Visualdx.com no longer supports your web browser (Internet Explorer version 9 or lower). See what browsers we support.

COVID-19

Pictures of COVID-19 and disease information have been excerpted from VisualDx clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.

How VisualDx Works Media Kit

VisualDx Blog: Coronavirus (COVID-19): What You Need to Know

Click here for the full clinical write-up and images in VisualDx

Updated March 12, 2020.

Synopsis

Clinicians should immediately implement recommended infection prevention and control practices if a patient is suspected of having COVID-19. Minimize the number of personnel that interact with a suspected or positive COVID-19 patient and record all personnel who have entered the room.

Notify infection control personnel at the healthcare facility and state or local health department if patient is classified as under investigation for COVID-19. See Diagnostic Pearls and Best Tests for information on evaluating and reporting suspected cases. Per the US Centers for Disease Control and Prevention (CDC):

  • Adhere to Standard, Contact, and Airborne Precautions, Including the use of Eye Protection (ie, gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection).
  • Isolate the patient under investigation for COVID-19 in an Airborne Infection Isolation Room (AIIR), if available.

On March 10, 2020, the CDC updated infection prevention and control recommendations, including PPE for the care of patients:

  • If there are shortages of respirators, they should be prioritized for aerosol-generating procedures. Facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand.
  • Patients presenting with symptoms of respiratory infection should wear a facemask. If patients cannot tolerate a facemask or one is not available, they should use tissues to cover their mouth and nose.
  • If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to hands and clothing.

Contrary to CDC Recommendations, the World Health Organization (WHO) does not recommend use of Airborne Precautions unless the patient is undergoing high-risk interventions for aerosolization (intubation, induced sputum, etc). Currently, all US providers should follow CDC recommendation.

The situation is rapidly changing. Refer to the CDC (Information for Healthcare Professionals) for the most current information.

About COVID-19

Coronavirus disease 2019 (COVID-19), previously known as 2019 novel coronavirus (2019-nCoV), is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus and the responsible agent for an outbreak of pneumonia cases in Wuhan City, Hubei Province, China, initially reported to the World Health Organization on December 31, 2019, and reportedly linked to a large seafood and animal market. Coronaviruses are a family of viruses, some of which cause infection in humans and others in animals such as camels, cats, and bats. When animal coronaviruses evolve, on rare occasion they can become infectious to and spread between humans as has occurred with Middle East respiratory syndrome (MERS) and SARS. This animal-to-human spread has been postulated to have occurred with SARS-CoV-2 with subsequent person-to-person transmission reported.

Person-to-person spread in the community is occurring in many countries, including the United States. High-risk countries include China, Iran, South Korea, and Italy. The virus is transmitted via infectious secretions (respiratory droplets, sputum, serum, or blood) between individuals in close contact (within about 6 feet). It is possible that, in addition, the virus can be transmitted by saliva, urine, and stool.

Clinical features and epidemiologic risks include fever and symptoms of lower respiratory tract illness (eg, cough, shortness of breath) as well as a history of travel to affected regions or close contact with someone with suspected COVID-19 illness. Reported cases have ranged from mild to severe; some cases have been fatal. A large study from China suggests that < 1% of cases are asymptomatic.

Travelers or those who may have been exposed should wash hands often; the CDC recommends washing with soap and water for at least 20 seconds, or using an alcohol-based hand sanitizer if soap and water are not available.

Look For

Limited information is available to define the spectrum of clinical illness attributed to COVID-19. The incubation period is estimated to be between 2 and 14 days after exposure, with an estimated median incubation period of about 5 days.

In an analysis of > 1000 patients admitted to the hospital with laboratory-confirmed COVID-19 infection in China, median age was 47 (range 35-58), and < 1% patients were younger than 15.

  • The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%).
  • Other symptoms included fatigue (38.1%), sputum production (33.7%), dyspnea (18.7%), myalgia or arthralgia (14.9%), sore throat (13.9%), and headache (13.6%).
  • Nausea, vomiting, and diarrhea were uncommon (5% or less).
  • Laboratory findings included lymphocytopenia (83.2%), thrombocytopenia (36.2%), and leukopenia (33.7%). Most patients had elevated C-reactive protein. Laboratory scores were worse in patients with severe illness.
  • On admission, chest CT image abnormalities were detected in 86.2% of patients. The most common abnormalities were ground-glass opacity (56.4%) and bilateral patchy shadowing (51.8%).

Some patients initially presented without fever and without abnormal radiologic findings. The median duration of hospitalization was 12 days (mean 12.8), and most patients (91.1%) received a diagnosis of pneumonia. Other complications included acute respiratory distress syndrome (ARDS) (3.4%) and shock (1.1%). Uncommon complications were acute kidney injury, acute cardiac injury, secondary infection, and rhabdomyolysis.

Imaging:

  • A review article highlighting the role of chest CT in early detection and management of COVID-19 reports that typical chest CT findings include multifocal bilateral ground glass opacities with patchy consolidations, peripheral subpleural distribution, and posterior part or lower lobe predilection. Less commonly, crazy-paving pattern or air bronchogram sign was observed. Pure consolidation, reversed halo sign, or pleural effusion was uncommonly detected.
  • Pure ground glass opacity lesions can be an early presentation of COVID-19 pneumonia. 
  • Chest CT is superior to chest x-ray in early detection of COVID-19 pneumonia.


covid_1.png

covid_2.png

Phan LT, Nguyen TV, Luong QC, et al. Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. N. Engl J Med. 2020 Jan 28. DOI: 10.1056/NEJMc2001272. Massachusetts Medical Society. Appears with permission from Massachusetts Medical Society.

covid_3.png

Zhu N, Zhang D, Wang W, et al; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Jan 24. DOI: 10.1056/NEJMoa2001017. Massachusetts Medical Society. Appears with permission from Massachusetts Medical Society.

covid_4.png

Zhu N, Zhang D, Wang W, etc al; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Jan 24. DOI: 10.1056/NEJMoa2001017. Massachusetts Medical Society. Appears with permission from Massachusetts Medical Society.

covid_5.png

Zhu N, Zhang D, Wang W, etc al; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Jan 24. DOI: 10.1056/NEJMoa2001017. Massachusetts Medical Society. Appears with permission from Massachusetts Medical Society.

Unlock Your Unlimited Access to VisualDx. Start your 30 day free trial. Cancel at any time.

VisualDx is trusted for diagnostic decision support in over 2,300 hospitals, large clinics, and medical schools across the globe.

Start your 30 day free trial