updated info from reliable source . it helps in understanding complications due to covid . it is handy for interns and postgraduates to act when cases come ,

1. UPDATES ON COVID -19
MONISHA J YADAV
GUIDANCE : TEAM B

2. CORONAVIRUS
 FAMILY : Coronaviridae
 It is spherical particle with crown like projection
 Average diameter – 125nm
 Viral envelope consists of lipid bilayer with anchored proteins
 Nucleocapsid – N protein and positive sense single stranded
RNA genome

4. REPLICATION CYCLE
1. ENTRY – S protein + ACE2
2. TRANSLATION : virus particle uncoated and attaches to
ribosome
 Host ribosome translates open reading frames ORF1a and
ORF1b into polyproteins pp1a and pp1b .
 Polyproteins are cleaved by PROTEASES into 16
nonstructural proteins

5.  Includes RNA dependent RNA polymerase , RNA helicase
 Number of nsp’s coalesce to form replicase transcriptase
complex (RTC)
 RdRp mediates replication of viral genome
3. TRANSCRIPTION – genomic RNA to mRNAs .
 In host endoplasmic reticulum RNA translation to structural
proteins happen.
 In Golgi apparatus assembly of virions happen and forms
secretory vesicles
 Progeny virus are released by exocytosis .

7. PATHOGENESIS
 Viral antigens presented to APC
 Stimulates cellular and humoral immunity
 IgM and IgG antibodies are formed . They are S and N protein
specific .
 CD4 and CD8 T cells are activated .
 Overproduction of proinflammatory cytokines
 IL-6 , IL-1β, Tumour necrosis factor : CYTOKINE STORM

8. THREE PHASES
 STAGE 1 : asymptomatic state
 Nasal cavity epithelial cells are infected
 Virus starts multiplying and propagating down
 Innate immunity acts
 Most infectious period
 Nasal swabs detect virus
 Mason rj et all , national jewishealth , USA

9. STAGE 2
 Upper airway and conducting airway response
 Epithelial cells are infected
 Beta and lamba interferons produced
 CXCL 10 – interferon gamma induced protein 10 is a disease
marker .
 Disease will be mild . Symptomatic therapy is advised

10. STAGE 3
 20% infected patients progress .
 Viral particles infect type 2 cells of alveoli
 Self replicating pulmonary toxin is released
 Causes diffuse alveolar damage with fibrin rich hyaline
membrane and multinucleated giant cells
 Severe scarring and fibrosis
 Wound healing is also impaired
 Leads to severe ARDS .

11. CYTOKINE STORM
 Leads to vascular hyperpermeability
 Defective procoagulant – anticoagulant balance
 Leads to formation of thrombin
 Thrombin activates protease activated receptor 1
on platelets and leads to aggregation and
microthrombosis

12. HYPERCOAGULABLE STATE
 Endothelial injury : due to direct invasion by virus and
cytokine storm .
 Stasis : immobilization in critically ill patients .
 Decrease in Antithrombin , Protein S and Protein C .
 Elevated factor vш , Fibrinogen , VWF
UPTODATE

13. INCUBATION PERIOD
 2-14 days
 Mean is 5 days after exposure .
 CDC

14. MODES OF TRANSMISSION
 PERSON – PERSON :
 DROPLET transmission
 Infected person coughs , sneezes or talks - direct contact
 Droplets donot travel more than 6 feet .
 Indirect spread – touching an infected surface followed by
eyes , nose or mouth
International pulmonary consensus

15.  VIABILITY :
 Aerosols – 3 hours
 Plastic and stainless steel – 72 hours
 Copper – 4 hours
 Cardboard – 24 hours
 Clothes – 8 hours
CDC

16. RISK FACTORS
 Asthma
 Chronic lung diseases
 Chronic kidney disease
 Chronic liver disease
 Diabetes mellitus
 Hypertension
 Cardiovascular disease
 Obesity
 People above 65 years
old
 People living in long term
care facility
 Thalasemmia
 Sickle cell disease
uptodate

