Coronavirus Disease (COVID-19): A primer for emergency physicians



Rapid worldwide spread of Coronavirus Disease 2019 (COVID-19) has resulted in a global pandemic.


This review article provides emergency physicians with an overview of the most current understanding of COVID-19 and recommendations on the evaluation and management of patients with suspected COVID-19.


Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for causing COVID-19, is primarily transmitted from person-to-person through close contact (approximately 6 ft) by respiratory droplets. Symptoms of COVID-19 are similar to other viral upper respiratory illnesses. Three major trajectories include mild disease with upper respiratory symptoms, non-severe pneumonia, and severe pneumonia complicated by acute respiratory distress syndrome (ARDS). Emergency physicians should focus on identifying patients at risk, isolating suspected patients, and informing hospital infection prevention and public health authorities. Patients with suspected COVID-19 should be asked to wear a facemask. Respiratory etiquette, hand washing, and personal protective equipment are recommended for all healthcare personnel caring for suspected cases. Disposition depends on patient symptoms, hemodynamic status, and patient ability to self-quarantine.


This narrative review provides clinicians with an updated approach to the evaluation and management of patients presenting to the emergency department with suspected COVID-19.


Coronavirus Disease
Infectious disease

1. Introduction

On January 30, 2020, the World Health Organization (WHO) designated an outbreak of a novel coronavirus not seen before in humans to be a “public health emergency of international concern” (PHEIC); this was followed by the declaration of a pandemic on March 11, 2020 [1,2]. Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), previously referred to as 2019-nCoV, is the virus responsible for causing Coronavirus Disease 2019 (COVID-19) [[3][4][5][6][7]]. The pandemic traces its early beginnings to the report of a cluster of 27 unexplained pneumonia cases in late December 2019 originating from a seafood and live animal market in Wuhan, Hubei Province, China [[8][9][10][11]]. From the outset, the causative agent was thought to be viral, with most patients reporting fever or dyspnea [9,11]. With unprecedented numbers of individuals under travel restrictions or quarantine, worldwide spread, and no known cure or vaccine yet available, COVID-19 has proven a formidable adversary [12,[13][14][15]].

The Ebola Virus Disease (EVD) outbreak of 2014 in West Africa provided valuable lessons with regards to emergency preparedness, personal protective equipment use, and triage processes, and underscored the important role that emergency physicians play on the frontlines of emerging infectious diseases [[16][17][18]]. We describe the virology, epidemiology, clinical presentation, radiographic and laboratory findings, current testing protocols, and management of patients presenting with COVID-19 to the emergency department (ED). In this review article, we provide emergency physicians with best practices based on the rapidly evolving body of literature surrounding COVID-19.

2. Discussion

2.1. Virology

SARS-CoV-2 is a member of the coronavirus family, named for the crown-like appearance of spikes on the virus surface [5,19]. Other members of the coronavirus family include Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and SARS-CoV, as well as coronaviruses responsible for the common cold (Fig. 1Fig. 2) [5,6,8,19]. Like MERS-CoV and SARS-CoV, SARS-CoV-2 is a betacoronavirus and is likely associated with an animal reservoir (e.g., bats) [6,8,14]. While an exact animal source has not been confirmed for COVID-19, many of the early cases in China were linked to a live animal and seafood market [6,14,20,21].

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