The Management Of ICU Patients With COVID-19
The Management Of ICU Patients With COVID-19

The Management Of ICU Patients With COVID-19

The international panel issues guidelines on the management of ICU patients with COVID-19The Surviving Sepsis Campaign COVID-19 panel, comprised of 36 specialists from 12 countries, has issued new guidelines for healthcare workers who treat intensive care unit (ICU) patients with COVID-19.

 

The guidelines, co-published in Critical Care Medicine and the Journal of Intensive Care Medicine, contain 54 recommendations on topics such as infection control, laboratory diagnosis and sampling, blood flow support dynamics, ventilation support, and COVID-19 therapy.

 

The Surviving Sepsis Campaign COVID-19 Panel issued recommendations to assist healthcare workers caring for critical ICU patients with COVID-19.

Previously, there was limited guidance on the acute management of critically ill patients with COVID-19, although the United States World Health Organization and Disease Control and Prevention issued initial guidance on infection control, screening, and diagnosis in the general population have made.  McMaster University Dr. Walid Alhajani and St. Joseph Healthcare Hamilton said.

“Generally, great clinical practice guidelines like these take a year or two to develop. Given the urgency and overwhelming need for these guidelines, we assembled the team, searched the literature, summarized the evidence, and prepared the recommendations within 18 days. “

 

They all worked hard to make this guide increasingly available to the end user while maintaining methodological rigor. The guideline will be used by frontline physicians, allied health professionals, and policy makers involved in the care of patients with COVID-19.

 

The Surviving Sepsis Campaign COVID-19 panel included experts in guideline development, infection control, infectious diseases and microbiology, critical care, emergency medicine, nursing, and public health.

The researchers began by proposing 53 questions that they considered relevant for the management of COVID-19 in the ICU.

 

He then searched the literature for direct and indirect evidence on the management of COVID-19 in the ICU. They found recent and relevant systematic reviews on most questions related to supportive care. The panel then assessed the certainty of the evidence using the Recommendations, Assessment, Developmental Rating and Assessment (GRADE) approach.

 

GRADE is a method of evaluating previous work, a transparent framework for developing and presenting a summary of evidence, and providing a systematic approach for health professionals to make clinical practice recommendations.

 

The resulting 54 recommendations include four best practice statements, nine strong recommendations, and 35 weak recommendations. No recommendations were made for six questions. The four best-practice statements based on high-quality evidence include:

 

  • (i) Healthcare workers performing aerosol-generating procedures such as intubation, bronchoscopy, open suction for patients with COVID-19 should wear tight-fitting respirators, such as N95, FFP2 or equivalent, rather than surgical masks, other equipment personal protection. Such as gloves, gowns and eye protection;
  • (ii) Aerosol generation procedures should be performed in ICU patients with COVID-19 in a negative pressure room, if available; Negative pressure rooms are designed to prevent the spread of infectious pathogens from one room to another;
  • (iii) Endotracheal intubation of patients with COVID-19 should be performed by healthcare workers with experience in airway management to reduce the number of attempts and the risk of transmission;
  • (iv) Adults with COVID-19 who are being treated with non-invasive positive pressure ventilation or a high-flow nasal cannula should be closely monitored for worsening respiratory conditions and, if necessary. Must be intubated early.

COVID-19 Management of critically ill adults: guidelines for the sepov survival campaign. Survivor Sepsis Campaign (SSC) has published its guidelines on the management of COVID-19 in critically ill adults. These guidelines were written by 36 experts from 12 countries.

 

The recommendations were developed based on limited direct evidence with cases of COVID-19 and indirect evidence derived from previous epidemics such as Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and other coronavirus infections.

 

In total, the panel issued 54 statements: 4 best practice statements, 9 strong recommendations and 35 weak recommendations. (No recommendations were made for the remaining 6 subjects.) Also read: The AHA has issued an interim guideline on CPR and emergency CV care in patients with COVID-19.

 

Coronavirus 2 of severe acute respiratory syndrome (SARS-CoV-2) is the cause of COVID-19, an epidemic that has affected more than 700,000 people, of whom approximately 5% to 10% of patients enter to the intensive care unit (ICU) y Mechanical ventilation is required. The main recommendations are:

 

use of fitted respirators for aerosol-generating procedures (eg endotracheal intubation, nebulizer treatment, open suction) for infection control and medical care (EN 95 serve, FFP 2), surgery For other personal protective equipment (PPE) (best practice statement), other than masks.

 

Respiratory masks, in addition to other PPE – weak recommendation, low-quality evidence [LQE], for general care of non-ventilated patients, or for performing non-aerosol-generating procedures in patients receiving mechanical ventilation. It is recommended to wear a medical mask instead.

