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For a quick reference guide, please see our COVID-19 summary article.
COVID-19 (coronavirus disease-2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a strain of coronavirus. The first cases were seen in Wuhan, China, in December 2019 before spreading globally. The current outbreak was officially recognized as a pandemic by the World Health Organization (WHO) in March 2020. The WHO declared an end to the global health emergency in May 2023 but it remains a pandemic.
A definitive diagnosis of COVID-19 requires a positive RT-PCR test. The current best practice advises that CT chest is not used to diagnose COVID-19, but may be helpful in assessing for complications. The non-specific imaging findings are most commonly of atypical or organizing pneumonia, typically with a bilateral, peripheral, and basal predominant distribution.
For most sick patients, respiratory support is the cornerstone of successful treatment. Dexamethasone and monoclonal antibody-based agents have been shown to be effective in reducing the severity of illness. Multiple vaccines are available.
The official name of the illness is COVID-19 (a shortening of COronaVIrus Disease-2019) 15 and it is caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) 16,22,46. The names of both the disease and the virus should be fully capitalized, except for the letter 'o' in the viral name, which is in lowercase 16,22,41.
The official virus name is similar to SARS-CoV-1, the virus strain that caused epidemic severe acute respiratory syndrome (SARS) in 2002-2004, potentially causing confusion 38. The World Health Organization (WHO) has stated it will use "COVID-19 virus" or the "virus that causes COVID-19" instead of its official name, SARS-CoV-2 when communicating with the public 45.
As of June 2023, the number of cases of confirmed COVID-19 globally is over 670 million, having affected virtually every territory 5,156.
The R0 (basic reproduction number) of the original wild type SARS-CoV-2 has been estimated between 2.2 and 3.3 in a non-lockdown population, that is each infected individual, on average, causes between 2-3 new infections 12,33. Multiple variants have emerged, and some variants are more transmissible (see "Variants" in Pathology below) 211, 212.
The incubation period for COVID-19 was initially calculated to be about 5 days, which was based on 10 patients only 12. An American group performed an epidemiological analysis of 181 cases, for which days of exposure and symptom onset could be estimated accurately. They calculated a median incubation period of 5.1 days, that 97.5% became symptomatic within 11.5 days (CI 8.2 to 15.6 days) of being infected, and that extending the cohort to the 99th percentile results in almost all cases developing symptoms in 14 days after exposure to SARS-CoV-2 92. A large meta-analysis of 53 studies worldwide showed a mean incubation period of 6.0 days 234.
As of June 2023, the official number of deaths from COVID-19 exceeds six million globally 5. The case fatality rate is ~2-3% 5,93. It is speculated that the true case fatality rate is lower than this because many mild/asymptomatic cases are not being tested, which thus skews the apparent death rate upwards 93.
A paper published by the Chinese Center for Disease Control and Prevention (CCDC) analyzed all 44,672 cases diagnosed up to 11 February 2020. Of these, ~1% were asymptomatic, and ~80% were classed as "mild" 25.
Another study looked at clinical characteristics of COVID-19 positively tested close contacts of COVID-19 patients 81. Approximately 30% of those COVID-19-positive close contacts never developed any symptoms or changes on chest CT scans. The remainder showed changes in CT, but ~20% reportedly developed symptoms during their hospital course, and none developed severe disease 81. This suggests that a high percentage of COVID-19 carriers are asymptomatic.
In the Chinese population, 55-60% of COVID-19 patients were male; the median age has been reported between 47 and 59 years 12,93.
As of June 2023, more than 13 billion vaccine doses had been administered globally 5.
Children seem to be less seriously affected by this virus than adults, or indeed other closely-related coronaviruses 31,47,90 with large cohort studies reporting that 1-2% of symptomatic COVID-19 patients are children 59,90,91. However, there have been cases of critically-ill children with infants under 12 months likely to be more seriously affected 59. A very low number of pediatric deaths has been reported 90,91. In children, male gender does not seem to be a risk factor 59. The incubation period has been reported to be shorter than in adults, at about two days 90. In a small proportion of the patients however a severe, delayed complication termed multisystem inflammatory syndrome in children (MIS-C) can develop, which is characterized by systemic shock with multiorgan involvement.
NB: Surveillance methods and capacity vary dramatically between countries.
COVID-19 typically presents with systemic (multiple organ dysfunction, MODS-SARS-CoV-2) 227 and/or respiratory manifestations 93,170. Some also experience mild gastrointestinal or cardiovascular symptoms, although these are less common 18,50. Others may rarely present solely with a gastroenteritis-like illness, which may not initially be recognized to be COVID-19 171.
Individuals infected with SARS-CoV-2 can remain asymptomatic throughout the course of their illness acting as potential carriers 70,113,164.
The full spectrum of clinical manifestations of COVID-19 is broad 1,13. Symptoms and signs are non-specific 68:
sputum production (30-35%)
shortness of breath (15-20%)
headaches (10-36%) 121
cutaneous lesions (~20%), most commonly erythematous rash 100,210
sore throat (10-15%)
diarrhea (3-34%) 171
nasal congestion (<10%) 93
stroke (6%) 149-151,210 (most commonly cryptogenic 150,151)
palpitations, chest tightness 50
hemoptysis (<5%) 134
confusion 137, seizures, paresthesia, altered consciousness 121,210
ocular symptoms, e.g. conjunctivitis (1%) 103,104,140,141, epiphora 210
In the main, the clinical presentation in children with COVID-19 is milder than in adults 59,90,210. Symptoms are similar to any acute chest infection, encompassing most commonly pyrexia, dry cough, wheezing, sore throat, sneezing, myalgia, and/or lethargy 59,90. Less common (<10%) symptoms in children include diarrhea, lethargy, rhinorrhea and/or vomiting 91.
The gold standard diagnostic test for SARS-CoV-2 is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test. This also allows searching for specific sequences from the viral genome: E (envelope protein gene), N (nucleocapsid protein gene) and RdRP (RNA-dependent RNA polymerase gene) 207. It is believed to be highly specific, but with sensitivity reported as low as 60-70% 32 and as high as 95-97% 56. Meta-analysis has reported the pooled sensitivity of RT-PCR to be 89% 116. Thus, false negatives are a real clinical problem, and several negative tests might be required in a single case to be confident about excluding the disease.
Its sensitivity is predicated on time since exposure to SARS-CoV-2, with a false-negative rate of 100% on the first day after exposure, dropping to 67% on the fourth day. On the day of symptom onset (~4 days after exposure) the false-negative rate remains at 38%, and it reaches its nadir of 20% three days after symptoms begin (8 days post-exposure). From this point on, the false-negative rate starts to climb again reaching 66% on day 21 after exposure 138.
Serological and immunological tests
Lateral flow assay
Lateral flow immunochromatographic assays, a.k.a. lateral flow assays or lateral flow tests (LFTs), are immunoassay-based techniques, in which an analyte, such as antigens or antibodies, may be detected in a test sample from a human subject. These are often binary (i.e. a 'yes' or 'no' result) tests. The urine pregnancy test is probably the most commonly used of this type of assay.
A body fluid sample is applied to the end of a rectangular test strip and via capillary action flows along the absorbent substrate. Towards the other end of the strip are antibodies attached to the substrate which will react with any active viral proteins in the body fluid as it moves along. When this fluid (containing viral antigens) reaches the test strip it will induce a chemical reaction producing a visible colored line 235. Further along the strip, the fluid will then encounter the control line inducing a second reaction to show a second line.
During the COVID-19 pandemic, lateral flow tests of small samples from the upper respiratory tract have become widely used for detecting whether SARS-CoV-2 antigens are present or absent 235.
CT as a diagnostic test
Multiple radiological organizations and learned societies stated early in the pandemic that CT should not be relied upon as a diagnostic/screening tool for COVID-19 52,57,87,88,116. On 16 March 2020, an American-Singaporean panel published that CT findings were not part of the diagnostic criteria for COVID-19 56. However, CT findings have been used controversially as a surrogate diagnostic test by some 2,32,89.
The most common ancillary laboratory findings in patients, including a study of 61,742, were the following 13,89:
Other commonly identified abnormalities include:
mildly elevated serum amylase: 17% patients (study of 52 cases) 145
mildly deranged liver function tests are common, primarily elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 145,146,210
In one study of hospitalized patients, reviewing 1,099 individuals across China, the admission rate to the intensive care unit (ICU) was 5% 93. In this same study, 6% of all patients required ventilation, whether invasive or non-invasive. ICU patients tend to be older with more comorbidities 13,93.
Commonly reported sequelae are:
acute respiratory distress syndrome (ARDS): ~22.5% (range 17-29%) 89
acute thromboembolic disease 130
acute cardiac injury: elevated troponin levels 210
delirium (15%) 137,210
diffuse leukoencephalopathy 157
juxtacortical white matter and corpus callosum (particularly of the splenium)
stroke (6%): cryptogenic/ischemic 150,151,210
higher mortality and greater severity of stroke in the context of COVID-19 150
Guillain-Barré syndrome (GBS): rare 182
hepatobiliary: liver is the most frequently affected organ after the lungs, although serious sequelae are rare 210
acute pancreatitis 210
rhabdomyolysis (late sequela, case reports only) 210
In a small subgroup of severe ICU cases:
Risk factors for pulmonary thromboembolism
In a multivariate analysis, an elevated risk of developing PE was associated with 133:
rising D-dimer over time
In April 2020, reports started to appear of critically-ill children presenting with a severe inflammatory state like atypical Kawasaki disease and toxic shock syndrome 126,127. This is now called pediatric multisystem inflammatory state (PMIS).
Other sequelae have also been reported in children, including 210:
On 9 January 2020, the World Health Organization (WHO) confirmed that SARS-CoV-2 was the cause of COVID-19 (2019-nCoV was the name of the virus at that time) 14,37. It is one of the two strains of the SARS-CoV species known to cause human disease, the other being the original severe acute respiratory syndrome coronavirus (SARS-CoV-1), the cause of SARS. 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, mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS, and intestinal diseases.
As with many human infections, SARS-CoV-2 is zoonotic. The closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus 11,19,26. The disease can also be transmitted by snakes 24.
Six other coronaviruses are known to cause human disease. Two are zoonoses: the severe acute respiratory syndrome coronavirus (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV), both of which may sometimes be fatal. The remaining four viruses all cause the common cold.
The SARS-CoV-2 virus, like the closely-related MERS and SARS coronaviruses, effects its cellular entry via attachment of its virion spike protein (a.k.a. S protein) to the angiotensin-converting enzyme 2 (ACE2) receptor. This receptor is commonly found on alveolar cells of the lung epithelium, underlying the development of respiratory symptoms as the commonest presentation of COVID-19 50. It is thought that the mediation of the less common cardiovascular effects is also via the same ACE2 receptor, which is also commonly expressed on the cells of the cardiovascular system 50.
The SARS-CoV-2 virus, like all viruses, continually mutates, thereby creating new variants perpetually, certain variants, are particularly worrisome to scientists. These might be particularly transmissible or pathogenic. These have been termed "variants of concern" (VOC) by the World Health Organization 220. The "original" virus, i.e. as it was before the alpha variant arose, is now known as "wild type" virus.
Previously there were several "variants of interest" (VOI), which had genetic sequences that could affect important viral characteristics, e.g. transmissibility, pathogenicity, ability to circumvent vaccines, etc., and were found to form multiple disease clusters or substantial transmission in the community but none are currently designated as such 220,241.
Some previous variants of interest were later downgraded (e.g. epsilon variant) to the lowest named tier, "variants under monitoring" (VUM) or not designated at all (e.g. theta variant) 220,241.
