Epidemiologi, faktor risiko, definisidan manifestasi klinis COVID-19

Dr. Paul Harijanto, SpPD-KPTI

Pelatihan Penanganan Covid-19, Aula RSUP Kandouw, Rabu 29, 30 April 2020,

Perjalanan kejadian 2019-nCoV

12 /02/20

27 cases

Pneumonia

WMHC

30 Jan WHO

PHEIC

11 Feb2020

COVID-19

COVID-19

• WHO announced the current outbreak of coronavirus which was first reported from Wuhan, China, on December 31, 2019

• The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” ( COVID-19)

WHO Report 44,4 March , 80.422

WHO report 55,15 March 2020China: 81.048Outside: 72.469

WHO report 56,16 March 2020China : 81077Outside: 86438

WHO report 65,25 March 2020China : 81.848)utside : 331.619

11 days

1 day

9 days

RISK FACTORS :

Strong • residence in/travel to location reporting community

transmission during the 14 days prior to symptom onset

• close contact with a confirmed case

• older age and/or underlying health conditions

• obesity

• smoking

• malignancy

• surgery

( Chinese Center for Disease Control and Prevention , CCDC Weekly / Vol. 2 / No. 8 )

GEJALA KLINIS

RESPIRATORY MANIFESTATIONS

• UPPER RESPIRATORY INFECTIONS ( Cold, Pharyngitis )

• LOWER RESPIRATORY INFECTIONS PNEUMONIA :• CAP : Infection of the pulmonary parenchyma acquired from

exposure in the communityClassically divided into “typical” and “atypical” syndromes:

I. “Typical” CAP:

• presents with “typical” severe, acute infection

• infectious agent (usually S. pneumo or H. flu) is culturable/ identifiable

• responsive to cell-wall active antibiotics

II. “Atypical” CAP:

• presentation is usually sub-acute

• causative pathogens are difficult to culture/identify by standard methods

• not responsive to penicillins

• Viral pneumonia

MANIFESTASIKARDIO VASKULER

20.4%Cutaneus manifestations:- Erythrmatous rash- Urticaria- Chicken –pox like vesicle

( Dr. S . Recalcati, Italy )

MANIFESTASISISTIM KULIT

MANIFESTASISISTIM KULIT

13 patients :3 pts discharged uncomplicated pregnancy10 pts SC ( 5 emergency due to : with multidicipline approach )

- 3 Fetal distress- 1 Premature rupture of membrane- 1 stillbirth

- 6 pts (46%) , preterm labour 32-36 weeks due to- MOF, ARDS, ARF, ALF, septic shock

- 12 pts discharged- 1 pts severe pneumonia

7 pts , 37-41 weeks• All SC• 2 pts chronic ilness hypothyroid & POS• 3 uterine scraring• Multidisicipline approach• Good outcome for mothers and child

MANIFESTASIPADA

KEHAMILAN

Neurological manifestations :febrile seizures, convulsions, change in mental status, and encephalitis, nasal infection,,causing inflammation and demyelination [

214 pts, 36.4% had neurological manifestations :• CNS : Headache, dizziness, convulsion, 24.8%• Peripheral Nervous S: 8.9%, taste & smell

impairment• Skeletal muscle injury: 10,7%

MANIFESTASISISTIM SARAF

Incidence of 3% (1/41)-79% (159/201), gastrointestinal symptoms of COVID-19 included:

• anorexia 39.9% (55/138)-50.2% (101/201), • diarrhoea 2% (2/99)-49.5% (146/295), • vomiting 3.6% (5/138)-66.7% (4/6), • nausea 1% (1/99)-29.4% (59/201), • abdominal pain 2.2% (3/138)-6.0% (12/201) and• gastrointestinal bleeding 4% (2/52)-13.7% (10/73).

• 2 – 11% Liver co morbid• 16 -53% Abnormal ALT and AST• The more severe covid-19, the more higher liver abnormality

MANIFESTASIGASTRO INTESTINAL

& HATI

• Occur in patient, public & health workers

• Anxiety 44.7%

• Stress 73.4%

• Depression 50.7%

• Emotion

• Insomnia 36.1%

Psychiatric

Manifestation in

Covid-19

Endocrine Manifestation in Covid-19

• DIABETES increased mortality & morbidity• OBESITY• UNDERNOURISHMENT• HYPOADRENALISM

“ Conjunctival congestion “Conjunctival hyperaemiaChemosisEpiphoraIncreased secretions

MANIFESTASIPADA MATA

MANIFESTASISISTIM MUSCULO-SKELETAL

Case Definition And Surveillance

• ILI and Pneumonia surveillance have to be strengthened AND ensure all ILI and/or pneumonia cases being asked for travel history, residences and possible close contact-→meet case definition

• If suspected case found, immediately contact local authority for further follow up on case investigation and contact tracing as containment measure.

Case Definitions:

Case Definition Surveillance

Close Contact:

• Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15 minutes;

• Direct physical contact with a probable or confirmed case;• Direct care for a patient with probable or confirmed COVID-19 disease

without using proper personal protective equipment;• Other situations as indicated by local risk assessments.

Suspect: • Patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset

• Patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case in the last 14 days prior to symptom onset

• Patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation

Case Definitions:

Case Definition After Testing Performed

Confirmed: • A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms

Probable: • A suspect case for whom testing for the COVID-19 virus is inconclusive.• A suspect case for whom testing could not be performed for any reason

Hu et all :• 24 cases asymptomatic :

• 20.8% developed stmptom fever, cough• 50 % typical GGO• 20.8% strip shadowing in the lung• 29.2% normal CT scan & symptoms

• None have symptoms fever, cough, breathless, headache• 62.5% had history of contact cases Covid-19• Physical exam no abnormality of pneumonia• CT scan strongly pneumonia• 25 % developed symptom• 50% CRP increased

COVID-19

• On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization declared the outbreak a “public health emergency of international concern external icon” (PHEIC).

• On January 31, 2020, Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19.

CLINICAL COURSE & DISCHRGE / MORTALITY