Coronavirus disease 2019: a revolution in biological triage in the emergency setting

Main Article Content

Shahram Manoochehry
Fatemeh Saboori
Mehrdad Faraji
Mohammad Javad Behzadnia


Triage is a familiar concept for all who work at the forefront of the treatment of patients and the emergency medical staff know their duty in different situations including crisis and epidemics. Accordingly, the coronavirus outbreak has also a major effect on the emergency department (ED) as it changes the routine ED function. Our main question was what are the main triage challenges in the recent pandemic and how we could overcome these challenges? Therefore, a search of the main Web databases was performed for articles published till May 1st, 2020 using various related keywords. In various steps, the title, summary, methodology, results, and discussion of the selected studies were assessed to find out the recent triage strategies in the COVID-19 outbreak. Hence, all the available and related English review articles, case series, and experimental studies were evaluated. Among 200 studies initially reviewed, 59 met the study criteria for the final assessment. COVID-19 puts a significant load on public health services and potential damage to social and psychiatric situations by marked morbidity and mortality. In line with the various presentations and according to the changing of the COVID-19 epidemic to a worldwide pandemic problem, the management and treatment protocols changed several times. Accordingly, the local and even global hospital protocols were changed as well. The first simple concept of coronavirus triage in an emergency department is the separation of COVID-19 infected patients from the others. This approach has been practiced around the world. Changing the ED layout from a usual triage or fast track set to an isolated room is necessary for such a pandemic situation. It is very important to consider staff communication and the application of PPE. All the efforts should be taken to protect patients as well as the medical staff from unnecessary exposure and infection; this serves to keep the health facilities working well in the outbreak and diffusion of SARS-CoV-2.

Article Details

How to Cite
Manoochehry, S., Saboori, F., Faraji, M., & Behzadnia, M. J. (2020). Coronavirus disease 2019: a revolution in biological triage in the emergency setting. Universa Medicina, 39(3), 212–223.
Review Article


Hassan A, Arora RC, Adams C, et al. on behalf of the Canadian Society of Cardiac Surgeons, Cardiac surgery in Canada during the COVID-19 pandemic: a guidance statement from the Canadian Society of Cardiac Surgeons. Can J Cardiol 2020;36:952-5. DOI:

Ross SW, Lauer CW, Miles WS, et al. Maximizing the calm before the storm: Tiered surgical response plan for novel coronavirus (COVID-19). J Am Coll Surg 2020;230:1080-91.e3. doi: 10.1016/j.jamcollsurg.2020.03.019.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklist.

Alfaraj SH, Al-Tawfiq JA, Gautret P, Alenazi MG, Asiri AY, Memishet ZA. Evaluation of visual triage for screening of Middle East respiratory syndrome coronavirus patients. New Microbes New Infect 2018;26:49-52. doi: 10.1016/j.nmni. 2018.08.008.

Civantos FJ, Leibowitz JM, Arnold DJ, et al. Ethical surgical triage of head and neck cancer patients during the COVID-19 pandemic. Head Neck 2020;1-25.10.1002/hed.26229. doi: 10.1002/hed. 26229.

Valenza F, Papagni G, Marchianò A, et al. Response of a comprehensive cancer center to the COVID-19 pandemic: the experience of the Fondazione IRCCS-Istituto Nazionale dei Tumori di Milano. Tumori J 2020:1-10. doi: 10.1177/0300891620923790.

Wang Q, Wang X, Lin H. The role of triage in the prevention and control of COVID-19. Infect Control Hosp Epidemiol 2020;1-5. doi: 10.1017/ice.2020.185.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, and the Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323:2052-9. doi:10.1001/jama.2020.6775.

Korupolu R, Stampas A, Gibbons C, Jimenez IH, Skelton F, Verduzco-Gutierrezet M. COVID-19: screening and triage challenges in people with disability due to spinal cord injury. Spinal Cord Ser Cases 2020;6:35.

Wollina U, Karadað AS, Rowland-Payne C, Chiriac A, Lotti T. Cutaneous signs in COVID-19 patients: a review. Dermatol Ther 2020;e13549. doi: 10.1111/dth.13549.

Werner C, Scullen T, Mathkour M, et al. Neurological impact of coronavirus disease (COVID-19): practical considerations for the neuroscience community. World Neurosurg 2020;139:344–54. doi: 10.1016/j.wneu.2020.04.222.

Turcato G, Zaboli A, Pfeifer N. The COVID-19 epidemic and reorganisation of triage, an observational study. Intern Emerg Med 2020;15: 1517–24.

