COVID-19 (SARS-CoV-2) - Comprehensive PSM Notes

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import ListFlowable, ListItem

OUTPUT = "/tmp/workspace/covid-psm-notes/COVID19_PSM_Notes.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
BLUE_DARK  = colors.HexColor("#1a3a5c")
BLUE_MID   = colors.HexColor("#2d6ea5")
BLUE_LIGHT = colors.HexColor("#daeaf7")
TEAL       = colors.HexColor("#17a589")
TEAL_LIGHT = colors.HexColor("#d1f2eb")
RED        = colors.HexColor("#c0392b")
RED_LIGHT  = colors.HexColor("#fadbd8")
ORANGE     = colors.HexColor("#e67e22")
ORANGE_LIGHT = colors.HexColor("#fdebd0")
GREY_LIGHT = colors.HexColor("#f2f3f4")
GREY_MED   = colors.HexColor("#d5d8dc")
WHITE      = colors.white
BLACK      = colors.black

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=1.5*cm, rightMargin=1.5*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

styles = getSampleStyleSheet()

# Custom styles
def S(name, **kw):
    return ParagraphStyle(name, **kw)

title_style = S("DocTitle",
    fontSize=22, textColor=WHITE, alignment=TA_CENTER,
    fontName="Helvetica-Bold", spaceAfter=4, spaceBefore=4)

subtitle_style = S("DocSub",
    fontSize=12, textColor=BLUE_LIGHT, alignment=TA_CENTER,
    fontName="Helvetica", spaceAfter=2)

h1 = S("H1",
    fontSize=13, textColor=WHITE, fontName="Helvetica-Bold",
    spaceBefore=10, spaceAfter=4, leftIndent=0)

h2 = S("H2",
    fontSize=11, textColor=BLUE_DARK, fontName="Helvetica-Bold",
    spaceBefore=8, spaceAfter=3, leftIndent=0,
    borderPad=2)

h3 = S("H3",
    fontSize=10, textColor=TEAL, fontName="Helvetica-Bold",
    spaceBefore=6, spaceAfter=2, leftIndent=0)

body = S("Body",
    fontSize=9, textColor=BLACK, fontName="Helvetica",
    spaceBefore=2, spaceAfter=2, leftIndent=4,
    leading=13, alignment=TA_JUSTIFY)

bullet = S("Bullet",
    fontSize=9, textColor=BLACK, fontName="Helvetica",
    spaceBefore=1, spaceAfter=1, leftIndent=12,
    bulletIndent=4, leading=12)

highlight_box = S("HighlightBox",
    fontSize=9, textColor=BLUE_DARK, fontName="Helvetica",
    spaceBefore=2, spaceAfter=2, leftIndent=6,
    leading=13, backColor=BLUE_LIGHT, borderPad=6)

warning_box = S("WarningBox",
    fontSize=9, textColor=RED, fontName="Helvetica-Bold",
    spaceBefore=2, spaceAfter=2, leftIndent=6,
    leading=13, backColor=RED_LIGHT, borderPad=6)

caption = S("Caption",
    fontSize=8, textColor=colors.grey, fontName="Helvetica-Oblique",
    alignment=TA_CENTER, spaceBefore=1, spaceAfter=4)

# ── Helper functions ─────────────────────────────────────────────────────────

def section_header(text, level=1):
    """Returns a coloured section header block."""
    if level == 1:
        bg = BLUE_DARK
        st = h1
    elif level == 2:
        bg = BLUE_MID
        st = S("H2W", fontSize=11, textColor=WHITE, fontName="Helvetica-Bold",
               spaceBefore=8, spaceAfter=3)
    else:
        bg = TEAL
        st = S("H3W", fontSize=10, textColor=WHITE, fontName="Helvetica-Bold",
               spaceBefore=6, spaceAfter=2)
    t = Table([[Paragraph(text, st)]], colWidths=[18*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("ROUNDEDCORNERS", [4,4,4,4]),
    ]))
    return t

def make_table(headers, rows, col_widths=None, header_bg=BLUE_MID, zebra=True):
    """Generic styled table."""
    data = [[Paragraph(f"<b>{h}</b>", S("TH", fontSize=8, textColor=WHITE,
             fontName="Helvetica-Bold", leading=11)) for h in headers]]
    for row in rows:
        data.append([Paragraph(str(c), S("TD", fontSize=8, textColor=BLACK,
                     fontName="Helvetica", leading=11)) for c in row])
    if col_widths is None:
        col_widths = [18*cm / len(headers)] * len(headers)
    t = Table(data, colWidths=col_widths, repeatRows=1)
    style = [
        ("BACKGROUND",   (0,0), (-1,0),  header_bg),
        ("TEXTCOLOR",    (0,0), (-1,0),  WHITE),
        ("FONTNAME",     (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",     (0,0), (-1,-1), 8),
        ("GRID",         (0,0), (-1,-1), 0.4, GREY_MED),
        ("TOPPADDING",   (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0), (-1,-1), 4),
        ("LEFTPADDING",  (0,0), (-1,-1), 5),
        ("RIGHTPADDING", (0,0), (-1,-1), 5),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
        ("ROWBACKGROUNDS",(0,1),(-1,-1), [WHITE, GREY_LIGHT] if zebra else [WHITE]),
    ]
    t.setStyle(TableStyle(style))
    return t

def bp(text):
    return Paragraph(f"• {text}", bullet)

def para(text):
    return Paragraph(text, body)

def sp(n=4):
    return Spacer(1, n)

def hr():
    return HRFlowable(width="100%", thickness=0.5, color=GREY_MED, spaceAfter=4, spaceBefore=4)

