Coronavirus disease 2019

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Coronavirus disease 2019 (COVID-19)
Other names
  • Coronavirus
  • Corona
  • COVID
  • 2019-nCoV acute respiratory disease
  • Sars-Cov
  • Novel coronavirus pneumonia [1] [2]
  • Severe pneumonia with novel pathogens [3]
Novel Coronavirus SARS-CoV-2.jpg
Pronunciation
Specialty Infectious disease
SymptomsFever, cough, fatigue, shortness of breath, loss of smell; sometimes no symptoms at all [5] [6]
Complications Pneumonia, viral sepsis, acute respiratory distress syndrome, kidney failure, cytokine release syndrome
Usual onset2–14 days (typically 5) from infection
Causes Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Risk factors Travel, viral exposure
Diagnostic method rRT-PCR testing, CT scan
Prevention Hand washing, face coverings, quarantine, social distancing [7]
Treatment Symptomatic and supportive
Frequency11,187,193 [8] confirmed cases
Deaths528,364 (4.7% of confirmed cases) [8]

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). [9] It was first identified in December 2019 in Wuhan, Hubei, China, and has resulted in an ongoing pandemic. [10] [11] The first confirmed case has been traced back to 17 November 2019 in Hubei. [12] As of 5 July 2020, more than 11.1 million cases have been reported across 188 countries and territories, resulting in more than 528,000 deaths. More than 6.03 million people have recovered. [8]

Contents

Common symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste. [13] [5] [6] [14] While the majority of cases result in mild symptoms, some progress to acute respiratory distress syndrome (ARDS) possibly precipitated by cytokine storm, [15] multi-organ failure, septic shock, and blood clots. [16] [17] [18] The time from exposure to onset of symptoms is typically around five days, but may range from two to fourteen days. [5] [19]

The virus is primarily spread between people during close contact, [lower-alpha 1] most often via small droplets produced by coughing, [lower-alpha 2] sneezing, and talking. [6] [20] [22] The droplets usually fall to the ground or onto surfaces rather than travelling through air over long distances. [6] However, research as of June 2020 has shown that speech-generated droplets may remain airborne for tens of minutes. [23] Less commonly, people may become infected by touching a contaminated surface and then touching their face. [6] [20] It is most contagious during the first three days after the onset of symptoms, although spread is possible before symptoms appear, and from people who do not show symptoms. [6] [20] The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab. [24] Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using CT imaging for routine screening. [25] [26]

Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), quarantine (especially for those with symptoms), covering coughs, and keeping unwashed hands away from the face. [7] [27] [28] The use of cloth face coverings such as a scarf or a bandana has been recommended by health officials in public settings to minimise the risk of transmissions, with some authorities requiring their use. [29] [30] Health officials also stated that medical-grade face masks, such as N95 masks, should only be used by healthcare workers, first responders, and those who directly care for infected individuals. [31] [32]

There are no vaccines nor specific antiviral treatments for COVID-19. [6] Management involves the treatment of symptoms, supportive care, isolation, and experimental measures. [33] The World Health Organization (WHO) declared the COVID‑19 outbreak a public health emergency of international concern (PHEIC) [34] [35] on 30 January 2020 and a pandemic on 11 March 2020. [11] Local transmission of the disease has occurred in most countries across all six WHO regions. [36]

Video summary (script)

Signs and symptoms

Symptoms of COVID-19 [37]
SymptomRange
Fever83–99%
Cough59–82%
Loss of appetite40–84%
Fatigue44–70%
Shortness of breath31–40%
Coughing up sputum28–33%
Muscle aches and pains11–35%
Symptoms of COVID-19. Symptoms of coronavirus disease 2019 4.0.svg
Symptoms of COVID-19.

Fever is the most common symptom of COVID-19, [13] but is highly variable in severity and presentation, with some older, immunocompromised, or critically ill people not having fever at all. [38] [39] In one study, only 44% of people had fever when they presented to the hospital, while 89% went on to develop fever at some point during their hospitalization. [40]

Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains. [13] [1] [5] [41] Symptoms such as nausea, vomiting, and diarrhoea have been observed in varying percentages. [42] [43] [44] Less common symptoms include sneezing, runny nose, sore throat, and skin lesions. [45] Some cases in China initially presented with only chest tightness and palpitations. [46] A decreased sense of smell or disturbances in taste may occur. [47] [48] Loss of smell was a presenting symptom in 30% of confirmed cases in South Korea. [14] [49]

As is common with infections, there is a delay between the moment a person is first infected and the time he or she develops symptoms. This is called the incubation period. The typical incubation period for COVID‑19 is five or six days, but it can range from one to fourteen days [6] [50] with approximately ten percent of cases taking longer. [51] [52] [53]

An early key to the diagnosis is the tempo of the illness. Early symptoms may include a wide variety of symptoms but infrequently involves shortness of breath. Shortness of breath usually develops several days after initial symptoms. Shortness of breath that begins immediately along with fever and cough is more likely to be anxiety than COVID-19. The most critical days of illness tend to be those following the development of shortness of breath. [54]

A minority of cases do not develop noticeable symptoms at any point in time. [55] These asymptomatic carriers tend not to get tested, and their role in transmission is not fully known. [56] [57] Preliminary evidence suggested they may contribute to the spread of the disease. [58] In June 2020, a spokeswoman of WHO said that asymptomatic transmission appears to be "rare," but the evidence for the claim was not released. [59] The next day, WHO clarified that they had intended a narrow definition of "asymptomatic" that did not include pre-symptomatic or paucisymptomatic (weak symptoms) transmission and that up to 41% of transmission may be asymptomatic. Transmission without symptoms does occur. [55]

Complications

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. [10] [16] [60] [61] Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. [62]

A study published in The New England Journal of Medicine concluded that "the risk for severe COVID-19 was 45% higher for people with type A blood than those with other blood types." [63] [64]

Approximately 20-30% of people who present with COVID‑19 have elevated liver enzymes reflecting liver injury. [65] [66]

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). [67] Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. [68] [69]

Cause

Transmission

Respiratory droplets produced when a man sneezes, visualised using Tyndall scattering Sneeze.JPG
Respiratory droplets produced when a man sneezes, visualised using Tyndall scattering

COVID-19 spreads primarily when people are in close contact and one person inhales small droplets produced by an infected person (symptomatic or not) coughing, sneezing, talking, or singing. [22] [70] The WHO recommends 1 metre (3 ft) of social distance; [6] the U.S. Centers for Disease Control and Prevention (CDC) recommends 2 metres (6 ft). [20] People can transmit the virus without showing symptoms, but it is unclear how often this happens. [6] [20] [22] A June 2020 review found the likelihood of those infected that are asymptomatic to be 40-45%. [71]

People are most infectious when they show symptoms (even mild or non-specific symptoms), but may be infectious for up to two days before symptoms appear (pre-symptomatic transmission). [22] They remain infectious an estimated seven to twelve days in moderate cases and an average of two weeks in severe cases. [22]

When the contaminated droplets fall to floors or surfaces they can, though less commonly, remain infectious if people touch contaminated surfaces and then their eyes, nose or mouth with unwashed hands. [6] On surfaces the amount of active virus decreases over time until it can no longer cause infection, [22] and surfaces are thought not to be the main way the virus spreads. [20] It is unknown what amount of virus on surfaces is required to cause infection via this method, but it can be detected for up to four hours on copper, up to one day on cardboard, and up to three days on plastic (polypropylene) and stainless steel (AISI 304). [22] [72] [73] Surfaces are easily decontaminated with household disinfectants which kill the virus outside the human body or on the hands. [6] Disinfectants or bleach are not a treatment for COVID‑19, and cause health problems when not used properly, such as when used inside the human body. [74]

Sputum and saliva carry large amounts of virus. [6] [20] [22] [75] Although COVID‑19 is not a sexually transmitted infection, kissing, intimate contact, and faecal-oral routes are suspected to transmit the virus. [76] [77] Some medical procedures are aerosol-generating, [78] and result in the virus being transmitted more easily than normal. [6] [22]

COVID‑19 is a new disease, and many of the details of its spread are still under investigation. [6] [20] [22] It spreads easily between people—easier than influenza but not as easily as measles. [20] Estimates of the number of people infected by one person with COVID-19 (the R0) have varied widely. The WHO's initial estimates of the R0 were 1.4-2.5 (average 1.95), however a more recent[ when? ] review found the basic R0 (without control measures) to be higher at 3.28 and the median R0 to be 2.79. [79]

The virus may occur in breast milk, but it's unknown whether it's infectious and transmittable to the baby. [80] [81]

Virology

Illustration of SARSr-CoV virion Coronavirus virion structure.svg
Illustration of SARSr-CoV virion

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. [82] All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature. [83] Outside the human body, the virus is killed by household soap, which bursts its protective bubble. [25]

SARS-CoV-2 is closely related to the original SARS-CoV. [84] It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus , in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). [45] In February 2020, Chinese researchers found that there is only one amino acid difference in the binding domain of the S protein between the coronaviruses from pangolins and those from humans; however, whole-genome comparison to date[ when? ] found that at most 92% of genetic material was shared between pangolin coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be the intermediate host. [85]

Pathophysiology

The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. [86] The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. [87] The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested decreasing ACE2 activity might be protective, [88] [89] [ unreliable medical source? ] though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. [90] As the alveolar disease progresses, respiratory failure might develop and death may follow. [89] [ unreliable medical source? ]

SARS-CoV-2 may also cause respiratory failure through affecting the brainstem as other coronaviruses have been found to invade the central nervous system (CNS). While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. [91] [92] [ unreliable medical source? ]

