Answer to Question 1

Isolation is a when a sick individual with a confirmed contagious disease (e.g. COVID19) is separated from others without that disease. Quarantine is when a person who does not have symptoms for a contagious disease (e.g. COVID-19) has been in close contact with someone who has it and is separated from others who are not exposed; or who is awaiting test results.

Differential diagnosis:

• Typical Community acquired Pneumonia (CAP) – discounted due to bilateral positive lung finding
• Atypical pneumonia – discounted due to bilateral positive lung finding
• Tuberculosis- chest x-rays not suggestive, no purulent sputum
• Other viral diseases – discounted because of known high risk positive COVID-19 contact.

Management: Patient admitted to a general ward, nursed in contact and droplet precautions. He was started on nasal prong oxygen and responded well. Healthcare workers in the ward wore surgical masks, visors, plastic aprons and non-sterile gloves to protect themselves against droplet and contact transmission. On day 3 in the ward, he suddenly deteriorated and was recorded as having an oxygen saturation reading of 83% on double barrel oxygen. He was noticeably distressed and tachycardic. He was discussed with a consultant and was accepted to high care for high flow nasal oxygen. He spent a total of 13 days in high care (10 days on high flow and 3 days on 40% FMO2). He completed a 14-day course of prednisone at 40mg daily and received therapeutic clexane.

Healthcare workers in high care wore N95 respirators, visors, disposable gowns and nonsterile gloves as standard precautions (to protect themselves against droplet and contact transmission). They used additional precautions to protect against airborne contagions due to aerosol-generating procedures (AGP) (e.g. high flow nasal oxygen). They practiced strict hand hygiene according to the WHO “My 5 Moments” and also cleaned and disinfected the environment frequently with soap and water followed by a hypochlorite solution 1000ppm or 70% alcohol surface disinfectant

Patient developed a thrombophlebitis in his right arm while in HCU and was started on Flucloxacillin. He was transferred back to the general ward and successfully weaned to room air. He remained comfortable on room air with a saturation of 92%. Patient also developed an acute kidney injury that resolved with supportive management.

Patient was discharged on the 13th August 2020 after 24 days in hospital. He was in time for the birth of his first born.

Question 2: Provide a list of aerosol-generating procedures.

Final diagnosis:

COVID-19 pneumonitis

The World Health Organization (WHO) declared Covid-19 a global pandemic on 11th March 2020. The first case was diagnosed in South Africa on 5th March 2020. South Africa faces a particular challenge given the large vulnerable immunocompromised population living in overcrowded conditions.

Question 4: Name the characteristics of the SARS CoV-2 virus.