presentations on covid 19

• Patient Care & Health Information
• Diseases & Conditions
• Coronavirus disease 2019 (COVID-19)

COVID-19, also called coronavirus disease 2019, is an illness caused by a virus. The virus is called severe acute respiratory syndrome coronavirus 2, or more commonly, SARS-CoV-2. It started spreading at the end of 2019 and became a pandemic disease in 2020.

• Coronavirus

Coronaviruses are a family of viruses. These viruses cause illnesses such as the common cold, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19).

The virus that causes COVID-19 spreads most commonly through the air in tiny droplets of fluid between people in close contact. Many people with COVID-19 have no symptoms or mild illness. But for older adults and people with certain medical conditions, COVID-19 can lead to the need for care in the hospital or death.

Staying up to date on your COVID-19 vaccine helps prevent serious illness, the need for hospital care due to COVID-19 and death from COVID-19 . Other ways that may help prevent the spread of this coronavirus includes good indoor air flow, physical distancing, wearing a mask in the right setting and good hygiene.

Medicine can limit the seriousness of the viral infection. Most people recover without long-term effects, but some people have symptoms that continue for months.

Typical COVID-19 symptoms often show up 2 to 14 days after contact with the virus.

Symptoms can include:

• Shortness of breath.
• Loss of taste or smell.
• Extreme tiredness, called fatigue.
• Digestive symptoms such as upset stomach, vomiting or loose stools, called diarrhea.
• Pain, such as headaches and body or muscle aches.
• Fever or chills.
• Cold-like symptoms such as congestion, runny nose or sore throat.

People may only have a few symptoms or none. People who have no symptoms but test positive for COVID-19 are called asymptomatic. For example, many children who test positive don't have symptoms of COVID-19 illness. People who go on to have symptoms are considered presymptomatic. Both groups can still spread COVID-19 to others.

Some people may have symptoms that get worse about 7 to 14 days after symptoms start.

Most people with COVID-19 have mild to moderate symptoms. But COVID-19 can cause serious medical complications and lead to death. Older adults or people who already have medical conditions are at greater risk of serious illness.

COVID-19 may be a mild, moderate, severe or critical illness.

• In broad terms, mild COVID-19 doesn't affect the ability of the lungs to get oxygen to the body.
• In moderate COVID-19 illness, the lungs also work properly but there are signs that the infection is deep in the lungs.
• Severe COVID-19 means that the lungs don't work correctly, and the person needs oxygen and other medical help in the hospital.
• Critical COVID-19 illness means the lung and breathing system, called the respiratory system, has failed and there is damage throughout the body.

Rarely, people who catch the coronavirus can develop a group of symptoms linked to inflamed organs or tissues. The illness is called multisystem inflammatory syndrome. When children have this illness, it is called multisystem inflammatory syndrome in children, shortened to MIS -C. In adults, the name is MIS -A.

When to see a doctor

Contact a healthcare professional if you test positive for COVID-19 . If you have symptoms and need to test for COVID-19 , or you've been exposed to someone with COVID-19 , a healthcare professional can help.

People who are at high risk of serious illness may get medicine to block the spread of the COVID-19 virus in the body. Or your healthcare team may plan regular checks to monitor your health.

Get emergency help right away for any of these symptoms:

• Can't catch your breath or have problems breathing.
• Skin, lips or nail beds that are pale, gray or blue.
• New confusion.
• Trouble staying awake or waking up.
• Chest pain or pressure that is constant.

This list doesn't include every emergency symptom. If you or a person you're taking care of has symptoms that worry you, get help. Let the healthcare team know about a positive test for COVID-19 or symptoms of the illness.

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COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2, also called SARS-CoV-2.

The coronavirus spreads mainly from person to person, even from someone who is infected but has no symptoms. When people with COVID-19 cough, sneeze, breathe, sing or talk, their breath may be infected with the COVID-19 virus.

The coronavirus carried by a person's breath can land directly on the face of a nearby person, after a sneeze or cough, for example. The droplets or particles the infected person breathes out could possibly be breathed in by other people if they are close together or in areas with low air flow. And a person may touch a surface that has respiratory droplets and then touch their face with hands that have the coronavirus on them.

It's possible to get COVID-19 more than once.

• Over time, the body's defense against the COVID-19 virus can fade.
• A person may be exposed to so much of the virus that it breaks through their immune defense.
• As a virus infects a group of people, the virus copies itself. During this process, the genetic code can randomly change in each copy. The changes are called mutations. If the coronavirus that causes COVID-19 changes in ways that make previous infections or vaccination less effective at preventing infection, people can get sick again.

The virus that causes COVID-19 can infect some pets. Cats, dogs, hamsters and ferrets have caught this coronavirus and had symptoms. It's rare for a person to get COVID-19 from a pet.

Risk factors

The main risk factors for COVID-19 are:

• If someone you live with has COVID-19 .
• If you spend time in places with poor air flow and a higher number of people when the virus is spreading.
• If you spend more than 30 minutes in close contact with someone who has COVID-19 .

Many factors affect your risk of catching the virus that causes COVID-19 . How long you are in contact, if the space has good air flow and your activities all affect the risk. Also, if you or others wear masks, if someone has COVID-19 symptoms and how close you are affects your risk. Close contact includes sitting and talking next to one another, for example, or sharing a car or bedroom.

It seems to be rare for people to catch the virus that causes COVID-19 from an infected surface. While the virus is shed in waste, called stool, COVID-19 infection from places such as a public bathroom is not common.

Serious COVID-19 illness risk factors

Some people are at a higher risk of serious COVID-19 illness than others. This includes people age 65 and older as well as babies younger than 6 months. Those age groups have the highest risk of needing hospital care for COVID-19 .

Not every risk factor for serious COVID-19 illness is known. People of all ages who have no other medical issues have needed hospital care for COVID-19 .

Known risk factors for serious illness include people who have not gotten a COVID-19 vaccine. Serious illness also is a higher risk for people who have:

• Sickle cell disease or thalassemia.
• Serious heart diseases and possibly high blood pressure.
• Chronic kidney, liver or lung diseases.

People with dementia or Alzheimer's also are at higher risk, as are people with brain and nervous system conditions such as stroke. Smoking increases the risk of serious COVID-19 illness. And people with a body mass index in the overweight category or obese category may have a higher risk as well.

Other medical conditions that may raise the risk of serious illness from COVID-19 include:

• Cancer or a history of cancer.
• Type 1 or type 2 diabetes.
• Weakened immune system from solid organ transplants or bone marrow transplants, some medicines, or HIV .

This list is not complete. Factors linked to a health issue may raise the risk of serious COVID-19 illness too. Examples are a medical condition where people live in a group home, or lack of access to medical care. Also, people with more than one health issue, or people of older age who also have health issues have a higher chance of severe illness.

Related information

• COVID-19: Who's at higher risk of serious symptoms? - Related information COVID-19: Who's at higher risk of serious symptoms?

Complications

Complications of COVID-19 include long-term loss of taste and smell, skin rashes, and sores. The illness can cause trouble breathing or pneumonia. Medical issues a person already manages may get worse.

Complications of severe COVID-19 illness can include:

• Acute respiratory distress syndrome, when the body's organs do not get enough oxygen.
• Shock caused by the infection or heart problems.
• Overreaction of the immune system, called the inflammatory response.
• Blood clots.
• Kidney injury.

Post-COVID-19 syndrome

After a COVID-19 infection, some people report that symptoms continue for months, or they develop new symptoms. This syndrome has often been called long COVID, or post- COVID-19 . You might hear it called long haul COVID-19 , post-COVID conditions or PASC. That's short for post-acute sequelae of SARS -CoV-2.

Other infections, such as the flu and polio, can lead to long-term illness. But the virus that causes COVID-19 has only been studied since it began to spread in 2019. So, research into the specific effects of long-term COVID-19 symptoms continues.

Researchers do think that post- COVID-19 syndrome can happen after an illness of any severity.

Getting a COVID-19 vaccine may help prevent post- COVID-19 syndrome.

The Centers for Disease Control and Prevention (CDC) recommends a COVID-19 vaccine for everyone age 6 months and older. The COVID-19 vaccine can lower the risk of death or serious illness caused by COVID-19.

The COVID-19 vaccines available in the United States are:

2023-2024 Pfizer-BioNTech COVID-19 vaccine. This vaccine is available for people age 6 months and older.

Among people with a typical immune system:

• Children age 6 months up to age 4 years are up to date after three doses of a Pfizer-BioNTech COVID-19 vaccine.
• People age 5 and older are up to date after one Pfizer-BioNTech COVID-19 vaccine.
• For people who have not had a 2023-2024 COVID-19 vaccination, the CDC recommends getting an additional shot of that updated vaccine.

2023-2024 Moderna COVID-19 vaccine. This vaccine is available for people age 6 months and older.

• Children ages 6 months up to age 4 are up to date if they've had two doses of a Moderna COVID-19 vaccine.
• People age 5 and older are up to date with one Moderna COVID-19 vaccine.

