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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.

Template:Use Commonwealth English

Coronavirus disease 2019
(COVID-19)
Other names
  • 2019-nCoV acute respiratory disease
  • Novel coronavirus pneumonia[1]
  • (Colloquially) Wuhan coronavirus, Wuhan pneumonia,[2][3] Wuhan flu[4]
  • (Colloquially) "Coronavirus" or other names for SARS-CoV-2
Microscopy image showing SARS-CoV-2. The spikes on the outer edge of the virus particles resemble a crown, giving the disease its characteristic name.
Pronunciation
SpecialtyAcute respiratory infection[5]
SymptomsFever, cough, shortness of breath[6]
ComplicationsPneumonia, ARDS, kidney failure
CausesSARS-CoV-2
Diagnostic methodrRT-PCR testing, immunoassay, CT scan
PreventionCorrect handwashing technique, cough etiquette, avoiding close contact with sick people
TreatmentSymptomatic and supportive
Deaths6,881,955[7] (3.4% of confirmed cases;[8] estimated to be 0.7–1.0% when including people without symptoms)[9]

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[10] The disease has spread globally since 2019, resulting in the 2019–20 coronavirus pandemic.[11][12] Common symptoms include fever, cough and shortness of breath. Muscle pain, sputum production and sore throat are some of the less common symptoms.[6][13] While the majority of cases result in mild symptoms,[14] some progress to pneumonia and multi-organ failure.[11][15] The deaths per number of diagnosed cases is estimated at between 1% and 5% but varies by age and other health conditions.[16][17]

The infection is spread from one person to others via respiratory droplets, often produced during coughing.[18][19] Time from exposure to onset of symptoms is generally between 2 and 14 days, with an average of 5 days.[20][21] The standard method of diagnosis is by reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab or sputum sample. Antibody assays can also be used, using a blood serum sample.[22] The infection can also be diagnosed from a combination of symptoms, risk factors and a chest CT scan showing features of pneumonia.[23][24]

Recommended measures to prevent the disease include frequent hand washing, maintaining distance from other people and not touching one's face.[25] The use of masks is recommended for those who suspect they have the virus and their caregivers but not for the general public.[26][27] There is no vaccine or specific antiviral treatment for COVID-19; management involves treatment of symptoms, supportive care and experimental measures.[28]

The World Health Organization (WHO) has declared the 2019–20 coronavirus outbreak a pandemic[12] and a Public Health Emergency of International Concern (PHEIC).[29][30] Evidence of local transmission of the disease has been found in multiple countries across all six WHO regions.[31]

Signs and symptoms

COVID-19 symptoms
Rate of symptoms[32]
Symptom Percentage
Fever 87.9%
Dry cough 67.7%
Fatigue 38.1%
Sputum production 33.4%
Shortness of breath 18.6%
Muscle pain or joint pain 14.8%
Sore throat 13.9%
Headache 13.6%
Chills 11.4%
Nausea or vomiting 5.0%
Nasal congestion 4.8%
Diarrhea 3.7%
Haemoptysis 0.9%
Conjunctival congestion 0.8%

Those infected with the virus may either be asymptomatic or develop flu-like symptoms that include fever, cough and shortness of breath.[6][33][34] Diarrhoea and upper respiratory symptoms such as sneezing, runny nose, or sore throat are less common.[35] Cases can progress to pneumonia, multi-organ failure and death in the most vulnerable.[11][15]

The incubation period ranges from two to 14 days, with an estimated median incubation period of five to six days, according to the World Health Organization (WHO).[36][37] Symptomatic disease lasts from a few days to weeks, and the duration correlates with other ongoing health issues in the individual.[38]

One study in China found that CT scans showed ground-glass opacities in 56%, but 18% had no radiological findings. 5% were admitted to intensive care units, 2.3% needed mechanical support of ventilation and 1.4% died.[39] Bilateral and peripheral ground glass opacities are the most typical CT findings.[40] Consolidation, linear opacities and reverse halo sign are other radiological findings.[40] Initially, the lesions are confined to one lung, but as the disease progresses, indications manifest in both lungs in 88% of so-called "late patients" in the study group (the subset for whom time between onset of symptoms and chest CT was 6–12 days).[40]

