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, with more than 2 million deaths and 100 million cases now confirmed. The current outbreak was officially recognized as a pandemic by the World Health Organization (WHO) on 11 March 2020.
Definitive diagnosis of COVID-19 requires a positive RT-PCR test. Current best practice advises that CT chest is not used to diagnose COVID-19, but maybe 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.
An mRNA-based vaccine has recently received regulatory approval from several countries.
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 January 2021, the number of cases of confirmed COVID-19 globally is over 100 million, having affected virtually every territory, other than a few isolated South Atlantic and Pacific island states 156, according to an online virus tracker created by the medical journal, The Lancet, and hosted by Johns Hopkins University 5.
The R0 (basic reproduction number) of SARS-CoV-2 has been estimated between 2.2 and 3.28 in a non-lockdown population, that is each infected individual, on average, causes between 2-3 new infections 12,33.
The incubation period for COVID-19 was initially calculated to be about five 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.
As of January 2021, the number of deaths from COVID-19 exceeds 2 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 in 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, none of them 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.
Children seem to be relatively unaffected by this virus, or indeed other closely-related coronaviruses 31,47,90 with large cohort studies reporting that 1-2% of 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 multi-organ ivolvement.
NB: Surveillance methods and capacity vary dramatically between countries. The epidemiological parameters of any new disease are likely to change as larger cohorts of COVID-19 positive cases are studied, although this will only to some extent reflect a true change in the underlying reality of disease activity (as a disease is studied and understood people will be simultaneously changing their behaviors to alter transmission or prevalence patterns).
COVID-19 typically presents with systemic and/or respiratory manifestations 93,170. Some also experience mild gastrointestinal or cardiovascular symptoms, although these are less common 18,50. Others may present solely with a gastroenteritis-like illness, which may not initially be recognized to be COVID-19 171.
A significant minority of individuals infected with SARS-CoV-2 remain asymptomatic throughout the course of their illness acting as carriers 70,113,164.
The full spectrum of clinical manifestations of COVID-19 is broad 1,13. Symptoms and signs are non-specific 68:
- fever (85-90%)
- cough (65-70%)
- anosmia (and other taste and/or smell disturbances) (40-50%)
- fatigue (35-40%)
- sputum production (30-35%)
- shortness of breath (15-20%)
- myalgia/arthralgia (10-15%)
- headaches (10-36%) 121
- sore throat (10-15%)
- chills (10-12%)
- pleuritic pain
- diarrhea (3-34%) 171
- nausea, vomiting, abdominal pain, GI bleeding 93,171
- nasal congestion (<10%) 93
- palpitations, chest tightness 50
- hemoptysis (<5%) 134
- confusion 137, seizures, paresthesia, altered consciousness 121
- stroke 149-151 (most commonly cryptogenic 150,151)
COVID-19 sufferers have reported high rates of disturbances of smell and taste, including anosmia, hyposmia, ageusia, and dysgeusia. The numbers of patients affected vary and current evidence points more towards a neurological than a conductive cause of the olfactory dysfunction 79,98,105-107,139.
Various reports suggest patients with the disease may have symptoms of conjunctivitis, and those affected, may have positive viral PCR in their conjunctival fluid 103,104. However, a meta-analysis of over 1,100 patients found that conjunctivitis was only present in 1.1% cases 140. A small case series found isolated conjunctivitis as the only visible manifestation in some COVID-19 patients 141.
Cutaneous lesions may also be seen, similar to many other viral infections. In a cohort of 88 patients, 20% developed skin disease, most commonly an erythematous rash. Most of the skin abnormalities were self-limiting, resolving in a few days 100.
In the main, the clinical presentation in children with COVID-19 is milder than in adults 59,90. Symptoms are similar to any acute chest infection, encompassing most commonly pyrexia, dry cough, sore throat, sneezing, myalgia and lethargy. Wheezing has also been noted 59,90. Other less common (<10%) symptoms in children included diarrhea, lethargy, rhinorrhea and vomiting 91.
The definitive 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, N and RdRP 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.
The place of antibody tests in the investigation of present and previous cases of COVID-19 remains unclear and contentious. It may have a complementary role in diagnosis, especially when the RT-PCR test is negative in those whom remain suspected to have COVID-19 160.
