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Hello everyone, Here are some important facts about COVID-19. From Clinical presentations to treatment. Please check it out and feel free to add more points. CLINICAL PRESENTATION: In a study describing 1099 patients with COVID-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were: •Fever in 88% •Fatigue in 38% •Dry cough in 67% •Myalgias in 14.9% •Dyspnea in 18.7% Pneumonia appears to be the most common and severe manifestation of infection. In this group of patients breathing difficulty developed after a median of five days of illness. Acute respiratory distress syndrome developed in 3.4% of patients. Other symptoms •Headache •Sore throat •Rhinorrhea •Gastrointestinal symptoms About 80% of confirmed COVID-19 cases suffer from only mild to moderate disease and nearly 13% have the severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours). Critical illness (respiratory failure septic shock, and/or multiple organ dysfunction/failure) is noted in only in less than 6% of cases. INCUBATION PERIOD: The exact incubation period is not known. It is presumed to be between 2 to 14 days after exposure, with most cases occurring within 5 days after exposure. THE SPECTRUM OF ILLNESS SEVERITY: Most infections are self-limiting. COVID-19 tends to cause more severe illness in the elderly population or in patients with underlying medical problems. As per the report from the Chinese center for disease control and prevention that included approximately 44,500 confirmed Infections with an estimation of disease severity. • Mild illness was reported in 81% of patients. • Severe illness (Hypoxemia, >50% lung involvement on imaging within 24 to 48 hours) in 14%. • Critical Disease (Respiratory failure, shock, multi-organ dysfunction syndrome) was reported in 5 percent. • Overall case fatality rate was between 2.3 to 5%. AGE AFFECTED: • Mostly middle-aged (>30 years) and elderly. • Symptomatic infection in children appears to be uncommon, and when it occurs, it is usually mild. **The 4th version of Belgian guidance for COVID 19 is published on19th March 2020. It is one of the most precise guidelines published yet. Some points from that: 1. Chloroquine is found to have good efficacy in vitro and it reduces the duration of viral shedding. But the drug has a narrow therapeutic window and cardiac toxicity is the most limiting side effect. 2. Hydroxychloroquine is more potent and is superior to chloroquine according to the very recent Gautret’ study. 3. Azithromycin may have a viral suppressive effect, but this needs to be proved as it was noticed accidentally in 6 patients of Gautret’ study. But I think it is a good choice for coverage of bacterial pneumonia. 4. Lopinavir/Ritonavir recently shown not to provide clinical benefit in hospitalized patients with COVID-19. It may reduce ICU stay if given within 10 days of infection but not beyond. 5. Remdesivir is promising but the studies are ongoing. Also, availability is a key issue. 6. Corticosteroids are not recommended as a systemic adjunctive treatment. 7. Paracetamol is the first-line analgesic and antipyretic over NSAIDs which are used with caution. 8. No need to stop ACEIs/ARBs in non-hospitalized patients. CONSIDER changing ACEIs/ARBs to another equivalent antihypertensive in hospitalized patients. 9. Antiviral therapy is not indicated in all patients with suspected/confirmed COVID19.

A 64 year old male on tacrolimus, brought with tachypnea and low O2 saturation (50% RA). Deterioration with fever over a week. Note the miliary appearance of infiltrates in this COVID patient.

Covid19 pneumonia 40 years old male patient (bank employee) with a history of coughing for 2 weeks, becomes febrile 2 days before presentation, the fever is responsive to acetaminophen, then chills and myalgia becomes apparent and he develops dyspnea on exertion. when he presented with ill-looking, fever and chills were significant, his vitals were PR 100, RR 20, peripheral O2 sat 85%, BP 140/90, sublingual Temp 39.5. He had DOE and on chest exam, he had coarse crackles all over both lungs. we immediately admitted this patient giving him nasal oxygenation by cannula, IV fluids, paracetamol IV administration , ABG was done pCO2 42, HCO3 22, pH 7.38, paO2 83. we requested a chest CT scan and yup , multiple patchy ground glass opacities infiltrating the peripherals, thus the patient was isolated immediately, multiple nasal swab specimens were sent for rtPCR. CBC was done . mild leukocytosis with no lymphopenia, no thrombocytopenia ... procalcitonin undetectable.. crp 2+ ... renal, hepatic and cardiac markers were all within normal ranges . the patient was then marked as covid19 pneumonia after the second rtPCR test.( first one negative) hydroxychloroquine 400 mg bid then 200 mg bid and azithromycin 500 mg stat and 250 mg daily were continued for 10 days ... no ECG abnormality was noted. the patient remained in a plateau phase, fever disappeared after 5 days, nasal oxygenation discontinued, only some mild dyspnea and mild cough were noted before discharge ( after 10 days) ... He was lucky, as i have seen people with this presentation undergoing intubation and have a poor outcome.

77 yeas old female with a background notable of metastatic small bowel GIST. The patient is on chemotherapy, HTN, thyroidectomy, cholecystectomy presented with 10 day Hx of intermittent fevers, nonproductive cough, and increased Shortness of breath. PO2 8.8 on FiO2 0.85 on admission Admitted to ICU and Intubated Lung protective ventilation commenced but desaturated to 80% following RIJ CVC. Decompressed by the bedside and a CXR was performed that revealed large pneumothorax. The chest drain inserted with pneumothorax resolved gradually. 1 day after admission the admitting diagnosis was confirmed COVID-19. What are your experiences and knowledge of managing COVID-19 patients? Please discuss

Drs. H, G, and A had an interesting conversation regarding COVID-19 vaccination affecting IVF outcomes. Catch their conversation here.