Coronavirus disease 2019 (COVID-19)

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China.

The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Symptoms

Signs and symptoms of coronavirus disease 2019 (COVID-19) may appear two to 14 days after exposure. This time after exposure and before having symptoms is called the incubation period. You can still spread COVID-19 before you have symptoms, called presymptomatic. Common signs and symptoms can include:

• Fever
• Cough
• Tiredness

Early symptoms of COVID-19 may include a loss of taste or smell.

Other symptoms can include:

• Shortness of breath or difficulty breathing
• Muscle aches
• Chills
• Sore throat
• Runny nose
• Headache
• Chest pain
• Pink eye (conjunctivitis)
• Nausea
• Vomiting
• Diarrhea
• Rash

This list is not all inclusive. Children have similar symptoms to adults and generally have mild illness.

The severity of COVID-19 symptoms can range from very mild to severe. Some people may have only a few symptoms, and some people may have no symptoms at all, also called asymptomatic. Some people may experience worsened symptoms, such as worsened shortness of breath and pneumonia, about a week after symptoms start.

People who are older have a higher risk of serious illness from COVID-19, and the risk increases with age. People who have existing medical conditions also may have a higher risk of serious illness. Certain medical conditions that may increase the risk of serious illness from COVID-19 include:

• Serious heart diseases, such as heart failure, coronary artery disease or cardiomyopathy
• Cancer
• Chronic obstructive pulmonary disease (COPD)
• Type 1 or type 2 diabetes
• Overweight, obesity or severe obesity
• High blood pressure
• Smoking
• Chronic kidney disease
• Sickle cell disease or thalassemia
• Weakened immune system from solid organ transplants
• Pregnancy
• Asthma
• Chronic lung diseases such as cystic fibrosis or pulmonary fibrosis
• Liver disease
• Dementia
• Down syndrome
• Weakened immune system from bone marrow transplant, HIV or some medications
• Brain and nervous system conditions
• Substance use disorders

This list is not all inclusive. Other underlying medical conditions may increase your risk of serious illness from COVID-19.

When to see a doctor

If you have COVID-19 signs or symptoms or you've been in contact with someone diagnosed with COVID-19, contact your doctor or clinic right away for medical advice. Tell your health care team about your symptoms and possible exposure before you go to your appointment.

If you have emergency COVID-19 signs and symptoms, seek care immediately. Emergency signs and symptoms can include:

• Trouble breathing
• Persistent chest pain or pressure
• Inability to stay awake
• New confusion
• Pale, gray or blue-colored skin, lips or nail beds — depending on skin tone

This list isn't all inclusive. Let your doctor know if you are an older adult or have chronic medical conditions, such as heart disease or lung disease, as you may have a greater risk of becoming seriously ill with COVID-19. During the pandemic, it's important to make sure health care is available for those in greatest need.

 

Causes

Infection with the new coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2) causes coronavirus disease 2019 (COVID-19).

The virus that causes COVID-19 spreads easily among people, and more continues to be discovered over time about how it spreads. Data has shown that it spreads mainly from person to person among those in close contact (within about 6 feet, or 2 meters). The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes, breathes, sings or talks. These droplets can be inhaled or land in the mouth, nose or eyes of a person nearby.

In some situations, the COVID-19 virus can spread by a person being exposed to small droplets or aerosols that stay in the air for several minutes or hours — called airborne transmission. It's not yet known how common it is for the virus to spread this way.

It can also spread if a person touches a surface or object with the virus on it and then touches his or her mouth, nose or eyes, but the risk is low.

The virus that causes COVID-19 can spread from someone who is infected but has no symptoms, also called asymptomatic. The virus that causes COVID-19 can also spread from someone who is infected but hasn’t developed symptoms yet, also called presymptomatic.

It’s possible to get reinfected with the virus that causes COVID-19, or to get COVID-19 twice or more, but this is uncommon.

Risk factors

Risk factors for COVID-19 appear to include:

• Close contact (within 6 feet, or 2 meters) with someone who has COVID-19
• Being coughed or sneezed on by an infected person

Complications

Although most people with COVID-19 have mild to moderate symptoms, the disease can cause severe medical complications and lead to death in some people. Older adults or people with existing medical conditions are at greater risk of becoming seriously ill with COVID-19.

Complications can include:

• Pneumonia and trouble breathing
• Organ failure in several organs
• Heart problems
• A severe lung condition that causes a low amount of oxygen to go through your bloodstream to your organs (acute respiratory distress syndrome)
• Blood clots
• Acute kidney injury
• Additional viral and bacterial infections

Prevention

The U.S. Food and Drug Administration (FDA) has given emergency use authorization to some COVID-19 vaccines in the U.S. The FDA has approved the Pfizer-BioNTech COVID-19 vaccine, now called Comirnaty, to prevent COVID-19 in people age 16 and older. The FDA has given emergency use authorization to a Pfizer-BioNTech COVID-19 vaccine for ages 5 through 15.