CT as diagnostic test
Multiple radiological organizations and learned societies have stated 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:
- mild elevated inflammatory markers (CRP 89 and ESR)
- elevated D-dimer
- 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
In one of the largest studies 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
- delirium 137
- viral encephalitis 121
- diffuse leukoencephalopathy 157
- juxtacortical white matter and corpus callosum particularly of the splenium)
- stroke: cryptogenic/ischemic 150,151
- higher mortality and greater severity of stroke in context of COVID-19 150
- Guillain-Barré syndrome (GBS): rare 182
- secondary infections, e.g. bacterial pneumonia
- acute kidney injury (AKI)
- coagulopathy 144
- multiorgan failure 66
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:
- elevated D-dimer
- elevated CRP
- rising D-dimer over time
In April 2020, reports started to appear of critically-ill children presenting with a multisystem inflammatory state which bore some resemblance to Kawasaki disease and toxic shock syndrome. Typically abdominal pain and other GI symptoms were present and often evidence of a myocarditis. The presentations necessitated ICU admission and rare fatalities have been reported 126,127.
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 disease.
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.
Although originating from animals, COVID-19 is now considered to be an indirect zoonosis, as its transmission is now 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.
It is now 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 an increasing 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.
It remains unclear if COVID-19 could be transmitted through a blood transfusion although no cases have yet be seen. Nevertheless, many national bodies have instituted 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.
Cohort studies have been unable to rule out the possibility of vertical transmission, but it seems to be a rare event if it does occur 21,82,94,152. 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.
Presymptomatic carriers are likely present in many communities and presymptomatic transmission has been documented 163.
Asymptomatic carriage and transmission are also thought to occur 163,164.
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 (August 2020) droplet-type precautions are in place for COVID-19 patients, that is, medical mask, gown, 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 in 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, 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
- crazy paving appearance (GGOs and inter-/intra-lobular septal thickening)
- air space consolidation
- bronchovascular thickening in the lesion
- traction bronchiectasis
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:
- peripheral distribution
- ground-glass opacity
- 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:
- mediastinal lymphadenopathy 17
- pleural effusions: may occur as a complication of COVID-19
- multiple tiny pulmonary nodules (unlike many other types of viral pneumonia)
- atoll sign
- pneumomediastinum 206
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:
- multiple B-lines
- irregular, thickened pleural line with scattered discontinuities 63
- subpleural consolidations
- can be associated with a discrete, localized pleural effusion
- relatively avascular with color flow Doppler interrogation
- pneumonic consolidation typically associated with preservation of flow or hyperemia 65
- alveolar consolidation
- 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) have 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:
- typical appearance
- 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 CT findings and the presence of
- 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)
- lung cavitation
- smoother interlobular septal thickening with pleural effusion
- absence of typical or indeterminate features and the presence of
- 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.
Treatment and prognosis
No specific treatment exists for COVID-19 (January 2021). Therefore 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:
- meticulous hand-washing
- wearing of face masks
- social distancing
- avoidance of large crowds/crowded environments
There is now increasing concern that 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.
Mechanical ventilation, both invasive and non-invasive, and extracorporeal membrane oxygenation (ECMO) have also been used where clinically necessary.
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.
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.
Combination of remdesivir and baricitinib shown 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 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. 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.
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. Human vaccines for coronaviruses have been under development since the SARS outbreak, none have been approved for immunisation against SARS or MERS 11,26. Over 125 vaccine candidates are now in preclinical/clinical trials 154.
In December 2020, a novel mRNA vaccine originally designated BNT162b2, and now with the generic name tozinameran 202, 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; 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 vaccinees in the UK 201. This vaccine has received regulatory approval in multiple territories 201.
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. Several international and national medical regulatory agencies now state that there are no associated risks with using NSAIDs in those with, or at risk of developing, COVID-19 166.
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.
Early reports show that in some well patients, the RT-PCR test remains falsely positive despite an apparent clinical recovery. This raises the concern that asymptomatic carriage may occur 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 outcome 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
- old age
- male gender
- people in a long-term care facility or nursing home
- comorbidities 68,95,188
- patient condition and laboratory values at hospital admission 96
- high sequential organ failure assessment (SOFA) score on admission
- D-dimer levels greater than 1 µg/mL on hospital admission
- elevated levels of IL-6, troponin I, lactate dehydrogenase
In general, pregnant women do not have worse outcomes than non-pregnant women with COVID-19 152. 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.
"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 August 2020 there is a dearth of 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% 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, and 100 million on 26 January 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 and two million on 15 January 2021 5.
