Update on COVID-19 pandemic
Over 31.3 million cases of COVID-19 have been reported globally, with over 21.4 million cases recovered so far, and approximately 965,000 deaths according to data compiled by the Center for Systems Science and Engineering at Johns Hopkins University. The US has the highest number of reported infections and deaths in the world. India has the second largest number of reported cases, followed by Brazil, Russia, Colombia, Peru, Mexico, Spain, and South Africa.
Listen to our COVID-19 podcasts. The podcasts feature Best Practice editors talking about the latest developments in COVID-19 guidance.
See our separate topic on the management of co-existing conditions in the context of COVID-19.
This topic is based on the best evidence currently available, but as this is a rapidly evolving situation, evidence is limited and some recommendations may be based on case reports, observational studies, and retrospective analyses, as well as randomised controlled trials and guidelines.
Original source of updateexternal link opens in a new window
Coronavirus disease 2019 (COVID-19) is an infectious acute respiratory disease caused by a novel coronavirus. The World Health Organization (WHO) was informed of cases of pneumonia of unknown microbial aetiology associated with Wuhan City, Hubei Province, China on 31 December 2019. The WHO later announced that a novel coronavirus had been detected in samples taken from these patients. Since then, the epidemic has escalated and rapidly spread around the world, with the WHO first declaring a public health emergency of international concern on 30 January 2020, and then formally declaring it a pandemic on 11 March 2020. Clinical trials and investigations to learn more about the virus, its origin, how it affects humans, and its management are ongoing.
A potentially severe acute respiratory infection caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical presentation is generally that of a respiratory infection with a symptom severity ranging from a mild common cold-like illness, to a severe viral pneumonia leading to acute respiratory distress syndrome that is potentially fatal. Characteristic symptoms include fever, cough, and dyspnoea, although some patients may be asymptomatic. Complications of severe disease include, but are not limited to, multi-organ failure, septic shock, and blood clots.
History and exam
- myalgia or arthralgia
- sputum production/expectoration
- chest tightness
- gastrointestinal symptoms
- sore throat
- neurological symptoms
- ocular symptoms
- cutaneous symptoms
- rhinorrhoea/nasal congestion
- chest pain
- bronchial breath sounds
- crackles/rales on auscultation
- residence/work/travel in location with high risk of transmission
- contact with probable or confirmed case
- older age
- residence in a long-term care facility
- male sex
- presence of comorbidities
- cardiovascular disease
- chronic respiratory disease
- chronic kidney disease
- sickle cell disease
- solid organ transplant
- cerebrovascular disease
- chronic liver disease
- metabolic dysfunction-associated fatty liver disease
- air pollution
- climate and latitude
- residence in urban or deprived areas
- vitamin D deficiency
- ACE inhibitor/angiotensin-II receptor antagonist use
- statin use
- proton-pump inhibitor use
- HIV infection
- autoimmune disease
- neurological conditions
- children with certain underlying conditions
- blood group A
- gut dysbiosis
- real-time reverse transcription polymerase chain reaction (RT-PCR)
- pulse oximetry
- comprehensive metabolic panel
- blood glucose level
- coagulation screen
- cardiac biomarkers
- serum C-reactive protein
- serum erythrocyte sedimentation rate
- serum lactate dehydrogenase
- serum interleukin-6 level
- serum procalcitonin
- serum ferritin level
- serum amyloid A level
- serum creatine kinase and myoglobin
- blood and sputum cultures
- chest x-ray
Consultant and Honorary Senior Lecturer in Infectious Diseases
Royal Liverpool University Hospital and Liverpool School of Tropical Medicine
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
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
Clinical Epidemiology and Health Care Research
Institute of Health Policy, Management and Evaluation
Dalla Lana School of Public Health
University of Toronto
Tory Trauma Program
RF declares that he has no competing interests.
Division of Infectious Diseases and International Health
University of Virginia
WAP declares that he has no competing interests.
The Fifth Medical Center of PLA General Hospital
Clinical Division and Research Center of Infectious Disease
XZ declares that he has no competing interests.
Associate Professor in Medicine
Department of Clinical Microbiology and Infectious Diseases
Hadassah Hebrew University Medical Center
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.
Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
Lead Section Editor, BMJ Best Practice
IC declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Consultant, Older People's Medicine
Norfolk and Norwich University Hospitals
NHS Foundation Trust
MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018). MP has accepted sponsorship for travel expenses and accommodation costs from Astellas Pharma Ltd to attend the European Geriatric Society Meeting (Lisbon 2016).
Consultant Renal Physician
Honorary Associate Professor
Leeds Teaching Hospitals NHS Trust
AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).
Professor of Cardiology
Imperial College London (Royal Brompton Hospital)
MC is a Non-Executive Director of NICE and Chair the Digital Health Committee of the European Society of Cardiology. MC’s university receives support for his research from Abbott, ResMed, Boston Scientific, and Medtronic. MC speaks at educational events and provides consultancy advice to a number of device, diagnostic, and pharmaceutical companies including Novartis, Servier, Bayer, Pfizer, AstraZeneca, Boehringer Ingelheim, Roche Diagnostics, Medtronic, Abbott, ResMed, and Boston Scientific. MC declares that none of these interests is directly related to topics advised on for this project.
Associate Professor (Clinical)
University of Leicester
Honorary Consultant Respiratory Physician
RAE has been reimbursed for a GSK Advisory Board meeting on Physical Activity and Asthma in November 2016, and three Chiesi Education meetings for GPs on COPD care in 2019. RAE received a travel award for ERS 2017 from Chiesi and participated in the GSK clinical experience programme - respiratory in August 2018. RAE participated in the BTS/SIGN guidelines for asthma update 2016 (no fee).
Consultant Physician and Head of Service
Diabetes and Endocrine Centre and the Diabetes Research Unit
Ipswich Hospitals NHS Trust
GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.
Consultant Liaison Neuropsychiatrist
King’s College Hospital
South London and Maudsley NHS Foundation Trust
Honorary Senior Clinical Lecturer
Institute of Psychiatry, Psychology & Neuroscience
King’s College London
SP declares that he has no competing interests.
BMJ Best Practice would like to gratefully acknowledge Professor Asangaedem Akpan for his peer review of the dementia comorbidity content.
Asangaedem Akpan, MPH FRCP
Liverpool University Hospitals NHS Foundation Trust
Visiting Professor, University of Cumbria
Honorary Clinical Associate Professor
University of Liverpool
BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.
Matthew Jones, MD, FRCP
Greater Manchester Neurosciences Centre
Salford Royal Foundation Trust
Honorary Senior Lecturer
University of Manchester
AA and MJ declare that they have no competing interests.
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