Internal Medicine and COVID-19

Abstract

Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is novel, many clinicians would consider coronavirus disease 2019 (COVID-19) an internal medicine disease, with striking similarities to the early days of the HIV/AIDS pandemic nearly 40 years ago. Evaluating the protean manifestations of COVID-19 and determining the optimal approach to treating patients are basic elements of internal medicine. Hypoxia that can progress to acute respiratory distress syndrome, renal failure, myocarditis, and thrombosis are conditions that internists have always treated. The most pressing clinical issues have included determining whether the traditional treatment modalities are the right ones for each manifestation of COVID-19, dealing with the huge volume of patients that has challenged staffing and resources, and having enough personal protective equipment to keep everyone safe. Several surprising aspects of COVID-19 have increased the challenges of treatment and prevention of new infections. SARS-CoV-2 has a remarkable range in that the infection can be entirely benign and asymptomatic in one person, yet rapidly lethal in another person. Moreover, individuals infected with SARS-CoV-2 are most infectious to others before they have symptoms and soon after they develop symptoms. If only those who were symptomatic could transmit the virus, controlling the pandemic would be considerably easier and less worrisome. The clinical care of patients has been complicated by the lack of evidence from randomized clinical trials to guide treatment. Observational data about patient care can be obtained quickly. Observational studies, however, are inherently subject to confounding and lack randomized controls. Thus, even when data are rigorously analyzed, observational studies can be helpful but cannot substitute for data from randomized clinical trials. Consider the use of corticosteroids in the treatment of COVID-19, which has been one of the most challenging issues. Early in the course of the pandemic, an observational study from Wuhan, China (where many of the first cases of were reported), described an association between methylprednisolone and reduced mortality. 1 In 201 patients with COVID-19 pneumonia, 42% developed acute respiratory distress syndrome and treatment with methylprednisolone was associated with a significantly decreased risk of death (hazard ratio, 0.38; 95% CI, 0.20-0.72). Although this intriguing study suggested a benefit from the use of a widely available inexpensive medication, the findings could have been wrong, particularly because numerous clinical trials have not found corticosteroids to be effective in individuals with acute respiratory illness. The study by Wu et al 1 was followed by a larger open-label randomized clinical trial of 6400 patients with suspected or confirmed SARS-CoV-2 infection. 2

Impact of COVID-19 Outbreak on Emergency Visits and Emergency Consultations: A Cross-Sectional Study

“…Gastrointestinal and internal problems associated with COVID-19 have been reported in the literature [14,15]. While the count of internal medicine and gastroenterology consultations decreased, the consultation rates did not change.…”

Considerations on the distribution and administration of the new COVID-19 vaccines

“…Based upon findings by Havers et al in a seroprevalence data analysis of SARS-CoV-2 infection, including ten regions across the US with serum samples from 16 025 persons, Havers et al [26] projected that the estimated total number of infections was between 6-and 24-fold higher than the number of confirmed COVID-19 cases reported in each location before the study [26,27]. Therefore, the chance of exposure to frontline healthcare workers is higher than anticipated in previous studies.…”

Pasos adelante y hacia atrás en la pandemia COVID-19

“…Se conoce ahora su morfología, genoma y su asidero selectivo al receptor de la enzima convertidora de angiotensina 2 (ACE2), abundante en el endotelio de arterias y venas, pero también en el epitelio del tracto respiratorio (1) . Al ingresar al cuerpo humano y multiplicarse, ocasiona un síndrome de insuficiencia respiratoria aguda, seguido por shock cardiogénico, eventos tromboembólicos, afectación de bronquios, pulmones, sistema nervioso (2) , riñones (3) , sistema gastrointestinal (4) , la mente (5) , piel (6) , entre otros. El niño parece infectarse poco, frecuentemente de manera asintomática, pero su carga viral puede contagiar a los adultos (7) .…”