Dödligt virus från Kina orsakar panik (SARS-CoV-2, COVID-19)

The Strategic preparedness and response plan outlines WHO’s strategic objectives to end the COVID-19 pandemic and assists national stakeholders with developing a structured approach to their response.

The World Health Organization’s (WHO) main objectives for COVID-19 are to:

1) slow and stop transmission;
2) provide optimized care for all patients; and
3) minimize the impact of the epidemic on health systems, social services and economic activity.
To achieve these objectives, the WHO Operational considerations for case management of COVID- 19 in health facility and community describes key actions that should be taken in each transmission scenario: no cases; sporadic cases; clusters of cases; and community transmission, in order to enable timely surge of clinical and public health operations.

(...)While most people with COVID-19 develop only mild (40%) or moderate (40%) disease, approximately 15% develop severe disease that requires oxygen support, and 5% have critical disease with complications such as:

respiratory failure, acute respiratory distress syndrome (ARDS), sepsis and septic shock, thromboembolism, and/or multiorgan failure, including acute kidney injury and cardiac injury.

Older age, smoking and underlying noncommunicable diseases (NCDs), such as diabetes, hypertension, cardiac disease, chronic lung disease and cancer, have been reported as risk factors for severe disease and death, and multivariable analyses have confirmed older age, higher sequential organ failure assessment (SOFA) score and D-dimer > 1 μg/L on admission were associated with higher mortality.

This study also observed a median duration of viral RNA detection of 20.0 days (IQR 17.0–24.0) in survivors, but COVID-19 viral RNA was detectable until death in non-survivors. The longest observed duration of viral RNA detection in survivors was 37 days.

COVID-19 is associated with mental and neurological manifestations, including delirium or encephalopathy, agitation, stroke, meningo-encephalitis, impaired sense of smell or taste anxiety, depression and sleep problems.

In many cases, neurological manifestations have been reported even without respiratory symptoms. Anxiety and depression appear to be common amongst people hospitalized for COVID-19, with one hospitalized cohort from Wuhan, China, revealing over 34% of people experiencing symptoms of anxiety and 28% experiencing symptoms of depression.

An observational case series from France found that 65% of people with COVID-19 in intensive care units (ICUs) showed signs of confusion (or delirium) and 69% experienced agitation.

Delirium, in particular, has been associated with increased mortality risk in the context of COVID-19.

Moreover, there have been concerns related to acute cerebrovascular disease (including ischaemic and haemorrhagic stroke) in multiple case series from China, France, the Netherlands, and the United States of America

Case reports of Guillain-Barré syndrome and meningo-encephalitis among people with COVID-19 have also been reported

There are few data on the clinical presentation of COVID-19 in specific populations, such as children and pregnant women. Clinical manifestations of COVID-19 are generally milder in children compared with adults. Relatively few cases of infants confirmed with COVID-19 have been reported; infants also experience mild illness.

However, most recently, an acute presentation with a hyperinflammatory syndrome leading to multiorgan failure and shock has been described, now described as multisystem inflammatory syndrome temporally associated with COVID-19 in children and adolescents.

Robust evidence associating underlying conditions with severe illness in children is still lacking. Among 345 children with laboratory-confirmed COVID-19 and complete information about underlying conditions, 23% had an underlying condition, with chronic lung disease (including asthma), cardiovascular disease and immunosuppression most commonly reported (32).

There is currently no known difference between the clinical manifestations of COVID-19 in pregnant women and non-pregnant adults of reproductive age.

Patients with mild and moderate illness may not require emergency interventions or hospitalization; however, isolation is necessary for all suspect or confirmed cases to contain virus transmission.

The decision to monitor a suspect case in a health facility, community facility or home should be made on a case-by-case basis. This decision will depend on the clinical presentation, requirement for supportive care, potential risk factors for severe disease, and conditions at home, including the presence of vulnerable persons in the household.

Some patients develop severe pneumonia and require oxygen therapy, and a minority progress to critical disease with complications such as respiratory failure or septic shock.