Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2] Sabawoon Mirwais, M.B.B.S, M.D.[3] Aditya Govindavarjhulla, M.B.B.S. [4]

Coronavirus is a genus of animal virus belonging to the family Coronaviridae. Coronavirus, named due to the “crown” like appearance of its surface projections, was first isolated from chickens in 1937. In 1965, Tyrrell and Bynoe used cultures of human ciliated embryonal trachea to propagate the first human coronavirus (HCoV) in vitro. There are now approximately 15 species in this family, which infect not only humans but cattle, pigs, rodents, cats, dogs and birds (some are serious veterinary pathogens, especially chickens). Coronavirus gained international popularity after the deadly SARS epidemic caused by SARS-CoV in 2002 – 2003. A novel coronavirus known as the MERS-CoV was the highlight of the year 2012 when it caused the Middle East respiratory syndrome (MERS) epidemic. 2019 Novel Coronavirus (2019-nCoV) is a virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China. Based on the grouping, coronavirus can be classified into three groups. It can also be classified into families based on the genome and the method of replication. The virus can also be classified based on human infectivity. Coronavirus infection is very common and occurs worldwide. The incidence of infection is strongly seasonal, with the greatest incidence in children in winter. Adult infections are less common. The number of coronavirus serotypes and the extent of antigenic variation is unknown. Re-infections appear to occur throughout life, implying multiple serotypes (at least four are known) and/or antigenic variation, hence the prospects for immunization appear bleak. Due to the lack of data, the exact incidence rate of coronavirus infections can not be approximated. With 8,098 confirmed cases, the case fatality-rate of SARS was 9.6%. With 2465 laboratory-confirmed cases, the case fatality-rate of MERS was 34.4%. The case fatality-rate of 2019-nCoV in the first 99 patients at a Wuhan hospital (the epicenter of the outbreak) has been found to be 11%. Diagnosis of coronaviruses causing infection in humans is based on combination of clinical and epidemiological criteria. Close contact with infected individuals, travel to endemic area and detection of viral RNA in the patient’s serum are the most important criteria for confirmation of diagnosis. The history of coronavirus infection includes exposure to an infected animal or human. Patients report flu like symptoms in the initial stages. Infected people can also report upper respiratory symptoms. Common symptoms of coronavirus infection include fever, cough, and shortness of breath. The incubation period can vary depending on the infection. The mean incubation period for 2019-nCoV has been set to be 5.2 days. The pathognomonic physical examination findings in patients infected with coronavirus include fever, flu-like-symptoms, cough, and body aches. General appearance of the patient infected with coronavirus depends on the incubation period of the illness. The chest x ray findings in a suspected case of coronavirus infection can mimic the findings in pneumonia. There are no specific ECG findings associated with coronavirus infection. Non specific findings can include sinus tachycardia and diffuse T wave inversion. Chest CT scan findings in patients infected with coronavirus can include unilateral or bilateral pneumonia, mottling and ground glass opacity, focal or multifocal opacities, consolidation, and septal thickening with subpleural and lower lobe involvement more likely. Treatment should be supportive. No specific treatment available. Most people with coronavirus illness will recover on their own.

Coronaviruses were first isolated from chickens in 1937. In 1965, Tyrrell and Bynoe used cultures of human ciliated embryonal trachea to propagate the first human coronavirus (HCoV) in vitro. There are now approximately 15 species in this family, which infect not only man but cattle, pigs, rodents, cats, dogs and birds (some are serious veterinary pathogens, especially chickens). Coronavirus gained international popularity after the deadly SARS epidemic caused by SARS-CoV in 2002 – 2003. A novel coronavirus known as the MERS-CoV was the highlight of the year 2012 when it caused the Middle East respiratory syndrome (MERS) epidemic. 2019 Novel Coronavirus (2019-nCoV) is a virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.

Based on the grouping, coronavirus can be classified into three groups. It can also be classified into families based on the genome and the method of replication. The virus can also be classified based on human infectivity.

