What we should know about

COVID-19!
 Corona Virus
• Corona virus, an enveloped RNA virus, is the
etiological agent of following diseases but of
different strains
• COVID-19- COrona VIrus Disease 2019
• SARS- Severe Acute Respiratory Syndrome
• MERS- Middle East Respiratory Syndrome
 How many cases in India?
• Till 4.3.2019, 28 cases
• Rajasthan- 17
• UP-6
• Kerala – 3
• Delhi-1
• Hyderabad -1
 Clinical features
Common symptoms Uncommon symptoms
• Fever • Diarrhea
• Productive cough • Vomiting
• Breathlessness • Headache
• Body pain • Hemoptysis
• Sore throat • Chest pain
• Poor appetite
• Incubation period = 2-14 days( median 5 days)
• Mode of transmission – droplet infection, also
through direct contact
• Avoid hand shakes!
 When should I suspect COVID-19?
• Patients with LRTI symptoms( not URI) and
with
– Recent travel to high risk countries in last 14 days
– Exposure to COVID-19 patients in last 14 days
 How to take the samples?

• RT-PCR is the recommended test

• Nasopharyngeal swab – transported at 2-4
degree celsius in viral media
• ET aspirate/BAL – in Sterile container – at
room temp
 Where to send the samples?
• Private practitioners in TN cannot send samples
directly
• Suspected Patients are sent to Rajiv Gandhi
Government General Hospital, MMC(Adults) or
ICH, Egmore(Children)
• Samples are taken in respective institutions and
sent to King’s Institute, Guindy, Chennai
• (Note- whether to take samples or not will be
decided in respective institutes)
• From there, samples are sent to National institute
of Virology, Pune
 CXR/ CT findings
• Infiltrates
• Consolidation
• Mottling
• Ground glass appearance
• Pleural effusion is rare
• All of them not specific for COVID 19
 Antiviral drugs tried(not proven)
• Lopinavir
• Ritonavir
• Ganciclovir
• Oseltamivir
• Remdesivir
• Interferon alpha
Dose of Lopinavir/Ritonavir in Children
Weight Lopniavir(mg/kg) Ritonavir(mg/kg)
7-15 kg 12 mg/kg 3mg/kg
16-40kg 10 mg/kg 2.5mg/kg
> 40kg 400mg 100mg

• Given twice a day for 7-14 days

 Role of steroids
• May be useful in
• Severe pneumonia
• ARDS
• Encephalopathy
• HLH
• Septic shock
• Presence of wheeze

• IV Methylprednisolone 1-2 mg/kg/day

• Course 3-5 days
• Long course of steroids(like Meduri protocol in ARDS due to other
causes) is not recommended
 Can I start Oseltamivir for OPD
patients?
• Not recommended
• Can be useful for hospitalised patients with
severe pneumonia/ARDS
 What is the role of IVIg?
• Not proven
• May act as an immunomodulator in severe
diasease
 Is Chloroquine useful?
• Chloroquine was found to be useful in SARS-
Co-2
• At present, not useful in COVID-19
 Should I use N 95 mask?
• Indications for N-95 masks
• For health care workers handling positive patients
during
– Intubation
– Open suctioning
– Bronchoalveolar lavage
– Handling HFNC
– Nebulization
– Non Invasive Ventilation
– In patients with Tracheostomy tube
– During CPR
 Should I avoid nebulization in my
clinic?
• Yes, if positive cases are reported in your
locality
• Better to avoid nebulization as it increases the
risk of spread of droplets to longer distances
• Reliever therapy via Inhaler can be a better
alternative
 Which is a better oxygen delivery
device who requires low flow oxygen?
• O2 prongs is a better option when compared
to simple face mask
 A person in the flight in which I
travelled was positive!
• Need not panic
• If you were seated more than 2 seats radius
from the affected person, the risk of infection
is less
• Case fatality rate is only 3.4%
 Is quarantine poses additional risk of
infection?
• If the space between two beds in quarantine
is less than 6 feet, it poses higher risk
 What are the high risk countries
should I avoid travel?
• China
• South Korea
• Italy
• France
• Iran
• Japan
 Prevention
• Hand hygiene
• Frequent hand washing with soap
• Surgical mask in contact with positive cases( o
course to the patients)
• Avoid touching the face and adjusting the mask(!)
• Maintain at least 6 feet distance from the positive
cases
• No vaccine available!
Are children resistant to COVID-19?
• Probably yes
• Less than 1% of positive cases are under 18
years of age
 Are Pediatricians safe as incidence in
children is very less?
• No
• All children are brought by adults
Thank You