Outpatient Evaluation and Management of COVID-19
Authors: Christine Laine, Deborah Cotton, Darilyn V. Moyer
Journal: Annals of Internal Medicine (2022)

Special ArticlesApril 2022Outpatient Evaluation and Management of COVID-19FREEChristine Laine, MD, MPH, Deborah Cotton, MD, MPH, Darilyn V. Moyer, MDChristine Laine, MD, MPHEditor in Chief, Annals of Internal Medicine Search for more papers by this author, Deborah Cotton, MD, MPHDeputy Editor, Annals of Internal Medicine Search for more papers by this author, Darilyn V. Moyer, MDExecutive Vice President and Chief Executive Officer, American College of PhysiciansSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-0403 Eligible for CME Point-of-CareCME/MOC SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The rapid rise of the Omicron SARS-CoV-2 variant ushered in year 3 of the COVID-19 pandemic. Omicron changed the nature of the pandemic in many ways. While transmission is rampant, resulting illness, particularly in vaccinated persons, is generally less severe than with prior variants. While the Omicron surge stressed health care systems in many locations, the situation has tended to be less dire in most areas of the United States than earlier in the pandemic when critical care resources were in short supply and morgues were overflowing. Further, just as Omicron emerged, so did effective outpatient therapies to prevent severe illness and death if administered to high-risk persons soon after COVID-19 diagnosis. These therapies promise to further change the nature of the pandemic.With these developments came many questions about the outpatient evaluation and management of COVID-19. Are the appropriate actions following an exposure different for vaccinated and unvaccinated persons? What is the best way to use COVID-19 tests for diagnosis and to gauge infectiousness? Who is eligible for each of the newly available therapies, and when will availability be widespread? For persons currently ineligible for or without access to newly approved therapies, should unapproved uses of readily available drugs and supplements be considered? To seek practical answers to these questions based on current knowledge, the Annals of Internal Medicine and the American College of Physicians held their eighth COVID-19 forum on 9 February 2022. The topic of this program was outpatient evaluation and management of COVID-19. Panelists included Dr. Roy M. Gulick, the Rochelle Belfer Professor in Medicine and Chief of the Division of Infectious Diseases at Weill Medical College of Cornell University and Attending Physician at the New York–Presbyterian Hospital; Dr. Megan L. Ranney, the Warren Alpert Endowed Professor of Emergency Medicine and Professor of Behavioral and Social Sciences/Health Services, Policy, and Practice, and Academic Dean for the Brown University School of Public Health; Dr. Jason Gallagher, Clinical Professor at Temple University School of Pharmacy and Clinical Pharmacy Specialist in Infectious Diseases at Temple University Hospital; and Dr. Paul E. Sax, Clinical Director of the Division of Infectious Diseases at Brigham and Women's Hospital, where he is Professor of Medicine at Harvard Medical School and holds the Bruce A. Beal and Robert L. Beal Distinguished Chair in Infectious Diseases. Dr. Rebecca Andrews, a practicing primary care general internal medicine physician, moderated the program. Dr. Andrews is Professor of Medicine, Director of Ambulatory Education, and Associate Internal Medicine Residency Program Director at University of Connecticut, Farmington, and is the current Chair of the American College of Physicians' Board of Governors.The program began with presentation of 4 clinical cases, a poll of what attendees would do in each case, and then a discussion of what the panelists would do in each of the 4 situations. Following the discussion of the cases, the panelists addressed questions submitted by attendees.Although panelists acknowledged that there were no absolute correct answers to many of the current questions about COVID-19, they aimed to offer practical advice based on what we know right now. When to test, in which situations polymerase chain reaction or rapid antigen tests are most useful, and cautions about using antibody tests to guide clinical decisions were topics of robust debate. There was lively discussion about the need to emphasize the use of proven therapies over those whose effectiveness and safety have not been demonstrated and the importance of equitable distribution of therapies based on medical need. Along with the promise of emerging therapies, the panelists addressed the substantial shortcomings related to logistic challenges, limited availability, contraindications, and drug interactions.In this as in the previous programs (1–7), the challenge of keeping clinical and public health actions aligned with rapidly evolving knowledge was evident.Video. ACP/Annals COVID-19 Forum VIII: Evaluation and Management of Patients with COVID-19 The ACP/Annals COVID-19 Forum VIII, held on 9 February 2022, features speakers Roy M. Gulick, MD, MPH; Megan L. Ranney, MD, MPH; Jason Gallagher, PharmD; Paul E. Sax, MD; and Rebecca Andrews, MD. (Duration 1:25:00)References1. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: what physicians need to know. Ann Intern Med. 2020;173:830. [PMID: 33074704] doi:10.7326/M20-6841 LinkGoogle Scholar2. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: promoting vaccine acceptance. Ann Intern Med. 2021;174:252-253. [PMID: 33347321] doi:10.7326/M20-8008 LinkGoogle Scholar3. Laine C, Cotton D, Moyer DV. COVID-19 vaccine distribution and allocation: what physicians need to know. Ann Intern Med. 2021;174:413-414. [PMID: 33492990] doi:10.7326/M21-0331 LinkGoogle Scholar4. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: practical clinical considerations. Ann Intern Med. 2021;174:694. [PMID: 33769829] doi:10.7326/M21-1260 LinkGoogle Scholar5. Laine C, Cotton D. COVID-19: evaluation and care of patients with persistent symptoms following acute SARS-CoV-2 infection. Ann Intern Med. 2021;174:1159-1160. [PMID: 34115532] doi:10.7326/M21-2342 LinkGoogle Scholar6. Laine C, Cotton D, Moyer DV. COVID-19: clinical and public health implications of SARS-CoV-2 immunology. Ann Intern Med. 2021;174:1733-1734. [PMID: 34633835] doi:10.7326/M21-3840 LinkGoogle Scholar7. Laine C, Moyer DV, Cotton D. COVID-19: challenging clinical questions. Ann Intern Med. 2022;175:276-277. [PMID: 34904908] doi:10.7326/M21-4611 LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPH; Deborah Cotton, MD, MPH; Darilyn V. Moyer, MDAffiliations: Editor in Chief, Annals of Internal Medicine Deputy Editor, Annals of Internal Medicine Executive Vice President and Chief Executive Officer, American College of PhysiciansDisclosures: All relevant financial relationships have been mitigated. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-0403.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Stephanie Chang, MD, MPH, Deputy Editor, reports employment with the Agency for Healthcare Research and Quality, travel compensation from the Guidelines International Network, and participation in the Patient-Centered Outcomes Research Institute methodology committee. Vineet Chopra, MD, MSc, Deputy Editor, reports grants received from the Agency for Healthcare Research and Quality and royalties from UpToDate and Oxford University Press. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he is employed at Johns Hopkins University. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center and consultancy with Boston Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports employment with the Perelman School of Medicine, University of Pennsylvania, and consultancies with the U.S. Food and Drug Administration and the State of Colorado.Corresponding Author: Christine Laine, MD, MPH, Editor in Chief, Annals of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, [email protected]org.This article was published at Annals.org on 15 February 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCOVID-19 Vaccine: What Physicians Need to Know Christine Laine , Deborah Cotton , and Darilyn V. Moyer COVID-19 Vaccine: Promoting Vaccine Acceptance Christine Laine , Deborah Cotton , and Darilyn V. Moyer COVID-19 Vaccine Distribution and Allocation: What Physicians Need to Know Christine Laine , Deborah Cotton , and Darilyn V. Moyer COVID-19 Vaccine: Practical Clinical Considerations Christine Laine , Deborah Cotton , Darilyn V. Moyer COVID-19: Evaluation and Care of Patients With Persistent Symptoms Following Acute SARS-CoV-2 Infection Christine Laine and Deborah Cotton COVID-19: Clinical and Public Health Implications of SARS-CoV-2 Immunology Christine Laine , Deborah Cotton , Darilyn V. Moyer COVID-19: Challenging Clinical Questions Christine Laine , Darilyn V. Moyer , Deborah Cotton Care of Patients With New, Continuing, or Recurring Symptoms After Acute SARS-CoV-2 Infection Christine Laine and Deborah Cotton Current Clinical Challenges in the Prevention and Management of COVID-19 Christine Laine and Deborah Cotton COVID-19 Is No Longer a Public Health Emergency: Implications for Patients and Clinicians Christine Laine and Darilyn V. Moyer Metrics April 2022Volume 175, Issue 4Page: 590-591KeywordsCOVID-19Infectious diseasesPrevention, policy, and public health ePublished: 15 February 2022 Issue Published: April 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. 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