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium [93] as well as endothelial cells and enterocytes of the small intestine. [94] [ unreliable medical source? ]

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. [95] An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, [43] and is more frequent in severe disease. [96] [ unreliable medical source? ] Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. [95] ACE2 receptors are highly expressed in the heart and are involved in heart function. [95] [97] A high incidence of thrombosis (31%) and venous thromboembolism (25%) have been found in ICU patients with COVID‑19 infections, and may be related to poor prognosis. [98] [ unreliable medical source? ] [99] [ unreliable medical source? ] Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in patients infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. [100] [ better source needed ]

Another common cause of death is complications related to the kidneys. [100] [ better source needed ] Early reports show that up to 30% of hospitalized patients in both China and New York have experienced some injury to their kidneys, including some persons with no previous kidney problems. [101]

Autopsies of people who died of COVID‑19 have found diffuse alveolar damage (DAD), and lymphocyte-containing inflammatory infiltrates within the lung. [102] [ unreliable medical source? ]

Immunopathology

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, patients with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology. [43]

Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin. [103]

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in COVID‑19 patients.[ citation needed ] Lymphocytic infiltrates have also been reported at autopsy. [102] [ unreliable medical source? ]

Diagnosis

Demonstration of a nasopharyngeal swab for COVID-19 testing Infektionsschutzzentrum im Rautenstrauch-Joest-Museum, Koln-6313 (cropped).jpg
Demonstration of a nasopharyngeal swab for COVID-19 testing
CDC rRT-PCR test kit for COVID-19 CDC 2019-nCoV Laboratory Test Kit.jpg
CDC rRT-PCR test kit for COVID-19

The WHO has published several testing protocols for the disease. [105] The standard method of testing is real-time reverse transcription polymerase chain reaction (rRT-PCR). [106] The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. [24] [107] Results are generally available within a few hours to two days. [108] [109] Blood tests can be used, but these require two blood samples taken two weeks apart, and the results have little immediate value. [110] Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the world could independently develop polymerase chain reaction (PCR) tests to detect infection by the virus. [10] [111] [112] As of 4 April 2020, antibody tests (which may detect active infections and whether a person had been infected in the past) were in development, but not yet widely used. [113] [114] [115] The Chinese experience with testing has shown the accuracy is only 60 to 70%. [116] The US Food and Drug Administration (FDA) approved the first point-of-care test on 21 March 2020 for use at the end of that month. [117]

Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying people who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected people: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count. [118]

A study asked hospitalised COVID‑19 patients to cough into a sterile container, thus producing a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has the potential of being quicker than a swab and involving less risk to health care workers (collection at home or in the car). [75]

Along with laboratory testing, chest CT scans may be helpful to diagnose COVID‑19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. [25] [26] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. [25] Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. [25] [119]

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID‑19 without lab-confirmed SARS-CoV-2 infection. [120]

COVID19CT2.webp
Typical CT imaging findings
COVID19CT1.webp
CT imaging of rapid progression stage

Pathology

Few data are available about microscopic lesions and the pathophysiology of COVID‑19. [121] [122] The main pathological findings at autopsy are:[ citation needed ]

Prevention

Without pandemic containment measures--such as social distancing, vaccination, and use of face masks--pathogens can spread exponentially. This graphic shows how early adoption of containment measures tends to protect wider swaths of the population. 20200609 Effect of pandemic containment measures.gif
Without pandemic containment measures—such as social distancing, vaccination, and use of face masks—pathogens can spread exponentially. This graphic shows how early adoption of containment measures tends to protect wider swaths of the population.
Progressively stronger mitigation efforts to reduce the number of active cases at any given time--"flattening the curve"--allows healthcare services to better manage the same volume of patients. Likewise, progressively greater increases in healthcare capacity--called raising the line--such as by increasing bed count, personnel, and equipment, helps to meet increased demand. 20200410 Flatten the curve, raise the line - pandemic (English).gif
Progressively stronger mitigation efforts to reduce the number of active cases at any given time—"flattening the curve"—allows healthcare services to better manage the same volume of patients. Likewise, progressively greater increases in healthcare capacity—called raising the line—such as by increasing bed count, personnel, and equipment, helps to meet increased demand.
Mitigation attempts that are inadequate in strictness or duration--such as premature relaxation of distancing rules or stay-at-home orders--can allow a resurgence after the initial surge and mitigation. 20200409 Pandemic resurgence - effect of inadequate mitigation.gif
Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of distancing rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation.

A COVID-19 vaccine is not expected until 2021 at the earliest. [132] The U.S. National Institutes of Health guidelines do not recommend any medication for prevention of COVID‑19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. [133] [66] Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID‑19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". [128] This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available. [128] [131]

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands. [134] [135] [136] [137]

The CDC and WHO recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. [138] [29] [139] This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symtomatic individuals and is complementary to established preventive measures such as social distancing. [29] [140] Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. [29] [140] Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus. [141] [142] [143] [144]

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. [145] When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. [135] Proper hand hygiene after any cough or sneeze is encouraged. [135]

Social distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel, and cancelling large public gatherings. [146] Distancing guidelines also include that people stay at least 6 feet (1.8 m) apart. [147] After the implementation of social distancing and stay-at-home orders, many regions have been able to sustain an effective transmission rate ("Rt") of less than one, meaning the disease is in remission in those areas. [148]

The CDC also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose, coughing or sneezing. The CDC further recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. [135] For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant. [149]

Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items. [31] [150]

Management

People are managed with supportive care, which may include fluid therapy, oxygen support, and supporting other affected vital organs. [151] [152] [153] The CDC recommends those who suspect they carry the virus wear a simple face mask. [31] Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.[ citation needed ] [154] Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity. [155] Supportive treatments may be useful in those with mild symptoms at the early stage of infection. [156]

The WHO, the Chinese National Health Commission, and the United States' National Institutes of Health have published recommendations for taking care of people who are hospitalised with COVID‑19. [133] [157] [158] Intensivists and pulmonologists in the U.S. have compiled treatment recommendations from various agencies into a free resource, the IBCC. [159] [160]

Prognosis

Severity-of-coronavirus-cases-in-China-1.png
The severity of diagnosed COVID-19 cases in China [161]
COVID-CFR-by-age-CN-KR-ES-IT-latest-nolegend.svg
Case fatality rates by age group:
  China, as of 11 February 2020 [162]
  South Korea, as of 5 June 2020 [163]
  Spain, as of 18 May 2020 [164]
  Italy, as of 3 June 2020 [165]
Comorbidity and severity in covid-19 data from China CDC Weekly 2020, 2(8), pp. 113-122 (cropped).png
Case fatality rate in China depending on other health problems. Data through 11 February 2020. [162]
Covid-19-total-confirmed-cases-vs-total-confirmed-deaths.svg
The number of deaths vs total cases by country and approximate case fatality rate [166]

The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. [45]

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. [22] They are likely to have milder symptoms and a lower chance of severe disease than adults. In those younger than 50 years the risk of death is less than 0.5%, while in those older than 70 it is more than 8%. [167] [168] [169] Pregnant women may be at higher risk of severe COVID‑19 infection based on data from other similar viruses, like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), but data for COVID‑19 is lacking. [170] [171] According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, [172] [173] air pollution is similarly associated with risk factors, [173] and obesity contributes to an increased health risk of COVID-19. [173] [174] [175]

Case fatality rates (%) by age and country
Age
Country0–910–1920–2930–3940–4950–5960–6970–7980–8990+
Argentina as of 7 May [176] 0.00.00.10.41.33.612.918.828.4
Australia as of 4 June [177] 0.00.00.00.00.10.21.14.118.140.8
Canada as of 3 June [178] 0.00.10.711.230.7
    Alberta as of 3 June [179] 0.00.00.10.10.10.21.911.930.8
    Br. Columbia as of 2 June [180] 0.00.00.00.00.50.84.612.333.833.6
    Ontario as of 3 June [181] 0.00.00.10.20.51.55.617.726.033.3
    Quebec as of 2 June [182] 0.00.10.10.21.16.121.430.436.1
Chile as of 31 May [183] [184] 0.10.30.72.37.715.6
China as of 11 February [162] 0.00.20.20.20.41.33.68.014.8
Colombia as of 3 June [185] 0.30.00.20.51.63.49.418.125.635.1
Denmark as of 4 June [186] 0.24.116.528.148.2
Finland as of 4 June [187] 0.00.0<0.4<0.4<0.50.83.818.142.3
Germany as of 5 June [188] 0.00.00.11.919.731.0
   Bavaria as of 5 June [189] 0.00.00.10.10.20.95.415.828.035.8
Israel as of 3 May [190] 0.00.00.00.90.93.19.722.930.831.3
Italy as of 3 June [191] 0.30.00.10.30.92.710.625.932.429.9
Japan as of 7 May [192] 0.00.00.00.10.30.62.56.814.8
Mexico as of 3 June [193] 3.30.61.22.97.515.025.333.740.340.6
Netherlands as of 3 June [194] 0.00.20.10.30.51.78.125.633.334.5
Norway as of 4 June [195] 0.00.00.00.00.30.42.29.022.757.0
Philippines as of 4 June [196] 1.60.90.50.82.45.513.220.931.5
Portugal as of 3 June [197] 0.00.00.00.00.31.33.610.521.2
South Africa as of 28 May [198] 0.30.10.10.41.13.89.215.012.3
South Korea as of 15 June [199] 0.00.00.00.20.20.72.610.125.6
Spain as of 17 May [164] 0.20.30.20.30.61.44.914.321.022.3
Sweden as of 5 June [200] 0.50.00.20.20.61.76.623.435.640.3
Switzerland as of 4 June [201] 0.60.00.00.10.10.63.411.628.2
United States
    Colorado as of 3 June [202] 0.20.20.20.20.81.96.218.539.0
    Connecticut as of 3 June [203] 0.20.10.10.30.71.87.018.031.2
    Georgia as of 3 June [204] 0.00.10.50.92.06.113.222.0
    Idaho as of 3 June [205] 0.00.00.00.00.00.43.18.931.4
    Indiana as of 3 June [206] 0.10.10.20.61.87.317.130.2
    Kentucky as of 20 May [207] 0.00.00.00.20.51.95.914.229.1
    Maryland as of 20 May [208] 0.00.10.20.30.71.96.114.628.8
    Massachusetts as of 20 May [209] 0.00.00.10.10.41.55.216.828.9
    Minnesota as of 13 May [210] 0.00.00.00.10.31.65.426.9
    Mississippi as of 19 May [211] 0.00.10.50.92.18.116.119.427.2
    Missouri as of 19 May [212] 0.00.00.10.20.82.26.314.322.5
    Nevada as of 20 May [213] 0.00.30.30.41.72.67.722.3
    N. Hampshire as of 12 May [214] 0.00.00.40.01.20.02.212.021.2
    Oregon as of 12 May [215] 0.00.00.00.00.50.85.612.128.9
    Texas as of 20 May [216] 0.00.50.40.30.82.15.510.130.6
    Virginia as of 19 May [217] 0.00.00.00.10.41.04.412.924.9
    Washington as of 10 May [218] 0.00.21.39.831.2
    Wisconsin as of 20 May [219] 0.00.00.20.20.62.05.014.719.930.4

Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful in early screening for severe illness. [220]

Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. [221] The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 97% of people had at least one comorbidity with the average person having 2.7 diseases. [222] According to the same report, the median time between the onset of symptoms and death was ten days, with five being spent hospitalised. However, people transferred to an ICU had a median time of seven days between hospitalisation and death. [222] In a study of early cases, the median time from exhibiting initial symptoms to death was 14 days, with a full range of six to 41 days. [223] In a study by the National Health Commission (NHC) of China, men had a death rate of 2.8% while women had a death rate of 1.7%. [224] In 11.8% of the deaths reported by the National Health Commission of China, heart damage was noted by elevated levels of troponin or cardiac arrest. [46] According to March data from the United States, 89% of those hospitalised had preexisting conditions. [225]

The availability of medical resources and the socioeconomics of a region may also affect mortality. [226] Concerns have been raised about long-term sequelae of the disease. The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage. [227] This may also lead to post-intensive care syndrome following recovery. [228]

History

The virus is thought to be natural and has an animal origin, [83] through spillover infection. [229] The first known human infections were in China. A study of the first 41 cases of confirmed COVID‑19, published in January 2020 in The Lancet , reported the earliest date of onset of symptoms as 1 December 2019. [230] [231] [232] Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. [233] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. [234] [235] According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. [236] In May 2020, George Gao, the director of the Chinese Center for Disease Control and Prevention, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but it was not the site of the initial outbreak. [237] Traces of the virus have been found in wastewater that was collected from Milan and Turin, Italy, on 18 December 2019. [238]

There are several theories about where the very first case (the so-called patient zero) originated. [239] According to an unpublicised report from the Chinese government, the first case can be traced back to 17 November 2019; the person was a 55-year old citizen in the Hubei province. There were four men and five women reported to be infected in November, but none of them were "patient zero". [12] By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. [162] [240] The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December [241] and at least 266 by 31 December. [242] On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. [243] A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. [244] On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. That evening, the Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause". [245] Eight of these doctors, including Li Wenliang (punished on 3 January), [246] were later admonished by the police for spreading false rumours, and another, Ai Fen, was reprimanded by her superiors for raising the alarm. [247]

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases [248] [249] [250] —enough to trigger an investigation. [251]

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. [252] In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. [253] On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. [254] Later official data shows 6,174 people had already developed symptoms by then, [255] and more may have been infected. [256] A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". [257] [258] On 30 January, the WHO declared the coronavirus a public health emergency of international concern. [256] By this time, the outbreak spread by a factor of 100 to 200 times. [259]

On 31 January 2020, Italy had its first confirmed cases, two tourists from China. [260] As of 13 March 2020, the WHO considered Europe the active centre of the pandemic. [261] On 19 March 2020, Italy overtook China as the country with the most deaths. [262] By 26 March, the United States had overtaken China and Italy with the highest number of confirmed cases in the world. [263] Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. [264] Retesting of prior samples found a person in France who had the virus on 27 December 2019 [265] [266] and a person in the United States who died from the disease on 6 February 2020. [267]

On 11 June 2020, after 55 days without a locally transmitted case [268] , Beijing reported the first COVID-19 case, followed by two more cases on 12 June. [269] By 15 June, 79 cases were officially confirmed. [270] Most of these patients went to Xinfadi Wholesale Market. [268] [271]

Epidemiology

Several measures are commonly used to quantify mortality. [272] These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. [273]

The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is

Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time-bound and follow a specific population from infection through case resolution. Many academics have attempted to calculate these numbers for specific populations. [275]

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. [276] [277] In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID‑19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare. [276]

Total-cases-covid-19-who.png
Total confirmed cases over time
Total-deaths-covid-19-who (1).png
Total deaths over time
Total-confirmed-cases-of-covid-19-per-million-people.png
Total confirmed cases of COVID‑19 per million people [278]
Total-covid-deaths-per-million.png
Total confirmed deaths due to COVID‑19 per million people [279]

Infection fatality rate

Infection fatality rate (or infection fatality ratio) is distinguished from case fatality rate . The case fatality rate ("CFR") for a disease is the proportion of deaths from the disease compared to the total number of people diagnosed with the disease (within a certain period of time). The infection fatality ratio ("IFR"), in contrast, is the proportion of deaths among all the infected individuals. IFR, unlike CFR, attempts to account for all asymptomatic and undiagnosed infections.

Our World in Data states that, as of 25 March 2020, the infection fatality rate (IFR) for coronavirus cannot be accurately calculated. [280] In February, the World Health Organization reported estimates of IFR between 0.33% and 1%. [281] [282] The University of Oxford Centre for Evidence-Based Medicine (CEBM) estimated a global CFR of 0.8 to 9.6 percent (last revised 30 April) and IFR of 0.10 to 0.41 percent (last revised 2 May). [283] According to CEBM, random antibody testing in Germany suggested an IFR of 0.37% (0.12% to 0.87%) there. [283] [284] [285] Firm lower limits of infection fatality rates have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 25 June, in New York City, with a population of 8.4 million, 22,421 individuals (17,753 confirmed and 4,668 probable) have died with COVID-19 (0.27% of the population). [286] In Bergamo province, 0.57% of the population has died. [287] The CDC estimates for planning purposes that the fatality rate among those who are symptomatic is 0.4% (0.2% to 1%) and that 35% of infected individuals are asymptomatic, for an overall infection fatality rate of 0.26% (as of 20 May). [288] [289] To get a better view on the number of people infected, as of April 2020, initial antibody testing had been carried out, but peer-reviewed scientific analyses had not yet been published. [290] [291] On 1 May antibody testing in New York suggested an IFR of 0.86%. [292]

Sex differences

Early reviews of epidemiologic data showed greater impact of the pandemic and a higher mortality rate in men in China and Italy. [293] [1] [294] The Chinese Center for Disease Control and Prevention reported the death rate was 2.8 percent for men and 1.7 percent for women. [295] Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. [296] [297] One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. [298]

Ethnic differences

In the U.S., a greater proportion of deaths due to COVID-19 have occurred among African Americans. [299] Structural factors that prevent African Americans from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as public transit and health care. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. [300] Similar issues affect Native American and Latino communities. [299] According to a U.S. health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. [301] The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. [302] Leaders have called for efforts to research and address the disparities. [303]

In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. [304] [305] [306] Several factors such as poverty, poor nutrition and living in overcrowded properties, may have caused this.[ citation needed ]

Society and culture

Name

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", [307] [308] [309] with the disease sometimes called "Wuhan pneumonia". [310] [311] In the past, many diseases have been named after geographical locations, such as the Spanish flu, [312] Middle East Respiratory Syndrome, and Zika virus. [313]

In January 2020, the World Health Organisation recommended 2019-nCov [314] and 2019-nCoV acute respiratory disease [315] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species or groups of people in disease and virus names to prevent social stigma. [316] [317] [318]

The official names COVID‑19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. [319] WHO chief Tedros Adhanom Ghebreyesus explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). [320] The WHO additionally uses "the COVID‑19 virus" and "the virus responsible for COVID‑19" in public communications. [319]

Misinformation

After the initial outbreak of COVID‑19, conspiracy theorists spread misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease, which rapidly spread online. [321] [322] [323]

Decreased emergency room use

In Austria, 39% fewer persons sought help for cardiac symptoms in the month of March. A study estimated that there were 110 incidents of preventable cardiac death as compared to 86 confirmed deaths from Coronavirus as of 29 March. [324]

A preliminary study in the U.S. found 38% under-utilization of cardiac care units as compared to normal. [325] The head of cardiology at the University of Arizona has stated, "My worry is some of these people are dying at home because they're too scared to go to the hospital." [326] There is also concern that persons with symptoms of stroke and appendicitis are delaying seeking help. [326] [327]

Other animals

Humans appear to be capable of spreading the virus to some other animals. A domestic cat in Liège, Belgium, tested positive after it started showing symptoms (diarrhoea, vomiting, shortness of breath) a week later than its owner, who was also positive. [328] Tigers and lions at the Bronx Zoo in New York, United States, tested positive for the virus and showed symptoms of COVID‑19, including a dry cough and loss of appetite. [329] Minks at two farms in the Netherlands also tested positive for COVID-19. [330]

