Everything About New Coronavirus Disease (COVID-19)

Definition Of Disease The new coronavirus pneumonia is acute infectious pneumonia whose pathogen is a new coronavirus previously not fo...

Everything About New Coronavirus

Definition Of Disease

The new coronavirus pneumonia is acute infectious pneumonia whose pathogen is a new coronavirus previously not found in humans, namely the new coronavirus 2019. On February 7, 2020, the National Health Commission decided to temporarily name "new coronavirus-infected pneumonia" as "new coronavirus pneumonia", referred to as "new corona pneumonia". On February 11, the World Health Organization (WHO) named its English name Corona Virus Disease 2019 (COVID-19). On February 22, the National Health and Medical Commission decided to revise the English name of "new coronavirus pneumonia" to "COVID-19", which is consistent with the World Health Organization name, and the Chinese name remains unchanged.
On January 30, 2020, the WHO announced that the new coronavirus pneumonia epidemic was listed as a public health emergency of concern (PHEIC).
The initial symptoms of the patient were mostly fever, fatigue and dry cough, and gradually developed severe symptoms such as dyspnea. Most patients have a good prognosis, and some severe cases may develop acute respiratory distress syndrome or septic shock, or even die. At present, there is a lack of effective antiviral drugs for pathogens, mainly in isolation and symptomatic supportive treatment.

Epidemiology

Based on the current epidemiological investigation, the incubation period is 1-14 days, mostly 3-7 days. The incubation period is contagious, the asymptomatic infection may also become a source of infection, and the population is generally susceptible.
Respiratory droplets and close contact transmission are the main routes of transmission. As new coronaviruses can be isolated in feces and urine, attention should be paid to the environmental pollution caused by feces and urine to aerosol or contact transmission. There is a possibility of aerosol transmission in a relatively closed environment with prolonged exposure to high concentrations of aerosol. The risk of aerosol transmission may exist in closed and unventilated places, and prevention and isolation measures need to be strengthened.
  • In December 2019, Wuhan City, Hubei Province found multiple cases of "unknown cause of pneumonia", and subsequent patients mostly had a history of South China seafood market exposure or family clustering;
  • At 21:00 on January 7, 2020, researchers detected a new type of coronavirus in patient specimens;
  • At 24 o'clock on January 10, the detection of pathogenic nucleic acid was completed;
  • On January 12, the World Health Organization (WHO) temporarily named the new coronavirus causing the pneumonia epidemic in Wuhan as 2019 new coronavirus (2019-nCoV);
  • On January 30, WHO announced that the new coronavirus epidemic was listed as a public health emergency of international concern.
  • On February 7, the National Health and Medical Commission decided to temporarily name "new coronavirus-infected pneumonia" as "new coronavirus pneumonia", referred to as "new coronavirus pneumonia". The English name is "Novel Coronavirus Pneumonia", referred to as "NCP";
  • On February 11, WHO named the disease caused by the new coronavirus as Coronavirus disease 2019, and the English name was "Corona Virus Disease 2019", referred to as "COVID-19";
  • As of 24:00 on March 16, according to reports from 31 provinces (autonomous regions and municipalities) and the Xinjiang Production and Construction Corps, there were 8,976 confirmed cases (among which, 2830 were severe cases), 68,869 cases were cured and discharged, and 3,226 were dead cases A total of 80,881 confirmed cases have been reported and 128 suspected cases have been reported. A total of 681,404 close contacts were tracked, and 9,351 were close contacts still in medical observation. A total of 235 confirmed cases were reported from Hong Kong, Macao, and Taiwan: 157 cases in Hong Kong Special Administrative Region (88 cases discharged, 4 deaths), 11 cases in Macau Special Administrative Region (10 cases discharged), 67 cases in Taiwan (22 cases discharged, 1 case died ).

Patient's Most Common Problems

What are the symptoms of human infection with the new coronavirus?
The severity of human infection with the new coronavirus depends on the type of virus and the immune level of the human body. Fever, cough, shortness of breath, or dyspnea are common. In more severe cases, acute respiratory distress syndrome, septic shock, etc. Can cause patient death.

