COVID-19 Radiology findings

By Dr Deepu Changappa Cheriamane

Radiographic features

The primary findings of COVID-19 on chest radiograph and CT are thos

e of atypical pneumonia or organizing pneumonia.

However imaging has limited sensitivity for COVID-19, as up to 18% demonstrate normal chest radiographs or CT when mild or early in the disease course, but this decreases to 3% in severe disease. Bilateral and/or multilobar involvement is common.

The current recommendation of the vast majority of learned societies and professional radiological associations is that imaging should not be employed as a screening/diagnostic tool for COVID-19, but reserved for the evaluation of complications.

Plain radiograph

Although less sensitive than chest CT, chest radiography is typically the first-line imaging modality used for patients with suspected COVID-19. For ease of decontamination, use of portable radiography units is preferred.

Chest radiographs may be normal in early/mild disease. 

In those COVID-19 cases requiring hospitalization, 69% had an abnormal chest radiograph at the initial time of admission, and 80% had radiographic abnormalities sometime during hospitalization. Findings are most extensive about 10-12 days after symptom onset.

The most frequent findings are airspace opacities, whether described as consolidation or, less commonly, GGO. The distribution is most often bilateral, peripheral, and lower zone predominant 89.97. In contrast to parenchymal abnormalities, pleural effusion is rare (3%).

CT

The primary findings on CT in adults have been reported as 

• ground-glass opacities (GGO): bilateral, subpleural, peripheral

• crazy paving appearance (GGOs and inter-/intra-lobular septal thickening)

• air space consolidation

• bronchovascular thickening in the lesion

• traction bronchiectasis

The ground-glass and/or consolidative opacities are usually bilateral, peripheral, and basal in distribution.

A retrospective study of 112 patients found 54% of asymptomatic patients had pneumonic changes on CT.

The following chest CT findings have been reported to have the highest discriminatory value (p<0.001).

peripheral distribution

ground-glass opacity

bronchovascular thickening (in lesions)

Atypical CT findings

These findings only seen in a small minority of patients should raise concern for superadded bacterial pneumonia or other diagnoses.

Temporal CT changes

Four stages on CT have been described

• early/initial stage (0-4 days): normal CT or GGO only
• halo half of patients have normal CT scans within two days of symptom onset
• progressive stage (5-8 days): increased GGO and crazy paving appearance
• peak stage (9-13 days): consolidation
• absorption stage (>14 days): with an improvement in the disease course, "fibrous stripes" appear and the abnormalities resolve at one month and beyond

Pediatric CT

In a small study of five children that had been admitted to hospital with positive COVID-19 RT-PCR tests and who had CT chest performed, only three children had abnormalities. The main abnormality was bilateral patchy ground-glass opacities, similar to the appearances in adults, but less florid, and in all three cases the opacities resolved as they clinically recovered.

On 18 March 2020, the details of a much larger cohort of 171 children with confirmed COVID-19, and evaluated in a hospital setting was published as a letter in the New England Journal of Medicine. Ground-glass opacities were seen in one-third of the total, whereas almost 16% of children had no imaging features of pneumonia.

Ultrasound

Initial work on patients in China suggests that lung ultrasound may be useful in the evaluation of critically ill COVID-19 patients. The following patterns have been observed, tending to have a bilateral and posterobasal predominance:

• multiple B-lines
• ranging from focal to diffuse with spared areas
• representing thickened subpleural interlobular septa
• may also manifest as a light beam sign, an evanescent, broad-based vertical reverberation artifact arising from a regular pleural line
• irregular, thickened pleural line with scattered discontinuities
• subpleural consolidations
• can be associated with a discrete, localized pleural effusion
• relatively avascular with color flow Doppler interrogation
• pneumonic consolidation typically associated with preservation of flow or hyperemia 65
• alveolar consolidation
• tissue-like appearance with dynamic and static air bronchograms
• associated with severe, progressive disease 
• restitution of aeration during recovery
• reappearance of bilateral A-lines

 

