Sars-Cov-2

Covid-19

V. Wazeed Pharma-D
 introduction
The new coronavirus that jumped from some animal to a person in the city of Wuhan at
the end of last year has managed, in only a few weeks, to draw huge attention from the
media, scientists and the international community. On January 30, the WHO declared the
epidemic a Public health emergency of international concern (PHEIC).
 At present around 12 064 828+ cases of coronavirus disease 2019 (COVID-19) and
550 384 deaths have been reported around the world.
 India has reported 794K+ cases and 21,604 deaths till date.
 The new coronavirus, first called 2019–nCoV and officially renamed as SARS-CoV2 (the virus)
and COVID-19 (the disease), belongs to the family of coronavirus, which owe the name to
crown-like spikes on their surface. Most described coronavirus are found in birds or mammals,
particularly bats. 
 The new coronavirus is called SARS-CoV2 because its genetic sequence is very similar to that
of SARS, another coronavirus that appeared for first (and only) time in 2002 and caused a
pandemic with more than 8,000 infected people and 800 deaths.
 Another coronavirus that causes severe disease in humans is MERS-CoV, identified for the first
time in 2012 in the Middle East and associated with camels.
public health emergency of international

Public health emergency of

concern

international concern (PHEIC)

declared by WHO to date
 Stats about covid-19 in india

878,190
900,000

800,000
553856
700,000
585,362
600,000
347921
500,000

400,000

300,000 190,52391598
5357 17311 23225
1142
200,000 Deaths
8949
35,433 Cured/Discharged
100,000
Active Cases
0
Apr-30 May-31 Jun-30 Jul-12

Active Cases Cured/Discharged Deaths

 H i g h R i s k G ro u p s

COVID-19 is peculiar in its disproportionate case fatality rates among patients >60 years as
opposed to young adults or pediatric population.

The highest mortality rates were seen among individuals above 80 yr of age at 14.8 per cent.

While further research is going on, the data suggests that tobacco smoking is also a risk
factor for COVID-19. Smokers (both former and current) are more likely to have severe
symptoms, are admitted to intensive care unit (ICU), need mechanical ventilation or die
compared to non-smokers.
 Comorbid illness and case fatality rates in high-risk groups
Age, year (case fatality rate, %) Comorbid illness (case fatality rate, %)

Cardiovascular disease (10.5)

60-70 (4)
Diabetes mellitus (7.3)
>70-80 (8)
Chronic respiratory disease (6.3)
>80 (15)
Systemic hypertension (6.0)
Cancer (5.6)

The high-risk groups and age-wise case fatality rates are depicted in
above table
NOTE: case fatality rate is the proportion of deaths from a certain
disease compared to the total number of people diagnosed with the
disease for a certain period of time.
 HOW do YOU get
COVID-19?
A person can contract COVID-19 if:
● They come in contact with another person infected with the virus
● Someone infected coughs or sneezes directly to them
● They touch any surface with little droplets from infected people’s cough or
sneezes and then touch their eyes, nose or mouth
 Clinical features
The most common presenting features of COVID-19
infection are listed below:
Symptoms (frequency in %)
 Fever (80-90)
f e a t u r e s

 Cough (60-80)
 Breathlessness (18-46)
 Fatigue (38)
C l i n i c a l

 Body ache/joint pain (15)

 Sore throat (11-14)
 Headache (6-14) The incubation period of COVID-19 is 1-14 days
 Chills (12) (mean duration of 5-7 days), with peak viraemia
 Running nose (5) occurring before the onset of symptoms.
 Nausea/vomiting (5)
 Diarrhea (2-10)
 Wa r n i n g s i g n s

Warning signs or red flag signs that can assist in triage,

EMERGENCY
indicating the need for urgent care/hospitalization, are
listed below:
signs

 Fever and upper respiratory symptoms lasting for >5

days and any of the following:

Warning

1. Breathlessness/respiratory rate >24/min

2. Oxygen saturation (SpO2 )

3. 110/bpm Systolic blood pressure

Asymptomatic condition

COVID nucleic acid test positive. Without

any clinical symptoms and signs and the chest

imaging is normal.
 Categorization of probable coronavirus disease 2019 (COVID-19) severity, testing and admission strategy

Clinical category of
Features Testing strategy Level of care
COVID-19
Mild Fever with upper respiratory symptoms Low priority Home care
Mild sore throat and GI symptoms
Testing may be considered in select individuals
in the high-risk group

Moderate Breathlessness/respiratory rate >24/min High priority Inpatient care

Oxygen saturation (SpO2) <95% in room air
Fatigue with heart rate of >110/bpm
Systolic blood pressure <90 mmHg

