Coronavirus Disease 2019 (COVID-19)
Updated: April 5, 2020 20:05 EDT
What’s New Here
Updated and new sections
What’s New Elsewhere on Site
Coronavirus 2019-20 Outbreak Overview
A large family of viruses that cause a variety of illness:
- Common cold
- Middle East Respiratory Syndrome (MERS-CoV)
- Severe Acute Respiratory Syndrome (SARS-CoV)
Novel Coronavirus (SARS-CoV-2; 2019-nCoV) History
- In late 2019, a new coronavirus – not seen previously in humans – was identified as the cause of human illness in China and given the name 2019-nCoV.
- By late January 2020, outbreak declared a public health emergency of international concern by WHO and US Centers for Disease Control and Prevention (CDC).,
- Categorized as a pandemic by WHO in March 2020.
Case Definition and Patient Under Investigation (PUI)
- COVID-19 name given by WHO to the disease caused by the SARS-CoV-2 (2019-nCoV) virus.
- See Case Definitions for WHO Surveillance Case Definition and CDC Patient Under Investigation (PUI) Clinical Criteria for COVID-19.
- If a PUI for COVID-19 is identified, notify your health department immediately. See Reporting COVID-19 in the United States for details.
- A detailed travel history is recommended for all patients being evaluated with fever and acute respiratory illness.
Front-line healthcare personnel in the United States should be prepared to evaluate patients for coronavirus disease 2019 (COVID-19). The following checklist from the CDC highlights key steps for healthcare personnel in preparation for transport and arrival of patients with confirmed or possible COVID-19.
- Stay up to date on the latest information about signs and symptoms, diagnostic testing, and case definitions for coronavirus disease 2019
- Review your infection prevention and control policies and CDC infection control recommendations for COVID-19 for:
- Assessment and triage of patients with acute respiratory symptoms
- Patient placement
- Implementation of Standard, Contact, and Airborne Precautions, including the use of eye protection
- Visitor management and exclusion
- Source control measures for patients (e.g., put facemask on suspect patients)
- Requirements for performing aerosol generating procedures
- Be alert for patients who meet the persons under investigation (PUI) definition
- Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials
- Know who, when, and how to seek evaluation by occupational health following an unprotected exposure (i.e., not wearing recommended PPE) to a suspected or confirmed coronavirus disease 2019 patient
- Remain at home, and notify occupational health services, if you are ill
- Know how to contact and receive information from your state or local public health agency (See Reporting COVID-19 in the United States)
World Health Organization
Objectives of global surveillance
- Monitor trends in COVID-19 disease at national and global levels.
- Rapidly detect new cases in countries where the virus is not circulating, and monitor cases in countries where the virus has started to circulate.
- Provide epidemiological information to conduct risk assessments at the national, regional and global level.
- Provide epidemiological information to guide preparedness and response measures.
Surveillance Case Definitions for COVID-19
- Case and contact definitions are based on the current available information and are regularly revised as new information accumulates.
- Countries may need to adapt case definitions depending on their local epidemiological situation and other factors.
- All countries are encouraged to publish definitions used online and in regular situation reports, and to document periodic updates to definitions which may affect the interpretation of surveillance data.
The case definitions are based on the current information available and will be revised as new information accumulates. Countries may need to adapt case definitions depending on their own epidemiological situation.
*Definition of contact
A contact is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a probable or confirmed case:
†Source: Global surveillance for COVID-19 caused by human infection with COVID-19 virus. World Health Organization. Revised 20 March 2020.
1 Inconclusive being the result of the test reported by the laboratory.
Classification of transmission scenarios
- WHO recommends using the following categories to describe transmission patterns at national and sub-national levels (wherever possible) to guide decisions for preparedness, readiness and response activities.
Countries/territories/areas with no cases
Countries/territories/areas with one or more cases, imported or locally detected
Clusters of cases
Countries/territories/areas experiencing cases, clustered in time, geographic locationand/or by common exposures
Countries/area/territories experiencing larger outbreaks of local transmission definedthrough an assessment of factors including, but not limited to: - Large numbers of cases not linkable to transmission chains - Large numbers of cases from sentinel lab surveillance - Multiple unrelated clusters in several areas of the country/territory/area
Recommendations for laboratory testing
Any suspected case should be tested for COVID-19 infection using available molecular tests. However, depending on the intensity of the transmission, the number of cases and the laboratory capacity, only a subset of the suspect cases may prioritized for testing.