 

Diagnostic samples from the lower respiratory tract (endotracheal aspirates) are preferred to bronchial lavage, bronchoalveolar lavage, and upper respiratory tract samples (nasopharyngeal or oropharyngeal) – weak recommendation, LQE.

 

For acute resuscitation of adults with hemodynamic support shock, the following suggestions have been made: responsiveness to fluids (weak) using a conservative fluid administration strategy (weak recommendation, very LQE) and using crystalloids (strong) in colloids.

 

Recommendation, LQE) to measure dynamic parameters. Recommendation; Medium qi). Balanced crystalloids are preferred over unbalanced crystalloids (weak recommendation, moderate qi). For adults with tremors, the following suggestions have been made.

 

Use norepinephrine as the first-line vasoactive (weak recommendation, LQE), use of vasopressin or epinephrine as the first-line (weak recommendation, if nasurinphrine is not available) LQE). Dopamine is not recommended if norepinephrine is not available (strong recommendation, high Qi).

 

It is suggested to add vasopressin as a second line agent if the target (60-65 mm Hg) means that norepinephrine alone cannot achieve blood pressure (weak recommendation, moderate QE). If supplement 2 is less than 90% (strong recommendation, moderate qi).

 

It is recommended to start ventilatory support with supplemental oxygen. Spo2 should not be kept above 96% (strong recommendation, moderate qi). For acute hypoxymic respiratory failure despite conventional oxygen therapy, a high-flow nasal cannula (HFNC) is used in conjunction with conventional oxygen therapy and nonspecific positive pressure ventilation (NIPPV) (weak recommendation, LQE).

 

If HFNC is not available, a NIPPV test is suggested (weak recommendation, very LQE). Close monitoring is recommended for worsening respiratory status and if worsening condition is reported (best practice statement). For adults receiving mechanical ventilation who have acute respiratory distress syndrome (ARDS).

 

It is recommended to use low tidal volume (4–8 ml / kg body weight) and high tidal volume (> 8 Ml / kg) (strong) ventilation. ) is preferable to recommendation, moderate QE). It is recommended to target plateau pressures of <30 cm H2O (strong recommendation, moderate Qi).

 

The use of a high positive final respiratory pressure (PrEP) strategy has been suggested over a low PrEP strategy (weak recommendation, LQE). For adults receiving mechanical ventilation who have moderate to severe ARDS, prone ventilation for 12 to 16 hours was suggested, with no prone ventilation (weak recommendation, LQE).

 

It is suggested that essential neuromuscular blocking agents (NMBAs) be used instead of continuous infusion of NMBAs to facilitate protective pulmonary ventilation (weak recommendation, LQE). For adults receiving mechanical ventilation who have severe ARDS and hypoxemia despite optimizing ventilation, an inhaled pulmonary vasodilator test was suggested.

 

If no rapid improvement in oxygen is observed, treatment should be reduced (weak recommendation, very LQE). Pulmonary recruitment maneuvers (40 cm H2O respiration is held for 40 seconds to closed lung segments when recruitment maneuvers are not used (weak recommendation, LQE).

 

But ladder recruitment maneuvers (incremental PEEP) are not used. Intended to open) its use has been suggested. Not recommended (strong recommendation, moderate qi).

The use of venerevascular circulation to the extracorporeal membrane oxygenation center (ECMO) or to the ECMO referral center is suggested, if available for selected patients (weak recommendation, LQE).

 

Therapy against routine use of systemic corticosteroids is suggested in adults receiving mechanical ventilation who do not have ARDS (weak recommendation, LQE). In people with ARDS, the use of corticosteroids is suggested (weak recommendation, LQE).

 

Patients receiving mechanical ventilation on COVID-19 who have respiratory failure have been suggested to use empirical antimicrobial / antibacterial agents (no evidence classification); De-escalation evaluation. In critically ill adults with fever, pharmacological agents for temperature control are used without non-pharmacological agents or treatment.

 

Regular use of standard IV immunoglobulin has not been suggested. Occasional plasma is not suggested. There is insufficient evidence to issue a recommendation for the use of any of the following: antiviral agents, recombinant interferons, chloroquine / hydroxychloroquine, or tocilizumab.

 

The COVID-19 epidemic is challenging because the disease has overwhelmed health systems. This SSC Guide 2 will often be updated online as global evidence, but it illustrates the core tenants of best practice for ARDS: low tidal volume strategy, PrEP titration, hyperoxia prevention, and a conservative fluid strategy.

 

Coronavirus Disease 2019: This article is about the disease. For the virus, see severe acute coronavirus of respiratory syndrome 2. For epidemics, see 2019-20 coronovirus epidemics.

