Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19)
Identifieur interne : 000274 ( Pmc/Corpus ); précédent : 000273; suivant : 000275Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19)
Auteurs : Fang Jiang ; Liehua Deng ; Liangqing Zhang ; Yin Cai ; Chi Wai Cheung ; Zhengyuan XiaSource :
- Journal of General Internal Medicine [ 0884-8734 ] ; 2020.
Abstract
In late December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia (SARS-CoV-2) in Wuhan, China, aroused worldwide concern. Previous studies have reported epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19). The purpose of this brief review is to summarize those published studies as of late February 2020 on the clinical features, symptoms, complications, and treatments of COVID-19 and help provide guidance for frontline medical staff in the clinical management of this outbreak.
Url:
DOI: 10.1007/s11606-020-05762-w
PubMed: NONE
PubMed Central: 7088708
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19)</title><author><name sortKey="Jiang, Fang" sort="Jiang, Fang" uniqKey="Jiang F" first="Fang" last="Jiang">Fang Jiang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</nlm:aff></affiliation></author><author><name sortKey="Deng, Liehua" sort="Deng, Liehua" uniqKey="Deng L" first="Liehua" last="Deng">Liehua Deng</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.410560.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 1760 3078</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Affiliated Hospital of Guangdong Medical University,</institution></institution-wrap>Zhanjiang, China</nlm:aff></affiliation></author><author><name sortKey="Zhang, Liangqing" sort="Zhang, Liangqing" uniqKey="Zhang L" first="Liangqing" last="Zhang">Liangqing Zhang</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.410560.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 1760 3078</institution-id><institution>Department of Anesthesiology,</institution><institution>Affiliated Hospital of Guangdong Medical University,</institution></institution-wrap>Zhanjiang, China</nlm:aff></affiliation></author><author><name sortKey="Cai, Yin" sort="Cai, Yin" uniqKey="Cai Y" first="Yin" last="Cai">Yin Cai</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</nlm:aff></affiliation></author><author><name sortKey="Cheung, Chi Wai" sort="Cheung, Chi Wai" uniqKey="Cheung C" first="Chi Wai" last="Cheung">Chi Wai Cheung</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</nlm:aff></affiliation></author><author><name sortKey="Xia, Zhengyuan" sort="Xia, Zhengyuan" uniqKey="Xia Z" first="Zhengyuan" last="Xia">Zhengyuan Xia</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</nlm:aff></affiliation><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.410560.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 1760 3078</institution-id><institution>Department of Anesthesiology,</institution><institution>Affiliated Hospital of Guangdong Medical University,</institution></institution-wrap>Zhanjiang, China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7088708</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088708</idno><idno type="RBID">PMC:7088708</idno><idno type="doi">10.1007/s11606-020-05762-w</idno><idno type="pmid">NONE</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000274</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000274</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19)</title><author><name sortKey="Jiang, Fang" sort="Jiang, Fang" uniqKey="Jiang F" first="Fang" last="Jiang">Fang Jiang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</nlm:aff></affiliation></author><author><name sortKey="Deng, Liehua" sort="Deng, Liehua" uniqKey="Deng L" first="Liehua" last="Deng">Liehua Deng</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.410560.