Coronaviruses have a worldwide distribution, causing 10-15% of common cold cases. Infections show a seasonal pattern with most cases occurring in the winter months. Coronavirus infection is very common and occurs worldwide. The incidence of infection is strongly seasonal, with the greatest incidence in children in winter. Adult infections are less common. The number of coronavirus serotypes and the extent of antigenic variation is unknown. Re-infections appear to occur throughout life, implying multiple serotypes (at least four are known) and/or antigenic variation, hence the prospects for immunization appear bleak. Due to the lack of data, the exact incidence rate of coronavirus infections can not be approximated. With 8,098 confirmed cases, the case fatality-rate of SARS was 9.6%. With 2465 laboratory-confirmed cases, the case fatality-rate of MERS was 34.4%. The case fatality-rate of 2019-nCoV in the first 99 patients at a Wuhan hospital (the epicenter of the outbreak) has been found to be 11%.

The most significant risk factor for coronavirus infection is exposure. to infected animals or humans.

There is insufficient evidence to recommend routine screening for coronavirus infection.

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.

Diagnosis of coronaviruses causing infection in humans is based on combination of clinical and epidemiological criteria. Close contact with infected individuals, travel to endemic area and detection of viral RNA in the patient’s serum are the most important criteria for confirmation of diagnosis.

The history of coronavirus infection includes exposure to an infected animal or human. Patients report flu like symptoms in the initial stages. Infected people can also report upper respiratory symptoms. Common symptoms of coronavirus infection include fever, cough, and shortness of breath. The incubation period can vary depending on the infection. The mean incubation period for 2019-nCoV has been set to be 5.2 days.

The pathognomonic physical examination findings in patients infected with coronavirus include fever, flu-like-symptoms, cough, and body aches. General appearance of the patient infected with coronavirus depends on the incubation period of the illness.

Laboratory tests can be done to confirm whether illness may be caused by human coronaviruses. However, these tests are not used very often because people usually have mild illness. Also, testing may be limited to a few specialized laboratories. Laboratory tests include serology for viral antigen, molecular testing and viral culture. All these tests can be used to confirm infection with coronavirus.

The chest x ray findings in a suspected case of coronavirus infection can mimic the findings in pneumonia.

There are no specific ECG findings associated with coronavirus infection. Non specific findings can include sinus tachycardia and diffuse T wave inversion.

There are no specific echocardiography/ultrasound findings associated with coronavirus infection. Non specific echocardiographic findings can include left ventricular systolic dysfunction and pericardial effusion.

Chest CT scan findings in patients infected with coronavirus can include unilateral or bilateral pneumonia, mottling and ground glass opacity, focal or multifocal opacities, consolidation, and septal thickening with subpleural and lower lobe involvement more likely.

There are no specific MRI findings associated with coronavirus infection. MRI can aide in making the diagnosis on the basis of exclusion.

Research laboratories have used isolation methods, electron microscopy, serology and PCR-based assays to diagnose coronavirus infections for surveillance studies.

Treatment should be supportive. No specific treatment available. Most people with coronavirus illness will recover on their own.

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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], Aditya Govindavarjhulla, M.B.B.S. [3]

Coronavirus, named due to the “crown” like appearance of its surface projections, was first isolated from chickens in 1937. In 1965, Tyrrell and Bynoe used cultures of human ciliated embryonal trachea to propagate the first human coronavirus (HCoV) in vitro. There are now approximately 15 species in this family, which infect not only humans but cattle, pigs, rodents, cats, dogs and birds (some are serious veterinary pathogens, especially chickens).