Originally all variants were officially given formal scientific designations, however, the media and general public assigned them easy to remember names based on their site of first identification. This led to geographic-related stigmatisation, and thus the variants were renamed by the WHO on 31 May 2021, using sequential letters from the Greek alphabet (i.e. α (alpha), β (beta), γ (gamma) etc.).
The formal scientific designations remain in use for virologists and epidemiologists; one of these is the Pango lineage, which ascribes a letter and numbers to SARS-CoV-2 strains which share similar genomes and hence phylogenetic relationships (e.g. B.1.1.7) 217,220,221.
Variants of concern (VOC)
There are no current variants of concern (as of June 2023). Omicron and its various lineages have been downgraded to "variants of interest" and "variants under monitoring" 241.
Former VOCs 241
alpha (B.1.1.7 - Kent, UK, discovered Sep 2020)
beta (B.1.351 - South Africa, May 2020)
gamma (P.1 - Brazil, Nov 2020)
delta (B.1.617.2 - India, Oct 2020)
omicron (B.1.1.529 - multiple countries Nov 2021)
Variants of interest (VOI)
Current variants of interest are both omicron lineages 241:
The epsilon (B.1.427/B.1.429), eta (B.1.525), iota (B.1.526), kappa (B.1.617.1), lambda (C.37) and mu (B.1.621) variants are no longer considered to be VOIs (on 20 September 2021) 220.
Variants under monitoring (VUM)
multiple lineages of omicron 241
B.1.640 (Sep 2021)
XD (France, Jan 2022)
Theta (P.3) and zeta (P.2) variants were formerly VUMs, but now are not formally labeled 220.
Although originating from animals, COVID-19 is considered to be an indirect zoonosis, as its transmission is primarily human-to-human. It was initially thought to be predominantly transmitted in a similar way to the common cold, via contact with droplets of infected individuals' upper respiratory tract secretions, e.g. from sneezing or coughing 19.
However, it is thought that aerosol transmission of SARS-CoV-2, i.e. airborne transmission, also occurs 58,161,162,172. In the early stages of the pandemic aerosol risk was thought to be limited to so-called aerosol-generating procedures (AGPs) in healthcare facilities. However, there is a broad evidence base to show that aerosols are also produced by talking, singing, coughing and expiration 162.
Fomites transmission is also seen, explaining the emphasis on regular handwashing and regular cleaning of surfaces that might have been exposed to droplets/aerosols containing virion particles 58,162,172-174. The SARS-CoV-2 has a short half-life on some non-porous surfaces, including copper and latex, but is more persistent on other materials such as glass, plastics, stainless steel and porous fabrics 174.
Sexual transmission has not been seen in the field but remains possible, not least because the SARS-CoV-2 virus has been found in all bodily secretions including seminal and vaginal fluids 143.
There is no evidence that COVID-19 can be transmitted through a blood transfusion and no cases have been reported. Nevertheless, many national bodies have controls to reduce the chance of this happening including advising that potential donors do not give blood until 28 days after recovering from COVID-19 142,243.
Vertical transmission (mother-to-fetus transfer of COVID-19), does occur but is rare (~5%) 21,82,94,152,210,244. A large prospective cohort study of 427 pregnant women from all 194 birth units across the UK found that 5% of 265 live births were confirmed as COVID-19 on RT-PCR 152. The most plausible route of vertical transmission seems to be placental 244.
Widespread asymptomatic carriage and transmission occurs 163,164,245.
Considerations for medical imaging departments
The threshold for the imaging of patients with potential/confirmed COVID-19 demonstrates a degree of variation globally due to local resources, the published guidelines of individual learned bodies and sociocultural approaches to imaging.
The use of CT as a primary screening tool is discouraged, not least because these studies tended to suffer from selection bias 52,57,87,88,115, with a meta-analysis, in April 2020, reporting a pooled sensitivity of 94% and specificity 37% 116. In low prevalence (<10%) countries, the positive predictive value of RT-PCR was ten-fold that of CT chest 116.
According to a Fleischner Society consensus statement published on 7 April 2020 101:
imaging is not indicated in patients with suspected COVID-19 and mild clinical features unless they are at risk for disease progression
imaging is indicated in a patient with COVID-19 and worsening respiratory status
in a resource-constrained environment, imaging is indicated for medical triage of patients with suspected COVID-19 who present with moderate-severe clinical features and a high pretest probability of disease
Moreover performing CT routinely for large cohorts of patients carries additional risks 115:
depletion of finite resources, especially PPE due to excessive usage
increased risk of viral transmission (to staff, patients and carers) as COVID-19 positive and negative patients come into close proximity in the radiology department
additional ionizing radiation exposures
Given that the staff in a medical imaging department are often in the frontline when dealing with COVID-19 patients, clear infection control guidelines are imperative. At the time of writing (September 2021) droplet-type precautions are in place for COVID-19 patients, that is, medical masks, gowns, gloves, and eye protection (aerosol-generating procedures require N95 masks and aprons). A study of 420 clinical staff found that personal protective equipment (PPE) protected the development of SARS-CoV-2 infection 39,155.
Patients requiring general radiography should receive it portably (to limit transporting patients) or in dedicated auxiliary units. Patients that require transport to departments must wear a mask to and from the unit. Machines, including any ancillary equipment used during examinations, should be cleaned after examinations 40. It is recommended that any imaging examinations have two radiographers in attendance using the 'one clean, one in contact with the patient' system to minimize cross-contamination 89. The causative organism, SARS-CoV-2, can survive on surfaces for up to 72 hours, reinforcing the need for protection of equipment with barriers such as covers and thorough cleaning of equipment between patients 58.
There are case studies of portable chest x-rays performed through the glass window of the patient's room to decrease both staff exposure and amount of personal protective equipment 102,165, although departmental protocols will vary significantly.
Please follow your departmental policies on personal protective equipment (PPE).
Both the American College of Radiology (ACR) and the Centers for Disease Control and Prevention (CDC) in the United States advise that non-urgent outpatient appointments should be rescheduled 83,84. The British Society of Skeletal Radiologists has advised that intra-articular, soft tissue and perineural steroid injections may reduce viral immunity and therefore should not be performed unless they are unavoidable 85. This decision has been criticized for its uncompromising approach, especially when the underlying evidence is far from being clear-cut, with a suggestion that for many the risk-benefit calculation is in favor of performing the joint injection 181.
Patients requiring CT should receive a non-contrast chest CT (unless iodinated contrast medium is indicated), with reconstructions of the volume at 0.625 mm to 1.5 mm slice thickness (gapless) 57. If iodinated contrast medium is indicated, for example, a CT pulmonary angiogram (CTPA), a non-contrast scan should be considered prior to contrast administration, as contrast may impact the interpretation of ground-glass opacification (GGO) patterns 89.
Currently, there is no diagnostic benefit to performing a CTPA examination on initial presentation 203. Although the risk of pulmonary thrombosis is higher in severe cases of COVID-19, it is recommended that D-dimer values are used to guide clinical pathways to justify a CTPA 203-205.
However imaging has limited sensitivity for COVID-19, as up to 18% demonstrate normal chest radiographs or CT when mild or early in the disease course, but this decreases to 3% in severe disease 89,93. Bilateral and/or multilobar involvement is common 6,78.
The current recommendation of the vast majority of learned societies and professional radiological associations is that imaging should not be employed as a screening/diagnostic tool for COVID-19, but reserved for the evaluation of complications 115.
Although less sensitive than chest CT, chest radiography is typically the first-line imaging modality used for patients with suspected COVID-19 97. For ease of decontamination, the use of portable radiography units is preferred 52.
Chest radiographs may be normal in early/mild disease. In those COVID-19 cases requiring hospitalization, 69% had an abnormal chest radiograph at the initial time of admission, and 80% had radiographic abnormalities sometime during hospitalization 97. Findings are most extensive about 10-12 days after symptom onset 97.
The most frequent findings are airspace opacities, whether described as consolidation or, less commonly, GGO 89,97. The distribution is most often bilateral, peripheral, and lower zone predominant 89.97. In contrast to parenchymal abnormalities, pleural effusion is rare (3%) 97.
Although cardiac manifestations of COVID-19 are well-recognized, there is no published evidence of cardiac disease on chest radiographs 175.
The primary findings on CT in adults have been reported as 13,17,27,28,36:
ground-glass opacities (GGO): bilateral, subpleural, peripheral
bronchovascular thickening in the lesion
The ground-glass and/or consolidative opacities are usually bilateral, peripheral, and basal in distribution 2,32.
A retrospective study of 112 patients found 54% of asymptomatic patients had pneumonic changes on CT 67.
The following chest CT findings have been reported to have the highest discriminatory value (p<0.001) 51:
bronchovascular thickening (in lesions)
A small number of patients have shown a pulmonary target sign 196, which has only been reported in COVID-19 patients so far. At present, it is unclear if this new sign is pathognomonic or simply newly recognized.
Atypical CT findings
These findings only seen in a small minority of patients should raise concern for superadded bacterial pneumonia or other diagnoses 2,32,89:
pleural effusions: may occur as a complication of COVID-19
Temporal CT changes
Four stages on CT have been described 17,24,32,86:
early/initial stage (0-4 days): normal CT or GGO only
up to half of patients have normal CT scans within two days of symptom onset
progressive stage (5-8 days): increased GGO and crazy paving appearance
peak stage (9-13 days): consolidation
absorption stage (>14 days): with an improvement in the disease course, "fibrous stripes" appear and the abnormalities resolve at one month and beyond
In a small study of five children that had been admitted to hospital with positive COVID-19 RT-PCR tests and who had CT chest performed, only three children had abnormalities. The main abnormality was bilateral patchy ground-glass opacities, similar to the appearances in adults, but less florid, and in all three cases the opacities resolved as they clinically recovered 48.
On 18 March 2020, the details of a much larger cohort of 171 children with confirmed COVID-19, and evaluated in a hospital setting was published as a letter in the New England Journal of Medicine. Ground-glass opacities were seen in one-third of the total, whereas almost 16% of children had no imaging features of pneumonia 91.
Initial work on patients in China suggests that lung ultrasound may be useful in the evaluation of critically ill COVID-19 patients 55. The following patterns have been observed, tending to have a bilateral and posterobasal predominance:
irregular, thickened pleural line with scattered discontinuities 63
can be associated with a discrete, localized pleural effusion
relatively avascular with color flow Doppler interrogation
pneumonic consolidation is typically associated with preservation of flow or hyperemia 65
tissue-like appearance with dynamic and static air bronchograms
associated with severe, progressive disease
restitution of aeration during recovery
reappearance of bilateral A-lines
The British Society of Thoracic Imaging (BSTI) has published a reporting proforma for the plain chest radiographic appearances of potential COVID-19 cases 168.
lower lobe and peripheral predominant multiple opacities that are bilateral (>> unilateral)
indeterminate for COVID-19
does not fit classic or non-COVID-19 descriptors
pneumothorax / lobar pneumonia / pleural effusion(s) / pulmonary edema / other
COVID-19 not excluded
The Radiological Society of North America (RSNA) has released a consensus statement endorsed by the Society of Thoracic Radiology and the American College of Radiology (ACR) that classifies the CT appearance of COVID-19 into four categories for standardized reporting language 99:
absence of typical CT findings and the presence of
multifocal, diffuse, perihilar, or unilateral GGO +/- consolidation lacking a specific distribution and are non-rounded or non-peripheral
few very small GGO with a non-rounded and non-peripheral distribution
absence of typical or indeterminate features and the presence of
isolated lobar or segmental consolidation without GGO
discrete small nodules (e.g. centrilobular, tree-in-bud)
smoother interlobular septal thickening with pleural effusion
negative for pneumonia: no CT features to suggest pneumonia, in particular, absent GGO and consolidation
A study evaluating the RSNA chest CT classification system for COVID-19 against RT-PCR results found moderate interobserver agreement. Using a cohort of 96 patients, it reported that 76.9-96.6% of "typical" scans, 51.2-64.1% of "indeterminate" scans, 2.8-5.3% "atypical" scans and 20-25% of "negative" scans returned a RT-PCR confirming COVID-19 99,147.
