SARS-CoV-2: Difference between revisions
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*Incubation period [[Usual incubation period::4 to 5 days]] (range [[Incubation period::2 to 11 days]]), possibly as long as 14 days in some cases |
*Incubation period [[Usual incubation period::4 to 5 days]] (range [[Incubation period::2 to 11 days]]), possibly as long as 14 days in some cases |
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| − | *Main presenting symptoms were fever and cough, followed by myalgia, fatigue, headache, dyspnea |
+ | *Main presenting symptoms were [[fever]] and [[cough]], followed by [[myalgia]], [[fatigue]], [[headache]], [[dyspnea]] |
| − | *Other symptoms include dyspnea, rhinorrhea, vomiting, diarrhea, anosmia/hyposmia |
+ | *Other symptoms include [[dyspnea]], [[rhinorrhea]], [[vomiting]], [[diarrhea]], [[anosmia]]/[[hyposmia]] |
| − | *Lymphopenia is common, as is hypoalbuminemia, elevated D-dimer, CRP, LDH, AST/ALT |
+ | *[[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 |
*Viral load detectable before symptom onset and peaks around the time of symptom onset |
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| + | === Pregnancy === |
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| + | * Please refer to [https://doi.org/10.1136/bmj.m3320 a living systematic review on the topic] |
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===Complications=== |
===Complications=== |
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*PCR from NP swab |
*PCR from NP swab |
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| + | **Highest sensitivity within 5 days of symptom onset, with decreasing sensitivity as the disease enters the immune-mediated phase |
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**May be positive long after no longer infectious |
**May be positive long after no longer infectious |
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Revision as of 19:49, 13 September 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 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
Complications
- In critically ill patients:
- ARDS (75%)
- AKI (40%)
- Thrombosis (10%)
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
- Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. doi: 10.1001/jama.2020.12839
- UHN-MSH Ontario Clinical Practice Guidelines
- PHAC Interim guidelines for the clinical management of patients with moderate to severe COVID-19
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.
