NR eae oy Tome COVID-19 GUIDE) r ~ CO stand for Corona, VI stand for Virus, D Stand for Disease, 19 Means 2019, the Year in which the outbreak of the disease first identified; So named by World health organization in 2020 [| BackGrounD ] ‘ Whatis a Coronaviruses? Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease COVID-19. Whatis COVID-19? COVID-19 is the infectious disease caused by the most recently discovered coronavirus, This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. COVID-19 is now a pandemic affecting many countries globally. Infections with 2019-nCoV, most of them associated with travel from Wuhan, also are being reported in a growing number of international_locations, including the United States. % The United States reported the first confirmed instance of person-to-person spread with this virus on January 30, 2020. On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization declared the outbreak a “public health emergency of international concern external icon” (PHEIC). % On 11 March 2020, WHO Director General characterized COVID-19 as a pandemic. ‘+ The virus was confirmed to have reached Pakistan on 26 February 2020, when a student in Karachi tested positive upon returning from Iran, Covid-19 Guide (xotiis ®NASEEM SHERZAD HOUSE JOB GUIDE leo ees Covid-19 Guide t MODE OF TRANSMISSION ] Person-to-person spread: The virus is thought to spread mainly from person-to- person, = Between people who are in close contact with one another (within about 6 feet or 2 meter). "Through respiratory droplets produced when an infected person coughs or sneezes. "These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread from contact with contaminated surfaces of objects = It may be possible that a person can get COVID-19 by touching a surface or ‘object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads, | EPIDEMIOLOGICAL RISK FACTORS J * Older age * Male sex * Medical Comorbidities * Chronic Pulmonary disease * Cardiovascular disease * Chronic Kidney disease * Diabetes {| symptoms ] It can take up to 14 days for symptoms of coronavirus to appear. The main symptoms to look out for are: + Most common Symptoms = Fever up to 101 = Dry Cough * Tirednessarea eed erty cee ‘Serum Ferritin % CBC: Lymphopenia is more common, seen in more than 80% of patient. Mild thrombocytopenia Is commonly seen. However thrombocytopenia is considered as a poor prognostic sign + Procalcitonin (PCT) levels. # Pracaleitanin (PCT) is a sepsis biomarker, tt does nat significantly Increase in COVID-18 unlike CAP so can help along with clinical assessment with diagnosing/ ruling out superimpased bacterial infection for COVIO patients, and to guide the initiation and cessation of antibiotics. > D-dimer: * O:dimer is commonly elevated in patients with COVIO-19, O-dimer levels carrelate with disease sovetity and is a rellable pragnostic marker far in- hospital mortality in patients admitted for COVIO-18. = Reference: us icles: —— 1 seuetonanc SRST TREATMENT Atthe mament, the therapeutic strategies ta deal the Infection are only suppartl Prevention aimed at reducing transmission in the community is our best weapons ‘ Supportive management would be according to the symptoms which include antipyretics, analgesics and respiratary support. To date, there is no vaccine and no specific antiviral medicine to prevent or treat COVID-2019, Hawaver, thase affected should receive care ta relieve symptoms. 4 People with serious illness shauld be hosprtatined © Oxygen saturation ta be maintained above 90% “> if Fever, Panadol (every & hrs depending on your fever), Monitor the fever with ‘Thermometer Anti-diarrhea-—if there is diarrhea: Entergermina twice a day, Conservative fluid management if you have anorexia and vomiting thrice a day 15 mins before meal) © Cough and Cold medication: including cough drops and lozenges, cough syrup like Dayquil/Nyquil and decongestants syrup like Sudafed. Muconyl expectorant Syrup and Tab cafcol © Give Empirical Antibiotics ake Tab Ondansetron (Brand Name: onset)NRG ea aS Re Chapter 14 COT RRL + Vitamins for immunity: = Tab Berocca (Multivitamin, contain Vit-C and C) (once a day) or Tab Surbex-Z (once a day) = Calcium supplement, Tab Adora Calcium supplement (Once a day) OR Cac 1000 Plus (once a day) ‘Magnesium supplement (Once a day) 1 veT_]) This will destroy your taste buds and sense of smell. You won't feel like eating anything but that is even worst for your health. This will hit your core and energy levels. Make sure you take protein-based diet. Eat less but take meals frequently. Yogurt Yakhni Soup Fresh juices Milk shake Fruits % Take small portions but eat every hour. [cos] e * Take rest > Take steam Sleep as much as possible Minimum physical activity Take medicines, eat, sleep and repeat. Try to do breathing exercises * Note temperature every 3-4 hrs * Check pulse through an Pulse oximeter * Make sure you take Panadol (Paractamol) before temperature rises *% Take a sleeping pill at night if the situation is making you anxious and building up tension. “Make sure you open up all the windows and ventilate the room you are isolated in.. EyNaa RAT RRL eLL Chapter 14 [ pont’s Do ] Covid-19 Guide % Donot roam around % Do not go close to kids + Do not eat junk % Donot miss medicine * Donot exert [PREVENTION ] WHO and CDC recommend following these precautions for avoi 1g COVID-19 * Avoid large events and mass gatherings. + Avoid close contact (within about 6 feet, or 2 meters) with anyone who is sick or has symptoms. % Keep distance between yourself and others if COVID-19 is spreading in your community, especially if you have a higher risk of serious illness. * Wash your hands often with soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer that