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This article is about the disease. For the virus, see Severe acute respiratory syndrome
coronavirus 2. For the pandemic, see 2019–20 coronavirus pandemic.
Coronavirus disease 2019 (COVID-19)
 "Coronavirus"
Other names
 2019-nCoV acute respiratory disease
 Novel coronavirus pneumonia[1][2]
Symptoms of COVID-19
Pronunciation /kəˈroʊnəˌvaɪrəs dɪˈziːz, ˈkoʊvɪd/
Specialty Infectious diseases
Symptoms Fever, cough, shortness of breath, none[3][4]
Complications Pneumonia, viral sepsis, acute respiratory distress
syndrome, kidney failure
Usual onset 5 days from exposure (may range between 2–14
days)
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, quarantine, physical distancing

Treatment Symptomatic and supportive
Frequency 1,203,485[5] confirmed cases
Deaths 64,784 (5.4% of confirmed cases)[5]
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe

acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[6] The disease was first
identified in December 2019 in Wuhan, the capital of China's Hubei province, and has
since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic.[7]
[8]
Common symptoms include fever, cough, and shortness of breath.[9] Other symptoms
may include muscle pain, diarrhea, sore throat, loss of smell, and abdominal pain.[3][10]
[11]
While the majority of cases result in mild symptoms, some progress to
viral pneumonia and multi-organ failure.[7][12] As of 5 April 2020, more than 1.2
million[5] cases of have been reported in more than two hundred countries and territories,
[13]
resulting in over 64,700 deaths.[5] More than 247,000 people have recovered.[5]
The virus is mainly spread during close contact,[a] and by small droplets produced when
people cough, sneeze, or talk.[4][15][14] These small droplets may be produced during
breathing but the virus is not generally airborne.[4][15][16] People may also catch COVID-19
by touching a contaminated surface and then their face. [4][14] The virus can survive on
surfaces up to 72 hours.[17] It is most contagious during the first three days after symptom
onset, although spread may be possible before symptoms appear and in later stages of
the disease.[18] Time from exposure to onset of symptoms is generally between two and
fourteen days, with an average of five days.[9][19] The standard method of diagnosis is
by reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal
swab.[20] The infection can also be diagnosed from a combination of symptoms, risk
factors and a chest CT scan showing features of pneumonia.[21][22]
Recommended measures to prevent infection include frequent hand washing, social
distancing or physical distancing (maintaining physical distance from others, especially
from those with symptoms), covering coughs and sneezes with a tissue or inner elbow,
and keeping unwashed hands away from the face. [23][24] The use of masks is
recommended for those who suspect they have the virus and their caregivers.
[25]
Recommendations for mask use by the general public vary, with some authorities
recommending against their use, some recommending their use, and others requiring
their use.[26][27][28] Currently, there is no vaccine or specific antiviral treatment for COVID-
19.[4] Management involves treatment of symptoms, supportive care, isolation,
and experimental measures.[29]
The World Health Organization (WHO) declared the 2019–20
coronavirus outbreak a Public Health Emergency of International Concern (PHEIC)[30]
[31]
on 30 January 2020, and a pandemic on 11 March 2020.[8] Local transmission of the
disease has been recorded in many countries across all six WHO regions.[32]
Video summary (script)
Contents
 1Signs and symptoms

 2Cause
o 2.1Transmission
o 2.2Virology
 3Pathophysiology
 4Diagnosis
o 4.1Pathology
 5Prevention
 6Management
o 6.1Medications
o 6.2Personal protective equipment (PPE)
o 6.3Mechanical ventilation
o 6.4Manufacturing technology
o 6.5Acute respiratory distress syndrome
o 6.6Experimental treatment
o 6.7Information technology
o 6.8Psychological support
 7Prognosis
o 7.1Reinfection
 8History
 9Epidemiology
 10Society and culture
o 10.1Terminology
o 10.2Misinformation
 11Research
o 11.1Vaccine
o 11.2Post-infection treatments
o 11.3Anti-cytokine storm
o 11.4Passive antibody therapy
 12See also
 13Notes
 14References
 15External links
Signs and symptoms

