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]


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

Prognosis can be calculated with


Risk factors for bad prognosis


Obesity is a risk factor that may[8][9][10] or may not[11] negate the impact of race.

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[12].


Cardiovascular Complications

Dermatologic Complications

Gastrointestinal and Hepatic Complications

  • COVID-19-associated digestive symptoms

Hematologic Complications

Infectious Disease Complications

Nephrologic Complications

Neurologic Complications

  • COVID-19-associated CNS manifestations
  • COVID-19-associated PNS manifestations

Pulmonary Complications

Endocrine Complications

Pediatric Complications


  1. 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.
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  3. 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.
  4. 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. 5.0 5.1 "".
  6. 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,
  7. "The association between biomarkers and clinical outcomes in novel coronavirus pneumonia in a US cohort | Biomarkers in Medicine".
  8. Tartof SY, Qian L, Hong V, Wei R, Nadjafi RF, Fischer H; et al. (2020). "Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization". Ann Intern Med. 173 (10): 773–781. doi:10.7326/M20-3742. PMC 7429998 Check |pmc= value (help). PMID 32783686 Check |pmid= value (help).
  9. Garibaldi BT, Fiksel J, Muschelli J, Robinson ML, Rouhizadeh M, Perin J; et al. (2021). "Patient Trajectories Among Persons Hospitalized for COVID-19 : A Cohort Study". Ann Intern Med. 174 (1): 33–41. doi:10.7326/M20-3905. PMC 7530643 Check |pmc= value (help). PMID 32960645 Check |pmid= value (help).
  10. Price-Haywood EG, Burton J, Fort D, Seoane L (2020). "Hospitalization and Mortality among Black Patients and White Patients with Covid-19". N Engl J Med. 382 (26): 2534–2543. doi:10.1056/NEJMsa2011686. PMC 7269015 Check |pmc= value (help). PMID 32459916 Check |pmid= value (help).
  11. Anderson MR, Geleris J, Anderson DR, Zucker J, Nobel YR, Freedberg D; et al. (2020). "Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection : A Retrospective Cohort Study". Ann Intern Med. 173 (10): 782–790. doi:10.7326/M20-3214. PMC 7397550 Check |pmc= value (help). PMID 32726151 Check |pmid= value (help).
  12. "World Health Organization - Draft landscape of COVID-19 candidate vaccines". WHO. 07/20/2020. Check date values in: |date= (help)