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{{Infobox - virus
{{Infobox - virus
| název = SARS-CoV-2
| name = SARS-CoV-2
| obrázek = 2019-nCoV kmen 02.jpg
| image = 2019-nCoV strain 02.jpg
| popisek = Elektronmikroskopická fotografie kmene 02 koronaviru SARS-CoV-2. Převzato z <ref>{{Citace
| caption = Electron microscopy image of SARS-CoV-2 strain 02. Adapted from <ref>{{Citation
| typ = db
| type = db
| odpovědnost = Národní knihovna patogenů. Čínské centrum pro kontrolu a prevenci nemocí
| responsibility = National Library of Pathogens. Chinese Center for Disease Control and Prevention
| url = http://nmdc.cn/#/nCoV
| url = http://nmdc.cn/#/nCoV
| název = [Národní systém vědeckých a technologických zdrojů pro nové koronaviry]
| title = [National System of Scientific and Technological Resources for New Coronaviruses]
| citováno = 2020-01-27
| cited = 2020-01-27
}}
}}
  </ref>
  </ref>
| čeleď =  
| family =  
| nk = (+)ssRNA
| nk = (+)ssRNA
| zdroj =  
| source =  
| přenos = kapénková infekce
| transmission = droplet infection
| výskyt =  
| occurrence =  
| onemocnění = bilaterální pneumonie
| disease = bilateral pneumonia
| inkubační doba = (2–)5–6(–10) dní
| incubation period = (2-)5-6(-10) days
| diagnostika = real-time PCR z nazofaryngeálního výtěru <ref>{{Citace
| diagnosis = real-time PCR from nasopharyngeal swab <ref>{{Citation
| typ = web
| type = web
| příjmení1 = SZÚ
| last name1 = SZÚ
| url = http://www.szu.cz/uploads/Epidemiologie/Coronavirus/Lab_vysetrovani/infovirollab_final_28012020_2_.pdf
| url = http://www.szu.cz/uploads/Epidemiologie/Coronavirus/Lab_vysetrovani/infovirollab_final_28012020_2_.pdf
| název = Informace NRL o testování
| title = NRL testing information
| citováno = 2020-02-25
| cited = 2020-02-25
}}</ref>
}}</ref>


| terapie =  
| therapy =  
| očkování =  
| vaccination =  
| MeSH ID =  
| MeSH ID =  
| Medscape =   
| Medscape =   
}}
}}


'''COVID-19''' (''''co'''rona'''vi'''rus '''d'''isease 20''''19''''') causes ''coronavirus'' '''SARS-CoV-2''' (''severe acute respiratory syndrome coronavirus 2'', initially professionally referred to as ''2019-nCoV''). Usually the disease manifests itself as an upper respiratory tract infection, in some patients develops [[pneumonia]] with a potentially serious, in some cases even fatal course. The infection may be associated with [[coagulopathy|coagulopathy]]. Due to the global spread of the disease, who declared COVID-19 a pandemic on 11/03/2020 <ref>{{Citace
The '''COVID-19''' disease ('''''co'''rona''''vi''''rus''''d''''isease 20'''19''''') is caused by the '''coronavirus''' '''SARS-CoV-2'''' (''severe acute respiratory syndrome coronavirus 2''', initially working title ''2019-nCoV''). The disease usually manifests as an upper respiratory tract infection, with some patients developing [[pneumonia]] with a potentially serious, in some cases fatal, course. Infection may be associated with [[coagulopathy|coagulopathy]]. Due to the global spread of the disease, the WHO declared COVID-19 a pandemic on March 11, 2020<ref>{{Citation
| typ = web
| type=web
| korporace = WHO
| corporation = WHO
| url = https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
| url = https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
| název = WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020
| title = WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020
| datum_revize = 2020-03-11
| date_revision = 2020-03-11
| citováno = 2020-08-17
| cited = 2020-08-17
}}
}}
</ref>.
</ref>.


== Virology ==  
== Virology ==  
The SARS-CoV-2 virus was first identified in China in early 2020 as the causative agent of an epidemic of [[pneumonia|pneumonia]] in the city of Wuhan. By sequencing epithelium from the respiratory tract of patients, it was possible to prove that the causative agent of the disease is the hitherto unknown β-coronavirus from the subgenus ''sarbecovirus'' subfamily ''Orthocoronaviridae''. It is the seventh representative of the family [[coronaviruses|coronaviruses]], which causes human diseases. <ref>{{Citace
The SARS-CoV-2 virus was first identified in China in early 2020 as the causative agent of an epidemic of [[pneumonia|pneumonia]] in the city of Wuhan. By sequencing epithelium from the respiratory tract of patients, it was possible to prove that the causative agent of the disease is the hitherto unknown β-coronavirus from the subgenus ''sarbecovirus'' subfamily ''Orthocoronaviridae''. It is the seventh representative of the family [[coronaviruses|coronaviruses]], which causes human diseases. <ref>{{Citations
  | typ = článek
| type = article
  | příjmení1 = Zhu
| surname1 = Zhu  
  | jméno1 = Na
|name1 = Na
  | příjmení2 = Zhang
| surname2 = Zhang
  | jméno2 = Dingyu
| name2 = Dingyu
  | příjmení3 = Wang
| surname3 = Wang
  | jméno3 = Wenling
| name3 = Wenling
  | kolektiv = ano
| collective = yes
  | článek = A Novel Coronavirus from Patients with Pneumonia in China, 2019
| article = A Novel Coronavirus from Patients with Pneumonia in China, 2019
  | časopis = N Engl J Med
| magazine = N Engl J Med
  | rok = 2020
| year = 2020
  | strany = -
| pages = -  
  | svazek = -
| volume = -
  | url = https://doi.org/10.1056/NEJMoa2001017
| url = https://doi.org/10.1056/NEJMoa2001017 | issn = 0028-4793 (print), 1533-4406 }}. The SARS-CoV-2 sequence is 70% identical to the genetic information of the virus [[SARS| SARS-CoV]] {{Citations[[SARS|SARS-CoV]] ref name="Hui">{{Citations
  | issn = 0028-4793 (print), 1533-4406
| type = article
}}</ref>. Sekvence SARS-CoV-2 se ze 70 % shoduje s genetickou informací viru [[SARS|SARS-CoV]] <ref name="Hui">{{Citace
| surname1 = Hui
  | typ = článek
| name1 = David S
  | příjmení1 = Hui
| surname2 = I Azhar
  | jméno1 = David S
| name2 = Esam
  | příjmení2 = I Azhar
| surname3 = Madani
  | jméno2 = Esam
| name3 = Tariq A
  | příjmení3 = Madani
| collective = yes
  | jméno3 = Tariq A
| article = The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China
  | kolektiv = ano
| magazine = Int J Infect Dis
  | článek = The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China
| year = 2020 | volume=91
  | časopis = Int J Infect Dis
| pages = 264-266
  | rok = 2020
| url = https://doi.org/10.1016/j.ijid.2020.01.009 | issn = 1201-9712 (print), 1878-3511
  | svazek = 91
}}</ref>. The first cases of this coronavirus at the end of 2019 were linked to a visit to a seafood and live animal market in the city of Wuhan. The probable source is a bat, e.g. ''Rhinolopus affinis'', ''sinicus'' or ''ferrumequinum''. Some authors believe that transmission to humans may have occurred directly, as excrement and dried parts of bat bodies are used in Chinese folk medicine. However, the virus isolated from bats differs from viruses that are transmitted interhumanly in several amino acids crucial for binding to human cells. It is therefore more likely that the transmission to humans occurred through intermediate hosts, which could be, for example, some snakes, turtles or minks. Especially discussed are pangolins, whose meat is consumed in China and whose body parts are also used in folk medicine. The sequence [[RNA]] isolated from pangolin coronaviruses differed more from SARS-CoV-2 than from bats [[coronavirus|coronaviruses]], but it was identical in the domain responsible for binding to human cells. <ref>{{Citation
  | strany = 264-266
| type = article
  | url = https://doi.org/10.1016/j.ijid.2020.01.009
  | surname1 = Xu
  | issn = 1201-9712 (print), 1878-3511
  | first name1 = Jiabao
}}</ref>. The first cases of this coronavirus at the end of 2019 were linked to a visit to a seafood and live animal market in the city of Wuhan. The probable source is a bat, e.g. ''Rhinolopus affinis'', ''sinicus'' or ''ferrumequinum''. Some authors believe that transmission to humans may have occurred directly, as excrement and dried parts of bat bodies are used in Chinese folk medicine. However, the virus isolated from bats differs from viruses that are transmitted interhumanly in several amino acids crucial for binding to human cells. It is therefore more likely that the transmission to humans occurred through intermediate hosts, which could be, for example, some snakes, turtles or minks. Especially discussed are pangolins, whose meat is consumed in China and whose body parts are also used in folk medicine. The sequence [[RNA]] isolated from pangolin coronaviruses differed more from SARS-CoV-2 than from bats [[coronavirus|coronaviruses]], but it was identical in the domain responsible for binding to human cells. <ref>{{Citace
  | surname2 = Zhao
| typ = článek
  | first name2 = Shizhe
  | příjmení1 = Xu
  | surname3 = Teng
  | jméno1 = Jiabao
  | first name3 = Tieshan
  | příjmení2 = Zhao
| article = Systematic Comparison of Two Animal-to-Human Transmitted Human Coronaviruses: SARS-CoV-2 and SARS-CoV
  | jméno2 = Shizhe
| journal = Viruses
  | příjmení3 = Teng
| year = 2020
  | jméno3 = Tieshan
| Volume = 2
| článek = Systematic Comparison of Two Animal-to-Human Transmitted Human Coronaviruses: SARS-CoV-2 and SARS-CoV
| Volume = 12
| časopis = Viruses
| pages = 244
| rok = 2020
| ročník = 2
| svazek = 12
| strany = 244
| issn = 1999-4915
| issn = 1999-4915
| doi = 10.3390/v12020244}}</ref><ref>{{Citace
| doi = 10.3390/v12020244}}</ref><ref>{{Citation
| typ = článek
| type = article
  | příjmení1 = Wassenaar
  | last name1 = Wassenaar
  | jméno1 = T.M.
  | first name1 = T.M.
  | příjmení2 = Zou
  | surname2 = Zou
  | jméno2 = Y.
  | first name2 = Y.
| článek = 2019_nCoV/SARS‐CoV‐2: rapid classification of betacoronaviruses and identification of Traditional Chinese Medicine as potential origin of zoonotic coronaviruses
| article = 2019_nCoV/SARS-CoV-2: rapid classification of betacoronaviruses and identification of Traditional Chinese Medicine as potential origin of zoonotic coronaviruses
| časopis = Letters in Applied Microbiology
| journal = Letters in Applied Microbiology
| rok = 2020
| year = 2020
| ročník = ?
| volume = ?
| svazek = ?
| volume = ?
| strany = ?
| pages = ?
| issn = 0266-8254
| issn = 0266-8254
| doi = 10.1111/lam.13285}}</ref>. Uvažuje se proto, že SARS-CoV-2 vznikl rekombinací velmi podobného netopýřího koronaviru s koronavirem luskounů <ref>{{Citace
| doi = 10.1111/lam.13285}}</ref>. Therefore, it is speculated that SARS-CoV-2 arose from recombination of a very similar bat coronavirus with a scavenger coronavirus <ref>{{Citation
| typ = článek
| type=article
  | příjmení1 = Zhang
  | last name1 = Zhang
  | jméno1 = Tao
  | first name1 = Tao
  | příjmení2 = Wu
  | last name2 = Wu
  | jméno2 = Qunfu
  | first name2 = Qunfu
  | příjmení3 = Zhang
  | surname3 = Zhang
  | jméno3 = Zhigang
  | first name3 = Zhigang
| článek = Probable Pangolin Origin of 2019-nCoV Associated with Outbreak of COVID-19
| article = Probable Pangolin Origin of 2019-nCoV Associated with Outbreak of COVID-19
| časopis = SSRN Electronic Journal
| journal = SSRN Electronic Journal
| rok = 2020
| year = 2020
| ročník = ?
| year = ?
| svazek = ?
| volume = ?
| strany = ?
| pages = ?
| issn = 1556-5068
| issn = 1556-5068
| doi = 10.2139/ssrn.3542586}}</ref><ref>{{Citace
| doi = 10.2139/ssrn.3542586}}</ref><ref>{{Citation
| typ = článek
| type = article
  | příjmení1 = Cyranoski
  | last name1 = Cyranoski
  | jméno1 = David
  | first name1 = David
| článek = Mystery deepens over animal source of coronavirus
| article = Mystery deepens over animal source of coronavirus
| časopis = Nature
| journal = Nature
| rok = 2020
| year = 2020
| ročník = 7797
| year = 7797
| svazek = 579
| volume = 579
| strany = 18-19
| pages = 18-19
| issn = 0028-0836
| issn = 0028-0836
| doi = 10.1038/d41586-020-00548-w}}</ref>.
| doi = 10.1038/d41586-020-00548-w}}</ref>.


