SEX & GENDER IN EM Sex and Gender Differences in COVID-19 By Lily Gordon on behalf of the SAEM Sex & Gender in Emergency Medicine Interest Group
Case Overview
This case study follows the clinical courses of two individuals suffering from COVID-19 with the goal of understanding how sex and gender impact clinical presentation and outcomes. Each case is composite narrative based on the known patterns of risk factors, clinical presentation, and disease course in cisgender men and women.
Patient Information
Patient Information
Chief Complaint
Chief Complaint
Name: Elijah Cooper Age: 55 Sex: Male Occupation: Real estate agent Confusion with associated cough and fever
History of Present Illness
Elijah noticed that he was starting to feel fatigued about seven days ago. He went to sleep and woke up the next morning with a low-grade fever. Over the next four days he developed a dry cough and his fever persisted, hovering between 100-101 degrees. This morning his wife noticed he seemed confused and took him to the ED.
Past Medical and Social History
SAEM PULSE | NOVEMBER-DECEMBER 2021
Elijah has a past medical history of diabetes and hypertension. He is a current smoker with a 20 pack a year history. He doesn’t drink alcohol.
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Diagnosis
Elijah receives a positive result on a SARs-COV-2 RT- PCR test.
Work-Up and Clinical Course
Elijah’s pulse oximeter reads 88%. His CXR shows bilateral ground-glass opacities in the lower lung lobes. Elijah is started on supplemental oxygen via nasal canula and dexamethasone in the ED. He is quickly admitted to the ICU where he is also given a single dose of Tocilizumab. Over the next 12 hours Elijah develops hypercapnia and the decision to intubate is made on day one of his hospitalization. Elijah is extubated on day 10 of his hospitalization and eventually discharged on day 15.
Name: Olivia James Age: 39 Sex: Female Occupation: Elementary school teacher Dyspnea and fatigue
History of Present Illness
Olivia noticed her food tasted odd about 8 days ago. She went into work that day, and by the end of the day had a throbbing headache and muscle pains. Olivia was concerned and got a rapid COVID test that evening and tested positive. She spent the next five days in quarantine, but her symptoms did not subside. Yesterday she started to feel as though she couldn't quite catch her breath while going upstairs and decided to come into the emergency department today.
Past Medical and Social History
Olivia does not have any active medical conditions. She is overweight with a BMI of 30. She does not smoke and has 1-2 drinks of alcohol on the weekend with friends.
Diagnosis
Olivia receives a positive result on a SARsCOV2 RT-PCR test.
Work-Up and Clinical Course
Olivia’s CXR shows consolidation in the peripheries of the lower lungs bilaterally. She had an SaO2 of 94%. She is put on a high flow nasal canula and started on oral dexamethasone. She is admitted to the hospital and spends three days on supplemental oxygen before being discharged.
