COVID-19 Yo

____________ symptoms are common after receiving the COVID-19 vaccine (80-90%) and include pain, swelling, and erythema at the injection site (may also see axillary lymphadenopathy)

localized

Describe the Pfizer COVID-19 vaccine.

mRNA vaccine given in a 2-dose (0.3 mL) IM injection series, 21 days apart 95% efficacy, 0.6% hypersensitivity rxns stored at -70C, needs to be diluted, mixed, and inverted 10 times prior to administration

Describe the Moderna vaccine.

mRNA vaccine given in a 2-dose (0.5 mL) IM injection series, 28 days apart 94.1% efficacy, 1.5% hypersensitivity rxns stored at -20C, no dilution necessary

____________ symptoms are also common after receiving the COVID-19 vaccine. They are mostly mild-moderate and only last 1-3 days. It does not mean that the individual has the virus, but rather that the immune system is recognizing the vaccine as something it doesn't like and working!

systemic

Who do we test for COVID-19?

* All symptomatic persons * Asymptomatic persons with: - exposure or close contact to COVID+ individual(s) - hospital admits - before surgical procedures - congregate living facilities, schools, etc...

How long are patients observed after vaccine administration?

- 30 minutes if they have a history of an allergic reaction to a vaccine or any history of anaphylaxis of any cause (may be sent home with epi-pen) - 15 minutes for all other persons

What are the risk factors for severe illness in patients with COVID-19?

- Age - Males - Ethnicity (Black, Hispanic, South Asian) - Comorbidities

What the cormorbidities in patients with sever illness due to COVID-19?

- Cardiovascular disease (CAD, CHF) - DM - HTN - Chronic lung disease (COPD) - Cancer - CKD - Obesity - Smoking

What other laboratory tests are affected by COVID-19 infection?

- D-dimer elevation - increased CRP - increased LDH - Troponin elevation - decrease in Absolute Lymphocyte Count

What are the different types of vaccines and a common example of each?

- DNA/RNA (COVID-19 is the first of its kind) - Live attenuated (MMR, Varicella) - Inactivated (Polio) - Viral Vector (Ebola) - Subunit (Hepatitis B, HPV, Pertussis)

What are the adverse effects of Remdesivir?

- Hepatotoxicity (increased LFTs) - Nausea, headache, rash - Infusion reactions

How do we test for COVID-19?

- Nasopharyngeal swab, nasal swab, saliva specimens - *NAAT (amplified reverse transcription PCR) test* preferred over antigen testing *Positive NAAT confirms diagnosis, but a Negative NAAT does not exclude diagnosis due to frequent false negatives* (up to 40%) - IgG antibody testing

What are the two types of COVID-19 vaccines?

- Pfizer-BioNTech - Moderna

What are the pharmacologic treatment options for persons infected with SARS-CoV-2?

- Remdesivir (adenosine nucleotide analogue that competes to get into viral RNA chain, originally developed for Ebola) - Bamlanivimab (mAb) - convalescent plasma?

What other diseases are caused by coronaviruses?

- SARS (severe acute respiratory syndrome) - MERS (middle east respiratory syndrome) - some common colds

What is the management for patients with COVID-19 in the inpatient setting?

- VTE prophylaxis with LMWH - Antipyretics (Tylenol) - Oxygen - Mechanical ventilation if needed - Prone position

What are the most common clinical manifestations of COVID-19?

- cough - myalgias - headache - fever Others may include diarrhea, sore throat, smell/taste abnormalities, dyspnea, nausea/vomiting, conjunctivitis, and derm findings (rash, *COVID toes* - nodules on distal digits)

What is the main mode of transmission of SARS-CoV-2?

- direct person-to-person respiratory transmission (likely droplet, but possibly airborne) - it is transmissible before symptoms develop, with highest transmission rates early in the course of illness (or even prior to symptom onset) - prolonged contact in indoor settings is the highest risk of transmission - possibly transmitted through contact with virus on a surface and then touching a MM - initially thought to have been transmitted via live animals in a seafood market in Wuhan, China

What is the management for patients with COVID-19 in the outpatient setting?

- isolation, infection control - risk assessment - pulse oximetry if needed - *do not use nebulized meds around others* - antipyretics - self-proning

What are the most common AE of the COVID-19 vaccines?