In March 2020, the "COVID-19 standardized reporting working group" of the Dutch Association for Radiology (NVvR) proposed a CT scoring system for COVID-19. They called it CO-RADS (COVID-19 Reporting and Data System) to ensure CT reporting is uniform and replicable. This assigns a score of CO-RADS 1 to 5, dependent on the CT findings. In some cases, a score of 0 or 6 may need to be assigned as an alternative. If the CT is uninterpretable then it is CO-RADS 0, and if there is a confirmed positive RT-PCR test then it is CO-RADS 6 109,124.
The first study investigating the use of CO-RADS found a reasonable level of interobserver variation, with a Fleiss' kappa score of 0.47 (cf. 0.24 for PI-RADS and 0.67 for Lung-RADS) 124. Another study found that CO-RADS is sensitive and specific for diagnosing COVID-19, using RT-PCR as the gold standard 184. CO-RADS-AI, a system using deep machine learning has been validated for diagnosing COVID-19 on CT chest 183.
In April 2020, American radiologists based at the University of Southern California proposed the COVID-19 imaging reporting and data system (COVID-RADS), which has a confusingly similar name to CO-RADS (see above) 125.
CO-RADS vs COVID-RADS
A 2020 study comparing the head to head performance of the CO-RADS and COVID-RADS reporting systems for 200 cases of COVID-19, found that interobserver consensus was similarly moderate to good, however, CO-RADS demonstrated a higher median intraobserver consensus 216.
A 2021 study researched the comparative performance of the CO-RADS, COVID-RADS and RSNA consensus statement in diagnosing COVID-19 on CT and how good interobserver agreement was, in a cohort from Tokyo, Japan, a locale with a low prevalence of COVID-19. CO-RADS demonstrated optimal performance with the highest specificity and positive predictive value, coupled with high accuracy and negative predictive value, all particularly pertinent in a low prevalence group of individuals 246. Interobserver agreement was moderate for all three systems 246.
Treatment and prognosis
Most 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 11:
wearing of face masks
avoidance of large crowds/crowded environments
Aerosol transmission has a more significant role in viral spread than initially thought and this means that additional public health measures will need to be introduced, these will include 161,162:
better ventilation, especially in indoor public spaces, workplaces, educational establishments, healthcare facilities, and community residential centers for the elderly, in many cases this will be as simple as opening windows
specific aerosol infection control systems, such as:
high throughput and effective air filtration
virucidal UV (ultraviolet) lighting
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, and supportive measures.
Historical studies have demonstrated a net benefit for patients with moderate to severe ARDS being turned prone 118. Many health care facilities have adopted the practice of turning the sicker COVID-19 patients into a prone position, so-called "proning" to improve their lung oxygenation 119.
Ronapreve, a branded formulation of potent two monoclonal antibodies, casirivimab and imdevimab, was the first licensed specific antiviral treatment for COVID-19 in adult patients 231.
Molnupiravir, is a chemical analog of cytidine, a ribosomal nucleoside, which was originally developed for treating the influenza virus. It is now in phase 3 trials, and showing promise, as the first specific antiviral for COVID-19. However, whilst initial trial data looks promising, conclusive peer-reviewed data remains to be published 229,230.
Whilst specific antiviral therapies for SARS-2-CoV do not currently exist, the combination of the protease inhibitors, ritonavir, and lopinavir, or a triple combination of these antiviral agents with the addition of ribavirin, showed some success in the treatment of SARS 20, and early reports suggested similar efficacy in the treatment of COVID-19 23. However, a more recent randomized, controlled open-label trial failed to demonstrate any added benefit of lopinavir-ritonavir combination therapy 66.
A combination of remdesivir and baricitinib showed to be effective against MERS-CoV and SARS-CoV, showed promising in vitro results against SARS-CoV-2 29,197. A preliminary trial in May 2020 showed a small decrease in time to recovery, from 15 to 11 days, in those treated with remdesivir 153. However there are concerns about this evidence, and remdesivir has not been shown to decrease mortality nor reduce the length of hospital stay 169. Other antivirals in phase III trials include oseltamivir, ASC09F (HIV protease inhibitor), lopinavir, ritonavir, darunavir, and cobicistat 80.
Dexamethasone, a synthetic steroid, was demonstrated in the large RECOVERY (Randomized Evaluation of COVid-19 thERapY) randomized controlled trial, in June 2020 to decrease deaths by a third in those on mechanical ventilation (p=0.0003), and by a fifth of those non-ventilated patients requiring oxygen (p=0.0021). No benefit was seen in those not needing respiratory support 148,198.
In early 2020, published reports showed that two antimalarial drugs, chloroquine, and its close chemical derivative, hydroxychloroquine, had strong anti-SARS-2-CoV activity in vitro. An initial open-label, randomized clinical trial, demonstrated a significant reduction of viral carriage, and a lower average carrying duration in patients treated with hydroxychloroquine. Furthermore, a combination with the antibiotic azithromycin resulted in a synergistic effect 69,228. However, this trial was later strongly criticized for methodological flaws and questionable conclusions. Later studies have failed to replicate the beneficial effects of these agents and also highlight potential side-effects 135.
There are a number of studies exploring the use of ivermectin, the literature is quite heterogeneous. The World Health Organization recommends, that for patients with COVID-19, regardless of disease severity, "not to use ivermectin, except in the context of a clinical trial" 240.
From a very recent retrospective cohort study, it emerged that the early treatment (<72 hours) of Covid-19, with drugs such as indomethacin, aspirin (low dose), omeprazole, bioflavonoids plus azithromycin, heparin and - if necessary - betamethasone, reduces the severity of the disease and the rate of hospitalizations 238.
Treatment with convalescent plasma (plasma from patients who have recovered from COVID-19 which therefore contains anti-SARS-CoV-2 antibodies) or hyperimmune immunoglobulin (purified antibodies prepared from convalescent plasma) has shown some success in some critically ill patients. Reports are still preliminary and about a small number of patients 110-112,136. A Cochrane review in May 2020 failed to find convincing evidence that convalescent plasma was an effective treatment, but this will be kept under active review 136.
The primary target in developing coronavirus vaccines has been the spike protein (S protein) which is on the surface of the virion particle, and in vivo is the most important antigen for triggering an immune response 75,222,223. Human vaccines for coronaviruses have been under development since the SARS outbreak 2002-2004, none have been approved for immunisation against SARS or MERS 11,26. Over 125 SARS-CoV-2 vaccine candidates were originally in development 154. Ten (or so) of these are now in use globally, whilst others remain in development or have been abandoned due to lack of efficacy 222,223.
Vaccines for SARS-CoV-2 may be classified by their different mechanisms of action 222,223:
mRNA-based e.g. Pfizer
adenoviral vector e.g. AstraZeneca
inactivated virion e.g. Sinopharm
subunit e.g. Novavax
In December 2020, a novel mRNA vaccine originally designated BNT162b2, now called tozinameran 202,233, and co-developed by BioNTech and Pfizer, demonstrated 95% efficacy in protecting adult (>16 years old) subjects, inoculated with two 3-week apart doses, from COVID-19 infection 200. The vaccine - made up of molecules of messenger ribonucleic acid (mRNA) and inserted into lipid nanoparticles (LNPs: ALC-0315 and ALC-0159) to facilitate their entry into human cells - contains the instructions for human cells to synthesize spike protein. The proteins thus produced will stimulate the immune system to produce specific antibodies 200. This messenger RNA, compared to that of viral origin, presents changes to consider, the most important of which is the replacement of uracil with the 1-methylpseudouridine base (U vs Ψ) 236; modifications that allow it to evade the immune system to be used correctly by ribosomes 208,209. This vaccine's side-effects were mild including pain at the injection site, headaches and fatigue. Anaphylaxis has been reported in two vaccinated people in the UK 201. This vaccine has received regulatory approval in multiple territories 201.
The Moderna vaccine is very similar to the Pfizer vaccine, the main differences being in the quantity of RNA (Moderna has more) and the lipids used for formulating the nanoparticles 223.
Adenoviral vector vaccines
The adenovirus vector type of vaccine is typified by the annual influenza vaccine. Several SARS-CoV-2 vaccines are based on a viral vector platform, such as the Oxford-AstraZeneca vaccine which was developed in the UK at the University of Oxford 222-224. It relies on a modified adenovirus to deliver the genetic material to the target cell.
Other vaccines using adenovirus vector technology are the Sputnik V vaccine (developed by the Gamaleya Research Institute, Russia) and the Janssen-Johnson & Johnson vaccines (jointly developed in the Netherlands and USA).
High efficacy has been demonstrated for the AstraZeneca vaccine in symptomatic patients with COVID-19 in randomized controlled trials 224,225.
Inactivated vaccines historically were the most common form of the vaccine (e.g. rabies vaccine). They rely on creating an inert form of the virus that primes the immune system without leading to the disease. The Sinopharm vaccine (developed by the Beijing Institute of Biological Products Company in China) is one such agent employing an inactivated form of the SARS-CoV-2 virus particle 223.
In early 2020 there were concerns raised about the safety of non-steroidal anti-inflammatory drugs (NSAIDs) in those with COVID-19. This was based upon anecdotal reports and expert opinion rather than published scientific evidence 61,166. There remains no evidence that the use of NSAIDs increases the risk of developing COVID-19 or worsens established disease 166.
Since the SARS-CoV-2 virus acts via the angiotensin-converting enzyme 2 (ACE2) receptor, there have been questions raised about the effect that being on ACE inhibitors or angiotensin receptor blockers might have on COVID-19. A randomized controlled trial in Brazil could find no difference in survival between those stopping or continuing taking the agents 214.
In Italy, a document detailing 6801 patients who died from COVID-19 discovered that the median time from the first symptoms to hospital admission was five days, and nine days from symptom onset to death 178.
Progressive deterioration of imaging changes despite medical treatment is thought to be associated with poor prognosis 27. There is an increased risk of death in men over the age of 60 years old 62. The mortality rate is estimated to be 3.6% 89.
The RT-PCR test may remain falsely positive despite an apparent clinical recovery, consistent with asymptomatic carriage 35.
In a study of 101 patients with COVID-19 who were referred for palliative care, breathlessness, delirium, drowsiness and agitation were the most frequently found symptoms 180.
Risk factors for severe illness or poor outcome
Studies have shown that the most important risk factors for poor outcomes are increasing age, male sex and obesity 68,95,188. Indeed obesity seems to trump all other comorbidities as a risk factor and its risk is not limited to inpatient populations 188.
vitamin D deficiency 190-195
people in a long-term care facility or nursing home
patient condition and laboratory values at hospital admission 96
There is no evidence that pregnant women are more likely to contract COVID-19 or more likely to experience complications from it 152,210. In a cohort of 427 women in the UK, 10% required admission to critical care for respiratory support and 1% succumbed to the disease 152.
The imaging of pregnant COVID-19 patients has found the same typical CT findings as other infected adults 210.
"Long covid" has been used to refer to the condition whereby those who have recovered from COVID-19 still experience persistent manifestations or those with COVID-19 suffer symptoms for a longer time than normal 177.
As of September 2021, there is growing published evidence of the long term effects following COVID-19 infection. An Italian study of 143 patients who had been discharged from hospital following a recovery from COVID-19 reveals that almost 90% of people were still complaining of at least one symptom 60 days after the illness had begun 176. Common symptoms included lethargy, breathlessness, arthralgia and chest discomfort 176.
