• Users Online: 657
  • Print this page
  • Email this page

Table of Contents
Year : 2020  |  Volume : 21  |  Issue : 1  |  Page : 81-95

Continuing education series Coronavirus Disease 2019 (COVID-19)

1 Nurse Manager, Armed Forces Hospital, Southern Region, Saudi Arabia
2 Director of Nursing, Armed Fources Hospital, Southern Region, Saudi Arabia
3 Lecturer, College of Nursing, CMC, Vellore, Tami Nadu, India

Date of Submission16-May-2020
Date of Decision29-May-2020
Date of Acceptance30-May-2020
Date of Web Publication14-Sep-2020

Correspondence Address:
Prof. Mary Johnson
Armed Fources Hospital, Southern Region, Khamis Mushait
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCN.IJCN_80_20

Rights and Permissions

The coronavirus disease 2019 emerged as an epidemic in Wuhan, China, in December 2019 and has exponentially extended into a global pandemic in 2020. As a highly contagious disease, it has forced individuals, communities and countries to take various steps to combat the spread. Although majority of the affected individuals suffer with mild-to-moderate symptoms, the infectious nature, the wild spread and the fatality rates in many countries have led to implementing protocols and procedures applicable to emergency situations. Testing, contact screening, quarantining contacts and isolation and treatment of infected individuals along with measures to control spread are all have been the specific measures mandated globally. This continuing education article highlights the different aspects of coronavirus infection.

Keywords: Coronavirus, COVID-19, infectious disease, pandemic

How to cite this article:
Johnson M, Chetty J, Priyadarsini IS, Suganandam DK. Continuing education series Coronavirus Disease 2019 (COVID-19). Indian J Cont Nsg Edn 2020;21:81-95

How to cite this URL:
Johnson M, Chetty J, Priyadarsini IS, Suganandam DK. Continuing education series Coronavirus Disease 2019 (COVID-19). Indian J Cont Nsg Edn [serial online] 2020 [cited 2021 Jan 18];21:81-95. Available from: https://www.ijcne.org/text.asp?2020/21/1/81/295052

  Introduction Top

This year 2020 has been marked as the year of coronavirus disease 2019 (COVID-19) globally. In December 2019, several individuals were hospitalised with an acute respiratory illness of unknown cause, in Wuhan, Hubei Province, China. Most of them had a link to the Huanan Seafood Wholesale Market. These patients presented with fever, dry cough and fatigue and occasional gastrointestinal symptoms. The disease has now been identified as COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] The disease since its first identification in December 2019 has rapidly spread creating a pandemic situation causing major disruption on everyday life of human beings, affecting individuals from all spheres of lives.

The outbreak of the disease was initially linked to Wuhan market, China, in December 2019 when the staff of the market were affected. In an effort to contain the spread of infection, the market was shut down on 1 January 2020 after an epidemiologic alert. Despite the efforts to curtail the disease, COVID-19 spread to different countries. The COVID-19 pandemic due to SARS-CoV-2 was declared as a public health emergency of international concern by the World Health Organization (WHO) on 30 January 2020 and a pandemic on 11 March 2020.[1]

At the end of June, according to a report by the WHO, the total number of cases of COVID-19 worldwide was 9,962,193 and the deaths 498,723.[2]

Majority of the population (80%) affected by COVID-19 are either asymptomatic or present with mild infection.[3] However, the disease is known to cause severe pneumonia and multiple complications, especially in certain high-risk groups. Some infected individuals (about 20%) may require hospitalisation and about 5% of them may present with severe respiratory distress needing ventilation and intensive care. Infection with COVID-19 is associated with significant morbidity, especially in patients with chronic medical conditions. At least one-fifth of cases require supportive care in medical intensive care units, which is especially limited in most developing countries.[4]

  Disease Burden Top

It has been estimated that 349 million (UI 186–787) people – 4% (3–9) of the global population – are at high risk of severe COVID-19 and would require hospital admission if infected.[5] There has been evidence showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19.[6] Countries with ageing population are at high risk for an increased morbidity and mortality from COVID-19.

