COVID-19: Symptoms, Causes, Treatment

SARS-CoV-2 (synonyms: novel coronavirus (2019-nCoV); 2019-nCoV (2019-novel coronavirus; coronavirus 2019-nCoV); Wuhan coronavirus; ICD-10-GM U07.1G: COVID-19, virus detected) may lead to a pulmonary disease called COVID-19 (Engl. Corona virus disease 2019; synonym: Novel coronavirus-infected pneumonia (NCIP); ICD-10-GM U07.2: COVID-19; secondarily also J06.9: Acute upper respiratory tract infection, unspecified or J12.8: Pneumonia due to other viruses). This is an atypical pneumonia (pneumonia). The Coronavirus Study Group of the International Committee on Taxonomy of Viruses, which named the new coronavirus disease, refers to the name SARS-CoV-2 as a very close relationship to the SARS virus (SARS-CoV-1). SARS-CoV-2 belongs to lineage B of the beta-coronaviruses; it is an enveloped (+)ssRNA virus.Meanwhile, 33 mutations of the virus with different cytopathogenicity (“cell damage”; up to a factor of 270) have been detected. A variant of SARS-CoV-2 characterized by a mutation at position 614 of the spike protein (mutation “D614G”) increases infectivity (ability to infect) but has no effect on pathogenicity (ability to cause disease). In December 2019, the first infections occurred in central China in the metropolis of Wuhan (population 11 million) and Hubei province, which includes Wuhan. In 2020, the disease spread, infecting more than 82,000 people in China to date, and approximately 2.3% died from COVID-19. During the course, SARS-CoV-2 infections occurred worldwide. Countries particularly affected include the United States, Italy, Spain, Germany, France, Iran, England, Switzerland, the Netherlands, and Korea. Cluster 5 virus: as of June 2020, at least 214 people have been infected with a variant of SARS-COV-2 coronavirus that originally occurred in minks.

Johns Hopkins University real-time map.

Robert Koch Institute real-time map: COVID-19 dashboard.

On 01/30/2020, WHO declared a “public health emergency of international concern.” On 11/03/2020, WHO classified the spread of the new coronavirus SARS-CoV-2 as a pandemic. The disease belongs to the viral zoonoses (animal diseases). The natural reservoir of the pathogen is bats/horseshoe-nosed bats. The intermediate host is not yet known. Manifestation index: Approximately 58% of those infected with the pathogen become recognizably ill. The baseline reproduction number R0 (basic reproduction rate; number of people an infected person infects on average) for SARS-CoV-2 is estimated to be 2.2, with an uncertainty range of 1.4 to 3.8. (Measles: 15-18; smallpox: 5-7; polio: 5-7; mumps: 4-7; HIV/AIDS: 2-5; SARS-CoV (SARS-CoV-1): 2-5; influenza: 2-3; Ebola: 1.5-2.5).Pathogen transmission (route of infection):

• By droplet infection, i.e., primarily via respiratory tract secretions (respiratory tract): infection can enter via mucous membranes of the respiratory tract or indirectly via hands, which are then brought into contact with oral or nasal mucosa as well as the conjunctiva of the eyes.
  • possibly also by aerosolization of the virus during normal breathing; however, to date, it is thought that pathogens spread via the respiratory air are probably not at high enough doses to lead to infection (animal studies with ferrets). At choir rehearsals or in restaurants, there are situations in which SARS-CoV-2 has been transmitted via aerosols.
    • Experimental evidence of SARS-CoV-2 transmission via aerosols: In a hospital room, despite regular air purification, virus inactivation with UV-C light, and dryness, viruses can be in the air to cause infection. The distance of up to 4.8 m suggests that viruses are not transmitted by droplets alone.
    • The U.S. Centers for Disease Control (CDC) indicates that SARS-CoV-2 can also be transmitted via aerosols, even over a distance longer than six feet (about 1.8 meters) in enclosed spaces “with only poor ventilation.”
• possibly also fecal-oral/smear infection is conceivableNote: SARS-CoV-2 is detectable longer in stool samples than in respiratory secretions.
• In liquid or dried material, SARS-CoV-2 coronavirus remains infectious for 9 days, e.g., on doorknobs, doorbells, etc.
• Vertical infection, i.e., through infected mothers:
  • Transplacental transmission, i.e., transmission via the placenta (placenta), of SARS-CoV-2 from a pregnant woman affected by COVID-19 during late pregnancy to her offspring.
  • 30 hours postpartum (after birth).
  • Through breast milk? (SARS-CoV-2 RNA was detected in the breast milk of one of the women for four consecutive days): one infant was infected (mother wore a mouth–nose protection when handling the infant, hands and breasts were disinfected, and breast pump and other breastfeeding utensils were regularly disinfected).