17. CLINICAL PRESENTATION
 Fever (83-99%)
 Cough (59-82%)
 Fatigue (44-77%)
 Anorexia (4-84%)
 Shortness of breath (31-40%)
 Myalgias(11-35%)
 Loss of smell ( anosmia )
 Loss of taste (ageusia )
 GI symptoms
 Sore throat
 nasal congestion
WHO

18. COVID 19 DISEASE SEVERITY
 MILD DISEASE : symptomatic patients without evidence of
pneumonia or hypoxia.
 MODERATE DISEASE : clinical signs of pneumonia but no signs
of severe pneumonia .
 SEVERE DISEASE :
 Severe pneumonia : clinical signs of pneumonia plus one of the
following
 RR- >30 breaths/min
 Severe respiratory distress
 Saturation <90 % on room air WHO

19. CRITICAL DISEASE
 1. ARDS
 ONEST : within 1 week of known pneumonia or worsening
respiratory symptoms .
 CHEST IMAGING : bilateral opacities , not fully explained
by volume overload , nodules
 MILD ARDS – PaO2 / FiO2 200-300 mmHg
 MODERATE – PaO2 /FiO2 100-200 mmHg
 SEVERE – PaO2/FiO2 < 100 mmHg

20. 2. SEPSIS
 Acute life threatening organ dysfunction
 Weak pulse , tachycardia , hypotension
 Low oxygen saturation , difficulty in breathing
 Altered mental status
 Reduced urine output
 Lab evidence of coagulopathy , thrombocytopenia , acidosis ,
high lactate , hyperbilirubinemia .

21. 3. SEPTIC SHOCK
 Persistent hypotension despite volume
resuscitation
 Requiring vasopressors to maintain MAP >
65mmHG
 Serum lactate level > 2 mmol/L.

22. CUTANEOUS MANIFESTATIONS
1. COVID toes : erythematous or purpuric macules on toes ,
lateral aspect of feet , fingers , elbows
Pernio like lesions of acral surfaces
Pathogenesis : ? Inflammatory cause
New onset , pernio like lesions with no clear cause should be
tested for covid 19
TREATMENT : topical corticosteroids to reduce discomfort .
UPTODATE

24.  Livedo reticularis
 Necrotic vascular lesions
 Histopathology shows : thrombotic vasculopathy with
laboratory coagulation alterations

25.  MORBILIFORM RASH : this rash involves trunk
 Most common manifestation
 Noted after recovery

26.  Urtiaria : acute urticaria with fever is presenting sign of
covid infection
 VARICELLA – like eruptions: small papules , vesicles ,
pustules appears 4-30 days after symptoms of covid
 Resolves in about 10 days
 Fluid from vesicle tested negative by RTPCR

27. COMPLICATIONS
British cardiovascular society

28. NEUROLOGICAL MANIFESTATIONS
Acute cerebrovascular disease : cerebrovascular
hemorrhage. And ischemic stroke ( most common )
1. Hypercoagulable state
2. Low platelet count
3. Elderly patients .
Liu k et al , BMJ

29. INTRACRANIAL INFECTION WITH SARS-COV 2
 Headache
 Disturbance in consciousness
 Convulsions
 First reported case in Beijing with covid encephalitis .
 CSF postive for RTPCR .

30.  Peripheral nervous system : hypogeusia , hyposmia .
 Deficit in visual function
 Neuralgia .
 MUSCLE DAMAGE RELATED : fatigue , muscle soreness .
 Elevated muscle enzyme
 Due to inflammation of muscles ,

31. ICMR STRATEGY FOR TESTING COVID 19
 1. symptomatic ILI individuals with history of international
travel in last 14 days .
2. Symptomatic contacts of laboratory confirmed case .
3. Symptomatic health care workers
4. All patients of severe acute respiratory infections .
5 . Asymptomatic direct and high risk contacts of a
confirmed case on day 5 and day 10 of exposure .