[[Soubor:2019-nCoV-CDC-23313.png | náhled | Model virionu koronaviru SARS-CoV-2. Na stavbě se podílejí čtyři strukturní bílkoviny. Šedě je znázorněná obálka, kterou tvoří fosfolipidová dvojvrstva. Pod ní je nukleokapsidový protein N s navázanou ribonukleovou kyselinou viru. Do obálky virionu jsou zavzaty proteiny S, E a M. Červeně znázorněný peplomerový  glykoprotein S (''spike'') je odpovědný za vazbu na hostitelskou buňku. Dále jsou vyznačeny proteiny E (''envelope'') a M (membránový protein). <ref>{{Citace
[[File:2019-nCoV-CDC-23313.png | náhled | Coronavirus SARS-CoV-2 virion model . 2. Four structural proteins are involved in the construction. The envelope is shown in grey, which consists of a phospholipid bilayer. Underneath is the nucleocapsid protein N with the ribonucleic acid of the virus bound to it. The envelope of the virion contains proteins S, E and M. The peplomeric glycoprotein S (''spike''), shown in red, is responsible for binding to the host cell. Also indicated are the E (''envelope'') and M (membrane protein) proteins. <ref>{{Citation
| typ = článek
| type=article
  | příjmení1 = Wu
  | last name1 = Wu
  | jméno1 = Canrong
  | name1 = Canrong
  | příjmení2 = Liu
  | surname2 = Liu
  | jméno2 = Yang
  | first name2 = Yang
  | příjmení3 = Yang
  | last name3 = Yang
  | jméno3 = Yueying
  | first name3 = Yueying
| článek = Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods
| article = Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods
| časopis = Acta Pharmaceutica Sinica B
| journal = Acta Pharmaceutica Sinica B
| rok = 2020
| year = 2020
| ročník = ?
| year = ?
| svazek = ?
| volume = ?
| strany = ?
| pages = ?
| issn = 2211-3835
| issn = 2211-3835
| doi = 10.1016/j.apsb.2020.02.008}}</ref>]]
| doi = 10.1016/j.apsb.2020.02.008}}</ref>]]


Pro vstup viru SARS-CoV-2 do hostitelské buňky je klíčový jeden z glykoproteinů virionového obalu („korony“), '''S-protein''' (''spike-protein''). Ten se váže na [[angiotenzin|angiotenzin konvertující enzym 2]] (ACE2) exprimovaný na povrchu vnímavých buněk a využívá jej jako receptor <ref>{{Citace
One of the glycoproteins of the virion envelope (''corona''), the '''S-protein'''' (''spike-protein''), is crucial for the entry of SARS-CoV-2 into the host cell. This binds to [[angiotensin|angiotensin converting enzyme 2]] (ACE2) expressed on the surface of susceptible cells and uses it as a receptor <ref>{{Citation
   | typ = článek
   | type=article
   | příjmení1 = Liu
   | last name1 = Liu
   | jméno1 = Zhixin
   | first name1 = Zhixin
   | příjmení2 = Xiao
   | surname2 = Xiao
   | jméno2 = Xiao
   | first name2 = Xiao
   | příjmení3 = Wei
   | surname3 = Wei
   | jméno3 = Xiuli
   | first name3 = Xiuli
   | kolektiv = ano
   | collective = yes
   | článek = Composition and divergence of coronavirus spike proteins and host ACE2 receptors predict potential intermediate hosts of SARS-CoV-2
   | article = Composition and divergence of coronavirus spike proteins and host ACE2 receptors predict potential intermediate hosts of SARS-CoV-2
   | časopis = J Med Virol
   | journal = J Med Virol
   | rok = 2020
   | year = 2020
   | ročník = Accepted Author Manuscript
   | Volume = Accepted Author Manuscript
   | strany = ?
   | pages = ?
   | url = https://doi.org/10.1002/jmv.25726
   | url = https://doi.org/10.1002/jmv.25726
   | issn = 0146-6615 (print), 1096-9071
   | issn = 0146-6615 (print), 1096-9071
}}</ref>.
}}</ref>.
Analysis of the ''spike protein'' coronavirus identified two variants, caused by the substitution of [[glycine]]u (G) for [[aspartate]] (D) at position 614. The G614 variant was associated with higher viral loads in vitro and may therefore indicate higher infectivity. The effect on the course of the disease and the risk of hospitalization has not been proven.<ref name="Uptodate">{{Citace
 
| typ = db
Analysis of the ''spike protein'' of coronavirus identified two variants caused by substitution of [[glycine]]u (G) for [[aspartate]] (D) at position 614. The G614 variant was associated with higher viral loads in vitro and may therefore indicate higher infectivity. No effect on disease course and risk of hospitalization was demonstrated. <ref name="Uptodate">{{Citation
| odpovědnost = MCINTOSH Kenneth, Martin S HIRSCH a Allyson BLOOM
| type=db
| responsibility = MCINTOSH Kenneth, Martin S HIRSCH and Allyson BLOOM
| url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention
| title = UpToDate
| subtitle = Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention
| publisher = Wolters Kluwer Health
| year = 2020
| revision_date = 2020-03-20
| cited = 2020-08-14
}}</ref>.
Analysis of the ''spike protein'' coronavirus identified two variants, caused by the substitution of [[glycine]]u (G) for [[aspartate]] (D) at position 614. The G614 variant was associated with higher viral loads in vitro and may therefore indicate higher infectivity. The effect on the course of the disease and the risk of hospitalization has not been proven.<ref name="Uptodate">{{Citation
| type = db
| responsibility = MCINTOSH Kenneth, Martin S HIRSCH and Allyson BLOOM
| url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention
| url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention
| název = UpToDate
| title = UpToDate
| podnázev = Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention
| subtitle = Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention
| vydavatel = Wolters Kluwer Health
| publisher = Wolters Kluwer Health
| rok = 2020
| year = 2020
| datum_revize = 2020-03-20
| revision_date = 2020-03-20
| citováno = 2020-08-14
| cited = 2020-08-14
}}
}}
</ref>
</ref>
== Incubation period and transfer ==  
== Incubation period and transfer ==  
The average incubation period is given as 4–5 days, with the range of the incubation period usually being 2–14 days.  
The average incubation period is given as 4–5 days, with the range of the incubation period usually being 2–14 days.  
<ref name="CDC2">{{Citace
<ref name="CDC2">{{Citation
| typ = web
| type = web
| korporace = CDC
| corporation = CDC
| url = https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
| url = https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
| název = Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)
| title = Interim Clinical Guideline for the Management of Patients with Confirmed Coronavirus Disease (COVID-19)
| datum_revize = 2020-07-30
| revision_date = 2020-07-30
| citováno = 2020-08-14
| cited = 2020-08-14
}}
}}
</ref>.
</ref>.
Line 191: Line 199:
Viral RNA has also been demonstrated in the blood, faeces and urine of patients, although these routes of transmission are probably not very epidemiologically significant <ref name="Uptodate" />. The epidemiological significance of transmission by touching contaminated areas and subsequent contact with eyes, mouth or nose is still unclear, but extensive contamination of areas near patients with viral particles that can be a source of infection has been repeatedly described. The risk of infection from surfaces is higher in the case of massive contamination, for example, in the house of a infected person <ref name="Uptodate" />.
Viral RNA has also been demonstrated in the blood, faeces and urine of patients, although these routes of transmission are probably not very epidemiologically significant <ref name="Uptodate" />. The epidemiological significance of transmission by touching contaminated areas and subsequent contact with eyes, mouth or nose is still unclear, but extensive contamination of areas near patients with viral particles that can be a source of infection has been repeatedly described. The risk of infection from surfaces is higher in the case of massive contamination, for example, in the house of a infected person <ref name="Uptodate" />.


'''Risk of infection''' depends on the course of the disease – an infected patient with a mild course of the disease usually becomes infectious approximately 2.5 days before the onset of symptoms, the highest risk is around the onset of symptoms and gradually decreases approximately by the 7th–10th day after the onset of symptoms <ref name="Uptodate" />. The risk of transmission after day 10 is small in immunocompetent patients with a mild course of the disease <ref name="Uptodate" /><ref name="CDC3">{{Citace
'''Risk of infection''' depends on the course of the disease – an infected patient with a mild course of the disease usually becomes infectious approximately 2.5 days before the onset of symptoms, the highest risk is around the onset of symptoms and gradually decreases approximately by the 7th–10th day after the onset of symptoms <ref name="Uptodate" />. The risk of transmission after day 10 is small in immunocompetent patients with a mild course of the disease <ref name="Uptodate" /><ref name="CDC3">{{Citation
| typ = web
| type = web
| korporace = CDC
| corporation = CDC
| url = https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
| url = https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
| název = Duration of Isolation and Precautions for Adults with COVID-19
| title = Duration of Isolation and Precautions for Adults with COVID-19
| datum_revize = 2020-07-22
| date_revision = 2020-07-22
| citováno = 2020-08-16
| cited = 2020-08-16
}}
}}
</ref>. Při závažném či kritickém průběhu onemocnění (dušnost, pneumonie) je obvykle pacient infekční ne déle než 20 dní <ref name="CDC3" />. [[PCR]] pozitivita však může přetrvávat výrazně déle i při neinfekčnosti vzhledem k přítomnosti neviabilních virových částic na sliznicích. Medián doby do negavního výsledku PCR testů ze sliznic je 18,4 dne, avšak pozitivita [[PCR]] detekce virové [[RNA]] může přetrvávat až po 3 měsíce <ref name="CDC3" /><ref>{{Citace
</ref>. In severe or critical illness (dyspnea, pneumonia), the patient is usually infectious for no longer than 20 days <ref name="CDC3" />. However, [[PCR]] positivity can persist significantly longer even when non-infectious due to the presence of non-vital viral particles on mucous membranes. The median time to a negative mucosal PCR result is 18.4 days, but positivity of [[PCR]] detection of viral [[RNA]] can persist for up to 3 months<ref name="CDC3" /><ref>{{Citation
| typ = článek
| type=article
  | příjmení1 = Fontana
  |ref name1= Fontana
  | jméno1 = Lauren
  | first name1 = Lauren
  | příjmení2 = Villamagna
  | last name2 = Villamagna
  | jméno2 = Angela Holly
  | first name2 = Angela Holly
  | příjmení3 = Sikka
  | last name3 = Sikka
  | jméno3 = Monica K.
  | first name3 = Monica K.
| článek = Understanding Viral Shedding of SARS-CoV-2: Review of Current Literature
| article = Understanding Viral Shedding of SARS-CoV-2: Review of Current Literature
| časopis = Infection Control & Hospital Epidemiology
| journal = Infection Control & Hospital Epidemiology
| rok = 2020
| year = 2020
| ročník = ?
| year = ?
| svazek = ?
| volume = ?
| strany = 1-35
| pages = 1-35
| issn = 0899-823X
| issn = 0899-823X
| doi = 10.1017/ice.2020.1273}}</ref>.
| doi = 10.1017/ice.2020.1273}}</ref>.
Line 220: Line 228:
Animal infections have been described in a case-by-case manner, but there is no evidence that transmission from animals to humans is present in a significant percentage. It is assumed only at the beginning of the epidemic, the further meaning is not confirmed <ref name="Uptodate" />.
Animal infections have been described in a case-by-case manner, but there is no evidence that transmission from animals to humans is present in a significant percentage. It is assumed only at the beginning of the epidemic, the further meaning is not confirmed <ref name="Uptodate" />.


Basic reproductive constant R <sub>0</sub> je kolem 3 <ref>{{Citace
Basic reproductive constant R <sub>0</sub> is around 3 <ref>{{Citation
| typ = článek
| type = article
  | příjmení1 = Lai
  | surname1 = Lai
  | jméno1 = Chih-Cheng
  | first name1 = Chih-Cheng
  | příjmení2 = Shih
  | last name2 = Shih
  | jméno2 = Tzu-Ping
  | first name2 = Tzu-Ping
  | příjmení3 = Ko
  | surname3 = Ko
  | jméno3 = Wen-Chien
  | first name3 = Wen-Chien
| článek = Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges
| article = Coronavirus 2 acute respiratory syndrome (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): epidemics and challenges
| časopis = International Journal of Antimicrobial Agents
| journal = International Journal of Antimicrobial Agents
| rok = 2020
| year = 2020
| ročník = ?
| Volume = ?
| svazek = ?
| volume = ?
| strany = 105924
| pages = 105924
| issn = 0924-8579
| issn = 0924-8579
| doi = 10.1016/j.ijantimicag.2020.105924}}</ref>.
| doi = 10.1016/j.ijantimicag.2020.105924}}</ref>.


