Вакцины от covid-19.

Chinese medics in Huanggang, Hubei, in 2020

Многие другие моноклональные антитела имели временное разрешение на использование (EUA); однако, по мере появления подвидов Омикрона, их временное разрешение на использование было отозвано, поскольку они перестали быть эффективными.

Для Нехоспитализированных Взрослых с Легкой до Умеренной Болезнью COVID-19, Которым не Требуется Дополнительный Кислород

Терапевтическое Лечение Госпитализированных Взрослых с COVID-19, Которым не Требуется Кислород

Терапевтическое Лечение Госпитализированных Взрослых с COVID-19, Которым Требуется Обычный Кислород

Терапевтическое Лечение Госпитализированных Взрослых с COVID-19, Которым Требуется Высокопоточный Насальный Канюлятор (HFNC) или Неинвазивная Механическая Вентиляция (NIV)

Терапевтическое Лечение Госпитализированных Взрослых с COVID-19, Которым Требуется Механическая Вентиляция (MV)

COVID-19 Плазма Высокой Титрованности

Профилактика Противо SARS-CoV-2 Инфекции

Прогноз

• Смертность и диабет
• Госпитализация и кардиометаболические состояния

Улучшение Результатов Работы Медицинского Персонала

SARS-CoV-2 и его варианты продолжают вызывать значительную заболеваемость и смертность по всему миру. Предотвращение и управление этой высокозаразной респираторной вирусной болезнью требуют комплексного и межпрофессионального подхода, включающего в себя экспертность врачей всех специальностей, медсестер, фармацевтов, специалистов общественного здравоохранения и государственных органов. Должно быть открытое общение среди клинических провайдеров, фармацевтов и медицинских работников при управлении пациентами с COVID-19.

Каждый член команды должен стремиться быть в курсе последних рекомендаций и руководящих принципов и свободно высказывать свою точку зрения, если он замечает что-то, что не соответствует последним принципам управления пациентами с COVID; в общении не должно быть иерархических барьеров, препятствующих любому члену команды высказывать свои опасения. Этот открытый межпрофессиональный подход принесет наилучшие результаты.

Провайдеры, работающие с пациентами с COVID-19 на передовой, должны периодически обновлять свои знания с последними клиническими рекомендациями о диагностике и терапевтических вариантах в управлении COVID-19, особенно учитывая появление новых вариантов SARS-CoV-2, которые могут значительно повлиять на заболеваемость и смертность. Постоянное вирусологическое наблюдение за новыми вариантами является критичным на регулярной основе с последующим вирусологическим секвенированием, учитывая возможность появления более высокозаразных, более вирулентных и устойчивых к лечению вариантов, которые могут иметь более катастрофическое воздействие на глобальное здоровье, вдобавок к текущему сценарию. Многоплановый подход, вовлекающий членов межпрофессиональной команды, способствует улучшению ухода за пациентами и результатов в борьбе с этой потенциально разрушительной болезнью и помогает всему миру завершить эту пандемию.

Цифры на пальцах

Узнавайте Последнее о COVID-19, Гриппе и RSV

Мониторинг воздействия COVID-19 и эффективности стратегий предотвращения и контроля остается приоритетом общественного здоровья. Центры по контролю и профилактике заболеваний (CDC) продолжают предоставлять устойчивую, высокоэффективную и своевременную информацию для принятия решений.

COVID-19 Трекер Данных

WHO ОТВЕТ В СТРАНАХ

Реакция ВОЗ в странах

9 февраля 2024 Годовые платежи здравоохранительным работникам повышают удержание, мотивацию и влияние 9 февраля 2024 Пожертвователи вносят разницу: ВОЗ, общины и партнеры сотрудничают для того, чтобы покончить с инфекционными заболеваниями 8 февраля 2024 Индия: Приведение первичных медицинских услуг в удаленные населенные пункты Чхаттисгарха 21 декабря 2023 Пожертвователи вносят разницу: спасибо, участники

Ссылка на видео

Диалог ВОЗ в науке. Цифровые решения и каналы, чтобы помочь обществам везде быть безопасными и информированными во время пандемии COVID-19 и позже.

