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Coronavirus Disease 2019 (COVID-19)

coronavirus Covid-19

Overview

  • Pneumonia caused by new coronavirus infection
  • Initial fever, fatigue, dry cough, dyspnoea, etc.
  • Have the ability to spread from person to person, wear a mask correctly to enhance protection
  • Most have a good prognosis, a few are critically ill and can even cause death
  • Covid-19 alert




Definition of disease

The new coronavirus pneumonia is an acute infectious pneumonia whose pathogen is a new coronavirus that has not been previously found in humans, namely the 2019 new coronavirus. On February 7, 2020, the National Health and Health Commission decided to temporarily name “new coronavirus-infected pneumonia” as “new coronavirus pneumonia”, referred to as “new coronary pneumonia”. On February 11, the World Health Organization (WHO) named its English name Corona Virus Disease 2019 (COVID-19). On February 22, the National Health and Health Commission decided to revise the English name of “new coronavirus pneumonia” to “COVID-19”, which is consistent with the World Health Organization naming and the Chinese name remains unchanged. On January 30, 2020, WHO announced that the new coronavirus pneumonia epidemic would be listed as a public health emergency (PHEIC) of international concern. The initial symptoms of the patient were mostly fever, fatigue, and dry cough, and serious symptoms such as dyspnea gradually appeared. Most patients have a good prognosis, and some severe cases may present with acute respiratory distress syndrome or septic shock or even death. At present there is a lack of effective antiviral drugs against pathogens, and isolation therapy and symptomatic support therapy are the mainstay.

Epidemiology

Based on the current epidemiological survey, the incubation period is 1-14 days, mostly 3-7 days. The incubation period is infectious, and asymptomatic infections may also become a source of infection, and people are generally susceptible.

Transmission through the respiratory tract droplets and close contact is the main transmission route. Because new coronavirus can be isolated in feces and urine, it should be noted that feces and urine cause aerosol or contact transmission of environmental pollution. Prolonged exposure to high-concentration aerosols in a relatively closed environment may spread through aerosols. There may be aerosol transmission risks in closed and non-ventilated places, and prevention and isolation need to be strengthened.




  1. In December 2019, Wuhan City, Hubei Province discovered many cases of “unexplained pneumonia”
  2. and the subsequent patients mostly had a history of exposure to the South China Seafood Market or
  3. family gatherings
  4. At 21 o’clock on January 7, 2020, the researchers detected a new coronavirus in patient specimens;
  5. At 24 o’clock on January 10, complete the detection of pathogenic nucleic acid;
  6. On January 12, the World Health Organization (WHO) temporarily named the new coronavirus that
  7. caused the Wuhan pneumonia epidemic as 2019 new coronavirus (2019-nCoV);
  8. On January 30, the WHO announced that the new coronavirus epidemic would be listed as a public
  9. health emergency of international concern.
  10. On February 7, the National Health and Health Commission decided to temporarily name “new
  11. coronavirus-infected pneumonia” as “new coronavirus pneumonia”, or “new crown pneumonia” for short.
  12. The English name is “Novel Coronavirus Pneumonia”, referred to as “NCP;
  13. On February 11, the WHO named the disease caused by the new coronavirus as 2019 coronavirus
  14. disease, the English name is “Corona Virus Disease 2019”, referred to as “COVID-19“;
  15. As of 24:00 on April 30, according to reports from 31 provinces (autonomous regions and municipalities
  16. and the Xinjiang Production and Construction Corps, there were 7,873,198 confirmed cases (including 38 severe cases), coronavirus world data total of , and a total of 432,477 deaths A total of 4,043,393 recovered cases were reported, and there are 9 suspected cases. A total of 732,966 close contacts were traced, and 7,761 close contacts were still under medical observation. A total of 1511 confirmed cases were reported from Hong Kong, Macao and Taiwan. Among them, there were 1037 cases in the Hong Kong Special Administrative Region (846 cases discharged and 4 deaths), 45 cases in the Macau Special Administrative Region (35 cases discharged), and 429 cases in Taiwan (322 cases discharged and 6 deaths).
  17. As of 24:00 on April 30, 31 provinces (autonomous regions, municipalities directly under the Central Government) and Xinjiang Production and Construction Corps reported the addition of 25 cases of asymptomatic infections (no overseas imports); 6 cases were confirmed as confirmed cases (1 overseas import); On the same day, 36 cases of medical observation were released (11 cases were imported from abroad); 981 cases of asymptomatic infection were still under medical observation (115 cases were imported from abroad).




