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Clinical presentation and management of COVID ‐19

Irani thevarajan.

1 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne VIC

2 University of Melbourne, Melbourne VIC

Kirsty L Buising

Benjamin c cowie.

3 WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne VIC

  • The rapid spread of severe acute respiratory syndrome coronavirus 2 led to the declaration of a global pandemic within 3 months of its emergence.
  • The majority of patients presenting with coronavirus disease 2019 ( COVID ‐19) experience a mild illness that can usually be managed in the community. Patients require careful monitoring and early referral to hospital if any signs of clinical deterioration occur.
  • Increased age and the presence of comorbidities are associated with more severe disease and poorer outcomes.
  • Treatment for COVID ‐19 is currently predominantly supportive care, focused on appropriate management of respiratory dysfunction.
  • Clinical evidence is emerging for some specific therapies (including antiviral and immune‐modulating agents). Investigational therapies for COVID ‐19 should be used in the context of approved randomised controlled trials.
  • Australian clinicians need to be able to recognise, diagnose, manage and appropriately refer patients affected by COVID ‐19, with thousands of cases likely to present over the coming years.

In December 2019, a novel coronavirus emerged in Wuhan, Hubei Province, China, leading to a global pandemic. The virus, named severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), causes a clinical syndrome termed coronavirus disease 2019 (COVID‐19).

The first reports of an undiagnosed pneumonia in Wuhan on 8 December 2019 were followed by an alert from China to the World Health Organization (WHO) about a cluster of pneumonia cases on 30 December. Isolation of a novel coronavirus occurred on 3 January 2020. On 30 January, the WHO declared a public health emergency of international concern, and a pandemic was declared on 12 March 2020.

Clinical presentation

Similar to other coronaviruses, SARS‐CoV‐2 is predominantly spread by respiratory droplets, although spread by contact with contaminated fomites also occurs, as does transmission by aerosols in certain circumstances. 1

Based on the experience in China, the typical incubation period of COVID‐19 infection has been estimated to be a median of 5.1 days (95% CI, 4.5–5.8 days), with 97.5% of those who develop symptoms doing so within 11 days of exposure (95% CI, 8.2–15.6 days). This has informed the use of a 14‐day time period for quarantining potentially exposed individuals in an effort to limit onward spread. 2

The recognition of asymptomatic infection has been an area of intense interest in understanding the epidemiology of COVID‐19. The ratio of asymptomatic to symptomatic infection is currently uncertain. Cross‐sectional studies have reported asymptomatic infection in women attending a maternity service in New York (33 of 215 infected, 88% asymptomatic) 3 and in general population testing in Iceland (87 of 10 797 infected, 41% asymptomatic). 4 In such cross‐sectional studies, a proportion of those who were asymptomatic at the time of testing may in fact have been in the pre‐symptomatic phase of infection. In a study conducted in a nursing home in the United States, 48 of 76 residents tested positive, with 27 (56%) being asymptomatic at the time of testing. However, 24 (89%) of these individuals went on to develop symptoms at a median of 4 days (interquartile range [IQR], 3–5 days) after the positive test result. 5

Symptomatic COVID‐19 infection usually presents as a respiratory syndrome, most commonly with fever and cough. 6 , 7

Fever has been reported in up to 99% of people at some time during the course of their illness, but importantly in one cohort, it was reported to be present at the time of hospital presentation in only 44% of patients, and at some time during the hospital admission in 89%. 8 Other common symptoms are cough, dyspnoea, fatigue, anorexia, anosmia, myalgia and sometimes confusion. Diarrhoea may occur in up to 10% of patients. 9 Symptoms reported less frequently (< 5% of cases) include sore throat, rhinorrhoea, headache, chest pain, dizziness, abdominal pain and nausea. 6 , 7

Around 80% of COVID‐19 infections present as a mild respiratory illness in a patient who is ambulatory and can generally be managed outside the hospital. Around 15% typically need hospital care (usually for moderate to severe pneumonia), and another 5% have critical illness requiring more intensive supports. 10

Of those who require hospitalisation, the median time from first symptoms to onset of dyspnoea is 5 days (IQR, 1–10 days), the median time to hospital admission is 7 days (IQR, 4–8 days), and in those who develop more severe manifestations, the median time to acute respiratory distress syndrome is 8 days (IQR, 6–12 days). 6 About a quarter of patients who are hospitalised may need transfer to the intensive care unit (ICU) for the management of complications such as hypoxaemic respiratory failure or hypotension requiring vasopressor support. 11

At presentation to hospital, the most common laboratory feature of COVID‐19 infection is lymphopenia (reported in 70.3% of cases). 6 Radiological imaging may reveal a clear chest, unilateral or bilateral consolidation, or ground glass opacity.

Nasopharyngeal specimens, deep nasal swabs, throat swabs or lower respiratory samples (eg, sputum) sent for molecular detection of SARS‐CoV‐2 by polymerase chain reaction (PCR) are currently the best means of specific diagnosis of COVID‐19 in Australia. Faecal samples may also be PCR positive for COVID‐19 but the role of the oral–faecal route for transmission remains unclear. 12 Patients with more severe disease tend to have higher viral loads in respiratory samples. Mild cases have been shown to clear the virus earlier, with over 90% returning negative PCR test results by day 10 compared with severe cases who more often remain positive beyond day 10. 13 Viral loads appear to be highest early in the illness. Prolonged viral shedding after the onset of symptoms has been described. 14 The virus has also been detected by PCR in asymptomatic patients with comparable viral loads to those still symptomatic. 15

Patients with suspected or confirmed COVID‐19 should be assessed for features of severe disease and risk factors for progression to severe disease. This assists in determining whether a patient can safely be managed in the community or requires referral and admission to a health care facility able to provide acute inpatient care. Current data suggest that older patients and those with comorbidities have increased risk of progression to severe disease and mortality. In a large surveillance report from China including over 44 000 confirmed cases of COVID‐19, the case fatality rate was < 0.5% for patients aged < 50 years, but rose to 8.0% for those in their 70s, and 14.8% in those aged > 80 years. 16 While these surveillance‐based case fatality rates are possibly overestimates, being influenced by under‐recognition of lower severity cases, the impact of increasing age and the presence of comorbidities on risk of severe and fatal illness should be recognised, 8 and such patients should generally be offered more careful monitoring.