Can new coronaviruses spread from person to person?
Yes, the new coronavirus can be transmitted from person to person. Transmission usually occurs in homes, workplaces, densely populated areas or hospitals.

Is there a vaccine against the new coronavirus?
No, new diseases may take longer to develop a vaccine.

Is there a treatment for the new coronavirus?
For the diseases caused by the new coronavirus infection, there is currently no effective treatment method, and the clinical treatment is mainly symptomatic supportive treatment.

Are health care workers at risk from new coronaviruses?
Yes. Healthcare workers need to be in close contact with patients and are more vulnerable to the threat of new coronavirus infections. Therefore, the World Health Organization (WHO) recommends that health care workers strengthen their own infection prevention and control measures. Strict implementation of standard precautionary principles, good personal protection and hand hygiene, to the greatest extent possible to avoid nosocomial infections.

What can I do to protect myself?
As there is no effective treatment for the disease, prevention and isolation are the most effective ways to minimize the chance of contact with infected or potentially infected patients. First of all, avoid going to crowded places and wearing a mask in public places. Secondly, pay attention to hand hygiene and diet hygiene, wash hands frequently, drink plenty of water, avoid fatigue, ensure sleep, and maintain more ventilation in the home and work environment. If you have fever and cough symptoms, pay attention to the etiquette of cough, seek medical treatment in time, and wear a mask on the way to the hospital.

Cause

  • New coronavirus pneumonia is an acute infectious disease.
  • Mainly caused by 2019 new coronavirus (2019-nCoV) infection.

Basic Cause

Coronaviruses are single-stranded positive-strand RNA viruses. There are six known coronaviruses that have previously infected humans, namely HCoV-229E, HCoV-OC43, SARSr-CoV, HCoV-NL63, HCoV-HKU1, and MERSr-CoV.
The coronavirus isolated from the lower respiratory tract of patients with unexplained pneumonia in Wuhan this time is a new type of coronavirus belonging to the genus β, which is the 2019 new coronavirus (2019-nCoV), which belongs to the seventh species. Current research shows that it has more than 85% homology with bat SARS-like coronavirus (bat-SL-CoVZC45).

Causative factor

The elderly and those with underlying diseases are more ill after infection.

symptom

According to the National Health and Medical Commission's "New Coronavirus Infected Pneumonia Diagnosis and Treatment Program (Trial Version 7)", severe and critically ill patients can have moderate to low fever or even no obvious fever during the course of their disease. Mild patients showed only low fever, mild fatigue, and no pneumonia.

Typical symptoms

  • Main symptoms are fever, fatigue, and dry cough;
  • Few patients have symptoms such as nasal congestion, runny nose, sore throat, and diarrhea;
  • Severe patients often develop dyspnea and/or hypoxemia one week after the onset of disease, and the severe ones rapidly progress to acute respiratory distress syndrome, septic shock, difficult to correct metabolic acidosis, coagulation dysfunction, and multiple organ failure.

Seek medical treatment

The disease is an acute infection, which usually worsens gradually during the first week. If you have any of the following conditions, please seek medical treatment in time:
  • Recent fever, fatigue, and cough of unknown cause;
  • Wuhan residence or travel history within two weeks before the onset of illness;
  • A history of close contact with confirmed patients two weeks before the onset of illness; Aggregative onset (2 and over).
During the consultation, the doctor may ask the following questions to get a preliminary understanding of the medical history, and patients can prepare corresponding answers in advance:
  • When do you experience fever and cough?
  • Where did you go before and who did you contact?
  • Does anyone have similar symptoms?
  • Are you having difficulty breathing?
  • What are the underlying diseases?

Diagnostic Criteria

According to the "Pneumonitis Diagnosis and Treatment Program for New Coronavirus Infection (Trial Version 7)" issued by the National Health Commission:

Suspected case

Combined with the following epidemiological history and clinical manifestation comprehensive analysis: there is any one of the epidemiological histories, and it meets any two of the clinical manifestations. If there is no clear epidemiological history, it meets 3 of the clinical manifestations.

