Last reviewed: July 2020
Last updated: August  2020
06 Aug 2020

Update on COVID-19 pandemic

Over 18.7 million cases of COVID-19 have been reported globally, with over 11.3 million cases recovered so far, and approximately 708,000 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, accounting for approximately one quarter of all global cases and deaths. Brazil has the second largest number of reported cases with over 2.8 million infections. India, Russia, South Africa, Mexico, Peru, Chile, and Colombia are the countries with the most numbers of cases after Brazil.

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Listen to our COVID-19 podcast. The podcast features Best Practice editors talking about the latest developments in COVID-19 guidance. 

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Best Practice has published a separate topic on the management of coexisting conditions in the context of COVID-19. 

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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 randomized controlled trials and guidelines.

See Epidemiology

Original source of updateexternal link opens in a new window

Summary

Definition

History and exam

Key diagnostic factors

  • fever
  • cough
  • dyspnea
  • altered sense of smell/taste

Other diagnostic factors

  • fatigue
  • myalgia or arthralgia
  • anorexia
  • sputum production/expectoration
  • chest tightness
  • sore throat
  • gastrointestinal symptoms
  • dizziness
  • headache
  • neurologic symptoms
  • cutaneous symptoms
  • rhinorrhea/nasal congestion
  • chest pain
  • conjunctivitis
  • hemoptysis
  • bronchial breath sounds
  • tachypnea
  • tachycardia
  • cyanosis
  • crackles/rales on auscultation

Risk factors

  • residence in/travel to location reporting community transmission
  • close contact with a confirmed case
  • older age
  • residence in a long-term care facility
  • male sex
  • ethnicity
  • presence of comorbidities
  • cardiovascular disease
  • hypertension
  • diabetes
  • chronic respiratory disease
  • chronic kidney disease
  • malignancy
  • obesity
  • sickle cell disease
  • solid organ transplant
  • smoking
  • cerebrovascular disease
  • chronic liver disease
  • metabolic dysfunction-associated fatty liver disease
  • surgery
  • pregnancy
  • immunosuppression
  • air pollution
  • climate and latitude
  • residence in urban or deprived areas
  • vitamin D deficiency
  • ACE inhibitor/angiotensin-II receptor antagonist use
  • statin use
  • autoimmune disease
  • neurologic conditions
  • thalassemia
  • children with certain underlying conditions
  • blood group A 
  • gut dysbiosis

Diagnostic investigations

1st investigations to order

  • pulse oximetry
  • ABG
  • CBC
  • comprehensive metabolic panel
  • blood glucose level
  • coagulation screen
  • serum C-reactive protein
  • serum erythrocyte sedimentation rate
  • serum lactate dehydrogenase
  • serum interleukin-6 level
  • cardiac biomarkers
  • serum procalcitonin
  • serum ferritin level
  • serum amyloid A level
  • serum creatine kinase
  • blood and sputum cultures
  • real-time reverse transcription polymerase chain reaction (RT-PCR)
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • computed tomography (CT) chest
  • serology
More investigations to consider

Emerging tests

  • antigen test
  • reverse transcription loop-mediated isothermal amplification (RT-LAMP)
  • lung ultrasound
More emerging tests

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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