Clinical features that have been identified more often in COVID‐19 infected patients who have had a fatal outcome compared with those who survive are: dyspnoea at presentation (70.6% v 24.7%; P  < 0.001); lower initial oxygen saturation (median oxygen saturation, 85% [IQR, 75–91%] v 97% [IQR, 95–98%]; P  < 0.001); and higher total white blood cell count but lower lymphocyte count at presentation accompanied by a lower lymphocyte count, expressed as a lower lymphocyte percentage (median, 7.1% [IQR, 4.5–12.7%] v 23.5% [IQR, 15.3–31.3%]; P  < 0.001). 17 In developing a predictive model, Chinese researchers found four factors independently associated with disease progression during hospitalisation in 208 consecutive patients: presence of comorbidity, age > 60 years, lymphocyte count < 1.0 × 10 9 /L, and elevated lactate dehydrogenase levels. 18

A propensity for deterioration in the second week of illness has been recognised in some cohorts of patients, typically 5–10 days after the onset of symptoms. 19 All patients should be warned about symptoms of concern (such as increasing breathlessness), and early referral for hospital admission should be suggested for any patient with signs of clinical deterioration. Individual circumstances need to be considered when determining the ideal monitoring strategy and site of care for each patient ( Box ).

Assessing disease severity and consideration for setting of care for patients diagnosed with COVID‐19

Adapted from World Health Organization interim guidance, 21 Australasian Society for Infectious Diseases interim guidelines, 20 and National COVID‐19 Clinical Evidence Taskforce living guidelines. 19

General management

It is critically important to ensure optimal infection prevention from the time a patient with suspected COVID‐19 is first assessed until their infection is resolved, irrespective of the site of care. This can present particular challenges for health care staff, who must learn to use personal protective equipment safely, and for patients and their loved ones who must manage the difficulties associated with isolation.

Patients with mild disease (about 80%) 10 can often be managed in the community if they are able to self‐isolate. They must also be capable of monitoring their own condition, be aware of which symptoms should prompt medical review, and be able to escalate any concerns. 19 , 20 , 21 For some patients, a more proactive program of monitoring by phone or telehealth or in‐person monitoring (eg, hospital in the home, regular review by general practitioner, or hospital admission) may be required. Strategies for care should be individualised to suit patient circumstances. Patients whose home environment is not conducive to safe management, or which is unacceptable from an infection prevention perspective, may require admission either to hospital or to alternative safe accommodation. Discussion with public health authorities is essential to ensure that appropriate isolation and follow‐up mechanisms are in place. In the face of high health care demand during the peak of a pandemic, safe management of low risk patients in the community will likely be essential to preserve hospital capacity for the more severely ill.

Patients with moderate or severe illness will generally require admission to hospital. This includes those who are dyspnoeic on minor exertion, tachypnoeic at rest (respiratory rate > 22 breaths/min), hypoxaemic (pulse oximetry [SpO 2 ] < 94% on room air), hypotensive (systolic blood pressure < 100 mmHg), have an acutely altered mental state, or who have extensive pulmonary infiltrates evident on chest imaging. 19 , 20 , 21

Severe illness, indicated by, among other features, a respiratory rate > 30 breaths/min, SpO 2  < 92% on room air 19 , 21 or sustained hypotension, warrants urgent hospitalisation and consideration of the need for intensive care if suitable for a given patient.

Respiratory management

Supplemental oxygen should be administered for patients with SpO 2  < 92%. 19 , 20 Once stabilised, the target SpO 2 range is usually 92–96%. The target will be lower in those with chronic hypercapnoeic respiratory failure (eg, 88–92%). 19 , 20 , 21

Manoeuvres to improve gas exchange should be implemented, such as positioning patients appropriately in bed (on either side with regular turning), elevating the bed head to 30 degrees, encouraging deep breathing every hour while awake, sitting patients out of bed every day when possible, and mobilising when able. For mechanically ventilated patients with persistent hypoxaemia, prone positioning may be effective. 19 , 22

In the setting of progressive hypoxaemia despite low or moderate flow oxygen (via nasal prongs or Hudson mask), high flow oxygen can be considered. Whether high flow oxygen devices (> 10 mL/min) are potentially aerosol‐generating is being studied, but current guidelines 1 , 23 advise that airborne precautions be taken by staff (personal protective equipment including N95/P2 masks) and single rooms where possible.

There are emerging views that the respiratory dysfunction observed in COVID‐19 infections is not uniform. 22 Initial recommendations have focused on consideration of early intubation and mechanical ventilation for patients with acute respiratory distress syndrome due to COVID‐19. 1 , 19 , 20 , 21 Experience from a multicentre Italian COVID‐19 patient cohort suggests that non‐invasive ventilation such as continuous positive airways pressure and bilevel positive airways pressure may also have a role both within and outside ICUs. 24 These non‐invasive ventilation devices are clearly aerosol‐generating and as such should only be used with appropriate precautions in place. 1 , 23 Advice from experts in respiratory medicine or critical care should be sought.