• Coronavirus, named due to the “crown” like appearance of its surface projections, was first isolated from chickens in 1937.
• In 1965, Tyrrell and Bynoe used cultures of human ciliated embryonal trachea to propagate the first human coronavirus (HCoV) in vitro.
• There are now approximately 15 species in this family, which infect not only humans but cattle, pigs, rodents, cats, dogs and birds (some are serious veterinary pathogens, especially chickens).^[1]

• Coronavirus gained international popularity after the deadly SARS epidemic caused by SARS-CoV in 2002 – 2003.
• Prior to the SARS epidemic, two coronaviruses (HCoV-OC43 and HCoV-229E) were recognized to be responsible for causing upper respiratory tract infections with more severe outcomes in the elderly and the immunocompromised.^[2]
• SARS-CoV however, not only caused severe respiratory illness with a mortality rate of 10% during the 2002 – 2003 epidemic but it also caused systemic disease affecting other organs and tissues.^[3][4]
• SARS-CoV’s striking feature was its ability to cross species enabling the virus to make its way from infecting animal handlers in the live animal retail markets to causing “superspreading events”.^[5]

• A novel coronavirus known as the MERS-CoV was the highlight of the year 2012 when it caused the Middle East respiratory syndrome (MERS) epidemic.^[6]
• MERS-CoV, believed to be enzootic in dromedary camels across the Arabian Peninsula and in parts of Africa, caused a lower respiratory tract infection that would progress to acute respiratory distress syndrome, multiorgan failure, and death.

• 2019 Novel Coronavirus (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), is a virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.^[7]
• Initially, the patients were believed to have contracted the virus from seafood/animal markets which suggested animal-to-human spread.
• The growing number of patients however, suggest that human-to-human transmission is actively occurring.
• In the United States, confirmed cases of COVID-19 have been reported in the states of Arizona, California, Colorado, Florida, Georgia, Illinois, Maryland, Massachusetts, Nevada, New Hampshire, New Jersey, New York, North Carolina, Oregon, Rhode Island, Tennessee, Texas, Washington, and Wisconsin.
• So far, the virus has spread globally and there are confirmed cases of the disease in the following countries:

• China, Hong Kong, Macau, Taiwan, Australia, Cambodia, Canada, Finland, France, Germany, India, Japan, Malaysia, Nepal, Philippines, Sri Lanka, Singapore, Thailand, The Republic of Korea, United Arab Emirates, United States, and Vietnam
  

• The recognition of SARS led the search for other pathogenic coronaviruses, which culminated in the discovery of HCoV-NL63 and HCoV-HKU1.
• HCoV-NL63 was isolated from hospitalized young children and HCoV-HKU1 was isolated from hospitalized elderly with comorbidities.^[8][9][10]
• HCoV-NL63, infecting humans for centuries, has been shown that it diverged from HCoV-229E approximately 1000 years ago.^[11]

• Genetic analyses performed at the time of the SARS epidemic showed that the virus underwent rapid adaptations in both animals and humans.^[12][13]
• The most significant of these adaptations was changing the receptor binding domain (RBD) of the S protein, allowing more efficient infection of the human cells.^[14]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Sabawoon Mirwais, M.B.B.S, M.D.[3]

Based on the grouping, coronavirus can be classified into three groups. It can also be classified into families based on the genome and the method of replication. The virus can also be classified based on human infectivity.

Genus Coronavirus

• Group 1
  • Canine coronavirus (CCoV)
  • Feline coronavirus (FeCoV)
  • Human coronavirus 229E (HCoV-229E)
  • Porcine epidemic diarrhea virus (PEDV)
  • Transmissible gastroenteritis virus (TGEV)
  • Human Coronavirus NL63 (HCoV-NL63)

• Group 2
  • Bovine coronavirus (BCoV)
  • Canine respiratory coronavirus (CRCoV) – Common in SE Asia and Micronesia
  • Human coronavirus OC43 (HCoV-OC43)
  • Mouse hepatitis virus (MHV)
  • Porcine hemagglutinating encephalomyelitis virus (HEV)
  • Rat coronavirus (RCV): Rat coronavirus is quite prevalent in Eastern Australia where, as of March/April 2008, it has been found among native and feral rodents colonies.
  • HCoV-HKU1^[1][2]
• Group 3
  • Infectious bronchitis virus (IBV)
  • Turkey coronavirus (Bluecomb disease virus)
  • Goose coronavirus
  • Duck coronavirus

