COVID 19 Evaluation and Assessment

Keywords:  corona virus, coronavirus, covid, covid-19
The patient in the present scenario presents with low grade fever, cough, shortness of breath, as well as back ache. It is also important to note that the patient suffers from gastroesophageal reflux disease, hypertension, and diabetes mellitus. The patient is a 54-year-old male. Some of the symptoms that the patient presents are consistent with COVID-19 symptoms. The main COVID-19 symptoms are inclusive of difficulty breathing/shortness of breath, cough, and fever (Adhikari, 2020). Yet another key consideration in making a decision to test is the patient’s travel history. The patient in the present scenario has recently traveled out of the U.S. He could, thus, be categories as a person under investigation (PUI), i.e. on the basis of the respiratory illness symptoms presented and based on the fact that he had traveled to a country having local transmission. Testing in this case would be consistent with CDC guidance for COVID-19 with reference to the Recommendations for Reporting, Testing, and Specimen Collection. Towards this end, it is important to note that “for initial diagnostic testing for COVID-19, CDC recommends collecting and testing upper respiratory tract specimens (nasopharyngeal swab)” (CDC, 2020). If the lab results come back positive for the novel virus, the treatment plan would be focused on the alleviation of the symptoms being experienced by the patient. This is more so the case given that at present, COVID-19 has no recommended antiviral medication.
There are specific barriers to diagnostic treatment and care in the present scenario owing to the patient’s other comorbidities, i.e. hypertension and diabetes mellitus. It should be noted that although the novel virus affects persons irrespective of their age, the World Health Organization – WHO (2020) points out that “people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus”. It therefore follows that the 54-year-old is at increased risk of developing severe illness as a consequence of the virus. Treatment would in this case would be rather difficult because the virus is harder to fight as a consequence of the compromised immune system. More specifically, in as far as diabetes is concerned, the elevated blood glucose could provide an ideal environment for the virus to thrive in. Taking into consideration all the factors highlighted above, the patient would be advised to take a lot of fluids. The need to ensure that blood glucose levels are kept stable would also be stressed. This could be achieved via adherence to the medication regimen for diabetes and sticking to the right diet (i.e. the consumption of foods whose glycemic index is low, etc.). It should also be noted that as Schiffrin, Flack, Sadayoshi, Muntner, and Webb (2020) observe, there are numerous studies in the past that have clearly indicated that in seeking to reduce disease burden, proper control of blood pressure is of great relevance.
The differential diagnosis in the present scenario would be rhinovirus infection and community-acquired pneumonia. The differential diagnosis is this case is made on the basis of the presenting symptoms. Some of the more common symptoms of rhinovirus infection include, but they are not limited to, malaise, congestion, cough, sore throat, shortness of breath, and fever. On the other hand, some of the presenting symptoms of community-acquired pneumonia are; fever and chills, heavy sputum, coughing, and shortness of breath. Thus, some of the symptoms exhibited by the 54-year-old mimic those of rhinovirus infection and community-acquired pneumonia.
Case Study 2
In the next scenario, we have a 68-year old female who has no other comorbidities. She presents the following symptoms: slight confusion, SOB, and cough. It should also be noted that the patient denies having travelled outside the United States over the last 6 months. On the basis of these facts, the patient’s chances of having COVID-19 are rather low given that she may not have travelled outside the U.S. in the recent past. Travel to countries with high infection rates increases one’s risk of contacting the novel virus (Pung et al., 2020). However, on the basis of the presenting symptoms, it would be prudent to take the necessary measures for her sake and that of those around her.
The first thing to do in this case would be to notify both the local health department and my institution’s infection control personnel of this suspected COVID-19 case. The 68-year old is at an especially increased risk of becoming severely ill with the disease as a consequence of her age. This is more so the case given that as WHO (2020) points out, in addition to pre-existing medical conditions, old age also appears to be a key contributing factor to severe illness following the acquisition of the novel virus. Indeed, research has indicated that fewer infections as well as fatalities in children (Wei, Yuan, and Liu, 2020). To a large extent, a person’s immune system weakens with advancement in age – effectively meaning that infections could wreak havoc to general health and wellbeing. Thus, it would be prudent to ensure that the 68-year old is tested by having her nasal sample taken and dispatched to the lab for testing. If positive results for COVID-19 were to be returned, treatment would commence and would be focused on the alleviation of symptoms. The patient may need to be treated in the hospital due to the risk of developing more severe symptoms. The two differential diagnosis for the scenario resented would be respiratory syncytial virus and influenza. Some of the shared symptoms of the two diseases in this case are: cough, fever, runny/stuffy nose, sore throat and shortness of breath. The 68-year old female presents with some of the said symptoms.
References
Adhikari, S.P., Meng, S., Wi, Y., Mao, Y., Ye., R., Wang, Q. …Zhou, H. (2020). Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infectious Diseases of Poverty, 9(29) 78-83.
CDC (2020). Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html
Pung, R., Chiew, C.J., Young, B.E., Chin, S., Chen, M., Clapham, H.E. …Lee, V.J. (2020). Investigation of three clusters of COVID-19 in Singapore: implications for surveillance and response measures. The Lancet, 395(10229), P1039-1046.
Schiffrin, E.L., Flack, J.M., Sadayoshi, I., Muntner, P. & Webb, R.C. (2020). Hypertension and COVID-19. American Journal of Hypertension, 057.
World Health Organization – WHO (2020). Coronavirus disease (COVID-19) advice for the public: Myth busters. Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
Wei, M., Yuan, J. & Liu, Y. (2020). Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA, 323(13), 1213-1314.