This document provides information about Coronavirus Disease 2019 (COVID-19). It discusses the epidemiology, causes, signs and symptoms, diagnosis, management, and preventive measures of COVID-19. The objectives are to introduce COVID-19, discuss its transmission, clinical presentation, testing and treatment approaches, complications, and prevention. Key points covered include that COVID-19 is caused by a novel coronavirus, spreads through respiratory droplets, and can cause pneumonia, respiratory failure, and multi-organ dysfunction in severe cases. Diagnosis is via PCR testing of respiratory samples and management focuses on supportive care. Prevention emphasizes hand hygiene, surface disinfection, and use of personal protective equipment during patient care activities.

1. CORONA VIRUS DISEASE
Prepared By:
Megha Rani
Minu Thapa Magar
Nandani Gupta
Narbada Koirala
B.Sc. Nursing 4th Year
BPKIHS,Dharan
3/19/2020
1

2. Contents:
• Introduction
• Epidemiology
• Risk factors and Causes
• Mode of Transmission
• Pathophysiology
• Signs and Symptoms
• Diagnosis
• Management
• Complication
• Preventive Measures
3/19/2020 2

3. Objectives:
At the end of session, participants will be able to:
• Introduce about Corona virus
• Enumerate the cause of corona virus
• Enlist the sign and symptoms of corona virus
• Explain the diagnosis of corona virus
• Explain the management of corona virus
• List out the complications of corona virus
• Explain the preventive measures of corona virus.
3/19/2020 3

4. Introduction
Corona viruses constitute the subfamily
Orthocoronavirinae in the family
Coronaviridae
3/19/2020 4

5. Introduction…
• They are enveloped viruses with a positive-
sense single-stranded RNA genome .
• The name corona virus is derived from the
Latin corona, meaning "crown" or "halo",
which refers to the characteristic appearance
reminiscent of a crown when viewed under
electron microscopy, due to the surface
covering in club-shaped protein spikes.
3/19/2020 5

6. Epidemiology
3/19/2020 6

7. Epidemiology…
Outbreaks of coronavirus types of relatively high mortality are as
follows
Outbreak Virus type Deaths
2003 severe acute respiratory
syndrome outbreak
SARS-CoV 774
2012 Middle East respiratory
syndrome coronavirus
outbreak
MERS-CoV Over 400
2015 Middle East respiratory
syndrome outbreak in South
Korea
MERS-CoV 36
2018 Middle East respiratory
syndrome outbreak
MERS-CoV 41
2019–20 coronavirus
pandemic
SARS-CoV-2 At least 5,833
3/19/2020 7

8. Corona virus disease
2019 (COVID-19)
• In December 2019, a pneumonia outbreak
was reported in Wuhan city of China.
• On 31 December 2019, the outbreak was
traced to a novel strain of corona virus, which
was given the interim name 2019-nCoV by the
World Health Organization (WHO), later
renamed SARS-CoV-2 by the International
Committee on Taxonomy of Viruses.
3/19/2020 8

9. Corona virus disease 2019
(COVID-19)
• As of 15 March 2020, there have been at least 5,833
confirmed deaths and more than 156,396
confirmed cases in the corona virus pneumonia
pandemic.
• The Wuhan strain has been identified as a new
strain of Beta corona virus from group 2B with
approximately 70% genetic similarity to the SARS-
CoV.
• The virus has a 96% similarity to a bat corona virus,
so it is widely suspected to originate from bats as
well. The pandemic has resulted in serious travel
restrictions.3/19/2020 9

10. Causes of COVID - 19
• It is caused by SARS-CoV-2 is closely related to
Sever Acute Respiratory Syndrome Corona
Virus which was outbreaks in 2003.
• It is thought to have a zoonotic origin.
3/19/2020 10

11. Mode of Transmission
• The primary mode of transmission is via
respiratory droplets that people exhale.
• Droplets only stay suspended in the air for a
short time but may stay viable and contagious on
a metal, glass or plastic surface.
• Disinfection of surfaces is possible with
substances such as 62–71% ethanol applied for
one minute.
3/19/2020 11

