Vol 25, No 1 (2021)

The lecture is devoted to lung damage in new coronavirus infection. The description of the pathogenetic mechanisms of lung damage is given. The characteristics of the morphological changes in the lungs with severe disease and their characteristics are given. Provides information on instrumental and laboratory diagnosis of lung lesions in COVID-19. Particular attention is paid to highlighting controversial and complex issues of managing patients with lung damage in COVID-19 in outpatient practice. In particular, controversial issues of terminology for defining lung damage, the complexity of differentiating viral lung damage and other causes, the complexity of diagnosing bacterial superinfection and its treatment. Aspects of patient management important for primary care physician are highlighted: current treatment regimens for COVID-19 patients with lung damage, the timing of the control X-ray examination. It provides information on the most common mistakes encountered in the management of patients with COVID-19 (over-prescribing radiation methods, over-prescribing antibacterial medications).

INTRODUCTION: The sudden appearance of a new coronavirus infection in the world has posed difficult challenges for science to determine the main clinical manifestations of this disease, as well as to approve standards for diagnosis, treatment and prevention. Research of the symptoms of mild COVID-19 is continuing. The data obtained in such studies are particularly relevant for primary care physicians.

THE AIM: To evaluate the features of the clinical course of COVID-19 among students of the North-Western State Medical University named after I.I. Mechnikov, placed in the observatory, during the first and second waves of rising morbidity.

MATERIALS AND METHODS: The study was conducted on the basis of the observatory of the NWSMU named after I.I. Mechnikov in two stages: in the period from 21.04.2020 to 31.08.2020 (the first wave) and from 16.09.2020 to 31.12.2020 (the second wave). Demographic, epidemiological, and clinical-anamnestic data were recorded in all participants of the study.

RESULTS: The study involved 309 people: 39.8% men (n = 123) and 58.9% women (n = 182). The average age of the respondents was 21.5 ± 2.6 years. The number of participants in the first and second waves was 113 and 196 people, respectively. The average age of participants with COVID-19 in the first wave was 1.5 years less and was 21.2 ± 2.5 years (р < 0.001). There was a significant increase in the frequency of the following symptoms: dry cough, loss of smell, headache, general weakness, increased body temperature to 38.0 °С, nasal congestion (р < 0.05) in students who were monitored in the second wave of increased incidence of COVID-19 compared to the first. The frequency of symptoms such as chest congestion, lower back pain, and fever above 38.0 °С significantly decreased (р < 0.05). There was a significant decrease in the incidence of viral pneumonia in patients who were observed during the second wave, compared with the data obtained during the first wave (р < 0.001).

This publication is a continuation of the article published in the 4^th issue of the journal Russian family doctor for 2020 “Heuristics, language and medical errors”, which described the ways of making medical decisions that can lead to errors in patient management tactics, in particular “affect of heuristics / visceral bias”, “attribution error”, “frame of reference”, “availability bias”, “one-word-one-meaning-fallacy”. This article discusses additional sources of diagnostic error, including “diagnosis momentum”, “confirmation bias”, “representativeness”, and “premature closure” also the conflict that arises from diagnostic uncertainty is discussed. All errors in the tactics and the diagnostic process are illustrated by clinical cases from the personal practice of the author of the article.