SARS-CoV-2: Difference between revisions
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*Other investigational therapeutics include [[tocilizumab]] |
*Other investigational therapeutics include [[tocilizumab]] |
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+ | ==Prevention== |
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+ | ===Infection Prevention and Control=== |
− | ==== |
+ | ====Healthcare Workers==== |
− | * |
+ | *Awaiting results |
− | ** |
+ | **If symptomatic, HCWs should be off work |
− | ** |
+ | **If asymptomatic, HCWs may return to work while awaiting results, depending on the reason for testing and the staffing needs |
+ | *Positive but asymptomatic: in exceptional circumstances, may return to work early |
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− | ==== |
+ | ====Clearance==== |
− | * |
+ | *Non-test based (preferred) |
− | ** |
+ | **Asymptomatic: isolate for 10 days from swab |
− | ** |
+ | **Mild to moderate symptoms in immunocompetent person: 10 days from onset of symptoms, as long as afebrile and clinically improving |
− | ** |
+ | **Severe (i.e. ICU-level care) or immunocompromised: 20 days from onset of symptoms, as long as afebrile and clinically improving |
− | *** |
+ | ***Immunocompromise includes chemotherapy, untreated [[HIV]] with CD4 <200, [[primary immunodeficiency]], [[prednisone]] 20 mg/day for 14 days, and other immunosuppressing medication |
− | * |
+ | *Test based (alternative): 2 negative swabs at least 24 hours apart (if still positive, repeat in 3 to 4 days), as long as afebrile and clinically improving |
==Further Reading== |
==Further Reading== |
Revision as of 09:28, 30 October 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
- 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:
- 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
Prevention
Infection Prevention and Control
Healthcare Workers
- Awaiting results
- If symptomatic, HCWs should be off work
- If asymptomatic, HCWs may return to work while awaiting results, depending on the reason for testing and the staffing needs
- Positive but asymptomatic: in exceptional circumstances, may return to work early
Clearance
- Non-test based (preferred)
- Asymptomatic: isolate for 10 days from swab
- Mild to moderate symptoms in immunocompetent person: 10 days from onset of symptoms, as long as afebrile and clinically improving
- Severe (i.e. ICU-level care) or immunocompromised: 20 days from onset of symptoms, as long as afebrile and clinically improving
- Immunocompromise includes chemotherapy, untreated HIV with CD4 <200, primary immunodeficiency, prednisone 20 mg/day for 14 days, and other immunosuppressing medication
- Test based (alternative): 2 negative swabs at least 24 hours apart (if still positive, repeat in 3 to 4 days), as long as afebrile and clinically improving
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