# ── COVER PAGE ───────────────────────────────────────────────────────────────
def cover_page():
    elems = []
    # Big coloured header box
    cover_table = Table(
        [[Paragraph("COVID-19", S("CT1", fontSize=36, textColor=WHITE,
                    fontName="Helvetica-Bold", alignment=TA_CENTER))],
         [Paragraph("(SARS-CoV-2)", S("CT2", fontSize=16, textColor=BLUE_LIGHT,
                    fontName="Helvetica", alignment=TA_CENTER))],
         [Paragraph("Comprehensive PSM Notes", S("CT3", fontSize=18, textColor=WHITE,
                    fontName="Helvetica-Bold", alignment=TA_CENTER))],
         [Paragraph("Epidemiology · Pathophysiology · Clinical Features · Diagnosis\n"
                    "Treatment · Vaccines · Public Health Programs · India Response",
                    S("CT4", fontSize=10, textColor=BLUE_LIGHT,
                      fontName="Helvetica", alignment=TA_CENTER, leading=16))]],
        colWidths=[18*cm]
    )
    cover_table.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), BLUE_DARK),
        ("TOPPADDING",    (0,0), (-1,-1), 14),
        ("BOTTOMPADDING", (0,0), (-1,-1), 14),
        ("LEFTPADDING",   (0,0), (-1,-1), 16),
        ("RIGHTPADDING",  (0,0), (-1,-1), 16),
    ]))
    elems.append(Spacer(1, 1.5*cm))
    elems.append(cover_table)
    elems.append(sp(12))

    # Key stats boxes
    stats = [
        ("700 M+", "Cases Worldwide"),
        ("7 M+", "Deaths Worldwide"),
        ("R₀ ~6", "Basic Reproduction No."),
        ("Jan 16, 2021", "India Vaccination Start"),
    ]
    stat_data = [[
        Table([[Paragraph(v, S("SV", fontSize=16, textColor=BLUE_DARK,
                          fontName="Helvetica-Bold", alignment=TA_CENTER))],
               [Paragraph(l, S("SL", fontSize=8, textColor=colors.grey,
                          fontName="Helvetica", alignment=TA_CENTER))]],
              colWidths=[4.2*cm])
        for v, l in stats
    ]]
    stat_table = Table(stat_data, colWidths=[4.4*cm]*4)
    stat_table.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), BLUE_LIGHT),
        ("GRID",          (0,0), (-1,-1), 0.5, BLUE_MID),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("ALIGN",         (0,0), (-1,-1), "CENTER"),
    ]))
    elems.append(stat_table)
    elems.append(sp(10))

    # Disclaimer
    disc = Table([[Paragraph(
        "Sources: Harrison's Principles of Internal Medicine 22E (2025) · Goldman-Cecil Medicine · "
        "Sherris & Ryan's Medical Microbiology 8E · Braunwald's Heart Disease · "
        "MoHFW India · WHO · ICMR",
        S("Disc", fontSize=7.5, textColor=colors.grey, fontName="Helvetica-Oblique",
          alignment=TA_CENTER))]],
        colWidths=[18*cm])
    disc.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), GREY_LIGHT),
        ("TOPPADDING", (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ]))
    elems.append(disc)
    elems.append(PageBreak())
    return elems

# ── BUILD DOCUMENT ───────────────────────────────────────────────────────────
story = []
story += cover_page()

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 1 - INTRODUCTION & CLASSIFICATION
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("1. INTRODUCTION & CLASSIFICATION", 1))
story.append(sp(4))
story.append(para("<b>Full Name:</b> Coronavirus Disease 2019 (COVID-19)"))
story.append(para("<b>Causative Agent:</b> Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)"))
story.append(para("<b>Family:</b> Coronaviridae | <b>Genus:</b> Betacoronavirus | <b>ICTV name:</b> Betacoronavirus pandemicum"))
story.append(para("<b>Genome:</b> Single-stranded, positive-sense RNA (~30,000 nucleotides — one of the largest RNA viral genomes)"))
story.append(sp(4))
story.append(bp("<b>Structural proteins:</b> S (Spike), E (Envelope), M (Membrane), N (Nucleocapsid)"))
story.append(bp("Spike protein RBD binds <b>ACE2</b> receptor; primed by <b>TMPRSS2</b> protease"))
story.append(bp("RNA-dependent RNA polymerase (RdRp) — error-prone, drives variant generation"))
story.append(sp(6))

story.append(section_header("Related Human Coronaviruses", 3))
story.append(sp(3))
story.append(make_table(
    ["Virus", "Disease", "Year", "Genome Identity with SARS-CoV-2"],
    [["SARS-CoV-1", "SARS epidemic", "2002–03", "~80%"],
     ["MERS-CoV", "MERS", "2012, 2015, 2018", "~50%"],
     ["HCoV-OC43 / HCoV-HKU1", "Common cold", "Endemic", "~50%"],
     ["SARS-CoV-2", "COVID-19 Pandemic", "2019–present", "Reference strain"]],
    col_widths=[4*cm, 4*cm, 3*cm, 7*cm]
))
story.append(sp(8))

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 2 - EPIDEMIOLOGY
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("2. EPIDEMIOLOGY (PSM Core)", 1))
story.append(sp(4))

story.append(section_header("2.1 Key Timeline", 2))
story.append(sp(3))
story.append(make_table(
    ["Date", "Event"],
    [["December 2019", "Cluster of viral pneumonia in Wuhan, Hubei province, China"],
     ["Jan 11–12, 2020", "Genomic sequence of SARS-CoV-2 published"],
     ["January 21, 2020", "First US case (Washington State)"],
     ["January 30, 2020", "WHO declared Public Health Emergency of International Concern (PHEIC)"],
     ["March 11, 2020", "WHO declared Global Pandemic"],
     ["January 16, 2021", "India COVID-19 vaccination program launched"],
     ["May 5, 2023", "WHO declared end to global COVID-19 emergency"],
     ["September 2024", ">700 million cases and >7 million deaths worldwide"]],
    col_widths=[4.5*cm, 13.5*cm]
))
story.append(sp(6))

story.append(section_header("2.2 Reservoir, Source & Transmission", 2))
story.append(sp(3))
story.append(bp("<b>Natural reservoir:</b> Horseshoe bats (presumed); possible intermediate host"))
story.append(bp("<b>R₀ (Basic Reproduction Number):</b> Peaks ~6 (seasonal influenza: 1–2); Omicron estimated 10–18"))
story.append(sp(4))
story.append(make_table(
    ["Route", "Details"],
    [["Respiratory droplets (PRIMARY)", "Droplets from coughing/sneezing landing on mucous membranes of others"],
     ["Aerosol/Airborne", "Short-range aerosol; long-distance airborne unlikely"],
     ["Fomite/Contact", "Hand-to-face transfer after touching contaminated surfaces"],
     ["Asymptomatic transmission", "Major driver — many asymptomatic individuals transmit virus freely"]],
    col_widths=[5*cm, 13*cm]
))
story.append(sp(4))