The dashboard on total number of cases worldwide is topped by the USA, followed by Brazil and Russia. Globally, as of 5 July 2020, there have been 11,125,245 confirmed cases of COVID-19, including 528,204 deaths, reported to the WHO. In the USA, there have been 2,983,142 cases and 132,571 as of July 2020.[7]

The positive cases for the infection and the fatality are continuing to rise globally. The United States ranks first in total infected cases and total number of deaths. While the concern of pandemic is escalating in most countries, in China, where the disease originated, the curve was high in March and April 2020 and the curve has flattened now. The curve for new cases has been uniform in Middle Eastern countries.[7]

The coronavirus (COVID-19) is spreading rapidly across the country in India. The ongoing rise in cases could be due to disease factors and testing measures. It may indicate a surge in infections, where the testing was reactive, but may also reflect the proactiveness of states where higher testing access may be a surrogate for mobilisation of more hospital resources and contact tracing. There appears to be a linear correlation where increased testing is associated with higher cases detected, and a higher number of laboratories per state are associated with more tests performed.[8]

India's novel coronavirus numbers are being powered mainly by the surge in the four southern states of Tamil Nadu, Karnataka, Telangana and Andhra Pradesh. Tamil Nadu continues to report huge rise in positive cases. After the spurt in the 3rd week of June, Delhi has slowed down considerably, though, in absolute terms, it is still reporting more than 2000 cases every day. Maharashtra is the worst-affected state in the country with over 1 lakh cases. Tamil Nadu and Delhi occupy the next two spots. Maharashtra has been leading the country's COVID cases.[9]

  Nature of Coronavirus Top

The term corona is derived from a Latin word 'coronum' which refers to crown. Because of the presence of glycoprotein spikes on its outer covering, it resembles a crown under electron microscope. Coronaviruses that cause human diseases belong to Orthocoronavirinae family. It is broadly classified based on the genomic structure into four genera, namely alpha, beta, gamma and delta. Based on the genomic character analysis, alpha- and betacoronavirus resembles the gene sources of bats and rodents, whereas avian species resembles the gene sources of delta- and gammacoronavirus.[10]

In the earlier days, SARS-CoV and Middle East respiratory syndrome-CoV were caused by betacoronaviruses. Current SARS-CoV-2 is 96% genetically identical to betacoronavirus isolated from bats and Malayan pangolins.[11] When a virus enters the human host, the life cycle passes through five steps [Figure 1].
Figure 1: Life cycle of coronavirus 2.

Click here to view

During the attachment stage, the virus comes in contact with the host cell surface. The spike protein which is present on the exterior surface of the virus has two subunits: S1 and S2. S1 is responsible for binding to receptors of the host cell, whereas S2 enables fusion of viral and cellular membranes. Furin or TMPRSS2 present in the host cell membrane breaks the spike protein to enable penetration. Virus strips its outer layers and capsid, thus enabling the release of nucleic acid into the host cell. Viral RNA enters the nucleus for replication. Viral mRNA is used to make viral proteins (biosynthesis). Then, new viral particles are made (maturation) and released.

Coronavirus consists of four structural proteins, namely spike, membrane, envelope and nucleocapsid.[12] Angiotensin-converting enzyme 2 (ACE2) is considered to be a major functional receptor for CoV-2.[13] The ACE2 receptor is expressed in alveolar epithelial cells of the lungs, kidney, heart and gastrointestinal tract.[14] Lung epithelial cells seem to be more vulnerable to SARS CoV-2 and act as a reservoir for the virus to replicate. The pathophysiology of COVID-19 infection is depicted in [Figure 2].
Figure 2: Pathophysiology.

Click here to view

  Mode of Transmission Top

COVID-19 is primarily transmitted from person to person through respiratory droplets when an infected person coughs, sneezes or speaks. People can also be infected by touching a contaminated surface and then their eyes, mouth or nose.[15] A study conducted on stability of coronavirus on various surfaces revealed that it was found to be more stable on plastic and stainless steel on which the virus was detected up to 72 h. On the other hand, no viable virus was found after 4 h in copper and after 24 h for cardboard.[16] Hence, frequent handwashing and periodic disinfection of contact area are highly essential in terms of breaking this chain of transmission.

The WHO explains the transmission in three possible ways: symptomatic transmission, pre-symptomatic transmission and asymptomatic transmission.[17]

Symptomatic transmission refers to transmission of virus from a person who is currently experiencing the symptoms. It is also noticed that shedding of the COVID-19 virus is highest in the upper respiratory tract in the initial course of illness rather than the later period.[18]

Pre-symptomatic transmission refers to transmission of virus from a person before the onset of symptom. Based on certain case studies, it was found that a person with positive COVID-19 can still transmit virus even before the first symptom could appear.[17]

Asymptomatic transmission refers to transmission of virus from an infected person who does not develop symptom. There are few documented asymptomatic transmission cases.[17] The incubation period of COVID-19 is 1-14 days (mean duration of 5-7 days), with peak viraemia occurring before the onset of symptoms.

  Clinical Features Top

The most common symptoms of COVID-19 are fever, dry cough and tiredness.[19]

Less common symptoms

  • Aches and pains
  • Nasal congestion
  • Headache
  • Conjunctivitis
  • Sore throat
  • Diarrhoea
  • Loss of taste (anosmia) or smell (ageusia)
  • Skin rashes
  • Discoloration of fingers or toes.