2023-2024 Novavax COVID-19 vaccine. This vaccine is available for people age 12 years and older.

• People age 12 years and older are up to date if they've had two doses of a Novavax COVID-19 vaccine.

In general, people age 5 and older with typical immune systems can get any vaccine approved or authorized for their age. They usually don't need to get the same vaccine each time.

Some people should get all their vaccine doses from the same vaccine maker, including:

• Children ages 6 months to 4 years.
• People age 5 years and older with weakened immune systems.
• People age 12 and older who have had one shot of the Novavax vaccine should get the second Novavax shot in the two-dose series.

Talk to your healthcare professional if you have any questions about the vaccines for you or your child. Your healthcare team can help you if:

• The vaccine you or your child got earlier isn't available.
• You don't know which vaccine you or your child received.
• You or your child started a vaccine series but couldn't finish it due to side effects.

People with weakened immune systems

Your healthcare team may suggest added doses of COVID-19 vaccine if you have a moderately or seriously weakened immune system. The FDA has also authorized the monoclonal antibody pemivibart (Pemgarda) to prevent COVID-19 in some people with weakened immune systems.

Control the spread of infection

In addition to vaccination, there are other ways to stop the spread of the virus that causes COVID-19 .

If you are at a higher risk of serious illness, talk to your healthcare professional about how best to protect yourself. Know what to do if you get sick so you can quickly start treatment.

If you feel ill or have COVID-19 , stay home and away from others, including pets, if possible. Avoid sharing household items such as dishes or towels if you're sick.

In general, make it a habit to:

• Test for COVID-19 . If you have symptoms of COVID-19 test for the infection. Or test five days after you came in contact with the virus.
• Help from afar. Avoid close contact with anyone who is sick or has symptoms, if possible.
• Wash your hands. Wash your hands well and often with soap and water for at least 20 seconds. Or use an alcohol-based hand sanitizer with at least 60% alcohol.
• Cover your coughs and sneezes. Cough or sneeze into a tissue or your elbow. Then wash your hands.
• Clean and disinfect high-touch surfaces. For example, clean doorknobs, light switches, electronics and counters regularly.

Try to spread out in crowded public areas, especially in places with poor airflow. This is important if you have a higher risk of serious illness.

The CDC recommends that people wear a mask in indoor public spaces if you're in an area with a high number of people with COVID-19 in the hospital. They suggest wearing the most protective mask possible that you'll wear regularly, that fits well and is comfortable.

• COVID-19 vaccines: Get the facts - Related information COVID-19 vaccines: Get the facts
• Comparing the differences between COVID-19 vaccines - Related information Comparing the differences between COVID-19 vaccines
• Different types of COVID-19 vaccines: How they work - Related information Different types of COVID-19 vaccines: How they work
• Debunking COVID-19 myths - Related information Debunking COVID-19 myths

Travel and COVID-19

Travel brings people together from areas where illnesses may be at higher levels. Masks can help slow the spread of respiratory diseases in general, including COVID-19 . Masks help the most in places with low air flow and where you are in close contact with other people. Also, masks can help if the places you travel to or through have a high level of illness.

Masking is especially important if you or a companion have a high risk of serious illness from COVID-19 .

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• Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. https://www.covid19treatmentguidelines.nih.gov/. Accessed Dec. 18, 2023.
• AskMayoExpert. COVID-19: Testing, symptoms. Mayo Clinic; Nov. 2, 2023.
• Symptoms of COVID-19. Centers for Disease Control and Preventions. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed Dec. 20, 2023.
• AskMayoExpert. COVID-19: Outpatient management. Mayo Clinic; Oct. 10, 2023.
• Morris SB, et al. Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection — United Kingdom and United States, March-August 2020. MMWR. Morbidity and Mortality Weekly Report 2020;69:1450. DOI: http://dx.doi.org/10.15585/mmwr.mm6940e1external icon.
• COVID-19 testing: What you need to know. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html. Accessed Dec. 20, 2023.
• SARS-CoV-2 in animals. American Veterinary Medical Association. https://www.avma.org/resources-tools/one-health/covid-19/sars-cov-2-animals-including-pets. Accessed Jan. 17, 2024.
• Understanding exposure risk. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/your-health/risks-exposure.html. Accessed Jan. 10, 2024.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed Jan. 10, 2024.
• Factors that affect your risk of getting very sick from COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/your-health/risks-getting-very-sick.html. Accessed Jan. 10, 2024.
• Regan JJ, et al. Use of Updated COVID-19 Vaccines 2023-2024 Formula for Persons Aged ≥6 Months: Recommendations of the Advisory Committee on Immunization Practices—United States, September 2023. MMWR. Morbidity and Mortality Weekly Report 2023; 72:1140–1146. DOI: http://dx.doi.org/10.15585/mmwr.mm7242e1.
• Long COVID or post-COVID conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed Jan. 10, 2024.
• Stay up to date with your vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Accessed Jan. 10, 2024.
• Interim clinical considerations for use of COVID-19 vaccines currently approved or authorized in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#CoV-19-vaccination. Accessed Jan. 10, 2024.
• Use and care of masks. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html. Accessed Jan. 10, 2024.
• How to protect yourself and others. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed Jan. 10, 2024.
• People who are immunocompromised. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-who-are-immunocompromised.html. Accessed Jan. 10, 2024.
• Masking during travel. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/masks. Accessed Jan. 10, 2024.
• AskMayoExpert. COVID-19: Testing. Mayo Clinic. 2023.
• COVID-19 test basics. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/covid-19-test-basics. Accessed Jan. 11, 2024.
• At-home COVID-19 antigen tests — Take steps to reduce your risk of false negative results: FDA safety communication. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/safety-communications/home-covid-19-antigen-tests-take-steps-reduce-your-risk-false-negative-results-fda-safety. Accessed Jan. 11, 2024.
• Interim clinical considerations for COVID-19 treatment in outpatients. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/outpatient-treatment-overview.html. Accessed Jan. 11, 2024.
• Know your treatment options for COVID-19. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/know-your-treatment-options-covid-19. Accessed Jan. 11, 2024.
• AskMayoExpert. COVID:19 Drug regimens and other treatment options. Mayo Clinic. 2023.
• Preventing spread of respiratory viruses when you're sick. Centers for Disease Control and Prevention. https://www.cdc.gov/respiratory-viruses/prevention/precautions-when-sick.html. Accessed March 5, 2024.
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• COVID-19 overview and infection prevention and control priorities in non-U.S. healthcare settings. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/overview/index.html. Accessed Jan. 16, 2024.
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• Emergency use authorizations for drugs and non-vaccine biological products. U.S. Food and Drug Association. https://www.fda.gov/drugs/emergency-preparedness-drugs/emergency-use-authorizations-drugs-and-non-vaccine-biological-products. Accessed March 25, 2024.
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News on coronavirus disease 2019 (COVID-19)

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Coronavirus Disease 2019 (COVID-19) Clinical Presentation

• Author: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
• Sections Coronavirus Disease 2019 (COVID-19)
• Practice Essentials
• Route of Transmission
• Epidemiology
• Physical Examination
• Complications
• Approach Considerations
• Laboratory Studies
• CT Scanning
• Chest Radiography
• Medical Care
• Antiviral Agents
• Immunomodulators and Other Investigational Therapies
• Investigational Antibody-Directed Therapies
• Antithrombotics
• Renin Angiotensin System Blockade and COVID-19
• Diabetes and COVID-19
• Therapies Determined Ineffective
• QT Prolongation with Potential COVID-19 Pharmacotherapies
• Investigational Devices
• Guidelines Summary
• CDC Evaluating and Testing Persons Under Investigation (PUI) for COVID-19 Clinical Guidelines
• CDC Sample Collection and Testing Guidelines for COVID-19
• Guidance for Hospitals on Containing Spread of COVID-19
• American Academy of Pediatrics Guidance on Management of Infants Born to Mothers with COVID-19
• NIH Coronavirus Disease 2019 (COVID-19) Treatment Guidelines
• Infectious Diseases Society of America (IDSA) Management Guidelines
• Thromboembolism Prevention and Treatment
• Medication Summary
• Corticosteroids
• Immunomodulators
• Complement Inhibitors
• COVID-19, Monoclonal Antibodies
• Questions & Answers
• Media Gallery

Presentations of COVID-19 range from asymptomatic/mild symptoms to severe illness and mortality. Common symptoms include fever, cough, and shortness of breath. [ 100 ]  Other symptoms, such as malaise and respiratory distress, also have been described. [ 90 ]

Symptoms may develop 2 days to 2 weeks after exposure to the virus. [ 100 ]  A pooled analysis of 181 confirmed cases of COVID-19 outside Wuhan, China, found the mean incubation period was 5.1 days, and that 97.5% of individuals who developed symptoms did so within 11.5 days of infection. [ 101 ]  

