How to Cite
Abstract
A cluster of pneumonia was reported from Wuhan, Hubei province, China in December 2019. The causative agent was named as novel coronavirus “SARS-CoV-2” and the disease as COVID-19. The disease rapidly spread to several countries and WHO declared the outbreak as a Public Health Emergency of International Concern and as a pandemic on 11th March 2020. In the Maldives, the first case of COVID-19 was detected on the 7th of March. At the time of writing, there are 3103 cases of confirmed COVID-19 including 15 fatalities. The SARS-CoV-2 causes mild to severe pneumonia complicated by ARDS, sepsis, and multi-organ dysfunction syndrome. Other manifestations include anosmia, ageusia, fatigue, and rash. In many requiring hospitalization, hypoxemia is a key clinical finding. The clinical manifestations including the clinical progression of COVID-19 is being described in this report. The case was conservatively managed in a makes-shift hospital, with the utilization of the awake prone positioning which had resulted in better oxygenation and aided in the improvement of hypoxemia.
References
Agency, H. P. (2020). COVID-19 Statistics Dashboard. https://COVID-19.health.gov.mv/dashboard/
Arabi, Y. M., Balkhy, H. H., Hayden, F. G., Bouchama, A., Luke, T., Baillie, J. K., Al-Omari, A., Hajeer, A. H., Senga, M., Denison, M. R., Nguyen-Van-Tam, J. S., Shindo, N., Bermingham, A., Chappell, J. D., Van Kerkhove, M. D., & Fowler, R. A. (2017, Feb 9). Middle East Respiratory Syndrome. N Engl J Med, 376(6), 584-594. https://doi.org/10.1056/NEJMsr1408795
Avellana Moreno, R., Estela Villa, L. M., Avellana Moreno, V., Estela Villa, C., Moreno Aparicio, M. A., & Avellana Fontanella, J. A. (2020, Jul). Cutaneous manifestation of COVID-19 in images: a case report. J Eur Acad Dermatol Venereol, 34(7), e307-e309. https://doi.org/10.1111/jdv.16531
Bernheim, A., Mei, X., Huang, M., Yang, Y., Fayad, Z. A., Zhang, N., Diao, K., Lin, B., Zhu, X., Li, K., Li, S., Shan, H., Jacobi, A., & Chung, M. (2020, Jun). Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology,295(3), 200463. https://doi.org/10.1148/radiol.2020200463
Bouffanais, R., & Lim, S. S. (2020, Jul). Cities - try to predict superspreading hotspots for COVID-19. Nature, 583(7816), 352-355. https://doi.org/10.1038/d41586-020-02072-3
Caputo, N. D., Strayer, R. J., & Levitan, R. (2020, May). Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED’s Experience During the COVID-19 Pandemic. Acad Emerg Med, 27(5), 375-378. https://doi.org/10.1111/acem.13994
Chen, J., Qi, T., Liu, L., Ling, Y., Qian, Z., Li, T., Li, F., Xu, Q., Zhang, Y., Xu, S., Song, Z., Zeng, Y., Shen, Y., Shi, Y., Zhu, T., & Lu, H. (2020, May). Clinical progression of patients with COVID-19 in Shanghai, China. J Infect, 80(5), e1-e6. https://doi.org/10.1016/j.jinf.2020.03.004
Cherry, J. D., & Krogstad, P. (2004, Jul). SARS: the first pandemic of the 21st century. Pediatr Res, 56(1), 1-5. https://doi.org/10.1203/01.PDR.0000129184.87042.FC
Cucinotta, D., & Vanelli, M. (2020, Mar 19). WHO Declares COVID-19 a Pandemic. Acta Biomed, 91(1), 157-160. https://doi.org/10.23750/abm.v91i1.9397
Ferguson, N. D., Fan, E., Camporota, L., Antonelli, M., Anzueto, A., Beale, R., Brochard, L., Brower, R., Esteban, A., Gattinoni, L., Rhodes, A., Slutsky, A. S., Vincent, J. L., Rubenfeld, G. D., Thompson, B. T., & Ranieri, V. M. (2012, Oct). The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med, 38(10), 1573-1582. https://doi.org/10.1007/s00134-012-2682-1
