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



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covid-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%):
  • 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%)

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