Infectious Diseases I

The incubation period for SARS-CoV-2 is estimated to be up to 14 days from exposure. Information on

onset and duration of viral shedding and infectious potential is still emerging and suggests variable time

intervals of 2–18 days from symptom onset. Individuals with symptoms likely have a higher potential

for transmitting the virus.

Several vaccines against SARS-CoV-2 are available and should be considered per CDC recommended

schedules.

Primary COVID-19 symptoms in hospitalized patients include fever (80%), dry cough (75%), shortness

of breath (70%), fatigue (40%), myalgias (35%), and gastrointestinal symptoms (30%). The most common

reason for hospitalization is shortness of breath or hypoxemia.

Lymphopenia (related to T-cell lysis from direct infection by SARS-CoV-2)

Elevated inflammatory markers (e.g., C-reactive protein, erythrocyte sedimentation rate, ferritin,

interleukin [IL]-6, tumor necrosis factor alpha). May resemble cytokine release syndrome

Coagulation abnormalities (e.g., prolonged prothrombin time, thrombocytopenia, elevated D-dimer,

hypofibrinogenemia)

Radiographic abnormalities can vary, but patients with severe disease commonly present with bilateral,

lower lobe–predominant infiltrates on chest radiography. Chest CT can reveal bilateral, ground-glass

opacities with or without consolidation, usually depending on the time course of presentation.

The CDC recommends that nasopharynx samples be used to detect SARS-CoV-2 in patients presenting

with COVID-19 symptoms. Lower respiratory tract samples (e.g., endotracheal aspirate, BAL) have a

higher diagnostic yield, but concerns with aerosolization and lack of tolerability in those with severe

hypoxemia may limit their usefulness.

COVID-19 diagnosis is confirmed using RT-PCR.

Management priorities for critically ill patients with COVID-19 include supportive care of hypoxemic

respiratory failure and septic shock; immunomodulation of the inflammatory coagulation response, in-

cluding consideration for anticoagulation; and primary antiviral therapy.

the IDSA Guidelines on the Treatment and Management of Patients with COVID-19 (www.idsociety.

org/practice-guideline/covid-19-guideline-treatment-and-management/) and the Surviving Sepsis Cam-

and now defer recommendations to physician specialty groups.

Hypoxemic respiratory failure

Supplemental oxygen to maintain SaO2 above 92%–96%; high-flow nasal cannula preferred to

noninvasive positive pressure ventilation

ii.

For patients who require MV: ARDSNet lung-protective strategy

blockade

iii.

Extracorporeal membrane oxygenation (ECMO): Venovenous ECMO in patients with refrac-

tory hypoxemia despite optimizing ventilation, rescue therapies, and proning

Septic shock

Goal blood pressure: MAP of 60–65 mmHg