Symptom[33] %
Fever 88
Dry cough 68
Fatigue 38
Sputum production 33
Loss of smell 15[34] to 30[11][35]
Shortness of breath 19
Muscle or joint pain 15
Sore throat 14
Headache 14
Chills 11
Nausea or vomiting 5
Nasal congestion 5
Diarrhoea 4 to 31[36]
Haemoptysis 0.9
Conjunctival congestio
0.8
n
Those infected with the virus may be asymptomatic or develop flu-like

symptoms, including fever, cough, fatigue, and shortness of breath. [3][37][38] Emergency
symptoms include difficulty breathing, persistent chest pain or pressure, confusion,
difficulty waking, and bluish face or lips; immediate medical attention is advised if these
symptoms are present.[39] Less commonly, upper respiratory symptoms, such
as sneezing, runny nose, or sore throat may be seen. Symptoms such
as nausea, vomiting, and diarrhea have been observed in varying percentages.[36][40]
[41]
Some cases in China initially presented only with chest tightness and palpitations.[42] In
March 2020 there were reports indicating that loss of the sense of smell (anosmia) may
be a common symptom among those who have mild disease, [11][35] although not as
common as initially reported.[34] In some, the disease may progress to pneumonia, multi-
organ failure, and death.[7][12] In those who develop severe symptoms, time from symptom
onset to needing mechanical ventilation is typically eight days. [43]
As is common with infections, there is a delay between the moment when a person is
infected with the virus and the time when they develop symptoms. This is called
the incubation period. The incubation period for COVID-19 is typically five to six days
but may range from two to 14 days.[44][45] 97.5% of people who develop symptoms will do
so within 11.5 days of infection.[46]
Reports indicate that not all who are infected develop symptoms, but their role in
transmission is unknown.[47] Preliminary evidence suggests asymptomatic cases may
contribute to the spread of the disease.[48][49] The proportion of infected people who do not
display symptoms is currently unknown and being studied, with South Korea's CDC
reporting that 20% of all confirmed cases remained asymptomatic during their hospital
stay.[49][50]
Cause
See also: Severe acute respiratory syndrome coronavirus 2
Transmission
Respiratory droplets, produced when a man is sneezing

A video discussing the basic reproduction number and case fatality rate in the context of the pandemic
Some details about how the disease is spread are still being determined.[14][15] The WHO
and CDC state that it is primarily spread during close contact and by small
droplets produced when people cough, sneeze, or talk; [4][14] with close contact being
within 1–3 m (3 ft 3 in–9 ft 10 in).[4] A study in Singapore found that an uncovered
coughing can lead to droplets travelling up to 4.5 meters (15 feet). [51][52]
Respiratory droplets may also be produced during breathing out, including when talking.
Though the virus is not generally airborne,[4][53] The National Academy of Science has
suggested that bioaerosol transmission may be possible and air collectors positioned in
the hallway outside of people's rooms yielded samples positive for viral RNA. [54] The
droplets can land in the mouths or noses of people who are nearby or possibly be
inhaled into the lungs.[55] Some medical procedures such as intubation
and cardiopulmonary resuscitation (CPR) may cause respiratory secretions to be
aerosolised and thus result in airborne spread. [53] It may also spread when one touches a
contaminated surface, known as fomite transmission, and then touches their eyes,
nose, or mouth.[4] While there are concerns it may spread by feces, this risk is believed
to be low.[4][14]
The virus is most contagious when people are symptomatic; while spread may be
possible before symptoms appear, this risk is low. [4][14] The European Centre for Disease
Prevention and Control (ECDC) states that while it is not entirely clear how easily the
disease spreads, one person generally infects two to three others. [15]
The virus survives for hours to days on surfaces. [4][15] Specifically, the virus was found to
be detectable for one day on cardboard, for up to three days on plastic and stainless
steel, and for up to four hours on copper. [17] This, however, varies based on the humidity
and temperature.[56] Surfaces may be decontaminated with a number of solutions (within
one minute of exposure to the disinfectant for a stainless steel surface), including 62–
71% ethanol, 50–100% isopropanol, 0.1% sodium hypochlorite, 0.5% hydrogen
peroxide, and 0.2–7.5% povidone-iodine. Other solutions, such as benzalkonium
chloride and chlorhexidine gluconate, are less effective.[57]
Virology
Main article: Severe acute respiratory syndrome coronavirus 2
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.[58] All features of the
novel SARS-CoV-2 virus occur in related coronaviruses in nature. [59] Outside the human
body, the virus is killed by household soap, which bursts its protective bubble.[60]
SARS-CoV-2 is closely related to the original SARS-CoV. [61] It is thought to have
a 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).[33] In February 2020, Chinese researchers found
that there is only one amino acid difference in certain parts of the genome sequences
between the viruses from pangolins and those from humans, however, whole-genome
comparison to date found at most 92% of genetic material shared between pangolin
coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be
the intermediate host.[62]
Pathophysiology
The lungs are the organs most affected by COVID-19 because the virus accesses host
cells via the enzyme ACE2, which is most abundant in the type II alveolar cells of the
lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to
connect to ACE2 and enter the host cell.[63] The density of ACE2 in each tissue
correlates with the severity of the disease in that tissue and some have suggested that
decreasing ACE2 activity might be protective,[64][65] though another view is that increasing
ACE2 using angiotensin II receptor blocker medications could be protective and that
these hypotheses need to be tested.[66] As the alveolar disease progresses, respiratory
failure might develop and death may follow. [65]
The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in
the glandular cells of gastric, duodenal and rectal epithelium[67] as well
as endothelial cells and enterocytes of the small intestine.[68]
The expanding part of the lungs, pulmonary alveoli, contain two main types of
functioning cells. One cell, type I, absorbs from the air, i.e. gas exchange. The
other, type II, produces surfactants, which serve to keep the lungs fluid, clean, infection
free, etc. COVID-19 finds a way into a surfactant producing type II cell, and smothers it
by reproducing COVID-19 virus within it. Each type II cell which perishes to the virus
causes an extreme reaction in the lungs. Fluids, pus, and dead cell material flood the
lung, causing the coronavirus pulmonary disease. [69]
Diagnosis
Main article: COVID-19 testing
Demonstration of a nasopharyngeal swab for COVID-19 testing
CDC rRT-PCR test kit for COVID-19[70]
The WHO has published several testing protocols for the disease. [71] The standard
method of testing is real-time reverse transcription polymerase chain reaction (rRT-
PCR).[72] The test is typically done on respiratory samples obtained by a nasopharyngeal
swab, however a nasal swab or sputum sample may also be used.[20][73] Results are
generally available within a few hours to two days. [74][75] Blood tests can be used, but
these require two blood samples taken two weeks apart and the results have little
immediate value.[76] 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.[7][77][78] The
FDA approved the first point-of-care test on 21 March 2020 for use at the end of that
month.[79] As of 19 March 2020, antibody tests (which can not just detect active
infections, but also determine whether a person had been infected in the past) were in
development, but not yet widely used.[80][81]
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.[21]
A March 2020 review concluded that chest X-rays are of little value in early stages,
whereas CT scans of the chest are useful even before symptoms occur. [60] Typical
features on CT include bilateral multilobar ground-glass opacificities with a peripheral,
asymmetric and posterior distribution.[60] Subpleural dominance, crazy paving (lobular
septal thickening with variable alveolar filling) and consolidation develop as the disease
evolves.[82] As of March 2020, the American College of Radiology recommends that "CT
should not be used to screen for or as a first-line test to diagnose COVID-19". [83]

