The Covid-19 pandemic seen from the frontline

Abstract

COVID-19 disease caused by infection with the SARS-CoV-2 virus produces respiratory symptoms, predominantly of the upper airways, which can progress to pneumonia after 7 days with persistent fever, cough and dyspnea, and even develop a syndrome of acute respiratory distress (ARDS), multi-organ failure and death. Since COVID-19 disease was declared by the WHO there has been a redistribution of the healthcare system for these types of patients, especially in the front line, which is, in primary care, emergencies and in intensive care units (ICU). In primary care, the fundamental role is the diagnosis of the suspected patients, follow-up mainly by telemedicine (specially telephone calls) to detect warning signs in case of worsening and subsequent referral to the emergency department; as well as explaining home isolation measures. In the emergency department, it is included the management of suspicious cases and, if it any risk factor is found, complementary tests are carried out for precise diagnosis and admission assessment; In case of oxygen saturation <95% and poor general condition, valuation is requested for admission to the ICU. Depending on the severity of the patient, he/she would be or not a candidate for invasive mechanical ventilation, which must be performed by trained personnel to prevent the spread of the infection minimizing the risk of contagion. ARDS's treatment strategies include pulmonary protection ventilation, prone position, recruitment maneuvers and, less frequently, oxygenation by extracorporeal membrane. Among the specific treatments for COVID-19 stand out mainly drugs to reduce viral load, although sometimes specific drugs will be needed to treat hyperinflammation, hypercoagulability and concomitant infections. One of the goals to be achieved is for patients to recover and be able to successfully return to work; for this purpose, an adequate physical and psychological rehabilitation program is essential, as about 50% have symptoms of anxiety and depression.

Ventilação protetora na síndrome do desconforto respiratório agudo causada pela COVID-19: o manejo do fisioterapeuta

“…Pacientes com SDRA aguda por COVID-19 frequentemente respondem à posição prona com melhora da oxigenação 25 . Além disso, a relação V/Q fica mais uniforme na posição prona em comparação com a posição supina 26,27 .…”

Resilience of Brazilian health-care professionals during the pandemic

“…Health professionals have shown remarkable dedication and empathy toward health-care during the pandemic, despite challenging and sometimes hazardous conditions (The Lancet, 2020). The risks are especially pervasive for frontline professionals involved in managing COVID-19 patients and carrying out treatment strategies (Bolina et al, 2020;Carmona et al, 2020).…”

Evolution of Acute Respiratory Distress Syndrome in Emergency and Critical Care: Therapeutic Management before and during the Pandemic Situation

“…In addition, correct emergency management, diagnostic tests, and rational use of resources are essential. If there are risk factors and the evolution is rapid, ICU admission should be considered to minimize mobility and mortality [52].…”