Coronavirus Disease 2019 (COVID-19)
GENERAL PRINCIPLES
• COVID-19 is caused by a novel coronavirus, Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) that has spread globally. Infection can be asymptomatic or manifest with a wide range of symptoms, ranging from mild respiratory disease to acute hypoxic respiratory failure requiring mechanical ventilation support.
• SARS-CoV-2 is a single-stranded RNA virus transmitted through respiratory droplets during talking, coughing, or sneezing. There is an increased risk of infection with prolonged exposure to an infected person (being within 6 ft for at least 15 minutes) or shorter exposures to individuals who are symptomatic.19
DIAGNOSIS
Clinical Presentation
• The mean incubation period for COVID-19 is 5 days (interquartile range of 2-7 days).
• Mild to moderate COVID-19 symptoms include cough, shortness of breath, fever, anosmia, ageusia, myalgias, and gastrointestinal symptoms.
• Severe disease will most commonly present with acute hypoxic respiratory failure. In addition, patients can develop acute kidney injury, liver dysfunction, bleeding and coagulation dysfunction, and septic shock.
Diagnostic Testing
Diagnosis is made using RT-PCR testing via nasal swab. Given possible false negative results, a presumptive diagnosis can be made with compatible clinical, laboratory, and imaging findings.
TREATMENT
• Strategies to treat COVID-19 are rapidly evolving. For updated recommendations, consult World Health Organization (www.who.int), CDC (www.cdc.gov), and National Institutes of Health (https://www.covid19treatmentguidelines.nih.gov/) treatment guidelines available online.
• Dexamethasone 6 mg PO qday for 10 days or until discharge is recommended for severely ill patients with COVID-19 requiring oxygen and/or ventilatory support. If dexamethasone is not available, it is reasonable to use other glucocorticoids at equivalent doses although data are limited.
• Remdesivir is a novel nucleotide analog with in vitro activity against SARS-CoV-2. It has been shown to reduce time to recovery and possibly mortality in those requiring supplemental oxygen.
• Convalescent plasma from individuals who have recovered from COVID-19 may provide passive immunity. The available evidence is unclear about its role in the treatment of COVID-19.
• Monoclonal antibodies developed to neutralize SARS-CoV-2 are still being studied in clinical trials.
• Supportive management of acute hypoxic respiratory failure and ARDS should be followed in severe disease.
• Vaccination is the most reliable prevention strategy to decrease symptomatic cases, hospitalization, and deaths.
Complications
• Adults older than 65 years, residents of nursing homes and other long-term care facilities, and patients with chronic medical conditions (e.g., pulmonary disease, cardiovascular disease, active malignancy, diabetes mellitus, chronic renal insufficiency, chronic liver disease, morbid obesity) are at greater risk of complications and death.
• Secondary bacterial pneumonia is uncommon. Use of steroids can cause reactivation of underlying infections in those with epidemiological risk factors such as strongyloidiasis, histoplasmosis, etc. Secondary fungal infections with Aspergillus spp. or COVID-19-associated pulmonary aspergillosis (CAPA) have been reported.