Covid 19 - Wikipedia

Coronavirus disease 2019 - Wikipedia https://en.wikipedia.org/wiki/Coronavirus_diseas...
Coronavirus disease 2019

Coronavirus disease 2019 (COVID-19) is
Coronavirus disease 2019
an infectious disease caused by severe acute
(COVID-19)
respiratory syndrome coronavirus 2 (SARS-
Other names
CoV-2).[9] The disease was first identified in 2019-nCoV acute
2019 in Wuhan, China, and has since spread respiratory disease
globally, resulting in the 2019–20
Novel coronavirus
coronavirus pandemic.[10][11] Common pneumonia [1]
symptoms include fever, cough, and
Wuhan
shortness of breath. Muscle pain, sputum
pneumonia [2][3]
production and sore throat are less common.
[6][12] While the majority of cases result in Wuhan flu [4]
"Coronavirus" or
mild symptoms,[13] some progress to severe
other names for
pneumonia and multi-organ failure.[10][14]
SARS-CoV-2
The rate of deaths per number of diagnosed
cases is on average 3.4%, ranging from 0.2% Informally, simply
in those under 20, to approximately 15% in "corona"
those over 80 years old.[8][15][16]
The infection is typically spread from one

person to another via respiratory droplets
produced during coughing and sneezing.
[17][18] Time from exposure to onset of
symptoms is generally between two and 14

days, with an average of five days.[19][20] The
standard method of diagnosis is by reverse
transcription polymerase chain reaction
(rRT-PCR) from a nasopharyngeal swab. The COVID-19 symptoms
infection can also be diagnosed from a
Pronunciation /kəˈroʊnəˌvaɪrəs dɪˈziːz/
combination of symptoms, risk factors and a
chest CT scan showing features of Specialty Acute respiratory
pneumonia.[21][22] infection [5]
Symptoms Fever, cough,
Recommended measures to prevent infection
shortness of breath [6]
include frequent hand washing, maintaining
distance from others, and not touching one's Complications Pneumonia, ARDS,
kidney failure
face.[23] The use of masks is recommended
1 of 38 3/19/20, 10:01
for those who suspect they have the virus and Causes SARS-CoV-2
their caregivers, but not the general public. Risk factors Not taking preventive
[24][25] There is no vaccine or specific
measures
antiviral treatment for COVID-19.
Diagnostic rRT-PCR testing,
Management involves treatment of
method immunoassay, CT scan
symptoms, supportive care, isolation, and
experimental measures.[26] Prevention Correct hand washing
technique, cough
The World Health Organization (WHO) etiquette, avoiding
declared the 2019–20 coronavirus outbreak a close contact with sick
pandemic[11] and a Public Health Emergency people or subclinical
of International Concern (PHEIC).[27][28] carriers
Evidence of local transmission of the disease Treatment Symptomatic and
has been found in many countries across all supportive
six WHO regions.[29]
Frequency 198,004[7] confirmed
cases since 30
December 2019
Contents Deaths 7,948[7] (3.4% of
confirmed cases; lower
Signs and symptoms
when unreported
Course and complications
cases are included)[8]
Cause
Diagnosis
Prevention
Management
Personal protective equipment
Mechanical ventilation
Treatment
Information technology
Psychological support
Prognosis
Long-term health
Children
Epidemiology
Terminology
Research
Vaccine
Antivirals
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Remdesivir
Chloroquine and
hydroxychloroquine
Tocilizumab
Other experimental
treatments
Passive antibody therapy
See also
References
External links
Signs and symptoms

Although those infected with the virus may be
asymptomatic, many develop flu-like symptoms Rate of symptoms[30]
including fever, cough, and shortness of breath. Symptom Percentage

[6][31][32] Less commonly, upper respiratory
Fever 87.9%
symptoms such as sneezing, runny nose, or sore
Dry cough 67.7%
throat may be seen. Gastrointestinal symptoms
such as nausea, vomiting, and diarrhoea are seen Fatigue 38.1%
in a minority of cases.[33] In some, the disease Sputum production 33.4%
may progress to pneumonia, multi-organ failure,
Shortness of breath 18.6%
and death.[10][14]
Muscle pain or joint pain 14.8%
As is common with infections, there is a delay
Sore throat 13.9%
from when a person is infected with the virus to
when they develop symptoms, known as the Headache 13.6%
incubation period. The incubation period for Chills 11.4%

