Characteristics of SARS-CoV-2 and COVID-19

Nature Reviews Microbiology, Journal Year: 2020, Volume and Issue: 19(3), P. 141 - 154

Published: Oct. 6, 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic that emerged in late 2019 has caused pandemic of disease, named 'coronavirus disease 2019' (COVID-19), which threatens human health public safety. In this Review, we describe the basic virology SARS-CoV-2, including genomic characteristics receptor use, highlighting its key difference from previously known coronaviruses. We summarize current knowledge clinical, epidemiological pathological features COVID-19, as well recent progress animal models antiviral treatment approaches for SARS-CoV-2 infection. also discuss potential wildlife hosts zoonotic origin emerging virus detail. Shi colleagues exceptional amount research characterized (COVID-19) since swept around globe. They what know so far about emergence pathogenesis COVID-19.

Language: Английский

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Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19)

JAMA, Journal Year: 2020, Volume and Issue: 324(8), P. 782 - 782

Published: July 10, 2020

Importance

The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. This review discusses current evidence regarding pathophysiology, transmission, diagnosis, management of COVID-19.

Observations

SARS-CoV-2 is spread primarily via droplets during close face-to-face contact. Infection can be by asymptomatic, presymptomatic, symptomatic carriers. average time from exposure symptom onset 5 days, 97.5% people who develop symptoms do so within 11.5 days. most common are fever, dry cough, shortness breath. Radiographic laboratory abnormalities, such as lymphopenia elevated lactate dehydrogenase, common, but nonspecific. Diagnosis made detection reverse transcription polymerase chain reaction testing, although false-negative test results may occur up 20% 67% patients; however, this dependent on quality timing testing. Manifestations COVID-19 include asymptomatic carriers fulminant characterized sepsis failure. Approximately 5% patients COVID-19, those hospitalized, experience necessitating intensive care. More than 75% hospitalized require supplemental oxygen. Treatment individuals includes best practices supportive hypoxic Emerging data indicate that dexamethasone therapy reduces 28-day mortality requiring oxygen compared usual care (21.6% vs 24.6%; age-adjusted rate ratio, 0.83 [95% CI, 0.74-0.92]) remdesivir improves recovery (hospital discharge or no requirement) 15 11 In randomized trial 103 convalescent plasma did not shorten recovery. Ongoing trials testing antiviral therapies, immune modulators, anticoagulants. case-fatality varies markedly age, ranging 0.3 deaths per 1000 cases among aged 17 years 304.9 85 older US. Among unit, case fatality 40%. At least 120 vaccines under development. Until an effective vaccine available, primary methods reduce face masks, social distancing, contact tracing. Monoclonal antibodies hyperimmune globulin provide additional preventive strategies.

Conclusions Relevance

As July 1, 2020, more 10 million had been infected SARS-CoV-2. Many aspects infection, treatment remain unclear. Advances prevention will basic clinical investigation public health interventions.

Language: Английский

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Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study

The Lancet, Journal Year: 2020, Volume and Issue: 395(10239), P. 1763 - 1770

Published: May 20, 2020

Over 40 000 patients with COVID-19 have been hospitalised in New York City (NY, USA) as of April 28, 2020. Data on the epidemiology, clinical course, and outcomes critically ill this setting are needed.

Language: Английский

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A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19

New England Journal of Medicine, Journal Year: 2020, Volume and Issue: 383(6), P. 517 - 525

Published: June 3, 2020

BackgroundCoronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection SARS-CoV-2 unknown.MethodsWe conducted a randomized, double-blind, placebo-controlled trial across United States parts Canada testing as postexposure prophylaxis. We enrolled adults had household or occupational someone with confirmed Covid-19 at distance less than 6 ft for more 10 minutes while wearing neither face mask nor an eye shield (high-risk exposure) but no (moderate-risk exposure). Within 4 days exposure, we randomly assigned participants receive either placebo (800 mg once, followed by 600 in 8 hours, then daily additional days). The primary outcome was incidence laboratory-confirmed illness compatible within 14 days.ResultsWe 821 asymptomatic participants. Overall, 87.6% (719 821) reported high-risk contact. new did not differ significantly between receiving (49 414 [11.8%]) those (58 407 [14.3%]); absolute difference −2.4 percentage points (95% confidence interval, −7.0 2.2; P=0.35). Side effects were common (40.1% vs. 16.8%), serious adverse reactions reported.ConclusionsAfter moderate-risk Covid-19, when used prophylaxis exposure. (Funded David Baszucki Jan Ellison others; ClinicalTrials.gov number, NCT04308668.) Quick Take Hydroxychloroquine Postexposure Prophylaxis 1m 57s

Language: Английский

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COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives

Nature Reviews Cardiology, Journal Year: 2020, Volume and Issue: 17(9), P. 543 - 558

Published: July 20, 2020

Language: Английский

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Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19

New England Journal of Medicine, Journal Year: 2020, Volume and Issue: 383(21), P. 2030 - 2040

Published: Oct. 8, 2020

Hydroxychloroquine and chloroquine have been proposed as treatments for coronavirus disease 2019 (Covid-19) on the basis of in vitro activity data from uncontrolled studies small, randomized trials.