Typical CT imaging findings

CT imaging of rapid progression stage
Pathology
Few data are available about microscopic lesions and the pathophysiology of COVID-
19.[84][85] The main pathological findings at autopsy are:
 Macroscopy: pleurisy, pericarditis, lung
consolidation and pulmonary oedema
 Four types of severity of viral pneumonia can be observed:
o minor pneumonia: minor serous exudation,
minor fibrin exudation
o mild pneumonia: pulmonary
oedema, pneumocyte hyperplasia, large
atypical pneumocytes,
interstitial inflammation with lymphocytic infiltration and
multinucleated giant cell formation
o severe pneumonia: diffuse alveolar damage (DAD) with
diffuse alveolar exudates. This diffuse DAD is
responsible of the acute respiratory distress
syndrome (ARDS) and severe hypoxemia observed in
this disease.
o healing pneumonia: organization of exudates in alveolar
cavities, and pulmonary interstitial fibrosis
o plasmocytosis in BAL[86]
 Blood: disseminated intravascular coagulation (DIC);
[87]
leukoerythroblastic reaction[88]
 Liver: microvesicular steatosis
Prevention
See also: 2019–20 coronavirus pandemic § Prevention, and Workplace hazard
controls for COVID-19
Inhibiting new infections to reduce the number of cases at any given time—known as flattening the curve—
allows healthcare services to better manage the same volume of patients. [89][90][91]
Alternatives to flattening the curve[92][93]
Preventive measures to reduce the chances of infection include staying at home,

avoiding crowded places, washing hands with soap and water often and for at least 20
seconds, practicing good respiratory hygiene and avoiding touching the eyes, nose, or
mouth with unwashed hands.[94][95][96] 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.[94] They also recommend proper hand hygiene after any cough or
sneeze.[94] Social distancing strategies aim to reduce contact of infected persons with
large groups by closing schools and workplaces, restricting travel, and cancelling mass
gatherings.[97] Social distancing also includes that people stay at least six feet apart (1.83
meters).[98]
Because a vaccine against SARS-CoV-2 is not expected to become available until 2021
at the earliest,[99] a key part of managing the COVID-19 pandemic is trying to decrease
the epidemic peak, known as "flattening the curve", through various measures seeking
to reduce the rate of new infections. [90] Slowing the infection rate helps decrease the risk
of health services being overwhelmed, allowing for better treatment of current cases,
and delaying additional cases until therapeutics or a vaccine become available.[90]
According to the WHO, the use of masks is recommended only if a person is coughing
or sneezing or when one is taking care of someone with a suspected infection. [100] Some
countries also recommend healthy individuals to wear face masks, including China,
[101]
Hong Kong,[102] Thailand,[103] Czech Republic,[104] and Austria.[105] In order to meet the
need for masks, the WHO estimates that global production will need to increase by
40%. Hoarding and speculation have worsened the problem, with the price of masks
increasing sixfold, N95 respirators tripled, and gowns doubled.[106] Some health experts
consider wearing non-medical grade masks and other face coverings like scarves or
bandanas a good way to prevent people from touching their mouths and noses, even if
non-medical coverings would not protect against a direct sneeze or cough from an
infected person.[107]
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.[108][109] 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. It further recommends using an alcohol-based hand sanitiser with at least
60% alcohol, but only when soap and water are not readily available. [94]
For areas where commercial hand sanitisers are not readily available, 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.[110]
Prevention efforts are multiplicative, with effects far beyond that of a