It has been noted that children seem to have milder symptoms than adults.[41]

Cause

Main article: Severe acute respiratory syndrome coronavirus 2

The disease is caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously referred to as the 2019 novel coronavirus (2019-nCoV).[42] It is primarily spread between people via respiratory droplets from coughs and sneezes.[19]

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 "spike", to connect to ACE2 and intrude the hosting cell.[43] 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,[44][45] though another view is that increasing ACE2 using Angiotensin II receptor blocker drugs could be protective and that these hypotheses need to be tested by datamining of clinical patient records.[46] As the alveolar disease progresses respiratory failure might develop and death might ensue.[45] ACE2 might also be the path for the virus to assault the heart causing acute cardiac injury. People with existing cardiovascular conditions have worst prognosis.[47]

The virus is thought to have an animal origin.[48] It was first transmitted to humans in Wuhan, China, in November or December 2019, and the primary source of infection became human-to-human transmission by early January 2020.[49][50]

Diagnosis

Main article: COVID-19 testing
CDC rRT-PCR test kit for COVID-19[51]

The WHO has published several testing protocols for the disease.[52] The standard method of testing is real-time reverse transcription polymerase chain reaction (rRT-PCR).[53] The test can be done on respiratory samples obtained by various methods, including a nasopharyngeal swab or sputum sample.[54] Results are generally available within a few hours to 2 days.[55][56] Blood tests can be used, but these require two blood samples taken two weeks apart and the results have little immediate value.[57] Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so that laboratories across the world could independently develop polymerase chain reaction (PCR) tests to detect infection by the virus.[11][58][59]

COVID-19 testing can also be done with antibody test kits.[60] Antibody assays use a blood serum sample and can provide a positive result even if the person has recovered and the virus is no longer present.[22] The first antibody test was demonstrated by a team at the Wuhan Institute of Virology on 17 February 2020.[61][22] On 25 February, a team from Duke–NUS Medical School in Singapore announced another antibody test for COVID-19 that can provide a result within a few days.[22][62]

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.[23] A study published by a team at the Tongji Hospital in Wuhan on 26 February 2020 showed that a chest CT scan for COVID-19 has more sensitivity (98%) than the polymerase chain reaction (71%).[24] False negative results may occur due to PCR kit failure, or due to either issues with the sample or issues performing the test. False positive results are likely to be rare.[63]

  • Typical CT imaging findings
    Typical CT imaging findings
  • CT imaging of rapid progression stage
    CT imaging of rapid progression stage

Prevention

See also: 2019–20 coronavirus pandemic § Prevention
An illustration of the effect of spreading out infections over a long period of time, known as flattening the curve; decreasing peaks allows healthcare services to better manage the same volume of patients.[64][65][66]
Alternatives to flattening the curve[67]

Because a vaccine against SARS-CoV-2 is not expected to become available until 2021 at the earliest,[68] a key part of managing the COVID-19 pandemic is trying to decrease the epidemic peak, known as flattening the epidemic curve.[65] This helps decrease the risk of health services being overwhelmed and provides more time for a vaccine and treatment to be developed.[65]

Preventive measures to reduce the chances of infection in locations with an outbreak of the disease are similar to those published for other coronaviruses: stay home, avoid travel and public activities, wash hands with soap and hot water often, practice good respiratory hygiene and avoid touching the eyes, nose, or mouth with unwashed hands.[69][70] Social distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel and canceling mass gatherings.