Radiology report

The Radiological Society of North America (RSNA) has released a consensus statement endorsed by the Society of Thoracic Radiology and the American College of Radiology (ACR) that classifies the CT appearance of COVID-19 into four categories for standardized reporting language:

typical appearance

peripheral, bilateral, GGO +/- consolidation or visible intralobular lines (“crazy paving” pattern)

multifocal GGO of rounded morphology +/- consolidation or visible intralobular lines (“crazy paving” pattern)

reverse halo sign or other findings of organizing pneumonia

indeterminate appearance

absence of typical CT findings and the presence of

multifocal, diffuse, perihilar, or unilateral GGO +/- consolidation lacking a specific distribution and are non-rounded or non-peripheral

few very small GGO with a non-rounded and non-peripheral distribution

atypical appearance

absence of typical or indeterminate features and the presence of

isolated lobar or segmental consolidation without GGO

discrete small nodules (e.g. centrilobular, tree-in-bud) 

lung cavitation

smoother interlobular septal thickening with pleural effusion

negative for pneumonia:

 no CT features to suggest pneumonia, in particular, absent GGO and consolidation.

CO-RADS

In March 2020, the "COVID-19 standardized reporting working group" of the Dutch Association for Radiology (NVvR) proposed a CT scoring system for COVID-19. They called it CO-RADS (COVID-19 Reporting and Data System) to ensure CT reporting is uniform and replicable. This assigns a score of CO-RADS 1 to 5, dependent on the CT findings. In some cases a score of 0 or 6 may need to be assigned as an alternative. If the CT is uninterpretable then it is CO-RADS 0, and if there is a confirmed positive RT-PCR test then it is CO-RADS 6.

The first study investigating the use of CO-RADS found a reasonable level of interobserver variation, with a Fleiss' kappa score of 0.47 (cf. 0.24 for PI-RADS and 0.67 for Lung-RADS).

COVID-RADS

In April 2020, American radiologists based at the University of Southern California proposed the COVID-19 imaging reporting and data system (COVID-RADS), which has a confusingly similar name to CO-RADS (see above) 

Read more

Treatment

COVID-19 Transmission

By Dr Deepu Changappa Cheriamane

Although originating from animals, COVID-19 is now considered to be an indirect zoonosis, as its transmission is now primarily human-to-human.

 It is predominantly transmitted in a similar way to the common cold, via contact with droplets of infected individuals' upper respiratory tract secretions, e.g. from sneezing or coughing.

A recent Bayesian regression model has found that aerosol and fomite transmission are plausible.

Orofecal spread was seen with the SARS epidemic, and although it remains unclear if SARS-CoV-2 can be transmitted in this way, there is some evidence for it.

Sexual transmission has not been seen in the field but remains possible, not least because the SARS-CoV-2 virus has been found in all bodily secretions including seminal and vaginal fluids.

It remains unclear if COVID-19 could be transmitted through a blood transfusion although no cases have yet be seen. Nevertheless, many national bodies have instituted controls to reduce the chance of this happening including advising that potential donors do not give blood until 28 days after recovering from COVID-19.

Cohort studies have been unable to rule out the possibility of vertical transmission, but it seems to be a rare event if it does occur. A large prospective cohort study of 427 pregnant women from all 194 birth units across the UK found that 5% of 265 live births were confirmed as COVID-19 on RT-PCR.

Read more

Radiology findings

COVID 19 Pathophysiology

By Dr Deepu Changappa Cheriamane

The SARS-CoV-2 virus, like the closely-related MERS and SARS coronaviruses, effects its cellular entry via attachment of its virion spike protein (a.k.a. S protein) to the angiotensin-converting enzyme 2 (ACE2) receptor. This receptor is commonly found on alveolar cells of the lung epithelium, underlying the development of respiratory symptoms as the commonest presentation of COVID-19 50. It is thought that the mediation of the less common cardiovascular effects is also via the same ACE2 receptor, which is also commonly expressed on the cells of the cardiovascular system.

Read more

Transmission

COVID 19 Pathology

By Dr Deepu Changappa Cheriamane

Etiology

On 9 January 2020, the World Health Organization (WHO) confirmed that SARS-CoV-2 was the cause of COVID-19 (2019-nCoV was the name of the virus at that time). It is one of the two strains of the SARS-CoV species known to cause human disease, the other being the original severe acute respiratory syndrome coronavirus (SARS-CoV), the cause of SARS. It is a member of the Betacoronavirus genus, one of the genera of the Coronaviridae family of viruses. Coronaviruses are enveloped single-stranded RNA viruses that are found in humans, mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS, and intestinal disease. 

