Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019.[5] The disease quickly spread worldwide, resulting in the COVID-19 pandemic.
| Coronavirus disease 2019 (COVID-19) |
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| Other names | COVID, (the) coronavirus |
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Transmission and life-cycle of SARS-CoV-2, which causes COVID-19 |
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| Pronunciation |
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| Specialty | Infectious disease |
| Symptoms | Fever, cough, fatigue, shortness of breath, vomiting, loss of taste or smell; some cases asymptomatic[2][3] |
| Complications | Pneumonia, sepsis, ARDS, kidney failure, respiratory failure, pulmonary fibrosis, CKS, MIS-C, long COVID |
| Usual onset | 2–14 days (typically 5) after infection |
| Duration | 5 days to chronic |
| Causes | SARS-CoV-2 |
| Diagnostic method | RT‑PCR testing, CT scan, rapid antigen test |
| Prevention | Vaccination, face coverings, quarantine, social distancing, ventilation, hand washing |
| Treatment | Symptomatic and supportive |
| Frequency | 676,609,955[4] cases |
| Deaths | 6,881,955[4] |
The symptoms of COVID‑19 are variable but often include fever,[6] cough, headache,[7] fatigue, breathing difficulties, loss of smell, and loss of taste.[8][9][10] Symptoms may begin one to fourteen days after exposure to the virus. At least a third of people who are infected do not develop noticeable symptoms.[11] Of those who develop symptoms noticeable enough to be classified as patients, most (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% develop critical symptoms (respiratory failure, shock, or multiorgan dysfunction).[12] Older people are at a higher risk of developing severe symptoms. Some people continue to experience a range of effects (long COVID) for months after recovery, and damage to organs has been observed.[13] Multi-year studies are underway to further investigate the long-term effects of the disease.[13]
COVID‑19 transmits when infectious particles are breathed in or come into contact with the eyes, nose, or mouth. The risk is highest when people are in close proximity, but small airborne particles containing the virus can remain suspended in the air and travel over longer distances, particularly indoors. Transmission can also occur when people touch their eyes, nose or mouth after touching surfaces or objects that have been contaminated by the virus. People remain contagious for up to 20 days and can spread the virus even if they do not develop symptoms.[14]
Testing methods for COVID-19 to detect the virus’s nucleic acid include real-time reverse transcription polymerase chain reaction (RT‑PCR),[15][16] transcription-mediated amplification,[15][16][17] and reverse transcription loop-mediated isothermal amplification (RT‑LAMP)[15][16] from a nasopharyngeal swab.[18]
Several COVID-19 vaccines have been approved and distributed in various countries, which have initiated mass vaccination campaigns. Other preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, use of face masks or coverings in public, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. While work is underway to develop drugs that inhibit the virus, the primary treatment is symptomatic. Management involves the treatment of symptoms through supportive care, isolation, and experimental measures.
Nomenclature
During the initial outbreak in Wuhan, the virus and disease were commonly referred to as «coronavirus» and «Wuhan coronavirus»,[19][20][21] with the disease sometimes called «Wuhan pneumonia».[22][23] In the past, many diseases have been named after geographical locations, such as the Spanish flu,[24] Middle East respiratory syndrome, and Zika virus.[25] In January 2020, the World Health Organization (WHO) recommended 2019-nCoV[26] and 2019-nCoV acute respiratory disease[27] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations or groups of people in disease and virus names to prevent social stigma.[28][29][30] The official names COVID‑19 and SARS-CoV-2 were issued by the WHO on 11 February 2020 with COVID-19 being shorthand for «coronavirus disease 2019».[31][32] The WHO additionally uses «the COVID‑19 virus» and «the virus responsible for COVID‑19» in public communications.[31][33]
Symptoms and signs
The symptoms of COVID-19 are variable depending on the type of variant contracted, ranging from mild symptoms to a potentially fatal illness.[34][35] Common symptoms include coughing, fever, loss of smell (anosmia) and taste (ageusia), with less common ones including headaches, nasal congestion and runny nose, muscle pain, sore throat, diarrhea, eye irritation,[36] and toes swelling or turning purple,[37] and in moderate to severe cases, breathing difficulties.[38] People with the COVID-19 infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; and a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea.[38] In people without prior ear, nose, or throat disorders, loss of taste combined with loss of smell is associated with COVID-19 and is reported in as many as 88% of symptomatic cases.[39][40][41]
Of people who show symptoms, 81% develop only mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) that require hospitalization, and 5% of patients develop critical symptoms (respiratory failure, septic shock, or multiorgan dysfunction) requiring ICU admission.[42][needs update] At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time.[43][44] These asymptomatic carriers tend not to get tested and can still spread the disease.[44][45][46][47] Other infected people will develop symptoms later (called «pre-symptomatic») or have very mild symptoms and can also spread the virus.[47]
As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days[48] possibly being infectious on 1-4 of those days.[49] Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.[48][50]
Most people recover from the acute phase of the disease. However, some people—over half of a cohort of home-isolated young adults identified in June 2021[51][52] continued to experience a range of effects, such as fatigue, for months even after recovery. This is the result of a condition called long COVID, which can be described as a range of persistent symptoms that continue for weeks or months at a time.[53] Long-term damage to organs has also been observed after the onset of COVID-19. Multi-year studies are underway to further investigate the potential long-term effects of the disease.[54]
The Omicron variant became dominant in the U.S. in December 2021. Symptoms with the Omicron variant are less severe than they are with other variants.[55]
Complications
Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death.[56][57][58][59] Cardiovascular complications may include heart failure, arrhythmias (including atrial fibrillation), heart inflammation, and thrombosis, particularly venous thromboembolism.[60][61][62][63][64][65] Approximately 20–30% of people who present with COVID‑19 have elevated liver enzymes, reflecting liver injury.[66][67]
Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions).[68][69] Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal.[70][71] 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.[72]
According to the US Centers for Disease Control and Prevention, pregnant women are at increased risk of becoming seriously ill from COVID‑19.[73] This is because pregnant women with COVID‑19 appear to be more likely to develop respiratory and obstetric complications that can lead to miscarriage, premature delivery and intrauterine growth restriction.[73]
Fungal infections such as aspergillosis, candidiasis, cryptococcosis and mucormycosis have been recorded in patients recovering from COVID‑19.[74][75]
Cause
COVID‑19 is caused by infection with a strain of coronavirus known as ‘Severe Acute Respiratory Syndrome coronavirus 2’ (SARS-CoV-2).[76]
Transmission
COVID-19 is mainly transmitted when people breathe in air contaminated by droplets/aerosols and small airborne particles containing the virus. Infected people exhale those particles as they breathe, talk, cough, sneeze, or sing.[77][78][79][80] Transmission is more likely the more physically close people are. However, infection can occur over longer distances, particularly indoors.[77][81]
Infectivity can begin four to five days before the onset of symptoms,[82] although contact tracing typically begins only two to three days before symptom onset.[83] Infected people can spread the disease even if they are pre-symptomatic or asymptomatic.[83] Most commonly, the peak viral load in upper respiratory tract samples occurs close to the time of symptom onset and declines after the first week after symptoms begin.[83] Current evidence suggests a duration of viral shedding and the period of infectiousness of up to ten days following symptom onset for people with mild to moderate COVID-19, and up to 20 days for persons with severe COVID-19, including immunocompromised people.[84][83]
Infectious particles range in size from aerosols that remain suspended in the air for long periods of time to larger droplets that remain airborne briefly or fall to the ground.[85][86][87][88] Additionally, COVID-19 research has redefined the traditional understanding of how respiratory viruses are transmitted.[88][89] The largest droplets of respiratory fluid do not travel far, but can be inhaled or land on mucous membranes on the eyes, nose, or mouth to infect.[87] Aerosols are highest in concentration when people are in close proximity, which leads to easier viral transmission when people are physically close,[87][88][89] but airborne transmission can occur at longer distances, mainly in locations that are poorly ventilated;[87] in those conditions small particles can remain suspended in the air for minutes to hours.[87][90]
The number of people generally infected by one infected person varies,[91] but it is estimated that the R0 («R nought» or «R zero») number is around 2.5.[92] The disease often spreads in clusters, where infections can be traced back to an index case or geographical location.[93] Often in these instances, superspreading events occur, where many people are infected by one person.[91]
Virology
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.[94] All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature,[95] particularly in Rhinolophus sinicus aka Chinese horseshoe bats.[96]
Outside the human body, the virus is destroyed by household soap which bursts its protective bubble.[97] Hospital disinfectants, alcohols, heat, povidone-iodine, and ultraviolet-C (UV-C) irradiation are also effective disinfection methods for surfaces.[98]
SARS-CoV-2 is closely related to the original SARS-CoV.[99] 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).[100][101][102] 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 about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV.[103]
SARS-CoV-2 variants
The many thousands of SARS-CoV-2 variants are grouped into either clades or lineages.[104][105] The WHO, in collaboration with partners, expert networks, national authorities, institutions and researchers, have established nomenclature systems for naming and tracking SARS-CoV-2 genetic lineages by GISAID, Nextstrain and Pango. The expert group convened by the WHO recommended the labelling of variants using letters of the Greek alphabet, for example, Alpha, Beta, Delta, and Gamma, giving the justification that they «will be easier and more practical to discussed by non-scientific audiences.»[106] Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).[107] The Pango tool groups variants into lineages, with many circulating lineages being classed under the B.1 lineage.[105][108]
Several notable variants of SARS-CoV-2 emerged throughout 2020.[109][110] Cluster 5 emerged among minks and mink farmers in Denmark.[111] After strict quarantines and a mink euthanasia campaign, the cluster was assessed to no longer be circulating among humans in Denmark as of 1 February 2021.[112]
As of December 2021, there are five dominant variants of SARS-CoV-2 spreading among global populations: the Alpha variant (B.1.1.7, formerly called the UK variant), first found in London and Kent, the Beta variant (B.1.351, formerly called the South Africa variant), the Gamma variant (P.1, formerly called the Brazil variant), the Delta variant (B.1.617.2, formerly called the India variant),[113] and the Omicron variant (B.1.1.529), which had spread to 57 countries as of 7 December.[114][115]
Pathophysiology
The SARS-CoV-2 virus can infect a wide range of cells and systems of the body. COVID‑19 is most known for affecting the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs).[116] The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the receptor for the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant on the surface of type II alveolar cells of the lungs.[117] The virus uses a special surface glycoprotein called a «spike» to connect to the ACE2 receptor and enter the host cell.[118]
Respiratory tract
Following viral entry, COVID‑19 infects the ciliated epithelium of the nasopharynx and upper airways.[119]
Nervous system
One common symptom, loss of smell, results from infection of the support cells of the olfactory epithelium, with subsequent damage to the olfactory neurons.[120] The involvement of both the central and peripheral nervous system in COVID‑19 has been reported in many medical publications.[121] It is clear that many people with COVID-19 exhibit neurological or mental health issues. The virus is not detected in the central nervous system (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 those who have died from COVID‑19, but these results need to be confirmed.[122] 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.[123][124][125] 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.[122]
Research conducted when Alpha was the dominant variant has suggested COVID-19 may cause brain damage. It is unknown if such damage is temporary or permanent, and whether Omicron has similar effects.[126][127] Observed individuals infected with COVID-19 (most with mild cases) experienced an additional 0.2% to 2% of brain tissue lost in regions of the brain connected to the sense of smell compared with uninfected individuals, and the overall effect on the brain was equivalent on average to at least one extra year of normal ageing; infected individuals also scored lower on several cognitive tests. All effects were more pronounced among older ages.[128]
Gastrointestinal tract
The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium[129] as well as endothelial cells and enterocytes of the small intestine.[130]
Cardiovascular system
The virus can cause acute myocardial injury and chronic damage to the cardiovascular system.[131][132] An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China,[133] and is more frequent in severe disease.[134] 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.[132] ACE2 receptors are highly expressed in the heart and are involved in heart function.[132][135]
A high incidence of thrombosis and venous thromboembolism occurs in people transferred to intensive care units with COVID‑19 infections, and may be related to poor prognosis.[136] Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) may have a significant role in mortality, incidents of clots leading to pulmonary embolisms, and ischaemic events (strokes) within the brain found as complications leading to death in people infected with COVID‑19.[137] Infection may initiate a chain of vasoconstrictive responses within the body, including pulmonary vasoconstriction – a possible mechanism in which oxygenation decreases during pneumonia.[137] Furthermore, damage of arterioles and capillaries was found in brain tissue samples of people who died from COVID‑19.[138][139]
COVID‑19 may also cause substantial structural changes to blood cells, sometimes persisting for months after hospital discharge.[140] A low level of blood lymphocytes may result from the virus acting through ACE2-related entry into lymphocytes.[141]
Other organs
Another common cause of death is complications related to the kidneys.[137] Early reports show that up to 30% of hospitalised patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.[142]
Autopsies of people who died of COVID‑19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.[143]
Immunopathology
Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people 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 gamma-induced protein 10 (IP‑10), monocyte chemoattractant protein 1 (MCP1), macrophage inflammatory protein 1‑alpha (MIP‑1‑alpha), and tumour necrosis factor (TNF‑α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.[133]
Interferon alpha plays a complex, Janus-faced role in the pathogenesis of COVID-19. Although it promotes the elimination of virus-infected cells, it also upregulates the expression of ACE-2, thereby facilitating the SARS-Cov2 virus to enter cells and to replicate.[144][145] A competition of negative feedback loops (via protective effects of interferon alpha) and positive feedback loops (via upregulation of ACE-2) is assumed to determine the fate of patients suffering from COVID-19.[146]
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.[147]
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 people with COVID‑19.[148] Lymphocytic infiltrates have also been reported at autopsy.[143]
Viral and host factors
Virus proteins
Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus-host range and cellular tropism via the receptor-binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID‑19 vaccines.[149]
The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope.[150] The N and E protein are accessory proteins that interfere with the host’s immune response.[150]
Host factors
Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-CoV-2 virus targets causing COVID‑19. Theoretically, the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID‑19, though animal data suggest some potential protective effect of ARB; however no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.[151]
The effect of the virus on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.[152]
Among healthy adults not exposed to SARS-CoV-2, about 35% have CD4+ T cells that recognise the SARS-CoV-2 S protein (particularly the S2 subunit) and about 50% react to other proteins of the virus, suggesting cross-reactivity from previous common colds caused by other coronaviruses.[153]
It is unknown whether different persons use similar antibody genes in response to COVID‑19.[154]
Host cytokine response
The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm.[155] Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID‑19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID‑19 disease.[156]
A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID‑19, it is related to worse prognosis and increased fatality. The storm causes acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.[157]
Pregnancy response
There are many unknowns for pregnant women during the COVID-19 pandemic. Given that they are prone to have complications and severe disease infection with other types of coronaviruses, they have been identified as a vulnerable group and advised to take supplementary preventive measures.[158]
Physiological responses to pregnancy can include:
- Immunological: The immunological response to COVID-19, like other viruses, depends on a working immune system. It adapts during pregnancy to allow the development of the foetus whose genetic load is only partially shared with their mother, leading to a different immunological reaction to infections during the course of pregnancy.[158]
- Respiratory: Many factors can make pregnant women more vulnerable to hard respiratory infections. One of them is the total reduction of the lungs’ capacity and inability to clear secretions.[158]
- Coagulation: During pregnancy, there are higher levels of circulating coagulation factors, and the pathogenesis of SARS-CoV-2 infection can be implicated. The thromboembolic events with associated mortality are a risk for pregnant women.[158]
However, from the evidence base, it is difficult to conclude whether pregnant women are at increased risk of grave consequences of this virus.[158]
In addition to the above, other clinical studies have proved that SARS-CoV-2 can affect the period of pregnancy in different ways. On the one hand, there is little evidence of its impact up to 12 weeks gestation. On the other hand, COVID-19 infection may cause increased rates of unfavourable outcomes in the course of the pregnancy. Some examples of these could be foetal growth restriction, preterm birth, and perinatal mortality, which refers to the foetal death past 22 or 28 completed weeks of pregnancy as well as the death among live-born children up to seven completed days of life.[158] For preterm birth, a 2023 review indicates that there appears to be a correlation with COVID-19.[159]
Unvaccinated women in later stages of pregnancy with COVID-19 are more likely than other patients to need very intensive care. Babies born to mothers with COVID-19 are more likely to have breathing problems. Pregnant women are strongly encouraged to get vaccinated.[160]
Diagnosis
COVID‑19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions.[18][161] Along with laboratory testing, chest CT scans may be helpful to diagnose COVID‑19 in individuals with a high clinical suspicion of infection.[162] Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.[18]
Viral testing
The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests,[18][163] which detects the presence of viral RNA fragments.[164] As these tests detect RNA but not infectious virus, its «ability to determine duration of infectivity of patients is limited.»[165] The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used.[166][167] Results are generally available within hours.[18] The WHO has published several testing protocols for the disease.[168]
Several 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.[169]
The University of Oxford’s CEBM has pointed to mounting evidence[170][171] 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»[172] In September 2020, 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».[173]
Imaging
A CT scan of a person with COVID-19 shows lesions (bright regions) in the lungs
CT scan of rapid progression stage of COVID-19
Chest X-ray showing COVID‑19 pneumonia
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.[162][174] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection.[162][175] Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses.[162][176] Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.[177]
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.[178] Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID‑19.[177] 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.[161]
Coding
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.[179]
Pathology
The main pathological findings at autopsy are:
- Macroscopy: pericarditis, lung consolidation and pulmonary oedema[143]
- Lung findings:
- minor serous exudation, minor fibrin exudation[143]
- pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation[143]
- diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxaemia.[143]
- organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis[143]
- plasmocytosis in BAL[180]
- Blood and vessels: disseminated intravascular coagulation (DIC);[181] leukoerythroblastic reaction,[182] endotheliitis,[183] hemophagocytosis[183]
- Heart: cardiac muscle cell necrosis[183]
- Liver: microvesicular steatosis[143]
- Nose: shedding of olfactory epithelium[120]
- Brain: infarction[183]
- Kidneys: acute tubular damage.[183]
- Spleen: white pulp depletion.[183]
Prevention
Without pandemic containment measures – such as social distancing, vaccination, and face masks – pathogens can spread exponentially.[184] This graphic shows how early adoption of containment measures tends to protect wider swaths of the population.
