COVI D-19 Upda te E pi (tiny bit), c linic al manife statio ns, - - PowerPoint PPT Presentation

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COVI D-19 Upda te E pi (tiny bit), c linic al manife statio ns, - - PowerPoint PPT Presentation

Mar 09, 2023 177 likes •383 views

COVI D-19 Upda te E pi (tiny bit), c linic al manife statio ns, diagno stic s, tre atme nt, & pre ve ntio n Bria n Sc hwa rtz, MD Pro fe sso r o f Me dic ine UCSF , Divisio n o f I nfe c tio n Dise a se s Outline E pi upda te

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SLIDE 1

COVI D-19 Upda te

E pi (tiny bit), c linic al manife statio ns, diagno stic s, tre atme nt, & pre ve ntio n

Bria n Sc hwa rtz, MD Pro fe sso r o f Me dic ine UCSF , Divisio n o f I nfe c tio n Dise a se s

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SLIDE 2

Outline

  • E

pi upda te

  • Vira l pa tho g e ne sis
  • Clinic a l dise a se
  • Dia g no stic s
  • T

he ra pe utic s

  • Pre ve ntio n
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SLIDE 3

Outline

  • E

pi update

  • Vira l pa tho g e ne sis
  • Clinic a l dise a se
  • Dia g no stic s
  • T

he ra pe utic s

  • Pre ve ntio n
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SLIDE 4

E pide mio lo g y

Case s De aths Wor ldwide Unite d State s

https:/ / c o ro na virus.jhu.e du/ us-ma p

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SLIDE 5

Outline

  • E

pi upda te

  • Vir

al pathoge ne sis

  • Clinic a l dise a se
  • Dia g no stic s
  • T

he ra pe utic s

  • Pre ve ntio n
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SLIDE 6

SARS-Co V-2  COVI D-19

SAR S-CoV-2 binds ACE

  • 2 r

e c e ptor Patie nt with se ve r e COVID-19

?

Inflammator y ge ne e xpr e ssion in patie nts who die d of COVID-19 vs. Influe nza A

Ac ke rma nn M. NE

  • JM. 2020

Wide spr e ad thr

  • mbosis and

mic r

  • angiopathy
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SLIDE 7

Outline

  • E

pi upda te

  • Vira l pa tho g e ne sis
  • Clinic al dise ase
  • Dia g no stic s
  • T

he ra pe utic s

  • Pre ve ntio n
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SLIDE 8

Clinic a l Ma nife sta tio ns o f COVI D-19

E NT : L

  • ss o f sme ll/ ta ste

L ungs: Pne umo nia -> ARDS GI: Dia rrhe a , N/ V, tra nsa minitis E ye s: Co njunc tivitis Ne ur

  • logic al: de lirium, stro ke s? ?

CV: Myo c a rditis, c a rdio myo pa thy Skin: Ac ra l e rythe ma ? ? He me : T

hro mb o sis

Constitutional: F

e ve r -> c yto kine sto rm

Multisyste m Inflammator y Syndr

  • me in Childr

e n Asymptomatic 17%

Mild - mode r ate 67%

Se ve r e 12% ICU 4% Asymptomatic gr

  • ups:

P r e-symptomatic: sympto ms la te r Asymptomatic: ne ve r sympto ms

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SLIDE 9

Outline

  • E

pi upda te

  • Vira l pa tho g e ne sis
  • Clinic a l dise a se
  • Diagnostic s
  • T

he ra pe utic s

  • Pre ve ntio n
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SLIDE 10

Dia g no stic s

R T

  • PCR

:

  • Prima ry me tho d fo r Dx o f COVI

D-19

  • Na so pha ryng e a l swa b
  • Se nsitivity ~80%

Se r

  • logy (IgM/ IgG):
  • L

a te Dx o f COVI D-19

  • I

g M do e s no t o ffe r muc h

  • Se nsitivity va rie s b y te st
  • E

pide mio lo g ic a l surve y

  • Do na te c o nva le sc e nt pla sma
  • Va c c ine re spo nse

Antige n:

