Actualización sobre la pandemia de COVID-19
Se han informado más de 101.3 millones de casos en todo el mundo, con más de 55.9 millones de casos recuperados hasta la fecha y aproximadamente 2.1 millones de muertes según los datos recogidos por el Center for Systems Science and Engineering de la Johns Hopkins University. EE.UU. es el país que presenta el mayor número de infecciones y muertes informadas en el mundo. India es el segundo país con mayor número de casos informados, seguido de Brasil, Reino Unido, Rusia, Francia, España, Italia y Turquía.
Johns Hopkins University: coronavirus COVID-19 global cases external link opens in a new window
[Figure caption and citation for the preceding image starts]: Número de casos de COVID-19 informados semanalmente por cada región de la OMS, y muertes en todo el mundo al 24 de enero de 2021Organización Mundial de la Salud [Citation ends].
¿Qué hay de nuevo en esta actualización?
Epidemiología: datos actualizados sobre niños y mujeres embarazadas.
Etiología: información actualizada sobre VOC 202012/01 variante (B.1.1.7).
Pruebas diagnósticas: la OMS recomienda repetir las pruebas cuando el resultado de una prueba no se corresponde con la presentación clínica.
Algoritmo de tratamiento: la OMS actualiza la guía de orientación de manejo clínico para recomendar: la monitorización de la oximetría de pulso en el domicilio, en pacientes sintomáticos que presentan factores de riesgo de avance a enfermedad grave que no están hospitalizados; la posición en decúbito prono en pacientes graves que requieren oxígeno, oxígeno nasal de alto flujo o ventilación no invasiva; y la dosificación estándar de tromboprofilaxis en pacientes hospitalizados sin una indicación establecida para la anticoagulación de dosis más alta.
Prevención: los CDC recomiendan que la segunda dosis de las vacunas de ARNm se pueda programar hasta 6 semanas después de la primera dosis si no es posible cumplir el intervalo de dosificación recomendado y las vacunas pueden considerarse intercambiables en circunstancias excepcionales; los estudios de preimpresión sugieren que las vacunas podrían ser eficaces frente a las variantes del SARS-CoV-2; los datos preliminares encontrados en Israel plantean dudas sobre la eficacia de la vacuna.
Seguimiento: la OMS recomienda que los pacientes que presenten síntomas persistentes, nuevos o cambiantes deben tener acceso a la atención sanitaria de seguimiento.
Podcasts
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Contenido asociado
Véase nuestro tema separado sobre el manejo de las condiciones coexistentes en el contexto de COVID-19:
Este tema se basa en las mejores evidencias disponibles en la actualidad, pero como se trata de una situación que evoluciona rápidamente, las evidencias son limitadas y algunas recomendaciones pueden estar basadas en informes de casos, estudios de observación y análisis retrospectivos, así como en ensayos aleatorizados controlados y guías de práctica clínica.
Fuente original de la actualizaciónexternal link opens in a new window
Resumen
Definición
Anamnesis y examen
Otros factores de diagnóstico
- fatiga
- mialgia o artralgia
- producción de esputo/expectoración
- opresión en el pecho
- síntomas gastrointestinales
- dolor de garganta
- cefalea
- mareos
- síntomas neurológicos
- síntomas oculares
- rinorrea/congestión nasal
- dolor torácico
- síntomas cutáneos
- hemoptisis
- sonidos de respiración bronquial
- taquipnea
- taquicardia
- cianosis
- crepitaciones/estertores durante la auscultación
Factores de riesgo
- contacto con el caso probable o confirmado
- residencia/trabajo/viajes en lugares con alto riesgo de transmisión
- edad avanzada
- sexo masculino
- grupo étnico
- residencia en un centro de cuidados a largo plazo
- presencia de comorbilidades
- enfermedad cardiovascular
- diabetes
- obesidad
- enfermedad respiratoria crónica
- enfermedad renal crónica
- embarazo
- tabaquismo
- neoplasia maligna
- trasplante de órganos sólidos
- síndrome de Down
- trastornos de la hemoglobina
- hipertensión
- enfermedad cerebrovascular
- demencia
- hepatopatía crónica.
