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Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] The disease was first identified in 2019 in Wuhan, Central China, and has since spread globally, resulting in a pandemic and affecting over 100 countries of the world.[2][3] Common symptoms include fever, cough, and shortness of breath. Muscle pain, sputum production and sore throat are less common.[4] While the majority of cases result in mild symptoms,[5] some progress to severe pneumonia and multi-organ failure.[2][6] Around 0.2% to 15% of those affected with coronavirus disease die.[7]

The virus is typically transmitted from one person to another via respiratory droplets produced during coughing.[8] It may also be spread from touching contaminated surfaces and then touching one's face.[8] Time from exposure to onset of symptoms is generally between two and 14 days, with an average of five days.[9][10] The standard method of diagnosis is by reverse transcription polymerase chain reaction (rRT-PCR) test from a swab taken from the nose or throat or an anal swab that is said to give more accurate results. The infection can also be diagnosed from a combination of symptoms, risk factors and a chest CT scan showing features of pneumonia.[11]

Recommended measures to prevent infection include frequent hand washing, maintaining distance from others, and keeping hands away from the face.[12] The use of masks is recommended only for those who suspect they have the virus and their caregivers, but not the general public.[13][14] There is no vaccine or specific antiviral treatment for this disease although research is ongoing. Management involves treatment of symptoms, supportive care, isolation, and experimental measures.[15]

The World Health Organization declared the 2019–20 coronavirus outbreak a pandemic[3] and a Public Health Emergency of International Concern.[16][17] Evidence of local transmission has been confirmed in many countries in the world.[18]

Signs and symptoms

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Symptoms of coronavirus disease. (Translate this image to your language using SVG translate and use it on your language Wikipedia.)

Although those infected with the virus may be asymptomatic, many develop flu-like symptoms, including fever, cough, and shortness of breath.[19] Emergency symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking, and bluish face or lips; immediate medical attention is advised if these symptoms are present.[20] There is a delay from when a person is infected with the virus to when they develop symptoms, known as the incubation period. The incubation period for COVID-19 is typically five to six days but may range from two to 14 days.[21]

Cause

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Microscopy image showing SARS-CoV-2. The spikes on the outer edge of the virus particles resemble a crown, giving the disease its characteristic name.

The disease is caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[22] It is primarily spread between people via respiratory droplets from coughs and sneezes.[23] The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin converting enzyme-2, which is most abundant in the type II alveolar cells of the lungs.[24] The virus also affects gastrointestinal organs as angiotensin converting enzyme-2 is abundantly found in the glandular cells of the epithelium of organs of the digestive system.[25]

The virus is thought to be natural and have an animal origin.[26] It was first transmitted to humans in Wuhan, China, in November or December 2019, and the primary source of infection became human-to-human transmission by early January 2020.[27] The earliest known infection occurred on 17 November 2019 in Wuhan, China.[28]

Diagnosis

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The standard method of testing is real-time reverse transcription polymerase chain reaction (rRT-PCR).The test can be done on respiratory samples obtained by various methods, including a nasopharyngeal swab or sputum sample.[29] Results are generally available within a few hours to two days.[30] Blood tests can be used, but these require two blood samples taken two weeks apart and the results have little immediate value.[31] CT scans have been used to identify the pneumonia caused by the virus[32], but they are not fully conclusive.

Prevention

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An illustration of the effect of spreading out infections over a long period of time, known as flattening the curve; decreasing peaks allows healthcare services to better manage the same volume of patients. Note: Translate the image using SVG Translate tool.

Because a vaccine against SARS-CoV-2 is not expected to become available until 2021 at the earliest,[33] a key part of managing the COVID-19 pandemic is trying to decrease the epidemic peak, known as flattening the epidemic curve through various measures seeking to reduce the rate of new infections.[34] Slowing the infection rate helps decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and provides more time for a vaccine and treatment to be developed.[34] Preventive measures to reduce the chances of infection in locations with an outbreak of the disease are similar to those published for other coronaviruses: stay home, avoid travel and public activities, wash hands with soap and warm water often and for at least 20 seconds, practice good respiratory hygiene and avoid touching the eyes, nose, or mouth with unwashed hands.[35] Physical distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel, and canceling mass gatherings.[36] Physical distancing also includes that people stay at least about 1.80 meters apart.[37] According to the World Health Organization, the use of masks is only recommended if a person is coughing or sneezing or when one is taking care of someone with a suspected infection.[38]

Management

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Infected individuals requiring hospital admission are managed with supportive care, which may include fluid, oxygen support, and supporting other affected vital organs.[39][40][41] Most cases of COVID-19 are not severe enough to require mechanical ventilation (artificial assistance to support breathing), but a percentage of cases do.[42][43] Severe cases are most common in older adults (those older than 60 years). Many developed countries do not have enough hospital beds per capita, which limits a health system's capacity to handle a sudden spike in the number of COVID-19 cases severe enough to require hospitalization. his limited capacity is a significant driver of the need to flatten the curve (to keep the speed at which new cases occur and thus the number of people sick at one point in time lower).[44] Although new medications for COVID-19 may take until 2021 to develop,[45] several of the medications being tested are already approved for other uses, or are already in advanced testing. Antiviral medication may be tried in people with severe disease.[39] Big data analytics on cellphone data, facial recognition technology, mobile phone tracking and artificial intelligence are used to track infected people and people whom they contacted in some countries.[46][47] Infected individuals may experience distress from quarantine, travel restrictions, side effects of treatment, or fear of the infection itself. They may need psychological support.[48]

References

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