History and etymology
The first cases were seen in Wuhan, China, in early December 2019 before spreading globally 1,2,10.
The first mention in the medical press about the emerging infection was in the British Medical Journal (BMJ) on 8 January 2020 in a news article, which reported "outbreak of pneumonia of unknown cause in Wuhan, China, has prompted authorities in neighboring Hong Kong, Macau, and Taiwan to step up border surveillance, amid fears that it could signal the emergence of a new and serious threat to public health" 54. On 9 January 2020, the World Health Organization confirmed that SARS-CoV-2 was the cause of the new disease 14,37.
The first scientific article about the new disease, initially termed 2019‐new coronavirus (2019‐nCoV) by the World Health Organization (WHO), was published in the Journal of Medical Virology on 16 January 2020 53.
On 13 January 2020, the first confirmed case outside China was diagnosed, a Chinese tourist in Thailand 10. On 20 January, the first infected person in the United States was confirmed to be a man who had recently returned from Wuhan 9. The infection was declared a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 by the WHO 7. On 28 February 2020, the WHO increased the global risk assessment of COVID-19 to “very high” which is the highest level. On 11 March 2020, COVID-19 was declared a pandemic by the WHO 44.
On 27 March 2020, the USA surpassed China as the country with the most confirmed cases 5. The number of confirmed cases globally exceeded one million on 3 April 2020, two million on 15 April, five million on 21 May, 10 million on 28 June, 15 million on 23 July, 20 million on 11 August, 25 million on 30 August, 50 million on 7 November 2020, 100 million on 26 January 2021 and 250 million on 8 November 2021 5. The number of global deaths surpassed 100,000 on 10 April, 200,000 on 26 April, 500,000 on 28 June, 750,000 on 13 August, one million on 29 September 2020, two million on 15 January 2021, three million on 17 April 2021, four million on 9 July 2021, and five million on 1 November 2021 5.
The WHO declared an end to the global health emergency on 5 May 2023 242.
The WHO originally called this illness "novel coronavirus-infected pneumonia (NCIP)" and the virus itself had been named "2019 novel coronavirus (2019-nCoV)" 1. On 11 February 2020, the WHO officially renamed the clinical condition COVID-19 (a shortening of COronaVIrus Disease-19) 15. On the same day, the Coronavirus Study Group of the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) 16,22,46.
viral pneumonia including 71,72:
influenza pneumonia A and B
distribution more along the bronchovascular bundles
bronchial wall thickening
adenovirus pneumonia 71,72
in immunocompromised patients
often shows pleural effusions
atypical bacterial pneumonia
pulmonary edema 71
certain drug-induced pneumonitides
for a "crazy paving" predominant manifestation also consider conditions such as
Clinical differential diagnoses
The clinical differential diagnosis is very similar to the imaging differential when patients present with typical symptoms, e.g. cough and fever. However, some divergence might be seen if there are less typical presentations, e.g. acute breathlessness, which might raise suspicion for acute pulmonary embolism which is not an imaging differential in many cases 134.
These lists are in alphabetical order:
research publications and datasets
- 1. Zhu N, Zhang D, Wang W et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. doi:10.1056/NEJMoa2001017 - Pubmed
- 2. Perlman S. Another Decade, Another Coronavirus. N Engl J Med. 2020;382(8):760-2. doi:10.1056/NEJMe2001126 - Pubmed
- 3. Huang C, Wang Y, Li X et al. Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5 - Pubmed
- 4. Douglas D. Richman, Richard J. Whitley, Frederick G. Hayden. Clinical Virology. (2016) ISBN: 9781555819422 - Google Books
- 5. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) Case Dashboard. [accessed 9 May 2023].
- 6. Chen N, Zhou M, Dong X et al. Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Coronavirus Pneumonia in Wuhan, China: A Descriptive Study. Lancet. 2020;395(10223):507-13. doi:10.1016/S0140-6736(20)30211-7 - Pubmed
- 7. "WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020". Who.int, 2020. [Link].
- 8. Wu J, Leung K, Leung G. Nowcasting and Forecasting the Potential Domestic and International Spread of the 2019-NCoV Outbreak Originating in Wuhan, China: A Modelling Study. The Lancet. 2020;395(10225):689-97. doi:10.1016/s0140-6736(20)30260-9
- 9. Holshue M, DeBolt C, Lindquist S et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;382(10):929-36. doi:10.1056/NEJMoa2001191 - Pubmed
- 10. Hui D, I Azhar E, Madani T et al. The Continuing 2019-NCoV Epidemic Threat of Novel Coronaviruses to Global Health - The Latest 2019 Novel Coronavirus Outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-6. doi:10.1016/j.ijid.2020.01.009 - Pubmed
- 11. Chen Y, Liu Q, Guo D. Emerging Coronaviruses: Genome Structure, Replication, and Pathogenesis. J Med Virol. 2020;92(4):418-23. doi:10.1002/jmv.25681 - Pubmed
- 12. Li Q, Guan X, Wu P et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207. doi:10.1056/NEJMoa2001316 - Pubmed
- 13. Wang D, Hu B, Hu C et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. doi:10.1001/jama.2020.1585 - Pubmed
- 14. Wu P, Hao X, Lau E et al. Real-Time Tentative Assessment of the Epidemiological Characteristics of Novel Coronavirus Infections in Wuhan, China, as at 22 January 2020. Euro Surveill. 2020;25(3). doi:10.2807/1560-7917.ES.2020.25.3.2000044 - Pubmed
- 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. doi:10.1101/2020.02.07.937862
- 17. Pan F, Ye T, Sun P et al. Time Course of Lung Changes at Chest CT During Recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;295(3):715-21. doi:10.1148/radiol.2020200370 - Pubmed
- 18. Velavan T & Meyer C. The COVID-19 Epidemic. Trop Med Int Health. 2020;25(3):278-80. doi:10.1111/tmi.13383 - Pubmed
- 19. Heymann D, Shindo N, Shindo N. COVID-19: What is Next for Public Health? Lancet. 2020;395(10224):542-5. doi:10.1016/S0140-6736(20)30374-3 - Pubmed
- 20. Zhang L & Liu Y. Potential Interventions for Novel Coronavirus in China: A Systematic Review. J Med Virol. 2020;92(5):479-90. doi:10.1002/jmv.25707 - Pubmed
- 21. Chen H, Guo J, Wang C et al. Clinical Characteristics and Intrauterine Vertical Transmission Potential of COVID-19 Infection in Nine Pregnant Women: A Retrospective Review of Medical Records. The Lancet. 2020;395(10226):809-15. doi:10.1016/s0140-6736(20)30360-3
- 22. Enserink, M. (2020). Update: ‘A bit chaotic.’ Christening of new coronavirus and its disease name create confusion. [online] Sciencemag.org. Available at: https://www.sciencemag.org/news/2020/02/bit-chaotic-christening-new-coronavirus-and-its-disease-name-create-confusion [Accessed 18 February 2020].
- 23. Lim J, Jeon S, Shin H et al. Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: The Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR. J Korean Med Sci. 2020;35(6):e79. doi:10.3346/jkms.2020.35.e79 - Pubmed
- 24. Pan Y, Guan H, Zhou S et al. Initial CT Findings and Temporal Changes in Patients with the Novel Coronavirus Pneumonia (2019-NCoV): A Study of 63 Patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-9. doi:10.1007/s00330-020-06731-x - Pubmed
- 25. [The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-51. doi:10.3760/cma.j.issn.0254-6450.2020.02.003 - Pubmed
- 26. Ng LFP, Hiscox JA. Coronaviruses in animals and humans. (2020) BMJ (Clinical research ed.). 368: m634. doi:10.1136/bmj.m634 - Pubmed
- 27. Shi H, Han X, Jiang N et-al. (2020) Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. [online] thelancet.com 24 February 2020. Available at: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30086-4/fulltext#figures . https://doi.org/10.1016/S1473-3099(20)30086-4 [accessed 25 February 2020].
- 28. Lee EYP, Ng M-Y, Khong P-L. (2020) COVID-19 pneumonia: what has CT taught us? [online] thelancet.com. Published: February 24, 2020. Available at: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30134-1/fulltext#%20 DOI:https://doi.org/10.1016/S1473-3099(20)30134-1
- 29. Wang M, Cao R, Zhang L et-al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. (2020) Cell research. doi:10.1038/s41422-020-0282-0 - Pubmed
- 30. ClinicalTrials.gov [Internet]. Kalil A: National Institute of Allergy and Infectious Diseases (NIAID) (US). 2020 Feb 21 - . Identifier NCT04280705, A Multicenter, Adaptive, Randomized Blinded Controlled Trial of the Safety and Efficacy of Investigational Therapeutics for the Treatment of COVID-19 in Hospitalized Adults. Available from: ClinicalTrials.gov
- 31. Min Wei, Jingping Yuan, Yu Liu et-al. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. (2020) JAMA. doi:10.1001/jama.2020.2131 - Pubmed
- 32. Jeffrey P Kanne, Brent P Little, Jonathan H Chung et-al. Essentials for Radiologists on COVID-19: An Update—Radiology Scientific Expert Panel. (2020) Radiology. doi:10.1148/radiol.2020200527 - Pubmed
- 33. Liu Y, Gayle AA, Wilder-Smith A et-al. The reproductive number of COVID-19 is higher compared to SARS coronavirus. (2020) Journal of travel medicine. doi:10.1093/jtm/taaa021 - Pubmed
- 34. Tao Ai, Zhenlu Yang, Hongyan Hou et-al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. (2020) Radiology. doi:10.1148/radiol.2020200642 - Pubmed
- 35. Lan Lan, Dan Xu, Guangming Ye et-al. Positive RT-PCR Test Results in Patients Recovered From COVID-19. (2020) JAMA. doi:10.1001/jama.2020.2783 - Pubmed
- 36. Wei Zhao, Zheng Zhong, Xingzhi Xie et-al. Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. (2020) American Journal of Roentgenology. doi:10.2214/AJR.20.22976 - Pubmed
- 37. World Health Organization (WHO). WHO Statement Regarding Cluster of Pneumonia Cases in Wuhan, China. Beijing: WHO; 9 January 2020. [Accessed 5 March 2020]. https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-cases-in-wuhan-china
- 38. Jiang S, Shi Z, Shu Y et-al. A distinct name is needed for the new coronavirus. (2020) Lancet (London, England). doi:10.1016/S0140-6736(20)30419-0 - Pubmed
- 39. "World Health Organization: Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19)", 2020. [Link].
- 40. Kooraki S, Hosseiny M, Myers L, Gholamrezanezhad A. Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should Know. (2020) Journal of the American College of Radiology : JACR. doi:10.1016/j.jacr.2020.02.008 - Pubmed
- 41. Goh S. Rapid response to "Covid-19: a puzzle with many missing pieces". 2020. BMJ 2020;368:m627 https://www.bmj.com/content/368/bmj.m627/rr-8 [accessed 9 March 2020].
- 42. Qin C, Liu F, Yen TC et-al. F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. (2020) European journal of nuclear medicine and molecular imaging. doi:10.1007/s00259-020-04734-w - Pubmed
- 43. Xiao F, Tang M, Zheng X et-al. Evidence for gastrointestinal infection of SARS-CoV-2. (2020) Gastroenterology. doi:10.1053/j.gastro.2020.02.055 - Pubmed
- 44. "WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020". Who.int. 2020. [Link].
