Coronavirus Disease 2019 - Wikipedia

Coronavirus disease
2019
Coronavirus disease 2019 (COVID-19) is

an infectious disease caused by severe
acute respiratory syndrome coronavirus
2 (SARS-CoV-2).[9] It was first identified
in December 2019 in Wuhan, Hubei,
China, and has resulted in an ongoing
pandemic.[10][11] The first confirmed case
has been traced back to 17 November
2019 in Hubei.[12] As of 7 August 2020,
more than 19.1 million cases have been
reported across 188 countries and
territories, resulting in more than 716,000
deaths. More than 11.6 million people
have recovered.[8]
Coronavirus disease 2019
(COVID-19)
Other names Coronavirus
Corona
COVID
2019-nCoV acute
respiratory disease
Sars-Cov
Novel coronavirus
pneumonia[1][2]
Severe pneumonia
with novel
pathogens[3]
False-color transmission electron
microscope image of Coronavirus
Pronunciation /kəˈroʊnəˌvaɪrəs dɪ
ˈziːz/
/ˌkoʊvɪdnaɪnˈtiːn,
ˌkɒvɪd-/[4]
Specialty Infectious disease
Symptoms Fever, cough,

fatigue, shortness of
breath, loss of smell;
sometimes no
symptoms at all[5][6]
Complications Pneumonia, viral

sepsis, acute
respiratory distress
syndrome, kidney
failure, cytokine
release syndrome
Usual onset 2–14 days (typically
5) from infection
Causes Severe acute

respiratory syndrome
coronavirus 2
(SARS-CoV-2)
Diagnostic method rRT-PCR testing, CT

scan
Prevention Hand washing, face

coverings,
quarantine, social
distancing[7]
Treatment Symptomatic and

Frequency supportive
19,160,806[8]
confirmed cases
Deaths 716,083 (3.7% of

confirmed cases)[8]
Common symptoms include fever,

cough, fatigue, shortness of breath, and
loss of smell and taste.[13][5][6][14] While
the majority of cases result in mild
symptoms, some progress to acute
respiratory distress syndrome (ARDS)
possibly precipitated by cytokine
storm,[15] multi-organ failure, septic
shock, and blood clots.[16][17][18] The
time from exposure to onset of
symptoms is typically around five days,
but may range from two to fourteen
days.[5][19]
The virus is primarily spread between

people in proximity,[a] most often via
small droplets produced by coughing,[b]
sneezing, and talking.[6][20][22] The
droplets usually fall to the ground or onto
surfaces rather than travelling through air
over long distances.[6][23] However, the
transmission may also occur through
smaller droplets that are able to stay
suspended in the air for longer periods of
time in enclosed spaces, as typical for
airborne diseases.[24] Less commonly,
people may become infected by
touching a contaminated surface and
then touching their face.[6][20] It is most
contagious during the first three days
after the onset of symptoms, although
spread is possible before symptoms
appear, and from people who do not
show symptoms.[6][20] The standard
method of diagnosis is by real-time
reverse transcription polymerase chain
reaction (rRT-PCR) from a
nasopharyngeal swab.[25] Chest CT
imaging may also be helpful for
diagnosis in individuals where there is a
high suspicion of infection based on
symptoms and risk factors; however,
guidelines do not recommend using CT
imaging for routine screening.[26][27]
Recommended measures to prevent

infection include frequent hand washing,
maintaining physical distance from
others (especially from those with
symptoms), quarantine (especially for
those with symptoms), covering coughs,
and keeping unwashed hands away
from the face.[7][28][29] The use of cloth
face coverings such as a scarf or a
bandana has been recommended by
health officials in public settings to
minimise the risk of transmissions, with
some authorities requiring their
use.[30][31] Health officials also stated
that medical-grade face masks, such as
N95 masks, should be used only by
healthcare workers, first responders, and
those who directly care for infected
individuals.[32][33]
There are no vaccines nor specific

antiviral treatments for COVID-19.[6]
Management involves the treatment of
symptoms, supportive care, isolation,
and experimental measures.[34] The
World Health Organization (WHO)
declared the COVID‑19 outbreak a public
health emergency of international
concern (PHEIC)[35][36] on 30 January
2020 and a pandemic on 11 March
2020.[11] Local transmission of the
disease has occurred in most countries
across all six WHO regions.[37]
Signs and symptoms

Symptoms of COVID-19[38]
Symptom Range
Fever 83–99%
Cough 59–82%
Loss of appetite 40–84%
Fatigue 44–70%
Shortness of breath 31–40%
Coughing up sputum 28–33%
Muscle aches and pains 11–35%
Symptoms of COVID-19.
Fever is the most common symptom of
COVID-19,[13] but is highly variable in
severity and presentation, with some
older, immunocompromised, or critically
ill people not having fever at all.[39][40] In
one study, only 44% of people had fever
when they presented to the hospital,
while 89% went on to develop fever at
some point during their
hospitalization.[41]
Other common symptoms include

cough, loss of appetite, fatigue,
shortness of breath, sputum production,
and muscle and joint pains.[13][1][5][42]
Symptoms such as nausea, vomiting,
and diarrhoea have been observed in
varying percentages.[43][44][45] Less
common symptoms include sneezing,
runny nose, sore throat, and skin
lesions.[46] Some cases in China initially
presented with only chest tightness and
palpitations.[47] A decreased sense of
smell or disturbances in taste may
occur.[48][49] Loss of smell was a
presenting symptom in 30% of
confirmed cases in South Korea.[14][50]
As is common with infections, there is a

delay between the moment a person is
first infected and the time he or she
develops symptoms. This is called the
incubation period. The typical incubation
period for COVID‑19 is five or six days,
but it can range from one to fourteen
days[6][51] with approximately 10% of
cases taking longer.[52][53][54]
An early key to the diagnosis is the

tempo of the illness. Early symptoms
may include a wide variety of symptoms
but infrequently involves shortness of
breath. Shortness of breath usually
develops several days after initial
symptoms. Shortness of breath that
begins immediately along with fever and
cough is more likely to be anxiety than
COVID-19. The most critical days of
illness tend to be those following the
development of shortness of breath.[55]
A minority of cases do not develop
noticeable symptoms at any point in
time.[56] These asymptomatic carriers
tend not to get tested, and their role in
transmission is not fully known.[57][58]
Preliminary evidence suggested they
may contribute to the spread of the
disease.[59] In June 2020, a
spokeswoman of WHO said that
asymptomatic transmission appears to
be "rare", but the evidence for the claim
was not released.[60] The next day, WHO
clarified that they had intended a narrow
definition of "asymptomatic" that did not
include pre-symptomatic or
paucisymptomatic (weak symptoms)
transmission and that up to 41% of
transmission may be asymptomatic.
Transmission without symptoms does
occur.[56]
Cause
Transmission
Respiratory droplets produced when a man

sneezes visualised using Tyndall scattering
sneezes, visualised using Tyndall scattering
COVID‑19 is a new disease, and many of

the details of its spread are still under
investigation.[6][20][22] It spreads easily
between people—more easily than
influenza but not as easily as
measles.[20] People are most infectious
when they show symptoms (even mild or
non-specific symptoms), but may be
infectious for up to two days before
symptoms appear (pre-symptomatic
transmission).[22] They remain infectious
for an estimated seven to twelve days in
moderate cases and an average of two
weeks in severe cases.[22] People can
also transmit the virus without showing
any symptom (asymptomatic
transmission), but it is unclear how often
this happens.[6][20][22] A June 2020
review found that 40–45% of infected
people are asymptomatic.[61]
COVID-19 spreads primarily when

people are in close contact and one
person inhales small droplets produced
by an infected person (symptomatic or
not) coughing, sneezing, talking, or
singing.[22][62] The WHO recommends 1
metre (3 ft) of social distance;[6] the US
Centers for Disease Control and
Prevention (CDC) recommends 2 metres
(6 ft).[20]
Transmission may also occur through

aerosols, smaller droplets that are able
to stay suspended in the air for longer
periods of time.[24] Experimental results
show the virus can survive in aerosol for
up to three hours.[63] Some outbreaks
have also been reported in crowded and
inadequately ventilated indoor locations
where infected persons spend long
periods of time (such as restaurants and
nightclubs).[64] Aerosol transmission in
such locations has not been ruled out.[24]
Some medical procedures performed on
COVID-19 patients in health facilities can
generate those smaller droplets,[65] and
result in the virus being transmitted more
easily than normal.[6][22]
Less commonly, when the contaminated

