Epidemic Alert Support for patients Covid (Coronavirus disease) -19 * Current knowledge

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1- Virologie :

  • RNA viruses wrapped belonging to the family Coronaviridae, genre betacoronavirus
  • In humans: six known species of coronavirus
  1. seasonal hCoV: 220E, OC43, NL63, HKU1
  2. CoV emerging with increased pathogenicity
  • SRAS -The: lethality 10%
  • MERS: lethality 37%
  • SARS-CoV-2 shares
  1. 80% genetic identity with SARS-CoV
  2. 96% identity with a virus bat (Rhinolophusaffinis)

SARS 2

SARS 2 _

2- Epidemiology :

  • Reproduction rate (R0)
  • 2,2 at 3,28
  • Ages patients (years)
  • Way: 55 (+/-13)
  • Median: 59 [15-89]
  • Doubling time
  • 6,4 at 7,5 days
  • Continuous updating of the epidemic dynamics

coronavirus Epidemiology

coronavirus Epidemiology

3- Transmission :

  • Transmission interhumaine
  • average incubation: 5,2 days

Professionnels de santé contaminés :

  • N=1716; 247 sévères/critiques, 5 décès
  • n=40; services de médecine (31), urgences (7), réanimation (2)
  • Proportions augmentant dans le temps de 3% (1er au 11/01) à 7% (12 au 22/01)
  • Cluster six membres, family in Wuhan:
  • two members, hospital visit a close for pneumonia; contamination 4 other members:
  • including a child (7 years) asymptomatic, radiographic abnormalities;
  • and another child (10 years), uncontaminated (wearing mask)

Coronavirus Transmission

4- Protection :

  • Coronavirus ProtectionPrecautions standard andAdditionalOf type " air"And" contact"Precautions reinforced REB = :
  • SHA
  • FFP2 mask
  • On disposable gown (waterproof so care souillants)
  • disposable non-sterile gloves
  • Protective glasses
  • Patient suspect or cases possible = Single room, closed door
  • Case confirmed = Single room, closed door, ideally negative pressure

Élimination EPI en DASRI avant la sortie de la chambre, sauf pour les lunettes et l’APR qui seront retirés après la sortie de la chambre

5- clinical picture, Biological and imaging :

Demography :

  • Median age (years) : 56
  • Women : 63 (46%)
  • Comorbidités: 64 (46%)
  • Cardiovascular : 27 (20%)
  • Diabetes : 14 (10%)
  • Cancer : 10 (7%)

Biology :

  • Leucocytes (/mm3) : 4500
  • Lymphocytes (/mm3) : 800
  • LDH (U / L) : 261
  • Procalcitonine (ng / mL) : 49

Clinique :

  • Fever : 136 (99%)
  • Cough : 82 (59%)
  • Dyspnea : 43 (31%)
  • Myalgies : 48 (35%)
  • Odynophagie : 24 (11%)
  • Diarrhea : 14 (10%)

Evolution :

  • Pass doors : 36 (26%)
  • SDRA : 27 (20%)
  • Acute renal failure : 5 (4%)
  • Septic shock : 12 (9%)
  • Healing : 47 (34%)
  • Death : 14 (14%) ; 6 (4%)

Clinique, imagery :

Clinical and radiological worsening with fatal
Clinical and radiological worsening with fatal
Clinical and radiological improvement at D14
Clinical and radiological improvement at D14

Evolution :

J8 J9 period of clinical worsening
J8 J9 period of clinical worsening

Treatment :

antiviral treatments :

  • patients treated:
  • Oseltamivir: 124 (90%)
  • patients treated: 75 (76%)
  • Oseltamivir
  • Ganciclovir
  • Lopinavir/ritonavir

antibiotics :

  • patients treated:
  • Moxifloxacine: 89 (64%)
  • Ceftriaxone: 34 (25%)
  • patients treated: 70 (71%)

supporting treatments :

  • oxygen therapy: 106 (77%)
  • Mechanical ventilation
  • Non invasive: 15 (11%)
  • Invasive: 17 (12%)
  • dialysis: 2 (1%)
  • ECMO: 4 (3%)

