Describes all about SARS CoV- 2 its introduction, epidemiology, life cycle of virus, its transmission, pathophysiology of the disease, its complications, diagnostic methods and management through different system of medicines.

1. CORONA VIRUS DISEASE
Dr. Satyendra Singh
BNYS, MD

2. Applied Anatomy & Physiology
Transmission
Introduction Complications
Epidemiology & Risk Factor
Life cycle of Virus
History & Physical Examination
Pathophysiology
Diagnostic Methods
Management

3. Non-Pulmonary function
▸ 8. Endocrine function - Lungs synthesizes hormones like prostaglandins,
serotonin, histamine.
▸ Source: APUD- Amino Precursor Uptake and Decarboxylation cells

4. Functional Physiology & Anatomy of Respiratory System
▸ Respiration is defined as complex physiological process by which living
organisms exchange oxygen and carbon-dioxide between the organism
and environment.
▸ It includes three steps
▸ 1. External respiration
▸ 2. Transport of gases in the blood
▸ 3. Internal respiration

5. External & Internal Respiration
▸ The exchange of oxygen and carbon-dioxide between the blood (in the
pulmonary capillaries) and the air.
▸ The exchange of oxygen and carbon-dioxide between the cells and
ECF and utilization of oxygen and production of carbon-dioxide by the
cells.

6. Functions of Respiratory function
▸ Pulmonary
▸ Non pulmonary

7. Pulmonary function
▸ Transport of oxygen
▸ Transport of carbon-dioxide
▸ Synthesize surfactant
▸ Synthesize collagen
▸ Synthesize elastin Necessary for proper expansion of lungs
▸ Last 3 are important for proper lung expansion

8. Non-Pulmonary function
Protective function
▸ 1. Filter of dust particles in nose
▸ 2. Mucociliary system in airways
▸ 3. Alveolar macrophages
▸ 4.Acid base balance

9. Non-Pulmonary function
▸ 5. Regulation of blood pressure - The endothelial cells of pulmonary
capillaries secretes an enzyme called angiotensin-converting enzyme
(ACE), which converts angiotensin I to active angiotensin II, which is a
potent vasoconstrictor. This will increase blood pressure.
▸ 6. Endocrine function - Lungs synthesizes hormones like prostaglandins,
serotonin, histamine.

10. Innervation
▸ The walls of bronchi and bronchioles are innervated by Autonomic nervous
system.
▸ Parasympathetic - vagus
▸ Sympathetic – Sympathetic trunk

11. Vascularization
▸ Pulmonary circulation- Pulmonary artery and pulmonary vein.
▸ Bronchial circulation- Bronchial vessels nourish bronchi and parietal
pleura.

12. V/Q matching

13. Innervation

14. Introduction
▸ A series of acute atypical respiratory infections.
▸ Discovered to be a novel coronavirus - family Coronaviridae and was named as the severe
acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
▸ SARS – CoV-2 is the second detected virus from the same family.
▸ After being broadcast as a public health emergency on January 30, 2020, COVID-19 was
subsequently declared a pandemic on March 11, 2020 by the WHO.
Anant Parasher : A COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment Postgraduate
Medical Journal 2021;97:312-320.

15. 15

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17. “
Risk Factors
▸ Elderly
▸ Diabetes Mellitus
▸ Hypertension
▸ Cardiorespiratory disorders
▸ Chronic liver diseases and renal failure.
▸ Patient with cancer & those receiving immunosuppressive
medication.

18. 18
Life Cycle of Virus

19. How it is transmitted ?

20. Transmission
▸ Communicable
▸ Person to person (respiratory droplets)
▸ Sputum
▸ Positive naso-pharyngeal swab
▸ Faeces
▸ Vertical transmission
▸ Incubation- 5.2-15.5 days (14 days quarantine)

21. Pathophysiology of Covid 19
ASYMPTOMATIC PHASE
INVASION AND INFECTION
OF THE UPPER
RESPIRATORY TRACT
INVOLVEMENT OF
THE LOWER
RESPIRATORY
TRACT AND
PROGRESSION TO
ARDS

