COVID-19 Basics

COVID-19 Basics

PRESENTATION:

COMMON:

  • Fever (>100.4F)
  • Fatigue and Myalgia (muscle pain)
  • Dry Cough

LESS COMMON:

  • Loss of appetite
  • Sputum production
  • Loss of taste and smell

Associated with severe disease:

  • Shortness of breath

Rare:

  • Upper respiratory tract symptoms (nasal congestion, nasal discharge, and sore throat)
  • Headache
  • Vertigo
  • Gastrointestinal symptoms (abdominal pain and diarrhea)

Risk Factors:

  • Male > Female
  • Comorbidities: hypertension, diabetes, cardiovascular disease, COPD, malignancy (3)
  • No or low fever
  • Smoking
  • Age > 50

Concerning Outcomes:

  • Severe Pneumonia
  • Pulmonary Edema
  • Acute respiratory distress syndrome (ARDS) rankhaya.com apoteketgenerisk.com
  • Multiple organ failure possibly related to multi-clotting

Hospital Interventions

  • Suplemental oxygen
  • Mechanical ventilation
  • Corticosteroids
  • Immunoglobulin
  • Expectorants
  • Trials of the following ongoing:
    • Antivirals: lopinavir and ritonavir, Interferon
    • Antiparasitics:
    • Hydroxychloroquine (Plaquinil) or Chloroquine (considered in combination with azithromycin)
    • Ivermeticin

DIFFERENCES IN THE YOUNG AND OLD

OLDER:

  • Lower virus fighting white blood cells
  • Higher inflammatory mediators in lungs catalunyafarm.com
  • Males > Females cz-lekarna.com
  • Worse outcome with low or no fewer

YOUNG:

  • Presentation:
    • Most common: fever, cough
    • Less common: diarrhea (15%), nasal discharge (15%), sore throat (5%), vomiting (10%), tachypnea (rapid breathing) (10%), and fatigue (5%) ed-italia.com
  • Median age of 2-3 years
  • Males > Females
  • In an observational study of 20 pediatric patients with confirmed SARS-COV-2 pneumonia, Procalcitonin (PCT) was increased in 16/20 or 80% of cases. This marker rises in response to bacterial infections suggesting a possible confection in these children may explain the development in pneumonia.

These observations suggest that the SARS-COV-2 virus is more virulent in older populations due to a combination of factors.

    1. Lower numbers of lymphocytes seen in older populations with SARS-COV-2 suggests that the infection overwhelms the immune system.
    2. Higher levels of inflammatory mediators suggests that older populations have an inflated inflammatory response and/or weak anti-inflammatory/anti-oxidant control and this leads to more severe cases of respiratory distress and need for intervention.

Other viral illnesses the create a milder course in children: Varicella zoster, the virus that causes the chicken pox produces a mild illness in children but can cause pneumonia in adults.

REFERENCES:

https://www.ncbi.nlm.nih.gov/pubmed/32181672#

https://www.ncbi.nlm.nih.gov/pubmed/32173725

https://www.ncbi.nlm.nih.gov/pubmed/32217650

https://erj.ersjournals.com/content/21/5/886

https://www.ncbi.nlm.nih.gov/pubmed/32134205

https://www.ncbi.nlm.nih.gov/pubmed/32171866

https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0529-4