COVID

19
DENNIS N. MUÑOZ, RN, RM, LPT
Seven documented Human Coronaviruses (hCoVs)

1. hCoV-229E (alpha) mainly cause asymptomatic

2. hCoV-NL63 (alpha) or mild respiratory and
3. hCoV-OC43 (beta) gastrointestinal infections,
they have been circulating in
4. hCoV-HKU1 (beta) humans since they were
recognized, and accounting
for approximately 5–30% of
common colds
Seven documented Human Coronaviruses
(hCoVs)

5. MERS-CoV, a beta virus To date, there

that causes Middle East have been three
respiratory syndrome documented
(MERS) highly pathogenic
6. SARS-CoV, a beta virus and lethal hCoVs
that causes Severe
because of their
Acute Respiratory
Syndrome (SARS) dreadful impacts
7. SARS-CoV-2, which on humans
causes COVID-19.
Human Coronaviruses
 Overview of COVID-19, SARS-CoV-2 replication, and therapeutic targets.

Copyright © 2020 The Cleveland Clinic Foundation. All Rights Reserved Cornelia C. Bergmann, and Robert H. Silverman CCJM 2020;ccjm.87a.20047
Leading COVID-19
Vaccines
Vaccines against COVID-
19 which are on phase III
of clinical trials
or have already been
approved in at least one
country.
[ Updated on 02/02/2021 ]
Wang, C., Horby, P. W., Hayden, F. G., & Gao, G. F. (2020). A novel coronavirus outbreak of global health concern. The Lancet, 395(10223), 470-473. https://doi.org/10.1016/s0140-
6736(20)30185-9
Zhu, Z., Lian, X., Su, X., Wu, W., Marraro, G. A., & Zeng, Y. (2020). From SARS and MERS to COVID-19: A brief summary and comparison of severe acute respiratory infections caused by three highly
pathogenic human coronaviruses. Respiratory Research, 21(1). https://doi.org/10.1186/s12931-020-01479-w
Zhu, Z., Lian, X., Su, X., Wu, W., Marraro, G. A., & Zeng, Y. (2020). From SARS and MERS to COVID-19: A brief summary and comparison of severe acute respiratory infections caused by three highly
pathogenic human coronaviruses. Respiratory Research, 21(1). https://doi.org/10.1186/s12931-020-01479-w
• December 2019, several
patients from Wuhan,
People’s Republic of
China, developed
pneumonia and respiratory
failure reminiscent of the
SARS epidemic in 2003
In early January 2020, a new virus was isolated from bronchoalveolar
lavage fluid samples and found to be a betacoronavirus
Transmission Hotspots

The following settings are 6. Aircraft carriers and other

catalyzers of local outbreaks: military vessels
1. Homes (+ intense social life 7. Mass gatherings and religious
gatherings
with friend and colleagues)
8. Schools
2. Workplaces
9. Prisons
3. Hospitals 10. Homeless shelters
4. Nursing facilities 11. Industrial meat-packing plants
5. Cruise ships 12. Choirs
• Household contacts and those travelling with a COVID-19 case had a 6 to 7
times higher risk of infection than other close contacts, and that children
were as likely to be infected as adults

• Another group found that the odds of infection among children and young
people (<20 years old) was only 0.26 times of that among the elderly (≥60
years old) (Jing QL 2020).

• A third group calculated that the secondary attack rate in children was 4%
compared to 17.1% in adults, and that the secondary attack rate in contacts
who were spouses of index cases was 27.8% compared to 17.3% in other adult
members in the households
• One hospital study reports that the virus was widely present in the
air and on object surfaces in both the intensive care units and
general wards, implying a potentially high infection risk for medical
staff. Contamination was greater in ICUs.

• Virus was found on floors, computer mice, trash cans, sickbed

handrails, and was detected in the air up to approximately 4 m
from patients (Guo 2020).

• The virus was also isolated from toilet bowl and sink samples,
suggesting that viral shedding in stool could be a potential route
of transmission (Young 2020, Tang 2020).

• However, most of these studies have evaluated only viral RNA.

• There is evidence that more consistent and full use of
recommended PPE measures was associated with decreased risk
for infection, suggesting a dose–response relationship.

• Association was most consistent for masks but was also observed
for gloves, gowns, and eye protection, as well as hand hygiene.

• Some evidence was found that N95 respirators might be

associated with higher reduction of risk for infection than surgical
masks.