Severe SpO2 <90% in room air High priority Intensive care

Hypotension requiring ionotropic support
ARDS/myocarditis
Steps to be followed if you have
symptoms

STEP 01 STEP 03
You have symptoms or have You will be given a home test
been in an infected area over the phone

STEP 02
Call the designated phone
number for your region
 ………Continue

STEP 04
Patiently wait for the results
of the test

STEP 05
Follow the instructions
provided by the doctor
The life cycle of SARS-CoV-2 in the host cells
 diagnosis

1. Travel history to endemic countries

2. CBC (leukopenia, seen in 30% to 45% of
patients, and lymphocytopenia, seen in 85% of
diagnosis

the patients)
3. Chest X-Ray (cheaper & easier with 60%
sensitivity)
4. PCR (30%-70% sensitivity)
5. Chest CT Scan (95% sensitivity, low specificity)
6. IgM/IgG combo test for COVID-19
IgM/IgG combo test for COVID-19 IgM/IgG combo test for COVID-19
 clinical
management
 At present, the role of specific antiviral medication is at best adjunctive in nature. The following drugs
have shown some promise for the management of COVID-19

1. Hydroxychloroquine:
 The 4-aminoquinolone, commonly used as an antimalarial and anti-inflammatory agent, possesses broad antiviral
activity. While the exact mechanisms are unknown, it is considered to gain its antiviral effects through alkalinization
Management

of the phagolysosome as well as inhibition of viral entry by blocking receptor binding and membrane fusion. With a
similar mechanism of action, hydroxychloroquine (HCQ) has demonstrated more potent in vitro inhibition of SARS-
CoV-2 virus compared to chloroquine.
 Its fewer side effects, safety in pregnancy and inexpensive nature makes it more preferable to chloroquine
 If chosen for the treatment of confirmed COVID-19, the dose of HCQ suggested is 400 mg twice a day (bd) for one
day followed by 200 mg (bd) for 5-10 days.
 ADRS: Nausea, vomiting, loss of appetite, diarrhea, dizziness, or headache
 2. Lopinavir/ritonavir:
 A boosted protease inhibitor combination, while commonly used in the treatment of HIV-1 infection,
came into spotlight during the SARS outbreak in 2003
 the lopinavir arm had numerically lesser deaths and ventilator days. However, the drug did not reduce the
viral loads when compared to the control arm.
Management

 The dose used was lopinavir 400 mg-ritonavir 100 mg twice a day for 14 days

3. Oseltamivir:
 A neuroaminidase inhibitor, is a pivotal drug in influenza management. It has not been shown to have
activity for CoVs due to lack of neuraminidase and is hence unlikely to be of benefit.
 Though it was used in the earlier part of the epidemic in China, it is no longer recommended by most
guidelines
 4. Remdesivir:
 It is an adenosine analogue and RNA polymerase blocker, is a novel drug developed for the treatment of Ebola virus
infection. A randomized control trial on remdesivir in severe COVID-19 patients did not show any significant benefit.
 However, there was a trend towards shortened illness in patients who received the drug early. While the drug is
available in different countries through multiple clinical trials, it is also being provided by the manufacturers on a
compassionate use basis. In view of its broad antiviral properties, safety profile from Ebola studies and in vitro
activity against SARS-CoV-2, remdesivir is considered as a promising agent.
Management

 A recent case series of the drug in a compassionate use programme in COVID-19 patients with hypoxemia showed
clinical improvement in two-thirds of the patients.
5. Favipiravir:
 It is an a RNA polymerase inhibitor, has shown modest activity against SARS-CoV-2 virus with pronounced
cytopathy in Vero cell studies
 The drug has been used in China for the treatment of COVID-19 and is being studied in a clinical trial for mild
SARS-CoV-2 disease and also as an adjunct agent in moderate and severe diseases
 6. Interleukin-6 (IL-6) inhibitors
 A subgroup of patients with COVID-19 develop severe cytokine activation and secondary
haemophagocytic lymphohistiocytosis (HLH), leading to rapid-onset hypoxemia, shock and multiorgan
dysfunction. A higher neutrophil count and elevated C-reactive protein may predict this subgroup of
patients.
 Interleukin-6 (IL-6) is a key cytokine in the cytokine storm, and tocilizumb, a humanized anti-IL-6
Management

receptor antibody, is proposed as a therapeutic agent in severe SARS-CoV-2 disease.