Gao, Y., Li, T., Han, M., Li, X., Wu, D., Xu, Y., Zhu, Y., Liu, Y., Wang, X., & Wang, L. (2020, Jul). Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol, 92(7), 791-796. https://doi.org/10.1002/jmv.25770
Gattinoni, L., Carlesso, E., Taccone, P., Polli, F., Guerin, C., & Mancebo, J. (2010, Jun). Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis. Minerva Anestesiol, 76(6), 448-454. https://www.ncbi.nlm.nih.gov/pubmed/20473258
Gossman, P. (2020). Migrant Workers in Maldives at Added Risk from COVID-19. https://www.hrw.org/news/2020/03/27/migrant-workers-maldives-added-risk-COVID-19
Guerin, C., Reignier, J., Richard, J. C., Beuret, P., Gacouin, A., Boulain, T., Mercier, E., Badet, M., Mercat, A., Baudin, O., Clavel, M., Chatellier, D., Jaber, S., Rosselli, S., Mancebo, J., Sirodot, M., Hilbert, G., Bengler, C., Richecoeur, J., Gainnier, M., Bayle, F., Bourdin, G., Leray, V., Girard, R., Baboi, L., Ayzac, L., & Group, P. S. (2013, Jun 6). Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 368(23), 2159-2168. https://doi.org/10.1056/NEJMoa1214103
Hornuss, D., Lange, B., Schroter, N., Rieg, S., Kern, W. V., & Wagner, D. (2020, May 22). Anosmia in COVID-19 patients. Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2020.05.017
Lu, H., Stratton, C. W., & Tang, Y. W. (2020, Apr). Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol, 92(4), 401-402. https://doi.org/10.1002/jmv.25678
Maldives, U. (2020). Addressing the Socio-Economic Impact of COVID-19 on the Maldives https://www.undp.org/content/dam/undp/library/COVID-19/Maldives Socio-Economic-Impact-Analysis.pdf
Maquet, J., Lafaurie, M., Sommet, A., Moulis, G., Covid-Clinic-Toul investigators, g., Alvarez, M., Amar, J., Attal, M., Balardy, L., Balen, F., Beyne-Rauzy, O., Bouali, O., Bounes, F., Bureau, C., Buscail, L., Calviere, L., Charpentier, S., Chollet, F., Claudet, I., Constantin, A., Debard, A., Delavigne, K., Delobel, P., Delrieu, J., Didier, A., Faruch, M., Fourcade, O., Georges, B., Grunenwald, E., Guyonnet, S., Hanaire, H., Hein, C., Kamar, N., Lairez, O., Mansat, P., Martin-Blondel, G., Minville, V., Pariente, J., Paul, C., Payoux, P., Pugnet, G., Piel-Julian, M. L., Recher, C., Rolland, Y., Ruyssen-Witrand, A., Sabatier, J., Sailler, L., Salles, J. P., Sans, N., Secher, M., Sevely, A., Silva, S., Thalamas, C., & Toulza, O. (2020, Jun 17). Thrombocytopenia is independently associated with poor outcome in patients hospitalized for COVID-19. Br J Haematol. https://doi.org/10.1111/bjh.16950
Ministry of Health, M. First cases of COVID-19 confirmed in the Maldives. https://COVID-19.health.gov.mv/first-cases-of-COVID-19-confirmed-in-the-maldives/
Organization, I. L. (2019). Maldives Anti-Human Trafficking National Action Plan 2015 - 2019. https://www.ilo.org/dyn/natlex/docs/ELECTRONIC/106009/129799/F-669704569/MDV106009.pdf
Pan, F., Ye, T., Sun, P., Gui, S., Liang, B., Li, L., Zheng, D., Wang, J., Hesketh, R. L., Yang, L., & Zheng, C. (2020, Jun). Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology, 295(3), 715-721. https://doi.org/10.1148/radiol.2020200370
Plewa, P. (2018, 2018). Migration in Maldives: A country profile 2018. International Organization for Migration (IOM). publications.iom.int/books/migration-maldives-country-profile-2018 https://publications.iom.int/books/migrationmaldives-country-profile-2018 .