Other management considerations

Empirical antibiotic therapy for bacterial pneumonia should be considered in patients whose illness is severe, where there is evidence of sepsis or septic shock, or where the patient is clinically deteriorating. 19 , 20 Empirical treatment for influenza with a neuraminidase inhibitor should be considered for patients with severe pneumonia (guided by local epidemiology) until influenza PCR results are available. 20 , 21 Empirical antibiotics are not recommended for patients with mild or moderate pneumonia unless there is additional clinical evidence to suggest bacterial infection. De‐escalation of empirical antimicrobial therapy should be undertaken as appropriate, guided by microbiology results (where available) and clinical judgement. 21

Hypovolaemia may be contributed to by reduced oral intake and increased losses, but management requires cautious administration of intravenous fluids with regular assessments given the risk of exacerbating pulmonary oedema in the setting of acute respiratory distress syndrome 19 , 22 and given the possibility of underlying cardiac injury. 25

A range of possible complications related to SARS‐CoV‐2 infection have been reported and their incidence is being monitored. These include thromboembolic events in the lungs 22 and cerebrovascular system, 26 Prophylaxis with anticoagulants for adults with moderate, severe or critical COVID‐19 infection is generally recommended, unless there are contraindications. 19 , 21 Acute cardiac injury presenting with electrocardiogram changes, arrhythmias, left ventricular dysfunction, cardiomyopathy and congestive cardiac failure have also been described, and assessment of baseline electrocardiogram is suggested for patients with moderate or severe COVID‐19 illness. 25 , 27

There is considerable interest in monitoring large patient cohorts and conducting analysis of linked datasets at a population level to establish whether there are any rare or longer term complications or associations of COVID‐19 with other medical conditions. Given the very recent emergence of SARS‐CoV‐2, data are currently limited but it is likely that information will emerge in coming months from populations that have experienced a high attack rate. An example of a rare condition with potential association is paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2, presenting as hyperinflammatory shock with features similar to atypical Kawasaki disease. 28 Similarly, there is interest in monitoring long term incidence of cardiovascular complications, thromboembolic disease, chronic respiratory dysfunction, renal or neurological disorders, and post‐infectious inflammatory syndromes after COVID‐19, in addition to inspection of large datasets for complications that are as yet unsuspected.

Specific therapies

A range of pharmacotherapies have been proposed as possible treatments for COVID‐19. Early evidence of clinical benefit for some agents has emerged. The WHO interim guidance on the clinical management of COVID‐19 21 asserts that investigational therapeutics should be used only in approved randomised controlled trials. This position is endorsed by the Australasian Society for Infectious Diseases interim guidelines for the clinical management of COVID‐19 in adults, 20 and the Australian guidelines for the clinical care of people with COVID‐19, 19 which state that even where conditional recommendations for use of disease modifying agents are made, whenever possible these should be administered in the context of randomised trials with appropriate ethical approval.

The understandable interest in evaluating potential treatments has led to a large number of clinical trials being registered globally; by late April 2020, over 1100 clinical studies were registered, including over 500 randomised controlled trials. 29

Antimicrobials

Lopinavir–ritonavir.

Lopinavir–ritonavir, a combined antiretroviral agent, was proposed as a potential treatment for severe acute respiratory syndrome in 2003, based on apparent reductions in mortality in preliminary research in Hong Kong. 30 Given its hypothesised role, five of the first 18 patients diagnosed with COVID‐19 in Singapore were administered this agent. 31

On 18 March 2020, a randomised controlled open label trial of lopinavir–ritonavir in 199 hospitalised adults with COVID‐19 in China was published. 32 No benefit was observed in participants treated with the antiviral compared with controls. Nearly 14% of those receiving lopinavir–ritonavir were unable to complete 14 days of treatments owing to adverse events.

Chloroquine and hydroxychloroquine

Chloroquine and hydroxychloroquine are antimalarial agents which also have immunomodulatory properties that led to established indications for use in the treatment of rheumatological conditions. Potential adverse effects include retinal toxicity, QT interval prolongation and other cardiological and dermatological effects.

In early February 2020, chloroquine was reported to inhibit SARS‐CoV‐2 replication in vitro. 33 By mid‐February, treatment of COVID‐19 with chloroquine was being described as a “breakthrough”: a published letter stated that the results of treatment in over 100 patients in China had demonstrated that chloroquine was “superior to the control treatment”, but no data were provided. 34 A small French open label non‐randomised clinical trial examining hydroxychloroquine with or without azithromycin suggested a significant viral load reduction in those receiving therapy; 35 however, concerns have been raised about the design and analysis of the study. 36

Despite the lack of clinical evidence from randomised clinical trials, several institutional and local guidelines, and notable public figures, have supported the potential use of chloroquine or hydroxychloroquine for the treatment of COVID‐19. 37 , 38

However, given the current lack of evidence of clinical benefit and reports of significant limitations of supply of hydroxychloroquine for patients with rheumatological conditions, in March 2020, the Pharmaceutical Society of Australia and the Australasian Society for Infectious Diseases called for immediate cessation of prescribing and dispensing of hydroxychloroquine for indications relating to COVID‐19, outside use in approved clinical trials. 39 , 40

On 5 June 2020, the chief investigators on the RECOVERY trial (comprising over 11 500 patients enrolled from hospitals across the United Kingdom) issued a press release stating that no beneficial effect of hydroxychloroquine had been observed. 41 No difference in 28‐day mortality, duration of admission, or other outcomes were observed between the 1542 patients randomised to hydroxychloroquine and the 3132 patients randomised to usual care. Further details regarding this analysis are awaited.

In January 2020, the first patient diagnosed with COVID‐19 in the US received the investigational nucleotide prodrug remdesivir, supplied on a compassionate basis. 42 Developed as a potential therapy for Ebola, there is in vitro evidence that remdesivir inhibits replication of coronaviruses, including Middle East respiratory syndrome coronavirus and SARS‐CoV‐2. 33 , 43 By late March 2020, four clinical trials to assess the efficacy of remdesivir against COVID‐19 had commenced in the US and two were registered in China. 44 On 29 April, results of the first randomised clinical trial conducted in China were published; 45 while this found no clinical benefit of remdesivir, the trial was underpowered (237 participants) owing to the success of public health measures in controlling COVID‐19 in China. The authors noted a non‐significant numerical reduction in time to clinical improvement in patients commencing treatment earlier in the course of illness.

