COVID-19
Updates to Article Attributes
COVID-19 is a zoonotic illness caused by a hitherto unknownnovel coronavirus, which has provisionally beenis called 2019 novelsevere acute respiratory syndrome coronavirus 2 or (2019-nCoVSARS-CoV-2 by the World Health Organisation (WHO). The first cases were seen in the city of Wuhan, China in December 2019, and have been linked to the Huanan Seafood Wholesale Market 1,2,10. Person Person-to-person transmission can occur.
The imaging findings are of pneumonia, often bilateral.No effective treatment or vaccine currently exists.
Terminology
On February 11th 2020, the World Health Organisation (WHO) officially named the condition COVID-19 (apparently a shortening of COronaVIrus Disease-19), which was announced in a tweet 15. On the same day the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) 16.
The WHO had originally called this emerging zoonotic infectious illness "novel coronavirus-infected pneumonia (NCIP)" and the virus itself had been named 2019 novel coronavirus (2019-nCoV) 1,2.
Epidemiology
As of February 10th11 2020, over 40,50043,000 cases of novel coronavirus-infected pneumonia haveCOVID-19 had been identified worldwide, with the vast majority (~99%) in China, according to a Johns Hopkins online virus tracker 5.
The infection was declared a Public Health Emergency of International Concern (PHEIC) on January 30th 2020 by the WHO 7.
On January 13th13 2020, the first confirmed case outside China was diagnosed, a Chinese tourist in Thailand 10. On January 20th20, the first infected person in the United States was confirmed to be a man in the State of Washington who had recently returned from a visit to Wuhan 9. The disease has now been diagnosed in 28 territories, including Macau and Hong Kong, in five continents 5,13.
The mortality rate is about 2-3% 2,5 with currently 9101018 confirmed deaths (February 10th11, 2020) 5. Only two confirmed deaths have been outside mainland China, one in Hong Kong, and a second one in the Philippines 5.
A recent modelling study suggested that the true number of cases of infection is much higher than published official figures, being greater than 75,000 infected persons in Wuhan 8.
In an article examining the first 425 infected cases in Wuhan, 56% of the infectees were male and the median age was 59 years 12. In this early cohort there were no children under 15 years old. Using this dataset, the group estimated that the R0 (basic reproduction number) of the novel coronavirus was 2.2, that is each infected individual - on average - causes 2.2 new cases of the disease. The incubation period in this group has been calculated to be 5.2 days on average 12.
NB: it is important to appreciate that the epidemiological parameters of the disease are likely to change as larger cohorts of infected people are studied.
Clinical presentation
The novel coronavirusCOVID-19 primarily presents as pneumonia, however, its full spectrum of clinical effects remains to be determined 1,2,13. Symptoms are non-specific:
- fever
- myalgia
- malaise
- non-productive cough
- pleuritic pain
- dyspnoea
Laboratory tests
The most common findings in a study of 138 hospitalised patients were 13:
- lymphopenia
- increased prothrombin time (PT)
- increased lactate dehydrogenase
Complications
In a study of 138 patients who had been hospitalised, 26% were admitted to the intensive care unit (ICU). The ICU patients tended to be older with more comorbidities 13.
- acute respiratory distress syndrome (ARDS)
- acute cardiac injury
- secondary infections
- sepsis
Pathology
The recently identified 2019-nCoVSARS-CoV-2 was confirmed as the cause of novel coronavirus-infected pneumoniaCOVID-19 on January 9 2020 14. It is a member of the Betacoronavirus genus, one of the genera of the Coronaviridae family of viruses. Coronaviruses are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease.
The natural animal host of 2019-nCoVSARS-CoV-2 remains undetermined 11.
Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the common cold.
Radiographic features
The primary findings of COVID-19 on chest radiograph and CT are those of pneumonia 3. 75% of cases have presented with bilateral pneumonia 6.
CT
- ground glass opacities (GGO) in all hospitalised patients 13
- air space consolidation
Treatment and prognosis
No specific treatment or vaccine exists for this emerging illnessCOVID-19 (as of February 2020). Therefore in the meantime, resources have been concentrated on public health measures, to prevent further interhuman transmission of the virus. This has required a multipronged approach and for individuals includes meticulous personal hygiene, fitted masks, and the avoidance of large crowds/crowded environments 11.