COVID-19 is typically five to six days but may Nausea or vomiting 5.0%
range from two to 14 days.[34][35]
Nasal congestion 4.8%
Mild cases typically recover within two weeks, Diarrhoea 3.7%
while those with severe or critical disease may
Haemoptysis 0.9%
take three to six weeks to recover. Among those
who have died, the time from symptom onset to Conjunctival congestion 0.8%
death has ranged from two to eight weeks.[36]
Course and complications
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The severity of COVID-19 varies. The disease may take a mild course with little or no
symptoms, resembling other common upper respiratory diseases such as the common cold.
However, in some COVID-19 may affect the lungs causing pneumonia. In those most
severely affected, COVID-19 may rapidly progress to acute respiratory distress syndrome
(ARDS) causing respiratory failure, septic shock, or multi-organ failure.[37][38]
Complications associated with COVID-19 include sepsis, abnormal clotting, and damage to
the heart, kidneys, and liver. Clotting abnormalities, specifically an increase in the time
required for the blood to clot (prothrombin time) have been described in 6% of those
admitted to hospital with COVID-19, while abnormal kidney function is seen in 4% of this
group.[39] Blood markers of damage to the heart (Troponin I) are increased in more than
50% of severe cases of COVID-19, and abnormal heart rhythms leading to cardiac arrest
have been described.[40] Liver injury as shown by blood markers of liver damage is
frequently seen in severe cases, although liver failure has not been described as of March
2020.[41]
Several factors predict the severity of COVID-19 infection. Children are likely to have milder
symptoms and a much lower chance of severe disease than adults.[42] Older age and a high
SOFA score (a clinical scoring scale assessing function of various metabolic systems and
organs, e.g. lungs, heart, liver, kidneys, etc.) are associated with a worse prognosis. Those
with pre-existing heart conditions are at greater risk of cardiac complications. Blood tests
associated with more severe disease include d-dimer greater than 1 μg/mL on admission;
elevated levels of blood interleukin-6, high-sensitivity cardiac troponin I, lactate
dehydrogenase; and abnormally low levels of lymphocytes (a type of white blood cell).
Cause
The disease is caused by the virus severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2),
previously referred to as the 2019 novel coronavirus
(2019-nCoV).[43] It is primarily spread between people
via respiratory droplets from coughs and sneezes.[18]
The virus has been found in the feces of infected
persons, but whether transmission through feces is
possible is unknown.[44]
SARS-CoV-2 is transmitted from person to person. It Microscopy image showing