story.append(section_header("Surface Stability of SARS-CoV-2", 3))
story.append(sp(3))
story.append(make_table(
    ["Surface", "Stability"],
    [["Aerosol", "~2–4 hours"], ["Plastic", "~72 hours"], ["Steel", "~48 hours"],
     ["Cardboard", "~24 hours"], ["Copper", "~8 hours"]],
    col_widths=[6*cm, 12*cm], header_bg=TEAL
))
story.append(sp(6))

story.append(section_header("2.3 Risk Factors for Severe Disease", 2))
story.append(sp(3))
story.append(para("<b>Age</b> is the PRINCIPAL risk factor:"))
story.append(bp(">95% of COVID-19 deaths in persons >45 years"))
story.append(bp(">80% of deaths in persons >65 years"))
story.append(bp("Male sex associated with higher risk (OR ~1.8)"))
story.append(sp(4))
story.append(make_table(
    ["Comorbidity Category", "Examples"],
    [["Obesity", "BMI >25 (overweight), ≥30 (obese), ≥40 (severe obesity) — progressive risk increase"],
     ["Chronic lung disease", "COPD, moderate–severe asthma, cystic fibrosis, pulmonary hypertension"],
     ["Cancer / Immunosuppression", "Hematologic malignancies, solid organ transplant, HIV, steroids"],
     ["Cardiovascular", "Hypertension, heart failure, CAD, cardiomyopathies, stroke"],
     ["Metabolic", "Diabetes mellitus (Type 1 & 2), chronic liver disease (cirrhosis)"],
     ["Renal", "Chronic kidney disease"],
     ["Hematologic", "Sickle cell disease, thalassemia"],
     ["Neurological", "Cognitive impairment, Down syndrome, cerebrovascular disease"],
     ["Pregnancy", "Higher risk of severe illness, preterm birth"]],
    col_widths=[5.5*cm, 12.5*cm]
))
story.append(sp(8))

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 3 - PATHOPHYSIOLOGY
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("3. PATHOPHYSIOLOGY", 1))
story.append(sp(4))

story.append(section_header("3.1 Viral Entry Mechanism", 2))
story.append(sp(3))
story.append(make_table(
    ["Step", "Event"],
    [["1", "Virus enters via respiratory tract; nasopharyngeal/oropharyngeal cells are initial targets"],
     ["2", "Spike protein RBD binds ACE2 (Angiotensin-Converting Enzyme 2) receptor"],
     ["3", "TMPRSS2 primes Spike protein; S1/S2 cleavage by cellular cathepsins allows fusion"],
     ["4", "Virus enters cell; RNA released; RdRp drives replication"],
     ["5", "Spreads to bronchial epithelium, alveolar cells, vascular endothelium, macrophages"]],
    col_widths=[1*cm, 17*cm], header_bg=TEAL
))
story.append(sp(4))
story.append(Paragraph(
    "<b>PSM Key Point:</b> ACE2 receptors in lungs, heart, kidneys, intestines, brain → explains multi-organ involvement. "
    "Mutations in RBD increase ACE2 affinity → more infectious variants.",
    highlight_box))
story.append(sp(6))

story.append(section_header("3.2 Stages of Disease Progression", 2))
story.append(sp(3))
story.append(make_table(
    ["Stage", "Timing", "Pathology", "Clinical Picture"],
    [["1 — Early Infection", "Days 1–5", "Viral replication in upper airway; innate immune response", "Mild symptoms or asymptomatic"],
     ["2 — Pulmonary Phase", "Days 5–10", "Lower airway invasion; bilateral pneumonia; ACE2 downregulation disrupts RAAS → pulmonary edema", "Dyspnoea, hypoxia, ground-glass opacities on CT"],
     ["3 — Hyperinflammatory", "Days 10+", "Cytokine Storm: massive IL-6, TNF-α, IL-1β, IL-8, IFN-γ → ARDS", "Severe hypoxia, ICU admission"],
     ["4 — Coagulopathy", "Concurrent with Stage 3", "Endothelial damage + cytokines → hypercoagulability; DIC; VTE", "DVT, PE, stroke, limb ischaemia"]],
    col_widths=[3.5*cm, 3*cm, 6*cm, 5.5*cm]
))
story.append(sp(4))

story.append(section_header("3.3 Key Laboratory Correlates of Severity", 2))
story.append(sp(3))
story.append(make_table(
    ["Parameter", "Direction", "Significance"],
    [["Lymphocytes", "↓ (Lymphopenia)", "Impaired adaptive immunity"],
     ["IL-6, TNF-α, Ferritin, CRP", "↑↑ (markedly)", "Cytokine storm markers — predict severe disease"],
     ["D-dimer, Prothrombin time", "↑", "Coagulopathy, DIC, VTE risk"],
     ["LDH, Liver enzymes", "↑", "Multi-organ involvement"],
     ["Troponin, CPK", "↑", "Cardiac injury"],
     ["Creatinine", "↑", "Acute kidney injury"],
     ["Platelets", "↓ (Thrombocytopenia)", "Consumption in coagulopathy"]],
    col_widths=[5*cm, 4*cm, 9*cm], header_bg=RED
))
story.append(sp(8))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 4 - CLINICAL FEATURES
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("4. CLINICAL FEATURES", 1))
story.append(sp(4))
story.append(para("<b>Incubation Period:</b> Typically 4–5 days after exposure; range 1–14 days (nearly always within 14 days)"))
story.append(sp(6))