Symptom rebound and viral rebound have been described in patients (with or without antiviral treatment). In untreated patients, those (n = 563) receiving placebo in the ACTIV-2/A5401 (Adaptive Platform Treatment Trial for Outpatients with COIVD-19) platform trial recorded 13 symptoms daily between days 1 and 28. Symptom rebound was identified in 26% of participants at a median of 11 days after initial symptom onset. Viral rebound was detected in 31% and high-level viral rebound in 13% of participants. [ 102 ]  

The following symptoms may indicate COVID-19 [ 100 ] :

• Fever or chills
• Shortness of breath or difficulty breathing
• Muscle or body aches
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting

Other reported symptoms include the following:

• Sputum production
• Respiratory distress
• Neurologic (eg, headache, altered mentality) 

Wu and McGoogan reported that, among 72,314 COVID-19 cases reported to the CCDC, 81% were mild (absent or mild pneumonia), 14% were severe (hypoxia, dyspnea, >50% lung involvement within 24-48 hours), 5% were critical (shock, respiratory failure, multiorgan dysfunction), and 2.3% were fatal. [ 103 ] These general symptom distributions have been reconfirmed across multiple observations. [ 104 , 105 ]

Clinicians evaluating patients with fever and acute respiratory illness should obtain information regarding travel history or exposure to an individual who recently returned from a country or US state experiencing active local transmission. [ 106 ]

Williamson and colleagues, in an analysis of 17 million patients, reaffirmed that severe COVID-19 and mortality was more common in males, older individuals, individuals in poverty, Black persons, and patients with medical conditions such as diabetes and severe asthma, among others. [ 107 ]

A multicenter observational cohort study conducted in Europe found frailty was a greater predictor of mortality than age or comorbidities. [ 108 ]

Type A blood has been suggested as a potential factor that predisposes to severe COVID-19, specifically in terms of increasing the risk for respiratory failure. Blood type O appears to confer a protective effect. [ 109 , 110 ]

Patients with suspected COVID-19 should be reported immediately to infection-control personnel at their healthcare facility and the local or state health department. CDC guidance calls for the patient to be cared for with airborne and contact precautions (including eye shield) in place. [ 22 ] Patient candidates for such reporting include those with fever and symptoms of lower respiratory illness who have travelled from Wuhan City, China, within the preceding 14 days or who have been in contact with an individual under investigation for COVID-19 or a patient with laboratory-confirmed COVID-19 in the preceding 14 days. [ 106 ]

A complete or partial loss of the sense of smell (anosmia) has been reported as a potential history finding in patients eventually diagnosed with COVID-19. [ 20 ] A phone survey of outpatients with mildly symptomatic COVID-19 found that 64.4% (130 of 202) reported any altered sense of smell or taste. [ 111 ] In a European study of 72 patients with PCR results positive for COVID-19, 53 patients (74%) reported reduced olfaction, whereas 50 patients (69%) reported a reduced sense of taste. Forty-nine patients (68%) reported both symptoms. [ 112 ]

Patients who are under investigation for COVID-19 should be evaluated in a private room with the door closed (an airborne infection isolation room is ideal) and asked to wear a surgical mask. All other standard contact and airborne precautions should be observed, and treating healthcare personnel should wear eye protection. [ 22 ]

The most common serious manifestation of COVID-19 upon initial presentation is pneumonia. Fever, cough, dyspnea, and abnormalities on chest imaging are common in these cases. [ 113 , 114 , 115 , 116 ]

Huang and colleagues found that, among patients with pneumonia, 99% had fever, 70% reported fatigue, 59% had dry cough, 40% had anorexia, 35% experienced myalgias, 31% had dyspnea, and 27% had sputum production. [ 113 ]

Complications of COVID-19 include  pneumonia ,  acute respiratory distress syndrome , cardiac injury, arrhythmia,  septic shock , liver dysfunction,  acute kidney injury , and multi-organ failure, among others.

Approximately 5% of patients with COVID-19, and 20% of those hospitalized, experience severe symptoms necessitating intensive care. The common complications among hospitalized patients include pneumonia (75%), ARDS (15%), AKI (9%), and acute liver injury (19%). Cardiac injury has been increasingly noted, including troponin elevation, acute heart failure, dysrhythmias, and myocarditis. Ten percent to 25 percent of hospitalized patients with COVID-19 experience prothrombotic coagulopathy resulting in venous and arterial thromboembolic events. Neurologic manifestations include impaired consciousness and stroke.

ICU case fatality is reported up to 40%. [ 104 ]  

As the COVID-19 pandemic has matured, more patients have reported long-term, post-infection sequelae. Most patients recover fully, but those who do not have reported adverse symptoms such as fatigue, dyspnea, cough, anxiety, depression, inability to focus (ie, “brain fog”), gastrointestinal problems, sleep difficulties, joint pain, and chest pain lasting weeks to months after the acute illness. Long-term studies are underway to understand the nature of these complaints. [ 117 ]  

Post-acute sequelae of SARS-CoV-2 (PASC) infection is the medical term for what is commonly called long COVID or "long haulers". The NIH includes discussion of persistent symptoms or organ dysfunction after acute COVID-19 within guidelines that discuss the clinical spectrum of the disease. [ 118 ]  

The UK National Institute for Health and Care Excellence (NICE) issued guidelines on care of long COVID that define the syndrome as: signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks, and are not explained by an alternative diagnosis. [ 119 ]  

Please see Long COVID-19 .

Future public health implications

Public health implications for long COVID need to be examined, as reviewed by Datta et al. As with other infections (eg, Lyme disease, syphilis, Ebola), late inflammatory and virologic sequelae may emerge. Accumulation of evidence beyond the acute infection and postacute hyperinflammatory illness is important to evaluate to gain a better understanding of the full spectrum of the disease. [ 120 ]  

Thrombotic manifestations of severe COVID-19 are caused by the ability of SARS-CoV-2 to invade endothelial cells via angiotensin-converting enzyme-2 (ACE-2), which is expressed on the surface of endothelial cells. Subsequent endothelial inflammation, complement activation, thrombin generation, platelet and leukocyte recruitment, and the initiation of innate and adaptive immune responses culminate in immunothrombosis, and can ultimately cause microthrombotic complications (eg, DVT, PE, stroke). [ 121 ]  

Kotecha et al describe patterns of myocardial injury in hospitalized patients with severe COVID-19 who had elevated troponin levels. During convalescence, myocarditis-like injury was observed, with limited extent and minimal functional consequence. However, in a proportion of patients, there was evidence of possible ongoing localized inflammation. Roughly 25% of patients had ischemic heart disease, of which two thirds had no previous history. [ 122 ]  

Reinfection

COVID-19 reinfection is defined as an infected person who has undergone full vaccination, whether they have had a booster or boosters. According to the CDC, reinfection is COVID-19 infection of an individual with 2 different viral strains that occurs at least 45 days apart. It also may occur when an individual has 2 positive CoV-2 RT-PCR tests with negative tests between the 2 positive tests. [ 123 ]

It is essential to determine reinfection rates to establish the effectiveness of current vaccine prophylaxis. Reinfection in vaccinated and non-vaccinated persons probably is due to a variant. [ 123 , 124 ]  

It is important to differentiate reinfection from reactivation or relapse of the virus, which occurs in a clinically recovered person within the first 4 weeks of infection, during which viral RNA testing has remained positive. During relapse, a tiny viral load of dormant virus reactivates, the reason of which often is unclear.

The only way to prove this state is to show that genetic samples taken at the beginning and at the time of reactivation differ genetically; such testing is unusual at the beginning of a person’s illness.

For more information, see COVID-19 Reinfections

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Lim EHT, Vlaar APJ, Bos LDJ, and the, Amsterdam UMC COVID-19 Biobank Investigators. Anti-C5a antibody vilobelimab treatment and the effect on biomarkers of inflammation and coagulation in patients with severe COVID-19: a substudy of the  phase 2 PANAMO trial. Respir Res . 2022 Dec 24. 23 (1):375. [QxMD MEDLINE Link] . [Full Text] .

Management Strategies in Children and Adolescents with Mild to Moderate COVID-19. American Academy of Pediatri cs. Available at https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/outpatient-covid-19-management-strategies-in-children-and-adolescents/ . Updated February 8, 2023; Accessed: March 6, 2024.

Huang YH, Kuo HC. Kawasaki Disease, MIS-C and COVID-19. Children (Basel) . 2023 Sep 22. 10 (10): [QxMD MEDLINE Link] . [Full Text] .

Simbar M, Nazarpour S, Sheidaei A. Evaluation of pregnancy outcomes in mothers with COVID-19 infection: a systematic review and meta-analysis. J Obstet Gynaecol . 2023 Dec. 43 (1):2162867. [QxMD MEDLINE Link] .

Rojas-Suarez J, Miranda J. Coronavirus Disease-2019 in Pregnancy. Clin Chest Med . 2023 Jun. 44 (2):373-384. [QxMD MEDLINE Link] .

