A study of the clinical facets of COVID-19 in the context of an acute hospital

The severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) pandemic has presented several medical, economical, and societal challenges. This thesis presents a body of work that explores several aspects of defining a novel infectious disease in the hospital context at the Mater Misericordiae University Hospital including clinical presentation, investigation, management, post hospital outcomes and post-infectious sequelae. The main findings of this thesis identified through peer reviewed publication are as follows; 1) many patients presenting to the emergency department who were founds to be SARS-CoV-2 positive did not have typical symptoms including fever. Tachycardia was the most sensitive marker for acute COVID-19, 2) The use of a rapid antibody test in high risk hospital cohorts lacks specificity and is not a useful adjunct in identifying acute COVID-19 in patients and healthcare workers for whom attending hospital was essential, 3) Antibiotics are over prescribed in patients with COVID-19 admitted acutely and treated empirically for bacterial pneumonia; the duration of antibiotics correlates highly with duration of supplemental oxygenation which may act as a surrogate marker for perceived response to treatment, 4) After discharge, the readmission rate was comparable to international reports; persistence of respiratory symptoms was the main reason for readmission, which lasted usually 48 hours, as a function of investigating complications including pulmonary embolism, 5) Post COVID-19 syndrome (PoCS) persists in approximately 25% of patients presenting to a follow up COVID clinic at 1 year, those with PoCS had considerable impact on physical health measured by SF-12 score measurements, a health related quality of life questionnaire. Increased resting heart rate and low SF-12 scores were predictive of PoCS at one year