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 1760 3078</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Affiliated Hospital of Guangdong Medical University,</institution></institution-wrap>Zhanjiang, China</nlm:aff></affiliation></author><author><name sortKey="Zhang, Liangqing" sort="Zhang, Liangqing" uniqKey="Zhang L" first="Liangqing" last="Zhang">Liangqing Zhang</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.410560.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 1760 3078</institution-id><institution>Department of Anesthesiology,</institution><institution>Affiliated Hospital of Guangdong Medical University,</institution></institution-wrap>Zhanjiang, China</nlm:aff></affiliation></author><author><name sortKey="Cai, Yin" sort="Cai, Yin" uniqKey="Cai Y" first="Yin" last="Cai">Yin Cai</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</nlm:aff></affiliation></author><author><name sortKey="Cheung, Chi Wai" sort="Cheung, Chi Wai" uniqKey="Cheung C" first="Chi Wai" last="Cheung">Chi Wai Cheung</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</nlm:aff></affiliation></author><author><name sortKey="Xia, Zhengyuan" sort="Xia, Zhengyuan" uniqKey="Xia Z" first="Zhengyuan" last="Xia">Zhengyuan Xia</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</nlm:aff></affiliation><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.410560.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 1760 3078</institution-id><institution>Department of Anesthesiology,</institution><institution>Affiliated Hospital of Guangdong Medical University,</institution></institution-wrap>Zhanjiang, China</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of General Internal Medicine</title><idno type="ISSN">0884-8734</idno><idno type="eISSN">1525-1497</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p id="Par1">In late December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia (SARS-CoV-2) in Wuhan, China, aroused worldwide concern. Previous studies have reported epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19). The purpose of this brief review is to summarize those published studies as of late February 2020 on the clinical features, symptoms, complications, and treatments of COVID-19 and help provide guidance for frontline medical staff in the clinical management of this outbreak.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Wang, Chen" uniqKey="Wang C">Chen Wang</name></author><author><name sortKey="Horby, Peter W" uniqKey="Horby P">Peter W Horby</name></author><author><name sortKey="Hayden, Frederick G" uniqKey="Hayden F">Frederick G Hayden</name></author><author><name sortKey="Gao, George F" uniqKey="Gao G">George F Gao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhu, Na" uniqKey="Zhu N">Na Zhu</name></author><author><name sortKey="Zhang, Dingyu" uniqKey="Zhang D">Dingyu Zhang</name></author><author><name sortKey="Wang, Wenling" uniqKey="Wang W">Wenling Wang</name></author><author><name sortKey="Li, Xingwang" uniqKey="Li X">Xingwang Li</name></author><author><name sortKey="Yang, Bo" uniqKey="Yang B">Bo Yang</name></author><author><name sortKey="Song, Jingdong" uniqKey="Song J">Jingdong Song</name></author><author><name sortKey="Zhao, Xiang" uniqKey="Zhao X">Xiang Zhao</name></author><author><name sortKey="Huang, Baoying" uniqKey="Huang B">Baoying Huang</name></author><author><name sortKey="Shi, Weifeng" uniqKey="Shi W">Weifeng Shi</name></author><author><name sortKey="Lu, Roujian" uniqKey="Lu R">Roujian Lu</name></author><author><name sortKey="Niu, Peihua" uniqKey="Niu P">Peihua Niu</name></author><author><name sortKey="Zhan, Faxian" uniqKey="Zhan F">Faxian Zhan</name></author><author><name sortKey="Ma, Xuejun" uniqKey="Ma X">Xuejun Ma</name></author><author><name sortKey="Wang, Dayan" uniqKey="Wang D">Dayan Wang</name></author><author><name sortKey="Xu, Wenbo" uniqKey="Xu W">Wenbo Xu</name></author><author><name sortKey="Wu, Guizhen" uniqKey="Wu G">Guizhen Wu</name></author><author><name sortKey="Gao, George F" uniqKey="Gao G">George F. