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Coronavirus Infectious Disease 2019 (COVID-19)

by Sean Elliott, MD

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    00:01 SARS Coronavirus-2.

    00:04 SARS Coronavirus-2, beginning in 2019, a physician and then several physicians in Wuhan, China began to notice the emergence of a fairly severe respiratory illness beginning with mild upper respiratory tract infection signs, but rapidly progressing to severe underlying or lower respiratory tract disease.

    00:24 This illness was also characterized by high infectivity and incredibly high case load.

    00:29 Because of that high infectivity and the impact on healthcare systems and certainly on patients with severe lower respiratory disease, that virus or that infection began to gain notice internationally as the cause of a potential following pandemic.

    00:47 In fact, ultimately, the virus identified causing this infection process was a member of the coronavirus family and aligned very closely with former outbreak viruses including Middle East Respiratory Syndrome (MERS virus) and Severe Acute Respiratory Syndrome (SARS virus) And to that end, the virus has now been named Severe Acute Respiratory Syndrome or SARS Coronavirus-2, the second one in the lineage of SARS respiratory type illnesses.

    01:16 The disease associated with SARS Coronavirus-2 is coronavirus infectious disease 2019 or COVID-19 as it is has been nicknamed.

    01:26 And it is characterized again by that high infectivity, high attack rate in a population and potential progression to severe pneumonia including acute respiratory distress syndrome and multiorgan dysfunction failure and severe acute respiratory syndrome.

    01:43 The initial COVID-19 process began as I noted in Wuhan, China would rapidly spread in nearby provinces in China followed by spread to other areas and countries in Asia including South Korea and Japan.

    01:57 And then unfortunately and now, to the rest of the world where nearly every country in the world has checked in with cases.

    02:04 An incredibly unfortunate inclusion in this are cruise ships which are floating hotels in which multiple patients in a closed space can be and have been infected and then must undergo quarantine.

    02:18 In March 2020, the World Health Organization named the COVID-19 as a pandemic.

    02:24 In large part to stimulate all countries around the world to create and implement intense global response with a goal of limiting internal spread and hopefully even limiting further global spread.

    02:37 The clinical aspects of COVID-19 : First of all, high infectivity, high attack rate, very easy through respiratory droplets to be infected with the disease.

    02:47 Majority of cases are mild as noted.

    02:51 In fact, at least 80 if not more, 85% of cases are already mild those occurring in children, young adults, even some older adults.

    02:59 But severe disease can and does occur most especially in patients with some risk factors including those of older age - so age 60 and higher, those patients we have some degree of immunodeficiency whether they are immunocompromised or immunosuppressed, or something like that.

    03:16 Certainly those patients who have preexisting lung or even other organ disease, including those with type 1 insulin dependent, diabetes mellitus.

    03:25 The mortality rate's estimated at 1-6% although this is only an estimate as of this point because the N - the denominator is not yet known.

    03:34 The virus testing is so far not complete and so the number of mild cases who are not coming to testing are not known, hence it's hard to predict exactly what the true mortality rate is.

    03:46 That said, comparing mortality rates of COVID-19 with influenza, it is estimated to be at least 10-fold higher, if not more.

    03:55 Those areas of either the world or patients who have the mortality rates of 6% typically are those with an older average age or those who are in a close unprotected environment such as an extended care facility or a cruise ship or a nursing home, etc.

    04:12 Clinically, the incubation period for COVID-19 is thought to be 2 days to 14 days with a tail end however of at least 21 days.

    04:21 Concerning evidence just emerging is that the virus itself, SARS-Coronavirus-2 may persist in an infectious state for at least 3-4 days and not longer on environmental surfaces including counter tops, utensils, doorknobs, etc. and so forth After the incubation period, most patients present with fever.

    04:44 over 60% may have a dry cough and myalgias so. so far a very influenza-like illness.

    04:48 so far a very influenza-like illness.

    04:51 However, shortness of breath occurring in over 30% so far is emerging as a symptom or a complaint which may be more specifically predictive of infection with COVID-19 versus influenza, rhinovirus, parainfluenza, etc.

    05:07 As noted, those patients who had the severe disease, do so by entering into respiratory failure followed by hypotensive shock, multiorgan dysfunction, etc Diagnosis.

    05:19 Well first and foremost, as one way to anticipate given that COVID-19 occurs simultaneously with other respiratory illnesses, it is important to evaluate for and hopefully exclude other such illnesses, such as influenza, parainfluenza, rhinovirus, even other coronaviruses causing upper respiratory tract infection and even including bacterial pathogens such as pertussis and Mycoplasma.

    05:44 However, to specifically evaluate or screen for COVID-19 infection and the SARS Coronavirus-2, one can send a nasopharyngeal or oropharyngeal specimen, a swab for a nucleic acid amplification testing which can be done fairly rapidly both commercially as well as by country-held department labs.

    06:06 Other diagnostics are emerging including electrodiagnostics and also, a blot spot testing for Immunoglobulin M/G for presence of SARS Coronavirus-2.

    06:17 It remains to be seen the utility of these testing strategies in a screening process versus a reserve in the use of confirmatory testing.

    06:26 Treatment unfortunately as with many other viral infections, is scant.

    06:32 There are no confirmed yet antiviral therapy agents with known effect in this against SARS Coronavirus-2 although multiple agents are being evaluated.

