What's new at this update
WHO authorizes Nuvaxovid® and Covovax® vaccines
The World Health Organization has issued an emergency-use listing for Nuvaxovid® and Covovax® vaccines (NVX-CoV2373). Nuvaxovid® is the originator product produced by the company Novavax, while Covovax® is produced by the Serum Institute of India. These are the first protein subunit platform vaccines to be authorized for use globally. Regulatory agencies in the UK, Europe, and the US are currently assessing authorization applications.
See the Prevention section for more information.
US guideline recommends remdesivir for mild to moderate disease
The National Institutes of Health guidelines panel now recommends remdesivir to treat nonhospitalized patients with mild to moderate disease who are at high risk of clinical progression when the Omicron variant represents the majority of infections in a region. It should be initiated as soon as possible within 7 days of symptom onset, with a treatment course of 3 days. Previously, the guideline panel recommended remdesivir only in patients with severe disease.
See the Treatment algorithm section for more information.
Oral antivirals authorized for use in patients with mild to moderate disease
Molnupiravir and nirmatrelvir/ritonavir have been authorized for use in some countries. They are authorized for the treatment of mild to moderate disease in patients who are at high risk of developing severe disease. These agents should be initiated as soon as possible after diagnosis and within 5 days of symptom onset.
See the Emerging section for more information.
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 etiology 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. This topic is based on the best evidence currently available, but as this is an evolving situation, evidence is limited in some areas and some recommendations may be based on observational studies and retrospective analyses, as well as randomized controlled trials and guidelines.
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, dyspnea, and loss of taste/smell, although some patients may have mild upper respiratory tract symptoms or be asymptomatic. Complications of severe disease include, but are not limited to, multi-organ failure, septic shock, and venous thromboembolism. Symptoms may be persistent and continue for more than 12 weeks in some patients.
History and exam
- sore throat
- rhinorrhea/nasal congestion
- myalgia or arthralgia
- sputum production/expectoration
- chest tightness
- gastrointestinal symptoms
- neurologic symptoms
- ocular symptoms
- audio-vestibular symptoms
- chest pain
- bronchial breath sounds
- crackles/rales on auscultation
- cutaneous symptoms
- oral mucosal lesions
- lower urinary tract symptoms
- contact with probable or confirmed case
- residence/work/travel in location with high risk of transmission
- older age
- male sex
- residence in a long-term care facility
- presence of comorbidities
- cardiovascular disease
- chronic respiratory disease
- chronic kidney disease
- chronic liver disease
- cerebrovascular disease
- mental health disorders
- solid organ or blood stem cell transplant
- Down syndrome or disability
- hemoglobin disorders
- HIV infection
- substance use disorders
- children with certain underlying conditions
- vitamin D deficiency
- proton-pump inhibitor use
- autoimmune disease
- thyroid disease
- Parkinson disease
- physical inactivity
- blood groups A and B
- gut dysbiosis
- environmental factors
- real-time reverse transcription polymerase chain reaction (RT-PCR)
- pulse oximetry
- comprehensive metabolic panel
- thyroid function tests
- 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
Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H
Consultant and Emeritus Professor of Tropical and 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 the UK Health Security Agency (UKHSA; formerly Public Health England), 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 UKHSA.
Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H
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 the UK Health Security Agency (UKHSA; formerly Public Health England) 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 UKHSA.
Robert Fowler, MDCM, MS (Epi), FRCP(C)
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.
William A. Petri, Jr., MD, PhD
Division of Infectious Diseases and International Health
University of Virginia
WAP declares that he has no competing interests.
Xin Zhang, MD, PhD
The Fifth Medical Center of PLA General Hospital
Clinical Division and Research Center of Infectious Disease
XZ declares that he has no competing interests.
Ran Nir-Paz, MD
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.
Use of this content is subject to our disclaimer