A large scale study conducted in Wuhan, China, regarding the clinical presentation of COVID-19 reveals that fever, cough and fatigue were predominant among infected cases [20] [Table 1].
Table 1: Common manifestation of patients with coronavirus disease 2019

Click here to view

  COVID-19 Disease Severity Top

Based on the manifestations, the WHO had classified the COVID-19 cases [21] [Table 2].
Table 2: Coronavirus disease 2019 disease severity category

Click here to view

  Diagnostic Findings Top

Preferred sample for testing is throat and nasal swab in viral transport media maintained in cold chain.[22]

Molecular real-time reverse transcription–polymerase chain reaction (RT-PCR) is the diagnostic test recommended by the WHO for identification and laboratory confirmation of COVID-19 cases. RT-PCR first uses reverse transcription to obtain DNA, followed by PCR to amplify that DNA, creating enough number for the analysis. It usually requires a few hours.

The following tests are not recommended by the WHO. However, it encourages them for identifying its usefulness in disease surveillance and epidemiological research.

Rapid diagnostic test for antigen detection detects the presence of viral protein expressed by the COVID-19 in a sample. Antibodies will be fixed to a paper strip enclosed in plastic casing and the sufficient amount of antigen in the sample will bind to the antibody and the result can be viewed within 30 min. The specificity can vary from 34% to 80%.[23]

Rapid diagnostic test for antibody detection detects the presence of antibodies in the serum of those who are exposed to COVID-19. This test may not be useful in diagnosing the acute infection as antibodies will appear only in the 2nd week following the symptom onset.[23] However, it will aid in the development of vaccine.

Other diagnostic features include chest X-ray, chest computed tomography (CT), arterial blood gas studies, blood counts (total and differential count), renal function test (urea and creatinine), D-dimer, serum electrolytes (sodium, potassium, chloride, magnesium and calcium), inflammatory markers (procalcitonin and C-reactive protein [CRP]) and liver function test (bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase and lactate dehydrogenase).

A study conducted in Wuhan, China, regarding clinical presentation of patients with COVID-19 revealed that 59.1% of patients had abnormalities in chest X-ray. Thirty-seven per cent of patients had bilateral patchy shadowing and 20.1% had ground-glass opacity. The CT chest findings highlighted that 56.4% had ground-glass opacity, whereas 51.8% had bilateral patchy shadowing. Laboratory investigations showed that 83.2% of patients had abnormal lymphocytes count, 36.2% had deranged platelet count, 60.7% with high CRP and 26.4% had elevated D-dimer.[20]

  Treatment Modalities Top

The treatment guidelines are based on the recommendations from the WHO [Table 3].[21]
Table 3: Treatment of COVID 19

Click here to view

  Other Supportive Therapies Top

There are many other pharmacological management which are carried out in managing COVID-19 patients. The WHO does not recommend its usage for treatment; however, it can be used under clinical trials.

  • Chloroquine and hydroxychloroquine
  • Azithromycin
  • Antivirals such as lopinavir/ritonavir, remdesivir, umifenovir and favipiravir
  • Immunomodulators such as tocilizumab and interferon-β-1a
  • Plasma therapy
  • Use of dexamethasone is used in critically ill hospitalised.

Usage of antimicrobials – for mild/moderate COVID-19 cases, antibiotics should not be prescribed unless there is a clinical suspicion of infection. In case of severe COVID-19, antimicrobial therapy can be prescribed based on local epidemiology, patient factors and clinical judgement. However, de-escalation is advised based on the daily response.

Patients with pre-existing non-communicable diseases continue or modify drug regimen according to patient condition. Antihypertensive should not be stopped on a regular basis. Dosage can be titrated depending on hypotension and renal function. Blood sugar values need to be constantly monitored and controlled for patients with diabetes. The complications of COVID 19 are listed in [Table 4].
Table 4: Complications of COVID 19

Click here to view

Vaccine update

As on 2 July 2020, based on the WHO report, there are 18 candidate vaccines in clinical evaluation and 129 in preclinical evaluation. Among clinical evaluation, one is currently in Phase 3 trial and rest in Phase 2/1.[25]

  Strategies for Prevention and Control of Coronavirus Disease 2019 Top

Strategies for prevention and control of COVID-19 include improving epidemic surveillance, quarantining the source of infection, speeding up the diagnosis of suspected cases, optimising the management of close contacts, tightening prevention and control of cluster outbreaks and hospital infection.[26]

In recent years, social media has become an important source to broadcast awareness and information regarding control of infectious disease. Social networking sites including WhatsApp, Twitter, Facebook and YouTube are being used extensively to disseminate knowledge regarding COVID-19.[27]