During community transmission WHO recommends prioritizing persons to be tested as indicated in the WHO global testing strategy for COVID-19.
To monitor the full extent of the circulation of the virus in the general population, WHO recommends implementing testing for COVID-19 via existing national sentinel surveillance sites for influenza-like illness (ILI) and severe acute respiratory infection (SARI). Guidance will be made available here:
U.S. Centers for Disease Control
- For any patient meeting criteria for evaluation for COVID-19, clinicians are encouraged to contact and collaborate with their state or local health department. See Reporting COVID-19 in the United States.
- For patients that are severely ill, evaluation for COVID-19 may be considered even if a known source of exposure has not been identified.
- With limited testing capacities in many locations, clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.
- The most common symptoms include fever (subjective or confirmed) and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing).
- Other considerations that may guide testing are epidemiologic factors such as the occurrence of local community transmission of COVID-19 infections in a jurisdiction.
Ensures optimal care options for all hospitalized patients, lessen the risk of healthcare-associated infections, and maintain the integrity of the U.S. healthcare system.
Ensures those at highest risk of complications of infection are rapidly identified and appropriately triaged.
As resources allow, test individuals in the surrounding community of rapidly increasing hospital cases to decrease community spread, and ensure the health of essential workers.
†Source: U.S. Centers for Disease Control and Prevention. Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19) Revised March 24, 2020.
Recommendations for Reporting, Testing, and Specimen Collection
- Clinicians should immediately implement recommended infection prevention and control practices if a patient is suspected of having COVID-19 and notify infection control personnel at their healthcare facility and their state or local health department if a patient is classified as a PUI for COVID-19.
- State health departments that have identified a PUI or a laboratory-confirmed case should complete a PUI and Case Report form through the processes identified on CDC’s Coronavirus Disease 2019 website. State and local health departments can contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 for assistance with obtaining, storing, and shipping appropriate specimens to CDC for testing, including after hours or on weekends or holidays.
- For initial diagnostic testing for COVID-19, CDC recommends collecting and testing upper respiratory tract specimens (nasopharyngeal swab) and lower respiratory tract specimens, if available.
- For patients who develop a productive cough, sputum should be collected and tested for COVID-19. The induction of sputum is not recommended.
- For patients for whom it is clinically indicated (e.g., those receiving invasive mechanical ventilation), a lower respiratory tract aspirate or bronchoalveolar lavage sample should be collected and tested as a lower respiratory tract specimen.
- Specimens should be collected as soon as possible once a PUI is identified, regardless of the time of symptom onset.
- See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for COVID-19 and Biosafety FAQs for handling and processing specimens from suspected cases and PUIs.
- On March 19th, WHO issued guidance on infection prevention and control strategies for healthcare workers (HCW) when COVID-19 is suspected.
- See  for full details and references.
- Infection prevention and control (IPC) strategies to prevent or limit transmission in health care settings include the following:
- Ensuring triage, early recognition, and source control (isolating patients with suspected COVID-19);
- Applying standard precautions for all patients;
- Implementing empiric additional precautions (droplet and contact and, whenever applicable, airborne precautions) for suspected cases of COVID-19;
- Implementing administrative controls;
- Using environmental and engineering controls.
Contact and droplet precautions
- In addition to using standard precautions, all individuals, including family members, visitors and HCWs, should use contact and droplet precautions before entering the room of suspected or confirmed COVID-19 patients.
- Patients should be placed in adequately ventilated single rooms. For general ward rooms with natural ventilation, adequate ventilation is considered to be 60 L/s per patient.
- When single rooms are not available, patients suspected of having COVID-19 should be grouped together.
- All patients’ beds should be placed at least 1 metre apart regardless of whether they are suspected to have COVID-19.
- Where possible, a team of HCWs should be designated to care exclusively for suspected or confirmed cases to reduce the risk of transmission.
Healthcare Worker (HCW) Protection
- HCWs should:
- Wear a medical mask.