single spread. Each avoided case leads to more avoided cases down
the line, which in turn can stop the outbreak in its tracks.


Handwashing instructions
Management
Four steps to putting on personal protective equipment [111]
People are managed with supportive care, which may include fluid, oxygen support, and
supporting other affected vital organs.[112][113][114] The CDC recommends that those who
suspect they carry the virus wear a simple face mask.[25] Extracorporeal membrane
oxygenation (ECMO) has been used to address the issue of respiratory failure, but its
benefits are still under consideration.[115][116]
The WHO and Chinese National Health Commission have published recommendations
for taking care of people who are hospitalised with COVID-19. [117]
[118]
Intensivists and pulmonologists in the U.S. have compiled treatment
recommendations from various agencies into a free resource, the IBCC.[119][120]
Medications
Some medical professionals recommend paracetamol (acetaminophen)
over ibuprofen for first-line use.[121][122] The WHO does not oppose the use of non-steroidal
anti-inflammatory drugs (NSAIDs) such as ibuprofen for symptoms,[123] and the FDA says
currently there is no evidence that NSAIDs worsen COVID-19 symptoms. [124]
While theoretical concerns have been raised about ACE inhibitors and angiotensin
receptor blockers, as of 19 March 2020, these are not sufficient to justify stopping these
medications.[125][126][127] Steroids such as methylprednisolone are not recommended unless
the disease is complicated by acute respiratory distress syndrome.[128][129]
Personal protective equipment (PPE)
Precautions must be taken to minimise the risk of virus transmission, especially in
healthcare settings when performing procedures that can generate aerosols, such
as intubation or hand ventilation.[130] For healthcare professionals caring for people with
COVID19, the CDC recommends placing the person in an Airborne Infection Isolation
Room (AIIR) in addition to using standard precautions, contact precautions, and
airborne precautions.[131]
CDC outlines the specific guidelines for the use of personal protective equipment (PPE)
during the pandemic. The recommended gear includes:
 respirator or facemask[132][133]
 gown [134]
 medical gloves[135][136]
 eye protection[137]
When available, respirators (instead of facemasks) are preferred. [138] N95 respirators are
approved for industrial settings but the FDA has authorised the masks for use under
an Emergency Use Authorization (EUA). They are designed to protect from airborne
particles like dust but effectiveness against a specific biological agent is not guaranteed
for off-label uses.[139] When masks are not available the CDC recommends using face
shields, or as a last resort homemade masks.[140]
Mechanical ventilation
Most cases of COVID-19 are not severe enough to require mechanical
ventilation (artificial assistance to support breathing), but a percentage of cases do. [141]
[142]
Some Canadian doctors recommend the use of invasive mechanical
ventilation because this technique limits the spread of aerosolised transmission vectors.
[141]
Severe cases are most common in older adults (those older than 60 years [141] and
especially those older than 80 years).[143] Many developed countries do not have
enough hospital beds per capita, which limits a health system's capacity to handle a
sudden spike in the number of COVID-19 cases severe enough to require
hospitalization.[144] This limited capacity is a significant driver of the need to flatten the
curve (to keep the speed at which new cases occur and thus the number of people sick
at one point in time lower).[144] One study in China found 5% were admitted to intensive
care units, 2.3% needed mechanical support of ventilation, and 1.4% died. [115] Around
20–30% of the people in hospital with pneumonia from COVID19 needed ICU care for
respiratory support.[145]
Manufacturing technology
Due to fails in the supply chains, digital manufacturers are stepping in to crank out nasal
swabs, ventilator parts, and more.[146][147] An Italian startup employed 3D
printing technology to produce valves for life-saving coronavirus treatment due to a
broken supply chain of original manufacturing. [148] 3D printed valves costed $1 instead of
$10,000 and were ready overnight.[149]
Acute respiratory distress syndrome
Mechanical ventilation becomes more complex as ARDS develops in COVID-19 and
oxygenation becomes increasingly difficult. [150] Ventilators capable of pressure control
modes and high PEEP[151] are needed to maximise oxygen delivery while minimizing the
risk of ventilator-associated lung injury and pneumothorax.[152] High PEEP may not be
available on older ventilators.
Options for ARDS[150]
Therapy Recommendations
High-flow nasal oxygen For SpO2 <93%. May prevent the need for intubation and ventilation
Tidal volume 6mL per kg and can be reduced to 4mL/kg
Keep below 30 cmH2O if possible (high respiratory rate (35 per minute)

