COVID-19 (Coronavirus disease 2019) is a highly contagious viral infection. This is caused by the SARS-CoV-2 or severe acute respiratory syndrome coronavirus 2.
Quick Facts
- It infected millions of people and caused almost 6 million deaths worldwide
- The first case of illness was from Wuhan, Hubei Province, China in December 2019 based on reports
- WHO declared COVID-19 a global pandemic in March 2020
- COVID-19 ripped off the global economy
- The virus mutates rapidly
- Bats and rodents are the probable sources of the virus
- SARS-CoV-2 causes respiratory, enteric, hepatic, and neurological symptoms
- The virus can cause mild flu-like symptoms then may progress to MERS or SARS-like symptoms
- The origin is unknown until now
- SARS-CoV-2 targets the vascular and respiratory system
- SARS-CoV-2 has 4 main structures:
- Spike: resembles a crown
- Envelope
- Glycoprotein
- Nucleocapsid
Variants of Concern
According to WHO, there are 5 variants of concern (VOC) as of December 2021. These variants are labeled as highly contagious.
- Alpha (B.1.1.7)
- Beta (B.1.351)
- GAmma (P.1)
- Delta (B.1.617.2)
- Omicron (B.1.1.529)
Variants of Interest
These variants are considered as variants of interest. The mutation of the virus shows that it can be very contagious.
- Epsilon ( B.1.427 and B.1.429) are also variants of concern according to CDC
- Zeta (P.2) CDC called this as variants of concern as well
- Eta (B.1.525) and Iota (B.1.529)
- Theta (P.3) also known as GR/109K.VI
- Kappa (B.1.617.1)
- Lambda (C.37)
- Mu (B.1.621)
Transmission
- Droplet spread: the infected person may transmit this virus through coughing or sneezing. The virus can stick or adhere to something near it such as clothes or skin, especially when it is coughed out. The infected person can either be asymptomatic or symptomatic. Also, they can be presymptomatic.
- Airborne: the virus can be transmitted through the air.
- Fomite: this virus can be transmitted through things. The virus sticks on steel and plastic things. The virus can last up to 28 days at 20 degrees celsius on surfaces such as stainless steel or glass. The virus can be detected within 3 days on surfaces such as plastic and stainless steel.
Risk Factors
Everyone is at risk of harboring this contagious virus. Yet, people with the following medical conditions are at higher risk:
- Cardiovascular disease
- Obese
- Chronic kidney disease
- Chronic lung disease
- Diabetes
- Smokers
- Cancer
- Hematopoietic stem cell transplant patients
- Solid organ transplant patients
Clinical Manifestations
- Patients will develop signs in 11 days after exposure to the virus. The median incubator is known to be 5 days.
- Clinical spectrum: Starts from asymptomatic to paucisymptomatic forms to clinical illness. The clinical illness is characterized by respiratory failure that requires mechanical ventilation. Also, patients may have septic shock and multiple organ failures.
- Symptomatic patients may have a cough, fever, shortness of breath, sore throat, taste disorder (dysgeusia), and loss of appetite. To add, some may develop nausea, malaise, muscle pain (myalgia), loss of smell (anosmia), and diarrhea.
- Most patients remain asymptomatic
NIH (National Institutes of Health) classified COVID 19 into 5 distinct types
- Asymptomatic: Also known as presymptomatic infection. These are people who have a positive test for SARS-CoV-2 but have no clinical signs.
- Mild illness: mild flu-like signs and symptoms such as cough, sore throat, and headache.
- Moderate illness: X-ray results shows signs of lower respiratory tract infection. Oxygen saturation (SpO2) is at greater or equal to 94% on room air.
- Severe illness: Oxygen saturation (SpO2) is less than or equal to 94%, marked rapid breathing that is more than 30 breaths per minute.
- Critical illness: These are patients with acute respiratory failure, septic shock, or have multiple organ failure. Severe COVID- 19 patients may progress to acute respiratory distress syndrome (ARDS). It may occur one week after the start of the symptoms.
Diagnosis
Molecular testing
- Nasopharyngeal swab
- SARS-Cov-2 antigen test
Serology testing
- Antibody test
Others
- CBC (complete blood count)
- CMP (comprehensive metabolic panel): testing for renal function and liver function
- ESR: inflammatory markers
- Chest Xray
- Chest CT
- Lung ultrasound
Treatment
Antiviral Therapy
- Molnupiravur
- Paxlovid
- Remdesivir
- Ivermectin
Neutralizing Antibody products
- Convalescent plasma
- REGN-COV2 (CAsirivimab and Imdevimab)
Immunomodulatory Agents
- Corticosteroids
- Interleukin (IL)-1 Antagonist
Nursing Interventions
- Assess the patient’s severity of illness and manage accordingly.
- Use personal protective equipment to protect yourself and other patients.
- Tell patients who may have signs and symptoms of COVID- 19 to isolate themselves and monitor according to the CDC guidelines.
- Administer medicines as prescribed.
- Notify the healthcare team if there are major changes in the patient’s lab results.
- Educate the patients to do frequent handwashing for 20 seconds with soap and water.
- Educate the patients about the benefits of the vaccine.
- Encourage the patient and their family to follow the CDC guidelines while traveling and social distancing.
- Patients that are at higher risk should be encouraged to get treatment earlier.