- Wear eye protection (goggles) or facial protection (face shield) to avoid contamination of mucous membranes.
- Wear a clean, non-sterile, long-sleeved gown.
- Use gloves.
- Boots, coverall, and apron is not required during routine care.
- Carry out hand hygiene and appropriate doffing and disposal of all Personal Protective Equipment (PPE) after care of each patient.
- Refrain from touching eyes, nose, or mouth with potentially contaminated gloved or bare hands.
- Use new set of PPE when care is given to a different patient.
- Equipment should be either single-use and disposable or dedicated equipment (e.g., stethoscopes, blood pressure cuffs and thermometers).
- If equipment needs to be shared among patients, clean and disinfect it between use for each individual patient (e.g., by using ethyl alcohol 70%).
- Avoid moving and transporting patients out of their room or area unless medically necessary.
- Use designated portable X-ray equipment or other designated diagnostic equipment. If transport is required, use predetermined transport routes to minimize exposure for staff, other patients and visitors, and have the patient wear a medical mask.
- Ensure that HCWs who are transporting patients perform hand hygiene and wear appropriate PPE as described in this section.
- Notify the area receiving the patient of any necessary precautions as early as possible before the patient’s arrival.
- Routinely clean and disinfect surfaces with which the patient is in contact.
- Limit the number of HCWs, family members, and visitors who are in contact with suspected or confirmed COVID-19 patients.
- Maintain a record of all persons entering a patient’s room, including all staff and visitors.
Airborne precautions for aerosol-generating procedures
- Some aerosol-generating procedures, such as tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, and bronchoscopy, have been associated with an increased risk of transmission of coronaviruses.
- Ensure that HCWs performing aerosol-generating procedures:
- Perform procedures in an adequately ventilated room – that is, natural ventilation with air flow of at least 160 L/s per patient or in negative- pressure rooms with at least 12 air changes per hour and controlled direction of air flow when using mechanical ventilation.
- Use a particulate respirator at least as protective as a US National Institute for Occupational Safety and Health (NIOSH)-certified N95, European Union (EU) standard FFP2, or equivalent.
- When HCWs put on a disposable particulate respirator, they must always perform the seal check.Note that facial hair (e.g. a beard) may prevent a proper respirator fit.
- Use eye protection (i.e., goggles or a face shield).
- Wear a clean, non-sterile, long-sleeved gown and gloves. If gowns are not fluid-resistant, HCWs should use a waterproof apron for procedures expected to create high volumes of fluid that might penetrate the gown.
- Limit the number of persons present in the room to the absolute minimum required for the patient’s care and support.
- For abbreviations used below see Glossary of Coronavirus terms.
- Syndromes range from mild upper respiratory infection to severe pneumonia, ARDS and death.
- All age groups are susceptible to the virus, but elderly patients with comorbidities are more likely to experience severe illness.
- Major risk factors for severe illness and mortality from COVID-19:
- Comorbidities: heart disease, hypertension, prior stroke, diabetes, chronic lung disease, and chronic kidney disease have all been associated with increased illness severity and adverse outcomes.
†Source: Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. ePub: 18 March 2020.
Chronic respiratory disease
†Source: The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China.
Mortality associated with COVID-19 in the United States has been reported to be similar to China.
Less common (< 10%)
- Anosmia or ageusia preceeding the onset of respiratory symptoms has been reported anecdotally, but more information is needed to understand its role in identifying COVID-19.
Asymptomatic and Pre-Symptomatic Infection
- Several studies have documented SARS-CoV-2 infection in patients who never develop symptoms (asymptomatic) and in patients not yet symptomatic (pre-symptomatic).,,,,
- Since asymptomatic persons are not routinely tested, the prevalence of asymptomatic infection and detection of pre-symptomatic infection is not well understood.
- One study found that as many as 13% of RT-PCR-confirmed cases of SARS-CoV-2 infection in children were asymptomatic.
- Patients may have abnormalities on chest imaging before the onset of symptoms.,
- Although transmission of SARS-CoV-2 from asymptomatic or pre-symptomatic persons has been reported, risk of transmission is thought to be greatest when patients are symptomatic.