Epidemiological History

  • Travel history or residence history in Wuhan and surrounding areas or other communities with case reports within 14 days before the onset of illness;
  • Patients with fever or respiratory symptoms from Wuhan and surrounding areas or from communities with case reports within 14 days before the onset of illness;
  • Have a history of contact with a new coronavirus infected person (positive nucleic acid test) within 14 days before the onset of illness;
  • Cluster onset.

Clinical Manifestation

  • Fever and/or respiratory symptoms;
  • Have the above-mentioned pneumonia imaging characteristics;
  • The total number of white blood cells is normal or decreased in early-onset, or the lymphocyte count is reduced.

Confirmed Case

Suspected cases with one of the following pathogenic evidence:
  • Real-time fluorescent RT-PCR for the detection of novel coronavirus nucleic acids.
  • Viral gene sequencing is highly homologous to known new coronaviruses.

Clinical typing

Light

The clinical symptoms were mild, and no pneumonia manifested in imaging.

Normal Type

With fever, respiratory tract and other symptoms, imaging show pneumonia.

Heavy

Adults meet any of the following:
  • Respiratory distress, breathing frequency ≥ 30 times/minute;
  • In the resting state, it means oxygen saturation ≤ 93%;
  • Arterial blood oxygen partial pressure (PaO₂) / oxygen concentration (FiO₂) ≤ 300 mmHg (1 mmHg = 0.133kPa), and the area of high altitude (above 1000 meters) should be corrected according to the following formula: PaO2 /FiO2 × [Atmospheric pressure (mmHg) / 760].
In addition, pulmonary imaging showed that the lesions progressed significantly> 50% within 24 to 48 hours, and were managed according to heavyweight.
Children meet any of the following:
  • Shortness of breath (<2 months of age, RR≥60 times/minute; 2 to 12 months of age, RR≥50 times/minute; 1 to 5 years of age, RR≥40 times/minute;> 5 years of age, RR≥30 times/minute Points), except for the effects of fever and crying;
  • Oxygen saturation ≤92% at rest;
  • Assisted breathing (groaning, nasal fan movement, tri-concave sign), cyanosis, intermittent apnea; lethargy, convulsions;
  • Refuse to feed or feed, with signs of dehydration.

Critical

One of the following:

  • Respiratory failure occurs and requires mechanical ventilation;
  • Appear shocked
  • Combining other organ failures requires ICU monitoring and treatment.
Heavy and critical clinical warning indicators

Adult severe and critical clinical warning indicators:

  • Progressive decline in peripheral blood lymphocytes;
  • Peripheral blood inflammatory factors such as IL-6 and C-reactive protein are increasing; Progressive increase in lactic acid;
  • Lesions in the lungs progress rapidly in the short term.

Children's severe and critical clinical warning indicators:

  • Faster breathing rate;
  • Poor mental response and drowsiness;
  • Progressive increase in lactic acid;
  • Imaging shows bilateral or multilobe infiltration, pleural effusion, or rapid progression of lesions in the short term; Infants under 3 months of age may have underlying diseases (congenital heart disease, bronchopulmonary dysplasia, respiratory malformations, abnormal hemoglobin, severe malnutrition, etc.), and immunodeficiency or low (prolonged use of immunosuppressive agents)

Visiting Department

Fever clinic, infectious disease department, intensive care unit.

Related inspection

Physical examination

Mainly check the lungs, auscultation of breathing sounds, etc.

Laboratory Inspection

  • In the early stage of the disease, the total number of peripheral white blood cells is normal or decreased, and the lymphocyte count is decreased;
  • Liver enzymes, lactate dehydrogenase (LDH), muscle enzymes, and creatine kinase were elevated in some patients;
  • Increased troponin is seen in some critical patients;
  • Most patients have elevated C-reactive protein (CRP) and ESR, and normal procalcitonin;
  • In severe cases, D-dimer increases and peripheral blood lymphocytes progressively decrease.