32. 6 .All symptomatic ILI within containment zones
7 . All hospitalised patients who develop ILI symptoms
8. All symptomatic ILI among returnees and migrants within 7
days of illness
CLOSE CONTACT :
Cohabiting family members of covid 19 patient .
Atleast 15 minutes within 6 feet of a patient with confirmed
covid .

33. RT-PCR
 Diagnosis of covid 19 is made by direct detection of
SARS-CoV2 RNA by reverse transcription polymerase
chain reaction
 TARGET GENES :
1. nucleocapsid (N)
2. spike (S)
3. envelope (E)
4. RNA dependent RNA polymerase

34. COVID TESTING POSITIVITY RATES
Sl no . TYPE OF SPECIMEN POSITIVE
1. Bronchoalveolar lavage fluid 93%
2. Sputum 72%
3. Nasopharyngeal swab 63%
4. Oropharyngeal swab 32%
5. Feces 29%
6. Blood 1%
7. Urine 0%
International pulmonary consensus 2nd edition

35. FALSE NEGATIVE RATES
 100% on day of exposure
 38% on day 5
 20 % at day 8
 66% at day 21
CDC

36. SEROLOGIC ASSAY
 It has Emergency Use Authorization(EUA) by U.S. FDA .
 Detects past infection and measures host humoral immune
response .
 Plays important role in virus epidemiology
 IgM and IgG antibodies arise within 2-3 weeks simultaneously .
 Helps to establish diagnosis when patient presents with late
complications
 People presenting 9-14 days after illness onset this test
supports clinical diagnosis .
 Positive test qualifies a person to donate blood to manufacture
covalescent plasma . CDC

37. BINDING ANTIBODY DETECTION
 These tests use purified proteins of SARS-CoV-2
 Duration : < 30 minutes .
 1. point of care (POC) tests : detects antibodies using
whole blood obtained by fingerstick .
 2. lab tests using ELISA .
 Requires trained laboratrians , specialized instruments
and reagents .
CDC

38. ANTIGEN BASED
 On MAY 9 2020 U.S. FDA issued emergency use authorization
for antigen test .
 Highly specific
 Not sensitive as RTPCR.
 It can detect active infection .
 Helps prevent spread by identifying patients early .
 Detects fragments of protein found on or within virus .
 Samples : nasal cavity swab
 Lower cost and test results within minutes
 False negative rate is high , suspected cases must undergo
RTPCR CDC

39. OTHER INVESTIGATIONS
ABNORMALITY POSSIBLE THRESHOLD
D-dimer >1000 ng/ml ( normal < 500 ng/ml
)
CRP > 100 mg /L ( normal < 8 mg/L )
LDH >245 units /L ( 110-210 units /L)
Troponin > 2 times upper limit
Ferritin > 500 mcg/L ( 10-300 mcg/L)
CPK > 2 times upper limit
Neutrophil/lymphocyte ratio >3.5
uptodate

40. RADIOLOGICAL
 CHEST XRAY : includes bilateral lobar/multilobar
consolidation .
 CT CHEST :
 EARLY STAGE (0-4 days ) ground glass opacities ,
subpleural distribution predominantly in lower lobes .
 . PROGRESSIVE STAGE ( 5-8 days ) : rapidly involves both
lungs , multi lobar distribution . Crazy paving pattern
International pulmonary
consensus 2nd edition

41.  .
 PEAK STAGE ( 9-13 days ) : consolidation becomes denser
 ABSORPTION STAGE ( > 14 days ) : no crazy paving
pattern , GGO remains
 LUNG ULTRASOUND : preferred as it is done bedside .
 Subpleural areas of consolidation
 Areas of white lung

44. MANAGEMENT
 Isolation protocol
 General measures
 Specific therapy
 Managing chronic conditions
 Management guidelines approved by RGUHS

