Last reviewed: 6 Jun 2022
Last updated: 12 May 2022
12 May 2022

What’s new at this update

FDA limits use of Janssen COVID-19 vaccine to certain individuals

  • The US Food and Drug Administration (FDA) has limited the authorized use of the Janssen COVID-19 vaccine to people 18 years of age and older for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate, or people who elect to receive the vaccine because they would not otherwise receive a COVID-19 vaccine. The move comes after the FDA has determined that the rare risk of thrombosis with thrombocytopenia syndrome warrants limiting use of the vaccine.

  • See the Prevention section for more information.

WHO strongly recommends Paxlovid® for people at high risk of severe disease

  • The World Health Organization (WHO) has updated its living guideline on COVID-19 therapeutics to include a strong recommendation for the oral antiviral nirmatrelvir/ritonavir (available as Paxlovid®). The WHO recommends the drug for patients with nonsevere disease who are at highest risk of hospitalization, calling it the best therapeutic choice for high-risk patients to date. The recommendation is based on new data that shows that nirmatrelvir/ritonavir reduces the risk of hospitalization by 85% in this group of patients.

  • See the Emerging section for more information.

Valneva COVID-19 vaccine approved in UK

  • The Medicines and Healthcare products Regulatory Agency (MHRA) has approved the Valneva COVID-19 vaccine. It is the sixth COVID-19 vaccine to be granted an MHRA authorization, and is the first whole-virus inactivated vaccine to be available in the UK.

  • See the Prevention section for more information.

[Figure caption and citation for the preceding image starts]: Number of COVID-19 cases reported weekly by WHO Region, and global deaths, as of 8 May 2022World Health Organization [Citation ends].com.bmj.content.model.Caption@7a362751

See Management: prevention

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • fever
  • cough
  • dyspnea
  • altered sense of smell/taste

Other diagnostic factors

  • headache
  • sore throat
  • rhinorrhea/nasal congestion
  • sneezing
  • fatigue
  • myalgia or arthralgia
  • sputum production/expectoration
  • chest tightness
  • gastrointestinal symptoms
  • dizziness
  • neurologic symptoms
  • ocular symptoms
  • audio-vestibular symptoms
  • chest pain
  • hemoptysis
  • bronchial breath sounds
  • tachypnea
  • tachycardia
  • cyanosis
  • crackles/rales on auscultation
  • cutaneous symptoms
  • oral mucosal lesions
  • lower urinary tract symptoms

Risk factors

  • contact with probable or confirmed case
  • residence/work/travel in location with high risk of transmission
  • older age
  • male sex
  • ethnicity
  • residence in a long-term care facility
  • presence of comorbidities
  • obesity
  • cardiovascular disease
  • diabetes
  • chronic respiratory disease
  • chronic kidney disease
  • chronic liver disease
  • pregnancy
  • smoking
  • malignancy
  • cerebrovascular disease
  • mental health disorders
  • solid organ or blood stem cell transplant
  • disabilities
  • dementia
  • immunosuppression
  • HIV infection
  • hemoglobin disorders
  • hypertension
  • substance use disorders
  • children with certain underlying conditions
  • vitamin D deficiency
  • proton-pump inhibitor use
  • autoimmune disease
  • thyroid disease
  • Parkinson disease
  • physical inactivity
  • gout
  • dyslipidemia
  • surgery
  • blood groups A and B
  • gut dysbiosis
  • environmental factors

Diagnostic investigations

1st investigations to order

  • real-time reverse transcription polymerase chain reaction (RT-PCR)
  • pulse oximetry
  • ABG
  • CBC
  • comprehensive metabolic panel
  • thyroid function tests
  • blood glucose level
  • coagulation screen
  • cardiac biomarkers
  • serum C-reactive protein
  • serum erythrocyte sedimentation rate
  • serum lactate dehydrogenase
  • serum interleukin (IL) level
  • serum procalcitonin
  • serum ferritin level
  • serum amyloid A level
  • serum creatine kinase and myoglobin
  • blood and sputum cultures
  • chest x-ray

Investigations to consider

  • computed tomography (CT) chest
  • rapid antigen test
  • serology

Emerging tests

  • lung ultrasound
  • reverse transcription loop-mediated isothermal amplification (RT-LAMP)
  • CRISPR-based diagnostics
  • breathalyzers
  • calprotectin

Treatment algorithm

Contributors

Authors

Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H

Consultant and Emeritus Professor of Tropical and Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Disclosures

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA; formerly Public Health England), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.

Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Disclosures

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA; formerly Public Health England) in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.

Robert Fowler, MDCM, MS (Epi), FRCP(C)

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

Disclosures

RF declares that he has no competing interests.

Peer reviewers

William A. Petri, Jr., MD, PhD

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Disclosures

WAP declares that he has no competing interests.

Xin Zhang, MD, PhD

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China

Disclosures

XZ declares that he has no competing interests.

Ran Nir-Paz, MD

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

Disclosures

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

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