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Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020
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Image from the National Institute of Allergy and Infectious Diseases (NIAID) Integrated Research Facility (IRF), Fort Detrick, Maryland, National Institutes of Health (NIH), via Flickr.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
In December 2019, the city of Wuhan in Hubei Province—which has a population of 11 million and is China's seventh largest city[1]—became the center of a pneumonia outbreak of unknown cause, with global implications[2] and an ongoing impact.[3] An immediate investigation of these clustered cases to identify and control its spread by isolating suspected infected patients, closely monitoring their contacts, and obtaining detailed clinical and epidemiologic data[1] aided Chinese scientists in early January 2020 in pinpointing a novel coronavirus (nCoV) strain from the patient groups in Wuhan.[4-7] The outbreak is believed to have started at a local seafood/wild animal market.[4,5]
The image depicts severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), previously known as 2019-nCoV, the novel virus that causes coronavirus disease 2019 (COVID-19).[8] The name reflects its genetic relationship to the original SARS-CoV that caused an outbreak in 2002-2003.[9]
This slideshow will be updated as events, diagnostic testing, treatment, and recommendations continue to evolve.
Transmission electron microscopic (TEM) images from the Centers for Disease Control and Prevention (CDC) | CS Goldsmith and TG Ksiazek (left) and NIAID (right). Arrowhead = corona/halo around a virion.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Coronaviruses
Coronaviruses, first discovered in the 1960s,[10] are a large family of viruses. Some coronaviruses cause illness in people, and others circulate among animals, including camels, cattle, cats, and bats.[11] Rarely, animal coronaviruses evolve into human coronaviruses that subsequently infect individuals, and then they spread between people, such as occurred in previous outbreaks with the first known SARS[10,12] (left image) and Middle East respiratory syndrome (MERS) (2012 to present [ongoing surveillance]) (right image).[13,14]
Three-dimensional image of SARS-CoV-2 and labeled surface protein particles from Scientific Animations Wiki Images | Avijeet Ranjan. [CC BY SA license.]
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Coronaviruses account for a significant percentage of common colds and are transmitted in a similar fashion, primarily via respiratory droplets and contact with contaminated surfaces.[15] Although they are often seasonally associated (eg, winter, spring), coronaviruses can cause fever as well as upper and lower respiratory symptoms. There are currently seven known strains of human coronaviruses.[10]
Common human coronaviruses[10]
Alphacoronaviruses: HCoV-229E, HCoV-NL63
Betacoronaviruses: HCoV-OC43, HCoV-HKU1
The above four human coronaviruses continually circulate in the human population, causing respiratory infections in adults and children worldwide.[10]
Other human coronaviruses (all betacoronaviruses)
SARS-CoV-1
MERS-CoV
SARS-CoV-2[16]
Left: A wild pangolin pup and its curled-up mother | Shukran888. Right: Smuggled pangolin meat | Jmiah12. Both images via Wikimedia Commons.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
SARS-CoV-2
The SARS-CoV-2 is a betacoronavirus, as with MERS and the first novel SARS outbreaks, all of which have their origins in bats.[16] The sequences obtained from infected US patients are similar to the one that China initially posted, which suggests there is a likely single, recent emergence of this virus from an animal reservoir.[16] More recent studies implicate pangolins and suggest that SARS-CoV-2 has mutated at least once, based on the identification of two strains of the coronavirus.[17,18]
Although the initial outbreak of respiratory illness in Wuhan, China, was linked early to a large seafood and live animal market, suggesting animal-to-person spread, an increasing number of patients in the following weeks had no reported exposure to animal markets, indicating ongoing, sustained person-to-person transmission within China, which subsequently proliferated outside of the country.[16]
Image of passenger health checks at Italy's Milan Linate Airport from Flickr | Dipartimento Protezione Civile. [CC BY license.]