• Evidence also indicated an association between certain exposures

(such as involvement in intubations, direct contact with infected
patients, or contact with bodily fluids) (Chou 2020).
In South Korea and
elsewhere more than 100
people who had recovered
from COVID-19 were
retested positive (Ye 2020)
and there was concern that
patients who recover from
COVID-19 may be at risk of
reinfection. However, there
was no indication that they
were contagious.
What are the advantages of the
Rapid tests :

1. Rapid-screening within 10-15

minutes.
2. High detection efficiency:
simultaneous monitoring of
IgM and IgG.
3. Detection without any testing
equipments .
4. Easy to operate, and is
compatible with serum/
whole blood/ plasma.
5. Room-temperature storage.
The rapid test for SARS-CoV-2 diagnosis provides qualitative
detection of IgG and/or IgM from human serum, whole blood or
plasma in approximately 10-15 minutes.

The rapid tests are based on the principle of lateral flow

immunoassay chromatography and are available in cassette form.
The test is based on the separation of the components of a
mixture through a medium using capillary force and the specific
and rapid binding of an antibody to its antigen.

IgM and IgG are immunoglobulins produced by the immune

system to provide protection against SARS-CoV-2. Anti-SARS-
CoV-2 IgM and IgG can therefore be detected in samples from
affected patients.
What is the principle
of the Rapid tests for
SARS-CoV-2

The test detects the

presence of patient-
generated antibodies
against SARS-CoV-
2, the virus which
causes the disease
COVID-19. The test
can detect two types
of antibody isotypes:
IgG and IgM.
Breaking the chain of infection transmission

Equipment cleaning Hand Hygiene Compliance w/ Precautions

Training should also stress preventing further spread of
contamination while wearing PPE by:

1.Keeping hands away from face.

2.Limiting surfaces touched.
3.Removing PPE when leaving work areas.
4.Performing hand hygiene.
What’s wrong with this picture?
Heightened level of precaution
Standard Precautions

Standard Precautions are the minimum infection prevention

practices that apply to all patient care, regardless of suspected or
confirmed infection status of the patient, in any setting where health
care is delivered.
Contact Precautions
• “Contact Precautions are intended to prevent transmission of infectious
agents, including epidemiologically important microorganisms, which are
spread by direct or indirect contact with the patient or the patient’s
environment.”
• Healthcare personal caring for patients on contact precautions MUST wear an isolation gown and gloves/personal
protective equipment (PPE) for all interactions (that may involve contact with the patient or potentially
contaminated areas in the patients environment)
• Donning (putting on) of PPE must occur immediately prior to entry
• Doffing (removing) PPE must occur immediately prior to exiting