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
- paramyxovirus pneumonia
- cytomegalovirus (CMV) pneumonia
- adenovirus pneumonia 71,72
- SARS-CoV pneumonia
- MERS coronavirus
- in immunocompromised patients
- often shows pleural effusions
- respiratory syncytial virus (RSV) pneumonia
- influenza pneumonia A and B
- atypical bacterial pneumonia
- community-acquired pneumonias 175
- pulmonary edema 71
- interstitial lung disease 73
- certain drug-induced pneumonitides
- neutropenic sepsis
- aspiration pneumonitis
- 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 pulmonary embolism which is not an imaging differential in many cases 134.
These lists are in alphabetical order:
- general information
- research publications and datasets
- ARRS - AJR Open Access COVID-19 Collection
- British Medical Journal COVID-19 collection
- COVID-19 Open Research Dataset (CORD-19)
- European Radiology COVID-19 - latest articles
- New England Journal of Medicine COVID-19 resources
- RSNA COVID-19 research
- The Lancet COVID-19 resource center
- World Health Organization Database of publications on COVID-19
- government information
- Australia (Department of Health)
- Australia (Smartraveller)
- Canada (Government of Canada)
- Canada (Infection Prevention and Control Canada)
- Europe (European Center for Disease Prevention and Control)
- Israel (Ministry of Health)
- Italy (Dipartimento della Protezione Civile)
- Mexico (Secretaría de Salud)
- New Zealand (Ministry of Health)
- Singapore (Ministry of Health)
- United Kingdom (National Health Service UK)
- United States of America (Centers for Disease Control and Prevention)
- 1. Na Zhu, Dingyu Zhang, Wenling Wang et-al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. (2020) New England Journal of Medicine. doi:10.1056/NEJMoa2001017 - Pubmed
- 2. Another Decade, Another Coronavirus. (2020) New England Journal of Medicine. 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. (2020) Lancet (London, England). doi:10.1016/S0140-6736(20)30183-5 - Pubmed
- 4. Douglas D. Richman, Richard J. Whitley, Frederick G. Hayden. Clinical Virology. (2016) ISBN: 9781555819422
- 5. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) Case Dashboard. [accessed 27 January 2021].
- 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. (2020) Lancet (London, England). 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. Joseph T Wu, Kathy Leung, Gabriel M Leung. "Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study". (2020) The Lancet. https://doi.org/10.1016/S0140-6736(20)30260-9
- 9. Holshue ML, DeBolt C, Lindquist S et-al. First Case of 2019 Novel Coronavirus in the United States. (2020) The New England journal of medicine. doi:10.1056/NEJMoa2001191 - Pubmed
- 10. Hui DS, I Azhar E, Madani TA et-al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. (2020) International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 91: 264-266. doi:10.1016/j.ijid.2020.01.009 - Pubmed
- 11. Chen Y, Liu Q, Guo D. Emerging coronaviruses: genome structure, replication, and pathogenesis. (2020) Journal of medical virology. 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. (2020) The New England journal of medicine. 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. (2020) JAMA. doi:10.1001/jama.2020.1585 - Pubmed
- 14. Wu P, Hao X, Lau EHY et-al. Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020. (2020) Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 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. Severe acute respiratory syndrome-related coronavirus – The species and its viruses, a statement of the Coronavirus Study Group. Alexander E. Gorbalenya. bioRxiv 2020.02.07.937862; https://doi.org/10.1101/2020.02.07.937862
- 17. Pan F, Ye T, Sun P 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
- 18. Velavan TP, Meyer CG. The Covid-19 epidemic. (2020) Tropical medicine & international health : TM & IH. doi:10.1111/tmi.13383 - Pubmed
- 19. Heymann DL, Shindo N. COVID-19: What Is Next for Public Health? (2020) Lancet. https://pubmed.ncbi.nlm.nih.gov/32061313-covid-19-what-is-next-for-public-health/?from_term=covid&from_pos=2
- 20. Zhang L, Liu Y. Potential Interventions for Novel Coronavirus in China: A Systemic Review. (2020) Journal of medical virology. doi:10.1002/jmv.25707 - Pubmed
- 21. Huijun C, 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. Published online February 12, 2020. https://doi.org/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 HY 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. (2020) Journal of Korean medical science. 35 (6): e79. doi:10.3346/jkms.2020.35.e79 - Pubmed
- 24. Yueying Pan, Hanxiong Guan, Shuchang Zhou 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. (2020) European Radiology. doi:10.1007/s00330-020-06731-x - Pubmed
- 25. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. (2020) Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi. 41 (2): 145-151. 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. (2020) Journal of the European Academy of Dermatology and Venereology : JEADV. doi:10.1111/jdv.16387 - Pubmed
- 101. Rubin Geoffrey D., Linda B. Haramati and Jeffrey P. Kanne 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): 201365. . doi:10.1148/radiol.2020201365.
