Describe the general approach.
Determine site of care based on disease severity and the presence of risk factors for severe COVID-19.
Asymptomatic or mild disease in low-risk patients: outpatient management
Moderate to severe disease, or risk factors for severe COVID-19: in-person evaluation; hospitalization if needed
List risk factos for severe COVID-19.
Age (strongest risk factor): older adults, especially ≥ 65 years of age
Cancer
Cardiovascular disease
Cerebrovascular disease
Chronic kidney disease
Chronic liver disease
Chronic lung diseases
Diabetes mellitus type I and type II
Mental health disorders
Obesity (BMI ≥ 30)
Pregnancy or recent pregnancy
Smoking (current and/or former)
Tuberculosis
Immunosuppression
Describe the supportive care and pharmocotherapy for outpatient management.
Supportive care
Antipyretics and analgesia
Antitussives
Prone positioning
Pharmacotherapy
patients with risk factors for progression to severe COVID-19
Preferred agents: ritonavir-boosted nirmatrelvir, remdesivir
Describe the general principles of management of hospitalized patients.
Patients with moderate to severe COVID-19 often require hospitalization.
Determine severity of illness and admit patients to the appropriate level of care.
Tailor additional diagnostics (laboratory studies, imaging) to the clinical presentation
For patients with complications related to COVID-19, see also the management sections in the following articles:
Sepsis
Pneumonia
Acute respiratory distress syndrome
Airway management
Mechanical ventilation
Venous thromboembolism
List routine laboratory studies needed.
CBC: may show lymphopenia, thrombocytopenia
Basic metabolic panel
Elevated serum creatinine in acute kidney injury
Possible electrolyte abnormalities
Liver chemistry: may show ↑ ALT, ↑ AST
List further studies for evaluation based on clinical presentation.
Inflammatory markers: ↑ CRP, ↑ ferritin, ↑ lactate dehydrogenase
Coagulation studies: ↑ prothrombin time, ↑ D-dimer
Cardiac enzymes: ↑ troponin and ↑ NT-proBNP may indicate cardiac injury related to COVID-19
Describe the indication and supportive findings of chest x-ray.
Indications: initial test to asses disease severity and rule out differential diagnoses
Supportive findings
Pulmonary consolidations
Unilateral or bilateral opacities
Progression to diffuse opacities suggests development of ARDS.
Describe the indication and supportive findings of chest ultrasound.
Indications: an alternative to chest x-ray to assess disease severity and rule out other chest pathologies (e.g., pneumothorax, pleural effusion) in critically ill patients; often performed in emergency department and ICU settings
Pleural thickening
B lines
Consolidations with air bronchograms
Describe the indication and supportive findings of chest CT.
Indications: specific clinical indications for a chest CT
Findings
Ground glass opacities with or without consolidation
Interlobular septal thickening
The combination of the above findings is often referred to as a “crazy-paving pattern.”
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