- Viral RNA shedding, measured indirectly by RT-PCR cycle threshold values, is greatest at the time of symptom onset and declines over the course of several days to weeks.,
- The exact degree of SARS-CoV-2 viral RNA shedding that confers risk of transmission is not yet clear.
In 44,600 COVID-19 cases from China, disease severity was classified as:
- Mild to moderate (mild symptoms up to mild pneumonia): 81%
- Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14%
- Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%
- Case fatality rate was 49% among patients in this group and 2.3% overall.
Among 2,143 pediatric patients studied in China
- 94% had asymptomatic, mild or moderate disease
- 5% had severe disease
- < 1% had critical disease
- Only one (< 0.1%) death was reported in a person under 18 years old.
Among U.S. COVID-19 cases with known disposition
- Hospitalized: 19%
- Admitted to the intensive care unit (ICU): 6%
- Among patients who developed severe disease, the mean duration to develop the following conditions: 
- Dyspnea: 5–8 days
- Acute respiratory distress syndrome (ARDS): 8–12 days
- ICU admission: 10–12 days.
- Some patients can rapidly deteriorate one week after illness onset.
- Mortality among patients admitted to the ICU: 39%–72%
- Median length of hospitalization among survivors: 10–13 days
- There are no current data concerning reinfection with SARS-CoV-2 after recovery from COVID-19.
- Viral RNA shedding declines with resolution of symptoms, and may continue for days to weeks. However, the detection of RNA during convalescence does not necessarily indicate the presence of viable infectious virus.
- Clinical recovery has been correlated with the detection of IgM and IgG antibodies which signal the development of immunity.,
COVID-19 Diagnostic Tests
Samples to be collected
- Respiratory material
- Nasopharyngeal and oropharyngeal (URT) swab in ambulatory patients and sputum (if produced) and/or endotracheal aspirate or bronchoalveolar lavage (LRT) in patients with more severe respiratory disease.
- Send for SARS-CoV-2 testing by reverse transcription polymerase chain reaction (RT-PCR).
- In hospitalized patients with confirmed SARS-CoV-2 infection
- Repeat URT and LRT samples should be collected to demonstrate viral clearance.
- Frequency of specimen collection will depend on local circumstances but should be at least every 2 to 4 days until there are two consecutive negative results (both URT and LRT samples if both are collected) in a clinically recovered patient at least 24 hours apart.
- If local infection control practice requires two negative results before removal of droplet precautions, specimens may be collected as often as daily. 
- Serum for serological testing, acute sample and convalescent sample (this is additional to respiratory materials and can support the identification of the true agent, once serologic assay is available). Serology for diagnostic purposes is recommended only when RT-PCR is not available.
- Blood cultures for bacteria that cause pneumonia and sepsis, when indicated, ideally before antimicrobial therapy.
- Detection of SARS-CoV-2 RNA by RT-PCR
- Diagnostic for COVID-19
- Detection better in nasopharynx compared to throat samples and lower compared to upper respiratory samples
- Detection in blood may be a marker of severe illness
- A single negative RT-PCR result, particularly if this is from an upper respiratory specimen, does not exclude infection. Repeat sampling and testing or lower respiratory tract specimen is strongly recommended in severe or progressive disease.
- Viral RNA shedding
- 7–12 days in moderate cases
- My be longer for older persons and those who had severe illness requiring hospitalization (12–20 days).
- U.S. FDA issued Emergency Use Authorization (EUA) for the first serologic test for SARS-CoV-2 immunoglobulins (Cellex; qSARS-CoV-2 IgG/IgM Rapid Test) on April 1. More serologic tests should reach the market in the U.S. soon.
- Serology among 173 patients in an early study from China:
- Median seroconversion time for Total Antibody (Ab), IgM and then IgG were day-11, day-12 and day-14 from symptom onset.
- Presence of antibodies was < 40% among patients within 1-week from symptom onset, and rapidly increased to 100.0% (Ab), 94.3% (IgM) and 79.8% (IgG) at day-15 after onset.
- A higher titer of Ab was independently associated with a worse clinical classification (p=0.006).
Days after Symptom Onset
RNA by RT-PCR
Adapted from: Zhao J et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis. 2020 Mar 28.
- Most common: lymphopenia (83% of hospitalized patients).
