Chest Medicine Made Easy-Dr Deepu

How to protect from Corona Virus.

By Dr Deepu Changappa Cheriamane.

Hi friends this was sent by my friend. As I found it interesting, I thought of sharing it here. Please read this and follow the rules.

If any of you want credit for the same please let me know.

How to protect yourself from Coronavirus ? Tips for health care workers as an Infectious Diseases physician.

"The most important defense that is going to protect you from the Coronavirus is still common sense with some soap, and not the N95 mask !"

If you have a habit of touching the face with your unsanitized hand, eating snacks with a lowered mask, repositioning the mask with pinching on the front side, then probably you are already infected. You are done!

1. First, know your enemy-simple two rules-the virus spreads through air at a very close distance or through contact. All your moves will be based on this information with eternal vigilance with improvement in each moment.

2. First you need to relax; understand the mortality figures you see in the newspapers.

The virus runs an asymptomatic course probably in the majority.(1)⁠ Imagine the virus is sprayed on 100 peoples’ nose. 60 of them will never develop any symptoms and out of the rest 40, 20 may develop severe symptoms requiring hospital admission and out of these last 20, one person dies. The hospital will report the ‘case fatality rate’ as 1/20= 5%. Note that only 20 reached the hospital to get the testing done. The actual risk of death is 1/100 which is called the ‘infection fatality rate’. Its very difficult to find the figure, as no body knows the asymptomatic infection rates. For the current Corona epidemic it is estimated(2)⁠ by mathematicians to be around 0.5%. So don’t worry, 99.5% of the time, odds are in favor.

3. Being a health care worker (HCW), are you at higher risk of complications compared to public ? Probably no. All the complications depends on your age, and not the number of the viruses that goes inside. No significantly different viral loads in nasal swabs were observed between symptomatic and asymptomatic patients with SARS Cov-2 infection.(3)

4. During a cough or sneeze, salivary spray contain different types of particles. The larger respiratory ‘droplets’, are >5-10 μm, and travel only 3-6 feet due to their weight. The transmission through this is called ‘droplet transmission’. Very small ‘droplet nuclei’, <5μm in diameter, can remain suspended in the air for long periods of time and travel greater than 1 m- Airborne transmission.

In an analysis by WHO and China of 75,465 COVID-19 cases in China, airborne transmission was not reported.(4)

⁠

Now let the fear factor disappear, and you can think clearly and calmly about the defense.

5. N95 vs Surgical mask vs cloth masks- choose the right shield at right time.

Hence use a surgical mask when you are sitting in OPD or taking rounds, and N95 (to filter small droplet nuclei) only when you are doing or near to an aerosol generating procedure. Wear a cloth mask when you are in community, as the purpose is to prevent transmission from you. Use resources intelligently and effectively. You may require it for the big and long battle, just in case.

6. Don’t underestimate the surgical mask. It was found good even when intubating.(5)⁠⁠

7. Refrain yourself from lowering mask for making phone calls, while talking to your colleague, or inside your OPD. Refrain yourself from touching the front side. Refrain yourself from saying that the mask is suffocating (it is and will be; you need to compromise).

8. When you remove the mask for taking a tea, remove the lower tie first. Don't touch the front side. Keep the mask inside your table drawer on a tissue paper, frontside down carefully. Practice hand hygiene after handling it- after removing or putting it back.

9. Make sure that, all around you are using the mask properly. If a friend lowers his mask for chatting with you (with a sigh of relief on his face) he is ready to shoot 3000 droplets in 5 minutes into air. Shoot him before that.

10. Don’t go near your colleagues wearing mask with nose exposed, over the head, under the chin. Preach to them from a distance.

11. Don’t go to canteen or mess room; bring food and eat inside your room or order food. Ask your nurse or assistant to eat inside your room too. Don’t talk during chewing.

12. Practice hand hygiene after each patient. Ask your colleague to monitor you. Watch your colleagues and give feedback; they shouldn't get infected so that you also won’t.

13. Inside the OPD, install a good exhaust fan. Maintain good air circulation inside the room. Keep the temperature of AC to the highest tolerable; droplet wont travel towards sky. They will settle on floor soon. Install an exhaust inside the toilet also.

