COVID-19

Disease Description
COVID-19 is the illness that presents on being infected by a deadly coronavirus called SARS-
CoV-2.
The new coronavirus binds to receptors on healthy cells, especially those in your lungs, with its
spiky surface proteins. The viral proteins enter cells through ACE2 receptors. Once inside, the
coronavirus takes control of healthy cells. It eventually destroys some healthy cells.
This SARS-like virus was first discovered in late 2019 in the Chinese city of Wuhan. Initially,
snakes were thought to be a possible source of the outbreak, but other experts dismissed this
theory and suggested bats as a potential reservoir instead. Pangolins have been linked to the
transfer chain as a possible connection.

Coronavirus (who.int)
Coronavirus: What Happens To People's Body If They Get Infected (webmd.com)
What Is a Coronavirus? (sciencealert.com)

Causative Agent
Extreme acute respiratory syndrome coronavirus 2 is the cause of novel coronavirus disease
(COVID-19) (SARS-CoV-2). SARS-CoV-2 has RNA as a genetic material and shares 79
percent of the genome with the bat SARS-COV, which caused an outbreak in 2002. COVID-19
is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
virus strain.
The SARS-CoV-2 peripheral Spike-Fc protein binds to ACE2 receptors on bronchial epithelial
cells and alveolar pneumocytes, inhibiting their expression and causing extreme acute
respiratory failure. The disease is highly contagious from person to person and has flu-like
symptoms.
The elderly and immunocompromised population are particularly vulnerable, and healthcare
professionals around the world have used a variety of treatment methods, including repurposing
antimalarial medications, hydroxychloroquine, and antiviral drugs.
An update on COVID-19: SARS-CoV-2 life cycle, immunopathology, and BCG vaccination -
PubMed (nih.gov)

Characteristics of Organism
The virus that causes COVID-19 is in a family of viruses called Coronaviridae. Antibiotics do not
work against viruses. Coronaviruses are named for the crown-like spikes on their surface. There
are four main sub-groupings of coronaviruses, known as alpha, beta, gamma, and delta.

Human coronaviruses were first identified in the mid-1960s. The seven coronaviruses that can
infect people are:
Common human coronaviruses
1. 229E (alpha coronavirus)
2. NL63 (alpha coronavirus)
3. OC43 (beta coronavirus)
4. HKU1 (beta coronavirus)
Other human coronaviruses
1. MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or
MERS)
2. SARS-CoV (the beta coronavirus that causes severe acute respiratory syndrome, or
SARS)
3. SARS-CoV-2 (the novel coronavirus that causes coronavirus disease 2019, or COVID-
19)
People around the world commonly get infected with human coronaviruses 229E, NL63, OC43,
and HKU1.
Sometimes coronaviruses that infect animals can evolve and make people sick and become a
new human coronavirus. Three recent examples of this are 2019-nCoV, SARS-CoV, and
MERS-CoV.
Human Coronavirus Types | CDC
What are coronaviruses and how are they made?
Coronaviruses are a form of virus that primarily affects mammals (including humans, but
only in rare cases) and birds. The genome is enclosed in a tiny shell, and it is made up of a
single strand of positive polarity RNA (ssRNA +), which is very high in comparison to other RNA
viruses, with a sequence ranging from 26 to 32 thousand nucleotide bases (the "building blocks"
of the genetic code). This gene is responsible for the development of seven distinct viral
proteins.
Going from the inside to the outside, the RNA is covered by a nucleocapsid, a layer
consisting of the M protein or membrane and an envelope protein, composed of phospholipid
bilayer which is derived from the infected cells. It’s this last layer that "deceives" the immune
defenses of host cells, which don’t recognize it as an external threat. Finally, there are hammer-
shaped tips (called spike proteins) on the surface of the capsid. These are the S glycoproteins
that cross the envelope protein and act like harpoons to attach to the infected cells and give the
virus its characteristic crown shape.
How big are coronaviruses?
 Coronaviruses have a diameter of 80-160 nanometres (nm). About a thousand would
need to be lined up to equal the diameter of a human hair: about 70 micrometres (µm), that is
70,000 nm. As a comparison, the fine powders – known as PM10 - have a diameter of 10 µm,
that is 10,000 nm.
Covid-19, what it is and how it behaves (eni.com)

Mode of Transmission
SARS-CoV-2 is spread by contaminated secretions such as saliva and respiratory secretions,
as well as respiratory droplets, which are expelled when an infected individual coughs, sneezes,
speaks, or sings.

Contact/ Droplet Transmission

Respiratory droplets have a diameter of >5-10 m, while droplets with a diameter of less than 5
m are called droplet nuclei or aerosols. When a person comes into close contact (within 1
meter) with an infected person who is experiencing respiratory symptoms, respiratory droplet
transmission may occur (e.g. coughing or sneezing) or who is talking or singing; in these
situations, virus-laden respiratory droplets may enter a susceptible person's mouth, nose, or
eyes, resulting in infection. Indirect contact transmission (fomite transmission) occurs when a
susceptible host comes into contact with a contaminated object or surface.