- 102. Mossa-Basha Mahmud, Jonathan Medverd and Kenneth Linnau et al. "Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of Washington". Radiology (2020): 201326. . doi:10.1148/radiol.2020201326.
- 103. Ping Wu, Fang Duan, Chunhua Luo et-al. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. (2020) JAMA Ophthalmology. 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. (2020) The British journal of ophthalmology. doi:10.1136/bjophthalmol-2020-316304 - Pubmed
- 105. Lechien JR, Chiesa-Estomba CM, De Siati DR 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. (2020) European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. doi:10.1007/s00405-020-05965-1 - Pubmed
- 106. Russell B, Moss C, Rigg A et-al. Anosmia and ageusia are emerging as symptoms in patients with COVID-19: What does the current evidence say?. (2020) Ecancermedicalscience. 14: ed98. doi:10.3332/ecancer.2020.ed98 - Pubmed
- 107. Vaira LA, Salzano G, Deiana G et-al. Anosmia and ageusia: common findings in COVID-19 patients. (2020) The Laryngoscope. doi:10.1002/lary.28692 - Pubmed
- 108. Gane SB, Kelly C, Hopkins C. Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome?. (2020) Rhinology. 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. Chenguang Shen, Zhaoqin Wang, Fang Zhao et-al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. (2020) JAMA. doi:10.1001/jama.2020.4783 - Pubmed
- 111. Kai Duan et al. Effectiveness of convalescent plasma therapy in severe COVID-19 patients. (2020) Proceedings of the National Academy of Sciences. doi:10.1073/pnas.2004168117 - Pubmed
- 112. Zou Y, Zhang S. Treatment with convalescent plasma for critically ill patients with SARS-CoV-2 infection. (2020) Chest. doi:10.1016/j.chest.2020.03.039 - Pubmed
- 113. World Health Organisation. Coronavirus disease 2019 (COVID-19) Situation Report – 73.
- 114. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association?. (2020) European heart journal. doi:10.1093/eurheartj/ehaa254 - Pubmed
- 115. Constantine A. Raptis, Mark M. Hammer, Ryan G. Short et-al. Chest CT and Coronavirus Disease (COVID-19): A Critical Review of the Literature to Date. (2020) American Journal of Roentgenology. 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. (2020) Radiology. doi:10.1148/radiol.2020200432 - Pubmed
- 117. Hare S et al., The continuing evolution of COVID-19 imaging pathways in the UK: a British Society of Thoracic Imaging expert reference group update, Clinical Radiology doi:10.1016/j.crad.2020.04.002
- 118. Henderson WR, Griesdale DE, Dominelli P et-al. Does prone positioning improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome?. (2014) Canadian respiratory journal. 21 (4): 213-5. doi:10.1155/2014/472136 - Pubmed
- 119. Duca A, Piva S, Focà E et-al. Calculated Decisions: Brescia-COVID Respiratory Severity Scale (BCRSS)/Algorithm. (2020) Emergency medicine practice. 22 (5 Suppl): CD1-CD2. Pubmed
- 120. Hongde Hu, Fenglian Ma, Xin Wei et-al. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. doi:10.1093/eurheartj/ehaa190/5807656
- 121. Wu Y, Xu X, Chen Z et-al. Nervous system involvement after infection with COVID-19 and other coronaviruses. (2020) Brain, behavior, and immunity. 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. (2020) Brain, behavior, and immunity. doi:10.1016/j.bbi.2020.04.046 - Pubmed
- 123. L Davoodi, M Taghavi, A Razavi. 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 with suspected COVID-19: definition and evaluation. (2020) Radiology. doi:10.1148/radiol.2020201473 - Pubmed
- 125. Sana Salehi, Aidin Abedi, Sudheer Balakrishnan et-al. 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. (2020) European Radiology. doi:10.1007/s00330-020-06863-0 - Pubmed
- 126. Jones VG, Mills M, Suarez D et-al. COVID-19 and Kawasaki Disease: Novel Virus and Novel Case. (2020) Hospital pediatrics. doi:10.1542/hpeds.2020-0123 - Pubmed