- Associated with greater illness severity: 
- Lymphopenia, neutrophilia
- ↑ serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH)
- ↑ C-reactive protein (CRP), ferritin.
- Associated with greater mortality: ↑ D-dimer and lymphopenia.
- Chest X-ray (CXR)
- Bilateral air-space consolidation
- May be unremarkable early in the disease
- Chest CT
- Bilateral, peripheral ground glass opacities – a non-specific pattern seen in other infections
- Role of radiologic imaging in COVID-19 diagnosis
- Because radiologic findings are non-specific, the American College of Radiology does not recommend CXR or CT for screening or as a first-line test for diagnosis of COVID-19.
Specific COVID-19 treatments
- There is no current evidence from RCTs to recommend any specific treatment for patients with suspected or confirmed COVID-19.
- Care is primarily supportive (see Supportive Therapy below)
- Antiviral drugs commonly used in clinical practice, including ganciclovir, acyclovir and ribavirin, are not currently recommended for SARS-CoV-2.
- Treatments under study:
- Convalescent plasma: in an uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in clinical status. Other Convalescent Plasma Clinical Trials are underway.
- Hydroxychloroquine and chloroquine inhibit growth of SARS-CoV-2 in vitro, but no clinical trials have demonstrated conclusively their effectiveness in humans. See Chloroquine / Hydroxychloroquine in Coronavirus COVID-19.
- Remdesivir (Gilead), an investigational IV drug with broad antiviral activity, is being investigated in multiple clinical trials. In the US, it can be obtained as part of participation in a clinical trial.
- Lopinavir-ritonavir (AbbVie; Kaletra, Aluvia) showed "no benefit" in hospitalized adult patients with severe COVID-19 according to a study published in the New England of Journal of Medicine. Many other trials are underway, see Lopinavir-Ritonavir Clinical Trials.
- Tocilizumab (Genentech; Actemra) a monoclonal antibody which blocks the IL-6 signalling pathway is being investigated in a number of Tocilizumab Clinical Trials.
- Favipiravir (Toyama Chemical; Avigan), an antiviral drug under study alone and in combination with tocilizumab, see Favipiravir Clinical Trials.
- Systemic corticosteroids are under investigation in clinical trials. Some authors advise that they should not given routinely for the treatment of COVID-19.
- Unlicensed treatments
- Should be administered only in the context of ethically-approved clinical trials or the Monitored Emergency Use of Unregistered Interventions Framework (MEURI), with strict monitoring.
- For the latest journal research
Supportive therapy and monitoring
Mild to Moderate Disease
- Patients with a mild clinical presentation (absence of viral pneumonia and hypoxia) can often manage their illness at home.
- Outpatient or inpatient monitoring may be required, depending on:
- Clinical presentation, need for supportive care, risk factors for severe disease, and the ability to self-isolate at home.
- Risk factors for severe illness: these patients should be monitored closely given the possible risk of progression to severe illness in the second week after symptom onset.
- Inpatient management of COVID-19 is supportive and focused on the management of complications (see below)
- WHO and the Surviving Sepsis Campaign have produced guidelines for inpatient and ICU management of patients with COVID-19:
- For management of children with COVID-19:
Discontinuation of Precautions or Isolation
Recommendations on discontinuation of Transmission-Based Precautions or home isolation for patients who have recovered from COVID-19 (all from CDC):
For health professionals
- Coronavirus COVID-19 Outbreak | What’s New
- Reporting COVID-19 in the United States
- Epidemic (Epi) Curves for Coronavirus COVID-19
- Specimen Collection and Testing for Coronavirus COVID-19
- PubMed Searches for Coronavirus COVID-19
- VIDEO | Coronavirus: What Nurses Need to Know
For the Public
- Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). World Health Organization. 30 January 2020. [https://www.who.int…]
- Determination that a Public Health Emergency Exists. US Department of Health and Human Services. 31 January 2020. [https://www.phe.gov…]
- WHO Director-General’s opening remarks at the media briefing on COVID-19. World Health Organization. 11 March 2020. [https://www.who.int…]
- Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020. [PMID:32150748]
- Healthcare Professional Preparedness Checklist For Transport and Arrival of Patients With Confirmed or Possible COVID-19. US Centers for Disease Control and Prevention. Accessed 26 February 2020. [https://www.cdc.gov…
- Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. World Health Organization. Updated 17 January 2020. [https://www.who.int…
- Global Surveillance for human infection with coronavirus disease (COVID-19). World Health Organization. Updated 20 March 2020. [https://www.who.int…
- Infection prevention and control during health care when COVID-19 is suspected. World Health Organization. 19 March 2020. [https://www.who.int…]
- CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346. [PMID:32214079]
- Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-151. [PMID:32064853]
- Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020. [PMID:32109013]
- Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. [PMID:32007143]
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020. [PMID:32031570]
- Dong Y, Mo X, Hu Y, et al. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics. 2020. [PMID:32179660]
- Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020. [PMID:32187458]
- Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. [PMID:31986261]
- Wang Y, Liu Y, Liu L, Wang X, Luo N, Ling L. Clinical outcome of 55 asymptomatic cases at the time of hospital admission infected with SARS-Coronavirus-2 in Shenzhen, China. The Journal of infectious diseases. 2020.