story.append(section_header("4.1 Spectrum of Illness", 2))
story.append(sp(3))
story.append(make_table(
    ["Severity", "Definition", "Approx %"],
    [["Asymptomatic/Presymptomatic", "SARS-CoV-2 positive, no symptoms", "20–40%"],
     ["Mild", "Symptoms (fever, cough); SpO₂ normal; no dyspnoea", "40–50%"],
     ["Moderate", "SpO₂ ≥94%; lower respiratory tract disease", "~15%"],
     ["Severe", "SpO₂ <94%; RR >30/min; lung infiltrates >50%", "5–10%"],
     ["Critical", "Respiratory failure, shock, multi-organ failure/dysfunction", "1–5%"]],
    col_widths=[4.5*cm, 10.5*cm, 3*cm]
))
story.append(sp(6))

story.append(section_header("4.2 Symptoms by System", 2))
story.append(sp(3))
story.append(make_table(
    ["System", "Symptoms"],
    [["General/Constitutional", "Fever, fatigue, myalgia, headache"],
     ["Respiratory", "Cough, dyspnoea, sore throat"],
     ["Neurological (HALLMARK)", "Sudden onset ANOSMIA (loss of smell) + DYSGEUSIA (loss of taste); encephalopathy; delirium"],
     ["Gastrointestinal", "Nausea, vomiting, diarrhoea"],
     ["Dermatological", "Diverse rashes; 'COVID toes' (pernio/chilblains-like)"],
     ["Psychiatric", "Fatigue, depression, anxiety, sleep disturbance, cognitive deficit, PTSD"]],
    col_widths=[4.5*cm, 13.5*cm]
))
story.append(sp(6))

story.append(section_header("4.3 Complications", 2))
story.append(sp(3))
story.append(make_table(
    ["System", "Complications"],
    [["Pulmonary", "ARDS (MOST COMMON SEVERE COMPLICATION) — requires O₂/mechanical ventilation"],
     ["Cardiovascular", "Myocarditis, pericarditis, heart failure, arrhythmia, myocardial injury"],
     ["Thrombotic", "PE, DVT, DIC, stroke, limb ischaemia (COVID-19 coagulopathy)"],
     ["Renal", "Acute kidney injury — may require dialysis"],
     ["Neurological", "Encephalopathy, seizures, ataxia, motor/sensory deficits, Guillain-Barré"],
     ["Paediatric", "MIS-C: multisystem inflammatory syndrome in children — persistent fever, multi-organ, elevated CRP; most common in Black/Latino children 3–12 yrs"],
     ["Long COVID (PASC)", "Symptoms persisting ≥3 months: fatigue, brain fog, dyspnoea, chest pain, depression, PTSD, ↑ suicidal ideation"]],
    col_widths=[4*cm, 14*cm]
))
story.append(sp(8))

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 5 - DIAGNOSIS
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("5. DIAGNOSIS", 1))
story.append(sp(4))

story.append(make_table(
    ["Test", "Details", "Notes"],
    [["RT-PCR (GOLD STANDARD)", "Reverse transcription PCR; converts viral RNA to cDNA; nasopharyngeal swab most common; saliva for mass screening", "High sensitivity; requires reference lab"],
     ["Rapid Antigen Test", "Point-of-care; detects viral antigens", "Less sensitive; useful for mass screening, home testing"],
     ["Antibody (IgM/IgG)", "Serological detection of immune response", "NOT for acute diagnosis; used for seroprevalence studies"],
     ["Chest X-Ray", "Bilateral consolidation + ground-glass opacities (lower zones)", "May be normal early; used for management"],
     ["Chest CT", "Ground-glass opacification ± consolidation; pleural thickening; septal thickening; air bronchograms", "More sensitive than CXR; for management NOT primary diagnosis"],
     ["Lung Ultrasound", "Detects some COVID-19 lung abnormalities", "Bedside utility in ICU"]],
    col_widths=[4*cm, 9*cm, 5*cm]
))
story.append(sp(4))

story.append(section_header("WHO Clinical Case Definitions (PSM)", 3))
story.append(sp(3))
story.append(bp("<b>Suspected case:</b> Acute febrile illness OR acute respiratory illness with epidemiological link"))
story.append(bp("<b>Probable case:</b> Suspected case with typical CT findings but RT-PCR negative/unavailable"))
story.append(bp("<b>Confirmed case:</b> Positive RT-PCR regardless of symptoms"))
story.append(sp(8))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 6 - TREATMENT
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("6. TREATMENT", 1))
story.append(sp(4))

story.append(section_header("6.1 Outpatient Treatment — Mild/Moderate Disease (High-Risk Patients)", 2))
story.append(sp(3))
story.append(para("Antiviral drugs should be started within <b>5 days of symptom onset</b> for maximum benefit:"))
story.append(sp(3))
story.append(make_table(
    ["Drug", "Mechanism", "Dose", "Notes"],
    [["Nirmatrelvir/Ritonavir (Paxlovid) ★ FIRST LINE", "Protease inhibitor + CYP3A4 booster",
      "300 mg/100 mg BD × 5 days PO", "Drug of choice; check drug interactions carefully"],
     ["Remdesivir", "RdRp inhibitor (nucleoside analog)",
      "200 mg IV day 1 → 100 mg IV daily × 3 days", "Outpatient 3-day IV course; for high-risk"],
     ["Molnupiravir", "RdRp error induction (lethal mutagenesis)",
      "800 mg BD × 5 days PO", "Third-line; AVOID in pregnancy"]],
    col_widths=[4.5*cm, 4*cm, 4.5*cm, 5*cm]
))
story.append(sp(3))
story.append(Paragraph("<b>NOT recommended:</b> Ivermectin (no proven benefit); aspirin or anticoagulants (unless other indications).", warning_box))
story.append(sp(6))

story.append(section_header("6.2 Hospitalized Patients — Severe/Critical COVID-19", 2))
story.append(sp(3))

story.append(section_header("A. Antiviral", 3))
story.append(sp(2))
story.append(bp("<b>Remdesivir</b> 200 mg IV day 1, then 100 mg/day for up to 5–10 days"))
story.append(bp("Speeds recovery; mortality benefit limited to non-ventilated patients"))
story.append(bp("Recommended by both US NIH guidelines and WHO for patients requiring supplemental O₂"))
story.append(sp(4))