On 27 May 2020, the first positive results of a randomised double‐blind controlled trial of a treatment for COVID‐19 were published. 46 This international multicentre study reported the preliminary results of 1059 hospitalised patients who received up to 10 days of remdesivir or placebo. Those receiving remdesivir had a significantly shorter median recovery time of 11 days compared with 15 days for those receiving placebo (rate ratio for recovery, 1.32; 95% CI, 1.12–1.55; P  < 0.001); no significant difference in mortality was found. Benefit was reported for the group requiring oxygen but not yet requiring invasive or non‐invasive ventilatory support. This new evidence has led Australian national guidelines to adopt a conditional recommendation for use of remdesivir outside of a trial setting where necessary. 19

Combination therapy with interferon beta‐1b, lopinavir–ritonavir and ribavirin

In May 2020, a randomised trial in Hong Kong reported results of a comparison of lopinavir–ritonavir alone ( n  = 24) with a combination of lopinavir–ritonavir, ribavirin and subcutaneous interferon beta‐1b ( n  = 52). 47 The combination group experienced a faster median time to viral clearance (7 days v 13 days; P  < 0.0001) and shorter median length of hospital stay (8 days v 15 days; P  = 0.0030) if the combination was commenced in the first 7 days from symptom onset. Importantly, the cohort of patients studied was not particularly unwell, with very few requiring ICU support and no deaths in the group.

Immunomodulatory treatments

Corticosteroids.

Interim guidance from the WHO states that corticosteroids should not be used in routine treatment of COVID‐19. 21 This is based on systematic reviews in the context of severe acute respiratory syndrome and Middle East respiratory syndrome which showed lack of effectiveness, and possible harm. 48

In a study of 138 hospitalised patients with COVID‐19 in Wuhan, 49 72.2% of ICU patients and 35.3% of non‐ICU patients received glucocorticoid therapy. The authors commented that while the dose of methylprednisolone varied depending on disease severity, no effective outcomes were observed.

However, on 22 June 2020, a preliminary report regarding interim findings from the UK RECOVERY trial suggested that low dose dexamethasone (6 mg daily orally or intravenous for 10 days) may substantially reduce mortality in hospitalised patients with COVID‐19 who received supplemental oxygen or mechanical ventilation. 50 In comparing 2104 patients randomised to receive dexamethasone with 4321 randomised to receive usual care, dexamethasone was found to reduce mortality by 35% (rate ratio, 0.65; 95% CI, 0.51–0.82; P  < 0.001) among ventilated patients, and for those receiving oxygen without mechanical ventilation, mortality was reduced by 20% (rate ratio, 0.80; 95% CI, 0.70–0.92; P  = 0.002). No benefit of dexamethasone was observed among hospitalised patients who did not require respiratory support. While peer review and formal publication of this analysis is awaited, it is likely that these findings will be reflected in national and international guidelines.

Interleukin 6 antagonists

Tocilizumab is a humanised monoclonal antibody which binds to interleukin 6 (IL‐6) receptors, resulting in reduced immune activation and inflammation. It is licensed in Australia for use in autoimmune conditions including rheumatoid arthritis and giant cell arteritis. In addition to complications of immunosuppression including serious infections, adverse effects include hepatotoxicity and gastrointestinal complications. The theory behind use of tocilizumab or other agents that target the IL‐6 pathway (eg, sarilumab) in the context of COVID‐19 is that part of the pathogenesis in some patients may be attributable to an acute inflammatory syndrome or cytokine storm, which is associated with elevated IL‐6 levels. Clinical trials of these agents are currently underway. 44

Other agents

Numerous immunomodulatory agents have been proposed as potential adjunctive treatments for COVID‐19, with a range of different immunological targets including other inflammatory cytokines. These include anakinra (an IL‐1 receptor antagonist), bevacizumab (an antivascular endothelial growth factor agent), and eculizumab (which inhibits terminal complement and prevents formation of the membrane attack complex). 44 , 51 While clinical trials are underway overseas for several proposed agents, no data exist to support their use at this time. 44

Passive immunotherapy

A preliminary, uncontrolled case series of five critically ill Chinese patients with COVID‐19 who received convalescent plasma containing high SARS‐CoV‐2‐specific antibody titres was published on 27 March 2020. 52 While improvement in clinical status was reported following this intervention, the small sample size and uncontrolled nature of the study precludes drawing any conclusions regarding the efficacy of this intervention. Once again, further research is needed.

Holistic care

A global pandemic causes understandable fear and anxiety for many people in the community. For those at particular risk of worse outcomes of infection — older people and those with significant pre‐existing illness or multiple comorbidities — COVID‐19 represents a particular threat. In addition, the health care workforce is under substantial strain and faces a potentially overwhelming challenge in delivering care to patients. Ensuring emotional care for the most vulnerable and those experiencing high levels of stress will be a fundamental determinant of the resilience of our society during this challenge.

For vulnerable and frail patients at particular risk of poor outcomes, it is important to provide personalised care and to develop an understanding of each individual's perspectives and preferences for health management. Involving caregivers and family members in decision making and establishing goals of care is necessary. 21 Discussing goals of care early and, where appropriate, assisting patients to make advance care directives or resuscitation plans early in illness (or before infection) may provide substantial peace of mind and allow families to face the pandemic openly and with unity as they support vulnerable loved ones.

It is essential to ensure that all patients receive the best standard of care irrespective of the setting in which the care is delivered, or of the existence of any proposed limitations to life‐extending interventions. Under no circumstances should the best possible symptom control and compassionate, individualised care be denied any patient affected by COVID‐19.

SARS‐CoV‐2 has caused a global pandemic with a profound public health impact, changing the daily lives of billions of people. It has exposed weaknesses in even strong and well resourced health systems internationally, and the economic impact alone will be staggering.

However, never before has the global community had the tools currently available to address a pandemic threat. A strong commitment to social and public health strategies and communicable disease control will ensure our health system retains the capacity to address COVID‐19, including sufficient hospital and intensive care resources to care for those with severe illness.