Preventive measures to reduce the chances of infection include getting vaccinated, staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, managing potential exposure durations,[185] washing hands with soap and water often and for at least twenty seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.[186][187]
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.[188][189]
The first COVID‑19 vaccine was granted regulatory approval on 2 December 2020 by the UK medicines regulator MHRA.[190] It was evaluated for emergency use authorisation (EUA) status by the US FDA, and in several other countries.[191] 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.[192][67] 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».[193] This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of active cases, and delaying additional cases until effective treatments or a vaccine become available.[193][194]
Vaccine
Different vaccine candidate types in development for SARS-CoV-2
Face masks and respiratory hygiene
Masks with an exhalation valve. The valves are a weak point that can transmit the viruses outwards.
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.[195][196] 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.[196][197] Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing.[196][197] A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection.[198] However, if the mask includes an exhalation valve, a wearer that is infected (and possibly asymptomatic) may transmit the virus through the valve. 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.[199]
Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease.[200] 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 people who have COVID‑19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.[201]
Indoor ventilation and avoiding crowded indoor spaces
The CDC recommends that crowded indoor spaces should be avoided.[202] When indoors, increasing the rate of air change, decreasing recirculation of air and increasing the use of outdoor air can reduce transmission.[202][203] The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.[204][205][206]
Exhaled respiratory particles can build-up within enclosed spaces with inadequate ventilation. The risk of COVID‑19 infection increases especially in spaces where people engage in physical exertion or raise their voice (e.g., exercising, shouting, singing) as this increases exhalation of respiratory droplets. Prolonged exposure to these conditions, typically more than 15 minutes, leads to higher risk of infection.[202]
Displacement ventilation with large natural inlets can move stale air directly to the exhaust in laminar flow while significantly reducing the concentration of droplets and particles. Passive ventilation reduces energy consumption and maintenance costs but may lack controllability and heat recovery. Displacement ventilation can also be achieved mechanically with higher energy and maintenance costs. The use of large ducts and openings helps to prevent mixing in closed environments. Recirculation and mixing should be avoided because recirculation prevents dilution of harmful particles and redistributes possibly contaminated air, and mixing increases the concentration and range of infectious particles and keeps larger particles in the air.[207]
Hand-washing and hygiene
Thorough hand hygiene after any cough or sneeze is required.[208] The WHO also recommends that individuals wash hands often with soap and water for at least twenty seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one’s nose.[209] When soap and water are not available, the CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol.[210] 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.[211]
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.[212] Many governments are mandating or recommending social distancing in regions affected by the outbreak.[213]
Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing.[214][215] In the United States, the prisoner population is ageing 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.[214]
Surface cleaning
After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body and cause infection.[216] Evidence indicates that contact with infected surfaces is not the main driver of COVID‑19,[217][218][219] leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes.[220][221] Deep cleaning and other surface sanitation has been criticised as hygiene theatre, giving a false sense of security against something primarily spread through the air.[222][223]
The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity.[224] Coronaviruses die very quickly when exposed to the UV light in sunlight.[224] Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).[224]
On many surfaces, including glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions.[224][225] On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours.[224] The virus dies faster on porous surfaces than on non-porous surfaces due to capillary action within pores and faster aerosol droplet evaporation.[226][219][224] However, of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.[224]
The CDC says that in most situations, cleaning surfaces with soap or detergent, not disinfecting, is enough to reduce risk of transmission.[227][228] 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 ATMs used by the ill persons should be disinfected.[229] Surfaces may be decontaminated with 62–71 per cent ethanol, 50–100 per cent isopropanol, 0.1 per cent sodium hypochlorite, 0.5 per cent hydrogen peroxide, 0.2–7.5 per cent povidone-iodine, or 50–200 ppm hypochlorous acid. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used,[204] although popular devices require 5–10 min exposure and may deteriorate some materials over time.[230] A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inoculum volumes) can be seen in the supplementary material of.[220]
Self-isolation
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.[231] 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.[232] 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.[233]
A 2021 Cochrane rapid review found that based upon low-certainty evidence, international travel-related control measures such as restricting cross-border travel may help to contain the spread of COVID‑19.[234] Additionally, symptom/exposure-based screening measures at borders may miss many positive cases.[234] While test-based border screening measures may be more effective, it could also miss many positive cases if only conducted upon arrival without follow-up. The review concluded that a minimum 10-day quarantine may be beneficial in preventing the spread of COVID‑19 and may be more effective if combined with an additional control measure like border screening.[234]
Treatment
An overview of COVID-19 therapeutics and drugs
Although several medications have been approved in different countries as of April 2022, not all countries have these medications. Patients with mild to moderate symptoms who are in the risk groups can take nirmatrelvir/ritonavir (marketed as Paxlovid) or remdesivir, either of which reduces the risk of serious illness or hospitalization.[235] In the US, the Biden Administration COVID-19 action plan includes the Test to Treat initiative, where people can go to a pharmacy, take a COVID test, and immediately receive free Paxlovid if they test positive.[236]
Highly effective vaccines have reduced mortality related to SARS-CoV-2; however, for those awaiting vaccination, as well as for the estimated millions of immunocompromised persons who are unlikely to respond robustly to vaccination, treatment remains important.[237] The cornerstone of management of COVID-19 has been 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.[238][239][240]
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.[241][242][243][244] Good personal hygiene and a healthy diet are also recommended.[245] As of April 2020 the U.S. Centers for Disease Control and Prevention (CDC) recommended that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.[246]
As of November 2020 use of the glucocorticoid dexamethasone had been strongly recommended in those severe cases treated in hospital with low oxygen levels, to reduce the risk of death.[247][248][249] Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing.[250] Extracorporeal membrane oxygenation (ECMO) has been used to address respiratory failure, but its benefits are still under consideration.[251][252] Some of the cases of severe disease course are caused by systemic hyper-inflammation, the so-called cytokine storm.[253]
Prognosis and risk factors
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 hospitalisation.[254] 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.[100] 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.[255] Abnormal sodium levels during hospitalisation with COVID-19 are associated with poor prognoses: high sodium with a greater risk of death, and low sodium with an increased chance of needing ventilator support.[256][257] 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.[258][259]
Some early studies suggest 10% to 20% of people with COVID‑19 will experience symptoms lasting longer than a month.[260][261] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath.[262] On 30 October 2020, WHO chief Tedros Adhanom 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 therefore concluded that a strategy of achieving herd immunity by infection, rather than vaccination, is «morally unconscionable and unfeasible».[263]
In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within two months of discharge. The average to readmit was eight 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.[264][265]
According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers.[266][267] Acting on the same ACE2 pulmonary receptors affected by smoking, air pollution has been correlated with the disease.[267] Short term[268] and chronic[269] exposure to air pollution seems to enhance morbidity and mortality from COVID‑19.[270][271][272] Pre-existing heart and lung diseases[273] and also obesity, especially in conjunction with fatty liver disease, contributes to an increased health risk of COVID‑19.[267][274][275][276]
It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2.[277] One research study that looked into the COVID‑19 infections in hospitalised kidney transplant recipients found a mortality rate of 11%.[278]
Men with untreated hypogonadism were 2.4 times more likely than men with eugonadism to be hospitalised if they contracted COVID-19; Hypogonad men treated with testosterone were less likely to be hospitalised for COVID-19 than men who were not treated for hypogonadism.[279]
Genetic risk factors
Genetics plays an important role in the ability to fight off Covid.[280] For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID‑19.[281][282] Genetic screening is able to detect interferon effector genes.[283] Some genetic variants are risk factors in specific populations. For instance, and allele of the DOCK2 gene (dedicator of cytokinesis 2 gene) is a common risk factor in Asian populations but much less common in Europe. The mutation leads to lower expression of DOCK2 especially in younger patients with severe Covid.[284] In fact, many other genes and genetic variants have been found that determine the outcome of SARS-CoV-2 infections.[285]
Children
While very young children have experienced lower rates of infection, older children have a rate of infection that is similar to the population as a whole.[286][287] Children are likely to have milder symptoms and are at lower risk of severe disease than adults.[288] The CDC reports that in the US roughly a third of hospitalised children were admitted to the ICU,[289] while a European multinational study of hospitalised children from June 2020, found that about 8% of children admitted to a hospital needed intensive care.[290] Four of the 582 children (0.7%) in the European study died, but the actual mortality rate may be «substantially lower» since milder cases that did not seek medical help were not included in the study.[291][292]
Longer-term effects
Some early studies suggest that 10–20% of people with COVID‑19 will experience symptoms lasting longer than a month.[293][261] A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath.[294] About 5–10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.[295]
By a variety of mechanisms, the lungs are the organs most affected in COVID‑19.[296] In people requiring hospital admission, up to 98% of CT scans performed show lung abnormalities after 28 days of illness even if they had clinically improved.[297]
People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long-lasting effects, including pulmonary fibrosis.[298] Overall, approximately one-third of those investigated after four weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in asymptomatic people, but with the suggestion of continuing improvement with the passing of more time.[296] After severe disease, lung function can take anywhere from three months to a year or more to return to previous levels.[299]
The risks of cognitive deficit, dementia, psychotic disorders, and epilepsy or seizures persists at an increased level two years after infection.[300]
Immunity
The immune response by humans to SARS-CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production,[301] just as with most other infections.[302] B cells interact with T cells and begin dividing before selection into the plasma cell, partly on the basis of their affinity for antigen.[303] 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.[304] The presence of neutralising antibodies in blood strongly correlates with protection from infection, but the level of neutralising antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralising antibody two months after infection. In another study, the level of neutralising antibodies fell four-fold one to four months after the onset of symptoms. However, the lack of antibodies in the blood does not mean antibodies 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 six months after the appearance of symptoms.[304]
As of August 2021, reinfection with COVID‑19 was possible but uncommon. The first case of reinfection was documented in August 2020.[305] A systematic review found 17 cases of confirmed reinfection in medical literature as of May 2021.[305] With the Omicron variant, as of 2022, reinfections have become common, albeit it is unclear how common.[306] COVID-19 reinfections are thought to likely be less severe than primary infections, especially if one was previously infected by the same variant.[306][additional citation(s) needed]
Mortality
Several measures are commonly used to quantify mortality.[307] 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.[308]
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.[309][310][311] In fact, one relevant factor of mortality rates is the age structure of the countries’ populations. For example, the case fatality rate for COVID‑19 is lower in India than in the US since India’s younger population represents a larger percentage than in the US.[312]
Case fatality rate
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 1.02% (6,881,955/676,609,955) as of 10 March 2023.[4] The number varies by region.[313][314]
-
Total confirmed cases over time
-
Total confirmed cases of COVID‑19 per million people[315]
-
Total confirmed deaths over time
-
Total confirmed deaths due to COVID‑19 per million people[316]
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.[317][318][319] 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.[320]
Estimates
The red line shows the estimate of infection fatality rate (IFR), in percentage terms, as a function of age. The shaded region depicts the 95% confidence interval for that estimate. Markers denotes specific observations used in the meta-analysis.[321]
The same relationship plotted on a log scale
A December 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.[321] 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.[321] These results were also highlighted in a December 2020 report issued by the WHO.[322]
| Age group | IFR |
|---|---|
| 0–34 | 0.004% |
| 35–44 | 0.068% |
| 45–54 | 0.23% |
| 55–64 | 0.75% |
| 65–74 | 2.5% |
| 75–84 | 8.5% |
| 85 + | 28.3% |
An analysis of those IFR rates indicates that COVID‑19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate of COVID-19 is two orders of magnitude greater than the annualised risk of a fatal automobile accident and far more dangerous than seasonal influenza.[321]
Earlier estimates of IFR
At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[323][324] 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%.[325][326] In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%.[327] 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. (After sufficient time however, people can get reinfected).[328] 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).[329] Antibody testing in New York City suggested an IFR of ≈0.9%,[330] and ≈1.4%.[331] In Bergamo province, 0.6% of the population has died.[332] In September 2020, the U.S. Centers for Disease Control and Prevention (CDC) reported preliminary estimates of age-specific IFRs for public health planning purposes.[333]
Sex differences
| Percentage of infected people who are hospitalised | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 0–19 | 20–29 | 30–39 | 40–49 | 50–59 | 60–69 | 70–79 | 80+ | Total | |
| Female | 0.1 (0.07–0.2) |
0.5 (0.3–0.8) |
0.9 (0.5–1.5) |
1.3 (0.7–2.1) |
2.6 (1.5–4.2) |
5.1 (2.9–8.3) |
7.8 (4.4–12.8) |
19.3 (10.9–31.6) |
2.6 (1.5–4.3) |
| Male | 0.2 (0.08–0.2) |
0.6 (0.3–0.9) |
1.2 (0.7–1.9) |
1.6 (0.9–2.6) |
3.2 (1.8–5.2) |
6.7 (3.7–10.9) |
11.0 (6.2–17.9) |
37.6 (21.1–61.3) |
3.3 (1.8–5.3) |
| Total | 0.1 (0.08–0.2) |
0.5 (0.3–0.8) |
1.1 (0.6–1.7) |
1.4 (0.8–2.3) |
2.9 (1.6–4.7) |
5.8 (3.3–9.5) |
9.3 (5.2–15.1) |
26.2 (14.8–42.7) |
2.9 (1.7–4.8) |
| Percentage of hospitalised people who go to Intensive Care Unit | |||||||||
| 0–19 | 20–29 | 30–39 | 40–49 | 50–59 | 60–69 | 70–79 | 80+ | Total | |
| Female | 16.7 (14.3–19.3) |
8.7 (7.5–9.9) |
11.9 (10.9–13.0) |
16.6 (15.6–17.7) |
20.7 (19.8–21.6) |
23.1 (22.2–24.0) |
18.7 (18.0–19.5) |
4.2 (4.0–4.5) |
14.3 (13.9–14.7) |
| Male | 26.9 (23.1–31.1) |
14.0 (12.2–16.0) |
19.2 (17.6–20.9) |
26.9 (25.4–28.4) |
33.4 (32.0–34.8) |