The Baltimore classification, developed by David Baltimore, is a virus classification system that groups viruses into families, depending on their type of genome (DNA, RNA, single-stranded (ss), double-stranded (ds), etc.) and their method of replication.^[3]

• Virus
• ssRNA positive-strand viruses
• No DNA stage
• Nidovirales
• Coronaviridae
• Coronavirus

• HCoV-229E
• HCoV-OC43
• SARS-CoV
• NL63/NL/New Haven coronavirus
• HKU1-CoV
• Novel Coronavirus 2012 (HCoV-EMC)
• SARS-CoV-2
• MERS-CoV

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

Coronaviruses are enveloped viruses with a positive-sense single-stranded RNA genome and a helical symmetry. The genomic size of coronaviruses ranges from approximately 16 to 31 kilobases, extraordinarily large for an RNA virus. The name coronavirus is derived from the greek (κορώνα, meaning crown) as the virus envelope appears under electron microscopy (E.M.) to be crowned by a characteristic ring of small bulbous structures. This morphology is actually formed by the viral spike (S) peplomers, which are proteins that populate the surface of the virus and determine host tropism. Coronaviruses are grouped in the order Nidovirales, named for the Latin (nidus, meaning nest) as all viruses in this order produce a 3′ co-terminal nested set of subgenomic mRNA’s during infection.

Proteins that contribute to the overall structure of all coronaviruses are the spike (S), envelope (E), membrane (M) and nucleocapsid (N). In the specific case of SARS, a defined receptor-binding domain on S mediates the attachment of the virus to its cellular receptor, angiotensin-converting enzyme 2 (ACE2).^[1] Members of the group 2 coronaviruses also have a shorter spike-like protein called hemagglutinin esterase (HE) encoded in their genome, but for some reason this protein is not always brought to expression (produced) in the cell.^[2]

Replication of Coronavirus begins with entry to the cell takes place in the cytoplasm in a membrane-protected microenvironment, upon entry to the cell the virus particle is uncoated and the RNA genome is deposited into the cytoplasm. The Coronavirus genome has a 5’ methylated cap and a 3’polyadenylated-A tail to make it look as much like the host RNA as possible. This also allows the RNA to attach to ribosomes for translation. Coronaviruses also have a protein known as a replicase encoded in its genome which allows the RNA viral genome to be translated into RNA by using the host cells machinery. The replicase is the first protein to be made as once the gene encoding the replicase is translated the translation is stopped by a stop codon. This is known as a nested transcript, where the transcript only encodes one gene- it is monocistronic. The RNA genome is replicated and a long polyprotein is formed, where all of the proteins are attached. Coronaviruses have a non-structural protein called a protease which is able to separate the proteins in the chain. This is a form of genetic economy for the virus allowing it to encode the most amounts of genes in a small amount of nucleotides.

Coronavirus transcription involves a discontinuous RNA synthesis (template switch) during the extension of a negative copy of the subgenomic mRNAs. Base pairing during transcription is a requirement. Coronavirus N protein is required for coronavirus RNA synthesis, and has RNA chaperone activity that may be involved in template switch. Both viral and cellular proteins are required for replication and transcription. Coronaviruses initiate translation by cap-dependent and cap-independent mechanisms. Cell macromolecular synthesis may be controlled after Coronavirus infection by locating some virus proteins in the host cell nucleus. Infection by different coronaviruses cause in the host alteration in the transcription and translation patterns, in the cell cycle, the cytoskeleton, apoptosis and coagulation pathways, inflammation, and immune and stress responses.^[3]

They are transmitted by aerosols of respiratory secretions, by the fecal-oral route, and by mechanical transmission. Most virus growth occurs in epithelial cells. Occasionally the liver, kidneys, heart or eyes may be infected, as well as other cell types such as macrophages. In cold-type respiratory infections, growth appears to be localized to the epithelium of the upper respiratory tract, but there is no adequate animal model for the human respiratory coronaviruses.