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
International transmission
Infected travelers introduced the virus outside of Wuhan (mainly by air and rail).[19] Thailand reported the first international case outside China on January 13, 2020, whereas the first cases outside of Wuhan but within China were reported in the cities of Guangdong and Beijing on January 19. The next day, China's National Health Commission (NHC) confirmed ongoing person-to-person spread, and Japan and South Korea also announced confirmed cases of the novel coronavirus. By January 21, the United States and Taiwan detected cases in travelers returning from Wuhan, and several more provinces in China reported new cases, including infections in 15 healthcare workers and six fatalities.[19]
Image from the CDC.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Public health emergency and travel/health alerts
On January 22, 2020, the World Health Organization (WHO) emergency committee convened to determine whether to classify the outbreak as a public health emergency of international concern (PHEIC), but they declined to do so owing to differing opinions among its members.[20] The next day, the US Department of State ordered the departure of all nonemergency US personnel and their families from Wuhan.[21] As the numbers of confirmed cases escalated within China, along with rising deaths, and worldwide, the WHO reconvened on January 30 and designated the novel coronavirus outbreak as a PHEIC.[22] The same day, the United States issued a level 4 (do not travel) alert for China.[21]
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Tracking worldwide COVID-19 and pandemic classification
Multiple international organizations including WHO, CDC, JHU CSSE,[23] and the European Centre for Disease Prevention and Control (ECDC)[24] are actively tracking cases of COVID-19, which has helped agencies like the CDC and WHO make public health recommendations and enact screening precautions for travelers and nations. WHO is also reviewing how it classifies international epidemics, potentially moving from a binary system to a graded one.[25]
On March 11, 2020, about 6 weeks after designating COVID-19 a PHEIC—during which the disease spread to every continent except Antarctica,[26] WHO raised the COVID-19 threat to the highest level,[27] and more new cases were reported outside of China than from within[28]—WHO officially declared it a pandemic, citing nations were not acting as fast and aggressively as needed to contain COVID-19.[29] The next day, the ECDC stated that COVID-19 was not containable and would overwhelm hospitals in a matter of days to weeks.[30] Multiple countries and regions have since gone on lockdown, closing their borders, imposing travel restrictions, and/or requiring 14-day quarantines on all travelers to avoid importing cases.[31]
Adapted image from the CDC.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
The pandemic has accelerated. Between February 18 and March 27, 2020, global laboratory- and clinically-confirmed cases of COVID-19 rose nearly 8-fold (from 73,328 to 553,244) (primarily in the Italy and, later, the United States),[23,24] surpassing 100,000 cases on March 7,[32] 200,000 cases on March 18,[33] 300,000 on March 21,[34] 400,000 on March 24,[80] and 500,000 on March 26.[81] In the same 5-week period, reported global deaths rose from 1,873 (mostly in China) to 25,035 (mainly in Italy).[23,24] Over 176 countries and territories have been affected,[23] as well as nearly 10 cruise ships.[35] Europe initially became the new center for the spread of COVID-19, with Italy impacted the greatest, followed by Spain, Germany, France, then Iran.[23] As of March 26, however, US cases have exceeded those of China and Italy.[82] Additionally, as cases climb rapidly in Africa,[36,80] this continent may be the next hard hit due to weak existing health systems, the prevalence of other infectious diseases, and overcrowding in cities and poor districts.[37]
The US outbreak may be mirroring that of Italy’s. Italy gradually restricted regional travel and activities, beginning with the Lombardy region (50,000 residents) on February 23[38]; northern Italy (16M people) on March 8[39]; and, finally, the entire nation went on lockdown on March 9 (>60M people).[40] The escalation of cases and deaths has crippled Italy’s healthcare system, resulting in a major shortage of personnel and necessary resources such as ventilators, hospital and intensive care unit (ICU) beds, and personal protective equipment [PPE] (eg, face masks, gowns)[41]—a situation that is occurring in the United States and elsewhere.[42,83-86] On March 19, China reported no new infections, but Italy had 41,035 total cases with 3,405 deaths, exceeding China’s total deaths from COVID-19.[43] Six days later, Spain’s 3,434 COVID-19 deaths also overtook China’s.[87]