37.3 (36.0–38.6) |
30.2 (29.1–31.3) |
6.8 (6.5–7.2) |
23.1 (22.6–23.6) |
| Total | 22.2 (19.1–25.7) |
11.6 (10.1–13.2) |
15.9 (14.5–17.3) |
22.2 (21.0–23.5) |
27.6 (26.5–28.7) |
30.8 (29.8–31.8) |
24.9 (24.1–25.8) |
5.6 (5.3–5.9) |
19.0 (18.7–19.44) |
| Percent of hospitalised people who die | |||||||||
| 0–19 | 20–29 | 30–39 | 40–49 | 50–59 | 60–69 | 70–79 | 80+ | Total | |
| Female | 0.5 (0.2–1.0) |
0.9 (0.5–1.3) |
1.5 (1.2–1.9) |
2.6 (2.3–3.0) |
5.2 (4.8–5.6) |
10.1 (9.5–10.6) |
16.7 (16.0–17.4) |
25.2 (24.4–26.0) |
14.4 (14.0–14.8) |
| Male | 0.7 (0.3–1.5) |
1.3 (0.8–1.9) |
2.2 (1.7–2.7) |
3.8 (3.3–4.4) |
7.6 (7.0–8.2) |
14.8 (14.1–15.6) |
24.6 (23.7–25.6) |
37.1 (36.1–38.2) |
21.2 (20.8–21.7) |
| Total | 0.6 (0.2–1.3) |
1.1 (0.7–1.6) |
1.9 (1.5–2.3) |
3.3 (2.9–3.8) |
6.5 (6.0–7.0) |
12.6 (12.0–13.2) |
21.0 (20.3–21.7) |
31.6 (30.9–32.4) |
18.1 (17.8–18.4) |
| Percent of infected people who die – infection fatality rate (IFR) | |||||||||
| 0–19 | 20–29 | 30–39 | 40–49 | 50–59 | 60–69 | 70–79 | 80+ | Total | |
| Female | 0.001 (<0.001–0.002) |
0.004 (0.002–0.007) |
0.01 (0.007–0.02) |
0.03 (0.02–0.06) |
0.1 (0.08–0.2) |
0.5 (0.3–0.8) |
1.3 (0.7–2.1) |
4.9 (2.7–8.0) |
0.4 (0.2–0.6) |
| Male | 0.001 (<0.001–0.003) |
0.007 (0.003–0.01) |
0.03 (0.02–0.05) |
0.06 (0.03–0.1) |
0.2 (0.1–0.4) |
1.0 (0.6–1.6) |
2.7 (1.5–1.4) |
14.0 (7.9–22.7) |
0.7 (0.4–1.1) |
| Total | 0.001 (<0.001–0.002) |
0.005 (0.003–0.01) |
0.02 (0.01–0.03) |
0.05 (0.03–0.08) |
0.2 (0.1–0.3) |
0.7 (0.4–1.2) |
1.9 (1.1–3.2) |
8.3 (4.7–13.5) |
0.5 (0.3–0.9) |
| Numbers in parentheses are 95% credible intervals for the estimates. |
COVID‑19 case fatality rates are higher among men than women in most countries. However, in a few countries like India, Nepal, Vietnam, and Slovenia the fatality cases are higher in women than men.[312] Globally, men are more likely to be admitted to the ICU and more likely to die.[335][336] One meta-analysis found that globally, men were more likely to get COVID‑19 than women; there were approximately 55 men and 45 women per 100 infections (CI: 51.43–56.58).[337]
The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women.[338] Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders.[339][340] 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.[341] Smoking, which in some countries like China is mainly a male activity, is a habit that contributes to increasing significantly the case fatality rates among men.[312] 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.[342] In Europe as of February 2020, 57% of the infected people were men and 72% of those died with COVID‑19 were men.[343] As of April 2020, the US government is not tracking sex-related data of COVID‑19 infections.[344] Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.[344]
Ethnic differences
In the US, a greater proportion of deaths due to COVID‑19 have occurred among African Americans and other minority groups.[345] Structural factors that prevent them from practising 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 of underlying conditions such as diabetes,[346] hypertension, and heart disease also increase their risk of death.[347] Similar issues affect Native American and Latino communities.[345] On the one hand, in the Dominican Republic there is a clear example of both gender and ethnic inequality. In this Latin American territory, there is great inequality and precariousness that especially affects Dominican women, with greater emphasis on those of Haitian descent.[348] 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.[349] 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.[350]
Leaders have called for efforts to research and address the disparities.[351] In the UK, a greater proportion of deaths due to COVID‑19 have occurred in those of a Black, Asian, and other ethnic minority background.[352][353][354] More severe impacts upon patients including the relative incidence of the necessity of hospitalisation 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.[355] The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet.[355] 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.[355]
Comorbidities
Biological factors (immune response) and the general behaviour (habits) can strongly determine the consequences of COVID‑19.[312] Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus,[346] and cardiovascular disease.[356] According to March data from the United States, 89% of those hospitalised had preexisting conditions.[357] 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.[255] According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), ischaemic 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 US Centers for Disease Control and Prevention (CDC), are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis.[358] Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes.[359][360] When someone with existing respiratory problems is infected with COVID‑19, they might be at greater risk for severe symptoms.[361] COVID‑19 also poses a greater risk to people who misuse opioids and amphetamines, insofar as their drug use may have caused lung damage.[362]
In August 2020, the CDC issued a caution that tuberculosis (TB) infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID‑19 could not 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.[363]
History
The virus is thought to be of natural animal origin, most likely through spillover infection.[95][364][365] A joint-study conducted in early 2021 by the People’s Republic of China and the World Health Organization indicated that the virus descended from a coronavirus that infects wild bats, and likely spread to humans through an intermediary wildlife host.[366] There are several theories about where the index case originated and investigations into the origin of the pandemic are ongoing.[367] According to articles published in July 2022 in Science, virus transmission into humans occurred through two spillover events in November 2019 and was likely due to live wildlife trade on the Huanan wet market in the city of Wuhan (Hubei, China).[368][369][370] Doubts about the conclusions have mostly centered on the precise site of spillover.[371] Earlier phylogenetics estimated that SARS-CoV-2 arose in October or November 2019.[372][373][374] A phylogenetic algorithm analysis suggested that the virus may have been circulating in Guangdong before Wuhan.[375]
Most scientists believe the virus spilled into human populations through natural zoonosis, similar to the SARS-CoV-1 and MERS-CoV outbreaks, and consistent with other pandemics in human history.[376][377] According to the Intergovernmental Panel on Climate Change several social and environmental factors including climate change, natural ecosystem destruction and wildlife trade increased the likelihood of such zoonotic spillover.[378][379] One study made with the support of the European Union found climate change increased the likelihood of the pandemic by influencing distribution of bat species.[380][381]
Available evidence suggests that the SARS-CoV-2 virus was originally harboured by bats, and spread to humans multiple times from infected wild animals at the Huanan Seafood Market in Wuhan in December 2019.[376][377] A minority of scientists and some members of the U.S intelligence community believe the virus may have been unintentionally leaked from a laboratory such as the Wuhan Institute of Virology.[382][383] The US intelligence community has mixed views on the issue,[384][385] but overall agrees with the scientific consensus that the virus was not developed as a biological weapon and is unlikely to have been genetically engineered.[386][387][388][389] There is no evidence SARS-CoV-2 existed in any laboratory prior to the pandemic.[390][391][392]
The first confirmed human infections were in Wuhan. 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.[393][394][395] Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019.[396] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020.[397][398] According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals.[399] 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 that it was not the site of the initial outbreak.[400] Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.[401]
By December 2019, the spread of infection was almost entirely driven by human-to-human transmission.[338][402] The number of COVID-19 cases in Hubei gradually increased, reaching sixty by 20 December,[403] and at least 266 by 31 December.[404] 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.[405] 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.[406] 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. The Wuhan Municipal Health Commission issued a notice to various medical institutions on «the treatment of pneumonia of unknown cause» that same evening.[407] Eight of these doctors, including Li Wenliang (punished on 3 January),[408] were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.[409]
The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases[410][411][412] – enough to trigger an investigation.[413]
During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days.[414] 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.[100] On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen.[415] Later official data shows 6,174 people had already developed symptoms by then,[338] and more may have been infected.[416] 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».[133][417] On 30 January, the WHO declared COVID-19 a Public Health Emergency of International Concern.[416] By this time, the outbreak spread by a factor of 100 to 200 times.[418]
Italy had its first confirmed cases on 31 January 2020, two tourists from China.[419] Italy overtook China as the country with the most deaths on 19 March 2020.[420] By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world.[421] 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.[422] Retesting of prior samples found a person in France who had the virus on 27 December 2019,[423][424] and a person in the United States who died from the disease on 6 February 2020.[425]
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.[426] 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.[427]
As of 1 October 2021, Reuters reported that it had estimated the worldwide total number of deaths due to COVID‑19 to have exceeded five million.[428]
Misinformation
After the initial outbreak of COVID‑19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.[429][430][431]
In September 2020, the US Centers for Disease Control and Prevention (CDC) published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.[432][433]
Other species
Humans appear to be capable of spreading the virus to some other animals,[434][435] a type of disease transmission referred to as zooanthroponosis.[436][437]
Some pets, especially cats and ferrets, can catch this virus from infected humans.[438][439] Symptoms in cats include respiratory (such as a cough) and digestive symptoms.[438] Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven.[438][440] Compared to cats, dogs are less susceptible to this infection.[440] Behaviours which increase the risk of transmission include kissing, licking, and petting the animal.[440]
The virus does not appear to be able to infect pigs, ducks, or chickens at all.[438] Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.[440]
Tigers and lions in zoos have become infected as a result of contact with infected humans.[440] As expected, monkeys and great ape species such as orangutans can also be infected with the COVID‑19 virus.[440]
Minks, which are in the same family as ferrets, have been infected.[440] Minks may be asymptomatic, and can also spread the virus to humans.[440] Multiple countries have identified infected animals in mink farms.[441] Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations,[441] following an outbreak referred to as Cluster 5. A vaccine for mink and other animals is being researched.[441]
Research
International research on vaccines and medicines in COVID‑19 is underway by government organisations, academic groups, and industry researchers.[442][443] The CDC has classified it to require a BSL3 grade laboratory.[444] There has been a great deal of COVID‑19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.[445]
As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica.[446] As of November 2020, more than 200 possible treatments have been studied in humans.[447]
Transmission and prevention research
Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission,[448] diagnosis and prognosis of infection,[449] estimation of the impact of interventions,[450][451] or allocation of resources.[452] Modelling studies are mostly based on compartmental models in epidemiology,[453] 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 pandemic including computational fluid dynamics models to study the flow physics of COVID‑19,[454] retrofits of crowd movement models to study occupant exposure,[455] mobility-data based models to investigate transmission,[456] or the use of macroeconomic models to assess the economic impact of the pandemic.[457] Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID‑19 on organisations worldwide.[458][459]
Seven possible drug targets in viral replication process and drugs
Repurposed antiviral drugs make up most of the research into COVID‑19 treatments.[460][461] Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.[461]
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.[462][463] More than 300 active clinical trials are underway as of April 2020.[67]
Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best,[464][465] and that they may reduce the antiviral activity of remdesivir.[466] By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID‑19 treatment.[467]
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.[468] 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.[469][470] 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.[471]
In September 2020, the WHO released updated guidance on using corticosteroids for COVID‑19.[472][473] 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).[472] The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID‑19 (conditional recommendation, based on low certainty evidence).[472] The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID‑19 patients.[474][475]
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.[476][477] Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.[476]
In November 2020, the US Food and Drug Administration (FDA) issued an emergency use authorisation for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID‑19.[478] Bamlanivimab is authorised 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 hospitalisation.[478] This includes those who are 65 years of age or older, or who have chronic medical conditions.[478]
In February 2021, the FDA issued an emergency use authorisation (EUA) for bamlanivimab and etesevimab administered together for the treatment of mild to moderate COVID‑19 in people twelve years of age or older weighing at least 40 kilograms (88 lb) who test positive for SARS‑CoV‑2 and who are at high risk for progressing to severe COVID‑19. The authorised use includes treatment for those who are 65 years of age or older or who have certain chronic medical conditions.[479]
In April 2021, the FDA revoked the emergency use authorisation (EUA) that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID‑19 in adults and certain paediatric patients.[480]
Cytokine storm
Various therapeutic strategies for targeting cytokine storm
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.[481] 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.[482]
Tocilizumab has been included in treatment guidelines by China’s National Health Commission after a small study was completed.[483][484] It is undergoing a Phase II non-randomised trial at the national level in Italy after showing positive results in people with severe disease.[485][486] 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.[487] The interleukin-6 receptor (IL-6R) 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.[488] 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.[489]
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.[490]
Passive antibodies
Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID‑19 to people who need them is being investigated as a non-vaccine method of passive immunisation.[491][492][needs update] Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS-CoV-2. The spike protein of SARS-CoV-2 is the primary target for neutralising antibodies.[493] As of 8 August 2020, eight neutralising antibodies targeting the spike protein of SARS-CoV-2 have entered clinical studies.[494] It has been proposed that selection of broad-neutralising antibodies against SARS-CoV-2 and SARS-CoV might be useful for treating not only COVID‑19 but also future SARS-related CoV infections.[493] Other mechanisms, however, such as antibody-dependant cellular cytotoxicity or phagocytosis, may be possible.[491] Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.[491]
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 people who recovered from the infection and contains antibodies specific to this virus, which is then administered to active patients.[491] This strategy was tried for SARS with inconclusive results.[491] An updated Cochrane review in May 2021 found high certainty evidence that, for the treatment of people with moderate to severe COVID‑19, convalescent plasma did not reduce mortality or bring about symptom improvement.[492] There continues to be uncertainty about the safety of convalescent plasma administration to people with COVID‑19 and differing outcomes measured in different studies limits their use in determining efficacy.[492]
Bioethics
Since the outbreak of the COVID‑19 pandemic, scholars have explored the bioethics, normative economics, and political theories of healthcare policies related to the public health crisis.[495] Academics have pointed to the moral distress of healthcare workers, ethics of distributing scarce healthcare resources such as ventilators,[496] and the global justice of vaccine diplomacies.[citation needed] The socio-economic inequalities between genders,[497] races,[498] groups with disabilities,[499] communities,[500] regions, countries,[501] and continents have also drawn attention in academia and the general public.