In healthcare facilities, concerted efforts are required to effect rapid diagnosis, quarantine infected cases and provide effective supportive therapies. This will encompass empirical treatments with antibiotics, antivirals, steroids and supportive measures. Mechanical ventilation and extracorporeal membrane oxygenation (ECMO) have also been used where clinically necessary.
Vaccines for the coronaviruses have been under development since the SARS outbreak, but none are yet available for human patients 11.
In the earliest studies, mortality rate was estimated as 3%, although later data, suggests it as being slightly lower at 2%. In a Chinese study looking at 138 hospitalised patients only, mortality was 4.3% 2,5,13.
-<p><strong>Novel coronavirus-infected pneumonia</strong> (<strong>NCIP</strong>) is an emerging <a href="/articles/zoonosis">zoonotic</a> illness caused by a hitherto unknown <a href="/articles/human-coronavirus-1">coronavirus</a>, which has provisionally been called <strong>2019 novel coronavirus</strong> or <strong>2019-nCoV</strong> by the <a href="/articles/world-health-organisation-who">World Health Organisation (WHO)</a>. The first cases were seen in the city of Wuhan, China in December 2019, and have been linked to the Huanan Seafood Wholesale Market <sup>1,2,10</sup>. Person-to-person transmission can occur.</p><p>The imaging findings are of <a href="/articles/pneumonia">pneumonia</a>, often bilateral.<br>No effective treatment currently exists.</p><h4>Epidemiology</h4><p>As of February 10th 2020, over 40,500 cases of novel coronavirus-infected pneumonia have been identified worldwide, with the vast majority (~99%) in China, according to a Johns Hopkins online virus tracker <sup>5</sup>. </p><p>The infection was declared a Public Health Emergency of International Concern (PHEIC) on January 30th 2020 by the WHO <sup>7</sup>.</p><p>On January 13th 2020, the first confirmed case outside China was diagnosed, a Chinese tourist in Thailand <sup>10</sup>. On January 20th, the first infected person in the United States was confirmed to be a man in the State of Washington who had recently returned from a visit to Wuhan <sup>9</sup>. The disease has now been diagnosed in 28 territories, including Macau and Hong Kong, in five continents <sup>5,13</sup>. </p><p>The mortality rate is about 2-3% <sup>2,5</sup> with currently 910 confirmed deaths (February 10th, 2020) <sup>5</sup>. Only two confirmed deaths have been outside mainland China, one in Hong Kong, and a second one in the Philippines <sup>5</sup>. </p><p>A recent modelling study suggested that the true number of cases of infection is much higher than published official figures, being greater than 75,000 infected persons in Wuhan <sup>8</sup>.</p><p>In an article examining the first 425 infected cases in Wuhan, 56% of the infectees were male and the median age was 59 years <sup>12</sup>. In this early cohort there were no children under 15 years old. Using this dataset, the group estimated that the <a href="/articles/r0-basic-reproduction-number">R<sub>0</sub> (basic reproduction number)</a> of the novel coronavirus was 2.2, that is each infected individual - on average - causes 2.2 new cases of the disease. The <a href="/articles/incubation-period">incubation period</a> in this group has been calculated to be 5.2 days on average <sup>12</sup>.</p><p>NB: it is important to appreciate that the epidemiological parameters of the disease are likely to change as larger cohorts of infected people are studied.</p><h4>Clinical presentation</h4><p>The novel coronavirus primarily presents as <a href="/articles/pneumonia">pneumonia</a>, however, its full spectrum of clinical effects remains to be determined <sup>1,2,13</sup>. Symptoms are non-specific:</p><ul>- +<p><strong>COVID-19</strong> is a <a href="/articles/zoonosis">zoonotic</a> illness caused by a novel <a href="/articles/human-coronavirus-1">coronavirus</a>, which is called <strong>severe acute respiratory syndrome coronavirus 2</strong> (<strong>SARS-CoV-2</strong>). The first cases were seen in the city of Wuhan, China in December 2019, and have been linked to the Huanan Seafood Wholesale Market <sup>1,2,10</sup>. Person-to-person transmission can occur. The imaging findings are of <a href="/articles/pneumonia">pneumonia</a>, often bilateral. No effective treatment or vaccine currently exists.