== Clinical course ==  
== Clinical course ==  
The clinical course of the disease can be diverse, the manifestations range from asymptomatic or very mild to a critical course ending in the death of the patient <ref name="sympt">{{Citace
The clinical course of the disease can be varied, with manifestations ranging from asymptomatic or very mild to a critical course ending in the death of the patient <ref name="sympt">{{Citation
| typ = db
| type=db
| odpovědnost = MCINTOSH Kenneth, Martin S HIRSCH a Allyson BLOOM
| responsibility = MCINTOSH Kenneth, Martin S HIRSCH and Allyson BLOOM
| url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features
| url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features
| název = UpToDate
| title = UpToDate
| podnázev = Coronavirus disease 2019 (COVID-19): Clinical features
| subtitle = Coronavirus disease 2019 (COVID-19): clinical picture
| vydavatel = Wolters Kluwer Health
| publisher = Wolters Kluwer Health
| rok = 2020
| year = 2020
| datum_revize = 2020-08-14
| revision_date = 2020-08-14
| citováno = 2020-08-16
| cited = 2020-08-16
}}</ref>.
}}</ref>.


Line 254: Line 262:
According to the current concept, no symptom is downright pathognomonic and diagnosis solely on the basis of clinical signs can be difficult.
According to the current concept, no symptom is downright pathognomonic and diagnosis solely on the basis of clinical signs can be difficult.


Symptoms of ongoing COVID-19 may include <ref name="sympt" /><ref>{{Citace
Symptoms of ongoing COVID-19 may include <ref name="sympt" /><ref>{{Citation
| typ = web
| type = web
| korporace = Mayo Clinic
| corporation = Mayo Clinic
| url = https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963
| url = https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963
| název = Coronavirus disease 2019 (COVID-19)
| title = Coronavirus Disease 2019 (COVID-19)
| datum_revize = 2020-08-07
| revision_date = 2020-08-07
| citováno = 2020-08-16
| cited = 2020-08-16
}}
}}
</ref><ref>{{Citace
</ref><ref>{{Citation
| typ = web
|type=web
| korporace = CDC
|corporation = CDC
| url = https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
| url = https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
| název = Symptoms of Coronavirus
| title = Symptoms of coronavirus
| datum_revize = 2020-05-13
| revision_date = 2020-05-13
| citováno = 2020-08-16
| cited = 2020-08-16
}}
}}
</ref>:
</ref>:
Line 309: Line 317:
Deaths most commonly occur in patients with significant comorbidities (cardiovascular disease, lung disease, diabetes mellitus, cancer or high blood pressure). Higher mortality is associated with higher age, with 80% of deaths due to COVID-19 occurring at age ≥ 65 years according to Chinese data<ref name="Uptodate" />. The mortality rate under 19 years is 0.1% and 14.8% over 80 years <ref name="CEBM" />.
Deaths most commonly occur in patients with significant comorbidities (cardiovascular disease, lung disease, diabetes mellitus, cancer or high blood pressure). Higher mortality is associated with higher age, with 80% of deaths due to COVID-19 occurring at age ≥ 65 years according to Chinese data<ref name="Uptodate" />. The mortality rate under 19 years is 0.1% and 14.8% over 80 years <ref name="CEBM" />.


Recovery occurs after approximately two weeks in patients with a mild course, in 3-6 weeks in a severe course <ref>{{Citace
Recovery occurs after approximately two weeks in patients with a mild course, in 3-6 weeks in a severe course <ref>{{Citation
| typ = web
| type = web
| korporace = World health organisation
| corporation = World health organization
| url = https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february-2020
| url = https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february- 2020
| název = WHO Director-General's opening remarks at the media briefing on COVID-19 - 24 February 2020
| title = WHO Director-General's opening remarks at the media briefing on COVID-19 - 24 February 2020
| rok = 2020
| year = 2020
| datum_revize = 2020-02-24
| revision_date = 2020-02-24
| citováno = 2020-03-04
| cited = 2020-03-04
}}</ref>.
}} </ref>.


Some patients who have had COVID-19 have one or more symptoms that persist after the acute phase of the disease (''long COVID'', ''long-haul COVID'', ''chronic post-COVID syndrome''). The most common symptoms are fatigue, shortness of breath, chest pain, cough or cognitive impairment. Preliminary data suggest that full recovery occurs after about three additional weeks if the course of COVID-19 has been mild. In the case of a moderate or severe course, symptoms persist for more than two months after hospital discharge.
Some patients who have had COVID-19 have one or more symptoms that persist after the acute phase of the disease (''long COVID'', ''long-haul COVID'', ''chronic post-COVID syndrome''). The most common symptoms are fatigue, shortness of breath, chest pain, cough or cognitive impairment. Preliminary data suggest that full recovery occurs after about three additional weeks if the course of COVID-19 has been mild. In the case of a moderate or severe course, symptoms persist for more than two months after hospital discharge.
<ref>{{Citace
<ref>{{Citation
| typ = db
| typ = db
| název = UpToDate
| name = UpToDate
| podnázev = Coronavirus disease 2019 (COVID-19): Evaluation and management of adults following acute viral illness
| subtitle = Coronavirus disease 2019 (COVID-19): Evaluation and management of adults following acute viral illness
| vydavatel = Wolters Kluwer
| publisher = Wolters Kluwer
| rok = 2020
| year = 2020
| odpovědnost = MIKKELSEN, Mark E and Benjamin ABRAMOFF
| responsibility = MIKKELSEN, Mark E and Benjamin ABRAMOFF
| citováno = 2021-01-21
| cited = 2021-01-21
| datum_revize = 2020-12-21
| revision_date = 2020-12-21
url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-evaluation-and-management-of-adults-following-acute-viral-illness?sectionName=COVID-19%20RECOVERY&search=undefined&topicRef=128323&anchor=H1945726940&source=see_link#H1945726940
url =https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-evaluation-and-management-of-adults-following-acute-viral-illness?sectionName=COVID-19%20RECOVERY&search=undefined&topicRef=128323&anchor=H1945726940&source=see_link#H1945726940
}}</ref>
}}</ref>


Line 347: Line 355:
|cough|17-26 %|| 2-3 months  
|cough|17-26 %|| 2-3 months  
|---------------------------------------------------------------------------------------------------------------------------------  
|---------------------------------------------------------------------------------------------------------------------------------  
| Loss of smell|| 13 %|| 1 month |---------------------------------------------------------------------------------------------------------------------------------  
| Loss of smell|| 13 %|| 1 month  
|---------------------------------------------------------------------------------------------------------------------------------  
! colspan="3" | Psychic and cognitive  
! colspan="3" | Psychic and cognitive  
|---------------------------------------------------------------------------------------------------------------------------------  
|---------------------------------------------------------------------------------------------------------------------------------  
Line 367: Line 376:
The treatment strategy depends on the severity of the manifestations. In mild cases, the patient can be left in '''home isolation''', where the basis is '''prevention of further spread of the virus''' e.g. by wearing a mask when close to another person or by frequently disinfecting surfaces. Such a patient should be regularly monitored for symptoms to worsen and there is no need for hospitalization. Home isolation is terminated according to valid hygiene regulations, always in sufficient time after the symptoms subside (reduction of fever without the use of antipyretics and improvement of respiratory symptoms). (see [https://covid.gov.cz/situace/onemocneni-obecne-o-opatrenich/izolace rules of isolation according to valid regulations of the Ministry of Health of the Czech Republic])
The treatment strategy depends on the severity of the manifestations. In mild cases, the patient can be left in '''home isolation''', where the basis is '''prevention of further spread of the virus''' e.g. by wearing a mask when close to another person or by frequently disinfecting surfaces. Such a patient should be regularly monitored for symptoms to worsen and there is no need for hospitalization. Home isolation is terminated according to valid hygiene regulations, always in sufficient time after the symptoms subside (reduction of fever without the use of antipyretics and improvement of respiratory symptoms). (see [https://covid.gov.cz/situace/onemocneni-obecne-o-opatrenich/izolace rules of isolation according to valid regulations of the Ministry of Health of the Czech Republic])


Therapy of complicated cases require treatment during hospitalization, often with varying degrees of '''[oxygen therapy|oxygen therapy]''' from a simple half mask with a reservoir, through high-flow oxygen therapy to [[artificial lung ventilation|artificial lung ventilation]] when developing '''[Acute respiratory distress syndrome|syndrome acute respiratory distress]] (ARDS)'''. In carefully indicated cases with refractory hypoxia, '''[[ECMO|extracorporal membrane oxygenation]] (ECMO)''' may be indicated. {{details| ARDS}} ===Pharmacotherapy=== * '''Corticosteroids''' – dexamethasone is most commonly used ** indication: Patients with severe disease whose treatment requires oxygen therapy or ventilation support are recommended to receive '''{{HVLP|dexamethasone}}''' <ref name="UpToDateManagement">{{Citace
Therapy of complicated cases require treatment during hospitalization, often with varying degrees of '''[oxygen therapy|oxygen therapy]''' from a simple half mask with a reservoir, through high-flow oxygen therapy to [[artificial lung ventilation|artificial lung ventilation]] when developing '''[Acute respiratory distress syndrome|syndrome acute respiratory distress]] (ARDS)'''. In carefully indicated cases with refractory hypoxia, '''[[ECMO|extracorporal membrane oxygenation]] (ECMO)''' may be indicated. {{details| ARDS}}  
| typ = web
===Pharmacotherapy===  
| příjmení1 = Kim
 
| jméno1 = Arthur Y
* '''Corticosteroids''' – dexamethasone is most commonly used ** indication: Patients with severe disease whose treatment requires oxygen therapy or ventilation support are recommended to receive '''{{HVLP|dexamethasone}}''' <ref name="UpToDateManagement">{{Citation
| příjmení2 = Gandhi
| type = web
| jméno2 = Rajesh T
| last name1 = Kim
| name1 = Arthur Y
| surname2 = Gandhi
| name2 = Rajesh T
| url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197
| url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197
| název = UpToDate
| name = UpToDate
| podnázev = Coronavirus disease 2019 (COVID-19): Management in hospitalized adults
| subtitle = Coronavirus disease 2019 (COVID-19): Management in hospitalized adults
| vydavatel = Wolters Kluwer
| publisher = Wolters Kluwer
| rok = 2020
| year = 2020
| datum_revize = 2020-10-19
| revision_date = 2020-10-19
| citováno = 2020-10-23
| cited = 2020-10-23
}}</ref>.  
}}</ref>.  
Administration of dexamethasone leads to a reduction in mortality, especially in the group of patients requiring mechanical ventilation or ECMO.
Administration of dexamethasone leads to a reduction in mortality, especially in the group of patients requiring mechanical ventilation or ECMO.
Line 399: Line 411:
* '''Tocilizumab'''', an IL-6 monoclonal antibody, is being evaluated for efficacy in the treatment of severe forms of COVID-19 with IL-6 elevation in systemic inflammation.
* '''Tocilizumab'''', an IL-6 monoclonal antibody, is being evaluated for efficacy in the treatment of severe forms of COVID-19 with IL-6 elevation in systemic inflammation.
* '''Favipavir'''' - an RNA polymerase inhibitor that preliminary data suggest may accelerate viral clearance.
* '''Favipavir'''' - an RNA polymerase inhibitor that preliminary data suggest may accelerate viral clearance.
* '''{{HVLP| Ivermectin}}''' – antiparasitic, which also has antiviral effects. An ''in vitro'' effect on SARS-CoV-2 has been demonstrated, but its concentration was much higher than the safe doses of this substance. <ref>{{Citace
* '''{{HVLP| Ivermectin}}''' – antiparasitic, which also has antiviral effects. An ''in vitro'' effect on SARS-CoV-2 has been demonstrated, but its concentration was much higher than the safe doses of this substance. <ref>{{Citation
  | typ = článek
  | type = article
  | příjmení1 = Heidary
  | surname1 = Heidary
  | jméno1 = Fatemeh
  | name1 = Fatemeh
  | příjmení2 = Gharebaghi
  | surname2 = Gharebaghi
  | jméno2 = Reza
  | name2 = Section
  | článek = Ivermectin: a systematic review from antiviral effects to COVID-19 complementary regimen
  | article = Ivermectin: a systematic review of antiviral effects to COVID-19 complementary regimen
  | časopis = J Antibiot Tokyo
  | magazine = J Antibiot Tokyo
  | rok = 2020
  | year = 2020
  | číslo = 9
  | number = 9
  | svazek = 73
  | volume = 73
  | strany = 593-602
  | pages = 593-602
  | url = https://doi.org/10.1038/s41429-020-0336-z
  | url = https://doi.org/10.1038/s41429-020-0336-z
  | issn = 0021-8820 (print), 1881-1469
  | issn = 0021-8820 (print), 1881-1469
}}</ref>. In one retrospective study, ivermectin was associated with lower mortality in COVID-19 patients, but more patients treated with ivermectin required corticosteroids. <ref>{{Citace
}} </ref>. In one retrospective study, ivermectin was associated with lower mortality in COVID-19 patients, but more patients treated with ivermectin required corticosteroids. <ref> {{Citation
| typ = článek
| type = article
| příjmení1 = Rajter
  | surname1 = Rajter
| jméno1 = Juliana Cepelowicz
  | name1 = Juliana Cepelowicz
| příjmení2 = Sherman
  | last name2 = Sherman
| jméno2 = Michael S.
  | name2 = Michael S.
| příjmení3 = Fatteh
  | surname3 = Fatteh
| jméno3 = Naaz
  | name3 = Naaz
| článek = Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019
| article = Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019
| časopis = Chest
| magazine = Chest
| rok = 2021
| year = 2021
| ročník = 1
| year = 1
| svazek = 159
| volume = 159
| strany = 85-92
| pages = 85-92
| issn = 0012-3692
| issn = 0012-3692
| doi = 10.1016/j.chest.2020.10.009}}</ref>. In a recently published double-blind intervention study of less than 500 subjects, administration of 300 μg of ivermectin per kilogram body weight for 5 days compared to placebo had no significant effect either on recovery time or on the number of deaths <ref>[https://jamanetwork.com/journals/jama/fullarticle/2777389?fbclid=IwAR1sk6LjGItOHhzqvA30eY95NNMFGdMKe1q6yHVx9AC5eN6Vzv27KKFBmNA]</ref>.
| doi = 10.1016/j.chest.2020.10.009}}</ref>. In a recently published double-blind intervention study of less than 500 subjects, administration of 300 μg of ivermectin per kilogram body weight for 5 days compared to placebo had no significant effect either on recovery time or on the number of deaths <ref>[https://jamanetwork.com/journals/jama/fullarticle/2777389?fbclid=IwAR1sk6LjGItOHhzqvA30eY95NNMFGdMKe1q6yHVx9AC5eN6Vzv27KKFBmNA]</ref>.
Line 432: Line 444:
* {{No}} '''Chloroquine/hydroxychloroquine''' - these antimalarials have been shown to inhibit SARS-CoV-2 in vitro. Despite initially promising study results, treatment is no longer recommended either alone or in combination with '''azithromycin'''. No sufficient benefit has been demonstrated and all these drugs are not recommended because of their side effects.
* {{No}} '''Chloroquine/hydroxychloroquine''' - these antimalarials have been shown to inhibit SARS-CoV-2 in vitro. Despite initially promising study results, treatment is no longer recommended either alone or in combination with '''azithromycin'''. No sufficient benefit has been demonstrated and all these drugs are not recommended because of their side effects.
* {{No}} '''Lopinavir-ritonavir''' - this drug has also not been shown to be effective.
* {{No}} '''Lopinavir-ritonavir''' - this drug has also not been shown to be effective.
* Many other agents are being tested in clinical trials without widespread use. An example is Famotidine, a histamine receptor antagonist used for the treatment of gastric ulcer disease. <ref>{{Citace
* Many other agents are being tested in clinical trials without widespread use. An example is Famotidine, a histamine receptor antagonist used for the treatment of gastric ulcer disease. <ref>{{Citation
| typ = článek
| type = article
| příjmení1 = Mather
  | last name1 = Mather
| jméno1 = Jeffrey F.
  | name1 = Jeffrey F.
| příjmení2 = Seip
  | surname2 = Seip
| jméno2 = Richard L.
  | name2 = Richard L.
| příjmení3 = McKay
  | last name3 = McKay
| jméno3 = Raymond G.
  | name3 = Raymond G.
| článek = Impact of Famotidine Use on Clinical Outcomes of Hospitalized Patients With COVID-19
| article = Impact of Famotidine Use on Clinical Outcomes of Hospitalized Patients With COVID-19
| časopis = American Journal of Gastroenterology
| journal = American Journal of Gastroenterology
| rok = 2020
| year = 2020
| ročník = 10
| year = 10
| svazek = 115
| volume = 115
| strany = 1617-1623
| pages = 1617-1623
| issn = 0002-9270
| issn = 0002-9270
| doi = 10.14309/ajg.0000000000000832}}</ref>
| doi = 10.14309 / ajg.0000000000000832}} </ref>
 