droplets fall to floors or surfaces they
can remain infectious if people touch
contaminated surfaces and then their
eyes, nose or mouth with unwashed
hands.[6] On surfaces the amount of
viable active virus decreases over time
until it can no longer cause infection,[22]
and surfaces are thought not to be the
main way the virus spreads.[20] The level
of contamination required to transmit
infection via surfaces is unknown, but
the virus can be detected for up to four
hours on copper, up to one day on
cardboard, and up to three days on
plastic (polypropylene) and stainless
steel (AISI 304).[22][66][67] Surfaces are
easily decontaminated with household
disinfectants which destroy the virus
outside the human body or on the
hands.[6] Disinfectants or bleach are not
a treatment for COVID‑19, and cause
health problems when not used properly,
such as when used inside the human
body.[68]
Sputum and saliva carry large amounts
of virus.[6][20][22][69] Although COVID‑19
is not a sexually transmitted infection,
direct contact such as kissing, intimate
contact, and fecal–oral routes are
suspected to transmit the virus.[70][71]
The virus may occur in breast milk, but
whether it is transmittable to the baby is
unknown.[72][73]
Estimates of the number of people

infected by one person with COVID-19,
the R0, have varied. The WHO's initial
estimates of R0 were 1.4–2.5 (average
1.95); however, a review in early April
2020 found the basic R0 (without control
measures) to be higher at 3.28 and the
median R0 to be 2.79.[74]
Virology
Illustration of SARSr-CoV virion
Severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2) is a novel
severe acute respiratory syndrome
coronavirus, first isolated from three
people with pneumonia connected to
the cluster of acute respiratory illness
cases in Wuhan.[75] All features of the
novel SARS-CoV-2 virus occur in related
coronaviruses in nature.[76] Outside the
human body, the virus is destroyed by
household soap, which bursts its
protective bubble.[26]
SARS-CoV-2 is closely related to the

original SARS-CoV.[77] It is thought to
have an animal (zoonotic) origin.
Genetic analysis has revealed that the
coronavirus genetically clusters with the
genus Betacoronavirus, in subgenus
Sarbecovirus (lineage B) together with
two bat-derived strains. It is 96%
identical at the whole genome level to
other bat coronavirus samples (BatCov
RaTG13).[46] In February 2020, Chinese
researchers found that there is only one
amino acid difference in the binding
domain of the S protein between the
coronaviruses from pangolins and those
from humans; however, whole-genome
comparison to date found that at most
92% of genetic material was shared
between pangolin coronavirus and
SARS-CoV-2, which is insufficient to
prove pangolins to be the intermediate
host.[78]
Pathophysiology
COVID-19 can affect the upper
respiratory tract (sinuses, nose, and
throat) and the lower respiratory tract
(windpipe and lungs).[79] The lungs are
the organs most affected by COVID‑19
because the virus accesses host cells via
the enzyme angiotensin-converting
enzyme 2 (ACE2), which is most
abundant in type II alveolar cells of the
lungs.[80] The virus uses a special
surface glycoprotein called a "spike"
(peplomer) to connect to ACE2 and
enter the host cell.[81] The density of
ACE2 in each tissue correlates with the
severity of the disease in that tissue and
some have suggested decreasing ACE2
activity might be protective,[82][83]
though another view is that increasing
ACE2 using angiotensin II receptor
blocker medications could be
protective.[84] As the alveolar disease
progresses, respiratory failure might
develop and death may follow.[83]
SARS-CoV-2 may also cause respiratory

failure through affecting the brainstem
as other coronaviruses have been found
to invade the central nervous system
(CNS). While virus has been detected in
cerebrospinal fluid of autopsies, the
exact mechanism by which it invades the
CNS remains unclear and may first
involve invasion of peripheral nerves
given the low levels of ACE2 in the
brain.[85][86]
The virus also affects gastrointestinal

organs as ACE2 is abundantly expressed
in the glandular cells of gastric, duodenal
and rectal epithelium[87] as well as
endothelial cells and enterocytes of the
small intestine.[88]
The virus can cause acute myocardial

injury and chronic damage to the
cardiovascular system.[89] An acute
cardiac injury was found in 12% of
infected people admitted to the hospital
in Wuhan, China,[44] and is more
frequent in severe disease.[90] Rates of
cardiovascular symptoms are high,
owing to the systemic inflammatory
response and immune system disorders
during disease progression, but acute
myocardial injuries may also be related
to ACE2 receptors in the heart.[89] ACE2
receptors are highly expressed in the
heart and are involved in heart
function.[89][91] A high incidence of
thrombosis (31%) and venous
thromboembolism (25%) have been
found in ICU patients with COVID‑19
infections, and may be related to poor
prognosis.[92][93] Blood vessel
dysfunction and clot formation (as
suggested by high D-dimer levels) are
thought to play a significant role in
mortality, incidences of clots leading to
pulmonary embolisms, and ischaemic
events within the brain have been noted
as complications leading to death in
patients infected with SARS-CoV-2.
Infection appears to set off a chain of
vasoconstrictive responses within the
body, constriction of blood vessels
within the pulmonary circulation has also
been posited as a mechanism in which
oxygenation decreases alongside the
presentation of viral pneumonia.[94]
Another common cause of death is
complications related to the kidneys.[94]
Early reports show that up to 30% of
hospitalized patients both in China and in
New York have experienced some injury
to their kidneys, including some persons
with no previous kidney problems.[95]
Autopsies of people who died of

COVID‑19 have found diffuse alveolar
damage (DAD), and lymphocyte-
containing inflammatory infiltrates within
the lung.[96]
Immunopathology
Although SARS-CoV-2 has a tropism for
ACE2-expressing epithelial cells of the
respiratory tract, patients with severe
COVID‑19 have symptoms of systemic
hyperinflammation. Clinical laboratory
findings of elevated IL-2, IL-7, IL-6,
granulocyte-macrophage colony-
stimulating factor (GM-CSF), interferon-
γ inducible protein 10 (IP-10), monocyte
chemoattractant protein 1 (MCP-1),
macrophage inflammatory protein 1-α
(MIP-1α), and tumour necrosis factor-α
(TNF-α) indicative of cytokine release
syndrome (CRS) suggest an underlying
immunopathology.[44]
Additionally, people with COVID‑19 and
acute respiratory distress syndrome
(ARDS) have classical serum biomarkers
of CRS, including elevated C-reactive
protein (CRP), lactate dehydrogenase
(LDH), D-dimer, and ferritin.[97]
Systemic inflammation results in

vasodilation, allowing inflammatory
lymphocytic and monocytic infiltration of
the lung and the heart. In particular,
pathogenic GM-CSF-secreting T-cells
were shown to correlate with the
recruitment of inflammatory IL-6-
secreting monocytes and severe lung
pathology in COVID‑19 patients.
Lymphocytic infiltrates have also been
reported at autopsy.[96]
Diagnosis
Demonstration of a nasopharyngeal swab for

COVID-19 testing
US CDC rRT-PCR test kit for COVID-19[98]
The WHO has published several testing

protocols for the disease.[99] The
standard method of testing is real-time
reverse transcription polymerase chain
reaction (rRT-PCR).[100] The test is
typically done on respiratory samples
obtained by a nasopharyngeal swab;
however, a nasal swab or sputum
sample may also be used.[25][101] Results
are generally available within a few
hours to two days.[102][103] Blood tests
can be used, but these require two blood
samples taken two weeks apart, and the
results have little immediate value.[104]
Chinese scientists were able to isolate a
strain of the coronavirus and publish the
genetic sequence so laboratories across
the world could independently develop
polymerase chain reaction (PCR) tests to
detect infection by the virus.[10][105][106]
As of 4 April 2020, antibody tests (which
may detect active infections and
whether a person had been infected in
the past) were in development, but not
yet widely used.[107][108][109] Antibody
tests may be most accurate 2–3 weeks
after a person's symptoms start.[110] The
Chinese experience with testing has
shown the accuracy is only 60 to
70%.[111] The US Food and Drug
Administration (FDA) approved the first
point-of-care test on 21 March 2020 for
use at the end of that month.[112] The
absence or presence of COVID-19 signs
and symptoms alone is not reliable
enough for an accurate diagnosis.[113]
Diagnostic guidelines released by

