Journal Article: https://jamanetwork.com/journals/jama/fullarticle/2768391

 

This JAMA review published just the other week (7/10/2020) discusses the pathophysiology, transmission, diagnosis and treatment of COVID-19. As we already know, this pandemic has caused a surge in hospitalizations with its first appearance being back in December 2019 in Wuhan China. As of July 1st, this virus has affected more than 200 countries, there have been over 10 million cases worldwide, and 508,000 confirmed deaths. A lot of beneficial information has been obtained over the past few months regarding COVID-19, however many aspects still remain unclear and further investigation and interventions are certainly warranted.

 

 

PATHO: SARS-COV-2 is the third coronavirus to cause severe disease in humans globally in the past 2 decades (first= SARS). It is an RNA virus that got its nickname from its virons having the appearance of a solar corona. Characteristic features of COVID-19 include endothelial barrier disruption, dysfunctional alveolar-capillary oxygen transmission, and impaired oxygen diffusion capacity.

 

TRANSMISSION: This virus spreads primarily by respiratory droplets during face to face contact (i.e. talking, coughing, sneezing). To a lesser degree, the virus can also be spread via contaminated surfaces. Unfortunately the infection can be spread by a person who is asymptomatic or even pre-symptomatic, not just those who are already symptomatic.

 

PRESENTATION: The most common symptoms are fever, dry cough, and/or shortness of breath. Others include fatigue, myalgia, nausea/vomiting, diarrhea, headache, weakness or rhinorrhea. Interestingly, only about 3% of individuals with COVID-19 present with the sole complaint of either anosmia or ageusia (loss of smell/taste respectively).

 

DIAGNOSIS: The diagnosis is typically made by polymerase chain reaction testing of a nasopharyngeal swab. It should be noted that there remains the possibility of false-negative test results, and therefore laboratory/imaging (i.e. elevated ESR/CRP, D-dimer, lower lobe infiltrates on chest x-ray, ground glass opacities on CT) can be used to make the diagnosis for those with a high index of suspicion. Regarding the serologic test for antibodies, it remains unclear how long that protection lasts or if it is still susceptible to a subsequent infection

 

TREATMENT: Supportive care including supplemental oxygen is the mainstay of treatment for most patients. There have been recent trials indicating the use of dexamethasone to decrease mortality and the use of remdesivir to improve overall time to recovery. Deciding if/when to intubate remains a controversial topic, and there are ongoing trials that are testing other antiviral therapies, immune modulators, and anticoagulants.

 

PROGNOSIS: Age is a big factor as seen in differences of case-fatality rate between patients aged 5-17 years vs. patients aged 85 years and older. In the ICU in particular, the case fatality rate is up to about 40%

 

PREVENTION: There is no current vaccine available for COVID-19 but fortunately there are nearly 120 currently under development. In the meantime, the use of face masks along with social distancing are recommended to prevent the virus’ spread.