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Coronavirus Presentation templates

Raise awareness about one of the hottest topics of the 21st century by downloading and editing our free ppt templates and google slides themes about coronavirus..

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COVID-19 Explained for Middle School

The pandemic has completely changed the way we live. The youngest have had to adapt without understanding what was going on. If you want to make COVID-19 understandable for your middle school students, we recommend using this editable template from Slidesgo. With it you can explain the symptoms, prevention measures,...

Arbovirus Disease: Lassa Fever

Download the Arbovirus Disease: Lassa Fever presentation for PowerPoint or Google Slides. Taking care of yourself and of those around you is key! By learning about various illnesses and how they are spread, people can get a better understanding of them and make informed decisions about eating, exercise, and seeking...

Omicron COVID-19 Variant Clinical Case

A new variant of COVID-19 has been notified by the World Health Organization and has been named "the Omicron variant". Questions and doubts start to arise and to solve them, there is no better idea than a clinical case with real examples to illustrate any doubt you may have. For...

Flu vs. COVID-19 Infographics

How to tell the difference between the flu and other diseases such as COVID-19? Some of their symptoms are similar, so we think a lot of healthcare workers will agree that people should be informed about this. Help patients or society in general by using these editable infographics. The variety...

Digestive System Diseases: Viral Gastroenteritis

Download the "Digestive System Diseases: Viral Gastroenteritis" presentation for PowerPoint or Google Slides. Taking care of yourself and of those around you is key! By learning about various illnesses and how they are spread, people can get a better understanding of them and make informed decisions about eating, exercise, and...

Stop The Virus! Distance Learning Escape Room

If you are a fan of escape rooms you will love this template that we have created in Slidesgo. It is inspired by these games and features a virus that you have to escape from. The design is creative, with purple background, fun illustrations and sans serif typography. Go solving...

COVID-19 High School Lesson

It's true that COVID-19 has been around for almost a year now, but it's never too late to explain all about this virus and the prevention measures. This new template will be useful for high schools, as it's been designed with an educational purpose in mind. With a color palette...

Rotavirus Infection Breakthrough

Download the Rotavirus Infection Breakthrough presentation for PowerPoint or Google Slides.Treating diseases involves a lot of prior research and clinical trials. But whenever there’s a new discovery, a revolutionary finding that opens the door to new treatments, vaccines or ways to prevent illnesses, it’s great news. Should there be a...

Viral Exanthem Rash

Download the Viral Exanthem Rash presentation for PowerPoint or Google Slides. Taking care of yourself and of those around you is key! By learning about various illnesses and how they are spread, people can get a better understanding of them and make informed decisions about eating, exercise, and seeking medical...

Arboviral Encephalitis Disease

Download the Arboviral Encephalitis Disease presentation for PowerPoint or Google Slides. Taking care of yourself and of those around you is key! By learning about various illnesses and how they are spread, people can get a better understanding of them and make informed decisions about eating, exercise, and seeking medical...

COVID-19 Vaccine Breakthrough

Aren't you tired of COVID-19? Great news: vaccines are already here! Use this new editable template to tell your audience all the latest discoveries on the matter. Since blue is the color of safety, we've used it to set the right atmosphere. We've used other resources, such as illustrations of...

COVID-19 Outbreak Thesis

Several fields of study can benefit from interesting dissertations on how COVID-19 has spread all around the world. Your thesis is about this matter and you need to defend it in front of the assessment committee? Use this presentation during your speech and have your data on the screen while...

Arbovirus Infections

Download the Arbovirus Infections presentation for PowerPoint or Google Slides. This incredible template is designed to help you create your own marketing plan that is sure to impress your entire team. Using this amazing tool, you'll be able to analyze your target audience, assess your competitors, map out your messaging...

Infectious Diseases Notebook

Download the Infectious Diseases Notebook presentation for PowerPoint or Google Slides. Taking care of yourself and of those around you is key! By learning about various illnesses and how they are spread, people can get a better understanding of them and make informed decisions about eating, exercise, and seeking medical...

Perinatal Death Caused COVID-19 Case Report

This template for a case report about perinatal death caused by COVID-19 is as elegant and tasteful as its serious subject deserves. Its green, yellow and white color scheme is understated without being dour, and several photos and illustrations add a visual component to the subjects of pregnancy, disease and...

COVID-19 Vaccine Breakthrough: Case Investigation and Reporting

The COVID-19 vaccine has improved the pandemic situation. We are gradually returning to our pre-COVID-19 lifestyle. All this has been achieved thanks to the enormous efforts of the scientific community, which has not rested until a remedy has been found. However, new variants of COVID-19 continue to emerge and we...

Norwalk Virus Clinical Case

The best way to understand a disease is through a clinical case. Your knowledge about Norwalk virus, which causes acute gastroenteritis, occurs in outbreaks and is easily transmitted, will be key to prevent it. And this template, with its modern, yet professional and functional design, will be your best ally...

National Influenza Vaccination Week

National Influenza Vaccination Week is a week in December when the importance of getting vaccinated against the flu is emphasized, especially for older people and those who are at more risk for any medical condition. Most people get through the flu just fine, but it can also have dire consequences....

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• Discussions
• Certificates
• Collab Space
• Course Details
• Announcements

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Coronaviruses are a large family of viruses that are known to cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

A novel coronavirus (COVID-19) was identified in 2019 in Wuhan, China. This is a new coronavirus that has not been previously identified in humans.

This course provides a general introduction to COVID-19 and emerging respiratory viruses and is intended for public health professionals, incident managers and personnel working for the United Nations, international organizations and NGOs.

As the official disease name was established after material creation, any mention of nCoV refers to COVID-19, the infectious disease caused by the most recently discovered coronavirus.

Please note that the content of this course is currently being revised to reflect the most recent guidance. You can find updated information on certain COVID-19-related topics in the following courses: Vaccination: COVID-19 vaccines channel IPC measures: IPC for COVID-19 Antigen rapid diagnostic testing: 1) SARS-CoV-2 antigen rapid diagnostic testing ; 2) Key considerations for SARS-CoV-2 antigen RDT implementation

Please note: These materials were last updated on 16/12/2020.

Course contents

Emerging respiratory viruses, including covid-19: introduction:, module 1: introduction to emerging respiratory viruses, including covid-19:, module 2: detecting emerging respiratory viruses, including covid-19: surveillance:, module 3: detecting emerging respiratory viruses, including covid-19: laboratory investigations:, module 4: risk communication :, module 5 : community engagement:, module 6: preventing and responding to an emerging respiratory virus, including covid-19:, enroll me for this course, certificate requirements.

• Gain a Record of Achievement by earning at least 80% of the maximum number of points from all graded assignments.

Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

• Vaccines  
• Masking Guidelines
• Visitor Guidelines  

Health Infographic

Coronavirus at a Glance: Infographic

Coronavirus at a glance, understanding covid-19.

• COVID-19 is spread by close person-to-person contact and over long distances through respiratory droplets from speaking, coughing or sneezing.
• Symptoms may appear two to 14 days after exposure to the virus that causes COVID-19. A person does not have to have symptoms to spread the virus.
• COVID-19 can be diagnosed with a laboratory or at-home antigen test.

symptoms of COVID-19 INCLUDE:

Sore throat

Fever or chills

Congestion or runny nose

Shortness of breath or difficulty breathing

New loss of taste or smell

Muscle or body aches

Nausea or vomiting

The Best Ways to Protect Yourself

Get vaccinated as soon as you can.

Wear a face mask when in public to help prevent the spread of the virus.

If not wearing a mask, cough or sneeze into a tissue or bent elbow. Throw the tissue in the trash. When wearing a mask, you can cough or sneeze into the mask. Change mask as soon as possible.

Stay at least 6 feet away from others.

Consider getting tested before joining indoor gatherings with others who are not in your household.

If you feel sick, stay home and call your health care provider.

Do not touch your face without washing your hands first.

Clean and disinfect frequently touched objects and surfaces.

Frequently wash your hands with soap and water or use a hand sanitizer with at least 60% alcohol.

Avoid crowds and poorly ventilated spaces. Avoid indoor spaces that do not offer fresh air.

WHEN TO SEEK MEDICAL attention

• Call 911 if you have an emergency.
• If you feel sick, stay home and call your medical provider.
• Call your health care provider if you have been near someone with COVID-19.

Trauma Team Puts an Athlete Back in the Saddle

Patient Safety Infographic

Coronavirus: Younger Adults Are at Risk, Too

Related Topics

• Infectious Diseases

Coronavirus Disease 2019 (COVID-19) Clinical Presentation

• Author: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
• Sections Coronavirus Disease 2019 (COVID-19)
• Practice Essentials
• Route of Transmission
• Epidemiology
• Physical Examination
• Complications
• Approach Considerations
• Laboratory Studies
• CT Scanning
• Chest Radiography
• Medical Care
• Antiviral Agents
• Immunomodulators and Other Investigational Therapies
• Investigational Antibody-Directed Therapies
• Antithrombotics
• Renin Angiotensin System Blockade and COVID-19
• Diabetes and COVID-19
• Therapies Determined Ineffective
• QT Prolongation with Potential COVID-19 Pharmacotherapies
• Investigational Devices
• Guidelines Summary
• CDC Evaluating and Testing Persons Under Investigation (PUI) for COVID-19 Clinical Guidelines
• CDC Sample Collection and Testing Guidelines for COVID-19
• Guidance for Hospitals on Containing Spread of COVID-19
• American Academy of Pediatrics Guidance on Management of Infants Born to Mothers with COVID-19
• NIH Coronavirus Disease 2019 (COVID-19) Treatment Guidelines
• Infectious Diseases Society of America (IDSA) Management Guidelines
• Thromboembolism Prevention and Treatment
• Medication Summary
• Corticosteroids
• Immunomodulators
• Complement Inhibitors
• COVID-19, Monoclonal Antibodies
• Questions & Answers
• Media Gallery

Presentations of COVID-19 range from asymptomatic/mild symptoms to severe illness and mortality. Common symptoms include fever, cough, and shortness of breath. [ 100 ]  Other symptoms, such as malaise and respiratory distress, also have been described. [ 90 ]

Symptoms may develop 2 days to 2 weeks after exposure to the virus. [ 100 ]  A pooled analysis of 181 confirmed cases of COVID-19 outside Wuhan, China, found the mean incubation period was 5.1 days, and that 97.5% of individuals who developed symptoms did so within 11.5 days of infection. [ 101 ]  

Symptom rebound and viral rebound have been described in patients (with or without antiviral treatment). In untreated patients, those (n = 563) receiving placebo in the ACTIV-2/A5401 (Adaptive Platform Treatment Trial for Outpatients with COIVD-19) platform trial recorded 13 symptoms daily between days 1 and 28. Symptom rebound was identified in 26% of participants at a median of 11 days after initial symptom onset. Viral rebound was detected in 31% and high-level viral rebound in 13% of participants. [ 102 ]  

The following symptoms may indicate COVID-19 [ 100 ] :

• Fever or chills
• Shortness of breath or difficulty breathing
• Muscle or body aches
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting

Other reported symptoms include the following:

• Sputum production
• Respiratory distress
• Neurologic (eg, headache, altered mentality) 

Wu and McGoogan reported that, among 72,314 COVID-19 cases reported to the CCDC, 81% were mild (absent or mild pneumonia), 14% were severe (hypoxia, dyspnea, >50% lung involvement within 24-48 hours), 5% were critical (shock, respiratory failure, multiorgan dysfunction), and 2.3% were fatal. [ 103 ] These general symptom distributions have been reconfirmed across multiple observations. [ 104 , 105 ]

Clinicians evaluating patients with fever and acute respiratory illness should obtain information regarding travel history or exposure to an individual who recently returned from a country or US state experiencing active local transmission. [ 106 ]

Williamson and colleagues, in an analysis of 17 million patients, reaffirmed that severe COVID-19 and mortality was more common in males, older individuals, individuals in poverty, Black persons, and patients with medical conditions such as diabetes and severe asthma, among others. [ 107 ]

A multicenter observational cohort study conducted in Europe found frailty was a greater predictor of mortality than age or comorbidities. [ 108 ]

Type A blood has been suggested as a potential factor that predisposes to severe COVID-19, specifically in terms of increasing the risk for respiratory failure. Blood type O appears to confer a protective effect. [ 109 , 110 ]

Patients with suspected COVID-19 should be reported immediately to infection-control personnel at their healthcare facility and the local or state health department. CDC guidance calls for the patient to be cared for with airborne and contact precautions (including eye shield) in place. [ 22 ] Patient candidates for such reporting include those with fever and symptoms of lower respiratory illness who have travelled from Wuhan City, China, within the preceding 14 days or who have been in contact with an individual under investigation for COVID-19 or a patient with laboratory-confirmed COVID-19 in the preceding 14 days. [ 106 ]

A complete or partial loss of the sense of smell (anosmia) has been reported as a potential history finding in patients eventually diagnosed with COVID-19. [ 20 ] A phone survey of outpatients with mildly symptomatic COVID-19 found that 64.4% (130 of 202) reported any altered sense of smell or taste. [ 111 ] In a European study of 72 patients with PCR results positive for COVID-19, 53 patients (74%) reported reduced olfaction, whereas 50 patients (69%) reported a reduced sense of taste. Forty-nine patients (68%) reported both symptoms. [ 112 ]

Patients who are under investigation for COVID-19 should be evaluated in a private room with the door closed (an airborne infection isolation room is ideal) and asked to wear a surgical mask. All other standard contact and airborne precautions should be observed, and treating healthcare personnel should wear eye protection. [ 22 ]

The most common serious manifestation of COVID-19 upon initial presentation is pneumonia. Fever, cough, dyspnea, and abnormalities on chest imaging are common in these cases. [ 113 , 114 , 115 , 116 ]

Huang and colleagues found that, among patients with pneumonia, 99% had fever, 70% reported fatigue, 59% had dry cough, 40% had anorexia, 35% experienced myalgias, 31% had dyspnea, and 27% had sputum production. [ 113 ]

Complications of COVID-19 include  pneumonia ,  acute respiratory distress syndrome , cardiac injury, arrhythmia,  septic shock , liver dysfunction,  acute kidney injury , and multi-organ failure, among others.