TEM of SARS-CoV-2 particles emerging from the surface of lab-cultured cells from NIAID-Rocky Mountain Laboratories.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
United States transmission
In the 5-week period between February 17, 2020, and March 27, US COVID-19 cases identified and confirmed rose from 15 imported cases and no deaths in seven states, to 85,356 cases, with over 1,200 deaths.[44] Each of the initial five infections were in individuals who returned from China. However, on January 30, the sixth US case was the first person-to-person transmission reported in the country,[26] followed by a second such case on February 2.[46]
On February 27, California reported the first known community transmission, in which no association with travel or an infected traveler was found.[47] As of March 17, all 50 states have confirmed cases of COVID-19,[48] and there is sustained community spread within the country, concentrated mainly in New York (>39,000 cases [>10-fold that of all other states except New Jersey (>5.6-fold)], >360 deaths[44]; cases are ~doubling every 3 days, comprising 50% of all new US cases and >30% of total US cases[88]), followed by New Jersey, California, and Washington states.[44] The United States is now the world leader for COVID-19 cases.[82] Due to the lack of universally available, reliable, and fast COVID-19 test kits, several states have developed their own tests, but widespread testing for SARS-CoV-2 has not taken place, and the true extent of US transmission remains unknown.[49,50,51]
Image of SARS-CoV-2 virus particles (yellow) infecting apoptotic cells (green) isolated from a patient sample from NIAID IRF, Fort Detrick, Maryland, NIH, via Flickr.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Patient characteristics
China
An analysis of medical records from the Chinese Center for Disease Control and Prevention (CCDC) comprising data from December 31, 2019, when the outbreak of pneumonia with unknown cause was first recognized, through February 11, 2020, when the data were collected, revealed a total of 72,314 patients who either had confirmed (44,672 [61.8%]) or suspected COVID-19 (16,186 [22.4%]), or who were asymptomatic carriers of the virus (eg, no fever or dry cough) (889 [1.2%]).[52] Selected findings include the following[52]:
COVID-19 took only 30 days to spread from Hubei Province to the rest of China.
The overall fatality rate was 2.3% (2.9% in Hubei; 0.4% in other provinces).
There was a male predominance in infections (51.4%; vs women, 48.6%) and fatalities (2.8% vs 1.7%).
Those at greatest risk of fatal COVID-19 were seniors aged 60 years and older (especially ≥80 years) and those with comorbidities (cardiovascular disease, hypertension, diabetes, chronic respiratory disease, cancer).
Most confirmed cases were mild (80.9%) and involved those aged 30-69 years (77.8%) with Wuhan-related exposures (85.8%).
Severe cases (dyspnea, respiratory rate ≥30/min, blood oxygen saturation ≤93%, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen [PaO2/FiO2] <300, lung infiltrates >50% within 24-48 h) involved 13.8% of patients.
All patients with pneumonia had anomalies on lung computed tomography (CT) scans: ground-glass opacities, often bilaterally
All fatalities occurred in critical patients with COVID-19 (respiratory failure, septic shock, multiple organ dysfunction/failure) (4.7%) (49% fatality rate).
Of 1,716 infected health workers, 5 died (0.3%). (Another died 3 days after the data collection
Image from the CDC.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
United States
A preliminary analysis of outcomes among US patients with COVID-19 indicates that the highest fatality (10%-27%) is among the elderly (aged ≥85 years), followed by seniors aged 65-84 years (3%-11%), adults aged 55-64 years (1%-3%), and persons aged 20-54 years (<1%).[53] No fatalities were noted among persons aged 19 years and younger. Moreover, of all COVID-19 cases reported between February 12 and March 16, adults aged 65 years and older comprised 31% of cases, including 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths.[53] The most severe outcomes occurred among seniors aged 85 years and older. Of note, adults aged 20-54 accounted for 35.5%-49.1% of hospitalizations, 7.4%-14.6% of ICU admissions, and 0.6%-1.0% of deaths.
Initially, children appeared to be relatively unscathed by COVID-19. More recent data from China show that they may become infected at rates similar to adults, with the majority of children developing mild (fever, fatigue, cough, congestion) or moderate symptoms (pneumonia, lung anomalies on CT scans), whereas others are asymptomatic.[54] However, very young children (<5 years) may become critically ill (respiratory/organ failure).
