The COVID-19 Living Textbook

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The COVID-19 Living Textbook Carey Kriz • Naiyer Imam Sarah Zaidi Editors BREAKING DOWN COVID-19 A Living Textbook Publication of First Medicine and Global Clinical Partners Breaking Down COVID-19 Carey Kriz • Naiyer Imam • Sarah Zaidi Editors BREAKING DOWN COVID-19 A Living Textbook Publication of First Medicine and Global Clinical Partners Contents Chapter 1 Overview of COVID-19 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1 Carey Kriz, Naiyer Imam M.D., and Sarah Zaidi Sc.D., MSc. 1.1 Introduction ������������������������������������������������������������������������������ 1 1.2 COVID-19 Outbreak to Pandemic Status �������������������������������� 2 1.3 Human Coronaviruses �������������������������������������������������������������� 4 1.4 Cross-Species Transmission. 6 1.5 Past Pandemics and COVID-19 in the Context of History ������ 8 References . 10 Chapter 2 Virology and the Immune System Response to COVID-19 �� � � 13 Carey Kriz and Syed Imran Ahmad 2.1 Introduction ���������������������������������������������������������������������������� 13 2.2 SARS-CoV-2 Structure ���������������������������������������������������������� 14 2.3 The Immune System �������������������������������������������������������������� 15 2.3.1 Innate Immunity �������������������������������������������������������� 15 2.3.2 Adaptive Immunity . 17 2.3.2.1 Humoral immunity ������������������������������������ 17 2.3.2.2 Cell-mediated immunity . 18 2.4 Pathophysiology of SARS-CoV-2 ������������������������������������������ 19 2.4.1 Interaction between SARS-CoV-2 and ACE2. 20 2.4.2 Pathogenesis and Biochemistry. 20 2.4.3 Pathophysiology of COVID-19-Related Organ System Involvement . 21 References �������������������������������������������������������������������������������������� 24 Chapter 3 Transmission, Prevention, and Risk Factors of COVID-19� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 25 Naiyer Imam M.D., Sarah Zaidi Sc.D., MSc., and Arijit Robin Chakraborty 25 3.1 Introduction ���������������������������������������������������������������������������� 25 3.2 Viral Transmission . 25 3.3 Reproductive Rate and Dispersion. 27 v Contents 3.4 Assessing Risk of Transmission. 28 3.5 Individual Disease Prevention ������������������������������������������������ 28 3.6 Community Prevention: Nonpharmaceutical Interventions �������������������������������������������������������������������������� 30 3.7 Risk Factors . 32 3.8 Conclusion . 33 References . 34 Chapter 4 Outpatient Management: Mild and Moderate Symptoms of COVID-19 �. 37 Naiyer Imam M.D., Nooshi Karim M.D. and Abena Baah-Fordjour 4.1 Introduction ���������������������������������������������������������������������������� 37 4.2 COVID-19 Overview of Symptoms. 37 4.3 Current Management Strategies for Mild Disease. 38 4.3.1 Management of Underlying Conditions with COVID-19 Infection . 43 4.3.2 Protective Health Measures. 44 4.4 Management by Telemedicine . 44 References . 46 Chapter 5 Pulmonary Manifestations of COVID-19 �� � � � � � � � � � � � � � � � � � � � � 47 Syed Mehdi M.D., Nishat Mehdi M.D., and Sabbir Chowdhury 5.1 Introduction ���������������������������������������������������������������������������� 47 5.2 Origins, Transmission, and Pathogenesis of COVID-19 Disease ���������������������������������������������������������������� 48 5.3 Pathophysiology. 48 5.3.1 Symptoms ������������������������������������������������������������������ 50 5.3.2 Happy Hypoxics �������������������������������������������������������� 51 5.3.3 Mechanism ���������������������������������������������������������������� 51 5.4 Respiratory Failure. 52 5.5 COVID-19 and Pulmonary Embolisms . 52 5.6 COVID-19 and COPD . 53 5.7 COVID-19 and Asthma ���������������������������������������������������������� 54 5.8 COVID-19 and Lung Cancer . 55 5.9 Acute Respiratory Distress Syndrome. 55 5.9.1 Diagnostic Criteria ���������������������������������������������������� 55 5.9.2 Clinical Features . 56 5.9.3 Types of ARDS . 56 5.10 Outcome with Ventilated Patients ������������������������������������������ 57 5.11 Treatment . 57 5.11.1 Interferon (IFN-λ) . 58 5.11.2 Steroids ���������������������������������������������������������������������� 58 5.11.3 Tocilizumab. 58 vi Contents 5.11.4 Chloroquine. 58 5.11.5 Remdesivir ���������������������������������������������������������������� 59 References . 59 Chapter 6 Cardiovascular Manifestations of COVID-19 � � � � � � � � � � � � � � � � � 63 Arshad Quadri M.D., Samer Kabbani M.D., Syed Raza M.D., and Urmila Bharathan 6.1 Introduction ���������������������������������������������������������������������������� 63 6.2 Epidemiology. 