Epidemiology & clinical management of COVID-19
Transcript of Epidemiology & clinical management of COVID-19
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT| EVENTS
Epidemiology & clinical management of COVID-19
CORONAVIRUS (COVID-19) UPDATE NO. 3119 June 2020
CURRENT SITUATION | EPIDEMIOLOGY | CLINICAL MANAGEMENT | EVENTS
• Nearly 8.25 million COVID-19 cases globally• Nearly 450 000 deaths
Top ten countries with the highest number of new cases over the past 24 hours:Chile - 36 179Brazil – 34 918USA – 27 921India - 12 881Russian Federation – 7 790Pakistan - 5 358 Saudi Arabia - 4 919Mexico - 4 599Peru - 4 164South Africa - 4 078
Current situation 1/2
Current global situation
Data as of 06h00 18.06.20
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Current situation 2/2
Current global situation
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Number of new deaths of COVID-19 per day, by WHO Region
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Epidemiological characteristics COVID-19
Epidemiology 1/6
This update covers two recently published reports on the epidemiological characteristics of COVID-19: One from China1 and one from The United States of America2
Time period analysed:• China: From December 2019 to 20 February 2020 • USA: From 22 January to 30 May 2020
Cases and deaths• China:
• 75 565 total, 55 924 lab confirmed , 2114 deaths• Median age: 48 years (IQR: 39-63); 51,1% male
• USA: • 1 761 503 total, 1 320,488 lab confirmed, 103 700 deaths• Median age: 48 years (IQR: 33-65); 48.9% female
1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51
2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w
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Age distribution of laboratory confirmed COVID-19 cases in China (01.12.19 – 20.02.20) and USA (22.01.20 – 30.05.20)
Epidemiology 2/6
1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f512. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w
0.9%
1.2%
8.1%
17.0%
19.2%
22.4%
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0.0% 5.0% 10.0% 15.0% 20.0% 25.0%
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Case fatality ratio by age group for laboratory confirmed COVID-19 cases in China (01.12.19 – 20.02.20) and USA (22.01.20 –
30.05.20)
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≤80
Case fatality ratio USA China
Age
1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f512. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w
Epidemiology 3/6
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Proportion of cases of COVID-19 reporting selected symptoms –data from China (01.12.19 – 20.02.20) and USA (22.01.20 – 30.05.20)
88%
68%
19%15%
5%
14% 14%
5% 4%1% 1%
33%
11%
38%
43%
50%
29%
36%
6%
20%
34%
12%8%
19%
8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
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feverCough
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ess of b
reath
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roat
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e
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omiting
Abdominal Pain
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of smell o
r tast
e
hemoptysis
conjuncti
val…
sputum producti
onch
ills
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ue
China USA
Epidemiology 4/6
1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f512. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w
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32.2%
30.2%
17.5%
4.8%
1.4%
7.6%
5.3%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%
Any cardiovascular disease
Diabetes
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Cancer
Neurological disability
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USA % CHINA %
Reported underlying medical conditions for laboratory confirmed COVID-19 cases in China (01.12.19 – 20.02.20) and USA (22.01.20 – 30.05.20)
Epidemiology 5/6
1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f512. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w
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Disease severity in laboratory confirmed COVID-19 cases in China (01.12.19 – 20.02.20) and USA (22.01.20 – 30.05.20)
Disease severity China USA
Mild to moderate 80% 84%
Severe 15% 14%
Critical 5% 2%USA data:• Hospitalization was six times more frequent among patients with a reported underlying
condition (45.4%) compared to those without such conditions (7.6%)
• Death occurred 12 times more often among patients with reported underlying conditions (19.5%) compared with those without such conditions (1.6%)
Epidemiology 6/6
1. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f512. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w
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Clinical disease progression for COVID-19
Clinical management 1/5
Incubation period
Mild moderate disease
80%
Severe disease
15%
Critical5%
Death
Infectious
Onset symptoms (cough, fever)
Shortness of breath, hypoxia
Respiratory failure, multiorgan system dysfunction
Median 4-5 days (1-14 days)
Recovery average14 days
Median 7-10 days after onset symptoms
Median 10-12 days after onset symptoms
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Care of suspected or confirmed mild COVID-19: symptomatic treatment
• Isolate to stop virus transmission, at a designated COVID-19 health facility, community facility or at home.
• Give symptomatic treatment such as antipyretics for fever and pain, adequate nutrition and appropriate rehydration.
• Counsel patients about signs and symptoms that should prompt urgent care.
Ø Antibiotic therapy or prophylaxis are not indicated
Clinical management 2/5
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Care of moderate COVID-19 with pneumonia
• Isolate to stop virus transmission, at a designated COVID-19 health facility, community facility or at home. Patients with moderate illness may not require hospitalization.
• For patients at higher risk of severe disease, isolation in hospital is preferred.
• Antibiotics are not indicated unless there is clinical suspicion of a bacterial infection
• Monitor closely for signs or symptoms of disease progression.
Clinical management 3/5
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Care of severe COVID-19 with pneumonia
• Equip all areas for severely ill patients with functioning oxygen system.
• Closely monitor patients for signs of clinical deterioration, such as rapidly progressive respiratory failure and shock; respond immediately with supportive care interventions.
• Monitor patients for signs of thromboembolism or related conditions, such as stroke, deep venous thrombosis, pulmonary embolism or acute coronary syndrome.
Clinical management 4/5
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Recovery trial: Dexamethasone in ventilated COVID-19 patients• Statement by trial investigators (University of Oxford)Ø The results have not been published in a journal yet
• Over 6000 hospitalized patients were randomized to receive either dexamethasone (6 mg daily) or usual care for 10 days
• Dexamethasone was associated with significantly fewer deaths among patients compared with those given usual care
v Patients on oxygen: dexa group had one-fifth fewer deaths compared to usual care
v Patients on ventilator: dexa group had one-third fewer deaths compared to usual care
• For patients who didn't require oxygen or respiratory support, there was no observed additional benefit with dexamethasone
https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19
Clinical management 5/5
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Upcoming eventsWebinar: Public Health Emergency Operations Centres (PHEOCs) for COVID 19 Response. Tuesday 23 June 14h00 Geneva time.Register
Pre-conference of the 1st WHO infodemiology conference.29 June 2020. https://www.who.int/news-room/events/detail/2020/06/29/default-calendar/pre-conference-1st-who-infodemiology-conference