What are important history details when evaluating a patient for coronavirus disease 2019 (COVID-19)?

Updated: Jan 14, 2021
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Clinicians evaluating patients with fever and acute respiratory illness should obtain information regarding travel history or exposure to an individual who recently returned from a country or US state experiencing active local transmission. [135]

Risk factors for severe COVID-19, regardless of age, include the following: [43, 15, 136, 99492]

  • Chronic kidney disease
  • COPD
  • Immunocompromised state due to solid organ transplant
  • Obesity (BMI ≥30)
  • Serious heart conditions (eg, heart failure, coronary artery disease, cardiomyopathies)
  • Sickle cell disease
  • Type 1 diabetes mellitus
  • Type 2 diabetes mellitus

The following are underlying conditions that may represent an increased risk of severe COVID-19:

  • Asthma (moderate to severe)
  • Cerebrovascular disease
  • Cystic fibrosis
  • Immunocompromised state due to blood or bone marrow transplant, immunodeficiencies, HIV infection, corticosteroid use (or other medications that weaken the immune system)
  • Neurologic conditions (eg, dementia)
  • Liver disease
  • Pregnancy
  • Pulmonary fibrosis
  • Smoking
  • Thalassemia

Williamson et al, in an analysis of 17 million patients, reaffirmed that severe COVID-19 and mortality was more common in males, older individuals, individuals in poverty, Black persons, and patients with medical conditions such as diabetes and severe asthma, among others. [138]

A multicenter observational cohort study conducted in Europe found frailty to be a greater predictor of mortality than age or comorbidities. [139]

Type A blood has been suggested as a potential factor that predisposes to severe COVID-19, specifically in terms of increasing the risk of respiratory failure. Blood type O appears to confer a protective effect. [140, 141]

Patients with suspected COVID-19 should be reported immediately to infection-control personnel at their healthcare facility and the local or state health department. Current CDC guidance calls for the patient to be cared for with airborne and contact precautions (including eye shield) in place. [19] Patient candidates for such reporting include those with fever and symptoms of lower respiratory illness who have travelled from Wuhan City, China, within the preceding 14 days or who have been in contact with an individual under investigation for COVID-19 or a patient with laboratory-confirmed COVID-19 in the preceding 14 days. [135]

Early in the outbreak, one patient with COVID-19 (a 61-year-old man with an underlying abdominal tumor and cirrhosis) was admitted with severe pneumonia and respiratory failure. Complications of infection included severe pneumonia, septic shock, acute respiratory distress syndrome (ARDS), and multiorgan failure, resulting in death. [33]

A complete or partial loss of the sense of smell (anosmia) has been reported as a potential history finding in patients eventually diagnosed with COVID-19. [17] A phone survey of outpatients with mildly symptomatic COVID-19 found that 64.4% (130 of 202) reported any altered sense of smell or taste. [18] In a European study of 72 patients with PCR results positive for COVID-19, 53 patients (74%) reported reduced olfaction, while 50 patients (69%) reported a reduced sense of taste. Forty-nine patients (68%) reported both symptoms. [142]


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