Recovery from Critical COVID-19 Despite Delays in Diagnosis and Respiratory Treatment: a Cautionary Tale
1Department of Cardiovascular Medicine, Zhuzhou Central Hospital, Hunan province, P. R. China
†These authors contributed aqually
DOI: 10.22514/sv.2020.16.0027 Vol.16,Issue 1,June 2020 pp.193-198
Published: 30 June 2020
† These authors contributed equally.
Although an acute, usually self-resolving disease, COVID-19 can also be deadly. Thus far, no approved specific treatments for this novel highly contagious disease are available, which posed great challenges on clinicians worldwide. Here we present the case of a relatively young COVID-19 patient who recovered well, despite delayed diagnosis and initiation of aggressive treatment. From the case, we speculated that: (a) Delayed diagnosis may miss the optimal antiviral treatment period for severe cases. (b) Monitoring of inflammatory markers and blood gas analysis in early stage may assist in identifying high-risk patients.(c) Glucocorticoids therapy in early stage may be harmful to the patient. (d) Once progressed to ARDS, mechanical ventilatory support should be considered as soon as possible in case of refractory hypoxemia. (e) ECMO, a scarce medical resource, should not be abused to treat COVID-19 patients with very low expected survival rates, especially during the period when medical resources are run out. (f) convalescent plasma therapy should be initiated in earlier stage of disease.
COVID-19, Respiratory, Glucocorticoids therapy, ARDS
Ouyang Fan,Fu Qiang,Guo Shuhong,Yang Haibing,Li Xiangyang,Tang Min,Yang Li. Recovery from Critical COVID-19 Despite Delays in Diagnosis and Respiratory Treatment: a Cautionary Tale. Signa Vitae. 2020. 16(1);193-198.
 Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579:265-269.
 Pan A, Liu L, Wang C, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. Published online April 10, 2020. doi:10.1001/jama.2020.6130.
 Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Resp Med. 2020.
 Bhatia M, Moochhala S. Role of inflammatory mediators in the pathophysiology of acute respiratory distress syndrome. J Pathol. 2004;202:145-156.
 Meduri G U, Headley S, Kohler G, et al. Persistent elevation of inflammatory cytokines predicts a poor outcome in ARDS: plasma IL-1β and IL-6 levels are consistent and efficient predictors of outcome over time. Chest. 1995;107:1062-1073.
 Cao B, Gao H, Zhou B, et al. Adjuvant corticosteroid treatment in adults with influenza A (H7N9) viral pneumonia. Crit Care Med. 2016;44:e318-e328.
 Lee N, Chan K C A, Hui D S, et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentra-tions in adult patients. J Clin Virol. 2004;31:304-309.
 Arabi Y M, Mandourah Y, Al-Hameed F, et al. Corticosteroid therapy for critically ill patients with Middle East respiratory syndrome. Am J Resp Crit Care. 2018;197:757-767.
 Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Resp Med. 2020.
 Liu Qian, Wang Rongshuai, Qu Guoqiang. Report of gross autopsy findings of a dead COVID-19 patient. J Forensic Sci. 2020;36:19-21.
 Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020.
 Schmidt M, Bailey M, Sheldrake J, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Sur-vival Prediction (RESP) score. Am J Resp Crit Care. 2014;189:1374-1382.
 Maclennan S, Barbara J A. Risks and side effects of therapy with plasma and plasma fractions. Best Pract Res Cl Ha. 2006;19:169-189.
Science Citation Index Expanded (SciSearch) The Science Citation Index (SCI) is a citation index originally produced by the Institute for Scientific Information (ISI) and created by Eugene Garfield. It (Science Citation Index Expanded) covers more than 8,500 notable and significant journals, across 150 disciplines in science and technology, from 1900 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.