Recalcati, S. (2020, May). Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol, 34(5), e212-e213. https://doi.org/10.1111/jdv.16387
Terpos, E., Ntanasis-Stathopoulos, I., Elalamy, I., Kastritis, E., Sergentanis, T. N., Politou, M., Psaltopoulou, T., Gerotziafas, G., & Dimopoulos, M. A. (2020, Jul). Hematological findings and complications of COVID-19. Am J Hematol, 95(7), 834-847. https://doi.org/10.1002/ajh.25829
University, J. H. (2020). COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) https://www.arcgis.com/apps/opsdashboard/index.html - /bda7594740fd40299423467b48e9ecf6
Vaira, L. A., Deiana, G., Fois, A. G., Pirina, P., Madeddu, G., De Vito, A., Babudieri, S., Petrocelli, M., Serra, A., Bussu, F., Ligas, E., Salzano, G., & De Riu, G. (2020, Jun). Objective evaluation of anosmia and ageusia in COVID-19 patients: Single-center experience on 72 cases. Head Neck, 42(6), 1252-1258. https://doi.org/10.1002/hed.26204
van Doremalen, N., Bushmaker, T., Morris, D. H., Holbrook, M. G., Gamble, A., Williamson, B. N., Tamin, A., Harcourt, J. L., Thornburg, N. J., Gerber, S. I., Lloyd-Smith, J. O., de Wit, E., & Munster, V. J. (2020, Apr 16). Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med, 382(16), 1564-1567. https://doi.org/10.1056/NEJMc2004973
Wang, K., Zuo, P., Liu, Y., Zhang, M., Zhao, X., Xie, S., Zhang, H., Chen, X., & Liu, C. (2020, May 3). Clinical and laboratory predictors of in-hospital mortality in patients with COVID-19: a cohort study in Wuhan, China. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa538
Wang, L. (2020, Jun). C-reactive protein levels in the early stage of COVID-19. Med Mal Infect, 50(4), 332-334. https://doi.org/10.1016/j.medmal.2020.03.007
Wong, H. Y. F., Lam, H. Y. S., Fong, A. H., Leung, S. T., Chin, T. W., Lo, C. S. Y., Lui, M. M., Lee, J. C. Y., Chiu, K. W., Chung, T., Lee, E. Y. P., Wan, E. Y. F., Hung, F. N. I., Lam, T. P. W., Kuo, M., & Ng, M. Y. (2019, Mar 27). Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients. Radiology, 201160. https://doi.org/10.1148/radiol.2020201160
Yu, Y., Xu, D., Fu, S., Zhang, J., Yang, X., Xu, L., Xu, J., Wu, Y., Huang, C., Ouyang, Y., Yang, L., Fang, M., Xiao, H., Ma, J., Zhu, W., Hu, S., Hu, Q., Ding, D., Hu, M., Zhu, G., Xu, W., Guo, J., Xu, J., Yuan, H., Zhang, B., Yu, Z., Chen, D., Yuan, S., & Shang, Y. (2020, May 14). Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study. Crit Care, 24(1), 219. https://doi.org/10.1186/s13054-020-02939-x
Zhang, T., Wu, Q., & Zhang, Z. (2020, Apr 20). Probable Pangolin Origin of SARS-CoV-2 Associated with the COVID-19 Outbreak. Curr Biol, 30(8), 1578. https://doi.org/10.1016/j.cub.2020.03.063
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020, Mar 28). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 395(10229), 1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3