- 45. "Naming the coronavirus disease (COVID-19) and the virus that causes it". Who.int. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
- 46. The species Severe acute respiratory syndrome-related coronavirus : classifying 2019-nCoV and naming it SARS-CoV-2. (2020) Nature Microbiology. doi:10.1038/s41564-020-0695-z - Pubmed
- 47. Caselli D, Aricò M. 2019-nCoV: Polite with children!. (2020) Pediatric reports. 12 (1): 8495. doi:10.4081/pr.2020.8495 - Pubmed
- 48. Wei Li, Huaqian Cui, Kunwei Li et-al. Chest computed tomography in children with COVID-19 respiratory infection. Pediatric Radiology. doi:10.1007/s00247-020-04656-7
- 49. Puja Mehta, Daniel F McAuley, Michael Brown et-al. COVID-19: consider cytokine storm syndromes and immunosuppression. Published 13 March 2020 link(20)30628-0. Lancet.com. [retrieved 15 March 2020].
- 50. Zheng YY, Ma YT, Zhang JY et-al. COVID-19 and the cardiovascular system. (2020) Nature reviews. Cardiology. doi:10.1038/s41569-020-0360-5 - Pubmed
- 51. Bai HX, Hsieh B, Xiong Z et-al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. (2020) Radiology. doi:10.1148/radiol.2020200823 - Pubmed
- 52. “ACR Recommendations for the Use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection.” American College of Radiology, 11 Mar. 2020, ACR [accessed 16 March 2020]
- 53. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. (2020) Journal of medical virology. 92 (4): 401-402. doi:10.1002/jmv.25678 - Pubmed
- 54. Parr J. Pneumonia in China: lack of information raises concerns among Hong Kong health workers. (2020) BMJ (Clinical research ed.). 368: m56. doi:10.1136/bmj.m56 - Pubmed
- 55. Qian-Yi Peng, Xiao-Ting Wang, Li-Na Zhang. Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic. (2020) Intensive Care Medicine. doi:10.1007/s00134-020-05996-6 - Pubmed
- 56.Mahmud Mossa-Basha, Carolyn C Meltzer, Danny C Kim et-al. Radiology Department Preparedness for COVID-19: Radiology Scientific Expert Panel. (2020) Radiology. doi:10.1148/radiol.2020200988 - Pubmed
- 57. "COVID-19 Updates". Ranzcr.com, 2020. [Link].
- 58. Neeltje van Doremalen, Trenton Bushmaker, Dylan H. Morris et-al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. (2020) New England Journal of Medicine. doi:10.1056/NEJMc2004973 - Pubmed
- 59. Dong Y, Mo X, Hu Y et-al. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. (2020) Pediatrics. doi:10.1542/peds.2020-0702 - Pubmed
- 60. Amici C, Di Caro A, Ciucci A et-al. Indomethacin has a potent antiviral activity against SARS coronavirus. (2006) Antiviral therapy. 11 (8): 1021-30. Pubmed
- 61. Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. (2020) BMJ (Clinical research ed.). 368: m1086. doi:10.1136/bmj.m1086 - Pubmed
- 62. Wu C, Chen X, Cai Y et-al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. (2020) JAMA internal medicine. doi:10.1001/jamainternmed.2020.0994 - Pubmed
- 63. Huang, Yi, Wang, Sihan, Liu et-al. A Preliminary Study on the Ultrasonic Manifestations of Peripulmonary Lesions of Non-Critical Novel Coronavirus Pneumonia (COVID-19). (2020) doi:10.2139/ssrn.3544750
- 64. Erika Poggiali, Alessandro Dacrema, Davide Bastoni et-al. Can Lung US Help Critical Care Clinicians in the Early Diagnosis of Novel Coronavirus (COVID-19) Pneumonia?. (2020) Radiology. doi:10.1148/radiol.2020200847 - Pubmed
- 65. Stefania Ianniello, Claudia Lucia Piccolo, Grazia L Buquicchio et-al. First-line diagnosis of paediatric pneumonia in emergency: lung ultrasound (LUS) in addition to chest-X-ray (CXR) and its role in follow-up. (2016) The British Journal of Radiology. 89 (1061): 20150998. doi:10.1259/bjr.20150998 - Pubmed
- 66. Bin Cao, Yeming Wang, Danning Wen et-al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. (2020) New England Journal of Medicine. doi:10.1056/NEJMoa2001282 - Pubmed
- 67. Inui Shohei, Akira Fujikawa and Motoyuki Jitsu et-al. "Chest CT Findings in Cases from the Cruise Ship “Diamond Princess” with Coronavirus Disease 2019 (COVID-19)". Radiology: Cardiothoracic Imaging 2, no. 2 (2020): e200110. . doi:10.1148/ryct.2020200110.
- 68. WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Report. World Health Organization (WHO); 2020 16-24.02.2020.[Link]
- 69. Philippe Gautret, Jean-Christophe Lagier, Philippe Parola et-al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020. doi:10.1016/j.ijantimicag.2020.105949
- 70. Zhiliang Hu, Ci Song, Chuanjun Xu et-al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. (2020) Science China Life Sciences. doi:10.1007/s11427-020-1661-4 - Pubmed
- 71. Wei-cai Dai, Han-wen Zhang, Juan Yu et-al. CT Imaging and Differential Diagnosis of COVID-19:. (2020) Canadian Association of Radiologists Journal. doi:10.1177/0846537120913033 - Pubmed
- 72. Yan Li, Liming Xia. Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management. (2020) American Journal of Roentgenology. doi:10.2214/AJR.20.22954 - Pubmed
- 73. Takashi Ishiguro, Yasuhito Kobayashi, Ryuji Uozumi et-al. Viral Pneumonia Requiring Differentiation from Acute and Progressive Diffuse Interstitial Lung Diseases. (2019) Internal Medicine. 58 (24): 3509. doi:10.2169/internalmedicine.2696-19 - Pubmed
- 74. Hyun Jung Koo, Soyeoun Lim, Jooae Choe et-al. Radiographic and CT Features of Viral Pneumonia. (2018) RadioGraphics. 38 (3): 719-739. doi:10.1148/rg.2018170048 - Pubmed
- 75. Dhama K, Sharun K, Tiwari R et-al. COVID-19, an emerging coronavirus infection: advances and prospects in designing and developing vaccines, immunotherapeutics, and therapeutics. (2020) Human vaccines & immunotherapeutics. doi:10.1080/21645515.2020.1735227 - Pubmed
- 76. Zou S, Zhu X. FDG PET/CT of COVID-19. (2020) Radiology. doi:10.1148/radiol.2020200770 - Pubmed
- 77. Deng Y, Lei L, Chen Y et-al. The potential added value of FDG PET/CT for COVID-19 pneumonia. (2020) European journal of nuclear medicine and molecular imaging. doi:10.1007/s00259-020-04767-1 - Pubmed
- 78. Michael Chung, Adam Bernheim, Xueyan Mei et-al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). (2020) Radiology. 295 (1): 202-207. doi:10.1148/radiol.2020200230 - Pubmed
- 79. Hopkins C, Kumar N. Loss of sense of smell as marker of COVID-19 infection (letter). ENT UK website Accessed: 23 March 2020.
- 80. Li G, De Clercq E. Therapeutic options for the 2019 novel coronavirus (2019-nCoV). (2020) Nature reviews. Drug discovery. 19 (3): 149-150. doi:10.1038/d41573-020-00016-0 - Pubmed
- 81. Zhiliang Hu, Ci Song, Chuanjun Xu et-al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. (2020) Science China Life Sciences. doi:10.1007/s11427-020-1661-4 - Pubmed
- 82. Chen D, Yang H, Cao Y et-al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. (2020) International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. doi:10.1002/ijgo.13146 - Pubmed
- 83. American College of Radiology. COVID-19 Radiology-Specific Resources [website]. Accessed: 24 Mar 2020.
- 84. Centres for Disease Control and Prevention. Coronavirus 2019 (COVID-19) - Resources for Clinics and Healthcare Facilities [website]. Accessed: 24 Mar 2020.
- 85. Fascia D et al. Recommendations of the British Society of Skeletal Radiologists - The safety of corticosteroid injections during the COVID-19 global pandemic. PDF. 19 March 2020. Accessed: 24 Mar 2020.
- 86. Feng Pan, Tianhe Ye, Peng Sun et-al. Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. (2020) Radiology. doi:10.1148/radiol.2020200370 - Pubmed
- 87. "RCR position on the role of CT in patients suspected with COVID-19 infection | The Royal College of Radiologists". Rcr.ac.uk, 2020. [Link].
- 88. "Canadian Society of Thoracic Radiology and Canadian Association of Radiologists’ Statement on COVID -19 - CAR - Canadian Association of Radiologists". CAR - Canadian Association of Radiologists, 2020. [Link].
- 89. Rodrigues, J.C.L. et-al. An update on COVID-19 for the radiologist - A British society of Thoracic Imaging statement. (2020) Clinical Radiology. https://doi.org/10.1016/j.crad.2020.03.003
- 90. Ludvigsson JF. Systematic review of COVID-19 in children show milder cases and a better prognosis than adults. (2020) Acta paediatrica (Oslo, Norway : 1992). doi:10.1111/apa.15270 - Pubmed
- 91. Lu X, Zhang L, Du H et-al. SARS-CoV-2 Infection in Children. (2020) The New England journal of medicine. doi:10.1056/NEJMc2005073 - Pubmed
- 92. Lauer SA, Grantz KH, Bi Q et-al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. (2020) Annals of internal medicine. doi:10.7326/M20-0504 - Pubmed
- 93. Guan WJ, Ni ZY, Hu Y et-al. Clinical Characteristics of Coronavirus Disease 2019 in China. (2020) The New England journal of medicine. doi:10.1056/NEJMoa2002032 - Pubmed
- 94. Lingkong Zeng, Shiwen Xia, Wenhao Yuan et-al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatrics. doi:10.1001/jamapediatrics.2020.0878
- 95. Centers for Disease Control and Prevention Coronavirus 2019 (COVID-19) - People who are at higher risk for severe illness
- 96. Zhou F, Yu T, Du R et-al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. (2020) Lancet (London, England). doi:10.1016/S0140-6736(20)30566-3 - Pubmed
- 97. Wong HYF, Lam HYS, Fong AH et-al. Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients. (2019) Radiology. doi:10.1148/radiol.2020201160 - Pubmed
- 98. Lüers JC, Klußmann JP, Guntinas-Lichius O. [The Covid-19 pandemic and otolaryngology: What it comes down to?]. (2020) Laryngo- rhino- otologie. doi:10.1055/a-1095-2344 - Pubmed
- 99. Simpson S et-al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic Imaging 2020 2:2. https://doi.org/10.1148/ryct.2020200152
- 100. Recalcati S. Cutaneous Manifestations in COVID-19: A First Perspective. J Eur Acad Dermatol Venereol. 2020;34(5):e212-3. doi:10.1111/jdv.16387 - Pubmed
- 101. Rubin G, Ryerson C, Haramati L et al. The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Radiology. 2020;296(1):172-80. doi:10.1148/radiol.2020201365 - Pubmed
- 102. Mossa-Basha M, Medverd J, Linnau K et al. Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of Washington. Radiology. 2020;296(2):E26-31. doi:10.1148/radiol.2020201326 - Pubmed
- 103. Wu P, Duan F, Luo C et al. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020;138(5):575-8. doi:10.1001/jamaophthalmol.2020.1291 - Pubmed
- 104. Chen L, Liu M, Zhang Z et al. Ocular Manifestations of a Hospitalised Patient with Confirmed 2019 Novel Coronavirus Disease. Br J Ophthalmol. 2020;104(6):748-51. doi:10.1136/bjophthalmol-2020-316304 - Pubmed
- 105. Lechien J, Chiesa-Estomba C, De Siati D et al. Olfactory and Gustatory Dysfunctions as a Clinical Presentation of Mild-To-Moderate Forms of the Coronavirus Disease (COVID-19): A Multicenter European Study. Eur Arch Otorhinolaryngol. 2020;277(8):2251-61. doi:10.1007/s00405-020-05965-1 - Pubmed
- 106. Russell B, Moss C, Rigg A, Hopkins C, Papa S, Van Hemelrijck M. Anosmia and Ageusia Are Emerging as Symptoms in Patients with COVID-19: What Does the Current Evidence Say? Ecancermedicalscience. 2020;14:ed98. doi:10.3332/ecancer.2020.ed98 - Pubmed
- 107. Vaira L, Salzano G, Deiana G, De Riu G. Anosmia and Ageusia: Common Findings in COVID-19 Patients. Laryngoscope. 2020;130(7):1787. doi:10.1002/lary.28692 - Pubmed
- 108. Gane S, Kelly C, Hopkins C. Isolated Sudden Onset Anosmia in COVID-19 Infection. A Novel Syndrome? Rhinology. 2020;58(3):299-301. doi:10.4193/Rhin20.114 - Pubmed
- 109. Dutch Association for Radiology (Nederlandse Vereniging voor Radiologie, NVvR) . https://www.radiologen.nl/secties/netwerk-covid-19/documenten/handreiking-standaardverslag-ct-thorax-covid-inclusief-co-rads. (in Dutch) [accessed 14 April 2020].