All countries throughout the world have used different strategies to control the pandemic. The WHO states that all countries should prepare to respond to different public health scenarios, recognising that there is no 'one-size-fits-all' approach to managing cases and outbreaks of COVID-19. Each country should assess its risk and rapidly implement the necessary measures at the appropriate scale to reduce both COVID-19 transmission and economic, public and social impacts.[28]

Telemedicine has effectively come into use with emergence of COVID-19. Home quarantined and mildly/asymptomatic patients can contact their healthcare team through telemedicine and videoconferencing. Countries have created mobile apps to enhance communication and monitoring of quarantined individuals by healthcare professionals. Implementing an electronic health information system to support healthcare workers (HCWs) in providing healthcare services to an individual client and to enable data exchange among service providers needs to be one of the global health priorities to help respond to community's health needs, particularly during the current COVID-19 pandemic.[29]

  Prevention Top

Early protection, early identification, early diagnosis and early isolation are crucial to combat COVID-19 outbreaks. Early detection and isolation of cases have been the bedrock for curbing the rapid spread of communicable diseases [Figure 3] and [Figure 4].[30]
Figure 3: Sequence of donning. Using personal protective equipment, Centers for Disease Control https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html.

Click here to view
Figure 4: Sequence of doffing.

Click here to view

The prevention of spread of COVID-19 in the hospitals from patient to patient and to the HCWs is outlined below.[31]

All HCWs in COVID care areas should use personal protective equipment (PPE) as per guidelines. Staff should follow correct donning and doffing protocols.

  • If a patient needs admission, single room should be given with contact isolation precautions
  • Visitor control protocols should be put in place
  • Strict hand hygiene should be mandated for everyone coming into the healthcare facility. The seven steps in handwashing should be religiously followed every time for handwashing to be effective
  • A spatial separation of 1 m in between patients should be maintained in any area within the healthcare facility
  • Patients coming into outpatient departments (OPDs) should be triaged for infection
  • All individuals should wear a mask.

Environmental and engineering controls such as adequate ventilation of all healthcare facilities and proper environmental and article disinfection have to be meticulously carried out.

The WHO recommends the following mandatory strategies to prevent the transmission and spread of COVID-19 infection in the community:[19]

  • Hands should be washed thoroughly with soap and water or alcohol-based hand rub. A social distance of minimum 1 m (3 feet) between individuals and at least 6 feet distance between persons in public is advised
  • Asymptomatic persons may still be able to spread virus; therefore, everyone, especially those who have been exposed or have a history of contact with COVID-positive patients, is to be considered potentially infective until tested negative
  • A mask to be worn when outside the home, especially in crowded places. HCWs and persons within the premises of hospital or healthcare facilities are advised to wear a surgical or N95 mask as indicated. It is better to avoid crowded areas or large gatherings by saying at home. The following respiratory hygiene practices such as covering nose and mouth while coughing or sneezing will reduce the spread of respiratory droplet particles
  • If and when symptoms suggestive of COVID-19 infection occur, immediate isolation either at home or at a quarantine facility is advised
  • Seeking early medical advice and help when symptomatic will improve outcome in illness and also will contain the spread of infection
  • A positive and optimistic outlook promotes psychological well-being in times of stress
  • Vigilance rather than hypervigilance for potential symptoms for COVID is essential.

  Nursing Management Top

COVID-19 has led to a surge of patients requiring acute and post-acute care. Management strategies in the administration level include:

  • Education and training of all medical staffs in the ward towards the use of PPE and asepsis
  • Modification of environmental layout of the ward to include areas for isolation and quarantine facilities and for donning and doffing procedures
  • Environmental control to include control of visitors and waste management
  • Strict disinfection system that looks at disinfection of linen, rooms, articles and other things used by infected persons and regular disinfection of surfaces and articles in all areas
  • Management strategies of the protective supplies.

  Nursing Care of Patients With Coronavirus Disease 2019 Infection Top

Ensuring comprehensive assessment

The first step in nursing care is to complete appropriate assessment to gather objective and subjective data based on which the interventions can be planned and provided. When a patient presents to the OPD or the emergency, the foremost step is to collect history which is an essential part of assessment. The nurse should elicit history on presenting symptoms and history related to contact. The single first essential question related to symptoms has been whether the person has or had fever or cough or both in the past few days. If history of fever is given, then other presenting complaints have to be elicited. Further history related to contact including the geographical area they are from (to know whether they are from containment zones or high prevalence areas), history of travel (high risk of contracting the infection during travel or travel to and from high prevalence areas) and exposure to individuals deemed to be positive for or suspected to have the infection or contact with healthcare professionals who have cared for patients with COVID-19 infection. A person who does not have any symptoms that are related to COVID-19 or any contact history may safely be identified for non-probability of having the infection.