As with many human infections, SARS-CoV-2 is zoonotic. The closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus. The disease can also be transmitted by snakes.

Six coronaviruses are known to cause human disease. Two are zoonoses: the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), both of which may sometimes be fatal. The remaining four viruses all cause the common cold. 

Read more

Pathophysiology

COVID19 Complications

By Dr Deepu Changappa Cheriamane

Complications of COVID 19

In one of the largest studies of hospitalized patients, reviewing 1,099 individuals across China, the admission rate to the intensive care unit (ICU) was 5%.

 In this same study, 6% of all patients required ventilation, whether invasive or non-invasive.

 

ICU patients tend to be older with more comorbidities.

Commonly reported sequelae are:

acute respiratory distress syndrome (ARDS): ~22.5% (range 17-29%)

acute thromboembolic disease

pulmonary embolism

deep vein thrombosis (DVT)

acute cardiac injury: 

elevated troponin levels

myocardial ischemia

cardiac arrest

myocarditis

CNS

delirium

viral encephalitis

diffuse leukoencephalopathy

microhemorrhage (seen in juxtacortical white matter and corpus callosum particularly of the splenium)

stroke: cryptogenic/ischemic

higher mortality and greater severity of stroke in context of COVID-19

secondary infections, e.g. bacterial pneumonia

sepsis

acute kidney injury (AKI)

coagulopathy

disseminated intravascular coagulation (DIC)

multiorgan failure

In a small subgroup of severe ICU cases:

secondary hemophagocytic lymphohistiocytosis (a cytokine storm syndrome)

Risk factors for pulmonary embolism

In a multivariate analysis, an elevated risk of developing PE was associated with:

obesity

elevated D-dimer

elevated CRP

rising D-dimer over time

Pediatric complications

In April 2020, reports started to appear of critically-ill children presenting with a multisystem inflammatory state which bore some resemblance to Kawasaki disease and toxic shock syndrome. Typically abdominal pain and other GI symptoms were present and often evidence of a myocarditis. The presentations necessitated ICU admission and fatalities have been reported. 

Read more...

Pathology

COVID 19 Other investigations

By Dr Deepu Changappa Cheriamane

Laboratory tests

The most common ancillary laboratory findings in a study of 138 hospitalized patients were the following.

lymphopenia

increased prothrombin time (PT)

increased lactate dehydrogenase

Other commonly identified abnormalities include:

mild elevated inflammatory markers (CRP 89 and ESR)

elevated D-dimer

mildly elevated serum amylase: 17% patients (study of 52 cases)

frank acute pancreatitis has not been reported

mildly deranged liver function tests are common, primarily elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

bilirubin rise is generally mild

alkaline phosphatase (AKP) and gamma‐glutamyl transferase (GGT) levels remain normal

Read more...

Complications

COVID Radiology investigation

By Dr Deepu Changappa Cheriamane

Chest X ray 

 It doesn't have any sensitivity or specificity in diagnosing COVID, but can lead to diagnosis with strong suspicion and further referral for PCR.

HRCT Thorax

Multiple radiological organizations and learned societies have stated that CT should not be relied upon as a diagnostic/screening tool for COVID-19. On 16 March 2020, an American-Singaporean panel published that CT findings were not part of the diagnostic criteria for COVID-19. However, CT findings have been used controversially as a surrogate diagnostic test by some.

Read more

Other investigations

COVID19 Diagnostic tests

By Dr Deepu Changappa Cheriamane

RT-PCR

The definitive test for SARS-CoV-2 is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test. It is believed to be highly specific, but with sensitivity reported as low as 60-70% and as high as 95-97%. Meta-analysis has reported the pooled sensitivity of RT-PCR to be 89%. Thus, false negatives are a real clinical problem, and several negative tests might be required in a single case to be confident about excluding the disease.

Its sensitivity is predicated on time since exposure to SARS-CoV-2, with a false negative rate of 100% on the first day after exposure, dropping to 67% on the fourth day. On the day of symptom onset (~4 days after exposure) the false negative rate remains at 38%, and it reaches its nadir of 20% three days after symptoms begin (8 days post exposure). From this point on, the false negative rate starts to climb again reaching 66% on day 21 after exposure.