Airborne Transmission
Scientists and physicians have been warning of aerial transmission of SARS-CoV-2, the virus
that causes CoVID-19 since the early days of the coronavirus pandemic. Finally, public health
agencies recognized the potential of airborne spread in October 2020 – a seven months period
after the pandemic.
The transmission of the coronavirus through respiratory droplets from coughs and sneezes has
long been established, which is why everybody is advised to wear masks and keep six feet
apart. The issue of airborne transmission has been a source of debate for months, with some
scientists advocating for preventive measures while public health authorities have been slow to
recognize it. We now know, however, that the 6 feet are not sufficient to avoid aerosol particle
inhalation.
An infectious substance that is caused by the spreading of droplet (aerosols) nuclei which
remain contagious when suspended in air for long periods and time is defined as airborne
transmission. During medical procedures that generate aerosols ("aerosol generating
procedures"), aerobic SARS-CoV-2 transmission may occur. In the absence of aerosol
generation processes, particularly indoor settings with a low ventilation, the WHO has also been
actively discussing and assessing whether SARS-CoV-2 could also spread through aerosols.
The physics of the physical expansion of air and flow have led to hypotheses about possible
transmission mechanisms of SARS-CoV-2 by sprays. These theories suggest that (1)
microscopic Aerosols (<5 μm) are generated by a number of respiratory droplets by evaporation
and that normal breathing lead to aerosol expansion. Therefore, if the aerosols contain the virus
in a large sufficient quantity to cause infection in the beneficiate, a susceptible person may
inhale and become infected. The proportion of exhaled droplet nuclei or respiratory droplets
evaporating for aerosols and the infectious dose of viable SARS-CoV-2 necessary to cause
another individual infection is not known, however other respiratory viruses were studied. It was
also examined.

Other modes of transmission

SARS-CoV-2 RNA has also been detected in other biological samples, including the urine and
feces of some patients. One study found viable SARS-CoV-2 in the urine of one patient. Three
studies have cultured SARS-CoV-2 from stool specimens. To date, however, there have been
no published reports of transmission of SARS-CoV-2 through feces or urine.
Some studies have reported detection of SARS-CoV-2 RNA, in either plasma or serum, and the
virus can replicate in blood cells. However, the role of bloodborne transmission remains
uncertain; and low viral titers in plasma and serum suggest that the risk of transmission through
this route may be low. Currently, there is no evidence for intrauterine transmission of SARS-
CoV-2 from infected pregnant women to their fetuses, although data remain limited. WHO has
recently published a scientific brief on breastfeeding and COVID-19.
This brief explains that viral RNA fragments have been found by RT-PCR testing in a few breast
milk samples of mothers infected with SARS-CoV-2, but studies investigating whether the virus
could be isolated, have found no viable virus. Transmission of SARS-CoV-2 from mother to
child would necessitate replicative and infectious virus in breast milk being able to reach target
sites in the infant and also to overcome infant defense systems. WHO recommends that
mothers with suspected or confirmed COVID-19 should be encouraged to initiate or continue to
breastfeed.
The coronavirus is airborne -- what that means for you - CNET

Prevention
1. STAY at home as much as you can
2. KEEP a safe distance
3. WASH hands often
4. COVER your cough
5. SICK? Call ahead

1. Wash your hands frequently for at least 20 seconds at a time with warm water and soap.
How long is 20 seconds? About as long as it takes to sing your “ABCs.”
2. Don’t touch your face, eyes, nose, or mouth when your hands are dirty.
3. Don’t go out if you’re feeling sick or have any cold or flu symptoms.
4. Stay at least 6 feet (2 meters) away from people. Avoid crowds and large gatherings.
 5. Cover your mouth with a tissue or the inside of your elbow whenever you sneeze or
cough. Throw away any tissues you use right away.
6. Wear a mask or face covering in public places.
7. Clean any objects you touch a lot. Use disinfectants on objects like phones, computers,
and doorknobs. Use soap and water for objects that you cook or eat with, like utensils
and dishware.
Coronavirus (COVID-19): Symptoms, Treatment & More (healthline.com)

Treatment
There’s currently no cure for an infection caused by the new coronavirus. However, many
treatments and vaccines are currently under study. These are some of the vaccines in
development.

