Clinical update on COVID-19 for the emergency clinician: Presentation and evaluation

Abstract

Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved.

Objective: This first in a two-part series on COVID-19 updates provides a focused overview of the presentation and evaluation of COVID-19 for emergency clinicians.

Discussion: COVID-19, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality worldwide. Several variants exist, including a variant of concern known as Delta (B.1.617.2 lineage) and the Omicron variant (B.1.1.529 lineage). The Delta variant is associated with higher infectivity and poor patient outcomes, and the Omicron variant has resulted in a significant increase in infections. While over 80% of patients experience mild symptoms, a significant proportion can be critically ill, including those who are older and those with comorbidities. Upper respiratory symptoms, fever, and changes in taste/smell remain the most common presenting symptoms. Extrapulmonary complications are numerous and may be severe, including the cardiovascular, neurologic, gastrointestinal, and dermatologic systems. Emergency department evaluation includes focused testing for COVID-19 and assessment of end-organ injury. Imaging may include chest radiography, computed tomography, or ultrasound. Several risk scores may assist in prognostication, including the 4C (Coronavirus Clinical Characterisation Consortium) score, quick COVID Severity Index (qCSI), NEWS2, and the PRIEST score, but these should only supplement and not replace clinical judgment.

Conclusion: This review provides a focused update of the presentation and evaluation of COVID-19 for emergency clinicians.

Keywords: COVID-19; Coronavirus-2019; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2.

Fig. 1

CDC Antigen Testing Algorithm [134,140]. 1a) Testing for Congregate Living Settings. 1b) Testing for Community Settings. From https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html#previous

Fig. 1

CDC Antigen Testing Algorithm [134,140]. 1a) Testing for Congregate Living Settings. 1b) Testing for Community Settings. From https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html#previous

Fig. 2

Chest x-ray with bilateral ground-glass opacities From: https://commons.wikimedia.org/wiki/File:COVID-19_Pneumonie_-_82m_Roe_Thorax_ap_-_001.jpg

Fig. 3

Chest CT with bilateral, multilobar areas of airspace consolidations leaving ground-glass opacities, with some subpleural parenchymal bands already emerging. From https://radiopaedia.org/cases/covid-19-pneumonia-158?lang=us

Fig. 4

Ultrasound demonstrating an irregular pleural line with a subpleural consolidation in a patient with COVID-19.