story.append(section_header("B. Corticosteroids (BACKBONE of Severe COVID Treatment)", 3))
story.append(sp(2))
story.append(make_table(
    ["Drug", "Dose", "Effect", "Indication"],
    [["Dexamethasone ★ FIRST LINE", "6 mg/day PO or IV × 10 days or discharge",
      "↓ Mortality ~20% (O₂); ↓ ~35% (ventilated)", "ALL patients requiring O₂"],
     ["Prednisone (alternative)", "40 mg/day", "Equivalent to dexamethasone", "If dexamethasone unavailable"],
     ["Methylprednisolone (alt)", "32 mg/day", "Equivalent", "If dexamethasone unavailable"],
     ["Hydrocortisone (alt)", "160 mg/day", "Equivalent", "If dexamethasone unavailable"]],
    col_widths=[4.5*cm, 4*cm, 5*cm, 4.5*cm], header_bg=ORANGE
))
story.append(Paragraph("<b>WARNING:</b> Dexamethasone is NOT beneficial and may harm patients NOT requiring oxygen.", warning_box))
story.append(sp(4))

story.append(section_header("C. Anti-inflammatory / Immunomodulatory Agents", 3))
story.append(sp(2))
story.append(make_table(
    ["Drug", "Class", "Dose", "Indication", "Mortality Benefit"],
    [["Tocilizumab ★", "IL-6 receptor blocker", "8 mg/kg IV (max 800 mg) × 1–2 doses",
      "Rapidly deteriorating; on steroids; elevated inflammation; ICU transfer", "~15% reduction"],
     ["Sarilumab", "IL-6 blocker", "Per protocol",
      "Alternative to tocilizumab", "Limited data"],
     ["Baricitinib ★", "JAK inhibitor", "4 mg/day PO × 14 days",
      "Added to steroids + elevated inflammatory markers", "~40% mortality reduction at day 28"],
     ["Tofacitinib", "JAK inhibitor", "10 mg BD PO × 14 days",
      "Alternative JAK inhibitor", "Benefit shown"],
     ["Abatacept / Infliximab", "Alternative immunomodulators", "Per protocol",
      "When first-line agents unavailable", "Alternative agents"]],
    col_widths=[3.5*cm, 3.5*cm, 4*cm, 4*cm, 3*cm]
))
story.append(sp(4))

story.append(section_header("D. Combined Therapy Guidelines", 3))
story.append(sp(2))
story.append(make_table(
    ["Clinical Scenario", "Recommended Regimen"],
    [["Requires O₂ but NOT ventilated (standard hospitalized)", "Remdesivir + Dexamethasone"],
     ["Minimal O₂ requirement only", "Remdesivir alone"],
     ["Rapidly deteriorating on above; high-flow O₂/ventilation/ICU; elevated inflammation",
      "Add Tocilizumab OR Baricitinib to corticosteroids"],
     ["Refractory hypoxia", "ECMO considered; continue immunomodulators"]],
    col_widths=[6*cm, 12*cm], header_bg=TEAL
))
story.append(sp(4))

story.append(section_header("E. Anticoagulation", 3))
story.append(sp(2))
story.append(bp("<b>Prophylactic anticoagulation</b> recommended for ALL hospitalized COVID-19 patients"))
story.append(bp("<b>Therapeutic anticoagulation</b> for confirmed VTE — requires expert consultation"))
story.append(bp("NOT recommended in outpatients without other indications"))
story.append(sp(4))

story.append(section_header("F. Supportive Care", 3))
story.append(sp(2))
story.append(make_table(
    ["Intervention", "Details"],
    [["Supplemental O₂", "Target SpO₂ ≥94%; nasal cannula → HFNC → NIV → intubation"],
     ["Mechanical ventilation", "Lung-protective strategy: low tidal volume 6 mL/kg IBW"],
     ["Prone positioning", "Improves oxygenation in ARDS; ≥16 hours/day"],
     ["ECMO", "Extracorporeal membrane oxygenation for refractory ARDS"],
     ["Antipyretics", "Acetaminophen PREFERRED over NSAIDs"],
     ["Antibiotics", "NOT routinely indicated; consider if bacterial co-infection suspected"]],
    col_widths=[4.5*cm, 13.5*cm], header_bg=TEAL
))
story.append(sp(8))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 7 - VACCINES
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("7. VACCINES", 1))
story.append(sp(4))

story.append(section_header("7.1 Types of COVID-19 Vaccines", 2))
story.append(sp(3))
story.append(make_table(
    ["Platform", "Mechanism", "Examples"],
    [["mRNA", "Lipid nanoparticle-encapsulated mRNA encodes spike protein; host cells produce spike → immune response",
      "Pfizer-BioNTech (Comirnaty), Moderna (Spikevax)"],
     ["Adenoviral Vector", "Non-replicating viral vector delivers spike gene",
      "AstraZeneca/Covishield (ChAdOx1), Janssen/J&J (Ad26), Sputnik V"],
     ["Inactivated Virus", "Killed SARS-CoV-2 induces immune response",
      "Covaxin (BBV152), Sinovac (CoronaVac), Sinopharm"],
     ["Protein Subunit", "Recombinant spike protein + adjuvant",
      "Novavax (Nuvaxovid), Corbevax, Covovax"],
     ["DNA/Plasmid", "Plasmid DNA delivered intradermally via needle-free device",
      "ZyCoV-D (India — world's first DNA vaccine for COVID)"]],
    col_widths=[4*cm, 8*cm, 6*cm]
))
story.append(sp(6))