12. Incubation Period
• Ranges from one to fourteen days; it is most
commonly five days. In one case, it had an
incubation period of 27 days
3/19/2020 12

13. Pathophysiology
Host mechanism is decreased (Impaired gag and cough reflex or
immunocompromized State)
Microorganisms enter the lower respiratory tract
Inflammatory reaction begins
Inflammatory reactions with WBC, neutrophils enter the alveoli and fill
normally air containing spaces
Interfere exchange of O2 and CO2
Hypoxemia3/19/2020 13

14. Signs and Symptoms
• Symptoms of COVID-19 are non-specific and
those infected may either be asymptomatic or
develop flu like symptoms such as fever,
cough, fatigue, shortness of breath, or muscle
pain.
3/19/2020 14

15. Signs and Symptoms…
Symptom %
Fever 87.9%
Dry cough 67.7%
Fatigue 38.1%
Sputum production 33.4%
Shortness of breath 18.6%
Muscle pain or joint pain 14.8%
Sore throat 13.9%
Headache 13.6%3/19/2020 15

16. Chills 11.4%
Nausea or vomiting 5.0%
Nasal congestion 4.8%
Diarrhoea 3.7%
Haemoptysis 0.9%
Conjunctival congestion 0.8%
3/19/2020 16

17. Clinical Syndrome associated with
COVID-19
1. Mild illness
2. Pneumonia
3. Severe Pneumonia
4. Acute respiratory distress Syndrome
5. Sepsis
6. Septic Shock
3/19/2020 17

18. Diagnosis
• Infection by the virus can be provisionally
diagnosed on the basis of symptoms, though
confirmation is ultimately by reverse
transcription polymerase chain reaction (rRT-
PCR) of infected secretions (71% sensitivity)
and CT imaging (98 % sensitivity).
3/19/2020 18

19. Diagnosis…
1. Viral testing
• Reverse transcription polymerase chain
reaction (rRT-PCR) is done. The test can be
done on respiratory or blood samples.
2. Imaging
• Radiographs and computed tomography.
3/19/2020 19

20. In the context of Nepal
• Test is done in National Public Health
Laboratory, Teku. Suspected patient is kept in
isolation and sample that is throat swab, nasal
swab are collected which is sent to Teku. The
test is free of cost . The test is done for those
cases only which is recommended by expert
physician. It takes 24- 48hours for the report
collection .If the Report found to be positive,
the information is given to the Hospital and
the Doctor immediately.
3/19/2020 20

21. MANAGEMENT
3/19/2020 21

22. WHO: Interim guidelines for the
management of severe acute
respiratory illness caused by novel
corona virus.
3/19/2020 22

23. 1. TRIAGE
• Recognition and sorting of all patients at the
first point of contact with the healthcare
system (e.g. Emergency Dept.)
• Recognize that nCoV is the possible etiology
for SARI, which is based on the conditions
outlined in Table 1.
3/19/2020 23

24. Table 1 Definitions of patients with SARI, suspected of 2019-nCoV infection
3/19/2020 24

25. WHO: Interim Guidelines…
2. Immediate implementation of appropriate
prevention and control (IPC) measures
3/19/2020 25

26. 3. Early supportive therapy and monitoring
• Supplemental oxygen therapy: SARI and respiratory
distress, hypoxemia, or shock.
• If there’s no evidence of shock in patients with SARI,
use conservative fluid management.
• Antimicrobials should be given to all patients with SARI
to treat all likely pathogens causing SARI. Antimicrobials
should be given within one hour of initial patient
assessment for patients with sepsis.
3/19/2020 26

27. Early supportive…
• Do NOT give routine corticosteroids for
treatment of viral pneumonia outside of
clinical trials unless indicated for another
reason.
• Early communication with patient and family
is key for successful management
3/19/2020 27

