CORONA VIRUS DISEASE

Prepared
By: Megha
Rani
Minu Thapa Magar
Nandani Gupta
Narbada Koirala
B.Sc. Nursing 4th Year
BPKIHS,Dharan

1
3/19/2020
Contents:
• Introduction
• Epidemiology
• Risk factors and Causes
• Mode of Transmission
• Pathophysiology
• Signs and Symptoms
• Diagnosis
• Management
• Complication
• Preventive Measures
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Objectives:
At the end of session, participants will be able to:
• Introduce about Corona virus
• Enumerate the cause of corona virus
• Enlist the sign and symptoms of corona virus
• Explain the diagnosis of corona virus
• Explain the management of corona virus
• List out the complications of corona virus
• Explain the preventive measures of corona virus.

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Introduction
Corona viruses constitute the subfamily
Orthocoronavirinae in the family
Coronaviridae

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 Introduction…
• They are enveloped viruses with a
positive- sense single-stranded RNA
genome .
• The name corona virus is derived from the
Latin corona, meaning "crown" or "halo",
which refers to the characteristic appearance
reminiscent of a crown when viewed under
electron microscopy, due to the surface
covering in club-shaped protein spikes.
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 Epidemiology

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Epidemiology…
Outbreaks of coronavirus types of relatively high mortality are as
follows
Outbreak Virus type Deaths
2003 severe acute respiratory
syndrome outbreak SARS-CoV 774

2012 Middle East respiratory

syndrome MERS-CoV Over 400
coronavirus outbreak
2015 Middle East respiratory
syndrome outbreak in South MERS-CoV 36
Korea

2018 Middle East respiratory

syndrome outbreak MERS-CoV 41

2019–20
coronavirus pandemic SARS-CoV-2 At least 5,833

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 Corona virus disease
2019 (COVID-19)
• In December 2019, a pneumonia outbreak
was reported in Wuhan city of China.
• On 31 December 2019, the outbreak was
traced to a novel strain of corona virus, which
was given the interim name 2019-nCoV by the
World Health Organization (WHO), later
renamed SARS-CoV-2 by the International
Committee on Taxonomy of Viruses.

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 Corona virus disease 2019
(COVID-19)
• As of 15 March 2020, there have been at least 5,833
confirmed deaths and more than 156,396
confirmed cases in the corona virus pneumonia
pandemic.
• The Wuhan strain has been identified as a new
strain of Beta corona virus from group 2B with
approximately 70% genetic similarity to the SARS-
CoV.
• The virus has a 96% similarity to a bat corona virus,
so it is widely suspected to originate from bats as
well. The pandemic has resulted in serious travel
r e st
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Causes of COVID - 19
• It is caused by SARS-CoV-2 is closely related to
Sever Acute Respiratory Syndrome Corona
Virus which was outbreaks in 2003.
• It is thought to have a zoonotic origin.

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Mode of Transmission
• The primary mode of transmission is via
respiratory droplets that people exhale.
• Droplets only stay suspended in the air for a
short time but may stay viable and contagious on
a metal, glass or plastic surface.
• Disinfection of surfaces is possible with
substances such as 62–71% ethanol applied for
one minute.

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Incubation Period

• Ranges from one to fourteen days; it is most

commonly five days. In one case, it had an
incubation period of 27 days

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Pathophysiology
Host mechanism is decreased (Impaired gag and cough reflex or

immunocompromized State)

Microorganisms enter the lower respiratory tract

Inflammatory reaction begins

Inflammatory reactions with W B C , neutrophils enter the alveoli and

fill normally air containing spaces

Interfere exchange of O 2 and C O 2

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Signs and Symptoms
• Symptoms of COVID-19 are non-specific and
those infected may either be asymptomatic or
develop flu like symptoms such as fever,
cough, fatigue, shortness of breath, or muscle
pain.

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Signs and Symptoms…
Symptom %

Fever 87.9%

Dry cough 67.7%

Fatigue 38.1%

Sputum production 33.4%

Shortness of breath 18.6%

Muscle pain or joint pain 14.8%

Sore throat 13.9%

H3/e19a/2d02a0che
13.6% 15
Chills 11.4%

Nausea or vomiting 5.0%

Nasal congestion 4.8%

Diarrhoea 3.7%

Haemoptysis 0.9%

Conjunctival congestion 0.8%

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Clinical Syndrome associated with
COVID-19
1. Mild illness
2. Pneumonia
3. Severe Pneumonia
4. Acute respiratory distress Syndrome
5. Sepsis
6. Septic Shock

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Diagnosis
• Infection by the virus can be provisionally
diagnosed on the basis of symptoms, though
confirmation is ultimately by reverse
transcription polymerase chain reaction (rRT-
PCR) of infected secretions (71% sensitivity)
and CT imaging (98 % sensitivity).

