- Editorial – Jana Šeblová
THEME OF THE YEAR: THE COVID-19 PANDEMIC
- Novel Coronavirus SARS-CoV-2 and COVID-19 – an Infectious Disease Specialist’s Perspective – Vyacheslav Grebenyuk, Milan Trojánek
- Risk of novel coronavirus transmission in prehospital care and implications from clinical physiology during airway management – David Astapenko, Vladimír Černý
- Respiratory support in patients presenting with COVID-19 – Roman Škulec, Michal Kalina
- Imaging methods in SARS-CoV-2 pneumonia – Eva Kočová, Martin Hyršl, Jiří Vaňásek
- Diversity of clinical characteristics of the COVID-19 disease in case reports – Robin Šín, Miroslav Kubiska, Dalibor Sedláček, Denisa Štruncová, Jana Váchalová
- COVID-19 in children during the first and the second pandemic outbreak in the Czech Republic in the year 2020 – Pavel Heinige, Martin Prchlík, Martin Fajt, Pavel Kamenický, Kateřina Barčíková
- COVID-19 Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) – a case report – Lucie Hřivnová, Miroslava Zimová, Miroslava Sulovcová, Filip Fencl, Vít Neumann, Tomáš Bačkai, Petr Pavlíček, Markéta Bloomfield, Hana Malcová, Jitka Dissou
- COVID-19 crisis and medical dispatch centres´ capacity – Ondřej Franěk
- SARS-CoV-2 pandemic and its consequences on mental health – Jana Šeblová, Dominika Šeblová, Dita Protopopová
NOVEL CORONAVIRUS SARS-COV-2 AND COVID-19 – AN INFECTIOUS DISEASE SPECIALIST’S PERSPECTIVE
Vyacheslav Grebenyuk, Milan Trojánek
The causative agent of COVID-19 is the SARS-CoV-2 betacoronavirus, which is closely related to the etiologic agent of the SARS. The transmission occurs mainly via respiratory droplets or contaminated fomites. The main factors contributing to the pandemic spread of COVID-19 include transmission during incubation period and the ability of the virus to reach high viral loads in the upper respiratory tract. The potential to transmit SARSCoV- 2 begins at least 2 days prior to the development of symptoms and is the highest at the time of symptom onset. The period of infectiousness lasts for a maximum of 10 days in most cases. The median incubation period is 4 to 5 days. The most common symptoms include fever, cough, shortness of breath, loss of smell and/or taste, fatigue, headache and myalgias. Approximately one half of cases are estimated to remain asymptomatic. The spectrum of disease severity ranges from mild flu-like illness, pneumonia with dyspnoea and/or hypoxia, to critical disease with respiratory or multiorgan failure. Severe complications include acute respiratory distress syndrome, acute kidney injury, cardiac disease and thrombosis. Diagnostic options include RT-PCR or detection of viral antigen from an upper respiratory tract specimen, serology and imaging. No single diagnostic method is entirely reliable in clinical practice and a combination of several tests together with specific clinical findings may be needed for establishing the diagnosis in some cases. Oxygen therapy and mechanical ventilation remain the mainstay of treatment for severe or critical cases. To date, no specific causal treatment of the SARS-CoV-2 has been developed. Dexamethasone and other corticosteroids are the only medications with a proven survival benefit.
Key words: COVID-19 – coronavirus transmission – clinical symptoms – diagnostics – complications
RISK OF NOVEL CORONAVIRUS TRANSMISSION IN PREHOSPITAL CARE AND IMPLICATIONS FROM CLINICAL PHYSIOLOGY DURING AIRWAY MANAGEMENT
David Astapenko, Vladimír Černý
Infection with the novel coronavirus SARS-CoV-2 is a multisystemic disease. The risk of infection in the first week after the onset of symptoms (usually flulike symptoms) occurs with massive replication of the virus. In the second week, up to 40% of symptomatic patients may develop symptoms of acute respiratory distress syndrome which usually require the initiation of oxygen therapy and supportive non-invasive ventilation in prehospital care and less often securing the airways by orotracheal intubation and initiation of intermittent mandatory ventilation. These are aerosol-generating procedures and they increase the risk of transmitting the infection. The airway management in pre-hospital care should include considering impending airway obstruction, signs of unsustainable work of breathing, refractory hypoxemia despite maximal oxygen therapy, possible impaired consciousness from hypercapnia and distance to the nearest medical facility with emergency department or intensive care unit background. During prehospital care for COVID-19 patients or high suspected patients prescribed personal protective equipment is compulsory to minimize the risk of transmission of the disease.
Key words: SARS-CoV-2 virus – acute respiratory distress syndrome – immunity system – aerosol generating procedures
Roman Škulec, Michal Kalina
Respiratory support is a key part of the management of patients with COVID-19 (Coronavirus Disease 2019). In this article, the authors summarize recent overview of the topic with a special focus on emergency medicine.
Key words: COVID-19 – oxygenation – ventilation – acute respiratory failure
IMAGING METHODS IN SARS-COV-2 PNEUMONIA
Eva Kočová, Martin Hyršl, Jiří Vaňásek
COVID-19 infection is the theme number one in the last months. From the radiological point of view, COVID-19 infection has some specific signs especially on computed tomography (CT) of the lung. Chest X ray in not recommended as a screening method for the detection of the infection. CT of the lung can be completelly negative in the first days of the infection. In the next days some specific signs can appear, like ground glass opacities bilaterally in subpleural space. Ground glass opacities can be seen alone or together with reticulations. Other typical signs are lienar opacities and consolidations. In the case of untransportable patient it is possible to use bed side ultrasound to detect lung involvement but by using this method it is impossible to detect the real extent of the lung involvement.