Read more

Radiology investigations

COVID clinical presentation

By Dr Deepu Changappa Cheriamane

Clinical presentation

COVID-19 typically presents with systemic and/or respiratory manifestations. Some individuals infected with SARS-CoV-2 are asymptomatic and can act as carriers. Some also experience mild gastrointestinal or cardiovascular symptoms, although these are much less common. 

The full spectrum of clinical manifestation of COVID-19 remains to be determined. Symptoms and signs are non-specific:

Common

fever (85-90%)

cough (65-70%)

disturbed taste and smell (40-50%) 

fatigue (35-40%)

sputum production (30-35%)

shortness of breath (15-20%)

Less common

myalgia/arthralgia (10-15%)

headaches (10-36%)

sore throat (10-15%)

chills (10-12%)

pleuritic pain

Rare

nausea, vomiting, nasal congestion (<10%), diarrhea (<5%)

palpitations, chest tightness

hemoptysis (<5%)

confusion, seizures, paraesthesia, altered consciousness

stroke(most commonly cryptogenic)

COVID-19 sufferers have reported high rates of disturbances of smell and taste, including anosmia, hyposmia, ageusia, and dysgeusia. The numbers of patients affected vary and current evidence points more towards a neurological than a conductive cause of the olfactory dysfunction. 

Various reports suggest patients with the disease may have symptoms of conjunctivitis, and those affected, may have positive viral PCR in their conjunctival fluid. However a meta-analysis of over 1,100 patients found that conjunctivitis was only present in 1.1% cases. A small case series found conjunctivitis to be the only clinical manifestation in some patients with COVID-19.

Cutaneous lesions may also be seen, similar to many other viral infections. In a cohort of 88 patients, 20% developed skin disease, most commonly an erythematous rash. Most of the skin abnormalities were self-limited, resolving in a few days.

Pediatric

In the main, the clinical presentation in children with COVID-19 is milder than in adults. Symptoms are similar to any acute chest infection, encompassing most commonly pyrexia, dry cough, sore throat, sneezing, myalgia and lethargy. Wheezing has also been noted. Other less common (<10%) symptoms in children included diarrhea, lethargy, rhinorrhea and vomiting.

Read more

Diagnostic tests

COVID - Epidemiology

By Dr Deepu Changappa Cheriamane

Epidemiology

As of July 2020, the number of cases of confirmed COVID-19 globally is over 11 million affecting virtually every territory, other than isolated South Pacific island states and Antarctica, according to an online virus tracker created by the medical journal, The Lancet, and hosted by Johns Hopkins University. As of June 2020, the United States had more than two million cases, Brazil more than one million, with Russia and India with >500,000 cases. 

The R0 (basic reproduction number) of SARS-CoV-2 has been estimated between 2.2 and 3.28 in a non-lockdown population, that is each infected individual, on average, causes between 2-3 new infections. 

The incubation period for COVID-19 was initially calculated to be about five days, which was based on 10 patients only. An American group performed an epidemiological analysis of 181 cases, for which days of exposure and symptom onset could be estimated accurately. They calculated a median incubation period of 5.1 days, that 97.5% became symptomatic within 11.5 days (CI 8.2 to 15.6 days) of being infected, and that extending the cohort to the 99th percentile results in almost all cases developing symptoms in 14 days after exposure to SARS-CoV-2.

As of June 2020 the number of deaths from COVID-19 passed half a million globally. The case fatality rate is ~2-3%. It is speculated that the true case fatality rate is lower than this because many mild/asymptomatic cases are not being tested, which thus skews the apparent death rate upwards.

A paper published by the Chinese Center for Disease Control and Prevention (CCDC) analyzed all 44,672 cases diagnosed up to 11 February 2020. Of these, ~1% were asymptomatic, and ~80% were classed as "mild". 

Another study looked at clinical characteristics in COVID-19 positively tested close contacts of COVID-19 patients. Approximately 30% of those COVID-19 positive close contacts never developed any symptoms or changes on chest CT scans. The remainder showed changes in CT, but ~20% reportedly developed symptoms during their hospital course, none of them developed severe disease. This suggests that a high percentage of COVID-19 carriers are asymptomatic.