- pain, swelling, redness at the injection site - myalgias/arthralgias - fever, chills - headache - fatigue, malaise - nausea - lymphadenopathy

What are the complications of COVID-19?

- respiratory failure (may require intubation, mechanical ventilation) - cardiac complications - thromboembolic complications (PE, CVA) - neuro complications (encephalopathy) - inflammatory complications

How is bamlanimivab administered?

- should be given ASAP after positive COVID test within 10 days of symptom onset (in context of clinical trial at this point) - IV infusion over 60 minutes

How do you prevent COVID-19 transmission?

- social distancing - wear masks in public - hand hygiene - avoid touching face (eyes, nose, mouth) - clean/disinfect surfaces/objects - adequate ventilation of indoor spaces

What is the preferred quarantine after exposure of COVID-19 (or after symptom onset)?

14 days from date of exposure 10 days may be acceptable or 7 days with negative test within 48 hours of planned end of quarantine *persons must remain asymptomatic throughout quarantine

The SARS-CoV-2 RNA sequence is most similar to what other coronaviruses?

2 bat coronaviruses, making bats the likely primary source of via direct transmission or through an intermediate reservoir/host

Asymptomatic infections take place in ______ - ______ % of cases. Asymptomatic individuals may have objective findings, such as what?

30-40% Some asymptomatic individuals have been found to have opacities as coincidental findings on lung CT

When is the typical onset of clinical manifestations of COVID-19?

4-5 days after onset of exposure

In symptomatic individuals, mild disease is most common (80%) wild mild or no pneumonia. However, the in hospital fatality rate is ______ times higher than influenza.

5

What is an inactivated vaccine?

A dead form of the virus (killed by chemicals or heat) that stimulates an immune response (Polio)

What is a viral vector vaccine?

A harmless virus that contains some viral genes and elicits a stronger immune response than a killed virus (Ebola)

What is a subunit vaccine?

A piece of the viral surface that will focus the immune system on a specific target, but may not elicit as strong of an immune response (HPV, Hep B, Pertussis)

What is a live attenuated vaccine?

A weakened version of the actual virus that stimulates a robust immune response without causing the disease (MMR, Varicella)

What are the contraindications of receiving a COVID-19 vaccine?

Anaphylaxis or any immediate allergic reaction of any severity after receiving a previous dose of an mRNA COVID-19 vaccine or any of its components

What is COVID-19 in comparison to SARS-CoV-2?

COVID-19 = the coronavirus disease 2019 SARS-CoV-2 = the virus that causes the COVID-19 disease

What is the indication for bamlanimivab?

COVID-positive test result in non-hospitalized patients with mild-moderate disease (not requiring oxygen) and who have risk factors for disease (obesity, DM, age > 65 yo, CKD, immunosupression, COPD, CAD, CHF)

What are the contraindications of using Remdesivir?

Drug interactions with hydroxychloroquine or chloroquine and CYP enzymes * No evidence of tertogenicity in pregnancy

What is the indication for Remdesivir treatment?

Infection of SARS-CoV-2 with pneumonia requiring supplemental oxygen (IV infusion over 30 mins with 200 mg loading dose and 100mg qday for 5-10 days) It may reduce time to recovery by 5 days, but no proven mortality benefit

How is MIS-C relevant in the setting of COVID-19?

May present after an infection of SARS-CoV-2 (can be weeks later and COVID-test may be negative)

What is MIS-C?

Multisystem Inflammatory Syndrome in Children * A rare but serious issue involving the inflammation of organs and tissues (heart, lungs, kidneys, brain, blood vessels, etc...) --> symptoms may include fever, rash, tachycardia, tachypnea, conjunctivitis, swelling of the tongue, lips, hands, feet (similar to Kawasaki's disease)

Is Remdesivir recommended in patients on mechanical ventilation or ECMO?

No, only in patients requiring supplemental oxygen (low flow or high flow)

What patients are most likely to be hospitalized?

Pt's with severe dyspnea at rest (unable to speak full sentences) or oxygen saturations less than 90% on room air

SARS-CoV-2 is a _______ virus with an ____________________ and _______________ proteins on its surface.

RNA, envelope, spike

How long does immunity last after infection?

approximately 90 days