COVID-19 natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2] Syed Hassan A. Kazmi BSc, MD [3] Aisha Adigun, B.Sc., M.D.[4]
Overview
In symptomatic patients, the clinical features of the disease usually start within a week, consisting of fever, cough, nasal congestion, fatigue, and other signs of upper respiratory tract infections. Disease progression and severity is manifested by dyspnea and severe chest symptoms corresponding to pneumonia in approximately 75% of the patients.
Natural History
- The clinical course of the disease consists of three major patterns:[1]
- Mild illness with upper respiratory tract presenting symptoms
- Non-life-threatening pneumonia
- Severe pneumonia with acute respiratory distress syndrome (ARDS) that begins with mild symptoms for 7 - 8 days and progressing to rapid deterioration and ARDS requiring advanced life support
- In a study of 44,672 confirmed cases in Mainland China:[2]
- 80.9% were reported to have a mild disease
- 13.8% were reported to have severe disease with the indication for hospitalization
- 4.7% were reported to have critical disease with the indication for intensive care
- In symptomatic patients, the clinical features of the disease usually start within a week, consisting of fever, cough, nasal congestion, fatigue, and other signs of upper respiratory tract infections.[3]
- Disease progression and severity is manifested by dyspnea and severe chest symptoms corresponding to pneumonia in approximately 75% of the patients.[4]
- Pneumonia mostly occurs in the second or third week of a symptomatic disease.
- Signs of the above mentioned pneumonia (viral pneumonia) include decreased oxygen saturation, blood gas deviations, and changes on chest X‐ray and other imaging techniques.
- A retrospective, single-center study of 99 hospitalized patients with confirmed SARS-CoV-2 infection in china showed that factors influencing SARS-CoV-2 viral clearance include male sex, disease severity, and lymphopenia[5][6].
- The study also found that positive fecal viral RNA causes viral clearance time to be prolonged.
- An observational retrospective study was published online on the 19th of July 2020[7][5]. The study subjects were 299 adult COVID-19 patients on admission at George Washington University Hospital from March 12, 2020, to May 9, 2020. Results showed that increase or elevations in levels of D-dimer (≥3 μg/mL), LDH (≥1200 units/L), CRP (≥100 mg/L), IL-6 (≥50 pg/mL), and ferritin (≥450 ng/mL) were each independently associated with elevated odds of transfer to the ICU, intubation, and death.
Global Course
Currently, 30,087,916 cases of COVID-19 have been reported worldwide to date (September 17, 2020) with 945,988 confirmed deaths. In relation to its global course, there were three possible projections for the pandemic:
- With all countries working together to contain the virus, due to its similarity with the SARS virus which caused an outbreak in 2003, the pandemic was projected to be contained by July-August, 2020. It was taken into account that in the 2003 outbreak, international travel was not as frequent as it presently is. However, lock-down measures were not equally put in place in all countries and this let to the importation of cases from worse hit areas.
- Similar to the seasonal flu, the virus was projected to stay until the summer of 2020 in the northern hemisphere after which it may turn up in the southern hemisphere and reappear in the northern hemisphere during the months of November-December.
- It is the hope that vaccination can eradicate COVID-19 similar to other viruses such as smallpox, polio and others. There are more than 160 vaccines under development for preventing COVID-19 infection, 26 of them already undergoing clinical trials[8].
Complications
Cardiovascular Complications
- COVID-19-associated myocardial injury
- COVID-19-associated myocarditis
- COVID-19-associated myocardial infarction
- COVID-19-associated heart failure
- COVID-19-associated arrhythmia and conduction system disease
- COVID-19-associated cardiogenic shock
- COVID-19-associated cardiac arrest
- COVID-19-associated pericarditis
- COVID-19-associated spontaneous coronary artery dissection
- COVID-19-associated stress cardiomyopathy
Dermatologic Complications
Gastrointestinal and Hepatic Complications
- COVID-19-associated digestive symptoms
Hematologic Complications
- COVID-19-associated coagulopathy
- COVID-19-associated cytokine storm
- COVID-19-associated hematologic symptoms
Infectious Disease Complications
Nephrologic Complications
Neurologic Complications
- COVID-19-associated CNS manifestations
- COVID-19-associated PNS manifestations
Pulmonary Complications
- COVID-19-associated acute respiratory distress syndrome
- COVID-19-associated hypoxemia
- COVID-19-associated pneumonia
- COVID-19-associated pulmonary embolism
- COVID-19-associated pulmonary hypertension
- COVID-19-associated respiratory failure
Endocrine Complications
Pediatric Complications
References
- ↑ Heymann, David L; Shindo, Nahoko (2020). "COVID-19: what is next for public health?". The Lancet. 395 (10224): 542–545. doi:10.1016/S0140-6736(20)30374-3. ISSN 0140-6736.
- ↑ http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51. Missing or empty
|title=(help) - ↑ Velavan, Thirumalaisamy P.; Meyer, Christian G. (2020). "The COVID‐19 epidemic". Tropical Medicine & International Health. 25 (3): 278–280. doi:10.1111/tmi.13383. ISSN 1360-2276.
- ↑ Guan, Wei-jie; Ni, Zheng-yi; Hu, Yu; Liang, Wen-hua; Ou, Chun-quan; He, Jian-xing; Liu, Lei; Shan, Hong; Lei, Chun-liang; Hui, David SC; Du, Bin; Li, Lan-juan; Zeng, Guang; Yuen, Kowk-Yung; Chen, Ru-chong; Tang, Chun-li; Wang, Tao; Chen, Ping-yan; Xiang, Jie; Li, Shi-yue; Wang, Jin-lin; Liang, Zi-jing; Peng, Yi-xiang; Wei, Li; Liu, Yong; Hu, Ya-hua; Peng, Peng; Wang, Jian-ming; Liu, Ji-yang; Chen, Zhong; Li, Gang; Zheng, Zhi-jian; Qiu, Shao-qin; Luo, Jie; Ye, Chang-jiang; Zhu, Shao-yong; Zhong, Nan-shan (2020). doi:10.1101/2020.02.06.20020974. Missing or empty
|title=(help) - ↑ 5.0 5.1 "www.univadis.com".
- ↑ Ding Shi, Wenrui Wu, Qing Wang, Kaijin Xu, Jiaojiao Xie, Jingjing Wu, Longxian Lv, Jifang Sheng, Jing Guo, Kaicen Wang, Daiqiong Fang, Yating Li, Lanjuan Li, Clinical Characteristics and Factors Associated With Long-Term Viral Excretion in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Single-Center 28-Day Study, The Journal of Infectious Diseases, Volume 222, Issue 6, 15 September 2020, Pages 910–918, https://doi.org/10.1093/infdis/jiaa388
- ↑ "World Health Organization - Draft landscape of COVID-19 candidate vaccines". WHO. 07/20/2020. Check date values in:
|date=(help)