COVID-19

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This article is about the disease. For the virus, see Severe acute respiratory syndrome coronavirus 2. For the outbreak, see 2019–20 coronavirus outbreak. For the other lethal coronavirus disease prevalent in 2019, see Middle East respiratory syndrome.

Coronavirus disease 2019
(COVID-19)
Other names
  • 2019-nCoV acute respiratory disease
  • Novel coronavirus pneumonia[1]
Symptoms
SpecialtyInfectious disease
SymptomsFever, cough, shortness of breath[2]
ComplicationsPneumonia, ARDS, kidney failure
CausesSARS-CoV-2
Diagnostic methodPCR testing, medical imaging
TreatmentSymptomatic and supportive

Coronavirus disease 2019 (COVID-19),[3] formerly known as 2019-nCoV acute respiratory disease, is an infectious disease caused by SARS-CoV-2, a virus closely related to the SARS virus.[4][5] The disease is the cause of the 2019–20 coronavirus outbreak.[6][7] It is primarily spread between people via respiratory droplets from infected individuals when they cough or sneeze.[8] Time from exposure to onset of symptoms is generally between 2 and 14 days.[9] Spread can be limited by handwashing and other hygiene measures.[10][11]

The disease may initially present with few or no symptoms, or may develop into fever, coughing, shortness of breath, pain in the muscles and tiredness.[12] Further development may include pneumonia and acute respiratory distress syndrome. There are no vaccines nor specific antiviral treatments, with management involving treatment of symptoms, supportive measures, and experimental measures.[13]

Cases were initially identified in Wuhan, capital of Hubei province in China in December 2019. Subsequently, infections have been reported around the world. Cases reported outside China have predominantly been in people who have recently travelled to Mainland China, however a few cases of local transmission have also occurred. More than 2,000 deaths have been reported in Mainland China, and 8 deaths in other parts of the world.[14]

The World Health Organization (WHO) and U.S. Centers for Disease Control (CDC) recommend that persons who suspect that they are carrying the virus wear a surgical face mask and seek medical advice by calling a doctor rather than directly visiting a clinic in person.[15][16] The WHO has declared the 2019–20 coronavirus outbreak to be a Public Health Emergency of International Concern (PHEIC).[17][18] As of 19 February 2020, only Mainland China is listed as an area with known ongoing community spread of the disease.[19]

Signs and symptoms

Those infected may either be asymptomatic or have symptoms, like fever, cough, shortness of breath.[20][21][2] Diarrhea or upper respiratory symptoms (e.g. sneezing, runny nose, sore throat) are less frequent.[22] Cases can progress to severe pneumonia, multi-organ failure, and death.[6][23]

The length of the incubation period before the onset of symptoms is estimated to be between two and ten days by the World Health Organization and between two and 14 days by the United States Centers for Disease Control and Prevention (CDC).[24][2]

Cause

Scanning electron microscope image of SARS-CoV-2 (yellow)
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).[4] The virus is thought to have an animal origin.[25]

It is primarily spread between people via respiratory droplets from the coughs and sneezes.[8] Officials in Shanghai confirmed several transmission modes, including direct transmission, contact transmission and aerosol transmission, the latter two involving transmission when someone touches a surface contaminated with tainted respiratory droplets and inhalation of air contaminated with tainted respiratory droplets.[26]

An epidemiological study of the first 72,314 cases suggested that there may have been a "continuous common source" of the outbreak in December 2019, which would imply that several animal to human zoonotic events occurred at the Huanan Seafood Wholesale Market. According to this theory, the primary source of infection became human-to-human transmission in early January 2020.[27]

Diagnosis

CDC laboratory test kit for COVID-19[28]

The WHO has published several testing protocols for the disease.[29][30] Testing uses real time reverse transcription-polymerase chain reaction (rRT-PCR).[31] The test can be done on respiratory or blood samples.[32] Results are generally available within a few hours to days.[33][34] 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 PCR tests to detect infection by the virus.[6][35][36][37][38]

Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying patients who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected patients: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count.[39]

Prevention

Global health organisations have published preventive measures to reduce the chances of infection. Recommendations are similar to those published for other coronaviruses and include: frequent washing of hands with soap and water; not touching the eyes, nose, or mouth with unwashed hands; and practicing good respiratory hygiene.[40][41]

The use of masks by healthy members of the public is not recommended outside of China.[42][10][11]

To prevent transmission, the CDC recommends that infected individuals stay at home except to get medical care; call ahead before visiting a healthcare provider; wear a facemask (especially in public); cover coughs and sneezes with a tissue; regularly wash hands with soap and water; and avoid sharing personal household items.[43]

No vaccine currently exists against SARS-CoV-2.

