Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics
Abstract
In December, 2019, numerous un explained pneumonia cases occurred in Wuhan, China. This outbreak was confirmed to be caused by severe acute respiratory syndrome corona virus 2 (SARSCoV2), belonging to the same family of viruses responsible for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The SARS epi demic in 2003 was controlled through numerous measures in China. One effect ive strategy was the establishment of fever clinics for triaging patients. Based on our firsthand experience in dealing with the present outbreak in Wuhan, we have established the following clinical strategies in adult fever clinics (figure). Patients can be afebrile in the early stages of infection, with only chills and respiratory symptoms. High temperature is not a general presentation. Elevated Creactive protein (CRP) is an important factor of 2019 novel coronavirus disease (COVID19; formally known as 2019nCoV) and impaired immunity, characterised by lymphopenia, is an essential characteristic. Therefore, in afebrile patients (temperature <37·3°C) without dyspnoea, we recommend measurements of complete blood count and CRP. Subsequently, if the lymphocyte concentration is ≥1100/μL, home care with selfisolation is advised. Oral azithromycin or amoxicillin can be prescribed (measure 1, figure). Chest CT is helpful (appendix) and is more sensitive than xray in identifying viral pneumonia. Imaging of patients with COVID19 initially revealed characteristic…
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