14. Corona can enter through eyes. Always wear a mask and an eye visor/ face shield right from the parking lot of hospital (personal recommendation).If you practice strict hand hygiene along with mask and visor for each and every patient, you will be in lowest risk, in case tomorrow if he turns positive (personal recommendation). Do not remove it even while talking to your friend or nurse.

15. Avoid lift and take the stairs. If you are using lift, stay facing the walls keeping social distancing.

16. Always insist all the patients to wear a mask.

17. Tell the front desk to advise to wear mask to who ever calls for an appointment.

18. Start a separate fever clinic at some corner of your hospital. A doctor with full PPE can see patients here. Arrange a separate pharmacy for them.

19. Don't go near the patients every time, unless absolutely needed. Turn their head to opposite side while auscultating, taking blood pressure, giving injections or drawing blood.

20. Limit the number of nurse visit to patients room by clubbing all the activities together- like checking vitals and delivering food and medicine.

21. Minimize transport of the patient inside the hospital, check the PPE of the accompanied persons.

22. All other staff stay outside the operation room, while the patient is being intubated and extubated during anesthesia.

23. Try to settle thing over phone as far as possible. Use Telemedicine. Don’t offer excuse; learn it.

24. Maintain social distancing inside the hospital like the same poles of a magnet. The droplets travel at very close distance only.

25. At home, don't go near your parents. Ask them to wear mask. If you happen to cross their path, keep your breath in slow inspiration.

Dr. Rakesh T Parakadavathu

Infectious Diseases consultant

Gimcare hospital, Kannur, Kerala, India

(As the information is evolving, please update it in comments, I can corrrect)

References

1. Day M. Covid-19: identifying and isolating asymptomatic people helped eliminate virus in Italian village. BMJ. 2020 Mar 23;368:m1165.

2. Russell TW, Hellewell J, Jarvis CI, van-Zandvoort K, Abbott S, Ratnayake R, et al. Estimating the infection and case fatality ratio for COVID-19 using age-adjusted data from the outbreak on the Diamond Princess cruise ship. medRxiv. 2020 Mar 9;2020.03.05.20031773.

3. D C, M T, F R, V D, M A, P P, et al. The early phase of the COVID-19 outbreak in Lombardy, Italy. 2020 Mar 20;

4. Aylward, Bruce (WHO); Liang W (PRC). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). WHO-China Jt Mission Coronavirus Dis 2019. 2020;2019(February):16–24.

5. Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, et al. COVID-19 and the Risk to Health Care Workers: A Case Report. Ann Intern Med. 2020 Mar 16;

COVID-19 Radiology findings

By Dr Deepu Changappa Cheriamane

Radiographic features

The primary findings of COVID-19 on chest radiograph and CT are thos

e of atypical pneumonia or organizing pneumonia.

However imaging has limited sensitivity for COVID-19, as up to 18% demonstrate normal chest radiographs or CT when mild or early in the disease course, but this decreases to 3% in severe disease. Bilateral and/or multilobar involvement is common.

The current recommendation of the vast majority of learned societies and professional radiological associations is that imaging should not be employed as a screening/diagnostic tool for COVID-19, but reserved for the evaluation of complications.

Plain radiograph

Although less sensitive than chest CT, chest radiography is typically the first-line imaging modality used for patients with suspected COVID-19. For ease of decontamination, use of portable radiography units is preferred.

Chest radiographs may be normal in early/mild disease.

In those COVID-19 cases requiring hospitalization, 69% had an abnormal chest radiograph at the initial time of admission, and 80% had radiographic abnormalities sometime during hospitalization. Findings are most extensive about 10-12 days after symptom onset.

The most frequent findings are airspace opacities, whether described as consolidation or, less commonly, GGO. The distribution is most often bilateral, peripheral, and lower zone predominant 89.97. In contrast to parenchymal abnormalities, pleural effusion is rare (3%).

The primary findings on CT in adults have been reported as

• ground-glass opacities (GGO): bilateral, subpleural, peripheral

• crazy paving appearance (GGOs and inter-/intra-lobular septal thickening)

• air space consolidation

• bronchovascular thickening in the lesion

• traction bronchiectasis

The ground-glass and/or consolidative opacities are usually bilateral, peripheral, and basal in distribution.