Coronavirus disease 2019 () is an infectious disease caused by coronavirus 2 of severe acute respiratory syndrome (). The disease was first identified in December 2019 in Wuhan, the capital of Hubei province, China, and has since spread across the world, resulting in the 2019-20 coronovirus epidemic.

Common symptoms include fever, cough, and shortness of breath. Other symptoms may include muscle pain, sputum production, diarrhea, sore throat, loss of smell, and abdominal pain. While most cases have mild symptoms, there is some progression to viral pneumonia and multiple organ failure.

 

As of April 4, 2020, more than 1,120,000 cases have been reported in more than two hundred countries and regions, causing more than 59,100 deaths. More than 228,000 people have been recovered. The virus spreads mainly during close contact and is produced by tiny droplets when people cough, sneeze, or speak.

 

These small droplets can be produced during respiration, but the virus is generally not transmitted through the air. People can also catch COVID-19 by touching the contaminated surface and then their face. The virus can survive on surfaces for up to 72 hours.

 

It is most contagious during the first 3 days after the onset of symptoms, although it may spread before symptoms appear and later in the disease.

The time from the onset of symptoms is typically between two and fourteen days, with an average of five days.

 

The standard method of diagnosis is the reverse transcription polymerase chain reaction (RRT-PCR) of a nasopharyngeal swab. The infection can also be diagnosed with a CT scan of the chest showing symptoms, risk factors, and features of pneumonia.

 

Recommended measures to prevent infection include frequent hand washing, social disturbances (keeping physical distance from others) and especially those symptoms), cover coughs and sneezes with a disposable or internal tissue and keep unwanted hands away from your face.

 

Masks are recommended for those who suspect they have viruses and caregivers. Recommendations for the use of masks by the general public, some officials recommend not wearing them, others recommend their use and others require their use.

 

Currently, there is no specific vaccine or antiviral treatment for COVID-19. Management includes symptom management, supportive care, isolation, and experimental measures.

The World Health Organization (WHO) stated that the 2019-2020 coronavirus was a Public Health International Health Emergency (PHEIC) on January 30, 2020 and an epidemic on March 11, 2020. Local transmission of the disease has been recorded in many countries. Six WHO areas.

Signs and symptoms

People infected with the virus may be asymptomatic or develop flu-like symptoms, such as fever, cough, fatigue, and shortness of breath. Emergency symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking up, and burning of the face or lips; Immediate medical attention is recommended if these symptoms are present.

 

Less often, symptoms of the upper respiratory tract, such as sneezing, runny nose, or sore throat, may be seen. Symptoms such as nausea, vomiting, and diarrhea have been observed in varying percentages. Some cases in China initially presented only with chest tightness and synergy.

 

In March 2020, there were reports that odor deficiency (anosmia) may be a common symptom in people with milder disease, although not as common as initially reported. In some, the disease can progress to pneumonia, multiple organ failure, and death.

 

In those who develop severe symptoms, the time between symptoms and the need for mechanical ventilation is usually eight days. As is common with infections, there is a delay between the time a person becomes infected with the virus and the time they develop symptoms. This is called an incubation period.

 

The incubation period for COVID-19 is usually five to six days, but can vary from two to 14 days. 97.5% of people who develop symptoms will do so within 11.5 days of infection.

Reports indicate that not all infected are symptomatic of the infection, but their role in transmission is unknown. Preliminary evidence suggests that asymptomatic cases may contribute to the spread of the disease. 

The Reason

Some details on how the disease spread are still being determined. The WHO and CDC state that it spreads mainly during close contact and is produced by small drops when people cough, sneeze, or speak; With close contact within 1-3 meters.

 

A study in Singapore found that droplets traveling up to 15 feet (4.5 m) can be caused by an open cough. Breath drops can also occur during breathing, including talking. Although the virus is not usually in the air.

 

The National Academy of Sciences has suggested that bioerosol transmission may be possible and that the airway positively receives samples of viral RNA from the air deployed in the hallway outside people’s rooms.

 

The drops can fall into the mouth or nose of those who are close to or possibly live in the lungs. Some medical procedures, such as intubation and cardiopulmonary resuscitation (CPR), can cause respiratory secretion to become aerosolized, thereby causing diffusion into the air.

 

It can also spread when someone touches a contaminated surface, known as foam transmission, and then touches their eyes, nose, or mouth. Although there is concern that it may spread through the stool, this risk is considered low.

 

The virus is most contagious when people are symptomatic; While symptoms can spread before they appear, this risk is minimal. The European Center for Disease Prevention and Control (ECDC) says that while it is not entirely clear how easily the disease spreads, one person usually infects two or three more.

 

On the surface, the virus survives for hours or days. In particular, the virus could be detected for one day in cardboard, up to three days in plastic and stainless steel, and up to four hours in copper. This, however, varies according to humidity and temperature.