Zhongnan Hospital of Wuhan University
suggested methods for detecting
infections based upon clinical features
and epidemiological risk. These involved
identifying people who had at least two
of the following symptoms in addition to
a history of travel to Wuhan or contact
with other infected people: fever,
imaging features of pneumonia, normal
or reduced white blood cell count, or
reduced lymphocyte count.[114]
A study asked hospitalised COVID‑19

patients to cough into a sterile container,
thus producing a saliva sample, and
detected the virus in eleven of twelve
patients using RT-PCR. This technique
has the potential of being quicker than a
swab and involving less risk to health
care workers (collection at home or in
the car).[69]
Along with laboratory testing, chest CT

scans may be helpful to diagnose
COVID‑19 in individuals with a high
clinical suspicion of infection but are not
recommended for routine
screening.[26][27] Bilateral multilobar
ground-glass opacities with a peripheral,
asymmetric, and posterior distribution
are common in early infection.[26]
Subpleural dominance, crazy paving
(lobular septal thickening with variable
alveolar filling), and consolidation may
appear as the disease
progresses.[26][115]
In late 2019, the WHO assigned

emergency ICD-10 disease codes U07.1
for deaths from lab-confirmed SARS-
CoV-2 infection and U07.2 for deaths
from clinically or epidemiologically
diagnosed COVID‑19 without lab-
confirmed SARS-CoV-2 infection.[116]
CT scan of rapid progression stage of
COVID-19.
Chest X-ray showing COVID-19

pneumonia.
Pathology
Few pieces of data are available about
microscopic lesions and the
pathophysiology of COVID‑19.[117][118]
The main pathological findings at
autopsy are:
Macroscopy: pleurisy, pericarditis,

lung consolidation and pulmonary
oedema
Four types of severity of viral
pneumonia can be observed:
minor pneumonia: minor serous
exudation, minor fibrin exudation
mild pneumonia: pulmonary
oedema, pneumocyte
hyperplasia, large atypical
pneumocytes, interstitial
inflammation with lymphocytic
infiltration and multinucleated
giant cell formation
severe pneumonia: diffuse
alveolar damage (DAD) with
diffuse alveolar exudates. DAD is
the cause of acute respiratory
distress syndrome (ARDS) and
severe hypoxemia.
healing pneumonia: organisation
of exudates in alveolar cavities
and pulmonary interstitial fibrosis
plasmocytosis in BAL[119]
Blood: disseminated intravascular
coagulation (DIC);[120]
leukoerythroblastic reaction[121]
Liver: microvesicular steatosis
Prevention
Without pandemic containment measures—such

as social distancing, vaccination, and use of face
masks—pathogens can spread exponentially.[122]
This graphic shows how early adoption of
containment measures tends to protect wider
swaths of the population.
Progressively stronger mitigation efforts to reduce
the number of active cases at any given time
—"flattening the curve"—allows healthcare services
to better manage the same volume of
patients.[123][124][125] Likewise, progressively
greater increases in healthcare capacity—called
raising the line—such as by increasing bed count,
personnel, and equipment, helps to meet
increased demand.[126]
Mitigation attempts that are inadequate in
strictness or duration—such as premature
relaxation of distancing rules or stay-at-home
orders—can allow a resurgence after the initial

surge and mitigation.[124][127]
A COVID-19 vaccine is not expected until

2021 at the earliest.[128] The US National
Institutes of Health guidelines do not
recommend any medication for
prevention of COVID‑19, before or after
exposure to the SARS-CoV-2 virus,
outside the setting of a clinical
trial.[129][130] Without a vaccine, other
prophylactic measures, or effective
treatments, a key part of managing
COVID‑19 is trying to decrease and delay
the epidemic peak, known as "flattening
the curve".[124] This is done by slowing
the infection rate to decrease the risk of
health services being overwhelmed,
allowing for better treatment of current
cases, and delaying additional cases
until effective treatments or a vaccine
become available.[124][127]
Preventive measures to reduce the

chances of infection include staying at
home, wearing a mask in public,
avoiding crowded places, keeping
distance from others, washing hands
with soap and water often and for at
least 20 seconds, practising good
respiratory hygiene, and avoiding
touching the eyes, nose, or mouth with
unwashed hands.[131][132][133][134]
The US Centers for Disease Control and

Prevention (CDC) and the World Health
Organization (WHO) recommend
individuals wear non-medical face
coverings in public settings where there
is an increased risk of transmission and
where social distancing measures are
difficult to maintain.[135][30][136] This
recommendation is meant to reduce the
spread of the disease by asymptomatic
and pre-symtomatic individuals and is
complementary to established
preventive measures such as social
distancing.[30][137] Face coverings limit
the volume and travel distance of
expiratory droplets dispersed when
talking, breathing, and coughing.[30][137]
Many countries and local jurisdictions
encourage or mandate the use of face
masks or cloth face coverings by
members of the public to limit the spread
of the virus.[138][139][140][141]
Masks are also strongly recommended

for those who may have been infected
and those taking care of someone who
may have the disease.[142] When not
wearing a mask, the CDC recommends
covering the mouth and nose with a
tissue when coughing or sneezing and
recommends using the inside of the
elbow if no tissue is available.[132] Proper
hand hygiene after any cough or sneeze
is encouraged.[132]
Social distancing strategies aim to

reduce contact of infected persons with
large groups by closing schools and
workplaces, restricting travel, and
cancelling large public gatherings.[143]
Distancing guidelines also include that
people stay at least 6 feet (1.8 m)
apart.[144] After the implementation of
social distancing and stay-at-home
orders, many regions have been able to
sustain an effective transmission rate
("Rt") of less than one, meaning the
disease is in remission in those
areas.[145]
The CDC also recommends that

individuals wash hands often with soap
and water for at least 20 seconds,
especially after going to the toilet or
when hands are visibly dirty, before
eating and after blowing one's nose,
coughing or sneezing. The CDC further
recommends using an alcohol-based
hand sanitiser with at least 60% alcohol,
but only when soap and water are not
readily available.[132] For areas where
commercial hand sanitisers are not
readily available, the WHO provides two
formulations for local production. In
these formulations, the antimicrobial
activity arises from ethanol or
isopropanol. Hydrogen peroxide is used
to help eliminate bacterial spores in the
alcohol; it is "not an active substance for
hand antisepsis". Glycerol is added as a
humectant.[146]
Those diagnosed with COVID‑19 or who

believe they may be infected are advised
by the CDC to stay home except to get
medical care, call ahead before visiting a
healthcare provider, wear a face mask
before entering the healthcare provider's
office and when in any room or vehicle
with another person, cover coughs and
sneezes with a tissue, regularly wash
hands with soap and water and avoid
sharing personal household
items.[32][147]
Sanitizing of frequently touched surfaces

is also recommended or required by
regulation for businesses and public
facilities; the United States
Environmental Protection Agency
maintains a list of products expected to
be effective.[148]
On 7 July 2020, the WHO said in a press

conference that it will issue new
guidelines about airborne transmission in
settings with close contact and poor
ventilation.[149]
For health care professionals who may

come into contact with COVID-19
positive bodily fluids, using personal
protective coverings on exposed body
parts improves protection from the
virus.[150] Breathable personal protective
equipment improves user-satisfaction
and may offer a similar level of
protection from the virus.[150] In addition,
adding tabs and other modifications to
the protective equipment may reduce
the risk of contamination during donning
and doffing (putting on and taking off the
equipment).[150] Implementing an
evidence-based donning and doffing
protocol such as a one-step glove and
gown removal technique, giving oral
instructions while donning and doffing,
double gloving, and the use of glove
disinfection may also improve protection
for health care professionals.[150]
Management
People are managed with supportive
care, which may include fluid therapy,
oxygen support, and supporting other
affected vital organs.[151][152][153] The
CDC recommends those who suspect
they carry the virus wear a simple face
mask.[32] Extracorporeal membrane
oxygenation (ECMO) has been used to
address the issue of respiratory failure,
but its benefits are still under
consideration.[154] Personal hygiene and
a healthy lifestyle and diet have been
recommended to improve immunity.[155]
Supportive treatments may be useful in
those with mild symptoms at the early
stage of infection.[156]
The WHO, the Chinese National Health
Commission, and the United States'
National Institutes of Health have
published recommendations for taking
care of people who are hospitalised with
COVID‑19.[129][157][158] Intensivists and
pulmonologists in the US have compiled
treatment recommendations from
various agencies into a free resource,
the IBCC.[159][160]
Prognosis
The severity of diagnosed
COVID-19 cases in
China[161]
Case fatality rates by age

