CORONA-VIRUS

Coronaviruses or (CoV) are the viruses belonging to a large family, causing illness ranging from common cold to more severe diseases.
These diseases include:
• Middle East Respiratory Syndrome or (MERS-CoV) and
• Severe Acute Respiratory Syndrome or (SARS-CoV)
Let’s now learn about Novel Coronavirus. Novel Coronavirus or (nCoV)
• A novel Coronavirus or nCoV has been identified as a new strain that has not been previously identified in humans
• However, an outbreak of unusual respiratory condition was first reported in Wuhan, China, due to the infection caused by novel Coronavirus, now known as COVID-19.
Now that we have learnt about novel Coronavirus, let us discuss about Severe Acute Respiratory Syndrome Coronavirus 2. Severe Acute Respiratory Syndrome Coronavirus 2 or (SARS - CoV-2)
• The International Committee on Taxonomy of Viruses or I.C.T.V. announced “Severe Acute Respiratory Syndrome Coronavirus 2, or SARS - CoV-2” as the name of the new virus.
• It is genetically associated with the Coronavirus that is responsible for the SARS outbreak of 2003.
• However, when related, they found both the viruses to be different. COVID - 19
• Further, on 11th February 2020, the World Health Organization or W.H.O., announced COVID-19 as the name of this disease and the “COVID-19 virus” as the virus responsible for this disease.
• Based upon the transmission rate, the W.H.O has declared the outbreak of the COVID-19 as a global health emergency. Countries Affected by Coronavirus
• A recent survey by the Centre for Disease Control or C.D.C. reports that till now COVID-19 has affected many countries around the world, including one international conveyance.
This was a brief intro about Coronavirus. Let’s recap what we have learnt so far.

Structure
• Coronaviruses are a family of positive single-stranded RNA virus, classified under Nidovirales order.
• These viruses are enveloped and are round and sometimes pleomorphic of approximately 80 to 120 nanometer in diameter.
Let us now discuss about RNA-protein.
• The virion contains an internal helical RNA-protein nucleocapsid surrounded by an envelope made up of lipids and viral glycoproteins. These glycoproteins are spike protein, membrane protein, and small membrane.
Let us discuss in detail about spike protein.
• The spike protein or “S” is a type I glycoprotein that forms the peplomers on the virion surface, giving the virus its corona or crown-like morphology in the electron microscope.
• The coronaviruses attach to the cell surfaces through the spike.
Let us now discuss about membrane and small membrane protein.
• The membrane protein or “M” is highly hydrophobic and spans the membrane three times.
• On the other hand, the small membrane protein or “E” spans the membrane twice, and in some group two Coronaviruses, an additional protein hemagglutinin esterase is present whose function, is unknown.
• However, literature studies have shown its importance in viral entry and pathogenesis.
Let us understand about the genome of Coronavirus.
• All Coronavirus genomes are arranged similarly with replicase locus encoded within 5-dash end and the structural proteins encoded in the 3-dash end of the genome.
• The viral replicase is a huge protein complex comprising of 16 viral sub-units and plays an essential role in the coronavirus replication and transcription at the cytoplasmic membrane.

Modes of Transmission
The main modes of transmission of Coronavirus are,
• Person to Person
• Household transmission
• From contact with infected surfaces or objects
Let us learn about each of these modes one by one in detail. Person to Person Spread
So how does this virus spread from person to person?
• COVID -19 can be transmitted between people who are in close contact with one another or (within about 6 feet).
• The transmission is through the respiratory droplets produced by the infected person when he or she sneezes or coughs.
• Possible inhalation or (into the lungs) of the droplets landing in the oral cavities or noses of people in close proximity.
• Furthermore, as per the statistical records on 20th February 2020, in Shenzhen City, among two thousand eight hundred and fourty two identified close contacts, eighty-eight or (3 percent) were found to be infected with COVID-19. Household Transmission
Let’s now look at household transmission mode.
• Recent reports from the World Health Organization or W.H.O, human-to-human transmission of the COVID-19 virus is mainly occurring in families, especially in China.
• For instance, among 344 clusters, involving 1308 cases out of 1836 cases reported, 78 to 85 percentage of positive cases have occurred in families in Guangdong and Sichuan Provinces, respectively. Contact with Infected Surfaces or Objects
• As per the World Health Organization or W.H.O, a person might be susceptible to COVID-19 if he or she touches a surface or object containing the virus and then touching their own mouth, nose, or face.
• However, this is not the main route of transmission.

