COVID-19 natural history, complications and prognosis: Difference between revisions

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'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''.<br>
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''.<br>
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''.<br>
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''.<br>
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==Natural History==
==Natural History==
* The clinical course of the [[disease]] consists of three major patterns:<ref name="HeymannShindo2020">{{cite journal|last1=Heymann|first1=David L|last2=Shindo|first2=Nahoko|title=COVID-19: what is next for public health?|journal=The Lancet|volume=395|issue=10224|year=2020|pages=542–545|issn=01406736|doi=10.1016/S0140-6736(20)30374-3}}</ref>
 
*# Mild [[illness]] with [[upper respiratory tract]] presenting [[Symptom|symptoms]]
*The clinical course of the [[disease]] consists of three major patterns:<ref name="HeymannShindo2020">{{cite journal|last1=Heymann|first1=David L|last2=Shindo|first2=Nahoko|title=COVID-19: what is next for public health?|journal=The Lancet|volume=395|issue=10224|year=2020|pages=542–545|issn=01406736|doi=10.1016/S0140-6736(20)30374-3}}</ref>
*# Non-life-threatening [[pneumonia]]
*#Mild [[illness]] with [[upper respiratory tract]] presenting [[Symptom|symptoms]]
*# Severe [[pneumonia]] with [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] that begins with mild [[Symptom|symptoms]] for 7 - 8 days and progressing to rapid deterioration and [[Acute respiratory distress syndrome|ARDS]] requiring [[advanced life support]]
*#Non-life-threatening [[pneumonia]]
*#Severe [[pneumonia]] with [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] that begins with mild [[Symptom|symptoms]] for 7 - 8 days and progressing to rapid deterioration and [[Acute respiratory distress syndrome|ARDS]] requiring [[advanced life support]]
*In a study of 44,672 confirmed cases in Mainland China:<ref>{{Cite web|url=http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*In a study of 44,672 confirmed cases in Mainland China:<ref>{{Cite web|url=http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
**80.9% were reported to have a mild disease
**80.9% were reported to have a mild disease
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*[[Pneumonia]] mostly occurs in the second or third week of a [[symptomatic]] [[disease]].
*[[Pneumonia]] mostly occurs in the second or third week of a [[symptomatic]] [[disease]].
*[[Medical sign|Signs]] of the above mentioned [[pneumonia]] [[Viral pneumonia|(viral pneumonia)]] include decreased [[oxygen saturation]], [[Blood gases|blood gas]] deviations, and changes on [[Chest X-ray|chest X‐ray]] and other [[imaging]] techniques.
*[[Medical sign|Signs]] of the above mentioned [[pneumonia]] [[Viral pneumonia|(viral pneumonia)]] include decreased [[oxygen saturation]], [[Blood gases|blood gas]] deviations, and changes on [[Chest X-ray|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<ref name="urlwww.univadis.com">{{cite web |url=https://www.univadis.com/viewarticle/covid-19-prolonged-viral-shedding-linked-to-male-sex-lymphopenia-disease-severity-04e1a15d-6c76-3e23-a115-e1a4e3c9e320 |title=www.univadis.com |format= |work= |accessdate=}}</ref><ref>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</ref>.
*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]]<ref name="urlwww.univadis.com">{{cite web |url=https://www.univadis.com/viewarticle/covid-19-prolonged-viral-shedding-linked-to-male-sex-lymphopenia-disease-severity-04e1a15d-6c76-3e23-a115-e1a4e3c9e320 |title=www.univadis.com |format= |work= |accessdate=}}</ref><ref>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</ref>.
*The study also found that positive fecal viral RNA causes viral clearance time to be prolonged.
*The study also found that positive fecal viral RNA causes viral clearance time to be prolonged.