23. Complications
The main complications reported in patients with SARS-CoV-2 may include:
▸ Coagulopathy
▸ Laryngeal oedema and laryngitis in critically ill patients with COVID-19.
▸ Necrotizing pneumonia
▸ Cardiovascular complications- including acute pericarditis, left ventricular dysfunction, acute myocardial injury, new or worsening arrhythmias and
new or worsening heart failure.
▸ Acute respiratory failure. Approximately 5% of COVID-19 patients require admittance to an intensive care unit because they develop severe
disease complicated by acute respiratory distress syndrome.
▸ Sepsis, septic shock and multiple organ failure.
▸ Higher risk of death, particularly in male patients with severe disease
▸ Ventilation-associated pneumonia in up to 30% of patients requiring intensive mechanical ventilation.
▸ Massive pulmonary embolism complicated by acute right-sided heart failure.
Azer SA. COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics. New Microbes New Infect. 2020

24. History taking & physical examination
Important factor in COVID-19 infection

25. While taking History !!
Common symptoms:
▸ Fever (in 44% of patients on presentation and up to 88% of admitted patients)
▸ Dry cough
▸ Shortness of breath, which may be severe and progressive, particularly when the
patient develops pneumonia
▸ Myalgia and tiredness
▸ Sore throat
▸ Nausea, vomiting and diarrhoea
Zhu J., Ji P., Pang J., Zhong Z., Li H., He C. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol. 2020 Apr 15 doi:
10.1002/jmv.25884. Online ahead of print.

26. While taking History !!
▸ Patients may have neurologically
related symptoms, including:
▸ Acute cerebrovascular diseases
▸ Headaches
▸ Dizziness
▸ Seizure
▸ Decreased level of consciousness
▸ Encephalopathy
▸ Agitation and confusion
▸ Recently, anosmia, hyposmia and
dysgeusia also have been reported
Gautret Philippe, Lagier Jean-Christophe, Parola Philippe, Hoang Van Thuan, Meddeb Line, Sevestre Jacques. Clinical and microbiological effect of a
combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study. Travel Med Infect
Dis. Mar-Apr 2020;34:101663. doi: 10.1016/j.tmaid.2020.101663. Epub 2020 Apr 11.

27. Physical Manifestations
▸ Raised body temperature
▸ Increased respiratory rate
▸ Decreased oxygen saturation
▸ Auscultation of the lungs may be
normal or show crackles
▸ Signs of heart failure
▸ Cardiac arrhythmias
▸ Myocarditis
▸ Acute coronary syndrome
▸ Shock
▸ Death also may occur.

28. Diagnostic Method

29. Viral Testing
▸ Performed by RT-qPCR
▸ Used for detection of the nucleic
acid for SARS-CoV-2.
▸ Procedure - Swabs are usually
taken from nasal, nasopharyngeal,
oropharyngeal, sputum.
Hong K.H., Lee S.W., Kim T.S., Huh H.J., Lee J., Kim S.Y. Guidelines for laboratory diagnosis of coronavirus disease 2019 (COVID-19) in
Korea. Ann Lab Med. 2020 Sep

30. Serology
▸ To assess prior exposure to Virus
Particular use:
▸ When the viral test is not available. Using the serology test together with
the clinical picture could guide in decision making.
▸ Patients with late disease complications and their physicians need to
make immediate decisions (the viral test takes more time to get the
results).
▸ In some patients, virus shedding is reduced, making RT-qPCR results
falsely negative.

31. Rapid Antigen Testing
▸ Monoclonal antibody test
▸ Nucleocapsid protein (N) is abnormally
expressed in infected cells.
▸ Monoclonal antibodies are specifically
directed against nucleocapsid protein
▸ By using enzyme-linked immunosorbent
assay
▸ Sensitivity - 84.1%
▸ Specificity of 98.5%.

32. Ultrasonography
▸ Considered an essential modality
▸ Regions- Thoracic, Cardiac, abdomen
▸ Areas- to rule out coagulopathy or
Thrombosis
Sikachi R., Agrawal A. Whole body point of care ultrasound for COVID-19: a multi-system approach to a multi-
system disease. Anaesthesia. 2020

33. CT - Scan
▸ Patients with and without SARS-CoV-2 can be differentiated by chest
computed tomographic imaging, together with clinical presentation and
the presence of pneumonia.
▸ Radiologic images and clinical features are excellent diagnostic tools for
COVID-19.
Chen X., Tang Y., Mo Y., Li S., Lin D., Yang Z. A diagnostic model for coronavirus disease 2019 (COVID-19)
based on radiological semantic and clinical features: a multi-center study. Eur Radiol. 2020 Apr