A study on domesticated animals inoculated with the virus found that cats and ferrets appear to be "highly susceptible" to the disease, while dogs appear to be less susceptible, with lower levels of viral replication. The study failed to find evidence of viral replication in pigs, ducks, and chickens. [331]

In March 2020, researchers from the University of Hong Kong have shown that Syrian hamsters could be a model organism for COVID-19 research. [332]

Research

No medication or vaccine is approved with the specific indication to treat the disease. [333] International research on vaccines and medicines in COVID‑19 is underway by government organisations, academic groups, and industry researchers. [334] [335] In March, the World Health Organisation initiated the "Solidarity Trial" to assess the treatment effects of four existing antiviral compounds with the most promise of efficacy. [336] The World Health Organization suspended hydroxychloroquine from its global drug trials for COVID-19 treatments on 26 May 2020 due to safety concerns. It had previously enrolled 3,500 patients from 17 countries in the Solidarity Trial. [337] France, Italy and Belgium also banned the use of hydroxychloroquine as a COVID-19 treatment. [338]

There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand. To minimise the harm from misinformation, medical professionals and the public are advised to expect rapid changes to available information, and to be attentive to retractions and other updates. [339]

Vaccine

There is no available vaccine, but various agencies are actively developing vaccine candidates. Previous work on SARS-CoV is being used because both SARS-CoV and SARS-CoV-2 use the ACE2 receptor to enter human cells. [340] Six vaccination strategies are being investigated. Four of these, as of early July 2020, are being tested in clinical trials [341] . First, researchers aim to build a whole virus vaccine. The use of such inactive virus aims to elicit a prompt immune response of the human body to a new infection with COVID‑19. A second strategy, subunit vaccines, aims to create a vaccine that sensitises the immune system to certain subunits of the virus. In the case of SARS-CoV-2, such research focuses on the S-spike protein that helps the virus intrude the ACE2 enzyme receptor. A third strategy is that of the nucleic acid vaccines (DNA or RNA vaccines, a novel technique for creating a vaccination). Fourthly, scientists are attempting to use viral vectors to deliver the SARS-CoV-2 antigen gene into the cell [342] . These can be replicating or non-replicating. As of early July 2020, only non-replicating viral vectors are in clinical trials. Viral vectors in clinical trials include Chimpanzee Adenovirus 63 [342] , Adenovirus type-5 [341] , and Adenovirus type-26 [343] . Scientists are also working to develop an attenuated COVID-19 vaccine and a COVID-19 vaccine using virus-like particles, but these are still in preclinical research [341] . Experimental vaccines from any of these strategies would have to be tested for safety and efficacy. [344]

On 16 March 2020, the first clinical trial of a vaccine started with four volunteers in Seattle, Washington, United States. The vaccine contains the genetic code of the spike [345] of the virus that causes the disease. [346]

Antibody-dependent enhancement has been suggested as a potential challenge for vaccine development for SARS-COV-2, but this is controversial. [347]

Medications

At least 29 phase II–IV efficacy trials in COVID‑19 were concluded in March 2020, or scheduled to provide results in April from hospitals in China. [348] [349] There are more than 300 active clinical trials underway as of April 2020. [66] Seven trials were evaluating already approved treatments, including four studies on hydroxychloroquine or chloroquine. [349] Repurposed antiviral drugs make up most of the research, with nine phase III trials on remdesivir across several countries due to report by the end of April. [348] [349] Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2. [349]

The COVID‑19 Clinical Research Coalition has goals to 1) facilitate rapid reviews of clinical trial proposals by ethics committees and national regulatory agencies, 2) fast-track approvals for the candidate therapeutic compounds, 3) ensure standardised and rapid analysis of emerging efficacy and safety data and 4) facilitate sharing of clinical trial outcomes before publication. [350] [351]

Several existing medications are being evaluated for the treatment of COVID‑19, [333] including remdesivir, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and lopinavir/ritonavir combined with interferon beta. [336] [352] There is tentative evidence for efficacy by remdesivir, and on 1 May 2020, the United States Food and Drug Administration (FDA) gave the drug an emergency use authorization for people hospitalized with severe COVID‑19. [353] Phase III clinical trials for several drugs are underway in several countries, including the U.S., China, and Italy. [333] [348] [354]

There are mixed results as of 3 April 2020 as to the effectiveness of hydroxychloroquine as a treatment for COVID‑19, with some studies showing little or no improvement. [355] [356] One study has shown an association between hydroxychloroquine or chloroquine use with higher death rates along with other side effects. [357] [358] A retraction of this study by its authors was published by The Lancet on 4 June 2020. [359] The studies of chloroquine and hydroxychloroquine with or without azithromycin have major limitations that have prevented the medical community from embracing these therapies without further study. [66] On 15 June 2020, the FDA updated the fact sheets for the emergency use authorization of remdesivir to warn that using chloroquine or hydroxychloroquine with remdesivir may reduce the antiviral activity of remdesivir. [360]

Initial clinical trial results of dexamethasone in the United Kingdom released in June showed a reduction of mortality of one third for patients who are critically ill on ventilators and one fifth for those on oxygen in a randomised trial involving 11,500 patients and six treatments. [361] Because this is a well tested and widely available treatment this was welcomed by the WHO. [362]

Cytokine storm

A cytokine storm can be a complication in the later stages of severe COVID‑19. There is preliminary evidence that hydroxychloroquine may be useful in controlling cytokine storms in late-phase severe forms of the disease. [363]

Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed. [364] [365] It is undergoing a phase 2 non-randomised trial at the national level in Italy after showing positive results in people with severe disease. [366] [367] Combined with a serum ferritin blood test to identify a cytokine storm (also called cytokine storm syndrome, not to be confused with cytokine release syndrome), it is meant to counter such developments, which are thought to be the cause of death in some affected people. [368] [369] [370] The interleukin-6 receptor antagonist was approved by the Food and Drug Administration (FDA) to undergo a phase III clinical trial assessing its effectiveness on COVID‑19 based on retrospective case studies for the treatment of steroid-refractory cytokine release syndrome induced by a different cause, CAR T cell therapy, in 2017. [371] To date,[ when? ] there is no randomised, controlled evidence that tocilizumab is an efficacious treatment for CRS. Prophylactic tocilizumab has been shown to increase serum IL-6 levels by saturating the IL-6R, driving IL-6 across the blood-brain barrier, and exacerbating neurotoxicity while having no effect on the incidence of CRS. [372]

Lenzilumab, an anti-GM-CSF monoclonal antibody, is protective in murine models for CAR T cell-induced CRS and neurotoxicity and is a viable therapeutic option due to the observed increase of pathogenic GM-CSF secreting T-cells in hospitalised patients with COVID‑19. [373]

The Feinstein Institute of Northwell Health announced in March a study on "a human antibody that may prevent the activity" of IL-6. [374]

Passive antibodies

Development of neutralizing antibodies for treating COVID-19. In the receptor binding stage, the S1 subunit of SARS-CoV-2 binds human ACE2 on the host cell surface. Antibodies that bind the RBD domain on the S1 subunit might block the interaction of the RBD and the ACE2. In the viral fusion stage, after the cleavage of S1 subunit, the viral fusion peptide (FP) on the S2 subunit inserts into the host cell membrane, inducing the conformational change of the S2 subunit, which forms a six-helix bundle (6-HB) with the HR1 and HR2 trimers. Antibodies that target the HR domains might block viral fusion. Ab, antibody Neutralizing antibodies for treating COVID-19.tif
Development of neutralizing antibodies for treating COVID-19. In the receptor binding stage, the S1 subunit of SARS-CoV-2 binds human ACE2 on the host cell surface. Antibodies that bind the RBD domain on the S1 subunit might block the interaction of the RBD and the ACE2. In the viral fusion stage, after the cleavage of S1 subunit, the viral fusion peptide (FP) on the S2 subunit inserts into the host cell membrane, inducing the conformational change of the S2 subunit, which forms a six-helix bundle (6-HB) with the HR1 and HR2 trimers. Antibodies that target the HR domains might block viral fusion. Ab, antibody

Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID‑19 to people who need them is being investigated as a non-vaccine method of passive immunisation. [376] This strategy was tried for SARS with inconclusive results. [376] Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS-CoV-2. The spike protein of SARS-CoV-2 is the primary target for neutralizing antibodies. [377] It has been proposed that selection of broad-neutralizing antibodies against SARS-CoV-2 and SARS-CoV might be useful for treating not only COVID-19 but also future SARS-related CoV infections. [377] Other mechanisms, however, such as antibody-dependent cellular cytotoxicity and/or phagocytosis, may be possible. [376] Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development. [376] Production of convalescent serum, which consists of the liquid portion of the blood from recovered patients and contains antibodies specific to this virus, could be increased for quicker deployment. [378]

See also

Notes

  1. Close contact is defined as less than one metre (~3.3 feet) by the WHO [6] and within ~1.8 metres (six feet) by the CDC. [20]
  2. An uncovered cough can travel up to 8.2 metres (27 feet). [21]

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Management of COVID-19 is usually done through supportive care, which may include fluid therapy, oxygen support, and supporting other affected vital organs. The CDC recommends those who suspect they carry the virus wear a simple face mask. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration. Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity. Supportive treatments may be useful in those with mild symptoms at the early stage of infection.

Prognosis of COVID-19

The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.