If patients have a positive history, then a physical assessment is continued to validate symptoms. The nurse should check vital signs and should document the body temperature, pulse, respiration and blood pressure. The fifth vital sign that is mandatory for patients with COVID infection is the oxygen saturation. A pulse oximetry reading will give an indication of the current oxygen saturation levels in the blood. As COVID-19 has an affinity to lungs, the respiratory system should be assessed comprehensively. Nurses should assess for the presence of increased respiratory rate and effort, cough, abnormal breath sounds such as wheeze or absent breath sounds, dyspnoea and low saturation levels (<94%) which indicates a severe form of infection.

A patient with positive or probable signs of infection should be immediately isolated and prepared for further investigations if necessary. Nurses' responsibility includes preparing the patient for diagnostic tests such as RT-PCR. Secretions from the upper respiratory tract may have to swabbed and sent for testing. A nurse who is assessing a patient suspected to have COVID-19 infection should use complete PPE as per the WHO protocol to prevent getting infected.

  Maintaining Airway and Breathing Top

Maintaining a patent airway and ensuring adequate oxygen exchange at the alveolar level is the priority in patients with COVID-19 infection. Patients who do not manifest with respiratory insufficiency may have to be monitored continuously for worsening symptoms. Patients who have a moderate or severe disease have to be provided specific interventions as already mentioned in the management section. Patients who are conscious and non-delirious should be positioned in prone as prone position improves ventilation–perfusion ratio which enables better oxygenation.

If oxygen saturation by oximetry is <94%, a patient should be started on oxygen. A nasal cannula, ventury or rebreather mask may be used to initiate oxygen delivery depending on the oxygen saturation levels. If a patient is unable to maintain saturation with these devices, then non-invasive ventilation may be ordered with either continuous positive airway pressure or bilevel positive airway pressure. The nurse should be able to connect a patient to these types of ventilation whenever necessary. Therefore, keeping the necessary apparatus/equipment ready is important. The nurse should also ensure continuous flow of oxygen supply.

A patient may also be encouraged or assisted to change positions every few hours (semi-Fowler or lateral) to prevent pooling of bronchial and alveolar secretions found commonly in patients with severe infection. Deep breathing exercise is encouraged to facilitate maximum alveolar expansion. Steam inhalations twice or thrice a day may facilitate liquefying and mobilising secretions and may relieve symptoms like nasal congestion but does not cure infection. Medication to relieve symptoms and to control infection and complications has to administer as ordered. Patients are encouraged to rest or limit their activities to conserve energy and reduce body's oxygen demand.

Patients need to be explained about their condition and the need for each intervention. Patients also should be constantly monitored (National Early Warning Score is a very useful tool) for any worsening of symptoms so that escalation of treatment may be initiated at the earliest possible time.

  Reducing Symptoms Such as Fever, Myalgia, Cough and Fatigue Top

Patients will benefit from antipyretics which will address their fever and also myalgia. Tablet paracetamol is the most common antipyretic prescribed and can be administered as per the dose and interval prescribed by the physician. Cooling measures such as ice bag for headaches may provide comfort and so can be given according to patient's preference. Cough medication should be administered as ordered if cough is persistent and disrupts sleep and rest. Warm saline gargles may help in providing a soothing effect on the throat.

Patients are encouraged to stay in bed, limit their activities and take as much rest as possible to promote healing and recovery. Nurses have to assist in meeting the nutritional, hygienic and elimination needs at the bedside by providing meals and fluids, giving a bath and providing a bed pan or urinal if necessary. If patients can walk to the bathroom, they may be assisted with hygiene and elimination. The activities have to be paced to provide adequate rest periods. Patients with COVID-19 have been observed to have sudden drop in oxygen saturation. Therefore, constant monitoring is mandatory.

  Promoting Psychological Well-Being of the Patients and Family Top

As COVID patients are in isolation and visitors are strictly prohibited, they often develop feelings of loneliness and may feel abandoned and separated. Nurses should acknowledge these feelings and should try to provide a safe and secure as well as a caring environment within the unit. Maintaining open communication, providing accurate information and positive reinforcement, listening to their concerns and promoting an environment for expression of their feelings and fears are important nursing interventions that nurses can implement. Nurses also should facilitate communication and connection between the patient and the family through social media such as video calls and messaging. Information about the condition of the patient can be communicated with the family as per unit protocol. Fear about death is a legitimate concern, and this fear has to be addressed by referring patients for professional counselling. Spiritual support through prayers and visits of chaplains help patients to have hope during their time of suffering.

Patients can be encouraged to engage in diversional activity as tolerated as most of them may have mild symptoms and may be frustrated with isolation. Activities such as reading, listening to music, watching videos or even doing craft will help patients to use their time positively. All activities need to be provided or carried out maintaining isolation precautions and as tolerated.