===Other notes on selected drugs===
- ACEi, statins, aspirin etc.
 
== Diagnostics ==
[[File:Covid.jpeg|preview| 300 px | Difference between small extent of X-ray and CT scan in Covid 19]]
The laboratory finding most often describes lymphopenia, may also be present [[leukopenia]] or vice versa [[leukocytosis]]. [[Lymphopenia]] below 1000 μl <sup>−1</sup> was associated with severe course of illness <ref name="Singhal">{{Citation
| type = article
| surname1 = Singhal
| name1 = Tanu
| article = A Review of Coronavirus Disease-2019 (COVID-19)
| magazine = The Indian Journal of Pediatrics
| year = 2020
| year =?
| volume =?
| parties =?
| issn = 0019-5456
| doi = 10.1007 / s12098-020-03263-6}} </ref>.
Other non-specific laboratory findings include elevation of [[CRP]] and high erythrocyte sedimentation rate with normal [[procalcitonin]]u concentration. Elevation of ALT, AST, creatinine, D-dimers, creatine kinase, lactate dehydrogenase, and prolongation of prothrombin time may occur. More marked abnormalities in these parameters tend to be associated with a more severe course <ref name="Singhal" />.
 
X-ray findings of bilateral pulmonary infiltrates, cariated opacities, or a "ground glass" image on chest CT are frequent. Infiltrates are usually bilateral, peripheral and more commonly in the lower lobes <ref name="Uptodate" />.
 
Laboratory diagnosis is based on detection of the viral genome by '''RT-PCR'''' in nasopharyngeal or oropharyngeal swabs, sputum, or respiratory aspirate <ref name="labguid"<ref name="labguid">{{Citation
| type = web
| corporation = World health organization
| url = https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance
| title = Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans
| cited = 2020-03-04
}}
</ref>.
Confirmation is performed using RT-PCR with a different set of primers or sequencing. When taking material, sputum induction is not recommended. For safety reasons, virological culture is not performed in patients with suspected COVID-19. The WHO does not recommend approaches other than the detection of viral RNA for the diagnosis of COVID-19. However, '''rapid diagnostic tests''' based on evidence of IgG and IgM against SARS-CoV-2 are also available from auxiliary laboratory examination methods <ref name="Li">{{Citation
| type = article
  | surname1 = Li
  | name1 = Zhengtu
  | surname2 = Yi
  | name2 = Yongxiang
  | surname3 = Luo
  | name3 = Xiaomei
| article = Development and Clinical Application of A Rapid IgM ‐ IgG Combined Antibody Test for SARS ‐ CoV ‐ 2 Infection Diagnosis
| journal = Journal of Medical Virology
| year = 2020
| year =?
| volume =?
| parties =?
| issn = 0146-6615
| doi = 10.1002/jmv.25727}}</ref>.
They have the advantage of speed of execution (on the order of minutes compared to several hours required for RT-PCR) and low cost. The main disadvantage is the several-day diagnostic window. The sensitivity and specificity of rapid diagnostic tests are around 85-90% and 90% respectively in symptomatic individuals <ref name="Li" />.
 
Other laboratory procedures that detect viral RNA are also being tried. These include procedures using rapid amplification of a section of viral nucleic acid using RT-RPA and detection based on specific cleavage using '''CRISPR'''. The advantage should be faster execution (on the order of tens of minutes) and less demanding laboratory equipment compared to classically performed RT-PCR while maintaining high sensitivity and specificity. <ref>{{Citation
| type = article
| surname1 = Broughton
| first name1 = James P
| last name2 = Deng
| first name2 = Xianding
| surname3 = Yu
| first name3 = Guixia
| article = Rapid Detection of 2019 Novel Coronavirus SARS-CoV-2 Using a CRISPR-based DETECTR Lateral Flow Assay
| journal = ?
| year = 2020
| journal = ?
| volume = ?
| pages = ?
| issn = ?
| doi = 10.1101/2020.03.06.20032334}}</ref>
 
== Specific cases of infection ==
=== Pregnancy ===
Data for outcomes of infections in pregnancy are still very limited. Pregnancy appears to be a risk factor for a more severe course of maternal illness<ref name="UTDthe pregnancy">{{Citation
| type=web
| surname1=Berghella
| first name1 = Vincenzo
| collective = yes
| url = https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues-and-antenatal-care
| title = Coronavirus disease 2019 (COVID-19): Pregnancy issues and antenatal care
| publisher = UpToDate
| date_revision = 2020-11-12
| cited = 2020-11-16
}}.
</ref>. For now, there has been no evidence of an increased risk of fetal birth defects<ref>{{Citation
| type=article
|ref name1 = Woodworth
| first name1 = Kate R.
| last name2 = Olsen
| first name2 = Emily O'Malley
| last name3 = Neelam
| first name3 = Varsha
| article = Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy - SET-NET, 16 Jurisdictions, March 29-October 14, 2020
| journal = MMWR. Morbidity and Mortality Weekly Report
| year = 2020
| Volume = 44
| Volume = 69
| pages = ?
| issn = 0149-2195
| doi = 10.15585/mmwr.mm6944e2}}</ref>, however, there may be an increased risk of preterm delivery and associated complications, or complications of inadequate uterine perfusion in the critical course of the mother's illness <ref name="UTDtěho" />. Limited data suggest that the risk of spontaneous abortion is not increased.
 
The significance of vertical transmission is still uncertain; neonatal infections may be largely due to postnatal close contact between mother and child. The course of the disease in newborns is mild in the vast majority of cases, with complications usually due to premature birth. <ref name="UTDtěho" />
 
=== Infections in children ===
During the Chinese epidemic, the SARS-CoV-2 virus spread rapidly among children, so children are considered to be strong carriers. Infection in these children can range in severity from asymptomatic to severe respiratory failure. Respiratory failure has been described mainly in children with pre-existing chronic disease. In general, however, COVID-19 disease usually has a mild course in children. The most common manifestations include fever, malaise and dry cough. A few patients have had symptoms of upper respiratory tract inflammation, such as feeling stuffy, nasal secretions and sore throat. Gastrointestinal symptoms include abdominal discomfort, vomiting, abdominal pain and diarrhea. Mycoplasma pneumoniae, [[influenza|influenza A]], [[influenza|influenza B]], [[RSV]] and [[EB virosis]] may coexist with SARS-CoV-2 infection. The clearance time of SARS-CoV-2 nucleic acid from nasopharyngeal swabs was monitored in 3 children - 9 days in 2 children and 12 days in 1 child. <ref>{{Citation | type = article | last name1 = | first name1 = | article = [Recommendation for the diagnosis and treatment of novel coronavirus infection in children in Hubei (Trial version 1)] | journal = Zhongguo Dang Dai Er Ke Za Zhi | year = 2020 | issue = 2 | volume = 22 | pages = 96-99 | url = https://www.ncbi.nlm.nih.gov/pubmed/32051073 | issn = 1008-8830}}</ref><ref name="Liu" />
 
In Wuhan, 6 children were caught positive for SARS-CoV-2 in January 2020. They were aged 1 to 7 years old, previously quite healthy. All had fever above 39°C, cough and (4 of the 6) vomited. They had decreased lymphocytes (all), leukocytes (2/3) and neutrophils (1/2). 4 of these children had radiographic evidence of pneumonia, with CT scans showing a typical picture of viral pneumonia. One of the children was admitted to the intensive care unit and received immunoglobulins from healthy donors. All of these children were treated empirically with antivirals, antibiotics, and supportive care and recovered in 5 to 13 days. <ref name="Liu">{{Citation| type = article | last name1 = Liu | first name1 = Weiyong | last name2 = Zhang | last name2 = Qi | last name3 = Chen | last name3 = Junbo| article = Detection of Covid-19 in Children in Early January 2020 in Wuhan, China| journal = New England Journal of Medicine| year = 2020| volume = ?
| pages = ?| issn = 0028-4793| doi = 10.1056/nejmc2003717}}</ref>
The treatment of COVID-19 in children is based on the experience of adult treatment. Of the antiviral agents, remdesivir or lopinavir-ritonavir is used. The pharmacology of i.v. remdesivir is unknown, while lopinavir-ritonavir has been shown to be safe in pregnancy but is only available in tablets. <ref>{{{Citation| type = article | last name1 = De Luca | first name1 = Daniele| article = Managing neonates with respiratory failure due to SARS-CoV-2| journal = The Lancet Child & Adolescent Health| year = 2020| volume = ?| pages = ?| issn = 2352-4642| doi = 10.1016/s2352-4642(20)30073-0}}</ref>
 
In an analysis of 72 314 cases from China, there were no confirmed deaths in the age category ≤ 9 years (0/416) and 1 death in the age category ≤ 19 years (1/549)<ref name="CEBM">{{Citation
| type=web
| surname1=Oke
| first name1 = Jason
| last name2 = Heneghan
| first name2 = Carl
| url = https://www.cebm.net/global-covid-19-case-fatality-rates/
| title = Global Covid-19 Case Fatality Rates
| publisher = CEBM - The Centre for Evidence-Based Medicine
| revision_date = 2020-03-23
| cited = 2020-03-24
}}</ref>.
 
A rare complication of SARS-CoV-2 infection in children is '''pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2, PIMS-TS'''.
{{Details|PIMS-TS}}
 
== Prevention ==
Several types of vaccines can be [[vaccinated|vaccinated]] against SARS-CoV-2 infection. The development of this active immunization was based on earlier research conducted during the MERS-CoV and SARS-CoV-1 epidemics.
{{details|COVID-19 vaccination}}
 
 
'''Pharmacological prophylaxis''' is currently unknown.
 
