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 4-5 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:
Diagnosis
PCR from NP swab
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 , 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
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 .