• Incubation period: 2 – 4 days.
• Communicability: Human-to-human transmission is possible during the presence of infectious droplets, which can cause infection via inhalation, or through contaminated surfaces.
• Dissemination
  • Reservoir: Humans.
  • Vectors: None.
  • Dissemination: None.

• They induce neutralizing antibody.
• They are important in relating host cell tropism.
• Hemagglutination.
• They mediate the cell to cell or cell to viral fusion by the interaction between viral envelope and the specific receptor of host cell membrane.

Coronaviruses primarily infect the upper respiratory and gastrointestinal tract of mammals and birds. Four to five different currently known strains of coronaviruses infect humans. The most publicized human coronavirus, SARS-CoV which causes SARS, has a unique pathogenesis because it causes both upper and lower respiratory tract infections and can also cause gastroenteritis. Coronaviruses are believed to cause a significant percentage of all common colds in human adults. Coronaviruses cause colds in humans primarily in the winter and early spring seasons. The significance and economic impact of coronaviruses as causative agents of the common cold are hard to assess because, unlike rhinoviruses (another common cold virus), human coronaviruses are difficult to grow in the laboratory.

These viruses infect a variety of mammals and birds. The exact number of human isolates are not known as many cannot be grown in culture. In humans, they cause:

• Respiratory infections (common), including Severe Acute Respiratory Syndrome (SARS).
• Enteric infections (occasional – mostly in infants <12 months).
• Neurological syndromes (rare).

Coronaviruses also cause a range of diseases in farm animals and domesticated pets, some of which can be serious and are a threat to the farming industry. Economically significant coronaviruses of farm animals include porcine coronavirus (transmissible gastroenteritis, TGE) and bovine coronavirus, which both result in diarrhea in young animals. Feline enteric coronavirus is a pathogen of minor clinical significance, but spontaneous mutation of this virus can result in feline infectious peritonitis (FIP), a disease associated with high mortality. There are two types of canine coronavirus (CCoV), one that causes mild gastrointestinal disease and one that has been found to cause respiratory disease. Mouse hepatitis virus (MHV) is a coronavirus that causes an epidemic murine illness with high mortality, especially among colonies of laboratory mice. Prior to the discovery of SARS-CoV, MHV had been the best studied coronavirus both in vivo and in vitro as well as at the molecular level. Some strains of MHV cause a progressive demyelinating encephalitis in mice which has been used as a murine model for multiple sclerosis. Significant research efforts have been focused on elucidating the viral pathogenesis of these animal coronaviruses, especially by virologists interested in veterinary and zoonotic diseases.

HCoV-229E and HCoV-OC43 cause the common cold, a self-limiting upper respiratory tract infection. Infection can lead to a number of illnesses such as bronchitis, gastroenteritis, progressive demyelinating encephalitis, diarrhea, peritonitis, nasal obstruction, rhinorrhea, sneezing, sore throat and cough. They can cause more severe lower respiratory tract infection, including pneumonia in infants, elderly and immunocompromised individuals.

HCoV-229E is a common agent if coryza, whereas HCoV-OC43 is generally characterized by sore throats.

HCoV-NL63 causes laryngotracheitis (croup) and nonfatal upper and lower respiratory tract infections in children, elderly, and immunocompromised individuals. HCoV-HKU1 causes mild upper respiratory diseases, the common cold, bronchiolitis, and pneumonia, with symptoms such as rhinorrhea, fever, cough, febrile seizure, and wheezing. More severe illness may occur in children, adults with underlying disease, the elderly, and may be associated with gastrointestinal illness.

No infections have been reported. However, this may be an underestimate of the number of incidences as symptoms are nonspecific and self limiting.

• Source: Specimens of upper and lower respiratory tract.
• Primary Hazard: Aerosols and contact with stools.

• Drug Susceptibility: Currently, there are no specific antiviral drugs for coronavirus available.^[4]
• Susceptibility to Disinfectants: Susceptible to 0.1% sodium hypochlorite, 0.1% organochlorine, 10% iodophore, 70% ethanol and 2% glutaraldehyde. Resistant to 0.04% quaternary ammonium compound and phenolics.
• Physical Inactivation: Inactivation by UV light can be done by exposure to 1200 µJ/cm2 for 30 minutes.
• Survival Outside Host: Survives up to six days in aqueous mediums and up to 3 hours on dry inanimate surfaces.