  Enhancing Peaceful Death and Departure Top

Critically ill patients with comorbidities succumb to illness due to multiple systemic complications produced by the infection. Death produces a unique situation in COVID-19 infection as family members are restricted in the way they can handle their loved ones with infection after death. As the normal process of expressing grief and loss is disrupted, nurses become key persons in mediating between the family who is grieving and the person who is dead or in the verge of death. Nurses can assure the family members that the best possible care is being provided even in the last minutes of life for their loved ones and that they are there for the patient on behalf of the family. A patient should be given a dignified death by ensuring grooming the dead person and bagging the patient in the body bag with the utmost respect. The family's preference for burial should be respected and arranged as much as possible. The family also has to be explained about the need for the following strict protocols in handling the body and clarified about their cooperation in this matter. The family should be consulted on what needs to be done with the patient's belonging. Nurses have to obtain assistance from designated administrative personnel for communicating to the appropriate authorities on transporting and performing the last rights as per the government rules and infection control protocols. Appropriate information through correct channels should be ensured to avoid miscommunication and unnecessary delays in the last rights being performed.

  Conclusion Top

COVID-19 has emerged as a pandemic and requires multidimensional approach. The government and healthcare sectors need to emphasise on training healthcare professionals in effectively identifying and treating COVID-19. The government, healthcare services and each individual have a key role to play in the prevention of transmission of COVID-19 infection.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Corona Virus (COVID 19) Disease

Continuing Nursing Education series no:38

  1. The virus that causes COVID-19 disease is

    1. SARS-CoV-1
    2. HCoV-Co43
    3. MERS-CoV
    4. SARS-CoV-2

  2. The first case of the novel corona virus was identified in

    1. Wuhan, China
    2. Macau, China
    3. Guangzhous, China
    4. Beijing, China

  3. Which of the following statement is NOT true about the important properties of Coronavirus?

    1. Non-Enveloped RNA virus
    2. Enveloped RNA virus
    3. Distributed around the world
    4. Can spread from person to person

  4. The following country has reported the highest cases of COVID-19 (July 2020) infections?

    1. USA
    2. Italy
    3. Brazil
    4. India

  5. The following enzyme present in the host enables the virus to penetrate the host cells

    1. Furin
    2. >
    3. Angiotensin B
    4. >
    5. Glycopeptide
    6. >
    7. Neucleocapsid

  6. The incubation period for COVID-19 infection has been estimated as

    1. Less than 2 days
    2. 2 to 5 days
    3. 7 to 14 days
    4. 14 -21 days

  7. What are the most common symptoms of COVID-19?

    1. Sneezing and runny nose
    2. Fever and dry cough
    3. Shortness of breath, headache
    4. Joint pain and fatigue

  8. A client who has a history of international travel comes to the emergency department (ED) with increasing shortness of breath and is strongly suspected of having a COVID-19. Which of these prescribed actions will you take first?

    1. Place the client on contact and airborne precautions
    2. Obtain blood, urine, and sputum for cultures
    3. Administer methylprednisolone (Solu-Medrol) 1 gram/IV
    4. Infuse normal saline at 100ml/hr

  9. The common CT findings seen in COVID- 19 patients is _______

    1. ground glass appearance
    2. centrilobular small nodules
    3. air trapping
    4. pulmonary hyperinflation

  10. Using personal protective equipment (PPE) is vital when caring for patients with COVID- 19 disease. The sequence of donning PPE is __________

    1. handhygiene, shoe cover, cap, apron, gown, gloves, mask, goggles, head gear
    2. handhygiene, shoe cover, cap, apron, goggles, head gear, gown, gloves, mask
    3. handhygiene, gown, gloves, cap, goggles, head gear, shoe cover, mask, apron
    4. handhygiene, cap, goggles, head gear, shoe cover, mask, apron, gown, gloves

  11. The nurse assesses a COVID patient using the National early warning score (NEWS) and identifies the following: Temperature 37.20 C, Oxygen saturation 92%, systolic blood pressure 100 and the patient is being administered oxygen. She will document the score as

    1. 4
    2. 6
    3. 8
    4. 10

  12. A 20 year old female with COVID- 19 infection is admitted for over 7 days in the hospital, whose vital signs are stable is found to be anxious and verbalizes fear of death. What is the priority nursing action?

