2020 Symposia Series 1 COVID-19: Update for NPs and PAs Learning - - PowerPoint PPT Presentation

▶
2020 symposia series 1
SMART_READER_LITE
LIVE PREVIEW

2020 Symposia Series 1 COVID-19: Update for NPs and PAs Learning - - PowerPoint PPT Presentation

Oct 09, 2023 131 likes •313 views

2020 Symposia Series 1 COVID-19: Update for NPs and PAs Learning Objectives Describe what is currently known about COVID-19 transmission and how to prevent it Assess current COVID-19 diagnostic strategies Discuss evolving therapeutic

slide-1
SLIDE 1

2020 Symposia Series 1

slide-2
SLIDE 2

COVID-19: Update for NPs and PAs

slide-3
SLIDE 3

3

Learning Objectives

  • Describe what is currently known about COVID-19 transmission

and how to prevent it

  • Assess current COVID-19 diagnostic strategies
  • Discuss evolving therapeutic strategies for patients with COVID-19

infection

slide-4
SLIDE 4

4

US Incidence Rates (5/27/2020)

Johns Hopkins University & Medicine. coronavirus.jhu.edu/us-map. Accessed May 27, 2020.

  • US Cases: 1,681,793
  • US Deaths: 98,933

Key Concerns

  • Transmission
  • Diagnosis
  • Therapeutics
  • Prevention
slide-5
SLIDE 5

5

COVID-19 Is Spread Chiefly by Droplets

  • Droplet

‒ 3 to 6 feet (uncovered, more) ‒ Contaminates surfaces/fomites ‒ Hand to face

  • Airborne

‒ Especially with intubation, suctioning, close exposure ‒ ? Aerosolization of tissue containing virus

  • Other routes

‒ Fecal?

Centers for Disease Control and Prevention. www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html#adhere. Accessed May 27, 2020.

TRANSMISSION

slide-6
SLIDE 6

6

  • Why rapid and global spread?

‒ Asymptomatic shedding

  • Estimates 25% to 50% of infected (CDC/NIAID)?
  • Role of asymptomatic cases affecting models/forecasts
  • Second wave? High risk events?

‒ Church gatherings (indoors) ‒ Mass gatherings

Transmission and Contagiousness

CDC = Centers for Disease Control and Prevention. Redfield R. CDC; Fauci A. NIAID/NIH.

TRANSMISSION

slide-7
SLIDE 7

7

COVID-19: PPE for Healthcare Personnel—CDC Guidelines

Centers for Disease Control and Prevention. www.cdc.gov/coronavirus/2019-ncov/downloads/COVID-19_PPE_illustrations-p.pdf. Accessed 5/27/2020.

TRANSMISSION

slide-8
SLIDE 8

8

Range of COVID-19 Disease States and Potential Therapeutic Targets

Siddiqi HK, Mehra MR. J Heart Lung Transplant. 2020. doi: https://doi.org/10.1016/j.healun.2020.03.012. ARDS = acute respiratory distress syndrome; CRP = C-reactive protein; IL = interleukin; JAK = Janus kinase; LDH = lactate dehydrogenase; SIRS = systemic inflammatory response syndrome.

DIAGNOSIS

slide-9
SLIDE 9

9

  • Descriptions mostly limited to

hospitalized patients

  • Signs, symptoms

‒ Fever (46%-98%) ‒ Cough (46%-82%, usually dry) ‒ Myalgia or fatigue (11%-44%) ‒ Shortness of breath at onset (31%) ‒ Chills

Clinical Presentations

  • Less common symptoms

‒ Pharyngitis ‒ Loss of taste/smell ‒ Headache ‒ Productive cough ‒ GI symptoms

  • May be heralding

‒ Hemoptysis – Leukopenia in ~70% hospitalized patients – LDH often elevated

Chan JF, et al. Lancet. 2020;395:514-523; Huang C, et al. Lancet. 2020;395:497-506; Wang D, et al. JAMA. 2020; [Epub ahead of print]; Zhu N, et al. N Engl J Med. 2020;382:727-733.

DIAGNOSIS

slide-10
SLIDE 10

10

  • Increasing testing capacity, but still

limited in many places

  • Issues with sensitivity of NP swabs

‒ 75% to 85%?

  • Need for additional
  • High clinical suspicion

? need for test

  • Is (+) later in course reflective of

infectiousness?

