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Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19)A Review

Educational Objective
To understand the pathophysiology, transmission, diagnosis, and treatment of COVID
1 Credit CME

Importance  The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19.

Observations  SARS-CoV-2 is spread primarily via respiratory droplets during close face-to-face contact. Infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers. The average time from exposure to symptom onset is 5 days, and 97.5% of people who develop symptoms do so within 11.5 days. The most common symptoms are fever, dry cough, and shortness of breath. Radiographic and laboratory abnormalities, such as lymphopenia and elevated lactate dehydrogenase, are common, but nonspecific. Diagnosis is made by detection of SARS-CoV-2 via reverse transcription polymerase chain reaction testing, although false-negative test results may occur in up to 20% to 67% of patients; however, this is dependent on the quality and timing of testing. Manifestations of COVID-19 include asymptomatic carriers and fulminant disease characterized by sepsis and acute respiratory failure. Approximately 5% of patients with COVID-19, and 20% of those hospitalized, experience severe symptoms necessitating intensive care. More than 75% of patients hospitalized with COVID-19 require supplemental oxygen. Treatment for individuals with COVID-19 includes best practices for supportive management of acute hypoxic respiratory failure. Emerging data indicate that dexamethasone therapy reduces 28-day mortality in patients requiring supplemental oxygen compared with usual care (21.6% vs 24.6%; age-adjusted rate ratio, 0.83 [95% CI, 0.74-0.92]) and that remdesivir improves time to recovery (hospital discharge or no supplemental oxygen requirement) from 15 to 11 days. In a randomized trial of 103 patients with COVID-19, convalescent plasma did not shorten time to recovery. Ongoing trials are testing antiviral therapies, immune modulators, and anticoagulants. The case-fatality rate for COVID-19 varies markedly by age, ranging from 0.3 deaths per 1000 cases among patients aged 5 to 17 years to 304.9 deaths per 1000 cases among patients aged 85 years or older in the US. Among patients hospitalized in the intensive care unit, the case fatality is up to 40%. At least 120 SARS-CoV-2 vaccines are under development. Until an effective vaccine is available, the primary methods to reduce spread are face masks, social distancing, and contact tracing. Monoclonal antibodies and hyperimmune globulin may provide additional preventive strategies.

Conclusions and Relevance  As of July 1, 2020, more than 10 million people worldwide had been infected with SARS-CoV-2. Many aspects of transmission, infection, and treatment remain unclear. Advances in prevention and effective management of COVID-19 will require basic and clinical investigation and public health and clinical interventions.

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Article Information

Accepted for Publication: June 30, 2020.

Corresponding Author: W. Joost Wiersinga, MD, PhD, Division of Infectious Diseases, Department of Medicine, Amsterdam UMC, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands (w.j.wiersinga@amsterdamumc.nl).

Published Online: July 10, 2020. doi:10.1001/jama.2020.12839

Conflict of Interest Disclosures: Dr Wiersinga is supported by the Netherlands Organisation of Scientific Research outside the submitted work. Dr Prescott reported receiving grants from the US Agency for Healthcare Research and Quality (HCP by R01 HS026725), the National Institutes of Health/National Institute of General Medical Sciences, and the US Department of Veterans Affairs outside the submitted work, being the sepsis physician lead for the Hospital Medicine Safety Continuous Quality Initiative funded by BlueCross/BlueShield of Michigan, and serving on the steering committee for MI-COVID-19, a Michigan statewide registry to improve care for patients with COVID-19 in Michigan. Dr Rhodes reported being the co-chair of the Surviving Sepsis Campaign. Dr Cheng reported being a member of Australian government advisory committees, including those involved in COVID-19. No other disclosures were reported.

Disclaimer: This article does not represent the views of the US Department of Veterans Affairs or the US government. This material is the result of work supported with resources and use of facilities at the Ann Arbor VA Medical Center. The opinions in this article do not necessarily represent those of the Australian government or advisory committees.

