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CHAPTER SUMMARY

All information in this chapter is current as of July 20, 2021. The COVID-19 pandemic is a rapidly evolving situation with frequently changing information. While this text should serve as a foundational reference, the National Institutes of Health (NIH) and Infectious Diseases Society of America (IDSA) COVID-19 Treatment Guidelines and the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination site should be referenced electronically for the most current treatment and prevention recommendations.

KEY CONCEPTS

KEY CONCEPTS

  1. Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, is associated with high morbidity and mortality particularly among patients 65 years of age and older, those with chronic comorbidities, and/or patients of select racial and ethnic backgrounds.

  2. The primary route of transmission of SARS-CoV-2 is direct person-to-person respiratory transmission via infected particles (i.e., droplets, aerosols). Risk of transmission is greatest for individuals in close contact for a significant period of time, especially while indoors. Transmission can occur from symptomatic, presymptomatic, or asymptomatic individuals.

  3. COVID-19 disease progression occurs in three phases of increasing severity: (i) early infection, (ii) pulmonary phase, and (iii) hyperinflammation. The majority of patients recover in the early infection phase; yet a small proportion may progress to the pulmonary (14%) and hyperinflammation (2-5%) phases.

  4. Signs and symptoms typically emerge 4 to 5 days from onset of infection but may occur sooner or take up to 14 days to manifest. Common symptoms include fever, cough, shortness of breath, loss of taste or smell, and fatigue. Oxygen saturation and patient location (hospitalized vs. non-hospitalized) are defining characteristics that determine eligibility for specific pharmacotherapy.

  5. Symptomatic COVID-19 is diagnosed by a positive nucleic acid amplification test (NAAT) for SARS-CoV-2 or an antigen test. Asymptomatic infection is a positive test in the absence of symptoms. Probable COVID-19 can be diagnosed by a compatible syndrome in either the absence of viral testing or a negative test. False negative tests are most common early in infection.

  6. Three vaccines are available in the United States under Emergency Use Authorization (EUA): two as a two-dose series using an mRNA technology platform (Pfizer, Moderna) and one as a one-dose injection using an adenovirus vector platform (Johnson & Johnson).

  7. All patients eligible should receive a vaccine as soon as possible to prevent COVID-19. There is no preferential recommendation between vaccines and choice should be primarily based on vaccine availability. Patient-specific preferences, including, but not limited to, the desire for a one versus two dose option and individual risk factors for rare adverse events, should be taken into consideration.

  8. Monoclonal antibodies (bamlanivimab and etesevimab, casirivimab and imdevimab, or sotrovimab) can decrease the need for hospitalization in outpatients with mild-moderate COVID-19 if administered within 7 days of symptom onset.

  9. Remdesivir is the only antiviral agent approved by the US Food and Drug Administration for treatment of COVID-19. It may shorten time to clinical recovery by up to 2 days in patients receiving supplemental oxygen.

  10. Dexamethasone is ...

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