 

Surfaces can be separated by various solutions (within one minute of disinfectant exposure to a stainless steel surface.

Including 62-71% ethanol, 50-100% isopropanol, 0.1% sodium hypochlorite, 0.5% Contains hydrogen peroxide and 0.2. -7.5% povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective.

Virology

Coronavirus 2 of severe acute respiratory syndrome (SARS-CoV-2) is a new coronavirus of severe acute respiratory syndrome, previously isolated from three people with pneumonia associated with a group of cases of acute respiratory disease in Wuhan.

 

All the characteristics of the new SARS-CoV-2 viruses occur in related coronaviruses in nature. Outside of the human body, the virus is killed with household soap, which breaks its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is believed to have a zoonotic origin. Genetic analysis showed that the coronavirus was genetically clustered with betacoronovirus, with two strains derived from bait in the subgenus Sarbecovirus (lineage B).

 

It is 96% similar across the genome to other bat coronavirus samples (Batkov RaTG13). In February 2020, Chinese researchers discovered that there is only an amino acid difference in parts of the genome sequences between virus pangolins and human viruses.

 

However, full-genome comparisons date back over 92% of the shared genetic material between the pangolin coronavirus and SARS-CoV-2, which is insufficient to demonstrate that pangolin is an intermediate host.

 

Pathophysiology

The lungs are most affected by COVID-19 because viral enzymes reach host cells through ACE2, which is most abundant in alveolar type II lung cells. The virus uses a special surface glycoprotein called a “spike” (periplasmar) to bind ACE2 and enter the host cell.

 

The density of ACE2 in each tissue correlates with the severity of disease in that tissue, and some have suggested that reduced ACE2 activity may be protective, although another approach is that ACE2 uses angiotensin II receptor blocking drugs. Improvement may be protective and may require testing these hypotheses.

 

As alveolar disease progresses, respiratory failure may develop and death may follow. The virus also affects gastrointestinal organs because ACE2 is abundantly expressed in glandular cells of the gastric, duodenal, and anal epithelium, as well as endothelial cells and enterocytes of the small intestine.

The diagnosis


The WHO has published several test protocols for the disease. The standard test method is the real-time reverse transcription polymerase chain reaction (RRT-PCR). The test is generally performed on respiratory samples obtained with a nasopharyngeal swab.

 

Although you can also use a sample of nasal inflammation or sputum. Results are generally available in a few hours to two days. Blood tests can be used, but this requires two blood samples for two weeks and the results are of immediate value.

 

Chinese scientists were able to isolate a coronavirus strain and publish a genetic sequence so that laboratories around the world could independently develop polymerase chain reaction (PCR) tests to detect virus infection.

 

As of March 19, 2020, there were no tests for antibodies, although efforts to develop them are ongoing. The FDA approved the first point-of-care test on March 21, 2020 for use at the end of that month.

 

Clinical guidelines issued by Wuhan University Zhongnan Hospital suggested methods for detecting infections based on clinical facilities and epidemiological risk.

These included identifying people who had at least two symptoms in addition to a visit to Wuhan or contact with other infected people: fever, imaging features of pneumonia, normal or low white blood cell count. 

The subfural domain, the pavement loco (lobular septal thickening with variable alveolar filling) and consolidation develop as the disease develops. As of March 2020, the American College of Radiology recommends that “CT should not be used to detect or as a first-line test to diagnose CTV-19.”

 

 

Prevention

Preventive measures to reduce the likelihood of infection include staying home, avoiding crowded spaces, washing your hands frequently with soap and water, and practicing good respiratory hygiene and eyes with unwanted hands for at least 20 seconds.

 

You should avoid touching your nose or mouth

The CDC recommends covering your mouth and nose with a disposable tissue when coughing or sneezing, and using the inside of your elbow if a tissue is not available. They also recommend proper hand hygiene after coughing or sneezing.

 

Social elimination strategies aim to reduce contact with infected individuals with larger groups by closing schools and workplaces, restricting travel, and canceling mass gatherings. Social unrest also includes people staying at least six feet (1.83 m) away.

 

Because SARS-CoV-2 vaccines are not expected to be available until 2021 at the earliest, an important part of managing the COVID-19 pandemic is trying to reduce the pandemic, which, through various measures , “curves”. Reduction “. Demand to reduce the rate of new infections.

 

Lowering the infection rate helps reduce the risk of health services, allowing better treatment of current cases and delaying additional cases until a therapy or vaccine is available.

According to the WHO, masks are used only when a person coughs or sneezes or when someone cares for someone with a suspected infection. Some countries also recommend that healthy people wear face masks. 

