The Rheumatologist’s Role in COVID-19

The novel coronavirus (severe acute respiratory syndrome; SARS-CoV-2) pandemic has spread rapidly throughout the planet. It is believed to have originated in the Wuhan province of China, but this highly contagious respiratory virus has spread to over 140 countries on 6 continents as of mid-March 2020, according to the World Health Organization. Worldwide, there have been over 164,000 cases identified and over 6500 deaths attributed to the viral infection. As of mid-March 2020, there are over 3700 confirmed cases and 68 deaths ascribed to the coronavirus disease 2019 (COVID-19; the disease caused by SARS-CoV-2) in the United States (www.livescience.com/coronavirus-updates-united-states.html). These numbers will only continue to grow globally. Based primarily on data out of China, about 80% of those infected with SARS-CoV-2 experience a relatively mild “cold,” as is seen with more common coronavirus infections. However, 20% of those infected require hospitalization, with 5–15% overall necessitating intensive care1. As the true denominator of those infected is not yet known, it remains unclear what the overall mortality rate is associated with COVID-19, but estimates range between 1% and 4%2. Although the mortality rate is lower than that reported for previous coronavirus epidemics such as SARS and MERS (Middle East respiratory syndrome), the much larger absolute number of infected individuals with SARS-CoV-2 will result in substantially more total deaths worldwide. Those at highest risk of dying from COVID-19 are elderly (> 60 yrs and increasing with age), those with immunodeficiencies, and those with underlying chronic medical conditions (e.g., diabetes, heart disease). Although children tend to experience only mild symptoms, younger previously healthy adults have also succumbed to COVID-19. Once hospitalized, for some patients, death can occur within a few days, many with adult respiratory distress syndrome, and some with multiorgan dysfunction syndrome3. In those critically ill patients, … Address correspondence to Dr. R.Q. Cron, Children’s of Alabama, Division of Rheumatology, 1600 7th Ave. S., CPPN, Suite G10, Birmingham, Alabama 35233-1711, USA. E-mail: rcron{at}peds.uab.edu

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