He YF, Liu JQ, Hu XD, Li HM, Wu N, Wang J, et al. Breastfeeding vs. breast milk transmission during COVID-19 pandemic, which is more important?. Front Pediatr . 2023. 11:1253333. [QxMD MEDLINE Link] . [Full Text] .

Weiss A, Donnachie E, Beyerlein A, Ziegler AG, Bonifacio E. Type 1 Diabetes Incidence and Risk in Children With a Diagnosis of COVID-19. JAMA . 2023 Jun 20. 329 (23):2089-2091. [QxMD MEDLINE Link] .

Lippi G, Sanchis-Gomar F, Henry BM. COVID-19 and its long-term sequelae: what do we know in 2023?. Pol Arch Intern Med . 2023. 133: [Full Text] .

Brolly J, Chadwick DR. COVID-19 infection in people living with HIV. Br Med Bull . 2023 Sep 12. 147 (1):20-30. [QxMD MEDLINE Link] . [Full Text] .

• The heart is normal in size. There are diffuse, patchy opacities throughout both lungs, which may represent multifocal viral/bacterial pneumonia versus pulmonary edema. These opacities are particularly confluent along the periphery of the right lung. There is left midlung platelike atelectasis. Obscuration of the left costophrenic angle may represent consolidation versus a pleural effusion with atelectasis. There is no pneumothorax.
• The heart is normal in size. There are bilateral hazy opacities, with lower lobe predominance. These findings are consistent with multifocal/viral pneumonia. No pleural effusion or pneumothorax are seen.
• The heart is normal in size. Patchy opacities are seen throughout the lung fields. Patchy areas of consolidation at the right lung base partially silhouettes the right diaphragm. There is no effusion or pneumothorax. Degenerative changes of the thoracic spine are noted.
• The same patient as above 10 days later.
• The trachea is in midline. The cardiomediastinal silhouette is normal in size. There are diffuse hazy reticulonodular opacities in both lungs. Differential diagnoses include viral pneumonia, multifocal bacterial pneumonia or ARDS. There is no pleural effusion or pneumothorax.
• Axial chest CT demonstrates patchy ground-glass opacities with peripheral distribution.
• Coronal reconstruction chest CT of the same patient above, showing patchy ground-glass opacities.
• Axial chest CT shows bilateral patchy consolidations (arrows), some with peripheral ground-glass opacity. Findings are in peripheral and subpleural distribution.
• Table 1. SARS-CoV-2 Monoclonal Antibodies – inactive EUAs

Contributor Information and Disclosures

David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS Associate Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Rutgers New Jersey Medical School David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine , American Academy of Pediatrics , American College of Physicians , American Medical Association , HIV Medicine Association , Infectious Diseases Society of America , Medical Society of New Jersey , Pediatric Infectious Diseases Society Disclosure: Nothing to disclose.

Scott J Bergman, PharmD, FCCP, FIDSA, BCPS, BCIDP Antimicrobial Stewardship Program Coordinator, Infectious Diseases Pharmacy Residency Program Director, Department of Pharmaceutical and Nutrition Care, Division of Infectious Diseases, Nebraska Medicine; Clinical Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center Scott J Bergman, PharmD, FCCP, FIDSA, BCPS, BCIDP is a member of the following medical societies: American Association of Colleges of Pharmacy , American College of Clinical Pharmacy , American Pharmacists Association , American Society for Microbiology , American Society of Health-System Pharmacists , Infectious Diseases Society of America , Society of Infectious Diseases Pharmacists Disclosure: Received research grant from: Merck & Co., Inc.

Keith M Olsen, PharmD, FCCP, FCCM Dean and Professor, College of Pharmacy, University of Nebraska Medical Center Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha , American College of Physicians , American Medical Association , Association of Professors of Medicine , Infectious Diseases Society of America , Oklahoma State Medical Association , Southern Society for Clinical Investigation Disclosure: Nothing to disclose.

Molly Marie Miller, PharmD Clinical Infectious Diseases Pharmacist Practitioner, Nebraska Medicine Molly Marie Miller, PharmD is a member of the following medical societies: Society of Infectious Diseases Pharmacists Disclosure: Nothing to disclose.

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• COVID-19 Variants
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• COVID-19 Reinfections
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• Symptoms and Management of Coronavirus Disease 2019 (COVID-19) FAQ
• Diagnostics for Coronavirus Disease 2019 (COVID-19) Patients
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Introduction to COVID-19: methods for detection, prevention, response and control

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Coronaviruses are a large family of viruses that are known to cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

A novel coronavirus (COVID-19) was identified in 2019 in Wuhan, China. This is a new coronavirus that has not been previously identified in humans.

This course provides a general introduction to COVID-19 and emerging respiratory viruses and is intended for public health professionals, incident managers and personnel working for the United Nations, international organizations and NGOs.

As the official disease name was established after material creation, any mention of nCoV refers to COVID-19, the infectious disease caused by the most recently discovered coronavirus.

Please note that the content of this course is currently being revised to reflect the most recent guidance. You can find updated information on certain COVID-19-related topics in the following courses: Vaccination: COVID-19 vaccines channel IPC measures: IPC for COVID-19 Antigen rapid diagnostic testing: 1) SARS-CoV-2 antigen rapid diagnostic testing ; 2) Key considerations for SARS-CoV-2 antigen RDT implementation

Please note: These materials were last updated on 16/12/2020.

Course contents

Emerging respiratory viruses, including covid-19: introduction:, module 1: introduction to emerging respiratory viruses, including covid-19:, module 2: detecting emerging respiratory viruses, including covid-19: surveillance:, module 3: detecting emerging respiratory viruses, including covid-19: laboratory investigations:, module 4: risk communication :, module 5 : community engagement:, module 6: preventing and responding to an emerging respiratory virus, including covid-19:, enroll me for this course, certificate requirements.

• Gain a Record of Achievement by earning at least 80% of the maximum number of points from all graded assignments.
• Gain an Open Badge by completing the course.

COVID-19 Presentations

This page describes presentations on COVID-19 communication that the Center has been a part of.

Talking With Patients and Communities About the COVID-19 Vaccines: Tips for Effective Communication

Jan 13, 2021 - Online webinar, recording posted to  YouTube

This webinar is the second in a series to support effective communication around the approval and use of COVID-19 vaccines. It builds on concerns and questions from health care providers, administrators, public health practitioners and community health workers as they listen to patients and community members. The focus was on sharing effective strategies to enhance acceptance and uptake of the vaccine. Dr. Baur was a panelist at this event and shared examples of how to communicate about the COVID-19 vaccine. 

Ethical Challenges for Public Health Practice When Working for Federal Agencies

Oct 27, 2020 - Horowitz Center for Health Literacy, University of Maryland School of Public Health

Public health agencies depend on well-trained, ethical professionals to carry out the complex and varied work of public health and to protect the public's health. The coronavirus has put public health practitioners in a spotlight and made the work more difficult and even dangerous, given some types of public reactions. Drs. Boris Lushniak, Dushanka Kleinman, Olivia Carter-Pokras and Cynthia Baur worked in several agencies of the federal US Department of Health and Human Services over several decades and now teach and research public health. They share their perspectives and suggestions of how future public health leaders can learn from the coronavirus outbreak and prepare themselves to be ethical public health leaders when the next outbreaks and disasters come. Find more information about the Ethical Challenges for Public Health Practice When Working for Federal Agencies webinar.

Effective Risk Communication as an Antidote to COVID-19 Misinformation

Oct 9, 2020 - Great Lakes Health Literacy Conference 2020: Implications for Health Literacy during Times of Crisis

Dr. Cynthia Baur presented the Crisis and Emergency Risk Communication (CERC) framework and examples of how COVID-19 communication has violated many of those principles. She recommended that health communicators pay special attention to how COVID-19 risks are explained and showed how health literacy techniques can help.

Health Literacy as a Corrective to a Misinformation Culture for Coronavirus Communications

Oct 8, 2020 - National Conference on Health Communication, Marketing and Media

Dr. Cynthia Baur discussed the many ways the COVID-19 "infodemic" and misinformation is undermining health literacy and creating unnecessary and dangerous confusion. She proposed that health literacy techniques can help bridge scientific findings and public acceptance of recommendations.

Participating in a Pandemic: Ensuring Safe Voting Public 

Oct 5, 2020 - University of Maryland School of Public Policy

Dr. Cynthia Baur participated in a panel hosted by the UMD School of Public Policy for the BIG10 network on safe voting. She talked in general about risk communication and specifically about the importance of clear directions for voters, poll workers, the media, and election officials.  Read the panel summary here.

