THREAD
Some doctors have had info passed onto us about COVID-19 but some healthcare staff still seem in the dark
Key things we know about COVID-19 from studies & literature so far- explained terms & kept language simple as possible,so it can also be useful to the general public
Some doctors have had info passed onto us about COVID-19 but some healthcare staff still seem in the dark
Key things we know about COVID-19 from studies & literature so far- explained terms & kept language simple as possible,so it can also be useful to the general public
Stages of illness (Young et al. 2020)
1.Replicative stage– viral replication occurs over several days. An innate immune response (immediate non-specific response from body) occurs, but this fails to contain the virus. Can get mild symptoms. But some people show no symptoms.
1.Replicative stage– viral replication occurs over several days. An innate immune response (immediate non-specific response from body) occurs, but this fails to contain the virus. Can get mild symptoms. But some people show no symptoms.
2.Adaptive immunity stage
- adaptive immune response (specific response to virus) eventually kicks in. This leads to virus levels falling.
However, it may also increase levels of inflammatory markers called cytokines which cause tissue damage causing more severe symptoms
- adaptive immune response (specific response to virus) eventually kicks in. This leads to virus levels falling.
However, it may also increase levels of inflammatory markers called cytokines which cause tissue damage causing more severe symptoms
This staged progression may explain the phenomenon where patients are relatively OK for several days, but then their symptoms suddenly deteriorate when they enter the adaptive immunity stage
Therefore, initial symptoms aren't predictive for how you may deteriorate later on.
Therefore, initial symptoms aren't predictive for how you may deteriorate later on.
Signs & Symptoms when presenting
•May appear after 2-14 days
•Fever- 88%
- ABSENCE OF FEVER DOESN'T EXCLUDE COVID-19
•Cough- 68%
•Fatigue- 38%
•Breathlessness- 19%
•Muscle/joint pain- 15%
•Sore throat- 14%
•9% can present with diarrhoea/nausea, which occur before fever
•May appear after 2-14 days
•Fever- 88%
- ABSENCE OF FEVER DOESN'T EXCLUDE COVID-19
•Cough- 68%
•Fatigue- 38%
•Breathlessness- 19%
•Muscle/joint pain- 15%
•Sore throat- 14%
•9% can present with diarrhoea/nausea, which occur before fever
•Emergency warning signs for COVID-19 - NEED MEDICAL ATTENTION immediately & potentially hospital admission
- Difficulty breathing
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
- Difficulty breathing
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
Hospital tests
•Nasal & oral swabbing (PCR)
-seems to have sensitivity of around 75% - 25% false negative results (Ai et al. 2019, Kanne et al.2020)
-Therefore,if swab is negative but symptoms remain then ongoing isolation and re-swabbing several days later should be considered
•Nasal & oral swabbing (PCR)
-seems to have sensitivity of around 75% - 25% false negative results (Ai et al. 2019, Kanne et al.2020)
-Therefore,if swab is negative but symptoms remain then ongoing isolation and re-swabbing several days later should be considered
•Blood tests
- Raised C-reactive protein (CRP)
- White blood cell count - normal
- But low lymphocytes in approx 80% of patients (Guan et al. 2020 and Yang et al. 2020)
- Mildly low platelets common but very low platelets is a poor sign for future prognosis
- Raised C-reactive protein (CRP)
- White blood cell count - normal
- But low lymphocytes in approx 80% of patients (Guan et al. 2020 and Yang et al. 2020)
- Mildly low platelets common but very low platelets is a poor sign for future prognosis
- Raised troponin (Ruan et al. report approximately 7% die of fulminant myocarditis) - appears a strong indicator for mortality
- Raised D-dimer
- Raised D-dimer
•Imaging
-can be used to differentiate COVID-19 from usual lung infections (swabs take 24-48 hrs to return)
-patients will often get a Chest X-ray on admission to hospital - however changes may not always be seen (Guan et al. 2020 showed sensitivity of 59% - 41% false negatives)
-can be used to differentiate COVID-19 from usual lung infections (swabs take 24-48 hrs to return)
-patients will often get a Chest X-ray on admission to hospital - however changes may not always be seen (Guan et al. 2020 showed sensitivity of 59% - 41% false negatives)
-CT scan
-show 'ground glass opacities' in lungs
-greater the severity of the disease,the more
lung segments involved
-better sensitivity than Chest-X-ray (86% in Guan
et al.2020)
-may also show these signs before people get
symptoms (Shi et al.2020)
-show 'ground glass opacities' in lungs
-greater the severity of the disease,the more
lung segments involved
-better sensitivity than Chest-X-ray (86% in Guan
et al.2020)
-may also show these signs before people get
symptoms (Shi et al.2020)
•Anti-viral therapy
- No anti-viral therapy has been proven to work for COVID-19 in humans.