    06:41 There is emerging evidence that some antiretroviral therapies may, such as what we see used in HIV infection, may have some impact.

    06:51 Passive immunotherapy including treatment with monoclonal antibodies is also being evaluated for impact.

    06:58 This is very similar to interventions used in Ebola virus disease, initially in West Africa and currently in the Democratic Republic of Congo.

    07:09 Refractory cases.

    07:11 This is a concern.

    07:12 Whether it's because patients are progressing into severe disease despite initial support of care, or for those patients who appear to have been clinically improving and then apparently relapse who enter into respiratory failure and shock.

    07:27 There is a suggestion in a manuscript just published in clinical infectious diseases that patients who are male, who present with anorexia and absence of fever may have high risk of developing refractory cases.

    07:43 Ultimately, the best treatment is prevention and to that end, at least six vaccine products separately are being developed as I speak, at least one of those has been administered to live human volunteers in California in the States.

    07:57 There remains to be seen the utility or efficacy of the vaccine products, until a day in which vaccines can be appropriately developed and are effective, then social distancing and quarantine are the two most robust interventions possible.

    08:11 Social distancing - a limiting contact with other human beings within at least 6 feet, avoiding large gatherings, practicing of course good cough etiquette, etc.

    08:23 And then the more invasive, if you will, intervention that would be quarantine and this involves closing borders, closing restaurants, pubs, concerts, sports events, any area in which humans may be too close to violate that 6-foot distance rule.

    08:44 Quarantine and that degree of intervention was ultimately used very successfully in Wuhan, China.

    08:51 And it is hopefully being rolled out around the rest of the world as I speak.

    08:57 It remains to be seen, if this is too little too late however.

    09:00 The two challenges that are anticipated and one is attempting to avoid via quarantine: Number 1 - is limit the number of patients at risk who progress into severe disease with COVID-19.

    09:14 This is a fear because the sheer number of patients who might develop this progression have high potential to overwhelm the healthcare system of any country in the world and certainly overrun the use of ventilators and healthcare providers, hospital beds, even hospitals available to care for them.

    09:35 This was found to be a major challenge in the initial province in China, in Wuhan which experience exactly those complications.

    09:43 The other concern that's being addressed with quarantine is to try and limit the insertion of SARS Coronavirus-2 into the viral milieu of humans in the world such as has happened with influenza both A and B Viruses that are so inserted has the potential for seasonal recurrence and the same impact in terms of morbidity and mortality as recurrently seen with COVID-19 and see many times in a decade with Influenza A and B.

    10:16 So, the more that once we're effective in preventing COVID-19, the more successfully we'll see our way through this particular pandemic but this is just one of the many many many more to come, So until then, continue to support vaccine development, continue to develop antiviral development and WASH THOSE HANDS!


    About the Lecture

    The lecture Coronavirus Infectious Disease 2019 (COVID-19) by Sean Elliott, MD is from the course Viruses.


    Included Quiz Questions

    1. Development of severe rash
    2. High infectivity
    3. Progression to severe pneumonia and/or ARDS
    4. High attack rate in a population
    5. Progression to hypotensive shock
    1. To stimulate a global response with the goal of limiting the worldwide spread of COVID-19
    2. To free up international resources to fight the disease in Wuhan, China
    3. To support the governments of China, South Korea, and Japan in their battle against the local spread of COVID-19
    4. To prevent the entry of COVID-19 into Switzerland, where the international headquarters of WHO is located
    5. To stabilize the world economic indices and prevent a global recession
    1. 2–14 days
    2. 3–7 days
    3. 5–10 days
    4. 1–4 days
    5. 7–21 days
    1. Shortness of breath
    2. Fever
    3. Dry cough
    4. Myalgias
    5. Fatigue
    1. Refractory COVID-19
    2. Permanent hearing loss
    3. Rapid resolution of COVID-19
    4. Development of diabetes mellitus
    5. SARS-CoV-2–associated viral exanthem

    Author of lecture Coronavirus Infectious Disease 2019 (COVID-19)

     Sean Elliott, MD

    Sean Elliott, MD


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    Fantastic succinct video
    By Rye C. on 26. March 2020 for Coronavirus Infectious Disease 2019 (COVID-19)

    Very insightful and helpful for doctors on the frontline. Thank you.

     
    thanks
    By Mathel`o R. on 24. March 2020 for Coronavirus Infectious Disease 2019 (COVID-19)

    good information .... in this moment we must know the actual situation at the world

     
    High quality & quick delivery
    By Jean-François E. on 21. March 2020 for Coronavirus Infectious Disease 2019 (COVID-19)

    As a senior medical student about to graduate and join the healthcare workforce as a general practitioner in the midst of the COVID-19 pandemic, I can count on Lecturio for providing high yield, practice-enhancing information. I am actually impressed by how quickly Lecturio did put together and deliver this evidence-based and up-to-date course. Dr. Elliott is a great teacher and his contribution to this video is likely to end up having a significant impact on COVID-19 patient management throughout the world. Also, thank you for making all content related to COVID-19 free for everyone including non-members. I intend to share this course and/or Lecturio's COVID-19 concept card with my professional network on LinkedIn (https://www.linkedin.com/in/jfechelard/). Stay safe. Jean-François Echelard