Covid Guide & Mnagement

Question 1

What are the mode of transmission for Covid 19?

Answer 1

Droplet transmission (eg: elevators, restrooms

Airborne can occur under special circumtances:

• Enclosed spaces
• Prolonged exposure to respiratory particles with expiratory exertion (eg: shouting, singing, exercising)
• Inadequate ventilation or air handling causing build up of suspended small respiratory droplets and particles

Question 2

What are the 3 stages and 2 phases of covid 19?

Answer 2

Stage 1 - Early infection
Stage 2 - Pulmonary phase
Stage 3 - Hyperinflammation phase

Phase 1 - Viral Response phase (15 days)
Phase 2 - Host inflammatory response phase (D5 till D28)

Question 3

Define suspected case of covid 19 by clinical and epidemiological criteria

Answer 3

Clinical criteria
- Acute onset of fever and cough
Or
- Acute onset of any two or more of the following ssx: fever, cough, general weakness/ fatigue, headache, myagia, sorethroat, coryza, dyspnea, nausea, vomiting, diarrhea, altered mental status

Epidemiological criteria
- Resides in area with high risk of transmission of virus
- Resides in area with community transmission
- Working in healthcare settings
Plus
Any time within 14 days prior to sign and symptoms

B - Patient with SARI with hx of fever and cough, onset within 10 days

Question 4

Define probable case of covid 19

Answer 4

• A person with rtk ag positive
• A suspected case with chest imaging showed findings suggestive of covid 19
• A pt who meets clinical criteria and is a closed contact of probable or confirmed case or linked to covid 19 cluster
• A person with recent onset of anosmia or ageusia
• Death in adult with respiratory distress preceding death and was a closed cntact or linked to covid 19 cluster

Question 5

Define confirmed case of covid 19

Answer 5

• A person with a positive rtk ag in predetermind areas with prevalence of covid 19 > 10%
• A person dead or alive with a positive rt pcr covid

Question 6

Define person under surveillance

Answer 6

Assymptomatic individuals subjected to hso

Question 7

Define close contact

Answer 7

• Health care associated exposure without appropriate PPE
• Working together in close proximity or sharing same classroom environment with covid 19 patient
• Travelling with covid 19 pt
• Living in same household as covid 19 patient

Question 8

What are the 5 clinical stages of covid 19?

Answer 8

Cat 1 - Assymptomatic
Cat 2 - Symptomatic, No pneumonia
Cat 3 - Symptomatic, With pneumonia
Cat 4 - Symptomatic, Pneumonia, Requiring supplemental oxygen
Cat 5 - Critically ill with multiorgan involvement

Question 9

Covid 19 imaging findings

Answer 9

Chest radiography
- Hazy opacity, often rounded in morphology with peripheral and lower lung distribution

Chest Ct
- Multiple b/l ground glass opacities, often rounded with peripheral and lower lung distribution

Lung ultrasound
- Thicken pleural lines, B lines (multifocal, discrete, confluent), consolidative patrerns w or w/o air bronchograms

Question 10

Causes of deterioration in covid 19

Answer 10

1. Cytokine Release Syndrome - SIRS asso. with rapidly worsening pneumonia with or without multiorgan involvement
2. Viral effect of the disease - 1st week usually and prolonged if immunomodulatory drugs were given too early
3. Decompensation of u/l comorbid
4. Complications (eg: thromboembolism, nosocomial pneumonia)

Question 11

Comorbidities supported by meta analysis

Answer 11

• Cancer
• Cerebrovascular dse
• Chronic kidney disease
• COPD
• Type 1 & 2 DM
• Heart conditions (HF, CAD or cardiomyopathies)
• Smoking, current and former
• Obesity (bmi > 30)
• Pregnancy and recent pregnancy

Question 12

What are the clinical warning signs?

Answer 12

• Persistent or new onset of fever
• Persisten symptoms - Lethargy, anorexia/ cough
• Reduced level of conciousness in absence of alternate explaination
• Respiratory compromise:
  Exertional dyspnea/ desat
  Resp rate > 25
  Spo2 room air < 95%

Question 13

What are the laboratory warning signs?

Answer 13

• Rising crp value or single value >50mg/l
• Dropping of ALC or single value <1
• Neutrophile lymphocyte ratio > 3.13

Question 14

What are the radiological warning signs?

Answer 14

• Features of severe pneumonia, multi-lobular involvement, or rapidly worsening chest xray

Question 15

Symptoms of Covid that should be monitored?

Answer 15

• Cough +- fever
• Sore throat; nose congestion +- anosmia
• Arthralgia, myalgia, malaise
• +- GI disturbance (abdominal pain, diarrhea, nausea, vomiting)

Question 16

What the specific treatment Cat 1 until 3

Answer 16

Cat 1 - No treatment required

Cat 2 & 3 - Supportive and symptomatic tx. Monitor for warning signs

Question 17

What are the treatment of Cat 4?

Answer 17

Cat 4A: Nasal prong