References

  1. 1 2 3 Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. (February 2020). "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study". Lancet. 395 (10223): 507–513. doi: 10.1016/S0140-6736(20)30211-7 . PMC   7135076 . PMID   32007143.
  2. Han X, Cao Y, Jiang N, Chen Y, Alwalid O, Zhang X, et al. (March 2020). "Novel Coronavirus Pneumonia (COVID-19) Progression Course in 17 Discharged Patients: Comparison of Clinical and Thin-Section CT Features During Recovery". Clinical Infectious Diseases. doi: 10.1093/cid/ciaa271 . PMC   7184369 . PMID   32227091.
  3. "Special Act for Prevention, Relief and Revitalization Measures for Severe Pneumonia with Novel Pathogens–Article Content–Laws & Regulations Database of The Republic of China". law.moj.gov.tw. Retrieved 10 May 2020.
  4. "Covid-19, n." Oxford English Dictionary . Retrieved 15 April 2020.
  5. 1 2 3 4 "Symptoms of Coronavirus". U.S. Centers for Disease Control and Prevention (CDC). 13 May 2020. Archived from the original on 17 June 2020. Retrieved 18 June 2020.
  6. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 "Q&A on coronaviruses (COVID-19)". World Health Organization. 17 April 2020. Archived from the original on 14 May 2020. Retrieved 14 May 2020.
  7. 1 2 Nussbaumer-Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, et al. (April 2020). "Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review". The Cochrane Database of Systematic Reviews. 4: CD013574. doi:10.1002/14651858.CD013574. PMC   7141753 . PMID   32267544.
  8. 1 2 3 4 "COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)". ArcGIS . Johns Hopkins University . Retrieved 5 July 2020.
  9. "Coronavirus disease 2019 (COVID-19)—Symptoms and causes". Mayo Clinic. Retrieved 14 April 2020.
  10. 1 2 3 Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. (February 2020). "The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—The latest 2019 novel coronavirus outbreak in Wuhan, China". International Journal of Infectious Diseases. 91: 264–266. doi: 10.1016/j.ijid.2020.01.009 . PMC   7128332 . PMID   31953166.
  11. 1 2 "WHO Director-General's opening remarks at the media briefing on COVID-19". World Health Organization (WHO) (Press release). 11 March 2020. Archived from the original on 11 March 2020. Retrieved 12 March 2020.
  12. 1 2 Ma, Josephine (13 March 2020). "Coronavirus: China's first confirmed Covid-19 case traced back to November 17". South China Morning Post . Archived from the original on 13 March 2020. Retrieved 28 May 2020.
  13. 1 2 3 Grant, Michael C.; Geoghegan, Luke; Arbyn, Marc; Mohammed, Zakaria; McGuinness, Luke; Clarke, Emily L.; Wade, Ryckie G.; Hirst, Jennifer A. (23 June 2020). "The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries". PLOS ONE. 15 (6): e0234765. doi:10.1371/journal.pone.0234765. PMC   7310678 . PMID   32574165. S2CID   220046286.
  14. 1 2 Hopkins C. "Loss of sense of smell as marker of COVID-19 infection". Ear, Nose and Throat surgery body of United Kingdom. Retrieved 28 March 2020.
  15. Ye Q, Wang B, Mao J (June 2020). "The pathogenesis and treatment of the 'Cytokine Storm' in COVID-19". J. Infect. 80 (6): 607–613. doi:10.1016/j.jinf.2020.03.037. PMC   7194613 . PMID   32283152.
  16. 1 2 Murthy S, Gomersall CD, Fowler RA (March 2020). "Care for Critically Ill Patients With COVID-19". JAMA. 323 (15): 1499. doi: 10.1001/jama.2020.3633 . PMID   32159735.
  17. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R (2020). "Features, Evaluation and Treatment Coronavirus (COVID-19)". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID   32150360 . Retrieved 18 March 2020.
  18. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. (April 2020). "COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up". Journal of the American College of Cardiology. 75 (23): 2950–2973. doi:10.1016/j.jacc.2020.04.031. PMC   7164881 . PMID   32311448.
  19. Velavan TP, Meyer CG (March 2020). "The COVID-19 epidemic". Tropical Medicine & International Health. 25 (3): 278–280. doi: 10.1111/tmi.13383 . PMC   7169770 . PMID   32052514.
  20. 1 2 3 4 5 6 7 8 9 10 "How COVID-19 Spreads". Centers for Disease Control and Prevention (CDC). 2 April 2020. Archived from the original on 3 April 2020. Retrieved 3 April 2020.
  21. Bourouiba L (March 2020). "Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19". JAMA. doi: 10.1001/jama.2020.4756 . PMID   32215590.
  22. 1 2 3 4 5 6 7 8 9 10 11 "Q & A on COVID-19". European Centre for Disease Prevention and Control. Retrieved 30 April 2020.
  23. Stadnytskyi V, Bax CE, Bax A, Anfinrud P (June 2020). "The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission". Proceedings of the National Academy of Sciences of the United States of America. 117 (22): 11875–11877. doi:10.1073/pnas.2006874117. PMC   7275719 . PMID   32404416.
  24. 1 2 "Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention (CDC). 11 February 2020. Archived from the original on 4 March 2020. Retrieved 26 March 2020.
  25. 1 2 3 4 5 Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A (March 2020). "Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients". AJR. American Journal of Roentgenology. 215 (1): 87–93. doi: 10.2214/AJR.20.23034 . PMID   32174129.
  26. 1 2 "ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection". American College of Radiology. 22 March 2020. Archived from the original on 28 March 2020.
  27. "Advice for public". World Health Organization (WHO). Archived from the original on 26 January 2020. Retrieved 25 February 2020.
  28. "Guidance on social distancing for everyone in the UK". GOV.UK. Archived from the original on 24 March 2020. Retrieved 25 March 2020.
  29. 1 2 3 4 "Recommendations for Cloth Face Covers". Centers for Disease Control and Prevention. 3 April 2020. Retrieved 3 June 2020.
  30. Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ (May 2020). "Rational use of face masks in the COVID-19 pandemic". The Lancet. Respiratory Medicine. 8 (5): 434–436. doi: 10.1016/S2213-2600(20)30134-X . PMC   7118603 . PMID   32203710.
  31. 1 2 3 Centers for Disease Control and Prevention (5 April 2020). "What to Do if You Are Sick". Centers for Disease Control and Prevention (CDC). Archived from the original on 14 February 2020. Retrieved 24 April 2020.
  32. "When and how to use masks". World Health Organization (WHO). Archived from the original on 7 March 2020. Retrieved 24 April 2020.
  33. "How to Protect Yourself & Others". Centers for Disease Control and Prevention (CDC). 8 April 2020. Archived from the original on 26 February 2020. Retrieved 9 April 2020.
  34. "Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)". World Health Organization (WHO). Archived from the original on 31 January 2020. Retrieved 11 February 2020.
  35. Mahtani S, Berger M, O'Grady S, Iati M (6 February 2020). "Hundreds of evacuees to be held on bases in California; Hong Kong and Taiwan restrict travel from mainland China". The Washington Post . Archived from the original on 7 February 2020. Retrieved 11 February 2020.
  36. "WHO Situation Report #87" (PDF). World Health Organization (WHO). 16 April 2020.
  37. "Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)". Centers for Disease Control and Prevention (CDC). 6 April 2020. Archived from the original on 2 March 2020. Retrieved 19 April 2020.
  38. Chavez S, Long B, Koyfman A, Liang SY (March 2020). "Coronavirus Disease (COVID-19): A primer for emergency physicians". The American Journal of Emergency Medicine. doi: 10.1016/j.ajem.2020.03.036 . PMC   7102516 . PMID   32265065.
  39. Tu H, Tu S, Gao S, Shao A, Sheng J (April 2020). "Current epidemiological and clinical features of COVID-19; a global perspective from China". The Journal of Infection. 81 (1): 1–9. doi: 10.1016/j.jinf.2020.04.011 . PMC   7166041 . PMID   32315723.
  40. Guan, Wei-jie; Ni, Zheng-yi; Hu, Yu; Liang, Wen-hua; Ou, Chun-quan; He, Jian-xing; Liu, Lei; Shan, Hong; Lei, Chun-liang; Hui, David S.C.; Du, Bin; Li, Lan-juan; Zeng, Guang; Yuen, Kwok-Yung; Chen, Ru-chong; Tang, Chun-li; Wang, Tao; Chen, Ping-yan; Xiang, Jie; Li, Shi-yue; Wang, Jin-lin; Liang, Zi-jing; Peng, Yi-xiang; Wei, Li; Liu, Yong; Hu, Ya-hua; Peng, Peng; Wang, Jian-ming; Liu, Ji-yang; Chen, Zhong; Li, Gang; Zheng, Zhi-jian; Qiu, Shao-qin; Luo, Jie; Ye, Chang-jiang; Zhu, Shao-yong; Zhong, Nan-shan (30 April 2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". New England Journal of Medicine. Massachusetts Medical Society. 382 (18): 1708–1720. doi:10.1056/nejmoa2002032. ISSN   0028-4793. PMC   7092819 . PMID   32109013.
  41. Hessen MT (27 January 2020). "Novel Coronavirus Information Center: Expert guidance and commentary". Elsevier Connect. Archived from the original on 30 January 2020. Retrieved 31 January 2020.
  42. Wei XS, Wang X, Niu YR, Ye LL, Peng WB, Wang ZH, et al. (26 February 2020). "Clinical Characteristics of SARS-CoV-2 Infected Pneumonia with Diarrhea". doi:10.2139/ssrn.3546120.
  43. 1 2 3 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. (February 2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". Lancet. 395 (10223): 497–506. doi: 10.1016/S0140-6736(20)30183-5 . PMC   7159299 . PMID   31986264.
