Novel coronavirus (COVID-19) etiological characteristics, clinical manifestations and management.

1. Novel coronavirus (COVID-19)
etiological characteristics,
clinical manifestations and
management
Presented By
Dr Izharul Hasan M.D (U)
Consultant Unani
Karol Bagh, New Delhi
Ph: 8287833547

2. ETIOLOGICAL CHARACTERISTICS:-
• The epidemic of novel coronavirus (COVID-
19) infections that began in China in late
2019 has rapidly grown and cases have been
reported worldwide. Covid-19 is a zoonotic,
new viral respiratory illness against which we
have no natural immunity.
• Virus is sensitive to ultraviolet and heat.
Exposure to 56 0C for 30 minutes and lipid
solvents such as ether. 75% ethanol, chlorine
containing disinfectants and peracetic acid
can effectively inactivate the virus.

3. ETIOLOGICAL CHARACTERISTICS:-
• The patients infected by coronavirus are main
source of infection.
• Asymptomatic infected people can also be an
source of infection.
• Transmission of the virus mainly through
respiratory droplet and close contact. (Coronavirus
disease spreads primarily through contact with an
infected person when they cough or sneeze. It also
spreads when a person touches a surface or object
that has the virus on it, then touches their eyes,
nose, or mouth).

4. ETIOLOGICAL CHARACTERISTICS:-
• There is possibility of aerosol transmission
in a relatively closed environment for a
long exposure in high concentration of
aerosol.
• Attention should be made to feces or urine
contaminated environmental that leads to
aerosol or contact transmission.

5. CLINICAL MANIFESTATION:-
• Illness ranges in severity from asymptomatic or mild
to severe; a significant proportion of patients with
clinically evident infection develop severe disease.
• The Incubation period is 1 to 14 days, generally 3 to 7
days.
• Main symptoms fever, fatigue and dry cough.
• Nasal congestion, running nose, sore throat, myalgia
are in few cases.
• Severe cases mostly developed dyspnea or hypoxemia
after one week.
• It is important to notice that for severe and critical ill
patients fever could be moderate to low or even barely
noticeable

6. CLINICAL MANIFESTATION:-
• The patients with mild symptoms did not
develop pneumonia but only low fever and
mild fatigue.
• Mostly patients have good prognosis and a
small number of patients critically ill.
• Symptoms in children are relatively mild.
• Mortality rate among diagnosed cases (case
fatality rate) is generally about 2% to 3% but
varies by country to country.
• Reported cases in adults of middle age or
older are on more risks.

7. DIAGNOSTIC PROCEDURES:-
• Infection should be suspected in persons with a
compatible respiratory illness and exposure
history (if identified).
• In the early stages of disease peripheral WBC
count normal or decreased and the lymphocytes
count decreases.
• Some patients see an increase in liver enzymes,
lactate dehydrogenase (LDH), muscle enzyme and
myoglobin.
• Mostly patients have increased C-reactive protein
and ESR.
• In severe and critically ill cases elevated
inflammatory factors.

8. DIAGNOSTIC PROCEDURES:-
• Novel coronavirus nucleic acid can be detected in
nasopharyngeal swabs (Nasopharyngeal swab is
preferred; oropharyngeal swab may be submitted
in addition), sputum, lower respiratory tract
secretion, blood, feces and other specimen using
RT-PCR method. Polymerase chain reaction tests
are the standard for diagnosis. Specific methods
and availability vary; public health authorities may
assist in arranging diagnostic testing in some
areas.
• It is more accurate if specimen from lower
respiratory tract (sputum) are tested.
• NCP virus specific IgM becomes detectable around
3-5 days after onset.

9. DIAGNOSTIC PROCEDURES:-
• Chest Imaging: In early stage, chest X-ray
shows multiple small shadows and interstitial
changes appear in outer lateral zone of lungs.
• As the disease progress, imaging then shows
multiple ground glass opacities and
infiltration in both lungs (Chest imaging eg.
plain radiography, CT, ultrasonography) has
shown abnormalities in most reported
patients).
• In severe cases, pulmonary consolidation
may occur.

10. DEFINITIONS:- Epidemiological
history:
• History of travel or residence in communities
where cases have been reported within 14 days
prior to the onset of disease.
• In contact with novel coronavirus infected people
with positive results for the nucleic acid test within
14 days prior to the onset of the disease.
• In contact with patients who have fever or
respiratory symptoms from communities where
confirmed cases have been reported within 14 days
before the onset of disease.
• Clustered cases or more cases with fever, and or
respiratory symptoms in a small area such
families, offices, schools etc within weeks.

11. DEFINITIONS:- Epidemiological
history:
• Clinical manifestations: Fever and or respiratory symptoms.
Normal or decreased WBC count, normal or decreased
lymphocyte count in the early stage of onset.
• A suspect case has any of the epidemiological history plus any
two clinical manifestations or all three clinical manifestations if
there is no clear epidemiological history.
• Suspect cases with one of the following etiological or serological
evidence can be CONFIRMED.
• Real time fluorescent RT-PCR indicates positive for new
coronavirus nucleic acid.
• Viral gene sequence is highly homologous to known new
coronaviruses.
• NCP virus specific IgM and IgG are detectable in serum.