The most frequently asked questions by patients

1: What should I do to protect myself?

Because there is currently no effective treatment for the disease, prevention and isolation are the most effective ways to minimize the chance of contact with infected or potentially infected patients. First of all avoid going to crowded places and wear masks in public places. Second, pay attention to hand hygiene and food hygiene, wash hands frequently, drink plenty of water, avoid fatigue, ensure sleep, and maintain more ventilation in the home and work environment. If you have fever or cough symptoms, pay attention to cough etiquette, seek medical attention in time, and wear a mask on the way to the hospital.

2. Types of Coronavirus

Common human coronaviruses

229E (alpha coronavirus)
NL63 (alpha coronavirus)
OC43 (beta coronavirus)
HKU1 (beta coronavirus)
Other human coronaviruses
MERS-CoV
SARS-CoV
SARS-CoV-2

3: Will medical staff be threatened by the new coronavirus?

Yes. Medical personnel need to be in close contact with patients and are more vulnerable to the threat of new coronavirus infection. Therefore, the World Health Organization (WHO) recommends that medical staff strengthen their own infection prevention and control measures. Strictly implement standard precautionary principles, do personal protection and hand hygiene, and avoid hospital infections as much as possible.

4: Is there a treatment for the new coronavirus?

For diseases caused by new coronavirus infections, there is currently no specific treatment, and clinical treatment is mainly symptomatic and supportive.

5: Is there a vaccine against the new coronavirus?

No, new diseases may take a long time to develop vaccines.

6: Can the new coronavirus spread from person to person?

Yes, the new coronavirus can be transmitted from person to person, and the transmission usually occurs in homes, workplaces, crowded areas or hospitals mention on coronavirus map.




7: What are the symptoms of people infected with the new coronavirus?

The severity of symptoms after human infection with the new coronavirus depends on the type of virus and the body’s immune level. Common symptoms include fever, cough, shortness of breath, or difficulty in breathing. In more severe cases, it can cause acute respiratory distress syndrome and septic shock Can Coronavirus numbers cause the patient to die.

Etiology

  • New coronavirus pneumonia is an acute infectious disease.
  • Mainly caused by 2019 new coronavirus (2019-nCoV) infection.

Basic cause

Coronaviruses are single-stranded positive-strand RNA viruses. There are 6 types of coronaviruses known to infect humans, namely HCoV-229E, HCoV-OC43, SARSr-CoV, HCoV-NL63, HCoV-HKU1 and MERSr-CoV.

The coronavirus isolated from the lower respiratory tract of unexplained pneumonia patients in Wuhan this time is a new coronavirus belonging to the genus B, namely 2019 new coronavirus (2019-nCoV), which belongs to the seventh species. Current research shows that the homology with bat SARS-like coronavirus (bat-SL-CoVZC45) is more than 85%.

Predisposing factor

The elderly and those with basic diseases are more ill after infection.

symptom

According to the National Health and Health Commission’s “New Coronavirus infected Pneumonia Diagnosis and Treatment Program (Trial Version 7)”, severe and critically ill patients can have moderate to low fever during the course of disease, or even no obvious fever. Mild patients only showed low fever, slight fatigue, and no pneumonia.

Typical symptoms




  • Mainly manifests as fever, fatigue, and dry cough;
  • A few patients have symptoms such as nasal congestion, runny nose, sore throat and diarrhea,
  • Severe patients often develop dyspnea and/or hypoxemia one week after the onset. In severe cases, they rapidly progress to acute respiratory distress syndrome, septic shock, metabolic acidosis that is difficult to correct, coagulopathy, and multiple organ failure.

