Table 1.

VA clinical algorithm for COVID-19 suspicion and testing/evaluation.

Clinical judgment supersedes this algorithm

1 Major or ≥ 2 minor = test

≥ 2 Major = ED evaluation (the 4th major criterion would by itself deserve ED evaluation)

Major criteria

1. New respiratory distress or new hypoxia <93% on RA (for patients on chronic O2 therapy, new increased O2 requirement to maintain their baseline goal O2 saturation)   2. Fever (≥100.4) with cough or dyspnea   3. New fatigue in immunosuppressed host   4. Cardiovascular decompensation/shock or other evidence of cytokine storm in patient with no ACS or other explanation

Minor criteria

1. Co-morbidities including CHF, COPD, or cardiomyopathy (ischemic or non-ischemic)   2. CXR showing infiltrate or CT showing GGOs not explained by another etiology   3. ≥1 Lab abnormalities of the following:    a. Lymphopenia (ALC <1000)    b. Elevated CRP    c. Newly elevated: ferritin (>700) or fibrinogen (>600)   4. Known exposure to SARS-CoV2   5. ≥2 Lab abnormalities of the following:    a. New abnormalities in liver tests (AST/ALT >60 IU, bilirubin >2 mg/dL)    b. New elevation of: ferritin (>400 but <700) or fibrinogen (>400 but <600)    c. Leukopenia with TLC <4.0 k    d. LDH > 350 or troponin elevation   6. Fever (≥100.4)   7. New onset unexplained anosmia or ageusia

Please note: Other less common clinical features of COVID-19 include nausea, vomiting, diarrhea, abdominal pain, only rarely seen without other criteria above.