can survive within aerosols generated by humans while SARS-CoV-2. The spikes on the
outer edge of the virus particles
breathing or coughing for three hours. It can stay stable
resemble a crown, giving the
on hard surfaces as well. On plastic and stainless steel
disease its characteristic name.
SARS-CoV-2 can last up to three days.[45]
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The lungs are the organs most affected by COVID-19 because the virus accesses host cells via
the enzyme ACE2, which is most abundant in the type II alveolar cells of the lungs. The virus
uses a special surface glycoprotein, called "spike", to connect to ACE2 and enter the host
cell.[46] The density of ACE2 in each tissue correlates with the severity of the disease in that
tissue and some have suggested that decreasing ACE2 activity might be protective, [47][48]
though another view is that increasing ACE2 using Angiotensin II receptor blocker
medications could be protective and that these hypotheses need to be tested.[49] As the
alveolar disease progresses, respiratory failure might develop and death may follow. [48]
ACE2 might also be the path for the virus to assault the heart causing acute cardiac injury.
People with existing cardiovascular conditions have the worst prognosis.[40]
The virus is thought to have an animal origin,[50] through spillover infection.[51] It was first
transmitted to humans in Wuhan, China, in November or December 2019, and the primary
source of infection became human-to-human transmission by early January 2020. [52][53]
On 14 March 2020, South China Morning Post reported that a 55-year-old from Hubei
province could have been the first person to have contracted the disease on 17 November
2019.[54] As of 14 March 2020, 67,790 cases and 3,075 deaths due to the virus have been
reported in Hubei province; a case fatality rate (CFR) of 4.54%.[54] On 17 March 2020,
scientists reported that the novel SARS-CoV-2 virus originated naturally, and not
otherwise.[55][56]
Diagnosis
The WHO has published several testing protocols for
the disease.[58] The standard method of testing is real-
time reverse transcription polymerase chain reaction
(rRT-PCR).[59] The test can be done on respiratory
samples obtained by various methods, including a
nasopharyngeal swab or sputum sample.[60] Results are
generally available within a few hours to two
days.[61][62] Blood tests can be used, but these require
two blood samples taken two weeks apart and the
results have little immediate value.[63] Chinese CDC rRT-PCR test kit for COVID-
scientists were able to isolate a strain of the coronavirus 19[57]
and publish the genetic sequence so that laboratories
across the world could independently develop
polymerase chain reaction (PCR) tests to detect infection by the virus.[10][64][65]
As of 26 February 2020, there were no antibody tests or point-of-care tests though efforts to
develop them are ongoing.[66]
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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.[21] A study published by a team at the Tongji Hospital in Wuhan on 26 February
2020 showed that a chest CT scan for COVID-19 has greater sensitivity (98%) than the
polymerase chain reaction (71%).[22] False negative results may occur due to PCR kit failure,
or due to either issues with the sample or issues performing the test. False positive results
are likely to be rare.[67]
One study in China found that CT scans showed ground-glass opacities in 56%, but 18% had
no radiological findings.[68] Bilateral and peripheral ground glass opacities are the most
typical CT findings, though they are non-specific.[69] Consolidation, linear opacities and
reverse halo sign are other radiological findings.[69] Initially, the lesions are confined to one
lung, but as the disease progresses, indications manifest in both lungs in 88% of so-called
"late patients" in the study group (the subset for whom time between onset of symptoms
and chest CT was 6–12 days).[69]
Typical CT imaging findings
CT imaging of rapid progression stage
Prevention
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Because a vaccine against SARS-

CoV-2 is not expected to become
available until 2021 at the earliest,[75]
a key part of managing the COVID-19
pandemic is trying to decrease the
epidemic peak, known as flattening
the epidemic curve through various
measures seeking to reduce the rate
of new infections.[71] Slowing the
infection rate helps decrease the risk
of health services being An illustration of the effect of spreading out
overwhelmed, allowing for better infections over a long period of time, known as
treatment of current cases, and flattening the curve; decreasing peaks allows
provides more time for a vaccine and healthcare services to better manage the same
volume of people, and allows for more preparation
treatment to be developed.[71]
time.[70][71][72]
Preventive measures to reduce the

chances of infection in locations with
an outbreak of the disease are similar
to those published for other
coronaviruses: stay home, avoid
travel and public activities, wash
hands with soap and warm water
often and for at least 20 seconds
(proper hand hygiene), practice good
respiratory hygiene and avoid
touching the eyes, nose, or mouth
with unwashed hands.[76][77] The Alternatives to flattening the curve[73][74]
CDC recommends covering up the
mouth and nose with a tissue during
any cough or sneeze and coughing or sneezing into the inside of the elbow if no tissue is
available.[76] They also recommend proper hand hygiene after any cough or sneeze.[76]
Social distancing strategies aim to reduce contact of infected persons with large groups by
closing schools and workplaces, restricting travel, and canceling mass gatherings. [78]
According to the WHO, the use of masks is only recommended if a person is coughing or
sneezing or when one is taking care of someone with a suspected infection. [79]
To prevent transmission of the virus, the Centers for Disease Control and Prevention (CDC)
in the United States recommends that infected individuals stay home except to get medical
care, call ahead before visiting a healthcare provider, wear a face mask when exposed to an
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individual or location of a suspected infection, cover coughs and sneezes with a tissue,
regularly wash hands with soap and water and avoid sharing personal household items.
[80][81] 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. It further recommended using
an alcohol-based hand sanitizer with at least 60% alcohol, but only when soap and water are
not readily available.[76] For remote areas where commercial hand sanitizers are not readily
available, WHO suggested two formulations for the local production. In both of these
formulations the antimicrobial activity of ethanol or isopropanol is enhanced by low
concentration of hydrogen peroxide while glycerol acts as a humectant[82]. The WHO
advises individuals to avoid touching the eyes, nose, or mouth with unwashed hands. [77]
Spitting in public places also should be avoided.[83]
Management
There are no specific antiviral medications. People are
managed with supportive care such as fluid and oxygen
support if needed,[85][86] while at the same time, there
is monitoring and supporting other affected vital
organs.[87] The WHO and Chinese National Health
Commission have published treatment
recommendations for taking care of people who are
hospitalised with COVID-19.[88][89] Steroids such as
methylprednisolone are not recommended unless the
disease is complicated by acute respiratory distress
syndrome.[90][91] Intensivists and pulmonologists in
the US have compiled treatment recommendations
from various agencies into a free resource, the
IBCC.[92][93] CDC recommends that those who suspect
they carry the virus wear a simple face mask.[24]
Ibuprofen, an anti-inflammatory medication commonly