45. TYPES OF COVID DEDICATED FACILITIES
 1. COVID care center – hostel, hotels for mild suspected
cases .
 2. Dedicated COVID health center – full hospital or a
block for moderate suspect cases .
 3. Dedicated COVID hospital – for severe suspected
cases till results are obtained admitted in ICU

46. GENERAL MEASURES
 Empiric antibiotics if secondary bacterial pneumonia is
suspected .
 Avoid nebulized medications .
 Glucocorticoids - according to WHO and CDC is not
indicated .
 Prevention of venous thromboembolism ;
 Prophylactic dose : inj Enoxaparin 40 mg once a day .
 Full dose : Enoxaparin 1 mg / kg every 12 hours .
uptodate

47. EMERGENCY USE AUTHORIZATION
MANAGEMENT FOR COVID 19
 1. Chloroquine and Hydroxychloroquine .
 2. Remdesivir
 3 . Convalescent plasma
 4. Hyperimmune globulin .

48. REMDESIVIR
 It is an adenosine nucleotide prodrug
 Competes for incorporation into RNA chains
 Delayed chain termination during viral RNA replication .
 DOSING : I.V. 200 mg on day 1
 Followed by 100 mg OD for 5 or 10 days based on
severity .

49. HYDROXYCHLOROQUINE / CHLOROQUINE
 Changes pH at cell membrane surface
 Inhibits viral fusion
 Inhibits nucleic acid replication , viral assembly and
release .
 DOSE: as per FDA
1. 800 mg PO on day 1
2. 400 mg PO OD for 4-7 days .
Baseline : ECG , RFT , electrolytes , LFT to be done .
Repeat ECG 2-4 hours , 48 hours and 96 hours after 1st
dose .

50. PLASMA THERAPY
 It is a strategy of passive immunization .
 Apheresis is the recommended procedure to obtain plasma
 1. neutralising antibodies – ANTIVIRAL EFFECTS .
 2. contains : antithrombotic factors , immunoglobulins ,
antibodies that block complement , inflammatory cytokines
TNα and IL-1β – IMMUNOMODULATORY EFFECTS .
Manuel Rojas et al , Elsevier on April 11 2020

52.  PATIENT ELIGIBILITY :
1. Laboratory confirmed covid 19
2.Informed consent by patient or attenders
3.Severe and critical disease – as per WHO .
DONOR ELIGIBILITY :
1. Evidence of covid – 19 documented by RTPCR or serology .
2. Complete resolution of symptoms atleast 14 days before
donation .
3. Female donors who have not been pregnant or negative for HLA
antibodies .. FDA

53.  Dose : 3 ml/kg body weight in divided doses.
 Covid 19 – convalescent plasma should be frozen within 8
hours of collection
 Stored at – 18 C .
 Expiration date – 1 year from date of collection .
FDA

54. CLINICAL MANAGEMENT AS PER
RGUHS
GROUP A :
TREATMENT :
1 . Cap oseltamivir 75mg bd for 5 days
2. Tab azithromycin 500 mg od for 5 days
3. Tab hydroxychloroquinine 400mg OD for 1 day
followed by 200 mg BD for 4 days

55. 4. Inj ENOXIPARIN 40 mg , s/c , OD for 7 days ( if D-dimer >
1000 ng/ml or CT thorax showing ground glass opacities )
SUPPORTIVE : Tab zinc 50 mg od for 7days
Tab vitamin C 500 mg TID for 7 days

56. GROUP B ( MODERATELY SICK PATIENTS)
 Same as GROUP A
 IV antibiotics according local antibiogram
 Tab N-acetyl cysteine TID in patients with cough
 Continous monitorong of oxygen saturation is advised
 If saturation < 94 % to start on oxygen – 5L/ min via face
mask or nasal prongs .

