Coronavirus disease 2019

Envelope

120 – 160 nm
 Envelope

(+) ssRNA

120 – 160 nm
 Spike glycoprotein (S)

M protein

Envelope

(+) ssRNA and N protein

HE dimer

120 – 160 nm
 HOST: Transmission Theory
Natural Animal Reservoirs

Intermediate Host

Final Host
Epidemiology
Originated from Wuhan City, China
Total cases of worldwide diagnosed 121,969,233

Prevalence: Total of deaths worldwide 2,694,094

Total worldwide recoveries 68,687,160
Case of fatality rate 2.208%
Recovery rate 56.701%
As of March 21, 2021

Worldwide distribution:
 Mode of transmission
Can be transmitted via droplet, contact, fomites and person to person transmission

● Imported case
● Local transmission
● Community transmission
Pathogenesis
Direct cytotoxic effect
Dysregulation of the RAAS
Endothelial cell damage & Dysregulated immune response
 Risk factors
& Clinical Manifestations
 Risk Factors
Risk factors for Acquiring the Disease Risk factors for Death

● Increase age (> 60 years old) ● Risk depends on access to care and
● Obese general health
● Smokers ● Lack of Oxygen
● Previous medical conditions ● More common in older adults
○ 65 – 75 yo (2-5%)
○ 75 – 85 to (4-10%)
○ > 85 yo (>10%)
Incubation Period
 Clinical Manifestations
Anosmia
Ageusia
Diarrhea
Nausea/Vomiting
Headache
Productive Cough
Sore Throat
Myalgia
Fatigue
Runny Nose
Dyspnea
Dry Cough
Fever

0 20 40 60 80 100 120
%
 Complication % Median
ARDS 19.6 12 days
Arrythmia 16.7
Shock 8.7
Acute Cardiac Injury 7.2 15 days
Sepsis 9 days
COVID – 19 Complications

Invasive Ventilation 2-17

COVID – 19 Complications
Death 6-11
Classification of Patients
 Recommended
Severity Signs and Symptoms
Diagnostics
Fever, cough, fatigue,
anorexia, myalgias Other
non-specific symptoms such
as sore throat, nasal
congestion, headache,
diarrhea, nausea and
SARS CoV-2 RT- PCR
Mild vomiting, Loss of smell
(anosmia) or loss of taste
(ageusia) preceding the
onset of respiratory
symptoms
NO signs of pneumonia or
hypoxia
With signs of Non- severe
SARS CoV-2 RT- PCR
pneumonia, RR 21-
Moderate CXR or CT scan CBC, ALT,
30/minute, SpO2 >92% on
AST, Creatinine ECG
room air
Severity Signs and Symptoms
Severe Pneumonia or severe
acute respiratory infection, as
follows: Fever, cough,
Severe dyspnea
RR >30 breaths/minute,
Severe respiratory distress
SpO2 <92% on room air
Onset within 1 week of known
clinical insult (pneumonia) or
new or worsening respiratory
symptoms, progressing
Critical
infiltrates on CXR or chest CT,
with respiratory failure not fully
explained by cardiac failure or
fluid overload (COVID- ARDS)
Recommended Diagnostics
SARS CoV-2 RT- PCR; CBC
Comprehensive metabolic
panel Ferritin, LDH,
Procalcitonin or CRP, INR/PT,
D- dimer, Lactate CXR or CT
scan Sputum GS/CS, Blood
cultures, as appropriate; ABG
SARS CoV-2 RT- PCR; CBC
Comprehensive metabolic
panel ABG; Ferritin, LDH,
CRP, INR/PT, D- dimer,
Procalcitonin, Lactate Repeat
CXR or CT scan ETA GS/CS,
Blood cultures, as appropriate
A. New Patient Classification
I. Suspected case
● All SARI cases where NO other etiology fully explains the clinical manifestations
● ILI cases with any one of the following:
- No other etiology AND history of residence in an area that reported local transmission of COVID-19
OR
- With contact to a confirmed or probable case of COVID-19 disease 14 days prior to symptom onset
● Individuals with fever or respiratory signs or symptoms and one of the following conditions
- Aged >60, with a comorbidity, health worker
 2. Probable case

● Suspect case who fulfills anyone of the following:

o Inconclusive COVID-19 test

o Suspect who underwent with COVID-19 test but not conducted in a

national or subnational reference laboratory

o Suspect case for whom testing could not be performed for any reason
3. Confirmed case
● any individual, irrespective of presence or absence of clinical signs and
symptoms, who was laboratory-confirmed for COVID-19
4. Contact

● a person who experienced any one of the following exposures of a probable or

confirmed case:
o Face-to-face contact with a probable or confirmed case within 1 meter and
more than 15 minutes;
o Direct physical contact with cases of COVID-19 disease without PPE
o Other situations as indicated by local risk assessments
Contact Tracing
Diagnosis
 A. Reverse Transcription Polymerase Chain Reaction (RT-PCR)

1. Detection Process and Interpretation: Viral RNA is measured by the

cycle threshold (Ct) value which becomes detectable day 1 of symptoms peaks
within the first week. Ct: <40 clinically report as positive

2. Specimen Samples: Upper Respiratory Tract Lower respiratory tract

Nasopharyngeal swab Sputum
Oropharyngeal swab Endotracheal aspirate

3. Results: False negative results of RT-PCR may be due to inadequate

sample or inappropriate timing of sample collection
 B. COVID-19 IgG & IgM Rapid Diagnostic Test Kits (RDT)

