Dr. Michael D. Kritzer: A 57-year-old woman with major depressive disorder and coronavirus disease 2019 (Covid-19) was evaluated at a hospital affiliated with this hospital because she was having delusions that she was dead. The patient had been in her usual state of health until 2 weeks before this presentation, when myalgias, cough, sore throat, nausea, and vomiting developed. She sought evaluation at the primary care clinic of an academic medical center affiliated with this hospital (the two hospitals are part of the same health care system). Nucleic acid testing of a nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, and the patient was instructed to quarantine at home. She lived with her father and assisted him with activities of daily living; he also received a diagnosis of Covid-19. During the following week, the patient’s cough persisted, and new shortness of breath developed. Her symptoms worsened; she felt that she was unable to take care of her father. Emergency medical services were called, and the patient and her father were taken to the emergency department of the other hospital, where they were both admitted for worsening Covid-19 pneumonia. The patient was treated with supplemental oxygen, remdesivir, and dexamethasone. Treatment with rem-desivir was stopped on hospital day 4 when the blood aminotransferase levels increased to three times the upper limit of the normal range.
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