Film Degree Exam

Multiple small patchy shadows and interstitial changes appeared early, and the extrapulmonary bands were obvious. Furthermore, it develops multiple ground glass infiltration and infiltrates in both lungs. In severe cases, pulmonary consolidation and pleural effusion are rare.

Special inspection

For pathogen detection, samples of throat swabs, sputum, or lower respiratory tract secretions were collected and subjected to real-time fluorescent RT-PCR. The results were positive for the new coronavirus nucleic acid test. Or sequencing of pathogen genes suggests a high degree of homology with the new coronavirus. In order to increase the positive rate of nucleic acid detection, it is recommended to take sputum as much as possible and to perform tracheal intubation on patients with lower respiratory tract secretions, and send them for examination as soon as possible after collection.

Differential Diagnosis

The doctor will make a detailed examination to determine from multiple aspects:
  • The mild manifestations of new coronavirus infections need to be distinguished from upper respiratory tract infections caused by other viruses;
  • The new type of coronavirus pneumonia is mainly distinguished from other known viral pneumonia and mycoplasma pneumonia infections such as influenza virus, adenovirus, and respiratory syncytial virus. Especially for suspected cases, methods such as rapid antigen detection and multiplex PCR nucleic acid detection should be adopted as much as possible. Detection of common respiratory pathogens;
  • It should also be distinguished from non-infectious diseases such as vasculitis, dermatomyositis, and organizing pneumonia.

Treatment

At present, there is a lack of effective antiviral drugs for pathogens, mainly in isolation and symptomatic supportive treatment.
According to the "Pneumonitis Diagnosis and Treatment Program for New Coronavirus Infection (Trial Version 7)" issued by the National Health and Medical Commission: For severe and critical cases, based on symptomatic treatment, actively prevent complications, treat basic diseases, and prevent secondary Infection, timely organ function support. Take the following measures:
  • Respiratory support: Including oxygen therapy, high-flow nasal catheter oxygen therapy or non-invasive mechanical ventilation, invasive mechanical ventilation, and rescue therapy. Salvage therapy is recommended for patients with severe ARDS, and lung expansion is recommended. In the case of sufficient human resources, prone ventilation should be performed for more than 12 hours per day. If the prone position does not respond well, ECMO should be considered as soon as possible if conditions permit.
  • Circulation support: Based on adequate fluid resuscitation, improve microcirculation, use vasoactive drugs, and perform hemodynamic monitoring if necessary. For non-invasive or invasive hemodynamic monitoring, during the treatment process, pay attention to the fluid balance strategy to avoid excess and deficiency.
  • Renal Failure and Renal Replacement Therapy: In addition to finding the cause of impaired renal function, continuous renal replacement therapy (CRRT) can be selected for severe patients with renal failure. Rehabilitation plasma treatment: recommended for patients with rapid disease progression, severe and critically ill patients. For usage and dosage, please refer to the "Clinical Treatment Plan for Recovery Period of New Coronary Pneumonia Rehabilitation Patients (Trial Version)".
  • Blood purification treatment: The blood purification system includes plasma exchange, adsorption, perfusion, blood/plasma filtration, etc., which can remove inflammatory factors, thereby reducing the damage of the inflammatory response to the body. It can be used in the early and middle stages of cytokine storms in severe and critically ill patients. Treatment.
  • Other treatment measures: Intravenous infusion of gamma globulin may be considered in children with severe and critical cases as appropriate. Patients with pregnancy combined with severe or critical illness should actively terminate the pregnancy, and cesarean delivery is preferred. Patients often have anxiety and fear, and psychological counseling should be strengthened.

Acute phase treatment

Patients with hypoxia and dyspnea should be given oxygen therapy (such as nasal catheter oxygen, mask oxygen) and non-invasive or invasive ventilator support if necessary.

