PAPER

COVID 19

Arranged by:

Gyrindra Firzatullah
Class: VII E

SEKOLAH MENENGAH PERTAMA NEGERI 9

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 FOREWORD

Our gratitude to Allah SWT for the abundance of His grace and guidance,
so that we can complete the task of this "Covid 19" paper on time. Do not forget
the prayers and greetings remain poured out to our lord Prophet Muhammad who
brought us later intercession at the end of time. Amen O 'Lord of the Worlds
May Allah SWT always repay all their kindness and always give His
blessings. We as ordinary people realize that the compilation of this paper is still
not perfect and of course there are deficiencies, perfection is only in God alone.
Therefore, constructive criticism and suggestions we hope for the good of
this paper going forward. Finally, we, all the authors, hope that this paper will be
able to benefit all of us, especially for readers and in the academic environment.
Amen O 'Lord of the Worlds.

Tasikmalaya, April 2020

Author

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 TABLE OF CONTENTS

FOREWORD ......................................................................................... i
TABLE OF CONTENTS ...................................................................... ii
BAB I PRELIMINARY
A. Background ................................................................... 1
BAB II DISCUSSION
A. COVID-19...................................................................... 2
B. Terminology................................................................... 2
C. Epidemiology................................................................. 3
D. Pediatric.......................................................................... 4
E. Clinical Presentation...................................................... 4
F. Diagnosis........................................................................ 5
G. Markers........................................................................... 5
H. Complications................................................................. 5
I. Etiology.......................................................................... 6
J. Pathophysiology............................................................. 6
K. Transmission.................................................................. 6
L. Treatment and Prognosis................................................ 7
BAB III CLOSING
A. Conclusion ..................................................................... 10
BIBLIOGRAPHY

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 BAB I
PRELIMINARY

A. Background
As Covid-19 has spread, so has our fear of surfaces. There are now some
familiar scenes in public places around the world – people trying to open
doors with their elbows, commuters studiously surfing their way through train
journeys to avoid grabbing a handle, office workers rubbing down their desks
each morning.
In the areas worst hit by the new coronavirus, teams of workers in
protective clothing have been dispatched to spray a fog of disinfectant in
plazas, parks and public streets. Cleaning regimes in offices, hospitals, shops
and restaurants have been increased. In some cities, well-meaning volunteers
even venture out at night to scrub the keypads of cash machines.
Like many respiratory viruses, including flu, Covid-19 can be spread in
tiny droplets released from the nose and mouth of an infected person as they
cough. A single cough can produce up to 3,000 droplets. These particles can
land on other people, clothing and surfaces around them, but some of the
smaller particles can remain in the air. There is also some evidence that the
virus is also shed for longer in faecal matter, so anyone not washing their
hands thoroughly after visiting the toilet could contaminate anything they
touch.
It is worth noting that, according to the Centers for Disease Control and
Prevention, touching a surface or object with the virus and then touching one's
own face "is not thought to be the main way the virus spreads". Even so, the
CDC, the World Health Organization and others health authorities, have
emphasised that both washing one's hands and cleaning and disinfecting
frequently touched surfaces daily are key in preventing Covid-19's spread. So
although we still don't know exactly how many cases are being caused directly
by contaminated surfaces, experts advise exercising caution.

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 BAB II
DISCUSSION

A. COVID-19
COVID-19 (coronavirus disease 2019) is an infectious disease caused by
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously
known as 2019 novel coronavirus (2019-nCoV), a strain of coronavirus. The
first cases were seen in Wuhan, China, in December 2019 before spreading
globally 1,2,10. The current outbreak was officially recognized as a
pandemic on 11 March 2020.
The non-specific imaging findings are most commonly of atypical or
organizing pneumonia, often with a bilateral, peripheral, and basal
predominant distribution 32. No effective treatment or vaccine exists currently
(April 2020).
B. Terminology
The World Health Organization (WHO) originally called this illness
"novel coronavirus-infected pneumonia (NCIP)", and the virus itself had been
provisionally named "2019 novel coronavirus (2019-nCoV)".
On 11 February 2020, the WHO officially renamed the clinical condition
COVID-19 (a shortening of COronaVIrus Disease-19) 15. Coincidentally, on
the same day, the Coronavirus Study Group of the International Committee on
Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome
coronavirus 2" (SARS-CoV-2) 16,22,46. The names of both the disease and the
virus should be fully capitalized, except for the 'o' in the viral name, which is
in lowercase. 
The official virus name is similar to SARS-CoV, the virus strain that
caused epidemic severe acute respiratory syndrome (SARS) in 2002-2004,
potentially causing confusion 38. The WHO has stated it will use "COVID-19
virus" or the "virus that causes COVID-19" instead of its official name,
SARS-CoV-2, when communicating with the public.

