Clinical Pathway for Early Diagnosis of COVID-19: Updates from Experience to Evidence-Based Practice

Abstract

The COVID-19 pandemic is a significant global event in the history of infectious diseases. The SARS-CoV-2 appears to have originated from bats but is now easily transmissible among humans, primarily through droplet or direct contact. Clinical features of COVID-19 include high fever, cough, and fatigue which may progress to ARDS. Respiratory failure can occur rapidly after this. The primary laboratory findings include lymphopenia and eosinopenia. Elevated D-dimer, procalcitonin, and CRP levels may correlate with disease severity. Imaging findings include ground-glass opacities and patchy consolidation on CT scan. Mortality is higher in patients with hypertension, cardiac disease, diabetes mellitus, cancer, and COPD. Elderly patients are more susceptible to severe disease and death, while children seem to have lower rates of infection and lower mortality. Diagnostic criteria and the identification of persons under investigation have evolved as more data has emerged. However, the approach to diagnosis is still very variable from region to region, country to country, and even among different hospitals in the same city. The importance of a clinical pathway to implement the most effective and relevant diagnostic strategy is of critical importance to establish the control of this virus that is responsible for more and more deaths each day.

Keywords: Acute respiratory distress syndrome; CDC; COVID-19; Clinical pathway; Coronavirus; Infection; Outbreak; Pandemic; Pneumonia; Quarantine; SARS-CoV-2; Transmission; Virus; WHO.

Fig. 1

Modes of transmission of SARS-CoV-2. The solid frames indicate confirmed modes of transmission whereas the dotted boxes have yet to be confirmed

Fig. 2

A clinical pathway for the diagnosis of COVID-19. An algorithm to guide clinical decisions in the diagnosis and treatment of COVID-19