General Treatment

  • Rest in bed, strengthen supportive treatment to ensure sufficient heat; pay attention to water and electrolyte balance to maintain internal environment stability; closely monitor vital signs, oxygen saturation, etc.
  • Monitor blood routine, urine routine, C-reactive protein (CRP), biochemical indicators (liver enzyme, myocardial enzyme, renal function, etc.), coagulation function according to the condition, and perform arterial blood gas analysis if necessary, and review chest imaging
  • According to the change of oxygen saturation, timely provide effective oxygen therapy measures, including a nasal catheter, mask to give oxygen, nasal high-flow oxygen therapy if necessary, non-invasive or invasive mechanical ventilation and so on.
  • Conditions can be treated with mixed oxygen and hydrogen inhalation (H / O2: 66.6% / 33.3%).

Medical Treatment

  • Antiviral treatment: alpha-interferon aerosol inhalation, lopinavir/ritonavir, ribavirin, chloroquine phosphate, and idol. Ribavirin is recommended with interferon or lopinavir / Ritonavir combined application. Attention should be paid to the adverse reactions, contraindications, and interactions with other drugs.
  • The duration of the trial of the drug is less than 10 days. It is recommended to further evaluate the efficacy of the currently tested drugs in clinical applications. It is not recommended to use 3 or more antiviral drugs at the same time, and the use of related drugs should be stopped when there are intolerable side effects.
  • Antibacterial treatment: Avoid blind or inappropriate use of antibacterials, especially in combination with broad-spectrum antibacterials.
  • Others: According to the patient's dyspnea and chest imaging progress, under the guidance of a doctor, use glucocorticoids for a short period of time (3-5 days) as appropriate.
  • For the treatment of pregnant women, the number of weeks of pregnancy should be considered, and as far as possible, drugs that have a small impact on the fetus, and whether to treat after the termination of pregnancy, should be informed.

Chinese Treatment

TCM treatment of the disease is currently lacking evidence-based medical evidence. According to the "Pneumonitis Diagnosis and Treatment Program for New Coronavirus Infection (Trial Version 6)" issued by the National Health and Medical Commission, localities can refer to the recommended program for dialectical treatment according to the disease, local climate characteristics, and different physical conditions. It is recommended to go to a regular medical institution for treatment under the guidance of a physician.

Prognosis

Judging from the current cases, most patients have a good prognosis, and a few patients are critically ill. The prognosis for the elderly and those with the chronic underlying disease is poor. The clinical course of pregnant women with new coronavirus pneumonia is similar to that of patients of the same age. Symptoms in children are relatively mild.

Sequelae

According to the 2019 Guidelines for Respiratory Rehabilitation of New Coronavirus Pneumonia:
  • Patients with mild isolation and general discharge: Most patients have minimal or no persistent residual lung function problems with reduced lung function and fewer physical dysfunctions.
  • Severe / Critical Discharge Patients: There may be a general weakness, shortness of breath, and limited physical function. Pulmonary function is shown as a restrictive ventilation disorder, which is consistent with changes in pulmonary fibrosis revealed by chest CT examination. This change may persist.
The sequelae of the new coronavirus pneumonia described above still require a large number of cases to be summarized and observed.

Rehabilitation

Individuals with severe illness may have pulmonary fibrosis and recovery may take longer.

Complication

Severe cases can be complicated by acute respiratory distress syndrome, septic shock, metabolic acidosis that is difficult to correct, and coagulopathy.

Daily

New coronavirus pneumonia currently lacks effective treatments. The management of daily life focuses on the prevention of infection and the effective isolation of suspected and confirmed cases.

Home Care

The new type of coronavirus pneumonia has a family gathering phenomenon, and if there are suspected symptoms, go to the infectious department for treatment in time. It needs to be isolated and treated in a hospital with effective isolation and protective conditions.

Daily Life Management

Diet

  • Do not eat wild animals (ie game), poultry, meat, and eggs should be cooked thoroughly before consumption; Pay attention to nutrition, avoid partial eclipse, and ensure diversified food intake, especially fresh vegetables and fruits;
  • Develop good eating habits, eat on time and in order to avoid overeating.