- Pan X, Chen D, Xia Y, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. The Lancet Infectious diseases. 2020.
- Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci. 2020. [PMID:32146694]
- Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020. [PMID:32125362]
- Zou L, Ruan F, Huang M, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med. 2020;382(12):1177-1179. [PMID:32074444]
- Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020. [PMID:32091533]
- Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020. [PMID:32105632]
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. [PMID:32171076]
- To KK, Tsang OT, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020. [PMID:32213337]
- Zhang W, Du RH, Li B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect. 2020;9(1):386-389. [PMID:32065057]
- Laboratory testing for Middle East Respiratory Syndrome Coronavirus: Interim guidance. World Health Organization. 2018 [https://www.who.int…].
- qSARS-CoV-2 IgG/IgM Rapid Test Letter of Authorization. U.S. Food and Drug Administration. [https://www.fda.gov…]
- Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis. 2020. [PMID:32221519]
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020. [PMID:31986264]
- Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020. [PMID:32167524]
- ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection. Updated March 22. [https://www.acr.org…]
- Cao B, Wang Y, Wen D, et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020. [PMID:32187464]
- Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223):473-475. [PMID:32043983]
- A Multicenter, Adaptive, Randomized Blinded Controlled Trial of the Safety and Efficacy of Investigational Therapeutics for the Treatment of COVID-19 in Hospitalized Adults. ClinicalTrials.gov NCT04280705. [https://clinicaltrials.gov…]
- ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33. [PMID:22797452]
- About new coronavirus infectious disease confirmed in cruise ship during quarantine in Yokohama Port, Japan Ministry of Health, Labor and Welfare. 27 February 2020. [https://www.mhlw.go.jp…]
- Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak. World Health Organization. Updated 28 January 2020
- Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020. [PMID:32101510]
- Alshahrani MS, Sindi A, Alshamsi F, et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care. 2018;8(1):3. [PMID:29330690]
- Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome. Am J Respir Crit Care Med. 2018;197(6):757-767. [PMID:29161116]
- Arabi YM, Arifi AA, Balkhy HH, et al. Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection. Ann Intern Med. 2014;160(6):389-97. [PMID:24474051]
- Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020. [PMID:32191259]
- Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020;25(5). [PMID:32046819]
- Bai HX, Hsieh B, Xiong Z, et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology. 2020. [PMID:32155105]
- Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA. 2020. [PMID:32083643]
- Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020. [PMID:32077789]
- Briel M, Meade M, Mercat A, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303(9):865-73. [PMID:20197533]
- Cai J, Xu J, Lin D, et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020.
- Chen W, Lan Y, Yuan X, et al. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerg Microbes Infect. 2020;9(1):469-473. [PMID:32102625]
- Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. World Health Organization. Updated 28 January 2020. [https://www.who.int…
- Combes A, Hajage D, Capellier G, et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. N Engl J Med. 2018;378(21):1965-1975. [PMID:29791822]
- Combes A, Brodie D, Bartlett R, et al. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 2014;190(5):488-96. [PMID:25062496]
- Corman VM, Albarrak AM, Omrani AS, et al. Viral Shedding and Antibody Response in 37 Patients With Middle East Respiratory Syndrome Coronavirus Infection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2016;62(4):477-483.
