COVID: NLE UPDATES / Dr.

Florence Grageda

COVID 19 CONCEPTS & COMMON BOARD QUESTIONS

SPIKE PROTEIN / S PROTEIN

- key for Coronavirus to ENTER the CELL
- key in MAKING the VACCINE
- in understanding GUIDELINES, TREATMENT, and PREVENTION
- has AFFINITY to the ALVEOLI where ACE 2 receptors are, specifically: Type II
alveolar cells which also produces SURFACTANT cells
"The shorter the serial interval, the higher rate of transmissibility"
“COVID was initially DROPLET. AIRBORNE if this become AEROSOLS.”

STEAM INHALATION / "Suob"

- AEROSOLS
- SHOULD NOT BE RECOMMENDED
- SHOULD BE AVOIDED OR MINIMIZED
- "When we steam, we inhale then exhale. This virus is being aerosolized - yung
virus nag-suspend sa air. It will be in air for a longer period of time, which can now
be an AIRBORNE TRANSMISSION.
- also in Air Conditioners
- both in HOT and COLD temperatures

"After completing quarantine for 14 days, no need for re-swab unlike last year"
"Remnants are still there that's why they are still positive even after completing the
quarantine"
"Asymptomatic for the last 3 days of quarantine – you're already free to go out and
considered not infectious"

MODE OF TRANSMISSION
- Still DROPLET
INCUBATION PERIOD: 2 – 14 days
Too early or way beyond: FALSE NEGATIVE RESULT

BEST TIME FOR SWAB / RT–PCR

- 5th – 7th day, average: 6th day
- Rationale: time wherein there is that VERY HIGH VIRAL LOAD
- even if asymptomatic

ACE 2 receptors are also found in the GIT

- in the jejunum and duodenum
- that's why it is possible to have DIARRHEA

“MAJORITY of ACE 2 receptors are found in the LUNGS”

Renin – Angiotensin – Aldosterone System (RAAS)

- Angiotensin II: proinflammatory ; not only increases BP but also initiates
IMMUNE RESPONSE to produce INFLAMMATORY CELLS
- Will try to NEUTRALIZE virus in the LUNGS

CRP: C –Reactive Protein

- One of the test in COVID
- produced in the LIVER
- produced when there is INFLAMMATION
- “Liver is already sensing that there is inflammation”

Where do antibodies come from? – PLASMA CELLS

INTERLEUKIN 6 (IL 6) – PROINFLAMMATORY
INTERLEUKIN 10 (IL 10) – ANTI INFLAMMATORY ; autoimmune diseases - control or
block IL 10
“Face–to–face contact without mask + within 1 meter + more than 15 minutes =
HIGH–RISK”

RT–PCR
- GOLD STANDARD IN DIAGNOSING COVID 19

3 MOST COMMON SYMPTOMS:

1. FEVER
2. COUGH
3. SHORTNESS OF BREATH
ANOSMIA: loss of sense of smell and AGEUSIA: loss of taste – common in new
variants, especially ANOSMIA

ENDOTRACHEAL INTUBATION
- for 2 weeks only
- more than 2 weeks: prone to infection
CT Scan
- presence of GROUND GLASS OPACITIES
Complete Blood Count
- HIGH LYMPHOCYTES - viral infection
- more than 12,000
- either LEUKOCYTOSIS or LEUKOPENIA

COVID + Pneumonia
- Tx: AZITHROMYCIN + CEFUROXIME

HAND WASHING
- MOST COMMON AND MOST IMPORTANT WAY OF PROTECTING SELF

“ALCOHOL BASED HAND RUB SHOULD BE AT LEAST 60%”

PRONING
- promote LUNG EXPANSION posteriorly and anteriorly
- para hindi naiipit alveoli
- 3x a day (30–120 minutes)
- STILL DEPENDS WITH PATIENT’S TOLERANCE
- CONSIDER COMFORT OF PATIENT

QUARANTINE – those who are EXPOSED

ISOLATE – SICK PEOPLE / (+) RT–PCR

4 STATIONS DURING VACCINATION

1. Assessment – meds taken are asked
2. Vital Signs are obtained
3. Vaccination
4. Monitoring – asked to wait to observe for possible side effects

Pfizer
- Booster dose after 6 months then annual vaccination – because of mutations

STOP / PREVENT / HAMPER VIRUS

- at least 70% OF POPULATION should be vaccinated to achieve HERD
IMMUNITY
- R NAUGHT MUST BE LESS THAN 1