contains at least 60% alcohol, * Cover your mouth and nose with your elbow or a tissue when you cough or sneeze. Throw away the used tissue. * Avoid Touching your eyes, nose and mouth + Avoid sharing dishes, glasses, bedding and other household items if you're sick. % Clean and disinfect high-touch surfaces daily. * Stay home from work, school and public areas if you are sick, unless you're going to get medical care. Avoid taking public transportation if you are sick. * The CDC recommends wearing cloth face coverings in public places, such as the grocery store, where it's difficult to avoid close contact with others. It's especially suggested in areas with ongoing community spread. This updated advice is based on SNERA RYT Re Chapter 14 Covid-19 Guide data showing that people with COVID-19 can transmit the virus before they realize they have it. Using masks in public may help reduce the spread from people who do not have symptoms. Non-medical cloth masks are recommended for the public. ‘Surgical masks and N-95 respirators are in short supply and should be reserved for health care providers. [| SOME MEDICATIONS AND THEIR DOSES J ‘These are not the approved treatment BY WHO but various studies available on these. NO Drug of choice © Tocilizumab: * IL-6 inhibitor Brand name Actemra Available in vial 80 mg/4ml, 200 mg/10m, 400 mg/20mI Proposed to reduce the cytokine storm in COVID-19 Dose: 4-8 mg/kg (max 400mg) IV in 1 Hr—-Max 80ome/infusion (rule out contraindication) > Antiviral: No anti-viral therapy has been proven to work for COVID-19 in humans. Multiple RCTs are ongoing; hopefully they will bring us further information soon. Experimental options = Remdesivir * Favipiravir Use of Antibiotics: = COVID-19 itself is not an indication to start antibiotics. * However antibiotics can be initiated to treat secondary bacterial pneumonia * Broad spectrum antibiotics to be initiated accordingto the institution based guide ines = Name of Antibiotics: Azithromycine, Moxifloxacin, Tazocin, Carbapenems & Azithromycin: * Brand name: Tab Azomax 500 = Once a day for 5 days * Used for lower respiratory infections and pneumonia, as well as asthma, bronchiolitis, and COPD. Convalescent Plasma (CP) therapy in moderate/severe cases: * Convalescent plasma is a rich source of antibodies that can kill the virus and ‘ * 60)NARAYAN RA OLY Chapter 14 Covid-19 Guide help treat patients who have severe illness from the diseases or are critical. Patients who have recovered from COVID-19 have antibodies against the virus SARS-CoV-2, which causes COVID-19; these antibodies from recovered patients can help other patients fight the infection. Reference:https://hospitals.aku.edu/pakistan/AboutUs/News/Pages/convales cent-plasma-donation-for-covid-19.aspx * Use of Steroids: "Dexamethasone, Brand name: Decadron, Doses: 10-20mg od x 5d * Prednisoine 40mg/d ‘Prophylactic dose of Enoxaparin in admitted Patient "Brand Name: clexane * Strength: inj 20mg/0.2ml syringe or inj 40mg/0.4ml syringe * NOTE: WHO does not recommend self-medication with any medicines, including antibiotics, as a prevention or cure for COVID-19. However, there are several ‘ongoing clinical trials of both western and traditional medicines. WHO is coordinating efforts to develop vaccines and medicines to prevent and treat COVID- 19 and will continue to provide updated information as soon research results become available. i ‘WHEN TO DISCHARGE PATIENT J Resolution of symptoms Radiological Improvement * Documented virological clearance in 2 samples at least 24 hours apart [concusion} % Corona virus disease 2019 (COVID-19) was reported as cluster of disease in China in December 2019 * Ithas since spread to all continents except Antarctica and WHO declared COVID-19 as a pandemic. % Elderly persons with co-morbidities are more affected It spreads mainly via Respiratory droplets Pneumonia is the most common complication “Severe cases have a mortality rate of 2.3 to.5% + Presently thereisnostandardizedtreatmentor vaccineavailablefor COVID-19 * Containment and prevention is the best option EAy Covid-19 Guide pig sa mana maa pao EE FSRNOK DEA OF SOSA “1 nok se s2eid40m Jo/pue sINOHd Fepeul ano J Avo wets paasn 28 prs nah Gt- AND 126 [Fs INE MOA “spa pueWoeInaK TsNOATOSEOIS EL “eNoA SIs =DeKD LON ‘apap 6-aicn HORS (oRay0054 pak aM at 42H 04, ont) voR>asur-e1 Woy peroyid oq Aes nox ST-OIAOD © VK 2484 A2HH BOK PRAT gy SINE PRL 0 90k sy somyoy soft ead fe tieoe alsst 98 pods POA swovaueAs Sn iv pais 398. paou noA pue swoy Busha yroge aKpe ea: stuoyaushs Susoquou daay pinoys noA “suowiuks ane "REID ON 00 KAM) NouDV agaNaMWo2sy NOMWLawaRaINI SLINSIY LSAL 6b-GIAOD ONILAYdYSALNI NOJINVGINDS annsaaNERY Ra oT awe) Covid-19 Guide [ pisctaimer ] COVID-19 is a new disease and is under research; the information right now is up-to- dated and will be edited in the subsequent editions with new studies [REFERENCES ] COVID.gov.pk WHO Guidelines Centers for Disease Control and Prevention (CDC) https://www.researchsquare.com/article/rs-20850/v1 https://hospitals.aku.edu/pakistan/AboutUs/News/Pages/convalescent-plasma- donation-for-covid-19.asp International Pulmonologist’s Consensus on COVID-19 eeoes e STi ek keke Salient Features Ss ara) ‘© All past paper BCQ's (around 15000 BCQ's) in 0 3 4 quick line points Points from standard book summarized = Pointsof 2020 papers added HIGH-YIELD ES All major and minor subjects included ‘Trieky questions revealed Covers every aspect of past paper subject wise Noneed to read separate theory and BCQs books Bach topic given in modular form Al in one rod to success Contains detailed Tables and Diagrams No Errata needed System wise organization of texts, figures and tables for building concepts and highly increasing chanceof suecess.