Epidemiologi, faktor risiko, definisi

dan manifestasi klinis COVID-19

Dr. Paul Harijanto, SpPD-KPTI

Pelatihan Penanganan Covid-19, Aula RSUP Kandouw, Rabu 29, 30 April 2020,
 Perjalanan kejadian 2019-nCoV

30 Jan WHO
PHEIC
12 /02/20
27 cases
Pneumonia
WMHC

11 Feb2020
COVID-19
 COVID-19
• WHO announced the current outbreak of
coronavirus which was first reported from
Wuhan, China, on December 31, 2019

• The virus has been named “SARS-CoV-2” and

the disease it causes has been named
“coronavirus disease 2019” ( COVID-19)
 11 days
WHO Report 44, WHO report 55,
4 March , 80.422 15 March 2020
China: 81.048
Outside: 72.469

1 day

WHO report 56,

16 March 2020
China : 81077
Outside: 86438

WHO report 65,

9 days 25 March 2020
China : 81.848
)utside : 331.619
RISK FACTORS :
Strong
• residence in/travel to location reporting community
transmission during the 14 days prior to symptom onset
• close contact with a confirmed case
• older age and/or underlying health conditions
• obesity
• smoking
• malignancy
• surgery
( Chinese Center for Disease Control and Prevention , CCDC Weekly / Vol. 2 / No. 8 )
GEJALA KLINIS
 RESPIRATORY MANIFESTATIONS
• UPPER RESPIRATORY INFECTIONS ( Cold, Pharyngitis )
• LOWER RESPIRATORY INFECTIONS PNEUMONIA :
• CAP : Infection of the pulmonary parenchyma acquired from
exposure in the community
Classically divided into “typical” and “atypical” syndromes:
I. “Typical” CAP:
• presents with “typical” severe, acute infection
• infectious agent (usually S. pneumo or H. flu) is culturable/ identifiable
• responsive to cell-wall active antibiotics
II. “Atypical” CAP:
• presentation is usually sub-acute
• causative pathogens are difficult to culture/identify by standard methods
• not responsive to penicillins
• Viral pneumonia
MANIFESTASI
KARDIO VASKULER
 MANIFESTASI
SISTIM KULIT

20.4%Cutaneus manifestations:
- Erythrmatous rash
- Urticaria
- Chicken –pox like vesicle
( Dr. S . Recalcati, Italy )
MANIFESTASI
SISTIM KULIT
13 patients :3 pts discharged uncomplicated pregnancy
10 pts SC ( 5 emergency due to : with multidicipline approach )
- 3 Fetal distress
- 1 Premature rupture of membrane
- 1 stillbirth MANIFESTASI
- 6 pts (46%) , preterm labour 32-36 weeks due to PADA
- MOF, ARDS, ARF, ALF, septic shock
- 12 pts discharged KEHAMILAN
- 1 pts severe pneumonia

7 pts , 37-41 weeks

• All SC
• 2 pts chronic ilness hypothyroid & POS
• 3 uterine scraring
• Multidisicipline approach
• Good outcome for mothers and child
Neurological manifestations :
febrile seizures, convulsions, change in mental status, and encephalitis, nasal infection,,
causing inflammation and demyelination [
MANIFESTASI
SISTIM SARAF

214 pts, 36.4% had neurological manifestations :

• CNS : Headache, dizziness, convulsion, 24.8%
• Peripheral Nervous S: 8.9%, taste & smell
impairment
• Skeletal muscle injury: 10,7%
Incidence of 3% (1/41)-79% (159/201), gastrointestinal symptoms of COVID-19
included:
• anorexia 39.9% (55/138)-50.2% (101/201), MANIFESTASI
• diarrhoea 2% (2/99)-49.5% (146/295), GASTRO INTESTINAL
• vomiting 3.6% (5/138)-66.7% (4/6),
• nausea 1% (1/99)-29.4% (59/201), & HATI
• abdominal pain 2.2% (3/138)-6.0% (12/201) and
• gastrointestinal bleeding 4% (2/52)-13.7% (10/73).

• 2 – 11% Liver co morbid

• 16 -53% Abnormal ALT and AST
• The more severe covid-19, the more higher liver abnormality
 Psychiatric
Manifestation in
Covid-19
• Occur in patient, public & health workers
• Anxiety 44.7%
• Stress 73.4%
• Depression 50.7%
• Emotion
• Insomnia 36.1%
Endocrine Manifestation in Covid-19

• DIABETES increased mortality & morbidity

• OBESITY
• UNDERNOURISHMENT
• HYPOADRENALISM
 “ Conjunctival congestion “
Conjunctival hyperaemia
MANIFESTASI Chemosis
Epiphora
PADA MATA Increased secretions
MANIFESTASI
SISTIM MUSCULO-SKELETAL
Case Definition And Surveillance
• ILI and Pneumonia surveillance
have to be strengthened AND
ensure all ILI and/or pneumonia
cases being asked for travel
history, residences and possible
close contact-→ meet case
definition
• If suspected case found,
immediately contact local
authority for further follow up on
case investigation and contact
tracing as containment measure.
 Case Definitions:
Case Definition Surveillance
Close • Face-to-face contact with a probable or confirmed case within 1 meter
Contact: and for more than 15 minutes;
• Direct physical contact with a probable or confirmed case;
• Direct care for a patient with probable or confirmed COVID-19 disease
without using proper personal protective equipment;
• Other situations as indicated by local risk assessments.
Suspect: • Patient with acute respiratory illness (fever and at least one sign/symptom
of respiratory disease, e.g., cough, shortness of breath), AND a history of
travel to or residence in a location reporting community transmission of
COVID-19 disease during the 14 days prior to symptom onset
• Patient with any acute respiratory illness AND having been in contact with
a confirmed or probable COVID-19 case in the last 14 days prior to
symptom onset
• Patient with severe acute respiratory illness (fever and at least one
sign/symptom of respiratory disease, e.g., cough, shortness of breath;
AND requiring hospitalization) AND in the absence of an alternative
diagnosis that fully explains the clinical presentation
 Case Definitions:
Case Definition After Testing Performed
Confirmed: • A person with laboratory confirmation of COVID-19 infection, irrespective
of clinical signs and symptoms
Probable: • A suspect case for whom testing for the COVID-19 virus is inconclusive.
• A suspect case for whom testing could not be performed for any reason
Hu et all :
• 24 cases asymptomatic :
• 20.8% developed stmptom fever, cough
• 50 % typical GGO
• 20.8% strip shadowing in the lung
• 29.2% normal CT scan & symptoms

• None have symptoms fever, cough, breathless, headache

• 62.5% had history of contact cases Covid-19
• Physical exam no abnormality of pneumonia
• CT scan strongly pneumonia
• 25 % developed symptom
• 50% CRP increased
 COVID-19
• On January 30, 2020, the International Health
Regulations Emergency Committee of the World
Health Organization declared the outbreak a
“public health emergency of international
concern external icon” (PHEIC).

• On January 31, 2020, Health and Human Services

Secretary Alex M. Azar II declared a public health
emergency (PHE) for the United States to aid the
nation’s healthcare community in responding to
COVID-19.
CLINICAL COURSE & DISCHRGE / MORTALITY