- 110. Shen C, Wang Z, Zhao F et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. 2020;323(16):1582-9. doi:10.1001/jama.2020.4783 - Pubmed
- 111. Duan K, Liu B, Li C et al. Effectiveness of Convalescent Plasma Therapy in Severe COVID-19 Patients. Proc Natl Acad Sci U S A. 2020;117(17):9490-6. doi:10.1073/pnas.2004168117 - Pubmed
- 112. Zhang B, Liu S, Tan T et al. Treatment With Convalescent Plasma for Critically Ill Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Chest. 2020;158(1):e9-e13. doi:10.1016/j.chest.2020.03.039 - Pubmed
- 113. World Health Organisation. Coronavirus disease 2019 (COVID-19) Situation Report – 73.
- 114. Danzi G, Loffi M, Galeazzi G, Gherbesi E. Acute Pulmonary Embolism and COVID-19 Pneumonia: A Random Association? Eur Heart J. 2020;41(19):1858. doi:10.1093/eurheartj/ehaa254 - Pubmed
- 115. Raptis C, Hammer M, Short R et al. Chest CT and Coronavirus Disease (COVID-19): A Critical Review of the Literature to Date. AJR Am J Roentgenol. 2020;215(4):839-42. doi:10.2214/AJR.20.23202 - Pubmed
- 116. Fang Y, Zhang H, Xie J et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020;296(2):E115-7. doi:10.1148/radiol.2020200432 - Pubmed
- 117. Hare S, Rodrigues J, Nair A et al. The Continuing Evolution of COVID-19 Imaging Pathways in the UK: A British Society of Thoracic Imaging Expert Reference Group Update. Clin Radiol. 2020;75(6):399-404. doi:10.1016/j.crad.2020.04.002 - Pubmed
- 118. Henderson W, Griesdale D, Dominelli P, Ronco J. Does Prone Positioning Improve Oxygenation and Reduce Mortality in Patients with Acute Respiratory Distress Syndrome? Can Respir J. 2014;21(4):213-5. doi:10.1155/2014/472136 - Pubmed
- 119. Duca A, Piva S, Focà E, Latronico N, Rizzi M. Calculated Decisions: Brescia-COVID Respiratory Severity Scale (BCRSS)/Algorithm. Emerg Med Pract. 2020;22(5 Suppl):CD1-2. - Pubmed
- 120. Hu H, Ma F, Wei X, Fang Y. Coronavirus Fulminant Myocarditis Treated with Glucocorticoid and Human Immunoglobulin. Eur Heart J. 2021;42(2):206. doi:10.1093/eurheartj/ehaa190 - Pubmed
- 121. Wu Y, Xu X, Chen Z et al. Nervous System Involvement After Infection with COVID-19 and Other Coronaviruses. Brain Behav Immun. 2020;87:18-22. doi:10.1016/j.bbi.2020.03.031 - Pubmed
- 122. Zhang J, Xie B, Hashimoto K. Current Status of Potential Therapeutic Candidates for the COVID-19 Crisis. Brain Behav Immun. 2020;87:59-73. doi:10.1016/j.bbi.2020.04.046 - Pubmed
- 123. Davoodi L, Taghavi M, Razavi A. COVID-19 Presented with Deep Vein Thrombosis: An Unusual Case Report. 2020. doi:10.21203/rs.3.rs-21602/v1
- 124. Prokop M, van Everdingen W, van Rees Vellinga T et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104. doi:10.1148/radiol.2020201473 - Pubmed
- 125. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19) Imaging Reporting and Data System (COVID-RADS) and Common Lexicon: A Proposal Based on the Imaging Data of 37 Studies. Eur Radiol. 2020;30(9):4930-42. doi:10.1007/s00330-020-06863-0 - Pubmed
- 126. Jones V, Mills M, Suarez D et al. COVID-19 and Kawasaki Disease: Novel Virus and Novel Case. Hosp Pediatr. 2020;10(6):537-40. doi:10.1542/hpeds.2020-0123 - Pubmed
- 127. Mahase E. Covid-19: Concerns Grow over Inflammatory Syndrome Emerging in Children. BMJ. 2020;369:m1710. doi:10.1136/bmj.m1710 - Pubmed
- 128. Volpicelli G & Gargani L. Sonographic Signs and Patterns of COVID-19 Pneumonia. Ultrasound J. 2020;12(1):22. doi:10.1186/s13089-020-00171-w - Pubmed
- 129. Volpicelli G, Lamorte A, Villén T. What's New in Lung Ultrasound During the COVID-19 Pandemic. Intensive Care Med. 2020;46(7):1445-8. doi:10.1007/s00134-020-06048-9 - Pubmed
- 130. Klok F, Kruip M, van der Meer N et al. Confirmation of the High Cumulative Incidence of Thrombotic Complications in Critically Ill ICU Patients with COVID-19: An Updated Analysis. Thromb Res. 2020;191:148-50. doi:10.1016/j.thromres.2020.04.041 - Pubmed
- 131. Grillet F, Behr J, Calame P, Aubry S, Delabrousse E. Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected with Pulmonary CT Angiography. Radiology. 2020;296(3):E186-8. doi:10.1148/radiol.2020201544 - Pubmed
- 132. Léonard-Lorant I, Delabranche X, Séverac F et al. Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to D-Dimer Levels. Radiology. 2020;296(3):E189-91. doi:10.1148/radiol.2020201561 - Pubmed
- 133. Poyiadji N, Cormier P, Patel P et al. Acute Pulmonary Embolism and COVID-19. Radiology. 2020;297(3):E335-8. doi:10.1148/radiol.2020201955 - Pubmed
- 134. Casey K, Iteen A, Nicolini R, Auten J. COVID-19 Pneumonia with Hemoptysis: Acute Segmental Pulmonary Emboli Associated with Novel Coronavirus Infection. Am J Emerg Med. 2020;38(7):1544.e1-3. doi:10.1016/j.ajem.2020.04.011 - Pubmed
- 135. Tang W, Cao Z, Han M et al. Hydroxychloroquine in Patients with Mainly Mild to Moderate Coronavirus Disease 2019: Open Label, Randomised Controlled Trial. BMJ. 2020;369:m1849. doi:10.1136/bmj.m1849 - Pubmed
- 136. Valk S, Piechotta V, Chai K et al. Convalescent Plasma or Hyperimmune Immunoglobulin for People with COVID-19: A Rapid Review. Cochrane Database Syst Rev. 2020;5:CD013600. doi:10.1002/14651858.CD013600 - Pubmed
- 137. Rogers J, Chesney E, Oliver D et al. Psychiatric and Neuropsychiatric Presentations Associated with Severe Coronavirus Infections: A Systematic Review and Meta-Analysis with Comparison to the COVID-19 Pandemic. The Lancet Psychiatry. 2020;7(7):611-27. doi:10.1016/s2215-0366(20)30203-0
- 138. Kucirka L, Lauer S, Laeyendecker O, Boon D, Lessler J. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests by Time Since Exposure. Ann Intern Med. 2020;173(4):262-7. doi:10.7326/M20-1495 - Pubmed
- 139. Tong J, Wong A, Zhu D, Fastenberg J, Tham T. The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg. 2020;163(1):3-11. doi:10.1177/0194599820926473 - Pubmed
- 140. Loffredo L, Pacella F, Pacella E, Tiscione G, Oliva A, Violi F. Conjunctivitis and COVID-19: A Meta-Analysis. J Med Virol. 2020;92(9):1413-4. doi:10.1002/jmv.25938 - Pubmed
- 141. Scalinci S & Trovato Battagliola E. Conjunctivitis Can Be the Only Presenting Sign and Symptom of COVID-19. IDCases. 2020;20:e00774. doi:10.1016/j.idcr.2020.e00774 - Pubmed
- 142. Cho H, Koo J, Roh S et al. COVID-19 Transmission and Blood Transfusion: A Case Report. J Infect Public Health. 2020;13(11):1678-9. doi:10.1016/j.jiph.2020.05.001 - Pubmed
- 143. Patrì A, Gallo L, Guarino M, Fabbrocini G. Sexual Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A New Possible Route of Infection? J Am Acad Dermatol. 2020;82(6):e227. doi:10.1016/j.jaad.2020.03.098 - Pubmed
- 144. Boccia M, Aronne L, Celia B et al. COVID-19 and Coagulative Axis: Review of Emerging Aspects in a Novel Disease. Monaldi Arch Chest Dis. 2020;90(2). doi:10.4081/monaldi.2020.1300 - Pubmed
- 145. Patel K, Patel P, Vunnam R et al. Gastrointestinal, Hepatobiliary, and Pancreatic Manifestations of COVID-19. J Clin Virol. 2020;128:104386. doi:10.1016/j.jcv.2020.104386 - Pubmed
- 146. Garrido I, Liberal R, Macedo G. Review Article: COVID-19 and Liver Disease-What We Know on 1st May 2020. Aliment Pharmacol Ther. 2020;52(2):267-75. doi:10.1111/apt.15813 - Pubmed
- 147. de Jaegere T, Krdzalic J, Fasen B, Kwee R, Kwee R. Radiological Society of North America Chest CT Classification System for Reporting COVID-19 Pneumonia: Interobserver Variability and Correlation with Reverse-Transcription Polymerase Chain Reaction. Radiol Cardiothorac Imaging. 2020;2(3):e200213. doi:10.1148/ryct.2020200213 - Pubmed
- 148. Horby P, Lim W, Emberson J et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704. doi:10.1056/NEJMoa2021436 - Pubmed
- 149. Oxley T, Mocco J, Majidi S et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020;382(20):e60. doi:10.1056/NEJMc2009787 - Pubmed
- 150. Yaghi S, Ishida K, Torres J et al. SARS-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020;51(7):2002-11. doi:10.1161/STROKEAHA.120.030335 - Pubmed
- 151. Merkler A, Parikh N, Mir S et al. Risk of Ischemic Stroke in Patients with Covid-19 Versus Patients with Influenza. MedRxiv. 2020. doi:10.1101/2020.05.18.20105494 - Pubmed
- 152. Knight M, Bunch K, Vousden N et al. Characteristics and Outcomes of Pregnant Women Admitted to Hospital with Confirmed SARS-CoV-2 Infection in UK: National Population Based Cohort Study. BMJ. 2020;369:m2107. doi:10.1136/bmj.m2107 - Pubmed
- 153. Beigel J, Tomashek K, Dodd L et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020;383(19):1813-26. doi:10.1056/NEJMoa2007764 - Pubmed
- 154. Mahase E. Covid-19: Oxford Team Begins Vaccine Trials in Brazil and South Africa to Determine Efficacy. BMJ. 2020;369:m2612. doi:10.1136/bmj.m2612 - Pubmed
- 155. Liu M, Cheng S, Xu K et al. Use of Personal Protective Equipment Against Coronavirus Disease 2019 by Healthcare Professionals in Wuhan, China: Cross Sectional Study. BMJ. 2020;369:m2195. doi:10.1136/bmj.m2195 - Pubmed
- 156. Korr M. Q&A with Dean Winslow, MD, on Volunteering in Antarctica Currently the Only Continent Without Confirmed Cases of COVID-19 During COVID-19 Pandemic. R I Med J (2013). 2020;103(5):85-8. - Pubmed