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Currently, 952,100 cases of [[COVID-19]] have been reported worldwide to date (April 2, 2020) with 48,100 confirmed deaths. This [[pandemic]] can have three possible scenarios in relation to its global course:
Currently, 952,100 cases of [[COVID-19]] have been reported worldwide to date (April 2, 2020) with 48,100 confirmed deaths. This [[pandemic]] can have three possible scenarios in relation to its global course:


** If all countries work together to contain the [[virus]], due to its similarity with the [[SARS]] virus which caused an outbreak in 2003, the [[pandemic]] may be contained by July-August, 2020 but it should be taken into account that in the 2003 outbreak, international travel was not as frequent as it is today which may worsen the situation due to imported cases.
**If all countries work together to contain the [[virus]], due to its similarity with the [[SARS]] virus which caused an outbreak in 2003, the [[pandemic]] may be contained by July-August, 2020 but it should be taken into account that in the 2003 outbreak, international travel was not as frequent as it is today which may worsen the situation due to imported cases.
* The second scenario may occur if the [[virus]] stays until the summer of 2020 in the northern hemisphere subsequent to which it may turn up in the southern hemisphere and reappear in the northern hemisphere during the months of November-December. This would be the case if the [[virus]] behaves as [[seasonal flu]].
*The second scenario may occur if the [[virus]] stays until the summer of 2020 in the northern hemisphere subsequent to which it may turn up in the southern hemisphere and reappear in the northern hemisphere during the months of November-December. This would be the case if the [[virus]] behaves as [[seasonal flu]].
* The third scenario is where we develop [[vaccination]] and [[Vaccination|vaccinate]] the human race against this fatal [[virus]] and eradicate it similar to other [[Virus|viruses]] such as [[smallpox]], [[polio]] and others.
*The third scenario is where we develop [[vaccination]] and [[Vaccination|vaccinate]] the human race against this fatal [[virus]] and eradicate it similar to other [[Virus|viruses]] such as [[smallpox]], [[polio]] and others.


==Complications==
==Complications==
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===Cardiovascular Complications===
===Cardiovascular Complications===


* [[COVID-19-associated myocardial injury]]
*[[COVID-19-associated myocardial injury]]
* [[COVID-19-associated myocarditis]]
*[[COVID-19-associated myocarditis]]
* [[COVID-19-associated myocardial infarction]]
*[[COVID-19-associated myocardial infarction]]
* [[COVID-19-associated heart failure]]
*[[COVID-19-associated heart failure]]
* [[COVID-19-associated arrhythmia and conduction system disease]]
*[[COVID-19-associated arrhythmia and conduction system disease]]
* [[COVID-19-associated cardiogenic shock]]
*[[COVID-19-associated cardiogenic shock]]
* [[COVID-19-associated cardiac arrest]]
*[[COVID-19-associated cardiac arrest]]
* [[COVID-19-associated pericarditis]]
*[[COVID-19-associated pericarditis]]
* [[COVID-19-associated spontaneous coronary artery dissection]]
*[[COVID-19-associated spontaneous coronary artery dissection]]
* [[COVID-19-associated stress cardiomyopathy]]
*[[COVID-19-associated stress cardiomyopathy]]


===Dermatologic Complications===
===Dermatologic Complications===
* [[COVID-19-associated dermatologic manifestations]]
 
*[[COVID-19-associated dermatologic manifestations]]


===Gastrointestinal and Hepatic Complications===
===Gastrointestinal and Hepatic Complications===
* COVID-19-associated digestive symptoms
 
:* [[COVID-19-associated anorexia]]  
*COVID-19-associated digestive symptoms
:* [[COVID-19-associated diarrhea]]  
 
:* [[COVID-19-associated nausea and vomiting]]
:*[[COVID-19-associated anorexia]]
:* [[COVID-19-associated abdominal pain]]
:*[[COVID-19-associated diarrhea]]
* [[COVID-19-associated hepatic injury]]
:*[[COVID-19-associated nausea and vomiting]]
:*[[COVID-19-associated abdominal pain]]
 
*[[COVID-19-associated hepatic injury]]


===Hematologic Complications===
===Hematologic Complications===
* [[COVID-19-associated coagulopathy]]
 