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Gen Intern Med</journal-id><journal-id journal-id-type="iso-abbrev">J Gen Intern Med</journal-id><journal-title-group><journal-title>Journal of General Internal Medicine</journal-title></journal-title-group><issn pub-type="ppub">0884-8734</issn><issn pub-type="epub">1525-1497</issn><publisher><publisher-name>Springer US</publisher-name><publisher-loc>New York</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">7088708</article-id><article-id pub-id-type="publisher-id">5762</article-id><article-id pub-id-type="doi">10.1007/s11606-020-05762-w</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19)</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Jiang</surname><given-names>Fang</given-names></name><address><email>fangjiang1210@163.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Deng</surname><given-names>Liehua</given-names></name><address><email>glinson@126.com</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Liangqing</given-names></name><address><email>zhanglq1970@163.com</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Cai</surname><given-names>Yin</given-names></name><address><email>caiyin1987@gmail.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Cheung</surname><given-names>Chi Wai</given-names></name><address><email>cheucw@hku.hk</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Xia</surname><given-names>Zhengyuan</given-names></name><address><email>zyxia@hku.hk</email></address><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff3">3</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.194645.b</institution-id><institution-id institution-id-type="ISNI">0000000121742757</institution-id><institution>Department of Anesthesiology, Li Ka Shing Faculty of Medicine,</institution><institution>The University of Hong Kong,</institution></institution-wrap>Hong Kong, SAR China</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.410560.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 1760 3078</institution-id><institution>Department of Critical Care Medicine,</institution><institution>Affiliated Hospital of Guangdong Medical University,</institution></institution-wrap>Zhanjiang, China</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="GRID">grid.410560.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 1760 3078</institution-id><institution>Department of Anesthesiology,</institution><institution>Affiliated Hospital of Guangdong Medical University,</institution></institution-wrap>Zhanjiang, China</aff></contrib-group><pub-date pub-type="epub"><day>4</day><month>3</month><year>2020</year></pub-date><fpage>1</fpage><lpage>5</lpage><history><date date-type="received"><day>24</day><month>2</month><year>2020</year></date><date date-type="rev-recd"><day>26</day><month>2</month><year>2020</year></date><date date-type="accepted"><day>27</day><month>2</month><year>2020</year></date></history><permissions><copyright-statement>© Society of General Internal Medicine 2020</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><abstract id="Abs1"><p id="Par1">In late December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia (SARS-CoV-2) in Wuhan, China, aroused worldwide concern. Previous studies have reported epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19). The purpose of this brief review is to summarize those published studies as of late February 2020 on the clinical features, symptoms, complications, and treatments of COVID-19 and help provide guidance for frontline medical staff in the clinical management of this outbreak.</p></abstract><kwd-group xml:lang="en"><title>KEY WORDS</title><kwd>COVID-19</kwd><kwd>SARS-CoV-2</kwd><kwd>coronavirus</kwd><kwd>pneumonia</kwd><kwd>Wuhan</kwd><kwd>review</kwd></kwd-group></article-meta></front><body><sec id="Sec1"><title>INTRODUCTION</title><p id="Par2">In December 31, 2019, hospitals reported a cluster of cases with pneumonia of unknown cause in Wuhan, Hubei, China, attracting great attention nationally and worldwide.