The COVID-19 Textbook


SECTION 5 • Medical Response

TABLE 15.1 Clinical spectrum of COVID-19 and staging by severity



Asymptomatic/presymptomatic infection

Positive SARS-CoV-2 test but no symptoms

Mild illness

Varied symptoms (eg, fever, cough, sore throat, taste/smell disturbance) but no shortness of breath or abnormal imaging SpO 2 ≥ 94% and lower respiratory disease (clinical or imaging findings) SpO 2 < 94%, PaO 2 /FiO 2 < 300, respiratory rate > 30/min, or lung infiltrates > 50%

Moderate illness

Severe illness

Critical illness

Respiratory failure, shock, and/or multiorgan dysfunction

COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. From Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA . 2020;323:1239-1242; Panel C-TG. Coronavirus 2019 (COVID-19) Treatment Guidelines . National Institutes of Health.

high-risk conditions should be closely monitored for signs and symptoms of progression, such as shortness of breath, hypoxemia, confusion, chest pain, or other unexplained symptoms, and if these conditions develop, additional expeditious evaluation is warranted. There is a correlation between increasing age and risk for severe COVID-19, and younger chil dren are at lower risk for most complications than older children and adults. Children, however, may develop complications such as multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection. As the pandemic progresses, the correlation between age and complications may change as individual and population immunity evolve and new viral variants emerge. The cor relation between age and risk for complications is different for other respiratory diseases like respira tory syncytial virus (RSV) or influenza in which, for example, neonates have a higher risk for severe complications than older children. People who have had a known exposure to COVID-19 or who have symptoms compatible with COVID-19 should be prioritized for SARS-CoV-2 testing and evaluated for possible treatment. Distinguishing COVID-19 from other acute respiratory and febrile illnesses is important as there are differences in specific therapies. Of note, patients can have concomitant or subsequently other viral or bacterial infections, which may require additional treatment. Depending on the risk for other infections, additional testing (eg, for influenza, RSV, and other circulating respiratory viruses, or for bacterial or fungal pneumonia) should be performed if the findings will change clinical management. Management of Acute COVID-19 Development and evaluation of new therapeutic strategies for acute COVID-19 are ongoing. The goals of treatment in the initial stages of COVID-19 are to reduce symptoms, hasten clinical recov ery, and prevent complications, including progression to severe COVID-19 and postacute sequelae of SARS-CoV-2 infection (PASC). There is a continuing need for more efficacious medications against COVID-19. Moreover, host and viral determinants are in flux and may necessitate adjust ments of therapeutic strategies in the future. For example, the immune status of individuals and the population at large continues to change because of prior infection with SARS-CoV-2 and vaccina tion. In addition, SARS-CoV-2 continues to evolve with emergence of variants with pronounced dif ferences in transmissibility, immune evasion, and, possibly, virulence. As individual and population immunity changes and as new viral variants develop, therapeutic strategies will continue to evolve to meet the goals of hastening recovery and preventing complications. Supportive Care Supportive care focuses on reducing symptoms and generally includes the use of antipyretic and anal gesic medications, for example, nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, and antitussives to control cough, as well as rest and adequate hydration. Although there was initial

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