COVID-19: BABY DISEASE STILL GROWING 01/12/2020

MOHAMED ELNADY

COVID-19:
BABY DISEASE STILL GROWING
Mohamed Elnady
Prof. Of Chest Diseases
Director of chest unit New Kasr Al-Aini
Teaching Hospital
Cairo University
Member of covid-19 scientific
committee for the Egyptian
Ministry of Health
hakimnady@hotmail.com
COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY

IMMUNOLOGICAL PASSPORT
COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY
COVID-19: BABY DISEASE STILL GROWING
MOHAMED ELNADY
The most difficult
scientific challenge for
this future vaccine
obtained in the
laboratory is the proof
of clinical safety and
efficacy.
International Journal of Molecular
MedicineJuly-2020 Volume 46 Issue 1
01/12/2020
International Journal of Molecular
Vaccine safety MedicineJuly-2020 Volume 46 Issue 1
The safety of the vaccine is initially assessed in laboratory studies with mice or
rabbits. If the animals do not show signs of disease after receiving the vaccine,
then the tests begin in humans, and the number of subjects gradually increases:
In phase I, also called the first human test, the vaccine is given to a small group
of healthy volunteers (10 to 100). The purpose is not to test whether the vaccine
protects against the disease, but whether it is safe or whether it causes severe
side effects.
In phase II, the candidate vaccine is administered to a larger group of subjects
(100-1,000), and in phase III, to an even larger group (1,000-100,000). Separate
studies may be required in adults, children and the elderly.
COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY
COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY

What's really going on? Are these patients actually

getting infected again?
Reason No. 1: Virus fragments remained in
the patient's body. Recent data has shown
that patients expel leftover materials from
their lungs during the recovery phase, and
these dead cells can produce FALSE positive
test results.

This is part of the healing process, but

Respiratory epithelial cells have a
doesn't mean these patients have been half-life of up to 3 months.
reinfected.
COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY

What's really going on? Are these patients actually

getting infected again? Are these patients infectious then?

Reason No. 2: Inaccurate test

results regarding chemicals Unfortunately, there's still no concrete answer in the
used in the test, and the way studies to date, but experts from both China and South
the sample was collected and Korea say there is an "extremely low risk" for these
stored.
patients to infect others.

NOT REINFECTION

HIV & HBV HIV

# CORONA

NOT REACTIVATION
COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY

• 40% of confirmed cases reported mild disease -- i.e.

treatment is symptomatic and can be managed at home,
and does not require inpatient care;
• 40% of confirmed cases reported moderate disease – i.e.
can be managed either at home, or as inpatient;
• 15% of confirmed cases reported severe disease – i.e.
requires oxygen therapy, has dyspnea, hypoxia, or >50
percent lung involvement on imaging within 24 to 48
hours;
In terms of the impact of age on severity, to date,
most of the fatal cases have occurred in patients
with advanced age or underlying medical
comorbidities.
Known risk factors for severe COVID-19 are age
>60 years, hypertension, diabetes, cardiovascular
disease, chronic lung disease, cancer and
immunocompromising conditions.

• 5% of confirmed cases reported critical disease – i.e. Pregnancy is not considered high risk for severe diseases.
requires mechanical ventilation, has respiratory failure,
shock, or multiorgan dysfunction.

Potential anti-viral drugs

❖ HydroxyChloroquine 400mg/12hrs 1st day followed by 200mg/12hrs for 6days

❖ Ivermectin 6mg ( 36mg on day 0-3-6)

❖ Favipiravir 1600mg twice daily 1st day then 600mg twice daily

❖ Remdesivir 200mg Ivon day 1 , followed by 100mg IV daily for high risk
population for 5 days that could be extended to 10 days if the resonse is
unsatisfactory

❖ Lopinavir/Ritonavir 200/50 mg 2 tablat PO BID

COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY

COVID-19 Associated Coagulopathy

COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY

Mild case HOME

ISOLATION
Symptomatic case With lymphopenia or leucopenia with
no radiological signs for pneumonia

