COVID 19 Year 4 Internal Medicine Notes OmpathStudy

COVID 19 Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / IMED 4.3 / MOGERE -- Slide 1 COVID 19 Dr Alex Mogere Consultant Physician Slide 3 What are corona viruses They’re a large family of viruses that have been around for a long time.\nMany of them can make people ill with sniffles or coughing.\nPrimarily infect the upper resp. and GI tract of mammals and birds 229E (alpha) NL63 (alpha) OC43 (beta) HKU1 (beta MERS-CoV, a beta virus that causes Middle East respiratory syndrome (MERS) SARS-CoV, a beta virus that causes severe acute respiratory syndrome (SARS) SARS-CoV-2, which causes COVID-19 Slide 4 SARS corona virus(SARS Cov) Identified in 2003. resulted in over 8000 infections 10% of which resulted in death thought to be an animal virus from an as-yet-uncertain animal reservoir, perhaps bats, that spread to other animals (civet cats)\nfirst infected humans in the Guangdong province of southern China in 2002. Unique pathogenesis as it causes bother upper an lower resp. tract infections and can also cause G/e Slide 5 Case fatality Rate SARS and MERS-CoV-2 were reported to have a 10% and 34.4% case fatality rate, respectively.5\nIn contrast, SARS-CoV-2 has been estimated to have a case fatality rate of ~2.3%. Slide 6 SARS Cov 2(Covid 19) Slide 7 Ct.Covid 19 Spread is similar to seasonal Flu Protection: Hand hygiene Stay home if unwell Cough etiquette Face masks Everyone is at potential risk Slide 8 Covid 19 Biology Single stranded RNA enveloped virus Spread: resp droplets and formites/even by asymptomatic Binds to ACE 2 receptors on type 2 pneumocytes Predominatly a resp disease Incubation period, 3-12 days(median 4-5 days ), ¾ develop symptoms btwn day 2-7 Slide 10 How Covid 19 is transmitted Person to person, predominantly by rsp droplet spread and contact\nlarger droplets ( 5um) remain in the air for a short period(<17 mins) Larger droplets travel short distances, gen < 1m Can survive on surfaces (formites) for up to 4 days Transmission occurs when contact with virus- laden formites is followed by contact with mucous membranes eg nose, mouth, eye Aerosol/airborne transmission also occurs Viable for at least 3 hrs in aerosolized envts Slide 11 Period of infectivity Not certain Duration of viral shedding is variable Viral RNA levels from upper respiratory specimens higher in acute phase than in later phase of disease Virus detection in resp specimen, stool and blood Slide 12 Case defn Suspect / Confirmed case Suspect case: Must satisfy epidemiological and clinical criteria Close/causal contact in 14 days before onset of illness with a confirmed covid 19 case Fever/acute rsp infection-sore throat, SOB, cough etc Confirmed Case: A person who tests +ve to a validated specific Sars Cov 2 nucleic acid test/electron microscopy/viral culture A person with a positive SARS-CoV-2 Antigen RDT AND meeting criteria for either suspected or probable case; OR has contact with a probable or confirmed case. Slide 13 Ct. case defn (MOH,2021) Clinical criteria: Acute onset cough AND fever; OR Acute onset of ANY TWO OR MORE of the following signs or symptoms: Cough, fever, loss of taste or smell, difficulty breathing, sore throat, running nose, chest pain, fatigue/general weakness, headache, diarrhoea, altered mental status (Children may present with atypical symptoms) Slide 14 Ct. case defn (MOH,2021) Epidemiologic criteria: Residing, working or travel (within the last 14 days) to an area with high risk of transmission of virus (In Kenya, this will be as reported by the Ministry of Health Where there is widespread community transmission in several regions of the country, then all patients will be considered to have met epidemiologic criteria Working in a healthcare facility International travel in the last 14 days Slide 15 Infection Prevention and Control (IPC) plan in response to COVID-19 Facility preparedness: All facilities should have: ● An IPC program or a dedicated IPC focal person ● A functional screening and triage area for early case identification ● A holding area for cases awaiting results or transfer ● A mechanism to ensure standard and transmission-based precautions. ● Adequate healthcare workers to provide 24-hour patient care without exhaustion. ● A plan to conduct health worker exposure risk assessment ● Continuous training and refresher courses to the existing staff and any new staff. ● Adequate IPC supplies and equipment Slide 16 Quarantine & isolation Quarantine: Quarantine is separation and restricted movement of well persons who have been exposed to persons with COVID-19. It can be applied at the individual, family or community level.\nAll persons who have had contact with a confirmed case of COVID 19 should quarantine for 14 days and get a COVID 19 test if they develop any symptoms.\nQuarantine can either be self-quarantine or carried out at a designated facility. Slide 17 Ct. Quarantine & isolation Isolation: Isolation is the separation of sick people with a contagious disease from peo