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C. Epidemiology
On 14 April 2020, the number of cases of confirmed COVID-19 globally
was over 1.9 million. COVID-19 has now been diagnosed in 185 territories, in
six continents according to an online virus tracker created by the medical
journal, The Lancet, and hosted by Johns Hopkins University . As of 14
5,13

April 2020, there are 5 countries with >100,000 cases, 17 countries with 1,000
to 10,000 confirmed cases and 50 countries with between 1000 and 10,000
confirmed cases. 
NB: surveillance methods and capacity vary dramatically between
countries, and there is reason to suspect that there may be a significant number
of undiagnosed asymptomatic carriers in many territories.
The R0 (basic reproduction number) of SARS-CoV-2 has been estimated
between 2.2 and 3.28, that is each infected individual, on average, causes
between 2-3 new infections. 
The incubation period for COVID-19 was initially calculated to be ~5
days, which was based on 10 patients only 12. An American group performed
an epidemiological analysis of 181 cases, for which days of exposure and
symptom onset could be estimated accurately. They calculated a median
incubation period of 5.1 days, that 97.5% became symptomatic within 11.5
days (CI, 8.2 to 15.6 days) of being infected, and that extending the cohort to
the 99th percentile results in almost all cases developing symptoms in 14 days
after exposure to SARS-CoV-2.
The number of deaths from COVID-19 exceeded 118,000 globally on 13
April 2020 5. The case fatality rate is ~2-3% . It is speculated that the true
5,93

case fatality rate is lower than this because many mild cases are not being
tested, which thus skews the apparent death rate upwards.
A paper published by the Chinese Center for Disease Control and
Prevention (CCDC) analyzed all 44,672 cases diagnosed up to 11 February
2020. Of these, ~1% were asymptomatic, and ~80% were classed as "mild". 

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 Another study looked at clinical characteristics in COVID-19 positively
tested close contacts of COVID-19 patients 81. Approximately 30% of those
COVID-19 positive close contacts never developed any symptoms or changes
on chest CT scans. The remainder showed changes on CT, but ~20%
reportedly developed symptoms during their hospital course, none of them
developed severe disease. This suggests that a high percentage of COVID-19
carriers are asymptomatic.
In the Chinese population, 55-60%% of COVID-19 patients were male;
the median age has been reported between 47 and 59 years.
D. Pediatric
Children seem to be relatively unaffected by this virus, or indeed other
closely-related coronaviruses with large cohort studies reporting that 1-2% of
COVID-19 patients are children. However, there have been cases of critically-
ill children with infants under 12 months likely to be more seriously affected
59
. A very low number of pediatric deaths has been reported. In children, male
gender does not seem to be a risk factor 59. The incubation period has been
reported to be shorter than in adults, at about two days.
NB: it is important to appreciate that the known epidemiological
parameters of any new disease are likely to change as larger cohorts of
infected people are studied, although this will only to some extent reflect a
true change in the underlying reality of disease activity (as a disease is studied
and understood humans will be simultaneously changing their behaviors to
alter transmission or prevalence patterns).
E. Clinical Presentation
COVID-19 typically presents with systemic and/or respiratory
manifestations 93
. Some individuals infected with SARS-CoV-2 are
asymptomatic and can act as carriers 70
. Some also experience mild
gastrointestinal or cardiovascular symptoms, although these are much less
common. 