A retrospective study of 112 patients found 54% of asymptomatic patients had pneumonic changes on CT.

The following chest CT findings have been reported to have the highest discriminatory value (p<0.001).

peripheral distribution

ground-glass opacity

bronchovascular thickening (in lesions)

Atypical CT findings

These findings only seen in a small minority of patients should raise concern for superadded bacterial pneumonia or other diagnoses.

Temporal CT changes

Four stages on CT have been described

early/initial stage (0-4 days): normal CT or GGO only
halo half of patients have normal CT scans within two days of symptom onset
progressive stage (5-8 days): increased GGO and crazy paving appearance
peak stage (9-13 days): consolidation
absorption stage (>14 days): with an improvement in the disease course, "fibrous stripes" appear and the abnormalities resolve at one month and beyond

Pediatric CT

In a small study of five children that had been admitted to hospital with positive COVID-19 RT-PCR tests and who had CT chest performed, only three children had abnormalities. The main abnormality was bilateral patchy ground-glass opacities, similar to the appearances in adults, but less florid, and in all three cases the opacities resolved as they clinically recovered.

On 18 March 2020, the details of a much larger cohort of 171 children with confirmed COVID-19, and evaluated in a hospital setting was published as a letter in the New England Journal of Medicine. Ground-glass opacities were seen in one-third of the total, whereas almost 16% of children had no imaging features of pneumonia.

Ultrasound

Initial work on patients in China suggests that lung ultrasound may be useful in the evaluation of critically ill COVID-19 patients. The following patterns have been observed, tending to have a bilateral and posterobasal predominance:

multiple B-lines
ranging from focal to diffuse with spared areas
representing thickened subpleural interlobular septa
may also manifest as a light beam sign, an evanescent, broad-based vertical reverberation artifact arising from a regular pleural line
irregular, thickened pleural line with scattered discontinuities
subpleural consolidations
can be associated with a discrete, localized pleural effusion
relatively avascular with color flow Doppler interrogation
pneumonic consolidation typically associated with preservation of flow or hyperemia 65
alveolar consolidation
tissue-like appearance with dynamic and static air bronchograms
associated with severe, progressive disease
restitution of aeration during recovery
reappearance of bilateral A-lines

Radiology report

The Radiological Society of North America (RSNA) has released a consensus statement endorsed by the Society of Thoracic Radiology and the American College of Radiology (ACR) that classifies the CT appearance of COVID-19 into four categories for standardized reporting language:

typical appearance

peripheral, bilateral, GGO +/- consolidation or visible intralobular lines (“crazy paving” pattern)

multifocal GGO of rounded morphology +/- consolidation or visible intralobular lines (“crazy paving” pattern)

reverse halo sign or other findings of organizing pneumonia

indeterminate appearance

absence of typical CT findings and the presence of

multifocal, diffuse, perihilar, or unilateral GGO +/- consolidation lacking a specific distribution and are non-rounded or non-peripheral

few very small GGO with a non-rounded and non-peripheral distribution

atypical appearance

absence of typical or indeterminate features and the presence of

isolated lobar or segmental consolidation without GGO

discrete small nodules (e.g. centrilobular, tree-in-bud)

lung cavitation

smoother interlobular septal thickening with pleural effusion

negative for pneumonia:

no CT features to suggest pneumonia, in particular, absent GGO and consolidation.

CO-RADS

In March 2020, the "COVID-19 standardized reporting working group" of the Dutch Association for Radiology (NVvR) proposed a CT scoring system for COVID-19. They called it CO-RADS (COVID-19 Reporting and Data System) to ensure CT reporting is uniform and replicable. This assigns a score of CO-RADS 1 to 5, dependent on the CT findings. In some cases a score of 0 or 6 may need to be assigned as an alternative. If the CT is uninterpretable then it is CO-RADS 0, and if there is a confirmed positive RT-PCR test then it is CO-RADS 6.

The first study investigating the use of CO-RADS found a reasonable level of interobserver variation, with a Fleiss' kappa score of 0.47 (cf. 0.24 for PI-RADS and 0.67 for Lung-RADS).