34. Others
▸ Depending on complications & comorbidities
▸ Self-reporting test (lacks documentation)

35. Available Treatment Modalities
No side-effects
Negative impact
Awareness & Hygiene
Self healing power
Preventive
Optimal Functioning
Prevention
Vaccination
Naturopathy
Yoga
Ayurveda
Pharmacotherapy

36. Pharmacotherapeutic Approach

37. Ayurveda Approach – General guidelines
▸ Follow physical distancing, respiratory and hand hygiene, wear mask
▸ Gargle with warm water added with a pinch of turmeric and salt. Water boiled
with Triphala or Yashtimadhu also can be used for gargling.
▸ Nasal instillation/application of medicated oil (Anu taila or Shadbindu Taila)
or plain oil (Sesame or Coconut) or nasal application of cow's ghee
(Goghrita) once or twice in a day, especially before going out and after
coming back
to home.

38. Ayurveda Approach – General guidelines
▸ Steam inhalation with Ajwain (Trachyspermum ammi) or Pudina (Mentha
spicata) or Eucalyptus oil once a day
▸ Adequate sleep of 6 to 8 hrs.
▸ Moderate physical exercises.
▸ Follow Yoga Protocol for Primary Prevention of COVID-19 and Protocol for
Post COVID-19 care (including care for COVID-19 patients)

39. Ayurveda Approach – Dietary guidelines
▸ Use warm water or boiled with herbs like ginger (Zingiber oficinale)
or coriander (Coriandrum sativum) or basil (Ocimum sanctum / Ocimum
basilicum), or cumin (Cuminum cyminum) seeds etc., for drinking purpose.
▸ Fresh, warm, balanced diet
▸ Drink Golden Milk (Half tea spoon Haldi (Curcuma longa) powder in
150 ml hot milk) once at night. Avoid in case of indigestion.
▸ Drink Ayush Kadha or Kwath (hot infusion or decoction) once a day.

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44. 44
Yoga Objectives: For Primary
Prevention
To improve respiratory and cardiac
efficiency
To reduce stress and anxiety
To enhance immunity

45. 45
Yoga Protocol for Post COVID – 19 Care
(including care for COVID – 19 patients)
To improve Pulmonary function & lung capacity
To reduce stress and anxiety.
To improve Muco – ciliary clearance
Morning Session (30 Minutes)

46. 46
Yoga Protocol for Post COVID – 19 care (including care for COVID – 19 Patients)

47. Preventive Naturopathy
Management

48. Mucosal Immunity & reducing airway reactivity
▸ Gargling with hot salt
water or with neem oil
▸ Aromatherapy
(eucalyptus, tulsi oil)
Sienkiewicz M, Łysakowska M, Pastuszka M, Bienias W, Kowalczyk E. The Potential of Use Basil and Rosemary
Essential Oils as Effective Antibacterial Agents. Molecules. 2013 Aug;18(8):9334–51.

49. Improving innate immunity immune response
▸ Intermittent fasting or lemon juice fasting once a week – which
reduces oxidative stress, improve autophagy, improve immune
homeostasis.
▸ Regular exercise to improve circulation, immune homeostasis
▸ Naturopathy nutrition(next slide)
1. Longo V, metabolism MM-C, 2014 undefined. Fasting: molecular mechanisms and clinical applications.
Elsevier.
2. Martinez-Lopez N, Tarabra E, metabolism MT-C, 2017 undefined. System-wide benefits of intermeal fasting
by autophagy. Elsevier.

50. 50

51. For reducing stress & improving sleep
▸ Poor sleep can increase susceptibility to respiratory infections
▸ Sound sleep helps in modulation of immunity
▸ Yoga
▸ Pranayama
▸ Relaxation
1. Patel S, Malhotra A, Gao X, Hu F, Sleep MN-, 2012 undefined. A prospective study of sleep duration and pneumonia risk in
women. academic.oup.com.
2. Cohen S, Tyrrell DA j., Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med. 1991 Aug
29;325(9):606–12.

