Management Considerations for the COVID-19 Patient with Severe Disease: a Case Scenario and Literature Review
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RESPONSE TO COVID-19/COMMENTARY
Management Considerations for the COVID-19 Patient with Severe Disease: a Case Scenario and Literature Review Meghan A. Kirksey, MD, PhD
& Elaine
I. Yang, MD & Mausam Kuvadia, MD & Andy O. Miller, MD
Received: 2 June 2020/Accepted: 3 August 2020/ * Hospital for Special Surgery 2020
Keywords
COVID-19 . coronavirus . critical care
Introduction COVID-19, the disease caused by the novel coronavirus, SARS-CoV-2, has triggered an ongoing global pandemic the likes of which have not been seen in over 100 years. This virus has proven to be remarkable for its ability to spread quickly through the human population with a broad range of manifestations, from asymptomatic infection to flu-like symptoms, multi-organ failure, and death. The mortality rate of COVID-19 is high compared with illnesses such as the seasonal flu in part because of unpredictable effects on nearly every organ system. Physicians and scientists struggle to understand the pathophysiology of SARS-CoV-2 and determine what treatments might improve outcomes while battling the disease in real time. In this commentary, we use the framework of a fictional patient to explore common concerns related to patients who require hospitalization for COVID-19, particularly the 20% or so who become critically ill and require transfer to an intensive care unit (ICU). We present evidence available as of July 2020. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09789-x) contains supplementary material, which is available to authorized users. M. A. Kirksey, MD, PhD (*) : E. I. Yang, MD : M. Kuvadia, MD Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA e-mail: [email protected] M. A. Kirksey, MD, PhD : E. I. Yang, MD Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA A. O. Miller, MD Department of Medicine, Infectious Diseases, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
Composite Case Mr. Z is a 55-year-old man with a past medical history of well-controlled type 2 diabetes, hypertension, and obesity (body mass index [BMI], 34) who presents to the emergency department complaining of 1 week of worsening exhaustion and body aches and several days of low-grade fever. On physical examination, he is found to be tachypneic, flushed, and confused. His vital signs are temperature, 38°C; blood pressure, 120/74 mmHg; heart rate, 115 beats per min; respiratory rate, 20 breaths per min; and oxygen saturation, 90% on room air. He is placed in an isolation room with 2-L oxygen via nasal cannula, and his oxygen saturation improves to 94%. He calls his family when his COVID-19 nasopharyngeal swab rapid test comes back positive, and he is told that he will be hospitalized for treatment. If antiviral treatments prove useful in managing COVID19, their utility will most likely be demonstrated in early stages of infection. While many potential antiviral ther
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