COVID-19: The Global Coronavirus Pandemic

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The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) have identified an outbreak of respiratory illnesses caused by a novel coronavirus originating in Wuhan, China. The WHO Director-General announced at a media briefing that the COVID-19 outbreak has been classified as a pandemic. This post is being updated as of October 28, 2020. As of October 28, 2020 there are a total of 44,081,789 global cases with 1,168,824 mortalities. A total of 8,871,354 cases have been reported in the United States, which surpasses the total number of cases reported anywhere else in the world. There have been a total of 226,752 deaths in the United States. In India, there have been 7,990,322 cases with with an associated 120,020 mortalities. In Brazil, there have been a total of 5,439,641 cases with an associated 157,946 mortalities. In Russia, there have been 1,553,028 cases with an associated 24,752 mortalities. The Johns Hopkins map reports updated data on the current case count around the world.

Coronaviruses comprise a large family of viruses and are a frequent cause of the common cold. Some cause less-severe disease, but more rarely, can cause severe disease as seen with the 2002 severe acute respiratory syndrome (SARS) and 2012 Middle East respiratory syndrome (MERS) outbreaks. The 2002 SARS epidemic, which originated in China, caused 8,300 illnesses and 785 mortalities. A total of 1,879 cases of MERS have been reported with a 39% mortality rate.

The mode of transmission of COVID-19 is by respiratory aerosol and is spread from person-to-person. However, all coronaviruses do not spread from person-to-person. For example, the primary mode of transmission of MERS was camel-to-human transmission, with the rates of human-to-human transmission being very low. Initially, the likelihood of human-to-human transmission of COVID-19 was thought to be very low. The outbreak has a possible zoonotic origin, as it has been linked to a large seafood and animal market. However, medical workers caring for patients in Wuhan city have become infected with the virus suggesting human-to-human transmission.  

The signs and symptoms associated with COVID-19 are variable and can mimic many other illnesses. According to the CDC,  the following signs and symptoms are associated with COVID-19 at time of illness onset: fever, constant or intermittent (77–98%), cough (46%–82%), myalgia or fatigue (11–52%), and shortness of breath (3-31%). The CDC also noted that while fever was present in only 44% of patients at the time of hospital admission, 89% of patients became febrile during their admission. Other possible symptoms include sore throat, headache, productive cough, nausea, and diarrhea.

The CDC and WHO have been working tirelessly to quickly develop and implement testing for COVID-19. The CDC developed an rRT-PCR test for rapid diagnosis. As of May 11, a total of 97 laboratories in the United States are offering testing. On June 13, the CDC updated its criteria to guide evaluation of persons under investigation for COVID-19.  On March 27, the FDA granted emergency authorization for laboratories to being using a new rapid COVID-19 test produced by Abbott Diagnostics that could provide results in less than 15 minutes. Details regarding timing of production and distribution are expected to be forthcoming.

Please visit this post for more detailed information on laboratory testing. In addition to the PCR test, the CDC notes other common laboratory abnormalities found in patients with COVID-19. These include: leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), elevated alanine aminotransferase and aspartate aminotransferase levels (37%), thrombocytopenia (36%), and leukopenia (34%).

For all new and updating information concerning the COVID-19 global pandemic, refer to the AccessMedicine COVID-19 Central channel (and "watch" the channel to receive alerts when new and updating information arrives).

Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education

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