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
Clinical Manifestations
- Incubation period 4 to 5 days (range 2 to 11 days), 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
Pregnancy
- Please refer to a living systematic review on the topic
- Slightly less reported fever and myalgias
- Slightly more ICU admissions and mechanical ventilation
- Risk factors included age, obesity, hypertension, and diabetes
- With regards to the fetus, there were more preterm deliveries (6%) and more needed NICU admission (25%)
Complications
- In critically ill patients:
Diagnosis
- PCR from NP swab
- Highest sensitivity within 5 days of symptom onset, with decreasing sensitivity as the disease enters the immune-mediated phase
- 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
