Case history #1
A 61-year-old man presents to the hospital with fever, dry cough, and difficulty breathing. He also reports feeling very tired and unwell. He has a history of hypertension, which is controlled with enalapril. On exam, his pulse is 120 bpm, his temperature is 101.6°F (38.7°C), and his oxygen saturation is 88%. He appears acutely ill. He is admitted to hospital in an isolation room and is started on oxygen, intravenous fluids, and venous thromboembolism prophylaxis. Blood and sputum cultures are ordered. Chest x-ray shows bilateral lung infiltrates, and computed tomography of the chest reveals multiple bilateral lobular and subsegmental areas of ground-glass opacity. A nasopharyngeal swab is sent for real-time reverse transcriptase polymerase chain reaction testing, and the result comes back positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a few hours later.
Case history #2
A 26-year-old woman with sickle cell disease presents at her local COVID-19 testing clinic with symptoms of a sore throat and loss of taste. She denies having a fever, and has not knowingly been in contact with a confirmed case of COVID-19. After being tested, she is advised to go home until her test results are sent to her via text message, and call her doctor if her symptoms get worse. She receives a text message later that day confirming that her test is positive for SARS-CoV-2. A clinician calls her to discuss treatment options given her increased risk of hospitalization.
For more information on other presentations see Diagnostic approach.
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