Basics of SARS Covid19

1. SARS COV 2-COVID 19
Dr Sravan kumar G
D.M Cardiology, SCTIMST

2. WHEN INFORMATION DOES NOT LEAD TO WISDOM
2007

3. 2017

4. • China appears to have looked other way, is liable for exporting the
virus, appears complicity of even WHO
• HCoV-OC43, HCoV-HKU1, HCoV-NL63, and HCoV-229E
SARS 2002 MERS COVID 19
INFECTIONS 8098 2494 453074
DEATH 774 858 20519
CFR 10% 37%
S GLYCOPROTEIN
S1-Receptor
binding
S2 – Cell
membrane fusion
Furin Cleavage site
YES
NO
YES
NO
YES
YES
RECEPTOR hACE2 DPP4 hACE2
Reservoir Bats Bats Bats
Intermediary host palm civets
racoon dogs
dromedary camels Unknown
Potential vaccine

5. SARS-CoV-2 uses ACE2 to enter target cells
SARS-CoV-2 and SARS-CoV bind with similar
affinities to ACE2
Structures of SARS-CoV-2 spike glycoprotein in
two conformations
SARS-CoV polyclonal antibodies inhibit SARS-
CoV-2 spike-mediated entry into cells

6. COVID -19 – Zoonotic
• SARS CoV 2 (79% sequence identity with SARS-CoV – SARS-2002)
• Family coronaviridae Genus beta coronavirus Subgenus sarbecovirus
• Natural Host & Reservoir – Horse Shoe bats, Intermediate host --?? Snakes,
yet to discover
• ACE-2 - receptor for cell entry
(Converts Angiotensin II
(Vasoconstrictor)  Angiotensin 1-7
(Vasodilator)
• Wet market (Huanan Seafood Wholesale
Market in Wuhan City, South china)
• Live animals

9. • R0 value - 2.2 (1.4-3.8) - similar to SARS-CoV-1 and pandemic
influenza

13. January 1, 2020 until February 23, 2020.

15. Demographics
41 PATIENTS (DEC 16- JAN
2)
1099 PATIENTS (DEC 11 –
JAN 29)
Metaanalysis(Jan 1 –feb
21) 2874 Patients
INCUBATION PERIOD
(DAYS)
4
MEDIAN AGE (YEARS) 49 47 52
MALE SEX (%) 30 (73%) 637 (58%) 56%
CHILDREN 0 9 (0.9%) (0-14 YRS)
ICU ADMISSION (%) 13 (32) 55 (5) 20.3%
UNDERLYING DISEASES
(%) Hypertension
Diabetes
CVD
13 (32)
6 (15)
8(20)
6 (15)
261 (24) 36.8%
18.6%
11.9%
14.4%
HUANAN SEAFOOD
MARKET EXPOS
27 (66%)

16. Symptoms
41 PATIENTS 1099 PATIENTS(DEC 11 –
JAN 29)
Metaanalysis(Jan 1 –feb
21) 2874 Patients
FEVER (%) 40 (98) 975 (89) 89%
COUGH (%) 31 (76) 745 (68) 58%
MYALGIA/FATIGUE (%) 18 (44) 29.4%
MYALGIA 164 (15)
FATIGUE 419 (38)
DYSPNEA (%) 22 (55) 205 (19) 45%
SPUTUM (%) 11 (28) 370 (34) 28.5%
HEADACHE (%) 3 (8) 150 (14) 8%
HEMOPTYSIS (%) 2 (5) 10 (1)
DIARREA 1 (3) 42 (3.8) 6%
NASAL CONGESTION 53 (5)
SORE THROAT 153 (14) 11%

17. Labs
41 patients(DEC 16-JAN
2)
1099 patients(DEC 11 –
JAN 29)
Metaanalysis(Jan 1 –feb
21) 2874 Patients
TLC (MEDIAN) 6200 4700 18.7%
LYMPHOCYTE (MEDIAN) 800 1000 43%
PLATELET (MEDIAN) 164000 168000
HB (MEDIAN) 12.6 13.4
CRP > 10 MG/L 481/793 (60.7) 58.3%
Procalcitonin ≥0.5 ng/ml 3/39 (8) 35/633 (5.5)
Lactate dehydrogenase
≥250 U/liter
29/40(73%) 277/675 (41.0) 57%
SGOT >40 U/liter 15/41 (37) 168/757 (22.2) 33%
SGPT>40 U/liter 158/741 (21.3) 24%
Bilirubin > 1mg/dL 76/722 (10.5)
Creatine kinase ≥200
U/liter
13/40 (33%) 90/657 (13.7)
d-dimer ≥0.5 mg/liter 260/560 (46.4)
Bilateral involvement of
chest
40/41 (98) 73%

18. Treatment used
41 PATIENTS(DEC 16-JAN 2) 1099 patients(DEC 11 –JAN 29)
Intravenous antibiotics 41 (100) 637 (58)
Oseltamivir — no. (%) 38 (93) 393 (35.8)
Antifungal medication — no. (%) 31(2.8)
Systemic glucocorticoids — no. (%) 9 (22) 204 (18.6)
Oxygen therapy — no. (%) 27 (66) 454 (41.3)
Mechanical ventilation — no. (%) 14 (34) 67 (6.1)
Use of intravenous immune
globulin — no. (%)
144 (13.1)