In the Chinese population, 55-60%% of COVID-19 patients were male; the median age has been reported between 47 and 59 years.

Pediatric

Children seem to be relatively unaffected by this virus, or indeed other closely-related coronaviruses.with large cohort studies reporting that 1-2% of COVID-19 patients are children. However, there have been cases of critically-ill children with infants under 12 months likely to be more seriously affected. A very low number of pediatric deaths has been reported . In children, male gender does not seem to be a risk factor. The incubation period has been reported to be shorter than in adults, at about two days.

Read..

Clinical presentation 

Terminology

By Dr Deepu Changappa Cheriamane

The World Health Organization originally called this illness "novel coronavirus-infected pneumonia (NCIP)", and the virus itself had been provisionally named "2019 novel coronavirus (2019-nCoV)" .

On 11 February 2020, the WHO officially renamed the clinical condition COVID-19 (a shortening of COronaVIrus Disease-19) 15. Coincidentally, on the same day, the Coronavirus Study Group of the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The names of both the disease and the virus should be fully capitalized, except for the 'o' in the viral name, which is in lowercase. 

The official virus name is similar to SARS-CoV-1, the virus strain that caused epidemic severe acute respiratory syndrome (SARS) in 2002-2004, potentially causing confusion 38. The WHO has stated it will use "COVID-19 virus" or the "virus that causes COVID-19" instead of its official name, SARS-CoV-2 when communicating with the public.

Read more...

Epidemiology

COVID 19

By Dr Deepu Changappa Cheriamane

Introduction

COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a strain of coronavirus. The first cases were seen in Wuhan, China, in December 2019 before spreading globally, with more than 11 million cases now confirmed. The current outbreak was officially recognized as a pandemic by the World Health Organization (WHO) on 11 March 2020.

Read more...

Terminology

Bandana Face Covering (no sew method) Materials

By Dr Deepu


• Bandana (or square cotton cloth approximately 20”x20”)
• Rubber bands (or hair ties)
• Scissors (if you are cutting your own cloth)
Tutorial

Quick Cut T-shirt Face Covering (no sew method)

By Dr Deepu

Materials
• T-shirt
• Scissors
Tutorial

Learn 

1. How to make see mask

2. How to make bandana Mask

Sewn Cloth Face Covering

By Dr Deepu

Materials
• Two 10”x6” rectangles of cotton fabric
• Two 6” pieces of elastic (or rubber bands, string, cloth strips, or hair ties)
• Needle and thread (or bobby pin)
• Scissors
• Sewing machine
Tutorial
1. Cut out two 10-by-6-inch rectangles of cotton fabric. Use tightly woven cotton, such as quilting fabric or cotton sheets. T-shirt fabric will work in a pinch. Stack the two rectangles; you will sew the mask as if it was a single piece of fabric.

2. Fold over the long sides ¼ inch and hem. Then fold the double layer of fabric over ½ inch along the short sides and stitch down.

3. Run a 6-inch length of 1/8-inch wide elastic through the wider hem on each side of the mask. These will be the ear loops. Use a large needle or a bobby pin to thread it through. Tie the ends tight.
Don’t have elastic? Use hair ties or elastic head bands. If you only have string, you can make the ties longer and tie the mask behind your head.

4. Gently pull on the elastic so that the knots are tucked inside the hem. Gather the sides of the mask on the elastic and adjust so the mask fits your face. Then securely stitch the elastic in place to keep it from slipping.

Learn how to make non sewn face mask in next post

How to Wear a Cloth Face Covering

By Dr Deepu

Cloth face coverings should—

• fit snugly but comfortably against the side of the face
• be secured with ties or ear loops
• include multiple layers of fabric
• allow for breathing without restriction
• be able to be laundered and machine dried without damage or change to shape

CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.  Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.

Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
The cloth face coverings recommended are not surgical masks or N-95 respirators.  Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

Should cloth face coverings be washed or otherwise cleaned regularly? How regularly?
Yes. They should be routinely washed depending on the frequency of use.

How does one safely sterilize/clean a cloth face covering?
A washing machine should suffice in properly washing a face covering.