<sup><xref ref-type="bibr" rid="CR1">1</xref></sup> On January 1, 2020, Wuhan public health authorities shut down the Huanan Seafood Wholesale Market, where wild and live animals were sold, due to a suspected link with the outbreak. On January 7, 2020, researchers rapidly isolated a novel coronavirus (SARS-CoV-2, also referred to as 2019-nCoV) from confirmed infected pneumonia patients. Real-time reverse transcription polymerase chain reaction (RT-PCR) and next-generation sequencing were used to characterize it.<sup><xref ref-type="bibr" rid="CR2">2</xref></sup> On January 23, 2020, owing to the large flow of people during the Chinese Spring Festival, public transport was suspended in Wuhan and, eventually, in all the cities in Hubei Province to reduce the risk of further transmission.</p><p id="Par3">The number of RT-PCR–confirmed cases has increased rapidly. On January 30, 2020, the World Health Organization (WHO) declared COVID-19 (as it would be officially known as of February 11) to be a Public Health Emergency of International Concern (PHEIC) and declared an epidemic. As of February 24, 2020, 80,239 cases were confirmed worldwide causing 2700 deaths. Mainland China, and especially Hubei Province, has borne the brunt of the epidemic, reporting 77,780 cases. Outside of mainland China, 33 countries have reported 2549 confirmed infections and 34 fatalities.<sup><xref ref-type="bibr" rid="CR3">3</xref></sup></p><p id="Par4">We reviewed the published clinical features, symptoms, complications, and treatments of patients with COVID-19 to help health workers around the world combat the current outbreak.</p><p id="Par5">We searched PubMed for all published articles regarding COVID-19 up to February 19, 2020. Keywords used were “COVID-19,” “2019 novel coronavirus,” “SARS-CoV-2,” “2019-nCoV,” “Wuhan coronavirus,” and “Wuhan seafood market pneumonia virus.” After careful screening, six published articles with confirmed cases were identified and included in this review. The summary of included clinical studies is shown in Table <xref rid="Tab1" ref-type="table">1</xref>.<table-wrap id="Tab1"><label>Table 1</label><caption><p>Summary of included clinical studies to date</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Author</th><th>Huang et al.<sup><xref ref-type="bibr" rid="CR4">4</xref></sup></th><th>Chen et al.<sup><xref ref-type="bibr" rid="CR5">5</xref></sup></th><th>Li et al.<sup><xref ref-type="bibr" rid="CR6">6</xref></sup></th><th>Song et al.<sup><xref ref-type="bibr" rid="CR7">7</xref></sup></th><th>Chen et al.<sup><xref ref-type="bibr" rid="CR8">8</xref></sup></th><th>Wang et al.<sup><xref ref-type="bibr" rid="CR9">9</xref></sup></th></tr></thead><tbody><tr><td>Study setting</td><td>Wuhan Jinyintan Hospital from Dec 16, 2019 to Jan 2, 2020</td><td>Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020</td><td>Hospitals in Wuhan on Jan 22, 2020</td><td>Shanghai Public Health Clinical Center from Jan 20 to Jan 27, 2020</td><td>Tongji Hospital from Jan 14 to Jan 29, 2020</td><td>Zhongnan Hospital of Wuhan University from Jan 1 to Jan 28, 2020, follow-up to Feb 3, 2020</td></tr><tr><td>City</td><td>Wuhan, China</td><td>Wuhan, China</td><td>Wuhan, China</td><td>Shanghai, China</td><td>Wuhan, China</td><td>Wuhan, China</td></tr><tr><td>Total patients</td><td>41</td><td>99</td><td>425</td><td>51</td><td>29</td><td>138</td></tr><tr><td>Age, mean (IQR) or mean ± SD, years</td><td>49 (41–58)</td><td>55.5 ± 13.1</td><td>56 (26–82)</td><td>49 ± 16</td><td>56 (26–79)</td><td>56 (42–68)</td></tr><tr><td>Gender, male</td><td>30 (73%)</td><td>67 (68%)</td><td>31 (66%)</td><td>25 (49%)</td><td>21 (72%)</td><td>75 (54.3%)</td></tr><tr><td>Exposure history, cases</td><td>27 (66%) exposed to Huanan Seafood Wholesale Market</td><td>49 (49%) exposed to Huanan Seafood Wholesale Market</td><td>26 (55%) exposed to Huanan Seafood Wholesale Market</td><td>50 (98%) exposed to Wuhan</td><td>2 (7%) exposed to Huanan Seafood Wholesale Market</td><td>12 (8.7%) exposed to Huanan Seafood Wholesale Market</td></tr><tr><td>X-ray and CT findings, cases</td><td>Bilateral ground glass opacity, 40 (98%)</td><td>Multiple mottling and ground glass opacity, 14 (14%)</td><td>Radiographic evidence of pneumonia</td><td>Ground glass opacity, 39 (77%)</td><td>NA</td><td>Ground glass opacity, 138 (100%)</td></tr><tr><td>Signs and symptoms</td><td><p>Fever, 40 (98%)</p><p>Cough, 31 (76%)</p><p>Myalgia or fatigue, 18 (44%)</p><p>Sputum production, 11/39 (28%)</p><p>Headache, 3/38 (8%)</p><p>Hemoptysis, 2/39 (5%)</p><p>Diarrhea, 1/38 (3%)</p><p>Dyspnea, 22/40 (55%)</p></td><td><p>Fever, 82 (83%)</p><p>Cough, 81 (82%)</p><p>Shortness of breath, 31 (31%)</p><p>Muscle ache, 11 (11%)</p><p>Confusion, 9 (9%)</p><p>Headache, 8 (8%)</p><p>Sore throat, 5 (5%)</p><p>Rhinorrhea, 4 (4%)</p><p>Chest pain, 2 (2%)</p><p>Diarrhea, 2 (2%)</p><p>Nausea and vomiting, 1 (1%)</p></td><td>Fever, with or without recorded temperature</td><td><p>Fever, 49 (96%)</p><p>Cough, 24 (47%)</p><p>Phlegm, 10 (20%)</p><p>Myalgia or fatigue, 16 (31%)</p><p>Headache and dizziness, 8 (16%)</p><p>Dyspnea or chest pain, 7 (14%)</p><p>Loss of appetite, 9 (18%)</p><p>Diarrhea 5, (10%)</p><p>Stuffy and runny nose, 2 (4%)</p><p>Sore throat, 3 (6%)</p><p>Nausea and vomiting, 3 (6%)</p></td><td><p>Fever, 28 (97%)</p><p>Cough or expectoration, 21 (72%)</p><p>Dyspnea, 17 (59%)</p><p>Myalgia or fatigue, 12 (41%)</p><p>Headache, 2 (7%)</p><p>Diarrhea, 4 (14%)</p></td><td><p>Fever, 136 (98.6%)</p><p>Fatigue, 96 (69.6%)</p><p>Dry cough, 82 (59.4%)</p><p>Anorexia, 55 (39.9%)</p><p>Myalgia, 48 (34.8%)</p><p>Dyspnea, 43 (31.2%)</p><p>Expectoration, 37 (26.8%)</p><p>Pharyngalgia, 24 (17.4%)</p><p>Diarrhea, 14 (10.1%)</p><p>Nausea, 14 (10.1%)</p><p>Dizziness, 13 (9.4%)</p><p>Headache, 9 (6.5%)</p><p>Vomiting, 5 (3.6%)</p><p>Abdominal pain, 3 (2.2%)</p></td></tr><tr><td>Complications</td><td><p>ARDS, 12 (29%)</p><p>RNAemia, 6 (15%)</p><p>Acute cardiac injury, 5 (12%)</p><p>Acute kidney injury, 3 (7%)</p><p>Secondary infection, 4 (10%)</p><p>Shock, 3 (7%)</p></td><td><p>ARDS, 17 (17%)</p><p>Acute renal injury, 3 (3%)</p><p>Acute respiratory injury, 8 (8%)</p><p>Septic shock, 4 (4%)</p><p>Ventilator-associated pneumonia, 1 (1%)</p></td><td>NA</td><td>NA</td><td>NA</td><td><p>Shock, 12 (8.7%)</p><p>Acute cardiac injury, 10 (7.2%)</p><p>Arrhythmia, 23 (16.7%)</p><p>ARDS, 27 (19.6%)</p><p>AKI, 5 (3.6%)</p></td></tr><tr><td>Treatments</td><td><p>Antiviral, 38 (93%)</p><p>Antibiotic, 41 (100%)</p><p>Corticosteroid, 9 (22%)</p><p>CRRT, 3 (7%)</p><p>Nasal cannula, 27 (66%)</p><p>Noninvasive ventilation or high-flow nasal cannula, 10 (24%)</p><p>Invasive mechanical ventilation, 2 (5%)</p><p>Invasive mechanical ventilation and ECMO, 2 (5%)</p></td><td><p>Oxygen therapy, 75 (76%)</p><p>Noninvasive ventilation, 13 (13%)</p><p>Invasive ventilation, 4 (4%)</p><p>CRRT, 9 (9%)</p><p>ECMO, 3 (3%)</p><p>Antibiotic, 70 (71%)</p><p>Antifungal, 15 (15%)</p><p>Antiviral, 75 (76%)</p><p>Glucocorticoids, 19 (19%)</p><p>Immunoglobulin, 27 (27%)</p></td><td>NA</td><td>NA</td><td>NA</td><td><p>Antiviral, 124 (89.9%)</p><p>Glucocorticoid, 62 (44.9%)</p><p>CRRT, 2 (1.45%)</p><p>Oxygen inhalation, 106 (76.81%)</p><p>NIV, 15 (10.9%)</p><p>IMV, 17 (12.32%)</p><p>ECMO, 4 (2.9%)</p></td></tr><tr><td>Discharged</td><td>28 (68%)</td><td>31 (31%)</td><td>NA</td><td>NA</td><td>NA</td><td>47 (34.1%)</td></tr><tr><td>Death</td><td>6 (15%)</td><td>11 (11%)</td><td>NA</td><td>NA</td><td>2 (7%)</td><td>6 (4.3%)</td></tr></tbody></table><table-wrap-foot><p><italic>NA</italic> not applicable, <italic>AKI</italic> acute kidney injury, <italic>ARDS</italic> acute respiratory distress syndrome, <italic>CRRT</italic> continuous renal replacement therapy, <italic>ECMO</italic> extracorporeal membrane oxygenation, <italic>IMV</italic> invasive mechanical ventilation, <italic>NIV</italic> noninvasive ventilation</p></table-wrap-foot></table-wrap></p></sec><sec id="Sec2"><title>NATURAL HISTORY AND CLINICAL CHARACTERISTICS</title><p id="Par6">Huang et al.