A Simple Mnemonic for Differential Diagnosis of Prolonged Oxygen or Respiratory Support Dependence in COVID-19 Patients

Abstract

The second wave of the novel coronavirus disease-2019 (COVID-19) in India has been more devastating than the first, in terms of a large number of caseloads, spread of infections in the younger population, and increased severity, thereby creating a huge pressure on the healthcare systems. The disease pattern is also different with quite a few patients needing prolonged oxygen or respiratory support.1 Some are getting into this prolonged support-dependent phase even after showing initial signs of improvement. Due to huge caseloads, both primary care physicians and doctors across all specialties (including residents) have to deal with such patients, even in resource-limited areas, where immediate investigations are not always possible. Moreover, transport of support-dependent patients to radiology suits for computer tomography (CT) is also being impossible even in good setups. In this scenario, we would like to propose a simple mnemonic (PE IF AF: pneumonia: non-resolved/ organizing; embolus; infection; fibrosis; airspaces; fluid and failure), so that even junior doctors and doctors across specialties with no formal training in acute medicine (but who have been deployed in acute care due to the pressure exerted by the pandemic on the healthcare system) can approach prolonged oxygen or respiratory support-dependent patients easily in a systematic way, without missing anything (Box 1).