Культура и общество

Прогресс взносов реакция ВОЗ в странах

Переход к более поздним этапам

Как упоминалось, вирусы, такие как SARS-CoV-2, постоянно меняются. Из сотен обнаруженных вариантов в первый год пандемии, наиболее обеспокоенными являются так называемые варианты особой озабоченности (VOCs). Исследователи непрерывно изучают, какие варианты могут изменить степень защиты от доступных вакцин и лечения антителами. На январь 2023 года нет активных EUAs для моноклональных антител, нацеленных на SARS-CoV-2 из-за текущих циркулирующих вариантов, которые нечувствительны.

Вариант Омикрон (B.1.1.529), изначально обнаруженный в Южной Африке, был объявлен вариантом особой озабоченности в Соединенных Штатах Центром по контролю и профилактике болезней 30 ноября 2021 года. Этот VOC содержит десятки мутаций, включая значительное количество в гене, что отвечает за белок-шиповку, больше, чем у предыдущих VOCs. Эти мутации включают в себя несколько, ассоциированных с увеличением передачи. Вариант Омикрон быстро стал доминирующим в Соединенных Штатах. На 8 января 2022 года он составил более 98% циркулирующего вируса, по сравнению менее 8% на 11 декабря 2021 года.

Эффективность противовирусного препарата

Старые варианты, отслеживаемые в Соединенных Штатах

Центр по контролю и профилактике болезней отслеживает долю вариантов, циркулирующих в Соединенных Штатах, и оценивает, что вариант B.1.1.7 (Альфа), обнаруженный впервые в Великобритании, составил более 44% случаев с 2 января по 27 марта 2021 года. 7 апреля 2021 года Центр по контролю и профилактике болезней объявил, что B.1.1.7 является доминирующим штаммом, циркулирующим в Соединенных Штатах. Он был доминирующим штаммом до середины июля 2021 года, когда доминирующим стал вариант Дельта.

VOC B.1.427 (Эпсилон) и B.1.429 (Эпсилон) возникли в Калифорнии. Эти варианты составляли 2,9% и 6,9% циркулирующих вариантов в Соединенных Штатах с 2 января по 27 марта 2021 года. Наблюдается приблизительное увеличение передачи на 20%.

Симптомы

Типичные симптомы COVID-19 чаще всего появляются через 2-14 дней после контакта с вирусом.

Симптомы могут включать в себя:

• Высокая температура
• Кашель
• Затрудненное дыхание или утомляемость
• Отсутствие обоняния или вкуса
• Горло болит
• Головная боль
• Кашель
• Головокружение
• Боль в мышцах или суставах

Некоторые люди могут иметь только несколько симптомов или вовсе не иметь никаких. Людей, у которых нет симптомов, но у которых тест положителен на COVID-19, называют асимптоматическими. Например, многие дети, у которых положительный результат теста, не имеют симптомов болезни COVID-19. Люди, у которых впоследствии появляются симптомы, считаются пресимптоматическими. Обе группы все еще могут распространять COVID-19 на других.

Некоторые люди могут иметь симптомы, которые усиливаются примерно через 7-14 дней после начала симптомов.

Большинство людей с COVID-19 имеют легкие или умеренные симптомы. Но COVID-19 может вызвать серьезные осложнения и привести к смерти. Пожилые люди или люди, у которых уже есть медицинские проблемы, подвержены большему риску серьезного заболевания.

COVID-19 может быть легким, умеренным, тяжелым или критическим заболеванием.

Редко люди, заразившиеся коронавирусом, могут развить группу симптомов, связанных с воспаленными органами или тканями. Это заболевание называется мультисистемным воспалительным синдромом. Когда у детей есть это заболевание, оно называется мультисистемным воспалительным синдромом у детей, сокращенно MIS-C. У взрослых это называется MIS-A.

Когда следует обратиться к врачу

Свяжитесь с медицинским профессионалом, если у вас положительный результат теста на COVID-19. Если у вас есть симптомы и вам нужно протестироваться на COVID-19 или вы были в контакте с кем-то с COVID-19, медицинский профессионал может помочь.

Немедленно обратитесь за экстренной помощью по любым из следующих симптомов:

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This list doesn’t include every emergency symptom. If you or a person you’re taking care of has symptoms that worry you, get help. Let the healthcare team know about a positive test for COVID-19 or symptoms of the illness.