used to reduce fever, has been used to treat flu-like
symptoms brought about by COVID-19.[94] Ibuprofen
increases ACE2 enzymes at the cellular level, which
could worsen COVID-19 infections,[95] raising concerns
on its usage. The WHO as well as an article published at Four steps to putting on
The BMJ warn against the use of ibuprofen, personal protective
recommending using paracetamol instead.[96][97] equipment[84]
The use of extracorporeal membrane oxygenation
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(ECMO) has been utilized to address the issue of respiratory failure, but its benefits are still
under consideration.[68][98]
Personal protective equipment

Management of people infected by the virus includes taking precautions while applying
therapeutic manoeuvres, especially when performing procedures like intubation or hand
ventilation that can generate aerosols.[99]
CDC outlines the specific personal protective equipment and the order in which healthcare
providers should put it on when dealing with someone who may have COVID-19: 1) gown, 2)
mask or respirator,[100][101] 3) goggles or a face shield, 4) gloves.[102][103]
Mechanical ventilation
Most cases of COVID-19 are not severe enough to require mechanical ventilation (artificial
assistance to support breathing), but a percentage of cases do.[104][105] This is most
common in older adults (those older than 60 years and especially those older than 80
years). Many developed countries do not have enough hospital beds per capita, which limits
a health system's capacity to handle a sudden spike in the number of COVID-19 cases severe
enough to require hospitalization.[106] This limited capacity is a significant driver of the
need to flatten the curve (to keep the speed at which new cases occur and thus the number
of people sick at one point in time lower).[106]
One study in China found 5% were admitted to intensive care units, 2.3% needed
mechanical support of ventilation, and 1.4% died.[68]
Treatment
No medication has yet been approved to treat coronavirus infections in humans by the
WHO although some are recommended by individual national medical authorities. [107]
Research into potential treatments for the disease was started in January 2020, and several
antiviral drugs are already in clinical trials.[108][109] Although completely new drugs may
take until 2021 to develop,[110] several of the drugs being tested are already approved for
other antiviral indications, or are already in advanced testing. [107]
Antiviral medication may be tried in people with severe disease.[85] The WHO
recommended volunteers take part in trials of the effectiveness and safety of potential
treatments.[111]
See § Research for more information on experimental treatments
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Information technology
In February 2020, China launched a mobile app to deal with the disease outbreak.[112] Users
are asked to enter their name and ID number. The app is able to detect 'close contact' using
surveillance data and therefore a potential risk of infection. Every user can also check the
status of three other users. If a potential risk is detected, the app not only recommends self-
quarantine, it also alerts local health officials.[113]
In March 2020, the Israeli government enabled security agencies to track mobile phone data
of people supposed to have coronavirus. The measure was taken to enforce quarantine and
protect those who may come into contact with infected citizens.[114]
Psychological support
Infected individuals may experience distress from quarantine, travel restrictions, side effects
of treatment, or fear of the infection itself. To address these concerns, the National Health
Commission of China published a national guideline for psychological crisis intervention on
27 January 2020.[115][116]
Prognosis
Many of those who die of COVID-19 have preexisting conditions, including hypertension,
diabetes mellitus, and cardiovascular disease.[117] The Italian Istituto Superiore di Sanità
reported that, out of over 2000 deaths from the disease in the country, 99.8% had at least
one preexisting condition with the average patient having 2.7.[118] According to the same
report, the median time between onset of symptoms and death was 8 days with a difference
of 1 day between patients who were been treated in an ICU compared to those who were
not.[118] In a study of early cases, the median time from exhibiting initial symptoms to death
was 14 days, with a full range of 6 to 41 days.[119] 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%.[120] 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%.[120] No deaths had occurred in people younger than 10 as
of 26 February 2020.[120] Pregnant women are at risk for severe infection.[121]
Availability of medical resources and the socioeconomics of a region may also affect
mortality.[122] Estimates of the mortality from the condition vary because of those regional
differences,[123] but also because of methodological difficulties. The under-counting of mild
cases can cause the mortality rate to be over-estimated.[124] However, the time lag in death
occurring can mean the mortality rate is underestimated.[125][126]
Histopathological examinations of post-mortem lung samples showed diffuse alveolar

