coronavirus - #covid19
Dr. David Lyness & Dr. Jonny Wilkinson
zoonotic, beta, novel, human coronavirus
can pass from animals to humans subtype of the virus new as of December 2019 is seen and can cause disease in humans, including respiratory symptoms
The virus is called sars-Cov-2 and the illness is covid19
It is a mutating virus, which may complicate matters in time
respiratory symptoms pneumonia ards
cough, fever, dyspnoea and sputum production are most common
also myalgia, headache, sore throat, rhinorrhoea, nausea & diarrhoea
patchy ground glass opacities
predominantly peripheral and basal
more = worse
can coalesce into denser consolidations
pleural effusion is rare <5%
masses, cavitations and lymphadenopathy = not commonly seen
sicker patients may be more likely to present with fever
generally unrevealing initial physical examination
can be hypoxaemic without signs of respiratory distress
incubation is a median time of ~4 days (IQR 2-7 days)
range of incubation time is up to 14 days
typical evolution
~6 days post exposure = dyspnoea
~ 8 days post exposure = admission
~10 days post exposure = icu admission/intubation
this, obviously, does not happen in every case!
large droplet transmission - limited risk at 6 feet away from patient
this is typical for viruses such as influenza too (flu)
this sort of transmission can be prevented via standard surgical facemask
airborne transmission - unsure if it can travel this way
if this route is the vector, one would need ffp3 masks &
advanced ppe if carrying out aerosol generating procedures
follow your own hospital's guidelines for the use of ppe if dealing with patients who have covid19
the virus persists on 'fomites' or vectors in the environment. all efforts to control the viral spread must focus on stopping the spread of the large droplets which are coughed out, settling on surfaces, being touched and then transmitted to the face.
surfaces will need to be frequently cleaned (ethanol or hypochlorite), hands washed appropriately + alcohol hand gel and avoid touching your face
transmission
treatment modalities
antibiotics - not unless severe disease with potential of bacterial addition - yes in late infection
antivirals - consider in deterioration - currently scant evidence base
steroids - unlikely a role - but some debate - may prolong viral shedding too
hfno, niv, nebs and mv - beware of aerosol generation & spread of infection
labs
- wbc tends to be normal
- lymphopenia is common in ~80%
- mild thrombocytopenia (<100 is uncommon)
- elevated d-dimer can occur
- does not appear to increase procalcitonin
- elevated procalcitonin may indicate bacterial involvement
- elevated liver enzymes in ~30%
- PTT decreased in about 30%
- lab findings tend to be generally nonspecific
the turning point - deterioration or recovery most commonly occurs at days 6-7 of illness
propofology.com
critical care & anaesthesia
and
those who are asymptomatic with no ct changes, don't transmit
risk factors that increase severity
- elderly, male patients
- >65 years of age
- hypertensive
- smoker/ex-smoker
- bacterial co-infection
- co-morbidities
@gas_craic
@wilkinsonjonny
www.cdc.gov
www.gov.uk
www.who.int
www.emcrit.org/ibcc/covid19/
www.esicm.org/resources/coronavirus-public-health-emergency/