Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Describe reporting and testing for the novel 2019 coronavirus
2. Discuss CDC guidelines for prevention of transmission of the novel 2019 coronavirus

Estimated time to complete activity: 0.5 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 03-23-2020 through 03-23-2022, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.5 contact hours.

Read Disclaimer & Fine Print

NOTE: Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date. This summary has been updated with the latest CDC guidelines on when to end quarantine.

SUMMARY:

The novel coronavirus, named SARS-CoV-2, is the pathogen underlying the pandemic (a global outbreak of disease). The disease associated with this virus has been officially named COVID-19. Coronaviruses represent a large family of viruses. They can cause human illness, but many are found in animals and, rarely, animal coronaviruses can evolve and infect people as was the case in previous infectious outbreaks such as MERS and SARS.

• COVID-19 Categories 
• Symptoms
• Those at Risk

COVID-19 Categories (NIH Panel)

• Asymptomatic or pre-symptomatic infection
  • Test positive for SARS-CoV-2 using a virologic test (i.e., a nucleic acid amplification test [NAAT] or an antigen test)
  • No symptoms that are consistent with COVID-19
• Mild illness
  • Have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell)
  • No shortness of breath, dyspnea, or abnormal chest imaging
• Moderate illness
  • Evidence of lower respiratory disease during clinical assessment or imaging and oxygen saturation (SpO₂) ≥94% on room air at sea level
• Severe illness
  • SpO₂ <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) <300 mm Hg, a respiratory rate >30 breaths/min, or lung infiltrates >50%
• Critical illness
  • Respiratory failure, septic shock, and/or multiple organ dysfunction

Note: SpO2 is a key parameter for defining the illness categories listed above | Pulse oximetry has important limitations (e.g., skin pigmentation, thickness or temperature) | Clinicians who use SpO2 when assessing a patient must be aware of those limitations and conduct the assessment in the context of that patient’s clinical status

Pregnancy: Oxygen supplementation in pregnancy generally used when SpO₂ <95% on room air at sea level to accommodate the physiologic needs of mother and fetus

Symptoms

• Incubation period
  • Time from exposure to development of symptoms: 2 to 14 days
    • Delta variant studies: Mean incubation period of 4.3 days (see ‘Learn More – Primary Sources Below) which was shorter than initial variants (5.0 days)
    • Omicron variant studies: Median incubation period of 3 to 4 days

• Signs and Symptoms
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
• Additional points regarding presentation
  • Older adults: Especially those with comorbidities may have delayed presentation of fever and respiratory symptoms
  • Fatigue, headache, and muscle aches (myalgia) are among the most commonly reported symptoms in people who are not hospitalized
  • Sore throat and nasal congestion or runny nose (rhinorrhea) also may be prominent symptoms
  • GI symptoms may be relatively common
    • Nausea, vomiting or diarrhea may occur prior to fever and lower respiratory tract signs and symptoms
  • Loss of smell (anosmia) or taste (ageusia) has been commonly reported, especially among women and younger or middle-aged patients

Those at Risk Based on Evidence (CDC)

• Age
  • The CDC states

Age is the strongest risk factor for severe COVID-19 outcomes. Approximately 54.1 million people aged 65 years or older reside in the United States; in 2020 this age group accounted for 81% of U.S. COVID-19 related deaths, and as of September 2021 the mortality rate in this group was more than 80 times the rate of those aged 18-29

Higher Risk: Meta-analysis or systematic review demonstrates good or strong evidence

• Asthma
• Cancer
• Cerebrovascular disease
• Chronic kidney disease*
• Chronic lung diseases limited to
  • Interstitial lung disease
  • Pulmonary embolism
  • Pulmonary hypertension
  • Bronchiectasis
  • COPD (chronic obstructive pulmonary disease)
• Chronic liver diseases limited to
  • Cirrhosis
  • Non-alcoholic fatty liver disease
  • Alcoholic liver disease
  • Autoimmune hepatitis
• Cystic fibrosis
• Diabetes mellitus, type 1 and type 2*‡
• Disabilities‡
  • Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Cerebral Palsy
  • Congenital Malformations (Birth Defects)
  • Down syndrome
  • Limitations with self-care or activities of daily living
  • Learning Disabilities
  • Spinal Cord Injuries
  • See ‘Learn More – Primary Care’ CDC reference that includes extensive list for included disabilities
• Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
• HIV (human immunodeficiency virus)
• Mental health disorders limited to
  • Mood disorders, including depression
  • Schizophrenia spectrum disorders
• Neurologic conditions limited to dementia‡
• Obesity (BMI ≥30 kg/m² or ≥95th percentile in children)*‡
• Primary Immunodeficiencies
• Pregnancy and recent pregnancy
• Physical inactivity
• Smoking, current and former
• Solid organ or hematopoietic cell transplantation
• Tuberculosis
• Use of corticosteroids or other immunosuppressive medications

Suggestive Higher Risk: Underlying medical condition or risk factor that neither has a published meta-analysis or systematic review nor completed the CDC systematic review process

• Children with certain underlying conditions
• Overweight (BMI ≥25 kg/m2, but <30 kg/m2)
• Sickle cell disease
• Substance use disorders

Comorbidities with mostly case series, case reports, or, if other study design, the sample size is small 

• Overweight (BMI ≥25 kg/m², but <30 kg/m²)
• Sickle cell disease
• Substance use disorders
• Thalassemia

Mixed Evidence: Meta-analysis or systematic review is inconclusive, either because the aggregated data on the association between an underlying condition and severe COVID-19 outcomes are inconsistent in direction or there are insufficient data

• Alpha 1 antitrypsin deficiency
• Bronchopulmonary dysplasia
• Hepatitis B
• Hepatitis C
• Hypertension*
• Thallassemia

Footnotes:

* indicates underlying conditions for which there is evidence for pregnant and non-pregnant people

‡ underlying conditions for which there is evidence in pediatric patients

Learn More – Primary Sources:

Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Providers

NIH: Clinical Spectrum | COVID-19 Treatment Guidelines

Impact of SARS-CoV-2 Delta variant on incubation, transmission settings and vaccine effectiveness: Results from a nationwide case-control study in France (Lancet Regional Health, 2022)

CDC: Clinical Presentation | Clinical Care Considerations

CDC Coronavirus Disease 2019: Overview of Testing for SARS-CoV-2

Clinical Questions about COVID-19: Questions and Answers

WHO: Novel coronavirus Information Page

JAMA: Coronavirus Disease 2019

FDA: Coronavirus Disease 2019

BMJ: Coronavirus Updates

Lancet: Coronavirus Hub

NEJM: 2019 Novel Coronavirus

Annals of Internal Medicine: Content Related to Coronavirus in Annals of Internal Medicine

JAMA: What Is a Pandemic?

Related ObG Topics:

Coronavirus and Pregnancy: CDC Guidance and Professional Recommendations

ARDS, Critical Care and COVID-19: ‘Surviving Sepsis Campaign’ Guidelines and Key Points

COVID-19 and NSAIDs: Is There Reason for Concern with Use of Ibuprofen?

COVID-19: The Importance of GI Symptoms and Elevated LFTs

Further Evidence for a 5 Day COVID-19 Incubation Period

Loss of Taste and Smell: Key Symptoms of COVID-19 Infection

NIH COVID-19 Treatment Guidelines