How does one safely remove a used cloth face covering?
Individuals should be careful not to touch their eyes, nose, and mouth when removing their face covering and wash hands immediately after removing.

Read the next article on how to prepare face mask at home

Hopes raise as new data released on hydroxychloroquine treatment for COVID-19.

By Dr Deepu

The new study, of which the abstract was released today, was performed at IHU Méditerranée Infection, Marseille, France. A cohort of 1061 COVID-19 patients, treated for at least 3 days with the Hydroxychloroquine-Azithromycin (HCQ-AZ) combination and a follow-up of at least 9 days was investigated.
Key findings are:
• No cardiac toxicity was observed.
• A good clinical outcome and virological cure was obtained in 973 patients within 10 days (91.7%).
A poor outcome was observed for 46 patients (4.3%); 10 were transferred to intensive care units, 5 patients died (0.47%) (74-95 years old) and 31 required 10 days of hospitalization or more.
The authors conclude that:
“The HCQ-AZ combination, when started immediately after diagnosis, is a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients. It avoids worsening and clears virus persistence and contagiosity in most cases.”

ABSTRACT
Background
In a recent survey, most physicians worldwide considered that hydroxychloroquine (HCQ) and azithromycin (AZ) are the two most effective drugs among available molecules against COVID-19. Nevertheless, to date, one preliminary clinical trial only has demonstrated its efficacy on the viral load. Additionally, a clinical study including 80 patients was published, and in vitro efficiency of this association was demonstrated.
Methods
The study was performed at IHU Méditerranée Infection, Marseille, France. A cohort of 1061 COVID-19 patients, treated for at least 3 days with the HCQ-AZ combination and a follow-up of at least 9 days was investigated. Endpoints were death, worsening and viral shedding persistence.
Findings
From March 3rd to April 9th, 2020, 59,655 specimens from 38,617 patients were tested for COVID-19 by PCR. Of the 3,165 positive patients placed in the care of our institute, 1061 previously unpublished patients met our inclusion criteria. Their mean age was 43.6 years old and 492 were male (46.4%). No cardiac toxicity was observed. A good clinical outcome and virological cure was obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage at completion of treatment was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p <1/100) but viral culture was negative at day 10 and all but one were PCR-cleared at day 5. A poor outcome was observed for 46 patients (4.3%); 10 were transferred to intensive care units, 5 patients died (0.47%) (74-95 years old) and 31 required 10 days of hospitalization or more. Among this group, 25 patients are now cured and 16 are still hospitalized (98% of patients cured so far). Poor clinical outcome was significantly associated to older age (OR 1.11), initial higher severity (OR 10.05) and low hydroxychloroquine serum concentration. In addition, both poor clinical and virological outcomes were associated to the use of selective beta-blocking agents and angiotensin II receptor blockers (P<0.05). Mortality was significantly lower in patients who had received > 3 days of HCQ-AZ than in patients treated with other regimens both at IHU and in all Marseille public hospitals (p< 1/100).
Interpretation
The HCQ-AZ combination, when started immediately after diagnosis, is a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients. It avoids worsening and clears virus persistence and contagiosity in most cases.



https://www.mediterranee-infection.com/pre-prints-ihu/

When and how to wear medical masks to protect against coronavirus

By Dr Deepu

• Before putting on a mask, clean hands with alcohol-based hand rub or soap and water.
• Cover mouth and nose with mask and make sure there are no gaps between your face and the mask.
• Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water.
• Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.
• To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.

COVID -19 update

By Dr Deepu

WHAT IS COVID-19?

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more serious diseases such as Severe Acute Respiratory Syndrome (SARS-CoV).

The 2019 novel coronavirus is a new strain that has not been seen in humans until now and has caused viral pneumonia. It was first linked to Wuhan’s South China Seafood City market which is a wholesale market for seafood and live animals in December 2019.

The virus has now been detected in several areas throughout China, along with countries across Asia, North and South America, Europe, Africa and Oceana.

WHAT DO THE DIFFERENT NAMES MEAN?

You may have noticed different names circulating which relate to the novel corona virus. Below we have listed some of the more common names and explained what they mean.