See a doctor

The Covid-19 alert disease is an acute infection, which usually gets worse in the first week. If you have any of the following conditions, please consult a doctor in time:

  • Unexplained fever, fatigue, cough, etc. recently,
  • Have a history of living or traveling in Wuhan within two weeks before the onset;
  • A history of close contact with the diagnosed patient two weeks before the onset;
  • It was clustered (2 persons and above).

During the visit, the doctor may ask the following questions to get a preliminary understanding of the medical history. The patient can prepare corresponding answers in advance:




  • When do symptoms such as fever and cough occur?
  • Where have you been before, and who have you contacted?
  • Does anyone around you have similar symptoms?
  • Are you having trouble breathing? .
  • What are the underlying diseases?

Diagnostic criteria

According to the “New Coronavirus infected Pneumonia Diagnosis and Treatment Program (Trial Version 7)” issued by the National Health and Health Commission:

Suspected case

Combined with the following comprehensive analysis of epidemiological history and clinical manifestations: there is any one of the epidemiological history, and it meets any two of the clinical manifestations. If there is no definite epidemiological history, it conforms to the 3 items in the clinical manifestations.

Epidemiology history
  • Within 14 days before the onset of illness, there is a history of travel or residence in Wuhan and
  • surrounding areas, or other communities with reported cases,
  • Have contacted patients with fever or respiratory symptoms from Wuhan and surrounding areas, or from
  • communities with reported cases within 14 days before the onset of illness;
  • Within 14 days before the onset of the disease, have a history of contact with a new coronavirus
  • infection (positive nucleic acid test)
  • Aggregated disease.
Clinical manifestations
  • Fever and/or respiratory symptoms;
  • Have the above-mentioned imaging features of pneumonia;
  • In the early stage of onset, the total number of white blood cells is normal or decreased, or the
  • lymphocyte count is reduced.
Confirmed cases
  • Suspected cases, with one of the following etiological evidence:
  • Real-time fluorescence RT-PCR detected positive for the new Noval Coronavirus nucleic acid.
  • Sequencing of viral genes is highly homologous to known new coronaviruses.
Clinical typing

Light

The clinical symptoms were mild, and there were no pneumonia manifestations on imaging.

normal type

Symptoms such as fever and respiratory tract, pneumonia can be seen on imaging.

Heavy

Adults meet any of the following:

Respiratory distress, respiratory rate 2 30 times/min;




  • At rest, it means that the oxygen saturation is s 93%;
  • Arterial blood oxygen partial pressure (PaO2) oxygen uptake concentration (FiO2) s 300 mmHg (1
  • mmHg = 0.133kPa). At high altitudes (altitude above 1000 meters), PaO2/Fi02 should be corrected according to the following formula: PaO2/FiO2 [Atmospheric pressure (mmHg)/760)

In addition, lung imaging showed that the lesions significantly progressed >50% within 24 to 48 hours, according to the heavy management.

Children meet any of the following:

  • Shortness of breath (< 2 months old, RR 2 60 times/min; 2 to 12 months old, RR 250 times/min; 1 to 5 years old, RR 240 times/minute> 5 years old, RR 30 times/minute Points), except for the effects of fever and crying;
  • Oxygen saturation s92% at rest;
  • Assisted breathing (moaning, nostril flapping, trident sign), cyanosis, intermittent apnea; lethargy, convulsions;
  • Refusing to eat or feeding is difficult, with signs of dehydration
Critical

One of the following conditions:

  • Respiratory failure occurs and requires mechanical ventilation;
  • Appear shock;
  • Combining other organ failure requires ICU monitoring treatment
Heavy and critical clinical warning indicators

Adult early warning and critical warning indicators:

  • Peripheral blood lymphocytes decrease progressively,
  • Peripheral blood inflammatory factors such as IL-6 and C-reactive protein progressively increase;
  • Progressively increased lactic acid;
  • Lesions in the lung progress rapidly in the short term.