damage with cellular fibromyxoid exudates in both lungs. Viral cytopathic changes were
10 of 38 3/19/20, 10:01
observed in the pneumocytes. The lung picture resembled acute respiratory distress
syndrome (ARDS).[127]
It is unknown if past infection provides effective and long-term immunity in people who
recover from the disease.[128] Immunity is likely, based on the behaviour of other
coronaviruses,[129] but cases in which recovery from COVID-19 have been followed by
positive tests for coronavirus at a later date have been reported.[130][131] It is unclear if these
cases are the result of reinfection, relapse, or testing error.
Case fatality rates (%) by age and country

Age 80+ 70–79 60–69 50–59 40–49 30–39 20–29 10–19 0–9
China as of 11
14.8 8.0 3.6 1.3 0.4 0.2 0.2 0.2 0.0
February[52]
Italy as of 16
19.2 11.8 3.2 1.0 0.3 0.2 0.0 0.0 0.0
March[118]
South Korea as
of 17 10.2 5.4 1.6 0.4 0.1 0.1 0.0 0.0 0.0
March[132]
The severity of diagnosed COVID19 cases

in China[133]
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Case fatality rates by age group in

China. Data through 11 February
2020.[52]
Case fatality rate depending on other health

problems
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Total deaths
Long-term health
The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in two to
three of around a dozen people who recovered from the disease. The people who recovered
gasp if they walk more quickly. Lung scans of the nine people infected at Princess Margaret
Hospital suggested they had sustained organ damage.[134]
Children
In a study of children in China with laboratory-confirmed or clinically-suspected cases of
COVID-19, children of all ages were found to be susceptible and no sex difference in
susceptibility was found. Of all children, 4.4% of cases were asymptomatic, 50.9% were
mild, 38.8% were moderate, 5.2% were severe, and 0.6% were critical. One fatality, a 14-
year-old boy, occurred in the study population.[135]
Severity by age group[135]

Asymptomatic Mild Moderate Severe Critical Total
<1 year 1.8% 54.1% 33.5% 8.7% 1.8% 379 cases
1-5 years 3.0% 49.7% 40.0% 6.9% 0.4% 493 cases
6-10 yrs 5.8% 53.4% 36.7% 4.2% 0.0% 521 cases
11-15 yrs 6.5% 48.2% 41.2% 3.4% 0.7% 413 cases
16-18 yrs 4.5% 49.0% 43.6% 2.7% 0.3% 335 cases
All 4.4% 51.0% 38.8% 5.2% 0.6% 2141 cases
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Epidemiology
The case fatality rate (CFR) depends
on the availability of healthcare, the
typical age and health problems
within the population, and the
number of undiagnosed cases.
[136][137] Preliminary research has
yielded case fatality rate numbers

