Last reviewed: April 2020
Last updated: May  2020
29 May 2020

Update on COVID-19 pandemic

Over 5.8 million cases of COVID-19 have been reported globally, with over 2.4 million cases recovered so far, and approximately 360,000 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 in the world, accounting for approximately 30% of all global cases. The US also has the most number of deaths globally at over 100,000, accounting for over one quarter of all global fatalities. Brazil, Russia, the UK, Spain, Italy, France, and Germany are the countries with the most numbers of cases after the US. Brazil and Russia now have the most number of cases after the US.

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

What's new

  • Etiology

    • New data on viral shedding duration in symptomatic versus asymptomatic people.

  • History and exam

    • Risk factor (smoking) – updated with WHO analysis.

    • Risk factor (air pollution) – updated. 

  • Investigations

    • New CDC guidance on serologic testing.

  • Emerging

    • MHRA issues positive opinion on the use of remdesivir in the UK.

    • WHO pauses hydroxychloroquine arm of Solidarity trial due to safety concerns. 

  • Complications

    • Cardiovascular complications – updated.

Listen to our new weekly COVID-19 podcast. This week’s podcast features Best Practice editors talking about the management of chronic kidney disease and interstitial lung disease in the setting of COVID-19, and testing in healthcare workers.

BMJ talk medicine podcast: Covid-19 update external link opens in a new window

Best Practice has published a new topic on the management of coexisting conditions in the context of COVID-19. The latest update contains information on the management of chronic kidney disease, interstitial lung disease, inflammatory bowel disease, and sickle cell anemia.

BMJ Best Practice: Management of coexisting conditions in the context of COVID-19 external link opens in a new window

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
  • sputum production/expectoration
  • sore throat
  • gastrointestinal symptoms
  • confusion/delirium
  • dizziness
  • headache
  • rhinorrhea or nasal congestion
  • hemoptysis
  • chest pain
  • conjunctivitis
  • cutaneous manifestations
  • 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
  • hypertension
  • cardiovascular disease
  • obesity
  • diabetes
  • smoking
  • chronic respiratory disease
  • malignancy
  • chronic kidney disease
  • chronic liver disease
  • metabolic dysfunction-associated fatty liver disease
  • organ transplant
  • surgery
  • air pollution
  • colder climate
  • residence in urban or deprived areas
  • ACE inhibitor/angiotensin-II receptor antagonist use
  • immunosuppression
  • blood group A 
  • dysbiosis

Diagnostic investigations

1st investigations to order

  • pulse oximetry
  • ABG
  • CBC
  • comprehensive metabolic panel
  • blood glucose level
  • coagulation screen
  • serum C-reactive protein
  • 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.

Use of this content is subject to our disclaimer