Thus, '''non-pharmacological preventive practices''' are the basis for preventing and limiting the spread of SARS-CoV-2. These include '''limitation of close social contact''', '''isolation of ill persons''', '''[[hand hygiene]]'''' or '''use of protective equipment''', especially to cover the mouth and nose in areas with a high risk of transmission according to current recommendations. The development of the current recommendations issued by health organisations can be followed, for example, on the [https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance-publications WHO website] or [https://koronavirus.mzcr.cz/ Ministry of Health of the Czech Republic].
 
== Video library ==
=== Ministry of Health information spot ===
''Added 31. 03. 2020''
 
{{Video|url=https://www.youtube.com/watch?v=dOhhRIs8-Pk}}
 
=== Summary video by Osmosis ===
''Added 12 Aug 2020''
 
{{Video|url=https://www.youtube.com/watch?v=DqnrqV6ogGw}}
 
 
=== PIMS-TS ===
''Added 21 Jan 2021''
A rare complication of Covid 19 in children
Etiopathogenesis, diagnosis, and treatment of covid-19-associated multisystem inflammatory response syndrome (PIMS-TS). Webinar. Paediatric Clinic of the 2nd Faculty of Medicine of Charles University and Motol University Hospital, Prague, 7 January 2021.
 
{{Video|url=https://www.youtube.com/watch?v=rj85lZlpQCY}}
<noinclude>
 
== Links ==
 
== External links ==
 
*[https://www.evms.edu/covid-19/covid_care_for_clinicians/ '''Trvale aktualizované postupy Eastern Virginia Medical School''']
*[https://vseobecnylekar.cz/wp-content/uploads/2020/11/Doporu%C4%8Den%C3%BD-postup-ordinace_akt.4.11..pdf Doporučený postup PL 10/2020]
*[https://www.stefajir.cz/covid-kucharka COVID - kuchařka (na webu stefajir.cz)]
*{{Akutně|430|Resuscitace COVID-19 pozitivního pacienta – interaktivní algoritmus}}
*[https://www.infekce.cz/ Web Společnosti infekčního lékařství]
*[http://www.szu.cz/tema/prevence/2019ncov SZÚ: Onemocnění COVID-19, nový koronavirus SARS-CoV-2]
*[https://koronavirus.mzcr.cz/ MZ ČR: Aktuálně o koronaviru]
*[https://www.ecdc.europa.eu/en European Centre for Disease Prevention and Control (ECDC)]
*[https://www.who.int/ World Health Organization (WHO)]
 
*[https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Mapa výskytu] spravovaná ''Center for System Science and Engineering'' na ''John Hopkins University'' (průběžně aktualizováno).
*[https://coronavirus.tghn.org/ The Global Health Network knowledge hub for 2019 Novel Coronavirus (2019-nCoV)]
*[https://www.czechtrans.com/covid-19-glossary-english-czech-part-3/ Anglicko-český slovník pojmů využívaných v souvislosti s pandemií COVID-19]
*[https://vesmir.cz/cz/casopis/archiv-casopisu/2020/cislo-6/paradoxy-infekce-zpusobene-sar-cov-2.html časopis Vesmír 6/20230 Paradoxy Covid 19] vědecko-populární článek, rozdíly v průběhu nemoci
*[https://www.lf2.cuni.cz/fakulta/clanky/audio-a-video/syndrom-multisystemove-zanetlive-odpovedi-spojene-s-covid-19-u-deti MIS-C neboli PIMS-TS (webinář FN Motol)]
 
=== Related Articles ===
*[[Coronaviruses]]
*[[Pneumonia]]
 
=== References ===
 
* {{Citations
| type = article
| surname1 = Huang
| name1 = Chaolin
| surname2 = Wang
| name2 = Yeming
| surname3 = Li
| name3 = Xingwang
| article = clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
| magazine = The Lancet
| year = 2020
| year =?
| volume =?
| pages =?
| issn = 0140-6736
| doi = 10.1016/s0140-6736(20)30183-5}}
 
</noinclude>
 
[[Category:Microbiology]]
[[Category:Hygiene]]
[[Category:Epidemiology]]
[[Category:Video articles]]
[[Category:Infectious Medicine]]

Revision as of 14:34, 18 February 2022

Template:Infobox - virus

The COVID-19 disease (corona'vi'rus'd'isease 2019) is caused by the coronavirus SARS-CoV-2' (severe acute respiratory syndrome coronavirus 2', initially working title 2019-nCoV). The disease usually manifests as an upper respiratory tract infection, with some patients developing pneumonia with a potentially serious, in some cases fatal, course. Infection may be associated with coagulopathy. Due to the global spread of the disease, the WHO declared COVID-19 a pandemic on March 11, 2020[1].

Virology

The SARS-CoV-2 virus was first identified in China in early 2020 as the causative agent of an epidemic of pneumonia in the city of Wuhan. By sequencing epithelium from the respiratory tract of patients, it was possible to prove that the causative agent of the disease is the hitherto unknown β-coronavirus from the subgenus sarbecovirus subfamily Orthocoronaviridae. It is the seventh representative of the family coronaviruses, which causes human diseases. [2]. The first cases of this coronavirus at the end of 2019 were linked to a visit to a seafood and live animal market in the city of Wuhan. The probable source is a bat, e.g. Rhinolopus affinis, sinicus or ferrumequinum. Some authors believe that transmission to humans may have occurred directly, as excrement and dried parts of bat bodies are used in Chinese folk medicine. However, the virus isolated from bats differs from viruses that are transmitted interhumanly in several amino acids crucial for binding to human cells. It is therefore more likely that the transmission to humans occurred through intermediate hosts, which could be, for example, some snakes, turtles or minks. Especially discussed are pangolins, whose meat is consumed in China and whose body parts are also used in folk medicine. The sequence RNA isolated from pangolin coronaviruses differed more from SARS-CoV-2 than from bats coronaviruses, but it was identical in the domain responsible for binding to human cells. [3][4]. Therefore, it is speculated that SARS-CoV-2 arose from recombination of a very similar bat coronavirus with a scavenger coronavirus [5][6].

Coronavirus SARS-CoV-2 virion model . 2. Four structural proteins are involved in the construction. The envelope is shown in grey, which consists of a phospholipid bilayer. Underneath is the nucleocapsid protein N with the ribonucleic acid of the virus bound to it. The envelope of the virion contains proteins S, E and M. The peplomeric glycoprotein S (spike), shown in red, is responsible for binding to the host cell. Also indicated are the E (envelope) and M (membrane protein) proteins. [7]

One of the glycoproteins of the virion envelope (corona), the S-protein' (spike-protein), is crucial for the entry of SARS-CoV-2 into the host cell. This binds to angiotensin converting enzyme 2 (ACE2) expressed on the surface of susceptible cells and uses it as a receptor [8].

Analysis of the spike protein of coronavirus identified two variants caused by substitution of glycineu (G) for aspartate (D) at position 614. The G614 variant was associated with higher viral loads in vitro and may therefore indicate higher infectivity. No effect on disease course and risk of hospitalization was demonstrated. [9]. Analysis of the spike protein coronavirus identified two variants, caused by the substitution of glycineu (G) for aspartate (D) at position 614. The G614 variant was associated with higher viral loads in vitro and may therefore indicate higher infectivity. The effect on the course of the disease and the risk of hospitalization has not been proven.[9]

Incubation period and transfer

The average incubation period is given as 4–5 days, with the range of the incubation period usually being 2–14 days. [10]. Transfer path data is not yet complete. The basic mode of transmission is direct interpersonal contact, it is assumed that it occurs mainly by droplet infection. Droplets usually do not spread further than 2 meters and do not remain in the air [9]. The risk of direct transmission through the air is also discussed, especially in aerosol-producing procedures, but its significance is debatable and the impact on the spread of the pandemic rather questionable. The possibilities of transmission over longer distances are likely to increase in enclosed, unventilated areas (restaurants, bus,...). [9].

Viral RNA has also been demonstrated in the blood, faeces and urine of patients, although these routes of transmission are probably not very epidemiologically significant [9]. The epidemiological significance of transmission by touching contaminated areas and subsequent contact with eyes, mouth or nose is still unclear, but extensive contamination of areas near patients with viral particles that can be a source of infection has been repeatedly described. The risk of infection from surfaces is higher in the case of massive contamination, for example, in the house of a infected person [9].

Risk of infection depends on the course of the disease – an infected patient with a mild course of the disease usually becomes infectious approximately 2.5 days before the onset of symptoms, the highest risk is around the onset of symptoms and gradually decreases approximately by the 7th–10th day after the onset of symptoms [9]. The risk of transmission after day 10 is small in immunocompetent patients with a mild course of the disease [9][11]. In severe or critical illness (dyspnea, pneumonia), the patient is usually infectious for no longer than 20 days [11]. However, PCR positivity can persist significantly longer even when non-infectious due to the presence of non-vital viral particles on mucous membranes. The median time to a negative mucosal PCR result is 18.4 days, but positivity of PCR detection of viral RNA can persist for up to 3 months[11][12].

The degree of risk of transmission of infection also depends on the time of contact, the protective equipment used and epidemiological measures, or the amount of viral particles in the secretion of the upper respiratory tract. The most common secondary transmission has been described between members of the same household or in healthcare facilities where personal protective equipment was not used [9]. Infection is also possible from asymptomatic carriers of the virus, who are likely to be infectious for a similar length of time as symptomatic patients, but the importance of this type of transmission for the spread of the epidemic is still unknown [9].

Animal infections have been described in a case-by-case manner, but there is no evidence that transmission from animals to humans is present in a significant percentage. It is assumed only at the beginning of the epidemic, the further meaning is not confirmed [9].

Basic reproductive constant R 0 is around 3 [13].

Clinical course

The clinical course of the disease can be varied, with manifestations ranging from asymptomatic or very mild to a critical course ending in the death of the patient [14].

The frequency of asymptomatic infections is questionable. Some studies estimate their incidence to be around 40%, but for now there are no analyses with a long enough follow-up to assess whether the symptoms did not manifest themselves later [14]. Thus, the number of purely asymptomatic cases is probably lower.

According to the current concept, no symptom is downright pathognomonic and diagnosis solely on the basis of clinical signs can be difficult.

Symptoms of ongoing COVID-19 may include [14][15][16]:

  • fever – the estimated incidence and height of which fluctuates significantly between studies (often only subfebrile is reported),
  • fatigue,
  • dry cough,
  • muscle pain, headache,
  • sore throat,
  • nausea, vomiting, diarrhea,
  • loss or disturbance of smell or taste – various studies report the incidence of these disorders in the range of 5–98%, but appears to be more common in the early stages of the disease than in other respiratory tract diseases,
  • shortness of breath – occurs in approximately one third of patients, typical is its onset approximately 5 days after the onset of the disease,
  • stuffy nose or runny nose.

Complications

In the course of the disease, even with an initially mild course, a spectrum of complications may develop. Originally mild pneumonia can progress, as mentioned in the previous chapter, to a more severe state with shortness of breath approximately 5 days after the onset of symptoms. Other complications include [14]:

Risk factors for the course of the disease, prognosis

More than 80% of symptomatic COVID-19 cases have a mild course. Approximately 15% of patients develop clinically severe pneumonia with dyspneas, hypoxia, and extensive bilateral infiltrates on radiographs 24 to 48 hours after onset. About 5% of patients require intensive care for respiratory distress, shock, or multiorgan failure [14]. A critical to fatal course of the disease can occur even in young, otherwise healthy persons, but is usually associated with one or more of the following risk factors.

Risk factors for severe COVID-19 [14]
Cardiovascular disease Smoking
Diabetes mellitus Chronic kidney disease
Arterial hypertension Obesity
Chronic lung disease Cancer (especially hematological malignancies,
lung cancer or metastatic disease)

Mortality in clinically manifested disease is estimated at 2.3%, with no deaths reported in patients with mild initial symptoms. According to the WHO-China fact-finding mission, the mortality rate in China ranged from 0.7% to 4%, depending on location [9].

Deaths most commonly occur in patients with significant comorbidities (cardiovascular disease, lung disease, diabetes mellitus, cancer or high blood pressure). Higher mortality is associated with higher age, with 80% of deaths due to COVID-19 occurring at age ≥ 65 years according to Chinese data[9]. The mortality rate under 19 years is 0.1% and 14.8% over 80 years [17].

Recovery occurs after approximately two weeks in patients with a mild course, in 3-6 weeks in a severe course [18].

Some patients who have had COVID-19 have one or more symptoms that persist after the acute phase of the disease (long COVID, long-haul COVID, chronic post-COVID syndrome). The most common symptoms are fatigue, shortness of breath, chest pain, cough or cognitive impairment. Preliminary data suggest that full recovery occurs after about three additional weeks if the course of COVID-19 has been mild. In the case of a moderate or severe course, symptoms persist for more than two months after hospital discharge. [19]

Memory impairment|| 18 %
Persistent symptoms after COVID-19 [14]
Symptom Proportion of patients Time to recovery
Somatic
Fatigue 15–87 % 3 months
Dyspnoe 10–71 % 2–3 months
months
17-26 % 2-3 months
Loss of smell 13 % 1 month
Psychic and cognitive
Post-traumatic stress disorder 24 % 6 weeks to 3 months
Impaired concentration 16 %
Anxiety, depression 22 %


There are increasing data that some patients have long-term respiratory or cardiac damage.