The Language of COVID-19: What’s Gone Wrong and How We Do Better

July 22, 2020 - IHA's 19th Annual Health Literacy Conference: Health Equities and Disparities in the Times of COVID-19

The coronavirus and COVID-19 disease have highlighted the central role of communication in public health emergencies and disasters. Information about the virus and disease—who's affected and why, protective behaviors, and consequences—have become so overwhelming and confusing that the World Health Organization declared an "infodemic of misinformation." Given that the basic structure of crisis and emergency response messaging is well-known in public health, how did COVID-19 communication go so wrong? How can health literacy and health communication practitioners contribute to a healthier information environment? This presentation will review the basic principles of clear and useful risk messages, examine examples of virus and COVID-19 information, and diagram improvements.  Full conference archive

Public Health Symposium on Coronavirus

Feb 20, 2020 - University of Maryland School of Public Health

Dr. Cynthia Baur addresses concerns about the international coronavirus outbreak in her presentation, Effective Risk Communication As an Antidote to Fear, Uncertainty and Misinformation.  Detailed summary of the entire event here.  

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• Continuing Education Activity

Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has had a catastrophic effect on the world, resulting in more than 6 million deaths worldwide. It has emerged as the most consequential global health crisis since the era of the influenza pandemic of 1918. As the virus mutates, treatment guidelines are altered to reflect the most efficacious therapies. This activity is a comprehensive review of the disease presentation, complications, and current guideline-recommended treatment options for managing this disease.

• Screen individuals based on exposure and symptom criteria to identify potential COVID-19 cases.
• Identify the clinical features and radiological findings expected in patients with COVID-19.
• Apply the recommended treatment options for patients with COVID-19.
• Create strategies with the interprofessional team for improving care coordination to care for patients with COVID-19 to help improve clinical outcomes.
• Introduction

Coronavirus disease 2019 (COVID-19) is a highly contagious viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has had a catastrophic effect on the world, resulting in more than 6 million deaths worldwide. After the first cases of this predominantly respiratory viral illness were reported in Wuhan, Hubei Province, China, in late December 2019, SARS-CoV-2 rapidly disseminated worldwide. This compelled the World Health Organization (WHO) to declare it a global pandemic on March 11, 2020. [1]

Even though substantial progress in clinical research has led to a better understanding of SARS-CoV-2, many countries continue to have outbreaks of this viral illness. These outbreaks are primarily attributed to the emergence of mutant variants of the virus. Like other RNA viruses, SARS-CoV-2 adapts with genetic evolution and developing mutations. This results in mutant variants that may have different characteristics than their ancestral strains. Several variants of SARS-CoV-2 have been described during the course of this pandemic, among which only a few are considered variants of concern (VOCs). Based on the epidemiological update by the WHO, 5 SARS-CoV-2 VOCs have been identified since the beginning of the pandemic:

• Alpha (B.1.1.7): First variant of concern, which was described in the United Kingdom (UK) in late December 2020 [2]
• Beta (B.1.351) : First reported in South Africa in December 2020 [2]
• Gamma (P.1) : First reported in Brazil in early January 2021 [2]
• Delta (B.1.617.2):  First reported in India in December 2020 [2]
• Omicron   (B.1.1.529): First reported in South Africa in November 2021 [3]

Despite the unprecedented speed of vaccine development against the prevention of COVID-19 and robust global mass vaccination efforts, the emergence of new SARS-CoV-2 variants threatens to overturn the progress made in limiting the spread of this disease. This review aims to comprehensively describe the etiology, epidemiology, pathophysiology, and clinical features of COVID-19. This review also provides an overview of the different variants of SARS-CoV-2 and the guideline-recommended treatment (as of January 2023) for managing this disease. 

Coronaviruses (CoVs) are positive-sense single-stranded RNA (+ssRNA) viruses with a crown-like appearance under an electron microscope ( coronam  is the Latin term for crown) due to the presence of spike glycoproteins on the envelope. [1] The subfamily  Orthocoronavirinae  of the  Coronaviridae  family (order  Nidovirales ) classifies into 4 genera of CoVs: 

• Alphacoronavirus (alphaCoV)
• Betacoronavirus (betaCoV)
• Deltacoronavirus (deltaCoV)
• Gammacoronavirus (gammaCoV)

BetaCoV genus is further divided into 5 sub-genera or lineages. [4]  Genomic characterization has shown that bats and rodents are the probable gene sources of alphaCoVs and betaCoVs. Avian species seem to be the source of deltaCoVs and gammaCoVs. CoVs have become significant pathogens of emerging respiratory disease outbreaks. Members of this large family of viruses can cause respiratory, enteric, hepatic, and neurological diseases in different animal species, including camels, cattle, cats, and bats.

These viruses can cross species barriers and infect humans as well. Seven human CoVs (HCoVs) capable of infecting humans have been identified. Some HCoVs were identified in the mid-1960s, while others were only detected in the new millennium. In general, estimates suggest that 2% of the population are healthy carriers of CoVs and that these viruses are responsible for about 5% to 10% of acute respiratory infections. [5]  

• Common human CoVs : HCoV-OC43 and HCoV-HKU1 (betaCoVs of the A lineage), HCoV-229E, and HCoV-NL63 (alphaCoVs). These viruses can cause common colds and self-limiting upper respiratory tract infections in immunocompetent individuals. However, in immunocompromised and older patients, lower respiratory tract infections can occur due to these viruses.
• Other human CoVs : SARS-CoV and MERS-CoV (betaCoVs of the B and C lineage, respectively). These viruses are considered more virulent and capable of causing epidemics with respiratory and extra-respiratory manifestations of variable clinical severity. [1]  

SARS-CoV-2 is a novel betaCoV belonging to the same subgenus as the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which have been previously implicated in SARS-CoV and MERS-CoV epidemics with mortality rates up to 10% and 35%, respectively. [6]  It has a round or elliptic and often pleomorphic form and a diameter of approximately 60 to 140 nm. Like other CoVs, it is sensitive to ultraviolet rays and heat. [6]  

The inactivation temperature of SARS-CoV-2 is being researched. A stainless steel surface held at an air temperature of 54.5°C (130 °F) results in the inactivation of 90% of SARS-CoV-2 in approximately 36 minutes. [7]  It resists lower temperatures, even those below 0°C. However, lipid solvents can effectively inactivate these viruses, including ether (75%), ethanol, chlorine-containing disinfectant, peroxyacetic acid, and chloroform (except for chlorhexidine).

Although the origin of SARS-CoV-2 is currently unknown, it is widely postulated to have a zoonotic transmission. [1]  Genomic analyses suggest that SARS-CoV-2 probably evolved from a strain found in bats. The genomic comparison between the human SARS-CoV-2 sequence and known animal coronaviruses revealed high homology (96%) between the SARS-CoV-2 and the betaCoV RaTG13 of bats ( Rhinolophus affinis ). [8]  Similar to SARS and MERS, it has been hypothesized that SARS-CoV-2 advanced from bats to intermediate hosts, such as pangolins and minks, and then to humans. [9] [10]

SARS-CoV-2 Variants

A globally dominant D614G variant was eventually identified and associated with increased transmissibility but without the ability to cause severe illness. [11] Another variant was attributed to transmission from infected farmed mink in Denmark but was not associated with increased transmissibility. [10]  Since then, multiple variants of SARS-CoV-2 have been described, of which a few are considered variants of concern (VOCs) due to their potential to cause enhanced transmissibility or virulence. The United States Centers for Disease Control and Prevention (CDC) and the WHO have independently established a classification system for distinguishing the emerging variants of SARS-CoV-2 into variants of concern(VOCs) and variants of interest(VOIs).

SARS-CoV-2 Variants of Concern (VOCs)