Zhu  N , Zhang  D , Wang  W ,  et al; China Novel Coronavirus Investigating and Research Team.  A novel coronavirus from patients with pneumonia in China, 2019.   N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017PubMedGoogle ScholarCrossref
Zhong  NS , Zheng  BJ , Li  YM ,  et al.  Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People’s Republic of China, in February, 2003.   Lancet. 2003;362(9393):1353-1358. doi:10.1016/S0140-6736(03)14630-2PubMedGoogle ScholarCrossref
Zaki  AM , van Boheemen  S , Bestebroer  TM , Osterhaus  AD , Fouchier  RA .  Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.   N Engl J Med. 2012;367(19):1814-1820. doi:10.1056/NEJMoa1211721PubMedGoogle ScholarCrossref
Goldsmith  CS , Tatti  KM , Ksiazek  TG ,  et al.  Ultrastructural characterization of SARS coronavirus.   Emerg Infect Dis. 2004;10(2):320-326. doi:10.3201/eid1002.030913PubMedGoogle ScholarCrossref
Lu  R , Zhao  X , Li  J ,  et al.  Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding.   Lancet. 2020;395(10224):565-574. doi:10.1016/S0140-6736(20)30251-8PubMedGoogle ScholarCrossref
Lam  TT , Jia  N , Zhang  YW ,  et al.  Identifying SARS-CoV-2-related coronaviruses in Malayan pangolins.   Nature. Published online March 26, 2020. doi:10.1038/s41586-020-2169-0PubMedGoogle Scholar
Hoffmann  M , Kleine-Weber  H , Schroeder  S ,  et al.  SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.   Cell. 2020;181(2):271-280. doi:10.1016/j.cell.2020.02.052PubMedGoogle Scholar
Sungnak  W , Huang  N , Bécavin  C ,  et al; HCA Lung Biological Network.  SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes.   Nat Med. 2020;26(5):681-687. doi:10.1038/s41591-020-0868-6PubMedGoogle ScholarCrossref
Zou  X , Chen  K , Zou  J , Han  P , Hao  J , Han  Z .  Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection.   Front Med. 2020;14(2):185-192. doi:10.1007/s11684-020-0754-0PubMedGoogle ScholarCrossref
Mancia  G , Rea  F , Ludergnani  M , Apolone  G , Corrao  G .  Renin-angiotensin-aldosterone system blockers and the risk of COVID-19.   N Engl J Med. 2020;382(25):2431-2440. doi:10.1056/NEJMoa2006923PubMedGoogle ScholarCrossref
Fosbøl  EL , Butt  JH , Østergaard  L ,  et al.  Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality.   JAMA. Published online June 19, 2020. doi:10.1001/jama.2020.11301PubMedGoogle Scholar
Xu  Z , Shi  L , Wang  Y ,  et al.  Pathological findings of COVID-19 associated with acute respiratory distress syndrome.   Lancet Respir Med. 2020;8(4):420-422. doi:10.1016/S2213-2600(20)30076-XPubMedGoogle ScholarCrossref
van de Veerdonk  FL , Netea  MG , van Deuren  M ,  et al.  Kallikrein-kinin blockade in patients with COVID-19 to prevent acute respiratory distress syndrome.   Elife. Published online April 27, 2020. doi:10.7554/eLife.57555PubMedGoogle Scholar
Tang  N , Li  D , Wang  X , Sun  Z .  Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia.   J Thromb Haemost. 2020;18(4):844-847. doi:10.1111/jth.14768PubMedGoogle ScholarCrossref
Thachil  J , Tang  N , Gando  S ,  et al.  ISTH interim guidance on recognition and management of coagulopathy in COVID-19.   J Thromb Haemost. 2020;18(5):1023-1026. doi:10.1111/jth.14810PubMedGoogle ScholarCrossref
Klok  FA , Kruip  MJHA , van der Meer  NJM ,  et al.  Incidence of thrombotic complications in critically ill ICU patients with COVID-19.   Thromb Res. 2020;191:145-147. doi:10.1016/j.thromres.2020.04.013PubMedGoogle ScholarCrossref
Ganyani  T , Kremer  C , Chen  D ,  et al.  Estimating the generation interval for coronavirus disease (COVID-19) based on symptom onset data, March 2020.   Euro Surveill. 2020;25(17). doi:10.2807/1560-7917.ES.2020.25.17.2000257PubMedGoogle Scholar