Biomedical innovations such as new and rapid point‐of‐care diagnostics, effective specific treatments and preventive vaccines are very high priorities which are rightly attracting substantial attention and funding. In the interim, high quality, evidence‐based clinical care — scaled up to face the pandemic challenge — together with robust public health interventions will save the lives of thousands in Australia, and millions globally.

Competing interests

No relevant disclosures.

Commissioned; externally peer reviewed.

Acknowledgements

We gratefully acknowledge the contributions of Anna Deng, Louis Irving, Ashleigh Qama and Lien Tran to this article.

The unedited version of this article was published as a preprint on mja.com.au on 8 April 2020

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Covid-19 teaching resources.

presentation of covid 19 ppt

Your students may have a lot of questions about COVID-19, from how it spreads to how it is detected and how it can be treated. This presents a rich opportunity to teach key concepts in biology through the lens of an ongoing real-world context. Bio-Rad offers a flexible array of hands-on kits, free resources, and lessons to help you teach the biology and detection of the SARS-CoV-2, the virus that causes COVID-19.

The Biology of SARS-CoV-2 and Detection Methods

What Is the SARS-CoV-2 Coronavirus?

What Is the SARS-CoV-2 Coronavirus?

Help your students understand the biology of SARS-CoV-2 by reviewing its origin, structure, and ways to prevent the spread of infection. This PowerPoint presentation walks you and your students through key biology concepts of the SARS-CoV-2 coronavirus.

Download PPT (PPT 16.3 MB)

How Do We Detect COVID-19?

How Do We Detect COVID-19?

Every day brings new developments in the race for effective and accurate COVID-19 testing, but most strategies are based on a few key fundamental technologies. This PowerPoint presentation explains some fundamental techniques and emerging strategies in COVID-19 detection.

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ELISA Antibody Detection

ELISA Antibody Detection

Several existing and emerging SARS-CoV-2 detection methods rely on the specificity of antibodies. In this activity, use real antibodies to determine whether simulated patients are or were infected with SARS-CoV-2.

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Animation of PCR

PCR Detection

Investigate the real life spread of SARS-CoV-2 that occurred in a restaurant. In this activity, students use agarose gel electrophoresis to analyze pre-amplified DNA samples from simulated patients and propose ways the virus may have spread.

This activity uses the ​ Virus Detection and Transmission Kit .

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History of PCR

Real-Time PCR Detection

Real-time PCR is currently the gold standard for COVID-19 diagnosis. In this activity, use real-time PCR to detect SARS-CoV-2 in simulated patient samples. Students analyze amplification and melt curves to determine which patients are positive and then quantify viral RNA.

This activity uses the reagents and DNA samples from the Crime Scene Investigator PCR Basics Real-Time PCR Starter Kit .

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ELISA Paper Model Activity

Your students can use this paper model activity to get a solid grasp of the components of an ELISA and how they work together in antibody/antigen detection.

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Animation of PCR

Animation: ELISA Antibody Test Animation: ELISA Antigen Test

Visualize two types of ELISA in these step-by-step animations.

Animation: Polymerase Chain Reaction

The steps of PCR are best visualized through animation.

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Clinical Presentation

Clinical considerations for care of children and adults with confirmed COVID-19

‹   View Table of Contents

  • The clinical presentation of COVID-19 ranges from asymptomatic to critical illness. An infected person can transmit of SARS-CoV-2 before the onset of symptoms. Symptoms can change over the course of illness and can progress in severity.
  • Uncommon presentations of COVID-19 can occur, might vary by the age of the patient, and are a challenge to recognize.
  • In adults, age is the strongest risk factor for severe COVID-19. The risk of severe COVID-19 increases with increasing age over 40 years and with increasing number of certain underlying medical conditions .

Incubation Period

Data suggest that incubation periods may differ by variant of the virus. Meta-analyses of studies published in 2020 identified a pooled mean incubation period of 6.5 days from exposure to symptom onset. (1) A study conducted during high levels of Delta variant transmission reported an incubation period of 4.3 days, (2) and studies performed during high levels of Omicron variant transmission reported a median incubation period of 3–4 days. (3,4)

Presentation

The clinical presentation of COVID-19 ranges from asymptomatic to severe illness, and COVID-19 symptoms may change over the course of illness. Symptoms can overlap with those of other viral respiratory illnesses. Because symptoms may progress quickly, close follow-up is needed, especially for older adults, people with disabilities, people with immunocompromising conditions, and people with medical conditions that place them at greater risk for severe illness or death. People with COVID-19 may be asymptomatic or experience one or more of the following symptoms (5) :

  • Fever or chills
  • Shortness of breath or difficulty breathing
  • Myalgia (Muscle or body aches)
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting

The NIH COVID-19 Treatment Guidelines  group SARS-CoV-2 infection into five categories based on severity of illness:

  • Asymptomatic or pre-symptomatic infection : people who test positive for SARS-CoV-2 using a virologic test (i.e., a nucleic acid amplification test [NAAT] or an antigen test) but who have no symptoms that are consistent with COVID-19.
  • Mild illness : people who may have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell) but who do not have shortness of breath, dyspnea, or abnormal chest imaging.
  • Moderate illness : people who have evidence of lower respiratory disease during clinical assessment or imaging and who have an oxygen saturation (SpO 2 ) ≥94% on room air at sea level.
  • Severe illness : people who have oxygen saturation <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 ) <300 mm Hg, a respiratory rate >30 breaths/min, or lung infiltrates >50%
  • Critical illness : people who have respiratory failure, septic shock, and/or multiple organ dysfunction

Asymptomatic and presymptomatic presentation

Studies have documented infection with SARS-CoV-2 in people who never develop symptoms (asymptomatic presentation) and in people who are asymptomatic when tested but then develop symptoms later (presymptomatic presentation). ( 6,7 ) However, it is unclear what percentage of people who have asymptomatic infection progress to clinical disease (presymptomatic presentation). People can experience asymptomatic SARS-CoV-2 infection, including people who are up to date with their vaccines  and people who were previously infected. (8) Multiple publications have reported cases of people with abnormalities on chest imaging that are consistent with COVID-19 very early in the course of illness, even before the onset of symptoms or a positive COVID-19 test. (9)