Conditions associated with coronavirus infection may include:

• Diabetes^[5]
• Cancer
• Chronic lung disease
• Chronic heart disease
• Chronic kidney disease
• Neurologic disease^[6]

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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] Syed Hassan A. Kazmi BSc, MD [3]

Coronavirus infection should be differentiated from other diseases presenting with cough, fever, shortness of breath and tachypnea.

Coronavirus infection should be differentiated from other diseases presenting with cough, fever, shortness of breath and tachypnea. The differentials include the following:^{[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]}

• Life threatening infection with 2019-nCoV, MERS-CoV and SARS-CoV should be differentiated from each other. The following table differentiates infection from these coronaviruses:^{[23][24][25][26][27][28][29][30][31][32][33][34]}

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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], Syed Hassan A. Kazmi BSc, MD [3]

Due to the lack of data, the exact incidence rate of coronavirus infections can not be approximated. With 8,098 confirmed cases, the case fatality-rate of SARS was 9.6%. With 2465 laboratory-confirmed cases, the case fatality-rate of MERS was 34.4%. The case fatality-rate of SARS-CoV-2 in the first 99 patients at a Wuhan hospital (the epicenter of the outbreak) has been found to be 11%.

• Due to the lack of data, the exact incidence rate of coronavirus infections can not be approximated.

• From June 2012 to April 2018, MERS-CoV infection was prevalent in 2206 people globally.
• To date, 100,330 confirmed cases of COVID-19 have emerged.
• For details on the real-time prevalence and spread of COVID-19, click here.^[1]

• With 8,098 confirmed cases, the case fatality-rate of SARS was 9.6%.^[2]
• With 2465 laboratory-confirmed cases, the case fatality-rate of MERS was 34.4%.
• The case fatality-rate of COVID-19 in the first 99 patients at a Wuhan hospital (the epicenter of the outbreak) has been found to be 11%.^[3]
• In a different study comprising of 138 patients infected with COVID-19, the mortality has been established to be 4.3%.^[4]

• Patients of all age groups can develop the disease.
• In multiple cohorts of patients hospitalized with confirmed COVID-19, the median age is established to range from 49 to 56 years.^[5][6][7]

• Coronavirus infections affect all races.

• Coronavirus infections affect men and women equally.
• In a recent study, SARS-CoV-2 has been found to have infected males more than females.^[8]

• Majority of the cases of SARS-CoV infection were reported in China before spreading to 29 other countries.^[9]
• Majority of the cases of MERS-CoV infection were reported in the Middle East (mainly in the Kingdom of Saudi Arabia) before spreading to 27 other countries.
• Majority of the cases of COVID-19 have been reported in China and the disease has spread to 67 countries (including the United States) so far.^[10]
  • For more real-time details regarding the spread of COVID-19, click here.^[11]

• Majority of the cases of COVID-19 have been reported in China and the disease has spread to 67 countries (including the United States) so far.^[10]

• These data represent cases detected and tested in the United States through U.S. public health surveillance systems since January 21, 2020. It does not include people who returned to the U.S. via State Department-chartered flights.^[13]
• For details on the real-time prevalence and spread of COVID-19 in the United States, click here.

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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]

The most significant risk factor for coronavirus infection is exposure to infected animals and humans.

• The most significant risk factor for coronavirus infection is exposure.^[1]
• Exposure to infected animals and humans is by far the most significant risk factor for developing the disease.

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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]

There is insufficient evidence to recommend routine screening for coronavirus infection.

• There is insufficient evidence to recommend routine screening for coronavirus infection.
• In the wake of the recent SARS-CoV-2 outbreak, people with a recent travel history of China and Southeast Asia are actively being screened and evaluated at the ports of entry.
  • The evaluation is majorly dependent on travelers’ history of travel and the presence/absence of symptoms.

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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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