group:
China, as of 11 February
2020[162]
South Korea, as of 17
July 2020[163]
Spain, as of 18 May
2020[164]
2020[164]
Italy, as of 3 June
2020[165]
Case fatality rate in China

depending on other health
problems. Data through 11
February 2020.[162]
The number of deaths vs

total cases by country and
approximate case fatality
approximate case fatality
rate[166]
The severity of COVID‑19 varies. The

disease may take a mild course with few
or no symptoms, resembling other
common upper respiratory diseases
such as the common cold. Mild cases
typically recover within two weeks, while
those with severe or critical diseases
may take three to six weeks to recover.
Among those who have died, the time
from symptom onset to death has
ranged from two to eight weeks.[46]
Children make up a small proportion of

reported cases, with about 1% of cases
being under 10 years and 4% aged 10–
19 years.[22] They are likely to have
milder symptoms and a lower chance of
severe disease than adults. In those
younger than 50 years the risk of death
is less than 0.5%, while in those older
than 70 it is more than 8%.[167][168][169]
Pregnant women may be at higher risk
of severe COVID‑19 infection based on
data from other similar viruses, like
severe acute respiratory syndrome
(SARS) and Middle East respiratory
syndrome (MERS), but data for
COVID‑19 is lacking.[170][171] According to
scientific reviews smokers are more
likely to require intensive care or die
compared to non-smokers,[172][173] air
pollution is similarly associated with risk
factors,[173] and obesity contributes to an
increased health risk of COVID-
19.[173][174][175]
A European multinational study of

hospitalized children published in The
Lancet on 25 June 2020 found that
about 8% of children admitted to a
hospital needed intensive care. Four of
those 582 children (0.7%) died, but the
actual mortality rate could be
"substantially lower" since milder cases
that did not seek medical help were not
included in the study.[176]
Case fatality rates (%) by age and country
Age
0– 10– 20– 30– 40– 50– 60– 70– 80–

Country 90+
9 19 29 39 49 59 69 79 89
Argentina as of 7 May[177] 0.0 0.0 0.1 0.4 1.3 3.6 12.9 18.8 28.4
Australia as of 4 June[178] 0.0 0.0 0.0 0.0 0.1 0.2 1.1 4.1 18.1 40.8
Canada as of 3 June[179] 0.0 0.1 0.7 11.2 30.7
Alberta as of 3 June[180] 0.0 0.0 0.1 0.1 0.1 0.2 1.9 11.9 30.8
Br. Columbia as of 2
0.0 0.0 0.0 0.0 0.5 0.8 4.6 12.3 33.8 33.6
June[181]
Ontario as of 3 June[182] 0.0 0.0 0.1 0.2 0.5 1.5 5.6 17.7 26.0 33.3
Quebec as of 2 June[183] 0.0 0.1 0.1 0.2 1.1 6.1 21.4 30.4 36.1
Chile as of 31 May[184][185] 0.1 0.3 0.7 2.3 7.7 15.6
China as of 11 February[162] 0.0 0.2 0.2 0.2 0.4 1.3 3.6 8.0 14.8
Colombia as of 3 June[186] 0.3 0.0 0.2 0.5 1.6 3.4 9.4 18.1 25.6 35.1
Denmark as of 4 June[187] 0.2 4.1 16.5 28.1 48.2
Finland as of 4 June[188] 0.0 0.0 <0.4 <0.4 <0.5 0.8 3.8 18.1 42.3
Germany as of 5 June[189] 0.0 0.0 0.1 1.9 19.7 31.0
Bavaria as of 5 June[190] 0.0 0.0 0.1 0.1 0.2 0.9 5.4 15.8 28.0 35.8
Israel as of 3 May[191] 0.0 0.0 0.0 0.9 0.9 3.1 9.7 22.9 30.8 31.3
Italy as of 3 June[192] 0.3 0.0 0.1 0.3 0.9 2.7 10.6 25.9 32.4 29.9
Japan as of 7 May[193] 0.0 0.0 0.0 0.1 0.3 0.6 2.5 6.8 14.8
Mexico as of 3 June[194] 3.3 0.6 1.2 2.9 7.5 15.0 25.3 33.7 40.3 40.6
Netherlands as of 3 June[195] 0.0 0.2 0.1 0.3 0.5 1.7 8.1 25.6 33.3 34.5
Norway as of 4 June[196] 0.0 0.0 0.0 0.0 0.3 0.4 2.2 9.0 22.7 57.0
Philippines as of 4 June[197] 1.6 0.9 0.5 0.8 2.4 5.5 13.2 20.9 31.5
Portugal as of 3 June[198] 0.0 0.0 0.0 0.0 0.3 1.3 3.6 10.5 21.2
South Africa as of 28
0.3 0.1 0.1 0.4 1.1 3.8 9.2 15.0 12.3
May[199]
South Korea as of 17 July[200] 0.0 0.0 0.0 0.1 0.2 0.6 2.3 9.5 25.2
Spain as of 17 May[164] 0.2 0.3 0.2 0.3 0.6 1.4 4.9 14.3 21.0 22.3
Sweden as of 5 June[201] 0.5 0.0 0.2 0.2 0.6 1.7 6.6 23.4 35.6 40.3
Switzerland as of 4 June[202] 0.6 0.0 0.0 0.1 0.1 0.6 3.4 11.6 28.2
United States
Colorado as of 3 June[203] 0.2 0.2 0.2 0.2 0.8 1.9 6.2 18.5 39.0
Connecticut as of 3
0.2 0.1 0.1 0.3 0.7 1.8 7.0 18.0 31.2
June[204]
Georgia as of 3 June[205] 0.0 0.1 0.5 0.9 2.0 6.1 13.2 22.0
Idaho as of 3 June[206] 0.0 0.0 0.0 0.0 0.0 0.4 3.1 8.9 31.4
Indiana as of 3 June[207] 0.1 0.1 0.2 0.6 1.8 7.3 17.1 30.2
Kentucky as of 20
0.0 0.0 0.0 0.2 0.5 1.9 5.9 14.2 29.1
May[208]
Maryland as of 20
0.0 0.1 0.2 0.3 0.7 1.9 6.1 14.6 28.8
May[209]
Massachusetts as of 20
0.0 0.0 0.1 0.1 0.4 1.5 5.2 16.8 28.9
May[210]
Minnesota as of 13
0.0 0.0 0.0 0.1 0.3 1.6 5.4 26.9
May[211]
Mississippi as of 19
0.0 0.1 0.5 0.9 2.1 8.1 16.1 19.4 27.2
May[212]
Missouri as of 19 May[213] 0.0 0.0 0.1 0.2 0.8 2.2 6.3 14.3 22.5
Nevada as of 20 May[214] 0.0 0.3 0.3 0.4 1.7 2.6 7.7 22.3
N. Hampshire as of 12
0.0 0.0 0.4 0.0 1.2 0.0 2.2 12.0 21.2
May[215]
Oregon as of 12 May[216] 0.0 0.0 0.0 0.0 0.5 0.8 5.6 12.1 28.9
Texas as of 20 May[217] 0.0 0.5 0.4 0.3 0.8 2.1 5.5 10.1 30.6
Virginia as of 19 May[218] 0.0 0.0 0.0 0.1 0.4 1.0 4.4 12.9 24.9
Washington as of 10
0.0 0.2 1.3 9.8 31.2
May[219]
Wisconsin as of 20 0.0 0.0 0.2 0.2 0.6 2.0 5.0 14.7 19.9 30.4
May[220]
Comorbidities
Most of those who die of COVID‑19 have

