A Collaborative Multidisciplinary Approach to the Management of Coronavirus Disease 2019 in the Hospital Setting

Abstract

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which presents an unprecedented challenge to medical providers worldwide. Although most SARS-CoV-2-infected individuals manifest with a self-limited mild disease that resolves with supportive care in the outpatient setting, patients with moderate to severe COVID-19 will require a multidisciplinary collaborative management approach for optimal care in the hospital setting. Laboratory and radiologic studies provide critical information on disease severity, management options, and overall prognosis. Medical management is mostly supportive with antipyretics, hydration, oxygen supplementation, and other measures as dictated by clinical need. Among its medical complications is a characteristic proinflammatory cytokine storm often associated with end-organ dysfunction, including respiratory failure, liver and renal insufficiency, cardiac injury, and coagulopathy. Specific recommendations for the management of these medical complications are discussed. Despite the issuance of emergency use authorization for remdesivir, there are still no proven effective antiviral and immunomodulatory therapies, and their use in COVID-19 management should be guided by clinical trial protocols or treatment registries. The medical care of patients with COVID-19 extends beyond their hospitalization. Postdischarge follow-up and monitoring should be performed, preferably using telemedicine, until the patients have fully recovered from their illness and are released from home quarantine protocols.

Figure 1

Overview of the hospital management of patients with coronavirus disease 2019 (COVID-19). ALT = alanine aminotransferase; AST = aspartate aminotransferase; CBC = complete blood cell; CRP = C-reactive protein; ECG = electrocardiography; ESR = erythrocyte sedimentation rate; GGO = ground-glass opacity; HRCT = high-resolution computed tomography; LDH = lactate dehydrogenase; LFT = liver function test; PCR = polymerase chain reaction; RSV = respiratory syncytial virus.

Figure 2

An elderly man with a history of congestive heart failure, atrial fibrillation, and hypertension presented to the emergency department for progressive dyspnea over 3 weeks. A, Portable chest radiography shows patchy peripheral opacities bilaterally. Chest computed tomographic angiogram was negative for pulmonary embolism or signs of heart failure but had typical findings commonly reported for coronavirus disease 2019. B and C, Axial and coronal computed tomographic images in lung windows show patchy bilateral ground-glass opacities with a peripheral and lower lung distribution.