|Coronavirus disease 2019|
|Symptoms||Fever, cough, fatigue, shortness of breath, loss of taste or smell; sometimes no symptoms at all|
|Complications||Pneumonia, viral sepsis, acute respiratory distress syndrome, kidney failure, cytokine release syndrome, respiratory failure, pulmonary fibrosis, pediatric multisystem inflammatory syndrome, chronic COVID syndrome|
|Usual onset||2–14 days (typically 5) from infection|
|Duration||5 days to 10+ months known|
|Causes||Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)|
|Diagnostic method||rRT-PCR testing, CT scan|
|Prevention||Hand washing, face coverings, quarantine, physical/social distancing|
|Treatment||Symptomatic and supportive|
|Frequency||96,938,729 confirmed cases|
|Part of a series on the|
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. It has since spread worldwide, leading to an ongoing pandemic.
Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Around one in five infected individuals do not develop any symptoms. While most people have mild symptoms, some people develop acute respiratory distress syndrome (ARDS). ARDS can be precipitated by cytokine storms, multi-organ failure, septic shock, and blood clots. Longer-term damage to organs (in particular, the lungs and heart) has been observed. There is concern about a significant number of patients who have recovered from the acute phase of the disease but continue to experience a range of effects—known as long COVID—for months afterwards. These effects include severe fatigue, memory loss and other cognitive issues, low-grade fever, muscle weakness, and breathlessness.
The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. It can spread as early as two days before infected persons show symptoms, and from individuals who never experience symptoms. People remain infectious for up to ten days in moderate cases, and two weeks in severe cases. Various testing methods have been developed to diagnose the disease. The standard diagnosis method is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.
Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and various countries have initiated mass vaccination campaigns.
Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.
Signs and symptoms
Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. In people without prior ears, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19 with a specificity of 95%.
Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Around one in five people are infected with the virus but do not develop noticeable symptoms at any point in time. A June 2020 review asserted that asymptomatic infections might be as high as 40 to 45 percent with the ability to transmit the virus for a period that extends beyond two weeks. These asymptomatic carriers tend not to get tested, and they can spread the disease. Other infected people will develop symptoms later (called pre-symptomatic) or have very mild symptoms, and can also spread the virus.As is common with infections, there is a delay, known as the incubation period, between the moment a person first becomes infected and the appearance of the first symptoms. The median incubation period for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all symptomatic people will experience one or more symptoms before day twelve.
COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus strain.
COVID-19 spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.
The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. The larger droplets may also evaporate into the aerosols (known as droplet nuclei). The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.
Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.The number of people generally infected by one infected person varies; as of September 2020 it was estimated that one infected person will, on average, infect between two and three other people. This is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature.
SARS-CoV-2 is closely related to the original SARS-CoV. 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). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is 98.6% similar to the M protein of bat SARS-CoV, maintains 98.2% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only 38% with the M protein of MERS-CoV. In silico analyses showed that the M protein of SARS-CoV-2 has a triple helix bundle, forms a single 3-transmembrane domain, and is homologous to the prokaryotic sugar transport protein SemiSWEET.
The many thousands SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divdes them into seven (L, O, V, S, G, GH, and GR).
Several notable variants of SARS-CoV-2 emerged in the fall of 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.
COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). 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. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. 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, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.
Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 patients with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of patients who died from COVID-19, but these results need to be confirmed. SARS-CoV-2 may cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the 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. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell by a "Trojan horse" mechanism.
The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.
The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. 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. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found in intensive care unit (ICU)-transferred patients with COVID-19 infections, and may be related to poor prognosis. 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.
Another common cause of death is complications related to the kidneys. 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.
Autopsies of people who died of COVID-19 have found diffuse alveolar damage (DAD), and lymphocyte-containing inflammatory infiltrates within the lung.
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.
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.
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.
COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of prior infection is possible with serological tests, which detect antibodies produced by the body in response to infection.
The standard method of testing for presence of SARS-CoV-2 is real-time reverse transcription polymerase chain reaction (rRT-PCR), which detects the presence of viral RNA fragments. As this test detects RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within a few hours to two days. Blood tests can be used, but these require two blood samples taken two weeks apart, and the results have little immediate value. The WHO has published several testing protocols for the disease.
A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.
On 22 June 2020, UK health secretary Matt Hancock announced the country would conduct a new "spit test" for COVID-19 on 14,000 key workers and their families in Southampton, having them spit in a pot, which was collected by Southampton University, with results expected within 48 hours. Hancock said the test was easier than using swabs and could enable people to conduct it at home.
The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."
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. 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. Antibody tests may be most accurate 2–3 weeks after a person's symptoms start. The Chinese experience with testing has shown the accuracy is only 60 to 70%. 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. The absence or presence of COVID-19 signs and symptoms alone is not reliable enough for an accurate diagnosis. Different clinical scores were created based on symptoms, laboratory parameters and imaging to determine patients with probable SARS-CoV-2 infection or more severe stages of COVID-19.
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).
In November 2020, research showed that breath analysis could make the "rapid identification" in seconds for coronavirus possible.
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. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.
Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.
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.
The main pathological findings at autopsy are:
- Macroscopy: pericarditis, lung consolidation and pulmonary oedema
- Lung findings:
- minor serous exudation, minor fibrin exudation
- pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation
- diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.
- organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis
- plasmocytosis in BAL
- Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction
- Liver: microvesicular steatosis
Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, 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. 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.
The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, 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. 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". 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.
A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against COVID‑19. Prior to the COVID‑19 pandemic, work to develop a vaccine against the coronavirus diseases SARS and MERS had established knowledge about the structure and function of coronaviruses, which accelerated development during early 2020 of varied technology platforms for a COVID‑19 vaccine.
By January 2021, 69 vaccine candidates were in clinical research, including 43 in Phase I–II trials and 26 in Phase II–III trials. In Phase III trials, several COVID‑19 vaccines demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of January 2021, nine vaccines have been authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer-BioNTech vaccine and the Moderna vaccine), three conventional inactivated vaccines (BBIBP-CorV from Sinopharm, BBV152 from Bharat Biotech and CoronaVac from Sinovac), two viral vector vaccines (Sputnik V from the Gamaleya Research Institute and the Oxford–AstraZeneca vaccine), and one peptide vaccine ( ).Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 14 January 2021, 32.64 million doses of COVID‑19 vaccine had been administered worldwide based on official reports from national health agencies. Pfizer, Moderna, and AstraZeneca predicted a manufacturing capacity of 5.3 billion doses in 2021, which could be used to vaccinate about 3 billion people (as the vaccines require two doses for a protective effect against COVID‑19). By December, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising only 14% of the world's population.
Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak. Non-cooperation with distancing measures in some areas has contributed to the further spread of the pandemic. Initial recommendations included maintaining a six-foot/two-meter distance from others outside the family unit. However, a case occurring in South Korea suggested that is inadequate, citing transmission despite a brief exposure (5 minutes) at 20 feet from the carrier in a restaurant. The maximum gathering size recommended by U.S. government bodies and health organizations was swiftly reduced from 250 people (if there were no known COVID-19 spread in a region) to 50 people, and later to 10. A Cochrane review found that early quarantine with other public health measures are effective in limiting the pandemic. The best manner of adopting and relaxing policies are uncertain, however, as local conditions vary.
Older adults and those with underlying medical conditions such as diabetes, heart disease, respiratory disease, hypertension, and compromised immune systems face increased risk of serious illness and complications and have been advised by the CDC to stay home as much as possible in areas of community outbreak.
In late March 2020, the WHO and other health bodies began to replace the use of the term "social distancing" with "physical distancing", to clarify that the aim is to reduce physical contact while maintaining social connections, either virtually or at a distance. The use of the term "social distancing" had led to implications that people should engage in total social isolation, rather than encouraging them to stay in contact through alternative means. Some authorities have issued sexual health guidelines for responding to the pandemic, which include recommendations to have sex only with someone with whom you live, and who does not have the virus or symptoms of the virus.
Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. 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.
Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation.
Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.
Face masks and respiratory hygiene
The WHO and the US CDC 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. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. Face coverings also filter out particles containing the virus from inhaled air, reducing the chance that the wearer will become infected. 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.
Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. 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. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with COVID-19 patients are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.
Hand-washing and hygiene
When not wearing a mask, the CDC, the WHO, and the NHS recommend 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. Proper hand hygiene after any cough or sneeze is encouraged. The WHO 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. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. 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.
Coronaviruses on surfaces die "within hours to days". Coronaviruses die faster when exposed to sunlight and warm temperatures.
Surfaces may be decontaminated with a number of solutions (within one minute of exposure to the disinfectant for a stainless steel surface), including 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected.
Ventilation and air filtration
Healthy diet and lifestyle
The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep. Dark-skinned people are at particular risk of a vitamin D deficiency which can impair the immune system.
There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.
Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.
People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.
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. In 3-4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. 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. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.
Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom has warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".
In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.
According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.
It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.
Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. 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.
Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.
|Argentina as of 7 May||0.0||0.0||0.1||0.4||1.3||3.6||12.9||18.8||28.4|
|Australia as of 4 June||0.0||0.0||0.0||0.0||0.1||0.2||1.1||4.1||18.1||40.8|
|Canada as of 3 December||0.0||0.0||0.0||0.1||0.6||2.9||11.6||26.5|
|Alberta as of 3 June||0.0||0.0||0.1||0.1||0.1||0.2||1.9||11.9||30.8|
|Br. Columbia as of 2 June||0.0||0.0||0.0||0.0||0.5||0.8||4.6||12.3||33.8||33.6|
|Ontario as of 3 June||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||0.0||0.1||0.1||0.2||1.1||6.1||21.4||30.4||36.1|
|Chile as of 31 May||0.1||0.3||0.7||2.3||7.7||15.6|
|China as of 11 February||0.0||0.2||0.2||0.2||0.4||1.3||3.6||8.0||14.8|
|Colombia as of 3 June||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||0.2||4.1||16.5||28.1||48.2|
|Finland as of 1 December||0.0||0.4||1.6||9.6||32.7|
|Germany as of 5 June||0.0||0.0||0.1||1.9||19.7||31.0|
|Bavaria as of 5 June||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||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||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||0.0||0.0||0.0||0.1||0.3||0.6||2.5||6.8||14.8|
|Mexico as of 3 June||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||0.0||0.2||0.1||0.3||0.5||1.7||8.1||25.6||33.3||34.5|
|Norway as of 1 December||0.0||0.1||0.2||1.1||5.3||16.5||36.9|
|Philippines as of 4 June||1.6||0.9||0.5||0.8||2.4||5.5||13.2||20.9||31.5|
|Portugal as of 3 June||0.0||0.0||0.0||0.0||0.3||1.3||3.6||10.5||21.2|
|South Africa as of 28 May||0.3||0.1||0.1||0.4||1.1||3.8||9.2||15.0||12.3|
|South Korea as of 1 December||0.0||0.0||0.0||0.0||0.1||0.4||1.2||6.4||18.2|
|Spain as of 29 May||0.3||0.2||0.2||0.3||0.6||1.4||5.0||14.3||20.8||21.7|
|Sweden as of 30 November||0.1||0.0||0.0||0.0||0.1||0.4||1.9||11.6||26.2||32.9|
|Switzerland as of 4 June||0.6||0.0||0.0||0.1||0.1||0.6||3.4||11.6||28.2|
|Colorado as of 3 June||0.2||0.2||0.2||0.2||0.8||1.9||6.2||18.5||39.0|
|Connecticut as of 3 June||0.2||0.1||0.1||0.3||0.7||1.8||7.0||18.0||31.2|
|Georgia as of 3 June||0.0||0.1||0.5||0.9||2.0||6.1||13.2||22.0|
|Idaho as of 3 June||0.0||0.0||0.0||0.0||0.0||0.4||3.1||8.9||31.4|
|Indiana as of 3 June||0.1||0.1||0.2||0.6||1.8||7.3||17.1||30.2|
|Kentucky as of 20 May||0.0||0.0||0.0||0.2||0.5||1.9||5.9||14.2||29.1|
|Maryland as of 20 May||0.0||0.1||0.2||0.3||0.7||1.9||6.1||14.6||28.8|
|Massachusetts as of 20 May||0.0||0.0||0.1||0.1||0.4||1.5||5.2||16.8||28.9|
|Minnesota as of 13 May||0.0||0.0||0.0||0.1||0.3||1.6||5.4||26.9|
|Mississippi as of 19 May||0.0||0.1||0.5||0.9||2.1||8.1||16.1||19.4||27.2|
|Missouri as of 19 May||0.0||0.0||0.1||0.2||0.8||2.2||6.3||14.3||22.5|
|Nevada as of 20 May||0.0||0.3||0.3||0.4||1.7||2.6||7.7||22.3|
|N. Hampshire as of 12 May||0.0||0.0||0.4||0.0||1.2||0.0||2.2||12.0||21.2|
|Oregon as of 12 May||0.0||0.0||0.0||0.0||0.5||0.8||5.6||12.1||28.9|
|Texas as of 20 May||0.0||0.5||0.4||0.3||0.8||2.1||5.5||10.1||30.6|
|Virginia as of 19 May||0.0||0.0||0.0||0.1||0.4||1.0||4.4||12.9||24.9|
|Washington as of 10 May||0.0||0.2||1.3||9.8||31.2|
|Wisconsin as of 20 May||0.0||0.0||0.2||0.2||0.6||2.0||5.0||14.7||19.9||30.4|
Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.
Some early studies suggest between 1 in 5 and 1 in 10 people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath.
On 30 October 2020 WHO chief Tedros has warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings and other symptoms. Tedros has underlined that therefore the "natural herd immunity" strategy is “morally unconscionable and unfeasible”.
The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4 fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year.
Several measures are commonly used to quantify mortality. 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. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.
The case fatality rate (CFR) 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 2.1% (2,077,005/96,938,729) as of 21 January 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.
Infection fatality rate
A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.
A recent (Dec 2020) systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.
Earlier estimates of IFR
At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%. 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%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. 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 (0.3% of the population). Antibody testing in New York City suggested an IFR of ~0.9%, and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.
Early reviews of epidemiologic data showed greater impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. 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. 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. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.
|Percentage of infected people who are hospitalized|
|Percentage of hospitalized people who go to Intensive Care Unit|
|Percent of hospitalized people who die|
|Percent of infected people who die – infection fatality rate (IFR)|
|Numbers in parentheses are 95% credible intervals for the estimates.|
In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. 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. Similar issues affect Native American and Latino communities. 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. 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. Leaders have called for efforts to research and address the disparities. 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. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.
Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), ischemic heart disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).
Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse patient outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.
In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that patients with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.
During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus.
In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease 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 in part to prevent social stigma.
The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.
The virus is thought to be natural and has an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats and spread to humans through an intermediary wildlife host.
The first known human infections were in Wuhan, Hubei, 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. Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020, George Gao, the director of the CDC, 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. Traces of the virus have been found in wastewater that was collected from Milan and Turin, Italy, on 18 December 2019.
By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December and at least 266 by 31 December. 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. 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. 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". Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours, and another, Ai Fen, was reprimanded by her superiors for raising the alarm.
The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.
During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. 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. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. 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". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.
On 31 January 2020, Italy had its first confirmed cases, two tourists from China. As of 13 March 2020, the WHO considered Europe the active centre of the pandemic. On 19 March 2020, Italy overtook China as the country with the most deaths. By 26 March, the United States had overtaken China and Italy with the highest number of confirmed cases in the world. 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. Retesting of prior samples found a person in France who had the virus on 27 December 2019 and a person in the United States who died from the disease on 6 February 2020.
On 11 June 2020, after 55 days without a locally transmitted case, Beijing reported the first COVID-19 case, followed by two more cases on 12 June. By 15 June 79 cases were officially confirmed. Most of these patients went to Xinfadi Wholesale Market.
RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.
Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis. 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. 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. Minks at two farms in the Netherlands also tested positive for COVID-19. In Denmark, as of October 31, 2020, 175 mink farms had seen COVID-19 infection in mink, and also USA; Finland, Sweden and Spain have seen infections in mink.
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. It is unknown if other great ape species can be infected with COVID-19, though many primate sanctuaries presume transmission from humans to other apes is possible, as it is for other respiratory viruses.
As of August 2020, dozens of domestic cats and dogs had tested positive, though according to the U.S. CDC, there was no evidence they transmitted the virus to humans. CDC guidance recommends potentially infected people avoid close contact with pets.
International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.
As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.
Transmission and prevention research
Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.
Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.
In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.
Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.
In June, initial results from the randomised RECOVERY trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH 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.
In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.
In September 2020, the European Medicines Agency (EMA) endorsed the use of dexamethasone in adults and adolescents from twelve years of age and weighing at least 40 kilograms (88 lb) who require supplemental oxygen therapy. Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.
In November 2020, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID-19. Bamlanivimab is authorized for people with positive results of direct SARS-CoV-2 viral testing who are twelve years of age and older weighing at least 40 kilograms (88 lb), and who are at high risk for progressing to severe COVID-19 or hospitalization. This includes those who are 65 years of age or older, or who have certain chronic medical conditions.
A cytokine storm can be a complication in the later stages of severe COVID-19. A cytokine storm is a potentially deadly immune reaction where a large amount of pro-inflammatory cytokines and chemokines are released too quickly; A cytokine storm can lead to ARDS and multiple organ failure. Data collected from Jin Yin-tan Hospital in Wuhan, China indicates that patients who had more severe responses to COVID-19 had greater amounts of pro-inflammatory cytokines and chemokines in their system than patients who had milder responses; These high levels of pro-inflammatory cytokines and chemokines indicate presence of a cytokine storm.
Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed. It is undergoing a Phase II non-randomised trial at the national level in Italy after showing positive results in people with severe disease. 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. The interleukin-6 receptor antagonist was approved by the 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. To date,[when?] 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.
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.
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. Viral neutralization 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. As of 8 August 2020, eight neutralizing antibodies targeting the spike protein of SARS-CoV-2 have entered clinical studies. 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. Other mechanisms, however, such as antibody-dependent cellular cytotoxicity and/or phagocytosis, may be possible. Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.
The use of passive antibodies to treat people with active COVID-19 is also being studied. This involves the production of convalescent serum, which consists of the liquid portion of the blood from recovered patients and contains antibodies specific to this virus, which is then administered to current patients. This strategy was tried for SARS with inconclusive results. A Cochrane review in October 2020 found insufficient evidence to recommend for or against this treatment in COVID-19, due in large part to the methodology of the clinical trials conducted so far. Specifically, there are no trials yet conducted for which the safety of convalescent serum administration to people with COVID-19 can be determined, and the differing outcomes measured in different studies limits their use in determining efficacy.
Research using alpacas and llamas in Peru may produce a treatment for COVID-19. Alpacas and other laminoid animals (South American camel-like animals) naturally produce a very small type of antibody known as nanobodies.
- Known as "close contact" which is variously defined, including within ~1.8 metres (six feet) by the US Centers for Disease Control and Prevention (CDC), and being face to face for a cumulative total of 15 minutes, or either 15 minutes of face to face proximity or sharing an enclosed space for a prolonged period such as two hours by the Australian Health Department.
- Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. (February 2020). "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study". Lancet. 395 (10223): 507–513. doi:10.1016/S0140-6736(20)30211-7. PMC 7135076. PMID 32007143.
- Han X, Cao Y, Jiang N, Chen Y, Alwalid O, Zhang X, et al. (March 2020). "Novel Coronavirus Pneumonia (COVID-19) Progression Course in 17 Discharged Patients: Comparison of Clinical and Thin-Section CT Features During Recovery". Clinical Infectious Diseases. 71 (15): 723–731. doi:10.1093/cid/ciaa271. PMC 7184369. PMID 32227091.
- "Special Act for Prevention, Relief and Revitalization Measures for Severe Pneumonia with Novel Pathogens–Article Content–Laws & Regulations Database of The Republic of China". law.moj.gov.tw. Retrieved 10 May 2020.
- "Covid-19". Oxford English Dictionary (Online ed.). Oxford University Press. April 2020. Retrieved 15 April 2020. (Subscription or participating institution membership required.)