story.append(section_header("7.2 Key Vaccine Characteristics (WHO/US-Authorized)", 2))
story.append(sp(3))
story.append(make_table(
    ["Feature", "Pfizer-BioNTech mRNA", "Moderna mRNA", "J&J (Janssen)", "Novavax Protein"],
    [["Type", "mRNA", "mRNA", "Adenovirus vector", "Protein subunit + Matrix-M adjuvant"],
     ["Minimum Age", "≥6 months", "≥6 months", "≥18 years", "≥12 years"],
     ["Primary Series", "2 doses (≥5 yrs)\n3 doses (6 mo–4 yrs)", "2 doses", "1 dose", "2 doses"],
     ["Interval", "3–8 weeks", "4–8 weeks", "Single dose", "3–8 weeks"],
     ["Booster", "Approved ≥5 yrs", "Approved", "Not approved", "Not approved"],
     ["Immunocompromised", "3-dose primary + boosters", "3-dose primary + boosters", "2-dose primary + mRNA booster", "2 doses + mRNA booster"]],
    col_widths=[4*cm, 3.5*cm, 3.5*cm, 3.5*cm, 3.5*cm]
))
story.append(sp(6))

story.append(section_header("7.3 Vaccine Adverse Effects", 2))
story.append(sp(3))
story.append(make_table(
    ["Adverse Effect", "Vaccine Type", "Frequency", "Management"],
    [["Local reaction (pain, swelling, redness)", "All", "Common", "Symptomatic"],
     ["Systemic (fatigue, headache, fever, myalgia)", "All (esp. after dose 2)", "Common", "Symptomatic; usually 1–2 days"],
     ["Myocarditis/Pericarditis", "mRNA vaccines and Novavax", "Rare (mainly adolescent/young adult males)", "Conservative; generally mild-moderate course"],
     ["VITT (thrombocytopenia + thrombosis)", "Adenoviral vector (AZ, J&J)", "Very rare", "IVIG + anticoagulation; AVOID heparin"],
     ["Anaphylaxis", "All", "Very rare (~2–5/million doses)", "Epinephrine; 15–30 min observation post-vaccination"]],
    col_widths=[4.5*cm, 4*cm, 3.5*cm, 6*cm], header_bg=RED
))
story.append(sp(8))

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 8 - PUBLIC HEALTH MEASURES
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("8. PUBLIC HEALTH MEASURES & CONTROL (PSM)", 1))
story.append(sp(4))

story.append(section_header("8.1 Non-Pharmaceutical Interventions (NPIs)", 2))
story.append(sp(3))
story.append(make_table(
    ["Measure", "Definition", "Purpose"],
    [["Social Distancing", "Stay ≥6 ft from others in public", "Reduce droplet/aerosol exposure"],
     ["Social Isolation", "Stay away from others when infected", "Source control"],
     ["Quarantine", "Stay home 14 days after potential exposure", "Interrupt transmission chain"],
     ["Lockdown", "Restrict movement; close non-essential services", "Reduce overall Re below 1"],
     ["Masking", "Surgical/N95/KN95 face masks", "Reduce droplet inhalation + exhalation"],
     ["Hand Hygiene", "Soap & water ≥20 sec; alcohol-based sanitizers", "Prevent fomite transmission"],
     ["Respiratory Etiquette", "Cover cough/sneeze; dispose tissues", "Source control"],
     ["Travel Restrictions", "Restrict inter-regional/international travel", "Slow geographic spread"],
     ["School/Workplace Closures", "Remote learning and work-from-home", "Reduce community transmission"]],
    col_widths=[4*cm, 7*cm, 7*cm]
))
story.append(sp(6))

story.append(section_header("8.2 Key Epidemiological Indicators (PSM)", 2))
story.append(sp(3))
story.append(make_table(
    ["Indicator", "Formula", "COVID-19 Value"],
    [["Attack Rate (AR)", "New cases / At-risk population × 100", "Varied widely by wave and variant"],
     ["Case Fatality Rate (CFR)", "Deaths / Confirmed cases × 100", "~1–3% globally (higher early; lower with Omicron/vaccination)"],
     ["Infection Fatality Rate (IFR)", "Deaths / Estimated total infections × 100", "~0.5–1% (overall population)"],
     ["Test Positivity Rate (TPR)", "Positive tests / Total tests × 100", "WHO threshold: <5% considered controlled"],
     ["R effective (Re)", "Actual transmission rate in partial immunity", "<1 = epidemic declining"],
     ["Herd Immunity Threshold", "1 - 1/R₀", "~83–90% for COVID-19 (R₀ ~6)"]],
    col_widths=[4.5*cm, 7*cm, 6.5*cm], header_bg=TEAL
))
story.append(sp(6))

story.append(section_header("8.3 Infection Prevention & Control (IPC) in Healthcare", 2))
story.append(sp(3))
story.append(bp("<b>Standard precautions:</b> All patients — hand hygiene (WHO 5 moments), gloves, gown, respiratory etiquette"))
story.append(bp("<b>Droplet + Contact precautions:</b> All suspected/confirmed COVID-19 patients"))
story.append(bp("<b>Airborne precautions</b> for Aerosol-Generating Procedures (AGPs): intubation, bronchoscopy, suctioning, CPR, nebulization"))
story.append(bp("<b>PPE for AGPs:</b> N95 respirator (FFP2/FFP3), goggles/face shield, gown, gloves"))
story.append(bp("<b>Negative pressure rooms</b> for AGPs where available"))
story.append(sp(8))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 9 - VARIANTS OF CONCERN
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("9. VARIANTS OF CONCERN (VOCs)", 1))
story.append(sp(4))
story.append(make_table(
    ["WHO Name", "Lineage", "Origin", "Key Features"],
    [["Alpha", "B.1.1.7", "United Kingdom", "~50% more transmissible than original strain"],
     ["Beta", "B.1.351", "South Africa", "Partial vaccine escape; reduced neutralization"],
     ["Gamma", "P.1", "Brazil", "Reinfection risk; immune evasion"],
     ["Delta", "B.1.617.2", "India", "Very high transmissibility; severe disease; R₀ ~6–7"],
     ["Omicron", "B.1.1.529", "South Africa", "HIGHEST transmissibility (R₀ ~10–18); partial vaccine evasion; less severe disease generally"]],
    col_widths=[2.5*cm, 3.5*cm, 4*cm, 8*cm]
))
story.append(sp(4))
story.append(para("<b>WHO Classification:</b> Variants Under Monitoring (VUM) → Variants of Interest (VOI) → Variants of Concern (VOC)"))
story.append(bp("WHO Technical Advisory Group on SARS-CoV-2 Virus Evolution monitors variants"))
story.append(bp("WHO CoViNet launched 2024 for early coronavirus detection and variant tracking"))
story.append(bp("WHO Technical Advisory Group on COVID-19 Vaccine Composition assesses VOC impact on vaccine performance"))
story.append(sp(8))