Language: Английский

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Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State

JAMA, Journal Year: 2020, Volume and Issue: 323(24), P. 2493 - 2493

Published: May 12, 2020

Hydroxychloroquine, with or without azithromycin, has been considered as a possible therapeutic agent for patients coronavirus disease 2019 (COVID-19). However, there are limited data on efficacy and associated adverse events.To describe the association between use of hydroxychloroquine, clinical outcomes among hospital inpatients diagnosed COVID-19.Retrospective multicenter cohort study from random sample all admitted laboratory-confirmed COVID-19 in 25 hospitals, representing 88.2% New York metropolitan region. Eligible were at least 24 hours March 15 28, 2020. Medications, preexisting conditions, measures admission, outcomes, events abstracted medical records. The date final follow-up was April 24, 2020.Receipt both hydroxychloroquine alone, azithromycin neither.Primary outcome in-hospital mortality. Secondary cardiac arrest abnormal electrocardiogram findings (arrhythmia QT prolongation).Among 1438 hospitalized diagnosis (858 [59.7%] male, median age, 63 years), those receiving more likely than not either drug to have diabetes, respiratory rate >22/min, chest imaging findings, O2 saturation lower 90%, aspartate aminotransferase greater 40 U/L. Overall mortality 20.3% (95% CI, 18.2%-22.4%). probability death + 189/735 (25.7% [95% 22.3%-28.9%]), 54/271 (19.9% 15.2%-24.7%]), 21/211 (10.0% 5.9%-14.0%]), neither drug, 28/221 (12.7% 8.3%-17.1%]). In adjusted Cox proportional hazards models, compared no significant differences (HR, 1.35 0.76-2.40]), alone 1.08 0.63-1.85]), 0.56 0.26-1.21]). logistic significantly (adjusted OR, 2.13 1.12-4.05]), but 1.91 0.96-3.81]) 0.64 0.27-1.56]), . regression relative likelihood findings.Among COVID-19, treatment both, treatment, interpretation these may be by observational design.

Language: Английский

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Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19

New England Journal of Medicine, Journal Year: 2020, Volume and Issue: 383(21), P. 2041 - 2052

Published: July 23, 2020

Hydroxychloroquine and azithromycin have been used to treat patients with coronavirus disease 2019 (Covid-19). However, evidence on the safety efficacy of these therapies is limited.We conducted a multicenter, randomized, open-label, three-group, controlled trial involving hospitalized suspected or confirmed Covid-19 who were receiving either no supplemental oxygen maximum 4 liters per minute oxygen. Patients randomly assigned in 1:1:1 ratio receive standard care, care plus hydroxychloroquine at dose 400 mg twice daily, daily 500 once for 7 days. The primary outcome was clinical status 15 days as assessed use seven-level ordinal scale (with levels ranging from one seven higher scores indicating worse condition) modified intention-to-treat population (patients diagnosis Covid-19). Safety also assessed.A total 667 underwent randomization; 504 had included analysis. As compared proportional odds having score seven-point not affected by alone (odds ratio, 1.21; 95% confidence interval [CI], 0.69 2.11; P = 1.00) 0.99; CI, 0.57 1.73; 1.00). Prolongation corrected QT elevation liver-enzyme more frequent hydroxychloroquine, azithromycin, than those agent.Among mild-to-moderate Covid-19, did improve care. (Funded Coalition Brazil EMS Pharma; ClinicalTrials.gov number, NCT04322123.).

Language: Английский

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Angiotensin‐converting enzyme 2 (ACE2), SARS‐CoV‐2 and the pathophysiology of coronavirus disease 2019 (COVID‐19)

The Journal of Pathology, Journal Year: 2020, Volume and Issue: 251(3), P. 228 - 248

Published: May 17, 2020

Angiotensin-converting enzyme 2 (ACE2) has been established as the functional host receptor for severe acute respiratory syndrome coronavirus (SARS-CoV-2), virus responsible current devastating worldwide pandemic of disease 2019 (COVID-19). ACE2 is abundantly expressed in a variety cells residing many different human organs. In physiology, pivotal counter-regulatory to ACE by breakdown angiotensin II, central player renin-angiotensin-aldosterone system (RAAS) and main substrate ACE2. Many factors have associated with both altered expression COVID-19 severity progression, including age, sex, ethnicity, medication, several co-morbidities, such cardiovascular metabolic syndrome. Although widely distributed various tissues its determinants well recognised, ACE2-expressing organs do not equally participate pathophysiology, implying that other mechanisms are involved orchestrating cellular infection resulting tissue damage. Reports pathologic findings specimens patients rapidly emerging confirm role activity pathogenesis. Identifying changes caused SARS-CoV-2 crucially important it major implications understanding pathophysiology development evidence-based treatment strategies. Currently, interventional strategies being explored ongoing clinical trials, encompassing drug classes strategies, antiviral drugs, biological response modifiers, RAAS inhibitors. Ultimately, prevention key combat appropriate measures taken accordingly, effective vaccines. this review, we describe influencing relation severity. addition, discuss relevant pathological from infection. Finally, highlight selection potential modalities COVID-19. © 2020 The Authors. Journal Pathology published John Wiley & Sons Ltd on behalf Pathological Society Great Britain Ireland.

Language: Английский

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“Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study”

The Journal of Steroid Biochemistry and Molecular Biology, Journal Year: 2020, Volume and Issue: 203, P. 105751 - 105751

Published: Aug. 29, 2020

Language: Английский

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