Common COVID-19 symptoms

Fever, cough, shortness of breath, fatigue, headache, and myalgia are among the most commonly reported symptoms in people with COVID-19. (5) Some people with COVID-19 have gastrointestinal symptoms such as nausea, vomiting, or diarrhea, sometimes prior to having fever or lower respiratory tract signs and symptoms. (10) Loss of smell and taste may be reported initial symptoms of COVID-19. (11)

Uncommon COVID-19 symptoms

Less common presentations of COVID-19 can occur. Older adults may present with different symptoms than children and younger adults. Some older adults can experience COVID-19 infection accompanied by delirium, falls, reduced mobility or generalized weakness, and glycemic changes. ( 12)

Several studies have reported ocular symptoms associated with COVID-19 infection, including redness, tearing, dry eye or foreign body sensation, discharge or increased secretions, and eye itching or pain. ( 13 )

A wide range of dermatologic manifestations have been associated with COVID-19; timing of skin manifestations in relation to other COVID-19 symptoms and signs is variable. ( 14) Some skin manifestations may be associated with increased disease severity. ( 15 ) Images of cutaneous findings in COVID-19 are available from the American Academy of Dermatology .

Transmission

People who have asymptomatic or symptomatic infections can transmit SARS-CoV-2, with varying rates and timelines for transmission. ( 16) Both people who have been vaccinated and those who have not been vaccinated can transmit virus. ( 17,18) Clinicians should consider encouraging all people to test for COVID-19 as recommended by CDC , protect themselves and others from infection by getting vaccinated, wear a high-quality mask  when recommended, and follow guidance based on community risk . Clinicians should also consider advising people who are infected with COVID-19 to follow CDC guidelines  for isolation.