A vaccine can prevent you from getting the COVID-19 virus or prevent you from becoming seriously ill if you get the COVID-19 virus. In addition, COVID-19 vaccination might offer better protection than getting sick with COVID-19. A recent study showed that unvaccinated people who already had COVID-19 are more than twice as likely as fully vaccinated people to get reinfected with COVID-19.

Also, if you are fully vaccinated, you can return to many activities you may not have been able to do because of the pandemic — including not wearing a mask or social distancing — except where required by a rule or law. However, if you are in an area with a high number of new COVID-19 cases in the last week, the CDC recommends wearing a mask indoors in public and outdoors in crowded areas or when you are in close contact with unvaccinated people. If you are fully vaccinated and have a condition or are taking medications that weaken your immune system, you may need to keep wearing a mask.

An additional dose of a COVID-19 vaccine is recommended for people who are fully vaccinated and might not have had a strong enough immune response. In contrast, a booster dose is recommended for some people who are fully vaccinated and whose immune response weakened over time.

Diagnosis

If you develop symptoms of coronavirus disease 2019 (COVID-19) or you've been exposed to the COVID-19 virus, contact your doctor. Also let your doctor know if you've had close contact with anyone who has been diagnosed with COVID-19.

Factors used to decide whether to test you for the virus that causes COVID-19 may differ depending on where you live. Depending on your location, you may need to be screened by your clinic to determine if testing is appropriate and available.

In the U.S., your doctor will determine whether to conduct tests for the virus that causes COVID-19 based on your signs and symptoms, as well as whether you have had close contact with someone diagnosed with COVID-19. Your doctor may also consider testing if you are at higher risk of serious illness or you are going to have a medical procedure. If you have had close contact with someone with COVID-19 but you've had COVID-19 in the past three months, you don’t need to be tested. If you’ve been fully vaccinated and you’ve had close contact with someone with COVID-19, get tested 5 to 7 days after you’ve had contact with them.

To test for the COVID-19 virus, a health care provider takes a sample from the nose (nasopharyngeal swab), throat (throat swab) or saliva. The samples are then sent to a lab for testing. If you're coughing up sputum, that may be sent for testing. The FDA has authorized at-home tests for the COVID-19 virus. These are available only with a doctor's prescription.

Treatment

Currently, only one medication has been approved to treat COVID-19. No cure is available for COVID-19. Antibiotics aren't effective against viral infections such as COVID-19. Researchers are testing a variety of possible treatments.

The FDA has approved the antiviral drug remdesivir (Veklury) to treat COVID-19 in hospitalized adults and children who are age 12 and older in the hospital.

The FDA has granted an emergency use authorization for the rheumatoid arthritis drug baricitinib (Olumiant) to treat COVID-19 in some cases. Baricitinib is a pill that seems to work against COVID-19 by reducing inflammation and having antiviral activity. The FDA states baricitinib may be used in people who are hospitalized with COVID-19 who are on mechanical ventilators or need supplemental oxygen.

Several monoclonal antibody medications are available. These include sotrovimab and a combination of two antibodies called casirivimab and imdevimab. These drugs are used to treat mild to moderate COVID-19 in people who have a higher risk of developing serious illness due to COVID-19. Treatment consists of a single intravenous infusion given in an outpatient setting. To be most effective, these medications need to be given soon after COVID-19 symptoms start and prior to hospitalization.

The FDA has also authorized the use of casirivimab and imdevimab as a treatment for people at higher risk of serious illness who have recently been exposed to the COVID-19 virus or who are at high risk of exposure. For example, people at high risk of exposure may include those living in nursing homes or prisons where others have recently been infected with the COVID-19 virus. This treatment is for people who aren't fully vaccinated, or who are fully vaccinated but have a weakened immune system.

The U.S. National Institutes of Health has recommended the corticosteroid dexamethasone for people hospitalized with severe COVID-19 who are on supplemental oxygen or need mechanical ventilation. Other corticosteroids, such as prednisone, methylprednisolone or hydrocortisone, may be used if dexamethasone isn't available.

The FDA has also granted emergency use authorization for convalescent plasma therapy with high antibody levels to treat COVID-19. Convalescent plasma is blood donated by people who've recovered from COVID-19. Convalescent plasma with high antibodies may be used to treat some hospitalized people ill with COVID-19 who are either early in their illness or who have weakened immune systems.

Many people with COVID-19 may have mild illness and can be treated with supportive care. Supportive care is aimed at relieving symptoms and may include:

• Pain relievers (ibuprofen or acetaminophen)
• Cough syrup or medication
• Rest
• Fluid intake

There is no evidence that ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) need to be avoided.

If you have mild symptoms, your doctor may recommend that you recover at home. He or she may give you special instructions to monitor your symptoms and to avoid spreading the illness to others. You'll likely be asked to isolate yourself as much as possible from family and pets while you're sick, wear a mask when you're around people and pets, and use a separate bedroom and bathroom.

Your doctor will likely recommend that you stay in home isolation for a period of time except to get medical care. Your doctor will likely follow up with you regularly. Follow guidelines from your doctor and local health department about when you can end home isolation.

If you're very ill, you may need to be treated in the hospital.