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COVID-19 | Spoon-Feed Version

March 16, 2020

Updated December 30, 2020

Written by Clay Smith

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This post compiles the most authoritative answers to your questions about COVID-19 all in one place.

Why does this matter?

COVID-19 is considered a global pandemic. In the U.S. alone, there are 330 million people. Estimates are that 60-70% of the population will become infected. That’s between 160 million and 214 million infected in the U.S., of which an estimated 200,000 to 1.7 million may die. The U.S. has only 924,000 staffed beds. These numbers assume no mitigation strategies and may be better than expected. This is a very important topic.

COVID-19 – Authoritative Answers In One Place

We have previously written about COVID-19 in a broad overview and a deep dive on the clinical presentation. This post is a quick way to find the most reliable sources of information to answer your clinical questions about COVID-19. If you see something that should be added, please help me and leave a comment or use the website’s contact form to let me know.

Basic Science

Where can I learn about the coronavirus, SARS-CoV-2, that causes the disease COVID-19?


What is the incubation period?

When do we expect the disease to peak? How can we predict resource utilization?

How is COVID-19 spread?

If I am infected, can I get infected again?

What is the case (or infection) fatality rate for COVID-19?

  • The CDC has several scenarios here.

  • An Icelandic study with extensive sampling and seroprevalance data suggests the infection fatality rate was 0.3% in this homogeneous population.

  • It depends on the age of the patient. There was 0% mortality in children 0-9 years and 14.8% mortality over age 80. It was a little worse than seasonal influenza in those aged 10 – 39 years, with case fatality rate of 0.2%. But case fatality steadily rose with age over ≥40.

  • Case fatality among healthcare providers in China was 0.3%.

  • This came from the China CDC, which loads very slowly. Here is a PDF version you can rapidly download. Citation credit: The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020[J]. China CDC Weekly, 2020, 2(8): 113-122.

Are children equally impacted by COVID-19?

How do I protect myself as a healthcare provider?

  • See this guidance from the CDC. Wear a surgical mask, gown (if possible), eye protection, and gloves.

  • If intubating or doing a procedure that creates aerosols, an N-95 mask is recommended.

  • Here is one recommended way to set up a healthcare facility to minimize transmission recommended by the IDSA, modeled on the response to SARS.

What are general ways to protect myself and my family?

  • The basics make a big difference (CDC).

  • Keys: Social distance (6 feet); wear a mask; handwashing (or hand sanitizer with 60% alcohol); don’t touch eyes, nose, or mouth; avoid close contact with sick people (obviously meant for a non-healthcare audience); stay home if sick; cover coughs and sneezes; disinfect high-touch surfaces like counters, doorknobs, etc.

Who is at higher risk from infection with COVID-19?

How widespread is the disease, COVID-19?

What are the best sites to keep informed about this emerging pandemic?

Clinical Pearls

What is the clinical presentation?

  • The CDC now considers the following: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea.

  • Acute cough is common. Fever on initial presentation was noted in 44% of patients and in almost 90% during hospitalization at some point. “Fever” was defined as an axillary temperature ≥ 37.5°C (99.5°F) in this large Chinese case series.

  • Some patients had fatigue, headache, myalgia, sore throat, or shortness of breath. (NEJM).

  • Around 80% have mild disease. They may be treated at home.

  • Approximately 14% will develop severe disease requiring hospitalization, and 5% will need critical care (JAMA).

What labs are helpful?

  • 83% of hospitalized patients with pneumonia had lymphocytopenia, <1,100. About one-third of these patients had leukopenia and thrombocytopenia.

  • Procalcitonin was rarely elevated. CRP was elevated in most patients. This is from the NEJM study with 1,099 patients.

What are imaging options for COVID-19?

  • CXR was abnormal in over half of hospitalized patients (same NEJM study above).

Which patients should be tested for possible COVID-19?

  • The CDC recommendations are found here. These are evolving over time.

  • Patients who have symptoms and are hospitalized, those with comorbidities, and healthcare workers should be prioritized.

How do I test for it?

What lab test is done to test for SARS-CoV-2?

  • It is a RT-PCR test.

  • Here are all the details.

  • Rapid molecular tests are on the market. There is increasing concern with the Abbott ID NOW device.

How is COVID-19 treated?

How should we manage cardiac arrest in the COVID-19 era?

  • This paper from the AHA is very helpful. You must see the new algorithms.

  • Minimize exposure. Limit personnel. Use PPE.

  • Use HEPA (viral) filter on exhalation ports; use video over direct laryngoscopy; minimize face mask ventilation and intubate or place a supraglottic device; have the most experienced intubator place the tube.

  • Consider if CPR should be started in end-stage patients. Consider if it should be stopped in futile cases. Have plans for both in place ahead of time. Discuss goals of care with patients in advance.

How do we prepare the ED to manage the surge of patients?

What if we have more patients than we have ventilators?

How long do patients remain contagious?

  • According to the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), “ virus can initially be detected in upper respiratory samples 1-2 days prior to symptom onset and persist for 7-12 days in moderate cases and up to 2 weeks in severe cases.”

  • The CDC has this guidance on return to normal after home isolation.

What should healthcare workers do if they are exposed to patients with confirmed COVID-19?

What should healthcare workers do if they develop symptoms?

  • You should be tested (CDC), wear a mask, and self-isolate.

When should healthcare workers return to work if they test positive for COVID-19?

  • This must be determined by your employer on a case-by-case basis at this point.

How should EMS handle confirmed or potential cases of COVID-19?

  • Here are recommendations for EMS related to COVID-19.

Will there be a vaccine for COVID-19?

  • There are numerous vaccine trials underway. Some have been granted emergency use. I got my first of two shots on December 19, 2020. That’s almost a miracle. Thank you to my friends and colleagues who have worked so hard to make this possible.

  • The NYT has a helpful vaccine tracker.

What additional questions would you like to see answered here?

Please contact us. We would love to hear from you.

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