COVID19

About 

This node in space is created by me: I am a M.D. working in the emergency clinic at a hospital in Stockholm, Sweden. It’s intended as a hub for all things of substance relating to the virus SARS-CoV-2 and the current COVID-19 pandemic. The aim of this node is to find the signal amid the noise.

The virus & Terminology 

The virus has been designated Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2). It’s a betacoronavirus in the same subgenus as Severe Acute Respiratory Syndrome (SARS). So far the other betacoronavirus called Middle East Respiratory Syndrome (MERS) seems to be more distantly related. SARS-CoV-2 causes the COronaVIrus Disease that broke out 2019 (COVID-19).

Clinical Features 

The incubation period for COVID-19 is in most causes approximately 4-5 days after exposure, but can be up to 14 days. The severity of the illness ranges from mild to critical, with most infections not leading to severe illness. One study * including 44,500 confirmed infections from the Chineses Center for Disease Control and Prevention reported:

  • 2,3 % fatality rate
  • 5 % critical disease (eg, with  respiratory failure, shock, or multiorgan dysfunction)
  • 14 % severe disease (eg, with dyspnea, hypoxia, or >50 percent lung involvement on imaging within 24 to 48 hours)
  • 81 % mild (no or mild pneumonia) *

With most of the fatal cases occurring in patients with advanced age and/or underlying medical comorbidities (eg, hypertension, cancer, diabetes mellitus, and cardiovascular disease). The most common symptoms of COVID-19 are fever, fatigue, dry cough, anorexia, myalgias, dyspnea, and sputum production. Less common symptoms include headache, sore throat, rhinorrhea and gastrointestinal symptoms such as nausea and diarrhea. The most frequent serious manifestation of the infection is pneumonia, characterized primarily by fever, cough, dyspnea, and bilateral infiltrates on chest imaging. In the severe cases COVID-19 can lead to Acute Respiratory Disease Syndrome (ARDS) requiring intubation and intensive care, putting a huge strain on the limited resources of each nations intensive care capacity.

Laboratory testing [In Sweden]

SARS-CoV-2 testing in Sweden is, for the time being, done by collection of a nasopharyngeal swab specimen. The detection is done by reverse-transcription polymerase chain reaction (RT-PCR). While most PCR-testing techniques are thought to have a high degree of sensitivity and specificity, there is a possibility of false-negatives when testing.

Clinical Management & Treatment 

While no treatment is yet approved for COVID-19, and in general people are advised to wait it out at home (self quarantine), for more severe cases the in-hospital treatment is mostly symptomatic (help with rehydration & intravenous fluids, respiration & oxygenation, infection control & antibiotics when suspicion of bacterial co-infection, etc). Other treatments discussed and currently explored by the community include glucocorticoids (current recommendation of WHO * & CDC * is that glucocorticoids should NOT be used when treating COVID-19 patients unless other indications require it) and NSAID (no official recommendation against it).

Also, as we are waiting for a vaccine to be developed, a number of investigational agents are being tested and reviewed as antiviral treatment for COVID-19 such as Remdesivir, Chloroquine/hydroxycholorquine, Tocilizumab, and Lopinavir-ritonavir. None of the substances mentioned are (yet?) approved for the routine treatment of COVID-19 patients in Sweden.

Further Reading

  1. Daily updates – I will write a short post every day with the latest numbers, including some personal reflections on the COVID-19 pandemic, [Starting Wednesday 25th of Mars 2020] 
  2. A-Z Resources COVID-19 – Unassorted links & resources to everything I find useful or interesting
  3. A-Z Studies COVID-19 – Unassorted, peer-reviewed, studies published in medical journals  

Feedback

profctsop

Disclaimer: I’m a clinical M.D. working in a emergency clinic, not a virologist nor a epidemiologist — or any kind of expert on COVID-19 for that matter. Even though I try to fact-check and discern the signal (what’s evidence-based and useful) from the noise (unsupported opinions and incorrect facts) there’s always the risk of making a mistake or getting something wrong. All (respectful) feedback is welcomed, especially if I get something wrong. This node in space is for learning, staying up to date, and evaluating how well we respond and adapt to this historical pandemic.