Plateau airway pressure
may be required)
Positive end-expiratory
Moderate to high levels
pressure
Prone positioning For worsening oxygenation
Fluid management Goal is a negative balance of 1/2–1L per day

Antibiotics For secondary bacterial infections
Glucocorticoids Not recommended
Experimental treatment
See also: Research
No medications are approved to treat the disease by the WHO although some are
recommended by individual national medical authorities. [153] Research into potential
treatments started in January 2020,[154] and several antiviral drugs are in clinical trials.[155]
[156]
Although new medications may take until 2021 to develop, [157] several of the
medications being tested are already approved for other uses, or are already in
advanced testing.[153] Antiviral medication may be tried in people with severe disease.
[112]
The WHO recommended volunteers take part in trials of the effectiveness and safety
of potential treatments.[158]
Information technology
See also: Government by algorithm
In February 2020, China launched a mobile app to deal with the disease outbreak.
[159]
Users are asked to enter their name and ID number. The app is able to detect 'close
contact' using surveillance data and therefore a potential risk of infection. Every user
can also check the status of three other users. If a potential risk is detected, the app not
only recommends self-quarantine, it also alerts local health officials. [160]
Big data analytics on cellphone data, facial recognition technology, mobile phone
tracking and artificial intelligence are used to track infected people and people whom
they contacted in South Korea, Taiwan, and Singapore. [161][162] In March 2020, the Israeli
government enabled security agencies to track mobile phone data of people supposed
to have coronavirus. The measure was taken to enforce quarantine and protect those
who may come into contact with infected citizens. [163] Also in March 2020, Deutsche
Telekom shared aggregated phone location data with the German federal government
agency, Robert Koch Institute, in order to research and prevent the spread of the virus.
[164]
Russia deployed facial recognition technology to detect quarantine breakers. [165] Italian
regional health commissioner Giulio Gallera said he has been informed by mobile
phone operators that "40% of people are continuing to move around anyway".
[166]
German government conducted a 48 hours weekend hackathon with more than
42.000 participants.[167][168] Also the president of Estonia, Kersti Kaljulaid, made a global
call for creative solutions against the spread of coronavirus. [169]
Psychological support
Individuals may experience distress from quarantine, travel restrictions, side effects of
treatment, or fear of the infection itself. To address these concerns, the National Health
Commission of China published a national guideline for psychological crisis intervention
on 27 January 2020.[170][171]
Prognosis
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The severity of diagnosed COVID-19 cases in China [172]
Case fatality rates by age group in China. Data through 11 February 2020. [173]
Case fatality rate in China depending on other health problems. Data through 11 February 2020. [173]
The number of deaths vs total cases by country and approximate case fatality rate
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. [33]
Children are susceptible to the disease, but 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%. [174][175] Pregnant
women may be at higher risk for severe infection with COVID-19 based on data from
other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.[176][177]
In some people, COVID-19 may affect the lungs causing pneumonia. In those most
severely affected, COVID-19 may rapidly progress to acute respiratory distress
syndrome (ARDS) causing respiratory failure, septic shock, or multi-organ failure. [178]
[179]
Complications associated with COVID-19 include sepsis, abnormal clotting, and
damage to the heart, kidneys, and liver. Clotting abnormalities, specifically an increase
in prothrombin time, have been described in 6% of those admitted to hospital with
COVID-19, while abnormal kidney function is seen in 4% of this group. [180] Liver injury as
shown by blood markers of liver damage is frequently seen in severe cases. [181]
Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful
in early screening for severe illness.[182]
Many of those who die of COVID-19 have pre-existing (underlying) conditions,
including hypertension, diabetes mellitus, and cardiovascular disease.[183] The Istituto
Superiore di Sanità reported that out of 8.8% of deaths where medical charts were
available for review, 97.2% of sampled patients had at least one comorbidity with the
average patient having 2.7 diseases.[184] According to the same report, the median time
between onset of symptoms and death was ten days, with five being spent hospitalised.
However, patients transferred to an ICU had a median time of seven days between
hospitalization and death.[184] 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. [185] 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%.[186] Histopathological examinations of post-
mortem lung samples show diffuse alveolar damage with cellular
fibromyxoid exudates in both lungs. Viral cytopathic changes were observed in
the pneumocytes. The lung picture resembled acute respiratory distress
syndrome (ARDS).[33] 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.[42]
Availability of medical resources and the socioeconomics of a region may also affect
mortality.[187] Estimates of the mortality from the condition vary because of those regional
differences,[188] but also because of methodological difficulties. The under-counting of
mild cases can cause the mortality rate to be overestimated. [189] However, the fact that
deaths are the result of cases contracted in the past can mean the current mortality rate
is underestimated.[190][191]
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. [192]
Case fatality rates (%) by age and country
0–
Age 10–19 20–29 30–39 40–49 50–59 60–69 70–79 80-89 90+
9
China as of 11 February[173] 0.0 0.2 0.2 0.2 0.4 1.3 3.6 8.0 14.8
Denmark as of 3 April[193] 0.0 0.0 0.0 0.0 0.0 0.0 3.1 8.7 18.1 34.8
Italy as of 2 April[194] 0.0 0.0 0.1 0.4 0.8 2.3 8.0 21.8 30.9 28.7
Netherlands as of 3 April[195] 0.0 0.0 0.0 0.1 0.1 1.0 5.4 14.9 25.1 21.3
South Korea as of 3 April[196] 0.0 0.0 0.0 0.1 0.2 0.6 1.9 7.3 18.9
Spain as of 2 April[197] 0.0 0.2 0.2 0.3 0.4 1.0 3.2 10.6 21.5 25.9
Case fatality rates (%) by age in the United States