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 Diagnosis…
1. Viral testing
• Reverse transcription polymerase chain
reaction (rRT-PCR) is done. The test can be
done on respiratory or blood samples.
2. Imaging
• Radiographs and computed tomography.

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 In the context of Nepal
• Test is done in National Public Health
Laboratory, Teku. Suspected patient is kept in
isolation and sample that is throat swab, nasal
swab are collected which is sent to Teku. The
test is free of cost . The test is done for those
cases only which is recommended by expert
physician. It takes 24- 48hours for the report
collection .If the Report found to be positive,
the information is given to the Hospital and
the Doctor immediately.
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 MANAGEMENT

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WHO: Interim guidelines for the
management severe acute
of
respiratory caused by
illness corona novel
virus.

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 1. TRIAGE

• Recognition and sorting of all patients at the

first point of contact with the healthcare
system (e.g. Emergency Dept.)
• Recognize that nCoV is the possible etiology
for SARI, which is based on the conditions
outlined in Table 1.

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Table 1 Definitions of patients with SARI, suspected of 2019-nCoV infection
 WHO: Interim Guidelines…
2. Immediate implementation of
appropriate prevention and control (IPC)
measures

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3. Early supportive therapy and monitoring
• Supplemental oxygen therapy: SARI and respiratory
distress, hypoxemia, or shock.
• If there’s no evidence of shock in patients with SARI, use
conservative fluid management.
• Antimicrobials should be given to all patients with SARI
to treat all likely pathogens causing SARI. Antimicrobials
should be given within one hour of initial patient
assessment for patients with sepsis.

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 Early supportive…
• Do give routine corticosteroids for
NOT
treatment of viral pneumonia of
clinical outside
trials unless indicated for
another reason.
• Early communication with patient and
family is key for successful management

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4. Collection of specimens for laboratory
diagnosis
• Blood cultures for bacteria that cause pneumonia
and sepsis should be collected, ideally, before
microbial therapy. But DO NOT delay the
antimicrobial therapy to collect blood cultures.
• Specimens should be collected from both upper
respiratory tract (URT) and lower respiratory tract
(LRT) for nCoV testing via RT-PCR.
• Serology a diagnostic procedure
recommended
as only when RT-PCR is is
available. NO
T

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 Caring for infants and mothers with
COVID-19: IPC and breastfeeding
• Infants born to mothers with suspected,
probable, or confirmed COVID-19 should be
fed according to standard infant feeding
guidelines, while applying necessary
precautions for IPC.

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 Caring for infants and mothers with
COVID-19…
• Breastfeeding should be initiated within 1
hour of birth. Exclusive breastfeeding should
continue for 6 months with timely
introduction of adequate, safe and properly
fed complementary foods at age 6 months,
while continuing breastfeeding up to 2 years
of age or beyond.

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 Caring for infants and mothers with
COVID-19…
• As with all confirmed or suspected COVID-19
cases, symptomatic mothers who are
breastfeeding or practising skin-to-skin contact
or kangaroo mother care should practice
respiratory hygiene, including during feeding (for
example, use of a medical mask when near a
child if the mother has respiratory symptoms),
perform hand hygiene before and after contact
with the child, and routinely clean and disinfect
surfaces with which the symptomatic mother
has been in contact.
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 PREVENTION

• Infection and Control

Prevention
Recommendationsfor Patients with
Suspected or Confirmed Corona virus Disease
2019 (COVID-19) in Healthcare Settings
( Centers for Disease Control and
Prevention)

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 Prevention…

1. Minimize Chance for Exposures

• Measures should be implemented before
patient arrival, upon arrival, throughout the
duration of the patient’s visit, and until the
patient’s room is cleaned and disinfected.

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 PREVENTION…
• Before Arrival
– When scheduling appointments routine
medical for
care (e.g., annual physical,
surgery), instruct patients to call ahead elective
and
discuss the need to reschedule their appointment
if they develop symptoms of a respiratory
infection (e.g., cough, sore throat, fever) on the
day they are scheduled to be seen.