  • Ve ry ra pid (15 mins)
  • Re duc e se nsitivity vs. RT
  • PCR
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SLIDE 11

Vira l dyna mic s

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SLIDE 12

Outline

  • E

pi upda te

  • Vira l pa tho g e ne sis
  • Clinic a l dise a se
  • Dia g no stic s
  • T

he r ape utic s

  • Pre ve ntio n
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SLIDE 13

T re a tme nts b e ing studie d fo r COVI D-19

T ho rlund K e t a l. L a nc e t

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SLIDE 14

Re mde sivir

  • I

nhib its vira l RNA po lyme ra se

  • Administe re d intra ve no usly
  • I

n vivo (mo nke y) COVI D-19 mo de l sug g e ste d b e ne fit

  • Studie s via NI

AI D a nd Gile a d

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SLIDE 15

Pre limina ry da ta fro m Re mde sivir RCT

Be ig e l JH. NE JM 2020; Go ldma n JD. NE

  • JM. 2020
  • RCT

, b linde d pla c e b o c o ntro l

  • 1063 ho spita lize d pa tie nts
  • Sho rte ne d time to re c o ve ry
  • 11 vs. 15 da ys (p<0.001)
  • T

re nd to de c re a se d mo rta lity

  • 7.1% vs. 11.9%
  • Mo st b e ne fit - hypo xic / no t intub a te d
  • I

n no n-ve ntila te d pa tie nts 5d = 10d

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SLIDE 16

Hydro xyc hlo ro q uine

Pr e ve ntion

  • Asympto ma tic a dults e xpo se d to

COVI D+

  • RCT

, HCQ vs. pla c e b o x 5 da ys

  • 1º e ndpo int: COVI

D Dx o r COVI D Sx in 14d

  • 821 e nro lle d
  • HCQ 11.8% (49) vs. pla c e b o 14.5%

(58), p=0.35

  • No b e ne fit HCQ to pre ve nt COVI

D

T r e atme nt

  • Ho spita lize d pa tie nts COVI

D+

  • RCT

, HCQ vs. usua l c a re

  • 1º e ndpo int 28-da y mo rta lity
  • 1542 HCQ vs. 3132 usua l c a re
  • HCQ 25.7% (1542) vs. usua l c a re

23.5% (3132); p=0.10

  • No b e ne fit o f HCQ o n mo rta lity o r

ho spita l sta y

Bo ulwa re DR. NE

  • JM. 2020

https:/ / www.re c o ve rytria l.ne t/

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SLIDE 17

Co nva le sc e nt Pla sma

  • What is c onvale sc e nt plasma?

Se rum fro m pa tie nts with re so lve d COVI D (a nti-COVI D I g G)

  • Is it be ing use d c ommonly?

Ye s, >20K do se s g ive n in US

  • Is it safe ? Ye s
  • Is it e ffe c tive ? 1 RCT

…?

https:/ / www.usc o vidpla sma .o rg / ;

R CT : Plasma infusion vs. standar d of c ar e

  • 1º e ndpoint: Clinic a l impro ve me nt a t 28d
  • 55 se ve re dise a se (hypo xia w/ o intub a tio n)
  • 91% (plasma) vs. 68%; HR

2.15, p=0.03

  • 59 with life -thre a te ning dise a se (intub a te d)
  • No diffe re nc e
  • L

imitations: Unde rpo we re d, he te ro g e no us

b a c kg ro und tre a tme nt

  • Conc lusion: Co nva le sc e nt pla sma ma y impro ve
  • utc o me s in no n-I

CU COVI D pa tie nts.

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SLIDE 18

Outline

  • E

pi upda te

  • Vira l pa tho g e ne sis
  • Clinic a l dise a se
  • Dia g no stic s
  • T

he ra pe utic s

  • Pr

e ve ntion

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SLIDE 19

Pre ve ntio n