Dr. Prashant Ved (Emergency Medicine) needs a second opinion on this medical case.
Hello everyone, Here are some important facts about COVID-19. From Clinical presentations to treatment. Please check it out and feel free to add more points.
In a study describing 1099 patients with COVID-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were:
•Fever in 88%
•Fatigue in 38%
•Dry cough in 67%
•Myalgias in 14.9%
•Dyspnea in 18.7%
Pneumonia appears to be the most common and severe manifestation of infection. In this group of patients breathing difficulty developed after a median of five days of illness.
Acute respiratory distress syndrome developed in 3.4% of patients.
About 80% of confirmed COVID-19 cases suffer from only mild to moderate disease and nearly 13% have the severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours). Critical illness (respiratory failure septic shock, and/or multiple organ dysfunction/failure) is noted in only in less than 6% of cases.
The exact incubation period is not known. It is presumed to be between 2 to 14 days after exposure, with most cases occurring within 5 days after exposure.
THE SPECTRUM OF ILLNESS SEVERITY:
Most infections are self-limiting. COVID-19 tends to cause more severe illness in the elderly population or in patients with underlying medical problems. As per the report from the Chinese center for disease control and prevention that included approximately 44,500 confirmed Infections with an estimation of disease severity.
• Mild illness was reported in 81% of patients.
• Severe illness (Hypoxemia, >50% lung involvement on imaging within 24 to 48 hours) in 14%.
• Critical Disease (Respiratory failure, shock, multi-organ dysfunction syndrome) was reported in 5 percent.
• Overall case fatality rate was between 2.3 to 5%.
• Mostly middle-aged (>30 years) and elderly.
• Symptomatic infection in children appears to be uncommon, and when it occurs, it is usually mild.
**The 4th version of Belgian guidance for COVID 19 is published on19th March 2020. It is one of the most precise guidelines published yet.
Some points from that:
1. Chloroquine is found to have good efficacy in vitro and it reduces the duration of viral shedding. But the drug has a narrow therapeutic window and cardiac toxicity is the most limiting side effect.
2. Hydroxychloroquine is more potent and is superior to chloroquine according to the very recent Gautret’ study.
3. Azithromycin may have a viral suppressive effect, but this needs to be proved as it was noticed accidentally in 6 patients of Gautret’ study. But I think it is a good choice for coverage of bacterial pneumonia.
4. Lopinavir/Ritonavir recently shown not to provide clinical benefit in hospitalized patients with COVID-19. It may reduce ICU stay if given within 10 days of infection but not beyond.
5. Remdesivir is promising but the studies are ongoing. Also, availability is a key issue.
6. Corticosteroids are not recommended as a systemic adjunctive treatment.
7. Paracetamol is the first-line analgesic and antipyretic over NSAIDs which are used with caution.
8. No need to stop ACEIs/ARBs in non-hospitalized patients. CONSIDER changing ACEIs/ARBs to another equivalent antihypertensive in hospitalized patients.
9. Antiviral therapy is not indicated in all patients with suspected/confirmed COVID19.