Approximately 5% of patients with COVID-19, and 20% of those hospitalized, experience severe symptoms necessitating intensive care. The common complications among hospitalized patients include pneumonia (75%), ARDS (15%), AKI (9%), and acute liver injury (19%). Cardiac injury has been increasingly noted, including troponin elevation, acute heart failure, dysrhythmias, and myocarditis. Ten percent to 25 percent of hospitalized patients with COVID-19 experience prothrombotic coagulopathy resulting in venous and arterial thromboembolic events. Neurologic manifestations include impaired consciousness and stroke.

ICU case fatality is reported up to 40%. [ 104 ]  

As the COVID-19 pandemic has matured, more patients have reported long-term, post-infection sequelae. Most patients recover fully, but those who do not have reported adverse symptoms such as fatigue, dyspnea, cough, anxiety, depression, inability to focus (ie, “brain fog”), gastrointestinal problems, sleep difficulties, joint pain, and chest pain lasting weeks to months after the acute illness. Long-term studies are underway to understand the nature of these complaints. [ 117 ]  

Post-acute sequelae of SARS-CoV-2 (PASC) infection is the medical term for what is commonly called long COVID or "long haulers". The NIH includes discussion of persistent symptoms or organ dysfunction after acute COVID-19 within guidelines that discuss the clinical spectrum of the disease. [ 118 ]  

The UK National Institute for Health and Care Excellence (NICE) issued guidelines on care of long COVID that define the syndrome as: signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks, and are not explained by an alternative diagnosis. [ 119 ]  

Please see Long COVID-19 .

Future public health implications

Public health implications for long COVID need to be examined, as reviewed by Datta et al. As with other infections (eg, Lyme disease, syphilis, Ebola), late inflammatory and virologic sequelae may emerge. Accumulation of evidence beyond the acute infection and postacute hyperinflammatory illness is important to evaluate to gain a better understanding of the full spectrum of the disease. [ 120 ]  

Thrombotic manifestations of severe COVID-19 are caused by the ability of SARS-CoV-2 to invade endothelial cells via angiotensin-converting enzyme-2 (ACE-2), which is expressed on the surface of endothelial cells. Subsequent endothelial inflammation, complement activation, thrombin generation, platelet and leukocyte recruitment, and the initiation of innate and adaptive immune responses culminate in immunothrombosis, and can ultimately cause microthrombotic complications (eg, DVT, PE, stroke). [ 121 ]  

Kotecha et al describe patterns of myocardial injury in hospitalized patients with severe COVID-19 who had elevated troponin levels. During convalescence, myocarditis-like injury was observed, with limited extent and minimal functional consequence. However, in a proportion of patients, there was evidence of possible ongoing localized inflammation. Roughly 25% of patients had ischemic heart disease, of which two thirds had no previous history. [ 122 ]  

Reinfection

COVID-19 reinfection is defined as an infected person who has undergone full vaccination, whether they have had a booster or boosters. According to the CDC, reinfection is COVID-19 infection of an individual with 2 different viral strains that occurs at least 45 days apart. It also may occur when an individual has 2 positive CoV-2 RT-PCR tests with negative tests between the 2 positive tests. [ 123 ]

It is essential to determine reinfection rates to establish the effectiveness of current vaccine prophylaxis. Reinfection in vaccinated and non-vaccinated persons probably is due to a variant. [ 123 , 124 ]  

It is important to differentiate reinfection from reactivation or relapse of the virus, which occurs in a clinically recovered person within the first 4 weeks of infection, during which viral RNA testing has remained positive. During relapse, a tiny viral load of dormant virus reactivates, the reason of which often is unclear.

The only way to prove this state is to show that genetic samples taken at the beginning and at the time of reactivation differ genetically; such testing is unusual at the beginning of a person’s illness.

For more information, see COVID-19 Reinfections

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• The heart is normal in size. There are diffuse, patchy opacities throughout both lungs, which may represent multifocal viral/bacterial pneumonia versus pulmonary edema. These opacities are particularly confluent along the periphery of the right lung. There is left midlung platelike atelectasis. Obscuration of the left costophrenic angle may represent consolidation versus a pleural effusion with atelectasis. There is no pneumothorax.
• The heart is normal in size. There are bilateral hazy opacities, with lower lobe predominance. These findings are consistent with multifocal/viral pneumonia. No pleural effusion or pneumothorax are seen.
• The heart is normal in size. Patchy opacities are seen throughout the lung fields. Patchy areas of consolidation at the right lung base partially silhouettes the right diaphragm. There is no effusion or pneumothorax. Degenerative changes of the thoracic spine are noted.
• The same patient as above 10 days later.
• The trachea is in midline. The cardiomediastinal silhouette is normal in size. There are diffuse hazy reticulonodular opacities in both lungs. Differential diagnoses include viral pneumonia, multifocal bacterial pneumonia or ARDS. There is no pleural effusion or pneumothorax.
• Axial chest CT demonstrates patchy ground-glass opacities with peripheral distribution.
• Coronal reconstruction chest CT of the same patient above, showing patchy ground-glass opacities.
• Axial chest CT shows bilateral patchy consolidations (arrows), some with peripheral ground-glass opacity. Findings are in peripheral and subpleural distribution.
• Table 1. SARS-CoV-2 Monoclonal Antibodies – inactive EUAs

Contributor Information and Disclosures

David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS Associate Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Rutgers New Jersey Medical School David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine , American Academy of Pediatrics , American College of Physicians , American Medical Association , HIV Medicine Association , Infectious Diseases Society of America , Medical Society of New Jersey , Pediatric Infectious Diseases Society Disclosure: Nothing to disclose.

Scott J Bergman, PharmD, FCCP, FIDSA, BCPS, BCIDP Antimicrobial Stewardship Program Coordinator, Infectious Diseases Pharmacy Residency Program Director, Department of Pharmaceutical and Nutrition Care, Division of Infectious Diseases, Nebraska Medicine; Clinical Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center Scott J Bergman, PharmD, FCCP, FIDSA, BCPS, BCIDP is a member of the following medical societies: American Association of Colleges of Pharmacy , American College of Clinical Pharmacy , American Pharmacists Association , American Society for Microbiology , American Society of Health-System Pharmacists , Infectious Diseases Society of America , Society of Infectious Diseases Pharmacists Disclosure: Received research grant from: Merck & Co., Inc.

Keith M Olsen, PharmD, FCCP, FCCM Dean and Professor, College of Pharmacy, University of Nebraska Medical Center Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha , American College of Physicians , American Medical Association , Association of Professors of Medicine , Infectious Diseases Society of America , Oklahoma State Medical Association , Southern Society for Clinical Investigation Disclosure: Nothing to disclose.

Molly Marie Miller, PharmD Clinical Infectious Diseases Pharmacist Practitioner, Nebraska Medicine Molly Marie Miller, PharmD is a member of the following medical societies: Society of Infectious Diseases Pharmacists Disclosure: Nothing to disclose.

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StatPearls [Internet].

Features, evaluation, and treatment of coronavirus (covid-19).

Marco Cascella ; Michael Rajnik ; Abdul Aleem ; Scott C. Dulebohn ; Raffaela Di Napoli .

Affiliations

Last Update: August 18, 2023 .

• Continuing Education Activity

Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has had a catastrophic effect on the world, resulting in more than 6 million deaths worldwide. It has emerged as the most consequential global health crisis since the era of the influenza pandemic of 1918. As the virus mutates, treatment guidelines are altered to reflect the most efficacious therapies. This activity is a comprehensive review of the disease presentation, complications, and current guideline-recommended treatment options for managing this disease.

• Screen individuals based on exposure and symptom criteria to identify potential COVID-19 cases.
• Identify the clinical features and radiological findings expected in patients with COVID-19.
• Apply the recommended treatment options for patients with COVID-19.
• Create strategies with the interprofessional team for improving care coordination to care for patients with COVID-19 to help improve clinical outcomes.
• Introduction

Coronavirus disease 2019 (COVID-19) is a highly contagious viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has had a catastrophic effect on the world, resulting in more than 6 million deaths worldwide. After the first cases of this predominantly respiratory viral illness were reported in Wuhan, Hubei Province, China, in late December 2019, SARS-CoV-2 rapidly disseminated worldwide. This compelled the World Health Organization (WHO) to declare it a global pandemic on March 11, 2020. [1]

Even though substantial progress in clinical research has led to a better understanding of SARS-CoV-2, many countries continue to have outbreaks of this viral illness. These outbreaks are primarily attributed to the emergence of mutant variants of the virus. Like other RNA viruses, SARS-CoV-2 adapts with genetic evolution and developing mutations. This results in mutant variants that may have different characteristics than their ancestral strains. Several variants of SARS-CoV-2 have been described during the course of this pandemic, among which only a few are considered variants of concern (VOCs). Based on the epidemiological update by the WHO, 5 SARS-CoV-2 VOCs have been identified since the beginning of the pandemic:

• Alpha (B.1.1.7): First variant of concern, which was described in the United Kingdom (UK) in late December 2020 [2]
• Beta (B.1.351) : First reported in South Africa in December 2020 [2]
• Gamma (P.1) : First reported in Brazil in early January 2021 [2]
• Delta (B.1.617.2):  First reported in India in December 2020 [2]
• Omicron   (B.1.1.529): First reported in South Africa in November 2021 [3]

Despite the unprecedented speed of vaccine development against the prevention of COVID-19 and robust global mass vaccination efforts, the emergence of new SARS-CoV-2 variants threatens to overturn the progress made in limiting the spread of this disease. This review aims to comprehensively describe the etiology, epidemiology, pathophysiology, and clinical features of COVID-19. This review also provides an overview of the different variants of SARS-CoV-2 and the guideline-recommended treatment (as of January 2023) for managing this disease. 

Coronaviruses (CoVs) are positive-sense single-stranded RNA (+ssRNA) viruses with a crown-like appearance under an electron microscope ( coronam  is the Latin term for crown) due to the presence of spike glycoproteins on the envelope. [1] The subfamily  Orthocoronavirinae  of the  Coronaviridae  family (order  Nidovirales ) classifies into 4 genera of CoVs: 

• Alphacoronavirus (alphaCoV)
• Betacoronavirus (betaCoV)
• Deltacoronavirus (deltaCoV)
• Gammacoronavirus (gammaCoV)

BetaCoV genus is further divided into 5 sub-genera or lineages. [4]  Genomic characterization has shown that bats and rodents are the probable gene sources of alphaCoVs and betaCoVs. Avian species seem to be the source of deltaCoVs and gammaCoVs. CoVs have become significant pathogens of emerging respiratory disease outbreaks. Members of this large family of viruses can cause respiratory, enteric, hepatic, and neurological diseases in different animal species, including camels, cattle, cats, and bats.