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Complications

Complications of COVID-19 include long-term loss of taste and smell, skin rashes, and sores. The illness can cause trouble breathing or pneumonia. Medical issues a person already manages may get worse.

Complications of severe COVID-19 illness can include:

Post-COVID-19 Syndrome

After a COVID-19 infection, some people report that symptoms continue for months, or they develop new symptoms. This syndrome has often been called long COVID, or post-COVID-19. You might hear it called long haul COVID-19, post-COVID conditions or PASC. That’s short for post-acute sequelae of SARS-CoV-2.

Other infections, such as the flu and polio, can lead to long-term illness. But the virus that causes COVID-19 has only been studied since it began to spread in 2019. So, research into the specific effects of long-term COVID-19 symptoms continues.

Researchers do think that post-COVID-19 syndrome can happen after an illness of any severity.

Getting a COVID-19 vaccine may help prevent post-COVID-19 syndrome.

Practice Essentials

Going forward, hospitalizations are the main data to track COVID-19 trends by geographic regions in the United States. Additionally, the tracker provides emergency department visits of COVID-19, which is an excellent early indicator of spread.

A voluntary network of laboratories that submit test data to the CDC will provide valuable information as another early indicator of spread, along with other respiratory diseases (eg, influenza, RSV).

Additionally, wastewater surveillance provides current levels compared with past levels of infection.

Monitoring continues for new variants to enable testing of vaccines and therapies for efficacy.

Early Pandemic Recommendations

The CDC postulated that large numbers of patients could require medical care concurrently, resulting in overloaded public health and healthcare systems and, potentially, elevated rates of hospitalizations and deaths. The CDC advised that nonpharmaceutical interventions (NPIs) are the most important response strategy for delaying viral spread and reducing disease impact. Unfortunately, these concerns were proven accurate.

According to the CDC, individuals at high risk for infection include persons in areas with ongoing local transmission, healthcare workers caring for patients with COVID-19, close contacts of infected persons, and travelers returning from locations where local spread has been reported.

Signs and symptoms

The most common serious manifestation of COVID-19 appears to be pneumonia.

COVID-19 should be considered a possibility (1) in patients with respiratory tract symptoms and newly onset fever or (2) in patients with severe lower respiratory tract symptoms with no clear cause. Suspicion is increased if such patients have been in an area with community transmission of SARS-CoV-2 or have been in close contact with an individual with confirmed or suspected COVID-19 in the preceding 14 days.

Microbiologic (PCR or antigen) testing is required for definitive diagnosis.

The first vaccine to gain full FDA approval was mRNA-COVID-19 vaccine (Comirnaty; Pfizer) in August 2021. A second mRNA vaccine (Spikevax; Moderna) was approved by the FDA in January 2022. Additionally, each of these vaccines have EUAs for children as young as 6 months.EUAs have been issued for other vaccines.

Baricitinib (Olumiant), a Janus kinase inhibitor, gained FDA approval for hospitalized adults with COVID-19 disease who require supplemental oxygen, noninvasive or invasive mechanical ventilation, or ECMO. An EUA for children has been issued for baricitinib.

Similar to baricitinib, tocilizumab (Actemra), an interleukin 6 inhibitor, was approved by the FDA for hospitalized adults. An EUA remains in place for children aged 2 years and older.

EUAs have also been issued for other antivirals, vaccines and convalescent plasma in the United States. A full list of EUAs and access to the Fact Sheets for Healthcare Providers is available from the FDA.

Prevention

The Centers for Disease Control and Prevention (CDC) recommends a COVID-19 vaccine for everyone age 6 months and older. The COVID-19 vaccine can lower the risk of death or serious illness caused by COVID-19. It lowers your risk and lowers the risk that you may spread it to people around you.

The COVID-19 vaccines available in the United States are:

In general, people age 5 and older with typical immune systems can get any vaccine approved or authorized for their age. They usually don’t need to get the same vaccine each time.

Some people should get all their vaccine doses from the same vaccine maker, including:

Talk to your healthcare professional if you have any questions about the vaccines for you or your child. Your healthcare team can help you if:

People with weakened immune systems

Your health care team may suggest added doses of COVID-19 vaccine if you have a moderately or severely weakened immune system.

Control the spread of infection

In addition to vaccination, there are other ways to stop the spread of the virus that causes COVID-19.