Treatment

Template:Working

The treatment strategy depends on the severity of the manifestations. In mild cases, the patient can be left in home isolation, where the basis is prevention of further spread of the virus e.g. by wearing a mask when close to another person or by frequently disinfecting surfaces. Such a patient should be regularly monitored for symptoms to worsen and there is no need for hospitalization. Home isolation is terminated according to valid hygiene regulations, always in sufficient time after the symptoms subside (reduction of fever without the use of antipyretics and improvement of respiratory symptoms). (see rules of isolation according to valid regulations of the Ministry of Health of the Czech Republic)

Therapy of complicated cases require treatment during hospitalization, often with varying degrees of [oxygen therapy|oxygen therapy] from a simple half mask with a reservoir, through high-flow oxygen therapy to artificial lung ventilation when developing [Acute respiratory distress syndrome|syndrome acute respiratory distress]] (ARDS). In carefully indicated cases with refractory hypoxia, extracorporal membrane oxygenation (ECMO) may be indicated.

Searchtool right.svg For more information see ARDS.

Pharmacotherapy

  • Corticosteroids – dexamethasone is most commonly used ** indication: Patients with severe disease whose treatment requires oxygen therapy or ventilation support are recommended to receive Template:HVLP [20].

Administration of dexamethasone leads to a reduction in mortality, especially in the group of patients requiring mechanical ventilation or ECMO.

'NSAIDs (non-steroidal anti-inflammatory drugs) are the mainstay of fever therapy in COVID-19 and should be dosed according to current recommendations. Single case reports of deterioration after NSAID use in younger patients have been published, but other observational studies have not confirmed an association between NSAID use and disease severity. According to current recommendations, NSAIDs should be used according to the usual clinical indications. [20]

  • "anticoagulation"

Due to the risk of thromboembolic complications, antithrombotic prophylaxis should be administered according to recommendations depending on the severity of the condition and the patient's history.

  • Nebulization'

Drugs under investigation

A list of ongoing trials for COVID-19 therapy can be viewed on this WHO website.

Drugs under investigation include[20]:

  • 'Remdesivir' - a nucleotide analogue with proven in vitro efficacy against SARS-CoV-2 confirmed in animal models. It is used for moderate and severe disease, and its efficacy in previous studies shows benefit when used in patients with severe disease with low need for oxygen supplementation. In the general population, available data suggest that it does not reduce mortality, but new research is being analysed.
  • Convalescent plasma - data on the provision of passive immunization by plasma administration to cured patients are still insufficient. The effect is mainly expected in patients in the early phase of the disease (before sufficient self-titre of antibodies is formed), in patients with immunosuppressive conditions or when plasma with high titres of neutralising antibodies is used.
  • Tocilizumab', an IL-6 monoclonal antibody, is being evaluated for efficacy in the treatment of severe forms of COVID-19 with IL-6 elevation in systemic inflammation.
  • Favipavir' - an RNA polymerase inhibitor that preliminary data suggest may accelerate viral clearance.
  • Template:HVLP – antiparasitic, which also has antiviral effects. An in vitro effect on SARS-CoV-2 has been demonstrated, but its concentration was much higher than the safe doses of this substance. [21]. In one retrospective study, ivermectin was associated with lower mortality in COVID-19 patients, but more patients treated with ivermectin required corticosteroids. [22]. In a recently published double-blind intervention study of less than 500 subjects, administration of 300 μg of ivermectin per kilogram body weight for 5 days compared to placebo had no significant effect either on recovery time or on the number of deaths [23].

Thus, there is not enough data for the use of ivermectin in COVID-19, and further studies are ongoing.

  • yesyes Chloroquine/hydroxychloroquine - these antimalarials have been shown to inhibit SARS-CoV-2 in vitro. Despite initially promising study results, treatment is no longer recommended either alone or in combination with azithromycin. No sufficient benefit has been demonstrated and all these drugs are not recommended because of their side effects.
  • yesyes Lopinavir-ritonavir - this drug has also not been shown to be effective.
  • Many other agents are being tested in clinical trials without widespread use. An example is Famotidine, a histamine receptor antagonist used for the treatment of gastric ulcer disease. [24]

Other notes on selected drugs

- ACEi, statins, aspirin etc.

Diagnostics

Difference between small extent of X-ray and CT scan in Covid 19 The laboratory finding most often describes lymphopenia, may also be present leukopenia or vice versa leukocytosis. Lymphopenia below 1000 μl −1 was associated with severe course of illness [25]. Other non-specific laboratory findings include elevation of CRP and high erythrocyte sedimentation rate with normal procalcitoninu concentration. Elevation of ALT, AST, creatinine, D-dimers, creatine kinase, lactate dehydrogenase, and prolongation of prothrombin time may occur. More marked abnormalities in these parameters tend to be associated with a more severe course [25].

X-ray findings of bilateral pulmonary infiltrates, cariated opacities, or a "ground glass" image on chest CT are frequent. Infiltrates are usually bilateral, peripheral and more commonly in the lower lobes [9].

Laboratory diagnosis is based on detection of the viral genome by RT-PCR' in nasopharyngeal or oropharyngeal swabs, sputum, or respiratory aspirate [26]. Confirmation is performed using RT-PCR with a different set of primers or sequencing. When taking material, sputum induction is not recommended. For safety reasons, virological culture is not performed in patients with suspected COVID-19. The WHO does not recommend approaches other than the detection of viral RNA for the diagnosis of COVID-19. However, rapid diagnostic tests based on evidence of IgG and IgM against SARS-CoV-2 are also available from auxiliary laboratory examination methods [27]. They have the advantage of speed of execution (on the order of minutes compared to several hours required for RT-PCR) and low cost. The main disadvantage is the several-day diagnostic window. The sensitivity and specificity of rapid diagnostic tests are around 85-90% and 90% respectively in symptomatic individuals [27].

Other laboratory procedures that detect viral RNA are also being tried. These include procedures using rapid amplification of a section of viral nucleic acid using RT-RPA and detection based on specific cleavage using CRISPR. The advantage should be faster execution (on the order of tens of minutes) and less demanding laboratory equipment compared to classically performed RT-PCR while maintaining high sensitivity and specificity. [28]

Specific cases of infection

Pregnancy

Data for outcomes of infections in pregnancy are still very limited. Pregnancy appears to be a risk factor for a more severe course of maternal illness[29]. For now, there has been no evidence of an increased risk of fetal birth defects[30], however, there may be an increased risk of preterm delivery and associated complications, or complications of inadequate uterine perfusion in the critical course of the mother's illness [31]. Limited data suggest that the risk of spontaneous abortion is not increased.

The significance of vertical transmission is still uncertain; neonatal infections may be largely due to postnatal close contact between mother and child. The course of the disease in newborns is mild in the vast majority of cases, with complications usually due to premature birth. [31]

Infections in children

During the Chinese epidemic, the SARS-CoV-2 virus spread rapidly among children, so children are considered to be strong carriers. Infection in these children can range in severity from asymptomatic to severe respiratory failure. Respiratory failure has been described mainly in children with pre-existing chronic disease. In general, however, COVID-19 disease usually has a mild course in children. The most common manifestations include fever, malaise and dry cough. A few patients have had symptoms of upper respiratory tract inflammation, such as feeling stuffy, nasal secretions and sore throat. Gastrointestinal symptoms include abdominal discomfort, vomiting, abdominal pain and diarrhea. Mycoplasma pneumoniae, influenza A, influenza B, RSV and EB virosis may coexist with SARS-CoV-2 infection. The clearance time of SARS-CoV-2 nucleic acid from nasopharyngeal swabs was monitored in 3 children - 9 days in 2 children and 12 days in 1 child. [32][33]

In Wuhan, 6 children were caught positive for SARS-CoV-2 in January 2020. They were aged 1 to 7 years old, previously quite healthy. All had fever above 39°C, cough and (4 of the 6) vomited. They had decreased lymphocytes (all), leukocytes (2/3) and neutrophils (1/2). 4 of these children had radiographic evidence of pneumonia, with CT scans showing a typical picture of viral pneumonia. One of the children was admitted to the intensive care unit and received immunoglobulins from healthy donors. All of these children were treated empirically with antivirals, antibiotics, and supportive care and recovered in 5 to 13 days. [33] The treatment of COVID-19 in children is based on the experience of adult treatment. Of the antiviral agents, remdesivir or lopinavir-ritonavir is used. The pharmacology of i.v. remdesivir is unknown, while lopinavir-ritonavir has been shown to be safe in pregnancy but is only available in tablets. [34]

In an analysis of 72 314 cases from China, there were no confirmed deaths in the age category ≤ 9 years (0/416) and 1 death in the age category ≤ 19 years (1/549)[17].

A rare complication of SARS-CoV-2 infection in children is pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2, PIMS-TS.

Searchtool right.svg For more information see PIMS-TS.

Prevention

Several types of vaccines can be vaccinated against SARS-CoV-2 infection. The development of this active immunization was based on earlier research conducted during the MERS-CoV and SARS-CoV-1 epidemics.

Searchtool right.svg For more information see COVID-19 vaccination.


Pharmacological prophylaxis is currently unknown.

Thus, non-pharmacological preventive practices are the basis for preventing and limiting the spread of SARS-CoV-2. These include limitation of close social contact, isolation of ill persons, hand hygiene' or use of protective equipment, especially to cover the mouth and nose in areas with a high risk of transmission according to current recommendations. The development of the current recommendations issued by health organisations can be followed, for example, on the WHO website or Ministry of Health of the Czech Republic.

Video library

Ministry of Health information spot

Added 31. 03. 2020



Summary video by Osmosis

Added 12 Aug 2020



PIMS-TS

Added 21 Jan 2021 A rare complication of Covid 19 in children Etiopathogenesis, diagnosis, and treatment of covid-19-associated multisystem inflammatory response syndrome (PIMS-TS). Webinar. Paediatric Clinic of the 2nd Faculty of Medicine of Charles University and Motol University Hospital, Prague, 7 January 2021.