- 127. Mahase E. Covid-19: concerns grow over inflammatory syndrome emerging in children. (2020) BMJ (Clinical research ed.). 369: m1710. doi:10.1136/bmj.m1710 - Pubmed
- 128. Giovanni Volpicelli, Luna Gargani. Sonographic signs and patterns of COVID-19 pneumonia. (2020) The Ultrasound Journal. 12 (1): 1. doi:10.1186/s13089-020-00171-w - Pubmed
- 129. Giovanni Volpicelli, Alessandro Lamorte, Tomás Villén. What’s new in lung ultrasound during the COVID-19 pandemic. (2020) Intensive Care Medicine. doi:10.1007/s00134-020-06048-9 - Pubmed
- 130. Klok FA, Kruip MJHA, van der Meer NJM et-al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. (2020) Thrombosis research. doi:10.1016/j.thromres.2020.04.041 - Pubmed
- 131. Grillet F, Behr J, Calame P et-al. Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected by Pulmonary CT Angiography. (2020) Radiology. doi:10.1148/radiol.2020201544 - Pubmed
- 132. Leonard-Lorant I, Delabranche X, Severac F et-al. Acute Pulmonary Embolism in COVID-19 Patients on CT Angiography and Relationship to D-Dimer Levels. (2020) Radiology. doi:10.1148/radiol.2020201561 - Pubmed
- 133. Poyiadi N, Cormier P, Patel PY et-al. Acute Pulmonary Embolism and COVID-19. (2020) Radiology. doi:10.1148/radiol.2020201955 - Pubmed
- 134. Casey K, Iteen A, Nicolini R et-al. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. (2020) The American journal of emergency medicine. 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. (2020) BMJ (Clinical research ed.). 369: m1849. doi:10.1136/bmj.m1849 - Pubmed
- 136. Valk SJ, Piechotta V, Chai KL et-al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a rapid review. (2020) The Cochrane database of systematic reviews. 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. (2020) The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(20)30203-0
- 138. Lauren M. Kucirka, Stephen A. Lauer, Oliver Laeyendecker et-al. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure. (2020) Annals of Internal Medicine. doi:10.7326/M20-1495 - Pubmed
- 139. Tong JY, Wong A, Zhu D et-al. The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis. (2020) Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. doi:10.1177/0194599820926473 - Pubmed
- 140. Loffredo L, Pacella F, Pacella E et-al. Conjunctivitis and COVID-19: A meta-analysis. (2020) Journal of medical virology. doi:10.1002/jmv.25938 - Pubmed
- 141. Scalinci SZ, Trovato Battagliola E. Conjunctivitis can be the only presenting sign and symptom of COVID-19. (2020) IDCases. 20: e00774. doi:10.1016/j.idcr.2020.e00774 - Pubmed
- 142. Cho HJ, Koo JW, Roh SK et-al. COVID-19 transmission and blood transfusion: A case report. (2020) Journal of infection and public health. doi:10.1016/j.jiph.2020.05.001 - Pubmed
- 143. Patrì A, Gallo L, Guarino M et-al. Sexual transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A new possible route of infection?. (2020) Journal of the American Academy of Dermatology. 82 (6): e227. doi:10.1016/j.jaad.2020.03.098 - Pubmed
- 144. Boccia M, Aronne L, Celia B, Mazzeo G et-al. COVID-19 and coagulative axis: review of emerging aspects in a novel disease. (2020) Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. doi:10.4081/monaldi.2020.1300 - Pubmed
- 145. Patel KP, Patel PA, Vunnam RR et-al. Gastrointestinal, hepatobiliary, and pancreatic manifestations of COVID-19. (2020) Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 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. (2020) Alimentary pharmacology & therapeutics. doi:10.1111/apt.15813 - Pubmed
- 147. de Jaegere TMH, Krdzalic J, Fasen BACM, Kwee RM. Radiological Society of North America Chest CT Classification System for Reporting COVID-19 Pneumonia: Interobserver Variability and Correlation with RT-PCR. Radiol Cardiothorac Imaging. 2020 Jun 1;2(3):e200213.