- Multiple (randomised controlled) trials are currently ongoing
-doctors encouraged to review available evidence and reach their own conclusions regarding whether to use anti-virals
- No anti-viral therapy has been proven to work for COVID-19 in humans.
- Multiple (randomised controlled) trials are currently ongoing
-doctors encouraged to review available evidence and reach their own conclusions regarding whether to use anti-virals
- most used so far are lopinavir with ritonavir and chloroquine
- Data from the SARS epidemic suggests that earlier treatment (e.g. within 1-2 days of admission) may be more effective than reserving therapy until later (Chan 2003)
- Data from the SARS epidemic suggests that earlier treatment (e.g. within 1-2 days of admission) may be more effective than reserving therapy until later (Chan 2003)
•Risk factors for severe disease (Chinese CDC):
- Older age
- Male sex
- Medical co-morbidities:
- COPD
- Cardiovascular disease (including hypertension
and coronary artery disease)
- Cerebrovascular disease - stroke, TIA
- Diabetes
- Older age
- Male sex
- Medical co-morbidities:
- COPD
- Cardiovascular disease (including hypertension
and coronary artery disease)
- Cerebrovascular disease - stroke, TIA
- Diabetes
•Main cause of death from COVID-19 is nearly always ARDS
- ARDS is fluid accumulation in the lungs caused by inflammation from the virus,which impairs the lungs' ability to exchange oxygen and carbon dioxide.
-Therefore have to be careful with giving patients intravenous fluids
- ARDS is fluid accumulation in the lungs caused by inflammation from the virus,which impairs the lungs' ability to exchange oxygen and carbon dioxide.
-Therefore have to be careful with giving patients intravenous fluids
• Data from the China outbreak up until February 11 2020 shows > 80% of patients were NOT hospitalised - mild
• Among hospitalised patients (severe & critical)
- 14% severe
- 5% intensive care admission - critical
- 2% die
• Among hospitalised patients (severe & critical)
- 14% severe
- 5% intensive care admission - critical
- 2% die
• Death rates by age group from China outbreak up to February 11 2020:
• Death rates by pre-existing health condition from China outbreak up to February 11 2020:
• Death rates vs US seasonal flu
References
Young et al. 2020
jamanetwork.com/journals/jama/…
Ai et al. 2020
pubs.rsna.org/doi/pdf/10.114…
Kanne et al. 2020
pubs.rsna.org/doi/10.1148/ra…
Yang et al. 2020
thelancet.com/action/showPdf…
Ruan et al. 2020
link.springer.com/article/10.100…
Chan et al. 2003 hkmj.org/abstracts/v9n6…
Young et al. 2020
jamanetwork.com/journals/jama/…
Ai et al. 2020
pubs.rsna.org/doi/pdf/10.114…
Kanne et al. 2020
pubs.rsna.org/doi/10.1148/ra…
Yang et al. 2020
thelancet.com/action/showPdf…
Ruan et al. 2020
link.springer.com/article/10.100…
Chan et al. 2003 hkmj.org/abstracts/v9n6…
Guan et al. 2020
nejm.org/doi/pdf/10.105…
Shi et al.2020
thelancet.com/action/showPdf…
Chinese CDC
weekly.chinacdc.cn/en/article/id/…
nejm.org/doi/pdf/10.105…
Shi et al.2020
thelancet.com/action/showPdf…
Chinese CDC
weekly.chinacdc.cn/en/article/id/…
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