• Alpha (B.1.1.7 lineage)
• In late December 2020, the Alpha variant,   or GRY  (formerly GR/501Y.V1), was reported in the UK based on whole-genome sequencing of samples from patients who tested positive for SARS-CoV-2. [12] [13]
• The variant   was also identified using a commercial assay characterized by the absence of the S gene (S-gene target failure, SGTF) in PCR samples. The B.1.1.7 variant includes 17 mutations in the viral genome. Of these, 8 mutations (Δ69-70 deletion, Δ144 deletion, N501Y, A570D, P681H, T716I, S982A, D1118H) are in the spike (S) protein. N501Y shows an increased affinity of the spike protein to ACE 2 receptors, enhancing the viral attachment and subsequent entry into host cells. [14] [15] [16]
• This alpha variant was reportedly 43% to 82% more transmissible, surpassing preexisting variants of SARS-CoV-2 to emerge as the dominant SARS-CoV-2 variant in the UK. [15]  
• An initial matched case-control study reported no significant difference in the risk of hospitalization or associated mortality with the B.1.1.7 lineage variant compared to other existing variants. However, subsequent studies have reported that people infected with B.1.1.7 lineage variant had increased disease severity compared to those infected with other circulating variants. [17] [13]  
• A large matched cohort study in the UK reported that the mortality hazard ratio of patients infected with the B.1.1.7 lineage variant was 1.64 (95% confidence interval 1.32 to 2.04, P<0.0001) compared to patients with previously circulating strains. [18]
• Another study reported that the B 1.1.7 variant was associated with increased mortality compared to other SARS-CoV-2 variants (HR= 1.61, 95% CI 1.42-1.82). [19]  The risk of death was reportedly greater (adjusted hazard ratio 1.67, 95% CI 1.34-2.09) among individuals with confirmed B.1.1.7 infection compared to individuals with non-B.1.1.7 SARS-CoV-2. [20]
• Beta (B.1.351 lineage)
• The Beta variant, or GH501Y.V2 with multiple spike mutations, resulted in the second wave of COVID-19 infections and was first detected in South Africa in October 2020. [21]
• The B.1.351 variant includes 9 mutations (L18F, D80A, D215G, R246I, K417N, E484K, N501Y, D614G, and A701V) in the spike protein, of which 3 mutations (K417N, E484K, and N501Y) are located in the receptor binding domain (RBD) and increase its binding affinity for the ACE receptors. [22] [14] [23]  
• SARS-CoV-2 501Y.V2 (B.1.351 lineage) was reported in the US at the end of January 2021.
• This variant had an increased risk of transmission and reduced neutralization by monoclonal antibody therapy, convalescent sera, and post-vaccination sera. [24]
• Gamma (P.1 lineage)
• The Gamma variant, or  GR/501Y.V3 , was identified in December 2020 in Brazil and was first detected in the US in January 2021. [25]  
• This B.1.1.28 variant harbors ten mutations in the spike protein (L18F, T20N, P26S, D138Y, R190S, H655Y, T1027I V1176, K417T, E484K, and N501Y). Three mutations (L18F, K417N, E484K) are located in the RBD, similar to the B.1.351 variant. [25]
• The Delta variant was initially identified in December 2020 in India and was responsible for the deadly second wave of COVID-19 infections in April 2021 in India. In the United States, this variant was first detected in March 2021. [2]
• The B.1.617.2 variant harbors ten mutations ( T19R, (G142D*), 156del, 157del, R158G, L452R, T478K, D614G, P681R, D950N) in the spike protein.
• The Omicron variant was first identified in South Africa on 23 November 2021 after an uptick in the number of cases of COVID-19. [26]  
• Omicron was quickly recognized as a VOC due to more than 30 changes to the spike protein of the virus and the sharp rise in the number of cases observed in South Africa. [27]  The reported mutations include T91 in the envelope, P13L, E31del, R32del, S33del, R203K, G204R in the nucleocapsid protein, D3G, Q19E, A63T in the matrix, N211del/L212I, Y145del, Y144del, Y143del, G142D, T95I, V70del, H69del, A67V in the N-terminal domain of the spike, Y505H, N501Y, Q498R, G496S, Q493R, E484A, T478K, S477N, G446S, N440K, K417N, S375F, S373P, S371L, G339D in the receptor-binding domain of the spike, D796Y in the fusion peptide of the spike, L981F, N969K, Q954H in the heptad repeat 1 of the spike as well as multiple other mutations in the non-structural proteins and spike protein. [28]
• Many subvariants of Omicron, such as BA.1, BA.2, BA.3, BA.4, and BA.5, have been identified. [3]

Transmission of SARS-CoV-2

• The primary mode of transmission of SARS-CoV-2 is via exposure to respiratory droplets carrying the infectious virus from close contact or direct transmission from presymptomatic, asymptomatic, or symptomatic individuals harboring the virus. [1]
• Airborne transmission with aerosol-generating procedures has also been implicated in the spread of COVID-19. Data implicating airborne transmission of SARS-CoV-2 in the absence of aerosol-generating procedures is present; however, this mode of transmission has not been universally acknowledged.
• Fomite transmission from contamination of inanimate surfaces with SARS-CoV-2 has been well characterized based on many studies reporting the viability of SARS-CoV-2 on various porous and nonporous surfaces. Under experimental conditions, SARS-CoV-2 was stable on stainless steel and plastic surfaces compared to copper and cardboard surfaces, with the viable virus being detected up to 72 hours after inoculating the surfaces with the virus. [29]  The viable virus was isolated for up to 28 days at 20°C from nonporous surfaces such as glass and stainless steel. Conversely, recovery of SARS-CoV-2 on porous materials was reduced compared with nonporous surfaces. [30]  In hospital settings, the SARS-CoV-2 has been detected on floors, computer mice, trash cans, sickbed handrails, and in the air (up to 4 meters from patients). [31]  The Centers for Disease Control and Prevention (CDC) has stated that individuals can be infected with SARS-CoV-2 via contact with surfaces contaminated by the virus, but the risk is low and is not the main route of transmission of this virus.
• Epidemiologic data from several case studies have reported that patients with SARS-CoV-2 infection have the live virus in feces implying possible fecal-oral transmission. [32]
• A meta-analysis that included 936 neonates from mothers with COVID-19 showed vertical transmission is possible but occurs in a minority of cases. [33]
• Epidemiology

COVID-19 was the third leading cause of death in the United States (USA) in 2020 after heart disease and cancer, with approximately 375,000 deaths. [34]  

Individuals of all ages are at risk of contracting this infection. However, patients aged ≥60 and patients with underlying medical comorbidities (obesity, cardiovascular disease, chronic kidney disease, diabetes, chronic lung disease, smoking, cancer, solid organ or hematopoietic stem cell transplant patients) have an increased risk of developing severe COVID-19 infection.

According to the CDC, age remains the strongest predictor of poor outcomes and severe illness in patients with COVID-19. Data from the National Vital Statistics System (NVSS) at CDC states that patients with COVID-19 aged 50 to 64 years have a 25 times higher risk of death when compared to adults infected with this illness and aged less than 30 years. In patients 65 to 74 years old, this risk increases to 60 times. In patients older than 85, the risk of death increases to 340 times. According to the CDC, these data include all deaths in the United States throughout the pandemic, from February 2020 to July 1, 2022, including deaths among unvaccinated individuals.

The percentage of COVID-19 patients requiring hospitalization was 6 times higher in those with preexisting medical conditions than those without medical conditions (45.4% vs. 7.6%) based on an analysis by Stokes et al. of confirmed cases reported to the CDC from January 22 to May 30, 2020. [35]  The study also reported that the percentage of patients who succumbed to this illness was 12 times higher in those with preexisting medical conditions than those without (19.5% vs 1.6%). [35]  

Data regarding the gender-based differences in COVID-19 suggests that male patients have a higher risk of severe illness and increased mortality due to COVID-19 compared to female patients. [36] [37]  Results from a retrospective cohort study from March 1 to November 21, 2020, evaluating the mortality rate in 209 United States of America (USA) acute care hospitals that included 42604 patients with confirmed SARS-CoV-2 infection, reported a higher mortality rate in male patients (12.5%) compared to female patients (9.6%). [38]

Racial and ethnic minority groups have been reported to have a higher percentage of COVID-19-related hospitalizations than White patients based on a recent CDC analysis of hospitalizations from an extensive administrative database that included approximately 300,000 COVID-19 patients hospitalized from March 2020 to December 2020. This high percentage of COVID-19-related hospitalizations among racial and ethnic groups was driven by a higher risk of exposure to SARS-CoV-2 and an increased risk of developing severe COVID-19 disease. [39]   A meta-analysis of 50 studies from USA and UK researchers noted that people of Black, Hispanic, and Asian ethnic minority groups are at increased risk of contracting and dying from COVID-19 infection. [40]  

COVID-19-related death rates were the highest among Hispanic persons. [34]  Another analysis by the CDC evaluating the risk of COVID-19 among sexual minority adults reported that underlying medical comorbidities which increase the risk of developing severe COVID-19 were more prevalent in sexual minority individuals than heterosexual individuals within the general population and within specific racial/ethnic groups. [41]

• Pathophysiology

Structurally and phylogenetically, SARS-CoV-2 is similar to SARS-CoV and MERS-CoV and is composed of 4 main structural proteins: spike (S), envelope (E) glycoprotein, nucleocapsid (N), and membrane (M) protein. It also contains 16 nonstructural proteins and 5-8 accessory proteins. [42]  

The surface spike (S) glycoprotein, which resembles a crown, is located on the outer surface of the virion. It undergoes cleavage into an amino (N)-terminal S1 subunit, which facilitates the incorporation of the virus into the host cell. The carboxyl (C)-terminal S2 subunit contains a fusion peptide, a transmembrane domain, and a cytoplasmic domain responsible for virus-cell membrane fusion. [43] [44]  The S1 subunit is further divided into a receptor-binding domain (RBD) and an N-terminal domain (NTD), which facilitates viral entry into the host cell and serves as a potential target for neutralization in response to antisera or vaccines . [45]  

The RBD is a fundamental peptide in the pathogenesis of infection as it represents a binding site for the human angiotensin-converting enzyme 2 (ACE2) receptors. Inhibition of the renin-angiotensin-aldosterone system (RAAS) does not increase the risk of hospitalization for COVID-19 and severe disease. [46]