- Coronavirus (COVID-19) Update: FDA Continues to Facilitate Development of Treatments [News]. March 19, 2020. [https://www.fda.gov…]
- Coronavirus Disease 2019 (COVID-19) Situation Reports. World Health Organization. [https://www.who.int…]
- Coronavirus Disease 2019 (COVID-19) in the U.S. Centers for Disease Control and Prevention. [https://www.cdc.gov…]
- Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans. World Health Organization. Accessed February 29, 2020. [https://www.who.int…]
- Criteria to Guide Evaluation of PUI for COVID-19. US Centers for Disease Control and Prevention. Revised February 27, 2020. [https://www.cdc.gov…]
- Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017;45(6):1061-1093. [PMID:28509730]
- Delaney JW, Pinto R, Long J, et al. The influence of corticosteroid treatment on the outcome of influenza A(H1N1pdm09)-related critical illness. Crit Care. 2016;20:75. [PMID:27036638]
- Detsky ME, Jivraj N, Adhikari NK, et al. Will This Patient Be Difficult to Intubate?: The Rational Clinical Examination Systematic Review. JAMA. 2019;321(5):493-503. [PMID:30721300]
- Ding Q, Lu P, Fan Y, Xia Y, Liu M. The clinical characteristics of pneumonia patients co-infected with 2019 novel coronavirus and influenza virus in Wuhan, China. Journal of medical virology. 2020.
- Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020. [PMID:32087114]
- Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017;195(9):1253-1263. [PMID:28459336]
- Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020. [PMID:32171062]
- Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020. [PMID:32074550]
- Goligher EC, Tomlinson G, Hajage D, et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome and Posterior Probability of Mortality Benefit in a Post Hoc Bayesian Analysis of a Randomized Clinical Trial. JAMA. 2018;320(21):2251-2259. [PMID:30347031]
- Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-68. [PMID:23688302]
- Harrison C. Coronavirus puts drug repurposing on the fast track [News]. Nature Biotechnology. February 27, 2020. [https://www.nature.com…]
- Hoehl S, Rabenau H, Berger A, et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. N Engl J Med. 2020;382(13):1278-1280. [PMID:32069388]
- Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020. [PMID:32004427]
- Interim Guidance for Coronavirus Disease 2019 (COVID-19) for Event Planners. US Centers for Disease Control. March 15, 2020. [https://www.cdc.gov…]
- Interim Infection Prevention and Control Recommendations for Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) or Persons Under Investigation for 2019-nCoV in Healthcare Settings. US Centers for Disease Control and Prevention (CDC). Updated February 3, 2020. [https://www.cdc.gov…]
- Interpretation of Epidemic (Epi) Curves during Ongoing Outbreak Investigations. US Centers for Disease Control and Prevention. [https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/epi-curves.html]
- Kam KQ, Yung CF, Cui L, et al. A Well Infant with Coronavirus Disease 2019 (COVID-19) with High Viral Load. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020.
- Kimball A HK, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morbidity and mortality weekly report. 2020;ePub: 27 March 2020.
- Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020. [PMID:32081636]
- Lamontagne F, Meade MO, Hébert PC, et al. Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial. Intensive Care Med. 2016;42(4):542-550. [PMID:26891677]
- Lee MK, Choi J, Park B, et al. High flow nasal cannulae oxygen therapy in acute-moderate hypercapnic respiratory failure. Clin Respir J. 2018;12(6):2046-2056. [PMID:29392846]
- Lei J, Li J, Li X, et al. CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology. 2020;295(1):18. [PMID:32003646]
- Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44(6):925-928. [PMID:29675566]
- Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020. [PMID:31995857]
- Lim J, Jeon S, Shin HY, et al. Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: the Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR. J Korean Med Sci. 2020;35(6):e79. [PMID:32056407]
- Liu W, Zhang Q, Chen J, et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. N Engl J Med. 2020. [PMID:32163697]
- Liu Y, Yan LM, Wan L, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020. [PMID:32199493]
- Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA. 2020. [PMID:32181795]
- Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care. 2015;30(3):653.e9-17. [PMID:25669592]
- Luo Y, Ou R, Ling Y, et al. [The therapeutic effect of high flow nasal cannula oxygen therapy for the first imported case of Middle East respiratory syndrome to China]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015;27(10):841-4. [PMID:27132449]
- McMichael TM CS, Pogosjans S, et al. COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020. MMWR Morbidity and mortality weekly report. 2020.
