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.
Original source of updateexternal link opens in a new window
Summary
Definition
History and exam
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
Emerging tests
- antigen test
- reverse transcription loop-mediated isothermal amplification (RT-LAMP)
- lung ultrasound
Treatment algorithm
Contributors
Authors
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 reviewers
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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