These viruses can cross species barriers and infect humans as well. Seven human CoVs (HCoVs) capable of infecting humans have been identified. Some HCoVs were identified in the mid-1960s, while others were only detected in the new millennium. In general, estimates suggest that 2% of the population are healthy carriers of CoVs and that these viruses are responsible for about 5% to 10% of acute respiratory infections. [5]  

• Common human CoVs : HCoV-OC43 and HCoV-HKU1 (betaCoVs of the A lineage), HCoV-229E, and HCoV-NL63 (alphaCoVs). These viruses can cause common colds and self-limiting upper respiratory tract infections in immunocompetent individuals. However, in immunocompromised and older patients, lower respiratory tract infections can occur due to these viruses.
• Other human CoVs : SARS-CoV and MERS-CoV (betaCoVs of the B and C lineage, respectively). These viruses are considered more virulent and capable of causing epidemics with respiratory and extra-respiratory manifestations of variable clinical severity. [1]  

SARS-CoV-2 is a novel betaCoV belonging to the same subgenus as the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which have been previously implicated in SARS-CoV and MERS-CoV epidemics with mortality rates up to 10% and 35%, respectively. [6]  It has a round or elliptic and often pleomorphic form and a diameter of approximately 60 to 140 nm. Like other CoVs, it is sensitive to ultraviolet rays and heat. [6]  

The inactivation temperature of SARS-CoV-2 is being researched. A stainless steel surface held at an air temperature of 54.5°C (130 °F) results in the inactivation of 90% of SARS-CoV-2 in approximately 36 minutes. [7]  It resists lower temperatures, even those below 0°C. However, lipid solvents can effectively inactivate these viruses, including ether (75%), ethanol, chlorine-containing disinfectant, peroxyacetic acid, and chloroform (except for chlorhexidine).

Although the origin of SARS-CoV-2 is currently unknown, it is widely postulated to have a zoonotic transmission. [1]  Genomic analyses suggest that SARS-CoV-2 probably evolved from a strain found in bats. The genomic comparison between the human SARS-CoV-2 sequence and known animal coronaviruses revealed high homology (96%) between the SARS-CoV-2 and the betaCoV RaTG13 of bats ( Rhinolophus affinis ). [8]  Similar to SARS and MERS, it has been hypothesized that SARS-CoV-2 advanced from bats to intermediate hosts, such as pangolins and minks, and then to humans. [9] [10]

SARS-CoV-2 Variants

A globally dominant D614G variant was eventually identified and associated with increased transmissibility but without the ability to cause severe illness. [11] Another variant was attributed to transmission from infected farmed mink in Denmark but was not associated with increased transmissibility. [10]  Since then, multiple variants of SARS-CoV-2 have been described, of which a few are considered variants of concern (VOCs) due to their potential to cause enhanced transmissibility or virulence. The United States Centers for Disease Control and Prevention (CDC) and the WHO have independently established a classification system for distinguishing the emerging variants of SARS-CoV-2 into variants of concern(VOCs) and variants of interest(VOIs).

SARS-CoV-2 Variants of Concern (VOCs)

• Alpha (B.1.1.7 lineage)
• In late December 2020, the Alpha variant,   or GRY  (formerly GR/501Y.V1), was reported in the UK based on whole-genome sequencing of samples from patients who tested positive for SARS-CoV-2. [12] [13]
• The variant   was also identified using a commercial assay characterized by the absence of the S gene (S-gene target failure, SGTF) in PCR samples. The B.1.1.7 variant includes 17 mutations in the viral genome. Of these, 8 mutations (Δ69-70 deletion, Δ144 deletion, N501Y, A570D, P681H, T716I, S982A, D1118H) are in the spike (S) protein. N501Y shows an increased affinity of the spike protein to ACE 2 receptors, enhancing the viral attachment and subsequent entry into host cells. [14] [15] [16]
• This alpha variant was reportedly 43% to 82% more transmissible, surpassing preexisting variants of SARS-CoV-2 to emerge as the dominant SARS-CoV-2 variant in the UK. [15]  
• An initial matched case-control study reported no significant difference in the risk of hospitalization or associated mortality with the B.1.1.7 lineage variant compared to other existing variants. However, subsequent studies have reported that people infected with B.1.1.7 lineage variant had increased disease severity compared to those infected with other circulating variants. [17] [13]  
• A large matched cohort study in the UK reported that the mortality hazard ratio of patients infected with the B.1.1.7 lineage variant was 1.64 (95% confidence interval 1.32 to 2.04, P<0.0001) compared to patients with previously circulating strains. [18]
• Another study reported that the B 1.1.7 variant was associated with increased mortality compared to other SARS-CoV-2 variants (HR= 1.61, 95% CI 1.42-1.82). [19]  The risk of death was reportedly greater (adjusted hazard ratio 1.67, 95% CI 1.34-2.09) among individuals with confirmed B.1.1.7 infection compared to individuals with non-B.1.1.7 SARS-CoV-2. [20]
• Beta (B.1.351 lineage)
• The Beta variant, or GH501Y.V2 with multiple spike mutations, resulted in the second wave of COVID-19 infections and was first detected in South Africa in October 2020. [21]
• The B.1.351 variant includes 9 mutations (L18F, D80A, D215G, R246I, K417N, E484K, N501Y, D614G, and A701V) in the spike protein, of which 3 mutations (K417N, E484K, and N501Y) are located in the receptor binding domain (RBD) and increase its binding affinity for the ACE receptors. [22] [14] [23]  
• SARS-CoV-2 501Y.V2 (B.1.351 lineage) was reported in the US at the end of January 2021.
• This variant had an increased risk of transmission and reduced neutralization by monoclonal antibody therapy, convalescent sera, and post-vaccination sera. [24]
• Gamma (P.1 lineage)
• The Gamma variant, or  GR/501Y.V3 , was identified in December 2020 in Brazil and was first detected in the US in January 2021. [25]  
• This B.1.1.28 variant harbors ten mutations in the spike protein (L18F, T20N, P26S, D138Y, R190S, H655Y, T1027I V1176, K417T, E484K, and N501Y). Three mutations (L18F, K417N, E484K) are located in the RBD, similar to the B.1.351 variant. [25]
• The Delta variant was initially identified in December 2020 in India and was responsible for the deadly second wave of COVID-19 infections in April 2021 in India. In the United States, this variant was first detected in March 2021. [2]
• The B.1.617.2 variant harbors ten mutations ( T19R, (G142D*), 156del, 157del, R158G, L452R, T478K, D614G, P681R, D950N) in the spike protein.
• The Omicron variant was first identified in South Africa on 23 November 2021 after an uptick in the number of cases of COVID-19. [26]  
• Omicron was quickly recognized as a VOC due to more than 30 changes to the spike protein of the virus and the sharp rise in the number of cases observed in South Africa. [27]  The reported mutations include T91 in the envelope, P13L, E31del, R32del, S33del, R203K, G204R in the nucleocapsid protein, D3G, Q19E, A63T in the matrix, N211del/L212I, Y145del, Y144del, Y143del, G142D, T95I, V70del, H69del, A67V in the N-terminal domain of the spike, Y505H, N501Y, Q498R, G496S, Q493R, E484A, T478K, S477N, G446S, N440K, K417N, S375F, S373P, S371L, G339D in the receptor-binding domain of the spike, D796Y in the fusion peptide of the spike, L981F, N969K, Q954H in the heptad repeat 1 of the spike as well as multiple other mutations in the non-structural proteins and spike protein. [28]
• Many subvariants of Omicron, such as BA.1, BA.2, BA.3, BA.4, and BA.5, have been identified. [3]

Transmission of SARS-CoV-2

• The primary mode of transmission of SARS-CoV-2 is via exposure to respiratory droplets carrying the infectious virus from close contact or direct transmission from presymptomatic, asymptomatic, or symptomatic individuals harboring the virus. [1]
• Airborne transmission with aerosol-generating procedures has also been implicated in the spread of COVID-19. Data implicating airborne transmission of SARS-CoV-2 in the absence of aerosol-generating procedures is present; however, this mode of transmission has not been universally acknowledged.
• Fomite transmission from contamination of inanimate surfaces with SARS-CoV-2 has been well characterized based on many studies reporting the viability of SARS-CoV-2 on various porous and nonporous surfaces. Under experimental conditions, SARS-CoV-2 was stable on stainless steel and plastic surfaces compared to copper and cardboard surfaces, with the viable virus being detected up to 72 hours after inoculating the surfaces with the virus. [29]  The viable virus was isolated for up to 28 days at 20°C from nonporous surfaces such as glass and stainless steel. Conversely, recovery of SARS-CoV-2 on porous materials was reduced compared with nonporous surfaces. [30]  In hospital settings, the SARS-CoV-2 has been detected on floors, computer mice, trash cans, sickbed handrails, and in the air (up to 4 meters from patients). [31]  The Centers for Disease Control and Prevention (CDC) has stated that individuals can be infected with SARS-CoV-2 via contact with surfaces contaminated by the virus, but the risk is low and is not the main route of transmission of this virus.
• Epidemiologic data from several case studies have reported that patients with SARS-CoV-2 infection have the live virus in feces implying possible fecal-oral transmission. [32]
• A meta-analysis that included 936 neonates from mothers with COVID-19 showed vertical transmission is possible but occurs in a minority of cases. [33]
• Epidemiology

COVID-19 was the third leading cause of death in the United States (USA) in 2020 after heart disease and cancer, with approximately 375,000 deaths. [34]  

Individuals of all ages are at risk of contracting this infection. However, patients aged ≥60 and patients with underlying medical comorbidities (obesity, cardiovascular disease, chronic kidney disease, diabetes, chronic lung disease, smoking, cancer, solid organ or hematopoietic stem cell transplant patients) have an increased risk of developing severe COVID-19 infection.

According to the CDC, age remains the strongest predictor of poor outcomes and severe illness in patients with COVID-19. Data from the National Vital Statistics System (NVSS) at CDC states that patients with COVID-19 aged 50 to 64 years have a 25 times higher risk of death when compared to adults infected with this illness and aged less than 30 years. In patients 65 to 74 years old, this risk increases to 60 times. In patients older than 85, the risk of death increases to 340 times. According to the CDC, these data include all deaths in the United States throughout the pandemic, from February 2020 to July 1, 2022, including deaths among unvaccinated individuals.

The percentage of COVID-19 patients requiring hospitalization was 6 times higher in those with preexisting medical conditions than those without medical conditions (45.4% vs. 7.6%) based on an analysis by Stokes et al. of confirmed cases reported to the CDC from January 22 to May 30, 2020. [35]  The study also reported that the percentage of patients who succumbed to this illness was 12 times higher in those with preexisting medical conditions than those without (19.5% vs 1.6%). [35]  

Data regarding the gender-based differences in COVID-19 suggests that male patients have a higher risk of severe illness and increased mortality due to COVID-19 compared to female patients. [36] [37]  Results from a retrospective cohort study from March 1 to November 21, 2020, evaluating the mortality rate in 209 United States of America (USA) acute care hospitals that included 42604 patients with confirmed SARS-CoV-2 infection, reported a higher mortality rate in male patients (12.5%) compared to female patients (9.6%). [38]

Racial and ethnic minority groups have been reported to have a higher percentage of COVID-19-related hospitalizations than White patients based on a recent CDC analysis of hospitalizations from an extensive administrative database that included approximately 300,000 COVID-19 patients hospitalized from March 2020 to December 2020. This high percentage of COVID-19-related hospitalizations among racial and ethnic groups was driven by a higher risk of exposure to SARS-CoV-2 and an increased risk of developing severe COVID-19 disease. [39]   A meta-analysis of 50 studies from USA and UK researchers noted that people of Black, Hispanic, and Asian ethnic minority groups are at increased risk of contracting and dying from COVID-19 infection. [40]  

COVID-19-related death rates were the highest among Hispanic persons. [34]  Another analysis by the CDC evaluating the risk of COVID-19 among sexual minority adults reported that underlying medical comorbidities which increase the risk of developing severe COVID-19 were more prevalent in sexual minority individuals than heterosexual individuals within the general population and within specific racial/ethnic groups. [41]

• Pathophysiology

Structurally and phylogenetically, SARS-CoV-2 is similar to SARS-CoV and MERS-CoV and is composed of 4 main structural proteins: spike (S), envelope (E) glycoprotein, nucleocapsid (N), and membrane (M) protein. It also contains 16 nonstructural proteins and 5-8 accessory proteins. [42]  

The surface spike (S) glycoprotein, which resembles a crown, is located on the outer surface of the virion. It undergoes cleavage into an amino (N)-terminal S1 subunit, which facilitates the incorporation of the virus into the host cell. The carboxyl (C)-terminal S2 subunit contains a fusion peptide, a transmembrane domain, and a cytoplasmic domain responsible for virus-cell membrane fusion. [43] [44]  The S1 subunit is further divided into a receptor-binding domain (RBD) and an N-terminal domain (NTD), which facilitates viral entry into the host cell and serves as a potential target for neutralization in response to antisera or vaccines . [45]  

The RBD is a fundamental peptide in the pathogenesis of infection as it represents a binding site for the human angiotensin-converting enzyme 2 (ACE2) receptors. Inhibition of the renin-angiotensin-aldosterone system (RAAS) does not increase the risk of hospitalization for COVID-19 and severe disease. [46]

SARS-CoV-2 gains entry into the host cells by binding the SARS-CoV-2 spike or S protein (S1) to the ACE2 receptors in the respiratory epithelium. ACE2 receptors are also expressed by other organs such as the upper esophagus, enterocytes from the ileum, myocardial cells, proximal tubular cells of the kidney, and urothelial cells of the bladder. [47]  The viral attachment process is followed by priming the spike protein S2 subunit by the host transmembrane serine protease 2 (TMPRSS2) that facilitates cell entry and subsequent viral replication. [48]

