2023 Автор: Stephanie Arnold | [email protected]. Последно модифициран: 2023-05-20 19:52
Ревизии бяха направени на 12 февруари 2020 г., за да отразят следното:
- Добавена е информация относно времето на настъпване на болестта до приемането в болница
- Добавена е информация за откриването на SARS-CoV-2 в екстрапулмонални проби
- Изясняване на типа напреднала подкрепа, наблюдавана сред хоспитализирани пациенти
- Временни указания за прекратяване на предпазните мерки, базирани на предаване, и изолация в дома
На тази страница
- Клинична презентация
- Клиничен курс
- Диагностично изследване
- Лабораторни и рентгенографски находки
-
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Медицинският персонал трябва да се грижи за пациенти в отделение за изолация във въздуха (AIIR).
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
При грижа за пациента трябва да се използват стандартни предпазни мерки, предпазни мерки за контакт и предпазване от въздух със защита на очите.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Вижте Временни препоръки за превенция и контрол на инфекциите в здравеопазването за пациенти, подложени на проучване за коронавирусна болест 2019 (COVID-19).
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Пациентите с леко клинично представяне може първоначално да не се нуждаят от хоспитализация.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Въпреки това, клиничните признаци и симптоми могат да се влошат с прогресията към заболяване на долните дихателни пътища през втората седмица на заболяването;
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
всички пациенти трябва да се наблюдават внимателно.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Възможните рискови фактори за прогресиране до тежко заболяване могат да включват, но не се ограничават до по-напреднала възраст и основни хронични заболявания като белодробна болест, рак, сърдечна недостатъчност, мозъчно-съдова болест, бъбречно заболяване, чернодробно заболяване, диабет, имунокомпрометиращи състояния и бременността.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Решението за наблюдение на пациент в стационарно или амбулаторно заведение трябва да се взема за всеки отделен случай.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Това решение ще зависи не само от клиничното представяне, но и от способността на пациента да участва в мониторинг, изолация в дома и риска от предаване в домашната среда на пациента.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
За повече информация вижте Критерии за ръководство за оценка на пациенти под изследване (PUI) за COVID-19.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Понастоящем няма специфично лечение за COVID-19.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Клиничното управление включва незабавно прилагане на препоръчителните мерки за превенция и контрол на инфекцията и поддържащо управление на усложненията, включително разширена поддръжка на органи, ако е посочено.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Кортикостероидите трябва да се избягват, освен ако не са посочени по други причини (например, хронично обструктивно обостряне на белодробната болест или септичен шок по Surviving Sepsis guideelinesexternal icon), поради потенциала за удължаване на репликацията на вируса, наблюдаван при пациенти с MERS-CoV.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
[12, 21–23]
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
За повече информация вижте: Временни указания на СЗО за клинично управление на тежка остра респираторна инфекция, когато се подозира нова коронавирусна (nCoV) инфекция pdf iconexternal icon и Диагностика и лечение на възрастни с придобита от Общността пневмония.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Официално ръководство за клиничната практика на Американското торакално общество и инфекциозните болести на Америка външна икона.
This interim guidance is for clinicians caring for patients with confirmed coronavirus disease 2019 (COVID-19). This update includes additional information regarding time from illness onset to hospital admission, detection of SARS-CoV-2, the virus that causes COVID-19, in extrapulmonary specimens, clarifies the type of advanced support observed among hospitalized patients and provides interim guidance for discontinuation of transmission-based precautions and in-home isolation. CDC will update this interim guidance as more information becomes available.