  44. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR (March 2020). "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges". International Journal of Antimicrobial Agents. 55 (3): 105924. doi:10.1016/j.ijantimicag.2020.105924. PMC   7127800 . PMID   32081636.
  45. 1 2 3 Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) (PDF) (Report). World Health Organization (WHO). 16–24 February 2020. Archived (PDF) from the original on 29 February 2020. Retrieved 21 March 2020.
  46. 1 2 Zheng YY, Ma YT, Zhang JY, Xie X (May 2020). "COVID-19 and the cardiovascular system". Nature Reviews. Cardiology. 17 (5): 259–260. doi: 10.1038/s41569-020-0360-5 . PMC   7095524 . PMID   32139904.
  47. Xydakis MS, Dehgani-Mobaraki P, Holbrook EH, Geisthoff UW, Bauer C, Hautefort C, et al. (April 2020). "Smell and taste dysfunction in patients with COVID-19". The Lancet. Infectious Diseases. doi:10.1016/S1473-3099(20)30293-0. PMC   7159875 . PMID   32304629.
  48. "Symptoms of Coronavirus". Centers for Disease Control and Prevention (CDC). 27 April 2020. Retrieved 28 April 2020.
  49. Iacobucci G (March 2020). "Sixty seconds on ... anosmia". BMJ. 368: m1202. doi: 10.1136/bmj.m1202 . PMID   32209546.
  50. World Health Organization (19 February 2020). "Coronavirus disease 2019 (COVID-19): situation report, 29". World Health Organization. hdl: 10665/331118 .
  51. Rapid Expert Consultation Update on SARS-CoV-2 Surface Stability and Incubation for the COVID-19 Pandemic. TheNational Academies Press. 27 March 2020. doi:10.17226/25763. ISBN   978-0-309-67610-6 . Retrieved 18 May 2020.
  52. "Interim Guidance: Public Health Management of cases and contacts associated with novel coronavirus (COVID-19) in the community" (PDF). BC Centre for Disease Control. 15 May 2020. Retrieved 18 May 2020.
  53. "Rapid Review of the literature: Assessing the infection prevention and control measures for the prevention and management of COVID-19 in health and care settings" (PDF). NHS Scotland. 20 April 2020. Retrieved 18 May 2020.
  54. Cohen PA, Hall LE, John JN, Rapoport AB (June 2020). "The Early Natural History of SARS-CoV-2 Infection: Clinical Observations From an Urban, Ambulatory COVID-19 Clinic". Mayo Clinic Proceedings. 95 (6): 1124–1126. doi: 10.1016/j.mayocp.2020.04.010 . PMC   7167572 . PMID   32451119.
  55. 1 2 Gao, Zhiru; Xu, Yinghui; Sun, Chao; Wang, Xu; Guo, Ye; Qiu, Shi; Ma, Kewei (15 May 2020). "A systematic review of asymptomatic infections with COVID-19". Journal of Microbiology, Immunology and Infection. doi:10.1016/j.jmii.2020.05.001. ISSN   1684-1182. PMC   7227597 . PMID   32425996 . Retrieved 13 June 2020.
  56. "Clinical Questions about COVID-19: Questions and Answers". Centers for Disease Control and Prevention (CDC). 11 February 2020. Archived from the original on 14 February 2020. Retrieved 31 March 2020.
  57. Lai CC, Liu YH, Wang CY, Wang YH, Hsueh SC, Yen MY, et al. (March 2020). "Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths". Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi. 53 (3): 404–412. doi:10.1016/j.jmii.2020.02.012. PMC   7128959 . PMID   32173241.
  58. Furukawa NW, Brooks JT, Sobel J (May 2020). "Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic". Emerging Infectious Diseases. 26 (7). doi: 10.3201/eid2607.201595 . PMC   7323549 . PMID   32364890.
  59. Feuer, William; Higgins-Dunn, Noah (8 June 2020). "Asymptomatic spread of coronavirus is 'very rare,' WHO says". CNBC. Retrieved 8 June 2020.
  60. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R (2020). "Features, Evaluation and Treatment Coronavirus (COVID-19)". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID   32150360 . Retrieved 18 March 2020.
  61. Heymann DL, Shindo N, et al. (WHO Scientific and Technical Advisory Group for Infectious Hazards) (February 2020). "COVID-19: what is next for public health?". Lancet. 395 (10224): 542–545. doi:10.1016/s0140-6736(20)30374-3. PMC   7138015 . PMID   32061313.
  62. Long B, Brady WJ, Koyfman A, Gottlieb M (April 2020). "Cardiovascular complications in COVID-19". The American Journal of Emergency Medicine. 38 (7): 1504–1507. doi:10.1016/j.ajem.2020.04.048. PMC   7165109 . PMID   32317203.
  63. Chander, Vishwadha (18 June 2020). "Blood type, genes tied to risk of severe COVID-19: European study". Reuters. Retrieved 22 June 2020. The risk for severe COVID-19 was 45% higher for people with type A blood than those with other blood types. It appeared to be 35% lower for people with type O.
  64. Ellinghaus, Ph.D., David; Degenhardt, M.Sc., Frauke (17 June 2020). "Genomewide Association Study of Severe Covid-19 with Respiratory Failure". New England Journal of Medicine. doi:10.1056/NEJMoa2020283. PMC   7315890 . PMID   32558485. S2CID   219921769. CONCLUSIONS[:]We identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with Covid-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. (Funded by Stein Erik Hagen and others.)
  65. Xu L, Liu J, Lu M, Yang D, Zheng X (May 2020). "Liver injury during highly pathogenic human coronavirus infections". Liver International. 40 (5): 998–1004. doi: 10.1111/liv.14435 . PMC   7228361 . PMID   32170806.
  66. 1 2 3 4 Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB (April 2020). "Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review". JAMA. doi: 10.1001/jama.2020.6019 . PMID   32282022.
  67. Carod-Artal FJ (May 2020). "Neurological complications of coronavirus and COVID-19". Revista de Neurologia. 70 (9): 311–322. doi:10.33588/rn.7009.2020179. PMID   32329044.
  68. "Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19". www.who.int. Retrieved 20 May 2020.
  69. "HAN Archive—00432 | Health Alert Network (HAN)". emergency.cdc.gov. 15 May 2020. Retrieved 20 May 2020.
  70. Hamner L, Dubbel P, Capron I, Ross A, Jordan A, Lee J, et al. (May 2020). "High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice—Skagit County, Washington, March 2020" (PDF). MMWR Morb. Mortal. Wkly. Rep. 69 (19): 606–610. doi:10.15585/mmwr.mm6919e6. PMID   32407303. S2CID   218647339.
  71. Oran, DP; Topol, EJ (3 June 2020). "Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review". Annals of Internal Medicine. doi:10.7326/M20-3012. PMC   7281624 . PMID   32491919.
  72. "New coronavirus stable for hours on surfaces". National Institutes of Health. 17 March 2020. Archived from the original on 23 March 2020. Retrieved 30 April 2020.
  73. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. (April 2020). "Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1". New England Journal of Medicine. 382 (16): 1564–1567. doi: 10.1056/NEJMc2004973 . PMC   7121658 . PMID   32182409.
  74. "Household cleaners and disinfectants can cause health problems when not used properly". Centers for Disease Control and Prevention (CDC). 24 April 2020. Retrieved 6 May 2020.
  75. 1 2 To KK, Tsang OT, Chik-Yan Yip C, Chan KH, Wu TC, Chan JM, et al. (February 2020). "Consistent detection of 2019 novel coronavirus in saliva". Clinical Infectious Diseases. Oxford University Press. doi:10.1093/cid/ciaa149. PMC   7108139 . PMID   32047895.
  76. "COVID-19 and Our Communities–ACON–We are a New South Wales based health promotion organisation specialising in HIV prevention, HIV support and lesbian, gay, bisexual, transgender and intersex (LGBTI) health". Acon.org.au. Retrieved 29 April 2020.
  77. "Sex and Coronavirus Disease 2019 (COVID-19)" (PDF). nyc.gov. 27 March 2020. Retrieved 29 April 2020.
  78. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J (2012). "Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review". PLOS ONE. 7 (4): e35797. Bibcode:2012PLoSO...735797T. doi:10.1371/journal.pone.0035797. PMC   3338532 . PMID   22563403.
  79. "Novel Coronavirus—Information for Clinicians" (PDF). Australian Government Dept of Health.
  80. Bingmann A (22 May 2020). "Latest findings by Ulm virologists - New coronavirus detected in breast milk" . Retrieved 5 June 2020.
  81. Groß R, Conzelmann C, Müller JA, Stenger S, Steinhart K, Kirchhoff F, Münch J (May 2020). "Detection of SARS-CoV-2 in human breastmilk". Lancet. 0 (10239): 1757–1758. doi:10.1016/S0140-6736(20)31181-8. PMC   7241971 . PMID   32446324.
  82. "Outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): increased transmission beyond China—fourth update" (PDF). European Centre for Disease Prevention and Control. 14 February 2020. Retrieved 8 March 2020.
  83. 1 2 Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF (April 2020). "The proximal origin of SARS-CoV-2". Nature Medicine. 26 (4): 450–452. doi:10.1038/s41591-020-0820-9. PMC   7095063 . PMID   32284615.
  84. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. (February 2020). "A Novel Coronavirus from Patients with Pneumonia in China, 2019". New England Journal of Medicine. 382 (8): 727–733. doi:10.1056/NEJMoa2001017. PMC   7092803 . PMID   31978945.
  85. Cyranoski D (March 2020). "Mystery deepens over animal source of coronavirus". Nature. 579 (7797): 18–19. Bibcode:2020Natur.579...18C. doi: 10.1038/d41586-020-00548-w . PMID   32127703.
