COVID-19 Case Studies: Diagnosis, Risk Factors, and Treatment

Case Study 1: The 54-Year-Old Male with Travel History

The patient in the first scenario presents with low-grade fever, cough, shortness of breath, and back pain. 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. Several of the symptoms he presents are consistent with COVID-19, whose core symptoms include difficulty breathing or shortness of breath, cough, and fever (Adhikari, 2020).

Another key consideration in the decision to test is the patient's travel history. The patient has recently traveled outside the United States and could therefore be classified as a person under investigation (PUI) — on the basis of the respiratory illness symptoms presented and the fact that he traveled to a country with 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, given that at present, COVID-19 has no recommended antiviral medication.

Comorbidities as Barriers to Treatment

There are specific barriers to diagnostic treatment and care in this scenario owing to the patient's comorbidities — namely hypertension and diabetes mellitus. Although the novel virus affects persons irrespective of 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 this 54-year-old is at increased risk of developing severe illness as a consequence of the virus. Treatment would be more difficult because the virus is harder to fight in the context of a compromised immune system. More specifically, with respect to diabetes, elevated blood glucose levels could provide an ideal environment for the virus to thrive.

Taking all of the above factors into consideration, the patient would be advised to maintain adequate fluid intake. The importance of keeping blood glucose levels stable would also be stressed. This could be achieved through adherence to the medication regimen for diabetes and maintaining an appropriate diet — including the consumption of foods with a low glycemic index. Additionally, as Schiffrin, Flack, Sadayoshi, Muntner, and Webb (2020) observe, numerous studies have clearly indicated that proper control of blood pressure is of great relevance in reducing disease burden.

Differential Diagnoses for Case Study 1

The differential diagnoses in the present scenario are rhinovirus infection and community-acquired pneumonia. These diagnoses are made on the basis of the presenting symptoms. Common symptoms of rhinovirus infection include malaise, nasal congestion, cough, sore throat, shortness of breath, and fever. Common symptoms of community-acquired pneumonia include fever and chills, heavy sputum production, coughing, and shortness of breath. Several of the symptoms exhibited by this 54-year-old patient closely mimic those of both rhinovirus infection and community-acquired pneumonia.

Case Study 2: The 68-Year-Old Female

In the second scenario, the patient is a 68-year-old female with no other comorbidities. She presents with slight confusion, shortness of breath (SOB), and cough. It should also be noted that the patient denies having traveled outside the United States over the last six months. On the basis of these facts, her chances of having COVID-19 are comparatively lower, given the absence of recent international travel. Travel to countries with high infection rates increases one's risk of contracting the novel virus (Pung et al., 2020). Nevertheless, on the basis of her presenting symptoms, it would be prudent to take the necessary precautionary measures for her safety and that of those around her.

The first step in this case would be to notify both the local health department and the institution's infection control personnel of this suspected COVID-19 case. The 68-year-old patient is at an especially elevated risk of becoming severely ill due to her age. As WHO (2020) notes, in addition to pre-existing medical conditions, advanced age also appears to be a key contributing factor to severe illness following acquisition of the novel virus. Research has further indicated fewer infections and fatalities among children (Wei, Yuan, and Liu, 2020). To a large extent, the immune system weakens with advancing age, meaning that infections can more readily compromise general health and wellbeing. It would therefore be prudent to ensure that the patient is tested by having a nasal sample taken and dispatched to the laboratory. If COVID-19 results were to come back positive, treatment would commence and would be focused on the alleviation of symptoms. The patient may need to be treated in a hospital setting due to the risk of developing more severe symptoms.