Guide to Leading a Patient with Symptoms of an Acute Respiratory Infection during a Coronavirus Pandemic (COVID-19)

Abstract

BACKGROUND: Over 500 viruses and bacteria primarily cause respiratory infections. During COVID-19 pandemic, these respiratory infections remain; i.e., COVID-19 has no ability to suppress these infections from the circulation. Therefore, it is very important to differentiate respiratory infections from COVID-19. Proving the presence of COVID-19 with polymerase chain reaction (PCR) is not evidence that the disease was caused by this virus. Possible options are: First, a random encounter of the virus in the patient’s upper respiratory tract; second, further possible colonization with a coronavirus (or with COVID-19); the third option is to have an infection; and the fourth possibility is to have a disease or COVID-19 upper respiratory infection. Unfortunately, the method with PCR, although it is with high sensitivity and specificity, does not help us to distinguish which of these four possibilities are in question.

AIM: We aimed to present a guide to leading a patient with symptoms of an acute respiratory infection during a coronavirus pandemic (COVID-19).

RESULTS: A pandemic of COVID-19 shows that many patients get primary viral pneumonia, but people with normal immune system have no problem recovering. People with reduced immunity die from COVID-19, as opposed to the pandemic influenza virus. It is indirectly concluded that COVID-19 in itself is not very virulent, but it weakens the immunity of those infected who already have some condition and impaired immunity. The available scientific papers show that there is no strong cytokine response, patients have leukopenia and lymphopenia, some patients have a decrease in CD4 T-lymphocytes. From the results of the autopsies available so far, it is clear that there are very few inflammatory cells in the lungs and a lot of fluid domination. Hence, SARS-Cov-2 only somehow speeds up the decline in immunity. The previously published radiographic findings of COVID-19 patients, gave a characteristic findings of the presence of multifocal nodules, described as milky glass, very often localized in the periphery of the lung. Whether it is typical pneumonia, atypical, viral, mixed-type pneumonia, or mycotic pneumonia, it can progress to severe pneumonia. The pneumonia becomes severe when breathing is over 30/min; diastolic pressure below 60 mmHg; low partial oxygen pressure in the blood (PaO2/FiO2 <250 mmHg) (1 mmHg = 0.133 kPa); massive pneumonia, bilateral or multilayered lung X-ray; desorientation; leukopenia; and increased urea.

CONCLUSION: Patients with COVID-19 placed in intensive care units should be led by a team of anesthesiologists with an infectious disease specialist or an anesthesiologist with a pulmonologist. Critical respiratory parameters should be peripheral oxygen saturation <90%, PaO2/FiO2 ratio 100 or <100, tachycardia above 110/min.