Some health experts prefer to wear non-medical grade masks and other facial covers, such as scarves or scarves, a good way to prevent people from touching their mouth and nose, even if the non-medical cover sneezes directly from an infected person. Or don’t protect him from coughing.

 

The CDC advises people diagnosed with COVID-19 or who believe they may be infected to leave health care and stay home, call before meeting with a health care provider. Wear a face mask before entering the provider’s office.

 

And when you’re in any room or vehicle with someone else, cover coughs and sneezes, wash your hands regularly with soap and water, and avoid sharing personal household items. The CDC also recommends that people wash their hands frequently with soap and water for at least 20 seconds.

 

For areas where commercial hand sanitizers are not available, the WHO provides two formulas for local production. In these formulations, antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used in alcohol to help eliminate bacterial spores. It is not “an active substance for hand antisapsis”. Glycerol is added as a humectant.

 

 

Management

People are managed with supportive care, which may include fluids, oxygen, and other affected vital organs. The CDC recommends that people who suspect they carry the virus wear a simple face mask.

 

Extracorporeal membrane oxygenation (ECMO) has been used to address the problem of respiratory failure, but its benefits are still under consideration.

The WHO and the Chinese National Health Commission have published recommendations for the care of people hospitalized with COVID-19.

 

Terrorists and pulmonologists in the US USA They have compiled treatment recommendations on IBCC, a free resource from various agencies.

 

 

Medicines

Some medical professionals recommend acetaminophen (acetaminophen) over ibuprofen for first-line use. The WHO does not oppose the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for symptoms, and the FDA states that there is currently no evidence that NSAIDs worsen COVID-19 symptoms.

 

While theoretical concerns have been raised about ACE inhibitors and angiotensin receptor blockers as of March 19, 2020, these are not enough to warrant discontinuing these medications. Steroids like methylprednisolone are not recommended unless the disease is compounded by acute respiratory distress syndrome.

 

 

Personal protection equipment

Caution should be taken to reduce the risk of virus transmission, particularly in medical care when aerosols can occur, such as intubation or manual ventilation.

 

For healthcare professionals caring for people with COVID19, the CDC recommends placing the person in an Air Infection Isolation Room (AIIR), in addition to using standard precautions, contact precautions, and air precautions.

 

The CDC outlines specific guidelines for the use of Personal Protective Equipment (PPE) during an epidemic. The recommended equipment includes:

  • Respirator or mask
  • Coat
  • Medical gloves
  • Eye protection

When available, respirators (rather than masks) are preferred. N95 respirators are approved for industrial settings, but the FDA has authorized the use of masks under the Emergency Use Authority (USA).

 

They are designed to protect against airborne particles such as dust, but do not guarantee effectiveness against a specific biological agent for off-label use. The CDC recommends using face shields when masks are not available, or as home masks as a last resort.

 

 

Mechanic ventilation

Most cases of COVID-19 are not severe enough to require mechanical ventilation (artificial support to aid breathing), but a percentage of cases do. Some Canadian doctors recommend the use of aggressive mechanical ventilation because this technique limits the spread of aerosolized transmission vectors.

 

Severe cases are more common in older adults (over 60 years and especially over 80 years). Many developed countries do not have enough hospital beds per capita, severely limiting the ability of a health system to handle a sudden increase in the number of COVID-19 cases for hospitalization.

 

This is an important factor in the need to flatten the finite capacity curve (to maintain the rate at which new cases arrive and thus reduce the number of sick people at any given time). A study in China found that 5% were admitted to intensive care units.

 

2.3% of ventilation required mechanical support and 1.4% died. Approximately 20-30% of people with COVID-19 in a hospital with pneumonia require ICU care for respiratory assistance. Many organizations are using 3D printing to produce various necessary devices.

 

 

Acute respiratory distress syndrome

Mechanical ventilation becomes more complex as ARDS develops in CODS-19 and oxidation becomes increasingly difficult. Ventilators capable of pressure control and high PrEP modes are required to maximize oxygen supply and minimize the risk of lung injury and pneumothorax associated with the ventilator. A higher PEEP may not be available on older fans.

 

 

Experimental treatment

The WHO does not approve any medication for the treatment of the disease, although some are recommended by the national medical authorities. Research on possible treatments began in January 2020, and many antiviral drugs are in clinical trials.

 

Although new drugs may take up to 2021 to develop, many of the drugs being tested are either already approved for other uses, or are already in advanced testing. Antiviral medication can be tried in people with serious illnesses. The WHO advised volunteers to participate in tests of effectiveness and safety of possible treatments.

 

 

Information Technology

In February 2020, China launched a mobile app to combat the disease outbreak. Users are asked to enter their name and identification number. The application is capable of detecting ‘close contact’ using surveillance data and therefore a potential risk of infection.