  86. Verdecchia P, Cavallini C, Spanevello A, Angeli F (June 2020). "The pivotal link between ACE2 deficiency and SARS-CoV-2 infection". European Journal of Internal Medicine. 76: 14–20. doi:10.1016/j.ejim.2020.04.037. PMC   7167588 . PMID   32336612.
  87. Letko M, Marzi A, Munster V (April 2020). "Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses". Nature Microbiology. 5 (4): 562–569. doi: 10.1038/s41564-020-0688-y . PMC   7095430 . PMID   32094589.
  88. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS (April 2020). "Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target". Intensive Care Medicine. 46 (4): 586–590. doi: 10.1007/s00134-020-05985-9 . PMC   7079879 . PMID   32125455.
  89. 1 2 Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. (February 2020). "High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa". International Journal of Oral Science. 12 (1): 8. doi: 10.1038/s41368-020-0074-x . PMC   7039956 . PMID   32094336.
  90. Gurwitz D (March 2020). "Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics". Drug Development Research. doi: 10.1002/ddr.21656 . PMC   7228359 . PMID   32129518.
  91. Li YC, Bai WZ, Hashikawa T (February 2020). "The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients". Journal of Medical Virology. 92 (6): 552–555. doi: 10.1002/jmv.25728 . PMC   7228394 . PMID   32104915.
  92. Baig AM, Khaleeq A, Ali U, Syeda H (April 2020). "Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms". ACS Chemical Neuroscience. 11 (7): 995–998. doi:10.1021/acschemneuro.0c00122. PMC   7094171 . PMID   32167747.
  93. Gu J, Han B, Wang J (May 2020). "COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission". Gastroenterology. 158 (6): 1518–1519. doi:10.1053/j.gastro.2020.02.054. PMC   7130192 . PMID   32142785.
  94. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H (June 2004). "Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis". The Journal of Pathology. 203 (2): 631–7. doi:10.1002/path.1570. PMC   7167720 . PMID   15141377.
  95. 1 2 3 Zheng YY, Ma YT, Zhang JY, Xie X (May 2020). "COVID-19 and the cardiovascular system". Nature Reviews. Cardiology. 17 (5): 259–260. doi:10.1038/s41569-020-0360-5. PMC   7095524 . PMID   32139904.
  96. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. (February 2020). "Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China". JAMA. 323 (11): 1061–1069. doi:10.1001/jama.2020.1585. PMC   7042881 . PMID   32031570.
  97. Turner AJ, Hiscox JA, Hooper NM (June 2004). "ACE2: from vasopeptidase to SARS virus receptor". Trends in Pharmacological Sciences. 25 (6): 291–4. doi:10.1016/j.tips.2004.04.001. PMC   7119032 . PMID   15165741.
  98. Klok FA, Kruip MJ, van der Meer NJ, Arbous MS, Gommers DA, Kant KM, et al. (April 2020). "Incidence of thrombotic complications in critically ill ICU patients with COVID-19". Thrombosis Research. 191: 145–147. doi:10.1016/j.thromres.2020.04.013. PMC   7146714 . PMID   32291094.
  99. Cui S, Chen S, Li X, Liu S, Wang F (April 2020). "Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia". Journal of Thrombosis and Haemostasis . 18 (6): 1421–1424. doi: 10.1111/jth.14830 . PMC   7262324 . PMID   32271988.
  100. 1 2 Wadman M (April 2020). "How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes". Science. doi: 10.1126/science.abc3208 .
  101. Coronavirus: Kidney Damage Caused by COVID-19, Johns Hopkins Medicine, C. John Sperati, updated 14 May 2020.
  102. 1 2 Barton LM, Duval EJ, Stroberg E, Ghosh S, Mukhopadhyay S (May 2020). "COVID-19 Autopsies, Oklahoma, USA". American Journal of Clinical Pathology . 153 (6): 725–733. doi:10.1093/ajcp/aqaa062. PMC   7184436 . PMID   32275742.
  103. Zhang C, Wu Z, Li JW, Zhao H, Wang GQ (March 2020). "The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist Tocilizumab may be the key to reduce the mortality". International Journal of Antimicrobial Agents. 55 (5): 105954. doi:10.1016/j.ijantimicag.2020.105954. PMC   7118634 . PMID   32234467.
  104. "CDC Tests for 2019-nCoV". Centers for Disease Control and Prevention . 5 February 2020. Archived from the original on 14 February 2020. Retrieved 12 February 2020.
  105. "Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases". World Health Organization (WHO). Archived from the original on 17 March 2020. Retrieved 13 March 2020.
  106. "2019 Novel Coronavirus (2019-nCoV) Situation Summary". Centers for Disease Control and Prevention . 30 January 2020. Archived from the original on 26 January 2020. Retrieved 30 January 2020.
  107. "Real-Time RT-PCR Panel for Detection 2019-nCoV". Centers for Disease Control and Prevention . 29 January 2020. Archived from the original on 30 January 2020. Retrieved 1 February 2020.
  108. "Curetis Group Company Ares Genetics and BGI Group Collaborate to Offer Next-Generation Sequencing and PCR-based Coronavirus (2019-nCoV) Testing in Europe". GlobeNewswire News Room. 30 January 2020. Archived from the original on 31 January 2020. Retrieved 1 February 2020.
  109. Brueck H (30 January 2020). "There's only one way to know if you have the coronavirus, and it involves machines full of spit and mucus". Business Insider. Archived from the original on 1 February 2020. Retrieved 1 February 2020.
  110. "Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases". Archived from the original on 21 February 2020. Retrieved 26 February 2020.
  111. Cohen J, Normile D (January 2020). "New SARS-like virus in China triggers alarm" (PDF). Science. 367 (6475): 234–235. Bibcode:2020Sci...367..234C. doi:10.1126/science.367.6475.234. PMID   31949058. S2CID   210701594. Archived (PDF) from the original on 11 February 2020. Retrieved 11 February 2020.
  112. "Severe acute respiratory syndrome coronavirus 2 data hub". NCBI. Archived from the original on 21 March 2020. Retrieved 4 March 2020.
  113. Petherick A (April 2020). "Developing antibody tests for SARS-CoV-2". Lancet. 395 (10230): 1101–1102. doi: 10.1016/s0140-6736(20)30788-1 . PMC   7270070 . PMID   32247384.
  114. Vogel G (March 2020). "New blood tests for antibodies could show true scale of coronavirus pandemic". Science. doi: 10.1126/science.abb8028 .
  115. Pang J, Wang MX, Ang IY, Tan SH, Lewis RF, Chen JI, et al. (February 2020). "Potential Rapid Diagnostics, Vaccine and Therapeutics for 2019 Novel Coronavirus (2019-nCoV): A Systematic Review". Journal of Clinical Medicine. 9 (3): 623. doi: 10.3390/jcm9030623 . PMC   7141113 . PMID   32110875.
  116. AFP News Agency (11 April 2020). "How false negatives are complicating COVID-19 testing". Al Jazeera website Retrieved 12 April 2020.
  117. "Coronavirus (COVID-19) Update: FDA Issues first Emergency Use Authorization for Point of Care Diagnostic" (Press release). U.S. Food and Drug Administration (FDA). 21 March 2020. Archived from the original on 21 March 2020. Retrieved 22 March 2020.
  118. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. (February 2020). "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)". Military Medical Research. 7 (1): 4. doi: 10.1186/s40779-020-0233-6 . PMC   7003341 . PMID   32029004.
  119. Lee EY, Ng MY, Khong PL (April 2020). "COVID-19 pneumonia: what has CT taught us?". The Lancet. Infectious Diseases. 20 (4): 384–385. doi:10.1016/S1473-3099(20)30134-1. PMC   7128449 . PMID   32105641. Archived from the original on 8 March 2020. Retrieved 13 March 2020.
  120. "ICD-10 Version:2019". World Health Organization . 2019. Archived from the original on 31 March 2020. Retrieved 31 March 2020. U07.2—COVID-19, virus not identified—COVID-19 NOS—Use this code when COVID-19 is diagnosed clinically or epidemiologically but laboratory testing is inconclusive or not available. Use additional code, if desired, to identify pneumonia or other manifestations
  121. Hanley B, Lucas SB, Youd E, Swift B, Osborn M (May 2020). "Autopsy in suspected COVID-19 cases". Journal of Clinical Pathology. 73 (5): 239–242. doi: 10.1136/jclinpath-2020-206522 . PMID   32198191.
  122. Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC, et al. (March 2020). "[A pathological report of three COVID-19 cases by minimally invasive autopsies]". Zhonghua Bing Li Xue Za Zhi = Chinese Journal of Pathology (in Chinese). 49 (5): 411–417. doi:10.3760/cma.j.cn112151-20200312-00193. PMID   32172546. S2CID   212729698.
  123. Giani M, Seminati D, Lucchini A, Foti G, Pagni F (May 2020). "Exuberant Plasmocytosis in Bronchoalveolar Lavage Specimen of the First Patient Requiring Extracorporeal Membrane Oxygenation for SARS-CoV-2 in Europe". Journal of Thoracic Oncology. 15 (5): e65–e66. doi:10.1016/j.jtho.2020.03.008. PMC   7118681 . PMID   32194247.
  124. Lillicrap D (April 2020). "Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia". Journal of Thrombosis and Haemostasis. 18 (4): 786–787. doi:10.1111/jth.14781. PMC   7166410 . PMID   32212240.
  125. Mitra A, Dwyre DM, Schivo M, Thompson GR, Cohen SH, Ku N, Graff JP (March 2020). "Leukoerythroblastic reaction in a patient with COVID-19 infection". American Journal of Hematology. doi: 10.1002/ajh.25793 . PMC   7228283 . PMID   32212392.