SARS-CoV-2 gains entry into the host cells by binding the SARS-CoV-2 spike or S protein (S1) to the ACE2 receptors in the respiratory epithelium. ACE2 receptors are also expressed by other organs such as the upper esophagus, enterocytes from the ileum, myocardial cells, proximal tubular cells of the kidney, and urothelial cells of the bladder. [47]  The viral attachment process is followed by priming the spike protein S2 subunit by the host transmembrane serine protease 2 (TMPRSS2) that facilitates cell entry and subsequent viral replication. [48]

In the early phase of the infection, viral replication results in direct virus-mediated tissue damage. In the late phase, the infected host cells trigger an immune response by recruiting T lymphocytes, monocytes, and neutrophils. Cytokines such as tumor necrosis factor-α (TNF α), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1 (IL-1), interleukin-6 (IL-6), ), IL-1β, IL-8, IL-12 and interferon (IFN)-γ are released. In severe COVID-19 illness, a 'cytokine storm' is seen. This is due to the over-activation of the immune system and high levels of cytokines in circulation. This results in a local and systemic inflammatory response. [49] [50]  

Effect of SARS-CoV-2 on the Respiratory System

Increased vascular permeability and subsequent development of pulmonary edema in patients with severe COVID-19 are explained by multiple mechanisms. [51] [52] [53]  These mechanisms include:

• Endotheliitis as a result of direct viral injury and perivascular inflammation leading to microvascular and microthrombi deposition
• Dysregulation of RAAS due to increased binding of the virus to the ACE2 receptors
• Activation of the kallikrein-bradykinin pathway, the activation of which enhances vascular permeability
• Enhanced epithelial cell contraction causes swelling of cells and disturbance of intercellular junctions
• The binding of SARS-CoV-2 to the Toll-Like Receptor (TLR) induces the release of pro-IL-1β, which mediates lung inflammation until fibrosis . [54]

Effect of SARS-CoV-2 on Extrapulmonary Organ Systems

Although the respiratory system is the principal target for SARS-CoV-2, other major organ systems such as the gastrointestinal tract (GI), hepatobiliary, cardiovascular, renal, and central nervous systems may also be affected. SARS-CoV-2–induced organ dysfunction is likely due to a combination of mechanisms, such as direct viral toxicity, ischemic injury caused by vasculitis, thrombosis, immune dysregulation, and renin-angiotensin-aldosterone system (RAAS) dysregulation. [55]

Cardiac involvement in COVID-19 is common and likely multifactorial. ACE2 receptors exhibited by myocardial cells may cause direct cytotoxicity to the myocardium leading to myocarditis. Proinflammatory cytokines such as IL-6 can also lead to vascular inflammation, myocarditis, and cardiac arrhythmias. [56]

Acute coronary syndrome (ACS) is a well-recognized cardiac manifestation of COVID-19. It is likely due to multiple factors, including proinflammatory cytokines, worsening of preexisting severe coronary artery disease, coronary plaque destabilization, microthrombogenesis, and reduced coronary blood flow. [57]  

SARS-CoV-2 has a significant effect on the hematological and hemostatic systems as well. The mechanism of leukopenia, one of the most common laboratory abnormalities encountered in COVID-19, is unknown. Several hypotheses have been postulated that include ACE 2 mediated lymphocyte destruction by direct invasion by the virus, lymphocyte apoptosis due to proinflammatory cytokines, and possible invasion of the virus in the lymphatic organs. [58]  

Thrombocytopenia is common in COVID-19 and is likely due to multiple factors, including virus-mediated suppression of platelets, autoantibodies formation, and coagulation cascade activation, resulting in platelet consumption. [59]  

Thrombocytopenia and neutrophilia are considered a hallmark of severe illness. [55] Although it is well known that COVID-19 is associated with a state of hypercoagulability, the exact mechanisms that lead to the activation of the coagulation system are unknown and likely attributed to the cytokine-induced inflammatory response. The pathogenesis of this associated hypercoagulability is multifactorial. The hypercoagulability is probably induced by direct viral-mediated damage or cytokine-induced injury of the vascular endothelium leading to the activation of platelets, monocytes, and macrophages, with increased expression of von Willebrand factor and Factor VIII that results in the generation of thrombin and formation of a fibrin clot. [59] [60]  

Other mechanisms that have been proposed include possible mononuclear phagocyte-induced prothrombotic sequelae, derangements in the renin-angiotensin system (RAS) pathways, and complement-mediated microangiopathy. [59]

• History and Physical

Clinical Manifestations of COVID-19

• The median incubation period for SARS-CoV-2 is estimated to be 5.1 days, and most patients will develop symptoms within 11.5 days of infection. [61]
• The clinical spectrum of COVID-19 varies from asymptomatic or paucisymptomatic forms to clinical illness characterized by acute respiratory failure requiring mechanical ventilation, septic shock, and multiple organ failure. 
• It is estimated that 17.9% to 33.3% of infected patients will remain asymptomatic. [62] [63]
• Most symptomatic patients present with fever, cough, and shortness of breath. Less common symptoms include sore throat, anosmia, dysgeusia, anorexia, nausea, malaise, myalgias, and diarrhea. Stokes et al. reported that among 373,883 confirmed symptomatic COVID-19 cases in the USA, 70% experienced fever, cough, and shortness of breath, 36% reported myalgia, and 34% reported headache. [35]
• A large meta-analysis evaluating clinicopathological characteristics of 8697 patients with COVID-19 in China reported laboratory abnormalities that included lymphopenia (47.6%), elevated C-reactive protein levels (65.9%), elevated cardiac enzymes (49.4%), and abnormal liver function tests (26.4%). Other laboratory abnormalities included leukopenia (23.5%), elevated D-dimer (20.4%), elevated erythrocyte sedimentation rate (20.4%), leukocytosis (9.9%), elevated procalcitonin (16.7%), and abnormal renal function (10.9%). [64]
• A meta-analysis of 212 published studies with 281,461 individuals from 11 countries/regions reported that severe disease course was noted in about 23% of the patients, with a mortality rate of about 6% in patients infected with COVID-19. [65]
• An elevated neutrophil-to-lymphocyte ratio (NLR), an elevated derived NLR ratio (d-NLR), and an elevated platelet-to-lymphocyte ratio indicate a cytokine-induced inflammatory storm. [66]

Based on the severity of the presenting illness, which includes clinical symptoms, laboratory and radiographic abnormalities, hemodynamics, and organ function, the National Institutes of Health (NIH) issued guidelines that classify COVID-19 into 5 distinct types.[ NIH COVID-19 Treatment Guidelines ]

• Asymptomatic or Presymptomatic Infection : Individuals with positive SARS-CoV-2 test without any clinical symptoms consistent with COVID-19.
• Mild illness : Individuals who have symptoms of COVID-19, such as fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, anosmia, or dysgeusia but without shortness of breath or abnormal chest imaging.
• Moderate illness : Individuals with clinical symptoms or radiologic evidence of lower respiratory tract disease and oxygen saturation (SpO 2 ) ≥94% on room air.
• Severe illness : Individuals who have SpO 2 less than 94% on room air, a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 ) of less than 300, marked tachypnea with a respiratory frequency of greater than 30 breaths/min, or lung infiltrates that are greater than 50% of total lung volume.
• Critical illness : Individuals with acute respiratory failure, septic shock, or multiple organ dysfunction. Patients with severe COVID-19 illness may become critically ill with the development of acute respiratory distress syndrome (ARDS). This tends to occur approximately one week after the onset of symptoms.

ARDS is characterized by a severe new-onset respiratory failure or worsening of an already identified respiratory picture. The diagnosis requires bilateral opacities (lung infiltrates >50%), not fully explained by effusions or atelectasis. The Berlin definition classifies ARDS into 3 types based on the degree of hypoxia, with the reference parameter being PaO 2 /FiO 2 or P/F ratio: [67]

• Mild ARDS : 200 mm Hg <PaO 2 /FiO 2 ≤300 mm Hg in patients not receiving mechanical ventilation or in those managed through noninvasive ventilation (NIV) by using positive end-expiratory pressure (PEEP) or a continuous positive airway pressure (CPAP) ≥5 cm H2O.
• Moderate ARDS : 100 mm Hg <PaO 2 /FiO 2 ≤200 mm Hg
• Severe ARDS : PaO 2 /FiO 2 ≤100 mm Hg

When PaO 2 is unavailable, a ratio of SpO 2 /FiO 2 ≤315 suggests ARDS. A multicenter prospective observational study that analyzed 28-day mortality in mechanically ventilated patients with ARDS concluded that COVID-19 patients with ARDS had features similar to other ARDS cohorts, and the risk of 28-day mortality increased with ARDS severity. [68]