Age 0–19 20–44 45–54 55–64 65–74 75–84 85+
0.5–
United States as of 16 March[198] 0.0 0.1–0.2 1.4–2.6 2.7–4.9 4.3–10.5 10.4–27.3
0.8
Note: The lower bound includes all cases. The upper bound excludes cases that were missing data.
Reinfection
As of March 2020, it was unknown if past infection provides effective and long-
term immunity in people who recover from the disease.[199] Immunity is seen as likely,
based on the behaviour of other coronaviruses, [200] but cases in which recovery from
COVID-19 have been followed by positive tests for coronavirus at a later date have
been reported.[201][202] It is[when?] unclear if these cases are the result of reinfection, relapse, or
testing error.[citation needed]
History
The virus is thought to be natural and have an animal origin,[59] through spillover
infection.[203] The origin is unknown but by December 2019 the spread of infection was
almost entirely driven by human-to-human transmission. [173][204] The earliest reported
infection has been unofficially reported to have occurred on 17 November 2019
in Wuhan, China.[205] A study of the first 41 cases of confirmed COVID-19, published in
January 2020 in The Lancet, revealed the earliest date of onset of symptoms as 1
December 2019.[206][207][208] Official publications from the WHO reported the earliest onset of
symptoms as 8 December 2019.[205]
Epidemiology
Main article: 2019–20 coronavirus pandemic
Several measures are commonly used to quantify mortality. [209] These numbers vary by
region and over time, and are influenced by the volume of testing, healthcare system
quality, treatment options, time since initial outbreak, and population characteristics
such as age, sex, and overall health.[210] In late 2019, WHO assigned the
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.[211]
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 5.4% (64,784/1,203,485) as of 5 April 2020.
[5]
The number varies by region.[212]
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. A number of academics have attempted to calculate
these numbers for specific populations. [213] In the epicenter of the outbreak in Italy,
Castiglione d'Adda, a small vilage of 4500, 80 (1.8%) are already dead. Most people in
the village appear to have become immune, most did so without being diagnosed, and
many did not have symptoms.[214][215]
Total confirmed cases over time

Total deaths over time


Total confirmed cases of COVID-19 per million people, 20 March

2020[216]