 

Each user can also view the status of three other users. If a potential risk is detected, the app not only recommends quarantine, but also alerts local health officials. Big data analytics on cell phone data, facial recognition technology, mobile phone tracking, and artificial intelligence are used to track down infected people and people they contacted in South Korea, Taiwan, and Singapore. .

In March 2020, the Israeli government allowed security agencies to trace the mobile phone data of people with coronavirus. Steps were taken to enforce quarantine and protect people exposed to infected civilians.

 

Also in March 2020, Deutsche Telekom shared the phone’s general location data with the German federal government agency, the Robert Koch Institute, to try to prevent the spread of the virus. Russia implemented facial recognition technology to detect quarantine switches.

 

Italian regional health commissioner Giulio Gallera said he was informed by mobile phone operators that “40% of people continue to move anyway.” The German government organized a 48-hour weekend hackathon with more than 42,000 participants. Also Estonian President Kersti Kaljulaid made a global call for creative solutions against the spread of the coronovirus.

 

 

Psychological Support

People may experience seizures due to quarantine, travel restrictions, treatment side effects, or fear of infection. To address these concerns, the China National Health Commission released a national guideline for intervention in psychological crises on January 27, 2020.

 

 

Forecast

COVID-19 severity varies. The disease may take a minor course with few or few symptoms, other common diseases of the upper respiratory tract such as the common cold. Mild cases generally heal in two weeks, while those with severe or serious illness can take three to six weeks to recover.

 

In those who have died, the time from symptom onset to death is two to eight weeks. In children, the disease is feared, but in adults it is less likely to have severe symptoms and illness; The risk of death is less than 0.5% in people younger than 50 years, while it is higher than 8% in people older than 70 years.

 

Pregnant women may be at increased risk for serious infection with COVID-19 based on data from other similar viruses, such as SARS and MERS, but data for COVID-19 is lacking. In some people, COVID-19 can affect the lungs and cause pneumonia.

 

In the most severely affected people, COVID-19 can rapidly progress to acute respiratory distress syndrome (ARDS), which can lead to respiratory failure, septic shock, or multiple organ failure. Complications associated with COVID-19 include sepsis, abnormal clots, and damage to the heart, kidneys, and liver.

 

Coagulation abnormalities, particularly an increase in prothrombin time, have been described in 6% of those hospitalized with COVID-19. Although abnormal kidney function is observed in 4% of this group. [178] Liver damage shown by blood markers of liver damage is often seen in severe cases.

 

Some studies have found that the ratio of neutrophils to lymphocytes (NLR) can be useful in the early detection of critical diseases. Many of those who died from COVID-19 have pre-existing (underlying) conditions including hypertension, diabetes, and heart disease.

 

The Isisuto Superiore de Sanita reported that of the 8.8% of deaths where medical records were available for review, 97.2% of patients in the sample had at least one partner with an average of 2.7 diseases.

 

According to the same report, the median time between symptom onset and death was 10 days, with five hospitalized. However, patients transferred to the ICU had an average time of seven days between hospitalization and death.

 

In an early case study, the average time from initial symptom onset to death was 14 days, with a full range of six to 41 days. In a study by the China National Health Commission (NHC), the male death rate was 2.8%, while the female death rate was 1.7%.

 

Histopathological examinations of postmortem lung samples show alveolar damage in both lungs with fibromycoid cell exudate. Viral cytopathic changes were observed in the pneumocytes. The lung image resembles acute respiratory distress syndrome (ARDS).

 

In 11.8% of deaths reported by the China National Health Commission, elevated troponin levels or cardiac arrest noted cardiac damage. The availability of medical and socioeconomic resources in a region can also affect mortality.

 

Mortality estimates by state vary due to regional differences [186], but also due to methodological difficulties. The mortality rate may be underestimated due to the low count of mild cases. However, the fact that death is the result of pre-contracted cases means that the current death rate can be underestimated.

 

Concerns have been raised about the long-term sequence of the disease. The Hong Kong Hospital Authority found a 20% to 30% drop in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage.

 

 

Re Transition

Until March 2020, it was unknown whether a previous infection provided effective and long-lasting immunity in people recovering from the disease. Immunity is seen as a possibility based on the behavior of other coronaviruses, but has subsequently been tested positive for coronoviruses in cases of COVID-19 recovery.

 

 

History

The virus is considered natural and originates from an animal through a contagious infection. The origin is unknown, but as of December 2019, the spread of the infection was driven almost entirely by person-to-person transmission.

 

The first reported infection occurred in Wuhan, China on November 17, 2019. In a study of the first 41 cases of COVID-19 published in The Lancet in January 2020, the symptom onset date was December 1. 2019. Initial symptoms were reported by official WHO publications on December 8, 2019.

