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As COVID-19 cases continue to rise across the United States, those of us in the emergency room managing many of these patients are faced with a difficult decision every shift: Is this patient OK for discharge?
We know the case fatality rate (CFR) of COVID-19 in patients younger than 50 with no significant comorbidities is low but this jumps multi-fold in subsequent decades of life. The otherwise healthy patient population under age 50 with reassuring vital signs is the easiest to manage, and they are almost always discharged.
On the other hand, we know what to do with the patient who is hypoxic and has signs of multi-organ involvement: They need to be admitted and considered for steroid and remdesivir treatment. Again, the key part here is considered, based on your hospital guidelines and the ever-changing published literature. At a minimum, these patients clearly need supplemental oxygen and close monitoring for respiratory decline.