Total confirmed deaths due to COVID-19 per million people, 24 March

2020[217]
Society and culture

Terminology
The World Health Organization announced in February 2020 that COVID-19 is the
official name of the disease. World Health Organization chief Tedros Adhanom
Ghebreyesus explained that CO stands for corona, VI for virus and D for disease,
while 19 is for when the outbreak was first identified: 31 December 2019. [218] The name
had been chosen to avoid references to a specific geographical location (e.g. China),
animal species, or group of people, in line with international recommendations for
naming aimed at preventing stigmatisation.[219][220]
The virus that causes COVID-19 is named severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2).[221] The WHO additionally uses "the COVID-19 virus" and
"the virus responsible for COVID-19" in public communications. [221] Coronaviruses were
named in 1968 for their appearance in electron micrographs which was reminiscent of
the solar corona, corona meaning crown in Latin.[222][223][224] Both the disease and virus are
commonly referred to as "coronavirus".
During the initial outbreak in Wuhan, China, the virus and disease were commonly
referred to as "coronavirus" and "Wuhan coronavirus". [225][226][227] In January 2020, WHO
recommended 2019-nCov[228] and 2019-nCoV acute respiratory disease [229] as interim
names for the virus and disease in accordance with 2015 guidance against using
locations in disease and virus names.[230] The official names COVID-19 and SARS-CoV-2
were issued on 11 February 2020. [231][232]
Following the official naming of the virus and disease, controversial terms, such as
"Wuflu" and "Kung Flu", emerged as offensive ways of describing COVID-19. Use of
these terms (popularised in social media and alt-right sources) not only downplays the
seriousness of the deadly disease but also misinforms by suggesting it is a strain
of influenza (when it is not a flu), while simultaneously mocking Chinese culture.[233][234]
Misinformation
Main article: Misinformation related to the 2019–20 coronavirus pandemic
After the initial outbreak of COVID-19, conspiracy theories, misinformation,
and disinformation emerged regarding the origin, scale, prevention, treatment, and other
aspects of the disease and rapidly spread online. [235][236][237][238]
Research
Main article: COVID-19 drug development
International clinical research programs on vaccines and therapeutic drug candidates
having potential to reduce illnesses caused by COVID-19 are underway by government
organizations, academic groups, and industry researchers. [239][240] In March, the World
Health Organization initiated the "SOLIDARITY Trial" in 10 countries, enrolling
thousands of people infected with COVID-19 to assess treatment effects of four existing
antiviral compounds with the most promise of efficacy. [241]
Personal hygiene and a healthy lifestyle and diet have been recommended to improve
immunity.[242]
Vaccine
Main article: COVID-19 vaccine
There is no available vaccine, but various agencies are actively developing vaccine
candidates. Previous work on SARS-CoV is being utilised because SARS-CoV-2 and
SARS-CoV both use the ACE2 receptor to enter human cells. [243] There are three
vaccination strategies being investigated. First, researchers aim to build a whole virus
vaccine. The use of such a virus, be it inactive or dead, 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). Experimental vaccines from any of these strategies would have to be
tested for safety and efficacy.[244]
On 16 March 2020, the first clinical trial of a vaccine started with four volunteers
in Seattle. The vaccine contains a harmless genetic code copied from the virus that
causes the disease.[245]
Post-infection treatments
Main article: COVID-19 drug repurposing research
According to two organizations tracking clinical trial progress on potential therapeutic
drugs for COVID-19 infections, 29 Phase II-IV efficacy trials were concluded in March
2020 or scheduled to provide results in April from hospitals in China – which
experienced the first outbreak of COVID-19 in late 2019. [246][247] Seven trials were
evaluating repurposed drugs already approved to treat malaria, including four studies on
hydroxychloroquine or chloroquine phosphate. [247] Repurposed antiviral drugs make up
most of the Chinese research, with nine Phase III trials on remdesivir across several
countries due to report by the end of April.[246][247] Other potential therapeutic candidates
under pivotal clinical trials concluding in March–April
are vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab,
and recombinant angiotensin-converting enzyme 2, among others.[247]
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.[248][249] A dynamic review of clinical development for
COVID-19 vaccine and drug candidates was in place, as of April 2020. [249]
Several existing antiviral medications are being evaluated for treatment of COVID-19,
[153]
including remdesivir, chloroquine and hydroxychloroquine, lopinavir/ritonavir, and
lopinavir/ritonavir combined with interferon beta.[241][250] There is tentative evidence for
efficacy by remdesivir, as of March 2020.[251] Remdesivir inhibits SARS-CoV-2 in vitro.
[252]
Phase 3 clinical trials are being conducted in the U.S., China, and Italy. [153][246][253]
Chloroquine, previously used to treat malaria, was studied in China in February 2020,
with positive preliminary results.[254] However, there are calls for peer review of the
research.[255] The Guangdong Provincial Department of Science and Technology and the
Guangdong Provincial Health and Health Commission issued a report stating that
chloroquine phosphate "improves the success rate of treatment and shortens the length
of person's hospital stay" and recommended it for people diagnosed with mild,
moderate and severe cases of novel coronavirus pneumonia. [256]
On 17 March, the Italian Pharmaceutical Agency included chloroquine and
hydroxychloroquine in the list of drugs with positive preliminary results for treatment of
COVID-19.[257] Korean and Chinese Health Authorities recommend the use
of chloroquine.[258][259] However, the Wuhan Institute of Virology, while recommending a
daily dose of one gram, notes that twice that dose is highly dangerous and could be
lethal. On 28 March 2020, the FDA issued an emergency use authorization for
hydroxychloroquine and chloroquine at the discretion of physicians treating people with
COVID-19.[260][261]
The Chinese 7th edition guidelines also include interferon, ribavirin, or umifenovir for
use against COVID-19.[259]
In 2020, a trial found that lopinavir/ritonavir was ineffective in the treatment of severe
illness.[262] Nitazoxanide has been recommended for further in vivo study after
demonstrating low concentration inhibition of SARS-CoV-2. [252]
Studies have demonstrated that initial spike protein priming by transmembrane protease
serine 2 (TMPRSS2) is essential for entry of SARS-CoV-2 via interaction with
the ACE2 receptor.[263] These findings suggest that the TMPRSS2
inhibitor camostat approved for use in Japan for inhibiting fibrosis in liver and kidney
disease might constitute an effective off-label treatment.
In February 2020, favipiravir was being studied in China for experimental treatment of
the emergent COVID-19 disease.[264][265]
In April 2020 Ivermectin is being studied in Australia for a possible treatment for COVID-
19 and has been shown to stop viral growth within 48 hours in vitro. [266][267]
There are mixed results as of April 3 as to the effectiveness of Hydroxychloroquine as a
treatment for COVID-19. With studies showing either little to no improvement over the
control groups.[268]
Anti-cytokine storm
Cytokine storm can be a complication in the later stages of severe COVID-19. There is
evidence that hydroxychloroquine may have anti-cytokine storm properties.[269]
Tocilizumab has been included in treatment guidelines by China's National Health
Commission after a small study was completed.[270][271] It is undergoing a phase 2 non
randomised test at the national level in Italy after showing positive results in people with
severe disease.[257][272][273][unreliable medical source?] Combined with a serum ferritin blood test to
identify cytokine storms, it is meant to counter such developments, which are thought to
be the cause of death in some affected people. [274][275][276] The interleukin-6 receptor
antagonist was approved by the FDA for treatment against cytokine release syndrome
induced by a different cause, CAR T cell therapy, in 2017.[277][unreliable medical source?]
The Feinstein Institute of Northwell Health announced in March a study on "a human
antibody that may prevent the activity" of IL-6.[278]
Passive antibody therapy
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.[279] This strategy was
tried for SARS with inconclusive results.[279] Viral neutralization is the
anticipated mechanism of action by which passive antibody therapy can mediate
defence against SARS-CoV-2. Other mechanisms however, such as antibody-
dependent cellular cytotoxicity and/or phagocytosis, may be possible.[279] Other forms of
passive antibody therapy, for example, using manufactured monoclonal antibodies, are
in development.[279] 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. [280]
See also
 Coronavirus diseases, a group of closely related
syndromes
 Li Wenliang, a doctor at Central Hospital of Wuhan, who
later contracted and died of COVID-19 after raising
awareness of the spread of the virus.
 Disease X, a World Health Organisation term
Notes
1. ^ Close contact is defined as one metre (three feet) by WHO and two [4]
metres (six feet) by the CDC [14]
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Coronavirus disease 2019

