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The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019. The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic. The spread of this virus is now global with lots of media attention. The virus has been named SARS-CoV-2 and the disease it causes has become known as coronavirus disease 2019 (COVID-19). This new outbreak has been producing lots of hysteria and false truths being spread, however the data surrounding the biology, epidemiology, and clinical characteristics are growing daily, making this a moving target.
Incubation period: 3 – 14 days
*Initially travelling was included, but this was removed as COVID became a community disease.
Clinical diagnosis of COVID-19 is cough and/or fever, lymphocytpenia and bilateral ground glass opacities on chest x-ray. Unilateral radiological signs can also indicate COVID.
Low Risk: These are well patients who are likely safe to be discharged home. When numbers are low this will be done with the approval of IP&C and Public Health (PH). If numbers get high, you will likely have a process put in place to discharge patients without IPC/PH approval just like you would do for influenza now. IPC/PH will likely want to know the patient’s name and contact information so they can track them. You should also have written instructions for patients about how to self-isolate and a telephone hotline they can call for advice to avoid a return visit.
Medium Risk: High CAP Score or supplemental 02< 50% needed to keep 02 sat >90. Admit to hospital or COVID-19 treatment site (possible, if numbers are high).
High Risk: High CAP Score or Fi02> 50 % needed to keep sat >90% OR signs of respiratory fatigue or hemodynamic instability. Early referral or transfer to a hospital with ICU capacity to perform controlled intubation is key. If this is not rapidly available, your team must have a process in place to manage this patient and perform airway management safely. Video or teleconsulting may be available in some areas.
Risk Factors for severe disease and increase mortality rate: (1)
Poor Prognostic Indicators:
Add other investigations at physician’s discretion: Blood Cultures, EKG, ABG, D-Dimer etc.
Lymphocytopenia is present in >80% in patients and is probably the most useful lab test in distinguishing COVID-19 from other causes of respiratory infection.
Nonspecific lab abnormalities include elevated LDH, AST, ALT, elevated D-dimer, abnormal WBC.
Troponin and CRP may be a predictor of mortality and severe illness, and should be considered in patients who are going to be admitted.
While influenza co-infection has been reported with COVID-19, our expert recommends leaving the decision to test for influenza to the inpatient team, your local infection control specialists or public health authorities. There may be a role for testing for influenza for all ICU patients admitted with suspected COVID-19, as some patients may benefit from neuraminidase inhibitors.
Bikdeli, B et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up.
Associated with high mortality
COVID CORE ON-CALL: Admission / Assessment
PREVIOUS MEDICAL HISTORY:
PREVIOUS SURGICAL HISTORY:
SPECIAL INVESTIGATIONS: 
ASSESSMENT: (Create a problem list for ongoing notes)
[Stipulate key aspects from the history and clinical parameters and provide the next physician with the key problem]
[Paste problem list from assessment notes – document assessment and plan for each problem in this list. Trend parameters within this section for example labs etc]
[List medical problems]
IV Fluids: 
[Provide an overview of subjective findings]
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