COVID-19 TRAINING FOR HEALTHCARE WORKERS

COVID-19 Key Features

Wei David Hao, MD, MS, MPH
S.V. Mahadevan, MD

LEARNING OBJECTIVES
At the end of this lecture, the learner will be able to:
1. Identify key signs and symptoms
2. Define spectrum of illness
3. Describe clinical course of illness

LECTURE OVERVIEW
I. Understand transmission
II. Recognize at-risk populations
III. Define spectrum of illness
IV. Describe typical course of illness
I. UNDERSTAND TRANSMISSION
1. Route

● Respiratory droplets (most likely): coughing, sneezing, talking or breathing

o Typically travel less than 2 meters
o Can remain in the air or land on surfaces
o Individuals can acquire the infection by inhaling the viral particles or touching
contaminated surfaces, such as:
▪ Door handles
▪ Sides of gurneys
▪ Keyboards
▪ Floors
o Be aware that the disease can be spread even before symptoms appear
2. Infectivity

● R0, basic reproduction number, is estimated to be 2 – 3

o 1 person infects about 2 – 3 people
o Eventually, one infected person can potentially trigger an infection of over 6,000
people within weeks.
▪ 1 →3 → 9 → 27 → 81 → 243 → 729→ 2187→ 6561
o This R0 is significantly larger than seasonal influenza
▪ COVID-19 is more easily transmitted from person to person
● The R0 can be reduced through public health interventions:
o Physical distancing
o Mask wearing
o Hand washing
o Vaccination
3. Super-Spreader

● Super-spreaders are more likely to infect others, compared with typically infected
individuals
● For example, in South Korea, Patient 31 went to a mass gathering with contacts of over
1,000 people
● Also, mass gatherings can be super-spreader events if multiple infected individuals
with typical spreading patterns contact many other individuals
4. Incubation

● Incubation can take up to 14 days before symptom onset

o Most patients develop symptoms around 4 days after exposure.
o Different than seasonal influenza
▪ Patients can suddenly develop symptoms within hours of exposure
● However, patients can be infectious before they develop symptoms
o Or, they may never develop symptoms
o This may lead to significant silent spread of disease
5. Case-Fatality Rate (CFR)

● CFR estimates vary from 0.7 – 7.2% depending on the sample population
● The true mortality rate will depend on testing entire populations
● Variants may have different CFRs

6. Variants
● Some variants are concerning due to increased transmission and severity
● The WHO has identified four Variants of Concern (VOC) as of May 11, 2021:

Variant First Identified Location

B.1.1.7 United Kingdom

B.1.351 South Africa

B.1.1.28.1 Brazil and Japan

B.1.167 India

● There are more Variants of Interest (VOI) and potentially emerging VOCs
○ The WHO will continue to track them with global partners
II. RECOGNIZE AT-RISK POPULATIONS
● Advanced age: older patients are at most risk for complications and death
● Cancer
● Cerebrovascular disease
● Chronic kidney disease
● Chronic lung disease
● Diabetes
● Heart disease
● Obesity
● Pregnancy
● Smoking

III. DEFINE SPECTRUM OF ILLNESS

● Not all patients with COVID-19 will develop symptoms

o In Iceland, a large population was tested
▪ 50% of people that tested positive had no symptoms
● Not all patients will develop a severe illness
o Many will recover without knowing that they had the infection
● Others, especially those with risk factors, will be at significant risk of severe illness
IV. DESCRIBE TYPICAL COURSE OF ILLNESS

● About 81% of patients will develop a mild infection around day 4

o Influenza-like illness
▪ Fever
▪ Cough
▪ Sore muscles
o Loss of taste +/- smell
● About 14% of all cases go on to develop a severe illness around day 9
o Shortness of breath
o Severe pneumonia with >50% lung involvement
o Some develop hypoxia
▪ Lack of oxygen in vital tissues
● About 5% of all patients will become critically-ill around day 12
o Respiratory failure often requiring ventilatory support
o Some will develop shock and multiorgan dysfunction
o Some will die while others may recover
▪ Currently no validated scoring systems to identify who are at highest risk for death
● The average time for recovery
o Mild cases: about 2 weeks
o Severe cases: about 3 – 6 weeks or longer
● Additional complications:
o Inflammatory: similar to cytokine release syndrome, although less severe
▪ Multisystem inflammatory syndrome in children (MIS-C): similar to Kawasaki
syndrome and has been described in children in rare cases
o Cardiovascular: range from having no symptoms to arrhythmias, myocardial injury,
heart failure, and cardiogenic shock
o Deep venous thrombosis and pulmonary embolism
▪ Up to ⅓ of ICU patients in some reports
o Neurologic: primarily as encephalopathy, especially in ICU patients
▪ Some patients report persistent symptoms for weeks to months
o Secondary bacterial infections can occur, but are not common