between 2% and 3%;[15] in January
2020 the WHO suggested that the
case fatality rate was approximately
3%,[138] and 2% in February 2020 in Total confirmed cases over time
Hubei.[139] Other CFR numbers,
which adjust for differences in time of
confirmation, death or remission but are not peer reviewed, are respectively 7% [140] and
33% for people in Wuhan 31 January.[141] An unreviewed preprint of 55 deaths noted that
early estimates of mortality may be too high as asymptomatic infections are missed. They
estimated a mean infection fatality ratio (IFR, the mortality among infected) ranging from
0.8% - 0.9%.[142] The outbreak in 2019–2020 has caused at least 198,004[7] confirmed
infections and 7,948[7] deaths.
An observational study of nine people found no vertical transmission from mother to the
newborn.[143] Also, a descriptive study in Wuhan found no evidence of viral transmission
through vaginal sex (from female to partner), but authors note that transmission during sex
might occur through other routes.[144]
Terminology
The World Health Organization announced on 11 February 2020 that "COVID-19" would be
the official name of the disease. World Health Organization chief Tedros Adhanom
Ghebreyesus said "co" stands for "corona", "vi" for "virus" and "d" for "disease", while "19"
was for the year, as the outbreak was first identified on 31 December 2019. Tedros said the
name had been chosen to avoid references to a specific geographical location (i.e. China),
animal species, or group of people in line with international recommendations for naming
aimed at preventing stigmatisation.[145][146]
While the disease is named COVID-19, the virus that causes it is named severe acute
respiratory syndrome coronavirus 2 or SARS-CoV-2.[147] The virus was initially referred to
as the 2019 novel coronavirus or 2019-nCoV.[148] The WHO additionally uses "the
COVID-19 virus" and "the virus responsible for COVID-19" in public communications. [147]
14 of 38 3/19/20, 10:01
Research
Korean Health Authorities recommend chloroquine[149] and the Chinese 7th edition
guidelines include interferon, ribavirin, chloroquine, and/or umifenovir.[150]
Because of its key role in the transmission and progression of the disease, ACE2 has been
the focus of a significant proportion of research and various therapeutic approaches have
been suggested.[48]
Vaccine
There is no available vaccine, but research into developing a vaccine has been undertaken by
various agencies. Previous work on SARS-CoV is being utilised because SARS-CoV-2 and
SARS-CoV both use the ACE2 receptor to enter human cells.[151] There are three vaccination
strategies being investigated. First, researchers aim to build a whole virus vaccine. The use
of such a virus, be it inactive or dead, 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 the nucleic acid vaccines (DNA or
RNA vaccines, a novel technique for creating a vaccination). Experimental vaccines from
any of these strategies would have to be tested for safety and efficacy.[152]
On 16 March 2020, the first clinical trial of a vaccine started with four volunteers in Seattle.
The vaccine contains a harmless genetic code copied from the virus that causes the
disease.[153]
Antivirals
Several existing antiviral drugs are being repurposed to treat COVID-19 and some are
moving into clinical trials.[107]
Remdesivir
There is tentative evidence for Remdesivir as of March 2020.[154] Remdesivir inhibits
SARS-CoV-2 in vitro.[155] Phase 3 clinical trials are being conducted in the US, in China and
in Italy.[156][157][107]
Chloroquine and hydroxychloroquine

Chloroquine, previously used to treat malaria, was being trialled in China in February 2020,
with preliminary results that seem positive.[158][159] Chloroquine phosphate has a wide
15 of 38 3/19/20, 10:01
range of antiviral effects and had been proposed as a treatment for SARS-CoV-2. [160]
Chloroquine and hydroxychloroquine effectively inhibit SARS-CoV-2 in vitro,[155] with
hydroxychloroquine proving to be more potent than chloroquine and with a more tolerable
safety profile.[161]
Preliminary results from a multicentre trial suggested that chloroquine is effective and safe
in treating COVID-19 associated pneumonia, "improving lung imaging findings, promoting
a virus-negative conversion, and shortening the disease course".[158] In March 2020, a
preliminary trial in France found that chloroquine (600 mg of hydroxychloroquine (brand
name Plaquenil) every day for 10 days) may be effective.[162]
The Guangdong Provincial Department of Science and Technology and the Guangdong
Provincial Health and Health Commission issued a report stating that chloroquine
phosphate "improves the success rate of treatment and shortens the length of patient’s
hospital stay" and recommended it for people diagnosed with mild, moderate and severe
cases of novel coronavirus pneumonia.[163] On 17 March, the Italian Pharmaceutical Agency
included chloroquine and hydroxychloroquine in the list of drugs with positive preliminary
results for treatment of COVID-19.[164]
Tocilizumab
Tocilizumab has been included in treatment guidelines by China's National Health
Commission after a small study was completed.[165][166] It is undergoing a phase 2 non
randomized test at the national level in Italy after showing positive results in people with
severe disease.[167][168][164] Combined with a serum ferritin blood test to identify cytokine
storms, it is meant to counter such developments, which are thought to be the cause of
death in some affected people.[169][170] The interleukin-6 receptor antagonist was approved
by the FDA for treatment against cytokine release syndrome induced by a different cause,
CAR T cell therapy, in 2017.[171]
Other experimental treatments