In the early phase of the infection, viral replication results in direct virus-mediated tissue damage. In the late phase, the infected host cells trigger an immune response by recruiting T lymphocytes, monocytes, and neutrophils. Cytokines such as tumor necrosis factor-α (TNF α), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1 (IL-1), interleukin-6 (IL-6), ), IL-1β, IL-8, IL-12 and interferon (IFN)-γ are released. In severe COVID-19 illness, a 'cytokine storm' is seen. This is due to the over-activation of the immune system and high levels of cytokines in circulation. This results in a local and systemic inflammatory response. [49] [50]  

Effect of SARS-CoV-2 on the Respiratory System

Increased vascular permeability and subsequent development of pulmonary edema in patients with severe COVID-19 are explained by multiple mechanisms. [51] [52] [53]  These mechanisms include:

• Endotheliitis as a result of direct viral injury and perivascular inflammation leading to microvascular and microthrombi deposition
• Dysregulation of RAAS due to increased binding of the virus to the ACE2 receptors
• Activation of the kallikrein-bradykinin pathway, the activation of which enhances vascular permeability
• Enhanced epithelial cell contraction causes swelling of cells and disturbance of intercellular junctions
• The binding of SARS-CoV-2 to the Toll-Like Receptor (TLR) induces the release of pro-IL-1β, which mediates lung inflammation until fibrosis . [54]

Effect of SARS-CoV-2 on Extrapulmonary Organ Systems

Although the respiratory system is the principal target for SARS-CoV-2, other major organ systems such as the gastrointestinal tract (GI), hepatobiliary, cardiovascular, renal, and central nervous systems may also be affected. SARS-CoV-2–induced organ dysfunction is likely due to a combination of mechanisms, such as direct viral toxicity, ischemic injury caused by vasculitis, thrombosis, immune dysregulation, and renin-angiotensin-aldosterone system (RAAS) dysregulation. [55]

Cardiac involvement in COVID-19 is common and likely multifactorial. ACE2 receptors exhibited by myocardial cells may cause direct cytotoxicity to the myocardium leading to myocarditis. Proinflammatory cytokines such as IL-6 can also lead to vascular inflammation, myocarditis, and cardiac arrhythmias. [56]

Acute coronary syndrome (ACS) is a well-recognized cardiac manifestation of COVID-19. It is likely due to multiple factors, including proinflammatory cytokines, worsening of preexisting severe coronary artery disease, coronary plaque destabilization, microthrombogenesis, and reduced coronary blood flow. [57]  

SARS-CoV-2 has a significant effect on the hematological and hemostatic systems as well. The mechanism of leukopenia, one of the most common laboratory abnormalities encountered in COVID-19, is unknown. Several hypotheses have been postulated that include ACE 2 mediated lymphocyte destruction by direct invasion by the virus, lymphocyte apoptosis due to proinflammatory cytokines, and possible invasion of the virus in the lymphatic organs. [58]  

Thrombocytopenia is common in COVID-19 and is likely due to multiple factors, including virus-mediated suppression of platelets, autoantibodies formation, and coagulation cascade activation, resulting in platelet consumption. [59]  

Thrombocytopenia and neutrophilia are considered a hallmark of severe illness. [55] Although it is well known that COVID-19 is associated with a state of hypercoagulability, the exact mechanisms that lead to the activation of the coagulation system are unknown and likely attributed to the cytokine-induced inflammatory response. The pathogenesis of this associated hypercoagulability is multifactorial. The hypercoagulability is probably induced by direct viral-mediated damage or cytokine-induced injury of the vascular endothelium leading to the activation of platelets, monocytes, and macrophages, with increased expression of von Willebrand factor and Factor VIII that results in the generation of thrombin and formation of a fibrin clot. [59] [60]  

Other mechanisms that have been proposed include possible mononuclear phagocyte-induced prothrombotic sequelae, derangements in the renin-angiotensin system (RAS) pathways, and complement-mediated microangiopathy. [59]

• History and Physical

Clinical Manifestations of COVID-19

• The median incubation period for SARS-CoV-2 is estimated to be 5.1 days, and most patients will develop symptoms within 11.5 days of infection. [61]
• The clinical spectrum of COVID-19 varies from asymptomatic or paucisymptomatic forms to clinical illness characterized by acute respiratory failure requiring mechanical ventilation, septic shock, and multiple organ failure. 
• It is estimated that 17.9% to 33.3% of infected patients will remain asymptomatic. [62] [63]
• Most symptomatic patients present with fever, cough, and shortness of breath. Less common symptoms include sore throat, anosmia, dysgeusia, anorexia, nausea, malaise, myalgias, and diarrhea. Stokes et al. reported that among 373,883 confirmed symptomatic COVID-19 cases in the USA, 70% experienced fever, cough, and shortness of breath, 36% reported myalgia, and 34% reported headache. [35]
• A large meta-analysis evaluating clinicopathological characteristics of 8697 patients with COVID-19 in China reported laboratory abnormalities that included lymphopenia (47.6%), elevated C-reactive protein levels (65.9%), elevated cardiac enzymes (49.4%), and abnormal liver function tests (26.4%). Other laboratory abnormalities included leukopenia (23.5%), elevated D-dimer (20.4%), elevated erythrocyte sedimentation rate (20.4%), leukocytosis (9.9%), elevated procalcitonin (16.7%), and abnormal renal function (10.9%). [64]
• A meta-analysis of 212 published studies with 281,461 individuals from 11 countries/regions reported that severe disease course was noted in about 23% of the patients, with a mortality rate of about 6% in patients infected with COVID-19. [65]
• An elevated neutrophil-to-lymphocyte ratio (NLR), an elevated derived NLR ratio (d-NLR), and an elevated platelet-to-lymphocyte ratio indicate a cytokine-induced inflammatory storm. [66]

Based on the severity of the presenting illness, which includes clinical symptoms, laboratory and radiographic abnormalities, hemodynamics, and organ function, the National Institutes of Health (NIH) issued guidelines that classify COVID-19 into 5 distinct types.[ NIH COVID-19 Treatment Guidelines ]

• Asymptomatic or Presymptomatic Infection : Individuals with positive SARS-CoV-2 test without any clinical symptoms consistent with COVID-19.
• Mild illness : Individuals who have symptoms of COVID-19, such as fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, anosmia, or dysgeusia but without shortness of breath or abnormal chest imaging.
• Moderate illness : Individuals with clinical symptoms or radiologic evidence of lower respiratory tract disease and oxygen saturation (SpO 2 ) ≥94% on room air.
• Severe illness : Individuals who have SpO 2 less than 94% on room air, a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 ) of less than 300, marked tachypnea with a respiratory frequency of greater than 30 breaths/min, or lung infiltrates that are greater than 50% of total lung volume.
• Critical illness : Individuals with acute respiratory failure, septic shock, or multiple organ dysfunction. Patients with severe COVID-19 illness may become critically ill with the development of acute respiratory distress syndrome (ARDS). This tends to occur approximately one week after the onset of symptoms.

ARDS is characterized by a severe new-onset respiratory failure or worsening of an already identified respiratory picture. The diagnosis requires bilateral opacities (lung infiltrates >50%), not fully explained by effusions or atelectasis. The Berlin definition classifies ARDS into 3 types based on the degree of hypoxia, with the reference parameter being PaO 2 /FiO 2 or P/F ratio: [67]

• Mild ARDS : 200 mm Hg <PaO 2 /FiO 2 ≤300 mm Hg in patients not receiving mechanical ventilation or in those managed through noninvasive ventilation (NIV) by using positive end-expiratory pressure (PEEP) or a continuous positive airway pressure (CPAP) ≥5 cm H2O.
• Moderate ARDS : 100 mm Hg <PaO 2 /FiO 2 ≤200 mm Hg
• Severe ARDS : PaO 2 /FiO 2 ≤100 mm Hg

When PaO 2 is unavailable, a ratio of SpO 2 /FiO 2 ≤315 suggests ARDS. A multicenter prospective observational study that analyzed 28-day mortality in mechanically ventilated patients with ARDS concluded that COVID-19 patients with ARDS had features similar to other ARDS cohorts, and the risk of 28-day mortality increased with ARDS severity. [68]

Extrapulmonary Manifestations 

• Acute kidney injury (AKI) is the most frequently encountered extrapulmonary manifestation of COVID-19 and is associated with an increased mortality risk. [69] A large multicenter cohort study of hospitalized patients with COVID-19 that involved 5,449 patients admitted with COVID-19 reported that 1993 (36.6%) patients developed AKI during their hospitalization, of which 14.3% of patients required renal replacement therapy (RRT). [70]  
• Myocardial injury manifesting as myocardial ischemia/infarction (MI) and myocarditis are well-recognized cardiac manifestations in patients with COVID-19. Single-center retrospective study analysis of 187 patients with confirmed COVID-19 reported that 27.8% of patients exhibited myocardial injury indicated by elevated troponin levels. The study also noted that patients with elevated troponin levels had more frequent malignant arrhythmias and a higher mechanical ventilation frequency than patients with normal troponin levels. [71]  A meta-analysis of 198 published studies involving 159698 COVID-19 patients reported that acute myocardial injury and a high burden of pre-existing cardiovascular disease were significantly associated with higher mortality and ICU admission. [72]
• Lymphopenia is a common laboratory abnormality in most patients with COVID-19. Other laboratory abnormalities include thrombocytopenia, leukopenia, elevated ESR levels, C-reactive protein (CRP), lactate dehydrogenase (LDH), and leukocytosis.
• COVID-19 is also associated with a hypercoagulable state, evidenced by the high prevalence of venous thromboembolic events. COVID-19 is associated with markedly elevated D-dimer and fibrinogen levels and prolonged prothrombin time (PT) and partial thromboplastin time (aPTT). [71] [55]  
• GI symptoms (such as diarrhea, nausea, vomiting), anorexia, and abdominal pain are common. A meta-analysis reported that the weighted pool prevalence of diarrhea was 12.4% (95% CI, 8.2% to 17.1%), nausea or vomiting was 9% (95% CI, 5.5% to 12.9%), loss of appetite was 22.3% (95% CI, 11.2% to 34.6%) and abdominal pain was 6.2% (95% CI, 2.6% to 10.3%). The study also reported that the mortality rate among patients with GI symptoms was similar to the overall mortality rate. [73] Cases of acute mesenteric ischemia and portal vein thrombosis have also been described. [74]
• An acute increase in aspartate transaminase (AST) and alanine transaminase (ALT) is noted in 14% to 53% of patients with COVID-19 infection. [75]
• Guillain-Barré syndrome (GBS) cases from Northern Italy have also been reported. [76] [77]
• Acral lesions resembling pseudo chilblains (40.4%) are the most common cutaneous manifestation noted in patients with COVID-19. [78]
• Other cutaneous manifestations include erythematous maculopapular rash (21.3%), vesicular rashes (13%), urticarial rashes (10.9%), vascular rashes (4%) resembling livedo or purpura, and erythema multiforme-like eruptions (3.7%). [78]

Diagnostic Testing in COVID-19

A nasopharyngeal swab for SARS-CoV-2 nucleic acid using a real-time PCR assay is the standard diagnostic test.[ NIH COVID-19 Treatment Guidelines ] Commercial PCR assays have been authorized by the USA Food and Drug Administration (FDA) for the qualitative detection of SARS-CoV-2 virus using specimens obtained from nasopharyngeal swabs as well as other sites such as oropharyngeal, anterior/mid-turbinate nasal swabs, nasopharyngeal aspirates, bronchoalveolar lavage (BAL) and saliva. 

The sensitivity of PCR testing depends on multiple factors, including the specimen's adequacy, time from exposure, and specimen source. [79]  However, the specificity of most commercial FDA-authorized SARS-CoV-2 PCR assays is nearly 100%, provided there is no cross-contamination during specimen processing. SARS-CoV-2 antigen tests are less sensitive but have a faster turnaround time than molecular PCR testing. [80]  

Despite the numerous antibody tests designed to date, serologic testing has limitations in specificity and sensitivity, and results from different tests vary. According to the NIH guidelines, diagnosing acute SARS-CoV-2 infection based on serologic testing is not recommended. They also stated that there is insufficient evidence to recommend for or against using serologic testing to assess immunity, even if it is used to guide clinical decisions about COVID-19 vaccines/monoclonal antibodies.[ NIH COVID-19 Treatment Guidelines ]

Other Laboratory Assessment

• Complete blood count (CBC), a comprehensive metabolic panel (CMP) that includes renal and liver function testing, and a coagulation panel should be performed in all hospitalized patients.
• Additional tests, such as ESR, C-reactive protein (CRP), ferritin, lactate dehydrogenase, and procalcitonin, can be considered in hospitalized patients. However, their prognostic significance in COVID-19 is not clear.
• A D-dimer level is required as it guides the use of therapeutic versus prophylactic doses of anticoagulation.