Image from the CDC.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Criteria for Evaluation of Patients
If an individual develops a fever (100.4°F [38°C]) and signs/symptoms of respiratory illness, such as cough or dyspnea, within 14 days after travel from China or another affected region, or if they have had close contact with someone showing these signs/symptoms who has recently traveled from China or an affected region or been exposed to someone that has, or who has had close contact with a patient with laboratory-confirmed COVID-19, then they should call ahead to a healthcare professional to assist with care planning.[55]
NOTE: Findings from a recent study suggest that SARS-CoV may be infectious for up to 4 weeks, twice as long as most of the current quarantine/isolation measures.[56]
Image from Ai T, Yang Z, Hou H, et al. Radiology. 2020:200642. [Open access.] PMID: 32101510.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
As noted earlier, people who develop pneumonia due to SARS-CoV-2 appear to have a distinct lung appearance on chest CT scans, primarily evidence of ground-glass opacities in specific shapes and sites.[7,57] As the disease severity progresses, features such as a "crazy-paving sign, multifocal organizing pneumonia, and architectural distortion in a peripheral distribution" may manifest.[57]
Above, the multiple axial chest CT images over an 18-day period are from a 62-year-old man with a 2-week fever and 1 day of dyspnea.[57] His swab samples obtained on February 3 and 11, 2020, were negative for SARS-CoV-2 on reverse transcriptase (RT)-polymerase chain reaction (PCR) assay; his CT scans, however, told different story. Column A: Multiple ground-glass opacities in both lungs. Column B: Enlarged multiple ground-glass opacities. Column C: Progression of the disease from ground-glass opacities to multifocal organizing consolidation. Column D: Partial absorption of the organizing consolidation.
About half of patients with COVID-19 and respiratory symptoms may also have gastrointestinal symptoms (eg, vomiting, diarrhea, abdominal pain).[58] Those whose main complaint is abdominal pain appear to have a more severe disease course than patients who do not have abdominal pain. Cardiac implications exist as well: Hospitalized patients with COVID-19 and underlying cardiovascular conditions may develop not only acute respiratory distress syndrome but potential arrhythmia, shock, or acute cardiac injury.[59]
Image from the CDC.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Infection Control and Prevention
To minimize the risk of spreading the infection, individuals who meet the criteria discussed on the previous slide should be asked to wear a surgical mask as soon as they are identified, should undergo rapid triage, and should be separated from others (≥ 6 feet [2 meters]), ideally in an airborne infection isolation room (AIIR).[60]Healthcare personnel and others with close contact with these individuals should use standard, contact, and airborne precautions, as well as wear eye protection.[60]
No vaccine is currently available to prevent COVID-19,[61] but at least three vaccine studies are in progress and others are in development.[62-64] Evidence exists to indicate that human coronaviruses may potentially remain infectious in air for at least 3 hours and on inanimate surfaces for 2-3 days up to 9 days, and perhaps longer.[65,66] (The CDC found SARS-CoV-2 RNA on various Diamond Princess cabin surfaces [both symptomatic and asymptomatic infected passengers’ cabins] up to 17 days after the cabins were vacated but before disinfection procedures took place.[89]) Moreover, similarities between SARS-CoV-1 and -2 in their aerosol and fomite transmission have implications for nosocomial SARS spread and super-spreading events.[66] Viable SARS-CoV-2 RNA has also been isolated from respiratory, blood, urine, and stool specimens.[67]
Image from the CDC.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
It is evident that a primary driver of the current pandemic is infected people unknowingly spreading the virus because they either don’t have, or don’t recognize, symptoms. Some evidence suggests many of these silent/hidden carriers may exhibit loss of smell (anosmia/hyposmia) and taste (dysgeusia).[90,91] Thus, people should actively perform social/physical distancing (ie, avoid in-person mass gatherings or large community events and not shake hands or give “high-fives.” )[68] Major US sports organizations have suspended or delayed their seasons,[69] medical associations have canceled conferences and/or moved them online,[70] concert promoters and theaters have canceled or postponed shows,[71,72] theme parks have closed,[73] and several states have imposed shelter-in-place/lockdown measures to mitigate the spread of COVID-19.[74] After much debate and controversy, the 2020 Tokyo Summer Olympics has been postponed beyond 2020 but no later than summer 2021.[75,92,93]
Best practices for the general public to prevent infection from respiratory viruses include the following[61]:
Wash hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand-sanitizer with at least 60% alcohol.
Avoid touching the eyes, nose, and mouth with unwashed hands.
Avoid close contact with people who are ill.
Stay home when ill.
Use tissues or inner elbows to cover coughs/sneezes; discard soiled tissue in the trash.