According to the WHO, the use of masks is only recommended if a person is coughing or sneezing or when one is taking care of someone with a suspected infection.[71]

To prevent transmission of the virus, the US Centers for Disease Control and Prevention (CDC) recommends that infected individuals stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask when exposed to an individual or location of a suspected infection, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.[72][73] 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 recommended using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available.[69] The WHO advises individuals to avoid touching the eyes, nose, or mouth with unwashed hands.[70] Spitting in public places also should be avoided.[74]

Management

Four steps to putting on personal protective equipment[75]

There are no antiviral medications specific to COVID-19. Patients are managed with supportive care such as fluid and oxygen support.[76][77] Antiviral drugs may be tried in people with severe disease.[76] The WHO and Chinese National Health Commission have published treatment recommendations for taking care of people who are hospitalised with COVID-19.[78][79] Steroids such as methylprednisolone are not recommended unless the disease is complicated by acute respiratory distress syndrome.[80][81] The CDC recommends that those who suspect they carry the virus wear a facemask.[26]

Management of people infected by the virus includes taking precautions while applying therapeutic manoeuvres, especially when performing procedures like intubation or hand ventilation that can generate aerosols.[82]

Technology

The CDC outlines the specific personal protective equipment and the order in which healthcare providers should put it on when dealing with someone who may have COVID-19: 1) gown, 2) mask or respirator, 3) goggles or a face shield, 4) gloves.[83][84]

In February 2020, China launched a mobile app to deal with the disease outbreak.[85] 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.[86]

Clinical trials

The WHO recommended volunteers take part in trials of the effectiveness and safety of potential treatments.[87] There is tentative evidence for remdesivir as of March 2020.[88] Lopinavir/ritonavir is also being studied in China.[89] Chloroquine was being trialled in China in February 2020, with preliminary results that seem positive.[90] Nitazoxanide has been recommended for further in vivo study after demonstrating low concentration inhibition of SARS-CoV-2.[91]

Psychological

Infected 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.[92][93]

Prognosis

Many of those who die of COVID-19 have preexisting conditions, including hypertension, diabetes and cardiovascular disease.[94] 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.[95] 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%.[96] In those under the age of 50 the risk of death is less than 0.5%, while in those over the age of 70 it is more than 8%.[96] No deaths had occurred in patients under the age of 10 as of 26 February 2020.[96] Availability of medical resources and the socioeconomics of a region may also affect mortality.[97]

Histopathological examinations of post-mortem lung samples showed 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).[98]

Case fatality rates by age in different countries
Age 80+ 70-79 60-69 50-59 40-49 30-39 20-29 10-19 0-9
China as of February 11th[99] 14.8 8.0 3.6 1.3 0.4 0.2 0.2 0.2 0.0
Italy as of March 9th[100] 13.2 6.4 2.5 0.2 0.1 0.0 0.0 0.0 0.0
South Korea as of March 12th[101] 8.2 4.8 1.4 0.4 0.1 0.1 0.0 0.0 0.0
  • The severity of diagnosed COVID19 cases in China[102]
    The severity of diagnosed COVID19 cases in China[102]
  • 3D Medical Animation Still Shot graph showing Case Fatality rates by age group from SARS-COV-2 in China.
    Case fatality rates by age group in China. Data through 11 February 2020.[103]
  • Case fatality rate depending on other health problems
    Case fatality rate depending on other health problems

Epidemiology

Main article: 2019–20 coronavirus pandemic
Total confirmed cases of COVID-19 as of March 12, 2020

Overall mortality and morbidity rates due to infection are not well established; while the case fatality rate (CFR) changes over time in the current outbreak, the proportion of infections that progress to diagnosable disease remains unclear.[104][105] However, preliminary research has yielded case fatality rate numbers between 2% and 3%;[16] in January 2020 the WHO suggested that the case fatality rate was approximately 3%,[106] and 2% in February 2020 in Hubei.[107] Other CFR numbers, which adjust for differences in time of confirmation, death or cured, are respectively 7%[108] and 33% for people in Wuhan 31 January.[109] An unreviewed preprint study by Imperial College London among 55 fatal cases noted that early estimates of mortality may be too high as asymptomatic infections are missed. They estimated a mean infection fatality ratio (IFR, the mortality among infected) ranging from 0.8% when including asymptomatic carriers to 18% when including only symptomatic cases from Hubei province.[110] Pauline Vetter, in an editorial in The BMJ noted that mortality outside of Hubei province seems to be lower than within Hubei.[80] The outbreak in 2019–2020 has caused at least 676,609,955Template:Edit sup[7] confirmed infections and 6,881,955Template:Edit sup[7] deaths.