Key words: COVID-9 – computed tomography – ground glass opacities – reticulations
DIVERSITY OF CLINICAL CHARACTERISTICS OF THE COVID-19 DISEASE IN CASE REPORTS
Robin Šín, Miroslav Kubiska, Dalibor Sedláček, Denisa Štruncová, Jana Váchalová
COVID-19 is an infectious disease caused by the new coronavirus SARS-CoV-2. It was demonstrated in the last quarter of 2019 in China at first. In the clinical picture by symptomatic patients dominate fever, cough, shortness of breath, total weakness and tiredness. Acute respiratory failure on the basis of viral pneumonia can develop in patients with more severe course and the condition can progress up to ARDS (Acute respiratory distress syndrome). Risk groups include the elderly and patients with diabetes and hypertension. Obesity or the presence of immunodeficiency is also a serious factor. There are many other symptoms in patients outside the respiratory tract, as shown by our presented case reports. It is possible to encounter gastrointestinal problems, variously localized pains or even an exanthema. It is even more complicated for doctors to diagnose COVID-19 disease just according to clinical picture.
Key words: SARS-CoV-2 – COVID-19 – viral pneumonia – shortness of breath – acute respiratory failure
COVID-19 IN CHILDREN DURING THE FIRST AND THE SECOND PANDEMIC OUTBREAK IN THE CZECH REPUBLIC IN THE YEAR 2020
Pavel Heinige, Martin Prchlík, Martin Fajt, Pavel Kamenický, Kateřina Barčíková
In the first months of the year 2020 the COVID 19 disease have spread worldwide. Children suffer from that disease significantly less frequently than the adults, nevertheless they cause quite large consequences for paediatric health care providers. Although children with symptoms of COVID-19 disease are quite rare, we suppose, that children are an important vector of viruses spreading. The goal of the highest priority is protection of the emergency medical staff and the staff of a paediatric departements from infection transmission from paediatric patients symptomatic for COVID-19 or more often of children requiring urgent health care for another reason – severe trauma, poisoning or acute abdomen etc. Rare, but serious disease of paediatric age, related to pandemia of COVID-19, is so called „Paediatric Inflammatory Multisystemic Syndrome, Temporally-associated with SARS-CoV-2“, shortened to acronym as PIMS-TS. This unit may present from 2 to 8 weeks after the new coronavirus exposition. There are some signs very simmilar to Kawasaki disease and the disease may run very dramaticaly or even fatal. The main complication, that may lead to death, is a circulation shock. Till the half of November there were few cases of this disease reported in the Czech Republic, including sudden deaths.
Key words: Child – COVID-19 – paediatric inflammatory multisystem syndrom (PIMS)
COVID-19 PAEDIATRIC INFLAMMATORY MULTISYSTEM SYNDROME TEMPORALLY ASSOCIATED WITH SARS-COV-2 (PIMS-TS) – A CASE REPORT
Lucie Hřivnová, Miroslava Zimová, Miroslava Sulovcová, Filip Fencl, Vít Neumann, Tomáš Bačkai, Petr Pavlíček, Markéta Bloomfield, Hana Malcová, Jitka Dissou
A case report of a 7 years old boy with long term fever and asymetric cervical lymphadenopathy examined in acute paediatric outpatient clinic is presented in this paper. He was admitted to hospital for altered general status, increase of laboratory inflammatory parameters, bilateral conjunctitvitis and postitive meningeal syndrom as suspected Kawasaki disease (KD). Left ventricle insufficiency presented during hospital stay and circulatory support and artificial lung ventilation was needed for the deterioration of patient´s general condition. Progression of patient´s status occurred within a few days. The diagnose of PIMS-TS (Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2) was stated by immunological consultant. There were no information of Covid-19 in patient´s case history and we have also no information about Covid-19 tests in patient´s family, nor negative or positive, but novel coronavirus antibodies were proven in our patient.
Key words: PIMS-TS (Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2) – children – Covid-19
COVID-19 CRISIS AND MEDICAL DISPATCH CENTRES´ CAPACITY
The aim of this article is to share experience in dealing with the extreme increase of workload of the emergency medical dispatch centres (EMD) associated with the ongoing COVID-19 epidemic in five European regions. The article presents solutions based on both change in the workflow of EMD and the use of modern technologies including those for sharing workspace. The basic precondition for managing the situation is continuous monitoring of the qualitative parameters of EMD, which allows not only a timely response to their deterioration, but also to monitor the effect of the changes introduced. The aim of the changes was not only to handle large number of calls, but to maintain the availability of timely emergency assistance for patients with a critical illness or injury above all.
Key words: Emergency medical dispatch – quality management – COVID-19
SARS-COV-2 PANDEMIC AND ITS CONSEQUENCES ON MENTAL HEALTH
Jana Šeblová, Dominika Šeblová, Dita Protopopová
The paper reviews current knowledge on mental health consequences both on general population and health care professionals. Many countries report higher rates of depression and anxiety, nevertheless vulnerable population groups may differ regionally. Additionally, substance abuse and rates of domestic violence also increased. Increase of suicidality is expected in the future after pandemic and so it is necessary to concentrate on both primary and secondary preventive programmes. It is also vital to ensure the access to care for patients with preexisting mental disorders despite of difficulties in providing health care in general. The authors also present preliminary results of the national part of a large international study HEROES which is a long term study on psychological stress of health care and social care workers. 1856 Czech respondents took part in the first part of the study and 1416 finished the questionnaire and were enrolled in the study. The goal of the study is not only international comparison of mental health impact of COVID-19 pandemic on professionals but mainly proposal of supportive programmes based on real needs of the professionals.
Key words: mental health – anxiety – depression – suicidality – substance abuse – COVID-19 pandemic