- 148. Horby P, Lim WS, Emberson JR et-al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. (2020) The New England journal of medicine. doi:10.1056/NEJMoa2021436 - Pubmed
- 149. Oxley TJ, Mocco J, Majidi S et-al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. (2020) The New England journal of medicine. 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. (2020) Stroke. 51 (7): 2002-2011. doi:10.1161/STROKEAHA.120.030335 - Pubmed
- 151. Merkler AE, Parikh NS, Mir S et-al. Risk of Ischemic Stroke in Patients with Covid-19 versus Patients with Influenza. (2020) medRxiv : the preprint server for health sciences. 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. (2020) BMJ (Clinical research ed.). 369: m2107. doi:10.1136/bmj.m2107 - Pubmed
- 153. Beigel JH, Tomashek KM, Dodd LE et-al. Remdesivir for the Treatment of Covid-19 - Preliminary Report. (2020) The New England journal of medicine. doi:10.1056/NEJMoa2007764 - Pubmed
- 154. Mahase E. Covid-19: Oxford team begins vaccine trials in Brazil and South Africa to determine efficacy. (2020) BMJ (Clinical research ed.). 369: m2612. doi:10.1136/bmj.m2612 - Pubmed
- 155. Liu M, Cheng SZ, Xu KW et-al. Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study. (2020) BMJ (Clinical research ed.). 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. (2020) Rhode Island medical journal (2013). 103 (5): 85-88. Pubmed
- 157. Radmanesh A, Derman A, Lui YW et-al. COVID-19 -associated Diffuse Leukoencephalopathy and Microhemorrhages. (2020) Radiology. 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. (2020) Radiology. doi:10.1148/radiol.2020202222 - Pubmed
- 159. Fitsiori A, Pugin D, Thieffry C et-al. Unusual Microbleeds in Brain MRI of Covid-19 Patients. (2020) Journal of neuroimaging : official journal of the American Society of Neuroimaging. doi:10.1111/jon.12755 - Pubmed
- 160. Deeks JJ, Dinnes J, Takwoingi Y et-al. Antibody tests for identification of current and past infection with SARS-CoV-2. (2020) The Cochrane database of systematic reviews. 6: CD013652. doi:10.1002/14651858.CD013652 - Pubmed
- 161. Dyer O. Covid-19: Airborne transmission is being underestimated, warn experts. (2020) BMJ (Clinical research ed.). 370: m2720. doi:10.1136/bmj.m2720 - Pubmed
- 162. Morawska L, Milton DK. It is Time to Address Airborne Transmission of COVID-19. (2020) Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. doi:10.1093/cid/ciaa939 - Pubmed
- 163. Lee S, Meyler P, Mozel M et-al. Asymptomatic carriage and transmission of SARS-CoV-2: What do we know?. (2020) Canadian journal of anaesthesia = Journal canadien d'anesthesie. doi:10.1007/s12630-020-01729-x - Pubmed
- 164. Yu X, Yang R. COVID-19 transmission through asymptomatic carriers is a challenge to containment. (2020) Influenza and other respiratory viruses. 14 (4): 474-475. doi:10.1111/irv.12743 - Pubmed
- 165. Zoe Brady, Heather Scoullar, Ben Grinsted et-al. Technique, radiation safety and image quality for chest X-ray imaging through glass and in mobile settings during the COVID-19 pandemic. Physical and Engineering Sciences in Medicine. doi:10.1007/s13246-020-00899-8
- 166. Moore N, Carleton B, Blin P et-al. Does Ibuprofen Worsen COVID-19?. (2020) Drug safety. 43 (7): 611-614. 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. (2020) Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 61 (5): 632-636. 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 JM. US purchases world stocks of Remdesivir—why the rest of the world should be glad to be at the back of the queue. (2020) BMJ. 370:m2797. https://blogs.bmj.com/bmj/2020/07/03/as-the-us-purchases-world-stocks-of-remdesivir-why-the-rest-of-the-world-should-be-glad-to-be-at-the-back-of-the-queue/ [accessed 19 June 2020].