 In a small series of 21 patients with severe or critical COVID-19 from China, tocilizumab showed
marked improvement in hypoxia, chest imaging, fever, lymphocyte counts and C-reactive protein.
7. Corticosteroids:
 These are generally not useful against similar severe respiratory viral illnesses such as SARS or Middle
East respiratory syndrome (MERS)-CoV disease.
 A recent retrospective review showed decreased likelihood of death among patients with SARS-CoV-2-
related acute respiratory distress syndrome (ARDS) who received methylprednisolone
 8. Convalescent plasma from COVID-19 survivors

 Uncontrolled studies during the SARS epidemic showed that convalescent plasma therapy

decreased hospital stay and mortality when used in the critically ill48. Convalescent plasma
Management

therapy was attempted with some benefit in MERS, Ebola and H1N1 pandemic influenza49-51. A

small case series of five patients with critically ill COVID-19 on mechanical ventilation improving

after receiving therapy on the third week of illness is encouraging52. Depicted in Table V is a

quick guide for adjunctive treatment strategy to be considered on the use of specific antivirals for

the management of COVID-19 patients depending on the clinical category and severity of illness.
 Antivirals for the management of coronavirus disease 2019 (COVID-19)

Clinical category of COVID-19 Specific/antiviral therapy

Mild Symptomatic treatment

Moderate* Tablet hydroxychloroquine 400 mg bd × 1 day

followed by 200 mg bd × 10 days
Management

Severe* Tablet hydroxychloroquine 400 mg bd × 1 day

followed by 200 mg bd × 2 wk Tablet lopinavir
400 mg/ritonavir 100 mg bd × 2 wk *

NOTE: There is insufficient evidence for or against most of the drugs mentioned above and should
preferably be used in discussion with the patients or the next of kin. May consider new antiviral
agents such as remdesivir or immunomodulatory therapy such as tocilizumab in the appropriate
setting
Flowchart for Management of covid-19 in Pregnant Women (Adapted from Lancet)
 COVID-19 IN DIFFERENT SURFACES

SURFACE TIME SURFACE TIME

Sprayers 3 hours Cardboard 24 hours

Copper 4 hours Steel 2-3 days

Plastic 2-3 days Wood 4 days

PROTECTING YOURSELF AND PREVENTING THE SPREAD OF THE
DISEASE

Wash your hands with an Keep a distance of at least 1 Try your best not to touch your
alcohol-based sanitizer or with meter between yourself and eyes, your nose and your mouth
soap and water anyone who coughs or sneezes

Cover your mouth and your Seek medical attention if you Follow the directions of your
nose with your bent elbow or a have difficulty breathing and a national or local health
tissue when coughing high fever authorities
 HOW TO USE A MASK

● Before wearing a mask, wash your hands with an alcohol-based disinfectant or with soap
and water.
● Cover your mouth and nose with the mask and make sure the mask is firmly pressed
against your face.
● Do not touch the mask while you are wearing it; if you do, wash your hands with an
alcohol-based disinfectant or with soap and water afterward.
● Replace the mask as soon as it gets wet and do not reuse disposable masks.
● Remove the mask from behind (do not touch its front side); throw it away in a closed
container and then wash your hands with an alcohol-based disinfectant or with soap and
water.
 Safe use of alcohol-based hand sanitizers
Safe use of alcohol-based hand sanitizers
 To protect yourself and others against COVID-19, clean your hands frequently and thoroughly. Use alcohol-based
hand sanitizer or wash your hands with soap and water. If you use an alcohol-based hand sanitizer, make sure you
use and store it carefully.

 Keep alcohol-based hand sanitizers out of children’s reach. Teach them how to apply the sanitizer and monitor
its use.

 Apply a coin-sized amount on your hands. There is no need to use a large amount of the product.

 Avoid touching your eyes, mouth and nose immediately after using an alcohol-based hand sanitizer, as it can
cause irritation.

 Hand sanitizers recommended to protect against COVID-19 are alcohol-based and therefore can
be flammable. Do not use before handling fire or cooking.

 Under no circumstance, drink or let children swallow an alcohol-based hand sanitizer. It can be poisonous. 

 Remember that washing your hands with soap and water is also effective against COVID-19.
 PROTECTIVE MEASURES FOR PEOPLE THAT
ARE IN OR VISITED INFECTED AREAS

01 02
Stay home if you do not feel well, even if you If you need to go out (for example, to buy
feel mild symptoms such as headaches, slight food or supplies), wear a mask to minimize
fever and a runny nose the risk of infecting others

03 04
If you have difficulty breathing and/or a high Call your provider and inform them of any
fever, seek medical advice as soon as possible recent travel, especially to countries with
reported cases
Referencess:-

1. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

2. http://www.ijmr.org.in/showBackIssue.asp?issn=0971-5916;year=2020;volume=151;issu

e=2;month=February%20&%20March

3. https://www.isglobal.org/en/coronavirus