Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Decreased appetite, Dyspnoea, Fatigue, Feeling abnormal, Impaired work ability
Clinical narrative: Patient is a 57 year old woman works as a cleaner with PMHx morbid obesity, HTN (on amlodipine, metoprolol, triamterene-HCTZ), CKD3 (baseline Cr 1.1-1.2) who presented to the ED on 5/28 with worsening shortness of breath, cough with yellow sputum, fatigue, and weakness, found to be COVID-19 positive. She was subsequently admitted to the MICU for acute hypoxic respiratory failure.    At baseline, she is independent in all ADLs and works as a cleaner at an office building. She got the first dose of the pfizer COVID vaccine series 5/10, scheduled for second dose 6/2. She lives with her husband and nephew in a house with additional family members who live downstairs. She says she only really goes to work and always wears a mask while there. Her daughter (lives downstairs) helps with grocery shopping. No recent travel or sick contacts that she is aware of.   She was in her usual state of health until 5/22 when she said she started to feel poorly. She had increasing shortness of breath over the next few days with worsening fatigue and cough to the extent that she was considering calling off from work. She continued to feel poorly and decided it was time to go to the ED on Friday, 5/28.    Today, she says she is feeling better and is less short of breath. She still has coughing that is occasionally productive for clear sputum. No fevers, chills, lightheadedness/dizziness, chest pain, abdominal pain, nausea, vomiting, diarrhea. Her appetite is improved, and she is eating and drinking better today.   Patient is a 57 year old female with PMHx obesity, HTN, CKD3 who presented to the ED with shortness of breath, cough, fatigue, found to have COVID-19. In the ED, she was hypoxic requiring increasing amounts of oxygen, ultimately with 40% FiO2 via Ventimask and HFNC when admitted to the MICU. CT chest with GGO/patchy consolidation in posterior lung areas and bases as is typically seen with COVID-19 infection.   She has been started on remdesivir and dexamethasone and is now requiring HFNC for oxygen supplementation. Likely her single dose of vaccine has helped to lessen her disease severity. She meets criteria for addition of tocilizumab.    Recommendations: - Continue dexamethasone and remdesivir - Can add tocilizumab - Health care maintenance: Screened for HIV 2009, HCV 2018, HBV 2018. Last TDAP 2015.    I saw and examined the patient. I strongly agree with the resident/fellow's findings and plan of care.  Patient with risk factors for severe Covid including obesity underlying kidney disease and hypertension presents with fever fatigue malaise and infiltrates on chest CT a little over 2 weeks after initial mRNA vaccination Denies any anosmia Agree with current treatment plan including dexamethasone and 5 days of remdesivir duction and maintenance and okay for tocilizumab as she is less than 24 hours into the ICU Other health maintenance up-to-date HIV negative remote hepatitis negative I will ask lab for cycle threshold out of curiosity as she has been vaccinated which likely has mitigated severe disease   Explained to patient in detail and questions answered. Spoke to ICU team please call back if questions