Mao  R , Qiu  Y , He  JS ,  et al.  Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis.   Lancet Gastroenterol Hepatol. 2020;5(7):667-678. doi:10.1016/S2468-1253(20)30126-6PubMedGoogle ScholarCrossref
Levi  M , Thachil  J , Iba  T , Levy  JH .  Coagulation abnormalities and thrombosis in patients with COVID-19.   Lancet Haematol. 2020;7(6):e438-e440. doi:10.1016/S2352-3026(20)30145-9PubMedGoogle ScholarCrossref
Long  B , Brady  WJ , Koyfman  A , Gottlieb  M .  Cardiovascular complications in COVID-19.   Am J Emerg Med. Published online April 18, 2020. doi:10.1016/j.ajem.2020.04.048PubMedGoogle Scholar
Mao  L , Jin  H , Wang  M ,  et al.  Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.   JAMA Neurol. 2020;77(6):1-9. doi:10.1001/jamaneurol.2020.1127PubMedGoogle ScholarCrossref
Middeldorp  S , Coppens  M , van Haaps  TF ,  et al.  Incidence of venous thromboembolism in hospitalized patients with COVID-19.   J Thromb Haemost. Published online May 5, 2020. doi:10.1111/jth.14888PubMedGoogle Scholar
Chen  YT , Shao  SC , Hsu  CK , Wu  IW , Hung  MJ , Chen  YC .  Incidence of acute kidney injury in COVID-19 infection: a systematic review and meta-analysis.   Crit Care. 2020;24(1):346. doi:10.1186/s13054-020-03009-yPubMedGoogle ScholarCrossref
Rodriguez-Morales  AJ , Cardona-Ospina  JA , Gutiérrez-Ocampo  E ,  et al; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19).  Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis.   Travel Med Infect Dis. 2020;34:101623. doi:10.1016/j.tmaid.2020.101623PubMedGoogle Scholar
Chu  DK , Akl  EA , Duda  S ,  et al; COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors.  Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis.   Lancet. 2020;395(10242):1973-1987. doi:10.1016/S0140-6736(20)31142-9PubMedGoogle ScholarCrossref
Bourouiba  L .  Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19.   JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4756PubMedGoogle Scholar
Lewis  D .  Is the coronavirus airborne? experts can’t agree.   Nature. 2020;580(7802):175. doi:10.1038/d41586-020-00974-wPubMedGoogle ScholarCrossref
Chia  PY , Coleman  KK , Tan  YK ,  et al; Singapore 2019 Novel Coronavirus Outbreak Research Team.  Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients.   Nat Commun. 2020;11(1):2800. doi:10.1038/s41467-020-16670-2PubMedGoogle ScholarCrossref
Dashraath  P , Wong  JLJ , Lim  MXK ,  et al.  Coronavirus disease 2019 (COVID-19) pandemic and pregnancy.   Am J Obstet Gynecol. 2020;222(6):521-531. doi:10.1016/j.ajog.2020.03.021PubMedGoogle ScholarCrossref
Chen  H , Guo  J , Wang  C ,  et al.  Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.   Lancet. 2020;395(10226):809-815. doi:10.1016/S0140-6736(20)30360-3PubMedGoogle ScholarCrossref
Zeng  L , Xia  S , Yuan  W ,  et al.  Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China.   JAMA Pediatr. Published online March 26, 2020. doi:10.1001/jamapediatrics.2020.0878PubMedGoogle Scholar
van Doremalen  N , Bushmaker  T , Morris  DH ,  et al.  Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.   N Engl J Med. 2020;382(16):1564-1567. doi:10.1056/NEJMc2004973PubMedGoogle ScholarCrossref
He  X , Lau  EHY , Wu  P ,  et al.  Temporal dynamics in viral shedding and transmissibility of COVID-19.   Nat Med. 2020;26(5):672-675. doi:10.1038/s41591-020-0869-5PubMedGoogle ScholarCrossref