<sup><xref ref-type="bibr" rid="CR4">4</xref></sup> first reported clinical features of 41 patients confirmed to be infected with COVID-19 on January 2, 2020, which include 13 ICU cases and 28 non-ICU cases. More than half of the cases (66%) had been exposed to the Huanan Seafood Wholesale Market. Almost all the patients had bilateral lung ground glass opacity on computed tomography imaging. The initial symptoms included fever (98%), cough (76%), dyspnea (55%), myalgia or fatigue (44%), sputum production (28%), headache (8%), hemoptysis (5%), and diarrhea (3%). Only one patient did not present fever in the early stage of disease. Twelve (29%) cases progressed to acute respiratory distress syndrome (ARDS), 5 (12%) had acute cardiac injury, 3 (7%) had acute kidney injury (AKI), and 3 (7%) had shock. At the data cutoff date, 28 (68%) patients were discharged and 6 (15%) had died.</p><p id="Par7">On January 20, 2020, Chen et al.<sup><xref ref-type="bibr" rid="CR5">5</xref></sup> reported 99 cases with SARS-CoV-2–infected pneumonia. This case series revealed that older males with comorbidities as a result of weaker immune function were the most susceptible to COVID-19 incidence. The symptoms, complications, and treatments in this study were similar to the previous published study by Huang and colleagues.<sup><xref ref-type="bibr" rid="CR4">4</xref></sup> At the data cutoff date, 31 (31%) were discharged and 11 (11%) died, and 57 (58%) of the patients were still hospitalized. A study of Li et al.<sup><xref ref-type="bibr" rid="CR6">6</xref></sup> reported on 425 COVID-19 cases in Wuhan confirmed between January 1 and 22, 2020. The mean incubation period was 5.2 days, with the 95th percentile of the distribution at 12.5 days, though uncertainty remains.</p><p id="Par8">Two subsequent studies confirmed the pattern of signs and symptoms.<sup><xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR8">8</xref></sup> At the time of this writing, the most recent published case series<sup><xref ref-type="bibr" rid="CR9">9</xref></sup> of 138 confirmed cases included 36 requiring intensive care by the data cutoff date of February 3, 2020. It also found the common presenting symptoms of fever (136, 99%), fatigue (96, 70%), and dry cough (82, 59%), though there were two patients who did not present any signs of fever at the onset of illness. A higher proportion of cases presented with gastrointestinal symptoms including diarrhea and nausea (14, 10%) than in previous series. Forty-seven (34%) were discharged while 6 (4%) died, while the remainder were still hospitalized. The organ failure complications were similar to the original studies.</p><p id="Par9">Taken together, these studies indicate the main clinical manifestations of COVID-19 are fever (90% or more), cough (around 75%), and dyspnea (up to 50%). A small but significant subset has gastrointestinal symptoms. Preliminary estimates of case fatality, likely to fall as better early diagnostic efforts come into play, is about 2%, mostly due to ARDS, AKI, and myocardial injury.</p></sec><sec id="Sec3"><title>BASIC VIROLOGY</title><p id="Par10">Coronaviruses are widespread in humans and several other vertebrates and cause respiratory, enteric, hepatic, and neurologic diseases. Notably, the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 have caused human epidemics. Comparison with the current virus shows several significant differences and similarities. Both MERS-CoV and SARS-CoV have much higher case fatality rates (40% and 10%, respectively). Though the current SARS-CoV-2 shares 79% of its genome with SARS-CoV, it appears to be much more transmissible.<sup><xref ref-type="bibr" rid="CR10">10</xref></sup></p><p id="Par11">Both SARS-CoVs enter the cell via the angiotensin-converting enzyme 2 (ACE2) receptor.