COVID-19- this is the name for the disease caused by the coronavirus. This is simply short for coronavirus disease 2019. The World Health Organization announced this name on the 11 February 2020.

SARS-CoV-2- severe acute respiratory syndrome-related coronavirus 2. This is the name of the virus, not the disease that results from it. The world Health Organization emphasizes that while the viruses are related, COVID-19 is different from the SARS outbreak of 2003.

Novel corona virus 2019 (nCoV-19)- this was initially used at the start of the outbreak. It refers to the virus which is a novel form of the coronavirus that was first seen in 2019.

Coronavirus- you may see or hear about the virus referred to just as the coronavirus. This is not inaccurate as it is a novel strain of a coronavirus.

SYMPTOMS

The World Health Organization (WHO) advises that the most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some people may experience aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually.

People with pre-existing medical conditions (such as asthma and COPD) are more likely to become severely ill with the virus.

WHAT CAN I DO TO LIMIT MY RISK OF CATCHING COVID-19?

• Do not touch your mouth, nose or eyes with unwashed hands
• Try to avoid contact with people who are sick
• Cover your coughs and sneezes with a tissue and throw it in a bin and
• Wash your hands thoroughly after touching surfaces that may be contaminated

PROPER HAND WASHING TECHNIQUE

• Wet your hands under running water
• apply soap
• rub hands together vigorously for at least 20 seconds.
• make sure you apply soap to all parts of your hands including the backs, between your fingers, fingertips, around and under your nails, thumbs and wrists
• thoroughly rinse your hands under running water
• turn off the tap with a paper towel to avoid recontaminating your hands and
• dry your hands with a disposable paper towel or hand dryer (do not touch the hand dryer).

PROPER ALCOHOL GEL (HAND SANITIZER) TECHNIQUE

• Apply one to two squirts of hand sanitizer to your hands
• rub all over your hands including: the backs, between your fingers, fingertips, around and under your nails, thumbs and wrists and
• allow the hand sanitizer to dry. This takes about 20-30 seconds.

SHOULD I BE WORRIED ABOUT TRAVELLING?

Due to the changing nature of travel restrictions, please refer to the World Health Organization for updates.

As symptoms include fever and difficulty breathing, you are advised to speak with a doctor and to make them aware of your travel history if you experience these during or after travel.

Exit screening at international airports and ports in the affected areas may take place to prevent the disease from spreading.

Severe COVID-19 risk could be increased in people with COPD and smokers

By Dr Deepu

People with chronic obstructive pulmonary disease (COPD) and people who currently smoke may have higher levels of a molecule, called angiotensin converting enzyme II (ACE-2), in their lungs according to a study published in the European Respiratory Journal (ERJ).

Previous research shows that ACE-2, which sits on the surface of lung cells, is the ‘entry point’ that allows coronavirus to get into the cells of the lungs and cause an infection.

The new study also shows that levels of ACE-2 in former smokers is lower than in current smokers.

The research was led by Dr Janice Leung at the University of British Columbia and St. Paul’s Hospital, Vancouver, Canada. She said: “The data emerging from China suggested that patients with COPD were at higher risk of having worse outcomes from COVID-19. We hypothesised that this could be because the levels of ACE-2 in their airways might be increased compared to people without COPD, which could possibly make it easier for the virus to infect the airway.”

The team studied samples taken from the lungs of 21 COPD patients and 21 people who did not have COPD. They tested the samples to gauge the level of ACE-2 and compared this with other factors, such whether they were from people who never smoked, were current smokers or former smokers. Not only did they find higher levels of ACE-2 in COPD patients, they also found higher levels in people who were smokers.

The researchers then checked their new findings against two existing study groups, which together contain data on a further 249 people – some non-smokers, some current smokers and some former smokers. Again, they found levels of ACE-2 were higher in current smokers but lower in non-smokers and in those who were former smokers.

Dr Leung said: “We found that patients with COPD and people who are still smoking have higher levels of ACE-2 in their airways, which might put them at an increased risk of developing severe COVID-19 infections. Patients with COPD should be counselled to strictly abide by social distancing and proper hand hygiene to prevent infection.

“We also found that former smokers had similar levels of ACE-2 to people who had never smoked. This suggests that there has never been a better time to quit smoking to protect yourself from COVID-19.”