52. Symptomatic
Management

53. Cold, running nose, nasal congestion
▸ Steam inhalation (tulsi, peppermint, eucalyptus oil)
▸ Nasal irrigation with saline water
1. Agnihotri S, Kant S, Verma V, ... SM-IJ of, 2016 undefined. Role of jalaneti and pranayama in allergic rhinitis with asthma. ijoyppp.org.
2. Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling
for the common cold. Sci Rep. 2019 Dec;9(1):1–11.
3. Kassel JC, King D, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. In: Cochrane Database of Systematic Reviews. John
Wiley & Sons, Ltd; 2010.
4. Sujan M, Rao M, ... RK-... of neurosciences in, 2016 undefined. Influence of hydrotherapy on clinical and cardiac autonomic function in migraine patients.
thieme-connect.com. 2016 Jan;7(1):109–13.

54. Sore throat, Hoarseness of voice
▸ Hot saline gargle or with neem water decoction with honey.
▸ Coriander, turmeric & black pepper herbal tea twice a day.
1. Verma A, Singhal A, Singh D, Vighyan Kendra K. Local health wisdom of rural women using medicinal plants.
Vol. 9, Indian Journal of Traditional Knowledge. 2010.
2. Prasad S, and BA-HMB, 2011 undefined. Turmeric, the golden spice. ncbi.nlm.nih.gov.

55. Expectorant cough
▸ Chewing ginger (Zingiber officinale).
▸ It is rich in 1,8 cineole which is an anti-inflammatory,
antispasmodic, antitussive, expectorant in nature.
Chang Y, Labban J, Gapin J, research JE-B, 2012 undefined. The effects of acute exercise on cognitive
performance: a meta-analysis. Elsevier.

56. Dry cough
▸ Ginger + honey +cloves+ cinnamon + turmeric + black pepper
with milk
Prasad S, and BA-HMB, 2011 undefined. Turmeric, the golden spice. ncbi.nlm.nih.gov.

57. Headache
▸ Hot foot immersion with cold compress on head
▸ Aromatherapy (tulsi, lavender)
Sujan M, Rao M, ... RK-... of neurosciences in, 2016 undefined. Influence of hydrotherapy on clinical and cardiac
autonomic function in migraine patients. thieme-connect.com. 2016 Jan;7(1):109–13.

58. Fever
▸ Cold chest pack
▸ Cold sponging
Yasuhara M. [Clinical experience with the use of cold packs on the chest-back region for the treatment of high fever and encephalitis
symptoms]. Nihon Densenbyo Gakkai Zasshi. 1968 Jun;42(3):51-5. Japanese. PMID: 4302742.

59. Wheeze, chest congestion
▸ Cold chest pack
▸ Hot fomentation to chest & upper back
▸ Hot foot immersion
1. Yasuhara M. [Clinical experience with the use of cold packs on the chest-back region for the treatment of high fever and
encephalitis symptoms]. Nihon Densenbyo Gakkai Zasshi. 1968 Jun;42(3):51-5. Japanese. PMID: 4302742.
2. Maheshkumar, K., Pandiaraja, M., Venugopal, V., Poonguzhali, S., & Sundareswaran, L. (2019). Effects of
Hotfoot and arm bath in Bronchial asthma: A single case report. The Foot.doi:10.1016/j.foot.2019.10.006

60. Malaise, fatigue
▸ Plant proteins
▸ Natural Vit. C
▸ Glucose (natural sources)
▸ Vit.D
▸ Lemon honey water
Organization WH. Cough and cold remedies for the treatment of acute respiratory infections in young children. 2001;

61. Acupressure:
Acupressure points LI-4, LI11, SP6, TW 5, CV17, ST36
(To confer immunity and improve respiratory effort)
Heliotherapy:
Exposure to the sun and air in the morning and evening
hours
To reduce stress and confer immunity by improving Vitamin
D metabolism.
Following a healthy regimen is very important to boost one's
immune response. The following lifestyle practices have
evidence to prevent one from getting infected with flu.

62. Arogya Rakshak Pancha tantra
▸ 2 meals/day
▸ Pray twice/day
▸ Exercise daily for 1 hour
▸ Fast once in a week
▸ Drink plenty of water
Panneerselvam NK, Suresh PK, Ravindran D, Manoharan ER. Effect of Arogya Raksha Panchatantra (five lifestyle principles) on
hematological parameters and anthropometric measures among healthy volunteers: a pilot study. J Complement Integr Med. 2021
May 7. doi: 10.1515/jcim-2020-0377. Epub ahead of print. PMID: 33962498.

63. Thank you