Clinical early warning indicators of children’s heavy and severe

Increased breathing rate;

  • Poor mental response and lethargy:
  • Progressively increased lactic acid;
  • Imaging shows that bilateral or multiple lung lobe infiltration, pleural effusion, or rapid progression of the lesion in a short time;
  • Babies under 3 months of age may have basic diseases (congenital heart disease, bronchopulmonary
  • dysplasia, respiratory malformations, abnormal hemoglobin, severe malnutrition, etc.), immunodeficiency or low (long-term use of immunosuppressive agents).

Coronavirus Treatment department

Fever clinic, infection department, intensive care unit.

Related inspection

Doctor’s physical examination

Mainly check the lungs, auscultate breath sounds, etc.

Laboratory examination
  • In the early stage of onset, the total number of peripheral blood leukocytes was normal or decreased,
  • and the lymphocyte count decreased;
  • Liver enzymes, lactate dehydrogenase (LDH), muscle enzymes and creatine kinase increased in some patients
  • Some critically ill people can see increased troponin; . Most patients have elevated C-reactive protein (CRP) and erythrocyte sedimentation rate, and normal procalcitonin;
  • In severe cases, D-dimer increased and peripheral blood lymphocytes decreased progressively.

Film degree exam

In the early stage, there were multiple small patch shadows and interstitial changes, with obvious extrapulmonary zone. Then it develops multiple ground glass shadows and infiltration shadows of the lungs. In severe cases, lung consolidation may occur, and pleural effusions are rare.

Special inspection

Pathogen detection, collecting pharyngeal swabs, sputum, or lower respiratory tract secretions, and performing real-time fluorescent RT-PCR, the result is that the new coronavirus nucleic acid test is positive Or pathogen gene sequencing suggests a high degree of homology with the new coronavirus. In order to increase the positive rate of nucleic acid detection, it is recommended to retain sputum as much as possible, and to collect lower respiratory tract secretions from patients with endotracheal intubation.

Differential diagnosis




  • The doctor will conduct detailed examinations to judge from various aspects:
  • The mild expression of new coronavirus infection must be distinguished from upper respiratory tract infections caused by other viruses;
  • New coronavirus pneumonia is mainly distinguished from influenza virus, adenovirus, respiratory syncytial virus and other known viral pneumonia and mycoplasma pneumoniae infections, especially for suspected cases, including rapid antigen detection and multiple PCR nucleic acid detection, etc. Detection of common respiratory pathogens,
  • It must also be distinguished from non-infectious diseases such as vasculitis, dermatomyositis, and organizing pneumonia.

Treatment

At present, there is a lack of effective antiviral drugs against pathogens, and isolation therapy and symptomatic support therapy are the mainstay.

According to the “New Coronavirus infected Pneumonia Diagnosis and Treatment Program (Trial Version 7)” issued by the National Health and Health Commission: For severe and critical cases, on the basis of symptomatic treatment, actively prevent complications, treat underlying diseases, and prevent secondary diseases Infection, timely organ function support. Take the following treatments:

  • Respiratory support: including oxygen therapy, high-flow nasal catheter oxygen therapy or non-invasive mechanical ventilation, invasive mechanical ventilation, and rescue treatment. Rescue treatment is recommended for patients with severe ARDS and lung recruitment is recommended. In the case of sufficient human resources, prone ventilation should be performed more than 12 hours a day. Those with poor ventilation in the prone position should consider extracorporeal membrane oxygenation (ECMO) as soon as possible.
  • Circulation support: on the basis of adequate fluid resuscitation, improve microcirculation, use vasoactive drugs, and perform hemodynamic monitoring if necessary. Carry out noninvasive or invasive hemodynamic monitoring, and pay attention to fluid balance strategies during the treatment process to avoid excess and deficiency.
  • Renal failure and renal replacement therapy: In addition to finding the cause of renal function damage, continuous renal replacement therapy (CRRT) can be selected for critically ill patients with renal failure.
  • Plasma therapy for rehabilitated persons: It is recommended for patients with rapid disease progression, severe and critically ill patients. For usage and dosage, please refer to “Clinical Treatment Plan of Plasma in the Recovery Stage of New Coronary Pneumonia (Trial Version 1)”.
  • Blood purification treatment: The blood purification system includes plasma replacement, adsorption, perfusion, blood/plasma filtration, etc., which can remove inflammatory factors, thereby reducing the damage of the inflammatory response to the body. It can be used in the early and middle stages of cytokine storms in severe and critical patients Cure .
  • Other treatments: In children with severe and critical cases, consider using intravenous infusion of gamma globulin as appropriate. Pregnant women with severe or critically ill patients should actively terminate pregnancy, and caesarean section is the first choice. Patients often have anxiety and fear, and psychological counseling should be strengthened.