57. GROUP C ( CRITICALLY SICK PATIENT )
 Oral medications same as GROUP A
 IV antiobiotics can be escalated
 Inj Enoxaparin 1 mg/kg body weight s/c BD for 7 days
 NOVEL THERAPY :
 1. TOCILIZUMAB
 2. REMDESIVIR
 3. CONVALESCENT PLASMA
Lopinavir / Ritonavir to be used when there is no response
for primary treatment .

58.  High flow nasal oxygen to be given
 If patient deteriorates early intubation to be considered
ABG to be done regularly for monitoring of acidosis and
hypoxemia .
Ionotrophic support to maintain MAP > 65 mmHg
Correction of electrolyte abnormalities and acidosis
Maintain HB > 8 gm %
Group C patient progresses to ARDS , SHOCK novel therapy
can be started

59. AIRWAY MANAGEMENT
 COVID 19 is a hypoxemic respiratory failure .
 High flow oxygen through nasal cannula upto 60 L/min
should be started
 If low flow oxygen therapy fails
 Since NIV works well with hypercapnic failure it is not
beneficial compared to high flow oxygen therapy
 In later stages intubation to be done following AHA protocol
creating a closed set up with HEPA filters at expiratory end
and in line suction catheter
 Minium oxygen fraction should be given to maintain spo2 0f
90-96%
 Fio2 – 0.6 ideal .

60. DISCHARGE POLICY FOR COVID 19
 Mild : after 10 days of symptom onset , afebrile - 3 days
 Moderate : after 10 days of symptom onset , afebrile and
off oxygen for 3 days .
 Severe : clinical recovery .
 Only severe patients need RTPCR negative test before
discharge
 Mild and moderate – 7 days of home isolation following
discharge , RTPCR not required
MOHFW on 8/5/2020

61. PROPHYLAXIS – HYDROXYCHLOROQUINE
Sl
no.
Category of personnel DOSAGE
1. Asymptomatic household contacts of lab
confirmed patient
400 mg BD on day 1
400 mg weekly * 3
weeks
2. a. All asymptomatic HCW
b. asymptomatic frontliners , surveillance
team , paramilitary / police personnel in
containment zone
400 mg bd on day 1
400 mg weekly once * 7
weeks
As per Icmr on 22/5/2020

62. VACCINE TRIALS
 Beijing Institute of Biotechnology , China conducted first human
trial with adenovirus type 5 vectored COVID 19 vaccine .
 It is a single centre , open label, non randomised dose
escalation phase 1 trial . 108 covid negative participants were
recruited
 Confirmed by negative results of serum specific IgM and IgG
with rapid test .
 Negative RTPCR for covid in pharyngeal swabs , anal swabs .
 Clear CT image with no evidence of lesions in lungs at the time
of screening Feng-CaiZhu et al , Beijing institute of biotech ,
lancet article , may 22 2020

63. divided into 3 groups with 36 participants in each group.
1st group received mild dose 5 *10 10 .
2nd group received moderate dose 1*10 11.
3rd group received high dose 1.5 * 10 11 .
received intramuscularly .

64. primary outcome after 7 days was adverse events ,
common injection site reaction was pain.
systemic adverse reactions were fever , fatigue , headache
and muscular pain .
these reactions occurred within 24 hours post vaccination
and persisted not more than 48 hours .

65.  Rapid binding antibody responses to RBD were observed
in all 3 groups from day 14 .
 Four- fold increase of anti – RBD antibodies was noted .
 Neutralising antibodies against live SARS-CoV-2 were all
negative at day 0 , increased at day 14 , peaking at 28
days post – vaccination .