12. DEFINITIONS:- Epidemiological
history:
• Mild Cases: The clinical symptoms are mild, no sign of
pneumonia on imaging. Moderate cases showing fever and
respiratory symptoms with radiological findings pneumonia.
• Severe cases: Adult cases meeting any of the following
criteria.
• Respiratory distress (>30 breaths/min)
• Oxygen saturation <93% at rest;
• Arterial partial pressure of oxygen (PaO2)/fraction of inspired
oxygen (FiO2) < 300mmHg (1 mmHg = 0.1333kPa).
• Cases with chest imaging that showed obvious lesion
progression within 48 hours >50% shall be managed as severe
cases.

13. DEFINITIONS:- Epidemiological
history:
• Critical Cases: meeting any of the
following criteria.
• Respiratory failure and requiring
mechanical ventilation.
• Shock
• With other organ failure that requires ICU
care.

14. WARNING INDICATORS:-
• of time. Adults
• Peripheral blood lymphocytes decrease
progressively.
• Peripheral blood inflammatory factors
such as IL-6 and C-reactive proteins
increase progressively.
• Lactate increases progressively;
• Lung lesions develop rapidly in a short
period

15. DIFFERENTIAL DIAGNOSIS:-
• Bacterial pneumonia
• Other known viral pneumonia such as
influenza virus, adenovirus etc.
• Mycoplasma pneumonia infections.

16. GENERAL TREATMENT
• A suspect case should be treated in isolation in a single
room.
• Confirmed cases can be treated in isolation in single
room.
• Critical cases should be admitted to ICU as soon as
possible.
• Strengthening support therapy
• Closely monitoring vital signs and oxygen saturation.
• Monitoring blood routine result, urine routine result,
c-reactive prtein (CRP), Liver enzyme, myocardial
enzyme, renal function test, arterial blood gas
analysis, chest imaging and cytokines detaction.
• Providing effective oxygen therapy.

17. TREATMENT OF SEVERE AND
CRITICAL CASES:-
• Symptomatic Treatment
• Prevent complications
• Treat underlying diseases
• Prevent secondary infections
• Provide organ function support.
• Respiratory support
• Oxygen therapy
• Noninvasive mechanical ventilation
• Rescue therapy
• Immunotherapy

18. DISCHARGE CRITERIA:-
• Body temperature is back to normal for more than 3
days.
• Respiratory symptoms improve obviously.
• Pulmonary imaging shows absorption of
inflammation.
• Nuclei acid tests negative twice consecutively on
respiratory tract samples such as sputum and
nasopharyngeal swabs being at least 24 hours.
• In hospitalized patients with proven COVID-19,
repeated testing is recommended to document
clearance of virus, defined as 2 consecutive negative
results on polymerase chain reaction tests at least 24
hours apart.

19. THE EXPERIENCE:-
• Early Detection
• Promote reporting to authorities
• Swift isolation
• Early Treatment

20. KEY POINTS OF SELF PROTECTION
FOR MEDICAL STAFF:-
• Hand hygiene
• Wearing and removing mask
• Correct removal of protective equipment

21. PREVENTION
• There’s currently no vaccine to prevent coronavirus
disease (COVID-19).
• Wash your hands regularly for 20 seconds, with soap
and water or alcohol-based hand rub
• Cover your nose and mouth with a disposable tissue or
flexed elbow when you cough or sneeze
• Avoid close contact (1 meter or 3 feet) with people who
are unwell
• Stay home and self-isolate from others in the
household if you feel unwell. Physical distancing
should be used as much as possible.
• Don't Touch your eyes, nose, or mouth if your hands
are not clean.

22. ADJUVANT UNANI
FORMULATION:-
• Arq Ajeeb 1 ml + sharbat khakshi 100 ml,
mix together. Adult dose: 2 tsf twice a
day, children 1 teaspoon twice a day for 7
days. Very helpful preparation to prevent
in most types of Flu's. Magic effects.
• You can put 5 to 7 drops of Arq ajeeb in 2
let of water and consume this water as
needful in divided amount. Very beneficial
effects to prevent mostly flu's.

23. ADJUVANT UNANI
FORMULATION:-
• Aforesaid Unani formulation can be used
as prophylaxis or as adjuvant therapy with
other allopathic medication or issued by
Govt of India. However researches/studies
are required to conduct beneficial effects
of these Unani medicines in such epidemic
conditions.

24. REFERENCE:
• World Health Organization. Infection prevention and control
during health care when COVID-19 is suspected.
• WHO: Coronavirus Disease 2019 (COVID-19): Situation
Report--51. WHO website. Published March 11, 2020.
Accessed April 7, 2020.
• https://www.who.int/docs/default-
source/coronaviruse/situation-reports/20200311-sitrep-51-
covid-19.pdf
• Oke J et al; Centre for Evidence-Based Medicine: Global
Covid-19 Case Fatality Rates. CEBM website.
• CDC: Coronavirus Disease 2019 (COVID-19) Situation
Summary. CDC website. Updated March 26, 2020. Reviewed
March 26, 2020. Accessed April 8, 2020

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