Vaccine Brand Name Who Can Get this How Many Shots You When Are You Fully
Vaccine Will Need Vaccinated?
Pfizer-BioNTech People 16 years and 2 shots 2 weeks after your
older Given 3 weeks (21 second shot
days) apart
Moderna People 18 years and 2 shots 2 weeks after your
older Given 4 weeks (28 second shot
days) apart
Johnson & Johnson’s People 18 years and 1 shot 2 weeks after your
Janssen older shot

As of May 12, 2020. The total doses that arrived in the Philippines is 7, 779, 050. As of May 11,
2021, the total doses distributed is 6, 408, 640, and total doses administered is 2, 539, 693.
First dose is 2, 025, 038 and second doses administered is 514, 655.

In Ilocos Region, 68, 711 doses were administered for the first dose and 27, 403 for the second
dose.
Philippines: COVID-19 Vaccine Tracker | ABS-CBN News
Different COVID-19 Vaccines | CDC

Nursing Care
COVID-19 is a highly contagious disease, which has human-to-human transmission through
droplet and contact. It is commonly manifested as fever, dry cough, myalgia, and dyspnea; the
severity of this disease may range from mild, severe to a critical-illness. Currently, there is no
definitive treatment or vaccine for COVID-19. The only proven form of management is isolation
and supportive care. The role of nurses in the management of patients with COVID-19, which
starts from the initial assessment and triaging, sample collection, care of patients with mild-to-
moderate symptoms, care of the critically-ill patient, and care of the dead body.
Clinical nursing care guidance for management of patient with COVID-19 - PubMed (nih.gov)

Nursing Care Planning and Goals

Establishing nursing care plan goals can help improve patient outcomes and decrease the
transmission of COVID-19. Major nursing care planning goals for COVID-19 may include:
1. Establishing goals, interventions
2. Assessing altered skin integrity risks, fatigue, impaired comfort, gas exchange,
nutritional needs, and nausea
3. Preventing the spread of coronavirus infection to the patient’s family members,
community, and healthcare providers
4. Providing more information about COVID-19 and its management to the patient – in a
Pew Research Center poll released June 29, 2020, only 64 percent of adults said the
CDC “mostly gets the facts about the outbreak right”
5. Reducing fever
6. Restoring normal respiratory patterns
7. Easing anxiety, which is relatively common in COVID-19 patients, with a combination of
anxiolytic medications and psychotherapy that includes relaxation techniques, breathing
exercises and encouragement

Nursing Interventions
Based on assessment data, nursing interventions for COVID-19 should focus on monitoring vital
signs, maintaining respiratory function, managing hyperthermia, and reducing transmission.

1. Monitor vital signs – particularly temperature and respiratory rate, as fever and dyspnea
are common symptoms of COVID-19.
2. Monitor O2 saturation – normal O2 saturation as measured with pulse oximeter should
be 94 or higher; patients with severe COVID-19 symptoms can develop hypoxia, with
values dropping low enough to warrant supplemental oxygen.
3. Manage fever – use appropriate therapy for hyperthermia, including adjusting room
temperature, eliminating excess clothing and covers, using cooling mattresses, applying
cold packs to major blood vessels, starting or increasing intravenous (IV) fluids as
allowed, administering antipyretic medications as prescribed, and readying oxygen
therapy in the event of respiratory problems resulting from the metabolic demands for
oxygen during a fever.
4. Maintain respiratory isolation – isolation rooms should be well-marked with limited
access; all who enter the restricted-access room should use personal protective
equipment, such as masks and gowns.
5. Enforce strict hand hygiene – to reduce or prevent transmission of coronavirus, patients
should wash hands after coughing, as should all who enter or leave the room.
6. Provide information – educate the patient and patient’s family members of the
transmission of COVID-19, the tests to diagnose the disease, disease process, possible
complications, and ways to protect oneself and one’s family from coronavirus.
Evaluation
Evaluation helps nurses determine if they have met their goals. Evidence for meeting nursing
goals for COVID-19 might include:
1. The patient successfully prevented the spread of infection to family, the community, or to
healthcare staff
2. The patient learned more about COVID-19 and its management
3. The patient had improved body temperature levels
4. Restoration to normal breathing patterns
5. Reduced anxiety
https://everynurse.org/blog/nursing-management-covid-19/

SIGNS AND SYMPTOMS

Most common symptoms:
1. Fever
2. Dry Cough
3. Tiredness
Less common symptoms:
1. Aches and Pains
2. Sore Throat
3. Diarrhea
4. Conjunctivitis
5. Headache
6. Loss of Taste or Smell
7. A Rash on Skin, or Discoloration of Fingers or Toes
Serious symptoms:
1. Difficulty Breathing or Shortness of Breath
2. Chest Pain or Pressure
3. Loss of Speech or Movement
4. Seek immediate medical attention if you have serious symptoms. Always call before
visiting your doctor or health facility.
People with mild symptoms who are otherwise healthy should manage their symptoms
at home. On average it takes 5–6 days from when someone is infected with the virus for
symptoms to show, however it can take up to 14 days.