Imaging ModalitiesThis s viral illness commonly manifests as pneumonia, so radiological imaging such as chest x-rays, lung ultrasounds, and chest computed tomography (CT) are often obtained. However, there are no guidelines regarding the timing and choice of pulmonary imaging in patients with COVID-19.

When obtained, the chest X-ray usually shows bilateral multifocal alveolar opacities. Pleural effusions can also be demonstrated. The most common CT chest findings in COVID-19 are multifocal bilateral ground glass opacities with consolidation changes, usually in a patchy peripheral distribution. [81]

Radiologic imaging is not a sensitive method for detecting this disease. A retrospective study of 64 patients with documented COVID-19 reported that 20% had no abnormalities on chest radiographs during the illness. [82]  A chest CT is more sensitive than a radiograph but is not specific. No finding on radiographic imaging can completely rule in or rule out COVID-19 illness. Therefore the American College of Radiology (ACR) advises against the routine use of chest CT for screening or diagnosis of COVID-19.[ ACR Position Statement for Diagnosis of COVID-19 ]

• Treatment / Management

According to the National Institutes of Health (NIH), the 2 main processes driving the pathogenesis of COVID-19 include replication of the virus in the early phase of the illness and dysregulated immune/inflammatory response to SARS-CoV-2 that leads to systemic tissue damage in the later phase of the disease.[ NIH COVID-19 Treatment Guidelines ] The guidelines, therefore, advise antiviral medications to halt viral replication in the early phase of the illness and immunomodulators in the later phase.

Remdesivir is the only antiviral drug approved by the USA Food and Drug Administration (FDA) to treat COVID-19. Ritonavir-boosted nirmatrelvir, molnupiravir, and high-titer COVID-19 convalescent plasma have Emergency Use Authorizations (EUAs) for treating COVID-19. Tixagevimab 300 mg plus cilgavimab 300 mg monoclonal antibodies have received EUAs that allow them to be used as SARS-CoV-2 preexposure prophylaxis (PrEP) in certain patients.

Many other monoclonal antibodies had EUAs; however, as Omicron subvariants emerged, their EUAs were revoked as they were no longer effective. 

The most recent NIH treatment guidelines for the management of COVID-19 illness (accessed on January 3rd, 2023) are outlined below:[ NIH COVID-19 Treatment Guidelines ]

Nonhospitalized Adults With Mild-to-Moderate COVID-19 Illness Who Do Not Require Supplemental Oxygen

• The NIH recommends against using dexamethasone or any other systemic corticosteroids in patients who are not hypoxic. [83]   
• Ritonavir-boosted nirmatrelvir is a combination of oral protease inhibitors. It has been shown to reduce hospitalization and death when given to high-risk, unvaccinated, nonhospitalized patients. It must be given within 5 days of symptoms onset. [84]
• It is a strong cytochrome P450 inhibitor with many drug-drug interactions that must be carefully assessed.
• Some interactions can be managed by temporarily holding the medication, some may be managed with dose adjustment, but some may warrant the use of alternate COVID-19 therapy. 
• Ritonavir-boosted nirmatrelvir is not recommended in patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min.
• The recommended dose is nirmatrelvir 300 mg with ritonavir 100 mg orally twice daily for 5 days.
• This is a nucleotide analog that inhibits the SARS-CoV-2 RNA polymerase  
• The recommended duration of therapy in this setting is 3 days.
• The recommended dose is 200 mg IV on day 1, followed by 100 mg IV for 2 more days.
• It is a mutagenic ribonucleoside antiviral agent.
• Fetal toxicity has been reported in animal studies with this agent. Due to the risk of genotoxicity with this agent, it is not recommended in pregnant patients. 
• This agent should only be used if both therapies are unavailable or cannot be given.
• The NIH guidelines recommend against using anti-SARS-CoV-2 monoclonal antibodies (mAbs) for treating COVID-19 in this cohort because the Omicron subvariants are not susceptible to these agents.  
• Adequate and close medical follow-up is recommended; however, the frequency and duration of follow-up depend on individual risk factors and the severity of their symptoms. 
• Risk factors for progression to severe disease include advanced age and underlying medical conditions. The CDC maintains an updated list of medical conditions associated with a high risk of progression. 
•  Asthma
• Cerebrovascular disease
• Chronic kidney disease
• Bronchiectasis
• COPD (Chronic obstructive pulmonary disease)
• Interstitial lung disease
• Pulmonary embolism
• Pulmonary hypertension
• Nonalcoholic fatty liver disease
• Alcoholic liver disease
• Autoimmune hepatitis
• Cystic fibrosis
• Diabetes, type 1 and 2
• Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
• HIV (Human immunodeficiency virus)
• Mental health conditions such as mood disorders and Schizophrenia spectrum disorders
• Obesity (defined as body mass index (BMI) of greater than 30 kg/m 2 or greater than 95th percentile in children)
• Pregnancy and recent pregnancy
• Smoking, current and former
• Solid organ or blood stem cell transplantation
• Tuberculosis
• Use of corticosteroids or other immunosuppressive medications ( CDC: Underlying Medical Conditions Associated with Higher Risk )

Therapeutic Management of Hospitalized Adults With COVID-19   Who Do Not Require Oxygen

• If patients are hospitalized for reasons other than COVID-19 illness and are not on oxygen, their management is similar to nonhospitalized patients. 
• If they are hospitalized for COVID-19 illness but do not require oxygen, the NIH advises against the use of dexamethasone or any other systemic corticosteroid.
• A prophylactic dose of anticoagulation should be given if there is no contraindication. 
• If they are hospitalized for COVID-19 illness, do not require oxygen, but are at high risk of progression to severe disease, they should be treated with remdesivir.
• The benefit of remdesivir is greatest when given early, ideally within ten days of symptom onset.
• Remdesivir should be given for 5 days or until hospital discharge. 

Therapeutic Management of Hospitalized Adults With COVID-19 Who Require Conventional Oxygen

• Conventional oxygen is defined as oxygen that is NOT high-flow nasal cannula, noninvasive mechanical ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO)
• For most patients in this cohort, the recommended treatment is dexamethasone plus remdesivir.
• Dexamethasone dose is 6 mg IV or oral (PO) once daily for up to 10 days or until hospital discharge (dexamethasone should not be continued at discharge). [83]  
• If the patient is on minimal oxygen, remdesivir monotherapy (without dexamethasone) should be used. 
• If remdesivir cannot be obtained or given, dexamethasone monotherapy is recommended.
• If dexamethasone is unavailable, corticosteroids such as prednisone, methylprednisolone, or hydrocortisone may be used.
• If the patient is already receiving dexamethasone but has rapidly increasing oxygen needs and/or signs of systemic inflammation, oral baricitinib or intravenous (IV) tocilizumab should be added to the treatment regimen as these agents have been shown to improve outcomes in rapidly decompensating patients. [85]
• Alternate immunomodulatory agents for this cohort include oral tofacitinib and IV sarilumab. These agents should only be used if baricitinib and tocilizumab are not available. 
• If the D-dimer level is above normal in this cohort of patients, they recommend therapeutic anticoagulation if the patient is not pregnant and has no increased risk of bleeding. Contraindications for therapeutic anticoagulation in these patients include a platelet count of less than 50 x10^9 /L, hemoglobin less than 8 g/dL, use of dual antiplatelet therapy, any significant bleeding within the past 30 days, a history of a bleeding disorder or an inherited or active acquired bleeding disorder. 
• For pregnant patients, a prophylactic dose of anticoagulation is recommended.

Therapeutic Management of Hospitalized Adults With COVID-19 who Require High-flow Nasal Cannula (HFNC) or Noninvasive Mechanical Ventilation (NIV)

• A meta-analysis study evaluating the effectiveness of HFNC compared to conventional oxygen therapy and NIV before mechanical ventilation reported that HFNC, when used before mechanical ventilation, could improve the prognosis of patients compared to conventional oxygen therapy and NIV. [86]  HFNC or NIV is associated with decreased dispersion of exhaled air, especially when used with good interface fitting, thus creating a low risk of nosocomial transmission of the infection. [87]  However, these treatment modalities are associated with a greater risk of aerosolization and should be used in negative-pressure rooms. [88]
• According to the NIH, dexamethasone plus oral baricitinib or dexamethasone plus IV tocilizumab are the preferred treatment regimens in these patients.
• Alternate immunomodulatory agents for this cohort include oral tofacitinib and IV sarilumab.
• Dexamethasone monotherapy is recommended if baricitinib, tocilizumab, or sarilumab cannot be obtained/given.
• Clinicians may consider adding remdesivir to corticosteroid and immunomodulator combination regimens in immunocompromised patients who require HFNC or NIV ventilation; however, using remdesivir without immunomodulators is not recommended.
• A prophylactic dose of anticoagulation is recommended in these patients. 
• If patients were started on a therapeutic dose of heparin while on conventional oxygen therapy, they should be switched to prophylactic dosing at this time unless they have another indication for full anticoagulation.

Therapeutic Management of Hospitalized Adults With COVID-19 who Require Mechanical Ventilation (MV)

• The management of this cohort is the same as those requiring HFNC or NIV, except that remdesivir is not recommended. 
• Remdesivir is most effective earlier in the course of the disease and in patients not on mechanical ventilation or ECMO.
• According to the NIH, one study showed a slight trend toward an increase in mortality in patients who received remdesivir while on mechanical ventilation or ECMO. [89]
• With this data in mind, the NIH recommends against using remdesivir in patients receiving MV or ECMO; however, if the patient was started on remdesivir and progressed to requiring mechanical ventilation or ECMO, they recommended continuing remdesivir to complete the treatment course. 

High-Titer COVID-19 Convalescent Plasma (CCP)

• The United States Food and Drug Administration (FDA) approved convalescent plasma therapy under a EUA for patients with severe life-threatening COVID-19. [90] [91]   Data from multiple studies evaluating the use of convalescent plasma in life-threatening COVID-19 has generated mixed results. Data from 3 small randomized control trials showed no significant differences in clinical improvement or overall mortality in patients treated with convalescent plasma versus standard therapy. [92] [93] [94]  
• According to the NIH, high-titer CCP is not recommended in immunocompetent individuals.
• However, the NIH states that some experts consider it appropriate for use in immunocompromised individuals. Therefore, the current NIH guidelines state that there is insufficient evidence for or against the use of high-titer CCP for treating COVID-19 in hospitalized or nonhospitalized patients who are immunocompromised.

Medications/Treatments That Should NOT Be Used for the Treatment of COVID-19 According to the Latest NIH Guidelines [ NIH COVID-19 Treatment Guidelines ]

• Chloroquine or hydroxychloroquine with or without azithromycin
• Lopinavir/ritonavir
• Azithromycin
• Doxycycline
• Fluvoxamine
• Inhaled corticosteroids
• Excess supplementation of vitamin C, vitamin D, and zinc
• Interferons alfa, beta, or lambda
• Nitazoxanide
• Bamlanivimab plus etesevimab
• Bebtelovimab
• Casirivimab plus imdevimab

Preexposure Prophylaxis for SARS-CoV-2 Infection

• According to the NIH guidelines, tixagevimab plus cilgavimab is authorized by the FDA for preexposure prophylaxis of SARS-CoV-2 in people who are not expected to mount an adequate immune response to COVID-19 vaccination; however, the prevalence of Omicron subvariants that are resistant to tixagevimab plus cilgavimab is noted to be increasing rapidly. 
• In the absence of alternative options, the NIH still recommends tixagevimab 300 mg plus cilgavimab 300 mg at this time.
• Tixagevimab and cilgavimab are potent anti-spike neutralizing monoclonal antibodies obtained from antibodies isolated from B cells of patients infected with SARS-CoV-2 that have demonstrated neutralizing activity against SARS-CoV-2 virus by binding to nonoverlapping epitopes of the viral spike-protein RBD. [95] [96] [97]  
• The EUA authorizes its use in adult and pediatric patients with no current evidence of SARS-CoV-2 infection and no recent exposure to SARS-CoV-2-positive individuals. They must be moderately or severely immunocompromised or be on immunosuppressive medications.
• Differential Diagnosis

The symptoms of the early stages of the disease are nonspecific. Differential diagnosis should include the possibility of a wide range of infectious and noninfectious respiratory disorders.