- 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. (2020) Microbial pathogenesis. doi:10.1016/j.micpath.2020.104390 - Pubmed
- 171. Suresh Kumar VC, Mukherjee S, Harne PS et-al. Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19. (2020) BMJ open gastroenterology. doi:10.1136/bmjgast-2020-000417 - Pubmed
- 172. Tan L, Kovoor JG, Williamson P et-al. Personal Protective Equipment and Evidence-Based Advice for Surgical Departments during COVID-19. (2020) ANZ journal of surgery. doi:10.1111/ans.16194 - Pubmed
- 173. Amato A, Caggiano M, Amato M et-al. Infection Control in Dental Practice During the COVID-19 Pandemic. (2020) International journal of environmental research and public health. doi:10.3390/ijerph17134769 - Pubmed
- 174. Aboubakr HA, Sharafeldin TA, Goyal SM. Stability of SARS-CoV-2 and other coronaviruses in the environment and on common touch surfaces and the influence of climatic conditions: A review. (2020) Transboundary and emerging diseases. doi:10.1111/tbed.13707 - Pubmed
- 175. Cleverley J, Piper J, Jones MM. The role of chest radiography in confirming covid-19 pneumonia. (2020) BMJ (Clinical research ed.). 370: m2426. doi:10.1136/bmj.m2426 - Pubmed
- 176. Angelo Carfì, Roberto Bernabei, Francesco Landi. Persistent Symptoms in Patients After Acute COVID-19. (2020) JAMA. doi:10.1001/jama.2020.12603 - Pubmed
- 177. Mahase E. Covid-19: What do we know about "long covid"?. (2020) BMJ (Clinical research ed.). 370: m2815. doi:10.1136/bmj.m2815 - Pubmed
- 178. Ting R, Edmonds P, Higginson IJ et-al. Palliative care for patients with severe covid-19. (2020) BMJ (Clinical research ed.). 370: m2710. doi:10.1136/bmj.m2710 - Pubmed
- 179. Keeley P, Buchanan D, Carolan C et-al. Symptom burden and clinical profile of COVID-19 deaths: a rapid systematic review and evidence summary. (2020) BMJ supportive & palliative care. doi:10.1136/bmjspcare-2020-002368 - Pubmed
- 180. Lovell N, Maddocks M, Etkind SN et-al. Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care. (2020) Journal of pain and symptom management. 60 (1): e77-e81. doi:10.1016/j.jpainsymman.2020.04.015 - Pubmed
- 181. Little CP, Birks ME, Horwitz MD et-al. COVID-19: A rethink of corticosteroid injection? (2020) Bone & Joint Open 1 (6): 253-256. https://online.boneandjoint.org.uk/doi/full/10.1302/2046-3758.16.BJO-2020-0050.R1
- 182. Paolo De Sanctis, Pietro Emiliano Doneddu, Luca Viganò et-al. Guillain Barré Syndrome associated with SARS‐CoV‐2 infection. A Systematic Review. European Journal of Neurology. doi:10.1111/ene.14462
- 183. Lessmann N, Sánchez CI, Beenen L et-al. Automated Assessment of CO-RADS and Chest CT Severity Scores in Patients with Suspected COVID-19 Using Artificial Intelligence. (2020) Radiology. doi:10.1148/radiol.2020202439 - Pubmed
- 184. Hermans JJR, Groen J, Zwets E et-al. Chest CT for triage during COVID-19 on the emergency department: myth or truth?. (2020) Emergency radiology. doi:10.1007/s10140-020-01821-1 - Pubmed
- 185. Rui Han, Lu Huang, Hong Jiang et-al. Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia. (2020) American Journal of Roentgenology. 215 (2): 338-343. doi:10.2214/AJR.20.22961 - Pubmed
- 186. Hadi A, Werge M, Kristiansen KT et-al. Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members. (2020) Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]. 20 (4): 665-667. doi:10.1016/j.pan.2020.04.021 - Pubmed
- 187. Bonney GK, Gao Y, Chew CA et-al. SARS-COV-2 associated acute pancreatitis: Cause, consequence or epiphenomenon?. (2020) Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]. 20 (5): 1017-1018. doi:10.1016/j.pan.2020.05.019 - Pubmed
- 188. Tartof SY, Qian L, Hong V et-al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. (2020) Annals of internal medicine. doi:10.7326/M20-3742 - Pubmed
- 189. John H. Beigel, Kay M. Tomashek, Lori E. Dodd et-al. Remdesivir for the Treatment of Covid-19 — Final Report. (2020) New England Journal of Medicine. doi:10.1056/NEJMoa2007764 - Pubmed
- 190. Radujkovic A, Hippchen T, Tiwari-Heckler S et-al. Vitamin D Deficiency and Outcome of COVID-19 Patients. (2020) Nutrients. doi:10.3390/nu12092757 - Pubmed
