Coronavirus natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Coronavirus infection can have a highly variable disease course. The infection can range from being subclinical to being an overt clinical condition. Coronavirus infection is most commonly complicated by respiratory distress indicating mechanical ventilation and ICU care. The prognosis of the coronovirus infection is highly dependent on the type of the virus involved and the disease presentation. It has been noted that young children, elderly, immunocompromised, and individuals with comorbid conditions are at the highest risk for worse prognosis.

• Coronavirus infection can have a highly variable disease course.
• The infection can range from being subclinical to being an overt clinical condition.

• SARS begins with high fever (temperature greater than 100.4°F [> 38.0°C]).^[1]
• Fever can later be accompanied by headache, general feeling of discomfort, and diffuse body pain.
• The condition worsens with time and patients can develop diarrhea, dry cough, and dyspnea.

• MERS follows almost the same course as SARS.^[2]
• A significant proportion of patients were asymptomatic during the 2012 outbreak.
• Others presented with respiratory and/or gastrointestinal symptoms.

• COVID-19 has been following the same pathway of the infamous coronavirus infections (SARS and MERS).
• The disease course can be insignificant in part due to the lack of symptoms.^[3]
• When present, the initial symptoms can include fever, cough, and shortness of breath.
• Patients presenting with worsening symptoms are requiring mechanical ventilation and ICU care.^[4]

• Coronavirus infection is most commonly complicated by respiratory distress indicating mechanical ventilation and ICU care.^[5]
• Other complications include:
  • Pneumonia^[6][7][8]
  • Kidney failure
  • Acute respiratory injury
  • Septic shock
  • Acute myocarditis

• The prognosis of the coronovirus infection is highly dependent on the type of the virus involved and the disease presentation.
• It has been noted that young children, elderly, immunocompromised, and individuals with comorbid conditions are at the highest risk for worse prognosis.
• A higher chest radiographic score coupled with a high number of medical comorbidities translated into poor prognosis and higher mortality in patients infected with MERS-CoV.^[9]

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