COVID-19, negative nasopharyngeal swab, clinical positivity. 8th of February, 2021 ANTE·MERIDIEM 12:21

I was in the interesting situation over the last few days of dealing with a patient with a recent hospital admission (discharged two weeks previously in the context of a distinct clinical problem), brought in by ambulance with a decreased level of consciousness, dyspnoea, and bilateral pneumonia on chest X-ray, CURB-65 of five. With our pre-test probabilities as they are, he almost certainly has COVID-19, and he improved dramatically on Airvo® treatment (high-flow nasal cannula), after iv dexamethasone, iv antibiotics, and a failed trial of CPAP. His nasopharyngeal swab was negative for COVID-19 (and it was correctly done, I was in the room as it happened), and I write this post to document that the man had a urea of about 48 mmol/litre (about 7 times the upper limit of normal) and was dry as a bone, with skin flaking and dry mucous membranes. From my assessment, the reason the nasopharyngeal swab was negative was because the man was secreting nothing at all from his upper airway, because he had little to no fluid to help with that secretion process, as is not shocking with a severe acute kidney injury.