66.  The Ad5 vectored COVID 19 vaccine is immunogenic ,
inducing humoral and T- cell responses peaking at day 14
and antibodies peaking at day 28 .
 In conclusion , Ad5 vectored COVID 19 vaccine is tolerable
and immunogenic in healthy adults

67. 1253 STUDIES ARE ONGOING FOR
MANAGEMENT OF COVID 19 .
 Includes
hydroxychloroquine .
 Plasma based therapy
 Lopinavir/ Ritonavir
 Azithromycin
 Remdesivir
 Vaccine
 Tocilizumab
 Favipiravir
 Sarilumab
 Anakinra
 Interferon therapy
 Umifenovir
 Corticosteroids
 Steam cell therapy

68. INDIAN TRIALS LISTED IN NATIONAL INSTITUTES OF
HEALTH
 1. efficacy of HCQ as post exposure prophylaxis for
prevention of COVID – 19 . By post graduate institute of
medical education , Chandigarh with 200 participants
started on march 1 2020 .
 2. Ivermectin versus standard treament by Max super
speciality hospital, new Delhi with 50 participants start date
on april 5 2020 , primary outcome being eradication of virus
.

69.  3. Efficacy of convalescent plasma therapy in severely sick
covid 19 patients . Conducted by Maulana Azad Medical
college . New Delhi and Institute of Liver and Biliary
sciences with 40 participants started on April 21 2020 ,
primary outcome being patients remaining free of
mechanical ventlation .

70.  4. Low dose radiation therapy with a dose of 70 cGy in
one fraction radiation for COVID 19 pneumonia by
AIIMS , New Delhi with 10 participants estimated to start
in june 2020 , primary outcome being symptomatic
improvement and to reduce length of hospital stay , and
ICUadmissions .

71.  5 . A clinical trial of Mycobacterium w in critically ill COVID
19 patients conducted by AIIMS , Bhopal , MP and PG
medical college , Chandigarh . With 40 participants started
on April 30 , 2020 .
 Suspension of heat killed Mycobacterium w , 0.3 ml of
intradermal injection for 3 consecutive days were given
along with standard therapy .
 Primary outcome : to study effect of Mw on recovery of
organ failure .

72. RAAS INHIBITORS AND RISK OF COVID
 Harmonay et al from New York University conducted this study ,
published on May 1 2020 at NEJM.
 Total of 12,594 patients were tested for covid out of which 5894
were tested positive .
2573 patients had hypertension and were on
 ACE inhibitors
 ARB’s
 Beta – blockers
 Calcium channel blockers
 Thiazide diuretic

73.  Previous treatment with medications acting on RAAS was
not associated with higher risk of testing positive for covid
19 .
 No high risk of severe Covid -19 associated with any of the
medications studied..
 Medications can be continued unless contraindicated
 Like: hypotension , hyperkalaemia , acute kidney injury .

74. COVID WITH DIABETES
 Diabetes is a risk factor for development of severe
pneumonia and sepsis , occurs in 20 % of patients .
 ACUTE HYPERGLYCEMIA : upregulates ACE2 expression
on cells facilitating virus cell entry .
 ACE2 on pancreatic β cell leads to damage causing insulin
deficiency.
 Hence monitoring for new onset diabetes is important .
Stefan et al , King’s college , London UK ,
LANCET diabetology on april 23

75. THERAPEUTIC AIMS
 Plasma glucose concentration : 72-180 mg/dl
 HBA1C : < 7 %
INSULIN THERAPY :
 Subcutaneous insulin therapy with basal or intermediate
acting insulin along with meal time bolus of short acting
insulin is preffered .
 DPP4 inhibitors may be continued due to low risk of
hypoglycemia ,

76. THERAPY WHEN USED IN COVID 19 SUGGESTIONS FOR
PRACTICE
METFORMIN Risk of lactic acidosis in
hypoxia and acute illness
Stop if severley ill with
hypoxia and hemodynamic
instability
SGLT2 inhibitors Risk of dehyration and
euglycaemic ketoacidosis
Stop in severely ill patients
GLP-1 RAs Gastrointestinal side effects
and risk of aspiration
Not advised in severe
disease
SULFONYLURE
AS
Risk of hypoglycaemia due
to poor oral intake and with
use of HCQ’s
Stop if poor oral intake or at
risk of hypoglycaemia

