Managing the pandemic from the radiology department's point of view

Abstract

The COVID-19 pandemic is forcing our entire society to adopt numerous changes, at least until an effective treatment and/or vaccine becomes widely available. Because COVID-19 is a new disease that has required us to make complex decisions based on scant evidence, the pandemic is having an enormous impact on our health system. Radiology departments play a fundamental role in the management of COVID-19, both in the diagnosis of the disease and in the posterior management of patients. To ensure the safety of patients and healthcare professionals, it is essential to understand the infection so that safe circuits can be implemented. This article summarizes the pathophysiology of COVID-19 infection and explains the measures that radiology departments need to adopt during the pandemic.

Keywords: Coronavirus infection; Gestión; Infección por coronavirus; Patient safety; Practice management; Seguridad del paciente.

Figure 1

General pathophysiology of the Covid-19 infection. The SARS-CoV-2 virus binds to the ACE2 receptor which is located on the surface of certain cells. Once bound to the membrane, it enters the cell and replicates, while also blocking the receptor. The phenomena produced by the virus can be divided into three major groups: those caused by inflammatory response and the immune system, those due to alteration of the angiotensin II system through receptor blockade, and those that are secondary to the coagulopathy and thrombotic phenomena produced by the virus.

Figure 2

General pathophysiology of Covid-19 infection. The chart summarises the different phenomena occurring in the tissues once the infection has been triggered. The mechanisms of infection are complex and are not fully understood. The effects on tissues are the result of the direct action of the virus and the host's response, both the indirect inflammation and immune response. The so-called "dysfunctional response" determines what is known as the "cytokine storm”, and this abnormal response is one of the main causes of severe pathology in cases with a poor clinical evolution. This effect is compounded by the action of thromboembolic alterations (virus induces an abnormal thrombotic response) and the effects produced by the alteration of the angiotensin 2 metabolic circuit.

Figure 3

Basic diagram of the published theories about the pathophysiology of Covid-19 infection in different organs. In all of them, the main agent is the ACE2 receptor, which allows the virus to bind to the cell. However, the phenomena related to immune response and coagulopathy sometimes play a more important role.

Figure 4

The main measures that should be taken in a radiology department to guarantee a safe working environment.