</p><h4>Terminology</h4><p>On February 11<sup>th</sup> 2020, the <a href="/articles/world-health-organisation-who">World Health Organisation (WHO)</a> officially named the condition COVID-19 (apparently a shortening of COronaVIrus Disease-19), which was announced in a tweet <sup>15</sup>. On the same day the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) <sup>16</sup>.</p><p>The WHO had originally called this emerging zoonotic infectious illness "novel coronavirus-infected pneumonia (NCIP)" and the virus itself had been named 2019 novel coronavirus (2019-nCoV) <sup>1,2</sup>.</p><h4>Epidemiology</h4><p>As of February 11 2020, over 43,000 cases of COVID-19 had been identified worldwide, with the vast majority (~99%) in China, according to a Johns Hopkins online virus tracker <sup>5</sup>. </p><p>The infection was declared a Public Health Emergency of International Concern (PHEIC) on January 30th 2020 by the WHO <sup>7</sup>.</p><p>On January 13 2020, the first confirmed case outside China was diagnosed, a Chinese tourist in Thailand <sup>10</sup>. On January 20, the first infected person in the United States was confirmed to be a man in the State of Washington who had recently returned from a visit to Wuhan <sup>9</sup>. The disease has now been diagnosed in 28 territories, including Macau and Hong Kong, in five continents <sup>5,13</sup>. </p><p>The mortality rate is about 2-3% <sup>2,5</sup> with currently 1018 confirmed deaths (February 11, 2020) <sup>5</sup>. Only two confirmed deaths have been outside mainland China, one in Hong Kong, and a second one in the Philippines <sup>5</sup>. </p><p>A recent modelling study suggested that the true number of cases of infection is much higher than published official figures, being greater than 75,000 infected persons in Wuhan <sup>8</sup>.</p><p>In an article examining the first 425 infected cases in Wuhan, 56% of the infectees were male and the median age was 59 years <sup>12</sup>. In this early cohort there were no children under 15 years old. Using this dataset, the group estimated that the <a href="/articles/r0-basic-reproduction-number">R<sub>0</sub> (basic reproduction number)</a> of the novel coronavirus was 2.2, that is each infected individual - on average - causes 2.2 new cases of the disease. The <a href="/articles/incubation-period">incubation period</a> in this group has been calculated to be 5.2 days on average <sup>12</sup>.</p><p>NB: it is important to appreciate that the epidemiological parameters of the disease are likely to change as larger cohorts of infected people are studied.</p><h4>Clinical presentation</h4><p>COVID-19 primarily presents as <a href="/articles/pneumonia">pneumonia</a>, however, its full spectrum of clinical effects remains to be determined <sup>1,2,13</sup>. Symptoms are non-specific:</p><ul>
-</ul><h4>Pathology</h4><p>The recently identified 2019-nCoV was confirmed as the cause of novel coronavirus-infected pneumonia on January 9 2020 <sup>14</sup>. It is a member of the <em>Betacoronavirus</em> genus, one of the genera of the <em>Coronaviridae</em> family of viruses. Coronaviruses are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease. </p><p>The natural animal host of 2019-nCoV remains undetermined <sup>11</sup>.</p><p>Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the <a href="/articles/sars">severe acute respiratory syndrome coronavirus (SARS-CoV)</a> and <a href="/articles/middle-east-respiratory-syndrome-coronavirus-mers-cov-infection">Middle East respiratory syndrome coronavirus (MERS-CoV)</a>, both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the common cold. </p><h4>Radiographic features</h4><p>The primary findings on chest radiograph and CT are those of pneumonia <sup>3</sup>. 75% of cases have presented with bilateral pneumonia <sup>6</sup>.</p><h5>CT</h5><ul>- +</ul><h4>Pathology</h4><p>SARS-CoV-2 was confirmed as the cause of COVID-19 on January 9 2020 <sup>14</sup>. It is a member of the <em>Betacoronavirus</em> genus, one of the genera of the <em>Coronaviridae</em> family of viruses. Coronaviruses are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease. </p><p>The natural animal host of SARS-CoV-2 remains undetermined <sup>11</sup>.