 

 

Epidemiology

Main article: Coronavirus epidemic 2019-2020: Various measures are commonly used to determine mortality. These numbers vary by region and time, and are influenced by the evidence, the quality of the healthcare system, treatment options, and the time since the initial outbreak.

 

And characteristics of the population, such as age, sex and general health. In late 2019, the WHO assigned emergency ICD-10 disease code U07.1 to deaths from laboratory-confirmed SARS-CoV-2 infection and clinically confirmed SARS-CoV without epidemic or medical epidemic.

 

The death-case relationship refers to the number of deaths divided by the number of cases diagnosed within a given time interval. According to data from Johns Hopkins University, the global mortality rate is 5.3% (60,115 / 1,134,418) as of April 4, 2020. This number varies by region.

 

Other measures include the case fatality rate (CFR), which refers to the percentage of diagnosed people who die of a disease, and the infection case fatality rate (IFR), which represents the percentage of infected individuals (diagnosed and unspecified).

 

These statistics do not have a time limit and follow a specific population from infection to resolution of the case. Many scholars have attempted to calculate these numbers for specific populations.

 

 

Society & Culture

The World Health Organization announced in February 2020 that COVID-19 was the official name of the disease. The head of the World Health Organization, Tedros Adholm Ghebayeus, said that CO means Corona, VI for the virus and D for the disease, while 19 is when the outbreak was identified on December 31, 2019.

 

The name was chosen to avoid references to a specific geographic location (such as China), animal species, or groups of people, in accordance with international recommendations for nomenclature aimed at preventing stigma.

 

The virus that causes COVID-19 has been called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The WHO also uses the “COVID-19 virus” and the “virus responsible for COVID-19” in public communication.

 

In 1968 Coronavirus was named for its appearance in an electron micrograph reminiscent of the Solar Crown, the crown that means crown in Latin. During the initial outbreak in Wuhan, China, the virus and disease were commonly known as “coronavirus” and “Wuhan coronavirus”.

 

In January 2020, the WHO recommended acute respiratory disease 2019-nCov and 2019-nCoV as tentative names for viruses and diseases, according to the 2015 guide against the use of locations in diseases and virus names.

 

The official names COVID-19 and SARS-CoV-2 were released on February 11, 2020. To avoid confusion with SARS, the WHO sometimes refers to SARS-CoV-2 as “COVID-19 virus” in communications. public health (appointment). 

 

The general public often calls SARS-CoV-2 and the disease a “coronavirus.”

After the official appointment of the virus and disease, controversial terms like “wolfu” and “kung flu” emerged as an aggressive way to describe COVID-19.

 

The use of these words (popular on social media and popular rights sources) not only reduces the severity of the fatal disease, but also provides incorrect information by suggesting that it is a strain of influenza (when not the flu), while together they make fun of Chinese culture.

 

Fake news

Main article: Disinformation related to the 2019-20 coronovirus epidemic. After the initial COVID-19 outbreak, conspiracy, disinformation, and misinformation theories about the origin, scale, prevention, treatment, and other aspects of the disease quickly spread online.

 

The investigation

Main article: Drug development COVID-19: Government organizations, academic groups, and industry researchers are conducting international clinical research programs on vaccines and candidates for therapeutic drugs to reduce diseases caused by COVID-19.

 

In March 2020, the World Health Organization launched a “Solidarity Trial” in 10 countries, enrolling thousands of people infected with COVID-19 to assess the effects of treatment on four existing antiviral compounds. Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity.

 

Commentary

Main article: COVID-19 vaccine: There is no vaccine available, but several agencies are actively developing candidate vaccines. Previous work on SARS-CoV is being used because both SARS-CoV-2 and SARS-CoV use the ACE2 receptor to enter human cells.

 

Three vaccination strategies are being investigated. First, the researchers aim to produce a complete vaccine against the virus. The use of this virus, which may be inactive or dead, aims to accelerate the human body’s rapid immune response to a new infection with COVID-19.

 

A second strategy, subunit vaccines, aims to produce a vaccine that sensitizes the immune system to certain virus subfractions. In the case of SARS-CoV-2, this research focuses on S-spike proteins that help the virus infiltrate the ACE2 enzyme receptor.

 

A third strategy is that of nucleic acid vaccines (DNA or RNA vaccines, a novel technique for creating a vaccine). Experimental vaccines of any of these strategies have to be tested for safety and efficacy.

 

On March 16, 2020, the first clinical trial of a vaccine began in Seattle with four volunteers. The vaccine contains a harmless genetic code copied from the virus that causes the disease.

 

Post Infection Treatment

Main article: Drug resuscitation investigation COVID-19According to two organizations that track the progress of clinical trials on potential prescription drugs for COVID-19 infections, 29 Phase II-IV efficacy trials were completed in March 2020 or delivered in April from hospitals in China. I was slated to do it, which was COVID’s first outbreak experience – 19 in late 2019.