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 PREVENTION…
• Upon Arrival and During the Visit
Take steps to ensure all persons with symptoms of
COVID-19 or other respiratory infection (e.g., fever,
cough) adhere to respiratory hygiene and cough
etiquette, hand hygiene, etc

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 Prevention…

2. Adhere to Standard and Transmission-Based

Precautions
• Hand Hygiene
• Personal Protective Equipment

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 HAND WASHING
• Hand washing is recommended to prevent the
spread of the disease. The US Centers for
Disease Control and Prevention (CDC)
recommends that people wash hands often
with soap and water for at least 20 seconds.

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 FOR MAKING HAND SANITIZER
• Ethanol=835 ml
• Hydrogen Peroxide=40 ml
• Glycerol=15 ml
• Sterile water=110ml
Total=1000ml

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 Prevention…

PERSONAL PROTECTIVE EQUIPMENTS:

• Respirator or Facemask
Put on a respirator or facemask (if a respirator
is not available) before entry into the patient
room or care area.
N95 respirators or respirators that offer a
higher level of protection should be used
instead of a facemask when performing or
present for an aerosol-generating procedure

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 Prevention…

• Eye Protection
• Gloves
• Gowns

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 3. Patient Placement

• For patients COVID-19 or other

respiratory
with infections, evaluate need
hospitalization. If hospitalization for is
medically necessary, home care is preferable
not if
the individual’s situation allows.
• If admitted, place a patient with known or
suspected COVID-19 in a single-person room
with the door closed. The patient should have
a dedicated bathroom.

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 Prevention…

4. Take Precautions WhenPerforming Aerosol-

Generating Procedures (AGPs
If performed, the following should occur:
– Health care personnel in the room should wear an N95 or
higher-level respirator, eye protection, gloves, and a gown.
– The number of health care personnel present during the
procedure should be limited to only those essential for
patient care and procedure support. Visitors should not be
present for the procedure.
– AGPs should ideally take place in an Airborne Infection
Isolation Room
– Clean and disinfect procedure room surfaces promptly.

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 Prevention…
5. Collection of Diagnostic Respiratory
Specimens
When collecting diagnostic respiratory
specimens (e.g., nasopharyngeal swab) from a
possible COVID-19 patient, the following
should occur:
– Health care personnel in the room should wear an
N-95 or higher-level respirator (or facemask if a
respirator is not available), eye protection, gloves,
and a gown.

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 Prevention…

– The number of Health care personnel present

during the procedure should be limited to only
those essential for patient care and procedure
support. Visitors should not be present for
specimen collection.

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 Prevention…

– Specimen collection should be performed in

a normal examination room with the door
closed.
– Clean and disinfect procedure room surfaces
promptly.

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 Prevention…

6. ManageVisitor Access and Movement

Within the Facility
Establish procedures for monitoring, managing
and training all visitors, which should include:
– All visitors should perform frequent hand hygiene
and follow respiratory hygiene and
etiquette precautions while in cough the
especially common areas. facility,

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 Prevention…

– Passively screen visitors for symptoms of acute

respiratory illness before entering the healthcare
facility
• Post visual alerts (e.g., signs, posters) at the
entrance and in strategic places (e.g., waiting
areas, elevators, cafeterias)

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 Prevention…

7. Implement Engineering Controls

Examples of engineering controls include:
– physical barriers or partitions to guide patients
through triage areas
– curtains between patients in shared areas
– air-handling systems (with appropriate
directionality, filtration, exchange rate, etc.) that
are installed and properly maintained

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 Prevention…

8. Monitor and Manage ill and Exposed

Healthcare Personnel
• Facilities and organization providing
healthcare should s sick leave
policies for Health care
implement
personnel that are
non-punitive, flexible, and consistent with
public health guidance.

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 Prevention…

9. Train and Educate Healthcare Personnel

Provide Health care personnel with job- or
task-specific education and training on
preventing transmission of infectious agents,
including refresher training.

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 Prevention…

10. Implement Environmental Infection Control

• All non-disposable medical equipment used
for patient care should be cleaned and
disinfected according to manufacturer’s
instructions and facility policies.
• Disposable medical equipment should be used
when caring for patients with known or
suspected COVID-19.

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 Prevention…

11. Establish Reporting within and between

Healthcare Facilities and to Public Health
Authorities.

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Complications
Further development can lead to
a) severe pneumonia
b)acute respiratory distress syndrome
c)sepsis
d)septic shock and
e)death

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 SUMMARY

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 References
1. https://www.who/2019-nCoV-clinical-2020.4
- eng.pdf retrived on 16th March, 2020
2. https://www.cdc.gov/coronavirus/2019-ncol-
recommendations.htmlov/infection-
control/contr retrived on16th March,2020
3. https://www.who.int/health- topics/coronavirus
retrived on 16th March, 2020

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