Consider minimal to no workup in well-appearing patients with mild disease
Testing+Surveillance:<unk> 
RT-PCR (reverse transcriptase polymerase chain reaction) is most commonly used test for confirming cases
Sensitivity may be only 75%, but highly specific
Turnaround time may be several hours to days
Real time RT-PCR e.g. Cepheid
Rapid test with results in <1hr
Serologic testing for IgM/IgG is not widely available, but likely more sensitive
The presence of IgG with a negative RT-PCR likely confirms past exposure and some immunity
Test kit availability varies widely by region and institution
Sensitivity may be only 75%, but highly specific
Turnaround time may be several hours to days
Rapid test with results in <1hr
The presence of IgG with a negative RT-PCR likely confirms past exposure and some immunity
Consider in sicker patients (likely requiring admission):
Chemistry
CBC w/diff
Lymphopenia - common (80%)
Thrombocytopenia - common but mild
<100 poor prognostic sign 
Coagulation studies
PT/PTT/INR - DIC possible
D-dimer, fibrinogen - markers of severity
LFTs - mild elevation of ALT/AST
Inflammatory Markers
CRP - Indicates disease severity , 
Negative points to non-infectious cause (CHF/ESRD)
Procalcitonin - normal/mild increased on admission. Normal procalcitonin makes bacterial superinfection less likely.
Ferritin
LDH
Troponin  - myocarditis
Sepsis labs
Lactate
Blood culture x2
Swabs - Co-infection has been reported as high as 7-20%
Flu swab
Respiratory viral panel
Note that BIOFIRE Respiratory Panel Corona Virus assay does NOT detect this<unk>  subtype
Urine pregnancy test in reproductive-age women
Other labs to consider in patients that will be admitted:
HBV serologies, HCV antibody
Consider (as clinically indicated): PCP DFA, beta-d-glucan, urine legionella Ag, IL-6
Lymphopenia - common (80%)
Thrombocytopenia - common but mild
<100 poor prognostic sign 
<100 poor prognostic sign 
PT/PTT/INR - DIC possible
D-dimer, fibrinogen - markers of severity
CRP - Indicates disease severity , 
Negative points to non-infectious cause (CHF/ESRD)
Procalcitonin - normal/mild increased on admission. Normal procalcitonin makes bacterial superinfection less likely.
Ferritin
LDH
Negative points to non-infectious cause (CHF/ESRD)
Lactate
Blood culture x2
Flu swab
Respiratory viral panel
Note that BIOFIRE Respiratory Panel Corona Virus assay does NOT detect this<unk>  subtype
Note that BIOFIRE Respiratory Panel Corona Virus assay does NOT detect this<unk>  subtype
HBV serologies, HCV antibody
Consider (as clinically indicated): PCP DFA, beta-d-glucan, urine legionella Ag, IL-6
Portable CXR preferred in PUI to prevent spread of infection
May be normal in early disease
Typical pattern is peripheral patchy ground glass opacities (GGO)
More opacities correlates with worse disease
GGOs may coalesce and appear as infiltrates
Not every PUI needs a chest X-ray. Patients who are more likely to need one include any moderate or high acuity patient, elderly, concerning chronic conditions, BMI > 40, high risk socioeconomic situations.
May be normal in early disease
Typical pattern is peripheral patchy ground glass opacities (GGO)
More opacities correlates with worse disease
GGOs may coalesce and appear as infiltrates
Not every PUI needs a chest X-ray. Patients who are more likely to need one include any moderate or high acuity patient, elderly, concerning chronic conditions, BMI > 40, high risk socioeconomic situations.
Many have normal imaging early on (CDC does not recommend CT for diagnostic purposes)
CT (86%) more sensitive than CXR (59%) for detecting GGOs
Generally, the findings on chest imaging are not specific and overlap with other infections, including influenza, H1N1, SARS and MERS.
CT (86%) more sensitive than CXR (59%) for detecting GGOs
Generally, the findings on chest imaging are not specific and overlap with other infections, including influenza, H1N1, SARS and MERS.
Uncertain role in diagnosis at this time
May reveal B lines, consolidation, or "ragged" appearance of pleural line
Useful in evaluating undifferentiated Dyspnea
Ultrasound: Cardiac
Ultrasound: Lungs
IVC ultrasound
May reveal B lines, consolidation, or "ragged" appearance of pleural line
Ultrasound: Cardiac
Ultrasound: Lungs
IVC ultrasound
Typically confirmed by viral testing (see above)
Some define moderate and severe acuity as follows
Low: SaO2 > 93% on RA, RR < 20, and HR < 110
Moderate: SaO2 = 91-93% on RA, RR 20-24, HR 110-124 with wheezing, rales, or an otherwise abnormal lung exam.
High: SaO2 < 91%, RR > 24, HR > 124.
^ If febrile, treat with acetaminophen and reassess acuity.
ROX Index for intubation after high-flow nasal cannula (HFNC}
Predicts HFNC failure/need for intubation
https://www.mdcalc.com/rox-index-intubation-hfnc
Predicts HFNC failure/need for intubation
https://www.mdcalc.com/rox-index-intubation-hfnc
COVID-19
Influenza
Rubella
URI
Anthrax
Pneumonia
H1N1 
Sinusitis