* Hydroxychloroqunie ( 400mg twice in 1st

day then 200mg twice for 6days)
* OR Ivermectin 6 mg ( 36 mg on day 0-3-6)
* OR Favipiravir 1600 TWICE daily 1st day
then 600mg twice daily
* Zinc 50mg daily
+
International Journal of
* Acetylecystine 200mg t.d.s
Research in Health Sciences,
Vol 8, Issue 1, Jan-Mar, 2020
* Lactoferrin 1 sachet twice daily
* Vit C 1 gm daily.
COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY

Treatment dose:
64-96 mg (20-30 ml) every 6 h daily to cure COVID-19 (256-384
mg/d). Doses can be increased to 128 mg every 6 h (512 mg) if
needed.

Preventive dose:
64 mg two to three times daily can prevent COVID-19 (128-192
mg/d).

- Pregnant women: 64 mg (20 ml) twice a day (128 mg/d).

- Infants: 32 mg (10 ml) twice daily.

Zinc Defense syrup: 10-30 mg/d (10-30 ml)

Moderate case Severe case

Patient has pneumonia manifestations on radiology associated RR>30, SO2<92 at room air , PaO2/FiO2 ratio<300, chest radiology showing
with symptoms &/or leucopenia or lymphopenia more than 50% lesion or progressive lesion within 24 to 48 hrs
Anti virals Anti-coagulant Anti-inflammatory Convalescent
antivirals Immune-modulators Anti-coagulation prophylactic plasma
Anto-i-inflammatory
Anticoagulation if D- Steriods
Remdesivir ( Dexamethasone 6 mg
Before day 12
Hydroxychloroquine + Steroids • Prophylactic dimer between 500-
Or or Methyl prednisolone ( under clinical
Ivermectin or ( if patients has severe anticoagulation if D-dimer 1000 therapeutic ant-
dyspnea ) RR >24 Or CT scan between 500-1000 Admit ( 1mg /kg/24hrs)
Lopinavir/ coagulation if D-dimer trial)
showing rapid deterioration • Therapeutic to
Lopinavir / ritonavir Dexamethasone 6 mg or its anticoagulation if D- >1000 Tocilizumab
or interm- Ritonavir 4-8 mg/kg/day for 2 ( after scientific
oral equivalent dimer >1000 Or if severe hypoxia
ediate doses 12 to 24 hrs
care apart after failure of committee aproval
Remdesivir for high risk
population with SaO2<92 steriod therapy to
improve the case for 24
hrs
COVID-19: BABY DISEASE STILL GROWING 01/12/2020
MOHAMED ELNADY

Tocilizumab
Early block the HFNO is an imp. modality in
4-8
storm if
Critically ill patients steroids failed
mg/kg/dose
2dose
the early management of
critically ill patients.
if SaO2< 92,.or RR>30 or PaO2/FiO2 <200 despite Oxygen therapy
Anti virals Anti-coagulant Anti-inflammatory Antiviral
prophylactic drugs
Steroids
Anticoagulation Prone Avoid
Methyl Hypoxia
as is in Severe prednisolone
Enoxaparine awake or
O2/NIV/HFNC/I
Therapeutic Steriods case 1mg/kg BID ventilated
Remdesivir ( Dexamethasone 6 mg or Methyl
1-2mg/kg/d MV

Anticoagulation
Admit Or prednisolone ( 1mg /kg/24hrs)
to ICU
Lopinavir/Ritonavir Tocilizumab
4-8 mg/kg/day for 2 doses 12 to Don’t wait too
1mg for non- Consider Improve much for any
24 hrs apart after failure of steriod Add anti-biotics
V/Q type of
As per ventilated & D-dimer
therapy to improve the case for 24 2mg for level matching support
protocol
hrs ventilated As a guide & survival Keep
plateau<30

POST COVID SYNDROME