Management

There are no specific antiviral medications approved for this disease. Symptoms are managed with supportive care.[44] The WHO has published detailed treatment recommendations for hospitalized patients with severe acute respiratory infection (SARI) when a SARS-CoV-2 infection is suspected.[45] The WHO also recommended volunteers take part in randomized controlled trials for testing the effectiveness and safety of potential treatments.[46]

The Beijing branch of China's National Health Commission suggested the use of lopinavir/ritonavir as part of treatment plans in the absence of an approved drug for this indication.[47] The lopinavir/ritonavir combination and interferon can now be claimed for via health insurance in some countries.[48]

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.[49][50]

Alternative medicine

See also: Misinformation related to the 2019–20 coronavirus outbreak § Vaccine and treatment

Chinese health authorities recommend the use of traditional Chinese medicine (TCM) to prevent or treat the disease. On 22 January, National Health Commission put TCM into the third issue of the COVID diagnostic and treatment plan.[51] On 2 February, Wuhan officials ordered all patients to be put on a specific TCM treatment.[52][53] On 14 February, Wuhan opened a TCM-oriented temporary hospital.[54] The efficacy and safety of TCM has not been established in coronavirus infections.[55][56]

Prognosis

According to WHO, based on analysis of 44,000 cases of COVID-19 in Hubei province, around 80% of patients only have a mild form of the disease, 14% developed more severe disease such as pneumonia, 5% have critical disease, and 2% of cases are fatal.[57] Of those who died, many had preexisting conditions, including hypertension, diabetes, or cardiovascular disease.[58]

In early cases that resulted in death, the median time of disease was found to be 14 days, with a total range from six to 41 days.[59]

Epidemiology

Main article: 2019–20 coronavirus outbreak

Overall mortality and morbidity rates due to infection are not well established; while the case fatality rate changes over time in the current outbreak, the proportion of infections that progress to diagnosable disease remains unclear.[60][61] However, preliminary research has yielded case fatality rate numbers between 2% and 3%;[62] in January 2020 the WHO suggested that the case fatality rate was approximately 3%,[63] and 2% in February 2020 in Hubei.[64] An unreviewed Imperial College preprint study 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 (the mortality among infected) ranging from 0.8% when including asymptomatic carriers to 18% when including only symptomatic cases from Hubei province.[65]

Research

Vaccine research

Many organizations are using published genomes to develop possible vaccines against SARS-CoV-2.[66][67] Bodies developing vaccines include the Chinese Center for Disease Control and Prevention,[68][69] the University of Hong Kong,[70] and Shanghai East Hospital.[70] Three vaccine projects are being supported by the Coalition for Epidemic Preparedness Innovations (CEPI), including projects by the biotechnology companies Moderna and Inovio Pharmaceuticals and another by the University of Queensland.[71] The United States National Institutes of Health (NIH) is cooperating with Moderna to create an RNA vaccine matching a spike of the coronavirus surface, and intends to start human trials by May 2020.[66] Inovio Pharmaceuticals is developing a DNA-based vaccination and collaborating with a Chinese firm, hoping to perform human trials in the summer of 2020.[72] In Australia, the University of Queensland is investigating the potential of a molecular clamp vaccine that would genetically modify viral proteins in order to stimulate an immune reaction.[71] In Canada, the International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, are working on a vaccine,[73] aiming to start animal testing in March 2020 and human testing in 2021.[73]

At the end of January 2020, Janssen Pharmaceutical Companies began work on developing a vaccine, utilizing the same technologies used to make its experimental Ebola vaccine.[74] In the following month, the U.S. Department of Health and Human Services' Biomedical Advanced Research and Development Authority (BARDA) announced that it would collaborate with Janssen and, later, Sanofi Pasteur (the vaccine division of Sanofi) to develop a vaccine.[75][76] Sanofi has previously worked on a vaccine for SARS and it stated to expect to have a vaccine candidate within six months that could be ready to test in people within a year to 18 months.[75]

Antiviral research

Antiviral medications are being tested, including both new medications and those already approved for other infections.

Research into potential treatments for the disease was initiated in January 2020, and several antiviral drugs are already in clinical trials.[66][67] Although completely new drugs may take until 2021 to develop,[77] several of the drugs being tested are already approved for other antiviral indications, or are already in advanced testing.[67] Antivirals being tested include the RNA polymerase inhibitor remdesivir,[78][79][80] interferon beta,[80] triazavirin,[81] chloroquine, the lopinavir/ritonavir combination (Kaletra) and others.[82][67] Other drugs being tested include galidesivir, a broad-spectrum antiviral that is a nucleoside RNA polymerase inhibitor; REGN3048-3051 (Regeneron), a combination of two neutralizing monoclonal antibodies; darunavir/cobicistat, an approved drug for HIV, and PRO 140, a Research into potential treatments for the disease was initiated in January 2020, and several antiviral drugs are already in clinical trials.[66][67] As it has effects against other coronaviruses[83][84] and modes of action that suggest they may be effective,[85] the lopinavir/ritonavir combination already has been the target of significant research and analysis.

Terminology

The World Health Organization on 11 February 2020 announced that "COVID-19" will be the official name of the disease. World Health Organization 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 December 31. 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.[86][87]

See also

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