Acute treatment

Patients with hypoxia and dyspnea should be given oxygen therapy (such as nasal catheter oxygen inhalation, mask oxygen inhalation) in time, and if necessary, non-invasive or invasive ventilator support.

General treatment

  • Rest in bed, strengthen supportive treatment, and ensure adequate heat, pay attention to water and electrolyte balance, maintain internal environment stability, closely monitor vital signs, oxygen saturation, etc.
  • Monitor blood routine, urine routine, C-reactive protein (CRP), biochemical indicators (liver enzymes, myocardial enzymes, renal function, etc.) and blood coagulation function according to the condition.Perform arterial blood gas analysis if necessary and recheck chest imaging.
  • According to the change of oxygen saturation, effective oxygen therapy measures should be given in time, including nasal catheter, mask oxygen, high-flow oxygen therapy through the nose, non-invasive or invasive mechanical ventilation if necessary.
  • Conditions can be treated with hydrogen-oxygen mixed inhalation gas (H2 /0 2: 66.6%/33.3%).

medical treatement




  • Antiviral therapy: may try alpha-interferon aerosol inhalation, lopinavir/ritonavir, ribavirin, chloroquin phosphate and abidol, ribavirin is recommended to interferon or lopinavir /Litonavir joint application. Attention should be paid to the adverse reactions, contraindications and interactions with other drugs.
  • The treatment course of the trial drugs does not exceed 10 days. It is recommended to further evaluate the efficacy of the drugs currently being tried in clinical applications. It is not recommended to use 3 or more antiviral drugs at the same time, and the use of related drugs should be stopped when there are intolerable toxic and side effects.
  • Antimicrobial therapy: Avoid blind or inappropriate use of antimicrobial drugs, especially in combination with broad-spectrum antimicrobial drugs.
  • Others: Glucocorticoids are used for a short period of time (3 to 5 days) as appropriate under the guidance of a doctor based on the degree of dyspnea and chest imaging progress.
  • For the treatment of pregnant women, the number of weeks of pregnancy should be considered, as far as possible the choice of drugs that have a small impact on the fetus, and whether to terminate the pregnancy before treatment, and informed.

Chinese treatment

The TCM treatment of the disease temporarily lacks evidence-based medical evidence. According to the “New Coronavirus infected Pneumonia Diagnosis and Treatment Program (Trial Version 6)” issued by the National Health and Health Commission, all localities can refer to the recommended program for syndrome differentiation and treatment according to the condition, local climatic characteristics and different physical conditions. It is recommended to go to a regular medical institution and treat under the guidance of a physician.

Prognosis

Judging from the current cases, most patients have a good prognosis and a few patients are in critical condition. The elderly and those with chronic underlying diseases have a poor prognosis. The clinical course of pregnant women with new coronavirus pneumonia is similar to that of patients of the same age. Symptoms in children are relatively mild.

Sequelae

According to “2019 New Coronavirus Pneumonia Respiratory Rehabilitation Guidance”:

  • Mild isolation and general discharge patients: Most patients have little or no persistent lung function problems and rarely have physical dysfunction.
  • Severe/critically discharged patients: There may be generalized weakness, shortness of breath resulting in limited physical function, and lung function is manifested as restrictive ventilation disorder, which is consistent with changes in pulmonary fibrosis shown by chest CT examination. This change may persist.

The sequelae of the new coronavirus pneumonia described above still need a large number of cases to summarize and observe.

