SARS-CoV-2: Difference between revisions
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*For patients no requiring supplemental oxygen, the focus is on supportive care |
*For patients no requiring supplemental oxygen, the focus is on supportive care |
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*For patients requiring supplemental oxygen: |
*For patients requiring supplemental oxygen: |
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**[[Dexamethasone]], which has a mortality benefit |
**[[Dexamethasone]] 6 mg PO/IV daily for 10 days, which has a mortality benefit |
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**[[Remdesivir]] 200 mg PO once on day one followed by 100 mg PO daily for 5-10 days, which has not been shown to have a mortality benefit |
**[[Remdesivir]] 200 mg PO once on day one followed by 100 mg PO daily for 5-10 days, which has not been shown to have a mortality benefit |
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*Avoid [[hydroxychloroquine]]/[[chloroquine]], [[lopinavir-ritonavir]] |
*Avoid [[hydroxychloroquine]]/[[chloroquine]], [[lopinavir-ritonavir]] |
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Revision as of 23:55, 30 July 2020
Background
Microbiology
- Coronavirus related to SARS-CoV
- Virion consists of:
- Spike glycoprotein (S)
- Membrane protein (M)
- Nucleocapsid protein (N)
- Hemagglutinin esterase (He)
- Envelope protein (E)
Epidemiology
- First cases detected Dec 2019 related to likely exposure in wet market in Wuhan, Hubei, China, and declared a pandemic in 2020
- Secondary household attack rate of 12-17%
Risk Factors for Mortality
- Greater age
- Male sex
- COPD
- Dyslipidemia
- Diabetes
Clinical Manifestations
- Incubation period 4-5 days (range 2 to 11), possibly as long as 14 days in some cases
- Main presenting symptoms were fever and cough, followed by myalgia, fatigue, headache, dyspnea
- Other symptoms include dyspnea, rhinorrhea, vomiting, diarrhea, anosmia/hyposmia
- Lymphopenia is common, as is hypoalbuminemia, elevated D-dimer, CRP, LDH, AST/ALT
- Viral load detectable before symptom onset and peaks around the time of symptom onset
Complications
- In critically ill patients:
- ARDS (75%)
- AKI (40%)
- Thrombosis (10%)
Diagnosis
- PCR from NP swab
- May be positive long after no longer infectious
Management
- For patients no requiring supplemental oxygen, the focus is on supportive care
- For patients requiring supplemental oxygen:
- Dexamethasone 6 mg PO/IV daily for 10 days, which has a mortality benefit
- Remdesivir 200 mg PO once on day one followed by 100 mg PO daily for 5-10 days, which has not been shown to have a mortality benefit
- Avoid hydroxychloroquine/chloroquine, lopinavir-ritonavir
- Other investigational therapeutics include tocilizumab
Further Reading
- Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. doi: 10.1001/jama.2020.12839
References
- ^ Louise Lansbury, Benjamin Lim, Vadsala Baskaran, Wei Shen Lim. Co-infections in people with COVID-19: a systematic review and meta-analysis. Journal of Infection. 2020;81(2):266-275. doi:10.1016/j.jinf.2020.05.046.
- ^ Scott Simpson, Fernando U. Kay, Suhny Abbara, Sanjeev Bhalla, Jonathan H. Chung, Michael Chung, Travis S. Henry, Jeffrey P. Kanne, Seth Kligerman, Jane P. Ko, Harold Litt. Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic Imaging. 2020;2(2):e200152. doi:10.1148/ryct.2020200152.
- ^ Robert L. Gottlieb, Carlos E. Vaca, Roger Paredes, Jorge Mera, Brandon J. Webb, Gilberto Perez, Godson Oguchi, Pablo Ryan, Bibi U. Nielsen, Michael Brown, Ausberto Hidalgo, Yessica Sachdeva, Shilpi Mittal, Olayemi Osiyemi, Jacek Skarbinski, Kavita Juneja, Robert H. Hyland, Anu Osinusi, Shuguang Chen, Gregory Camus, Mazin Abdelghany, Santosh Davies, Nicole Behenna-Renton, Frank Duff, Francisco M. Marty, Morgan J. Katz, Adit A. Ginde, Samuel M. Brown, Joshua T. Schiffer, Joshua A. Hill. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. New England Journal of Medicine. 2021. doi:10.1056/nejmoa2116846.