- "Symptoms of Coronavirus". U.S. Centers for Disease Control and Prevention (CDC). 13 May 2020. Archived from the original on 17 June 2020. Retrieved 18 June 2020.
- "Q&A on coronaviruses (COVID-19)". World Health Organization (WHO). 17 April 2020. Archived from the original on 14 May 2020. Retrieved 14 May 2020.
- Nussbaumer-Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, et al. (April 2020). "Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review". The Cochrane Database of Systematic Reviews. 4: CD013574. doi:10.1002/14651858.CD013574. PMC 7141753. PMID 32267544.
- "COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)". ArcGIS. Johns Hopkins University. Retrieved 21 January 2021.
- "Transmission of COVID-19". European Centre for Disease Prevention and Control. Retrieved 6 December 2020.
- Ye Q, Wang B, Mao J (June 2020). "The pathogenesis and treatment of the 'Cytokine Storm' in COVID-19". The Journal of Infection. 80 (6): 607–613. doi:10.1016/j.jinf.2020.03.037. PMC 7194613. PMID 32283152.
- Yelin D, Wirtheim E, Vetter P, Kalil AC, Bruchfeld J, Runold M, et al. (September 2020). "Long-term consequences of COVID-19: research needs". The Lancet. Infectious Diseases. 20 (10): 1115–1117. doi:10.1016/S1473-3099(20)30701-5. PMC 7462626. PMID 32888409.
- "What are the long-term symptoms of COVID-19?". HMRI. 4 August 2020. Retrieved 8 September 2020.
- "COVID-19 (coronavirus): Long-term effects". Mayo Clinic. 18 August 2020. Retrieved 8 September 2020.
- "What are the long-term health risks following COVID-19?". NewsGP. Royal Australian College of General Practitioners (RACGP). 24 June 2020. Retrieved 8 September 2020.
- "Coronavirus Disease 2019 (COVID-19)". U.S. Centers for Disease Control and Prevention (CDC). Retrieved 22 October 2020.
- "Quarantine for coronavirus (COVID-19)". Australian Government Department of Health. Retrieved 25 September 2020.
- "How COVID-19 Spreads". U.S. Centers for Disease Control and Prevention (CDC). 18 September 2020. Archived from the original on 19 September 2020. Retrieved 20 September 2020.
- "Coronavirus disease (COVID-19): How is it transmitted?". World Health Organization (WHO). Retrieved 6 December 2020.
- "Coronavirus Disease 2019 (COVID-19)". U.S. Centers for Disease Control and Prevention (CDC). 11 February 2020. Retrieved 6 December 2020.
- "Transmission of SARS-CoV-2: implications for infection prevention precautions". World Health Organization (WHO).
- "Symptoms of Coronavirus". U.S. Centers for Disease Control and Prevention (CDC). 13 May 2020. Archived from the original on 17 June 2020. Retrieved 18 June 2020.
- Grant MC, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke EL, Wade RG (23 June 2020). "The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries". PLOS ONE. 15 (6): e0234765. Bibcode:2020PLoSO..1534765G. doi:10.1371/journal.pone.0234765. PMC 7310678. PMID 32574165. S2CID 220046286.
- "Clinical characteristics of COVID-19". European Centre for Disease Prevention and Control. Retrieved 29 December 2020.
- Bénézit, François; Le Turnier, Paul; Declerck, Charles; Paillé, Cécile; Revest, Matthieu; Dubée, Vincent; Tattevin, Pierre (2020). "Utility of hyposmia and hypogeusia for the diagnosis of COVID-19". The Lancet Infectious Diseases. 20 (9): 1014–1015. doi:10.1016/S1473-3099(20)30297-8. PMC 7159866. PMID 32304632. S2CID 215769604.
- "Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)". U.S. Centers for Disease Control and Prevention (CDC). 6 April 2020. Archived from the original on 2 March 2020. Retrieved 19 April 2020.
- "Transmission of COVID-19". European Centre for Disease Prevention and Control. Retrieved 6 December 2020.
- Nogrady, Bianca (18 November 2020). "What the data say about asymptomatic COVID infections". Nature. 587 (7835): 534–535. doi:10.1038/d41586-020-03141-3. PMID 33214725.
- Gao Z, Xu Y, Sun C, Wang X, Guo Y, Qiu S, Ma K (May 2020). "A Systematic Review of Asymptomatic Infections with COVID-19". Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi. doi:10.1016/j.jmii.2020.05.001. PMC 7227597. PMID 32425996.
- Oran, Daniel P., and Eric J. Topol. “Prevalence of Asymptomatic SARS-CoV-2 Infection : A Narrative Review.” Annals of Internal Medicine. vol. 173,5 (2020): 362-367. doi:10.7326/M20-3012 PMID: 32491919 Retrieved 14 January 2021.
- Lai CC, Liu YH, Wang CY, Wang YH, Hsueh SC, Yen MY, et al. (June 2020). "Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths". Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi. 53 (3): 404–412. doi:10.1016/j.jmii.2020.02.012. PMC 7128959. PMID 32173241.
- Furukawa NW, Brooks JT, Sobel J (July 2020). "Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic". Emerging Infectious Diseases. 26 (7). doi:10.3201/eid2607.201595. PMC 7323549. PMID 32364890.
- Furukawa, Nathan W.; Brooks, John T.; Sobel, Jeremy (4 May 2020). "Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic". Emerging Infectious Diseases. 26 (7). doi:10.3201/eid2607.201595. PMC 7323549. PMID 32364890. Retrieved 29 September 2020.
- Gandhi RT, Lynch JB, Del Rio C (April 2020). "Mild or Moderate Covid-19". The New England Journal of Medicine. 383 (18): 1757–1766. doi:10.1056/NEJMcp2009249. PMID 32329974.
- Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC (August 2020). "Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review". JAMA. 324 (8): 782–793. doi:10.1001/jama.2020.12839. PMID 32648899. S2CID 220465311.
- "Q&A: How is COVID-19 transmitted? (How is the virus that causes COVID-19 most commonly transmitted between people?)". www.who.int. 9 July 2020. Retrieved 14 October 2020.
- "Transmission of COVID-19". www.ecdc.europa.eu. 7 September 2020. Retrieved 14 October 2020.
- "Q & A on COVID-19: Basic facts". www.ecdc.europa.eu. 25 September 2020. Retrieved 8 October 2020.
- "How COVID-19 Spreads". www.cdc.gov. 5 October 2020. Retrieved 7 October 2020.
- "Outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): increased transmission beyond China – fourth update" (PDF). European Centre for Disease Prevention and Control. 14 February 2020. Retrieved 8 March 2020.
- Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF (April 2020). "The proximal origin of SARS-CoV-2". Nature Medicine. 26 (4): 450–452. doi:10.1038/s41591-020-0820-9. PMC 7095063. PMID 32284615.
- Gibbens S (18 March 2020). "Why soap is preferable to bleach in the fight against coronavirus". National Geographic. Archived from the original on 2 April 2020. Retrieved 2 April 2020.
- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. (February 2020). "A Novel Coronavirus from Patients with Pneumonia in China, 2019". The New England Journal of Medicine. 382 (8): 727–733. doi:10.1056/NEJMoa2001017. PMC 7092803. PMID 31978945.
- Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) (PDF) (Report). World Health Organization (WHO). February 2020. Archived (PDF) from the original on 29 February 2020. Retrieved 21 March 2020. Lay summary.
- Rathore JS, Ghosh C (August 2020). "Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a newly emerged pathogen: an overview". Pathogens and Disease. 78 (6). doi:10.1093/femspd/ftaa042. OCLC 823140442. PMC 7499575. PMID 32840560.
- Thomas S (2020). "The Structure of the Membrane Protein of SARS-CoV-2 Resembles the Sugar Transporter SemiSWEET". Pathogens & Immunity. 5 (1): 342–363. doi:10.20411/pai.v5i1.377. PMC 7608487. PMID 33154981. S2CID 226246581.
- Koyama, Takahiko Koyama; Platt, Daniela; Parida, Laxmi (June 2020). "Variant analysis of SARS-CoV-2 genomes". Bulletin of the World Health Organization. 98 (7): 495–504. doi:10.2471/BLT.20.253591. PMC 7375210. PMID 32742035.
We detected in total 65776 variants with 5775 distinct variants.CS1 maint: multiple names: authors list (link)
- Alm E, Broberg EK, Connor T, Hodcroft EB, Komissarov AB, Maurer-Stroh S, Melidou A, Neher RA, O'Toole Á, Pereyaslov D (August 2020). "Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020". Euro Surveillance. 25 (32). doi:10.2807/1560-7917.ES.2020.25.32.2001410. PMC 7427299. PMID 32794443.
- "Emerging SARS-CoV-2 Variants". Centers for Disease Control and Prevention. 30 December 2020. Retrieved 30 December 2020.
- "Implications of Emerging SARS-CoV-2 Variant VOC 202012/01 in the UK". Centers for Disease Control and Prevention. 29 December 2020. Retrieved 30 December 2020.
- "Coronavirus and COVID-19: What You Should Know". WebMD. Retrieved 31 July 2020.
- Verdecchia P, Cavallini C, Spanevello A, Angeli F (June 2020). "The pivotal link between ACE2 deficiency and SARS-CoV-2 infection". European Journal of Internal Medicine. 76: 14–20. doi:10.1016/j.ejim.2020.04.037. PMC 7167588. PMID 32336612.
- Letko M, Marzi A, Munster V (April 2020). "Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses". Nature Microbiology. 5 (4): 562–569. doi:10.1038/s41564-020-0688-y. PMC 7095430. PMID 32094589.
- Rodríguez-Puertas R (October 2020). "ACE2 activators for the treatment of COVID 19 patients". Journal of Medical Virology. 92 (10): 1701–1702. doi:10.1002/jmv.25992. PMC 7267413. PMID 32379346.
- Gurwitz D (August 2020). "Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics". Drug Development Research. 81 (5): 537–540. doi:10.1002/ddr.21656. PMC 7228359. PMID 32129518.
- Gibson PG, Qin L, Puah SH (July 2020). "COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS". The Medical Journal of Australia. 213 (2): 54–56.e1. doi:10.5694/mja2.50674. PMC 7361309. PMID 32572965.