- inmunosupresión
- niños con ciertas afecciones subyacentes
- deficiencia de vitamina D
- uso de inhibidores de la bomba de protones
- enfermedad autoinmune
- Infección por VIH
- dislipidemia
- cirugía
- grupos sanguíneos A y B
- Disbiosis intestinal
- Factores ambientales
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- Reacción en cadena de la polimerasa de transcripción inversa en tiempo real (RT-PCR)
- oximetría de pulso
- GSA
- hemograma completo (HC)
- perfil metabólico completo (PMC)
- nivel de glucemia
- cribado de coagulación
- biomarcadores cardíacos
- proteína C-reactiva sérica
- velocidad de sedimentación globular en suero
- lactato deshidrogenasa en suero
- nivel de interleucina-6 en suero
- procalcitonina sérica
- nivel de ferritina en suero
- amiloide sérico nivel A
- creatina-cinasa y mioglobina en suero
- cultivos de esputo y hemocultivos
- radiografía de tórax
Pruebas diagnósticas que deben considerarse
- Tomografía computarizada (TC) de tórax
- serología
- prueba de antígenos
Pruebas emergentes
- amplificación isotérmica mediada por bucles de la transcripción inversa (RT-LAMP)
- ultrasonido de pulmón
Algoritmo de tratamiento
Colaboradores
Consejeros especializados
Consultant and Honorary Senior Lecturer in Infectious Diseases
Royal Liverpool University Hospital and Liverpool School of Tropical Medicine
Liverpool
UK
Divulgaciones
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 Public Health England (PHE), 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 PHE.
Senior Clinical Lecturer and Defence Consultant in Infectious Diseases
Royal Liverpool University Hospital and Liverpool School of Tropical Medicine
Liverpool
UK
Divulgaciones
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 Public Health England (PHE), 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 PHE.
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
Divulgaciones
RF declares that he has no competing interests.
Revisores por pares
Professor
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
Divulgaciones
WAP declares that he has no competing interests.
Attending Physician
The Fifth Medical Center of PLA General Hospital
Clinical Division and Research Center of Infectious Disease
Beijing
China
Divulgaciones
XZ declares that he has no competing interests.
Associate Professor in Medicine
Department of Clinical Microbiology and Infectious Diseases
Hadassah Hebrew University Medical Center
Jerusalem
Israel
Divulgaciones
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.
Editores
Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice
Divulgaciones
AM declares that he has no competing interests.
Lead Section Editor, BMJ Best Practice
Divulgaciones
IC declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
Divulgaciones
JC declares that she has no competing interests.
Consejeros especializados: comorbilidades
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
Norwich
UK
Divulgaciones
MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018). MP has accepted sponsorship for travel expenses and accommodation costs from Astellas Pharma Ltd to attend the European Geriatric Society Meeting (Lisbon 2016).
Consultant Renal Physician
Honorary Associate Professor
Nephrology Department
Leeds Teaching Hospitals NHS Trust
Leeds
UK
Divulgaciones
AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).
Professor of Cardiology
Imperial College London (Royal Brompton Hospital)
London
UK
Divulgaciones
MC is a Non-Executive Director of NICE and Chair the Digital Health Committee of the European Society of Cardiology. MC’s university receives support for his research from Abbott, ResMed, Boston Scientific, and Medtronic. MC speaks at educational events and provides consultancy advice to a number of device, diagnostic, and pharmaceutical companies including Novartis, Servier, Bayer, Pfizer, AstraZeneca, Boehringer Ingelheim, Roche Diagnostics, Medtronic, Abbott, ResMed, and Boston Scientific. MC declares that none of these interests is directly related to topics advised on for this project.
Associate Professor (Clinical)
University of Leicester
Honorary Consultant Respiratory Physician
Glenfield Hospital
Leicester
UK
Divulgaciones
RAE has been reimbursed for a GSK Advisory Board meeting on Physical Activity and Asthma in November 2016, and three Chiesi Education meetings for GPs on COPD care in 2019. RAE received a travel award for ERS 2017 from Chiesi and participated in the GSK clinical experience programme - respiratory in August 2018. RAE participated in the BTS/SIGN guidelines for asthma update 2016 (no fee).
Consultant Physician and Head of Service
Diabetes and Endocrine Centre and the Diabetes Research Unit
Ipswich Hospitals NHS Trust
Ipswich
UK
Divulgaciones
GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.
Consultant Liaison Neuropsychiatrist
King’s College Hospital
South London and Maudsley NHS Foundation Trust
Honorary Senior Clinical Lecturer
Institute of Psychiatry, Psychology & Neuroscience
King’s College London
London
UK
Divulgaciones
SP declares that he has no competing interests.
BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.
Matthew Jones, MD, FRCP
Consultant Neurologist
Greater Manchester Neurosciences Centre
Salford Royal Foundation Trust
Honorary Senior Lecturer
University of Manchester
Manchester
UK
Divulgaciones
AA and MJ declare that they have no competing interests.
Revisores por pares: comorbilidades
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
Norwich
UK
Divulgaciones
MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018). MP has accepted sponsorship for travel expenses and accommodation costs from Astellas Pharma Ltd to attend the European Geriatric Society Meeting (Lisbon 2016).
Consultant Geriatrician
Liverpool University Hospitals NHS Foundation Trust
Visiting Professor
University of Cumbria
Carlisle
Honorary Clinical Associate Professor
University of Liverpool
Liverpool
UK
Divulgaciones
AA declares that he has no competing interests.
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