Effects on other diseases
The use of social distancing and the wearing of surgical masks and similar precautions against COVID‑19 may have caused a drop in the spread of the common cold and the flu.[502][503]
See also
- Coronavirus diseases, a group of closely related syndromes
- Disease X, a WHO term
- Law of declining virulence – Disproved hypothesis of epidemiologist Theobald Smith
- Theory of virulence – Theory by biologist Paul W. Ewald
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- ^ a b c Piechotta V, Iannizzi C, Chai KL, Valk SJ, Kimber C, Dorando E, et al. (May 2021). «Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review». The Cochrane Database of Systematic Reviews. 2021 (5): CD013600. doi:10.1002/14651858.CD013600.pub4. PMC 8135693. PMID 34013969.
- ^ a b Ho M (April 2020). «Perspectives on the development of neutralizing antibodies against SARS-CoV-2». Antibody Therapeutics. 3 (2): 109–114. doi:10.1093/abt/tbaa009. PMC 7291920. PMID 32566896.
- ^ Yang L, Liu W, Yu X, Wu M, Reichert JM, Ho M (July 2020). «COVID-19 antibody therapeutics tracker: a global online database of antibody therapeutics for the prevention and treatment of COVID-19». Antibody Therapeutics. 3 (3): 205–212. doi:10.1093/abt/tbaa020. PMC 7454247. PMID 33215063.
- ^ Maccaro A, Piaggio D, Pagliara S, Pecchia L (June 2021). «The role of ethics in science: a systematic literature review from the first wave of COVID-19». Health and Technology. 11 (5): 1063–1071. doi:10.1007/s12553-021-00570-6. ISSN 2190-7188. PMC 8175060. PMID 34104626.
- ^ McGuire AL, Aulisio MP, Davis FD, Erwin C, Harter TD, Jagsi R, et al. (July 2020). «Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force». The American Journal of Bioethics. 20 (7): 15–27. doi:10.1080/15265161.2020.1764138. PMID 32511078. S2CID 219552665.
- ^ 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.
- ^ Tolchin B, Hull SC, Kraschel K (October 2020). «Triage and justice in an unjust pandemic: ethical allocation of scarce medical resources in the setting of racial and socioeconomic disparities». Journal of Medical Ethics. 47 (3): 200–202. doi:10.1136/medethics-2020-106457. PMID 33067315. S2CID 223558059.
- ^ Sabatello M, Burke TB, McDonald KE, Appelbaum PS (October 2020). «Disability, Ethics, and Health Care in the COVID-19 Pandemic». American Journal of Public Health. 110 (10): 1523–1527. doi:10.2105/AJPH.2020.305837. PMC 7483109. PMID 32816541.
- ^ Chin T, Kahn R, Li R, Chen JT, Krieger N, Buckee CO, et al. (September 2020). «US-county level variation in intersecting individual, household and community characteristics relevant to COVID-19 and planning an equitable response: a cross-sectional analysis». BMJ Open. 10 (9): e039886. doi:10.1136/bmjopen-2020-039886. PMC 7467554. PMID 32873684.
- ^ Elgar FJ, Stefaniak A, Wohl MJ (October 2020). «The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries». Social Science & Medicine. 263: 113365. doi:10.1016/j.socscimed.2020.113365. PMC 7492158. PMID 32981770.
- ^ Uttley H (2 March 2021). «Pandemic sends demand for cold and flu remedies to record low». The Telegraph. Archived from the original on 10 January 2022. Retrieved 28 March 2021.
- ^ «2020–2021 Flu Season Summary». U.S. Centers for Disease Control and Prevention (CDC). 25 October 2021. Retrieved 31 July 2022.
Further reading
- «Progress report on the coronavirus pandemic». Nature. 584 (7821): 325. 1 August 2020. doi:10.1038/D41586-020-02414-1. ISSN 1476-4687. PMID 32814893. Wikidata Q98568681.
- COVID-19 infection prevention and control measures for primary care, including general practitioner practices, dental clinics and pharmacy settings: first update. European Centre for Disease Prevention and Control (ECDC) (Report). October 2020.
- Erola Pairo-Castineira; Sara Clohisey; Lucija Klarić; et al. (11 December 2020). «Genetic mechanisms of critical illness in Covid-19». Nature. doi:10.1038/S41586-020-03065-Y. ISSN 1476-4687. PMID 33307546. Wikidata Q104287299. Scholia Q104287299.
External links
Health agencies
- Coronavirus (COVID‑19) by the UK National Health Service (NHS)
- Coronavirus 2019 (COVID-19) by the US Centers for Disease Control and Prevention (CDC)
- Coronavirus disease (COVID‑19) Facts by the World Health Organization (WHO)
Directories
- Coronavirus Resource Center at the Center for Inquiry
- COVID-19 at Curlie
- COVID‑19 Information on FireMountain.net Archived 13 January 2022 at the Wayback Machine
- COVID‑19 Resource Directory on OpenMD
Medical journals
- BMJ’s Coronavirus (covid‑19) Hub by the BMJ
- Coronavirus (Covid‑19) by The New England Journal of Medicine
- Coronavirus (COVID‑19) Research Highlights by Springer Nature
- Coronavirus Disease 2019 (COVID‑19) by JAMA
- COVID‑19 Resource Centre by The Lancet
- Covid‑19: Novel Coronavirus Archived 24 September 2020 at the Wayback Machine by Wiley Publishing
- Novel Coronavirus Information Center by Elsevier
Treatment guidelines
- «Bouncing Back From COVID-19: Your Guide to Restoring Movement» (PDF). Johns Hopkins Medicine.
- «Coronavirus Disease 2019 (COVID-19) Treatment Guidelines» (PDF). National Institutes of Health.
- «Guidelines on the Treatment and Management of Patients with COVID-19». Infectious Diseases Society of America.
- «JHMI Clinical Recommendations for Available Pharmacologic Therapies for COVID-19» (PDF). Johns Hopkins Medicine.
- NHS England and NHS Improvement. National Guidance for post-COVID syndrome assessment clinics (Report).
- World Health Organization (2022). Therapeutics and COVID-19: living guideline, 14 January 2022 (Report). hdl:10665/351006. WHO/2019-nCoV/therapeutics/2022.1.
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COVID-19
COVID-19 is “a mild to severe respiratory illness that is caused by a coronavirus,” one that is characterized especially by fever, cough, and shortness of breath and may progress to pneumonia and respiratory failure. The name is an odd sort of acronym, insofar as it is formed from portions of two distinct words (COronaVIrus & Disease) and the latter portion of a date (the 19 from 2019). COVID-19 was first identified in Wuhan, China in December 2019.
Social distance has been in use since the early 19th century, initially with the meaning of “the degree of acceptance or rejection of social interaction between individuals and especially those belonging to different social groups (such as those based on race, ethnicity, class, or gender).”
Here indeed they possess an advantage which they have not with respect to men: they are less separated by social distance.
— Christian Observer (Boston, MA), May 1824
In modern use the term is more often encountered with the meaning of “the avoidance of close contact with other people during the outbreak of a contagious disease in order to minimize exposure and reduce the transmission of infection.” The practice of maintaining a greater than usual physical distance from other people is referred to as social distancing, in use since 2003; the verb is socially distance.
Fomite (which rhymes with ‘toe blight’) is “an object (such as a dish or a doorknob) that may be contaminated with infectious organisms and serve in their transmission.” While this word is infrequently encountered, there has been considerable talk of late about possible surfaces and objects which might harbor infectious substances, and it may well be useful to have this specific word at hand.
Ten fomites (doorknobs and toilet seats) were sampled during July 21-22 before any cleaning took place by facilities management personnel.
—Sonia Fankem, et al, Journal of Environmental Health, Apr. 2014
An outbreak is “a sudden rise in the incidence of a disease”; an epidemic is “an outbreak of disease that spreads quickly and affects many individuals at the same time”; a pandemic is “an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population.” An outbreak may become an epidemic if it spreads enough, as an epidemic may likewise become a pandemic.
The difference between an epidemic and a pandemic is a matter of degree, and not all the dates listed by Hoyle and Wickramasinghe can be said to be those of pandemics.
— David Lyons and Gillian Murphy, Nature, 1 Mar. 1990
Community spread is “the spread of a contagious disease within a community.» It also has the specific meaning of “the spread of a contagious disease to individuals in a particular geographic location who have no known contact with other infected individuals or who have not recently traveled to an area where the disease has any documented cases.”
Prevention of community spread (and reintroduction of undiagnosed infectious TB patients into correctional facilities) requires the rapid investigation of contacts in the facility.
—Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 5 Feb. 1999
Contact tracing is “the practice of identifying and monitoring individuals who may have had contact with an infectious person as a means of controlling the spread of a communicable disease.”
State laws require that all cases treated by private physicians be reported to the public health departement. Yet, some doctors feel this would be violating their professional code of ethics, for if turning over to health authorities the patient is interviewed and required to give names of all his own sex contacts, as well as names of friends he suspects mght be infected. This is known as “contact tracing” and all information is kept in strictest confidence.
—Norma Lee Browning, Chicago Daily Tribune, 19 June 1960
Martial law is “the law administered by military forces that is invoked by a government in an emergency when the civilian law enforcement agencies are unable to maintain public order and safety.” We occasionally see the term misspelled as marshal law, probably due to the fact that marshal has a number of meanings dealing with the military (“a general officer of the highest military rank”) and the enforcement of laws (“an officer having charge of prisoners”).
The martial portion of martial law comes from the Latin word martalis, meaning “of Mars” (referring to the Roman god of war).
Self-quarantine
To self-quarantine is “to refrain from any contact with other individuals for a period of time (such as two weeks) during the outbreak of a contagious disease usually by remaining in one’s home and limiting contact with family members.” The verb is fairly recent, showing evidence of use only within the past 20 years or so. The noun has been in occasional use prior to this in the 20th century.
Dr. Banks said further that the Federal authority invested in him in the matter of quarantine had not yet been exerted to its fullest, but that if persons continued to disregard his advice about self-quarantine, he would bring into service all of the power of compulsion at his command.
— The New York Times, 10 Aug. 1916 (p. 1)
Quarantine is currently most often found with the meaning of “a restraint upon the activities or communication of persons or the transport of goods designed to prevent the spread of disease or pests.” The word has a number of other meanings, both archaic and current, many of which have to do with a period of 40 days (it may be traced back to the Latin word quadraginta, meaning “forty”), including a 40 day period during which a widow was permitted by law to remain in her deceased husband’s principal home without having to pay rent to his heirs, a period of 40 days set aside for penance or fasting (in early Christian church use), or a general period of 40 days set aside for a variety of uses.
One grand inconvenience attended on this army of Pilgrimes: For when their quarantine, or fourty dayes service, was expited, (the term the Pope set them to merit Paradise in) they would not stay one whit longer.
— Thomas Fuller, The historie of the holy warre, 1647
An index case is “the first documented case of an infectious disease or genetically transmitted condition or mutation in a population, region, or family.” It may also, however, refer to an individual who has a disease, condition, or mutation that is the first one identified in a population. This second sense is synonymous with index patient. A related term is patient zero, “a person identified as the first to become infected with an illness or disease in an outbreak.” Patient zero is especially used to refer to a person documented as being the first known case of a communicable disease in a particular population or region.
Super-spreader
A super-spreader (also written as superspreader) is “an individual who is highly contagious and capable of transmitting a communicable disease to an unusually large number of uninfected individuals.” The term for the spread of disease by super-spreaders is super-spreading.
In the Maine case, however, neither AIDS nor poverty was thought to be a factor. Dr. Ban Mishu of Vanderbilt University, who investigated the outbreak, said it began in 1989 with one «super spreader,» a man who was unknowingly infected with the bacteria in his lungs and throat.
—The Evening Sun (Baltimore, MD), 14 Oct. 1992According to the news reporters, the research concluded: «Super-spreading is thus partly due to super-spreaders, but modest gains are expected from targeting super-spreaders.”
—Zika & Mosquito Week, 17 Sept. 2019
Isolation ultimately derives from the Latin word insula, meaning “island.” The word’s path from Latin to English begins with the Italian derivative of insula, isolato (“isolated”), that became the French word isolé, and then moved into English. Early uses of the term in English were spelled in the French manner with a conventional English modifier ending d as isolé’d before it settled as the spelling isolated.
The literal etymological meaning of the word isolated is islanded. (The first hospitals built in Italy to protect the general population from the sick in the 14th century were located on an island.) Given its Classical roots, isolated is a relatively new word in English, only dating to the late 1700s. A verb was subsequently coined to correspond to this adjective, which is how we got isolate in English through the process of back-formation.