- Pezzini A, Padovani A (November 2020). "Lifting the mask on neurological manifestations of COVID-19". Nature Reviews. Neurology. 16 (11): 636–644. doi:10.1038/s41582-020-0398-3. PMC 7444680. PMID 32839585.
- Li YC, Bai WZ, Hashikawa T (February 2020). "The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients". Journal of Medical Virology. 92 (6): 552–555. doi:10.1002/jmv.25728. PMC 7228394. PMID 32104915.
- Baig AM, Khaleeq A, Ali U, Syeda H (April 2020). "Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms". ACS Chemical Neuroscience. 11 (7): 995–998. doi:10.1021/acschemneuro.0c00122. PMC 7094171. PMID 32167747.
- Yavarpour-Bali H, Ghasemi-Kasman M (September 2020). "Update on neurological manifestations of COVID-19". Life Sciences. 257: 118063. doi:10.1016/j.lfs.2020.118063. PMC 7346808. PMID 32652139.
- Gu J, Han B, Wang J (May 2020). "COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission". Gastroenterology. 158 (6): 1518–1519. doi:10.1053/j.gastro.2020.02.054. PMC 7130192. PMID 32142785.
- Zhang H, Li HB, Lyu JR, Lei XM, Li W, Wu G, et al. (July 2020). "Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection". International Journal of Infectious Diseases. Elsevier BV. 96: 19–24. doi:10.1016/j.ijid.2020.04.027. PMC 7165079. PMID 32311451.
- Zheng YY, Ma YT, Zhang JY, Xie X (May 2020). "COVID-19 and the cardiovascular system". Nature Reviews. Cardiology. 17 (5): 259–260. doi:10.1038/s41569-020-0360-5. PMC 7095524. PMID 32139904.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. (January 2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". Lancet. 395 (10223): 497–506. doi:10.1016/S0140-6736(20)30183-5. PMC 7159299. PMID 31986264.
- "Coronavirus disease 2019 (COVID-19): Myocardial infarction and other coronary artery disease issues". UpToDate. Retrieved 28 September 2020.
- Turner AJ, Hiscox JA, Hooper NM (June 2004). "ACE2: from vasopeptidase to SARS virus receptor". Trends in Pharmacological Sciences. 25 (6): 291–4. doi:10.1016/j.tips.2004.04.001. PMC 7119032. PMID 15165741.
- Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L (October 2020). "The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management". Thrombosis Research. Elsevier BV. 194: 101–115. doi:10.1016/j.thromres.2020.06.029. PMC 7305763. PMID 32788101.
- Wadman M (April 2020). "How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes". Science. doi:10.1126/science.abc3208.
- Coronavirus: Kidney Damage Caused by COVID-19, Johns Hopkins Medicine, C. John Sperati, updated 14 May 2020.
- Eketunde AO, Mellacheruvu SP, Oreoluwa P (July 2020). "A Review of Postmortem Findings in Patients With COVID-19". Cureus. Cureus, Inc. 12 (7): e9438. doi:10.7759/cureus.9438. PMC 7451084. PMID 32864262. S2CID 221352704.
- Zhang C, Wu Z, Li JW, Zhao H, Wang GQ (March 2020). "The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist Tocilizumab may be the key to reduce the mortality". International Journal of Antimicrobial Agents. 55 (5): 105954. doi:10.1016/j.ijantimicag.2020.105954. PMC 7118634. PMID 32234467.
- Gómez-Rial J, Rivero-Calle I, Salas A, Martinón-Torres F (2020). "Role of Monocytes/Macrophages in Covid-19 Pathogenesis: Implications for Therapy". Infection and Drug Resistance. 13: 2485–2493. doi:10.2147/IDR.S258639. PMC 7383015. PMID 32801787.
- "CDC Tests for 2019-nCoV". U.S. Centers for Disease Control and Prevention (CDC). 5 February 2020. Archived from the original on 14 February 2020. Retrieved 12 February 2020.
- "CT provides best diagnosis for COVID-19". ScienceDaily. Retrieved 14 March 2020.
- Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. (February 2020). "Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases". Radiology. 296 (2): E32–E40. doi:10.1148/radiol.2020200642. PMC 7233399. PMID 32101510.
- Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A (March 2020). "Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients". AJR. American Journal of Roentgenology. 215 (1): 87–93. doi:10.2214/AJR.20.23034. PMID 32174129.
- Vogel G (March 2020). "New blood tests for antibodies could show true scale of coronavirus pandemic". Science. doi:10.1126/science.abb8028. S2CID 216202171.
- "2019 Novel Coronavirus (2019-nCoV) Situation Summary". U.S. Centers for Disease Control and Prevention (CDC). 30 January 2020. Archived from the original on 26 January 2020. Retrieved 30 January 2020.
- "Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans". World Health Organization (WHO). Archived from the original on 15 March 2020. Retrieved 14 March 2020.
- Bullard J, Dust K, Funk D, Strong JE, Alexander D, Garnett L, et al. (May 2020). "Predicting infectious SARS-CoV-2 from diagnostic samples". Clinical Infectious Diseases. doi:10.1093/cid/ciaa638. PMC 7314198. PMID 32442256.
- "Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19)". U.S. Centers for Disease Control and Prevention (CDC). 11 February 2020. Archived from the original on 4 March 2020. Retrieved 26 March 2020.
- "Real-Time RT-PCR Panel for Detection 2019-nCoV". U.S. Centers for Disease Control and Prevention (CDC). 29 January 2020. Archived from the original on 30 January 2020. Retrieved 1 February 2020.
- "Curetis Group Company Ares Genetics and BGI Group Collaborate to Offer Next-Generation Sequencing and PCR-based Coronavirus (2019-nCoV) Testing in Europe". GlobeNewswire News Room. 30 January 2020. Archived from the original on 31 January 2020. Retrieved 1 February 2020.
- Brueck H (30 January 2020). "There's only one way to know if you have the coronavirus, and it involves machines full of spit and mucus". Business Insider. Archived from the original on 1 February 2020. Retrieved 1 February 2020.
- "Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases". Archived from the original on 21 February 2020. Retrieved 26 February 2020.
- "Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases". World Health Organization (WHO). Archived from the original on 17 March 2020. Retrieved 13 March 2020.
- "NHS staff will be first to get new coronavirus antibody test, medical chief promises". The Independent. 14 May 2020. Retrieved 14 May 2020.
- "Coronavirus 'spit test' to be trialled in Southampton". The Guardian. Retrieved 22 June 2020.
- Heneghan, Carl; Jefferson, Tom (1 September 2020). "Virological characterization of COVID-19 patients that test re-positive for SARS-CoV-2 by RT-PCR". CEBM. Retrieved 19 September 2020.
- Lu J, Peng J, Xiong Q, Liu Z, Lin H, Tan X, et al. (September 2020). "Clinical, immunological and virological characterization of COVID-19 patients that test re-positive for SARS-CoV-2 by RT-PCR". EBioMedicine. 59: 102960. doi:10.1016/j.ebiom.2020.102960. PMC 7444471. PMID 32853988.
- Spencer, Elizabeth; Jefferson, Tom; Brassey, Jon; Heneghan, Carl (11 September 2020). "When is Covid, Covid?". The Centre for Evidence-Based Medicine. Retrieved 19 September 2020.
- "SARS-CoV-2 RNA testing: assurance of positive results during periods of low prevalence". GOV.UK. Retrieved 19 September 2020.
- Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. (February 2020). "The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health – The latest 2019 novel coronavirus outbreak in Wuhan, China". International Journal of Infectious Diseases. 91: 264–266. doi:10.1016/j.ijid.2020.01.009. PMC 7128332. PMID 31953166.
- Cohen J, Normile D (January 2020). "New SARS-like virus in China triggers alarm" (PDF). Science. 367 (6475): 234–235. Bibcode:2020Sci...367..234C. doi:10.1126/science.367.6475.234. PMID 31949058. S2CID 210701594. Archived (PDF) from the original on 11 February 2020. Retrieved 11 February 2020.
- "Severe acute respiratory syndrome coronavirus 2 data hub". NCBI. Archived from the original on 21 March 2020. Retrieved 4 March 2020.
- Petherick A (April 2020). "Developing antibody tests for SARS-CoV-2". Lancet. 395 (10230): 1101–1102. doi:10.1016/s0140-6736(20)30788-1. PMC 7270070. PMID 32247384.
- Vogel G (March 2020). "New blood tests for antibodies could show true scale of coronavirus pandemic". Science. doi:10.1126/science.abb8028.
- Pang J, Wang MX, Ang IY, Tan SH, Lewis RF, Chen JI, et al. (February 2020). "Potential Rapid Diagnostics, Vaccine and Therapeutics for 2019 Novel Coronavirus (2019-nCoV): A Systematic Review". Journal of Clinical Medicine. 9 (3): 623. doi:10.3390/jcm9030623. PMC 7141113. PMID 32110875.
- Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Spijker R, Taylor-Phillips S, et al. (June 2020). "Antibody tests for identification of current and past infection with SARS-CoV-2". The Cochrane Database of Systematic Reviews. 6: CD013652. doi:10.1002/14651858.CD013652. PMC 7387103. PMID 32584464. S2CID 220061130.
- AFP News Agency (11 April 2020). "How false negatives are complicating COVID-19 testing". Al Jazeera website Retrieved 12 April 2020.
- "Coronavirus (COVID-19) Update: FDA Issues first Emergency Use Authorization for Point of Care Diagnostic" (Press release). U.S. Food and Drug Administration (FDA). 21 March 2020. Archived from the original on 21 March 2020. Retrieved 22 March 2020.
- Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, et al. (July 2020). "Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease". The Cochrane Database of Systematic Reviews. 7: CD013665. doi:10.1002/14651858.CD013665. PMC 7386785. PMID 32633856. S2CID 220384495.
- Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al. (August 2020). "Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19". JAMA Internal Medicine. 180 (8): 1081–1089. doi:10.1001/jamainternmed.2020.2033. PMC 7218676. PMID 32396163.