Evolution :

Chinese CDC, n = 72672

  • Confirmed by PCR : 44672 (62%)
  • asymptomatic: 889 (1%)

Demography :

  • Age : (n = 44672)
  • ≥80 years: 1408 (3%)
  • 30-79 years: 38680 (87%)
  • 20-29 years: 3619 (8%)
  • 10-19 years: 549 (1%)
  • <10 years: 416 (1%)
  • Man :  22 981 (51%)

Clinique :

  • clinical form: (n = 44415)
  • moderate: 36160 (81%)
  • Grave: 6168 (14%)
  • Critique: 2087 (5%)

Evolution

  • Death
  • Total: 2.3% (1023/44672)
  • Age ≥80: 14.8% (208/1408)
  • Age 70-79: 8.0% (312/3918)
  • Clinical form criticism: 49.0% (1023/2087)
  • Health professionals N=1716 (3,8%)
  • Wuhan: 63% (n=1080)
  • severe or critical: 14% (n=247)
  • Death: 0,3% (n=5)

Critique :

single-center study, retrospective, ICU, n = 52

Demography :

Middle age (years) : 59,7 (+/-13,3)

Man : 35 (67%)

  • Comorbidités: 21 (40%)
  • cardiac : 5 (10%)
  • respiratory : 4 (8%)
  • cerebrovascular: 7 (13,5%)
  • diabetes : 9 (17%)
  • cancer : 2 (4%)

Clinique :

  • Fever : 51 (98%)
  • Cough : 40 (77%)
  • Dyspnea : 33 (64%)
  • Malaise: 18 (35%)
  • Myalgies : 6 (12%)
  • Rhinorrhée : 3 (6%)

imagery :

  • bilateral pneumonitis :  52 (100%)
  • Median time between onset of symptoms and:
  • diagnosis of pneumonia: 5 (IQR 3-7)
  • admission en USI: 9,5 (IQR 7-12,5)

severity :

  • Score APACHE II: 17 (IQR14-19)
  • SDRA: 35 (67%)
  • Acute renal failure : 15 (29%)
  • Heart failure: 12 (23%)
  • Hepatic insufficiency: 15 (29%)
  • Septic shock : 12 (9%)

Treatment :

  • VNI: 29 (56%)
  • Intubation: 22 (42%)
  • prone: 6 (12%)
  • ECMO: 6 (12%)
  • antivirals (anti-COVID -19) : 23 (44%)
  • antibiotics: 49 (94%)
  • corticosteroids: 30 (58%)
  • immunoglobulins: 28 (54%)

Evolution :

  • Death: 32 (62%)
  • Healing: 8 (15%)

Synthesis :

  • Patients Covid-19
  • The most common clinical signs: fever, cough, dyspnea
  • radiological signs: condensation homes and extensive infiltrates
  • the most common benign forms ; serious or critical: 15 at 20%
  • Possible aggravation  secondary, to-J8 J9 (-SDRA dyspnoea)
  • Issue fatale: death 2% at 14%(according to studies)

6- Supported :

Sheet "Information for EMS and other caregivers 1st line -COREB" updated regularly on the site to see COREB here

The suspect patient BWR if confirmed or excluded ...

MILESTONES
MILESTONES

The suspect patient BWR if confirmed or excluded ...

SYNTHESIS
SYNTHESIS

7- Specimens :

Professionals performing ante lesprélèvements : individual protection equipment (AND)

Type respiratory samples Antique equipment
nasopharyngeal swab and oropharyngé Swabs flocked polyester or dacron
Broncho alveolar lavage Hol sterile
tracheal suctioning, nasopharyngeal aspirate or nasal wash Hol sterile
Expectoration Hol sterile

 

Transport temperature : 4C – Shelf life up to perform the test: If ≤5 days: 4 C, and >5 days: 70 C

coronavirus_protection_6SARS-2 : biological agent group 2, requiring triple packaging:

  • A leakproof primary receptacle
  • A sealed secondary container
  • A rigid outer packaging

Note the virus may be present in the stool, urine ...