We date self-isolation to 1834 and a passage from The Metropolitan Magazine. In contrast to the use of the term in the context of today’s health crisis, this first known use of the term seems to make reference to being unaware of the events of the world around us:
Few, indeed, are they whose relations with actual life are compatible with a complete self-isolation from the interests and the passions fluctuating around them, and who can so effectually detach themselves from the tumultuous current of events which every day swells in its rapid course to the silent gulf of the past time.
Contagious and infectious often cause confusion, as the words overlap in significant ways, yet also have meanings which are in some ways distinct. Contagious is “transmissible by direct or indirect contact with an infected person,” and infectious is “producing or capable of producing infection” and “containing pathogenic agents which may be transmitted.” Both infectious and contagious diseases are caused by bacteria and viruses; they differ in that contagious diseases may be spread by direct or indirect contact.
An ailment such as food poisoning is infectious, it is capable of producing infection, but it is not contagious. The coronavirus, on the other hand, is both contagious and _infectious. Anything that is contagious is automatically also infectious, but the reverse is not true. Both words are frequently used in a figurative manner.
Grace’s simple, light-hearted gayety was infectious, and Warren found the grave dignity of the successful graduate rapidly disappearing.
— A Lady, Juno Clifford, 1856She talked, sang, and recited—she exerted all the wit and vivacity of which she was mistress—she employed powers of humour which she herself had scarcely been conscious of possessing. Her gaiety soon became contagious.
— Mary Brunton, Self-Control, 1811
Virus has been used to describe something unwelcome for hundreds of years before it became a term for ‘the reason your computer is doing that funny thing that really isn’t funny at all.’ The word comes from classical Latin in which it referred a number of things which might make one wish to wash their hands (venom, pus, and poisonous emanations). The biological sense we all know and fear today (“any of a large group of submicroscopic infectious agents that are usually regarded as nonliving extremely complex molecules, that typically contain a protein coat surrounding an RNA or DNA core of genetic material but no semipermeable membrane, that are capable of growth and multiplication only in living cells, and that cause various important diseases in humans, animals, and plants”) began being used around the beginning of the 20th century. Prior to this virus had such meanings as “venom emitted by a poisonous animal,” and “a morbid corrupting quality in intellectual or moral conditions.”
I shall therefore, in the following remarks on this abominable libel, and in extracting and expelling the virus of it, substitute the word Protestant and Romanist for the words Colonist and Native.
— Patrick Duigenan, A fair representation of the present political state of Ireland, 1800
Official names have been announced for the virus responsible for COVID-19 (previously known as “2019 novel coronavirus”) and the disease it causes. The official names are:
Disease
coronavirus disease
(COVID-19)
Virus
severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2)
Why do the virus and the disease have different names?
Viruses, and the diseases they cause, often have different names. For example, HIV is the virus that causes AIDS. People often know the name of a disease, but not the name of the virus that causes it.
There are different processes, and purposes, for naming viruses and diseases.
Viruses are named based on their genetic structure to facilitate the development of diagnostic tests, vaccines and medicines. Virologists and the wider scientific community do this work, so viruses are named by the International Committee on Taxonomy of Viruses (ICTV).
Diseases are named to enable discussion on disease prevention, spread, transmissibility, severity and treatment. Human disease preparedness and response is WHO’s role, so diseases are officially named by WHO in the International Classification of
Diseases (ICD).
ICTV announced “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)” as the name of the new virus on 11 February 2020. This name was chosen because the virus is genetically related to the coronavirus responsible for the SARS
outbreak of 2003. While related, the two viruses are different.
WHO announced “COVID-19” as the name of this new disease on 11 February 2020, following guidelines previously developed with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO).
- WHO Director-General’s remarks at the media on 11 February 2020
- WHO Situation Report on 11 February 2020
WHO and ICTV were in communication about the naming of both the virus and the disease.
What name does WHO use for the virus?
From a risk communications perspective, using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia which was worst affected by the SARS outbreak in 2003.
For that reason and others, WHO has begun referring to the virus as “the virus responsible for COVID-19” or “the COVID-19 virus” when communicating with the public. Neither of these designations are intended as replacements
for the official name of the virus as agreed by the ICTV.
Material published before the virus was officially named will not be updated unless necessary in order to avoid confusion.
More information:
- How are new infectious diseases named?
- More about coronavirus disease (COVID-2019)
- WHO press briefings on the coronavirus disease (COVID-2019)
- International classification of diseases
- International Committee on Taxonomy of Viruses
Filter by:
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What does COVID mean?
- covid
- Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quickly spread worldwide, resulting in the COVID-19 pandemic.
The symptoms of COVID‑19 are variable but often include fever, cough, headache, fatigue, breathing difficulties, loss of smell, and loss of taste. Symptoms may begin one to fourteen days after exposure to the virus. At least a third of people who are infected do not develop noticeable symptoms. Of those who develop symptoms noticeable enough to be classified as patients, most (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% develop critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are at a higher risk of developing severe symptoms. Some people continue to experience a range of effects (long COVID) for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.COVID‑19 transmits when people breathe air contaminated by droplets and small airborne particles containing the virus. The risk of breathing these is highest when people are in close proximity, but they can be inhaled over longer distances, particularly indoors. Transmission can also occur if contaminated fluids are splashed or sprayed in the eyes, nose, or mouth, or, more rarely, via contaminated surfaces. People remain contagious for up to 20 days and can spread the virus even if they do not develop symptoms.Testing methods for COVID-19 to detect the virus’s nucleic acid include real-time reverse transcription polymerase chain reaction (rRT‑PCR), transcription-mediated amplification, and reverse transcription loop-mediated isothermal amplification (RT‑LAMP) from a nasopharyngeal swab.Several COVID-19 vaccines have been approved and distributed in various countries, which have initiated mass vaccination campaigns. Other preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, use of face masks or coverings in public, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. While work is underway to develop drugs that inhibit the virus, the primary treatment is symptomatic. Management involves the treatment of symptoms through supportive care, isolation, and experimental measures.
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Discuss these COVID abbreviations with the community:
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Like your style George cant agree with you more
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George Jones
Moornic liberals call Trump a racist! Liberalism is a mentall disorder!
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Explore the global situation
Coronavirus Country Profiles
We built 207 country profiles which allow you to explore the statistics on the coronavirus pandemic for every country in the world.
In a fast-evolving pandemic it is not a simple matter to identify the countries that are most successful in making progress against it. For a comprehensive assessment, we track the impact of the pandemic across our publication and we built country profiles for 207 countries to study in depth the statistics on the coronavirus pandemic for every country in the world.
Each profile includes interactive visualizations, explanations of the presented metrics, and the details on the sources of the data.
Every country profile is updated daily.
Every profile includes five sections:
- Cases: How many new cases are being confirmed each day? How many cases have been confirmed since the pandemic started? How is the number of cases changing?
- Deaths: How many deaths from COVID-19 have been reported? Is the number of deaths rising or falling? How does the death rate compare to other countries?
- Vaccinations: How many vaccine doses are being administered each day? How many doses have been administered in total? What share of the population has been vaccinated?
- Testing: How much testing for coronavirus do countries conduct? How many tests did a country do to find one COVID-19 case?
- Government responses: What measures did countries take in response to the pandemic?
Acknowledgements
We would like to acknowledge and thank a number of people in the development of this work: Carl Bergstrom, Bernadeta Dadonaite, Natalie Dean, Joel Hellewell, Jason Hendry, Adam Kucharski, Moritz Kraemer and Eric Topol for their very helpful and detailed comments and suggestions on earlier versions of this work. We thank Tom Chivers for his editorial review and feedback.
And we would like to thank the many hundreds of readers who give us feedback on this work. Your feedback is what allows us to continuously clarify and improve it. We very much appreciate you taking the time to write. We cannot respond to every message we receive, but we do read all feedback and aim to take the many helpful ideas into account.
Not sure what SARS-CoV-2 is, or the significance of nonmedical masks, PPE and ventilators? Want to know how to flatten the curve? Read this.
Jessica Dolcourt leads the CNET Franchises, How-To and Performance Optimization teams. Her career with CNET began in 2006, and spans reviews, reporting, analysis and commentary for desktop software; mobile software, including the very first Android and iPhone apps and operating systems; and mobile hardware, with an emphasis on iPhone and Samsung. Jessica was one of the first people in the world to test, review and report on foldable phones and 5G wireless speeds.
Jessica began leading CNET’s How-To section for tips and FAQs in 2019, guiding coverage of practical advice on expansive topics ranging from personal finance to phones and home. She holds an MA with Distinction from the University of Warwick (UK).
Expertise Team leadership, audience engagement, iPhone, Android, iOS, tips and FAQs.
For the most up-to-date news and information about the coronavirus pandemic, visit the WHO and CDC websites.
The coronavirus pandemic is putting words in the mouths of billions of people worldwide. Ventilator, BiPap, face coverings, homemade masks, PPE. These words are quickly becoming part of our daily terminology as the disease COVID-19, which has now killed more than 74,000 people around the globe, continues to spread.
Educating yourself on the science and the social responses will help you understand the situation and help explain it to others. If you know them all, well done on being so thoroughly informed. If not, this guide will help you brush up on the ever-changing lexicon you need to get along in a coronavirus world. We’ll continue to update this story as our social response to the virus evolves.
Novel coronavirus and SARS-CoV-2
No, the virus known to have infected over 400,000 people isn’t actually named «coronavirus.» The word refers to any in a family of viruses whose structure presents crownlike spikes when seen under a microscope. The term «novel coronavirus» is a general term for the current type we’re fighting. It became a fixture before the virus was given an official name: SARS-CoV-2.
COVID-19
You may be tempted to use COVID-19 as a synonym for coronavirus, but that will confuse matters. COVID-19 is the name of the disease that the novel coronavirus causes. It stands for «coronavirus disease 2019.»
The disease brings on flulike symptoms, but dangerously affects the lungs by filling them with fluid at a rapid rate. Patients with extreme cases may need respirators and oxygen to help them breathe, often for weeks. The fear is that fatalities will occur when patient need for ventilators outstrips the supply.
N95 respirator masks are effective at blocking the transmission of coronavirus, but currently in short supply.
Photo by Nora Tam/South China Morning Post via Getty ImagesNonmedical masks and face coverings
The Centers for Disease Control and Prevention, the US authority on health policy related to infectious diseases, has issued a recommendation for people to voluntarily wear face coverings in public when staying six feet from others outside your household is not an option.
The key takeaway is that the material you’re using to cover your nose and mouth is not a medical-grade mask needed by public health care workers. Face coverings can be made in a number of styles from materials like cotton, a laundered t-shirt or a bandana. Here’s everything you need to know about coronavirus prevention and homemade masks, and a resource guide on how to make your own face covering or mask.
N95 and surgical face masks
COVID-19 is a respiratory illness, and coronavirus spreads through vaporized droplets. N95 respirator masks are the type most proven to protect you from acquiring SARS-CoV-2. Other varieties, including surgical masks and homemade, are not proven to be effective at blocking the smallest particles that could carry the virus, which can remain in the air for up to 30 minutes.
Homemade coverings (above) are regarded as effective at protecting other people from large droplets ejected through coughing and sneezing. If you have N95 or surgical masks at home, the medical community is asking for donations to help curb the shortage of masks.
Ventilators
A ventilator is a machine that helps a person breathe by expanding their lungs and supplying them with oxygen when it’s too difficult to do so on their own. As the COVID-19 disease hospitalizes tens of thousands of people around the world, ventilators are critically low, and doctors are increasingly forced to decide which patients will receive their aid, and which will not. This is why ventilators are pivotal in the battle against COVID-19.
BiPap machine
A BiPap machine is a type of ventilator that some hospitals are using, or considering using, to help COVID-19 patients breathe. BiPap is short for bilevel positive airway pressure, and is similar to CPAP, or continuous positive airway pressure. These machines are commonly used for conditions like obstructive sleep apnea and pneumonia. If effective, they could potentially be used to treat more patients in need of ventilator support.
Uplifting scenes of coronavirus solidarity around the world
See all photos
At-home coronavirus tests
Tests kits for COVID-19 that you can administer at home are being explored by the medical community and the FDA. The benefit of being able to find out if you acquired the virus without leaving the house — potentially exposing others or yourself — is appealing. Direct-to-consumer testing kits aren’t authorized by the FDA at this point, however, and some fear that tests resulting in false negative results could endanger healthy people if the test-taker is actually positive for SARS-CoV-2.
PPE
Personal protective equipment, or PPE, refers to any gear necessary to minimize a person’s exposure to harmful materials that could cause illness or injury — gloves, full body suits, protective eyewear and so forth. In the case of the coronavirus pandemic, N95 masks for health care workers are in critically short supply.
Coronavirus updates
- I’m Eligible for a Second COVID Vaccine Booster. When Should I Get It?
- Free COVID Antiviral Pills: New Official Website Helps Find Them
- Long COVID Symptoms May Depend on the Variant You Contracted
- News, advice and more about COVID-19
Zoonotic disease
Coronaviruses are transmitted between humans and animals — that’s the «zoo» in «zoonotic.» It’s believed that the virus originated in a shoehorn bat before being transmitted to another animal, and then to humans. The SARS-CoV-2 virus can be transmitted to some individual animals — like a tiger at the Bronx zoo in New York — through direct contact with an infected human. Domestic pets are not currently considered reservoirs to widely spread the disease, however. Other zoonotic diseases include anthrax, rabies, Lyme disease, H1N1 («swine flu»), West Nile virus, salmonella and malaria.
WHO
The World Health Organization, often called WHO, is the global body that’s become a clearinghouse of information, research and safety guidelines. SARS-CoV-2, then referred to simply as novel coronavirus, was first reported to the WHO on Dec. 31, 2019, days after the first patients were hospitalized in the Chinese city of Wuhan.
PCR testing
A testing protocol to identify if you’ve contracted the SARS-CoV-2 coronavirus. This test works by identifying the virus’ DNA through a process called PCR, or polymerase chain reaction. The PCR test looks for telltale markers distinct to this viral strain. The sample can be obtained through a throat or nasal swab, which makes it ideal for the kind of drive-through testing centers proposed in countries like the US. More details about coronavirus testing here.
Positive versus presumptive cases
How do you know if you’re infected with the new coronavirus? Listing your symptoms isn’t enough. Positive, or confirmed, cases are identified with lab tests. Presumptive cases are not. If you’re exhibiting symptoms consistent with COVID-19 — including fever, a dry cough and fluid accumulation in the lungs — and have had contact with a confirmed case, you’re still considered presumptive.
Keeping those hands germ-free is essential.
Angela Lang/CNETCommunity spread
SARS-CoV-2 is highly contagious, spreading through «respiratory droplets» (a cough, sneeze, transfer of saliva) and contaminated objects, like a door handle or other shared surfaces. Person-to-person spread means you can trace how the disease got from one person to another through direct contact, like shaking hands. Community spread refers to people in the same location contracting the virus without an obvious chain of events.