- Levenfus I, Ullmann E, Battegay E, Schuurmans MM (August 2020). "Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score". The Brazilian Journal of Infectious Diseases. 24 (5): 458–461. doi:10.1016/j.bjid.2020.07.003. PMC 7440000. PMID 32828735.
- To KK, Tsang OT, Chik-Yan Yip C, Chan KH, Wu TC, Chan JM, et al. (February 2020). "Consistent detection of 2019 novel coronavirus in saliva". Clinical Infectious Diseases. Oxford University Press. 71 (15): 841–843. doi:10.1093/cid/ciaa149. PMC 7108139. PMID 32047895.
- "Covid: New breath test could detect virus in seconds". BBC. Retrieved 1 November 2020.
- "ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection". American College of Radiology. 22 March 2020. Archived from the original on 28 March 2020.
- Pormohammad A, Ghorbani S, Khatami A, Razizadeh MH, Alborzi E, Zarei M, et al. (October 2020). "Comparison of influenza type A and B with COVID-19: A global systematic review and meta-analysis on clinical, laboratory and radiographic findings". Reviews in Medical Virology: e2179. doi:10.1002/rmv.2179. PMC 7646051. PMID 33035373. S2CID 222255245.
- Lee EY, Ng MY, Khong PL (April 2020). "COVID-19 pneumonia: what has CT taught us?". The Lancet. Infectious Diseases. 20 (4): 384–385. doi:10.1016/S1473-3099(20)30134-1. PMC 7128449. PMID 32105641.
- Li Y, Xia L (March 2020). "Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management". AJR. American Journal of Roentgenology. 214 (6): 1280–1286. doi:10.2214/AJR.20.22954. PMID 32130038. S2CID 212416282.
- "COVID-19 Database". Società Italiana di Radiologia Medica e Interventistica (in Italian). Retrieved 11 March 2020.
- "ICD-10 Version:2019". World Health Organization (WHO). 2019. Archived from the original on 31 March 2020. Retrieved 31 March 2020.
U07.2 – COVID-19, virus not identified – COVID-19 NOS – Use this code when COVID-19 is diagnosed clinically or epidemiologically but laboratory testing is inconclusive or not available. Use additional code, if desired, to identify pneumonia or other manifestations
- Giani M, Seminati D, Lucchini A, Foti G, Pagni F (May 2020). "Exuberant Plasmocytosis in Bronchoalveolar Lavage Specimen of the First Patient Requiring Extracorporeal Membrane Oxygenation for SARS-CoV-2 in Europe". Journal of Thoracic Oncology. 15 (5): e65–e66. doi:10.1016/j.jtho.2020.03.008. PMC 7118681. PMID 32194247.
- Lillicrap D (April 2020). "Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia". Journal of Thrombosis and Haemostasis. 18 (4): 786–787. doi:10.1111/jth.14781. PMC 7166410. PMID 32212240.
- Mitra A, Dwyre DM, Schivo M, Thompson GR, Cohen SH, Ku N, Graff JP (March 2020). "Leukoerythroblastic reaction in a patient with COVID-19 infection". American Journal of Hematology. 95 (8): 999–1000. doi:10.1002/ajh.25793. PMC 7228283. PMID 32212392.
- Maier BF, Brockmann D (May 2020). "Effective containment explains subexponential growth in recent confirmed COVID-19 cases in China". Science. 368 (6492): 742–746. Bibcode:2020Sci...368..742M. doi:10.1126/science.abb4557. PMC 7164388. PMID 32269067. ("...initial exponential growth expected for an unconstrained outbreak.")
- "Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission". U.S. Centers for Disease Control and Prevention (CDC). 28 June 2020.
- Centers for Disease Control and Prevention (3 February 2020). "Coronavirus Disease 2019 (COVID-19): Prevention & Treatment". Archived from the original on 15 December 2019. Retrieved 10 February 2020.
- World Health Organization. "Advice for Public". Archived from the original on 26 January 2020. Retrieved 10 February 2020.
- "My Hand-Washing Song: Readers Offer Lyrics For A 20-Second Scrub". NPR.org. Archived from the original on 20 March 2020. Retrieved 20 March 2020.
- "Scientific Brief: SARS-CoV-2 and Potential Airborne Transmission". COVID-19 Published Science and Research. U.S. Centers for Disease Control and Prevention (CDC). Retrieved 30 October 2020.
- Centers for Disease Control and Prevention (5 April 2020). "What to Do if You Are Sick". U.S. Centers for Disease Control and Prevention (CDC). Archived from the original on 14 February 2020. Retrieved 24 April 2020.
- "Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment". U.S. Centers for Disease Control and Prevention (CDC). 10 March 2020. Archived from the original on 11 March 2020. Retrieved 11 March 2020.
- "UK medicines regulator gives approval for first UK COVID-19 vaccine". Medicines and Healthcare Products Regulatory Agency, Government of the UK. 2 December 2020. Retrieved 2 December 2020.
- Benjamin Mueller (2 December 2020). "U.K. Approves Pfizer Coronavirus Vaccine, a First in the West". The New York Times. Retrieved 2 December 2020.
- "COVID-19 Treatment Guidelines". www.nih.gov. National Institutes of Health. Retrieved 21 April 2020.
- Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB (April 2020). "Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review". JAMA. 323 (18): 1824–1836. doi:10.1001/jama.2020.6019. PMID 32282022.
- Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD (March 2020). "How will country-based mitigation measures influence the course of the COVID-19 epidemic?". Lancet. 395 (10228): 931–934. doi:10.1016/S0140-6736(20)30567-5. PMC 7158572. PMID 32164834.
A key issue for epidemiologists is helping policy makers decide the main objectives of mitigation—e.g. minimising morbidity and associated mortality, avoiding an epidemic peak that overwhelms health-care services, keeping the effects on the economy within manageable levels, and flattening the epidemic curve to wait for vaccine development and manufacture on scale and antiviral drug therapies.
- Wiles S (14 March 2020). "After 'Flatten the Curve', we must now 'Stop the Spread'. Here's what that means". The Spinoff. Archived from the original on 26 March 2020. Retrieved 13 March 2020.
- "COVID-19 vaccine development pipeline (Refresh URL to update)". Vaccine Centre, London School of Hygiene and Tropical Medicine. 18 January 2021. Retrieved 18 January 2021.
- Beaumont, Peter (18 November 2020). "Covid-19 vaccine: who are countries prioritising for first doses?". The Guardian. ISSN 0261-3077. Retrieved 26 December 2020.
- "Coronavirus (COVID-19) Vaccinations". Our World in Data. Retrieved 1 January 2021.
- Mullard, Asher (30 November 2020). "How COVID vaccines are being divvied up around the world Canada leads the pack in terms of doses secured per capita". Nature. doi:10.1038/d41586-020-03370-6. PMID 33257891. S2CID 227246811. Retrieved 11 December 2020.
- So AD, Woo J (December 2020). "Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis". BMJ. 371: m4750. doi:10.1136/bmj.m4750. ISSN 1756-1833. PMC 7735431. PMID 33323376.
- Nussbaumer-Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, et al. (April 2020). "Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review". The Cochrane Database of Systematic Reviews. 4: CD013574. doi:10.1002/14651858.CD013574. PMC 7141753. PMID 32267544.
- Ward A (28 April 2020). "Has Sweden found the best response to the coronavirus? Its death rate suggests it hasn't". Vox. Retrieved 30 April 2020.
- Infected after 5 minutes, from 20 feet away: South Korea study shows COVID-19's spread indoors, Los Angeles Times, Victoria Kim, December 11, 2020. Retrieved December 14, 2020.
- "Sex and coronavirus (COVID-19)". sexualwellbeing.ie. Retrieved 31 March 2020.
- "Sex and Coronavirus Disease 2019 (COVID-19)" (PDF). The Official Website of the City of New York. NYC Health Department. Retrieved 6 April 2020.
- Hawks L, Woolhandler S, McCormick D (April 2020). "COVID-19 in Prisons and Jails in the United States". JAMA Internal Medicine. 180 (8): 1041–1042. doi:10.1001/jamainternmed.2020.1856. PMID 32343355.
- Waldstein D (6 May 2020). "To Fight Virus in Prisons, C.D.C. Suggests More Screenings". The New York Times. Retrieved 14 May 2020.
- "COVID-19 Informational Resources for High-Risk Groups | Keeping Education ACTIVE | Partnership to Fight Chronic Disease". fightchronicdisease.org. Retrieved 31 May 2020.
- "Wear masks in public says WHO, in update of COVID-19 advice". Reuters. 5 June 2020. Retrieved 3 July 2020.
- "Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission". U.S. Centers for Disease Control and Prevention (CDC). 11 February 2020. Retrieved 17 April 2020.
- "Using face masks in the community – Technical Report" (PDF). ECDC. 8 April 2020.
- "Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2". U.S. Centers for Disease Control and Prevention (CDC). 10 November 2020.
- "Which countries have made wearing face masks compulsory?". Al Jazeera. 20 May 2020.
- Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L (April 2020). "Face masks for the public during the covid-19 crisis". BMJ. 369: m1435. doi:10.1136/bmj.m1435. PMID 32273267. S2CID 215516381.
- "Caring for Someone Sick at Home". U.S. Centers for Disease Control and Prevention (CDC). 11 February 2020. Retrieved 3 July 2020.
- "Using Personal Protective Equipment (PPE)". U.S. Centers for Disease Control and Prevention (CDC). 11 June 2020. Retrieved 4 July 2020.
- "Social distancing: what you need to do – Coronavirus (COVID-19)". nhs.uk. 2 June 2020. Retrieved 18 August 2020.
- "Advice for the public on COVID-19 – World Health Organization". World Health Organization (WHO). Retrieved 18 August 2020.
- "WHO-recommended handrub formulations". WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. World Health Organization (WHO). 19 March 2009. Retrieved 19 March 2020.
- "Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes" (PDF). U.S. Centers for Disease Control and Prevention (CDC). Lay summary.
- National Center for Immunization and Respiratory Diseases (NCIRD) (9 July 2020). "COVID-19 Employer Information for Office Buildings". U.S. Centers for Disease Control and Prevention (CDC). Retrieved 9 July 2020.
