A COVID-19 MIMICRY MYSTERY

SESSION TITLE: Signs and Symptoms of Chest Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Vaping products have been rapidly gaining popularity, with studies showing increasing use, even among school-going children and adolescents. E-cigarette or Vaping Associated Lung Injury (EVALI) is defined as respiratory failure within 90 days of e-cigarette use with pulmonary infiltrates on imaging, in the absence of infectious or alternative causes of respiratory failure.[1] Vitamin E acetate, a thickening agent in THC containing e-cigarettes, is thought to be the main causative agent of EVALI and has been found in the bronchoalveolar lavage samples in almost all cases of EVALI.[2] However, diagnosing EVALI in this era of COVID -19 is a challenge due to striking similarities in clinical symptoms and imaging findings. CASE PRESENTATION: A 32-year-old male with anxiety and polysubstance abuse, presented with headache, cough, low-grade fevers and chills of 1 week. In the ED, he was febrile to 102 F and hypoxic to 89% on room air and was started on 3 liters of oxygen. Labs showed leukocytosis and elevated inflammatory markers. Urine toxicology was positive for THC. Chest X-ray showed bilateral interstitial opacities. CT angio of the chest showed bilateral ground glass opacities. Despite 2 negative PCR tests, suspicion for COVID was high and the patient was initially started on dexamethasone and other supplements, along with antibiotic coverage for a possible bacterial etiology. Despite this, respiratory symptoms and hypoxia continued to worsen. Infectious work up including blood, sputum cultures with AFB staining, urine streptococcus and legionella tested negative. The patient however now revealed the regular use of THC containing vape and procuring the THC oil from a new street vendor. This prompted us to suspect vaping induced chemical pneumonitis. He was restarted on steroid therapy with methylprednisolone and within 1 week, had symptomatic improvement and resolution of hypoxia. The patient was eventually discharged on prednisone taper over 7-10 days. DISCUSSION: Our patient was initially treated for COVID pneumonia despite repeated negative PCR tests, as findings were suggestive of SARS-COV-2 infection. Fortunately, the patient eventually revealed about regular use of THC-oil vapes, making us consider a diagnosis of vaping induced chemical pneumonitis. The mainstay of treatment is steroid therapy and cessation of e-cigarette use. The severity of the pandemic has led to a low threshold for suspecting COVID, causing increased anchoring and availability bias, and potentially under-diagnosing conditions like EVALI which resemble COVID infection.[3] CONCLUSIONS: While it is important to have a low threshold for suspecting COVID-19, considering other mimics of COVID is prudent for providing treatment in an appropriate and timely manner. Detailed inquiry of e-cigarette use, particularly THC-oil containing vapes, duration of use and source of procurement, goes a long way in diagnosing of EVALI. Reference #1: EVALI and the Pulmonary Toxicity of Electronic Cigarettes: A Review Lydia Winnicka, MD and Mangalore Amith Shenoy, MD PMCID: PMC7351931 PMID: 32246394 Reference #2: Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study Denitza P Blagev 1, Dixie Harris 2, Angela C Dunn 3, David W Guidry 2, Colin K Grissom 4, Michael J Lanspa 5 PMID: 31711629 DOI: 10.1016/S0140-6736(19)32679-0 Reference #3: EVALI: A Mimicker of COVID-19 Mitchell M. Pitlick, MD,a Daenielle K. Lang, MD,a Anne M. Meehan, MBBCh, PhD,b and Christopher P. McCoy, MDb, PMCID: PMC8006188 PMID: 33817560 DISCLOSURES: No relevant relationships by Kaushik Darbha No relevant relationships by Rashmikant Doshi No relevant relationships by Ishan Sahu No relevant relationships by sara samad

Modeling the Spread of COVID-19 Among Doctors from the Asymptomatic Individuals

The present world is in dire straits due to the deadly SARS coronavirus-2 (CoV-2) outbreak, and the experts are trying heart and soul to discover any prevention and/or remedy. The people from all walks of life in the universe are fighting to defeat this novel coronavirus. In this case, doctors are in the front line fighters who have put themselves at a risk. In this paper, we have formulated a non-linear system of five differential equations of COVID-19 based on the tendency of doctors to be infected. The target of this study is to take a look at the transmission of COVID-19 from asymptomatic populations to the doctors. The model is analyzed with the determination of the basic reproduction number, equilibrium, and related stability analysis at both equilibrium points. The graph of the basic reproductive ratio for different parameters has been drawn to show the disease behavior. Finally, we have simulated our model numerically for visualizing the analytical findings. Our study shows that the asymptomatic population increases as the disease (COVID-19) transmission rate increases. The number of infected population increases with the infection rate. These increasing asymptomatic and infected populations lead the doctors to get infected by contacting with them. Thus, the whole medical service system is getting down over time. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Modelling the effect of self-immunity and the impacts of asymptomatic and symptomatic individuals on COVID-19 outbreak

COVID-19 is one of the most highly infectious diseases ever emerged and caused by newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has already led the entire world to health and economic crisis. It has invaded the whole universe all most every way. The present study demonstrates with a nine mutually exclusive compartmental model on transmission dynamics of this pandemic disease (COVID-19), with special focus on the transmissibility of symptomatic and asymptomatic infection from susceptible individuals. Herein, the compartmental model has been investigated with mathematical analysis and computer simulations in order to understand the dynamics of COVID-19 transmission. Initially, mathematical analysis of the model has been carried out in broadly by illustrating some well-known methods including exactness, equilibrium and stability analysis in terms of basic reproduction number. We investigate the sensitivity of the model with respect to the variation of the parameters' values. Furthermore, computer simulations are performed to illustrate the results. Our analysis reveals that the death rate from coronavirus disease increases as the infection rate increases, whereas infection rate extensively decreases with the increase of quarantined individuals. The quarantined individuals also lead to increase the concentration of recovered individuals. However, the infection rate of COVID-19 increases more surprisingly as the rate of asymptomatic individuals increases than that of the symptomatic individuals. Moreover, the infection rate decreases significantly due to increase of self-immunity rate. © 2020 Tech Science Press. All rights reserved.