- 157. Radmanesh A, Derman A, Lui Y et al. COVID-19-Associated Diffuse Leukoencephalopathy and Microhemorrhages. Radiology. 2020;297(1):E223-7. doi:10.1148/radiol.2020202040 - Pubmed
- 158. Kremer S, Lersy F, de Sèze J et al. Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study. Radiology. 2020;297(2):E242-51. doi:10.1148/radiol.2020202222 - Pubmed
- 159. Fitsiori A, Pugin D, Thieffry C, Lalive P, Vargas M. COVID-19 is Associated with an Unusual Pattern of Brain Microbleeds in Critically Ill Patients. J Neuroimaging. 2020;30(5):593-7. doi:10.1111/jon.12755 - Pubmed
- 160. Deeks J, Dinnes J, Takwoingi Y et al. Antibody Tests for Identification of Current and Past Infection with SARS-CoV-2. Cochrane Database Syst Rev. 2020;6(6):CD013652. doi:10.1002/14651858.CD013652 - Pubmed
- 161. Dyer O. Covid-19: Airborne Transmission is Being Underestimated, Warn Experts. BMJ. 2020;370:m2720. doi:10.1136/bmj.m2720 - Pubmed
- 162. Morawska L & Milton D. It Is Time to Address Airborne Transmission of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. 2020;71(9):2311-3. doi:10.1093/cid/ciaa939 - Pubmed
- 163. Lee S, Meyler P, Mozel M, Tauh T, Merchant R. Asymptomatic Carriage and Transmission of SARS-CoV-2: What Do We Know? Can J Anaesth. 2020;67(10):1424-30. doi:10.1007/s12630-020-01729-x - Pubmed
- 164. Yu X & Yang R. COVID-19 Transmission Through Asymptomatic Carriers is a Challenge to Containment. Influenza Other Respir Viruses. 2020;14(4):474-5. doi:10.1111/irv.12743 - Pubmed
- 165. Brady Z, Scoullar H, Grinsted B et al. Technique, Radiation Safety and Image Quality for Chest X-Ray Imaging Through Glass and in Mobile Settings During the COVID-19 Pandemic. Phys Eng Sci Med. 2020;43(3):765-79. doi:10.1007/s13246-020-00899-8 - Pubmed
- 166. Moore N, Carleton B, Blin P, Bosco-Levy P, Droz C. Does Ibuprofen Worsen COVID-19? Drug Saf. 2020;43(7):611-4. doi:10.1007/s40264-020-00953-0 - Pubmed
- 167. Albano D, Bertagna F, Bertoli M et al. Incidental Findings Suggestive of COVID-19 in Asymptomatic Patients Undergoing Nuclear Medicine Procedures in a High-Prevalence Region. J Nucl Med. 2020;61(5):632-6. doi:10.2967/jnumed.120.246256 - Pubmed
- 168. COVID-19 BSTI Reporting templates | The British Society of Thoracic Imaging, 2020. https://www.bsti.org.uk/covid-19-resources/covid-19-bsti-reporting-templates/. [accessed 12 June 2020].
- 169. Brophy J. US Purchases World Stocks of Remdesivir: Why the Rest of the World Should Be Glad to Be at the Back of the Queue. BMJ. 2020;370:m2797. doi:10.1136/bmj.m2797 - Pubmed
- 170. Pormohammad A, Ghorbani S, Baradaran B et al. Clinical Characteristics, Laboratory Findings, Radiographic Signs and Outcomes of 61,742 Patients with Confirmed COVID-19 Infection: A Systematic Review and Meta-Analysis. Microb Pathog. 2020;147:104390. doi:10.1016/j.micpath.2020.104390 - Pubmed
- 171. Suresh Kumar V, Mukherjee S, Harne P et al. Novelty in the Gut: A Systematic Review and Meta-Analysis of the Gastrointestinal Manifestations of COVID-19. BMJ Open Gastroenterol. 2020;7(1):e000417. doi:10.1136/bmjgast-2020-000417 - Pubmed
- 172. Tan L, Kovoor J, Williamson P et al. Personal Protective Equipment and Evidence-Based Advice for Surgical Departments During COVID-19. ANZ J Surg. 2020;90(9):1566-72. doi:10.1111/ans.16194 - Pubmed
- 173. Amato A, Caggiano M, Amato M, Moccia G, Capunzo M, De Caro F. Infection Control in Dental Practice During the COVID-19 Pandemic. Int J Environ Res Public Health. 2020;17(13):4769. doi:10.3390/ijerph17134769 - Pubmed
- 174. Aboubakr H, Sharafeldin T, Goyal S. Stability of SARS-CoV-2 and Other Coronaviruses in the Environment and on Common Touch Surfaces and the Influence of Climatic Conditions: A Review. Transbound Emerg Dis. 2021;68(2):296-312. doi:10.1111/tbed.13707 - Pubmed
- 175. Cleverley J, Piper J, Jones M. The Role of Chest Radiography in Confirming Covid-19 Pneumonia. BMJ. 2020;370:m2426. doi:10.1136/bmj.m2426 - Pubmed
- 176. Carfì A, Bernabei R, Landi F, Landi F. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603-5. doi:10.1001/jama.2020.12603 - Pubmed
- 177. Mahase E. Covid-19: What Do We Know About "Long Covid"? BMJ. 2020;370:m2815. doi:10.1136/bmj.m2815 - Pubmed
- 178. Ting R, Edmonds P, Higginson I, Sleeman K. Palliative Care for Patients with Severe Covid-19. BMJ. 2020;370:m2710. doi:10.1136/bmj.m2710 - Pubmed
- 179. Keeley P, Buchanan D, Carolan C, Pivodic L, Tavabie S, Noble S. Symptom Burden and Clinical Profile of COVID-19 Deaths: A Rapid Systematic Review and Evidence Summary. BMJ Support Palliat Care. 2020;10(4):381-4. doi:10.1136/bmjspcare-2020-002368 - Pubmed
- 180. Lovell N, Maddocks M, Etkind S et al. Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care. J Pain Symptom Manage. 2020;60(1):e77-81. doi:10.1016/j.jpainsymman.2020.04.015 - Pubmed
- 181. Little C, Birks M, Horwitz M, Ng C, Warwick D. COVID-19: A Rethink of Corticosteroid Injection? Bone & Joint Open. 2020;1(6):253-6. doi:10.1302/2046-3758.16.bjo-2020-0050.r1
- 182. De Sanctis P, Doneddu P, Viganò L, Selmi C, Nobile‐Orazio E. Guillain–Barré Syndrome Associated with SARS‐CoV‐2 Infection. A Systematic Review. Eur J Neurol. 2020;27(11):2361-70. doi:10.1111/ene.14462 - Pubmed
- 183. Lessmann N, Sánchez C, Beenen L et al. Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence. Radiology. 2021;298(1):E18-28. doi:10.1148/radiol.2020202439 - Pubmed
- 184. Hermans J, Groen J, Zwets E et al. Chest CT for Triage During COVID-19 on the Emergency Department: Myth or Truth? Emerg Radiol. 2020;27(6):641-51. doi:10.1007/s10140-020-01821-1 - Pubmed
- 185. Han R, Huang L, Jiang H, Dong J, Peng H, Zhang D. Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia. AJR Am J Roentgenol. 2020;215(2):338-43. doi:10.2214/AJR.20.22961 - Pubmed
- 186. Hadi A, Werge M, Kristiansen K et al. Coronavirus Disease-19 (COVID-19) Associated with Severe Acute Pancreatitis: Case Report on Three Family Members. Pancreatology. 2020;20(4):665-7. doi:10.1016/j.pan.2020.04.021 - Pubmed
- 187. Bonney G, Gao Y, Chew C, Windsor J. SARS-COV-2 Associated Acute Pancreatitis: Cause, Consequence or Epiphenomenon? Pancreatology. 2020;20(5):1017-8. doi:10.1016/j.pan.2020.05.019 - Pubmed
- 188. Tartof S, Qian L, Hong V et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med. 2020;173(10):773-81. doi:10.7326/M20-3742 - Pubmed
- 189. Beigel J, Tomashek K, Dodd L et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020;383(19):1813-26. doi:10.1056/NEJMoa2007764 - Pubmed
- 190. Radujkovic A, Hippchen T, Tiwari-Heckler S, Dreher S, Boxberger M, Merle U. Vitamin D Deficiency and Outcome of COVID-19 Patients. Nutrients. 2020;12(9):2757. doi:10.3390/nu12092757 - Pubmed
- 191. Brenner H & Schöttker B. Vitamin D Insufficiency May Account for Almost Nine of Ten COVID-19 Deaths: Time to Act. Comment On: “Vitamin D Deficiency and Outcome of COVID-19 Patients”. Nutrients 2020, 12, 2757. Nutrients. 2020;12(12):3642. doi:10.3390/nu12123642 - Pubmed
- 192. Ilie P, Stefanescu S, Smith L. The Role of Vitamin D in the Prevention of Coronavirus Disease 2019 Infection and Mortality. Aging Clin Exp Res. 2020;32(7):1195-8. doi:10.1007/s40520-020-01570-8 - Pubmed
- 193. Merzon E, Tworowski D, Gorohovski A et al. Low Plasma 25(OH) Vitamin D Level is Associated with Increased Risk of COVID-19 Infection: An Israeli Population-Based Study. FEBS J. 2020;287(17):3693-702. doi:10.1111/febs.15495 - Pubmed
- 194. Meltzer D, Best T, Zhang H, Vokes T, Arora V, Solway J. Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results. JAMA Netw Open. 2020;3(9):e2019722. doi:10.1001/jamanetworkopen.2020.19722 - Pubmed
- 195. Annweiler C, Hanotte B, Grandin de l'Eprevier C, Sabatier J, Lafaie L, Célarier T. Vitamin D and Survival in COVID-19 Patients: A Quasi-Experimental Study. J Steroid Biochem Mol Biol. 2020;204:105771. doi:10.1016/j.jsbmb.2020.105771 - Pubmed
- 196. Jafari R, Maghsoudi H, Saburi A. A Unique Feature of COVID-19 Infection in Chest CT; "Pulmonary Target" Appearance. Acad Radiol. 2021;28(1):146-7. doi:10.1016/j.acra.2020.11.004 - Pubmed
- 197. Kalil A, Patterson T, Mehta A et al. Baricitinib Plus Remdesivir for Hospitalized Adults with Covid-19. N Engl J Med. 2021;384(9):795-807. doi:10.1056/nejmoa2031994 - Pubmed
- 198. The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704. doi:10.1056/nejmoa2021436 - Pubmed
- 199. Dai L & Gao G. Viral Targets for Vaccines Against COVID-19. Nat Rev Immunol. 2021;21(2):73-82. doi:10.1038/s41577-020-00480-0 - Pubmed
- 200. Polack F, Thomas S, Kitchin N et al. Safety and Efficacy of the BNT162b2 MRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-15. doi:10.1056/NEJMoa2034577 - Pubmed
- 201. Ledford H. US Authorization of First COVID Vaccine Marks New Phase in Safety Monitoring. Nature. 2020;588(7838):377-8. doi:10.1038/d41586-020-03542-4 - Pubmed
- 202. National Center for Biotechnology Information (2020). PubChem Substance Record for SID 434370509, 5085ZFP6SJ, Source: ChemIDplus. Retrieved December 23, 2020 from https://pubchem.ncbi.nlm.nih.gov/substance/434370509
