[Artigo] Severe SARS-CoV-2 infections- practical considerations and management strategy for intensivists
On December 31, 2019, China reported cases of respiratory illness in humans appearing frst in Wuhan, Hubei Province, that involved a novel coronavirus SARS-CoV-2 (aka 2019-nCoV). Tis new emergency is a zoonotic disease with unknown animal reservoir and with evidence of person-to-person transmission [1]. Te basic reproductive number of this infection is estimated to be 2.2 (95% CI, 1.4–3.9) [2].
Etiological agent and epidemiology
The new agent causing this pneumonia, a coronavirus (SARS-CoV-2), was identifed and sequenced [3] and diagnostic tests were developed [4]. On January 30, 2020, the World Health Organization issued a worldwide public health alert on the emergence of a new epidemic viral disease. On February 3, 2020, 17,391 confrmed cases (153 cases outside of China) have been reported (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/). Te overall mortality rate of afected patients is difcult to assess at this time, because of the lack of a reliable denominator. Severe forms represent 14% of the reported cases, and the overall mortality is around 2% of the confrmed cases. To date, 153 cases have been reported in 23 countries outside China (overall, 24 cases in Europe), most of them being imported cases: tourists coming from China, or China-originating persons returning to their country of residence after traveling to visit family in Wuhan or other Chinese regions. In Europe, at least three cases in Germany and one case in France involved patients with no history of travel to China. Te German case occurred after exposure to an asymptomatic contact coming from China [5].
Clinical features
To date, the ECDC criteria to require diagnostic testing for suspected cases are patients with acute respiratory infection (requiring hospitalization or not) in the 14 days prior to the onset of symptoms with at least one of the following epidemiological criteria being present: close contact with a confrmed or probable case of SARS-CoV-2 infection (COrona Virus Disease 2019, COVID-19) (or) history of travel to China (or) having worked in or having attended a health care facility where patients with SARS-CoV-2 infections were being treated (https://www.ecdc.europa.eu/en/case-definition-andeuropean-surveillance-human-infection-novel-coronavirus-2019-ncov).
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