- McMichael TM CS, Pogosjans S, et al. COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020. MMWR Morbidity and mortality weekly report. 2020;69:339-342.
- Messerole E, Peine P, Wittkopp S, et al. The pragmatics of prone positioning. Am J Respir Crit Care Med. 2002;165(10):1359-63. [PMID:12016096]
- NIH clinical trial of investigational vaccine for COVID-19 begins: study enrolling Seattle-based healthy adult volunteers [News]. March 16, 2020. [https://www.nih.gov…]
- NIH clinical trial of remdesivir to treat COVID-19 begins [News]. National Institutes of Health. Accessed Febrary 28, 2020. [https://www.nih.gov/news-events/news-releases/nih-clinical-trial-remdesivir-treat-covid-19-begins]
- National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564-75. [PMID:16714767]
- National Heart, Lung, and Blood Institute PETAL Clinical Trials Network, Moss M, Huang DT, et al. Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome. N Engl J Med. 2019;380(21):1997-2008. [PMID:31112383]
- Ou X, Hua Y, Liu J, et al. Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials. CMAJ. 2017;189(7):E260-E267. [PMID:28246239]
- Pan L, Mu M, Ren HG, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020;[Epub ahead of print].
- Pan F, Ye T, Sun P, et al. Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology. 2020. [PMID:32053470]
- Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107-16. [PMID:20843245]
- Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020.
- Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-377. [PMID:28101605]
- Rochwerg B, Alhazzani W, Gibson A, et al. Fluid type and the use of renal replacement therapy in sepsis: a systematic review and network meta-analysis. Intensive Care Med. 2015;41(9):1561-71. [PMID:25904181]
- Rochwerg B, Alhazzani W, Sindi A, et al. Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med. 2014;161(5):347-55. [PMID:25047428]
- Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, et al. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev. 2016;3:CD010406. [PMID:26950335]
- Schultz MJ, Dunser MW, Dondorp AM, et al. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future. Intensive Care Med. 2017;43(5):612-624. [PMID:28349179]
- Shi H, Han X, Zheng C. Evolution of CT Manifestations in a Patient Recovered from 2019 Novel Coronavirus (2019-nCoV) Pneumonia in Wuhan, China. Radiology. 2020;295(1):20. [PMID:32032497]
- Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-434. [PMID:32105637]
- Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med. 2006;3(9):e343. [PMID:16968120]
- Tian S, Hu N, Lou J, et al. Characteristics of COVID-19 infection in Beijing. J Infect. 2020. [PMID:32112886]
- Tracking Every Coronavirus Case in the U.S.: Full Map. New York Times. [https://www.nytimes.com…]
- Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020. [PMID:32159775]
- Wang Y, Dong C, Hu Y, et al. Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study. Radiology. 2020. [PMID:32191587]
- Wei M, Yuan J, Liu Y, et al. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA. 2020. [PMID:32058570]
- Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017;318(14):1335-1345. [PMID:28973363]
- Wu Y, Guo C, Tang L, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. The Lancet Gastroenterology & Hepatology. 2020.
- Xie X, Zhong Z, Zhao W, et al. Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing. Radiology. 2020. [PMID:32049601]
- Xu XW, Wu XX, Jiang XG, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ (Clinical research ed). 2020;368:m606.
- Xu X, Yu C, Qu J, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur J Nucl Med Mol Imaging. 2020;47(5):1275-1280. [PMID:32107577]
- Yang W, Cao Q, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China. J Infect. 2020;80(4):388-393. [PMID:32112884]
- Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020. [PMID:32145190]
- Zhang L, Liu Y. Potential Interventions for Novel Coronavirus in China: A Systematic Review. J Med Virol. 2020. [PMID:32052466]
- Zhao W, Zhong Z, Xie X, et al. Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. AJR Am J Roentgenol. 2020. [PMID:32125873]