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Potentially life-threatening emergency
COVID-19
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Potentially life-threatening emergency

COVID-19

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Contributors: Paritosh Prasad MD, Lowell A. Goldsmith MD, MPH, Eric Ingerowski MD, FAAP
Other Resources UpToDate PubMed

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 Diagnosis 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.

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.

Codes

ICD10CM:
B34.2 – Coronavirus infection, unspecified

SNOMEDCT:
186747009 – Coronavirus infection

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential diagnosis includes other etiologies of lower respiratory tract infection.

Viral infection:
Bacterial pneumonia, eg:
Atypical bacterial pneumonia, eg:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 03/05/2020
Last Updated: 03/16/2020
Copyright © 2020 VisualDx®. All rights reserved.
Potentially life-threatening emergency
COVID-19
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COVID-19 (Mild disease) : Cough, Fever, Dyspnea
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