Clean/disinfect frequently touched objects/surfaces with an Environmental Protection Agency-registered household disinfectant, or use diluted household bleach (5 tablespoons [1/3 cup] bleach per gallon of water OR 4 teaspoons bleach per quart of water) or solutions of at least 70% alcohol.
Only wear facemasks when sick and if in proximity to others, and before entering a healthcare setting. If an ill person is unable to wear a facemask, they should cover coughs/sneezes as above, and the people caring for them should wear a facemask when entering the same room
Main image: CDC laboratory test kit for COVID-19 from the CDC. Inset: Scanning electron microscope image of SARS-CoV-2 (yellow) emerging from the surface of cells (blue/pink) cultured in the laboratory from NIAID-Rocky Mountain Laboratories, NIH, via Flickr.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Diagnostic Testing and Reporting
The COVID-19 situation in the United States and elsewhere is rapidly evolving. Aggressive testing is crucial to understanding the disease prevalence and severity. The CDC and state public health laboratories can perform diagnostic testing for SARS-CoV-2 from nose, throat, and lung samples, using a real-time RT-PCR panel.[76] The CDC, academic laboratories, and medical companies are also developing new serology tests to detect infections with few or no symptoms.[76,94] Moreover, on March 21, the US Food and Drug Administration (FDA) granted emergency use authorization (EUA) for the first rapid, bedside COVID-19 test: Cepheid’s Xpert Xpress SARS-CoV-2 test returns results in 45 minutes, much faster than the days usual for other tests, and it can be used in emergency departments and hospitals that have the GeneXpert Systems machines.[95]
Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of individuals suspected of being infected with SARS-CoV-2.[55]
State health departments that have identified a person under investigation (PUI) or a laboratory-confirmed case should complete a PUI and Case Report form, as well as contact the CDC's Emergency Operations Center (EOC) at 770-488-7100 for help with obtaining, storing, and shipping appropriate specimens to CDC for testing, including after hours or on weekends or holidays.[55]
Image of an extracorporeal membrane oxygenation (ECMO) machine in use by an ICU patient from the Wikimedia Commons | Cmenesesoliveira.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Treatment
The mainstay of treatment for COVID-19 is supportive care[67]; secondary infections may occur and should be treated as indicated. Advanced organ support may be necessary in severely ill patients.
Various therapies are under investigation and in development, including, but not limited to, the following[62,96]:
*Findings from a trial of the drug combination of lopinavir and ritonavir, two agents used to treat infection with human immunodeficiency virus (HIV), did not show clinical improvement or mortality compared to standard care for treatment of severe COVID-19.[77]
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
Mortality rates: SARS-CoV2 vs MERS-CoV, SARS-CoV, and influenza
Although comparisons of mortality rates between SARS-CoV-2 and the other human betacoronaviruses will likely change during the lifespan of the current outbreak, data comparisons through April 4, 2020, show MERS-CoV and SARS-CoV-1 to be more deadly—but much less contagious—than SARS-CoV-2 at this time.[12,13,23,77] Nonetheless, ongoing prevention, monitoring, and public health awareness remain essential to provide a current benchmark for COVID-19 illness severity projections.[2,12,23,24,44]
NOTE: The infectiousness and mortality rate of SARS-CoV-2 are several orders higher than that of influenza. However, although influenza has a low mortality (0.001%-0.05%), more people have been infected by (39,000,000-56,000,000) and died from the flu (24,000-62,000) in the 2019-2020 flu season (data from October 1, 2019, through April 4, 2020) than from MERS-CoV, SARS-CoV-1, and SARS-CoV-2 combined.[79]Therefore, annual vaccination against the flu is still strongly recommended.
Image of SARS-CoV-2 from NIAID-Rocky Mountain Laboratories.
Coronavirus Disease 2019 (COVID-19): A Global Crisis
Bret A Nicks, MD, MHA, FACEP; Olivia Wong, DO | April 2, 2020 | Contributor Information
From Ebola to yellow fever, rising global travel is increasing travelers' exposure to severe and life-threatening disorders. Can you identify and manage the following infectious travel diseases?Medscape Reference Slideshow, July 2019
2019-nCoV is a novel coronavirus that was first identified amid an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China.Medscape Drugs/Diseases, February 2020
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Authors
Bret A Nicks, MD, MHA, FACEP
Chief Medical Officer
Professor, Emergency Medicine
Wake Forest Baptist Health - Davie Medical Center;
Director, EM Global Health Fellowship
Wake Forest Baptist Health
Winston-Salem, NC
Disclosure: Bret A Nicks, MD, MHA, FACEP, has disclosed no relevant financial relationships.
