Epidemiology

of COVID 19
Introduction
• Viral diseases continue to emerge and represent a serious issue to public
health
• Some of viral epidemics in last twenty years
• SARS-CoV (2002 to 2003)
• H1N1 influenza (2009)
• MERS-CoV (2012)
• Present day, an epidemic of cases with unexplained low respiratory infections
detected tracing to beginning of December 2019 in Wuhan, China
• First reported to the WHO Country Office in China, on December 31, 2019
• Unable to identify the causative agent, these first cases were classified as
"pneumonia of unknown etiology."
• The Chinese Center for Disease Control and Prevention (CDC) and
local CDCs organized an intensive outbreak investigation program
• Etiology of this illness is now attributed to a novel virus belonging to
the coronavirus (CoV) family
• This new CoV was announced as "COVID-19," which is the acronym of
"coronavirus disease 2019“ on On February 11, 2020, by WHO
• It was the third of the corona virus epidemics in last twenty years
which was converted into a Global Pandemic
Objectives
• Burden of COVID 19 ( Global, national)
• Etiology
• Transmission
• Clinical features
• Diagnosis
• Management
• Prevention and control
Burden- Global
• WHO raised the threat to the CoV epidemic to the "very high" level,
on February 28, 2020
• On March 11, WHO declared the COVID-19 a pandemic as
• Number of COVID-19 cases outside China has increased 13 times
• Number of countries involved reached to 114 countries
• Total number of cases reached 118,000 cases in and over 4,000 deaths
• Data provided by the WHO Health Emergency Dashboard (April 4,
10.00 am CET) report 1051635 confirmed cases worldwide since the
beginning of the epidemic and 205 countries with reported cases
• 56985 (5.41%) cases have been fatal.
• As per the above data highest number of confirmed cases were
reported in USA ( 241703), followed by Italy ( 119827)
• The most up-to-date source for the epidemiology of this emerging
pandemic can be found at the following sources:
• The WHO Novel Coronavirus (COVID-19) Situation Board
• The Johns Hopkins Center for Systems Science and Engineering site
for Coronavirus Global Cases COVID-19, which uses openly public
sources to track the spread of the epidemic.
• The coronavirus COVID-19 pandemic is the defining global health
crisis of our time
• World governments are at work to establish countermeasures to stem
possible devastating effects
• Health organizations coordinate information flows and issues
directives and guidelines to best mitigate the impact of the threat
• It was estimated a total of US$675 million was needed to help protect
states with weaker health systems as part of its Strategic
Preparedness and Response Plan
• COVID 19 pandemic has the potential to create devastating social,
economic and political crises that will leave deep scars
• Dozens of the world’s greatest cities are deserted as people stay
indoors, either by choice or by government order
• Across the world, shops, theatres, restaurants and bars are closing
• The International Labour Organization estimates that 25 million jobs
could be lost
Burden (India)
• First case of COVID 19 in India was reported on 30th January 2020, in Keral which rose to
three cases by February 3, 2020: all were students returned from Wuhan, China.
• Transmission escalated in the month of March, after several cases were reported all over
the country
• Most of cases were linked to people with a travel history to affected countries
• First death reported was on 12 March, a 76-year-old man who had returned from Saudi
Arabia
• Confirmed cases crossed 100 on 15 March, 1,000 on 28 March and 2,000 on 2 April and
3,000 on 3 April
• Death toll crossed 50 on 1 April
• According to MOHFW, India, by 4th April(09:00PM) a there were a total of 2902
confirmed cases and 68 deaths
• A Sikh preacher that returned from travel to Italy and Germany turned into
"super spreader" by attending a Sikh festival in Anandpur Sahib
• Nearly twenty-seven COVID-19 cases were traced back to him and over 40,000
people in 20 villages in Punjab were quarantined
• On 31 March, a Taglibith Jamat, a religious congregation event that took place
in Delhi in early March emerged as a new virus hotspot
• About 200 people have shown symptoms of the disease of which, 24 people
have been confirmed positive in Delhi so far
• Over 128 cases across the country were found to be linked to the event
• Tamil Nadu reported more than 50 cases in a day, all who had been to the event
• Due to lockdown announcement on 23rd March 2020, as a preventive
measure to contain COVID 19 in India, entire country came to halt
• Except essential services all industries and activities came to halt
resulting a huge negative impact various sectors of country
Etiology
• Coronam is the Latin term for crown
• Corona viruses(CoVs) are positive-stranded RNA viruses with a crown-
like appearance
• COVID 19 belong to betaCov genus of coronaviridae family
• To date, seven human CoVs (HCoVs) — capable of infecting humans —
have been identified
• SARS-CoV, MERS-CoV, were two earlier viruses of the same family
which created epidemics with mortality rates are up to 10% and 35%,
respectively.
Structure of COVID 19
• It has round or elliptic and often pleomorphic form
• Diameter is of approximately 60–140 nm
• It is sensitive to ultraviolet rays and heat and can be effectively
inactivated by lipid solvents
• Genomic analyses suggest that SARS-CoV-2 probably evolved from a
strain found in bats
• The potential amplifying mammalian host, intermediate between bats
and humans, is, however, not known and actual presence of
intermediate host is uncertain
Transmission
• Virus could be transmitted from human-to-human, and symptomatic
people are the most frequent source of COVID-19 spread
• There is a possibility of transmission before symptoms develop
• There were reports of transmission by asymptomatic individuals
• Like other respiratory pathogens, transmission is believed to occur
through respiratory droplets from coughing and sneezing
• Aerosol transmission is also possible in case of protracted exposure to
elevated aerosol concentrations in closed spaces
• Analysis of data related to the spread of COVID 19 indicate that close
contact between individuals is necessary
• Incubation time could be generally within 3 to 7 days and up to 2 week
• Longest time from infection to symptoms was 12.5 days (95% CI, 9.2 to
18)
• Basic reproduction number (R0 - R naught) is 2.2
• Further studies are needed to understand the mechanisms of
transmission, the incubation times and the clinical course, and the
duration of infectivity.
