SARS-CoV-2

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

• Dexamethasone for patients requiring supplemental oxygen
• Investigational therapeutics include tocilizumab, lopinavir/ritonavir, and chloroquine

Further Reading

• Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. doi: 10.1001/jama.2020.12839