According to the Centre for Disease Control or CDC, patients above the age of 50 are more vulnerable for the attack and persons with underlying diseases like Diabetes, Parkinson’s disease and Cardiovascular diseases are at high risk.
As per the World Health Organization or W.H.O statistics, the median age of affected people is 51 years with the majority of cases that is 77.8 percent aged between 30–69 years. Statistical data also reveals that 51.1% of the affected population are males.
Let’s now learn about its clinical features. Clinical Features of COVID-19
Clinical Features of COVID-19 include:
• Decreased white blood cells
• Coughing and sneezing
• Runny nose
• Shortness of breath
• Breathing difficulties
• Sore throat
• Fever
• Fatigue
• Pneumonia
• Severe acute respiratory syndrome
• Lungs inflammation and congestion
• Cardiovascular damage
• Diarrhea
• Decreased Kidney functions and
• Kidney failure

Diagnosis
The prime suspects for COVID-19 include patients with fever and lower respiratory tract symptoms.
The geographical distribution and recent contact with the suspected patients should also be taken into consideration. Finally, if suspected with coronavirus, infection control measures should be implemented, and public health officials should be notified.
Let’s understand the diagnostic criteria for Covid-19.
Diagnostic Criteria
According to CDC, diagnosis should be based on clinical and epidemiological factors.
The clinical criteria for confirming the diagnosis of the severity of Coronavirus is broadly categorized into the following types
• Mild
• Moderate
• Severe
• Critical
In case of mild, the symptoms include fever less than 38 degrees centigrade In case of moderate condition, the patient may be presented with Fever, respiratory symptoms and imaging findings of pneumonia.
If the Patient is affected severely with corona virus then any of the below mentioned findings can be observed
1. Respiratory distress
2. Oxygen saturation less than 93% at rest
3. Partial pressure of oxygen and fraction of inspired oxygen less than or equal to 300 millimeters of mercury.
Patient should have a rapid progression that is greater than 50 % on CT imaging within 24 – 48 hours and should be managed as severe.
In case of critical condition such as Respiratory failure, Shock and Extra pulmonary organ failure Intensive care unit is necessary.
We have learnt the diagnostic criteria of corona virus. Let us now understand the investigation methods.
Early Investigations and Methods Respiratory material from upper and lower respiratory tract must be collected.
The upper respiratory tract specimen includes nasopharyngeal or oropharyngeal swab or wash in ambulatory patients.
The lower respiratory specimens include sputum and or endotracheal aspirate. Other methods of collection include blood and stool.
The specimens are to be collected in sterile containers and must be stored at 2 to 8 degree centigrade.
In case of delay, the specimens are frozen at minus 20 degree centigrade and then shipped.
Laboratory Investigations
The various laboratory investigations include:
• Nucleic acid amplification tests or NAAT tests by Real Time Reverse Transcription Polymerase Chain Reaction or RT-PCR for COVID 19 to check for evidence of viral load indicating active infection.
• Serological testing for detecting antibodies.
• Viral Sequencing.
• Viral culture. Rapid collection of the specimen and testing of specimens from patients meeting the suspect case definition for COVID-19 is a priority for clinical management and outbreak control and should be guided by a laboratory expert.