  In a small observational study (9 women), no vertical transmission (transmission) of the pathogen was detected in women who were sick in the 3rd trimester (third trimester of pregnancy). The same is true for a New York study: there was no vertical transmission among 100 newborns in the maternity hospital.

Transmission during the incubation period has now been demonstrated. COVID-19 patients are already infectious two and a half days before symptom onset; infectivity reaches the maximum half a day before the first symptoms. CONCLUSION: Approximately 44% of all COVID-19 patients could become infected in presymptomatic individuals.Asymptomatic transmission, i.e., without the presence of symptoms, is possible; even asymptomatic patients with negative PCR are likely to transmit the virus. Asymptomatic infected excrete similar amounts of virus as symptomatic patients, according to an RT-PCR study. Entry of the pathogen into the body is parenterally (the pathogen does not enter through the intestine but through the respiratory tract (inhalation infection)). Human-to-human transmission: Yes Members of the same household are particularly at risk (esp. if they share a bedroom). There is an increased risk of transmission during long conversations, shared car rides, and encounters with more than one COVID-19 patient.Children are less likely to become infected with SARS-CoV-2 than their parents (study of 5,000 parent-child pairs). Incubation period (time from infection to onset of illness) is usually 1-3-6-14 days; median incubation period was 4 days (interquartile range 2 to 7 daysDuration of illness is approximately two weeks. Sex ratio: males more common than females (60% vs. 40%)

Peak incidence: the maximum incidence of infection is in adulthood. The median age is 47 years. Most of those with the disease (84%) were of working age (15-64 years), with only 0.9% of patients younger and 15.1% older.ACE2 expression in the nasal mucosa, a portal of entry for SARS-CoV-2, increases with age and is lowest in those under ten years of age. This may be one reason for the less frequent occurrence of COVID-19 in the very young. The duration of infectivity (contagiousness) is not yet known; nor is the period of highest infectivity known. It is now considered likely that even asymptomatic patients with negative PCR can transmit the virus.There are reports of four COVID-19 patients who were initially virus-free after recovery but retested positive for SARS-CoV-2 several times in the weeks thereafter.A case series from China demonstrated that virus was still detectable in respiratory tract specimens after 22 days and in faeces after 2 weeks for up to more than 1 month.Re-infection can occur in very rare cases: A 25-year-old U.S. man re-infected with COVID-19 – just 48 days after testing positive for SARS-CoV-2 and two interim negative swabs. Note: Apparently, some of the patients recovered from COVID-19 continue to be virus carriers for a limited time! Course and prognosis: The infection is asymptomatic in most cases or with mild symptoms in 80.9% of cases.In the Italian locality of Vo, where the first European died of COVID-19 on February 21, more than 40% of those infected remained asymptomatic (3,275 residents were tested, examined, and interviewed for this purpose).The China CDC published data from 72,314 patient records.The disease was mild in 80.9%, severe in 13.8%, and critical in 4.7%. 1,023 patients died, which would correspond to a mortality rate of 2.3%.26% of patients admitted to the hospital required intensive care. Where severe courses were present, acute respiratory distress syndrome (ARDS) can occur within 2 days. Note: 40 to 45 percent of people infected with SARS-CoV-2 do not develop symptoms.Time from onset of illness to pneumonia (lung infection) approximately 4 days (IQR: 2-7 days).Time from onset of illness to acute respiratory failure 9 days (IQR: 7-11 days)Ventilation time in the hospital is approx. 14 to 21 days.Deaths occurred primarily in patients with prior severe underlying diseases (diabetes mellitus, hypertension (high blood pressure), cardiovascular disease/cardiovascular disease, or cerebrovascular disease/diseases affecting the blood vessels of the brain, i.e., the cerebral arteries or cerebral arteries). i.e., the cerebral arteries or cerebral veins) suffered.In the United States, preexisting conditions are the most important risk factor for severe course of SARS-CoV-2 infection; nearly 80% of all ICU patients have preexisting conditions.Young people aged 20-54 years account for 38% of COVID-19 patients hospitalized, according to data from the United States. Hospitalization must be prompt for critically ill patients: see Prognosis Score CRB-65 score under Physical Examination: lethality risk (risk of death) and Measures. Online risk assessment for a severe course of COVID-19.

