Keeping up with COVID-19: A review for family physicians

Nenacia Ranali Nirena R Palma-mendoza; Rojim J Sorrosa; Martha Jane Pauline S Umali; Kryszia Elouise Portal

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Keeping up with COVID-19: A review for family physicians

Author: Nenacia Ranali Nirena R. Palma-Mendoza ¹ ; Rojim J. Sorrosa ² ; Martha Jane Pauline S. Umali ³ ; Kryszia Elouise Portal ¹
Author Information

1. Learning Enhancement Group, FamilyDOC Family and Community Medicine Residency Training Program
2. Department of Family and Community Medicine, Southern Philippines Medical Center, Davao City
3. Department of Family and Community Medicine, Philippine General Hospital, University of the Philippines Manila
Publication Type:Journal Article
Keywords: Coronavirus Disease 2019 (COVID-19); Severe acute respiratory syndrome-related coronavirus; SARS-CoV-2
From: The Filipino Family Physician 2020;58(1):2-8
CountryPhilippines
Language:English
Abstract: Background:Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China in December 2019. This has rapidly spread worldwide, causing a pandemic. The Philippines ranks 3rd in Southeast Asia with more than 15,000 confirmed cases, and a case fatality rate of 6.01%, close to the global average of 6.33%.
Objective and Methods:This review aims to provide Family and Community Physicians the latest updates on epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment options, and prognosis of COVID-19. Online literature search was done with WHO and DOH websites prioritized for epidemiologic data, and MEDLINE for the most recent and relevant journal articles.
Pathogenesis:SARS-CoV-2, the etiologic agent of COVID-19, is an enveloped, positive sense single-stranded RNA virus which triggers immune-mediated responses responsible for most of the clinical manifestations of the disease. Angiotensin Converting Enzyme 2 appears to play a critical role in viral entry and disease severity.
Clinical Manifestations:There have been reports of asymptomatic cases. Majority have mild illness, with common symptoms of fever, cough, headache and fatigue. Those who progress to the critical stage of the disease present with Severe Acute Respiratory Syndrome, sepsis or Multiple Organ Dysfunction.
Diagnostic Evaluation:The definitive diagnosis of SARS-CoV-2 requires an analysis of respiratory specimens collected through oropharyngeal and nasopharyngeal swabs. The reverse transcriptase-polymerase chain reaction (RT-PCR) is considered the confirmatory test. Serological rapid detection test (RDT) for SARS-CoV-2 IgM and IgG may be done, but as an adjunct only because antibodies appear later in the course of disease. Imaging studies and other tests are used to monitor the severity of the condition, but not for diagnosis.
Treatment and Prognosis:Supportive therapy is the cornerstone of management. Currently, there is no FDA-approved drug or agent specifically for the treatment of COVID-19. Drugs being investigated for treatment are those that are currently used for other viral infections or indicated for other conditions. A vaccine is yet to be developed. Old age, the presence of comorbidities such as hypertension, diabetes, cardiovascular and lung diseases, and smoking history are risk factors that lead to severe complications and death.
Conclusion:COVID-19 has caused a global public health crisis. In the Philippines, cases are still on the rise. Majority of cases are mild. More severe and fatal disease is associated with old age and the presence of comorbidities. Definitive diagnosis is through RT-PCR. Supportive therapy is the cornerstone of management. The search continues for a proven, effective drug for treatment and vaccine for prevention of COVID-19.
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