 

Pre-approved drugs for the treatment of malaria were reused in seven trials, including four studies on hydroxychloroquine or chloroquine phosphate. With nine Phase III trials of remedisvir in many countries, most Chinese research on recombinant antiviral drugs is due in late April.

 

Other possible therapeutic candidates in clinical clinical trials that end between March and April are vasodilators, corticosteroids, immunotherapy, lipoic acid, bevacizumab, and the recombinant angiotene-converting enzyme 2, among others. The objectives of the Alliance for Clinical Research COVID-19 are:

 

  • 1) Facilitate the rapid review of clinical trial proposals by ethical committees and national regulatory agencies.
  • 2) Accelerated approval of candidate therapeutic compounds.
  • 3) Ensure a fast and standardized analysis of emerging efficacy and safety data.
  • 4) Ease of sharing clinical trial results before publication.

By April 2020, a dynamic review of the clinical development of vaccine and drug candidates COVID-19 was conducted. Several current antiviral drugs are being evaluated for the treatment of COVID-19.

 

In which remapedivir, chloroquine and hydroxychloroquine, lopinavir / ritonavir and lopinavir / ritonavir are combined with interferon beta. As of March 2020, there is provisional evidence of the efficacy of Remedisvir.

 

Remedswear inhibits SARS-CoV-2 in vitro. [26its] Phase 3 clinical trials are underway in the USA. USA, China and Italy. Chloroquine, previously used to treat malaria, was studied in China in February 2020 with positive initial results.

 

However, there are calls for peer review of the research. The Guangdong Provincial Department of Science and Technology and the Guangdong Provincial Health and Health Commission released a report stating that chloroquine phosphate “improves the success rate of treatment and shortens the length of a person’s hospital stay” and Mild.

 

Recommended for moderate and underdiagnosed people. Severe cases of new coronovirus pneumonia. On March 17, 2020, the Italian Pharmaceutical Agency added chloroquine and hydroxychloroquine to the list of drugs with positive preliminary results for the treatment of COVID-19.

 

Korean and Chinese health authorities recommend the use of chloroquine.

However, the Wuhan Institute of Virology, which recommends a daily dose of one gram, notes that double the dose is very dangerous and can be fatal. On March 28, 2020, the FDA issued an Emergency Use Authority for hydroxychloroquine.

 

And chloroquine at the discretion of doctors treating people with COVID-19. The Chinese seventh edition guidelines also include interferon, ribavirin, or eumifenovir for use against COVID-19.

 

In 2020, a trial found that lopinavir / ratanavir was not effective in treating critical illnesses. Nitazoxanide has been recommended for in vivo studies after exhibiting a low concentration inhibition of SARS-CoV-2.

 

Studies have shown that early priming of the peak protein by serine transmembrane protease 2 (TMPRSS2) is required for SARS-CoV-2 entry through interaction with the ACE2 receptor.

 

These findings suggest that the TMPRSS2 inhibitor camostat approved for use in Japan may constitute an effective off-label treatment to prevent fibrosis in liver and kidney disease.

 

In February 2020, FAVVRavir was being studied in China for the experimental treatment of emerging disease COVID-19.

 

Anti-Cytokine Storm

Cytokine storms, a life-threatening medical condition, can be a complication in the later stages of severe COVID-19. There is evidence that hydroxychloroquine has properties against cytokine storms.

 

Tocilizumab has been included in the treatment guidelines by the China National Health Commission after the completion of a small study. It is undergoing a non-randomized Phase 2 trial nationwide in Italy after showing positive results in people with critical illnesses.

 

Combined with a serum ferritin blood test to identify cytokine storms, it is meant to cope, like growth, which is believed to cause death in some affected people. The interleukin-6 receptor antagonist was approved by the FDA in 2017 for treatment against cytokine release syndrome. Which is CAR T-cell therapy. In 2017, the Feinstein Institute at Northwell Health announced a study that inhibits a human antibody. Activity “of IL-6.

 

Passive Antibody Therapy

Transferring the purified and concentrated antibodies produced by the immune system of COVID-19 to those in need is being investigated as a non-vaccination method of vaccination.

 

This strategy was tested for SARS. Viral neutralization is the anticipated mechanism of action by which passive antibody therapy can mediate defense against SARS-CoV-2. Other mechanisms may be possible, such as antibody-dependent cellular cytotoxicity and phagocytosis.

 

For example, other forms of passive antibody therapy are being developed, using manufactured monoclonal antibodies. The production of proto serum, which contains the liquid portion of blood from recovered patients and includes antibodies specific for this virus, can be increased for rapid deployment.

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