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5. COVID-19 – Clinical Significance
COVID-19 emerged in December 2019 in Wuhan [1] and rapidly spread, giving rise to a global outbreak which was assigned pandemic status by the WHO in March 2020. By March 2020, there were more than 200,000 confirmed cases of disease and in excess of 8,000 fatalities, with cases reported on all continents.
The disease is caused by the zoonotic virus SARS-CoV2 [2] which is thought to have originated, like previous related human coronaviruses including SARS and MERS, in bats [3]. Multiple sequences of the genome of this RNA virus have been data banked thus far; little conclusive evidence on strain variation and impact on severity of disease is currently available. Likewise, the seasonality of the virus is unknown at the moment, with some experts speculating that COVID-19 may become a global seasonal infection, like influenza, after the initial pandemic runs its course [4].
Symptoms of COVID-19 include fever, cough, fatigue and shortness of breath, and – less commonly – sore throat and headache [5]; however, asymptomatic carriage has also been widely reported [6]. While 80% of infected individuals recover without the need for specialist treatment, the disease can progress to pneumonia and other complications in some patients. The overall case fatality rate is unclear at the moment, but is estimated to be in the range of 0.25% – 3.0% [7], with the fatalities to date being predominantly among the older population (> 10% for individuals above 70 years of age [8]) and those with underlying health conditions.
The SARS-CoV-2 virus appears to be highly transmissible, being spread from person to person by droplets and surface contact; in some cases, contact of only 15 seconds in duration has been shown to be sufficient for transmission of the virus [9]. Transmission by other routes – e.g. ocular, faecal/oral, vertical transmission from mother to offspring – cannot be ruled out, and the role played by transmission from asymptomatic individuals is currently unclear. The average incubation period for the virus, from exposure to onset of symptoms, has been estimated at 5 days [10]. Current evidence suggests that viral load peaks at onset, decreasing within 1-3 weeks [11], with some data showing that infectiousness is reduced after 7-10 days of symptoms [12]
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