• Community-acquired bacterial pneumonia
• Viral pneumonia 
• Influenza infection
• Aspiration pneumonia
• Pneumocystis jirovecii pneumonia
• Middle East respiratory syndrome (MERS)
• Avian influenza A (H7N9) viral infection
• Avian influenza A (H5N1) viral infection
• Pulmonary tuberculosis

The prognosis of COVID-19 depends on various factors, including the patient's age, the severity of illness at presentation, preexisting conditions, how quickly treatment can be implemented, and response to treatment. The WHO currently estimates the global case fatality rate for COVID-19 is 2.2%. Results from a European multicenter prospective cohort study that included 4000 critically ill patients with COVID-19 reported a 90-day mortality of 31%, with higher mortality noted in geriatric patients and patients with diabetes, obesity, and severe ARDS. [98]

• Complications

COVID-19 is a systemic viral illness based on its involvement in multiple major organ systems.

• Patients with advanced age and comorbid conditions such as obesity, diabetes mellitus, chronic lung disease, cardiovascular disease, chronic kidney disease, chronic liver disease, and neoplastic conditions are at risk of developing severe COVID-19 and its associated complications. The most common complication of severe COVID-19 illness is progressive or sudden clinical deterioration leading to acute respiratory failure and ARDS or multiorgan failure leading to death.
• Patients with COVID-19 illness are also at increased risk of developing prothrombotic complications such as pulmonary embolisms, myocardial infarctions, ischemic strokes, and arterial thrombosis. [55]
• Cardiovascular system involvement results in malignant arrhythmias, cardiomyopathy, and cardiogenic shock.
• GI complications such as bowel ischemia, transaminitis, gastrointestinal bleeding, pancreatitis, Ogilvie syndrome, mesenteric ischemia, and severe ileus are often noted in critically ill patients with COVID-19. [99]
• Acute renal failure is the most common extrapulmonary manifestation of COVID-19 and is associated with an increased mortality risk. [69]
• A meta-analysis study of 14 studies evaluating the prevalence of disseminated intravascular coagulation (DIC) in hospitalized patients with COVID-19 reported that DIC was observed in 3% (95%: 1%-5%, P <0.001) of the included patients. Additionally, DIC was noted to be associated with severe illness and was a poor prognostic indicator. [100]
• More recent data have emerged regarding prolonged symptoms in patients who have recovered from COVID-19 infection, termed "post-acute COVID-19 syndrome." A large cohort study of 1773 patients performed 6 months after hospitalization with COVID-19 revealed that most exhibited at least one persistent symptom: fatigue, muscle weakness, sleep difficulties, or anxiety. Patients with severe illness also had an increased risk of chronic lung issues. [101]
• A retrospective cohort study that included 236,379 patients reported substantial neurological (intracranial hemorrhage, ischemic stroke) and psychiatric morbidity (anxiety disorder, psychotic disorder) 6 months after being diagnosed with COVID-19. [102]
• Secondary invasive fungal infections such as COVID-19-associated pulmonary aspergillosis and rhino-cerebro-orbital mucormycosis have increasingly been reported as complications in patients recovering from COVID-19. Risk factors for developing secondary fungal infection include comorbid conditions such as uncontrolled diabetes, associated lymphopenia, and excessive use of corticosteroids.
• Deterrence and Patient Education

The NIH COVID-19 Treatment Guidelines recommend COVID-19 vaccination as soon as possible for all eligible individuals. The CDC’s Advisory Committee on Immunization Practices (AI) determines eligibility eligibility. Four vaccines are authorized or approved in the United States to prevent COVID-19. According to the NIH guidelines, the preferred vaccines include:[ NIH COVID-19 Treatment Guidelines ]

• mRNA vaccine BNT162b2 (Pfizer-BioNTech)
• mRNA-1273 (Moderna)
• Recombinant spike protein with matrix-M1 adjuvant vaccine NVX-CoV2373 (Novavax)

The adenovirus vector vaccine Ad26.COV2.S (Johnson & Johnson/Janssen) is less preferred due to its risk of serious adverse events.[ NIH COVID-19 Treatment Guidelines ]

A primary series of COVID-19 vaccination is recommended for everyone older than 6 months in the United States. Bivalent mRNA vaccines that protect against the original SARS-CoV-2 virus strain and Omicron subvariants are recommended at least 2 months after receiving the primary vaccine series or a booster dose.[ NIH COVID-19 Treatment Guidelines ] 

• Enhancing Healthcare Team Outcomes

SARS-CoV-2 and its variants continue to cause significant morbidity and mortality worldwide. Prevention and management of this highly transmissible respiratory viral illness require a holistic and interprofessional approach that includes physicians' expertise across specialties, nurses, pharmacists, public health experts, and government authorities. There should be open communication among the clinical providers, pharmacists, and nursing staff while managing patients with COVID-19. Each team member should strive to keep abreast of the latest recommendations and guidelines and be free to speak up if they notice anything that does not comply with the latest tenets for managing COVID patients; there is no place for a hierarchy in communication that prohibits any team member from voicing their concerns. This open interprofessional approach will yield the best outcomes. 

Clinical providers managing COVID-19 patients on the frontlines should keep themselves periodically updated with the latest clinical guidelines about diagnostic and therapeutic options available in managing COVID-19, especially considering the emergence of new SARS-CoV-2 variants, which could significantly impact morbidity and mortality. Continued viral surveillance of new variants is crucial at regular intervals with viral genomic sequencing, given the possibility that more highly transmissible, more virulent, and treatment-resistant variants could emerge that can have a more catastrophic effect on global health in addition to the current scenario. A multi-pronged approach involving interprofessional team members can improve patient care and outcomes for this potentially devastating disease and help the world end this pandemic.

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• Comment on this article.

Covid 19, Corona Replication Contributed by Rohan Bir Singh, MD

Clinical Presentation of Patients with CoVID-19 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

SARS- CoV 2 Structure Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Transmission Cycle of SARS CoV 2 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Single-stranded RNA genome of SARS-CoV2 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Disclosure: Marco Cascella declares no relevant financial relationships with ineligible companies.

Disclosure: Michael Rajnik declares no relevant financial relationships with ineligible companies.

Disclosure: Abdul Aleem declares no relevant financial relationships with ineligible companies.

Disclosure: Scott Dulebohn declares no relevant financial relationships with ineligible companies.

Disclosure: Raffaela Di Napoli declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Cascella M, Rajnik M, Aleem A, et al. Features, Evaluation, and Treatment of Coronavirus (COVID-19) [Updated 2023 Aug 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Transmission

Getting vaccinated

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This page includes advice from WHO on ways to protect yourself and prevent the spread of COVID-19. The downloadable infographics below provide guidance on general and specific topics related to the pandemic.

Stay aware of the latest COVID-19 information by regularly checking updates from WHO in addition to national and local public health authorities.

Find out more about getting vaccinated:

• Advice for the public: COVID-19 vaccines

Keep yourself and others safe: Do it all!

Protect yourself and those around you:

• Get vaccinated as soon as it’s your turn and follow local guidance on vaccination.
• Keep physical distance of at least 1 metre from others, even if they don’t appear to be sick. Avoid crowds and close contact.
• Wear a properly fitted mask when physical distancing is not possible and in poorly ventilated settings.
• Clean your hands frequently with alcohol-based hand rub or soap and water.
• Cover your mouth and nose with a bent elbow or tissue when you cough or sneeze. Dispose of used tissues immediately and clean hands regularly. 
• If you develop symptoms or test positive for COVID-19, self-isolate until you recover.

Wear a mask properly

To properly wear your mask:

• Make sure your mask covers your nose, mouth and chin.
• Clean your hands before you put your mask on, before and after you take it off, and after you touch it at any time.
• When you take off your mask, store it in a clean plastic bag, and every day either wash it if it’s a fabric mask or dispose of it in a trash bin if it’s a medical mask.
• Don’t use masks with valves.

More about masks:

• When and how to wear masks
• Questions and answers about children and masks
• Guidance for decision makers and health workers

Make your environment safer

The risks of getting COVID-19 are higher in crowded and inadequately ventilated spaces where infected people spend long periods of time together in close proximity.

Outbreaks have been reported in places where people have gather, often in crowded indoor settings and where they talk loudly, shout, breathe heavily or sing such as restaurants, choir practices, fitness classes, nightclubs, offices and places of worship.

To make your environment as safe as possible:

• Avoid the 3Cs: spaces that are c losed, c rowded or involve c lose contact.
• Meet people outside. Outdoor gatherings are safer than indoor ones, particularly if indoor spaces are small and without outdoor air coming in.
• If you can’t avoid crowded or indoor settings, take these precautions:
• Open a window to increase the amount of natural ventilation when indoors.
• Wear a mask (see above for more details).
• Small public gatherings
• Ventilation and air conditioning (for the general public)
• Ventilation and air conditioning (for people who manage public spaces and buildings) 

Keep good hygiene

By following good respiratory hygiene you protect the people around you from viruses that cause colds, flu and COVID-19. 

To ensure good hygiene you should:

• Regularly and thoroughly clean your hands with either an alcohol-based hand rub or soap and water. This eliminates germs that may be on your hands, including viruses.
• Cover your mouth and nose with your bent elbow or a tissue when you cough or sneeze. Dispose of the used tissue immediately into a closed bin and wash your hands.
• Clean and disinfect surfaces frequently, especially those which are regularly touched, such as door handles, faucets and phone screens.

What to do if you feel unwell

If you feel unwell, here’s what to do. 

• If you have a fever, cough and difficulty breathing, seek medical attention immediately. Call by telephone first and follow the directions of your local health authority.
• Know the full range of symptoms of COVID-19. The most common symptoms of COVID-19 are fever, dry cough, tiredness and loss of taste or smell. Less common symptoms include aches and pains, headache, sore throat, red or irritated eyes, diarrhoea,  a skin rash or discolouration of fingers or toes.
• Stay home and self-isolate for 10 days from symptom onset, plus three days after symptoms cease. Call your health care provider or hotline for advice. Have someone bring you supplies. If you need to leave your house or have someone near you, wear a properly fitted mask to avoid infecting others.
• Keep up to date on the latest information from trusted sources, such as WHO or your local and national health authorities. Local and national authorities and public health units are best placed to advise on what people in your area should be doing to protect themselves.

How COVID-19 infects people and how our bodies react.

Be a champion in the fight against COVID-19

We're all on the same team in bringing an end to the spread of COVID-19

Cheering for your favorite athletes, players and teams? keep your mask on!

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If you have been diagnosed with COVID-19

Shopping for groceries: COVID-19

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How to prepare in case someone gets sick in your household

I just found out that I'm a confirmed contact for COVID-19

I just found out I have COVID-19

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Wash your hands

Protect yourself and others - wash your hands

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How to protect yourself from COVID-19

Alcohol-based handrub: WHO essential medicine

COVID-19: The amount of alcohol-based sanitizer you use matters

It is safer to frequently clean your hands and not wear gloves

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Homecare for people with COVID-19: ill people

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Homecare for people with COVID-19: ill people - square

Home care for COVID-19: Guide for family and caregivers

Homecare for people with COVID-19: Members of the household - square

What to do if someone in your household tests positive for COVID-19

Homecare for people with COVID-19: Caregivers - square

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Pregnancy & breastfeeding.

Updated 31 March 2020

I'm pregnant. How can I protect myself from COVID-19?

Before, during and after childbirth, all women have the right to high quality hair

A safe and positive childbirth, whether or not they have COVID-19

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Women with COVID-19 can breastfeed safely

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Coping with stress during COVID-19 outbreak

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5. Covid Virus - Medical PowerPoint Template

This Covid presentation template gives you the power to create an eye-catching presentation. Included are forty-six slides that feature modern designs. Many graphics are included to help you deliver a compelling presentation to your audience. Free web fonts are included, and you can drag and drop in images of your choice to any slide.

The premium templates mentioned are some of the highest quality available. If you're on a budget, you may not be able to afford the premium templates. In this next section, we'll go over the top free PowerPoint templates virus. 

15 Top Free Covid Coronavirus & Virus PowerPoint Templates to Download

Before looking for a free Covid PowerPoint template on the web, check Envato's free offerings first. Try out various premium template files (not always PowerPoint files) at no cost to you.

Here's the deal: 

With that in mind, here are the best free coronavirus and virus PowerPoint templates that you can find and download online for your presentation: 

1. Free Social Distance PowerPoint Template

With the help of this coronavirus PowerPoint template for free, you’ll have no problem explaining social distancing rules. The Covid PowerPoint template includes four pre-designed slides.

2. Medicine Health Care PowerPoint Templates

Try this medicine and healthcare PowerPoint template if you’re looking for a modern template. Use it to present all the necessary information about Coronavirus or any other medical emergency.

3. Medical Laboratory PowerPoint Templates

Here’s a free template virus that would be perfect for any type of virus research presentation. The template comes with individual slides as well as section covers. It includes 25 slides.

4. Coronavirus Pandemic PowerPoint Templates

Share important findings and information about Coronavirus or any other virus with this modern template. It comes with three master slides that you can customize.

5. Covid-19 Coronavirus PowerPoint Templates  

This free Covid PowerPoint template has a dark green background with virus icons. Use it to quickly create a presentation. The template comes with three master slides designed in several resolutions.