COVID-RADS

In April 2020, American radiologists based at the University of Southern California proposed the COVID-19 imaging reporting and data system (COVID-RADS), which has a confusingly similar name to CO-RADS (see above)

Treatment

COVID-19 Transmission

By Dr Deepu Changappa Cheriamane

Although originating from animals, COVID-19 is now considered to be an indirect zoonosis, as its transmission is now primarily human-to-human.

It is predominantly transmitted in a similar way to the common cold, via contact with droplets of infected individuals' upper respiratory tract secretions, e.g. from sneezing or coughing.

A recent Bayesian regression model has found that aerosol and fomite transmission are plausible.

Orofecal spread was seen with the SARS epidemic, and although it remains unclear if SARS-CoV-2 can be transmitted in this way, there is some evidence for it.

Sexual transmission has not been seen in the field but remains possible, not least because the SARS-CoV-2 virus has been found in all bodily secretions including seminal and vaginal fluids.

It remains unclear if COVID-19 could be transmitted through a blood transfusion although no cases have yet be seen. Nevertheless, many national bodies have instituted controls to reduce the chance of this happening including advising that potential donors do not give blood until 28 days after recovering from COVID-19.

Cohort studies have been unable to rule out the possibility of vertical transmission, but it seems to be a rare event if it does occur. A large prospective cohort study of 427 pregnant women from all 194 birth units across the UK found that 5% of 265 live births were confirmed as COVID-19 on RT-PCR.

Radiology findings

COVID 19 Pathophysiology

By Dr Deepu Changappa Cheriamane

The SARS-CoV-2 virus, like the closely-related MERS and SARS coronaviruses, effects its cellular entry via attachment of its virion spike protein (a.k.a. S protein) to the angiotensin-converting enzyme 2 (ACE2) receptor. This receptor is commonly found on alveolar cells of the lung epithelium, underlying the development of respiratory symptoms as the commonest presentation of COVID-19 50. It is thought that the mediation of the less common cardiovascular effects is also via the same ACE2 receptor, which is also commonly expressed on the cells of the cardiovascular system.

Transmission

COVID 19 Pathology

By Dr Deepu Changappa Cheriamane

Etiology

On 9 January 2020, the World Health Organization (WHO) confirmed that SARS-CoV-2 was the cause of COVID-19 (2019-nCoV was the name of the virus at that time). It is one of the two strains of the SARS-CoV species known to cause human disease, the other being the original severe acute respiratory syndrome coronavirus (SARS-CoV), the cause of SARS. It is a member of the Betacoronavirus genus, one of the genera of the Coronaviridae family of viruses. Coronaviruses are enveloped single-stranded RNA viruses that are found in humans, mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS, and intestinal disease.

As with many human infections, SARS-CoV-2 is zoonotic. The closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus. The disease can also be transmitted by snakes.

Six coronaviruses are known to cause human disease. Two are zoonoses: the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), both of which may sometimes be fatal. The remaining four viruses all cause the common cold.

Pathophysiology

COVID19 Complications

By Dr Deepu Changappa Cheriamane

Complications of COVID 19

In one of the largest studies of hospitalized patients, reviewing 1,099 individuals across China, the admission rate to the intensive care unit (ICU) was 5%.

In this same study, 6% of all patients required ventilation, whether invasive or non-invasive.

ICU patients tend to be older with more comorbidities.

Commonly reported sequelae are:

acute respiratory distress syndrome (ARDS): ~22.5% (range 17-29%)

acute thromboembolic disease

pulmonary embolism

deep vein thrombosis (DVT)

acute cardiac injury:

elevated troponin levels

myocardial ischemia

cardiac arrest

myocarditis

CNS

delirium

viral encephalitis

diffuse leukoencephalopathy

microhemorrhage (seen in juxtacortical white matter and corpus callosum particularly of the splenium)

stroke: cryptogenic/ischemic

higher mortality and greater severity of stroke in context of COVID-19

secondary infections, e.g. bacterial pneumonia

sepsis

acute kidney injury (AKI)

coagulopathy

disseminated intravascular coagulation (DIC)

multiorgan failure

In a small subgroup of severe ICU cases:

secondary hemophagocytic lymphohistiocytosis (a cytokine storm syndrome)

Risk factors for pulmonary embolism

In a multivariate analysis, an elevated risk of developing PE was associated with:

obesity

elevated D-dimer

elevated CRP

rising D-dimer over time

Pediatric complications

In April 2020, reports started to appear of critically-ill children presenting with a multisystem inflammatory state which bore some resemblance to Kawasaki disease and toxic shock syndrome. Typically abdominal pain and other GI symptoms were present and often evidence of a myocarditis. The presentations necessitated ICU admission and fatalities have been reported.