Table of Contents

  • › Clinical Presentation
  • Clinical Progression, Management, and Treatment
  • Special Clinical Considerations
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  • Nygaard U, Holm M, Hartling UB, et al. Incidence and clinical phenotype of multisystem inflammatory syndrome in children after infection with the SARS-CoV-2 delta variant by vaccination status: a Danish nationwide prospective cohort study. The Lancet Child & adolescent health. Jul 2022;6(7):459-465. doi:10.1016/s2352-4642(22)00100-6
  • Belay ED, Godfred Cato S, Rao AK, et al. Multisystem Inflammatory Syndrome in Adults After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection and Coronavirus Disease 2019 (COVID-19) Vaccination. Clin Infect Dis. Aug 24 2022;75(1):e741-e748. doi:10.1093/cid/ciab936
  • Patel P, DeCuir J, Abrams J, Campbell AP, Godfred-Cato S, Belay ED. Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review. JAMA Network Open. 2021;4(9):e2126456-e2126456. doi:10.1001/jamanetworkopen.2021.26456
  • Melgar M, Haston J, DeCuir J, et al. Multisystem inflammatory syndrome in adults (MIS-A): case finding through systematic review of electronic medical records. Clin Infect Dis. Apr 20 2022;doi:10.1093/cid/ciac303
  • Hernandez-Romieu AC, Leung S, Mbanya A, et al. Health Care Utilization and Clinical Characteristics of Nonhospitalized Adults in an Integrated Health Care System 28-180 Days After COVID-19 Diagnosis - Georgia, May 2020-March 2021. MMWR Morb Mortal Wkly Rep. Apr 30 2021;70(17):644-650. doi:10.15585/mmwr.mm7017e3
  • Chevinsky JR, Tao G, Lavery AM, et al. Late Conditions Diagnosed 1-4 Months Following an Initial Coronavirus Disease 2019 (COVID-19) Encounter: A Matched-Cohort Study Using Inpatient and Outpatient Administrative Data-United States, 1 March-30 June 2020. Clin Infect Dis. Jul 15 2021;73(Suppl 1):S5-S16. doi:10.1093/cid/ciab338
  • Wanga V, Chevinsky JR, Dimitrov LV, et al. Long-Term Symptoms Among Adults Tested for SARS-CoV-2 - United States, January 2020-April 2021. MMWR Morb Mortal Wkly Rep. Sep 10 2021;70(36):1235-1241. doi:10.15585/mmwr.mm7036a1
  • Bull-Otterson LB, S.; Saydah, S.; Boehmer, T.; Adjei, S.; Gray, S.; Harris, A. Post–COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years — United States, March 2020–November 2021. MMWR Morb Mortal Wkly Rep. May 27, 2022 71(21):713–717. doi:http://dx.doi.org/10.15585/mmwr.mm7121e1
  • Sudre CH, Murray B, Varsavsky T, et al. Attributes and predictors of long COVID. Nature medicine. Apr 2021;27(4):626-631. doi:10.1038/s41591-021-01292-y
  • Daugherty SE, Guo Y, Heath K, et al. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study. BMJ. May 19 2021;373:n1098. doi:10.1136/bmj.n1098
  • Antonelli M, Pujol JC, Spector TD, Ourselin S, Steves CJ. Risk of long COVID associated with delta versus omicron variants of SARS-CoV-2. Lancet. Jun 18 2022;399(10343):2263-2264. doi:10.1016/S0140-6736(22)00941-2
  • Notarte KI, Catahay JA, Velasco JV, et al. Impact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: A systematic review. EClinicalMedicine. Nov 2022;53:101624. doi:10.1016/j.eclinm.2022.101624
  • Tenforde MW, Olson SM, Self WH, et al. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged >/=65 Years - United States, January-March 2021. MMWR Morb Mortal Wkly Rep. May 7 2021;70(18):674-679. doi:10.15585/mmwr.mm7018e1
  • Zimmermann P, Pittet LF, Curtis N. The Challenge of Studying Long COVID: An Updated Review. Pediatr Infect Dis J. May 1 2022;41(5):424-426. doi:10.1097/inf.0000000000003502
  • Pellegrino R, Chiappini E, Licari A, Galli L, Marseglia GL. Prevalence and clinical presentation of long COVID in children: a systematic review. European Journal of Pediatrics. 2022/09/15 2022;doi:10.1007/s00431-022-04600-x
  • Zimmermann P, Pittet LF, Curtis N. How Common is Long COVID in Children and Adolescents? Pediatr Infect Dis J. Dec 1 2021;40(12):e482-e487. doi:10.1097/inf.0000000000003328
  • Kompaniyets L, Bull-Otterson L, Boehmer TK, et al. Post-COVID-19 Symptoms and Conditions Among Children and Adolescents - United States, March 1, 2020-January 31, 2022. MMWR Morb Mortal Wkly Rep. Aug 5 2022;71(31):993-999. doi:10.15585/mmwr.mm7131a3
  • Zavala M, Ireland G, Amin-Chowdhury Z, Ramsay ME, Ladhani SN. Acute and Persistent Symptoms in Children With Polymerase Chain Reaction (PCR)-Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Compared With Test-Negative Children in England: Active, Prospective, National Surveillance. Clin Infect Dis. Aug 24 2022;75(1):e191-e200. doi:10.1093/cid/ciab991
  • Davis HE, Assaf GS, McCorkell L, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. Aug 2021;38:101019. doi:10.1016/j.eclinm.2021.101019
  • Groff D, Sun A, Ssentongo AE, et al. Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review. JAMA Netw Open. Oct 1 2021;4(10):e2128568. doi:10.1001/jamanetworkopen.2021.28568
  • Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS-CoV-2: a case study. Lancet Infect Dis. Jan 2021;21(1):52-58. doi:10.1016/S1473-3099(20)30764-7
  • Wang J, Kaperak C, Sato T, Sakuraba A. COVID-19 reinfection: a rapid systematic review of case reports and case series. Journal of investigative medicine : the official publication of the American Federation for Clinical Research. Aug 2021;69(6):1253-1255. doi:10.1136/jim-2021-001853
  • Roskosky M, Borah BF, DeJonge PM, et al. Notes from the Field: SARS-CoV-2 Omicron Variant Infection in 10 Persons Within 90 Days of Previous SARS-CoV-2 Delta Variant Infection - Four States, October 2021-January 2022. MMWR Morb Mortal Wkly Rep. Apr 8 2022;71(14):524-526. doi:10.15585/mmwr.mm7114a2
  • Slezak J, Bruxvoort K, Fischer H, Broder B, Ackerson B, Tartof S. Rate and severity of suspected SARS-Cov-2 reinfection in a cohort of PCR-positive COVID-19 patients. Clin Microbiol Infect. Dec 2021;27(12):1860 e7-1860 e10. doi:10.1016/j.cmi.2021.07.030
  • Abu-Raddad LJ, Chemaitelly H, Bertollini R, National Study Group for C-E. Severity of SARS-CoV-2 Reinfections as Compared with Primary Infections. N Engl J Med. Dec 23 2021;385(26):2487-2489. doi:10.1056/NEJMc2108120
  • Statistics OfN. Coronavirus (COVID-19) Infection Survey Technical Article: Impact of vaccination on testing positive in the UK. October 2021;
  • Rossler A, Riepler L, Bante D, von Laer D, Kimpel J. SARS-CoV-2 Omicron Variant Neutralization in Serum from Vaccinated and Convalescent Persons. N Engl J Med. Feb 17 2022;386(7):698-700. doi:10.1056/NEJMc2119236
  • Leon TM, Dorabawila V, Nelson L, et al. COVID-19 Cases and Hospitalizations by COVID-19 Vaccination Status and Previous COVID-19 Diagnosis - California and New York, May-November 2021. MMWR Morb Mortal Wkly Rep. Jan 28 2022;71(4):125-131. doi:10.15585/mmwr.mm7104e1
  • Cavanaugh AM, Spicer KB, Thoroughman D, Glick C, Winter K. Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination - Kentucky, May-June 2021. MMWR Morb Mortal Wkly Rep. Aug 13 2021;70(32):1081-1083. doi:10.15585/mmwr.mm7032e1

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PresentationPoint

Coronavirus Tips PowerPoint Template

Mar 28, 2020 | Data Dashboards , DataPoint , DataPoint Real-time Screens , Healthcare

To help with the current coronavirus emergency, we have put together these free coronavirus tips Powerpoint slide templates for you to use. The slides include coronavirus prevention tips, symptoms and instructions on what to do if you have symptoms.

Feel free to adjust the templates based on your local health authority instructions and contact information. Download the templates by providing your name and email address below.

Coronavirus Tips – Symptoms

This slide shows the common coronavirus symptoms and gives patients instructions on what to do if they have symptoms so that they don’t go to the hospital or doctor in a panic and overload the local health system. You can edit this slide or add additional slides to add local phone numbers, websites or other resource information.

presentation of covid 19 ppt

nice template

Tạ Đức Huy

I would like to download and amend the COVID slides please.

Solved over chat. Now you can use the presentation. Good luck with it!

Nicole Mcdonald

I would like to download the template as well.

Did you sign up Nicole? That should be working. Check your spam folder maybe.

Millard Collier

Excellent template , I will use for professional and public presentations.

Great to read. Thanks.

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presentation of covid 19 ppt

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COVID-19 PowerPoint Presentation on How to Use the Toolkit English

COVID-19 PowerPoint Presentation on How to Use the Toolkit English

In January 2020 the World Health Organization (WHO) declared the outbreak of a new coronavirus disease in Hubei Province, China to be a Public Health Emergency of International Concern. Since then WHO has declared it as a Pandemic affecting more than 115 countries around the globe. India witnessed its first COVID-19 case in Kerala on 30th January 2020. With cases rising steadily, all sections of our society must play a role if we are to stop the spread of this disease and the frontline health worker has the responsibility, the reach and the influence within the community. UNICEF and WHO are supporting the government of India in taking action to contain the COVID-19 outbreak. Towards this UNICEF and WHO developed a training toolkit for training FLWs on COVID response and containment measures. The toolkit consists of this PowerPoint presentation on how to use the FLW Toolkit. This PPT is for Trainers and is a guide on each of the contents that are a part of the FLW Toolkit.

