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Organizational and clinical problems of outpatient COVID-19 diagnostics

DOI: https://doi.org/10.29296/25877305-2020-05-05
Issue: 
5
Year: 
2020

Professor I. Samorodskaya(1), MD; Professor V. Larina(2), MD; K. Nazimkin(2), Candidate of Medical Sciences; V. Larin(2), Candidate of Medical Sciences (1)National Medical Center for Therapy and Preventive Medicine, Moscow (2)Pirogov Russian National Research Medical University, Moscow

The review article highlights a number of organizational and clinical problems in outpatient COVID-19 diagnostics related to a lack of knowledge and new challenges for the healthcare system. The existing WHO definition for COVID-19 and laboratory tests do not allow a clear diagnosis of COVID-19, to assess the severity of the patient’s condition and to predict the course of the disease. The inclusion of cases in statistics based on laboratory tests is uncertain. With a significant increase in the number of people who are shown to be tested, the healthcare system inevitably faces resource supply problems. The non-specificity and heterogeneity of symptoms with COVID-19 complicate the diagnosis and differential diagnosis at the outpatient stage. A high risk of developing severe lung damage requires the use of computed tomography (CT), but the absence of changes on the CT does not exclude, and the presence does not confirm COVID-19. A quick result can provide better patient routing, but CT only identifies lung damage with COVID-19, has contraindications, is associated with a relatively high cost, requires additional organizational costs associated with transporting the patient to a medical facility and increases the likelihood of infection of staff and surrounding persons. The outpatient use of pulse oximetry can help resolve issues of timely hospitalization, avoid late admission of patients to the hospital, but can lead to deficiency, improper use, increased anxiety and fear in patients, and an increase in the load on emergency departments. Given the high contagiousness of the pathogen, a significant burden on primary care doctors during the epidemic, it is likely that widespread use of telemedicine consultations is advisable. Signs / indicators / criteria are needed that will help resolve the issues of patient management tactics for an outpatient doctor.

Keywords: 
infectious diseases
coronavirus
severe acute respiratory syndrome
symptoms
pneumonia
computed tomography
pulse oximetry



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