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 10 - INDIA VACCINATION PROGRAM
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("10. INDIA'S COVID-19 VACCINATION PROGRAM", 1))
story.append(sp(4))

story.append(section_header("10.1 Program Overview", 2))
story.append(sp(3))
story.append(bp("<b>Launch Date:</b> January 16, 2021 (launched at 3,006 vaccination centres)"))
story.append(bp("<b>Ministry:</b> Ministry of Health and Family Welfare (MoHFW)"))
story.append(bp("<b>Platform:</b> CoWIN (Covid Vaccine Intelligence Network) — registration, scheduling, certificates, cold chain monitoring"))
story.append(bp("165,714 people vaccinated on Day 1; 631,417 in first three days"))
story.append(sp(6))

story.append(section_header("10.2 Vaccines Used in India", 2))
story.append(sp(3))
story.append(make_table(
    ["Vaccine", "Type", "Manufacturer", "Approved"],
    [["Covishield ★ (most used >81% doses)", "Adenoviral vector (ChAdOx1)", "Serum Institute of India (SII) — AstraZeneca license", "Jan 1, 2021"],
     ["Covaxin (BBV152) ★ (indigenous)", "Inactivated whole-virus", "Bharat Biotech + ICMR + National Institute of Virology", "Jan 2, 2021"],
     ["Sputnik V", "Adenoviral vector (rAd26+rAd5)", "Dr. Reddy's Laboratories (Gamaleya license)", "Apr 2021"],
     ["Moderna (Spikevax)", "mRNA", "Moderna / SII production", "Jun 2021"],
     ["Corbevax", "Protein subunit (RBD)", "Biological E + Dynavax + Baylor College", "Dec 2021"],
     ["Covovax", "Protein subunit", "SII (Novavax technology)", "Dec 2021"],
     ["ZyCoV-D", "DNA plasmid (needle-free)", "Zydus Cadila — world's first DNA COVID vaccine", "Aug 2021"],
     ["Johnson & Johnson", "Adenoviral vector (Ad26)", "Janssen/J&J", "Aug 2021"]],
    col_widths=[5*cm, 4*cm, 6.5*cm, 2.5*cm]
))
story.append(sp(6))

story.append(section_header("10.3 Vaccine Efficacy — India's Key Vaccines", 2))
story.append(sp(3))
story.append(make_table(
    ["Vaccine", "Efficacy — Symptomatic COVID", "Efficacy — Severe COVID", "Notes"],
    [["Covishield (AstraZeneca/ChAdOx1)", "~70–79%", "~95% against severe disease",
      "Most widely deployed; >81% of India's doses"],
     ["Covaxin (BBV152)", "77.8% (130 confirmed cases eval)", "93.4%",
      "63.6% vs asymptomatic; 65.2% vs Delta; 100% Indian indigenous"],
     ["Corbevax (RBD subunit)", "~90% (Novavax data)", "High protection",
      "Used for 12–14 year age group in India"]],
    col_widths=[4.5*cm, 4.5*cm, 4*cm, 5*cm]
))
story.append(sp(6))

story.append(section_header("10.4 Rollout Phases in India", 2))
story.append(sp(3))
story.append(make_table(
    ["Phase", "Period", "Priority Group"],
    [["Phase 1", "Jan 16, 2021", "Healthcare Workers (HCW)"],
     ["Phase 2", "Feb 1, 2021", "Frontline Workers (FLW) — police, military, municipal workers"],
     ["Phase 3", "Mar 1, 2021", "≥60 years and ≥45 years with comorbidities"],
     ["Phase 4", "Apr 1, 2021", "All adults ≥45 years"],
     ["Phase 5", "May 1, 2021", "All adults ≥18 years"],
     ["Phase 6", "Jan 3, 2022", "Adolescents 15–18 years (Covaxin)"],
     ["Phase 7 (Precaution dose)", "Jan 10, 2022", "HCW, FLW, and adults ≥60 years (booster)"],
     ["Extended", "Apr 2022", "12–14 years (Corbevax); booster for all adults ≥18 years"]],
    col_widths=[4*cm, 4*cm, 10*cm]
))
story.append(sp(8))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 11 - INDIA COVID MANAGEMENT PROGRAMS
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("11. INDIA'S COVID-19 MANAGEMENT PROGRAMS", 1))
story.append(sp(4))

story.append(section_header("11.1 Surveillance Systems", 2))
story.append(sp(3))
story.append(make_table(
    ["System", "Role"],
    [["IDSP (Integrated Disease Surveillance Programme)", "COVID-19 integrated as notifiable disease; district/state/national surveillance network"],
     ["NCDC (National Centre for Disease Control)", "National coordination and epidemiological investigation"],
     ["ICMR (Indian Council of Medical Research)", "Testing guidelines, research, Covaxin co-development, clinical trial oversight"],
     ["CoWIN Platform", "Vaccine management: registration, scheduling, certificate, adverse event reporting, cold chain monitoring"],
     ["Aarogya Setu App", "Digital contact tracing using Bluetooth + GPS; voluntary self-reporting"]],
    col_widths=[5.5*cm, 12.5*cm]
))
story.append(sp(6))

story.append(section_header("11.2 Containment Strategy", 2))
story.append(sp(3))
story.append(bp("<b>Cluster Containment Strategy:</b> Used for localized outbreaks — define containment zone + buffer zone; active case-finding, testing, contact tracing, quarantine"))
story.append(bp("<b>Zone Classification:</b> Red (hotspot/high risk), Orange (limited spread), Green (no active cases)"))
story.append(bp("<b>Three-tier response:</b> District → State → National levels"))
story.append(sp(6))