Clinical Presentation
There are a limited number of reports that describe the clinical presentation of patients with confirmed COVID-19, and most are limited to hospitalized patients with pneumonia. The incubation period is estimated at ~5 days (95% confidence interval, 4 to 7 days). [1] Some studies have estimated a wider range for the incubation period; data for human infection with other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2-14 days. Frequently reported signs and symptoms include fever (83–98%), cough (46%–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. [2–4] Sore throat has also been reported in some patients early in the clinical course. Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities. [5]
Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).[1] In one study of 425 patients with pneumonia and confirmed COVID-19, 57% were male. [1] Approximately one-third to one-half of reported patients had underlying medical comorbidities, including diabetes, hypertension, and cardiovascular disease. [2–3] In another study, compared to patients not admitted to an intensive care unit, critically ill patients were older (median age 66 years versus 51 years), and were more likely to have underlying co-morbid conditions (72% versus 37%). [3]
Clinical Course
Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness.[2] In one report, among patients with confirmed COVID-19 and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days). [2] In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days.[1]
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. [2, 4] In one report, the median time from symptom onset to ARDS was 8 days.[3] Between 23–32% of hospitalized patients with COVID-19 and pneumonia have required intensive care for respiratory support.[2–3] In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation. [3] Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).[3–4] Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury. Among hospitalized patients with pneumonia, the case fatality proportion has been reported as 4–15%.[2–4] However, as this estimate includes only hospitalized patients it is biased upward. Nosocomial transmission among healthcare personnel and patients has been reported.
Diagnostic Testing
Information on specimen collection, handling, and storage is available at: Real-Time RT-PCR Panel for Detection Coronavirus Disease 2019. After initial confirmation of COVID-19, additional testing of clinical specimens can help inform clinical management, including discharge planning.
Laboratory and Radiographic Findings
The most common laboratory abnormalities reported among hospitalized patients with pneumonia on admission included leukopenia (9–25%), leukocytosis (24–30%), lymphopenia (63%), and elevated alanine aminotransferase and aspartate aminotransferase levels (37%). [2, 4] Most patients had normal serum levels of procalcitonin on admission. Chest CT images have shown bilateral involvement in most patients. Multiple areas of consolidation and ground glass opacities are typical findings reported to date. [2–4, 6–9]
Limited data are available about the detection of SARS-CoV-2 in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and the virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in the upper and lower respiratory tracts and in extrapulmonary specimens is not yet known. It is possible that RNA could detected for weeks, which has occurred in some cases of MERS-CoV or SARS-CoV infection.[9–18] Viable SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens. In contrast, viable MERS-CoV has only been isolated from respiratory tract specimens. [18–20]
Clinical Management and Treatment
Терапевтични изследвания
>
Понастоящем няма антивирусни лекарства, лицензирани от Американската агенция по храните и лекарствата (FDA) за лечение на пациенти със COVID-19. Някои in vitro или in vivo проучвания предполагат потенциална терапевтична активност на съединения срещу сродни коронавируси, но няма налични данни от наблюдателни проучвания или рандомизирани контролирани изпитвания при хора, които да подкрепят препоръчането на всякакви изследвания терапевтици за пациенти с потвърден или подозиран COVID-19 при този път. Съобщава се, че Remdesivir, проучвателно антивирусно лекарство, има активност in vitro спрямо SARS-CoV-2. [24] Малък брой пациенти с COVID-19 са получили интравенозен ремдезивир за състрадателна употреба извън клинично изпитване. В Китай е проведено рандомизирано плацебо-контролирано клинично изпитване на ремдезивир за лечение на хоспитализирани пациенти с пневмония и COVID-19. Проведено е и рандомизирано открито изпитване за комбинирано лечение с лопинавир-ритонавир при хоспитализирани пациенти с пневмония и COVID-19 в Китай, но до момента няма налични резултати. Предвиждат се клинични изпитвания на други потенциални терапевтици за COVID-19. За информация относно специфични клинични изпитвания, които са в ход за лечение на пациенти със COVID-19, вижте икона за клинични проучвания.
Междинно ръководство за прекратяване на предпазни мерки въз основа на предаване или изолация в дома за лица с лабораторно потвърден COVID-19 *
За лица с лабораторно потвърден COVID-19 трябва да се използват стандартни предпазни мерки на базата на предаване (т.е. предпазни мерки за контакт и въздух с предпазване на очите). Това ръководство се прилага за пациенти, които се управляват в болница в отделение за изолация от въздушна инфекция (AIIR) и за пациенти, които се грижат за изолация в дома.