Wei  WE , Li  Z , Chiew  CJ , Yong  SE , Toh  MP , Lee  VJ .  Presymptomatic transmission of SARS-CoV-2—Singapore, January 23-March 16, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(14):411-415. doi:10.15585/mmwr.mm6914e1PubMedGoogle ScholarCrossref
Bai  Y , Yao  L , Wei  T ,  et al.  Presumed asymptomatic carrier transmission of COVID-19.   JAMA. 2020;323(14):1406-1407. doi:10.1001/jama.2020.2565PubMedGoogle ScholarCrossref
Wölfel  R , Corman  VM , Guggemos  W ,  et al.  Virological assessment of hospitalized patients with COVID-2019.   Nature. 2020;581(7809):465-469. doi:10.1038/s41586-020-2196-xPubMedGoogle ScholarCrossref
Park  SY , Kim  YM , Yi  S ,  et al.  Coronavirus disease outbreak in call center, South Korea.   Emerg Infect Dis. 2020;26(8). doi:10.3201/eid2608.201274PubMedGoogle Scholar
Byambasuren  O , Cardona  M , Bell  K , Clark  J , McLaws  M , Glasziou  P . Estimating the extent of asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis. MedRxiv. Preprint posted June 4, 2020. doi:10.1101/2020.05.10.20097543
Tabata  S , Imai  K , Kawano  S ,  et al.  Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the Diamond Princess cruise ship: a retrospective analysis.   Lancet Infect Dis. Published online June 12, 2020. doi:10.1016/S1473-3099(20)30482-5PubMedGoogle Scholar
Sun  J , Xiao  J , Sun  R ,  et al.  Prolonged persistence of SARS-CoV-2 RNA in body fluids.   Emerg Infect Dis. Published online May 8, 2020. doi:10.3201/eid2608.201097PubMedGoogle Scholar
Cheng  HY , Jian  SW , Liu  DP ,  et al.  Contact tracing assessment of COVID-19 transmission dynamics in Taiwan and risk at different exposure periods before and after symptom onset.   JAMA Intern Med. Published online May 1, 2020. doi:10.1001/jamainternmed.2020.2020PubMedGoogle Scholar
Symptom-based strategy to discontinue isolation for persons with COVID-19. Centers for Disease Control and Prevention website. Updated May 3, 2020. Accessed July 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/strategy-discontinue-isolation.html
Lauer  SA , Grantz  KH , Bi  Q ,  et al.  The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application.   Ann Intern Med. 2020;172(9):577-582. doi:10.7326/M20-0504PubMedGoogle ScholarCrossref
Guan  WJ , Ni  ZY , Hu  Y ,  et al; China Medical Treatment Expert Group for Covid-19.  Clinical characteristics of coronavirus disease 2019 in China.   N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032PubMedGoogle ScholarCrossref
Garg  S , Kim  L , Whitaker  M ,  et al.  Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019—COVID-NET, 14 States, March 1-30, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(15):458-464. doi:10.15585/mmwr.mm6915e3PubMedGoogle ScholarCrossref
Richardson  S , Hirsch  JS , Narasimhan  M ,  et al; the Northwell COVID-19 Research Consortium.  Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.   JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775PubMedGoogle ScholarCrossref
Docherty  AB , Harrison  EM , Green  CA ,  et al; ISARIC4C investigators.  Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study.   BMJ. 2020;369:m1985. doi:10.1136/bmj.m1985PubMedGoogle ScholarCrossref
 The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020.   China CDC Weekly. 2020;2:10.Google Scholar
Grasselli  G , Zangrillo  A , Zanella  A ,  et al; COVID-19 Lombardy ICU Network.  Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy.   JAMA. 2020;323(16):1574-1581. doi:10.1001/jama.2020.5394PubMedGoogle ScholarCrossref
Huang  C , Wang  Y , Li  X ,  et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.   Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5PubMedGoogle ScholarCrossref
