Coronaviruses are a large family of viruses, some of which cause illness in humans.
COVID-19 (COVID-19 = Coronavirus Disease 2019) is the name of the disease caused by this virus, known as the SARS-CoV-2 virus.
Some coronaviruses cause only minor respiratory symptoms like those of a cold (NL63/OC43/229E/HKU1), whereas other coronaviruses, such as severe acute respiratory syndrome (SARS CoV) and Middle East respiratory syndrome (MERS CoV), have been associated with more serious and life-threatening diseases.
Incubation period is 5 days (median), but ranges from 2-14 days.
Transmission occurs via droplet and contact. Most commonly spread from an infected person through:
Coughing and sneezing
Close personal contact, touching, or shaking hands
Touching something with the virus on it, then touching your mouth, nose, or eyes before washing your hands.
Airborne spread is NOT known to occur outside of aerosol-generating medical procedures (AGMP).
Reported illnesses have ranged from people being mildly sick to people being severely ill and dying. Asymptomatic infections have also been well documented.
More frequent (>50%) | Less frequent (<50%) | Rare (<10%) |
---|---|---|
Fever (44-91%) | Sputum production (28–33%) | Confusion |
Cough (57-74%) | Muscle aches | (11–44%) Runny nose |
Shortness of breath (31–63%) | Chest pain (16-36%) | Fainting |
Fatigue (31–70%) | Diarrhea (5-24%) | Skin manifestations |
Loss of appetite (39-84%) | Nausea/vomiting (5-19%) | |
Loss of smell and/or taste (54-88%) | Headache (6-70%) | |
Dizziness (9-17%) | ||
Sore throat (11-13%) |
Note: Symptoms among older adults (65 years of age and older) and those with underlying medical conditions may be atypical or subtle; for instance they may be more likely to present without fever or respiratory symptoms.
Symptoms may appear in as few as 2 days or as long as 14 days after exposure. This is the longest known incubation period for this disease.
(adapted from the Public Health Agency of Canada)
In children, the reported signs and symptoms have been similar to those observed in adults, though they may often be less severe or altogether absent. See this link for general advice on how to care for a child with COVID-19.
Reports have found fever (children 56% vs. adults 71%), cough (children 46% vs. adults 80%), and shortness of breath (children 13% vs. adults 43%) at a lower frequency in children. Gastrointestinal symptoms are often predominant in clinical presentation, including abdominal pain, diarrhea, nausea, and vomiting.
Clinicians should be aware of very rare complications that have been associated with COVID-19 infection. A severe multisystem inflammatory syndrome in children (MIS-C) has been reported to share features of typical or atypical Kawasaki disease or toxic shock syndrome.
The WHO preliminary case definition for MIS-C states that cases should be suspected in children and adolescents 0-19 years of age with fever for ≥ 3 days and two of the following signs or symptoms:
AND
AND
AND
Clinicians should have a high index of suspicion to obtain bloodwork for children and adolescents who present with the symptoms mentioned above.
Adapted from the Public Health Agency of Canada.
Progression to severe or critical illness occurs late in the disease course at a median of 8 days after symptom onset.
Asymptomatic infections have been well documented but it is unclear what proportion of infected individuals remain asymptomatic. Some studies have estimated the frequency of pauci-symptomatic or asymptomatic individuals to be as high as 50%.
Outpatient, not requiring hospitalization
Patients NOT requiring supplementary oxygen.
Hospitalized, non-ICU-based care
Patients requiring supplementary oxygen therapy.
Hospitalized, ICU-based care
Patients requiring respiratory support (high-flow oxygen, noninvasive ventilation, or mechanical ventilation) and/or vasopressor or inotropic support
acute pulmonary embolism,
acute coronary syndrome,
acute stroke
delirium.
Clinical suspicion for these complications should be heightened when caring for COVID-19 patients, and appropriate diagnostic and treatment protocols available.