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 The full spectrum of clinical manifestation of COVID-19 remains to be
determined. Symptoms and signs are non-specific.
F. Diagnosis
The definitive test for SARS-CoV-2 is the real-time reverse transcriptase-
polymerase chain reaction (RT-PCR) test. It is believed to be highly specific,
but with sensitivity reported as low as 60-70% 32 and as high as 95-97%. Thus,
false negatives are a real clinical problem, and several negative tests might be
required in a single case to be confident about excluding the disease.
Multiple radiological organizations and learned societies have stated that
CT should not be relied upon as a diagnostic/screening tool for COVID-19.
On 16 March 2020, an American-Singaporean panel published that CT
findings were not part of the diagnostic criteria for COVID-19 56. However,
CT findings have been used as a surrogate diagnostic test by some. 
G. Markers
The most common ancillary laboratory findings in a study of 138
hospitalized patients were the following 13,89:
1. lymphopenia
2. increased prothrombin time (PT)
3. increased lactate dehydrogenase
Mild elevations of inflammatory markers (CRP 89 and ESR) and D-
dimer are also seen.
H. Complications
In one of the largest studies of hospitalized patients, reviewing 1,099
individuals across China, the admission rate to the intensive care unit
(ICU) was 5% 93. In this same study, 6% of all patients required ventilation,
whether invasive or non-invasive. 
ICU patients tend to be older with more comorbidities. Commonly
reported sequelae are:
1. acute respiratory distress syndrome (ARDS): ~22.5% (range 17-29%)
2. acute cardiac injury: elevated troponin levels

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I. Etiology
On 9 January 2020, the World Health Organization (WHO) confirmed
that SARS-CoV-2 was the cause of COVID-19 (2019-nCoV was the name of
the virus at that time) 14,37. It is a member of the Betacoronavirus genus, one of
the genera of the Coronaviridae family of viruses. Coronaviruses are
enveloped single-stranded RNA viruses that are found in humans, mammals
and birds. These viruses are responsible for pulmonary, hepatic, CNS, and
intestinal disease. 
As with many human infections, SARS-CoV-2 is zoonotic. The closest
animal coronavirus by genetic sequence is a bat coronavirus, and this is the
likely ultimate origin of the virus. The disease can also be transmitted by
snakes.
Six coronaviruses are known to cause human disease. Two are zoonoses:
the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle
East respiratory syndrome coronavirus (MERS-CoV), both of which may
sometimes be fatal. The remaining four viruses cause the common cold. 
J. Pathophysiology
The SARS-CoV-2 virus, like the closely-related MERS and SARS
coronaviruses, affects its cellular entry via attachment of its virion spike
protein (a.k.a. S protein) to the angiotensin-converting enzyme 2 (ACE 2)
receptor. This receptor is commonly found on alveolar cells of the lung
epithelium, underlying the development of respiratory symptoms as the
commonest presentation of COVID-19. It is thought that the mediation of the
less common cardiovascular effects is also via the same ACE-2 receptor,
which is also commonly expressed on the cells of the cardiovascular system.
K. Transmission
Although originating from animals, COVID-19 is not considered a direct
zoonosis as its transmission is now primarily human-to-human. It is primarily
transmitted in a similar way to the common cold, via contact with droplets of
infected individuals' upper respiratory tract secretions, e.g. from sneezing or

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 coughing. A recent Bayesian regression model has found that aerosol and
fomite transmission are plausible.
Orofecal spread was seen with the SARS epidemic, and although it
remains unclear if SARS-CoV-2 can be transmitted in this way, there is some
evidence for it.
A recently published cohort study (26 March 2020) could not rule out
the possibility of vertical transmission with 9% of neonates (n=3/33)
developing an early onset SARS-CoV-2 infection despite strict infection
control measures during delivery. However, a retrospective study of nine
pregnant patients infected by SARS-CoV-2 did not show any evidence of
vertical/intrauterine infection. More recent published (20 March 2020)
guidance from a joint American-Chinese consensus panel stated that it
remains unclear if vertical transmission can occur.
L. Treatment and Prognosis
THERAPY
If you or your child become ill
If you are showing symptoms of COVID-19, reduce your contact with others:
1. isolate yourself at home for 14 days to avoid spreading it to others
a. if you live with others, stay in a separate room or keep a 2-metre
distance
2. visit a health care professional or call your local public health authority
a. call ahead to tell them your symptoms and follow their instructions
Children who have mild COVID-19 symptoms are able to stay at home
with a caregiver throughout their recovery without needing
hospitalization. If you are caring for a child who has suspected or
probable COVID-19, it is important to follow the advice for
caregivers. This advice will help you protect yourself, others in your
home, as well as others in the community.

