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This article is about the disease. For the virus, see 2019 novel coronavirus. For the outbreak, see 2019–20 Wuhan coronavirus outbreak.

COVID-19
Other namesNovel coronavirus pneumonia[1]
Symptoms of COVID-19
SpecialtyInfectious diseases, pulmonology, virology, epidemiology, emergency medicine Edit this on Wikidata
SymptomsFever, cough, shortness of breath
ComplicationsPneumonia, ARDS, kidney failure
CausesSARS-CoV-2
Diagnostic methodPCR testing
TreatmentSymptomatic and supportive

2019-nCoV acute respiratory disease, also known as novel coronavirus pneumonia (NCP)[1] and coronavirus disease 2019 (COVID-19),[2][3][4] is an infectious disease caused by the 2019 novel coronavirus (SARS-CoV-2).[5][6] It was first detected during the 2019–20 Wuhan coronavirus outbreak.[7][8] It results in flu-like symptoms,[9][10] including fever, coughing, shortness of breath, pain in the muscles and tiredness. It may result in pneumonia, acute respiratory distress syndrome, sepsis and septic shock, and possible death. There is no specific treatment, with efforts typically to manage symptoms and support functioning.[9]

SARS-CoV-2 is thought to be of animal origin, however the most common method of spread is between people, generally by respiratory droplets that people sneeze, cough or exhale.[9] Symptoms generally begin between 2 to 14 days after exposure, during which time it can remain contagious.[11][12] Precautions should be taken to limit transmission, including good personal hygiene, washing hands regularly and wearing surgical masks.[13] Those who think they are infected should wear a surgical mask and ring a doctor immediately for advice.[14][10]

The disease was first identified by health authorities in the city of Wuhan, capital of Hubei province in China, among patients who had developed pneumonia of no clear cause.[15] It has caused alarm due to the absence of any effective vaccine nor medicine treatment and its relative quick spread globally from its initial discovery in early January.[16][17]

The World Health Organization has declared the 2019-20 Wuhan coronavirus outbreak to be a Public Health Emergency of International Concern (PHEIC), based on the impact the virus could have on poorer countries with weaker healthcare infrastructures.[18] Infections have been reported throughout the Western world and the Asia-Pacific, mostly of travelers originating in Mainland China, with local transmission also reported in Germany,[19] France,[20] Hong Kong,[21] Vietnam,[22] Thailand,[23] Singapore,[24] Japan,[25] South Korea,[26] and Australia.[27] The deaths have been reported in Mainland China, the Philippines,[28] and Hong Kong.[29] As of 11 February 2020, only Mainland China is listed as an area with known ongoing community transmission of SARS-CoV-2.[30]

Signs and symptoms

Those infected may either be asymptomatic or have mild to severe symptoms, like fever, cough, shortness of breath.[31][32][33] Diarrhoea or upper respiratory symptoms (e.g. sneezing, runny nose, sore throat) are less frequent.[34] Cases can progress to severe pneumonia, multi-organ failure, and death.[7][35]

The incubation period is estimated at 2 to 10 days by the World Health Organization,[36] and 2 to 14 days by the US Centers for Disease Control and Prevention (CDC).[37] A study published in February by several dozen researchers in China, including the doctor responsible for discovering SARS, found evidence of the incubation period stretching to 24 days.[38]

Cause

Main article: 2019 novel coronavirus

The cause is the virus provisionally named SARS-CoV-2, [39] which is thought to have a zoonotic origin.[40]

The primary mode of transmission is human-to-human transmission via respiratory droplets that people sneeze, cough or exhale.[9]

Diagnosis

The WHO has published several testing protocols for 2019-nCoV.[41][42] Testing uses real time reverse transcription-polymerase chain reaction (rRT-PCR).[43] The test can be done on respiratory or blood samples.[44] Results are generally available within a few hours to days.[45][46] Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so that laboratories across the world could independently develop PCR tests to detect infection by the virus.[7][47][48][49][50]

Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying patients who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected patients: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count.[51]

Prevention

Global health organizations have published preventive measures to reduce the chances of 2019-nCOV infection. Recommendations are similar to those published for other coronaviruses and include: frequent washing of hands with soap and water; not touching the eyes, nose, or mouth with unwashed hands; and practicing good respiratory hygiene.[52][53]

Management

As of 5 February 2020, there were no known treatments for the disease. The WHO recommended volunteers take part in randomized controlled trials for testing the effectiveness and safety of potential treatments.[54]

Research into potential treatments for the disease were initiated in January 2020, and new therapies may take until 2021 to develop.[55] The Chinese Center for Disease Control and Prevention started testing existing pneumonia treatments in coronavirus-related pneumonia in late January.[56] There has also been examination of the RNA polymerase inhibitor remdesivir,[57][58][59][60] and interferon beta.[60]

In late January 2020, Chinese medical researchers expressed an intent to start clinical testing on remdesivir, chloroquine, and lopinavir/ritonavir, all of which seemed to have "fairly good inhibitory effects" on 2019-nCoV at the cellular level in exploratory research.[61] On 5 February 2020, China started patenting use of remdesivir for the disease.[62][63][64]

The Russian Ministry of Health identified 3 medicines for adults to combat 2019-nCoV, in late January 2020. Ribavirin, lopinavir/ritonavir and interferon beta-1b can be used to fight the coronavirus, according to them. As these drugs are typically used to treat hepatitis C, HIV and multiple sclerosis respectively. The Russian Health Ministry offered descriptions and guidelines in how the treatments works, and in what quantities these recommendations should be prescribed for doctors in hospitals throughout Russia.[65] In February it was reported that China started testing Triazavirin, a Russian anti-viral drug, in the hope that it might be helpful in controlling the new coronavirus. Triazavirin was developed at Ural Federal University in Yekaterinburg, originally to combat the 'Bird Flu' (H5N1). Due to similarities between the two infections, the researchers feel it’s worth a try according to the reports. The 2014 drug Triazavirin, is claimed to be effective against Rift Valley fever and the West Nile virus, as well as other viral infections.[66][67]

Epidemiology

Main article: 2019–20 Wuhan coronavirus outbreak

Overall mortality and morbidity rates due to infection with 2019-nCoV are unknown, both because the case fatality rate may be changing over time in the current outbreak, and because the proportion of infections that progress to diagnosable disease remains unclear.[68][69] However, preliminary research into COVID-19 has yielded case fatality rate numbers between 2% and 3%,[70] and in January 2020 the WHO suggested that the case fatality rate was approximately 3%.[71] An unreviewed Imperial College preprint study among 55 fatal cases noted that early estimates of mortality may be too high as asymptomatic infections are missed. They estimated a mean infection fatality ratio (the mortality among infected) ranging from 0.8% when including asymptomatic carriers to 18% when including only symptomatic cases from Hubei province.[72]

As of 11 February 2020, 43,114 cases have been confirmed, 6,495 are severe (16%)[73] with 4,046 having recovered.[74]

Prognosis

Early data indicates that among the first 41 confirmed cases that were admitted to hospitals in Wuhan, 13 (32%) individuals required intensive care, and 6 (15%) individuals died.[34] Of those who died, many were in unsound health to begin with, exhibiting conditions like hypertension, diabetes, or cardiovascular disease that impaired their immune systems.[75]

In early cases of COVID-19 that resulted in death, the median time of disease was found to be 14 days, with a total range from six to 41 days.[76]

Psychological

Psychological effects may be caused by feeling trapped under quarantine, travel restrictions and isolation.[77] At the end of January 2020, the National Health Commission of China published a national guideline of psychological crisis intervention for 2019-nCoV, endorsing mental health care for people affected by 2019-nCoV, close contacts, those isolated at home, families and friends of affected people, health care workers and the general public who need it.[78][79]

See also

References

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