Lechien  JR , Chiesa-Estomba  CM , De Siati  DR ,  et al.  Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study.   Eur Arch Otorhinolaryngol. 2020;277(8):2251-2261. doi:10.1007/s00405-020-05965-1PubMedGoogle ScholarCrossref
Helms  J , Kremer  S , Merdji  H ,  et al.  Neurologic features in severe SARS-CoV-2 infection.   N Engl J Med. 2020;382(23):2268-2270. doi:10.1056/NEJMc2008597PubMedGoogle ScholarCrossref
Spinato  G , Fabbris  C , Polesel  J ,  et al.  Alterations in smell or taste in mildly symptomatic outpatients with SARS-CoV-2 infection.   JAMA. 2020;323(20):2089-2209. doi:10.1001/jama.2020.6771PubMedGoogle ScholarCrossref
Hendren  NS , Drazner  MH , Bozkurt  B , Cooper  LT  Jr .  Description and proposed management of the acute COVID-19 cardiovascular syndrome.   Circulation. 2020;141(23):1903-1914. doi:10.1161/CIRCULATIONAHA.120.047349PubMedGoogle ScholarCrossref
Myers  LC , Parodi  SM , Escobar  GJ , Liu  VX .  Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California.   JAMA. 2020;323(21):2195-2198. doi:10.1001/jama.2020.7202PubMedGoogle ScholarCrossref
Yang  X , Yu  Y , Xu  J ,  et al.  Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.   Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5PubMedGoogle ScholarCrossref
Götzinger  F , Santiago-García  B , Noguera-Julián  A , Lanaspa  M , Lancella  L , Carducci  FIC .  COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study.   Lancet Child Adolesc Health. Published online June 25, 2020. doi:10.1016/S2352-4642(20)30177-2PubMedGoogle Scholar
Verdoni  L , Mazza  A , Gervasoni  A ,  et al.  An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study.   Lancet. 2020;395(10239):1771-1778. doi:10.1016/S0140-6736(20)31103-XPubMedGoogle ScholarCrossref
Whittaker  E , Bamford  A , Kenny  J ,  et al.  Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.   JAMA. Published online June 8, 2020. doi:10.1001/jama.2020.10369PubMedGoogle Scholar
Levin  M .  Childhood multisystem inflammatory syndrome: a new challenge in the pandemic.   N Engl J Med. Published online June 29, 2020. doi:10.1056/NEJMe2023158PubMedGoogle Scholar
Wang  W , Xu  Y , Gao  R ,  et al.  Detection of SARS-CoV-2 in different types of clinical specimens.   JAMA. 2020;323(18):1843-1844. doi:10.1001/jama.2020.3786PubMedGoogle Scholar
Sethuraman  N , Jeremiah  SS , Ryo  A .  Interpreting diagnostic tests for SARS-CoV-2.   JAMA. Published online May 6, 2020. doi:10.1001/jama.2020.8259PubMedGoogle Scholar
Kucirka  LM , Lauer  SA , Laeyendecker  O , Boon  D , Lessler  J .  Variation in false-negative rate of reverse transcriptase polymerase chain reaction-based SARS-CoV-2 tests by time since exposure.   Ann Intern Med. Published online May 13, 2020. doi:10.7326/M20-1495PubMedGoogle Scholar
Williams  E , Bond  K , Zhang  B , Putland  M , Williamson  DA .  Saliva as a non-invasive specimen for detection of SARS-CoV-2.   J Clin Microbiol. Published online April 21, 2020. doi:10.1128/JCM.00776-20PubMedGoogle Scholar
Guo  L , Ren  L , Yang  S ,  et al.  Profiling early humoral response to diagnose novel coronavirus disease (COVID-19).   Clin Infect Dis. Published online March 21, 2020. doi:10.1093/cid/ciaa310PubMedGoogle Scholar
Zhao  J , Yuan  Q , Wang  H ,  et al.  Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019.   Clin Infect Dis. Published online March 28, 2020. doi:10.1093/cid/ciaa344PubMedGoogle Scholar
Bond  K , Nicholson  S , Hoang  T , Catton  M , Howden  B , Williamson  D . Post-Market Validation of Three Serological Assays for COVID-19. Office of Health Protection, Commonwealth Government of Australia; 2020.
