Guidance for the Management of Adult Patients with Coronavirus Disease 2019 (COVID-19)
In December 2019, a novel coronavirus was identified in Wuhan, Hubei Province, China. On January 12, 2020, the World Health Organization (WHO) temporarily named the virus “2019 novel coronavirus (2019-nCoV).” By February 8, the National Health Commission of the People’s Republic of China named the associated pneumonia “novel coronavirus pneumonia (NCP).” On February 12, the Coronaviridae Study Group of the International Committee on Taxonomy of Viruses officially named the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),” and the WHO designated the disease as “coronavirus disease 2019 (COVID-19).” By March 11, 2020, the WHO declared COVID-19 a global pandemic. This article provides comprehensive guidance on the etiology, pathogenesis, epidemiology, clinical features, diagnosis, treatment, rehabilitation, and prevention of COVID-19.
Definition, Etiology, and Pathogenesis of COVID-19
COVID-19 is an acute respiratory infectious disease caused by SARS-CoV-2. The incubation period ranges from 1 to 14 days, with symptoms including fever, dry cough, and fatigue. While most cases are mild, severe cases can rapidly progress to acute respiratory distress syndrome (ARDS), septic shock, and multi-organ dysfunction. SARS-CoV-2 belongs to the beta-coronavirus genus, sharing approximately 79% homology with SARS-CoV and 52% with MERS-CoV. The virus uses angiotensin-converting enzyme II (ACE2) as its receptor, which is widely distributed in the lungs, heart, kidneys, and gastrointestinal tract.
The pathogenesis of severe COVID-19 involves three mechanisms: (1) direct viral infection causing organ damage, (2) immune response imbalance characterized by cytokine storms and lymphopenia, and (3) multi-organ injury and coagulopathy. Pathological changes in severe cases include diffuse alveolar damage, pulmonary consolidation, and fibrosis.
Epidemiology of COVID-19
The primary source of infection is COVID-19 patients, including asymptomatic carriers. Transmission occurs mainly through respiratory droplets and close contact, with potential aerosol transmission in enclosed environments. Fecal-oral transmission is also possible. The global population is susceptible, with higher risks for the elderly and those with comorbidities like chronic obstructive pulmonary disease, diabetes, and hypertension.
Clinical Features of COVID-19
The incubation period is typically 3 to 7 days, with symptoms including fever, fatigue, and dry cough. Severe cases may develop ARDS, septic shock, and multi-organ failure. Laboratory findings often show lymphopenia, elevated C-reactive protein, and increased D-dimer levels. Chest imaging reveals ground-glass opacities and pulmonary consolidation.
Diagnosis of COVID-19
Diagnosis is based on epidemiological history, clinical manifestations, and pathogen confirmation. Real-time fluorescence quantitative reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for detecting SARS-CoV-2 nucleic acid. Serological tests for IgM and IgG antibodies are supplementary. Diagnostic criteria include travel history, contact with infected individuals, and characteristic clinical and imaging findings.
Treatment of COVID-19
General Treatment
Patients should receive supportive care, including rest, hydration, and monitoring of vital signs. Oxygen therapy is essential for hypoxemia.
Antiviral Treatment
No specific antiviral drugs are approved for COVID-19. Remdesivir, lopinavir/ritonavir, and favipiravir are under investigation. Chloroquine and hydroxychloroquine have shown potential in vitro but require further clinical validation.
Antibacterial Treatment
Antibiotics should be used only for secondary bacterial infections. Antimicrobial stewardship is crucial to prevent resistance.
Immunomodulatory Therapy
Glucocorticoids are recommended for severe cases with excessive inflammation. Cytokine-targeted therapies, such as tocilizumab (an IL-6 receptor antagonist), are used for cytokine storms.
Convalescent Plasma Therapy
Plasma from recovered patients, containing neutralizing antibodies, may benefit severe cases but requires further study.
Respiratory Support
Oxygen therapy, high-flow nasal oxygen (HFNO), and non-invasive ventilation (NIV) are used for respiratory failure. Invasive mechanical ventilation is reserved for refractory cases. Low tidal volume ventilation and prone positioning are recommended for ARDS.
Extracorporeal Membrane Oxygenation (ECMO)
ECMO is considered for severe ARDS when conventional therapies fail. Early application may improve outcomes.
Blood Purification
For acute kidney injury (AKI), renal replacement therapy and other blood purification methods are used to remove toxins and inflammatory mediators.
Nutrition Support
Nutritional therapy is critical for recovery. Enteral nutrition is preferred, with supplemental parenteral nutrition if necessary. Protein intake should be increased to 1.5–2.0 g/kg/day.
Venous Thromboembolism (VTE) Prophylaxis
Low-molecular-weight heparin is recommended for VTE prevention in severe cases. Monitoring for bleeding and heparin-induced thrombocytopenia is essential.
Rehabilitation and Health Management
Respiratory rehabilitation is vital for recovery, especially for severe and critically ill patients. Psychological support and physical therapy are essential for improving quality of life. Health management includes monitoring for residual symptoms, oxygen therapy for hypoxemia, and follow-up for chronic conditions.
Prevention of COVID-19
Prevention focuses on controlling the source of infection, cutting transmission routes, and protecting susceptible populations. Hand hygiene, environmental disinfection, and proper use of personal protective equipment (PPE) are critical. Medical institutions should implement strict infection control measures, including pre-screening, isolation, and surveillance.
Integrated Chinese and Western Medical Treatment
Traditional Chinese medicine (TCM) plays a complementary role in COVID-19 treatment. TCM formulations are tailored to different disease stages and syndromes, emphasizing the balance of “wet, poison, cold, heat, stasis, and deficiency.”
Medical Treatment Systems and Social Mobilization
A coordinated response involving primary care, county hospitals, and specialized centers is essential. Grassroots medical institutions are crucial for early detection, isolation, and community management. County-level hospitals must strengthen their capacity to handle infectious disease outbreaks.
Fangcang Shelter Hospitals
Fangcang hospitals, temporary facilities in large public spaces, have been instrumental in isolating and treating mild to moderate cases, reducing the burden on formal healthcare facilities.
This comprehensive guidance aims to provide healthcare professionals with up-to-date information on managing COVID-19, from diagnosis to treatment and prevention, to improve patient outcomes and control the pandemic.
doi.org/10.1097/CM9.0000000000000899
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