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If you become sick while travelling back to Canada:
3. inform the flight attendant or a Canadian border services officer
4. advise a Canada border services agent on arrival in Canada if you believe
you were exposed to someone who was sick with COVID-19, even if you
do not have symptoms
a. this is required under the Quarantine Act
b. the Canada border services agent will provide instructions for you to
follow
Check if you have been exposed
Have you been on a recent flight, cruise, train, or at a public gathering? Check
the listed exposure locations to see if you may have been exposed to COVID-
19.
Take care of your mental health
The COVID-19 pandemic is new and unexpected. This situation can be
unsettling and can cause a sense of loss of control. It is normal to feel sad,
stressed, confused, scared or worried in a crisis. Make sure to care for your
mental and physical wellbeing and to ask for help if you feel overwhelmed.
Diagnosing coronavirus
Coronavirus infections are diagnosed by a health care provider based on
symptoms and are confirmed through laboratory tests.
Treating coronavirus
Most people with mild coronavirus illness will recover on their own.
If you are concerned about your symptoms, you should self-monitor and
consult your health care provider. They may recommend steps you can take to
relieve symptoms.
Vaccine
If you have received a flu vaccine, it will not protect against coronaviruses.
At this time, a vaccine or therapy to treat or prevent this disease has not yet
been developed. However, the COVID-19 pandemic has resulted in a global
review of therapies that may be used to treat or prevent the disease.

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Health Canada is fast tracking the importation and sale of medical devices
used to diagnose, treat or prevent COVID-19.
About coronaviruses
Coronaviruses are a large family of viruses. Some cause illness in people and
others cause illness in animals. Human coronaviruses are common and are
typically associated with mild illnesses, similar to the common cold.
COVID-19 is a new disease that has not been previously identified in
humans. Rarely, animal coronaviruses can infect people, and more rarely,
these can then spread from person to person through close contact.
There have been 2 other specific coronaviruses that have spread from animals
to humans and which have caused severe illness in humans. These are the:
1. severe acute respiratory syndrome coronavirus (SARS CoV)
2. Middle East respiratory syndrome coronavirus (MERS CoV)

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 BAB III

CLOSING

A. Conclusion
As Covid-19 has spread, so has our fear of surfaces. There are now some
familiar scenes in public places around the world – people trying to open
doors with their elbows, commuters studiously surfing their way through train
journeys to avoid grabbing a handle, office workers rubbing down their desks
each morning.
In the areas worst hit by the new coronavirus, teams of workers in
protective clothing have been dispatched to spray a fog of disinfectant in
plazas, parks and public streets. Cleaning regimes in offices, hospitals, shops
and restaurants have been increased. In some cities, well-meaning volunteers
even venture out at night to scrub the keypads of cash machines.
Like many respiratory viruses, including flu, Covid-19 can be spread in
tiny droplets released from the nose and mouth of an infected person as they
cough. A single cough can produce up to 3,000 droplets. These particles can
land on other people, clothing and surfaces around them, but some of the
smaller particles can remain in the air. There is also some evidence that the
virus is also shed for longer in faecal matter, so anyone not washing their
hands thoroughly after visiting the toilet could contaminate anything they
touch.

10
 BIBLIOGRAPHY

https://jamanetwork.com/journals/jama/fullarticle/2763983

https://www.canada.ca/en/public-health/services/diseases/2019-novel-
coronavirus-infection/symptoms.html

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