COVID-19 – Clinical Management

COVID-19 – Airway and Ventilation

SJRHEM COVID-19 CLINICAL RESOURCES

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COVID-19 CLINICAL RESEARCH


Presenting Symptoms in early COVID-19 may include non-respiratory illness

Dr. Robon Clouston

March 19 2020

 

COVID-19 presents approximately 2 to 9 days after exposure, with a median of 5 days. Under conservative estimates, 99% of patients will develop symptoms within 14 days.1

The classic presenting symptoms of COVID-19 are2:

  • Fever
  • Dry cough
  • Dyspnea/SOB

However, not every patient will exhibit these classic signs. Symptoms which should raise index of suspicion for COVID-19 include3,4:

  • Fever seen in approx. 75% of hospitalized cases at some point but 50% are afebrile at time of admission
  • Cough 60 – 80% (dry or productive)
  • Dyspnea/SOB 20 – 40%
  • Myalgias or fatigue 44%
  • URTI symptoms <15% (headache, sore throat, rhinorrhea)
  • GI symptoms 3 – 10% (diarrhea, nausea, vomiting)
  • Hemoptysis 5%
  • Emerging reports of anosmia (no reference available)

COVID-19 tends to have a gradual onset, in contrast to influenza which typically has a rapid onset 4:

  • Median duration from illness onset to dyspnea: 8 days
  • Median duration from symptom onset to hospitalization: 7 days
  • Median duration from symptom onset to ARDS: 9 days
  • Median duration from symptom onset to mechanical ventilation: 10.5 days

From Martha Blum, MD, PhD attendance at Infectious Disease Association of California Winter Symposium on March 7 2020, recounting experience in Santa Clara, San Francisco and Orange County3:

“The most common presentation was one week prodrome of myalgias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.” 

 

References

  1. Lauer, SA et al. (March 10 2020). The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med.  DOI: 10.7326/M20-0504

Retrieved from: https://annals-org.qe2a-proxy.mun.ca/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported

  1. CDC Coronavirus Disease 2019. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
  2. Coronavirus Tech Handbook Resources for Doctors. UCSF COVID-19 Clinical Working Group. March 4 2020. https://www.digital.health/covid-clinical
  3. Prof Chaolin Huang et al. (Feb 2020). Clinical Features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. Vol. 395. Issue 10223. 15-21. 497-506.

Retrieved from: https://www-sciencedirect-com.qe2a-proxy.mun.ca/science/article/pii/S0140673620301835?via%3Dihub

 


SARS COVID-19 Clinical Management – SJRHEM Resource

Dr. Cherie Adams

 

SJRHEM SARS COVID-19 CLINICAL TREATMENT ALGORITHM

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SJRHEM SARS COVID-19 CLINICAL TREATMENT SOP

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SJRHEM SARS COVID-19 Obstetrical Patient Care Algorithm

Dr. Robin Clouston and Dr. Cherie Adams

Download (PDF, 233KB)

COVID-19 and Pregancy

 

 


SJRHEM SARS COVID-19 – DISCHARGE ADVICE

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Horizon Infectious Diseases Guideline

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Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected – WHO – 13 March