Outpatient Evaluation and Management of COVID-19

Abstract

This article summarizes the ACP/Annals COVID-19 Forum VIII held on 9 February 2022.

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), which are all available for viewing on Annals.org, 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 Outpatients 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. https://www.acpjournals.org/doi/10.7326/M22-0403(Duration 1:29:05)