Last reviewed: March 2020
Last updated: April  2020
01 Apr 2020

Update on COVID-19 pandemic

The US has the most cases of COVID-19 in the world, with over 189,000 cases. This is followed by Italy (over 105,000), Spain (over 95,000), China (over 82,000), and Germany (over 71,000). Italy has the highest death toll with over 12,000 deaths, followed by Spain with over 8400 deaths. More than 861,000 cases and 42,000 deaths have been reported globally according to data compiled by the Center for Systems Science and Engineering at Johns Hopkins University, with over 178,000 cases recovered.

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

What’s new in today’s update

  • Diagnosis approach: new US data on clinical presentation.

  • History and exam: updated data on ocular manifestations.

  • Investigations: BSTI and ACR recommendations for chest CT imaging.

  • Prevention: PHE guidelines on social distancing.

  • Prognosis: updated case fatality rates.

  • Complications: case report of cardiac tamponade.

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
  • conjunctivitis
  • confusion
  • dizziness
  • headache
  • gastrointestinal symptoms
  • haemoptysis
  • rhinorrhoea
  • chest pain
  • 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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