<sup><xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR12">12</xref></sup> The SARS-Cov-2 first predominantly infects lower airways and binds to ACE2 on alveolar epithelial cells. Both viruses are potent inducers of inflammatory cytokines. The “cytokine storm” or “cytokine cascade” is the postulated mechanism for organ damage. The virus activates immune cells and induces the secretion of inflammatory cytokines and chemokines into pulmonary vascular endothelial cells.</p></sec><sec id="Sec4"><title>TRANSMISSION DYNAMICS AND PROTECTIVE MEASURES</title><p id="Par12">The preliminary estimate of R0 (the expected number of cases directly produced by one person in a population susceptible to infection) for COVID-19 is 2.2 (95% CI, 1.4 to 3.9).<sup><xref ref-type="bibr" rid="CR6">6</xref></sup> Fomites are suspected as the main source of infectious particles, though some uncertainty remains. Other coronaviruses have been shown to persist for days on uncleaned surfaces.<sup><xref ref-type="bibr" rid="CR10">10</xref></sup> Additionally, SARS-CoV-2 RNA was detected in the stool specimen in a person who had symptoms while the serum specimen tested negative.<sup><xref ref-type="bibr" rid="CR13">13</xref></sup> Recently, SARS-Cov-2 was isolated from a swab sample of a confirmed patient’s feces by Chinese researchers,<sup><xref ref-type="bibr" rid="CR14">14</xref></sup> indicating the potential for fecal-oral transmission. Studies have shown effective person-to-person transmission of 2019-nCoV even in the presence of isolation efforts in medical facilities.<sup><xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR16">16</xref></sup> A case series of nine infected pregnant women did not reveal evidence of third trimester vertical transmission after cesarian section.<sup><xref ref-type="bibr" rid="CR17">17</xref></sup> Transmission in health settings is a very serious threat. The most recent case series reported 57 (41%) of 138 patients were infected hospital settings, including 40 (29%) medical staff.<sup><xref ref-type="bibr" rid="CR9">9</xref></sup> While further study is needed, it appears that asymptomatic persons are also potential sources of 2019-nCoV infection.<sup><xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR19">19</xref></sup></p><p id="Par13">Handwashing is the mainstay of viral control. Contact isolation gear such as masks, gowns, and gloves are also recommended. Transmission via ocular surface is possible,<sup><xref ref-type="bibr" rid="CR20">20</xref></sup> so eye protection should also be used.</p></sec><sec id="Sec5"><title>VACCINES AND TREATMENTS</title><p id="Par14">Several efforts to develop vaccines are underway, but the WHO estimates it will take 18 months for the COVID-19 vaccines to be available.<sup><xref ref-type="bibr" rid="CR21">21</xref></sup> At present, most treatment is symptomatic and supportive, though anti-inflammatory and antiviral treatments have been employed. Supportive treatment for complicated patients has included continuous renal replacement therapy (CRRT), invasive mechanical ventilation, and even extracorporeal membrane oxygenation (ECMO). No specific antiviral drugs have been confirmed effective. The first reported patient with 2019-nCoV infection in the USA was treated with remdesivir,<sup><xref ref-type="bibr" rid="CR13">13</xref></sup> and others have used antiretrovirals like ritonavir, with trials of both in progress.<sup><xref ref-type="bibr" rid="CR22">22</xref></sup> A recent study conducted by the “front-line” health care providers combating COVID-19 in Wuhan indicated that systemic corticosteroid treatment did not show significant benefit.<sup><xref ref-type="bibr" rid="CR23">23</xref></sup> Baricitinib has been suggested as a potential drug for the treatment in the hope that it might reduce the process of both virus invasion and inflammation.