Решенията за прекратяване на предпазните мерки въз основа на предаване или изолация в дома могат да се вземат за всеки отделен случай след консултация с клиницисти, специалисти по превенция и контрол на здравето и общественото здраве въз основа на множество фактори, включително тежестта на заболяването, признаците на заболяването и симптомите и резултати от лабораторни изследвания за SARS-CoV-2 в дихателни проби.
Вижте: Временни съображения за разположение на хоспитализирани пациенти с COVID-19
Вижте: Временни съображения за разположение на нехоспитализирани пациенти с COVID-19 под вътрешно изолация
Допълнителни ресурси:
- Временно ръководство за здравни специалисти
- Ресурси за болници и здравни специалисти, подготвящи се за пациенти със заподозрян или потвърден COVID-19
- Временни препоръки за профилактика и контрол на инфекциите в здравеопазването за лица, подложени на изследване за коронавирусна болест 2019 (COVID-19)
- Световна здравна организация. Временно ръководство за клинично лечение на тежка остра респираторна инфекция, когато се подозира нова инфекция с коронавирус (nCoV) външна икона
- Американско торакално общество и Инфекциозни болести на Америка. Диагностика и лечение на възрастни с придобити в общността пневмония външна икона
- Преживяла сепсисна кампания: Международни насоки за управление на сепсис и септичен шок: 2016 г. външна икона
- Насоки за клинична практика от Обществото на инфекциозните болести на Америка: 2018 г. Актуализация за диагностика, лечение, химиопрофилактика и институционално управление на огнища на сезонен грип външна икона
Препратки
- Li Q, Guan X, Wu P, Wang X, Zhou L и др. Динамика на ранната трансмисия в Ухан, Китай, от романата, заразена с коронавирус, пневмония. N Engl J Med. 2020 г., 29 януари.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z. Клинични особености на пациенти, заразени с нов коронавирус от 2019 г. в Ухан, Китай. Ланцетът. 2020 г., 24 януари.
- Wang D, Hu B, Hu C, Zhu F, Liu X и др. Клинична характеристика на 138 хоспитализирани пациенти с новата заразена с коронавирус пневмония в Ухан. Публикувано онлайн 7 февруари 2020 г.
- Chen N, Zhou M, Dong X, Qu J, Gong F. Епидемиологични и клинични характеристики на 99 случая на нова коронавирусна пневмония през 2019 г. в Ухан, Китай: описателно проучване. Ланцет. 2020 януари 30. [Epub преди печат]
- Chan JF, Yuan S, Kok K, To KK, Chu H, et al. Семеен клъстер на пневмония, свързан с новия коронавирус през 2019 г., показващ предаване от човек на човек: проучване на фамилен клъстер. Ланцет. 2020 януари 24. [Epub преди печат]
- Chang D, Minggui L, Wei L, Lixin X, Guangfa Z et al. Епидемиологични и клинични характеристики на новородени коронавирусни инфекции, включващи 13 пациенти извън Ухан Китай. Публикувано онлайн 7 февруари 2020 г.
- Zhu N, Zhang D, Wang W, Li X, Yang B, et al; Китайски Коронавирусен разследващ и изследователски екип. Нов коронавирус от пациенти с пневмония в Китай, 2019. N Engl J Med. 2020 януари 24. [Epub преди печат]
- Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT et al. Внос и предаване от човек на човек на роман Коронавирус във Виетнам. N Engl J Med. 2020 януари 28. doi: 10.1056 / NEJMc2001272. [Epub преди печат]
- Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J et al. Първи случай на романа на Коронавирус от 2019 г. в САЩ. N Engl J Med. 2020 януари 31. doi: 10.1056 / NEJMoa2001191. [Epub пред печат] Huang C, Wang Y, Li X, Ren L, Zhao J и др. Клинични особености на пациенти, заразени с новия коронавирус в 2019 г. в Ухан, Китай. Ланцет. 2020 януари 24. [Epub преди печат]
- Lei J, Li J, Li X, Qi X. CT изобразяване на пневмония за новородени коронавируси от 2019 г. (2019-nCoV). Рентгенология. 2020 г. 31 януари: 200236. doi: 10.1148 / radiol.2020200236. [Epub преди печат]
- Memish ZA, Assiri AM, Al-Tawfiq JA. Коронавирусът на коронавирус в Близкия изток (MERS-CoV) се отделя вируса в дихателните пътища: наблюдателен анализ с последствия за контрол на инфекцията. Int J Infect Dis. 2014 Дек; 29: 307-8.
