COVID-19 & Emerging Pathogens

SARS-CoV-2 causes COVID-19, transmitted primarily via respiratory droplets and aerosols, with a spectrum from asymptomatic to critical illness (ARDS, multi-organ failure). Key clinical features: fever, cough, dyspnea, fatigue, myalgia, anosmia/ageusia, and GI symptoms. Complications include hyperinflammatory response (rapid clinical deterioration with markedly elevated inflammatory markers), thromboembolic events (DVT, PE, stroke — even in young patients), acute kidney injury, and cardiac injury. Long COVID involves persistent symptoms (fatigue, cognitive dysfunction, dyspnea) for weeks to months after acute infection. Diagnosis: RT-PCR (nasopharyngeal swab, gold standard, high sensitivity); rapid antigen testing (lower sensitivity, useful for point-of-care). Treatment stratified by severity: mild/moderate in high-risk patients — nirmatrelvir/ritonavir (Paxlovid) within 5 days of symptom onset; hospitalized requiring supplemental oxygen — dexamethasone 6 mg daily for up to 10 days (reduces mortality); hypoxic patients — prone positioning improves oxygenation by redistributing ventilation to better-perfused lung regions. Remdesivir may be used in selected hospitalized patients, especially those with earlier disease or requiring supplemental oxygen but not yet on advanced ventilatory support, per current protocol. Precautions: at minimum, standard plus contact and droplet with eye protection for suspected/confirmed COVID-19. Use N95 or higher for aerosol-generating procedures (intubation, nebulization, high-flow nasal cannula, bronchoscopy) and when facility or community transmission risk warrants broader respirator use per current CDC guidance and facility policy. Vaccination: mRNA and protein-based platforms; recommended for all eligible individuals. Emerging pathogen preparedness principles: surveillance systems, rapid diagnostic deployment, surge capacity planning, and supply chain resilience. Nursing: monitor for rapid deterioration (silent hypoxia — patient appears comfortable despite SpO2 <90%), proning protocols, thromboprophylaxis assessment, isolation with dedicated equipment, and emotional support for isolated patients.