pre-existing (underlying) conditions,
including hypertension, diabetes
mellitus, and cardiovascular disease.[221]
The Istituto Superiore di Sanità reported
that out of 8.8% of deaths where
medical charts were available, 97% of
people had at least one comorbidity with
the average person having 2.7
diseases.[222] According to the same
report, the median time between the
onset of symptoms and death was ten
days, with five being spent hospitalised.
However, people transferred to an ICU
had a median time of seven days
between hospitalisation and death.[222]
In a study of early cases, the median
time from exhibiting initial symptoms to
death was 14 days, with a full range of
six to 41 days.[223] In a study by the
National Health Commission (NHC) of
China, men had a death rate of 2.8%
while women had a death rate of
1.7%.[224] In 11.8% of the deaths
reported by the National Health
Commission of China, heart damage
was noted by elevated levels of troponin
or cardiac arrest.[47] According to March
data from the United States, 89% of
those hospitalised had preexisting
conditions.[225]
Most critical respiratory comorbidities

according to the CDC, are: moderate or
severe asthma, pre-existing COPD,
pulmonary fibrosis, cystic fibrosis.[226]
Current evidence stemming from meta-
analysis of several smaller research
papers also suggests that smoking can
be associated with worse patient
outcomes.[227][228] When someone with
existing respiratory problems is infected
with COVID-19, they might be at greater
risk for severe symptoms.[229] COVID-19
also poses a greater risk to people who
misuse opioids and methamphetamines,
insofar as their drug use may have
caused lung damage.[230]
Complications and long-term effects
Complications may include pneumonia,

acute respiratory distress syndrome
(ARDS), multi-organ failure, septic
shock, and death.[10][16][231][232]
Cardiovascular complications may
include heart failure, arrhythmias, heart
inflammation, and blood
clots.[233][234][235]
Approximately 20–30% of people who
present with COVID‑19 have elevated
liver enzymes reflecting liver
injury.[236][130]
Neurologic manifestations include

seizure, stroke, encephalitis, and
Guillain–Barré syndrome (which includes
loss of motor functions).[237] Following
the infection, children may develop
paediatric multisystem inflammatory
syndrome, which has symptoms similar
to Kawasaki disease, which can be
fatal.[238][239]
Concerns have been raised about long-
term sequelae of the disease. The Hong
Kong Hospital Authority found a drop of
20% to 30% in lung capacity in some
people who recovered from the disease,
and lung scans suggested organ
damage.[240] This may also lead to post-
intensive care syndrome following
recovery.[241]
Immunity
It is unknown (as of April 2020) if past

infection provides effective and long-
term immunity in people who recover
from the disease.[242][243] Some of the
infected have been reported to develop
protective antibodies, so acquired
immunity is presumed likely, based on
the behaviour of other
coronaviruses.[244] Cases in which
recovery from COVID‑19 was followed
by positive tests for coronavirus at a later
date have been
reported.[245][246][247][248] However,
these cases are believed to be lingering
infection rather than reinfection,[248] or
false positives due to remaining RNA
fragments.[249] An investigation by the
Korean CDC of 285 individuals who
tested positive for SARS-CoV-2 in PCR
tests administered days or weeks after
recovery from COVID-19 found no
evidence that these individuals were
contagious at this later time.[250] Some
other coronaviruses circulating in people
are capable of reinfection after roughly a
year.[251][252]
History
The virus is thought to be natural and has
an animal origin,[76] through spillover
infection.[253] The first known human
infections were in China. A study of the
first 41 cases of confirmed COVID‑19,
published in January 2020 in The Lancet,
reported the earliest date of onset of
symptoms as 1 December
2019.[254][255][256] Official publications
from the WHO reported the earliest
onset of symptoms as 8 December
2019.[257] Human-to-human
transmission was confirmed by the WHO
and Chinese authorities by 20 January
2020.[258][259] According to official
Chinese sources, these were mostly
linked to the Huanan Seafood Wholesale
Market, which also sold live animals.[260]
In May 2020, George Gao, the director of
the Chinese Center for Disease Control
and Prevention, said animal samples
collected from the seafood market had
tested negative for the virus, indicating
that the market was the site of an early
superspreading event, but it was not the
site of the initial outbreak.[261] Traces of
the virus have been found in wastewater
that was collected from Milan and Turin,
Italy, on 18 December 2019.[262]
There are several theories about where

the very first case (the so-called patient
zero) originated.[263] According to an
unpublicised report from the Chinese
government, the first case can be traced
back to 17 November 2019; the person
was a 55-year old citizen in the Hubei
province. There were four men and five
women reported to be infected in
November, but none of them were
"patient zero".[12] By December 2019,
the spread of infection was almost
entirely driven by human-to-human
transmission.[162][264] The number of
coronavirus cases in Hubei gradually
increased, reaching 60 by 20
December[265] and at least 266 by 31
December.[266] On 24 December,
Wuhan Central Hospital sent a
bronchoalveolar lavage fluid (BAL)
sample from an unresolved clinical case
to sequencing company Vision Medicals.
On 27 and 28 December, Vision
Medicals informed the Wuhan Central
Hospital and the Chinese CDC of the
results of the test, showing a new
coronavirus.[267] A pneumonia cluster of
unknown cause was observed on 26
December and treated by the doctor
Zhang Jixian in Hubei Provincial
Hospital, who informed the Wuhan
Jianghan CDC on 27 December.[268] On
30 December, a test report addressed to
Wuhan Central Hospital, from company
CapitalBio Medlab, stated an erroneous
positive result for SARS, causing a group
of doctors at Wuhan Central Hospital to
alert their colleagues and relevant
hospital authorities of the result. That
evening, the Wuhan Municipal Health
Commission issued a notice to various
medical institutions on "the treatment of
pneumonia of unknown cause".[269]
Eight of these doctors, including Li
Wenliang (punished on 3 January),[270]
were later admonished by the police for
spreading false rumours, and another, Ai
Fen, was reprimanded by her superiors
for raising the alarm.[271]
The Wuhan Municipal Health

Commission made the first public
announcement of a pneumonia outbreak
of unknown cause on 31 December,
confirming 27 cases[272][273][274]—
enough to trigger an investigation.[275]
During the early stages of the outbreak,
the number of cases doubled
approximately every seven and a half
days.[276] In early and mid-January
2020, the virus spread to other Chinese
provinces, helped by the Chinese New
Year migration and Wuhan being a
transport hub and major rail
interchange.[277] On 20 January, China
reported nearly 140 new cases in one
day, including two people in Beijing and
one in Shenzhen.[278] Later official data
shows 6,174 people had already
developed symptoms by then,[279] and
more may have been infected.[280] A
report in The Lancet on 24 January
indicated human transmission, strongly
recommended personal protective
equipment for health workers, and said
testing for the virus was essential due to
its "pandemic potential".[281][282] On 30
January, the WHO declared the
coronavirus a public health emergency
of international concern.[280] By this
time, the outbreak spread by a factor of
100 to 200 times.[283]
On 31 January 2020, Italy had its first

confirmed cases, two tourists from
China.[284] As of 13 March 2020, the
WHO considered Europe the active
centre of the pandemic.[285] On 19
March 2020, Italy overtook China as the
country with the most deaths.[286] By 26
March, the United States had overtaken
China and Italy with the highest number
of confirmed cases in the world.[287]
Research on coronavirus genomes
indicates the majority of COVID-19 cases
in New York came from European
travellers, rather than directly from China
or any other Asian country.[288] Retesting
of prior samples found a person in
France who had the virus on 27
December 2019[289][290] and a person in
the United States who died from the
disease on 6 February 2020.[291]
On 11 June 2020, after 55 days without a
locally transmitted case,[292] Beijing
reported the first COVID-19 case,
followed by two more cases on 12
June.[293] By 15 June 79 cases were
officially confirmed.[294] Most of these
patients went to Xinfadi Wholesale
Market.[292][295]
Epidemiology
Several measures are commonly used to
quantify mortality.[296] These numbers
vary by region and over time and are
influenced by the volume of testing,
healthcare system quality, treatment
options, time since the initial outbreak,
and population characteristics such as
age, sex, and overall health.[297]
The death-to-case ratio reflects the

number of deaths divided by the number
of diagnosed cases within a given time
interval. Based on Johns Hopkins
University statistics, the global death-to-
case ratio is 3.7% (716,083/19,160,806)
as of 7 August 2020.[8] The number
varies by region.[298]
Other measures include the case fatality