6. Infection PowerPoint Templates

Use this fun infection PowerPoint template to create a presentation about virus research or to provide more information about a specific virus. The Coronavirus PPT includes three master slides that you can duplicate to create your presentation.

7. Free COVID-19 Vaccine PowerPoint Template

With the help of this free PowerPoint template with a virus theme, you can easily share all the information people need to know about Covid-19 vaccines. The Covid vaccine theme PowerPoint comes with four slides.

8. Free COVID-19 Presentation Template

Use this Covid presentation template to create a presentation that shares information about the virus and how to fight it. The template has four master slides that you can copy as many times as you need.

9. Free Covid PowerPoint Template

Here’s a minimal and simple COVID PowerPoint template. It features an image that shows the virus spreading all over the world. It also contains four master Covid PowerPoint slides that you can copy for your presentation. 

10. Free COVID PowerPoint Background

Consider this free COVID PowerPoint background for your presentation. It features an image of a word game spelling out coronavirus, pandemic, and virus. 

11. Medical Illustrated. Free PowerPoint Template & Google Slides Theme

Here’s another minimal and clean PowerPoint template. Use it for any type of medical presentation. The Covid presentation template comes with 25 slides.

12. Blue Medical. Free PowerPoint Template & Google Slides Theme

The blue color in this medical and virus PowerPoint template conveys professionalism. It comes with 25 covid PowerPoint slides.

13. Medical Virus. Free PowerPoint Template & Google Slides Theme

This coronavirus PowerPoint template for free can be used for sharing information about the virus and how to prevent the spread. The template comes with 25 slides that you can duplicate, re-order, and delete as you see fit.

14. Free COVID-19 Health System Capacity Curve PowerPoint

Use this free Covid-19 PowerPoint template to showcase the virus's effect on the health system capacity. The template includes several different slide variations.

15. Coronavirus PowerPoint Template

Use this coronavirus PowerPoint template for free to create informative presentations about coronavirus measures, treatments, and protection. It comes with several slides, including section cover and agenda slides. 

How to Make a Coronavirus Presentation in PowerPoint

1. Choose the Right Slides

Not all the slides in the template will work for your presentation. Go through each slide and pick the ones that pertain to your presentation. For the slides, you don't want to use, left-click the slide and choose Delete Slide .

2. Add In Your Content

Now it's time to add in your presentation's content. Have a document open with all the text you want to use for each slide. Then copy and paste the text to each slide.

Each slide has text placeholders. Double-click the placeholder text and select all the text. You can then paste in your text.

3. Add In Your Images

Next, we'll add in our images to make the presentation more visually appealing. Just like the text, there are also image placeholders. To add in your images, click the image icon on each slide. Your computer files pop up. Choose the image you want to add. 

4. Add in Animations

To help add professional polish to your presentation, we'll add in animations. Choose the top menu header that says Animations . From there, choose the animation that you want to have on your slides. To see what each animation looks like, choose the Preview button on the far left side of the menu.

5. Proofread Your Presentation

Often this step is skipped. We get caught up in making our design look perfect and forget to proofread our presentation. Having grammatical errors and misspelled words is the quickest way to make your presentation look unprofessional. Take the time to go over every slide in your presentation before calling it done.

5 Quick Tips To Make Virus-Themed PPT Presentations in 2024

You’ve just seen the best free and premium coronavirus slideshow templates. Now, here are a few quarantine PowerPoint ideas that'll help you design a standout presentation: 

1. Stand Out With Custom Icons and Illustrations

Custom icons and illustrations make your presentation more memorable. Not to mention, they'll make your presentation stand out. The Covid-19 PowerPoint template features modern custom vector graphics that you can use as inspiration.

2. Keep the Text to a Minimum

Don’t overwhelm your audience by adding a lot of text on your slides. This can cause them to read the slide before you’re done presenting it and they may become disengaged. Instead, keep the text to a minimum of one to three bullet points per slide.

3. Use a Professional Color Scheme

You don’t have to shy away from color in your presentation. Make sure that your color scheme is professional and doesn’t contain any clashing colors. You can draw inspiration from this modern Coronavirus Medical PowerPoint template from Envato Elements.

4. Use Charts for Complex Data and Statistics

If you've got a lot of complex data and statistics, consider using charts and infographic elements to represent them. This will make it easier for your audience to understand and absorb the information.

5. Customize the Slides With Your Photos

Using stock photos is a great way to make your presentation more memorable. But you can achieve an even better effect by including photos of you, your team, and your employees. A template like the Corona Virus PowerPoint Template has plenty of image placeholders for you to use.

Discover More Top PowerPoint Template Designs

If you want to see even more PowerPoint template examples or if you need to create a different type of presentation, look at the following template roundups:

Common PowerPoint Questions Answered (FAQ)

If you're creating a Coronavirus PPT presentation and you're not familiar with PowerPoint, you may have some questions. We've got you covered! Here are some common PowerPoint questions and their answers:

1. I'm New to PowerPoint, What Should I Know?

PowerPoint is a powerhouse presentation software. But learning just the basics of the software enables you to create a complete presentation. Check out our ultimate PowerPoint guide to learn these basics.

2. How Should I Design My Slides?

The visual hierarchy of the slides dictates the design. The arrangement of the elements on your page and how they're placed has the biggest effect on what your audience remembers. Your slide's colors, typography, and images used are major contributors to the design of your slides. 

3. Can I Collaborate on One Presentation?

PowerPoint Online makes collaboration possible. This makes it easy to delegate separate tasks that need to be completed for the presentation. For an in-depth guide on how to collaborate as a team, view the article below.

4. What Colors Should I Use In My Coronavirus PPT?

The colors that work well are blue and red. Red helps highlight the urgency and danger of the virus and blue helps build trust with your audience. If your business has a set of brand colors, then you can use these colors as well. 

5. Can I Print Out My Slides?

Yes, you can! Print out your slides may be necessary depending on where you're presenting. Check out the tutorial below for a complete guide on how to print out your slides.

Learn More About Making Great PowerPoint Presentations in 2024

The tips we shared above are only a small selection of what makes a great presentation. If you want to learn more about designing and writing great PowerPoint presentations , check out the tutorials below: 

Create a Coronavirus Presentation Quickly With Templates

If you need to create a presentation about Coronavirus or any other type of medical presentation, there's no shortage of free PowerPoint templates with a virus theme to choose from. But, if you want to make your presentation look more unique, don’t forget to check out premium templates. 

Stop by Envato Elements if you know you’ll be needing PowerPoint templates and other creative assets on the regular or if you've got multiple brands to promote. 

Editorial Note: This post has been updated with contributions from Daniel Strongin . Daniel is a freelance instructor for Envato Tuts+.

COVID-19: Who's at higher risk of serious symptoms?

Advanced age and some health conditions can raise the risk of serious COVID-19 (coronavirus disease 2019) illness.

Many people with COVID-19, also called coronavirus disease 2019, recover at home. But for some, COVID-19 can be a serious illness. Some people may need care in the hospital, treatment in the intensive care unit and the need for breathing help. In some people, severe COVID-19 illness can lead to death.

What raises the risk of severe or critical COVID-19 illness?

The risk for serious COVID-19 illness depends on your health status, age and activities. Your risk also depends on other factors. This includes where you live, work or learn, how easy it is for you to get medical care, and your economic stability.

If you have more than one risk factor, your risk goes up with each one.

Age raises the risk of serious COVID-19

People age 65 and older and babies younger than 6 months have a higher than average risk of serious COVID-19 illness. Those age groups have the highest risk of needing hospital care for COVID-19.

Babies younger than 6 months aren't eligible for the COVID-19 vaccine, which adds to their risk. For older people, the challenge is that the immune system is less able to clear out germs as people age. Also, as people age, medical conditions that raise the risk of severe COVID-19 are more likely. In the U.S. as of March 2024, about 76% of all deaths from COVID-19 have been among people age 65 and older.

Aging plus disease raises the risk of serious COVID-19

Severe COVID-19 disease is more likely for people who have other health issues.

Some common diseases linked to aging are:

• Heart disease. Examples are heart failure or coronary artery disease.
• Diabetes mellitus. The risk is higher for both type 1 and type 2.
• Chronic lung diseases. This includes airway disease and conditions that damage lung tissue.
• Obesity. The risk goes up as body mass index (BMI) increases, with the highest risk for a BMI of 40 or greater.
• Chronic kidney disease. Especially if you are on dialysis.

These diseases become more common as people age. But they can affect people of any age. The risk of serious COVID-19 illness is linked to having one or more underlying medical condition.

Asthma, COPD, other lung diseases raise risk of severe COVID-19

Your risk of having more severe COVID-19 illness is higher if you have lung disease. Having moderate to severe asthma raises some risks of serious COVID-19 illness. It raises the risk of needing care in the hospital, including intensive care, and needing mechanical help breathing.

The risk of serious COVID-19 illness also is higher for people who have conditions that damage lung tissue over time. Examples are tuberculosis, cystic fibrosis, interstitial lung disease, bronchiectasis or COPD, which stands for chronic obstructive pulmonary disease. These diseases raise the risk of needing care in the hospital for COVID-19. Depending on the condition, the risk of needing intensive care and the risk of death from COVID-19 also may go up.

Other lung conditions, such as a history of pulmonary hypertension or pulmonary embolism affect a person's risk of serious illness after COVID-19. The risk of death may be higher after these conditions.

Cancer raises the risk of severe COVID-19

In general, people with cancer have a greater risk of getting serious COVID-19. People who have or had blood cancer may have a higher risk of being sick for longer, or getting sicker, with COVID-19 than people with solid tumors.

Having cancer raises the risk of needing care in the hospital, intensive care and the use of breathing support. Having blood cancer and getting COVID-19 raises the risk of death from the illness.

Treatment for blood cancer may raise the risk of severe COVID-19 but the research is still unclear. Cancer treatment may also affect your COVID-19 vaccine. Talk to your healthcare professional about additional shots and getting vaccinated after treatments that affect some immune cells.

Other conditions that raise the risk of severe COVID-19

If an organ or body system is already weakened by disease, infection with the COVID-19 virus can cause further damage. In other cases, medicine for the original condition can lower the immune system's response to the virus that causes COVID-19.

Many different diseases can raise the risk of severe COVID-19 illness.

• Brain and nervous system diseases, such as strokes.
• Chronic liver disease, specifically cirrhosis, nonalcoholic fatty liver disease, alcoholic liver disease and autoimmune hepatitis.
• HIV not well managed with medicine.
• Heart disease, including congenital heart disease and cardiomyopathies.
• Mood disorders or schizophrenia.
• Having received an organ or stem cell transplant.
• Sickle cell anemia and thalassemia blood disorders.

Other risk factors for severe COVID-19 are:

• Not getting enough physical activity.
• Pregnancy or having recently given birth.
• Use of medicines that lower the immune system's ability to respond to germs.

Also, as a general group, disability is linked to an increased risk of severe COVID-19. The risks are different depending on the disability.

• Down syndrome is linked to a higher risk of needing care in the hospital. The risk of death from severe COVID-19 also is higher than typical for people with Down syndrome.
• Attention deficit/hyperactivity disorder is linked to an increased risk of needing care in the hospital from severe COVID-19.
• Cerebral palsy is linked to an increased risk of needing care in the hospital from severe COVID-19.

These are not the only conditions that increase the risk of severe COVID-19. Talk to your healthcare professional if you have questions about your health and risk for getting a serious COVID-19 illness.

A COVID-19 vaccine can lower your risk of serious illness

The COVID-19 vaccine can lower the risk of death or serious illness caused by COVID-19. Your healthcare team may suggest added doses of COVID-19 vaccine if you have a moderately or seriously weakened immune system.

How else can you lower the risk of severe COVID-19?

Everyone can lower the risk of serious COVID-19 illness by working to prevent infection with the virus that causes COVID-19.

• Avoid close contact with anyone who is sick or has symptoms, if possible.
• Use fans, open windows or doors, and use filters to move the air and keep any germs from lingering.
• Wash your hands well and often with soap and water for at least 20 seconds. Or use an alcohol-based hand sanitizer with at least 60% alcohol.
• Cough or sneeze into a tissue or your elbow. Then wash your hands.
• Clean and disinfect high-touch surfaces. For example, clean doorknobs, light switches, electronics and counters regularly.
• Spread out in crowded public areas, especially in places with poor airflow. This is important if you have a higher risk of serious illness.
• The U.S. Centers for Disease Control and Prevention recommends that people wear a mask in indoor public spaces if COVID-19 is spreading. This means if you're in an area with a high number of people with COVID-19 in the hospital. They suggest wearing the most protective mask possible that you'll wear regularly, that fits well and is comfortable.

These basic actions are even more important for people who have weakened immune systems, and their caregivers.