  • Lower vs upper samples

Diagnostics

  • Rapid molecular diagnostic tests

‒ Cepheid COVID GeneXpert, <45 minutes ‒ Abbott ID Now COVID, <5 min (+), <15 min (–)

NP = nasopharyngeal.

DIAGNOSIS

slide-11
SLIDE 11

11

  • FDA eased approvals, allowing laboratory-developed tests (LDTs)
  • Serology: “No IMMUNITY PASSPORT” likely valid at this time

‒ Many tests now available—unclear how well validated; FDA warnings ‒ Tests have not been reviewed by the FDA ‒ Negative results do not rule out COVID-19 infection (molecular needed) ‒ Results from antibody testing should not be used as the sole basis to diagnose or exclude COVID-19 infection ‒ Results from antibody testing should not be used to inform infection status or protective immunity ‒ Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E

Diagnostics (cont’d)

Food and Drug Administration. www.fda.gov. Accessed May 27 2020; Auwaerter P. Expert Opinion. 2020.

DIAGNOSIS

slide-12
SLIDE 12

12

Many Investigational Therapeutic and Preventive Approaches

Kupferschmidt K, Cohen J. Science. 2020;367:1412-1413.

THERAPEUTICS

slide-13
SLIDE 13

13

www.microbenotes.com/remdesivir/. Accessed May 27,2020. Image created with biorender.com.

Remdesivir: Potential Repurposed Drug Candidate for COVID-19 THERAPEUTICS

slide-14
SLIDE 14

14

Remdesivir: Potential Repurposed Drug Candidate for COVID-19

  • Added data to reduced length of stay
  • RDV patients 31% faster recovery vs placebo

(P <0.001, 11d vs 15 d)

  • 14 d (28 d in analysis)
  • No virologic data
  • Appears safe
  • Mechanically ventilated or ECMO patients don’t appear

to benefit

  • O2 requiring (largest group) most benefit

ECMO = extracorporeal membrane oxygenation; RDV = remdesivir. Beigel JH, et al. N Engl J Med. May 22. doi: 10.1056/NEJMoa2007764. Published ahead of print.

THERAPEUTICS

slide-15
SLIDE 15

15

Several Vaccines in Development

  • 115 candidates
  • >90 currently at exploratory or preclinical stages

‒ 10 in human trials

  • Most advanced candidates now in clinical

development ‒ mRNA-1273 (Moderna) ‒ Ad5-nCoV (CanSino Biologicals) ‒ INO-4800 (Inovio) ‒ LV-SMENP-DC and pathogen-specific aAPC (Shenzhen Geno-Immune Medical Institute)

  • Many others have indicated plans to initiate

human testing in 2020 (eg, J&J, phase 1 testing anticipated Oct. 2020)

COVID-19: Vaccines in Development

Thanh LT, et al. Nat Rev Drug Discov. 2020 [epub ahead of print].

9 22 2 4 4 8 4 2 5 2 9 7 6 8 2 5 2 2 2 2

10 20 30 40 50 60 Exploratory (confirmed) Exploratory (unconfirmed) Preclinical Phase I

Number of Projects Current Stage of Development

Live attenuated virus Inactivated Non-replicating viral vector Replicating viral vector Recombinant protein Peptide-based Virus-like particle DNA RNA Unknown

PREVENTION

slide-16
SLIDE 16

16

Clinical Phase Vaccine Candidates for COVID-19

www.microbenotes.com. Accessed May 27,2020. Image created with biorender.com.

PREVENTION

slide-17
SLIDE 17

17

Moderna Announces Positive Interim Phase 1 Data for its mRNA Vaccine (mRNA-1273) Against Novel Coronavirus

Moderna Press Release. investors.modernatx.com/news-releases/news-release-details/moderna-announces-positive-interim-phase-1-data-its- mrna-vaccine. Accessed May 27, 2020.

  • After 2 doses all participants evaluated to date across the 25g and 100g dose cohorts

seroconverted with binding antibody levels at or above levels seen in convalescent sera

  • mRNA-1273:

⎻ Elicited neutralizing antibody titer levels in all 8 initial participants across the 25g and 100g dose cohorts, reaching or exceeding neutralizing antibody titers generally seen in convalescent sera ⎻ Was generally safe and well tolerated ⎻ Provided full protection against viral replication in the lungs in a mouse challenge model

  • Anticipated dose for Phase 3 study between 25g and 100g: expected to start in

July 2020

PREVENTION

slide-18
SLIDE 18

2020 Symposia Series 1