28. 4. Collection of specimens for laboratory
diagnosis
• Blood cultures for bacteria that cause pneumonia
and sepsis should be collected, ideally, before
microbial therapy. But DO NOT delay the
antimicrobial therapy to collect blood cultures.
• Specimens should be collected from both upper
respiratory tract (URT) and lower respiratory tract
(LRT) for nCoV testing via RT-PCR.
• Serology as a diagnostic procedure is
recommended only when RT-PCR is NOT
available.
3/19/2020 28

29. Caring for infants and mothers with
COVID-19: IPC and breastfeeding
• Infants born to mothers with suspected,
probable, or confirmed COVID-19 should be
fed according to standard infant feeding
guidelines, while applying necessary
precautions for IPC.
3/19/2020 29

30. Caring for infants and mothers with
COVID-19…
• Breastfeeding should be initiated within 1
hour of birth. Exclusive breastfeeding should
continue for 6 months with timely
introduction of adequate, safe and properly
fed complementary foods at age 6 months,
while continuing breastfeeding up to 2 years
of age or beyond.
3/19/2020 30

31. Caring for infants and mothers with
COVID-19…
• As with all confirmed or suspected COVID-19
cases, symptomatic mothers who are
breastfeeding or practising skin-to-skin contact
or kangaroo mother care should practice
respiratory hygiene, including during feeding (for
example, use of a medical mask when near a
child if the mother has respiratory symptoms),
perform hand hygiene before and after contact
with the child, and routinely clean and disinfect
surfaces with which the symptomatic mother
has been in contact.
3/19/2020 31

32. 3/19/2020 32

33. PREVENTION
• Infection Prevention and Control
Recommendations for Patients with
Suspected or Confirmed Corona virus Disease
2019 (COVID-19) in Healthcare Settings
( Centers for Disease Control and
Prevention)
3/19/2020 33

34. Prevention…
1. Minimize Chance for Exposures
• Measures should be implemented before
patient arrival, upon arrival, throughout the
duration of the patient’s visit, and until the
patient’s room is cleaned and disinfected.
3/19/2020 34

35. PREVENTION…
• Before Arrival
– When scheduling appointments for routine
medical care (e.g., annual physical, elective
surgery), instruct patients to call ahead and
discuss the need to reschedule their appointment
if they develop symptoms of a respiratory
infection (e.g., cough, sore throat, fever) on the
day they are scheduled to be seen.
3/19/2020 35

36. PREVENTION…
• Upon Arrival and During the Visit
Take steps to ensure all persons with symptoms of
COVID-19 or other respiratory infection (e.g., fever,
cough) adhere to respiratory hygiene and cough
etiquette, hand hygiene, etc
3/19/2020 36

37. Prevention…
2. Adhere to Standard and Transmission-Based
Precautions
• Hand Hygiene
• Personal Protective Equipment
3/19/2020 37

38. HAND WASHING
• Hand washing is recommended to prevent the
spread of the disease. The US Centers for
Disease Control and Prevention (CDC)
recommends that people wash hands often
with soap and water for at least 20 seconds.
3/19/2020 38

39. FOR MAKING HAND SANITIZER
• Ethanol=835 ml
• Hydrogen Peroxide=40 ml
• Glycerol=15 ml
• Sterile water=110ml
Total=1000ml
3/19/2020 39

40. Prevention…
PERSONAL PROTECTIVE EQUIPMENTS:
• Respirator or Facemask
Put on a respirator or facemask (if a respirator
is not available) before entry into the patient
room or care area.
N95 respirators or respirators that offer a
higher level of protection should be used
instead of a facemask when performing or
present for an aerosol-generating procedure
3/19/2020 40

41. Prevention…
• Eye Protection
• Gloves
• Gowns
3/19/2020 41

42. 3/19/2020 42

43. 3/19/2020 43

44. 3/19/2020 44

45. 3. Patient Placement
• For patients with COVID-19 or other
respiratory infections, evaluate need for
hospitalization. If hospitalization is not
medically necessary, home care is preferable if
the individual’s situation allows.
• If admitted, place a patient with known or
suspected COVID-19 in a single-person room
with the door closed. The patient should have
a dedicated bathroom.
3/19/2020 45