FDA approved the use of antibody-based test kits for SARS- COV2
testing on March 30,2020
• Sensitivity of 88.86%
• Specificity of 90.63%
• Low sensitivity during the early phase of infection
• Insufficient evidence to use the kits as stand-alone kits for definitive diagnosis of
COVID-19
• Can only be used in people who had onset of symptoms for at least Day 5-21 (IgM-IgG)
C. Rapid Test Based on Antigen Production

• Rapid antigen test detects the presence

of viral proteins (antigens) expressed by
the COVID-19 virus in a sample from the
respiratory tract of a person.
• Target antigen present in sufficient
concentrations in the sample, it will bind
to specific antibodies fixed to a paper
strip enclosed in a plastic casing
Treatment
 A. Mainstay Supportive Treatment
• Oral Fluids for hydration
• Anti-pyretics for fever
• Oxygen
• Ventilatory Support
• Routine empiric antibiotics and anti-influenza drugs are NOT
recommended for mild COVID disease
B. Investigational Pharmacologic Treatment

1. Hydroxychloroquine/Chloroquine + Any Macrolide

• NO LONGER RECOMMENDED
• Chloroquine or hydroxychloroquine as monotherapy or in combination with a macrolide or
an antiviral agent among hospitalized patients with probable or confirmed COVID-19
pneumonia is NOT recommended.
• Hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with
azithromycin, did not improve clinical status at 15 days
2. Remdesivir
• MOA: inhibitor of the viral RNA and RNA dependent
polymerase with inhibitory activity against SARS-CoV and MERS-CoV
• Median recovery time of 11 days as compared with 15 days in those who
received placebo
• Believed to be efficacious in moderate to severe COVID-19
• 200 mg IV loading dose on Day 1, followed by 100 mg IV once a day for 5-10
days
3. Tocilizumab
• IL-6 inhibitor
• Used to treat patients in China with severe COVID-19 and elevated IL-6
levels (Treatment guidelines from China’s National Health Commission)
• Given to patients with severe to critical COVID-19
4. Lopinavir-Ritonavir
• NO LONGER RECOMMENDED
• Lopinavir-ritonavir (LPV/r) as monotherapy or in combination with
hydroxychloroquine is NOT recommended among hospitalized patients with
probable or confirmed COVID-19 pneumonia.
• Did not significantly accelerate clinical improvement, reduce mortality, or
diminish throat viral RNA detectability in patients with serious Covid-19
• Dose: 200/50mg twice daily orally
5. Favipiravir

• Mechanism of action: inhibitor of the RNA-polymerase by resembling the

endogenous guanine
• There is insufficient evidence to recommend the routine use of favipiravir in
the treatment of COVID-19 except in the context of a clinical trial or for
compassionate use among patients with moderate COVID-19 disease.
• Clinical trial dosage is 1800 mg 2x/day loading dose then 800 mg 2x/day for 13
days.
Management of
Asymptomatic
Patients
I. Immunocompetent Individuals
o These asymptomatic individuals should remain under home (or community facility) quarantine for 10
days from the time they tested positive for COVID-19

II. Immunocompromised Individuals

o Repeat RT PCR as early as 10 days from the initial positive RT PCR.
o A single negative RT PCR can be used to discontinue transmission-based precautions

Should asymptomatic individuals develop fever or respiratory symptoms within this 10-day
quarantine period, quarantine should be extended for 10 days after the first day of symptoms
Vaccines
Live attenuated vaccines Inactivated vaccines

weakened form of the viruses whose genetic

virus, which can still
grow and replicate,
but does not cause
illness.
material has been
destroyed by heat,
chemicals or radiation
so they cannot infect
cells and replicate but
can still trigger an
immune response.
 Sinovac (CoronaVac)

• Inactivated Vaccine
• Sinovac conducted phase 3 trials involving
volunteers in Brazil, Indonesia and Turkey.
• The company began phase 4 trials in
February 2021
 Sinopharm
• Inactivated Vaccine
• Beijing Institute of Biological Products
• The Institute has now begun a phase 4 trial for the vaccine
 Viral Vector Vaccine

There are two main types of viral vector-based vaccines

o Non-replicating vector vaccines are unable to make new

viral particles; they only produce the vaccine antigen.

o Replicating vector vaccines also produce new viral

particles in the cells they infect, which then go on to infect
new cells that will also make the vaccine antigen.
 Astra-Zeneca

• Viral Vector Vaccine

• ChAdOx1 vaccine developed by the University of Oxford
• 2 doses
• Efficacy was higher in those with a longer prime-boost
interval (≥12 weeks) than in those with a short interval
(<6 weeks)
Nucleic acid (mRNA) Vaccine

Nucleic acid vaccines use genetic material

from a disease- causing virus or bacterium (a pathogen) to stimulate an immune response against it.
 Pfizer/BioNTech’s mRNA
● mRNA vaccine encoding the prefusion spike
glycoprotein of SARS-CoV-2
● Contains small part of the genetic code of SARS-CoV-
2 Spike Protein, does not contain any live virus
● consists of 2 doses (30 μg, 0.3 mL each) administered
intramuscularly, 3 weeks apart
 MODERNA

• mRNA-1273 vaccine
• Moderna vaccine compared to the Pfizer
vaccine is easier to transport and store
because it is less temperature sensitive.
• Recommended to people 18 years of age
and older, with a dose of 50 μg (0.5 mL)
Prevention
THANK YOU and STAY SAFE!