COVID 19

COVID-19

A respiratory disease caused by the virus SARS-CoV-2. The virus is a coronavirus, similar to the one that causes the common cold.

Pathophysiology of COVID-19

-virus binds to ACE-2 receptors using spike proteins

-viral RNA replication, transcription, and translation take place leading to protein synthesis

-This causes a cytokine storm activating the immune system

-this inflammation can lead to cytotoxicity causing lung injury or acute respiratory distress syndrome (ARDS)

what does COVID-19 stand for?

coronavirus disease 2019

Another name for COVID-19

severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Two names of variants

Delta

Omicron

Delta variant

-2020

-more transmissible than previous variant

-higher risk of disease/hospitalization

Omnicron variant

-replication advantage

-more transmissible than delta

-higher risk of reinfection

-LOWER severity (NOT as sever of disease or death)

how is COVID transmitted?

person to person

cough, sneeze, talks

Can asymptomatic individuals with COVID still transmit the virus?

yes

-but less than symptomatic individuals

When are individuals most infectious?

in the earlier stages

-transmission is unlikely after 7-10 days of illness

Incubation period for COVID 19

14 days following exposure with most cases occurring around 4-5 days

Risk factors for severe illness

-increased age (>65)

-comorbidities (asthma, cancer, lung disease, etc)

-physical INactivity

-Males

-Low socioeconomic status (prision population)

-Abnormal labs (thrombocytopenia, high LDH, high CRP/ESR, high D-dimer, high troponin, high creatinine)

Most commonly reported symptoms of COVID 19

most common:

cough

myalgias

headache

others: diarrhea, smell or taste abnormalities, nasal congestion, sneezing

Most serious form of COVID 19

Pneumonias with fever, cough, dyspnea, and infiltrates on CXR

what will CXR for COVID-19?

"ground glass opacities"

bilateral, peripheral, and lower lung zone distributions

All symptomatic pts with COVID 19 should undergo testing. What testing is done?

NAAT (PCR test)

Antigen test

Is NAAT or Antigen test more specific?

NAAT (highly sensitive, highly specific)

Is NAAT or Antigen test done at home?

Antigen test

How many days after infection does NAAT remain positive?

90 days after infection

How many days after infection does the antigen test remain positive?

for a few weeks

Do vaccines influence the NAAT or antigen test results?

no

Outpatient management of COVID 19

healthy = nothing

high risk for progression/severe illness.= Paxlovid (nirmatrelvir/ritonavir)

What population is COVID 19 specific therapy is NOT routinely used for?

-immunocompetent adults < 65 who are vaccinated with no other risk factors

Indications for hospitalization for COVID 19

-O2 < 94% on RA or <90% with ambulation

-RR > 30

-lung infiltrates on CXR

-high risk for complications

Inpatient management for COVID 19

-remdesivir (antiviral IV med)

-VTE prophylaxis (anticoagulation)

-intubation, fluids, vasopressors

poor O2:

-dexamethasone (steroid)

What is added to inpatient therapy for pts who have escalating O2 requirements despite dexamethasone, elevated inflammatory markers, and are within 96 hours of hospitalizion?

-baricitinib or tocilizumab (JAK inhibitors)

Complications of COVID-19

-respiratory failure (ARDS)

-cardiac (arrhythmias, heart failure)

-thromboembolic (PE, stroke, CVA)

-neurologic (stroke, seizures, encephalopathy)

-secondary infections (bacterial pneumonia)

-organ failure

Vaccines for COVID 19

Pfizer and Moderna

"Long COVID"

- symptoms > 4 weeks and are not explained by alternative diagnosis

- fatigue, dyspnea, chest pain, cough

- treat symptoms

Most common symptoms in "long COVID"

fatigue

dyspnea

chest pain

cough

others: joint pain, HA, dizzy, insomnia, diarrhea, anosmia, PTSD, depression, confusion