Motion

Get active and control your weight. In addition, moderate exercise can also help improve immunity.

Lifestyle

  • Quit smoking and limit alcohol;
  • Ensure adequate sleep, pay attention to rest, and avoid staying up late;
  • Pay attention to mental health, pay attention to relieve tension and reduce psychological pressure.

Daily Condition Monitoring

Pay attention to monitoring body temperature. Seek timely consultation if you have fever, fatigue, or cough. If you have a history of living or traveling in the epidemic area (Wuhan) within two weeks before the onset of illness, have a history of contact with a confirmed or suspected patient, or have symptoms of collective illness, you need to seek medical treatment and take active isolation. The following precautions after discharge according to the "Diagnosis and Treatment of New Coronavirus Pneumonia (Trial Version 6)":
  • The designated hospitals should make good contact with the primary medical institutions where the patients live, share medical records, and promptly push the discharged patients' information to the patient's jurisdiction or residential committees and primary medical and health institutions.
  • After the patient was discharged from the hospital, due to the low immune function in the recovery period and the risk of infection with other pathogens, it is recommended to continue the self-health monitoring for 14 days, wear a mask, and live in a well-ventilated single room conditionally to reduce the close distance with the family Close contact, separate meals, good hand hygiene, and avoid going out.
  • It is recommended to follow up and return to the hospital in the 2nd and 4th weeks after discharge.

Special Considerations

The incubation period is 1-14 days, mostly 3-7 days. The incubation period is contagious, and those with asymptomatic infection may also become the source of infection. If there is a confirmed or suspected history of exposure to the patient, active isolation is required even if there are no symptoms such as fever.
The release of isolation requires that the body temperature return to normal for more than 3 days, the respiratory symptoms improve significantly, and the pathogen detection is negative for 2 consecutive times (at least 1 day apart).

Prevention

When an infectious disease outbreak spreads, measures taken include measures against pathogens, susceptible populations, routes of transmission and epidemic sources.
There is no effective vaccine for the new type of coronavirus pneumonia. Personal protection is the most practical way, including not going to crowds, washing hands, drinking more water, and taking rest.
Specific preventive measures are as follows:
  • Minimize going out, do not go to crowds, and avoid close contact with anyone with cold or flu-like symptoms; When going out to public places, medical treatments, and transportation, pay attention to wearing surgical masks or N95 masks;
  • Do not touch, buy and eat wild animals (ie game) and avoid contact with wild animals and poultry and livestock without protection;
  • Pay attention to hand hygiene, wash your hands frequently, use hand sanitizer or soap, wash your hands with running water, or use alcohol-free hand sanitizer;
  • Do not cover with your hands when sneezing or coughing. Cover your mouth and nose with your elbows or paper towels;
  • Keep the living room and workplace clean, open windows frequently, and maintain ventilation.
  • Pay attention to drink plenty of water, rest, avoid staying up late, and exercise moderately to improve individual immunity; pay attention to nutrition, a reasonable diet, meat, poultry, and eggs should be cooked thoroughly before consumption;
  • Prepare common supplies, such as thermometers, disposable masks, household disinfection supplies, etc.

References

  1. World Health Organization guidelines for New Coronavirus 2019: https://www.who.int/internal-publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov ) -infection-is-suspected.
  2. Diagnosis and treatment plan of pneumonitis caused by a new coronavirus (trial version 6)
  3. National Bureau of Health and Disease Control and Prevention, China Centers for Disease Control and Prevention. Guidelines for public protection of pneumonitis caused by new coronavirus infection [M]. People's Medical Publishing House: Beijing, 2020: 26.
  4. Chinese Rehabilitation Medicine Association: 2019 New Coronary Virus Pneumonia Respiratory Rehabilitation Guidelines (First Edition)
  5. https://en.wikipedia.org/wiki/2019%E2%80%9320_coronavirus_pandemic
  6. https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2
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