77. THERAPEUTIC AGENT Adverse events
Choloroquine/ HCQ 1.Hypoglycaemia .
Caution with Insulin and Insulin
secretagogues.
2. QT interval prolongation .
Lopinavir / Ritonavir 1.Hyperglycaemia ,
Poor glycaemic control .
2. Interaction with statins ,
Increases risk of hepatotoxicity and
muscle toxicity
Glucocorticoids 1. Hyperglycaemia
2. susceptibility to secondary
bacterial infection
Remdesivir Caution with statins.
Hepatotxicity

78. COVID AND PREGNANCY
 Clinical characteristics of pregnant covid 19 positive
patients are similar to non pregnant patients .
 Risk of transmission to infant is very low .
 There is no confirmed mother - to- child transmission ,
 no positive cord blood or vaginal samples

79. WHO GUIDELINES FOR PREGNANT WOMEN WITH
COVID
 Covid 19 positive status alone is not an indication for
caesarean section .
 Mode of birth should be individualized based on obstetric
indications .
 Mothers should not be separated from their infant unless
mother is too sick to care for her baby
 Breastfeeding to be initiated within 1 hour of birth .
 Advised to follow strict hygienic measures while handling
the baby .

80. GUIDANCE FOR STARTING AND CONTINUING RESUSCITATION .
 Health care system should institute policies for front liners in
determining the appropriateness of starting and terminating
CPR .
 Mortality of critically ill covid 19 patient is high
 It is reasonable to consider age , co morbidities , severity of
illness to start CPR
 To balance the success against the risk of rescuers .
 American Heart Association

81. GUIDELINES ON RATIONAL USE OF PPE
 Out patient department –
 Triage area , temperature recording area , waiting area ,
Doctor’s chamber with moderate risk
 No aerosol generating procedure shall be allowed .
 N95 mask and Gloves are the recommended PPE as per
Ministry of Health and Family Welfare .
 Icmr

82. IN- PATIENT SERVICES
 Isolation rooms with moderate risk – N95 mask and gloves
.
 ICU with high risk aerosol generating activities performed
– full component of PPE .
 ICU – dead body packing full component PPE .

83.  Other services :
 LABORATORY : sample collection and transportation –
full component of PPE .
 Sanitation , CSSD, Supportive staff only N95 mask and
Gloves .
 Other non – COVID treatment areas PPE as per hospital
protocol .

84. REUSE OF N95 MASKS
 Mask rotation : 5 masks as per CDC should be numbered ,
rotated every day
 Allow them to dry > 72 hours
 Store in clean paper bag .
 Dispose the mask if exposed to aerosol producing procedures .
 DECONTAMINATION :
 Hydrogen peroxide vaporization .
 UV treatment
 Moist and Dry heat .
 Baking , boiling , using bleach , alcohol , soapy water not
approved .

85. INDIAN STATISTICS
Confimed
2,17,187
Recovered
1,04,107
Deaths 6,088
Confimed
Recovered
Deaths

86. STATISTICS OF WORLD
Confirmed
65,75,177
Recovered
31,71,783
Deaths
3,88,060
Confirmed
Recovered
Deaths

87. PROGNOSIS
 INDIA :
 Incidence per million : 132
 Recovery rate : 48.31 %
 Case fatality rate : 2.82 %
 50 % death – senior citizens
 75% death – with co morbidities .

88. REFERANCES
 UPTODATE
 WHO guidelines on clinical management of covid 19
 International pulmonologist’s consensus on covid 19
 COVID 19 clinical management approved by RGUHS
 Centers for disease control and prevention .
 WORLD HEALTH ORGANIZATION
 U.S Food and Drug Administration
 ClinicalTrials.gov
 Harmony et al RAAS inhibitors and risk of covid 19 from
Grossman school of medicine , new york
 Practical recommendations for management of diabetes in
patients with Covid 19 by Stefan et al published in Lancet
journal

89. THANK YOU