<sup><xref ref-type="bibr" rid="CR24">24</xref></sup></p></sec><sec id="Sec6"><title>CONCLUSION</title><p id="Par15">Despite some diversity in initial symptoms, most COVID-19 patients have fever and respiratory symptoms. For now, travel history to epidemic areas is important to the diagnosis and should be obtained on all patients with flu-like syndromes. If positive, timely referral to the public health authorities for testing is crucial. Frontline medical staff are at risk and should employ protective measures. Treatment is mainly supportive and symptomatic, though trials of vaccines and antivirals are underway. Healthcare providers should follow subsequent reports as the situation will likely change rapidly.</p></sec></body><back><fn-group><fn><p><bold>Publisher’s Note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn></fn-group><notes notes-type="author-contribution"><title>Authors’ Contributions</title><p>F. J. and Z. X. planned the work. F. J. drafted the manuscript. Z. X. revised the manuscript. L. D., L. Z., Y. C., and C. W. C. participated in the literature search and discussion. All authors read and approved the final manuscript. Editor’s note: Several of the authors are natives of Hubei Province.</p></notes><notes notes-type="funding-information"><title>Funding Information</title><p>The authors’ work was supported by the National Natural Science Foundation of China (NSFC, 81970247).</p></notes><notes><title>Compliance with Ethical Standards</title><notes notes-type="COI-statement"><title>Conflict of Interest</title><p id="Par16">The authors declare that they do not have a conflict of interest.</p></notes></notes><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>Chen</given-names></name><name><surname>Horby</surname><given-names>Peter W</given-names></name><name><surname>Hayden</surname><given-names>Frederick G</given-names></name><name><surname>Gao</surname><given-names>George F</given-names></name></person-group><article-title>A novel coronavirus outbreak of global health concern</article-title><source>The Lancet</source><year>2020</year><volume>395</volume><issue>10223</issue><fpage>470</fpage><lpage>473</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(20)30185-9</pub-id></element-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhu</surname><given-names>Na</given-names></name><name><surname>Zhang</surname><given-names>Dingyu</given-names></name><name><surname>Wang</surname><given-names>Wenling</given-names></name><name><surname>Li</surname><given-names>Xingwang</given-names></name><name><surname>Yang</surname><given-names>Bo</given-names></name><name><surname>Song</surname><given-names>Jingdong</given-names></name><name><surname>Zhao</surname><given-names>Xiang</given-names></name><name><surname>Huang</surname><given-names>Baoying</given-names></name><name><surname>Shi</surname><given-names>Weifeng</given-names></name><name><surname>Lu</surname><given-names>Roujian</given-names></name><name><surname>Niu</surname><given-names>Peihua</given-names></name><name><surname>Zhan</surname><given-names>Faxian</given-names></name><name><surname>Ma</surname><given-names>Xuejun</given-names></name><name><surname>Wang</surname><given-names>Dayan</given-names></name><name><surname>Xu</surname><given-names>Wenbo</given-names></name><name><surname>Wu</surname><given-names>Guizhen</given-names></name><name><surname>Gao</surname><given-names>George F.</given-names></name><name><surname>Tan</surname><given-names>Wenjie</given-names></name></person-group><article-title>A Novel Coronavirus from Patients with Pneumonia in China, 2019</article-title><source>New England Journal of Medicine</source><year>2020</year><volume>382</volume><issue>8</issue><fpage>727</fpage><lpage>733</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa2001017</pub-id><pub-id pub-id-type="pmid">31978945</pub-id></element-citation></ref><ref id="CR3"><label>3.</label><mixed-citation publication-type="other">World Health Organization. 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