- 203. Ooi M, Rajai A, Patel R, Gerova N, Godhamgaonkar V, Liong S. Pulmonary Thromboembolic Disease in COVID-19 Patients on CT Pulmonary Angiography – Prevalence, Pattern of Disease and Relationship to D-Dimer. Eur J Radiol. 2020;132:109336. doi:10.1016/j.ejrad.2020.109336 - Pubmed
- 204. Jalaber C, Revel M, Chassagnon G et al. Role of Upfront CT Pulmonary Angiography at Admission in COVID-19 Patients. Thromb Res. 2020;196:138-40. doi:10.1016/j.thromres.2020.08.037 - Pubmed
- 205. Espallargas I, Rodríguez Sevilla J, Rodríguez Chiaradía D et al. CT Imaging of Pulmonary Embolism in Patients with COVID-19 Pneumonia: A Retrospective Analysis. Eur Radiol. 2020;31(4):1915-22. doi:10.1007/s00330-020-07300-y - Pubmed
- 206. Volpi S, Ali J, Suleman A, Ahmed R. Pneumomediastinum in COVID-19 Patients: A Case Series of a Rare Complication. Eur J Cardiothorac Surg. 2020;58(3):646-7. doi:10.1093/ejcts/ezaa222 - Pubmed
- 207. Feng W, Newbigging A, Le C et al. Molecular Diagnosis of COVID-19: Challenges and Research Needs. Anal Chem. 2020;92(15):10196-209. doi:10.1021/acs.analchem.0c02060 - Pubmed
- 208. Knezevic I, Liu M, Peden K, Zhou T, Kang H. Development of MRNA Vaccines: Scientific and Regulatory Issues. Vaccines (Basel). 2021;9(2):81. doi:10.3390/vaccines9020081 - Pubmed
- 209. Prüβ B. Current State of the First COVID-19 Vaccines. Vaccines (Basel). 2021;9(1):30. doi:10.3390/vaccines9010030 - Pubmed
- 210. Revzin M, Raza S, Srivastava N et al. Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations. Radiographics. 2020;40(7):1866-92. doi:10.1148/rg.2020200195 - Pubmed
- 211. Davies N, Abbott S, Barnard R et al. Estimated Transmissibility and Impact of SARS-CoV-2 Lineage B.1.1.7 in England. Science. 2021;372(6538). doi:10.1126/science.abg3055 - Pubmed
- 212. Planas D, Bruel T, Grzelak L et al. Sensitivity of Infectious SARS-CoV-2 B.1.1.7 and B.1.351 Variants to Neutralizing Antibodies. Nat Med. 2021;27(5):917-24. doi:10.1038/s41591-021-01318-5 - Pubmed
- 213. Topol E. COVID-19 Can Affect the Heart. Science. 2020;370(6515):408-9. doi:10.1126/science.abe2813 - Pubmed
- 214. Lopes R, Macedo A, de Barros E Silva P et al. Effect of Discontinuing Vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial. JAMA. 2021;325(3):254-64. doi:10.1001/jama.2020.25864 - Pubmed
- 215. Sarkar S, Gokhale T, Choudhury S, Deb A. COVID-19 and Orbital Mucormycosis. Indian J Ophthalmol. 2021;69(4):1002-4. doi:10.4103/ijo.IJO_3763_20 - Pubmed
- 216. Sushentsev N, Bura V, Kotnik M et al. A Head-To-Head Comparison of the Intra- and Interobserver Agreement of COVID-RADS and CO-RADS Grading Systems in a Population with High Estimated Prevalence of COVID-19. BJR Open. 2020;2(1):20200053. doi:10.1259/bjro.20200053 - Pubmed
- 217. Callaway E. Coronavirus Variants Get Greek Names - but Will Scientists Use Them? Nature. 2021;594(7862):162. doi:10.1038/d41586-021-01483-0 - Pubmed
- 218. McCallum M, Bassi J, Marco A et al. SARS-CoV-2 Immune Evasion by Variant B.1.427/B.1.429. BioRxiv. 2021. doi:10.1101/2021.03.31.437925 - Pubmed
- 219. Olsen R, Christensen P, Long S et al. Trajectory of Growth of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variants in Houston, Texas, January Through May 2021, Based on 12,476 Genome Sequences. Am J Pathol. 2021;191(10):1754-73. doi:10.1016/j.ajpath.2021.07.002 - Pubmed
- 220. https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/. WHO.int. https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/ [accessed 4 May 2022].
- 221. Mahase E. Covid-19: How Many Variants Are There, and What Do We Know About Them? BMJ. 2021;374:n1971. doi:10.1136/bmj.n1971 - Pubmed
- 222. Fathizadeh H, Afshar S, Masoudi M et al. SARS-CoV-2 (Covid-19) Vaccines Structure, Mechanisms and Effectiveness: A Review. Int J Biol Macromol. 2021;188:740-50. doi:10.1016/j.ijbiomac.2021.08.076 - Pubmed
- 223. Heinz F & Stiasny K. Distinguishing Features of Current COVID-19 Vaccines: Knowns and Unknowns of Antigen Presentation and Modes of Action. NPJ Vaccines. 2021;6(1):104. doi:10.1038/s41541-021-00369-6 - Pubmed
- 224. Voysey M, Clemens S, Madhi S et al. Safety and Efficacy of the ChAdOx1 NCoV-19 Vaccine (AZD1222) Against SARS-CoV-2: An Interim Analysis of Four Randomised Controlled Trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269):99-111. doi:10.1016/S0140-6736(20)32661-1 - Pubmed
- 225. Knoll M & Wonodi C. Oxford-AstraZeneca COVID-19 Vaccine Efficacy. Lancet. 2021;397(10269):72-4. doi:10.1016/S0140-6736(20)32623-4 - Pubmed
- 226. Akudjedu T, Mishio N, Elshami W et al. The Global Impact of the COVID-19 Pandemic on Clinical Radiography Practice: A Systematic Literature Review and Recommendations for Future Services Planning. Radiography (Lond). 2021;27(4):1219-26. doi:10.1016/j.radi.2021.07.004 - Pubmed
- 227. Robba C, Battaglini D, Pelosi P, Rocco P. Multiple Organ Dysfunction in SARS-CoV-2: MODS-CoV-2. Expert Rev Respir Med. 2020;14(9):865-8. doi:10.1080/17476348.2020.1778470 - Pubmed
- 228. Lagier J, Million M, Gautret P et al. Outcomes of 3,737 COVID-19 Patients Treated with Hydroxychloroquine/Azithromycin and Other Regimens in Marseille, France: A Retrospective Analysis. Travel Med Infect Dis. 2020;36:101791. doi:10.1016/j.tmaid.2020.101791 - Pubmed
- 229. Holman W, Holman W, McIntosh S et al. Accelerated First-In-Human Clinical Trial of EIDD-2801/MK-4482 (Molnupiravir), a Ribonucleoside Analog with Potent Antiviral Activity Against SARS-CoV-2. Trials. 2021;22(1):561. doi:10.1186/s13063-021-05538-5 - Pubmed
- 230. Kabinger F, Stiller C, Schmitzová J et al. Mechanism of Molnupiravir-Induced SARS-CoV-2 Mutagenesis. Nat Struct Mol Biol. 2021;28(9):740-6. doi:10.1038/s41594-021-00651-0 - Pubmed
- 231. Mahase E. Covid-19: Regeneron's Antibody Combination Cuts Deaths in Seronegative Patients, Trial Finds. BMJ. 2021;373:n1570. doi:10.1136/bmj.n1570 - Pubmed
- 232. Totomoch-Serra A, Ibarra-Miramon C, Manterola C. Persistent Hiccups as Main COVID-19 Symptom. Am J Med Sci. 2021;361(6):799-800. doi:10.1016/j.amjms.2021.01.001 - Pubmed
- 233. Walter E, Talaat K, Sabharwal C et al. Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age. N Engl J Med. 2022;386(1):35-46. doi:10.1056/nejmoa2116298
- 234. Cheng C, Zhang D, Dang D et al. The Incubation Period of COVID-19: A Global Meta-Analysis of 53 Studies and a Chinese Observation Study of 11 545 Patients. Infect Dis Poverty. 2021;10(1):119. doi:10.1186/s40249-021-00901-9 - Pubmed
- 235. Ahirwar R, Gandhi S, Komal K et al. Biochemical Composition, Transmission and Diagnosis of SARS-CoV-2. Biosci Rep. 2021;41(8). doi:10.1042/BSR20211238 - Pubmed
- 236. Buschmann M, Carrasco M, Alishetty S, Paige M, Alameh M, Weissman D. Nanomaterial Delivery Systems for MRNA Vaccines. Vaccines (Basel). 2021;9(1):65. doi:10.3390/vaccines9010065 - Pubmed
- 237. Liu L, Iketani S, Guo Y et al. Striking Antibody Evasion Manifested by the Omicron Variant of SARS-CoV-2. Nature. 2021;602(7898):676-81. doi:10.1038/d41586-021-03826-3
- 238. Fazio S, Bellavite P, Zanolin E, McCullough P, Pandolfi S, Affuso F. Retrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis of Early COVID-19 and Treated at Home Within 3 Days or After 3 Days of Symptom Onset with Prescribed and Non-Prescribed Treatments Between November 2020 and August 2021. Med Sci Monit. 2021;27:e935379. doi:10.12659/MSM.935379 - Pubmed
- 239. Bennett J, Brown C, Rouse M, Hoffmann M, Ye Z. Immune Thrombocytopenia Purpura Secondary to COVID-19. Cureus. 2020;12(7):e9083. doi:10.7759/cureus.9083 - Pubmed
- 240. Agarwal A, Rochwerg B, Lamontagne F et al. A Living WHO Guideline on Drugs for Covid-19. BMJ. 2020;370:m3379. doi:10.1136/bmj.m3379 - Pubmed
- 241. https://www.who.int/activities/tracking-SARS-CoV-2-variants. WHO.int. https://www.who.int/activities/tracking-SARS-CoV-2-variants [accessed 13 June 2023].
- 242. Wise J. Covid-19: WHO declares end of global health emergency. BMJ 2023;381:1041. https://www.bmj.com/content/381/bmj.p1041. https://www.bmj.com/content/381/bmj.p1041. BMJ.com [accessed 9 May 2023].
- 243. Mawalla W, Njiro B, Bwire G, Nasser A, Sunguya B. No Evidence of SARS-CoV-2 Transmission Through Transfusion of Human Blood Products: A Systematic Review. EJHaem. 2021;2(3):601-6. doi:10.1002/jha2.263 - Pubmed
- 244. Wang J & Dong W. COVID-19: The Possibility, Ways, Mechanisms, and Interruptions of Mother-To-Child Transmission. Arch Gynecol Obstet. 2023;307(6):1687-96. doi:10.1007/s00404-022-06639-5 - Pubmed
- 245. Wang B, Andraweera P, Elliott S et al. Asymptomatic SARS-CoV-2 Infection by Age: A Global Systematic Review and Meta-Analysis. Pediatr Infect Dis J. 2023;42(3):232-9. doi:10.1097/INF.0000000000003791 - Pubmed
- 246. Kurokawa R, Inui S, Gonoi W et al. Standardized Reporting Systems of Chest Computed Tomography in a Population with Low Coronavirus Disease 2019 Prevalence: A Retrospective Comparative Study. Heliyon. 2021;7(8):e07743. doi:10.1016/j.heliyon.2021.e07743 - Pubmed