Links

External links

Related Articles

References

  • AMBLER, Zdeněk. Basics of neurology. 6th edition. Prague: Galén, 2006. pp. 171-181. ISBN 80-7262-433-4 .
  1. {{#switch: web |book = Incomplete publication citation. WHO. . WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [online] . Also available from <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020>.  |collection = Incomplete citation of contribution in proceedings. WHO. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [online] . Also available from <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  WHO. also available from <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020>.  |web = Incomplete site citation. WHO. [cit. 2020-08-17]. <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020>. |cd = Incomplete carrier citation. WHO. [cit. 2020-08-17].  |db = Incomplete database citation. [cit. 2020-08-17]. <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020>. |corporate_literature = Incomplete citation of company literature. WHO. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [online] . Also available from <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020>. legislative_document = Incomplete citation of legislative document.  Also available from URL <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020>.
  2. AMBLER, Zdeněk. Basics of neurology. 6th edition. Prague: Galén, 2006. pp. 171-181. ISBN 80-7262-433-4 .. The SARS-CoV-2 sequence is 70% identical to the genetic information of the virus SARS-CoV {{CitationsSARS-CoV ref name="Hui">AMBLER, Zdeněk. Basics of neurology. 6th edition. Prague: Galén, 2006. pp. 171-181. ISBN 80-7262-433-4 .
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  4. {{#switch: article |book = Incomplete publication citation.  and ZOU2020. pp. ?.  |collection = Incomplete citation of contribution in proceedings.  and ZOU. 2020. pp. ?. {{ #if: |978-80-7262-438-6} } |article =  and ZOU. 2019_nCoV/SARS-CoV-2: rapid classification of betacoronaviruses and identification of Traditional Chinese Medicine as potential origin of zoonotic coronaviruses. 2020, year 2020, pp. ?, ISSN 0266-8254. DOI: 10.1111/lam.13285. |web = Incomplete site citation.  and ZOU. ©2020.  |cd = Incomplete carrier citation.  and ZOU. ©2020.  |db = Incomplete database citation. ©2020.  |corporate_literature = Incomplete citation of company literature.  and ZOU. 2020. legislative_document = Incomplete citation of legislative document.  2020. s. ?. ISSN 0266-8254.
  5. {{#switch: article |book = Incomplete publication citation.  and ZHANG?. pp. ?.  |collection = Incomplete citation of contribution in proceedings.  and ZHANG. ?. pp. ?. {{ #if: |978-80-7262-438-6} } |article =  and ZHANG. Probable Pangolin Origin of 2019-nCoV Associated with Outbreak of COVID-19. ?, year ?, pp. ?, ISSN 1556-5068. DOI: 10.2139/ssrn.3542586. |web = Incomplete site citation.  and ZHANG. ©?.  |cd = Incomplete carrier citation.  and ZHANG. ©?.  |db = Incomplete database citation. ©?.  |corporate_literature = Incomplete citation of company literature.  and ZHANG. ?. legislative_document = Incomplete citation of legislative document.  ?. s. ?. ISSN 1556-5068.
  6. {{#switch: article |book = Incomplete publication citation. 7797. pp. 18-19.  |collection = Incomplete citation of contribution in proceedings. . 7797. pp. 18-19. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  . Mystery deepens over animal source of coronavirus. 7797, year 7797, pp. 18-19, ISSN 0028-0836. DOI: 10.1038/d41586-020-00548-w. |web = Incomplete site citation. . ©7797.  |cd = Incomplete carrier citation. . ©7797.  |db = Incomplete database citation. ©7797.  |corporate_literature = Incomplete citation of company literature. . 7797. legislative_document = Incomplete citation of legislative document.  7797. s. 18-19. ISSN 0028-0836.
  7. {{#switch: article |book = Incomplete publication citation.  and LIU?. pp. ?.  |collection = Incomplete citation of contribution in proceedings.  and LIU. ?. pp. ?. {{ #if: |978-80-7262-438-6} } |article =  and LIU. Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods. ?, year ?, pp. ?, ISSN 2211-3835. DOI: 10.1016/j.apsb.2020.02.008. |web = Incomplete site citation.  and LIU. ©?.  |cd = Incomplete carrier citation.  and LIU. ©?.  |db = Incomplete database citation. ©?.  |corporate_literature = Incomplete citation of company literature.  and LIU. ?. legislative_document = Incomplete citation of legislative document.  ?. s. ?. ISSN 2211-3835.
  8. {{#switch: article |book = Incomplete publication citation. , XIAO and WEI, et al2020. pp. ?. Also available from <https://doi.org/10.1002/jmv.25726>.  |collection = Incomplete citation of contribution in proceedings. , XIAO and WEI, et al. 2020. pp. ?. Also available from <https://doi.org/10.1002/jmv.25726>. {{ #if: |978-80-7262-438-6} } |article = , XIAO and WEI, et al. Composition and divergence of coronavirus spike proteins and host ACE2 receptors predict potential intermediate hosts of SARS-CoV-2. 2020, year 2020, pp. ?, also available from <https://doi.org/10.1002/jmv.25726>. ISSN 0146-6615 (print), 1096-9071.  |web = Incomplete site citation. , XIAO and WEI, et al. ©2020. <https://doi.org/10.1002/jmv.25726>. |cd = Incomplete carrier citation. , XIAO and WEI, et al. ©2020.  |db = Incomplete database citation. ©2020. <https://doi.org/10.1002/jmv.25726>. |corporate_literature = Incomplete citation of company literature. , XIAO and WEI, et al. 2020. Also available from <https://doi.org/10.1002/jmv.25726>. legislative_document = Incomplete citation of legislative document.  2020. s. ?. Also available from URL <https://doi.org/10.1002/jmv.25726>. ISSN 0146-6615 (print), 1096-9071.
  9. Jump up to: a b c d e f g h i j k l m n {{#switch: db |book = Incomplete publication citation. . UpToDate : Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention [online] . Wolters Kluwer Health, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention>.  |collection = Incomplete citation of contribution in proceedings. UpToDate : Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention [online] . Wolters Kluwer Health, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  . 2020, year 2020, also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention>.  |web = Incomplete site citation. . Wolters Kluwer Health, ©2020. Last revision 2020-03-20, [cit. 2020-08-14]. <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention>. |cd = Incomplete carrier citation. . Wolters Kluwer Health, ©2020. Last revision 2020-03-20, [cit. 2020-08-14].  |db = Incomplete database citation. MCINTOSH Kenneth, Martin S HIRSCH and Allyson BLOOM. Wolters Kluwer Health, ©2020. Last revision 2020-03-20, [cit. 2020-08-14]. <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention>. |corporate_literature = . UpToDate : Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention [online] . Wolters Kluwer Health, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention>. legislative_document = Incomplete citation of legislative document.  2020. Also available from URL <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention>. Cite error: Invalid <ref> tag; name "Uptodate" defined multiple times with different content
  10. {{#switch: web |book = Incomplete publication citation. CDC. . Interim Clinical Guideline for the Management of Patients with Confirmed Coronavirus Disease (COVID-19) [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html>.  |collection = Incomplete citation of contribution in proceedings. CDC. Interim Clinical Guideline for the Management of Patients with Confirmed Coronavirus Disease (COVID-19) [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  CDC. also available from <https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html>.  |web = Incomplete site citation. CDC. Last revision 2020-07-30, [cit. 2020-08-14]. <https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html>. |cd = Incomplete carrier citation. CDC. Last revision 2020-07-30, [cit. 2020-08-14].  |db = Incomplete database citation. Last revision 2020-07-30, [cit. 2020-08-14]. <https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html>. |corporate_literature = Incomplete citation of company literature. CDC. Interim Clinical Guideline for the Management of Patients with Confirmed Coronavirus Disease (COVID-19) [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html>. legislative_document = Incomplete citation of legislative document.  Also available from URL <https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html>.
  11. Jump up to: a b c {{#switch: web |book = Incomplete publication citation. CDC. . Duration of Isolation and Precautions for Adults with COVID-19 [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html>.  |collection = Incomplete citation of contribution in proceedings. CDC. Duration of Isolation and Precautions for Adults with COVID-19 [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  CDC. also available from <https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html>.  |web = Incomplete site citation. CDC. [cit. 2020-08-16]. <https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html>. |cd = Incomplete carrier citation. CDC. [cit. 2020-08-16].  |db = Incomplete database citation. [cit. 2020-08-16]. <https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html>. |corporate_literature = Incomplete citation of company literature. CDC. Duration of Isolation and Precautions for Adults with COVID-19 [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html>. legislative_document = Incomplete citation of legislative document.  Also available from URL <https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html>.
  12. {{#switch: article |book = Incomplete publication citation. ?. pp. 1-35.  |collection = Incomplete citation of contribution in proceedings. . ?. pp. 1-35. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  . Understanding Viral Shedding of SARS-CoV-2: Review of Current Literature. ?, year ?, pp. 1-35, ISSN 0899-823X. DOI: 10.1017/ice.2020.1273. |web = Incomplete site citation. . ©?.  |cd = Incomplete carrier citation. . ©?.  |db = Incomplete database citation. ©?.  |corporate_literature = Incomplete citation of company literature. . ?. legislative_document = Incomplete citation of legislative document.  ?. s. 1-35. ISSN 0899-823X.
  13. {{#switch: article |book = Incomplete publication citation. LAI, and KO2020. pp. 105924.  |collection = Incomplete citation of contribution in proceedings. LAI, and KO. 2020. pp. 105924. {{ #if: |978-80-7262-438-6} } |article = LAI, and KO. Coronavirus 2 acute respiratory syndrome (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): epidemics and challenges. 2020, year 2020, pp. 105924, ISSN 0924-8579. DOI: 10.1016/j.ijantimicag.2020.105924. |web = Incomplete site citation. LAI, and KO. ©2020.  |cd = Incomplete carrier citation. LAI, and KO. ©2020.  |db = Incomplete database citation. ©2020.  |corporate_literature = Incomplete citation of company literature. LAI, and KO. 2020. legislative_document = Incomplete citation of legislative document.  2020. s. 105924. ISSN 0924-8579.
  14. Jump up to: a b c d e f g {{#switch: db |book = Incomplete publication citation. . UpToDate : Coronavirus disease 2019 (COVID-19): clinical picture [online] . Wolters Kluwer Health, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features>.  |collection = Incomplete citation of contribution in proceedings. UpToDate : Coronavirus disease 2019 (COVID-19): clinical picture [online] . Wolters Kluwer Health, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  . 2020, year 2020, also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features>.  |web = Incomplete site citation. . Wolters Kluwer Health, ©2020. Last revision 2020-08-14, [cit. 2020-08-16]. <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features>. |cd = Incomplete carrier citation. . Wolters Kluwer Health, ©2020. Last revision 2020-08-14, [cit. 2020-08-16].  |db = Incomplete database citation. MCINTOSH Kenneth, Martin S HIRSCH and Allyson BLOOM. Wolters Kluwer Health, ©2020. Last revision 2020-08-14, [cit. 2020-08-16]. <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features>. |corporate_literature = . UpToDate : Coronavirus disease 2019 (COVID-19): clinical picture [online] . Wolters Kluwer Health, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features>. legislative_document = Incomplete citation of legislative document.  2020. Also available from URL <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-features>.
  15. {{#switch: web |book = Incomplete publication citation. Mayo Clinic. . Coronavirus Disease 2019 (COVID-19) [online] . Also available from <https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963>.  |collection = Incomplete citation of contribution in proceedings. Mayo Clinic. Coronavirus Disease 2019 (COVID-19) [online] . Also available from <https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  Mayo Clinic. also available from <https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963>.  |web = Incomplete site citation. Mayo Clinic. Last revision 2020-08-07, [cit. 2020-08-16]. <https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963>. |cd = Incomplete carrier citation. Mayo Clinic. Last revision 2020-08-07, [cit. 2020-08-16].  |db = Incomplete database citation. Last revision 2020-08-07, [cit. 2020-08-16]. <https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963>. |corporate_literature = Incomplete citation of company literature. Mayo Clinic. Coronavirus Disease 2019 (COVID-19) [online] . Also available from <https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963>. legislative_document = Incomplete citation of legislative document.  Also available from URL <https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963>.
  16. {{#switch: web |book = Incomplete publication citation. CDC. . Symptoms of coronavirus [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html>.  |collection = Incomplete citation of contribution in proceedings. CDC. Symptoms of coronavirus [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  CDC. also available from <https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html>.  |web = Incomplete site citation. CDC. Last revision 2020-05-13, [cit. 2020-08-16]. <https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html>. |cd = Incomplete carrier citation. CDC. Last revision 2020-05-13, [cit. 2020-08-16].  |db = Incomplete database citation. Last revision 2020-05-13, [cit. 2020-08-16]. <https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html>. |corporate_literature = Incomplete citation of company literature. CDC. Symptoms of coronavirus [online] . Also available from <https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html>. legislative_document = Incomplete citation of legislative document.  Also available from URL <https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html>.
  17. Jump up to: a b {{#switch: web |book = Incomplete publication citation. OKE,. Global Covid-19 Case Fatality Rates [online] . CEBM - The Centre for Evidence-Based Medicine, Also available from <https://www.cebm.net/global-covid-19-case-fatality-rates/>.  |collection = Incomplete citation of contribution in proceedings. OKE,. Global Covid-19 Case Fatality Rates [online] . CEBM - The Centre for Evidence-Based Medicine, Also available from <https://www.cebm.net/global-covid-19-case-fatality-rates/>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  OKE,. also available from <https://www.cebm.net/global-covid-19-case-fatality-rates/>.  |web = Incomplete site citation. OKE,. CEBM - The Centre for Evidence-Based Medicine, Last revision 2020-03-23, [cit. 2020-03-24]. <https://www.cebm.net/global-covid-19-case-fatality-rates/>. |cd = Incomplete carrier citation. OKE,. CEBM - The Centre for Evidence-Based Medicine, Last revision 2020-03-23, [cit. 2020-03-24].  |db = Incomplete database citation. CEBM - The Centre for Evidence-Based Medicine, Last revision 2020-03-23, [cit. 2020-03-24]. <https://www.cebm.net/global-covid-19-case-fatality-rates/>. |corporate_literature = Incomplete citation of company literature. OKE,. Global Covid-19 Case Fatality Rates [online] . CEBM - The Centre for Evidence-Based Medicine, Also available from <https://www.cebm.net/global-covid-19-case-fatality-rates/>. legislative_document = Incomplete citation of legislative document.  Also available from URL <https://www.cebm.net/global-covid-19-case-fatality-rates/>.