</p><p>Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the <a href="/articles/sars">severe acute respiratory syndrome coronavirus (SARS-CoV)</a> and <a href="/articles/middle-east-respiratory-syndrome-coronavirus-mers-cov-infection">Middle East respiratory syndrome coronavirus (MERS-CoV)</a>, both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the common cold. </p><h4>Radiographic features</h4><p>The primary findings of COVID-19 on chest radiograph and CT are those of pneumonia <sup>3</sup>. 75% of cases have presented with bilateral pneumonia <sup>6</sup>.</p><h5>CT</h5><ul>
-</ul><h4>Treatment and prognosis</h4><p>No specific treatment or vaccine exists for this emerging illness (as of February 2020). Therefore in the meantime, resources have been concentrated on public health measures, to prevent further interhuman transmission of the virus. This has required a multipronged approach and for individuals includes meticulous personal hygiene, fitted masks, and the avoidance of large crowds/crowded environments <sup>11</sup>.</p><p>In healthcare facilities, concerted efforts are required to effect rapid diagnosis, quarantine infected cases and provide effective supportive therapies. This will encompass empirical treatments with antibiotics, antivirals, steroids and supportive measures. Mechanical ventilation and <a href="/articles/extracorporeal-membrane-oxygenation">extracorporeal membrane oxygenation (ECMO)</a> have also been used where clinically necessary.</p><p>Vaccines for the coronaviruses have been under development since the SARS outbreak, but none are yet available for human patients <sup>11</sup>.</p><p>In the earliest studies, mortality rate was estimated as 3%, although later data, suggests it as being slightly lower at 2%. In a Chinese study looking at 138 hospitalised patients only, mortality was 4.3% <sup>2,5,13</sup>.</p>- +</ul><h4>Treatment and prognosis</h4><p>No specific treatment or vaccine exists for COVID-19 (as of February 2020). Therefore in the meantime, resources have been concentrated on public health measures, to prevent further interhuman transmission of the virus. This has required a multipronged approach and for individuals includes meticulous personal hygiene, fitted masks, and the avoidance of large crowds/crowded environments <sup>11</sup>.</p><p>In healthcare facilities, concerted efforts are required to effect rapid diagnosis, quarantine infected cases and provide effective supportive therapies. This will encompass empirical treatments with antibiotics, antivirals, steroids and supportive measures. Mechanical ventilation and <a href="/articles/extracorporeal-membrane-oxygenation">extracorporeal membrane oxygenation (ECMO)</a> have also been used where clinically necessary.</p><p>Vaccines for the coronaviruses have been under development since the SARS outbreak, but none are yet available for human patients <sup>11</sup>.</p><p>In the earliest studies, mortality rate was estimated as 3%, although later data, suggests it as being slightly lower at 2%. In a Chinese study looking at 138 hospitalised patients only, mortality was 4.3% <sup>2,5,13</sup>.</p>
References changed:
- 15. WHO 2020, "We now have a name for the #2019nCoV disease: COVID-19. I’ll spell it: C-O-V-I-D hyphen one nine – COVID-19", Tweet, 11 February, viewed 11 February 2020, https://twitter.com/WHO/status/1227248333871173632
- 16. Gorbalenya A, Baker S, Baric R et al. Severe Acute Respiratory Syndrome-Related Coronavirus: The Species and Its Viruses – a Statement of the Coronavirus Study Group. BioRxiv. 2020;:2020.02.07.937862. <a href="https://doi.org/10.1101/2020.02.07.937862">doi:10.1101/2020.02.07.937862</a>
- 5. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) <a href="https://gisanddata.maps.arcgis.com/apps/dashboards/bda7594740fd40299423467b48e9ecf6" target="_blank">Case Dashboard</a>. [accessed 9 May 2023].
- 5. Wuhan Coronavirus (2019-nCoV) Global Cases (by Johns Hopkins CSSE). <a href="https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6" target="_blank">Case Dashboard</a>. [accessed 10th February 2020].
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