- Zumla A, Hui DS, Perlman S. Близкия изток респираторен синдром. Ланцет. 2015 септември 5; 386 (9997): 995-1007. doi: 10.1016 / S0140-6736 (15) 60454-8. Epub 2015 юни 3. Преглед.
- Chan KH, Poon LL, Cheng VC, Guan Y, Hung IF et al. Откриване на коронавирус на SARS при пациенти със съмнение за SARS. Emerg Infect Dis. 2004 февруари; 10 (2): 294-9.
- Cheng PK, Wong DA, Tong LK, Ip SM, Lo AC и др. Вирусни модели на коронавирус при пациенти с вероятен остър респираторен синдром. Ланцет. 2004 г. 22 май; 363 (9422): 1699-700.
- Hung IF, Cheng VC, Wu AK, Tang BS, Chan KH et al. Вирусни натоварвания в клинични проби и прояви на ТОРС. Emerg Infect Dis. 2004 септември; 10 (9): 1550-7.
- Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF и др.; Учебна група HKU / UCH SARS. Клинична прогресия и вирусен товар при избухване в общността на коронавирусна асоциирана пневмония на SARS: проспективно проучване. Ланцет. 2003, 24 май; 361 (9371): 1767-72.
- Liu W, Tang F, Fontanet A, Zhan L, Zhao QM et al. Дългосрочна екскреция на коронавирус на SARS от пациентска група, Китай. Emerg Infect Dis. 2004 октомври; 10 (10): 1841-3.
- Corman VM, Albarrak AM, Omrani AS, Albarrak MM, Farah ME и др. Вирусно засипване и реакция на антитела при 37 пациенти с близкоизточен респираторен синдром Коронавирусна инфекция. Clin Infect Dis. 2016 февруари 15; 62 (4): 477-483.
- Al-Abdely HM, Midgley CM, Alkhamis AM, Abedi GR, Lu X, et al. Динамика на коронавирусната инфекция в Близкия изток и реакции на антитела сред клинично разнообразни пациенти, Саудитска Арабия. Emerg Infect Dis. 2019 април; 25 (4): 753-766.
- Al-Abdely HM, Midgley CM, Alkhamis AM, Abedi GR, Tamin A et al. Инфекциозен MERS-CoV, изолиран от леко болен пациент, Саудитска Арабия. Отворен форум Infect Dis. 2018 г. 15 май; 5 (6): ofy111.
- Arabi YM, Mandourah Y, Al-Hameed F, Sindi AA, Almekhlafi GA и др.; Изпитателна група на саудитските критични грижи. Кортикостероидна терапия за критично болни пациенти с респираторен синдром от Близкия Изток. Am J Respir Crit Care Med. 2018 г., 15 март; 197 (6): 757-767.
- Ръсел CD, Millar JE, Baillie JK. Клиничните данни не подкрепят лечението с кортикостероиди за увреждане на белия дроб 2019-nCoV. Ланцет. 2020 февруари 6; S0140-6736 (20) 30305-6.
- Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J и др. Диагностика и лечение на възрастни с пневмония, придобита от общността. Официално ръководство за клинична практика на Американското общество по торакални болести и инфекциозни болести на Америка. Am J Respir Crit Care Med. 2019 октомври 1; 200 (7): e45-e67.
- Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, Shi Z, Hu Z, Zhong W, Xiao G. Remdesivir и хлорохин ефективно инхибират наскоро появилия се нов коронавирус (2019-nCoV) in vitro. Cell Res. 2020 февруари 4. doi: 1038 / s41422-020-0282-0. [Epub преди печат] PubMed PMID: 32020029.