Community spread is an early sign that a disease can rapidly affect local, even global, populations. Read more at the Centers for Disease Control and Prevention.
Social distancing
In addition to thorough hand-washing, the WHO and CDC recommend the practice of social distancing to slow the spread of COVID-19 by keeping at least six feet away from others, refraining from touching and by staying indoors, especially if you’re over 60, immunocompromised or suffering from an underlying condition. Local and national governments have responded by limiting gatherings of people, ranging from no more than 10 people to 50 or 250 or even 1,000.
Self-quarantine, self-isolation
People who largely stay inside their own home, hotel room or other space are said to self-quarantine or self-isolate. For example, many governments are asking travelers returning from afflicted areas to self-quarantine for two weeks. However, there’s a technical difference. Quarantine refers to people who appear healthy, but could be at risk for exposure or infection. Isolation refers to separating positive or presumptive cases (see above) from the healthy population.
Mitigation, not containment
This phrase acknowledges that at pandemic proportions, nations can’t contain the spread of coronavirus. But with social distancing, self-quarantine and isolation, the burden of COVID-19 can be mitigated. In other words, slowing down the rate of infection can increase chances of survival by avoiding overcrowding hospitals, running short on pivotal supplies before they can be replenished and overworking medical staff. This is a deeply sobering account of what happens when the COVID-19 disease overwhelms medical and support systems.
Pandemic versus epidemic
WHO officially declared the coronavirus SARS-CoV-2 a pandemic on March 11. The word «pan» (which roughly means «all») refers to the global nature of the spread, affecting virtually every country and region around the globe. An epidemic refers to a more localized region. Before reaching places like the US, coronavirus was considered an epidemic in China’s Hubei province, and then in the country itself. Here’s more on pandemics versus epidemics.
Flatten the curve
Without mitigation, social distancing and all the rest, epidemiologists and other health experts predict a sharp increase in COVID-19 cases that looks like a tall, narrow spike on a graph. By following guidelines, the projected model looks shorter and spread out over time. The curve is flatter, milder, less pronounced. The hope of flattening the curve is to reduce fatalities by buying hospitals time to treat and scientists time to discover therapies and create a vaccine.
Adapted from CDC pre-pandemic guidelines (2017)
CNETShelter in place
On March 16, six counties in the San Francisco Bay Area ordered residents to «shelter in place,» a directive aimed at keeping people in their homes for three weeks, with the order widened to the whole state a few days later. It’s now being implemented around the world. All nonessential businesses are shuttered, and with the exception of shopping for items like groceries and pharmaceuticals, picking up food and taking walks while maintaining a distance of six feet from others, locals are expected to stay inside. It’s a fairly strict measure aimed at curbing community spread.
Read more: Where can you go in coronavirus lockdown? This is what you can and can’t do
See the emptiness as coronavirus closes landmarks, stadiums, amusement parks
See all photos
An abundance of caution
The preemptive closure of offices, businesses and schools ahead of positive cases has often been met with the phrase «due to an (over)abundance of caution.»
70% isopropyl alcohol
Washing thoroughly with soap and water is the best way to kill the coronavirus on the skin, but surfaces can be harder to disinfect. Experts say that disinfectant wipes and spray, and solutions made with 70% isopropyl alcohol are also effective at destroying the virus’ structure. But be careful. Making your own hand sanitizer and other cleaning agents can be dangerous, and isn’t recommended.
Stay informed on coronavirus updates and developments, help your friends and neighbors dispel myths about the virus and use these 10 practical tips to avoid coronavirus when you need to leave the house.
This glossary of terms related to coronaviruses and COVID-19 in particular is intended for learners of English though it may be of interest to a wider audience. In times of crisis, knowing and understanding the terminology involved may help counter some of the fearmongering and lies that such times breed.
A virus is a micro-organism, too small to be seen without a microscope, that causes infectious disease in animals and humans.
In December 2019 a new disease was identified in China. On investigation, the disease was caused by a «new» virus of the coronavirus family, and has since been officially named COVID-19.
It is believed that COVID-19 originated in the Chinese city of Wuhan, though whether zoonotically or through viral manipulation in a local laboratory using American research and money remains a mystery to the public. It subsequently spread to other countries and was officially pronounced a pandemic by the World Health Organization (WHO) on 11 March 2020.
Peter Heilig, Dr. med. Univ.-Professor
Each of the following terms, listed in alphabetical order, has 1) a basic definition and 2) an example sentence showing how the term may be used in context.
While for simplicity we sometimes refer below to «humans and animals» or «animals and humans», we do of course recognize that humans are in fact animals.
animal-human interface (noun): any point where animals (domestic and wild) and humans meet — Animal diseases can potentially pass to humans at any animal-human interface such as a zoo, farm or animal market.
asymptomatic (adjective): showing no symptoms of a particular disease — She had no idea her husband had coronavirus because he was asymptomatic.
carrier (noun): a person or animal that transmits a disease to others, whether suffering from it themselves or not — People who are asymptomatic can still be carriers.
carry (verb): be infected with a disease and able to transmit it to others, whether symptomatic or asymptomatic — Some people may carry coronavirus without knowing it.
community spread (noun): transmission of a disease directly within a community and not by importation from a foreign source — With this many new positive cases, the evidence suggests that we now have community spread right here in our county.
contact tracing (noun): identification and monitoring of people who may have had contact with an infectious person — By insisting on strict contact tracing as soon as someone was potentially infected, they managed to control the spread of the disease.
contagious (adjective): describing a disease that can pass from person to person, usually by direct contact; describing a person with such a disease. See infectious — Patients who are still contagious are kept in isolation.
coronavirus (noun): any one of a large family of viruses that can cause disease in the breathing and eating systems of humans and animals (respiratory and digestive systems). Coronavirus diseases can range from the relatively harmless common cold to more severe and potentially fatal diseases such as SARS (Severe Acute Respiratory Syndrome). Seen through a microscope, coronaviruses appear circular with spikes, like crowns 👑, and are named from the Latin for crown, which is corona. Coronaviruses normally originate in animals and usually cannot be passed to humans. But very occasionally a coronavirus mutates and can then be transmitted from animal to human, and then from human to human. This is how the SARS epidemic started in the early 2000s, for example — Did you know that the common cold can be a coronavirus disease?
COVID-19 (noun): official name for the novel coronavirus disease that emerged in China in 2019. COVID-19 = COronaVIrus Disease-2019 — All countries are requested to report any new confirmed case of COVID-19 within 48 hours.
diagnose (verb): identify an illness by examining the symptoms — Only a medical professional can properly diagnose the cause of your problem.
diagnosis (noun): identification of an illness by examination of the symptoms — If you’re not happy with the doctor’s diagnosis you could always get a second opinion.
disease (noun): illness; sickness; a disorder of the body — Polio is one of several serious diseases that have been nearly eradicated.
droplets (noun): the spray produced when people cough or sneeze, and which can spread diseases like COVID-19 — Health care personnel wear protective clothing to guard against the disease carried in droplets when infected people sneeze or cough.
epidemic (noun): occurrence of a particular disease in a large number of people in a particular area. See outbreak, pandemic — The city was devastated by an epidemic of cholera in the 19th century.
flatten the curve (verb — figurative): change the steep upward curve on a graph of new disease cases to a flatter, shallower upward curve over a longer time period through measures such as social distancing — Authorities hope that by introducing social distancing they will be able to flatten the curve and avoid hospitals being rapidly overwhelmed with new cases.
gain-of-function (noun): modification of a virus (naturally or artificially) that makes it more virulent or deadly — It is believed that scientists were secretly engaged in gain-of-function research in a race to create new bioweapons.
herd immunity (noun): an indirect protection from a disease resulting from a large percentage of the population gaining immunity (as a result of either recovering from the disease or being vaccinated) — This virus is unlike other coronaviruses because there is currently no herd immunity to it, he said. According to Prof. Sir Andrew Pollard, Director of the Oxford Vaccine Group, herd immunity to Covid-19 by vaccination is not possible because it still infects vaccinated individuals.
iatrogenesis (noun): illness or death caused by a doctor or nurse conducting medical treatment — During the Covid panic, and mainly in New York, an estimated 30,000 Americans were killed by ventilators and iatrogenesis in April 2020.
incubation period (noun): the time from a person’s first exposure to a disease to the time when symptoms develop — When they know the incubation period they will know how long to keep people in quarantine.
infect (verb): affect a human or animal with a disease-causing organism — But can it infect human beings?
infected (adjective/past participle): affected with a disease-causing organism — They were able to cure the infected left lung before the infection could spread to the right lung.
infection (noun): process of infecting; state of being infected; infectious disease — Breast milk can help protect babies against various infections.
infectious (adjective): describing a disease that can be transmitted through the environment; describing a human or animal capable of spreading an infection. See contagious — Avoid the dogs as they may still be infectious.
Strictly speaking, a contagious disease is transmitted by physical contact, and an infectious disease is transmitted via micro-organisms in the air or water. But in practice there is little or no difference in meaning between contagious and infectious when related to disease.
isolate (verb): keep an infected person away from healthy people — They will isolate anyone suspected of having the disease.
isolation (noun): separation of infected people from healthy people for serious contagious diseases like COVID-19 — Travellers arriving from the infected area were immediately put in isolation.
lockdown (noun): official restriction of movement within or access to an area in the interests of public health — Sweden was one of the few countries that did not impose blanket lockdowns.
mask (noun): a piece of fibre or cloth that fits over the nose and mouth to protect other people from the wearer’s germs and/or the wearer from germs in the air — The World Health Organization have historically offered varying advice on whether or when people should wear masks.
mass psychosis (noun): an epidemic, or even pandemic, of madness driven by individual irrational fear. It occurs when a large portion of society loses touch with reality and descends into delusion. Mass psychosis sufferers are unaware of their condition. In blind panic they subconsciously sink to a lower moral and spiritual level, becoming increasingly irrational, irresponsible, emotional and unstable — able finally to commit atrocities that they would normally be incapable of. — Psychologists cite the American and European witch hunts of the 16th/17th centuries and 20th-century totalitarianism as examples of mass psychosis.
novel coronavirus (noun): the word novel means “new”, and a newly identified coronavirus strain is often called a novel coronavirus — Until they gave it a name, they mostly referred to COVID-19 as novel coronavirus (disease).
outbreak (noun): a sudden occurrence of a disease (or other unpleasant thing). See epidemic, pandemic — There was another outbreak of the disease in 1993 but the cause was uncertain.
pandemic (noun): occurrence of a particular disease throughout a whole country or the world. See epidemic, outbreak — Just after the First World War there was a pandemic of flu which killed up to 40 million people worldwide.
pandemic amnesty (noun): a proposed official agreement to take no action against people guilty of crimes during the Covid pandemic such as forced vaccination or illegal deprivation of liberty — LET’S DECLARE A PANDEMIC AMNESTY. Let’s focus on the future, and fix the problems we still need to solve.
pathogen (noun): a micro-organism or germ such as a bacterium or virus that can cause disease — Fortunately, most pathogens are dealt with by the body’s immune system.
patient zero (noun): the person identified as the first to become infected with a disease in an outbreak — Authoritites usually try to determine who patient zero was in any given outbreak as can help answer important questions about how, when and why it started.
PCR test (noun): test that detects viral particles in blood or other body fluids. (PCR = polymerase chain reaction) — Although the PCR test is widely used to diagnose Covid-19, Kary Mullis, who won the Nobel Prize in connection with his invention of the PCR method, doubted the validity of using the PCR test for this purpose.
personal protective equipment (PPE) (noun): special clothing, headgear, goggles, masks and other garments that shield people from injury or infection. — Much of the PPE worn by doctors and nurses has to be worn once only and destroyed after use.
person-to-person (adjective): describing the spread of a disease from one person to another, typically through touch including shaking hands, kissing, sexual intercourse etc. — In January an infected American woman returning home from China transmitted the virus to her husband, marking the first known example of person-to-person spread of the virus in the USA.
quarantine (noun): isolation and monitoring of people who seem healthy but may have been exposed to an infectious disease to see if they develop symptoms — For centuries it’s been common for ships arriving from infected areas to be kept in quarantine at the docks, originally for 40 days which is where the term comes from.
SARS-CoV-2 (noun): Severe Acute Respiratory Syndrome CoronaVirus 2; final official name for the coronavirus that causes COVID-19. (This virus was previously known as 2019-nCoV.) — SARS-CoV-2 is the name of the virus and COVID-19 is the name of the disease.
screening (noun): testing of people for the presence of a disease. For COVID-19 the first step in screening is usually taking a person’s temperature — They now conduct screening for all incoming passengers.
self-isolate (verb): isolate oneself; put oneself in quarantine, away from other people — The prime minister’s wife has tested positive for COVID-19 and the couple are now self-isolating and working by phone and Skype.
superspreader (noun): person infected with a virus etc who transmits or spreads it to an unusually large number of people — One so-called «superspreader» in South Korea infected at least 37 people at her church with the virus.
symptomatic (adjective): showing symptoms of a particular disease — Anyone who is symptomatic is advised to phone a doctor and get tested.
symptoms (noun): a physical or mental feature that indicates illness/disease — Typical symptoms of COVID-19 are fever, coughing, and shortness of breath.
test negative | test positive (verb): if you take a test for an infection and you test negative, that means you do not have the infection. If you test positive, that means you have the infection. — The President is pleased to announce that he has tested negative for the virus.
transmission (noun): transfer of a disease from animal to human or from human to human — Transmission of many diseases can be direct or indirect.
transmit (verb) — often passive: cause a disease to pass from animal to human or from human to human — Many diseases are transmitted through physical contact.
treat (verb): attempt to cure or alleviate an illness or injury through medical care — Doctors cannot currently treat COVID-19 directly and instead concentrate on relieving symptoms.
treatment (noun): medical care given to a patient for an illness or injury — There is currently no specific antiviral treatment for COVID-19, and infected patients receive supportive care to help relieve symptoms.
vaccine (noun): a substance used to protect humans and animals from a disease — A vaccine for cholera was invented in 1879.
vax (noun, informal): vaccine, vaccination — Have you had your flu vax this year? | anti-vaxer, anti-vaxxer (noun): a person opposed to vaccines and vaccination on principle — Some anti-vaxxers are against vaccines on religious grounds and others just believe vaccines are dangerous to health.
viral (adjective): describing something like, caused by, or relating to a virus or viruses — Antibiotics cannot be used to treat viral infections because they don’t kill viruses, only bacteria.
virus (noun): a living thing, too small to be seen without a microscope, that causes infectious disease in animals and humans — Like all diseases caused by viruses, the common cold cannot be cured with antibiotics.
zoonotic (adjective): describing a disease that can be transmitted from animals to humans — To protect yourself from zoonotic diseases it’s best to avoid bites and scratches from animals.