In 2020 lopinavir/ritonavir was found not to work in COVID19.[172] Nitazoxanide has been
recommended for further in vivo study after demonstrating low concentration inhibition of
SARS-CoV-2.[155]
Recent studies have demonstrated that initial spike protein priming by transmembrane
protease serine 2 (TMPRSS2) is essential for entry of SARS-CoV-2, SARS-CoV and MERS-
CoV via interaction with the ACE2 receptor.[173][174] These findings suggest that the
TMPRSS2 inhibitor Camostat approved for clinical use in Japan for inhibiting fibrosis in
liver and kidney disease, postoperative reflux esophagitis and pancreatitis might constitute
an effective off-label treatment option.[173]
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Passive antibody therapy

Using blood donations from healthy people who have already recovered from COVID-19 is
being investigated,[175] a strategy that has also been tried for SARS, an earlier cousin of
COVID-19.[175] The mechanism of action is that the antibodies naturally produced in the
immune systems of those who have already recovered are transferred to people in need of
them via a nonvaccine form of immunization.[175] Other forms of passive antibody therapy,
such as with manufactured monoclonal antibodies, may come later after biopharmaceutical
development,[175] but convalescent serum production could be increased for quicker
deployment.[176]
See also
Coronavirus diseases, a group of closely related syndromes
Li Wenliang, a doctor at Central Hospital of Wuhan and one of the first to
warn others about the disease, from which he later died
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Coronavirus disease 2019

The infection is typically spread from one

symptoms is generally between two and 14

Signs and symptoms

including fever, cough, and shortness of breath. Symptom Percentage

incubation period. The incubation period for Chills 11.4%

Course and complications

SARS-CoV-2 is transmitted from person to person. It Microscopy image showing

Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested

Typical CT imaging ﬁndings

CT imaging of rapid progression stage

Because a vaccine against SARS-

Preventive measures to reduce the

Ibuprofen, an anti-inflammatory medication commonly

The use of extracorporeal membrane oxygenation

Personal protective equipment

See § Research for more information on experimental treatments

Histopathological examinations of post-mortem lung samples showed diffuse alveolar

Case fatality rates (%) by age and country

The severity of diagnosed COVID19 cases

Case fatality rates by age group in

Case fatality rate depending on other health

Severity by age group[135]

<1 year 1.8% 54.1% 33.5% 8.7% 1.8% 379 cases

1-5 years 3.0% 49.7% 40.0% 6.9% 0.4% 493 cases

6-10 yrs 5.8% 53.4% 36.7% 4.2% 0.0% 521 cases

11-15 yrs 6.5% 48.2% 41.2% 3.4% 0.7% 413 cases

16-18 yrs 4.5% 49.0% 43.6% 2.7% 0.3% 335 cases

All 4.4% 51.0% 38.8% 5.2% 0.6% 2141 cases

yielded case fatality rate numbers

Chloroquine and hydroxychloroquine

Other experimental treatments

Passive antibody therapy

7. "Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE" (https://gisandd

16. "Report 4: Severity of 2019-novel coronavirus (nCoV)" (https://www.imperial.a

23. "Advice for public" (https://www.who.int/emergencies/diseases/novel-coronavi

30. World Health Organization. "Report of the WHO-China Joint Mission on

57. CDC (5 February 2020). "CDC Tests for 2019-nCoV" (https://www.cdc.gov/coro

71. Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD (March 2020).

79. "When and how to use masks" (https://www.who.int/emergencies/diseases/no

89. "Clinical management of severe acute respiratory infection when novel

109. Duddu P (19 February 2020). "Coronavirus outbreak: Vaccines/drugs in the

173. Hoﬀmann M, Kleine-Weber H, Krüger N, Müller M, Drosten C, Pöhlmann S (31

Retrieved from "https://en.wikipedia.org Classiﬁcation ICD-10: D

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