rate (CFR), which reflects the percentage
of diagnosed individuals who die from a
disease, and the infection fatality rate
(IFR), which reflects the percentage of
infected individuals (diagnosed and
undiagnosed) who die from a disease.
These statistics are not time-bound and
follow a specific population from
infection through case resolution. Many
academics have attempted to calculate
these numbers for specific
populations.[299]
Outbreaks have occurred in prisons due

to crowding and an inability to enforce
adequate social distancing.[300][301] In
the United States, the prisoner
population is aging and many of them
are at high risk for poor outcomes from
COVID‑19 due to high rates of coexisting
heart and lung disease, and poor access
to high-quality healthcare.[300]
Total confirmed cases over

time
Total deaths over time
Total confirmed cases of

COVID‑19 per million
people[302]
Total confirmed deaths due
to COVID‑19 per million
people[303]
Infection fatality rate
Infection fatality rate or infection fatality

ratio (IFR) is distinguished from case
fatality rate (CFR). The CFR for a disease
is the proportion of deaths from the
disease compared to the total number of
people diagnosed with the disease
(within a certain period of time). The IFR,
in contrast, is the proportion of deaths
among all the infected individuals. IFR,
unlike CFR, attempts to account for all
asymptomatic and undiagnosed
infections.
Our World in Data states that, as of 25

March 2020, the IFR for coronavirus
cannot be accurately calculated.[304] In
February, the World Health Organization
reported estimates of IFR between
0.33% and 1%.[305][306] On 2 July, The
WHO's Chief Scientist reported that the
average IFR estimate presented at a
two-day WHO expert forum was about
0.6%.[307][308]
The CDC estimates for planning

purposes that the IFR is 0.65% and that
40% of infected individuals are
asymptomatic, suggesting a fatality rate
among those who are symptomatic of
1.08% (.65/60) (as of 10 July).[309][310]
According to the University of Oxford
Centre for Evidence-Based Medicine
(CEBM), random antibody testing in
Germany suggested a national IFR of
0.37% (0.12% to 0.87%).[311][312][313] To
get a better view on the number of
people infected, as of April 2020, initial
antibody testing had been carried out,
but peer-reviewed scientific analyses
had not yet been published.[314][315] On
1 May antibody testing in New York City
suggested an IFR of 0.86%.[316]
Firm lower limits of IFRs have been
established in a number of locations
such as New York City and Bergamo in
Italy since the IFR cannot be less than
the population fatality rate. As of 10 July,
in New York City, with a population of
8.4 million, 23,377 individuals (18,758
confirmed and 4,619 probable) have
died with COVID-19 (0.28% of the
population).[317] In Bergamo province,
0.57% of the population has died.[318]
Sex differences
Early reviews of epidemiologic data

showed greater impact of the pandemic
and a higher mortality rate in men in
China and Italy.[319][1][320] The Chinese
Center for Disease Control and
Prevention reported the death rate was
2.8% for men and 1.7% for women.[321]
Later reviews in June 2020 indicated that
there is no significant difference in
susceptibility or in CFR between
genders.[322][323] One review
acknowledges the different mortality
rates in Chinese men, suggesting that it
may be attributable to lifestyle choices
such as smoking and drinking alcohol
rather than genetic factors.[324] Sex-
based immunological differences, lesser
prevalence of smoking in women and
men developing co-morbid conditions
such as hypertension at a younger age
than women could have contributed to
the higher mortality in men.[325] In
Europe, 57% of the infected people were
men and 72% of those died with COVID-
19 were men.[326] As of April 2020, the
US government is not tracking sex-
related data of COVID-19 infections.[327]
Research has shown that viral illnesses
like Ebola, HIV, influenza and SARS
affect men and women differently.[327]
Estimated prognosis by age and sex based on cases from France and Diamond Princess ship
Percentage of infected people who are hospitalized
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
0.1 0.5 0.9 1.3 2.6 5.1 7.8 19.3 2.6

Female (0.07– (0.3– (0.5– (0.7– (1.5– (2.9– (4.4– (10.9– (1.5–
0.2) 0.8) 1.5) 2.1) 4.2) 8.3) 12.8) 31.6) 4.3)
0.2 0.6 1.2 1.6 3.2 6.7 11.0 37.6 3.3

Male (0.08– (0.3– (0.7– (0.9– (1.8– (3.7– (6.2– (21.1– (1.8–
0.2) 0.9) 1.9) 2.6) 5.2) 10.9) 17.9) 61.3) 5.3)
0.1 0.5 1.1 1.4 2.9 5.8 9.3 26.2 2.9

Total (0.08– (0.3– (0.6– (0.8– (1.6– (3.3– (5.2– (14.8– (1.7–
0.2) 0.8) 1.7) 2.3) 4.7) 9.5) 15.1) 42.7) 4.8)
Percentage of hospitalized people who go to Intensive Care Unit
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
16.7 8.7 11.9 16.6 20.7 23.1 18.7 4.2 14.3

Female (14.3– (7.5– (10.9– (15.6– (19.8– (22.2– (18.0– (4.0– (13.9–
19.3) 9.9) 13.0) 17.7) 21.6) 24.0) 19.5) 4.5) 14.7)
26.9 14.0 19.2 26.9 33.4 37.3 30.2 6.8 23.1

Male (23.1– (12.2– (17.6– (25.4– (32.0– (36.0– (29.1– (6.5– (22.6–
31.1) 16.0) 20.9) 28.4) 34.8) 38.6) 31.3) 7.2) 23.6)
22.2 11.6 15.9 22.2 27.6 30.8 24.9 5.6 19.0

Total (19.1– (10.1– (14.5– (21.0– (26.5– (29.8– (24.1– (5.3– (18.7–
25.7) 13.2) 17.3) 23.5) 28.7) 31.8) 25.8) 5.9) 19.44)
Percent of hospitalized people who die
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
0.9 1.5 2.6 5.2 10.1 16.7 25.2 14.4

0.5
Female (0.5– (1.2– (2.3– (4.8– (9.5– (16.0– (24.4– (14.0–
(0.2–1.0)
1.3) 1.9) 3.0) 5.6) 10.6) 17.4) 26.0) 14.8)
1.3 2.2 3.8 7.6 14.8 24.6 37.1 21.2

0.7
Male (0.8– (1.7– (3.3– (7.0– (14.1– (23.7– (36.1– (20.8–
(0.3–1.5)
1.9) 2.7) 4.4) 8.2) 15.6) 25.6) 38.2) 21.7)
Total 0.6 1.1 1.9 3.3 6.5 12.6 21.0 31.6 18.1
(0.2–1.3) (0.7–1.6) (1.5– (2.9– (6.0– (12.0– (20.3– (30.9– (17.8–
2.3) 3.8) 7.0) 13.2) 21.7) 32.4) 18.4)
Percent of infected people who die – infection fatality rate (IFR)
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
0.001 0.004 0.01 0.03 0.1 0.5 1.3 4.9 0.4

Female (<0.001– (0.002– (0.007– (0.02– (0.08– (0.3– (0.7– (2.7– (0.2–
0.002) 0.007) 0.02) 0.06) 0.2) 0.8) 2.1) 8.0) 0.6)
0.001 0.007 0.03 0.06 0.2 1.0 2.7 14.0 0.7

Male (<0.001– (0.003– (0.02– (0.03– (0.1– (0.6– (1.5– (7.9– (0.4–
0.003) 0.01) 0.05) 0.1) 0.4) 1.6) 1.4) 22.7) 1.1)
0.001 0.005 0.02 0.05 0.2 0.7 1.9 8.3 0.5

