Coronavirus Disease 2019
In November 2019 the first cases of a novel virus called ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2) were noted in Wuhan, China. Over the following months the virus spread throughout the world. When the virus infects someone then the disease is called Coronavirus Disease 2019, or COVID-19.
Transmission
Transmission is spread predominantly from person to person. An infected person can release virus in their respiratory droplets when they cough, sneeze or talk.
Transmission is also spread by contact with objects and surfaces. A person that touches the infected surface can infect themselves if they then touch their eyes, mouth or nose.
It is currently unknown how long someone with COVID-19 is infectious for.
Risk Factors
People that are elderly are vulnerable to severe illness.
People with underlying health conditions are also vulnerable to severe disease. Examples are people with heart diseases, respiratory conditions, kidney disease, diabetes or cancer.
Children and healthy young adults usually only have mild illness, and usually recover fully.
Pregnant women should be cautious as it is a new virus and much is unknown about it. However at the time of writing (May 2020) there is no evidence that pregnant women are more likely to get severe illness or for it to cause problems for the developing baby.
Signs and symptoms
Fever, shortness of breath and persistent cough are the most common symptoms.
Differential diagnosis –
COVID-19 can be hard to differentiate from other viral chest infections, such as influenza. It also needs to be differentiated from bacterial chest infections, such as pneumonia.
Investigations
Diagnosis is usually made from taking a history and physical examination.
Diagnosis is confirmed with a nasopharyngeal swab.
Pulse oximeter may show a decreased oxygen saturation.
Blood tests can he useful, especially Full Blood Count (FBC).
Chest x-ray may show some lung tissue changes.
A chest CT scan will identify lung changes more clearly, but this is usually not required as a routine investigation.
Treatment
Patients with mild symptoms are advised to rest at home. They should ensure adequate oral hydration, and can use analgesics, antipyretics and cough medications to ease symptoms. They should isolate themselves to reduce transmission to others, as per the local guidelines.
Patients with moderate to severe symptoms may require hospitalisation. Oxygen administration may be required, with regular monitoring of oxygen saturation levels.
The most critical cases may require intensive care and mechanical ventilation.
Medications that treat COVID-19 are in development. Remdesivir is an experimental anti-viral medication which could be effective. However, it is still in drug trials at the time of writing (May 2020). Hydroxychloroquine is another potentially effective medicine, which has been used for decades in the treatment of malaria, but at present is not licenced for COVID-19.
Pharmaceutical companies around the world are currently attempting to develop a vaccine, however vaccine development is usually a process that takes many years. Vaccine trials are underway at the time of writing.
Prevention
Personal protective equipment (PPE) is required when caring for a patient with suspected or confirmed COVID-19. This is to reduce the clinician’s exposure to the virus, as well as to prevent spread to other patients. PPE includes mask, gloves and gown. Eye protection such as goggles or face shield should also be used if the patient is coughing, or if procedures are performed that produce aerosols, such as intubation or suctioning.
Cleaning equipment between patients is essential. It is also important to clean surfaces and frequently touched objects (such as door handles, computers and phones).
Washing hands regularly and thoroughly is essential. It is also important to avoid touching the face (especially the eyes, nose and mouth).
Social distancing should be followed according to the local guidelines.
Antibody blood test
A blood test can be performed to detect antibodies. The body makes antibodies to fight infections. This test is therefore used to determine whether someone has had COVID-19 in the past. This is useful to know, as previous infection of COVID-19 may offer some degree of immunity to the virus if exposed to it again.
COVID-19 is a new virus, and we are still learning about how it spreads and how to investigate and treat it. Our knowledge shall increase as more research is published in the following months and years.