Pathology

COVID 19 Other investigations

By Dr Deepu Changappa Cheriamane

Laboratory tests

The most common ancillary laboratory findings in a study of 138 hospitalized patients were the following.

lymphopenia

increased prothrombin time (PT)

increased lactate dehydrogenase

Other commonly identified abnormalities include:

mild elevated inflammatory markers (CRP 89 and ESR)

elevated D-dimer

mildly elevated serum amylase: 17% patients (study of 52 cases)

frank acute pancreatitis has not been reported

mildly deranged liver function tests are common, primarily elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

bilirubin rise is generally mild

alkaline phosphatase (AKP) and gamma‐glutamyl transferase (GGT) levels remain normal

Complications

COVID Radiology investigation

By Dr Deepu Changappa Cheriamane

Chest X ray

It doesn't have any sensitivity or specificity in diagnosing COVID, but can lead to diagnosis with strong suspicion and further referral for PCR.

HRCT Thorax

Multiple radiological organizations and learned societies have stated that CT should not be relied upon as a diagnostic/screening tool for COVID-19. On 16 March 2020, an American-Singaporean panel published that CT findings were not part of the diagnostic criteria for COVID-19. However, CT findings have been used controversially as a surrogate diagnostic test by some.

Other investigations

COVID19 Diagnostic tests

By Dr Deepu Changappa Cheriamane

RT-PCR

The definitive test for SARS-CoV-2 is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test. It is believed to be highly specific, but with sensitivity reported as low as 60-70% and as high as 95-97%. Meta-analysis has reported the pooled sensitivity of RT-PCR to be 89%. Thus, false negatives are a real clinical problem, and several negative tests might be required in a single case to be confident about excluding the disease.

Its sensitivity is predicated on time since exposure to SARS-CoV-2, with a false negative rate of 100% on the first day after exposure, dropping to 67% on the fourth day. On the day of symptom onset (~4 days after exposure) the false negative rate remains at 38%, and it reaches its nadir of 20% three days after symptoms begin (8 days post exposure). From this point on, the false negative rate starts to climb again reaching 66% on day 21 after exposure.

Radiology investigations

COVID clinical presentation

By Dr Deepu Changappa Cheriamane

Clinical presentation

COVID-19 typically presents with systemic and/or respiratory manifestations. Some individuals infected with SARS-CoV-2 are asymptomatic and can act as carriers. Some also experience mild gastrointestinal or cardiovascular symptoms, although these are much less common.

The full spectrum of clinical manifestation of COVID-19 remains to be determined. Symptoms and signs are non-specific:

Common

fever (85-90%)

cough (65-70%)

disturbed taste and smell (40-50%)

fatigue (35-40%)

sputum production (30-35%)

shortness of breath (15-20%)

Less common

myalgia/arthralgia (10-15%)

headaches (10-36%)

sore throat (10-15%)

chills (10-12%)

pleuritic pain

Rare

nausea, vomiting, nasal congestion (<10%), diarrhea (<5%)

palpitations, chest tightness

hemoptysis (<5%)

confusion, seizures, paraesthesia, altered consciousness

stroke(most commonly cryptogenic)

COVID-19 sufferers have reported high rates of disturbances of smell and taste, including anosmia, hyposmia, ageusia, and dysgeusia. The numbers of patients affected vary and current evidence points more towards a neurological than a conductive cause of the olfactory dysfunction.

Various reports suggest patients with the disease may have symptoms of conjunctivitis, and those affected, may have positive viral PCR in their conjunctival fluid. However a meta-analysis of over 1,100 patients found that conjunctivitis was only present in 1.1% cases. A small case series found conjunctivitis to be the only clinical manifestation in some patients with COVID-19.

Cutaneous lesions may also be seen, similar to many other viral infections. In a cohort of 88 patients, 20% developed skin disease, most commonly an erythematous rash. Most of the skin abnormalities were self-limited, resolving in a few days.