Total (<0.001– (0.003– (0.01– (0.03– (0.1– (0.4– (1.1– (4.7– (0.3–
0.002) 0.01) 0.03) 0.08) 0.3) 1.2) 3.2) 13.5) 0.9)
Numbers in parentheses are 95% credible intervals for the estimates.
Ethnic differences
In the US, a greater proportion of deaths

due to COVID-19 have occurred among
African Americans.[329] Structural factors
that prevent African Americans from
practicing social distancing include their
concentration in crowded substandard
housing and in "essential" occupations
such as public transit and health care.
Greater prevalence of lacking health
insurance and care and of underlying
conditions such as diabetes,
hypertension and heart disease also
increase their risk of death.[330] Similar
issues affect Native American and Latino
communities.[329] According to a US
health policy non-profit, 34% of
American Indian and Alaska Native
People (AIAN) non-elderly adults are at
risk of serious illness compared to 21%
of white non-elderly adults.[331] The
source attributes it to disproportionately
high rates of many health conditions that
may put them at higher risk as well as
living conditions like lack of access to
clean water.[332] Leaders have called for
efforts to research and address the
disparities.[333]
In the U.K., a greater proportion of

deaths due to COVID-19 have occurred
in those of a Black, Asian, and other
ethnic minority background.[334][335][336]
Several factors such as poverty, poor
nutrition and living in overcrowded
properties, may have caused this.
Society and culture
Name
This section may be expanded with text translated
from the corresponding article in Chinese.
During the initial outbreak in Wuhan,

China, the virus and disease were
commonly referred to as "coronavirus"
and "Wuhan coronavirus",[337][338][339]
with the disease sometimes called
"Wuhan pneumonia".[340][341] In the past,
many diseases have been named after
geographical locations, such as the
Spanish flu,[342] Middle East Respiratory
Syndrome, and Zika virus.[343]
In January 2020, the World Health

Organisation recommended 2019-
nCov[344] and 2019-nCoV acute
respiratory disease[345] as interim names
for the virus and disease per 2015
guidance and international guidelines
against using geographical locations
(e.g. Wuhan, China), animal species or
groups of people in disease and virus
names to prevent social
stigma.[346][347][348]
The official names COVID‑19 and SARS-

CoV-2 were issued by the WHO on 11
February 2020.[349] WHO chief Tedros
Adhanom Ghebreyesus explained: CO
for corona, VI for virus, D for disease and
19 for when the outbreak was first
identified (31 December 2019).[350] The
WHO additionally uses "the COVID‑19
virus" and "the virus responsible for
COVID‑19" in public
communications.[349]
Misinformation
After the initial outbreak of COVID‑19,

misinformation and disinformation
regarding the origin, scale, prevention,
treatment, and other aspects of the
disease rapidly spread
online.[351][352][353]
Other health issues

The pandemic has had many impacts on
global health beyond those caused by
the COVID-19 disease itself. It has led to
a reduction in hospital visits for other
reasons. There have been 38% fewer
hospital visits for heart attack symptoms
in the United States and 40% fewer in
Spain.[354] The head of cardiology at the
University of Arizona said, "My worry is
some of these people are dying at home
because they're too scared to go to the
hospital."[355] There is also concern that
people with strokes and appendicitis are
not seeking timely treatment.[355]
Shortages of medical supplies have
impacted people with various
conditions.[356] In several countries there
has been a marked reduction of spread
of sexually transmitted infections,
including HIV, attributable to COVID-19
quarantines and social distancing
measures.[357][358] Similarly, in some
places, rates of transmission of influenza
and other respiratory viruses significantly
decreased during the
pandemic.[359][360][361] The pandemic
has also negatively impacted mental
health globally, including increased
loneliness resulting from social
distancing.[362]
Other animals
Humans appear to be capable of
spreading the virus to some other
animals. A domestic cat in Liège,
Belgium, tested positive after it started
showing symptoms (diarrhoea, vomiting,
shortness of breath) a week later than its
owner, who was also positive.[363] Tigers
and lions at the Bronx Zoo in New York,
United States, tested positive for the
virus and showed symptoms of
COVID‑19, including a dry cough and
loss of appetite.[364] Minks at two farms
in the Netherlands also tested positive
for COVID-19.[365]
A study on domesticated animals
inoculated with the virus found that cats
and ferrets appear to be "highly
susceptible" to the disease, while dogs
appear to be less susceptible, with lower
levels of viral replication. The study failed
to find evidence of viral replication in
pigs, ducks, and chickens.[366]
In March 2020, researchers from the

University of Hong Kong have shown
that Syrian hamsters could be a model
organism for COVID-19 research.[367]
Research
No medication or vaccine is approved
with the specific indication to treat the
disease.[368] International research on
vaccines and medicines in COVID‑19 is
underway by government organisations,
academic groups, and industry
researchers.[369][370] In March, the World
Health Organisation initiated the
"Solidarity Trial" to assess the treatment
effects of four existing antiviral
compounds with the most promise of
efficacy.[371] The World Health
Organization suspended
hydroxychloroquine from its global drug
trials for COVID-19 treatments on 26
May 2020 due to safety concerns. It had
previously enrolled 3,500 patients from
17 countries in the Solidarity Trial.[372]
France, Italy and Belgium also banned
the use of hydroxychloroquine as a
COVID-19 treatment.[373]
There has been a great deal of COVID-

19 research, involving accelerated
research processes and publishing
shortcuts to meet the global demand. To
minimise the harm from misinformation,
medical professionals and the public are
advised to expect rapid changes to
available information, and to be attentive
to retractions and other updates.[374]
Vaccine
There is no available vaccine, but various

agencies are actively developing
vaccine candidates. Previous work on
SARS-CoV is being used because both
SARS-CoV and SARS-CoV-2 use the
ACE2 receptor to enter human cells.[375]
Six vaccination strategies are being
investigated. Four of these, as of early
July 2020, are being tested in clinical
trials.[376] First, researchers aim to build a
whole virus vaccine. The use of such
inactive virus aims to elicit a prompt
immune response of the human body to
a new infection with COVID‑19. A second
strategy, subunit vaccines, aims to
create a vaccine that sensitises the
immune system to certain subunits of
the virus. In the case of SARS-CoV-2,
such research focuses on the S-spike
protein that helps the virus intrude the
ACE2 enzyme receptor. A third strategy
is that of the nucleic acid vaccines (DNA
or RNA vaccines, a novel technique for
creating a vaccination). Fourthly,
scientists are attempting to use viral
vectors to deliver the SARS-CoV-2
antigen gene into the cell.[377] These can
be replicating or non-replicating. As of
early July 2020, only non-replicating viral
vectors are in clinical trials. Viral vectors
in clinical trials include Chimpanzee
Adenovirus 63,[377] Adenovirus type-
5,[376] and Adenovirus type-26.[378]
Scientists are also working to develop an
attenuated COVID-19 vaccine and a
COVID-19 vaccine using virus-like
particles, but these are still in preclinical
research.[376] Experimental vaccines
from any of these strategies would have
to be tested for safety and efficacy.[379]
Antibody-dependent enhancement has

been suggested as a potential challenge
for vaccine development for SARS-COV-
2, but this is controversial.[380]
Medications
At least 29 Phase II–IV efficacy trials in

COVID‑19 were concluded in March
2020, or scheduled to provide results in
April from hospitals in China.[381][382]
There are more than 300 active clinical
trials underway as of April 2020.[130]
Seven trials were evaluating already
approved treatments, including four
studies on hydroxychloroquine or
chloroquine.[382] Repurposed antiviral
drugs make up most of the research,
with nine Phase III trials on remdesivir
across several countries due to report by
the end of April.[381][382] Other
candidates in trials include vasodilators,
corticosteroids, immune therapies, lipoic
acid, bevacizumab, and recombinant
angiotensin-converting enzyme 2.[382]
The COVID‑19 Clinical Research

