Thread by @theABofPharmaC

I was🍀to be a part of this LARGE crowd @UMdPCCM amazing ppt by @UMMC trainees on COVID19

As @dustylinn requested👇🏻 read 📖some pearls from this awesome presenation!

Privileged to be part this great institution that keeps us well informed on the latest medical topics!👏🏻

https://twitter.com/heavnerpharmd/status/1235994018741252096

What IS a coronavirus?

Coronaviruses (CoV) are "promiscuous" originating from various🐄 🦇&transmitted to humans▶️CoV circled in blue have been around for years📆& cause mild illness🤒, HOWEVER COV strains in red (SARS, MER and SARS2) are novel viruses & cause severe disease

1st CoV outbreak ▶️(SARS)2002▶️2012(MERS)
Caused severe 🛑atypical🛑 PNA▶️AGE👵🏻dependent mortality (
Outbreaks were controlled by public health measures ALONE bc viral shedding🧬did not occur until pts were SYMPTOMATIC & already in 🏥 (isolated)
Case fatality rate=(CFR)

Why is COVID-19 is spreading?
1st case in 12/3/2019 in Wuhan (MAJOR transport hub✈🚌) city did not shut down until 1/23/20 (🙎🏻‍♂️exposed still🚗💨)

Pts w/COVID 19 present DIFFERENTLY then previous CoV▶️viral shedding🧬occurs BEFORE symptoms occur▶️ delayed isolation

Ro for CoV is ~1-3 (not much different then flu) this means🧍🏻infected can spread the🧬to 🧍🏻-👨‍👨‍👦

However CoV transmission is⤴️rapidly in US bc of asymptomatic transition and delayed isolation😬

As of 9 am on March 6 2020, 100,330 infections & 3408 deaths =CFR 1.4-3.4%

⚠️ CFR may be skewed
On 💎🚢screening was ⤴️ & found more asymptomatic cases leading to⏬CFR
Currently▶️U.S mainly testing pts @ high risk pts which ⤴️CFR (so may be lower then we🤔)

Important factor is🔎screening pts w/⤴️mortality risk▶️Elderly👴🏻
CFR⤴️to 50%😬

So if the spread is high why hasnt it been declared a pandemic?

If the WHO calls it a pandemic▶️strict isolation will decrease under the assumption “everyone will eventually get it” and the global implications of this are significant (👀below)

If we assume it spreads in the US we can expect 1M hospitalizations if its severe we can see up to 10M hospitalizations BUT only 46,500 ICU beds▶️emphasizes why we must be VIGILANT about prevention!

How is COVID identified?
⚠️ 90% of pts will eventually have fever🤒during their course but do NOT always present with fever so being afebrile does NOT rule out disease⚠️
Imaging🩺▶️ bilateral consolidations▶️tend to be peripheral & posterior but CAN differ based on case

Testing🧪 varies based on center currently but important NOT to do rapid flu test🛑Rule out other viruses and do a full viral panel!

Also, unique to COVID19 is the presence of lymphopenia or NORMAL WBC! 🦠

(FAV part of presentation) Pathogenesis
Binds w/⏫affinity to angiotensin conversion enzyme 2 (ACE2) causing⏬surfactant causing inflammation & cytokine storm⏬ACE2▶️ ACE2 plays a KEY role as a protective factor and down regulation w/COVID▶️ARDS🤯

(Role of ACE/ARB/AT2?!🤔)

Since no one is immune, how do we protect pts
✅Convalesant sera (serum of pts who had infection&resolved, give their sera to others to provide protective antibodies, HOW COOL!)
🛑COVID19 does not have same protease as HIV▶️⛔️Lip/Rit ⛔️
🛑Dont use steroids!🛑
Do use 👀 👇🏻

Remdesivir▶️🎯s RNA dependent RNA polymerase▶️produced by Gilead IV only💉 not a perfect medication because it does cause severe hepatoxicity (can get compassionate use but consider risks vs benefits)

If treatment isn’t great what CAN we do?
PREVENTION!
Wash🧽🧼Hands 🤚🏻
Wear PPE!
Identify, isolate, report, and provide symptomatic care to patientts
🛑AVOID the ROIDs🛑
Dont💋🐷? (ever🤣)

Thanks for the amazing presentation! Hope you all learned as much as I did!

https://twitter.com/cnnnewsroom/status/1236295525386813440?s=21

This clip explains the inflation of the CFR nicely, great job @Jeremyfaust 👏🏻

https://twitter.com/CNNnewsroom/status/1236295525386813440