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Prepare your presentation with Copilot for Microsoft 365

You’ve been asked to give a new presentation and Copilot for Microsoft 365 can help! For this example, we’ll imagine you’re a professional landscaper and you’ve been asked to present to a local community organization about tulips.

Start from an outline

Often the best way to prepare a new presentation is to create an outline of what you plan to cover. For our example we’ll start with Copilot in OneNote.

Start OneNote.

Navigate to the section where you want your presentation outline to live.

Create a new page for your presentation.

Start Copilot from the ribbon.

The Copilot pane will open on the right, waiting for your prompt. You can use natural language, and the more details you can give Copilot the better your results will be.

You could just enter:

Create an outline for a 45-minute presentation on tulips.

But you’ll get better results if you do a couple more things.

Give it context

Start by telling it what role you want Copilot to play in creating this content.

Act as a professional landscaper. Create an outline for a 45-minute presentation on tulips.

By setting that context first, you let the AI know how you want the content framed.

Give it more details

Try adding to your prompt details about what you want it to cover, and who the audience is.

Act as a professional landscaper speaking to a group of interested community members. Create an outline for a 45-minute presentation on tulips. Include sections on the history of the flower, different types, best time to plant, care and feeding.

Now when you run the prompt, you’ll get a more detailed response.

Tip:  Don’t be afraid to play around with the specifics – add or remove details, change the order, try different contexts.

If you’re happy (or mostly happy) with the draft outline Copilot has created, select the copy button in the Copilot pane and paste the outline onto your OneNote page.

Review and edit

Now you’ll want to add your own touches. Go through the outline and add or remove things as you see fit.

Tip:  OneNote excels as a research tool. Don’t be afraid to add your own notes, copy in content from websites, or add other supporting materials to the page that will be helpful as you prepare your presentation.

Create your handout

When you’re happy with your outline it’s time to create some handouts for the audience. Select your outline in OneNote and copy it to the clipboard. Then open Microsoft Word to a new, blank, document.

Screenshot shows Draft with Copilot in Word.

When Word opens the Copilot dialog should appear. Let’s give it a prompt:

Act as a professional landscaper creating an article for an audience of interested community members. Make it clear, simple, and engaging. Base it off this outline: <paste outline from OneNote>.

Copilot will draft an article for you based on your presentation outline.

Save to OneDrive

Before you spend much time editing your handout, save it to OneDrive. This will make sure your work is saved as you go and it’s key to our final step in preparing the presentation.

Go through the article and make sure that what Copilot added is what you wanted. Edit for voice and tone and make sure any facts it’s added are accurate. Remove anything you don’t want and add anything it missed.

Tip:  You can ask Copilot to add more content if you like. Place the cursor where you want that content to be, then click the Copilot button on the ribbon. Tell it what you want. Add two paragraphs about other plants that look good with tulips.

Go to the Insert tab, select Pictures , and then Online Pictures . Search for “Tulips” and select one or more nice images to make your article more appealing.

Create the slide deck

Now it’s time to let Copilot in PowerPoint get to work.

Open PowerPoint to a new blank deck.

Select Copilot from the ribbon.

In the prompt box type Create presentation from  file.

Copy Link button in Word share tray

Copilot in PowerPoint will build a draft presentation based on your Word document, complete with images and speaker notes.

As always, it’s important that you review the draft Copilot has created. Add any additional slides or information you want, remove any that you don’t.  Add your own expertise where appropriate.

If you want to change any of the images Copilot has added just right-click the image and select Change picture .

Tip:  Practice with Speaker Coach When you’re happy with the presentation you might want to practice it once or twice with Speaker Coach before the big day. For more information see  Rehearse your slide show with Speaker Coach.

Give it a try!

Next time you have a presentation to create let Copilot for Microsoft 365 help you at each step of the way.

Welcome to Copilot in PowerPoint

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Unleash your productivity with AI

Frequently asked questions: AI, Microsoft Copilot, and Microsoft Designer

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COVID-19 Spread & Contagion

Covid-19 spread & contagion presentation, premium google slides theme and powerpoint template.

Here at Slidesgo we’d also like to help fight against the coronavirus spread. Creating presentations is what we excel at, so we’ve just designed this new template with which you can talk about COVID-19, its spread and how to prevent it.

For this template, since we’d like you to reach as many people as possible, we’ve tried several things. These include the use of illustrations that offer a good visual appeal thanks to how they play with the lines and the fill. The backgrounds are clean, with a bluish light green tone, and the layouts are super simple and grab so much attention thanks to a striking yellow color. This presentation also aims to be informative, so we’ve made sure to include some customized text that suits the topic.

Features of this template

  • A simple yet modern slide design with soft, round shapes and illustrations
  • 100% editable and easy to modify
  • 31 different slides to impress your audience
  • Available in five colors
  • Contains easy-to-edit graphics, maps and mockups
  • Includes 500+ icons and Flaticon’s extension for customizing your slides
  • Designed to be used in Google Slides and Microsoft PowerPoint
  • 16:9 widescreen format suitable for all types of screens
  • Includes information about fonts, colors, and credits of the free and premium resources used

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    Coronavirus Tips PowerPoint Template Mar 28, 2020 | Data Dashboards, DataPoint, DataPoint Real-time Screens, Healthcare To help with the current coronavirus emergency, we have put together these free coronavirus tips Powerpoint slide templates for you to use.

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    COVID-19 vaccination service delivery strategies. Routine immunization and other vaccination services are delivered using a combination of delivery strategies (fixed site, outreach, mobile teams, and campaigns). These strategies can also be used for COVID-19 vaccination services.

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