Snapshot A 68-year-old man presents to the emergency department with cough and shortness of breath. The patient reports going to an urgent care approximately 2 weeks ago for abdominal pain. He has a medical history of hypertension, hyperlipidemia, and severe asthma. His temperature is 101°F (38.3°C), blood pressure is 158/95 mmHg, pulse is 100/min, and respirations are 26/min with an oxygen saturation of 85% on 6L nasal cannula. The patient is subsequently intubated, and a CT of the chest demonstrates ground glass opacities, fine reticular opacities, and vascular thickening. A nasal swab is positive for SARS-CoV-2. Introduction Overview a betacoronavirus that is designated as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) a positive sense single-stranded RNA virus SARS-CoV-2 is in the same subgenus as severe acute respiratory syndrome corona virus (SARS-CoV) enters cells via the angiotensin-converting enzyme 2 receptors, especially on epithelium that line the respiratory tract TMPRSS2 primes spike protein on SARS-CoV-2 for entry the incubation period is thought to be 2-14 days post-exposure illness severity of this infection ranges from mild to critical mild (~81% of cases) login to view 1 more bullet severe (~14%) login to view 3 more bullets critical (~5%) login to view 3 more bullets Epidemiology incidence United States cases worldwide cases risk factors close contact with suspected or confirmed cases of COVID-19 residence or travel to areas with high incidence of COVID-19 Transmission person-to-person transmission thought to mainly occur via respiratory droplets login to view 2 more bullets can also be transmitted longer distances via airborne route login to view 1 more bullet fomite transmission touching an infected surface and subsequently touching one's eyes, nose, or mouth can result in infection login to view 1 more bullet fecal-oral transmission the SARS-CoV-2 RNA has been detected in stool, so fecal-oral transmission is possible Prognosis unfavorable factors older age (≥ 65 years of age) login to view 1 more bullet chronic medical conditions login to view 7 more bullets immunocompromising conditions login to view 1 more bullet certain laboratory derrangements login to view 8 more bullets Presentation Symptoms fever (~99% of cases) fatigue (~70%) dry cough (~60%) myalgias (~35%) dyspnea (~30%) sputum (~27%) anosmia (10-50%) patients may develop gastrointestinal symptoms nausea (~12%) diarrhea (~19%) Imaging Chest CT findings ground-glass opacification (GGO) login to view 2 more bullets Studies Reverse-transcription PCR (RT-PCR) for SARS-CoV-2 procedure collection of a nasopharyngeal swab login to view 1 more bullet sputum collection in patients with a productive cough Serum labs WBC count variable (leukopenia, leukocytosis, and lymphopenia) login to view 1 more bullet lactate dehydrogenase and ferritin level are commonly elevated IL-6 may be elevated Differential COVID-19 Differential Diagnosis Virus Fever Cough Fatigue Myalgia Headache Rhinitis Sore Throat COVID-19 ↑↑↑ ↑↑↑ ↑↑ ↑↑ Rare ↑ ↑ Influenza ↑↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑ ↑ Common cold Rare ↑↑↑ ↑ ↑ ↑↑ ↑↑↑ ↑↑↑ Treatment A registry of clinical trials can be found here lopinavir-ritonavir a combined protease inhibitor remdesivir a novel nucleotide analog that impairs RNA-dependent polymerases IL-6 pathway inhibitors tocilizumab siltuximab sarilumab Medical supportive care and quarantine indications login to view 1 more bullet hospitalization with potential oxygen supplementation or mechanical ventilation indications login to view 7 more bullets Prevention Hygiene and isolation should be in accordance with state and local health department recommendations and regulations Hand hygiene should be washed with water and soap or virucidal hand disinfectant avoid face touching Respiratory hygiene maintain 6 feet of distance from others masks (N95 respirators) and face shields or goggles for health care personnel or persons taking care of infected individuals in a health care facility or home Face coverings the CDC and WHO recommend wearing masks when in public spaces and when in the presence of individuals outside of one's household Social and physical distancing Avoidance of crowds and non-essential travel Screening for infection in high-risk settings (e.g. nursing facilities, college campuses, hospital employees) testing-based screening is advantageous compared to symptom-based screening in that it allows identification of asymptomatic infections Vaccines primary antigenic target: surface spike protein multiple vaccine candidates have shown efficacy without major adverse effects in early-phase human clinical trials two mRNA vaccines have over 95% vaccine efficacy in preventing symptomatic COVID-19 BNT162b2 (Pfizer-BioNTech) COVID-19 mRNA vaccine login to view 1 more bullet mRNA-1273 (Moderna) COVID-19 mRNA vaccine login to view 1 more bullet Complications Acute respiratory distress syndrome has been associated with older age (≥ 65 years of age) diabetes mellitus hypertension Pneumonia Septic shock Cardiac arrhythmia Cardiac injury Sources Note, this page is not meant to diagnose or treat patients but more as an evolving source of information For more information, please see the following sources Center for Disease Control National Institutes of Health World Health Organization