63 6.3 The Role of ACE2 in the Cardiovascular System during COVID-19 ������������������������������������������������������������������ 65 6.4 Cardiac Inflammation due to SARS-CoV-2. 65 6.5 Heart Failure due to SARS-CoV-2. 66 6.6 Stress Cardiomyopathy due to SARS-CoV-2 ������������������������ 66 6.7 Vascular Manifestations of COVID-19 ���������������������������������� 66 6.8 Possible Long-Term Cardiovascular Implications Following COVID-19 ������������������������������������������������������������ 67 6.9 Conclusion . 68 References . 69 Chapter 7 Central Nervous System (CNS) Manifestations of COVID-19� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 71 Intezam Khan M.D., Usman Mirza M.D., Riyaz Ahmad M.D., MRCP, Naiyer Imam M.D., and Eesha Imam 7.1 Introduction ���������������������������������������������������������������������������� 71 7.2 How SARS-CoV-2 Can Infect the Nervous System �������������� 72 7.3 Cerebrovascular Disease �������������������������������������������������������� 73 7.4 Acute Encephalitis and Meningitis ���������������������������������������� 75 7.5 Headaches ������������������������������������������������������������������������������ 75 7.6 Peripheral Nervous System Manifestations . 76 7.7 Skeletal Muscle Injury . 80 7.8 Conclusion . 80 References . 80 Chapter 8 Gastrointestinal Manifestations of COVID-19� � � � � � � � � � � � � � � � 83 Lawrence Kogan M.D., Chung Sang Tse M.D., Farhan Qureshi, and Samir A. Shah M.D., FACG 8.1 Introduction ���������������������������������������������������������������������������� 83 8.2 Presentation ���������������������������������������������������������������������������� 84 8.3 Endoscopy and Risk of Transmission ������������������������������������ 85 8.4 Liver Diseases ������������������������������������������������������������������������ 87 8.5 Inflammatory Bowel Disease. 87 8.6 Celiac Disease ������������������������������������������������������������������������ 88 8.7 GI Cancers . 88 vii Contents 8.8 Telehealth in GI ���������������������������������������������������������������������� 91 8.9 Proton Pump Inhibitors and COVID-19 �������������������������������� 91 8.10 Tools for Health-care Providers . 92 References . 92 Chapter 9 Renal Manifestations of COVID-19� � � � � � � � � � � � � � � � � � � � � � � � � � � 95 Syed Muzaffar Ahsan M.D., Shariq Haider Hashmi M.D., and Sundus Nasim 9.1 Introduction ���������������������������������������������������������������������������� 95 9.2 Epidemiology. 96 9.3 Pathophysiology of COVID-19 Renal Manifestations ���������� 97 9.4 Monitoring COVID-19 Patients for AKI . 98 9.5 Early Management of AKI. 99 9.6 Note on Venous Thromboembolism (VTE) and Prophylaxis �������������������������������������������������������������������� 101 9.7 Note on ACE Inhibitor and ARB Usage in COVID-19 . 101 9.8 Conclusion . 102 References . 102 Chapter 10 Endocrine Manifestations of COVID-19 � � � � � � � � � � � � � � � � � � � � �103 Sudhir Bansal M.D. and Farhan Qureshi 10.1 Overview ������������������������������������������������������������������������������ 103 10.2 Mechanisms of Increased COVID-19 Severity in Diabetic Patients �������������������������������������������������������������� 104 10.3 Managing Diabetes in COVID Patients . 105 10.4 Other Endocrine Diseases ���������������������������������������������������� 107 10.4.1 Adrenal Insufficiency ���������������������������������������������� 107 10.4.2 Subacute Thyroiditis . 108 10.5 Telemedicine ������������������������������������������������������������������������ 108 10.6 Tools for Health-Care Providers ������������������������������������������ 109 10.7 Conclusion . 109 References . 110 Chapter 11 Dermatological Manifestations of COVID-19 �� � � � � � � � � � � � � � �113 Saeed Jaffer M.D. and Ashley Slack 11.1 Overview ������������������������������������������������������������������������������ 113 11.2 Clinical Manifestations �������������������������������������������������������� 116 11.3 PPE Usage Impact on Patients. 122 11.4 PPE Usage Impact on Health-care Workers. 123 References . 123 Chapter 12 Ophthalmological Manifestations of COVID-19� � � � � � � � � � � � �125 Ejaz Hussein M.D. and Eesha Imam 12.1 Introduction �������������������������������������������������������������������������� 125 12.2 Conjunctivitis. 125 12.3 Precautions. 126 viii Contents 12.3.1 Personal Protective Equipment (PPE). 126 12.3.2 Chloroquine and Hydroxychloroquine �������������������� 126 12.4 Testing ���������������������������������������������������������������������������������� 126 12.5 Conclusion . 126 References . 128 Chapter 14 Mental Health Manifestations of COVID-19� � � � � � � � � � � � � � � � �131 Syed Ashraf Imam Ph.D., Mehran Javeed MBChB,
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