SARS-CoV PCR-negative 2, as provided, may require verification

8- Traitements SRAS,  MERS :

  • Lopinavir-ritonavir+Ribavirine:
  • SRAS: 41 infected patients, treated for 21 days, clinical improvement in treated subjects
  • MERS: 76 infected patients, Study in progress (MIRACLE), Saudi Arabia
  • Remdesivir (RDV): Antiviral large spectre
  1. virus murine model of hepatitis (b-coronavirus) : inhibition of viral replication in vitro
  2. MERS: the upper remdesiviractivité LPVrin vitro

coronavirus_protection_7

9- References :

  1. Na Zhu et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. NEJM –24 jan2020 https://www.nejm.org/doi/10.1056/NEJMoa2001017
  2. With Wu et al. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA -24 February 2020
  3. Liu Y et al. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med –13 Fev2020
  4. Imperial College London. Report 3: Estimating the potential total number of novel coronavirus cases in Wuhan City, China. 22 Jan2020  https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-2019-nCoV-transmissibility.pdf
  5. Wu JT et al. Nowcastingand forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet. 2020 Jan 31 https://www.sciencedirect.com/science/article/pii/S0140673620302609?via=ihub
  6. QunLi et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. NEJM –29 jan2020 https://www.nejm.org/doi/full/10.1056/NEJMoa2001316?query=featured_home
  7. Nanshan Chen et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet –29 jan2020 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext
  8. Jasper Chan Fuk-Woo et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet –24 jan2020 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/fulltext
  9. Wang D et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020Feb https://jamanetwork.com/journals/jama/fullarticle/2761044
  10. French Corporation hospitalièrehttps hygiene://www.sf2h.net/avis-sf2h-2019-ncov-publication-de-28-janvier-2020
  11. Xiaoboet al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study Lancet RespirMed 2020 –21 fev2020 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/fulltext
  12. ChaolinHuanget al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet –24 jan2020 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext
  13. French Society for Microbiology  https://www.sfm-microbiologie.org/wp-content/uploads/2020/02/Fiche-nCOV-NL-14022020.pdf
  14. https://www.pasteur.fr/fr/sante-publique/centres-nationaux-reference/materiel-biologique/comment-expedier-ses-echantillons
  15. https://www.legifrance.gouv.fr/affichCodeArticle.do?idArticle=LEGIARTI000018530508&cidTexte = LEGITEXT000006072050&date = 20080501 texte
  16. https://apps.who.int/iris/bitstream/handle/10665/330374/WHO-2019-nCoV-laboratory-2020.1-eng.pdf
  17. CM Chu et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virologicaland clinical findings. Thorax Mar 2004 https://thorax.bmj.com/content/59/3/252
  18. Arabi YM et al. Treatment of Middle East Respiratory Syndrome with a combination of lopinavir-ritonavir and interferon-β1b (MIRACLE trial): study protocol for a randomized controlled trial. Trials Jan 2018 https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2427-0
  19. Maria L. Agostini et al. Coronavirus Susceptibility to the Antiviral Remdesivir(GS5734) Is Mediated by the Viral Polymerase and the Proofreading Exoribonuclease. Race -Mar 2018 https://mbio.asm.org/content/9/2/e00221-18.long
  20. Sheahan TP  et al. Comparative therapeutic efficacy of remdesivirand combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun-January 10 2020  https://www.nature.com/articles/s41467-019-13940-6
  21. Public health France, documentation https://partage.santepubliquefrance.fr/public/folder/1COECj7hj0K9Y0jGNeT0sQ/Novel Coronavirus_Daily Article List_February 2020

Contributions : JM Chapplain-G Mellon (Mission COREB), S van der Werf(CNR coronavirus), B Grandbastien(SF2H), B Hoen (SPILF Emergences),D Malvy D Nguyen (ESR Bordeaux) ref and infectious disease. ESR