story.append(section_header("11.3 India Clinical Management Protocol (MoHFW)", 2))
story.append(sp(3))
story.append(make_table(
    ["Severity", "Management"],
    [["Mild", "Home isolation; symptomatic (paracetamol); pulse oximetry monitoring; telemedicine follow-up; avoid unnecessary antibiotics"],
     ["Moderate", "Hospitalization; low-flow O₂; Remdesivir; steroids; anticoagulation prophylaxis; monitor SpO₂"],
     ["Severe/Critical", "ICU; high-flow O₂/NIV/mechanical ventilation; Dexamethasone; Remdesivir; Tocilizumab/Baricitinib; therapeutic anticoagulation; ECMO if refractory"]],
    col_widths=[3*cm, 15*cm], header_bg=RED
))
story.append(sp(6))

story.append(section_header("11.4 Social Support Programs During COVID", 2))
story.append(sp(3))
story.append(make_table(
    ["Program", "Purpose"],
    [["PM CARES Fund", "Emergency financial resource for COVID-19 response and healthcare"],
     ["Pradhan Mantri Garib Kalyan Anna Yojana", "Free food grains to 800 million beneficiaries during COVID lockdowns"],
     ["One Nation One Ration Card", "Portability of food security during lockdown-driven migration"],
     ["ECLGS (Emergency Credit Line Guarantee Scheme)", "Financial support to MSMEs affected by lockdowns"],
     ["PM Garib Kalyan Package", "Direct cash transfers to women Jan Dhan account holders, farmers, daily wage workers"]],
    col_widths=[6*cm, 12*cm]
))
story.append(sp(8))

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 12 - GLOBAL RESPONSE
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("12. GLOBAL RESPONSE FRAMEWORKS", 1))
story.append(sp(4))
story.append(make_table(
    ["Program/Initiative", "Description"],
    [["COVAX", "WHO + GAVI + CEPI initiative for equitable global vaccine access; target: 20% coverage in each participating country by end-2021; India key supplier through SII"],
     ["WHO Solidarity Trial", "International adaptive RCT testing multiple COVID-19 treatments simultaneously across 30+ countries"],
     ["WHO CoViNet (2024)", "Global coronavirus surveillance network for early detection and variant tracking"],
     ["ACT-Accelerator", "WHO framework: Access to COVID-19 Tools — vaccines, diagnostics, therapeutics, health system strengthening"],
     ["IHR Emergency Committee", "Advised WHO Director-General on PHEIC status; met regularly throughout pandemic"]],
    col_widths=[5*cm, 13*cm]
))
story.append(sp(8))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
# SECTION 13 - QUICK REVISION TABLE
# ═══════════════════════════════════════════════════════════════════════════
story.append(section_header("13. HIGH-YIELD QUICK REVISION — PSM EXAM TABLE", 1))
story.append(sp(4))
story.append(make_table(
    ["Topic", "Key Fact"],
    [["Causative agent", "SARS-CoV-2 — Betacoronavirus"],
     ["Receptor", "ACE2 (Angiotensin-Converting Enzyme 2) + TMPRSS2"],
     ["Genome", "Positive-sense, single-stranded RNA; ~30,000 nucleotides"],
     ["R₀", "~6 (Omicron ~10–18); seasonal flu ~1–2"],
     ["Incubation period", "4–5 days typically; max 14 days"],
     ["Primary transmission", "Respiratory droplets"],
     ["Surface stability", "Plastic: 72h | Steel: 48h | Cardboard: 24h | Copper: 8h"],
     ["Gold standard diagnosis", "RT-PCR (nasopharyngeal swab)"],
     ["WHO PHEIC declared", "January 30, 2020"],
     ["WHO pandemic declared", "March 11, 2020"],
     ["WHO ended PHEIC", "May 5, 2023"],
     ["Global cases (Sep 2024)", ">700 million cases; >7 million deaths"],
     ["Herd immunity threshold", "~83–90% (based on R₀ ~6)"],
     ["Best drug — mild high-risk outpatients", "Nirmatrelvir/Ritonavir (Paxlovid)"],
     ["Best antiviral — hospitalized", "Remdesivir (200→100 mg IV)"],
     ["Backbone of severe COVID treatment", "Dexamethasone 6 mg/day × 10 days"],
     ["IL-6 blocker (hospital)", "Tocilizumab (~15% mortality reduction)"],
     ["JAK inhibitor (hospital)", "Baricitinib (~40% mortality reduction at day 28)"],
     ["India vaccination launch", "January 16, 2021"],
     ["India indigenous vaccine", "Covaxin (BBV152) — Bharat Biotech + ICMR + NIV"],
     ["Most used vaccine in India", "Covishield (>81% of doses)"],
     ["India vaccine platform", "CoWIN (Covid Vaccine Intelligence Network)"],
     ["VITT", "Vaccine-Induced Immune Thrombocytopenia & Thrombosis — adenoviral vector vaccines; treat with IVIG (NOT heparin)"],
     ["Myocarditis post-vaccine", "mRNA vaccines; mainly adolescent/young adult males; usually mild"],
     ["Long COVID definition", "Symptoms persisting ≥3 months post-infection (PASC)"],
     ["MIS-C", "Multisystem inflammatory syndrome in children; most common: Black/Latino children 3–12 yrs"],
     ["Anosmia + Dysgeusia", "Hallmark neurological features of COVID-19"],
     ["PPE for AGPs", "N95 + goggles/face shield + gown + gloves"]],
    col_widths=[7*cm, 11*cm], header_bg=BLUE_DARK
))
story.append(sp(8))

# ── Footer section ──────────────────────────────────────────────────────────
story.append(hr())
story.append(Paragraph(
    "Sources: Harrison's Principles of Internal Medicine 22nd Ed. (2025, McGraw Hill) · Goldman-Cecil Medicine International Edition · "
    "Sherris & Ryan's Medical Microbiology 8th Ed. · Braunwald's Heart Disease · Washington Manual of Medical Therapeutics · "
    "MoHFW India · WHO COVID-19 Guidelines · ICMR · Bharat Biotech · Serum Institute of India",
    S("Footer", fontSize=7.5, textColor=colors.grey, fontName="Helvetica-Oblique",
      alignment=TA_CENTER, leading=11)
))

# ── Build PDF ────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")