*[[COVID-19-associated coagulopathy]]
*[[COVID-19-associated cytokine storm]]
*[[COVID-19-associated cytokine storm]]
* COVID-19-associated hematologic symptoms
*COVID-19-associated hematologic symptoms
**[[COVID-19-associated anemia]]
**[[COVID-19-associated anemia]]
**[[COVID-19-associated lymphopenia]]
**[[COVID-19-associated lymphopenia]]
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===Infectious Disease Complications===
===Infectious Disease Complications===
* [[COVID-19 and influenza co-infection]]
 
*[[COVID-19 and influenza co-infection]]


===Nephrologic Complications===
===Nephrologic Complications===
* [[COVID-19-associated acute kidney injury]]
 
* [[COVID-19-associated hemodialysis]]
*[[COVID-19-associated acute kidney injury]]
*[[COVID-19-associated hemodialysis]]


===Neurologic Complications===
===Neurologic Complications===
* COVID-19-associated CNS manifestations
 
*COVID-19-associated CNS manifestations


:*[[COVID-19-associated encephalitis]]
:*[[COVID-19-associated encephalitis]]
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:*[[COVID-19-associated encephalopathy]]
:*[[COVID-19-associated encephalopathy]]


* COVID-19-associated PNS manifestations
*COVID-19-associated PNS manifestations
:* [[COVID-19-associated anosmia]]
 
:* [[COVID-19-associated Guillain-Barre syndrome]]
:*[[COVID-19-associated anosmia]]
:* [[COVID-19-associated Miller-Fischer syndrome]]
:*[[COVID-19-associated Guillain-Barre syndrome]]
:* [[COVID-19-associated myelitis]]
:*[[COVID-19-associated Miller-Fischer syndrome]]
:* [[COVID-19-associated polyneuritis cranialis]]
:*[[COVID-19-associated myelitis]]
:*[[COVID-19-associated polyneuritis cranialis]]


===Pulmonary Complications===
===Pulmonary Complications===
* [[COVID-19-associated acute respiratory distress syndrome]]
 
* [[COVID-19-associated hypoxemia]]
*[[COVID-19-associated acute respiratory distress syndrome]]
* [[COVID-19-associated pneumonia]]
*[[COVID-19-associated hypoxemia]]
* [[COVID-19-associated pulmonary embolism]]
*[[COVID-19-associated pneumonia]]
* [[COVID-19-associated pulmonary hypertension]]
*[[COVID-19-associated pulmonary embolism]]
* [[COVID-19-associated respiratory failure]]
*[[COVID-19-associated pulmonary hypertension]]
*[[COVID-19-associated respiratory failure]]


===Endocrine Complications===
===Endocrine Complications===
* [[COVID-19-associated diabetes mellitus]]
 
*[[COVID-19-associated diabetes mellitus]]


===Pediatric Complications===
===Pediatric Complications===
* [[COVID-19-associated multisystem inflammatory syndrome]]
 
* [[COVID-19 associated pediatric complications]]
*[[COVID-19-associated multisystem inflammatory syndrome]]
*[[COVID-19 associated pediatric complications]]


</div>
</div>

Revision as of 22:04, 27 August 2020


For COVID-19 frequently asked inpatient questions, click here.
For COVID-19 frequently asked outpatient questions, click here.

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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]

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

Global Course

Currently, 952,100 cases of COVID-19 have been reported worldwide to date (April 2, 2020) with 48,100 confirmed deaths. This pandemic can have three possible scenarios in relation to its global course:

    • If all countries work together to contain the virus, due to its similarity with the SARS virus which caused an outbreak in 2003, the pandemic may be contained by July-August, 2020 but it should be taken into account that in the 2003 outbreak, international travel was not as frequent as it is today which may worsen the situation due to imported cases.
  • The second scenario may occur if the virus stays until the summer of 2020 in the northern hemisphere subsequent to which it may turn up in the southern hemisphere and reappear in the northern hemisphere during the months of November-December. This would be the case if the virus behaves as seasonal flu.
  • The third scenario is where we develop vaccination and vaccinate the human race against this fatal virus and eradicate it similar to other viruses such as smallpox, polio and others.

Complications

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

References

  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.
  2. ↑ http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51. Missing or empty |title= (help)
  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. ↑ "www.univadis.com".
  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, https://doi.org/10.1093/infdis/jiaa388
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