Coronavirus Disease 2019 (COVID-19): Diagnosis and Treatment
Despite the media frenzy and seemingly 24 hour a day coverage, coronavirus is not a new disease. Part of a family of viruses that range from the common cold to severe acute respiratory syndrome (SARS), coronaviruses have been infecting humans for decades. The newest virus outbreak, originating in the Eastern China city of Wuhan in December of 2019, is known as coronavirus disease 2019 (COVID-19). The World Health Organization (WHO) and United States Center for Disease Control and Prevention (CDC) are reporting COVID-19 cases in 185 countries, including the United States. Already declared a pandemic, the number of global cases is over 400,000 and has claimed over 16,000 lives. In the US alone, there have been over 40,000 infected and more than 500 fatalities. While the exact mortality rate is unknown at this time, health officials estimate that it is roughly 3%.
The common symptoms of COVID-19 first appear two to 14 days after initial exposure. The symptoms of the virus are quite similar to other respiratory illnesses such as influenza (the flu). Patients have reported a fever, muscle or joint aches, tiredness, a cough, and shortness of breath. Symptoms may be mild or severe and in some cases, patients show symptoms at all (asymptomatic). Those with pre-existing conditions and the elderly, appear to be a greater risk for contracting the illness and showing severe symptoms. Complications can arise from the virus may include pneumonia, failure of one or more organs, and death.
The primary, FDA approved method, of diagnosing COVID-19 is through a nasopharyngeal swab. Anyone showing symptoms or believe they have been exposed to the virus should promptly contact their healthcare provider for an appointment. In order for the provider and his or her staff to ensure they are adequately prepared for the appointment, let the medical team know of any recent travel (particularly internationally), any known or suspected exposure to the virus, a list of their symptoms, and any known medical conditions they may have prior to the appointment. During the appointment, the doctor will likely confirm when symptoms began, the severity of the symptoms, anyone the patient has been in close contact with, and recent travel.
In order to test for COVID-19, you may have an influenza swab first to exclude other viral illness, and COVID testing if indicated. Currently, most are sent to a laboratory for testing, although rapid testing is coming. The samples are taken using a long Q-tip and the process only takes about 10 seconds. Once taken, the samples go to a lab and placed in a machine to compare the person’s ribonucleic acid (RNA) with the coronavirus RNA. While it generally takes a laboratory about three hours to complete testing the samples, the large volume of patients being tested is creating backlogs within some pathology departments. To combat the backlogs, the US government has ramped up the number of labs to more than 2,000 locations nationwide. Test results are generally received in two to three days but again depends on the availability of labs in the patient’s city.
Because of the laboratory backlogs that have been created due to the high volume of test requests, several companies have created at-home testing kits for COVID-19. Large medical equipment makers, such as Roche and Thermo Fisher, have tests on the market that can be done at home. These tests can diagnose COVID-19 in three hours without requiring users to leave the comfort, and quarantine, of their homes. Another test, created by the California-based start-up company Cepheid, was recently given approval by the FDA that can diagnose the virus in only 45 minutes. Cepheid’s tests will first be sent to hospitals in the coming week and do not require training for providers to administer. The emergency clearance granted by the FDA, means that the tests can be used in any setting providing patient care.
Several states have also implemented drive-through tests for COVID-19. These tests, which have been successful in other countries, are capable of testing for the virus without requiring patients to leave their cars and potentially expose others to the infection. Patients can qualify for free testing if they show symptoms of COVID-19, have been in contact with someone infected, or have traveled to areas considered high risk. Patients must provide a photo ID and doctor’s note in order to receive the test for free. To mitigate any possible spread of the virus, patients are asked to obtain the doctor’s note via fax or email. Since test results may take up to 72 hours, patients should remain quarantined at home while awaiting results.
Patients that have been confirmed to have the virus are likely wondering what their treatment options are. Because it is such a new strain of virus that is still being researched, there is unfortunately no FDA approved antiviral treatment for COVID-19 at this time. As such, treatment centers around mitigating the symptoms associated with the illness. Using pain relievers , taking cough medication or syrup, getting adequate rest, and taking in plenty of fluid, are the primary methods for treating COVID-19 symptoms. If a patient’s symptoms are severe and they are having difficulty breathing, hospitalization and the use of a breathing machine (ventilator) could be required.
Despite the current lack of approved medication for treating COVID-19, the FDA is working in conjunction with academic institutions and other governmental agencies to investigate treatment options. One such option is the use of chloroquine for patients with mild cases of COVID-19. Already approved to treat lupus, malaria, and rheumatoid arthritis, chloroquine is being tested to see if the drug can reduce symptom duration and viral shedding to prevent the spread of the virus. Another option the FDA is testing for efficacy against COVID-19 is the use of the antiviral drug remdesivir. Manufactured by the pharmaceutical company Gilead Sciences, remdesivir is a broad-spectrum antiviral medication that has shown promise in treating other coronaviruses such as SARS and MERS. Additional time and testing will be necessary before the FDA can recommend either chloroquine or remdesivir for use against COVID-19 so patients should continue to use over the counter medications to mitigate their symptoms.