  18. {{#switch: web |book = Incomplete publication citation. World health organization. . WHO Director-General's opening remarks at the media briefing on COVID-19 - 24 February 2020 [online] . 2020. Also available from <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february- 2020>.  |collection = Incomplete citation of contribution in proceedings. World health organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 24 February 2020 [online] . 2020. Also available from <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february- 2020>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  World health organization. 2020, year 2020, also available from <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february- 2020>.  |web = Incomplete site citation. World health organization. ©2020. Last revision 2020-02-24, [cit. 2020-03-04]. <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february- 2020>. |cd = Incomplete carrier citation. World health organization. ©2020. Last revision 2020-02-24, [cit. 2020-03-04].  |db = Incomplete database citation. ©2020. Last revision 2020-02-24, [cit. 2020-03-04]. <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february- 2020>. |corporate_literature = Incomplete citation of company literature. World health organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 24 February 2020 [online] . 2020. Also available from <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february- 2020>. legislative_document = Incomplete citation of legislative document.  2020. Also available from URL <https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february- 2020>.
  19. {{#switch: {{{type}}} |book = Incomplete publication citation. Wolters Kluwer, 2020.  |collection = Incomplete citation of contribution in proceedings. . Wolters Kluwer, 2020. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  . UpToDate. 2020, year 2020,  |web = Incomplete site citation. . UpToDate : Coronavirus disease 2019 (COVID-19): Evaluation and management of adults following acute viral illness [online]. Wolters Kluwer, ©2020. Last revision 2020-12-21 url =https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-evaluation-and-management-of-adults-following-acute-viral-illness?sectionName=COVID-19%20RECOVERY&search=undefined&topicRef=128323&anchor=H1945726940&source=see_link#H1945726940, [cit. 2021-01-21].  |cd = Incomplete carrier citation. UpToDate : Coronavirus disease 2019 (COVID-19): Evaluation and management of adults following acute viral illness [CD/DVD]. Wolters Kluwer, ©2020. Last revision 2020-12-21 url =https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-evaluation-and-management-of-adults-following-acute-viral-illness?sectionName=COVID-19%20RECOVERY&search=undefined&topicRef=128323&anchor=H1945726940&source=see_link#H1945726940, [cit. 2021-01-21].  |db = Incomplete database citation. UpToDate : Coronavirus disease 2019 (COVID-19): Evaluation and management of adults following acute viral illness [database]. MIKKELSEN, Mark E and Benjamin ABRAMOFF. Wolters Kluwer, ©2020. Last revision 2020-12-21 url =https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-evaluation-and-management-of-adults-following-acute-viral-illness?sectionName=COVID-19%20RECOVERY&search=undefined&topicRef=128323&anchor=H1945726940&source=see_link#H1945726940, [cit. 2021-01-21].  |corporate_literature = Incomplete citation of company literature. . Wolters Kluwer, 2020. legislative_document = Incomplete citation of legislative document.  2020.
  20. Jump up to: a b c {{#switch: web |book = Incomplete publication citation.  and Rajesh T GANDHIWolters Kluwer, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197>.  |collection = Incomplete citation of contribution in proceedings.  and Rajesh T GANDHI. Wolters Kluwer, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.   and Rajesh T GANDHI. UpToDate. 2020, year 2020, also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197>.  |web =  and Rajesh T GANDHI. UpToDate : Coronavirus disease 2019 (COVID-19): Management in hospitalized adults [online]. Wolters Kluwer, ©2020. Last revision 2020-10-19, [cit. 2020-10-23]. <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197>. |cd =  and Rajesh T GANDHI. UpToDate : Coronavirus disease 2019 (COVID-19): Management in hospitalized adults [CD/DVD]. Wolters Kluwer, ©2020. Last revision 2020-10-19, [cit. 2020-10-23].  |db = Incomplete database citation. UpToDate : Coronavirus disease 2019 (COVID-19): Management in hospitalized adults [database]. Wolters Kluwer, ©2020. Last revision 2020-10-19, [cit. 2020-10-23]. <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197>. |corporate_literature = Incomplete citation of company literature.  and Rajesh T GANDHI. Wolters Kluwer, 2020. Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197>. legislative_document = Incomplete citation of legislative document.  2020. Also available from URL <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?topicRef=126981&source=see_link#H2223242197>.
  21. {{#switch: article |book = Incomplete publication citation. HEIDARY, Fatemeh and Section GHAREBAGHI2020. pp. 593-602. Also available from <https://doi.org/10.1038/s41429-020-0336-z>.  |collection = Incomplete citation of contribution in proceedings. HEIDARY, Fatemeh and Section GHAREBAGHI. 2020. pp. 593-602. Also available from <https://doi.org/10.1038/s41429-020-0336-z>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  HEIDARY, Fatemeh and Section GHAREBAGHI. Ivermectin: a systematic review of antiviral effects to COVID-19 complementary regimen. J Antibiot Tokyo [online]. 2020, year 2020, well. 9, pp. 593-602, also available from <https://doi.org/10.1038/s41429-020-0336-z>. ISSN 0021-8820 (print), 1881-1469.  |web = Incomplete site citation. HEIDARY, Fatemeh and Section GHAREBAGHI. ©2020. <https://doi.org/10.1038/s41429-020-0336-z>. |cd = Incomplete carrier citation. HEIDARY, Fatemeh and Section GHAREBAGHI. ©2020.  |db = Incomplete database citation. ©2020. <https://doi.org/10.1038/s41429-020-0336-z>. |corporate_literature = Incomplete citation of company literature. HEIDARY, Fatemeh and Section GHAREBAGHI. 2020. Also available from <https://doi.org/10.1038/s41429-020-0336-z>. legislative_document = Incomplete citation of legislative document.  2020. s. 593-602. Also available from URL <https://doi.org/10.1038/s41429-020-0336-z>. ISSN 0021-8820 (print), 1881-1469.
  22. {{#switch: article |book = Incomplete publication citation. RAJTER, Juliana Cepelowicz and Naaz FATTEH1. pp. 85-92.  |collection = Incomplete citation of contribution in proceedings. RAJTER, Juliana Cepelowicz and Naaz FATTEH. 1. pp. 85-92. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  RAJTER, Juliana Cepelowicz and Naaz FATTEH. Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019. Chest. 1, year 1, pp. 85-92, ISSN 0012-3692. DOI: 10.1016/j.chest.2020.10.009. |web = Incomplete site citation. RAJTER, Juliana Cepelowicz and Naaz FATTEH. ©1.  |cd = Incomplete carrier citation. RAJTER, Juliana Cepelowicz and Naaz FATTEH. ©1.  |db = Incomplete database citation. ©1.  |corporate_literature = Incomplete citation of company literature. RAJTER, Juliana Cepelowicz and Naaz FATTEH. 1. legislative_document = Incomplete citation of legislative document.  1. s. 85-92. ISSN 0012-3692.
  23. [1]
  24. {{#switch: article |book = Incomplete publication citation.  and Richard L. SEIP10. pp. 1617-1623.  |collection = Incomplete citation of contribution in proceedings.  and Richard L. SEIP. 10. pp. 1617-1623. {{ #if: |978-80-7262-438-6} } |article =  and Richard L. SEIP. Impact of Famotidine Use on Clinical Outcomes of Hospitalized Patients With COVID-19. 10, year 10, pp. 1617-1623, ISSN 0002-9270. DOI: 10.14309 / ajg.0000000000000832. |web = Incomplete site citation.  and Richard L. SEIP. ©10.  |cd = Incomplete carrier citation.  and Richard L. SEIP. ©10.  |db = Incomplete database citation. ©10.  |corporate_literature = Incomplete citation of company literature.  and Richard L. SEIP. 10. legislative_document = Incomplete citation of legislative document.  10. s. 1617-1623. ISSN 0002-9270.
  25. Jump up to: a b {{#switch: article |book = Incomplete publication citation. SINGHAL, Tanu?.  |collection = Incomplete citation of contribution in proceedings. SINGHAL, Tanu. ?. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  SINGHAL, Tanu. A Review of Coronavirus Disease-2019 (COVID-19). The Indian Journal of Pediatrics. ?, year ?, ISSN 0019-5456. DOI: 10.1007 / s12098-020-03263-6. |web = Incomplete site citation. SINGHAL, Tanu. ©?.  |cd = Incomplete carrier citation. SINGHAL, Tanu. ©?.  |db = Incomplete database citation. ©?.  |corporate_literature = Incomplete citation of company literature. SINGHAL, Tanu. ?. legislative_document = Incomplete citation of legislative document.  ?. ISSN 0019-5456.
  26. {{#switch: web |book = Incomplete publication citation. World health organization. . Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans [online] . Also available from <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance>.  |collection = Incomplete citation of contribution in proceedings. World health organization. Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans [online] . Also available from <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  World health organization. also available from <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance>.  |web = Incomplete site citation. World health organization. [cit. 2020-03-04]. <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance>. |cd = Incomplete carrier citation. World health organization. [cit. 2020-03-04].  |db = Incomplete database citation. [cit. 2020-03-04]. <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance>. |corporate_literature = Incomplete citation of company literature. World health organization. Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans [online] . Also available from <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance>. legislative_document = Incomplete citation of legislative document.  Also available from URL <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance>.
  27. Jump up to: a b {{#switch: article |book = Incomplete publication citation. LI, Zhengtu, Yongxiang YI and Xiaomei LUO?.  |collection = Incomplete citation of contribution in proceedings. LI, Zhengtu, Yongxiang YI and Xiaomei LUO. ?. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  LI, Zhengtu, Yongxiang YI and Xiaomei LUO. Development and Clinical Application of A Rapid IgM ‐ IgG Combined Antibody Test for SARS ‐ CoV ‐ 2 Infection Diagnosis. ?, year ?, ISSN 0146-6615. DOI: 10.1002/jmv.25727. |web = Incomplete site citation. LI, Zhengtu, Yongxiang YI and Xiaomei LUO. ©?.  |cd = Incomplete carrier citation. LI, Zhengtu, Yongxiang YI and Xiaomei LUO. ©?.  |db = Incomplete database citation. ©?.  |corporate_literature = Incomplete citation of company literature. LI, Zhengtu, Yongxiang YI and Xiaomei LUO. ?. legislative_document = Incomplete citation of legislative document.  ?. ISSN 0146-6615.
  28. {{#switch: article |book = Incomplete publication citation. BROUGHTON, and YU2020. pp. ?.  |collection = Incomplete citation of contribution in proceedings. BROUGHTON, and YU. 2020. pp. ?. {{ #if: |978-80-7262-438-6} } |article = BROUGHTON, and YU. Rapid Detection of 2019 Novel Coronavirus SARS-CoV-2 Using a CRISPR-based DETECTR Lateral Flow Assay. 2020, year 2020, pp. ?, ISSN ?. DOI: 10.1101/2020.03.06.20032334. |web = Incomplete site citation. BROUGHTON, and YU. ©2020.  |cd = Incomplete carrier citation. BROUGHTON, and YU. ©2020.  |db = Incomplete database citation. ©2020.  |corporate_literature = Incomplete citation of company literature. BROUGHTON, and YU. 2020. legislative_document = Incomplete citation of legislative document.  2020. s. ?. ISSN ?.
  29. {{#switch: web |book = Incomplete publication citation. BERGHELLA,, et al. Coronavirus disease 2019 (COVID-19): Pregnancy issues and antenatal care [online] . UpToDate, Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues-and-antenatal-care>.  |collection = Incomplete citation of contribution in proceedings. BERGHELLA,, et al. Coronavirus disease 2019 (COVID-19): Pregnancy issues and antenatal care [online] . UpToDate, Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues-and-antenatal-care>. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  BERGHELLA,, et al. also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues-and-antenatal-care>.  |web = Incomplete site citation. BERGHELLA,, et al. UpToDate, [cit. 2020-11-16]. <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues-and-antenatal-care>. |cd = Incomplete carrier citation. BERGHELLA,, et al. UpToDate, [cit. 2020-11-16].  |db = Incomplete database citation. UpToDate, [cit. 2020-11-16]. <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues-and-antenatal-care>. |corporate_literature = Incomplete citation of company literature. BERGHELLA,, et al. Coronavirus disease 2019 (COVID-19): Pregnancy issues and antenatal care [online] . UpToDate, Also available from <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues-and-antenatal-care>. legislative_document = Incomplete citation of legislative document.  Also available from URL <https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues-and-antenatal-care>. .
  30. {{#switch: article |book = Incomplete publication citation. 2020. pp. ?.  |collection = Incomplete citation of contribution in proceedings. . 2020. pp. ?. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  . Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy - SET-NET, 16 Jurisdictions, March 29-October 14, 2020. 2020, year 2020, pp. ?, ISSN 0149-2195. DOI: 10.15585/mmwr.mm6944e2. |web = Incomplete site citation. . ©2020.  |cd = Incomplete carrier citation. . ©2020.  |db = Incomplete database citation. ©2020.  |corporate_literature = Incomplete citation of company literature. . 2020. legislative_document = Incomplete citation of legislative document.  2020. s. ?. ISSN 0149-2195.
  31. Jump up to: a b Cite error: Invalid <ref> tag; no text was provided for refs named UTDtěho
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  33. Jump up to: a b {{#switch: article |book = Incomplete publication citation. 2020. pp. ?.  |collection = Incomplete citation of contribution in proceedings. . 2020. pp. ?. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  . Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. 2020, year 2020, pp. ?, ISSN 0028-4793. DOI: 10.1056/nejmc2003717. |web = Incomplete site citation. . ©2020.  |cd = Incomplete carrier citation. . ©2020.  |db = Incomplete database citation. ©2020.  |corporate_literature = Incomplete citation of company literature. . 2020. legislative_document = Incomplete citation of legislative document.  2020. s. ?. ISSN 0028-4793.
  34. {{{#switch: article |book = Incomplete publication citation. 2020. pp. ?.  |collection = Incomplete citation of contribution in proceedings. . 2020. pp. ?. {{ #if: |978-80-7262-438-6} } |article = Incomplete article citation.  . Managing neonates with respiratory failure due to SARS-CoV-2. 2020, year 2020, pp. ?, ISSN 2352-4642. DOI: 10.1016/s2352-4642(20)30073-0. |web = Incomplete site citation. . ©2020.  |cd = Incomplete carrier citation. . ©2020.  |db = Incomplete database citation. ©2020.  |corporate_literature = Incomplete citation of company literature. . 2020. legislative_document = Incomplete citation of legislative document.  2020. s. ?. ISSN 2352-4642.