Olivia Wong, DO
Section Editor
Medscape Drugs & Diseases
New York, New York
Disclosure: Olivia Wong, DO, has disclosed no relevant financial relationships.
Wang C, Horby PW, Hayden FG, Gao, GF. A novel coronavirus outbreak of global health concern. Lancet. 2020 Feb 15;395(10223):470-3. PMID: 31986257. [Full text]
Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Feb 15;395(10223):514-23. PMID: 31986261. [Full text]
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. PMID: 31986264 [Full text]
Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020 Mar 2. PMID: 32123347 [Full text]
Centers for Disease Control and Prevention. Coronavirus. Reviewed: February 15, 2020. Available at: https://www.cdc.gov/coronavirus/types.html. Accessed March 19, 2020.
Corman VM, Muth D, Niemeyer D, Drosten C. Hosts and sources of endemic human coronaviruses. Adv Virus Res. 2018;100:163-88. PMID: 29551135
Centers for Disease Control and Prevention. Severe acute respiratory syndrome (SARS). Reviewed: December 6, 2017. Available at: https://www.cdc.gov/sars/. Accessed March 19, 2020.
Crowe JE Jr. Common viral respiratory infections In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Long DL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 20th ed. New York, NY: McGraw Hill Education; 2018.
Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): situation summary. Updated: March 18, 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html. Accessed March 18, 2020.
Tang X, Wu C, Li X, et al. On the origin and continuing evolution of SARS-CoV-2. Natl Sci Rev. [Full text]
Andersen KG, Rambaut A, Lipkin WI, et al. The proximal origin of SARS-CoV-2. Nat Med. 2020; Mar 3. [Full text]
Gardner L. Mapping 2019-nCoV. Johns Hopkins University, Center for Systems Science and Engineering (JHU CSSE). January 23, 2020. Available at: https://systems.jhu.edu/research/public-health/ncov/. Accessed February 3, 2020.
Feng Z, Li Q, Zhang Y, et al, for the Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) — China, 2020. China CDC Weekly. February 17, 2020. Available at: http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51. Accessed February 18, 2020.
CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:343-6 ePub: 18 March 2020. [Full text]
Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020 Mar 16. pii: e20200702. PMID: 32179660. [Full text]
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. Lancet. 2020 Mar 11. pii: S0140-6736(20)30566-3. PMID: 32171076
Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020 Feb 26:200642. PMID: 32101510. [Full text]
Pan L, Mu M, Ren HG, et al, on behalf of Wuhan Medical Treatment Expert Group for COVID-19. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study [in press]. Am J Gastroenterol. [Full text]
Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in healthcare settings. Reviewed: March 19, 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html. Accessed March 20, 2020.
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. J Hosp Infect. 2020 Feb 6. pii: S0195-6701(20)30046-3. PMID: 32035997. [Full text]
van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020 Mar 17. doi: 10.1056/NEJMc2004973. [Full text]
Gravitz L, Frellick M. More medical conferences fall to coronavirus. Updated: March 18, 2020. Available at: https://www.medscape.com/viewarticle/926359. Accessed March 21, 2020.
Cao B, Wang Y, Wen D, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe covid-19. N Engl J Med. 2020 Mar 18. PMID: 32187464 [Full text]
Callaway E, Cyranoski D, Mallapaty S, Stoye E, Tollefson J. The coronavirus pandemic in five powerful charts. Nature. March 18, 2020. Available at: https://www.nature.com/articles/d41586-020-00758-2. Accessed March 18, 2020.
Ranney ML, Griffeth V, Jha AK. Critical supply shortages — the need for ventilators and personal protective equipment during the covid-19 pandemic. N Engl J Med. 2020 Mar 25. Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2006141. Accessed March 25, 2020.
Moriarty LF, Plucinski MM, Marston BJ, et al, and the CDC Cruise Ship Response Team, California Department of Public Health COVID-19 Team, Solano County COVID-19 Team. Public health responses to COVID-19 outbreaks on cruise ships — worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep. ePub: 23 March 2020. [Full text]
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