Chen S, Zhang Z, Yang J, et al. Fangcang shelter hospitals: a novel concept for responding to public health emergencies. Lancet 2020;395:1305-14. DOI: -3.

Carenzo L, Costantini E, Greco M, et al. Hospital surge capacity in a tertiary emergency referral centre during the COVID-19 outbreak in Italy. Anaesthesia 2020;75:928–34. doi:10.1111/anae. 15072.

Li Y, Zeng L, Li Z, et al. Emergency trauma care during the outbreak of corona virus disease 2019 (COVID-19) in China. World J Emerg Surg 2020;15: 33.

Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. J Craniomaxillofac Surg 2020;48:521-6.

Sprung CL, Joynt GM, Christian MD, Truog RD, Rello J, Nates JL. Adult ICU triage during the coronavirus disease 2019 pandemic: who will live and who will die? Recommendations to improve survival. Crit Care Med 2020;48:1196–202. doi: 10.1097/CCM.0000000000004410.

Nasir MU, Roberts J, Muller NL, et al. The role of emergency radiology in COVID-19: from preparedness to diagnosis. Can Assoc Radiol J 2020; 71:293-300. DOI: 10.1177/0846537120916419.

Simonato A, Giannarini G, Abrate A, et al. Clinical pathways for urology patients during the COVID-19 pandemic. Minerva Urol Nefrol 2020;72:376-83. doi: 10.23736/S0393-2249.20.03861-8.

Zou J, Yu H, Song D, Niu J , Yang H. Advice on standardized diagnosis and treatment for spinal diseases during the coronavirus disease 2019 pandemic. Asian Spine J 2020;14:258-63. DOI: 10.31616/asj.2020.0122.

de Marinis F, Attili I, Morgantiet S, et al. Results of multilevel containment measures to better protect lung cancer patients from COVID-19: the IEO model. Front Oncol 2020;10:665. doi: 10.3389/fonc.2020.00665.

Chen Y, Li Z, Zhang YY, Zhao WH , Yu ZY. Maternal health care management during the outbreak of coronavirus disease 2019. J Med Virol 2020;92:731-9. doi: 10.1002/jmv.25787.

Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol 2020;75:2352-71. DOI: 10.1016/j.jacc.2020.03.031.

Mobaraki K, Ahmadzadeh J. Current epidemiological status of Middle East respiratory syndrome coronavirus in the world from 1.1.2017 to 17.1.2018: a cross-sectional study. BMC Infect Dis 2019;19:351.

Tan KA, Thadani VN, Chan D, Oh JYL, Liu GKP. Addressing coronavirus disease 2019 in spine surgery: a rapid national consensus using the Delphi method via teleconference. Asian Spine J 2020;14:373-81. 0224.

Lai THT, Tang EWH, Chau SKY, Fung KSC, Li KKW. Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong. Graefes Arch Clin Exp Ophthalmol 2020;258:1049-55. doi: 10.1007/s00417-020-04641-8.

Modi PD, Nair G, Uppe A, et al. COVID-19 awareness among healthcare students and professionals in Mumbai Metropolitan Region: a questionnaire-based survey. Cureus 2020;12: e7514. doi: 10.7759/cureus.7514.

Maudet L, Sarasin F, Dami F, Carron PN, Pasquier M. Emergency medical services: COVID-19 crisis. Rev Med Suisse 2020;16(Nº 691-2):810-4.

Balkhy HH, Perl TM, Arabi YM. Preventing health care-associated transmission of the Middle East Respiratory Syndrome (MERS): our Achilles heel. J Infect Public Health 2016;9:208-12.

Al-Tawfiq JA, Rothwell S, Mcgregor HA, Khouri ZA. A multi-faceted approach of a nursing led education in response to MERS-CoV infection. J Infect Public Health 2018;11:260-4. doi: 10.1016/j.jiph.2017.08.006.

Park GE, Kang CI, Koet JH, et al. Differential cell count and CRP level in blood as predictors for Middle East respiratory syndrome coronavirus infection in acute febrile patients during nosocomial outbreak. J Korean Med Sci 2017;32: 151-4. doi: 10.3346/jkms.2017.32.1.151.

Dudea SM. Ultrasonography and SARS-CoV 2 infection: a review of what we know and do not yet know. Med Ultrason 2020;22:129-32. doi: 10.11152/mu-2612.

