COVID-19 Disease Recommendations

COVID-19 Disease Recommendations


  • In late 2019, a novel coronavirus, now designated SARS-CoV-2, was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China. In February 2020, the World Health Organization (WHO) designated the disease COVID-19, which stands for coronavirus disease 2019. (See 'Introduction' above.)
  • Since the first reports of COVID-19, infection has spread to include more than 700,000 confirmed cases worldwide, prompting the WHO to declare a public health emergency in late January 2020 and characterize it as a pandemic in March 2020. (See 'Epidemiology' above.)
  • The possibility of COVID-19 should be considered primarily in patients with fever and/or respiratory tract symptoms who reside in or have traveled to areas with community transmission or who have had recent close contact with a confirmed or suspected case of COVID-19. Clinicians should also be aware of the possibility of COVID-19 in patients with severe respiratory illness when no other etiology can be identified. Limitations in testing capacity may preclude testing all patients with suspected infection; suggested priorities include hospitalized patients, symptomatic health care workers, and symptomatic individuals who have risk factors for severe disease (table 1). (See 'Clinical features' above and 'Evaluation and diagnosis' above.)
  • In addition to testing for other respiratory pathogens, a nasopharyngeal swab specimen should be collected for reverse-transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2. (See 'Evaluation and diagnosis' above.)
  • Upon suspicion of COVID-19, infection control measures should be implemented and public health officials notified. In health care settings in the United States, the Centers for Disease Control and Prevention (CDC) recommends a single-occupancy room for patients and gown, gloves, eye protection, and a respirator (or facemask as an alternative) for health care personnel (figure 1 and figure 2). (See 'Infection control for suspected or confirmed cases' above.)
  • Management consists of supportive care, although investigational approaches are being evaluated. Home management may be possible for patients with mild illness who can be adequately isolated in the outpatient setting. (See 'Management' above.)
  • To reduce the risk of transmission in the community, individuals should be advised to wash hands diligently, practice respiratory hygiene (eg, cover their cough), and avoid crowds and close contact with ill individuals, if possible. Facemasks are not routinely recommended for asymptomatic individuals to prevent exposure in the community. Social distancing is advised, particularly in locations that have community transmission. (See 'Preventing exposure in the community' above.)
  • Interim guidance has been issued by the WHO and by the CDC. These are updated on an ongoing basis. (See 'Society guideline links' above.)

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