    1. Start Oxygen therapy
    2. prepare for intubation
    3. Provide counseling and diversional therapy
    4. Enhance peaceful death and departure

  13. The Fio2 supplied by a Non-rebreather mask with reservoir bag is

    1. 30 – 40%
    2. 40 – 50%
    3. 60 – 90%
    4. 24 – 60%

  14. Persistant hypotension and altered sensorium in a patient diagnosed with COVID-19 disease indicates

    1. Acute infection
    2. Meningeal involvement
    3. Severe disease
    4. Critical disease with septic shock

  15. The priority nursing action in 55 year old diabetic covid19 patient is ______

    1. Maintaining airway and breathing
    2. reducing the body temperature
    3. maintaining blood sugars
    4. Rehydration

  16. Prone position has shown a beneficial effect in the treatment of patients with COVID by improving

    1. mobilization of secretion
    2. ventilation perfusion ratio
    3. alveolar expansion
    4. airway patency

  17. ................. alcohol is found to be an effective disinfectant for the COVID-19 virus

    1. 50%
    2. Methyl
    3. 70 %
    4. All of the above

  18. Which of the following antiviral drug is seen as the possible experimental drug for COVID-19 but no 100% positive results have been shown by the drug yet?

    1. Peramivir
    2. Acyclovir
    3. Remdesivir
    4. Tamiflu

  19. A COVID patient with PaO2/FiO2 of 250 mmHg and peak end expiratory pressure (PEEP) of 6 cmH2O can be suggested to have

    1. Moderate disease
    2. Acute pneumonia
    3. Mild acute respiratory distress syndrome
    4. Severe respiratory distress syndrome

  20. Screening for corona virus is suggested as a priority if an individual

    1. has come in contact with a person infected with corona virus
    2. has recent onset of fever
    3. has travelled to other states in the country
    4. is working in a unit where corona patients are admitted

Answers for CE test no 37: Organophosphate Poisoning

  1. a
  2. a
  3. b
  4. a
  5. c
  6. d
  7. b
  8. b
  9. a
  10. b
  11. b
  12. d
  13. a
  14. a
  15. b
  16. b
  17. c
  18. a
  19. c
  20. a