If you are at a higher risk of serious illness, talk to your healthcare professional about how best to protect yourself. Know what to do if you get sick so you can quickly start treatment.

If you feel ill or have COVID-19, stay home and away from others, including pets, if possible. Avoid sharing household items such as dishes or towels if you’re sick.

In general, make it a habit to:

Try to spread out in crowded public areas, especially in places with poor airflow. This is important if you have a higher risk of serious illness.

The CDC recommends that people wear a mask in indoor public spaces if you’re in an area with a high number of people with COVID-19 in the hospital. They suggest wearing the most protective mask possible that you’ll wear regularly, that fits well and is comfortable.

Travel and COVID-19

Travel brings people together from areas where illnesses may be at higher levels. Masks can help slow the spread of respiratory diseases in general, including COVID-19. Masks help the most in places with low air flow and where you are in close contact with other people. Also, masks can help if the places you travel to or through have a high level of illness.

Masking is especially important if you or a companion have a high risk of serious illness from COVID-19.

More Information

Feb. 21, 2024

Research and studies

Latest updates and data

Continuing Education Activity

Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has had a catastrophic effect on the world, resulting in more than 6 million deaths worldwide. It has emerged as the most consequential global health crisis since the era of the influenza pandemic of 1918. As the virus mutates, treatment guidelines are altered to reflect the most efficacious therapies. This activity is a comprehensive review of the disease presentation, complications, and current guideline-recommended treatment options for managing this disease.

Access free multiple choice questions on this topic.

Review Questions

Covid 19, Corona Replication Contributed by Rohan Bir Singh, MD

Clinical Presentation of Patients with CoVID-19 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

SARS- CoV 2 Structure Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Transmission Cycle of SARS CoV 2 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Single-stranded RNA genome of SARS-CoV2 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Evaluation

Diagnostic Testing in COVID-19

Other Laboratory Assessment

Imaging ModalitiesThiss viral illness commonly manifests as pneumonia, so radiological imaging such as chest x-rays, lung ultrasounds, and chest computed tomography (CT) are often obtained. However, there are no guidelines regarding the timing and choice of pulmonary imaging in patients with COVID-19.

Risk factors

The main risk factors for COVID-19 are:

Many factors affect your risk of catching the virus that causes COVID-19. How long you are in contact, if the space has good air flow and your activities all affect the risk. Also, if you or others wear masks, if someone has COVID-19 symptoms and how close you are affects your risk. Close contact includes sitting and talking next to one another, for example, or sharing a car or bedroom.

It seems to be rare for people to catch the virus that causes COVID-19 from an infected surface. While the virus is shed in waste, called stool, COVID-19 infection from places such as a public bathroom is not common.

Serious COVID-19 illness risk factors

Some people are at a higher risk of serious COVID-19 illness than others. This includes people age 65 and older as well as babies younger than 6 months. Those age groups have the highest risk of needing hospital care for COVID-19.

Not every risk factor for serious COVID-19 illness is known. People of all ages who have no other medical issues have needed hospital care for COVID-19.

Known risk factors for serious illness include people who have not gotten a COVID-19 vaccine. Serious illness also is a higher risk for people who have:

People with dementia or Alzheimer’s also are at higher risk, as are people with brain and nervous system conditions such as stroke. Smoking increases the risk of serious COVID-19 illness. And people with a body mass index in the overweight category or obese category may have a higher risk as well.

Other medical conditions that may raise the risk of serious illness from COVID-19 include:

This list is not complete. Factors linked to a health issue may raise the risk of serious COVID-19 illness too. Examples are a medical condition where people live in a group home, or lack of access to medical care. Also, people with more than one health issue, or people of older age who also have health issues have a higher chance of severe illness.

COVID-19 Vaccines

Asymptomatic/presymptomatic SARS-CoV-2 infection and its role in transmission

Causes

COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2, also called SARS-CoV-2.

The coronavirus spreads mainly from person to person, even from someone who is infected but has no symptoms. When people with COVID-19 cough, sneeze, breathe, sing or talk, their breath may be infected with the COVID-19 virus.