From Wikipedia, the free encyclopedia

Coronavirus disease 2019 (COVID-19)

 Novel coronavirus pneumonia[1][2]

Specialty Infectious diseases

Symptoms Fever, cough, shortness of breath, none[3][4]

Complications Pneumonia, viral sepsis, acute respiratory distress

Usual onset 5 days from exposure (may range between 2–14

Causes Severe acute respiratory syndrome coronavirus

Risk factors Travel, viral exposure

Diagnostic method rRT-PCR testing, CT scan

Prevention Hand washing, quarantine, physical distancing

Frequency 1,203,485[5] confirmed cases

Deaths 64,784 (5.4% of confirmed cases)[5]

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe

 1Signs and symptoms

Signs and symptoms

Loss of smell 15[34] to 30[11][35]

Those infected with the virus may be asymptomatic or develop flu-like

Respiratory droplets, produced when a man is sneezing

Illustration of SARSr-CoV virion

CDC rRT-PCR test kit for COVID-19[70]

Typical CT imaging findings

CT imaging of rapid progression stage

Alternatives to flattening the curve[92][93]

Preventive measures to reduce the chances of infection include staying at home,

Prevention efforts are multiplicative, with effects far beyond that of a

Four steps to putting on personal protective equipment [111]

Options for ARDS[150]

Tidal volume 6mL per kg and can be reduced to 4mL/kg

Keep below 30 cmH2O if possible (high respiratory rate (35 per minute)

Prone positioning For worsening oxygenation

Fluid management Goal is a negative balance of 1/2–1L per day

Glucocorticoids Not recommended

The severity of diagnosed COVID-19 cases in China [172]

Case fatality rates (%) by age and country

Case fatality rates (%) by age in the United States

Total confirmed cases over time

Total deaths over time

Total confirmed cases of COVID-19 per million people, 20 March

Total confirmed deaths due to COVID-19 per million people, 24 March

Society and culture

metres (six feet) by the CDC [14]

briefing on COVID-19". World Health Organization (WHO) (Press

Disease 2019 (COVID-19) (PDF) (Report). World Health

 Media from Wikimedia Commons

 Coronavirus disease (COVID-19) by the World Health

 Coronavirus Disease 2019 (COVID-19) by JAMA

Infectious diseases – viral systemic diseases (A80–B34, 042–079)

2019–20 coronavirus pandemic

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