Health, disease and medical breakthroughs are topics of interest generally, but with so many people impacted by the COVID-19 pandemic, there are even more media stories on these topics than usual.
Even though many of these stories are written for the general public they often contain terms that are usually only used by health professionals and other types of researchers.
Some of these words used in these stories can be confusing, even if you’ve come across them before. To clear up some of this confusion we’ve created a list of COVID-19 useful words and phrases.
We will be adding words to this glossary regularly. If there is a word that you would like to know more about email [email protected]
A-E
| Word or phrase | Definition or explanation |
|---|---|
| Anosmia | Loss of your sense of smell. There are many reasons why this can happen including injury to the nerve that helps you smell, injury to the nose or sinuses, or a viral infection of the respiratory system. Anosmia is a reported symptom of COVID-19. |
| Antibodies | Antibodies are:
Antibodies help defend the body against infectious organisms such as bacteria (eg, Escherichia coli, Staphylococcus aureus) and viruses (eg, influenza A virus, hepatitis C virus) that can cause disease. There are different types of antibodies, some are produced soon after exposure to an antigen, while others appear after a longer period of time. Want to know more? If you have a normal immune response, your body will recognise a threatening antigen, like those attached to viruses, and will defend your body against it. A crucial part of this defence system is the production of antibodies, they tightly bind with a unique antigen, and either neutralise it or tag it for destruction. The body makes thousands of antibodies and each one is assigned to a specific antigen. After the first encounter with an antigen, your body may take some time to produce the required antibody. But in the future, the memory cells of your immune system can recognise an antigen and swiftly produce antibodies in response. This is called ‘active’ or ‘acquired’ immunity, and it can occur after a disease or a vaccine. Some people produce antibodies to substances that aren’t usually harmful, such as peanuts – this process is commonly known as an allergic response. If a person has an autoimmune disease, they produce antibodies that stick to their body’s own proteins and damage healthy cells. People who are immunodeficient cannot produce an appropriate immune response, which makes them prone to more serious bouts of illness. Related: antibody tests, immunity, plasma, vaccines |
| Antibody tests |
Blood tests that look for specific antibodies. Sometimes, they are called serology tests. Having the antibodies can be a sign you have been infected by (or immunised against) the disease caused by a particular antigen. Tests that detect the presence of antibodies to the antigens that cause certain diseases, such as measles, can sometimes determine if a person is immune to that disease. There are different types of antibody tests. Some are sensitive to the antibodies that your body produces immediately after an infection, while other antibody tests will detect antibodies that appear later. Antibody tests are not recommended for diagnosing an active (acute) infection, because antibodies to an antigen take time to develop. You may be infectious even if your serology or antibody test results are ‘negative’. Currently, a ‘reliable’ antibody test may show that someone has recovered, or is recovering, from COVID-19. However not enough is known about COVID-19 for the presence of antibodies specific to SARS-CoV-2 to lead to any conclusions about immunity. In Australia, antibody tests for COVID-19 or any other disease cannot legally be advertised because their results are complicated and need to be interpreted by a health professional. During an epidemic or pandemic like COVID-19, antibody tests show how many people in the population have or may have been infected with a disease. Related: antibodies, immunity, plasma, serology, vaccines |
| Antiviral medicines | These are medicines that stop a virus from infecting healthy cells or from multiplying. There are antiviral medicines available for:
You can read more about COVID-19 medicines including antivirals here. Related: coronavirus, virus |
| Bacteria | Microscopic, single-celled organisms that can cause human diseases. Bacteria can be killed or damaged by antibiotics.
Bacteria are larger than viruses. Not all bacteria in our bodies cause disease. For example some bacteria in your digestive system can protect you from gut infections caused by other bacteria. Infections caused by bacteria tend to be in one area of the body (eg, tuberculosis is an infection in the lungs). Unlike a virus, a bacterium is a living organism and can reproduce without invading a host cell. Want to know more? Using antibiotics for infections that are not bacterial, or for infections that would go away without treatment, has led to a problem called antibiotic resistance. This means there are bacteria that cannot be treated with antibiotics. These bacteria are sometimes described as ‘superbugs’. Related: coronavirus, virus |
| Booster | A booster dose is an extra dose of a vaccine after the first course of has been given. Booster doses are common for some vaccines given as part of the National Immunisation Program (NIP) Schedule, such as diphtheria, tetanus and pertussis (whooping cough). They are also part of the current COVID-19 vaccine program. |
| Cardiovascular system | A group of organs that includes the heart (cardio) and blood vessels (vascular). The cardiovascular system is responsible for pumping and circulating blood around the body.
Cardiovascular diseases include diseases affecting the heart, such as heart failure and coronary artery disease, and disease affecting the blood vessels like a stroke. Many COVID-19 symptoms affect the respiratory (lungs and airways) system. However, it can also cause problems with the heart and blood vessels. This is particularly true for people who already have problems with their heart, blood vessels or blood pressure. Related: respiratory system, comorbidity |
| Cohort study |
Research that involves studying a group of people (cohort) over a period of time to:
During the COVID-19 pandemic, cohort studies have helped researchers learn about how the virus affects people, what health conditions are risk factors for severe illness and what actions help prevent the spread of the virus. Want to know more? Retrospective cohort studies use studies or information that already exists. They try to identify risk factors that might increase someone’s chance of developing a specific health condition. For example, one retrospective-cohort study called ‘Dying to be famous’ looked at biographical data belonging to deceased rock and pop stars who reached fame between the years of 1956 and 2006, to see if negative childhood experiences predisposed them to risk-taking behaviour. Prospective cohort studies look towards the future. Researchers may have a theory about what might cause a disease. To test this theory they observe a group of people – a cohort – over a period of time and see if there are any changes in health outcomes linked to possible risk factors they have identified. The Framingham Farm Study is an example of a prospective cohort study, where 5209 men and women were recruited in 1948 and followed for decades to see if anything they did influenced their cardiovascular health. The study made several discoveries about the effects of smoking, cholesterol level and high blood pressure on heart health. Related: epidemiologist, incidence, prevalence, randomised control trial |
| Comorbidity |
When a person has more than one health condition at the same time. For example someone who is diagnosed with COVID-19 might already have been living with multiple health conditions like asthma or high-blood pressure (hypertension). These conditions are comorbidities. They are sometimes called ‘existing’, ‘pre-existing’ or ‘underlying’ conditions’. Comorbid conditions can make a person more vulnerable to illness from other causes. During this COVID-19 pandemic, researchers have been paying attention to comorbidities to 1help protect people who are at higher risk of worse health outcomes. Related: cardiovascular system, morbidity, respiratory system |
| Conjunctivitis | A condition where the membrane (called the conjunctiva) that lines the inside surface of the eyelids and the front of the eyeball is inflamed. Conjunctivitis
Note: ‘-itis’ at the end of a word usually signposts a disease characterised by inflammation. For example, appendicitis is a condition caused by the inflammation of the appendix. There are other ‘ itis’ examples in this document) |
| Contact tracing |
A method to find people who have been exposed to a person with a confirmed case of an infectious disease, like COVID-19. Close contacts of someone who has been exposed to infectious disease are at risk of being infected and infecting others. Close contacts will need to isolate. Contact tracing has been around since before COVID. For example, it has been used to help identify people who may be at risk of Hepatitis C or HIV infection.
|
| Coronavirus |
A large group of viruses that cause diseases in humans and animals. In humans coronaviruses can cause mild diseases like the common cold as well as more severe diseases such as COVID-19. The coronavirus that causes COVID-19 is called SARS-CoV-2. Other illnesses caused by coronaviruses include Middle East Respiratory Syndrome (MERS) caused by the MERS coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome caused by the SARS coronavirus (SARS-CoV). Corona means crown or wreath in Latin – under a microscope the coronavirus has bulbous spikes, like the pointy end of a crown. Related: bacteria, COVID-19, pandemic, SARS-CoV-2 |
| COVID-19 |
A new, infectious disease caused by the coronavirus SARS-CoV-2. Viruses often have different names from the diseases that they cause, for example HIV is the virus that causes AIDS. There have been a lot of words used to described COVID-19. Before 11 February 2020, when the World Health Organisation (WHO) gave COVID-19 its name, the disease was often referred to as coronavirus in the media. However, there are many coronaviruses in the world, and only one type that leads to the disease COVID-19. The name COVID-19 comes from Coronavirus disease 2019. Related: coronavirus, epidemic, pandemic, SARS-CoV-2, WHO |
| Cure |
A medical treatment that restores a sick person to health. If a person is cured, it means that they no longer have the condition that caused their illness. A cure is different from prevention, and from symptom management. For example,. tuberculosis can be cured by taking certain medicines while measles can be prevented with a vaccine. Generally, chronic conditions cannot be cured but their symptoms can be treated. Diabetes, for example, can be managed with medicines such as insulin injections. There is currently no cure for COVID-19. There are medicines that can help treat symptoms, and vaccines that can make it less likely you will get sick if infected. Related: treatment, vaccine |
| Dysgeusia |
Changes to, or loss of, the sense of taste. There are a number of reasons why this can happen including as a side effect of certain medicines (eg, chemotherapy), and as a result of viral infection. This can be a symptom of COVID-19. |
| Epidemic |
An illness, or other health-related event, that affects a large number of people in a community, population or region, and is occurring at a higher rate than expected. An epidemic can be caused by a disease (eg, typhoid, SARS-CoV-2), or by health-related behaviours (eg, no clean water, poor hygiene). A pandemic is declared when the infectious disease outbreak occurs on a global level. Related: contact tracing, COVID-19, epidemiologist, pandemic |
| Epidemiologists |
Public health professionals and researchers who study patterns, causes and prevention of disease and injury in people. During an outbreak, like COVID-19, they study:
Related: cohort study, contact tracing, incidence, prevalence, randomised control trial, WHO |
F-K
| Word or phrase | Definition or explanation |
|---|---|
| Herd immunity | This is a type of infection control that occurs naturally, or through immunisation programs. It happens when a large enough portion of a population becomes immune to a disease to stop further spread. Immunity may be either by recovering from the disease or by being vaccinated against it.
In the case of COVID-19, the possibility of herd immunity remains unclear due to the uncertainty of long term immunity to this virus. Related: antibodies, immunity, plasma, vaccine |
| Hygiene | Actions that prevent the spread of disease and maintain health through cleanliness.
Most infections enter our bodies when we touch our face with unwashed hands. While we don’t have a cure for COVID-19, we can prevent the spread of germs by washing hands regularly, and covering your mouth while coughing or sneezing. Discarding items like tissues shortly after use is also a way of practicing hygiene. Using a face mask in certain situations can also help reduce spread Related: physical distancing, quarantine, self-isolation |
| Immunity | Immunity is the ability to resist illness when exposed to a disease.
Want to know more? Active immunity is the result of being exposed to a disease, or vaccine for a disease. The exposure prompts your immune system to produce antibodies that help your body resist infection. If you re-encounter the disease your immune system’s ‘memory cells’ will swiftly reproduce those antibodies which should protect you from that disease. Passive immunity occurs when a person receives antibodies belonging to another person (see plasma) ,or naturally when an infant absorbs their mother’s antibodies from the placenta or via breast milk. This type of immunity does not last for a long time, because the persons own immune system was never activated and so their body did not produce it’s own protective antibodies. Related: antibodies, antibody tests, herd immunity, plasma, vaccine |
| Incidence | This term is used to describe the rate of new illness or injuries (morbidities) within a precise population over a specified period of time. Incidence can mean the number of new cases in a community, or the number of new cases in a unit of population over a period of time.
Related: morbidity, mortality, prevalence |
| Kawasaki disease |
A rare inflammatory condition that mostly affects children under 5 years of age. We don’t know what causes Kawasaki disease. We do know that it’s not contagious and that in Australia, there are around 200–300 cases of Kawasaki disease recorded every year. Kawasaki disease existed before the COVID-19 pandemic but has received attention because of a similar syndrome called ‘multisystem inflammatory disorder in children and adolescents.’ Cases of multisystem inflammatory disorder in children and adolescents have been recorded in UK, Europe and North America. Children with symptoms of the disorder have either been in contact with someone who has had COVID-19, or have antibodies to SARS-CoV-2 in their blood – implying that they have been infected with the coronavirus in the past. Little is known about multisystem inflammatory disorder in children and adolescents but the World Health Organization is monitoring recorded cases of the condition. Related: morbidity, epidemiologist, World Health Organization |
L-Q
| Word or phrase | Definition or explanation |
|---|---|
| Morbidity | Another word for illness. It refers to any physical or mental health symptom or condition that makes someone feel worse than usual.
The ‘rate of morbidity’ or ‘morbidity rate’ can also be used to discuss the amount of disease within a defined population over a specified period of time, but this is usually expressed with terms like ‘incidence’ and ‘prevalence’. If you have more than one condition at a time then you may be described as having co-morbidities. Related: epidemic, epidemiologist, comorbidity, incidence, prevalence, mortality, mortality rate |
| Mortality |
Another word for death, often used by researchers and statisticians to describe the rate and pattern of death within a specific population, during a specified time period. For example, the Australian Bureau of Statistics’ wrote: “Reductions in mortality over the past 50 years have seen life expectancy at birth increase by more than 10 years…” in their ‘Changing Patterns of Mortality in Australia’ report. Related: epidemiologist, mortality rate |
| Mortality rate |
The rate of deaths recorded within a specific population during a defined time period. There are several different measurements of death that researchers are interested in looking at during a health event such as the COVID-19 pandemic. Related: incidence, prevalence |
| Myalgia |
Muscle pain. This can be a symptom of COVID-19. Note: ‘algia’ in a word is usually an indicator that the word refers to a type of pain. For example, neuralgia is pain due to a damaged or irritated nerve. |
| Myocarditis | This is inflammation of the heart muscle. The inflammation can affect how it pumps. Myocarditis is usually caused by a viral infection.
Myocarditis is a rare side effect of some COVID-19 vaccines. It is temporary in most cases, and goes away after rest and treatment. |
| Pandemic |
A worldwide outbreak of a disease. The World Health Organization (WHO) is responsible for declaring pandemics because it has access to global public health data. Pandemics often start as epidemics that have been confined to a community or region. For example, AIDS was considered an epidemic in West Africa for several decades before becoming a pandemic in the late 20th century. On 11 March 2020, WHO announced that COVID-19 was a pandemic. Related: epidemic, WHO |
| Peer review | The process where relevant experts (‘peers’) evaluate the quality of other experts’ work before publication, to ensure that the methodology and findings are rigorous and coherent and relate to prior knowledge of the topic by referencing past research.
The pressure of publishing during a pandemic has led to a rushed peer-review process for research relating to COVID-19 and as a result, some early studies have come under question. Related: epidemiologist, cohort study, randomised control trial |
| Pericarditis | This is swelling of the lining around the heart. The swelling can cause sharp pain in the chest. Pericarditis is usually caused by a viral infection.