Rehabilitation

Individual severely ill patients may have pulmonary fibrosis, and recovery takes a long time.

complication

Severe cases may be complicated by acute respiratory distress syndrome, septic shock, metabolic acidosis that is difficult to correct, and coagulopathy

Daily

New coronavirus pneumonia currently lacks effective treatment. Daily life management focuses on preventing infections and effectively isolating suspected and confirmed cases.

Home care

The new coronavirus pneumonia has a family aggregation phenomenon. If there are suspected symptoms, they should go to the infectious department for treatment in time. They need to be isolated and treated in hospitals with effective isolation and protection conditions.

Daily life management

Diet

  • Wild animals (ie game) are not eaten, poultry, meat and eggs should be fully cooked;
  • Pay attention to nutrition, avoid partial eclipse, and ensure that the intake of food is diverse, especially fresh vegetables and fruits,
  • Develop good eating habits, eat meals on time and in order to avoid overeating.

Motion

Actively exercise to control weight. In addition, moderate exercise also helps improve immunity

Lifestyle

  • Quit smoking and limit alcohol;
  • Ensure adequate sleep, pay attention to rest, and avoid staying up late,
  • Concern about mental health, pay attention to ease tension and reduce psychological pressure

Daily condition monitoring

Pay attention to monitoring body temperature, and see a doctor if you have fever, fatigue, cough and other symptoms. If you have a history of residence or travel in the epidemic source (Wuhan City), contact history with a confirmed or suspected patient within two weeks before the onset of illness, or have a collective onset of symptoms, you need to see a doctor in time and take the initiative to isolate it. The precautions after discharge according to the “New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 6)” are as follows:

  • The designated hospital should make good contact with the primary medical institutions where the patients live, share medical records, and promptly push the information of discharged patients to the patient’s jurisdiction or the residential committee and the primary medical and health institutions of the place of residence.
  • After the patient is discharged from the hospital, due to the weakened immune system in the recovery period and the risk of infection with other pathogens, it is recommended that 14-day self-health monitoring should be continued, wear masks, and live in a well-ventilated single room conditionally to reduce the distance to family members Close contact, share meals, do hand hygiene, and avoid going out.
  • It is recommended to follow up and return to the hospital in the second and fourth weeks after discharge

Special considerations

  • The incubation period is 1-14 days, mostly 3-7 days. The incubation period is contagious, and people with asymptomatic infection may also become a source of infection. If there is a diagnosis or suspected patient’s history of exposure, even if there is no symptoms such as fever temporarily, active isolation is also required.
  • To release the isolation, body temperature needs to be restored to normal for more than 3 days.Respiratory symptoms are significantly improved, and the pathogen test is negative for 2 consecutive times (at least 1 day apart).




prevention

When an outbreak of an infectious disease occurs, the measures taken include measures against pathogens, susceptible people, transmission routes, and epidemic areas.

There is no effective vaccine for the new coronavirus pneumonia. Personal protection is the most practical way, including not going to crowds, washing hands, drinking more water, and taking rest.

Specific preventive measures are as follows:

  • Minimize going out, do not go to crowds, avoid close contact with anyone who has cold or flu-like symptoms;
  • When going out to public places, seeing doctors and taking transportation, wear medical surgical masks or N95 masks;
  • Do not touch, buy and eat wild animals (ie game), and avoid contact with wild animals and poultry and livestock without protection;
  • Pay attention to hand hygiene, wash hands frequently, use hand sanitizer or soap, wash your hands under running water, or use alcohol-free hand sanitizer,
  • Do not cover with your hands when sneezing or coughing, cover your mouth and nose with your elbows or tissues;
  • Keep the living room and workplace clean, open windows frequently, and maintain more ventilation;
  • Pay attention to drink plenty of water, rest, avoid staying up late, exercise moderately to improve the individual’s immune ability, pay attention to nutrition, reasonable diet, meat, poultry and eggs must be fully cooked;
  • Prepare common materials, such as thermometers, disposable masks, household disinfection supplies,etc.

Important Note: This article is only for knowledge and awareness because this article is written by blogger after collection information about COVID-19. And So, if you are feeling unwell then immediately consult from a doctor.

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