Covid-19 sars-coV-2 Lisa Gilbert, md, faafp, ctropMed 3/17/20 covid-19 sars-coV-2 2019-nCov hcoV-19

Symptoms and Disease Course

• Week 1: Fever (77-98%) (intermittent or persistent), Fatigue/Malaise (11-52%), Dry cough (46-82%), dyspnea (3-31%);
• Less common: Sputum (33%), Myalgia (15%), Headache (13%), Sore throat (14%), Diarrhea (4%), Nausea/Vomiting (5%), Nasal congestion (4%), Hemoptysis (1%)
• Week 2 (~ day 6-9 of symptoms): ~ 15-20% develop severe dyspnea due to viral pneumonia
• Hospitalization, supportive care, oxygen
• Week 2-3: Of hospitalized patients, 1/3 ultimately need ICU care, with up to half needing intubation (i.e. ~5% of total diagnosed cases need ICU)
• Can rapidly decline (over 12-24 hrs) from mild hypoxia to frank ARDS
• Cytokine Storm, Multi-organ failure
• Late stage sudden cardiomyopathy/viral myocarditis, cardiac shock

Cormorbidities and Risk Conditions

• Age
• HTN
• Diabetes
• Coronary Heart Disease
• Hep B
• Cerebrovascular Disease
• COPD
• Cancer
• Children and pregnant women seem to do okay

https://avatorl.org/covid-19/?page=ClinicalData1099

Diagnosis

• Travel History, Exposure and Symptoms most important
• Person Under Investigation Criteria
• No specific physical exam findings. Lungs may have rales or rhonchi.
• Hypoxia, even silent hypoxia, may be present, esp elders.
• Tachycardia and tachypnea.
• May present as severe asthma or COPD exacerbation.

Ancillary Studies

• Most Common:
• WBC usually normal, Lymphopenia in 80%, Mild thrombocytopenia
• Low Procal; Bacterial coinfection rare
• CRP and D-Dimer elevated proportionate to severity (marker of poor prognosis); DIC over time
• Increased ALT/AST to 70-100 range; Occasional increased alk phos
• Mild elevation of creatinine
• Generally normal troponin
• CXR (sensitivity 59%):
• Bilateral patchy or reticular infiltrates, perihilar infiltrates occasionally
• CT scan (sensitivity 86%; much better than RT-PCR!)
• Bilateral diffuse ground glass opacities, multifocal patchy consolidation, interstitial changes
• Changes prior to severe symptom onset!
• ECHO:
• Normal EF prior to late-onset sudden cardiogenic shock with dropping to EF <10%
• Co-infection rare but possible (5%)