The FDA also has authorized the monoclonal antibody pemivibart (Pemgarda) to prevent COVID-19 in some people with weakened immune systems.

People can take other actions based on their risk factors.

• If you're at a higher risk of serious illness, talk to your healthcare professional about how best to protect yourself. Know what to do if you get sick so you can quickly start treatment.
• Lower your risk of COVID-19 complications by making sure that any health issues are well managed. This includes staying on track with managing medical conditions, going to all healthcare appointments and planning ahead to avoid running out of medicine. Keep taking medicines as suggested by your healthcare professional.
• Stay up to date on vaccines. This includes vaccines for flu, pneumonia and RSV. These vaccines won't prevent COVID-19. But becoming ill with a respiratory illness may worsen your outcome if you also catch COVID-19.

You may consider making a care plan. In the care plan, write your medical conditions, the medicine you take, and any special food or diet needs you have. The care plan also includes who you see for care and your emergency contacts.

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• Goldman L, et al., eds. COVID-19: Epidemiology, clinical manifestations, diagnosis, community prevention, and prognosis. In: Goldman-Cecil Medicine. 27th ed. Elsevier; 2024. https://www.clinicalkey.com. Accessed April 5, 2024.
• Regan JJ, et al. Use of Updated COVID-19 Vaccines 2023-2024 Formula for Persons Aged ≥6 Months: Recommendations of the Advisory Committee on Immunization Practices—United States, September 2023. MMWR. Morbidity and Mortality Weekly Report 2023; doi:10.15585/mmwr.mm7242e1.
• Underlying medical conditions associated with higher risk for severe COVID-19: Information for healthcare providers. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html. Accessed April 2, 2024.
• Stay up to date with COVID-19 vaccines. Centers for Disease Control and Prevention. www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Accessed April 2, 2024.
• COVID data tracker. Centers for Disease Control and Prevention. https://covid.cdc.gov/covid-data-tracker/#demographics. Accessed April 2, 2024.
• Najafabadi BT, et al. Obesity as an independent risk factor for COVID‐19 severity and mortality. Cochrane Database of Systematic Reviews. 2023; doi:10.1002/14651858.CD015201.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed April 2, 2024.
• AskMayoExpert. COVID-19: Outpatient management (adult). Mayo Clinic; 2023.
• Emergency use authorizations for drugs and non-vaccine biological products. U.S. Food and Drug Association. https://www.fda.gov/drugs/emergency-preparedness-drugs/emergency-use-authorizations-drugs-and-non-vaccine-biological-products. Accessed April 2, 2024.
• How to protect yourself and others. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed April 2, 2024.
• COVID-19: What people with cancer should know. National Cancer Institute. https://www.cancer.gov/about-cancer/coronavirus/coronavirus-cancer-patient-information. Accessed April 2, 2024.
• Hygiene and respiratory viruses prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/respiratory-viruses/prevention/hygiene.html. Accessed April 2, 2024.
• Preventing respiratory viruses. Centers for Disease Control and Prevention. https://www.cdc.gov/respiratory-viruses/prevention/index.html. Accessed April 2, 2024.
• Maintaining a care plan. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/publications/features/caregivers-month.html. Accessed April 2, 2024.
• COVID-19: What People with Cancer Should Know. National Cancer Institute. https://www.cancer.gov/about-cancer/coronavirus/coronavirus-cancer-patient-information. Accessed April 11, 2024.

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FDA advisers urge targeting JN.1 strain in recipe for fall’s COVID vaccines

FILE - Jackson-Hinds Comprehensive Health Center nurse Maggie Bass, right, gives a COVID-19 vaccine to an unidentified person, Sept. 21, 2021, in Jackson, Miss. COVID-19 vaccines get updated each fall to match newer strains of the virus and government advisers on Wednesday, June 5, 2024, are urging that Americans’ next shot target a strain called JN.1. (AP Photo/Rogelio V. Solis, File)

FILE - Pre-loaded syringes of the COVID-19 vaccine are ready for use, Jan. 25, 2022, in New Orleans. COVID-19 vaccines get updated each fall to match newer strains of the virus and government advisers on Wednesday, June 5, 2024, are urging that Americans’ next shot target a strain called JN.1. (AP Photo/Ted Jackson, File)

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WASHINGTON (AP) — Government advisers Wednesday said it’s time to update the recipe for the COVID-19 vaccines Americans will receive in the fall -- targeting a version of the ever-evolving coronavirus called JN.1.

While COVID-19 cases currently are low, more surges are inevitable and manufacturers need time to brew shots for fall. Moderna, Pfizer and Novavax all have tested doses updated to match the JN.1 variant that became dominant last winter.

But just a few months later, numerous offshoots of JN.1 already are on the rise, prompting Moderna and Pfizer to also test a slightly different vaccine formula targeting what’s now the most common U.S. subtype, called KP.2.

That made for a tough choice as the Food and Drug Administration decides the final recipe. FDA’s advisers voted Wednesday that the next vaccine should come from the JN.1 “lineage” or family. Then FDA vaccine chief Dr. Peter Marks challenged them to be more specific about exactly which variant to target, wondering if KP.2 was a better option.

“If this evolves further in the fall, will we regret not having been a little bit closer?” Marks said, likening the choice to how he always picks the “freshest” milk with the longest expiration date in the grocery store.

But KP.2 isn’t likely to still be the biggest threat by fall, the panel responded. Having to make the choice now, they preferred the parent JN.1 variant itself rather than trying to predict which of its descendants was most likely to increase in the coming months.

“Having a vaccine that’s the trunk of the tree rather than the branches makes sense to me,” because it would offer some cross-protection to other subvariants that emerge, said one adviser, Dr. Melinda Wharton of the Centers for Disease Control and Prevention.

Health officials have told Americans to expect a yearly update to COVID-19 vaccines, just like they get a new flu shot each fall designed to match as best as possible the currently spreading strains. Even though just about everyone has either been infected or had at least one round of COVID-19 vaccinations, the coronavirus keeps churning out new varieties that can dodge prior immunity -– and protection also wanes over time.

Last fall’s COVID-19 vaccine targeted a completely different section of the coronavirus family tree, and CDC data shows only about 22.5% of adults and 14% of children received it. But even though public concern about COVID-19 has waned, it remains deadlier than the flu, according to a recent analysis of Veterans Affairs hospitalizations this past winter.

Moderna, Pfizer and Novavax all said they could have supplies of JN.1-specific shots ready by fall, although they didn’t provide amounts. Like it has in previous years, the CDC will make recommendations on who should receive updated shots and when.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Shaping the future of public health agencies

A series of public health emergencies and concerns have called into question whether countries have the most effective institutional arrangements for their national public health agencies (NPHAs) – the government bodies often tasked with coordinating responses to these emergencies. For example, during the COVID-19 pandemic, uncertainty over jurisdiction sometimes led to confusion and hampered the response. Other governance issues are also important for these agencies, from how they are funded to staff recruitment and retention. Many countries had to rapidly scale up their public health workforce in the middle of the COVID-19 pandemic, but that demand declined equally as rapidly following the end of the pandemic’s acute phase. These sorts of challenges impact all functions and all levels of these agencies.

Countries are increasingly aware of the need to strengthen NPHA. This is reflected in efforts across the globe to realign NPHAs and make them more fit for purpose. To inform these ongoing policy processes, the Alliance for Health Policy and Systems Research is partnering with the WHO Health Emergencies Programme (WHE) to generate policy-relevant learning and convene a national public health agency learning network.

To kick off this initiative, a consultation meeting was held in Singapore in early May, hosted in collaboration with Singapore’s interim Communicable Diseases Agency (iCDA). Policy-makers and researchers from 11 countries (representing six low- and middle-income countries and five high-income countries) attended the consultation alongside representatives from WHO regional offices, the Africa Centres for Disease Control and Prevention (Africa CDC), the United States Centers for Disease Control and Prevention (US CDC), the International Association of National Public Health Institutes (IANPHI), Resolve to Save Lives and the Johns Hopkins Bloomberg School of Public Health.

The three-day meeting reflected on experiences from NPHA reforms from different settings. Welcoming the participants to Singapore, Prof Vernon Lee from the Singapore Ministry of Health emphasized the need for continuous learning: “Singapore did generally well in many aspects in our response to COVID-19, but we realized that we need to enhance our preparedness planning and response to be agile and operationally ready, which is one of the reasons we are setting up a new Communicable Diseases Agency.”

Africa CDC’s Dr Haftom Taame also underscored the need to get the relationship right between NPHAs and the rest of government, especially when considering the degree of autonomy they should have. “The focus should on technical and scientific independence, which – with good relations with government – can then be adopted and implemented”, he suggested.

Other panels and presentations focused on country experiences responding to epidemics and pandemics and applying lessons learned from these emergencies to improve the performance of NPHAs. On the final day, countries presented and discussed research questions to inform the way ahead.

The Alliance and WHE will now work with country teams of policy-makers and researchers from a range of countries, including those who participated in this first meeting. This two-year collaboration will continue the conversation at the Eighth Global Symposium on Health Systems Research in Nagasaki, Japan, in November 2024 and document findings to inform how these national institutions can be better organized to protect the health and well-being of their people.

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How COVID-19 Spreads

COVID-19 spreads when an infected person breathes out droplets and very small particles that contain the virus. These droplets and particles can be breathed in by other people or land on their eyes, noses, or mouth. In some circumstances, they may contaminate surfaces they touch.

Many viruses are constantly changing, including the virus that causes COVID-19. These changes occur over time and can lead to the emergence of variants  that may have new characteristics, including different ways of spreading.

Anyone infected with COVID-19 can spread it, even if they do NOT have symptoms.

Learn more about what you can do to  protect yourself and others .

COVID-19 and Animals

COVID-19 can spread from people to animals in some situations. Pet cats and dogs can sometimes become infected by people with COVID-19. Learn what you should do if you have pets .

Food and Water

There is no evidence to suggest that handling food or consuming food  can spread COVID-19. Follow food safety guidelines when handling and cleaning fresh produce. Do not wash produce with soap, bleach, sanitizer, alcohol, disinfectant, or any other chemical.

Drinking Water

There is also no current evidence that people can get COVID-19 by drinking water. The virus that causes COVID-19 has not been detected in drinking water. Conventional water treatment methods that use filtration and disinfection, such as those in most municipal drinking water systems, should remove or kill the virus that causes COVID-19.​

Natural Bodies of Water (Lakes, Oceans, Rivers)

There are no scientific reports of the virus that causes COVID-19 spreading to people through the water in lakes, oceans, rivers, or other natural bodies of water.

Genetic material from the virus that causes COVID-19 has been found in  untreated wastewater (also referred to as “sewage”). There is no information to date that anyone has become sick with COVID-19 because of direct exposure to treated or untreated wastewater. Wastewater treatment plants use chemical and other disinfection processes to remove and degrade many viruses and bacteria. The virus that causes COVID-19 is inactivated by the disinfection methods used in wastewater treatment.

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Pfizer study finds Paxlovid ineffective against Long COVID despite federal research funds

by JACKSON WALKER | The National Desk

WASHINGTON (TND) — A study on the antiviral drug Paxlovid released last week found the medication is not effective in treating Long COVID.

Long COVID is a chronic condition resulting from an initial infective with COVID-19, according to the CDC. About 6.9% of U.S. adults reported having Long COVID in 2022.

Researchers, including members of the pharmaceutical giant Pfizer, found taking Paxlovid to be “generally safe,” but noted it “did not show significant benefit in improving fatigue, brain fog, body aches, cardiovascular symptoms, shortness of breath, or gastrointestinal symptoms” associated with Long COVID.

The study also noted a handful of adverse events which occurred during the trial, including patients who reported blood loss anemia, forearm fracture and melanoma, though they were found to be unrelated to the treatment. Seventeen participants reported becoming re-infected with COVID-19 during the study.

Paxlovid research has received billions in taxpayer funding as public health leaders continue to search for a remedy to Long COVID. In February, the Biden administration appropriated $515 million to studying the effects of Long COVID in addition to the already $1.15 billion given in 2020, Stat reported .

Pfizer said in a statement to The National Desk Wednesday further research is required to develop a more effective drug to treat Long COVID.

PAXLOVID remains available for treating eligible patients with COVID-19 who are at high risk for progression to severe illness,” a spokesperson wrote. “The World Health Organization describes PAXLOVID as ‘the best therapeutic choice for high-risk patients to date’ and is a National Institutes of Health-preferred treatment for adult patients at high risk of progressing to severe COVID-19.”

Dr. Anthony Fauci testified before Congress this month on his handling of the coronavirus. Rep. Marjorie Taylor Greene, R-Ga., sparked chaos during the hearing when she refused to refer to him as “doctor.”

“You’re not doctor, you’re Mr. Fauci in my few minutes,” she said.

Follow Jackson Walker on X at @_jlwalker_ for the latest trending national news. Have a news tip? Send it to [email protected].