It is a rare side effect of some COVID-19 vaccines. It is temporary in most cases, and goes away after rest. Some cases may need treatment. |
| Physical distancing |
This is a type of infection control that involves staying physically distant from other people to prevent the spread of disease. In Australia, the Department of Health and Aged Care recommends staying 1.5 metres from other people where possible during the COVID-19 pandemic. Sometimes the term ‘social distancing’ is used instead of ‘physical distancing’ but the World Health Organization stopped using the term ‘social distancing’ because it wants people to remain connected. Related: quarantine, self-isolation |
| Plasma |
The liquid component of blood. It’s made up mostly of water and contains electrolytes and crucial proteins, including antibodies. Plasma collected from people who have recovered from a disease is called convalescent plasma. People who have recovered from COVID-19 have been urged to donate their plasma for research, because it’s rich in antibodies and may be a potential treatment for COVID-19. The idea behind this therapy is that it may provide people who are infected with COVID-19 with antibodies, before they produce their own. This is an example of passive immunity. Related: antibodies, treatment, immunity, serology |
| Prevalence |
This term is used to described the number of people who have a medical condition or risk factor, during a defined time period. Prevalence describes how common something is for a particular population for a specified period of time. For example if we were looking at the number of COVID-19 cases in Australia, we could say that between 3 January 2020 and 31 August 2023 the prevalence was 10,018,025 confirmed cases of COVID-19. Related: cohort study, comorbidity, epidemiologist, incidence, morbidity |
| Quarantine |
A type of infection control using isolation to stop the spread of a disease. For example, animals are quarantined for 3 months in the case of rabies. Quarantine has been a key method of stopping infection spread during the COVID-19 pandemic. In Australia, people who are in quarantine should not leave their place of residence unless it’s an emergency. If they develop symptoms, they are advised to be tested for COVID-19. Related: contact tracing, hygiene, physical distancing, self-isolation |
R-Z
| Word or phrase | Definition or explanation |
|---|---|
| Randomised controlled trial |
The type of study considered to be the ‘gold standard’ (highest quality) in testing the effect of a treatment. Trial participants are randomly divided into two or more groups. One group does not receive the treatment. This is the control group. All other groups will be given the treatment that is on trial. Sometimes, the group that is not receiving treatment will be given a placebo. A placebo is a substance, test or procedure that looks the same as the new treatment, or is delivered the same way, but contains inactive ingredients. Using a placebo is a way of making sure that any improvements or benefits are in response to the actual treatment being tested, not to the idea of the treatment. The results from both groups are eventually compared to see if receiving the proposed treatment has better health outcomes than not receiving the treatment. Read more about clinical trials Related: cohort study, cure, epidemiologist, treatment |
| Respiratory system |
The group of organs that make breathing (respiration) possible. This includes the lungs, mouth, nose, diaphragm and airways. COVID-19 is a respiratory disease, although it can cause cardiovascular complications – especially for those with pre-existing heart conditions or uncontrolled, high blood pressure. Related: cardiovascular system, COVID-19 |
| SARS-CoV-2 |
The shortened name of the virus that causes the disease called COVID-19. The International Committee on Taxonomy of Viruses (ICTV) gave SARS-CoV-2 its name. The World Health Organization (WHO) named the disease COVID-19. Virus names are based on their genetic structures, which helps researchers target vaccines and medicines appropriately. On 11 February 2020 ICTV assigned the name ‘severe acute respiratory syndrome coronavirus 2 Related: coronavirus, COVID-19, virus, WHO |
| Self-isolation |
This is a type of infection control where a person diagnosed with, or suspected of having, an infectious disease avoids contact with other people. A person (outside of hospital) who is told to self-isolate can only leave their house or other place of residence if they need urgent medical care. They are advised to physically distance themselves from anyone who lives with them, and to avoid contact with people who don’t (outside of an emergency scenario). Related: contact tracing, hygiene, quarantine |
| Serology |
A medical science that studies blood serum, a fluid derived from plasma which is rich in antibodies. Serology tests look for antibodies in your blood to see if you have been vaccinated against or have had a specific disease in the past. The presence of some antibodies can also indicate an allergy or an autoimmune disease. Note: a word that ends in ‘-logy’ usually indicates that the whole word relates to a type of science or theory. For example, biology is a branch of science that studies living organisms. Related: antibodies, antibody tests, immunity, plasma, vaccine |
| Treatment |
A medicine, or other health-related intervention, that will reduce the symptoms of a disease or eliminate the disease completely. Chemotherapy, for example, is a treatment for cancer. It can cure specific types of cancer by destroying cancer cells and can also be used to improve the symptoms of cancer, when a cure is not possible. Treatments are important for chronic disease, which cannot be cured. For example, there are medicines that can help people with asthma breathe more easily, but they will not cure asthma. Related: cure, randomised control trial |
| Underlying condition | See comorbidity |
| Vaccine |
Medicines that help prepare our immune systems to defend against infection from certain diseases. Usually vaccines are given before the person is exposed to the disease. Each vaccine stimulates the immune system to make antibodies against a particular virus or bacteria. Some vaccines are given as injections, others are swallowed. Some vaccines provide lifelong immunity but others may require ‘booster shots’ to maintain immunity. The process of receiving a vaccine is called a vaccination, which is sometimes called an immunisation, but being vaccinated is different to being immunised. You are only immunised against the disease when your body starts producing antibodies. There are a number of vaccines approved for use. Read more about vaccines and COVID-19 Related: antibodies, antibody testing, immunity, plasma, treatment, serology |
| Virus |
An agent that causes disease. Viruses are significantly smaller than bacteria but they can be just as dangerous to your health. Different viruses cause diseases such as influenza, smallpox, measles, chickenpox and shingles. A virus is only active when it enters a host cell in an organism (such as a human body). A virus can only be harmful to an organism once it enters a living cells and starts to multiply. Because of the way viruses reproduce, they tend to spread throughout the whole body – rather than staying in one region like bacteria do. Viruses are also capable of invading the cells of bacteria. Antibiotics cannot destroy a virus. SARS-CoV-2 is the name of the virus that causes COVID-19. Related: bacteria, coronavirus, COVID-19, SARS-CoV-2 |
| WHO |
The World Health Organization (WHO) was founded in 1948, with the objective of helping countries achieve better health for their citizens through research, funding, public health campaigns and many other projects and programs. The WHO defines health as ‘…a state of complete physical, mental and social well-being’, not just the absence of illness. One of its many roles is to direct and coordinate international health work. During health-related emergencies, such as a global pandemic, the WHO must provide technical assistance and ‘…necessary aid upon the request or acceptance of Governments.’ 194 countries are member states of WHO. On 11 March 2020 the WHO announced that COVID-19 infection had become a pandemic. The group continues to monitor the situation around the world, collect information, support research and provide guidance for how to manage this infection. Related: |
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[ koh-vid-nahyn-teen ]
/ ˈkoʊ vɪd naɪnˌtin /
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noun Pathology.
coronavirus disease 2019: a potentially severe, primarily respiratory illness caused by a coronavirus and characterized by fever, coughing, and shortness of breath. In some people, the disease also damages major organs, as the heart or kidneys.
QUIZ
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Which sentence is correct?
Also Co·vid-19; CO·VID, Co·vid, co·vid [koh-vid] /ˈkoʊ vɪd/ .
Origin of COVID-19
Short for co(rona)vi(rus) d(isease) (20)19, the year in which the outbreak of the disease was first identified; so named by the World Health Organization in 2020
usage note for COVID-19
COVID-19 (all capital letters) is the spelling used internationally by scientific and medical professionals and their related organizations, which corresponds with the American convention of capitalizing an acronym such as AIDS or SARS. However, Covid-19 (spelled like a proper noun with an initial capital letter followed by lowercase letters) is the less obtrusive form used by several prominent media, such as The New York Times and The Times of London. And it is not uncommon to see both forms shortened to just COVID or Covid, respectively. The lowercase form covid is considerably less common in edited text.
Words nearby COVID-19
covet, coveted, covetous, covetousness, covey, COVID-19, Covilhã, covin, Covina, Covington, cow
Dictionary.com Unabridged
Based on the Random House Unabridged Dictionary, © Random House, Inc. 2023
ABOUT THIS WORD
What is COVID-19?
COVID-19 is a highly infectious respiratory disease caused by a new coronavirus. The disease was discovered in China in December 2019 and then spread around the world, causing an unprecedented public health crisis.
For health, safety, and medical emergencies or updates on the novel coronavirus pandemic, please visit the CDC (Centers for Disease Control and Prevention) and WHO (World Health Organization).
What are some variants of COVID-19?
- Covid-19
- covid-19
- COVID
- covid
How did COVID-19 become a pandemic?
COVID-19, also called coronavirus disease 2019, is the name of the disease caused by a newly discovered coronavirus. The virus and disease were first detected in Wuhan, China on December 31, 2019, and since led to an outbreak all countries across the globe, especially in the US.
While the coronavirus disease is popularly referred to as just coronavirus, coronavirus actually refers to a large family of viruses which can cause illnesses in humans and many animals. Some of these illnesses are rare but severe respiratory infections, including Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), and, as most recently discovered, COVID-19.
On February 11, 2020, the World Health Organization (WHO) officially named this novel coronavirus COVID-19. COVID is short for coronavirus disease. The number 19 refers to the fact that the disease was first detected in 2019, though the outbreak occurred in 2020. Novel coronavirus can be abbreviated as nCoV.
The technical name of the virus that causes COVID-19 is severe acute respiratory syndrome coronavirus 2, abbreviated as SARS-CoV-2. COVID-19 is genetically related to, but not the same as, the virus that led to the SARS outbreak in 2003. SARS is deadlier than COVID-19, but less infectious.
Coronaviruses contain RNA and are spherical. Under a microscope, the viruses appear to be surrounded by a spiky array thought to look like a corona, or crown-like shape, hence the name coronavirus.
The source of the new coronavirus is believed to be an animal. The virus spreads through droplets from the mouth and nose of a person with COVID-19 after coughing, sneezing, and exhaling. Other people can then pick up the virus by breathing in these droplets or coming into contact with surfaces that have been contaminated with the droplets (such as by touching an object and then touching parts of the face).
This is why it’s important to frequently wash your hands—among other practices—to reduce the risk of spreading or getting the virus. Please watch this video from the WHO for tips on protecting yourself and others from COVID-19:
Common symptoms of COVID-19 are fever, tiredness, dry cough, and difficulty breathing. Less common symptoms experienced include aches and pains, a runny nose, and diarrhea. Some people infected with COVID-19, however, don’t show symptoms or feel sick at all; they’re called asymptomatic, and can still spread the disease.
According to the WHO, most people (80%) recover from COVID-19. However, COVID-19 can develop into a severe illness, especially in older people or people who already have medical conditions.
The WHO has officially classified the coronavirus outbreak as a pandemic, which it defines as “a worldwide spread of a new disease.”
❗Update: As of July 5, 2020, COVID-19 has caused over 528,000 deaths, and over 11,125,000 cases have been confirmed around the world; the United States alone has had nearly 3 million cases and almost 130,000 deaths.
Efforts to contain the spread of COVID-19 include social distancing, a term for measures (such as avoiding mass gatherings) taken to reduce close contact between people. Learn more about social distancing and related terms in our coronavirus glossary.
Health professionals emphasize that protective measures like social distancing can flatten the curve. Flatten the curve means slowing the spread of an epidemic disease so that the capacity of the healthcare system doesn’t become overwhelmed. The curve represents the number of cases over time, and flattening that curve means preventing a huge surge of new cases in a very short period of time—which is extremely challenging for health officials to handle. Slowing the spread of an epidemic in this way is known as mitigation.
Our #FlattenTheCurve graphic is now up on @Wikipedia with proper attribution & a CC-BY-SA licence. Please share far & wide and translate it into any language you can! Details in the thread below. #Covid_19 #COVID2019 #COVID19 #coronavirus Thanks to @XTOTL & @TheSpinoffTV pic.twitter.com/BQop7yWu1Q
— Dr Siouxsie Wiles (@SiouxsieW) March 10, 2020
By June 2018, many countries around the world slowed the spread of COVID-19, while others saw a spike in cases after reopening businesses and easing stay-at-home and social-distancing orders.
Oklahoma’s daily #COVID19 numbers via the Oklahoma State Department of Health.
BIG increase today.
– 9,354 cases (+450)
– 366 reported deaths (+2)
– 197 hospitalizations (confirmed & suspected, as of 6/17)
– 3.9% positive rate (as of 6/17)— Kassie McClung (@KassieMcClung) June 18, 2020
The COVID-19 situation is continuing to evolve. Again, for help and information, please visit the CDC (Centers for Disease Control and Prevention) and WHO (World Health Organization).
Additional facts about the term COVID-19
COVID-19 is the official name of the disease caused by a newly discovered type of coronavirus.
What are five things you need to know about novel (new) #coronavirus? Watch as @DrNancyM_CDC answers important questions in this video. Stay updated with the latest information on #COVID19 at https://t.co/inSgagrDeE. pic.twitter.com/Wp2XJ9Vwmz
— CDC (@CDCgov) February 18, 2020
COVID-19 is sometimes written in lowercase as covid-19. Popularly, COVID-19 is referred to as COVID (or Covid and covid) for short. The disease is also commonly referred to as coronavirus, and corona for short. But, keep in mind that coronavirus is technically the name of a family of viruses, including SARS-CoV-2, which causes COVID-19.
There’s no evidence so far that the coronavirus is a threat to house pets like cats or dogs https://t.co/qUCAdAQEVX
— The New York Times (@nytimes) March 3, 2020
Rona, roni, (the) rona, and that/dat rona have emerged as a jocular, informal name for the disease, especially in jokes on Black Twitter.
Now black folks bout to take the rona seriously lol https://t.co/jphm2bj7lx
— Crooked Letter Y L V I A (@SylviaObell) March 10, 2020
Once again, for help and information, please visit the CDC (Centers for Disease Control and Prevention) and WHO (World Health Organization).
More examples of COVID-19:
“Test kits for the new coronavirus are now becoming more widely available in the U.S. And a surge in testing will likely cause an increase in identified cases of the COVID-19 illness … ”
—@NPR, March 2, 2020
“A genetic analysis suggested that the coronavirus, which causes a highly infectious respiratory disease called covid-19, has been spreading undetected for about six weeks in Washington state.”
—Siobhán O’Grady, Kim Bellware, Katie Mettler and Michael Brice-Saddler, Washington Post, March 2, 2020
“More than 100 Boulder County residents have tested positive for the respiratory disease COVID-19 since last week, making it the largest surge of novel coronavirus cases in the community since March — and public health officials warn more infections could be on the way.”
—Jessica Seaman and Meg Wingerter, Denver Post, June 17, 2020