The coronavirus carried by a person’s breath can land directly on the face of a nearby person, after a sneeze or cough, for example. The droplets or particles the infected person breathes out could possibly be breathed in by other people if they are close together or in areas with low air flow. And a person may touch a surface that has respiratory droplets and then touch their face with hands that have the coronavirus on them.

It’s possible to get COVID-19 more than once.

The virus that causes COVID-19 can infect some pets. Cats, dogs, hamsters and ferrets have caught this coronavirus and had symptoms. It’s rare for a person to get COVID-19 from a pet.

COVID-19 is a systemic viral illness based on its involvement in multiple major organ systems.

Epidemiology

Individuals of all ages are at risk of contracting this infection. However, patients aged ≥60 and patients with underlying medical comorbidities (obesity, cardiovascular disease, chronic kidney disease, diabetes, chronic lung disease, smoking, cancer, solid organ or hematopoietic stem cell transplant patients) have an increased risk of developing severe COVID-19 infection.

According to the CDC, age remains the strongest predictor of poor outcomes and severe illness in patients with COVID-19. Data from the National Vital Statistics System (NVSS) at CDC states that patients with COVID-19 aged 50 to 64 years have a 25 times higher risk of death when compared to adults infected with this illness and aged less than 30 years. In patients 65 to 74 years old, this risk increases to 60 times. In patients older than 85, the risk of death increases to 340 times. According to the CDC, these data include all deaths in the United States throughout the pandemic, from February 2020 to July 1, 2022, including deaths among unvaccinated individuals.

History and Physical

Clinical Manifestations of COVID-19

Coronavirus outbreak and pandemic

Racial health disparities

A prospective cohort study surveyed 170 adult patients who had recovered from COVID-19 1 year prior, during March and April of 2020. The patients participated in a telephone survey during March and April of 2021.

Almost half (79 patients; 46.5%) were of Hispanic ethnicity and 27.1% (46 patients) were African American. Job loss after COVID-19 diagnosis was highest among Hispanics (31/79; 39.2%) and African Americans (16/46; 34.7%). Hispanic individuals (31/79; 39.2%) and African Americans (17/46; 36.9%) also reported the most financial distress after COVID-19 diagnosis.

Hobbs et al compared MIS-C cases (38 cases) and COVID-19 hospitalizations (74 children) among non-Hispanic Black and White children in a defined catchment 16-county area of Mississippi.

Ward et al conducted a retrospective analysis of COVID-19 cases reported to the Alaska Department of Health and Social Services from March 12, 2020-December 31, 2021. The age-adjusted COVID-19 incidence among American Indian (AI)/Alaska Native (AN) individuals (26,583 per 100,000 standard population) was approximately twice the rate among White individuals (11,935).

CDC maintains a COVID-19 Data Tracker for near real time updates.

COVID-19 in children

Clinical characteristics and outcomes of hospitalized children and adolescents aged 1 month to 21 years with COVID-19 in the New York City area have been described. These observations alerted clinicians to rare, but severe illness in children. Of 67 children who tested positive for COVID-19, 21 (31.3%) were managed as outpatients. Among 46 hospitalized patients, 33 (72%) were admitted to the general pediatric medical unit and 13 (28%) to the pediatric intensive care unit (PICU). Obesity and asthma were highly prevalent, but not significantly associated with PICU admission (P = .99).

Symptoms are reminiscent of Kawasaki disease, atypical Kawasaki disease, or toxic shock syndrome. All patients had persistent fevers, and more than half had rashes and abdominal complaints. Interestingly, respiratory symptoms were rarely described. Many patients did not have PCR results positive for COVID-19, but many had strong epidemiologic links with close contacts who tested positive. Furthermore, many had antibody tests positive for SARS-CoV-2. These findings suggest recent past infection, and this syndrome may be a postinfectious inflammatory syndrome. The CDC case definition requires:

COVID-19 in pregnant individuals and neonates

COVID-19 in patients with HIV

COVID-19 in clinicians

References

Disclosure: Marco Cascella declares no relevant financial relationships with ineligible companies.

Disclosure: Michael Rajnik declares no relevant financial relationships with ineligible companies.

Disclosure: Abdul Aleem declares no relevant financial relationships with ineligible companies.

Disclosure: Scott Dulebohn declares no relevant financial relationships with ineligible companies.

Disclosure: Raffaela Di Napoli declares no relevant financial relationships with ineligible companies.