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
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 .