- 191. Brenner, Hermann, Schöttker, Ben. 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. (2020) Nutrients. 12 (12): 3642. doi:10.3390/nu12123642
- 192. Ilie PC, Stefanescu S, Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. (2020) Aging clinical and experimental research. 32 (7): 1195-1198. doi:10.1007/s40520-020-01570-8 - Pubmed
- 193. Merzon E, Merzon TD, Merzon GA et-al. Low plasma 25(OH) vitamin D level is associated with increased risk of COVID-19 infection: an Israeli population-based study. (2020) The FEBS journal. doi:10.1111/febs.15495 - Pubmed
- 194. David O. Meltzer, Thomas J. Best, Hui Zhang et-al. Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results. (2020) JAMA Network Open. 3 (9): e2019722. doi:10.1001/jamanetworkopen.2020.19722
- 195. Annweiler C, Hanotte B, Grandin de l'Eprevier C et-al. Vitamin D and survival in COVID-19 patients: A quasi-experimental study. (2020) The Journal of steroid biochemistry and molecular biology. 204: 105771. doi:10.1016/j.jsbmb.2020.105771 - Pubmed
- 196. Jafari R, Jafari MH, Jafari SA et-al. A Unique Feature of COVID-19 Infection in Chest CT; "Pulmonary Target" Appearance. (2021) Academic radiology. doi:10.1016/j.acra.2020.11.004 - Pubmed
- 197. Andre C. Kalil, Thomas F. Patterson, Aneesh K. Mehta et-al. Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19. (2020) New England Journal of Medicine. doi:10.1056/NEJMoa2031994?query=RP
- 198. Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report. (2020) New England Journal of Medicine. doi:10.1056/NEJMoa2021436?query=featured_coronavirus
- 199. Dai L, Gao GF. Viral targets for vaccines against COVID-19. (2020) Nature reviews. Immunology. doi:10.1038/s41577-020-00480-0 - Pubmed
- 200. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Pérez Marc G, Moreira ED, Zerbini C, Bailey R, Swanson KA, Roychoudhury S, Koury K, Li P, Kalina WV, Cooper D, Frenck RW, Hammitt LL, Türeci Ö, Nell H, Schaefer A, Ünal S, Tresnan DB, Mather S, Dormitzer PR, Şahin U, Jansen KU, Gruber WC. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. (2020) The New England journal of medicine. doi:10.1056/NEJMoa2034577 - Pubmed
- 201. Ledford H. US authorization of first COVID vaccine marks new phase in safety monitoring. (2020) Nature. 588 (7838): 377-378. 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.W.X., A. Rajai and R. Patel et al. "Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography – Prevalence, pattern of disease and relationship to D-dimer". European Journal of Radiology 132 (2020): 109336. . doi:10.1016/j.ejrad.2020.109336.
- 204. Jalaber Carole, Marie-Pierre Revel and Guillaume Chassagnon et al. "Role of upfront CT pulmonary angiography at admission in COVID-19 patients". Thrombosis Research 196 (2020): 138-140. . doi:10.1016/j.thromres.2020.08.037.
- 205. Irene Espallargas, Juan José Rodríguez Sevilla, Diego Agustín Rodríguez Chiaradía, Antonio Salar, Guillem Casamayor, Judit Villar-Garcia, Anna Rodó-Pin, Salvatore Marsico, Santiago Carbullanca, Diego Ramal, Luis Alexander del Carpio, Ángel Gayete, José María Maiques, Flavio Zuccarino. CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis. European Radiology. doi:10.1007/s00330-020-07300-y
- 206. Sara Volpi, Jason M Ali, Alishah Suleman, Rahim Nadeem Ahmed, Pneumomediastinum in COVID-19 patients: a case series of a rare complication, European Journal of Cardio-Thoracic Surgery, Volume 58, Issue 3, September 2020, Pages 646–647, https://doi.org/10.1093/ejcts/ezaa222
- 207. Wei Feng, Ashley M. Newbigging, Connie Le, Bo Pang, Hanyong Peng, Yiren Cao, Jinjun Wu, Ghulam Abbas, Jin Song, Dian-Bing Wang, Mengmeng Cui, Jeffrey Tao, D. Lorne Tyrrell, Xian-En Zhang, Hongquan Zhang, X. Chris Le. Molecular Diagnosis of COVID-19: Challenges and Research Needs. (2020) Analytical Chemistry. doi:10.1021/acs.analchem.0c02060
- 208. Knezevic, Ivana, Liu, Margaret A., Peden, Keith, Zhou, Tiequn, Kang, Hye-Na. Development of mRNA Vaccines: Scientific and Regulatory Issues. (2021) Vaccines. 9 (2): 81. doi:10.3390/vaccines9020081
- 209. Prüβ BM. Current State of the First COVID-19 Vaccines. (2021) Vaccines. doi:10.3390/vaccines9010030 - Pubmed