Pediatric

In the main, the clinical presentation in children with COVID-19 is milder than in adults. Symptoms are similar to any acute chest infection, encompassing most commonly pyrexia, dry cough, sore throat, sneezing, myalgia and lethargy. Wheezing has also been noted. Other less common (<10%) symptoms in children included diarrhea, lethargy, rhinorrhea and vomiting.

Diagnostic tests

COVID - Epidemiology

By Dr Deepu Changappa Cheriamane

Epidemiology

As of July 2020, the number of cases of confirmed COVID-19 globally is over 11 million affecting virtually every territory, other than isolated South Pacific island states and Antarctica, according to an online virus tracker created by the medical journal, The Lancet, and hosted by Johns Hopkins University. As of June 2020, the United States had more than two million cases, Brazil more than one million, with Russia and India with >500,000 cases.

The R0 (basic reproduction number) of SARS-CoV-2 has been estimated between 2.2 and 3.28 in a non-lockdown population, that is each infected individual, on average, causes between 2-3 new infections.

The incubation period for COVID-19 was initially calculated to be about five days, which was based on 10 patients only. An American group performed an epidemiological analysis of 181 cases, for which days of exposure and symptom onset could be estimated accurately. They calculated a median incubation period of 5.1 days, that 97.5% became symptomatic within 11.5 days (CI 8.2 to 15.6 days) of being infected, and that extending the cohort to the 99th percentile results in almost all cases developing symptoms in 14 days after exposure to SARS-CoV-2.

As of June 2020 the number of deaths from COVID-19 passed half a million globally. The case fatality rate is ~2-3%. It is speculated that the true case fatality rate is lower than this because many mild/asymptomatic cases are not being tested, which thus skews the apparent death rate upwards.

A paper published by the Chinese Center for Disease Control and Prevention (CCDC) analyzed all 44,672 cases diagnosed up to 11 February 2020. Of these, ~1% were asymptomatic, and ~80% were classed as "mild".

Another study looked at clinical characteristics in COVID-19 positively tested close contacts of COVID-19 patients. Approximately 30% of those COVID-19 positive close contacts never developed any symptoms or changes on chest CT scans. The remainder showed changes in CT, but ~20% reportedly developed symptoms during their hospital course, none of them developed severe disease. This suggests that a high percentage of COVID-19 carriers are asymptomatic.

In the Chinese population, 55-60%% of COVID-19 patients were male; the median age has been reported between 47 and 59 years.

Pediatric

Children seem to be relatively unaffected by this virus, or indeed other closely-related coronaviruses.with large cohort studies reporting that 1-2% of COVID-19 patients are children. However, there have been cases of critically-ill children with infants under 12 months likely to be more seriously affected. A very low number of pediatric deaths has been reported . In children, male gender does not seem to be a risk factor. The incubation period has been reported to be shorter than in adults, at about two days.

Read..

Clinical presentation

Terminology

By Dr Deepu Changappa Cheriamane

The World Health Organization originally called this illness "novel coronavirus-infected pneumonia (NCIP)", and the virus itself had been provisionally named "2019 novel coronavirus (2019-nCoV)" .

On 11 February 2020, the WHO officially renamed the clinical condition COVID-19 (a shortening of COronaVIrus Disease-19) 15. Coincidentally, on the same day, the Coronavirus Study Group of the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The names of both the disease and the virus should be fully capitalized, except for the 'o' in the viral name, which is in lowercase.

The official virus name is similar to SARS-CoV-1, the virus strain that caused epidemic severe acute respiratory syndrome (SARS) in 2002-2004, potentially causing confusion 38. The WHO has stated it will use "COVID-19 virus" or the "virus that causes COVID-19" instead of its official name, SARS-CoV-2 when communicating with the public.

Epidemiology

COVID 19

By Dr Deepu Changappa Cheriamane

Introduction

COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a strain of coronavirus. The first cases were seen in Wuhan, China, in December 2019 before spreading globally, with more than 11 million cases now confirmed. The current outbreak was officially recognized as a pandemic by the World Health Organization (WHO) on 11 March 2020.

Terminology

TOPICS