  References Top

World Health Organization. Middle East Respiratory Syndrome Coronavirus (aMERS-CoV). World Health Organization; 2019. Available from: http://www.who.int/emergencies/mers-cov/en [Last accessed on 2020 Jun 25].  Back to cited text no. 1
World Health Organization. Summary of Probable SARS Cases with Onset of Illness from 1 November 2002 to 31 July 2003. World Health Organization; 2020. Available from: https://www.who.int/csr/sars/country. [Last accessed on 2020 Jun 25].  Back to cited text no. 2
World Health Organization. Novel Coronavirus (2019-nCoV) Situation Report - 46. Geneva: World Health Organization; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid =Cj0KCQjwupD4BRD4ARIsABJMmZ_SkKc3SxEiTjlmz HxIGefhLo9gY yWkiqFCXCuUQDtA3uzSzIMC -2EaAkKfEALw_wcB. [Last accessed on 2020 Jun 25].  Back to cited text no. 3
Rodriguez Morales AJ, Cardona Ospina JA, Gutiérrez Ocampo E, Villamizar Peña R, Holguin Rivera Y, Escalera Antezana JP, et al. Clinical, laboratory and imaging features of COVID 19: A systematic review and meta analysis. Travel Med Infect Dis 2020;34:101623.  Back to cited text no. 4
Clark A, Jit M, Warren-Gash C, Guthrie B, Wang HH, Mercer SW, et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: A modelling study. Lancet Glob Health 2020;8:e1003-17.  Back to cited text no. 5
Wyper GM, Assunção R, Cuschieri S, Devleeschauwer B, Fletcher E, Haagsma JA, et al. Population vulnerability to COVID-19 in Europe: A burden of disease analysis. Arch Public Health 2020;78:1-8.  Back to cited text no. 6
WHO Coronavirus Disease (COVID-19) Dashboard; 2020. Available from: https://COVID19.who.int/?gclid=EAIaIQobChMIqa_B7vqA 6wIVzBErCh38zAk0EAAYASAAEgJ2m_D_BwE. [Last accessed on 2020 Jun 25].  Back to cited text no. 7
Joseph S, George TK. Riding the COVID-19 curves-Perspectives on cases in India. Cur Med Iss 2020;18:203-5.  Back to cited text no. 8
Coronavirus Highlights: India 9th in Terms of Deaths, Study Says Peak in Mid-Nov Likely; movement starts within Europe. CNBC; 25 June, 2020. Available from: https://www.cnbctv18.com/healthcare/coronavirus-news-live-updates-india-COVID-cases -today-maharashtra-mumbai-delhi-tamil-nadu-chennai-gujarat-ahm edabad-kerala-bengaluru-unlock1-coronavirus-vaccine-news-61133 71.htm. [Last accessed on 202 0 Jun 25].  Back to cited text no. 9
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, evaluation and treatment coronavirus (COVID 19). InStatpearls 2020. Available from https://www.ncbi.nlm.nih.gov/books/NBK554776/. [cited from 2020 May 16].  Back to cited text no. 10
World Health Organization. COVID-19 Pulmonary Management. World Health Organization; 2020. Available from: https://www.who.int/publications-detail-redirect/clinical-manage ment-of-COVID-19. [Last access ed on 2020 Jul 05].  Back to cited text no. 11
Bosch BJ, van der Zee R, de Haan CA, Rottier PJ. The coronavirus spike protein is a class I virus fusion protein: Structural and functional characterization of the fusion core complex. J Virol 2003;77:8801-11.  Back to cited text no. 12
Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003;426:450-4.  Back to cited text no. 13
Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med 2020;14:185-92.  Back to cited text no. 14
World Health Organization. Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations. World Health Organization; 2020. Available from: https://www.who.int/news-room/commentaries/detail/modes-of-tr ansmission-of-virus-causing-COVI D-19-implications-for-ipc-precautio n-recommendations. [Last accessed on 2020 Jul 05].  Back to cited text no. 15
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564-7.  Back to cited text no. 16
World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report – 73 (n.d.). World Health Organization; 2020. Available from: https://www.who.int/docs/d efault-source/coronaviruse/situation n-reports/20200402-sitrep-73-COVID-19.pdf?sfvrsn=5ae25bc7_6. [Last accessed on 2020 Jul 05].  Back to cited text no. 17
Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020;323:1843-4.  Back to cited text no. 18
World Health Organization. Critical Preparedness, Readiness and Response Actions for COVID-19. World Health Organization; 2020. Available from: https://www.who.int/publications/i/item/critical -preparedness-readiness-and-response-actions-for-COVID-19. [Last accessed on 2020 Jul 05].  Back to cited text no. 19
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 20
World Health Organization. Clinical Management of COVID-19. World Health Organization; 2020. Available from: https://www.who.int/publi cations-detail-redirect/clinical-management-of-COVID-19. [Last accessed on 2020 Jul 05].  Back to cited text no. 21
World Health Organization. Clinical Management of COVID-19. World Health Organization; 2020. Available from: https://www.who.int/publi cations-detail-redirect/clinical-management-of-COVID-19. [Last accessed on 2020 Jul 05].  Back to cited text no. 22
World Health Organization. Advice on the use of Point-of-Care Immunodiagnostic Tests for COVID-19. World Health Organization; 2020. Available from: https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for -COVID-19. [Last accessed on 2020 Jul 05].  Back to cited text no. 23
National Early Warning Score (NEWS) 2; 2020. Available from: https://github_account.github.io/github_repo/FHIR-NE WS2/. [Last retrieved on 2020 Ju l 04; Last accessed on 2020 Jul 05].  Back to cited text no. 24
Draft Landscape of COVID-19 Candidate Vaccines; 2020. Available from: https://www.who.int/publications/m/item/draft-landscape-of- COVID-19-candidate-vacc ines. [Last accessed on 2020 Jul 05].  Back to cited text no. 25
Special Expert Group for Control of the Epidemic of Novel Coronavirus Pneumonia of the Chinese Preventive Medicine Association. An update on the epidemiological characteristics of novel coronavirus pneumonia (COVID-19). Zhonghua Liu Xing Bing Xue Za Zhi 2020;41:139-44.  Back to cited text no. 26
Nazir M, Hussain I, Tian J, Akram S, Mangenda Tshiaba S, Mushtaq S, et al. A multidimensional model of public health approaches against COVID 19. Int J Environ Res Public Health 2020;17:3780.  Back to cited text no. 27
World Health Organization. Critical Preparedness, Readiness and Response Actions for COVID-19. World Health Organization; 2020. Available from: https://www.who.int/pu blications/i/item/critical-prep aredness-readiness-and-response-actions-for-COVID-19). [Last accessed on 2020 Jul 05].  Back to cited text no. 28
Khubone T, Tlou B, Mashamba Thompson TP. Electronic health information systems to improve disease diagnosis and management at point of care in low and middle income countries: A narrative review. Diagnostics (Basel) 2020;10:327.  Back to cited text no. 29
Centers for Disease Control and Prevention. Cleaning and Disinfecting your Home; 2020. Available from: https://www.cdc.g ov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html. [Last accessed on 2020 Jul 05].  Back to cited text no. 30
Udwadia ZF, Raju RS. How to protect the protectors: 10 lessons to learn for doctors fighting the COVID-19 coronavirus. Medical Journal, Armed Forces India. 2020; p. 128-131.  Back to cited text no. 31


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3], [Table 4]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Disease Burden
Nature of Corona...
Mode of Transmission
Clinical Features
COVID-19 Disease...
Diagnostic Findings
Treatment Modalities
Other Supportive...
Strategies for P...
Nursing Management
Nursing Care of ...
Maintaining Airw...
Reducing Symptom...
Promoting Psycho...
Enhancing Peacef...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded46    
    Comments [Add]    

Recommend this journal