Severity assessment of COVID-19 with comparative data on pneumonia (pneumonia) from the hospital sentinel for severe acute respiratory illness:

• COVID-19 patients are younger, have less frequent preexisting conditions, and require ventilation more frequently and for longer periods of time at the same time.
• Both groups have a similar proportion of patients requiring intensive care and dying.

COVID-19 patients continued to suffer persistent symptoms for weeks after the acute infection resolved: 87.4% (125 of 143 patients) still had at least one COVID-19 symptom 60 days after the first symptoms appeared. Fatigue (tiredness; 53.1%), dyspnea (shortness of breath; 43.4%), and arthralgias (joint pain; 27.3%) were particularly common. The lethality (mortality related to the total number of people suffering from the disease; case-fatality rate; CFR) is currently 2.3%. Taking into account that most infections are likely to be asymptomatic, the lethality rate is probably considerably lower. For MERS-CoV (37%) and for SARS (SARS-CoV-1) (10%), the lethality rates were much higher.According to the report of the Chinese disease control agency, most deaths occurred in the age group of 70 to 79 years, 30.5%. Men have a significantly higher risk of death, 2.8%, than women, 1.7%.Men with COVID-19, have a 62 percent higher mortality risk than diseased women, in all age groups. In the 10-19 age group, there has been only one death as of Feb. 11, according to the report from China’s disease control agency.The newspaper La Republica, citing Italian civil defense chief Angelo Borrelli, reports that only 1 percent of those who died were between the ages of 50-59; 10 percent were between 60 and 69; 31 percent were between 70 and 79; and nearly half (44 percent) were between the ages of 80 and 89.WHO reports the mortality rate worldwide to be 3.5 percent on average. Statistical data from 10,021 hospitalized patients in Germany from February 26 to April 19.The mean duration of ventilation was 13.5 days (SD 12.1). In-hospital mortality (death rate) was 22% overall (2229 of 10 021), with large differences between patients without ventilation (1323 of 8294) and with ventilation (906 of 1727; 65 of 145) for noninvasive ventilation only, 70 of 141 for noninvasive ventilation, and 696 of 1318 for invasive mechanical ventilation). In-hospital mortality among ventilated patients who required dialysis was 73% (342 of 469).In-hospital mortality for ventilated patients by age ranged from 28% (117 of 422) in patients aged 18 to 59 years to 72% (280 of 388) in patients aged 80 years or older. Note: “Superspreading” events (“superspreaders”) may occur: in one child, milk glass infiltrates were detected on computed tomography despite the absence of symptoms.A series of patients from Wuhan documented a “superspreading” event (138 infected persons): the proportion of nosocomial infections was 41%. Notes for pregnant women: Pregnancy seems to be a risk factor for an unfavorable COVID-19 course (60-90% higher than in women without pregnancy), moreover, preterm births occur 3-fold more frequently in diseased pregnant women.The German Society of Gynecology and Obstetrics (DGGG) also sees no indication for a caesarean section due to COVID-19. The extent to which the disease leads to immunity is not yet known, but it is very likely.A Chinese study of rhesus monkeys showed that animals were immune to re-infection after a first SARS-CoV-2 infection; thus, it is very likely that humans cannot contract the virus more than once. A U.S. study demonstrated that almost all convalescent patients who offered themselves as potential plasma donors after a documented COVID-19 illness were antibody positive. Vaccination: A vaccine is not yet available. This is not expected until early 2021 at the earliest. Interim data show that the mRNA-1273 vaccine induced anti-SARS-CoV-2 immune responses in study participants. Suspected illness with SARS-CoV-2 must be reported to the health department under the Infection Control Act. Meanwhile, mandatory reporting of SARS-CoV-2 infections in companion animals is also planned (July 4, 2020). Note: See also our notes on “Prevention” and “Further Therapy/Nutritional Medicine.”