1School of Medicine, Monash University, Clayton, Australia.
2ZiP Diagnostics Pty Ltd, Collingwood, Australia.
Am J Trop Med Hyg. 2020 Aug;103(2):625-638. doi: 10.4269/ajtmh.20-0564. Epub 2020 Jul 1.
Our understanding of SARS-CoV-2, the virus responsible for coronavirus disease 2019 (COVID-19), its clinical manifestations, and treatment options continues to evolve at an unparalleled pace. This review sought to summarize the key literature regarding transmission, case definitions, clinical management, and the burden of COVID-19. Our review of the literature showed that SARS-CoV-2 was mainly transmitted via inhalation of respiratory droplets containing the virus and had a mean incubation period of 4-6 days. The commonly reported symptoms were fever (75.3% ± 18.7%) and cough (62.6% ± 17.7%) across the spectrum of clinical disease-mild, moderate, severe, and critical, but with the disease phenotype varying with severity. Categorization of these cases for home care or hospital management needs to be defined, with risk stratification accounting for the age of the patient and the presence of underlying comorbidities. The case definitions varied among countries, which could have contributed to the differences in the case fatality rates among affected countries. The severity and risk of death due to COVID-19 was associated with age and underlying comorbidities. Asymptomatic cases, which constitute 40-80% of COVID-19 cases are a considerable threat to control efforts. The presence of fever and cough may be sufficient to warrant COVID-19 testing, but using these symptoms in isolation will miss a proportion of cases. A clear definition of a COVID-19 case is essential for the management, treatment, and tracking of clinical illness, and to inform the quarantine measures and social distancing that can help control the spread of SARS-CoV-2.
我们对导致 2019 年冠状病毒病（COVID-19）的病毒——严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的理解，以及其临床表现和治疗选择，正在以前所未有的速度不断发展。本综述旨在总结有关传播途径、病例定义、临床管理以及 COVID-19 负担的关键文献。我们对文献的回顾表明，SARS-CoV-2 主要通过吸入含有该病毒的呼吸道飞沫传播，平均潜伏期为 4-6 天。在各种临床疾病——轻度、中度、重度和危重度中，最常见的症状是发热（75.3%±18.7%）和咳嗽（62.6%±17.7%），但疾病表型因严重程度而异。需要对这些病例进行分类，以便进行居家护理或住院管理，对患者年龄和潜在合并症进行风险分层。各国的病例定义存在差异，这可能导致受影响国家的病死率存在差异。COVID-19 的严重程度和死亡风险与年龄和潜在合并症有关。无症状病例占 COVID-19 病例的 40-80%，对控制工作构成了相当大的威胁。发热和咳嗽的存在可能足以证明 COVID-19 检测是合理的，但仅使用这些症状会遗漏一部分病例。明确 COVID-19 病例的定义对于管理、治疗和跟踪临床疾病至关重要，并为隔离措施和社会隔离提供信息，这些措施有助于控制 SARS-CoV-2 的传播。