Clinical features
• Clinical spectrum of COVID-19 varies from
• Asymptomatic
• Paucisymptomatic forms
• Respiratory failure that necessitates mechanical ventilation
• Systemic manifestations in terms of sepsis, septic shock, and multiple organ
dysfunction syndromes (MODS)
• Uncomplicated (mild) Illness
• Mild fever, cough (dry), sore throat, nasal congestion, malaise, headache,
muscle pain, or malaise
• Moderate Pneumonia
• Respiratory symptoms such as cough and shortness of breath (or tachypnea in
children)
• Severe Pneumonia
• Fever is associated with severe dyspnea, respiratory distress, tachypnea (> 30
breaths/min), and hypoxia (SpO2 < 90% on room air).
• Cyanosis can occur in children.
• Acute Respiratory Distress Syndrome (ARDS)
• serious new-onset respiratory failure or for worsening of an already
identified respiratory picture
Different forms of ARDS are distinguished based on the degree of hypoxia
• Mild ARDS: 200 mmHg < PaO2/FiO2 ≤ 300 mmHg.
• Moderate ARDS: 100 mmHg < PaO2/FiO2 ≤ 200 mmHg.
• Severe ARDS: PaO2/FiO2 ≤ 100 mmHg. 
• When PaO2 is not available, a ratio SpO2/FiO2 ≤ 315 is
suggestive of ARDS.
• Chest imaging utilized includes chest radiograph, CT scan, or lung
ultrasound demonstrating bilateral opacities (lung infiltrates > 50%), not
fully explained by effusions, lobar, or lung collapse
Sepsis
• The clinical pictures of patients with COVID-19 and with sepsis are
particularly serious
• Reference for the evaluation of multiorgan damage and the related
prognostic significance is the Sequential Organ Failure Assessment
(SOFA) score
THE PECULIAR HISTORY OF THIS
NEW DISEASE
• It foresees that the patient manifests above all fever, which is not very
responsive to antipyretics, and a state of malaise
• A dry cough is often associated
• After 5-7 days, older patients with already impaired lung function
begin to experience shortness of breath and increased respiratory
rate
• In more fragile patients, however, dyspnea may already appear at the
onset of symptoms.
Evaluation
• Routine confirmation of cases of COVID-19 is based on detection of
unique sequences of virus RNA by NAAT such as real-time reverse-
transcription polymerase chain reaction (rRT-PCR)
Current testing strategy for COVID 19 as recommended by ICMR
include:
• All symptomatic people who have undertaken international travel
• All symptomatic contacts of laboratory confirmed positive cases
• All symptomatic health care workers managing respiratory distress /
Severe illness
• Concerning laboratory examinations include
• Normal or decreased total white blood cell count
• Decreased lymphocyte count can be demonstrated
• Lymphopenia appears to be a negative prognostic factor
• Increased values of liver enzymes, LDH, muscle enzymes, and C-reactive
protein can be found
• In critical patients,
• D-dimer value is increased
• Blood lymphocytes decreased persistently
• Laboratory alterations of multiorgan imbalance (high amylase, coagulation
disorders, etc.)
Treatment / Management
• There is no specific antiviral treatment recommended for COVID-19,
and no vaccine is currently available
• The treatment is symptomatic, and oxygen therapy represents the
major treatment intervention for patients with severe infection
• Mechanical ventilation may be necessary in cases of respiratory
failure refractory to oxygen therapy
• Hemodynamic support is essential for managing septic shock
• A lot of trails have been started for treatment/ management of COVID
19 which were in clinical/ pre clinical phase
Prevention
• Preventive measures are the current strategy to limit the spread of
cases
• Control measures must focus on reducing R0 value to less than 1
• Preventive strategies are focused on the isolation of patients and
careful infection control, including appropriate measures to
be adopted during the diagnosis and the provision of clinical care to
an infected patient
The WHO and other organizations have issued the following general
recommendations:
• Avoid close contact with subjects suffering from acute respiratory
infections
• frequently wash hands and use portable hand sanitizer and avoid
frequent contact with their face and
• Avoid unprotected contact with farm or wild animals
• People with symptoms of acute airway infection should keep their
distance, cover coughs or sneezes with disposable tissues or clothes
and wash their hands.
• Strengthen, in particular, in emergency medicine departments, the
application of strict hygiene measures for the prevention and control
of infections.
• Individuals that are immunocompromised should avoid public
gatherings.
• Healthcare workers caring for infected individuals should utilize
contact and airborne precautions to include PPE such as N95 or FFP3
masks, eye protection, gowns, and gloves to prevent transmission of
the pathogen
• Meanwhile, scientific research is growing to develop a coronavirus
vaccine.
• China has announced the first animal tests
• Researchers from the University of Queensland in Australia have also
announced that, after completing the three-week in vitro study, they
are moving on to animal testing
• National Institute for Allergy and Infectious Diseases (NIAID, U.S.A.,
has announced that a phase 1 trial has begun for a novel coronavirus
immunization in Washington state.
Differential Diagnosis
The symptoms of the early stages of the disease are nonspecific. Differential
diagnosis should include the possibility of a wide range of infectious and non-
infectious (e.g., vasculitis, dermatomyositis) common respiratory disorders. 
• Adenovirus
• Influenza
• Human metapneumovirus (HmPV)
• Parainfluenza
• Respiratory syncytial virus (RSV)
• Rhinovirus (common cold
Thank You