The key preventive measures are to follow good hygiene practices. Let us learn about them.
Practicing frequent hand-hygiene which involves:
• Washing hands with soap and water or alcohol-based hand-rub and
• Keeping a hand-sanitizer with self.
All offices should have liquid soaps, hand rubs, refilled or replaced.
• Follow the culture of ‘Namaste’ and maintain ‘two arms’ length or (6 feet) optimally but at least an arm’s length or (3 feet) from a person who is sneezing or coughing. Be aware, avoid close contact.
• Follow respiratory hygiene or cough etiquette (cough or sneeze into the inside of elbow or arms, not bare hands. If using disposable tissue paper, discard appropriately, and perform hand-hygiene).
• Offer a surgical mask to a person who is coughing or sneezing.
• Keep the workplace clean and hygienic.
• Avoid eating raw or undercooked meat.
• Visit the doctor if you are unwell.
Now that we have learnt about the preventive measures, let us move on to the various government measures.
Governmental Measures
• Globally, preventive and control measures are being implemented rapidly.
• They were first initiated in Wuhan city and other critical areas of Hubei, and then in the currently affected countries.
The governmental measures for prevention include three stages:
• First stage
• Second stage
• Third stage

First stage is the early stage of the outbreak.
It focuses on:
• Preventing the export of cases from the affected areas
• Control the source of infection, block the route of transmission and prevent the further spread of infection
Second stage:
• It focuses on reducing the intensity of the epidemic
Third stage:
It focuses on:
• Reducing the clusters of cases
• Controlling the epidemic
• Balancing between prevention and control Travel Advise
Finally, let us look at the travel advice given by the Centre of Disease Control or C.D.C
• According to the C.D.C, travelers are advised to refrain from traveling to China, Singapore, the Republic of Korea, Islamic Republic of Iran and Italy.
• Citizens with a history of travel to these countries may be quarantined for 14 days on arrival.
• The W.H.O has developed a guidance document for the International Air Transport Association or IATA to provide advice to cabin crew and airport workers.

As per the World Health Organization or W.H.O, the patients with suspected COVID-19 should be triaged at the first point of contact. The emergency treatment should be initiated based on the disease severity. Patients, household members and caregivers should be educated about personal hygiene, basic Infection Prevention and Control or IPC measures to prevent the widespread of the infection.
Let’s learn about the home management of patients with suspected COVID-19 infection: Home Management of Patients with Suspected COVID-19 Infection
The management of patients suspected with Coronavirus includes the following steps:
• The patient should be placed in a well-ventilated room, and his or her movement should be limited in the house.
• All the household members should reside in a different room or should maintain a distance of at least one meter from the sick person.
• The number of caregivers should be limited. Visitors should not be allowed to meet the patient until he or she recovers completely.
• Hand hygiene should be performed only if hands are visibly dirty. However, soap and water are indicated for visibly dirty hands.
• A medical mask should be provided to the patient to avoid the spread of infection.
• Caregivers should also be provided with the mask. Furthermore, masks should not be touched or handled during use and should be disposed of on a regular basis.
• Direct contact with body fluids must be avoided.
• Masks or gloves should not be reused.
• Use disposable glasses and plates for the patient.
• Daily surfaces should be disinfected. These include bedside tables, bedframes and other furniture. Regular household soap or detergent containing 0.5 percent of bleach solution should be used for cleaning.
• Disinfect the bathroom and toilet surfaces at least once in a day.
• The patient’s clothes, bed linen, and bath and hand towels should be washed at 60–90 degree centigrade and changed on regular basis. According to the Centre for Disease Control or CDC, there is no specific antiviral treatment available for COVID-19. However, people with COVID-19 should be provided with supportive care to help the patients
in relieving their symptoms. People with symptoms of COVID-19 should contact healthcare providers as early as possible.

NOTE-
ABOVE INFORMATION IS FROM WHAT I LEARNT DURING MY COURSE , SO I THOUGHT TO SHARE AND CREATE AN AWARENESS.
HERE IS MY CERTIFICATE-

IF ANYTHING I MISSED OR TO ADD OR MISTAKE , FEEL FREE TO EMAIL ME- nigam.dhar@gmail.com

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Dr. Nigam R.D