46. Prevention…
4. Take Precautions When Performing Aerosol-
Generating Procedures (AGPs
If performed, the following should occur:
– Health care personnel in the room should wear an N95 or
higher-level respirator, eye protection, gloves, and a gown.
– The number of health care personnel present during the
procedure should be limited to only those essential for
patient care and procedure support. Visitors should not be
present for the procedure.
– AGPs should ideally take place in an Airborne Infection
Isolation Room
– Clean and disinfect procedure room surfaces promptly.
3/19/2020 46

47. Prevention…
5. Collection of Diagnostic Respiratory
Specimens
When collecting diagnostic respiratory
specimens (e.g., nasopharyngeal swab) from a
possible COVID-19 patient, the following
should occur:
– Health care personnel in the room should wear an
N-95 or higher-level respirator (or facemask if a
respirator is not available), eye protection, gloves,
and a gown.
3/19/2020 47

48. Prevention…
– The number of Health care personnel present
during the procedure should be limited to only
those essential for patient care and procedure
support. Visitors should not be present for
specimen collection.
3/19/2020 48

49. Prevention…
– Specimen collection should be performed in a
normal examination room with the door closed.
– Clean and disinfect procedure room surfaces
promptly.
3/19/2020 49

50. Prevention…
6. Manage Visitor Access and Movement
Within the Facility
Establish procedures for monitoring, managing
and training all visitors, which should include:
– All visitors should perform frequent hand hygiene
and follow respiratory hygiene and cough
etiquette precautions while in the facility,
especially common areas.
3/19/2020 50

51. Prevention…
– Passively screen visitors for symptoms of acute
respiratory illness before entering the healthcare
facility
• Post visual alerts (e.g., signs, posters) at the
entrance and in strategic places (e.g., waiting
areas, elevators, cafeterias)
3/19/2020 51

52. 3/19/2020 52

53. 3/19/2020 53

54. 3/19/2020 54

55. Prevention…
7. Implement Engineering Controls
Examples of engineering controls include:
– physical barriers or partitions to guide patients
through triage areas
– curtains between patients in shared areas
– air-handling systems (with appropriate
directionality, filtration, exchange rate, etc.) that
are installed and properly maintained
3/19/2020 55

56. 3/19/2020 56

57. 3/19/2020 57

58. Prevention…
8. Monitor and Manage ill and Exposed
Healthcare Personnel
• Facilities and organizations providing
healthcare should implement sick leave
policies for Health care personnel that are
non-punitive, flexible, and consistent with
public health guidance.
3/19/2020 58

59. Prevention…
9. Train and Educate Healthcare Personnel
Provide Health care personnel with job- or
task-specific education and training on
preventing transmission of infectious agents,
including refresher training.
3/19/2020 59

60. 3/19/2020 60

61. Prevention…
10. Implement Environmental Infection Control
• All non-disposable medical equipment used
for patient care should be cleaned and
disinfected according to manufacturer’s
instructions and facility policies.
• Disposable medical equipment should be used
when caring for patients with known or
suspected COVID-19.
3/19/2020 61

62. Prevention…
11. Establish Reporting within and between
Healthcare Facilities and to Public Health
Authorities.
3/19/2020 62

63. Complications
Further development can lead to
a) severe pneumonia
b)acute respiratory distress syndrome
c)sepsis
d)septic shock and
e)death
3/19/2020 63

64. 3/19/2020 64

65. 3/19/2020 65

66. 3/19/2020 66

67. SUMMARY
3/19/2020 67

68. 3/19/2020 68

69. 3/19/2020 69

70. 3/19/2020 70

72. References
1. https://www.who/2019-nCoV-clinical-2020.4-
eng.pdf retrived on 16th March, 2020
2. https://www.cdc.gov/coronavirus/2019-ncol-
recommendations.htmlov/infection-
control/contr retrived on16th March,2020
3. https://www.who.int/health-
topics/coronavirusretrived on 16th March, 2020
3/19/2020 72

73. 3/19/2020 73