Last reviewed: February 2020
Last updated: March  2020
30 Mar 2020

Update on COVID-19 pandemic

The US has the most cases of COVID-19 in the world, with over 140,000 cases. This is followed by Italy (over 97,000), China (over 82,000), and Spain (over 80,000). Italy has the highest death toll with over 10,000 deaths, followed by Spain with over 6800 deaths. More than 720,000 cases and 34,000 deaths have been reported globally according to data compiled by the Center for Systems Science and Engineering at Johns Hopkins University, with nearly 150,000 cases recovered.

Johns Hopkins University: coronavirus COVID-19 global cases external link opens in a new window

The World Health Organization and its partners have launched the Solidarity trial, a large international study to compare different treatments and ensure clear evidence of which treatments are most effective. “Today we are delighted to announce that in Norway and Spain, the first patients will shortly be enrolled in the Solidarity Trial, which will compare the safety and effectiveness of four different drugs or drug combinations against COVID-19,” said World Health Organization chief Tedros Adhanom Ghebreyesus during a press briefing last Friday. “More than 45 countries are contributing to the trial, and more have expressed interest,” he said, adding that “a vaccine is still at least 12 to 18 months away.”[8]

What’s new in today’s update

  • Aetiology: the WHO clarifies position on airborne transmission.

  • History and exam: new data on anosmia/dysgeusia and cutaneous manifestations.

  • Treatment algorithm: new guideline on managing critically ill adults with COVID-19 published by the Surviving Sepsis Campaign; new NICE guideline on managing patients on radiotherapy.

  • Emerging: new data on use of convalescent plasma in small case series.

  • Prognosis: updated case fatality rates; new data on case fatality rate among people on board the Diamond Princess cruise ship.

  • Complications: updated sections on cardiovascular and pregnancy-related complications.

See Epidemiology

Original source of updateexternal link opens in a new window

Summary

Definition

History and exam

Other diagnostic factors

  • fatigue
  • myalgia
  • anorexia
  • sputum production/expectoration
  • sore throat
  • confusion
  • dizziness
  • headache
  • gastrointestinal symptoms
  • haemoptysis
  • rhinorrhoea
  • chest pain
  • conjunctival congestion
  • anosmia/dysgeusia
  • cutaneous manifestations
  • bronchial breath sounds
  • tachypnoea
  • tachycardia
  • cyanosis
  • crackles/rales on auscultation

Risk factors

  • residence in/travel to location reporting community transmission during the 14 days prior to symptom onset
  • close contact with a confirmed case
  • older age and/or underlying health condition
  • malignancy
  • smoking

Diagnostic investigations

1st investigations to order

  • pulse oximetry
  • ABG
  • FBC
  • coagulation screen
  • comprehensive metabolic panel
  • serum procalcitonin
  • serum C-reactive protein
  • serum lactate dehydrogenase
  • serum creatine kinase
  • serum troponin level
  • blood and sputum cultures
  • real-time reverse transcription polymerase chain reaction (RT-PCR)
  • chest x-ray
  • computed tomography (CT) chest
More 1st investigations to order

Treatment algorithm

Contributors

Consultant and Honorary Senior Lecturer in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Disclosures

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Disclosures

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

Disclosures

RF declares that he has no competing interests.

Peer reviewersVIEW ALL

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Disclosures

WAP declares that he has no competing interests.

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China 

Disclosures

XZ declares that he has no competing interests.

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

Disclosures

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

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