Coalition has goals to 1) facilitate rapid
reviews of clinical trial proposals by
ethics committees and national
regulatory agencies, 2) fast-track
approvals for the candidate therapeutic
compounds, 3) ensure standardised and
rapid analysis of emerging efficacy and
safety data and 4) facilitate sharing of
clinical trial outcomes before
publication.[383][384]
Several existing medications are being
evaluated for the treatment of
COVID‑19,[368] including remdesivir,
chloroquine, hydroxychloroquine,
lopinavir/ritonavir, and lopinavir/ritonavir
combined with interferon beta.[371][385]
There is tentative evidence for efficacy
by remdesivir, and on 1 May 2020, the
United States Food and Drug
Administration (FDA) gave the drug an
emergency use authorization for people
hospitalized with severe COVID‑19.[386]
Phase III clinical trials for several drugs
are underway in several countries,
including the US, China, and
Italy.[368][381][387]
There are mixed results as of 3 April
2020 as to the effectiveness of
hydroxychloroquine as a treatment for
COVID‑19, with some studies showing
little or no improvement.[388][389] One
study has shown an association
between hydroxychloroquine or
chloroquine use with higher death rates
along with other side effects.[390][391] A
retraction of this study by its authors was
published by The Lancet on 4 June
2020.[392] The studies of chloroquine
and hydroxychloroquine with or without
azithromycin have major limitations that
have prevented the medical community
from embracing these therapies without
further study.[130] On 15 June 2020, the
FDA updated the fact sheets for the
emergency use authorization of
remdesivir to warn that using
chloroquine or hydroxychloroquine with
remdesivir may reduce the antiviral
activity of remdesivir.[393]
In June, initial results from a randomised

trial in the United Kingdom showed that
dexamethasone reduced mortality by
one third for patients who are critically ill
on ventilators and one fifth for those
receiving supplemental oxygen.[394]
Because this is a well tested and widely
available treatment this was welcomed
by the WHO that is in the process of
updating treatment guidelines to include
dexamethasone or other
steroids.[395][396] Based on those
preliminary results, dexamethasone
treatment has been recommended by
the National Institutes of Health for
patients with COVID-19 who are
mechanically ventilated or who require
supplemental oxygen but not in patients
with COVID-19 who do not require
supplemental oxygen.[397]
Cytokine storm
A cytokine storm can be a complication
in the later stages of severe COVID‑19.
There is preliminary evidence that
hydroxychloroquine may be useful in
controlling cytokine storms in late-phase
severe forms of the disease.[398]
Tocilizumab has been included in

treatment guidelines by China's National
Health Commission after a small study
was completed.[399][400] It is undergoing
a Phase II non-randomised trial at the
national level in Italy after showing
positive results in people with severe
disease.[401][402] Combined with a serum
ferritin blood test to identify a cytokine
storm (also called cytokine storm
syndrome, not to be confused with
cytokine release syndrome), it is meant
to counter such developments, which
are thought to be the cause of death in
some affected people.[403][404][405] The
interleukin-6 receptor antagonist was
approved by the Food and Drug
Administration (FDA) to undergo a
Phase III clinical trial assessing its
effectiveness on COVID‑19 based on
retrospective case studies for the
treatment of steroid-refractory cytokine
release syndrome induced by a different
cause, CAR T cell therapy, in 2017.[406]
To date, there is no randomised,
controlled evidence that tocilizumab is
an efficacious treatment for CRS.
Prophylactic tocilizumab has been
shown to increase serum IL-6 levels by
saturating the IL-6R, driving IL-6 across
the blood-brain barrier, and
exacerbating neurotoxicity while having
no effect on the incidence of CRS.[407]
Lenzilumab, an anti-GM-CSF
monoclonal antibody, is protective in
murine models for CAR T cell-induced
CRS and neurotoxicity and is a viable
therapeutic option due to the observed
increase of pathogenic GM-CSF
secreting T-cells in hospitalised patients
with COVID‑19.[408]
The Feinstein Institute of Northwell

Health announced in March a study on
"a human antibody that may prevent the
activity" of IL-6.[409]
Passive antibodies
Transferring purified and concentrated

antibodies produced by the immune
systems of those who have recovered
from COVID‑19 to people who need
them is being investigated as a non-
vaccine method of passive
immunisation.[410][411] The safety and
effectiveness of convalescent plasma as
a treatment option requires further
research.[411] This strategy was tried for
SARS with inconclusive results.[410] Viral
neutralisation is the anticipated
mechanism of action by which passive
antibody therapy can mediate defence
against SARS-CoV-2. The spike protein
of SARS-CoV-2 is the primary target for
neutralizing antibodies.[412] It has been
proposed that selection of broad-
neutralizing antibodies against SARS-
CoV-2 and SARS-CoV might be useful
for treating not only COVID-19 but also
future SARS-related CoV infections.[412]
Other mechanisms, however, such as
antibody-dependent cellular cytotoxicity
and/or phagocytosis, may be
possible.[410] Other forms of passive
antibody therapy, for example, using
manufactured monoclonal antibodies,
are in development.[410] Production of
convalescent serum, which consists of
the liquid portion of the blood from
recovered patients and contains
antibodies specific to this virus, could be
increased for quicker deployment.[413]
See also
Coronavirus diseases, a group of
closely related syndromes
Coronavirus recession
Decoding COVID-19, 2020 PBS film
documentary about the 2019–2020
COVID-19 pandemic
Disease X, a WHO term
List of unproven methods against
COVID-19
Notes
a. The term of art used by
epidemiologists is "close contact"
which is defined as less than one
metre (~3.3 feet) by the WHO[6]
and within ~1.8 metres (six feet) by
the US Centers for Disease Control
and Prevention (CDC).[20]
b. An uncovered cough can travel up
to 8.2 metres (27 feet).[21]
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External links
Scholia has a profile for COVID-19
(Q84263196).
Health agencies
Coronavirus disease (COVID-19) by

the World Health Organization (WHO)
Coronavirus 2019 (COVID-19) by the
US Centers for Disease Control and
Prevention (CDC)
Coronavirus (COVID-19) by the UK
National Health Service (NHS)
Directories
COVID-19 at Curlie
COVID-19 Resource Directory on
OpenMD
Medical journals

19) by JAMA
Coronavirus: News and Resources by
the BMJ Publishing Group
Novel Coronavirus Information Center
by Elsevier
COVID-19 Resource Centre by The
Lancet
SARS-CoV-2 and COVID-19 by
Nature
Coronavirus (Covid-19) by The New
England Journal of Medicine
Covid-19: Novel Coronavirus by Wiley
Publishing
Treatment guidelines
"JHMI Clinical Recommendations for

Available Pharmacologic Therapies for
COVID-19" (PDF). The Johns Hopkins
University.
"Bouncing Back From COVID-19: Your
Guide to Restoring Movement" (PDF).
The Johns Hopkins School of
Medicine.
"Guidelines on the Treatment and
Management of Patients with COVID-
19" (PDF). Infectious Diseases Society
of America. Lay summary .
"Coronavirus Disease 2019 (COVID-
19) Treatment Guidelines" (PDF).
National Institutes of Health. Lay
summary .
Classification D
ICD-10: U07.1 ,
U07.2 •
MeSH:
C000657245 •
SNOMED CT:
840539006
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Coronavirus disease

Coronavirus disease 2019 (COVID-19) is

Specialty Infectious disease

Symptoms Fever, cough,

Complications Pneumonia, viral

Causes Severe acute

Diagnostic method rRT-PCR testing, CT

Prevention Hand washing, face

Treatment Symptomatic and

Deaths 716,083 (3.7% of

Common symptoms include fever,

The virus is primarily spread between

Recommended measures to prevent

There are no vaccines nor specific

Signs and symptoms

Loss of appetite 40–84%

Shortness of breath 31–40%

Coughing up sputum 28–33%

Muscle aches and pains 11–35%

Other common symptoms include

As is common with infections, there is a

An early key to the diagnosis is the

Respiratory droplets produced when a man

COVID‑19 is a new disease, and many of

COVID-19 spreads primarily when

Transmission may also occur through

Less commonly, when the contaminated

Estimates of the number of people

Illustration of SARSr-CoV virion

Severe acute respiratory syndrome

SARS-CoV-2 is closely related to the

SARS-CoV-2 may also cause respiratory

The virus also affects gastrointestinal

The virus can cause acute myocardial

Autopsies of people who died of

Systemic inflammation results in

Demonstration of a nasopharyngeal swab for

The WHO has published several testing

Diagnostic guidelines released by

A study asked hospitalised COVID‑19

Along with laboratory testing, chest CT

In late 2019, the WHO assigned

Chest X-ray showing COVID-19

Macroscopy: pleurisy, pericarditis,

Without pandemic containment measures—such

orders—can allow a resurgence after the initial

A COVID-19 vaccine is not expected until

Preventive measures to reduce the

The US Centers for Disease Control and

Masks are also strongly recommended

Social distancing strategies aim to

The CDC also recommends that

Those diagnosed with COVID‑19 or who

Sanitizing of frequently touched surfaces

On 7 July 2020, the WHO said in a press

For health care professionals who may

Case fatality rates by age

Case fatality rate in China

The number of deaths vs