Chen  N , Zhou  M , Dong  X ,  et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.   Lancet. 2020;395(10223):507-513. doi:10.1016/S0140-6736(20)30211-7PubMedGoogle ScholarCrossref
Wu  C , Chen  X , Cai  Y ,  et al.  Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China.   JAMA Intern Med. Published online March 13, 2020. doi:10.1001/jamainternmed.2020.0994PubMedGoogle Scholar
Shi  H , Han  X , Jiang  N ,  et al.  Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study.   Lancet Infect Dis. 2020;20(4):425-434. doi:10.1016/S1473-3099(20)30086-4PubMedGoogle ScholarCrossref
Bernheim  A , Mei  X , Huang  M ,  et al.  Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection.   Radiology. 2020;295(3):200463. doi:10.1148/radiol.2020200463PubMedGoogle Scholar
Alhazzani  W , Møller  MH , Arabi  YM ,  et al.  Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19).   Intensive Care Med. 2020;46(5):854-887. doi:10.1007/s00134-020-06022-5PubMedGoogle ScholarCrossref
Wilson  KC , Chotirmall  SH , Bai  C , Rello  J ; International Task Force on COVID-19. COVID-19: Interim Guidance on Management Pending Empirical Evidence. American Thoracic Society; 2020. Accessed July 7, 2020. https://www.thoracic.org/covid/covid-19-guidance.pdf
Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health website. Updated June 25, 2020. Accessed July 1, 2020. https://www.covid19treatmentguidelines.nih.gov/
Marini  JJ , Gattinoni  L .  Management of COVID-19 respiratory distress.   JAMA. Published online April 24, 2020. doi:10.1001/jama.2020.6825PubMedGoogle Scholar
Hager  DN , Krishnan  JA , Hayden  DL , Brower  RG ; ARDS Clinical Trials Network.  Tidal volume reduction in patients with acute lung injury when plateau pressures are not high.   Am J Respir Crit Care Med. 2005;172(10):1241-1245. doi:10.1164/rccm.200501-048CPPubMedGoogle ScholarCrossref
Tobin  MJ .  Basing respiratory management of COVID-19 on physiological principles.   Am J Respir Crit Care Med. 2020;201(11):1319-1320. doi:10.1164/rccm.202004-1076EDPubMedGoogle ScholarCrossref
Rawson  TM , Moore  LSP , Zhu  N ,  et al.  Bacterial and fungal co-infection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing.   Clin Infect Dis. Published online May 2, 2020. doi:10.1093/cid/ciaa530PubMedGoogle Scholar
Sanders  JM , Monogue  ML , Jodlowski  TZ , Cutrell  JB .  Pharmacologic treatments for coronavirus disease 2019 (COVID-19).   JAMA. Published online April 13, 2020. doi:10.1001/jama.2020.6019PubMedGoogle Scholar
Wang  M , Cao  R , Zhang  L ,  et al.  Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.   Cell Res. 2020;30(3):269-271. doi:10.1038/s41422-020-0282-0PubMedGoogle ScholarCrossref
Magagnoli  J , Narendran  S , Pereira  F ,  et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with COVID-19. MedRxiv. Preprint posted June 5, 2020. doi:10.1016/j.medj.2020.06.001
Mahévas  M , Tran  VT , Roumier  M ,  et al.  Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data.   BMJ. 2020;369:m1844. doi:10.1136/bmj.m1844PubMedGoogle ScholarCrossref
Tang  W , Cao  Z , Han  M ,  et al.  Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial.   BMJ. 2020;369:m1849. doi:10.1136/bmj.m1849PubMedGoogle ScholarCrossref
Rosenberg  ES , Dufort  EM , Udo  T ,  et al.  Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State.   JAMA. 2020;323(24):2493-2502. doi:10.1001/jama.2020.8630PubMedGoogle ScholarCrossref
Geleris  J , Sun  Y , Platt  J ,  et al.  Observational study of hydroxychloroquine in hospitalized patients with COVID-19.   N Engl J Med. 2020;382(25):2411-2418. doi:10.1056/NEJMoa2012410PubMedGoogle ScholarCrossref
Scavone  C , Brusco  S , Bertini  M ,  et al.  Current pharmacological treatments for COVID-19: what’s next?   Br J Pharmacol. Published online April 24, 2020. doi:10.1111/bph.15072PubMedGoogle Scholar
Cao  B , Wang  Y , Wen  D ,  et al.  A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19.   N Engl J Med. 2020;382(19):1787-1799. doi:10.1056/NEJMoa2001282PubMedGoogle ScholarCrossref
Beigel  JH , Tomashek  KM , Dodd  LE ,  et al.  Remdesivir for the treatment of COVID-19: preliminary report.   N Engl J Med. Published online May 22, 2020. doi:10.1056/NEJMoa2007764PubMedGoogle Scholar