  126. Maier, Benjamin F.; Brockmann, Dirk (15 May 2020). "Effective containment explains subexponential growth in recent confirmed COVID-19 cases in China". Science. 368 (6492): 742–746. Bibcode:2020Sci...368..742M. doi:10.1126/science.abb4557. PMC   7164388 . PMID   32269067. ("...initial exponential growth expected for an unconstrained outbreak.")
  127. Wiles S (9 March 2020). "The three phases of Covid-19—and how we can make it manageable". The Spinoff. Archived from the original on 27 March 2020. Retrieved 9 March 2020.
  128. 1 2 3 4 Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD (March 2020). "How will country-based mitigation measures influence the course of the COVID-19 epidemic?". Lancet. 395 (10228): 931–934. doi: 10.1016/S0140-6736(20)30567-5 . PMC   7158572 . PMID   32164834. A key issue for epidemiologists is helping policy makers decide the main objectives of mitigation—e.g. minimising morbidity and associated mortality, avoiding an epidemic peak that overwhelms health-care services, keeping the effects on the economy within manageable levels, and flattening the epidemic curve to wait for vaccine development and manufacture on scale and antiviral drug therapies.
  129. Barclay E (10 March 2020). "How canceled events and self-quarantines save lives, in one chart". Vox. Archived from the original on 12 March 2020. Retrieved 12 March 2020.
  130. Barclay E, Scott D, Animashaun A (7 April 2020). "The US doesn't just need to flatten the curve. It needs to "raise the line."". Vox. Archived from the original on 7 April 2020.
  131. 1 2 Wiles S (14 March 2020). "After 'Flatten the Curve', we must now 'Stop the Spread'. Here's what that means". The Spinoff. Archived from the original on 26 March 2020. Retrieved 13 March 2020.
  132. Grenfell R, Drew T (17 February 2020). "Here's Why It's Taking So Long to Develop a Vaccine for the New Coronavirus". Science Alert. Archived from the original on 28 February 2020. Retrieved 26 February 2020.
  133. 1 2 "COVID-19 Treatment Guidelines". www.nih.gov. National Institutes of Health. Retrieved 21 April 2020.
  134. "Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission". Centers for Disease Control and Prevention. 28 June 2020.
  135. 1 2 3 4 [[Centers for Disease Control and Prevention]|Centers for Disease Control and Prevention]] (3 February 2020). "Coronavirus Disease 2019 (COVID-19): Prevention & Treatment". Archived from the original on 15 December 2019. Retrieved 10 February 2020.
  136. World Health Organization. "Advice for Public". Archived from the original on 26 January 2020. Retrieved 10 February 2020.
  137. "My Hand-Washing Song: Readers Offer Lyrics For A 20-Second Scrub". NPR.org. Archived from the original on 20 March 2020. Retrieved 20 March 2020.
  138. "Wear masks in public says WHO, in update of COVID-19 advice". Reuters. 5 June 2020. Retrieved 3 July 2020.
  139. "When and how to use masks". WHO. Retrieved 3 July 2020.
  140. 1 2 "Using face masks in the community—Technical Report" (PDF). ECDC. 8 April 2020.
  141. "Which countries have made wearing face masks compulsory?". Al Jazeera. 20 May 2020.
  142. "Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission". U.S. Centers for Disease Control and Prevention (CDC). 11 February 2020. Retrieved 17 April 2020.
  143. "For different groups of people: how to choose masks". NHC.gov.cn. National Health Commission of the People's Republic of China. 7 February 2020. Retrieved 22 March 2020. Disposable medical masks: Recommended for: · People in crowded places · Indoor working environment with a relatively dense population · People going to medical institutions · Children in kindergarten and students at school gathering to study and do other activities[ permanent dead link ]
  144. Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L (April 2020). "Face masks for the public during the covid-19 crisis". BMJ. 369: m1435. doi:10.1136/bmj.m1435. PMID   32273267. S2CID   215516381.
  145. CDC (11 February 2020). "Caring for Someone Sick at Home". Centers for Disease Control and Prevention. Retrieved 3 July 2020.
  146. Maragakis LL. "Coronavirus, Social Distancing and Self Quarantine". www.hopkinsmedicine.org. Johns Hopkins University. Archived from the original on 18 March 2020. Retrieved 18 March 2020.
  147. Parker-Pope T (19 March 2020). "Deciding How Much Distance You Should Keep". The New York Times . ISSN   0362-4331. Archived from the original on 20 March 2020. Retrieved 20 March 2020.
  148. Systrom K, Krieger M, O'Rourke R, Stein R, Dellaert F, Lerer A (11 April 2020). "Rt Covid-19". rt.live. Retrieved 19 April 2020. Based on Bettencourt LM, Ribeiro RM (May 2008). "Real time bayesian estimation of the epidemic potential of emerging infectious diseases". PLOS ONE. 3 (5): e2185. Bibcode:2008PLoSO...3.2185B. doi:10.1371/journal.pone.0002185. PMC   2366072 . PMID   18478118.
  149. "WHO-recommended handrub formulations". WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. World Health Organization. 19 March 2009. Retrieved 19 March 2020.
  150. "Coronavirus Disease 2019 (COVID-19)—Prevention & Treatment". Centers for Disease Control and Prevention (CDC). 10 March 2020. Archived from the original on 11 March 2020. Retrieved 11 March 2020.
  151. Fisher D, Heymann D (February 2020). "Q&A: The novel coronavirus outbreak causing COVID-19". BMC Medicine. 18 (1): 57. doi: 10.1186/s12916-020-01533-w . PMC   7047369 . PMID   32106852.
  152. Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. (May 2020). "Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province". Chinese Medical Journal. 133 (9): 1025–1031. doi: 10.1097/CM9.0000000000000744 . PMC   7147277 . PMID   32044814.
  153. Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, Jiang B (March 2020). "Comorbidities and multi-organ injuries in the treatment of COVID-19". Lancet. 395 (10228): e52. doi: 10.1016/s0140-6736(20)30558-4 . PMC   7270177 . PMID   32171074.
  154. Henry BM (April 2020). "COVID-19, ECMO, and lymphopenia: a word of caution". The Lancet. Respiratory Medicine. 8 (4): e24. doi:10.1016/s2213-2600(20)30119-3. PMC   7118650 . PMID   32178774.
  155. Wang L, Wang Y, Ye D, Liu Q (March 2020). "Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence". International Journal of Antimicrobial Agents. 55 (6): 105948. doi:10.1016/j.ijantimicag.2020.105948. PMC   7156162 . PMID   32201353. Archived from the original on 27 March 2020. Retrieved 27 March 2020.
  156. Wang Y, Wang Y, Chen Y, Qin Q (March 2020). "Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures". Journal of Medical Virology. n/a (n/a): 568–576. doi: 10.1002/jmv.25748 . PMC   7228347 . PMID   32134116.
  157. Cheng ZJ, Shan J (April 2020). "2019 Novel coronavirus: where we are and what we know". Infection. 48 (2): 155–163. doi: 10.1007/s15010-020-01401-y . PMC   7095345 . PMID   32072569.
  158. "Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected". World Health Organization (WHO). Archived from the original on 31 January 2020. Retrieved 13 February 2020.
  159. Farkas J (March 2020). COVID-19—The Internet Book of Critical Care (digital) (Reference manual). USA: EMCrit. Archived from the original on 11 March 2020. Retrieved 13 March 2020.
  160. "COVID19—Resources for Health Care Professionals". Penn Libraries. 11 March 2020. Archived from the original on 14 March 2020. Retrieved 13 March 2020.
  161. Roser M, Ritchie H, Ortiz-Ospina E (4 March 2020). "Coronavirus Disease (COVID-19)". Our World in Data. Archived from the original on 19 March 2020. Retrieved 12 March 2020.
  162. 1 2 3 4 Yanping Z, et al. (The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team) (17 February 2020). "The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19)—China, 2020". China CDC Weekly. Chinese Center for Disease Control and Prevention. 2 (8): 113–122. Archived from the original on 19 February 2020. Retrieved 18 March 2020.
  163. 39 additional cases have been confirmed (Report). Korea Centers for Disease Control and Prevention. 5 June 2020. Retrieved 10 June 2020.
  164. 1 2 Actualización nº 109. Enfermedad por el coronavirus (COVID-19) (PDF) (Report) (in Spanish). Ministerio de Sanidad, Consumo y Bienestar Social. 18 May 2020. Retrieved 20 May 2020.
  165. "Epidemia COVID-19 – Bollettino sorveglianza integrata COVID-19" (PDF) (in Italian). Istituto Superiore di Sanità. 5 June 2020. Retrieved 10 June 2020.
  166. Roser M, Ritchie H, Ortiz-Ospina E (6 April 2020). "Coronavirus Disease (COVID-19)". Our World in Data. Retrieved 6 April 2020.
  167. Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. (April 2020). "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review". JAMA Pediatrics. doi: 10.1001/jamapediatrics.2020.1467 . PMID   32320004.
  168. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. (April 2020). "SARS-CoV-2 Infection in Children". New England Journal of Medicine. Massachusetts Medical Society. 382 (17): 1663–1665. doi:10.1056/nejmc2005073. PMC   7121177 . PMID   32187458.
  169. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S (March 2020). "Epidemiology of COVID-19 Among Children in China" (PDF). Pediatrics. 145 (6): e20200702. doi:10.1542/peds.2020-0702. PMID   32179660.