- "Interim Recommendations for US Community Facilities with Suspected/Confirmed Coronavirus Disease 2019". U.S. Centers for Disease Control and Prevention (CDC). 11 February 2020. Retrieved 4 April 2020.
- World Health Organization (29 October 2020). WHO's Science in 5 on COVID-19 - Ventilation. Retrieved 2 November 2020 – via YouTube.
- Somsen GA, van Rijn C, Kooij S, Bem RA, Bonn D (July 2020). "Small droplet aerosols in poorly ventilated spaces and SARS-CoV-2 transmission". The Lancet. Respiratory Medicine. Elsesier. 8 (7): 658–659. doi:10.1016/S2213-2600(20)30245-9. PMC 7255254. PMID 32473123.
- "Food safety, nutrition, and wellness during COVID-19". The Nutrition Source. Harvard T.H. Chan School of Public Health. 29 May 2020. Retrieved 8 November 2020.
- Villasanta, Arthur (15 September 2020). "Dr. Fauci Reveals Immune System Boosters For COVID-19: Vitamins That Help Prevent Coronavirus". International Business Times. Retrieved 13 November 2020.
Vitamin D is important to the function of the immune system and vitamin D supplements have previously been shown to lower the risk of viral respiratory tract infections
- Busby, Mattha (10 January 2021). "Does vitamin D combat Covid?". The Guardian. Retrieved 10 January 2021.
- Siemieniuk, Reed AC; Bartoszko, Jessica J; Ge, Long; Zeraatkar, Dena; Izcovich, Ariel; Kum, Elena; Pardo-Hernandez, Hector; Rochwerg, Bram; Lamontagne, Francois; Han, Mi Ah; Liu, Qin; Agarwal, Arnav; Agoritsas, Thomas; Chu, Derek K; Couban, Rachel; Darzi, Andrea; Devji, Tahira; Fang, Bo; Fang, Carmen; Flottorp, Signe Agnes; Foroutan, Farid; Ghadimi, Maryam; Heels-Ansdell, Diane; Honarmand, Kimia; Hou, Liangying; Hou, Xiaorong; Ibrahim, Quazi; Khamis, Assem; Lam, Bonnie; Loeb, Mark; Marcucci, Maura; McLeod, Shelley L; Motaghi, Sharhzad; Murthy, Srinivas; Mustafa, Reem A; Neary, John D; Qasim, Anila; Rada, Gabriel; Riaz, Irbaz Bin; Sadeghirad, Behnam; Sekercioglu, Nigar; Sheng, Lulu; Sreekanta, Ashwini; Switzer, Charlotte; Tendal, Britta; Thabane, Lehana; Tomlinson, George; Turner, Tari; Vandvik, Per O; Vernooij, Robin WM; Viteri-García, Andrés; Wang, Ying; Yao, Liang; Ye, Zhikang; Guyatt, Gordon H; Brignardello-Petersen, Romina (30 July 2020). "Drug treatments for covid-19: living systematic review and network meta-analysis". BMJ. BMJ: m2980. doi:10.1136/bmj.m2980. ISSN 1756-1833.
- "Coronavirus". WebMD. Archived from the original on 1 February 2020. Retrieved 1 February 2020.
- Fisher D, Heymann D (February 2020). "Q&A: The novel coronavirus outbreak causing COVID-19". BMC Medicine. 18 (1): 57. doi:10.1186/s12916-020-01533-w. PMC 7047369. PMID 32106852.
- Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. (May 2020). "Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province". Chinese Medical Journal. 133 (9): 1025–1031. doi:10.1097/CM9.0000000000000744. PMC 7147277. PMID 32044814.
- Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, Jiang B (March 2020). "Comorbidities and multi-organ injuries in the treatment of COVID-19". Lancet. Elsevier BV. 395 (10228): e52. doi:10.1016/s0140-6736(20)30558-4. PMC 7270177. PMID 32171074.
- Wang Y, Wang Y, Chen Y, Qin Q (March 2020). "Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures". Journal of Medical Virology. n/a (n/a): 568–576. doi:10.1002/jmv.25748. PMC 7228347. PMID 32134116.
- Martel J, Ko YF, Young JD, Ojcius DM (May 2020). "Could nasal breathing help to mitigate the severity of COVID-19". Microbes and Infection. 22 (4–5): 168–171. doi:10.1016/j.micinf.2020.05.002. PMC 7200356. PMID 32387333.
- "Coronavirus recovery: breathing exercises". www.hopkinsmedicine.org. Johns Hopkins Medicine. Retrieved 30 July 2020.
- Wang L, Wang Y, Ye D, Liu Q (March 2020). "Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence". International Journal of Antimicrobial Agents. 55 (6): 105948. doi:10.1016/j.ijantimicag.2020.105948. PMC 7156162. PMID 32201353. Archived from the original on 27 March 2020. Retrieved 27 March 2020.
- U.S. Centers for Disease Control and Prevention (5 April 2020). "What to Do if You Are Sick". Centers for Disease Control and Prevention (CDC). Archived from the original on 14 February 2020. Retrieved 24 April 2020.
- "Update to living WHO guideline on drugs for covid-19". BMJ (Clinical Research Ed.). 371: m4475. 19 November 2020. doi:10.1136/bmj.m4475. ISSN 1756-1833. PMID 33214213. S2CID 227059995.
- "Q&A: Dexamethasone and COVID-19". www.who.int. Retrieved 11 July 2020.
- "Home". National COVID-19 Clinical Evidence Taskforce. Retrieved 11 July 2020.
- "COVID-19 Treatment Guidelines". www.nih.gov. National Institutes of Health. Retrieved 18 January 2021.
- Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. (April 2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". The New England Journal of Medicine. Massachusetts Medical Society. 382 (18): 1708–1720. doi:10.1056/nejmoa2002032. PMC 7092819. PMID 32109013.
- Henry BM (April 2020). "COVID-19, ECMO, and lymphopenia: a word of caution". The Lancet. Respiratory Medicine. Elsevier BV. 8 (4): e24. doi:10.1016/s2213-2600(20)30119-3. PMC 7118650. PMID 32178774.
- Kim, Peter S.; Read, Sarah W.; Fauci, Anthony S. (1 December 2020). "Therapy for Early COVID-19". JAMA. American Medical Association (AMA). 324 (21): 2149. doi:10.1001/jama.2020.22813. ISSN 0098-7484.
- "COVID-19 Treatment Guidelines". www.nih.gov. National Institutes of Health. Retrieved 18 January 2021./
- Hsu, Jeremy (19 November 2020). "Covid-19: What now for remdesivir?". BMJ. BMJ: m4457. doi:10.1136/bmj.m4457. ISSN 1756-1833.
- Roser M, Ritchie H, Ortiz-Ospina E (4 March 2020). "Coronavirus Disease (COVID-19)". Our World in Data. Archived from the original on 19 March 2020. Retrieved 12 March 2020.
- Yanping Z, et al. (The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team) (February 2020). "The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) – China, 2020". China CDC Weekly. Chinese Center for Disease Control and Prevention. 2 (8): 113–122. doi:10.46234/ccdcw2020.032. Archived from the original on 19 February 2020. Retrieved 18 March 2020.
- 코로나바이러스감염증-19 국내 발생 현황(7월 17일, 정례브리핑) (Report) (in Korean). Korea Centers for Disease Control and Prevention. 17 July 2020. Retrieved 17 July 2020.
- Actualización nº 109. Enfermedad por el coronavirus (COVID-19) (PDF) (Report) (in Spanish). Ministerio de Sanidad, Consumo y Bienestar Social. 18 May 2020. Retrieved 20 May 2020.
- "Epidemia COVID-19 – Bollettino sorveglianza integrata COVID-19" (PDF) (in Italian). Istituto Superiore di Sanità. 5 June 2020. Retrieved 10 June 2020.
- Roser M, Ritchie H, Ortiz-Ospina E (6 April 2020). "Coronavirus Disease (COVID-19)". Our World in Data. Retrieved 6 April 2020.
- Doshi P (2020). "Will covid-19 vaccines save lives? Current trials aren't designed to tell us" (PDF). The BMJ. 371: m4037. doi:10.1136/bmj.m4037. PMID 33087398.
- Palmieri L, Andrianou X, Barbariol P, Bella A, Bellino S, Benelli E, et al. (22 July 2020). Characteristics of SARS-CoV-2 patients dying in Italy Report based on available data on July 22nd, 2020 (PDF) (Report). Istituto Superiore di Sanità. Retrieved 4 October 2020.
- Baranovskii, D. S.; Klabukov, I. D.; Krasilnikova, O. A.; Nikogosov, D. A.; Polekhina, N. V.; Baranovskaia, D. R.; Laberko, L. A. (November 2020). "Prolonged prothrombin time as an early prognostic indicator of severe acute respiratory distress syndrome in patients with COVID-19 related pneumonia". Current Medical Research and Opinion: 1–8. doi:10.1080/03007995.2020.1853510. ISSN 1473-4877. PMC 7738209. PMID 33210948. S2CID 227065216.
- Christensen, Bianca; Favaloro, Emmanuel J.; Lippi, Giuseppe; Van Cott, Elizabeth M. (October 2020). "Hematology Laboratory Abnormalities in Patients with Coronavirus Disease 2019 (COVID-19)". Seminars in Thrombosis and Hemostasis. 46 (7): 845–849. doi:10.1055/s-0040-1715458. ISSN 1098-9064. PMC 7645834. PMID 32877961.
- "Living with Covid19". NIHR Themed Reviews. National Institute for Health Research. 15 October 2020. doi:10.3310/themedreview_41169.
- "How long does COVID-19 last?". UK COVID Symptom Study. 6 June 2020. Retrieved 15 October 2020.
- "Summary of COVID-19 Long Term Health Effects: Emerging evidence and Ongoing Investigation" (PDF). University of Washington. 1 September 2020. Retrieved 15 October 2020.
- news.UN.org 30. Oktober 2020: Long-term symptoms of COVID-19 'really concerning', says WHO chief
- "Coronavirus disease 2019 (COVID-19) - Prognosis | BMJ Best Practice US". bestpractice.bmj.com. Retrieved 15 November 2020.
