Early clusters of COVID-19 or something else? | Figure 1

Early clusters of COVID-19 or something else?

In mid to late January we saw about 15 patients (aged 20-60) in our clinic with high fever (up to 104), headache, sore throat, dry cough, weakness, and watery diarrhea…several needed IV fluids for dehydration, do not know if any ended up in hospital. We were not aware or thinking of #COVID-19 at the time.

One of my patients who had these symptoms still has a cough; she told me two days ago that her friend, a healthy 49 y/o female, came down with similar symptoms in late January and died a few days later of fulminant pneumonia.

My patient works at a park where international travelers visit. One of the other park employees just tested positive for COVID-19 and the park is now closed. A nurse at our clinic has a son who traveled to Italy late last year. After he returned she became ill with high fever and headache and dry cough and was incapacitated for weeks.

In Late January I saw several members of one rural fire department with all the symptoms I have described. We are in rural northern New Mexico and several people in the area had traveled to Europe. Wondering if this-was an early representation of COVID-19…

Would you consider this a cluster of suspected COVID or something like adenovirus? Btw I saw no children with these symptoms.

Shared by an NP from New Mexico, US and posted by Figure 1 on March 21, 2020.

Clinical scenario - female in early twenties (in one of covid 19 endemic areas of Atlanta metro)

She works in a medical clinic seeing patients even some suspected with COVID19, (without protective gear) presents to you after going to ER a few days ago with “symptoms of cough and subjective fever” and diagnosed by ER physician as “bronchitis” without testing. She says that her symptoms over the last few days have become more intense including now a dry cough with some chest congestion and discomfort, along with a low grade fever, and shortness of breath. She indicates that her mother who is early forties is developing similarly symptoms. She asked what should she do, as she indicated that no one will test her. How do you think I advised her given this pandemic crisis ?

A 42-year-old male presented to the emergency department

for treatment of a rectal abscess. He reported a several day history of dry cough. He’s otherwise healthy with no past medical history and no recent travel. Oxygen saturation was 99% on room air. Leukocytosis was attributed to the abscess. A CT abdomen and pelvis to investigate the extent of the rectal abscess incidentally revealed bilateral basal pneumonia with ground glass appearance suggestive of COVID. He didn’t meet CDC requirements for screening, however a COVID nasal swab was sent to a private lab. He’s currently admitted and in isolation, receiving IV antibiotics. Vital signs are stable, and the dry cough persists. Awaiting results of the COVID results.

How many patients are we missing that don’t meet CDC requirements for screening? What do you think the epidemiological lessons will be in 20 years when all the statistics are in and the general population can be screened for antibodies to COVID? #COVID-19

The gastrointestinal (GI) involvement, including acute pancreatitis (AP) from the novel coronavirus disease-2019 (COVID-19)

Recent evidence suggests that the pathogenesis of COVID-19 is mediated by the angiotensin-converting enzyme 2 (ACE-2) receptors and transmembrane protease serine 2 (TMPRSS2) for “priming,” which is highly expressed in the pancreas. To our knowledge, there is no other reported case of AP associated with COVID-19 after the respiratory symptoms are resolved. In this article, we present a patient with COVID-19, who came with intractable epigastric pain and resolved respiratory symptoms. A diagnosis of AP complicated with COVID-19 was made after laboratory and imaging workup, which was successfully managed conservatively.

Image description

Computed tomography of the chest with contrast revealed few scattered rounded ground glass and consolidative opacities in the lingula of the left lung and middle lobe of the right lung along with segmental lung consolidation seen within the dependent portion of both lower lobes.

The novel coronavirus disease has brought the world to standstill with high infectivity and rapid transmission. The disease caused by novel coronavirus is termed as coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practice social distancing.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck

associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.

She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.

Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse

No chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?