throat, N/V, diarrhea, loss of taste or smell) WITHOUT sob, dyspnea or abnormal chest imaging
mild illness
this ‘illness category’ of COVID-19 is described as individuals who have evidence of lower respiratory disease by clinical assessment or imaging and a saturation of oxygen greater than or equal to 94% on room air at sea level
moderate illness
this ‘illness category’ of COVID-19 is described as individuals who have respiratory frequency of > 30 breaths per minutes, SpO2 < 94% on room air at sea level, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen < 300 or lung infiltrates > 50%
severe illness
this ‘illness category’ of COVID-19 is described as individuals who have respiratory failure, septic shock and/or multiple organ failure
critical illness
what are some laboratory markers that are evident in someone who has COVID
- lymphopenia
- elevated inflammatory markers (ESR, CRP, ferritin, TNF-alpha, IL-1, IL-6)
- abnormal coagulation parameters (thrombocytopenia, prolonged prothrombin time)
what are some radiographic findings of someone with COVID
- bilateral, lower lobe predominate infiltrates on chest imaging
- bilateral, peripheral, lower-lobe ground-glass opacities and/or consolidation on chest CT
this is a complication of COVID-19. occurs mainly in individuals < 21 y/o, fever, lab evidence of inflammation, hospitilized severe illness, multi-organ involvement + no alternate diagnosis + current/recent positive test for SARS-CoV-2 or COVID-19 exposure within 4 weeks of symptom onset
multisystem inflammatory syndrome (MIS-C or MIS-A)
this is a complication of COVID-19 where symptoms persist for weeks or months after their initial recovery. common symptoms include sleep disturbances, sob, difficulty thinking or concentrating, etc. there is no way to diagnose or treat this right now
long COVID
this type of COVID test needs a swab of the nasopharynx, nose or throat or saliva. it tests for the presence of the virus’s genetic material (RNA)
molecular (aka PCR, NAAT)
this type of COVID test needs a swab of the nasopharynx, nose or throat or saliva - it is not as good at picking up current strains with just nasopharynx therefore do swab of mouth (cheeks and back of throat) and then do nose. it tests for the presence of one or more proteins that are part of the virus
antigen (aka Rapid)
what tx options are recommended for non severe COVID-19 patients
Paxlovid (Nirmatrelvir and Ritonavir)
(weak rec for Remdesivir)
what tx options are recommended for severe COVID-19 patients
corticosteroids, IL-6 receptor blockers and Baricitinib
(weak rec for Remdesivir)
what treatment options are recommended for critical COVID-19 patients
corticosteroids, IL-6 receptor blockers and Baricitnib
this is used on a case-by-case basis in individuals with non-severe symptomatic COVID-19, confirmed by a positive COVID-19 test who are at high risk for progression to severe disease
Paxlovid (Nirmatrelvir/ritonavir)
this is used on a case-by-case basic in individuals with non-severe symptomatic COVID-19, confirmed by a positive COVID-19 test who are at high risk for progression to severe disease. IV administration limits use
Remdesivir
this part of Paxovid is a SARS-CoV-2 protease inhibitor
Nirmatrelvir
this part of Paxlovid is a low-dose protease inhibitor that acts as a “pharmacokinetic booster” to inhibit hepatic metabolism of nirmatrelvir and optimize dosing profile
ritonavir
what is the dosing for Paxlovid
Nirmatrelvir 300 mg (2 x 150mg tablets) and ritonavir 100 mg (1 x 100mg tablet) po bid x 5 days
eGFR between 30 and 60: Nirmatrelvir 150 mg (1 x 150 mg tablet) and ritonavir 100 mg (1 x 100 mg tablet) po bid x 5 days
true or false: Paxlovid tablets can be crushed
false
what are some a/e of Paxlovid
- change in sense of taste (due to ritonavir)
- diarrhea
- high blood pressure
- muscle aches
- hepatotoxicity
true or false: Paxlovid can be offered to children, breastfeeding women and pregnant women
false
what is the dosing for Remdesivir
non severe: 200 mg IV loading dose x 1 day then 100 mg IV daily x 2 days
moderate/severe: 200 mg IV loading dose x 1 day then 100 mg IV daily x 4-9 days
no adjustment needed for renal impairment
what are some a/e of Remdesivir
infusion related reactions (hypotension, nausea, vomiting, diaphoresis, shivering)
increased ALT
this is used in moderate-severe COVID-19 patients with SpO2 less than or equal to 94% on room air or supplemental oxygen, or mechanical ventilation
Corticosteroids (Dexamethasone preferred)
this is used in severe COVID-19 patients who are hospitalized and have a SpO2 of less than or equal to 92% on room air or supplemental oxygen and systemic inflammation (e.g. CRP > 75 mg/L)
IL-6 receptor blockers (Tocilizumab)
true or false: Baricitinib (JAK inhibitor) is approved for COVID-19 treatment in Canada
false
what is the dosing for Dexamethasone
6 mg IV once daily or po x 10 days (or until discharge) for patients on supplemental oxygen or receiving mechanical ventilation
- no adjustment needed for renal impairment
what are some a/e of dexamethasone
hyperglycaemia, secondary infections, psychiatric effects, avascular necrosis
what is the dosing for Tocilizumab (Actemra)
8 mg/kg to a maximum of 800 mg IV as a single infusion over 1 hour
no adjustment needed for renal impairment
what are some a/e of Tocilizumab (Actemra)
infection, hepatoxicity, hypertension, infusion reaction, neutropenia, bowel perforation