ANYONE ENTERING THE PATIENT ROOM MUST COMPLY WITH TRANSMISSION BASED PRECAUTIONS

Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
PPE Donning

6) Added wording that will ensure the

training of staff on the personal protective
equipment purchased. Ensuring the safety
of staff by having sufficient supplies and by
being properly trained with those
supplies. This inconsistency has been
witnessed with recent Ebola response
 Contact precautions should be used for the following infections
and conditions for the duration listed:
1. Abscess, major draining (duration of illness,
until the cessation of drainage).
2. Adenovirus: pneumonia (duration of
illness).
3. Burkholderia cepacia in cystic fibrosis
patients.
4. Bronchiolitis (duration of illness).
5. Clostridium difficile (duration of illness).
6. Congenital rubella (duration is until 1 year
of age, or urine and nasopharyngeal
cultures consistently negative after 3
months of age).
7. Conjunctivitis, viral (duration of illness).
8. Diphtheria: cutaneous (duration is until
completion and antibiotics and 2 negative
cultures 24 hours apart).
9. Staphylococcal furunculosis (duration of
illness).
10. Rotavirus (duration of illness).
11. Hepatitis A (duration is age-specific in
incontinent patients: children < 3 years old is
for the duration of hospitalization; 3 to 14
years old is 2 weeks after onset; > 14 years
old is 1 week after onset).
12. Herpes simplex: neonatal, disseminated,
severe, or mucocutaneous (duration is until
lesions dry and crust).
13. Herpes zoster: disseminated (duration of
illness).
14. Human metapneumovirus (duration of
illness).
15. Impetigo (duration is until 24 hours after
initiating effective therapy).
 Contact precautions should be used for the following infections
and conditions for the duration listed:
15. Lice: head (duration is until 24 hours after
initiating effective therapy).
16. Monkeypox (duration is until lesions crust).
17. Multidrug-resistant organisms infection or
colonization (duration is evidence of ongoing
or increased risk of transmission, or while
there are wounds that cannot be covered).
18. Parainfluenza virus (duration of illness).
19. Poliomyelitis (duration of illness).
20. Pressure ulcer, major infected (duration of
illness).
21. Respiratory syncytial virus: infants, young
children, and immunocompromised adults
(duration of illness).
22. Staphylococcal scalded skin syndrome,
Ritter’s disease (duration of illness).
23. Scabies.
24. Severe acute respiratory syndrome (duration of
illness plus 10 days after any fever and respiratory
symptoms have resolved or improved).
25. Smallpox (duration of illness).
26. Staphylococcus aureus skin infection, major
(duration of illness).
27. Group A streptococcus skin infection, major
(duration is until 24 hours after initiating effective
therapy).
28. Tuberculosis: extrapulmonary, draining lesions
(duration is until clinically improving and drainage
has stopped or three consecutive negative
cultures).
29. Vaccinia (duration is until lesions crust and dry).
30. Varicella-zoster (duration is until lesions crust and
dry).
31. Ebola, Marburg, Crimean-Congo, and Lassa fever
viruses: viral hemorrhagic fevers (duration of
illness).
 Droplet precautions should be used for the following
infections and conditions for the duration listed:
1. Adenovirus: pneumonia (duration of
illness).
2. Diphtheria: pharyngeal (duration is until
completion and antibiotics and 2
negative cultures 24 hours apart).
3. Haemophilus influenzae type b:
epiglottitis or meningitis (duration is until
24 hours after initiating effective
therapy).
4. Influenza, pandemic
5. Neisseria meningitidis: meningitis,
sepsis, or pneumonia (duration is until 24
hours after initiating effective therapy).
6. Mumps (duration is 5 days after onset).
7. Mycoplasma pneumonia (duration of
illness).
8. Parvovirus B19 (duration is 7 days in acute
disease, duration of hospitalization in chronic
disease of an immunocompromised host).
9. Pertussis (duration is 5 days).
10. Yersinia pestis: pneumonic plague (duration is
48 hours).
11. Group A Streptococcus: pneumonia, pharyngitis,
scarlet fever, serious invasive disease (duration
is until 24 hours after initiating effective therapy).
12. Rhinovirus (duration of illness).
13. Rubella (duration is until 7 days after rash
onset).
14. Severe acute respiratory syndrome (duration of
illness plus 10 days after any fever and
respiratory symptoms have resolved or
improved).
15. Ebola, Marburg, Crimean-Congo, and Lassa
fever viruses: viral hemorrhagic fevers (duration
Airborne precautions should be used for the following infections and conditions for
the minimum duration listed:

1. Aspergillosis if there is “massive soft tissue infection with copious drainage and
repeated irrigations required.”
2. Herpes zoster that is disseminated or in immunocompromised patients (duration of
illness).
3. Measles (duration of 4 days after onset of rash in an immunocompetent host; duration
of illness in immunocompromised).
4. Monkeypox (duration is until the diagnosis is confirmed and smallpox has been
excluded).
5. Severe acute respiratory syndrome (duration of illness plus 10 days after a fever and
respiratory symptoms have resolved or improved).
6. Smallpox (duration of illness).
7. Tuberculosis: pulmonary or laryngeal (duration until improving clinically on effective
therapy with three negative sputum smears on consecutive days).
8. Tuberculosis: extrapulmonary, draining lesions (duration until clinically improving and
drainage has stopped or consecutively three negative cultures).
9. Varicella Zoster (duration until the lesions crust and dry).
Meta analysis data:
1. Decreased albumin
2. High C reactive protein
3. High lactate dehydrogenase (LDH)
4. Lymphopenia
5. High erythrocyte sedimentation rate (ESR)
6. D dimer elevation (J Pathol 2020;251:228)

• Ground glass opacities, crazy paving pattern

and consolidation in bilateral lobes are
common findings (Radiology 2020;295:715)
• 15% of CT and 40% of chest radiograph
findings are normal early in the disease
(JAMA 2020;324:782)
• Evolution of abnormalities occurs in the first
2 weeks after onset