An observational study of nine people, found no intrauterine vertical transmission from mother to the newborn.[111] Also, a descriptive study in Wuhan found no evidence of viral transmission through vaginal sex (from female to partner), but authors note that transmission during sex might occur through other routes.[112]

Research

Because of its key role in the transmission and progression of the disease, ACE2 has been the focus of a significant proportion of research and various therapeutic approaches have been suggested.[45]

Vaccine

Main article: COVID-19 vaccine

There is no available vaccine, but research into developing a vaccine has been undertaken by various agencies. Previous work on SARS-CoV is being utilised because SARS-CoV-2 and SARS-CoV both use ACE2 enzyme to invade human cells.[113] 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 for 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. A third strategy is 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.[114]

Antiviral

No drug has yet been approved to treat coronavirus infections in humans by the WHO although some are recommended by the Korean and Chinese medical authorities.[115] Trials of many antivirals have been started in patients with COVID-19 including oseltamivir, lopinavir/ritonavir, ganciclovir, favipiravir, baloxavir marboxil, umifenovir, interferon alfa but currently there are no data to support their use.[116] Korean Health Authorities recommend lopinavir/ritonavir or chloroquine[117] and the Chinese 7th edition guidelines include interferon, lopinavir/ritonavir, ribavirin, chloroquine and/or umifenovir.[118]

Research into potential treatments for the disease was initiated in January 2020, and several antiviral drugs are already in clinical trials.[119][120] Although completely new drugs may take until 2021 to develop,[121] several of the drugs being tested are already approved for other antiviral indications, or are already in advanced testing.[115]

Remdesivir and chloroquine effectively inhibit the coronavirus in vitro.[91] Remdesivir is being trialled in US and in China.[116]

Preliminary results from a multicentric trial, announced in a press conference and described by Gao, Tian and Yang, suggested that chloroquine is effective and safe in treating COVID-19 associated pneumonia, "improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course".[90]

Recent studies have demonstrated that initial spike protein priming by transmembrane protease serine 2 (TMPRSS2) is essential for entry of SARS-CoV-2, SARS-CoV and MERS-CoV via interaction with the ACE2 receptor.[122][123] These findings suggest that the TMPRSS2 inhibitor Camostat approved for clinical use in Japan for inhibiting fibrosis in liver and kidney disease, postoperative reflux esophagitis and pancreatitis might constitute an effective off-label treatment option.[122]

Terminology

The process of naming the disease has been called "chaotic".[124]

The World Health Organisation announced on 11 February 2020 that "COVID-19" will be the official name of the disease. World Health Organisation chief Tedros Adhanom Ghebreyesus said "co" stands for "corona", "vi" for "virus" and "d" for "disease", while "19" was for the year, as the outbreak was first identified on 31 December 2019. Tedros said the name had been chosen to avoid references to a specific geographical location (i.e. China), animal species, or group of people in line with international recommendations for naming aimed at preventing stigmatisation.[125][126]

The disease has been named COVID-19 while the virus has been renamed as SARS-COV-2 by WHO.[127]

See also

References

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  126. ^ "The coronavirus spreads racism against – and among – ethnic Chinese". The Economist. 17 February 2020. Archived from the original on 17 February 2020. Retrieved 17 February 2020. {{cite news}}: Unknown parameter |name-list-format= ignored (|name-list-style= suggested) (help)
  127. ^ "Naming the coronavirus disease (COVID-19) and the virus that causes it". World Health Organization (WHO). Retrieved 13 March 2020.

External links

Scholia has a topic profile for COVID-19.
Retrieved from "https://en.wikipedia.org/w/index.php?title=COVID-19&oldid=945436487"