- Lavery, Amy M. (November 2020). "Characteristics of Hospitalized COVID-19 Patients Discharged and Experiencing Same-Hospital Readmission — United States, March–August 2020" (PDF). MMWR. Morbidity and Mortality Weekly Report. 69 (45): 1695–99. doi:10.15585/mmwr.mm6945e2. PMC 7660660. PMID 33180754.
- Vardavas CI, Nikitara K (March 2020). "COVID-19 and smoking: A systematic review of the evidence". Tobacco Induced Diseases. 18: 20. doi:10.18332/tid/119324. PMC 7083240. PMID 32206052.
- Engin AB, Engin ED, Engin A (August 2020). "Two important controversial risk factors in SARS-CoV-2 infection: Obesity and smoking". Environmental Toxicology and Pharmacology. 78: 103411. doi:10.1016/j.etap.2020.103411. PMC 7227557. PMID 32422280.
- "COVID-19: Who's at higher risk of serious symptoms?". Mayo Clinic.
- Tamara A, Tahapary DL (July 2020). "Obesity as a predictor for a poor prognosis of COVID-19: A systematic review". Diabetes & Metabolic Syndrome. 14 (4): 655–659. doi:10.1016/j.dsx.2020.05.020. PMC 7217103. PMID 32438328.
- Petrakis D, Margină D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, et al. (July 2020). "Obesity – a risk factor for increased COVID-19 prevalence, severity and lethality (Review)". Molecular Medicine Reports. 22 (1): 9–19. doi:10.3892/mmr.2020.11127. PMC 7248467. PMID 32377709.
- "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. 11 February 2020.
- Devresse A, Belkhir L, Vo B, Ghaye B, Scohy A, Kabamba B, et al. (November 2020). "COVID-19 Infection in Kidney Transplant Recipients: A Single-Center Case Series of 22 Cases From Belgium". Kidney Medicine. 2 (4): 459–466. doi:10.1016/j.xkme.2020.06.001. PMC 7295531. PMID 32775986.
- "Q & A on COVID-19: Basic facts". www.ecdc.europa.eu. 25 September 2020. Retrieved 8 October 2020.
- John Parkinson (25 June 2020). "Study: Majority of Children with COVID-19 Have Mild Disease, Mortality is Rare". ContagionLive.
- Wallis, Claudia. "One in Seven Dire COVID Cases May Result from a Faulty Immune Response". Scientific American.
- Bastard P, Rosen LB, Zhang Q, Michailidis E, Hoffmann HH, Zhang Y, et al. (October 2020). "Autoantibodies against type I IFNs in patients with life-threatening COVID-19". Science. 370 (6515): eabd4585. doi:10.1126/science.abd4585. PMID 32972996. S2CID 221914095.
- Fusco DN, Brisac C, John SP, Huang YW, Chin CR, Xie T, et al. (June 2013). "A genetic screen identifies interferon-α effector genes required to suppress hepatitis C virus replication". Gastroenterology. 144 (7): 1438–49, 1449.e1-9. doi:10.1053/j.gastro.2013.02.026. PMC 3665646. PMID 23462180.
- Fang L, Karakiulakis G, Roth M (April 2020). "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?". The Lancet. Respiratory Medicine. 8 (4): e21. doi:10.1016/S0140-6736(20)30311-1. PMC 7118626. PMID 32171062.
- "Coronavirus Disease 2019 (COVID-19)". U.S. Centers for Disease Control and Prevention (CDC). 11 February 2020. Archived from the original on 2 March 2020. Retrieved 2 March 2020.
- "Sala de Situación COVID-19 Nuevo Coronavirus 2019 Novedades al 07/05 - 18 hs- SE 19" (PDF) (in Spanish). 7 May 2020.
- Health, Australian Government Department of (4 June 2020). "COVID-19 cases by age group and sex". Australian Government Department of Health. Retrieved 4 June 2020. Health, Australian Government Department of (4 June 2020). "COVID-19 deaths by age group and sex". Australian Government Department of Health. Retrieved 4 June 2020.
- "Epidemiological summary of COVID-19 cases in Canada - Canada.ca". Public Health Agency of Canada. 3 December 2020. Retrieved 3 December 2020.
- "COVID-19 Alberta statistics". Government of Alberta.
- "British Columbia COVID-19 Daily Situation Report, June 3, 2020" (PDF). BC Centre for Disease Control.
- "Ontario COVID-19 Data Tool". Public Health Ontario.
- "Situation of the coronavirus (COVID-19) in Québec". www.quebec.ca.
- "22° informe epidemiológico COVID-19". Ministerio de Salud – Gobierno de Chile.
- Yanping Z, et al. (The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team) (17 February 2020). "The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19)—China, 2020". China CDC Weekly. Chinese Center for Disease Control and Prevention. 2 (8): 113–122. Archived from the original on 19 February 2020. Retrieved 18 March 2020.
- "Coronavirus Colombia". www.ins.gov.co.
- Overvågning af COVID-19 (Report) (in Danish). Statens Serum Institut. 4 June 2020. Retrieved 4 June 2020.
- "Confirmed coronavirus cases (COVID-19) in Finland". experience.arcgis.com. THL. "Tilannekatsaus koronaviruksesta - Infektiotaudit ja rokotukset - THL". Terveyden ja hyvinvoinnin laitos.
- "Coronavirus Disease 2019 (COVID-19) Daily Situation Report of the Robert Koch Institute 05/06/2020 - UPDATED STATUS FOR GERMANY" (PDF). Robert Koch Institute.
- "קורונה - משרד הבריאות". Ministry of Health (Israel). 3 May 2020. Retrieved 5 May 2020.
- "Integrated surveillance of COVID-19 in Italy" (PDF). Istituto Superiore di Sanità.
- "Coronavirus Disease (COVID-19) Situation Report in Japan". toyokeizai.net.
- COVID-19 Tablero México - CONACYT (Report) (in Spanish). Mexico City: CONACYT. 3 June 2020. Retrieved 4 June 2020.
- Epidemiologische situatie COVID-19 in Nederland 3 juni 2020 (Report) (in Dutch). Bilthoven: Rijksinstituut voor Volksgezondheid en Milie. 4 June 2020. Retrieved 4 June 2020.
- "Daily report and statistics about coronavirus and COVID-19". Folkehelseinstituttet. 1 December 2020. Retrieved 1 December 2020.
- "COVID-19 Tracker | Department of Health website". Doh.gov.ph. 4 June 2020. Retrieved 4 June 2020.
- "NOVO CORONAVÍRUS COVID-19 RELATÓRIO DE SITUAÇÃO" (PDF) (in Portuguese). 4 June 2020. Retrieved 4 June 2020.
- "Update on Covid-19 (28th May 2020)". sacoronavirus.co.za. 29 May 2020.
- The updates on COVID-19 in Korea as of 1 December (Report). Korea Centers for Disease Control and Prevention. 1 December 2020. Retrieved 1 December 2020.
- Actualización nº 120. Enfermedad por el coronavirus (COVID-19) (PDF) (Report) (in Spanish). Ministerio de Sanidad, Consumo y Bienestar Social. 29 May 2020. Retrieved 8 August 2020.
- "FOHM Covid-19". Public Health Agency of Sweden. 1 December 2020.
- "Todesfälle in der Schweiz nach Altersgruppen". datawrapper.dwcdn.net. 4 June 2020. Retrieved 4 June 2020.
- "Case data | Colorado COVID-19 Updates". covid19.colorado.gov.
- "COVID-19 confirmed cases and deaths by age group | Connecticut Data". data.ct.gov. 3 June 2020. Retrieved 4 June 2020.
- "Tableau Public". public.tableau.com.
- "COVID-19 Case Demographics - the Indiana Data Hub". hub.mph.in.gov.
- "KDPH COVID-19 Dashboard". Kygeonet.maps.arcgis.com. Retrieved 21 May 2020.
- https://coronavirus.maryland.gov Probable but not lab-confirmed deaths not included
- "COVID-19 Response Reporting". Mass.gov. 20 May 2020. Retrieved 20 May 2020.
- "Weekly COVID-19 Report 5/14/2020" (PDF). Minnesota Department of Health.
- "Coronavirus COVID-19 - Mississippi State Department of Health". msdh.ms.gov. 19 May 2020. Retrieved 20 May 2020.
- "Story Map Series". mophep.maps.arcgis.com.
- "Microsoft Power BI". app.powerbigov.us.
- "Microsoft Word - HAV Situation Report #6 07MAY19" (PDF). Retrieved 3 June 2020.
- "Oregon Health Authority | COVID-19 Updates". govstatus.egov.com.
- "Texas COVID-19 Data". Dshs.texas.gov. Retrieved 3 June 2020.
- "COVID-19 Cases in Virginia: Demographics". public.tableau.com. 20 May 2020. Retrieved 20 May 2020.
- "2019 Novel Coronavirus Outbreak (COVID-19)". Washington State Department of Health. 19 May 2020. Retrieved 20 May 2020.
- "COVID-19: Wisconsin Deaths". Wisconsin Department of Health Services. 17 April 2020.
- Murthy S, Gomersall CD, Fowler RA (March 2020). "Care for Critically Ill Patients With COVID-19". JAMA. 323 (15): 1499–1500. doi:10.1001/jama.2020.3633. PMID 32159735.
- Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R (2020). "Features, Evaluation and Treatment Coronavirus (COVID-19)". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32150360. Retrieved 18 March 2020.
- Heymann DL, Shindo N, et al. (WHO Scientific and Technical Advisory Group for Infectious Hazards) (February 2020). "COVID-19: what is next for public health?". Lancet. 395 (10224): 542–545. doi:10.1016/s0140-6736(20)30374-3. PMC 7138015. PMID 32061313.
- "COVID-19 (coronavirus): Long-term effects". Mayo Clinic.
- Various sources:
- Long B, Brady WJ, Koyfman A, Gottlieb M (July 2020). "Cardiovascular complications in COVID-19". The American Journal of Emergency Medicine. 38 (7): 1504–1507. doi:10.1016/j.ajem.2020.04.048. PMC 7165109. PMID 32317203.
- Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. (July 2020). "Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)". JAMA Cardiology. 5 (11): 1265–1273. doi:10.1001/jamacardio.2020.3557. PMC 7385689. PMID 32730619. Lay summary.
- Lindner D, Fitzek A, Bräuninger H, Aleshcheva G, Edler C, Meissner K, et al. (July 2020). "Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases". JAMA Cardiology. 5 (11): 1281–1285. doi:10.1001/jamacardio.2020.3551. PMC 7385672. PMID 32730555. Lay summary.
- Siripanthong, Bhurint (2020). "Recognizing COVID-19–related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management". Heart Rhythm. 17 (9): 1463–1471. doi:10.1016/j.hrthm.2020.05.001. PMC 7199677. PMID 32387246.
- Xu L, Liu J, Lu M, Yang D, Zheng X (May 2020). "Liver injury during highly pathogenic human coronavirus infections". Liver International. 40 (5): 998–1004. doi:10.1111/liv.14435. PMC 7228361. PMID 32170806.
- Carod-Artal FJ (May 2020). "Neurological complications of coronavirus and COVID-19". Revista de Neurologia. 70 (9): 311–322. doi:10.33588/rn.7009.2020179. PMID 32329044.
- Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. (June 2020). "Guillain-Barré Syndrome Associated with SARS-CoV-2". The New England Journal of Medicine. 382 (26): 2574–2576. doi:10.1056/NEJMc2009191. PMC 7182017. PMID 32302082.
- "Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19". World Health Organization (WHO). 15 May 2020. Retrieved 20 May 2020.
- HAN Archive – 00432. U.S. Centers for Disease Control and Prevention (CDC) (Report). 15 May 2020. Retrieved 20 May 2020.
- Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B (August 2020). "COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: Imaging Features". Radiology. 296 (2): E119–E120. doi:10.1148/radiol.2020201187. PMC 7233386. PMID 32228363.
- "How long does COVID-19 last?". UK COVID Symptom Study. 6 June 2020. Retrieved 15 October 2020.
- "Long-term symptoms of COVID-19 'really concerning', says WHO chief". news.UN.org. United Nations. 30 October 2020. Retrieved 15 November 2020.
- Immune responses and immunity to SARS-CoV-2, by European Centre for Disease Prevention and Control
- Vabret N, Britton GJ, Gruber C, Hegde S, Kim J, Kuksin M, et al. (June 2020). "Immunology of COVID-19: Current State of the Science". Immunity. 52 (6): 910–941. doi:10.1016/j.immuni.2020.05.002. PMC 7200337. PMID 32505227.
- Cohen JI, Burbelo PD (December 2020). "Reinfection with SARS-CoV-2: Implications for Vaccines". Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. doi:10.1093/cid/ciaa1866. PMID 33338197. S2CID 229323810.
- "What if immunity to covid-19 doesn't last?". MIT Technology Review. Retrieved 1 May 2020.
- Centers for Disease Control and Prevention (May 2012). "Lesson 3: Measures of Risk Section 3: Mortality Frequency Measures". Principles of Epidemiology in Public Health Practice (Third ed.). U.S. Centers for Disease Control and Prevention (CDC). No. SS1978. Archived from the original on 28 February 2020. Retrieved 28 March 2020.
- Ritchie H, Roser M (25 March 2020). Chivers T (ed.). "What do we know about the risk of dying from COVID-19?". Our World in Data. Archived from the original on 28 March 2020. Retrieved 28 March 2020.
- Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. (April 2020). "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review". JAMA Pediatrics. 174 (9): 882–889. doi:10.1001/jamapediatrics.2020.1467. PMID 32320004.
- Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. (April 2020). "SARS-CoV-2 Infection in Children". The New England Journal of Medicine. Massachusetts Medical Society. 382 (17): 1663–1665. doi:10.1056/nejmc2005073. PMC 7121177. PMID 32187458.
- Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S (June 2020). "Epidemiology of COVID-19 Among Children in China". Pediatrics. 145 (6): e20200702. doi:10.1542/peds.2020-0702. PMID 32179660. S2CID 219118986.
- Lazzerini M, Putoto G (May 2020). "COVID-19 in Italy: momentous decisions and many uncertainties". The Lancet. Global Health. 8 (5): e641–e642. doi:10.1016/S2214-109X(20)30110-8. PMC 7104294. PMID 32199072.
- "What do we know about the risk of dying from COVID-19?". Our World in Data. Archived from the original on 28 March 2020. Retrieved 28 March 2020.
- "Total confirmed cases of COVID-19 per million people". Our World in Data. Archived from the original on 19 March 2020. Retrieved 10 April 2020.[needs update]
- "Total confirmed deaths due to COVID-19 per million people". Our World in Data. Archived from the original on 19 March 2020. Retrieved 10 April 2020.[needs update]
- Mallapaty S (16 June 2020). "How deadly is the coronavirus? Scientists are close to an answer". Nature. 582 (7813): 467–468. Bibcode:2020Natur.582..467M. doi:10.1038/d41586-020-01738-2. PMID 32546810. S2CID 219726496.
- Alwan N, Burgess R, Ashworth S, Beale R, Bhadelia N, Bogaert D, Dowd J, Eckerle I, Goldman L, Greenhalgh T, Gurdasani D, Hamdy A, Hanage W, Hodcroft E, Hyde Z, Kellam P, Kelly-Irving M, Krammer F, Lipsitch M, McNally A, McKee M, Nouri A, Pimenta D, Priesemann V, Rutter H, Silver J, Sridhar D, Swanton C, Walensky R, Yamey G, Ziauddeen H (31 October 2020). "Scientific consensus on the COVID-19 pandemic: we need to act now". The Lancet. 396 (10260): E71–E72. doi:10.1016/S0140-6736(20)32153-X. PMC 7557300. PMID 33069277.
- Meyerowitz-Katz G, Merone L (December 2020). "A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates". International Journal of Infectious Diseases. 101: 138–148. doi:10.1016/j.ijid.2020.09.1464. PMC 7524446. PMID 33007452.
- Levin A, Hanage W, Owusu-Boaitey N, Cochran K, Walsh S, Meyerowitz-Katz G (December 2020). "Assessing the Age Specificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications". European Journal of Epidemiology. 35 (12): 1123–1138. doi:10.1007/s10654-020-00698-1. PMC 7721859. PMID 33289900. Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License.
- "Background paper on Covid-19 disease and vaccines: prepared by the Strategic Advisory Group of Experts (SAGE) on immunization working group on COVID-19 vaccines". World Health Organization. 22 December 2020. hdl:10665/338095.
- "Coronavirus disease 2019 (COVID-19) Situation Report – 30" (PDF). 19 February 2020. Retrieved 3 June 2020.
- "Coronavirus disease 2019 (COVID-19) Situation Report – 31" (PDF). 20 February 2020. Retrieved 23 April 2020.
- McNeil Jr., Donald G. (4 July 2020). "The Pandemic's Big Mystery: How Deadly Is the Coronavirus? – Even with more than 500,000 dead worldwide, scientists are struggling to learn how often the virus kills. Here's why". The New York Times. Retrieved 6 July 2020.
- "Global Research and Innovation Forum on COVID-19: Virtual Press Conference" (PDF). World Health Organization. 2 July 2020.
- "Estimating mortality from COVID-19". World Health Organization (WHO). Retrieved 21 September 2020.
- "COVID-19: Data". City of New York.
- Wilson, Linus (May 2020). "SARS-CoV-2, COVID-19, Infection Fatality Rate (IFR) Implied by the Serology, Antibody, Testing in New York City". SSRN 3590771.
- Yang W, Kandula S, Huynh M, Greene SK, Van Wye G, Li W, et al. (October 2020). "Estimating the infection-fatality risk of SARS-CoV-2 in New York City during the spring 2020 pandemic wave: a model-based analysis". The Lancet. Infectious Diseases. doi:10.1016/s1473-3099(20)30769-6. PMC 7572090. PMID 33091374.
- Modi C (21 April 2020). "How deadly is COVID-19? Data Science offers answers from Italy mortality data". Medium. Retrieved 23 April 2020.
- "Coronavirus Disease 2019 (COVID-19)". Centers for Disease Control and Prevention. 10 September 2020. Retrieved 9 December 2020.
- Wenham C, Smith J, Morgan R (March 2020). "COVID-19: the gendered impacts of the outbreak". Lancet. 395 (10227): 846–848. doi:10.1016/S0140-6736(20)30526-2. PMC 7124625. PMID 32151325.
- Epidemiology Working Group For Ncip Epidemic Response, Chinese Center for Disease Control Prevention (February 2020). "[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]". Zhonghua Liu Xing Bing Xue Za Zhi = Zhonghua Liuxingbingxue Zazhi (in Chamorro). 41 (2): 145–151. doi:10.3760/cma.j.issn.0254-6450.2020.02.003. PMID 32064853. S2CID 211133882.
- "The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19)". China CDC Weekly. 2 (8): 113–122. February 2020. doi:10.46234/ccdcw2020.032. ISSN 2096-7071. Retrieved 15 June 2020.
- Hu Y, Sun J, Dai Z, Deng H, Li X, Huang Q, et al. (June 2020). "Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis". Journal of Clinical Virology. 127: 104371. doi:10.1016/j.jcv.2020.104371. PMC 7195434. PMID 32315817.
- Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. (June 2020). "Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis". The Journal of Infection. 80 (6): 656–665. doi:10.1016/j.jinf.2020.03.041. PMC 7151416. PMID 32283155.
- Yuki K, Fujiogi M, Koutsogiannaki S (June 2020). "COVID-19 pathophysiology: A review". Clinical Immunology. 215: 108427. doi:10.1016/j.clim.2020.108427. PMC 7169933. PMID 32325252. S2CID 216028003.
- Rabin, Roni Caryn (20 March 2020). "In Italy, Coronavirus Takes a Higher Toll on Men". The New York Times. Retrieved 7 April 2020.
- "COVID-19 weekly surveillance report". World Health Organization (WHO). Retrieved 7 April 2020.
- Gupta, Alisha Haridasani (3 April 2020). "Does Covid-19 Hit Women and Men Differently? U.S. Isn't Keeping Track". The New York Times. Retrieved 7 April 2020.