19. COMPLICATIONS &PROGNOSIS
41 PATIENTS(DEC 16-JAN
2)
1099 PATIENTS(DEC 11 –
JAN 29)
Metaanalysis(Jan 1 –feb
21) 2874 Patients
ARDS 12 (29) 37(3.4) 32.8%
A Cardiac I 5 (12) 13%
AKI 3 (7) 6 (0.5) 7.9%
Shock 3 (7) 12 (1.1) 6.2%
RNAemia 6 (15) 96.8%
Death (%) 6 (15) 15 (1.4) 14%

20. Radiographic features Bilateral Lung Infiltrates/Consolidation

21. Bilateral GGO or Consolidation
Predominantly peripheral & basal

23. Prevention (“Flattening the Curve”)
• Median daily reproduction number (Rt) in Wuhan declined from 2.35 1 week before travel
restrictions were introduced on January 23, 2020, to 1.05 1 week after.
• Utilizing a stochastic transmission model parameterized to the COVID-19 outbreak, Hellewell et al
concluded that “highly effective contact tracing and case isolation is enough to control a new
outbreak of COVID-19 within 3 months.
• A study published on March 16, 2020 by the Imperial College of London and WHO compared 2
fundamental policy strategies to reduce the rate of spread of SARS-CoV-2: “(a) mitigation, which
focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare
demand while protecting those most at risk of severe disease from infection, and (b) suppression,
which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that
situation indefinitely.” The study found that “…optimal mitigation policies (combining home
isolation of suspect cases, home quarantine of those living in the same household as suspect
cases, and social distancing of the elderly and others at most risk of severe disease) might reduce
peak healthcare demand by two-thirds, and deaths by half. However, the resulting mitigated
epidemic would still result in hundreds of thousands of deaths and health systems (most notably
intensive care units) being overwhelmed.” This explains and lends support to the aggressive
measures taken by countries in recent days to battle the spread of the SARS-CoV-2 pandemic.

24. • Reports from Italy suggest that up to 20% of healthcare professionals
dealing with COVID-19 patients became infected with the virus, with some
reported deaths.
• assign one person to monitor compliance to PPE in the ED at all times
• half-lives for SARS-CoV-2 virus on various surfaces as follows:
• 1.1 hours in aerosols
• 0.77 hours on copper
• 3.46 hours on cardboard
• 5.46 hours on steel
• 6.81 hours on plastic.
• virus can remain viable and infectious in aerosols for hours and on surfaces
up to days

25. • SARS-CoV-2 virus being found in the feces of seropositive patients,
likelihood of fecal-oral and, hence, hand transmission is very high
• Healthcare professionals and patients should follow standard hand-
washing techniques
• wash hands with soap and water for at least 20 seconds, especially after going
to the bathroom; before and after eating; and after blowing the nose,
coughing, or sneezing
• If soap and water are not available, one should use an alcohol-based sanitizer
with at least 60% alcohol.

26. • Additional guidelines for those with close contacts and suspicious
exposures include “strong recommendations” for
• an observation period of 14 days, wearing of a facemask if coughing or with
URI symptoms
• prioritizing private transportation over public
• prenotification of the hospital (or clinic) prior to patient arrival
• cleansing of the transport vehicle with 500 mg/L chlorine-containing
disinfectant, with open ventilation.

27. Use of Personal Protective Equipment
Doffing of personal protective equipment (PPE) is often the highest-risk procedure during the patient-
physician interaction, in terms of spread of SARS-CoV-2.

29. emergency clinicians should re-emphasize to the
lay public what we already know of viral
respiratory infections
• that seeking treatment in a hospital setting for mild symptoms, fever,
mild diarrhea, or cough alone likely carries with it more risk than
benefit, both to themselves and to vulnerable patients around them.
• Patients experiencing severe symptoms such as difficulty breathing,
high fever (>39°C), and an inability to tolerate oral hydration should
seek emergency evaluation

31. US-Young are effected 20%-20-44 Years

33. Treatment Strategies
• Recent in vitro studies conducted on COVID-19 have found that
REMDESIVIR and CHLOROQUINE inhibit viral infection of cells with low
micromolar concentration with a high selectivity index.
• The National Taskforce for COVID-19 recommends the use of hydroxy-
chloroquine for prophylaxis of SARS-CoV-2 infection for selected individuals
as follows:
• Eligible individuals:
• Asymptomatic healthcare workers involved in the care of suspected or confirmed
cases of COVID-19:
• 400 mg twice a day on Day 1, followed by 400 mg once weekly for next 7 weeks; to be taken
with meals
• Asymptomatic household contacts of laboratory confirmed cases:
• 400 mg twice a day on Day 1, followed by 400 mg once weekly for next 3 weeks; to be taken
with meals

34. • Invito studies for HCQ - SARS CoV 19
• 400 mg loading dose twice daily for 1 day, followed by a 200 mg maintenance
dose twice daily for 4 days
• Nonrandomized clinical trial of 20 patients found hydroxychloroquine
treatment to be significantly associated with viral load reduction and
disappearance in COVID-19 patients, with this effect increased by the
addition of azithromycin
• Hydroxychloroquine dosing was 600 mg daily, and azithromycin was 500 mg
on the first day followed by 250 mg daily for 4 days
• Found reduction of viral load in nasal swab at day 6
• Both drugs cause QT Prolongation-be carefull

35. • The statistics from retrospective analyses in China indicate that up to
30% of admitted patients required NIV, while early reports from Italy
indicate figures approaching 31%
• Equip with NIV as a stop gap to Invasive Ventilation