Goldman  JD , Lye  DCB , Hui  DS ,  et al.  Remdesivir for 5 or 10 days in patients with severe COVID-19.   N Engl J Med. Published online May 27, 2020. doi:10.1056/NEJMoa2015301PubMedGoogle Scholar
Shen  C , Wang  Z , Zhao  F ,  et al.  Treatment of 5 critically ill patients with COVID-19 with convalescent plasma.   JAMA. 2020;323(16):1582-1589. doi:10.1001/jama.2020.4783PubMedGoogle ScholarCrossref
Li  L , Zhang  W , Hu  Y ,  et al.  Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: a randomized clinical trial.   JAMA. Published online June 3, 2020. doi:10.1001/jama.2020.10044PubMedGoogle Scholar
Wang  C , Li  W , Drabek  D ,  et al.  A human monoclonal antibody blocking SARS-CoV-2 infection.   Nat Commun. 2020;11(1):2251. doi:10.1038/s41467-020-16256-yPubMedGoogle ScholarCrossref
Brouwer  PJM , Caniels  TG , van der Straten  K ,  et al.  Potent neutralizing antibodies from COVID-19 patients define multiple targets of vulnerability.   Science. Published online June 15, 2020. doi:10.1126/science.abc5902PubMedGoogle Scholar
Alzghari  SK , Acuña  VS .  Supportive treatment with tocilizumab for COVID-19: a systematic review.   J Clin Virol. 2020;127:104380. doi:10.1016/j.jcv.2020.104380PubMedGoogle Scholar
Horby  P , Lim  WS , Emberson  J , Mafham  M , Bell  J ,  et al. Effect of dexamethasone in hospitalized patients with COVID-19: preliminary report. medRxiv. Published online June 22, 2020. doi:10.1101/2020.06.22.20137273:24
Wadhera  RK , Wadhera  P , Gaba  P ,  et al.  Variation in COVID-19 hospitalizations and deaths across New York City boroughs.   JAMA. 2020;323(21):2192-2195. doi:10.1001/jama.2020.7197PubMedGoogle ScholarCrossref
Price-Haywood  EG , Burton  J , Fort  D , Seoane  L .  Hospitalization and mortality among black patients and white patients with COVID-19.   N Engl J Med. 2020;382(26):2534-2543. doi:10.1056/NEJMsa2011686PubMedGoogle ScholarCrossref
COVID-19 in racial and ethnic minority groups. Centers for Disease Control and Prevention website. Updated June 25, 2020. Accessed July 7, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html
Pham  TM , Carpenter  JR , Morris  TP , Sharma  M , Petersen  I .  Ethnic differences in the prevalence of type 2 diabetes diagnoses in the UK: cross-sectional analysis of the health improvement network primary care database.   Clin Epidemiol. 2019;11:1081-1088. doi:10.2147/CLEP.S227621Google ScholarCrossref
Prescott  HC , Angus  D .  Enhancing recovery from sepsis: a review.   JAMA. 2018;319(1):62-75. doi:10.1001/jama.2017.17687Google ScholarCrossref
Jüni  P , Rothenbühler  M , Bobos  P ,  et al.  Impact of climate and public health interventions on the COVID-19 pandemic: a prospective cohort study.   CMAJ. 2020;192(21):E566-E573. doi:10.1503/cmaj.200920PubMedGoogle ScholarCrossref
Pan  A , Liu  L , Wang  C ,  et al.  Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China.   JAMA. 2020;323(19):1-9. doi:10.1001/jama.2020.6130PubMedGoogle ScholarCrossref
Coronavirus government response tracker. University of Oxford website. Accessed June 24, 2020. https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker
Flaxman  S , Mishra  S , Gandy  A ,  et al.  Estimating the effects of nonpharmaceutical interventions on COVID-19 in Europe.   Nature. Published online June 8, 2020. doi:10.1038/s41586-020-2405-7PubMedGoogle Scholar
Markel  H , Lipman  HB , Navarro  JA ,  et al.  Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic.   JAMA. 2007;298(6):644-654. doi:10.1001/jama.298.6.644PubMedGoogle ScholarCrossref
Xiao  Y , Tang  B , Wu  J , Cheke  RA , Tang  S .  Linking key intervention timings to rapid decline of the COVID-19 effective reproductive number to quantify lessons from mainland China.   Int J Infect Dis. Published online June 11, 2020. doi:10.1016/j.ijid.2020.06.030PubMedGoogle Scholar
Thanh Le  T , Andreadakis  Z , Kumar  A ,  et al.  The COVID-19 vaccine development landscape.   Nat Rev Drug Discov. 2020;19(5):305-306. doi:10.1038/d41573-020-00073-5PubMedGoogle ScholarCrossref
Lurie  N , Saville  M , Hatchett  R , Halton  J .  Developing Covid-19 vaccines at pandemic speed.   N Engl J Med. 2020;382(21):1969-1973. doi:10.1056/NEJMp2005630PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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