“COVID-19 is a new betacoronavirus. It is a variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Risk Factors
  • Older age
  • Race/ethnicity
  • Gender
  • Some medical conditions
    • Cancer
    • CKD
    • COPD
    • Obesity
    • Immunocompromised patients
    • Serious heart conditions like heart failure or coronary artery disease
  • Use of certain medications
  • Poverty and crowding
  • Certain occupations
  • Pregnancy
Aetiology
  • SARS-CoV-2 belongs to the Sarbecovirus subgenus of the Coronaviridae family and is the seventh coronavirus known to infect humans. The virus has been found to be similar to SARS-like coronaviruses from bats, but it is distinct from SARS-CoV and MERS-CoV.
  • COVID-19 has a predilection for the upper and lower respiratory tract alveolar cells and is spread human-human by droplets from sneezing and coughing.
Pathophysiology
  • Not fully understood.
  • SARS-CoV-2 binds to the angiotensin-converting enzyme-2 (ACE2) receptor in humans > downregulation of ACE2 > toxic overaccumulation of plasma angiotensin-II > may induce acute respiratory distress syndrome and fulminant myocarditis
  • ACE2 is expressed in the lungs, heart, oesophagus, kidneys, bladder and ileum, which may explain the extrapulmonary manifestations associated with infection.
Clinical Presentation
  • The illness is variable in severity from asymptomatic, to mild upper respiratory tract infection in some people to severe pneumonia in others.
  • Commonest symptoms:
    • Fever
    • Cough
    • Shortness of breath.
  • Other symptoms:
    • Headache, muscle pain, confusion, chest pain, vomiting and diarrhoea, loss of sense of smell, skin rashes (especially in younger people).
Investigations
  • Bloods:
    • Rapid serological testing for antibodies
    • Respiratory viral panel to look for other causes
  • Imaging:
    • Chest X-Ray
    • Chest CT
  • Special:
    • RT-PCR Test
Management
  • Mild or asymptomatic:
    • 7 day isolation at home, rest and fluids, and hygiene advice (wear face masks, wash hands regularly, catch sneezes in tissues etc.)
  • Severe symptoms:
    • Supportive care via fluids, oxygen, ventilatory support in the prone position; dexamethasone; convalescent plasma therapy, medications are in clinical trials, 7-day isolation
  • There is no clinical benefit with Remdesivir, Lopinavir, Ritonavir, Chloroquine and Hydroxychloroquine
  • No specific curative treatment for coronavirus infection at present. Treat patients according to their individual pathophysiology.
Complications
  • Acute Respiratory Distress Syndrome
  • Septic shock
  • Pulmonary fibrosis
  • Acute kidney/ liver/ cardiac injury
  • Pneumonia
  • Disseminated intravascular coagulation
  • Blood clots
  • Rhabdomyolysis

Leave a Reply

Search Our Notes

Get Updates

Get updates direct to your inbox as we post more notes!

Our Latest Notes