Li Q, Ding X, Xia G, et al. Eosinopenia and elevated C-reactive protein facilitate triage of COVID-19 patients in fever clinic: a retrospective case-control study. EClinicalMedicine 2020;23: 100375. DOI:

Varughese S, Read JGb, Al-khal AL, Saleh SA, El Deeb Y, Camerona PA. Effectiveness of the Middle East respiratory syndrome-coronavirus protocol in enhancing the function of an emergency department in Qatar. Eur J Emerg Med 2015;22:316-20. doi: 10.1097/MEJ.0000000000000285.

Her M. How Is COVID-19 affecting South Korea? What is our current strategy? Disaster Med Public Health Prep 2020:1-3. doi: 10.1017/dmp.2020.69.

Tran DL, Lai SR, Salah RY, et al. Rapid de-escalation and triaging patients in community-based palliative care. J Pain Symptom Manage 2020;60:e45–47. doi: 10.1016/j.jpainsymman.2020. 03.040.

Krausz M, Westenberg JN, Vigo D, Spence RT, Ramsey D. Emergency response to COVID-19 in Canada: platform development and implementation for eHealth in crisis management. JMIR Public Health Surveill 2020;6:e18995. doi: 10.2196/18995.

Montesi G, Biase SD, Chierchini S, et al. Radiotherapy during COVID-19 pandemic. How to create a no fly zone: a Northern Italy experience. Radiol Med 2020:1–4. doi: 10.1007/s11547-020-01217-8.

Judson TJ, Odisho AY, Neinstein AB, et al. Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19. J Am Med Inform Assoc 2020;27:860-6. doi: 10.1093/jamia/ocaa051.

Alwashmi MF. The use of digital health in the detection and management of COVID-19. Int J Environ Res Public Health 2020;17:2906.

John O. Video consultations for triage of patients with covid-19. BMJ 2020;369:m1583. doi:

Indini A, Aschele C, Cavanna L, et al. Reorganisation of medical oncology departments during the novel coronavirus disease-19 pandemic: a nationwide Italian survey. Eur J Cancer 2020;132:17-23. doi: 10.1016/j.ejca.2020. 03.024.

Bonavita S, Tedeschi G, Atreja A, Lavorgna L. Digital triage for people with multiple sclerosis in the age of COVID-19 pandemic. Neurol Sci 2020;41:1007-9. doi: 10.1007/s10072-020-04391-9.

Moazzami B, Khorasani NR, Moghadam AD, Farokhi E, Rezaei N. COVID-19 and telemedicine: Immediate action required for maintaining healthcare providers well-being. J Clin Virol 2020; 126:104345. doi: 10.1016/j.jcv.2020.104345.

Costantini M, Sleeman KE, Peruselli C, Higginson IJ. Response and role of palliative care during the COVID-19 pandemic: a national telephone survey of hospices in Italy. Palliat Med 2020;34:889-95. doi: 10.1177/0269216320920780.

Etkind SN, Bone AE, Lovell N, et al. The role and response of palliative care anh Hospice services in epidemics and pandemics: a rapid review to inform practice during the COVID-19 pandemic. J Pain Symptom Manage 2020;60:e31-40. doi: 10.1016/j.jpainsymman.2020.03.029.

Taheri MS, Falahati F, Alireza Radpour A, et al. Role of social media and telemedicine in diagnosis & management of COVID-19: an experience of the Iranian Society of Radiology. Arch Iran Med 2020;23:285-86. doi: 10.34172/aim.2020.15.

Moshayedi P, Ryan TE, Mejia LLP, Nour M, Liebeskind DS. Triage of acute ischemic stroke in confirmed COVID-19: large vessel occlusion associated with coronavirus infection. Front Neurol 2020;11:353. doi: 10.3389/fneur.2020.00353.

Oh MD, Choe PG, Oh HS, et al. Middle East respiratory syndrome coronavirus superspreading event involving 81 persons, Korea 2015. J Korean Med Sci 2015;30:1701-5. doi: 10.3346/jkms.2015.30.11.1701.

Agalar C, Engin DO, Protective measures for COVID-19 for healthcare providers and laboratory personnel. Turk J Med Sci 2020;50(Si-1):578-84. doi: 10.3906/sag-2004-132.

Pulia MS, O’Brien TP, Hou PC, Schuman A, Sambursky R. Multi-tiered screening and diagnosis strategy for COVID-19: a model for sustainable testing capacity in response to pandemic. Ann Med 2020;52:207-14. doi: 10.1080/07853890.2020.1763449.