Extrapulmonary Manifestations 

• Acute kidney injury (AKI) is the most frequently encountered extrapulmonary manifestation of COVID-19 and is associated with an increased mortality risk. [69] A large multicenter cohort study of hospitalized patients with COVID-19 that involved 5,449 patients admitted with COVID-19 reported that 1993 (36.6%) patients developed AKI during their hospitalization, of which 14.3% of patients required renal replacement therapy (RRT). [70]  
• Myocardial injury manifesting as myocardial ischemia/infarction (MI) and myocarditis are well-recognized cardiac manifestations in patients with COVID-19. Single-center retrospective study analysis of 187 patients with confirmed COVID-19 reported that 27.8% of patients exhibited myocardial injury indicated by elevated troponin levels. The study also noted that patients with elevated troponin levels had more frequent malignant arrhythmias and a higher mechanical ventilation frequency than patients with normal troponin levels. [71]  A meta-analysis of 198 published studies involving 159698 COVID-19 patients reported that acute myocardial injury and a high burden of pre-existing cardiovascular disease were significantly associated with higher mortality and ICU admission. [72]
• Lymphopenia is a common laboratory abnormality in most patients with COVID-19. Other laboratory abnormalities include thrombocytopenia, leukopenia, elevated ESR levels, C-reactive protein (CRP), lactate dehydrogenase (LDH), and leukocytosis.
• COVID-19 is also associated with a hypercoagulable state, evidenced by the high prevalence of venous thromboembolic events. COVID-19 is associated with markedly elevated D-dimer and fibrinogen levels and prolonged prothrombin time (PT) and partial thromboplastin time (aPTT). [71] [55]  
• GI symptoms (such as diarrhea, nausea, vomiting), anorexia, and abdominal pain are common. A meta-analysis reported that the weighted pool prevalence of diarrhea was 12.4% (95% CI, 8.2% to 17.1%), nausea or vomiting was 9% (95% CI, 5.5% to 12.9%), loss of appetite was 22.3% (95% CI, 11.2% to 34.6%) and abdominal pain was 6.2% (95% CI, 2.6% to 10.3%). The study also reported that the mortality rate among patients with GI symptoms was similar to the overall mortality rate. [73] Cases of acute mesenteric ischemia and portal vein thrombosis have also been described. [74]
• An acute increase in aspartate transaminase (AST) and alanine transaminase (ALT) is noted in 14% to 53% of patients with COVID-19 infection. [75]
• Guillain-Barré syndrome (GBS) cases from Northern Italy have also been reported. [76] [77]
• Acral lesions resembling pseudo chilblains (40.4%) are the most common cutaneous manifestation noted in patients with COVID-19. [78]
• Other cutaneous manifestations include erythematous maculopapular rash (21.3%), vesicular rashes (13%), urticarial rashes (10.9%), vascular rashes (4%) resembling livedo or purpura, and erythema multiforme-like eruptions (3.7%). [78]

Diagnostic Testing in COVID-19

A nasopharyngeal swab for SARS-CoV-2 nucleic acid using a real-time PCR assay is the standard diagnostic test.[ NIH COVID-19 Treatment Guidelines ] Commercial PCR assays have been authorized by the USA Food and Drug Administration (FDA) for the qualitative detection of SARS-CoV-2 virus using specimens obtained from nasopharyngeal swabs as well as other sites such as oropharyngeal, anterior/mid-turbinate nasal swabs, nasopharyngeal aspirates, bronchoalveolar lavage (BAL) and saliva. 

The sensitivity of PCR testing depends on multiple factors, including the specimen's adequacy, time from exposure, and specimen source. [79]  However, the specificity of most commercial FDA-authorized SARS-CoV-2 PCR assays is nearly 100%, provided there is no cross-contamination during specimen processing. SARS-CoV-2 antigen tests are less sensitive but have a faster turnaround time than molecular PCR testing. [80]  

Despite the numerous antibody tests designed to date, serologic testing has limitations in specificity and sensitivity, and results from different tests vary. According to the NIH guidelines, diagnosing acute SARS-CoV-2 infection based on serologic testing is not recommended. They also stated that there is insufficient evidence to recommend for or against using serologic testing to assess immunity, even if it is used to guide clinical decisions about COVID-19 vaccines/monoclonal antibodies.[ NIH COVID-19 Treatment Guidelines ]

Other Laboratory Assessment

• Complete blood count (CBC), a comprehensive metabolic panel (CMP) that includes renal and liver function testing, and a coagulation panel should be performed in all hospitalized patients.
• Additional tests, such as ESR, C-reactive protein (CRP), ferritin, lactate dehydrogenase, and procalcitonin, can be considered in hospitalized patients. However, their prognostic significance in COVID-19 is not clear.
• A D-dimer level is required as it guides the use of therapeutic versus prophylactic doses of anticoagulation.

Imaging ModalitiesThis s viral illness commonly manifests as pneumonia, so radiological imaging such as chest x-rays, lung ultrasounds, and chest computed tomography (CT) are often obtained. However, there are no guidelines regarding the timing and choice of pulmonary imaging in patients with COVID-19.

When obtained, the chest X-ray usually shows bilateral multifocal alveolar opacities. Pleural effusions can also be demonstrated. The most common CT chest findings in COVID-19 are multifocal bilateral ground glass opacities with consolidation changes, usually in a patchy peripheral distribution. [81]

Radiologic imaging is not a sensitive method for detecting this disease. A retrospective study of 64 patients with documented COVID-19 reported that 20% had no abnormalities on chest radiographs during the illness. [82]  A chest CT is more sensitive than a radiograph but is not specific. No finding on radiographic imaging can completely rule in or rule out COVID-19 illness. Therefore the American College of Radiology (ACR) advises against the routine use of chest CT for screening or diagnosis of COVID-19.[ ACR Position Statement for Diagnosis of COVID-19 ]

• Treatment / Management

According to the National Institutes of Health (NIH), the 2 main processes driving the pathogenesis of COVID-19 include replication of the virus in the early phase of the illness and dysregulated immune/inflammatory response to SARS-CoV-2 that leads to systemic tissue damage in the later phase of the disease.[ NIH COVID-19 Treatment Guidelines ] The guidelines, therefore, advise antiviral medications to halt viral replication in the early phase of the illness and immunomodulators in the later phase.

Remdesivir is the only antiviral drug approved by the USA Food and Drug Administration (FDA) to treat COVID-19. Ritonavir-boosted nirmatrelvir, molnupiravir, and high-titer COVID-19 convalescent plasma have Emergency Use Authorizations (EUAs) for treating COVID-19. Tixagevimab 300 mg plus cilgavimab 300 mg monoclonal antibodies have received EUAs that allow them to be used as SARS-CoV-2 preexposure prophylaxis (PrEP) in certain patients.

Many other monoclonal antibodies had EUAs; however, as Omicron subvariants emerged, their EUAs were revoked as they were no longer effective. 

The most recent NIH treatment guidelines for the management of COVID-19 illness (accessed on January 3rd, 2023) are outlined below:[ NIH COVID-19 Treatment Guidelines ]

Nonhospitalized Adults With Mild-to-Moderate COVID-19 Illness Who Do Not Require Supplemental Oxygen

• The NIH recommends against using dexamethasone or any other systemic corticosteroids in patients who are not hypoxic. [83]   
• Ritonavir-boosted nirmatrelvir is a combination of oral protease inhibitors. It has been shown to reduce hospitalization and death when given to high-risk, unvaccinated, nonhospitalized patients. It must be given within 5 days of symptoms onset. [84]
• It is a strong cytochrome P450 inhibitor with many drug-drug interactions that must be carefully assessed.
• Some interactions can be managed by temporarily holding the medication, some may be managed with dose adjustment, but some may warrant the use of alternate COVID-19 therapy. 
• Ritonavir-boosted nirmatrelvir is not recommended in patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min.
• The recommended dose is nirmatrelvir 300 mg with ritonavir 100 mg orally twice daily for 5 days.
• This is a nucleotide analog that inhibits the SARS-CoV-2 RNA polymerase  
• The recommended duration of therapy in this setting is 3 days.
• The recommended dose is 200 mg IV on day 1, followed by 100 mg IV for 2 more days.
• It is a mutagenic ribonucleoside antiviral agent.
• Fetal toxicity has been reported in animal studies with this agent. Due to the risk of genotoxicity with this agent, it is not recommended in pregnant patients. 
• This agent should only be used if both therapies are unavailable or cannot be given.
• The NIH guidelines recommend against using anti-SARS-CoV-2 monoclonal antibodies (mAbs) for treating COVID-19 in this cohort because the Omicron subvariants are not susceptible to these agents.  
• Adequate and close medical follow-up is recommended; however, the frequency and duration of follow-up depend on individual risk factors and the severity of their symptoms. 
• Risk factors for progression to severe disease include advanced age and underlying medical conditions. The CDC maintains an updated list of medical conditions associated with a high risk of progression. 
•  Asthma
• Cerebrovascular disease
• Chronic kidney disease
• Bronchiectasis
• COPD (Chronic obstructive pulmonary disease)
• Interstitial lung disease
• Pulmonary embolism
• Pulmonary hypertension
• Nonalcoholic fatty liver disease
• Alcoholic liver disease
• Autoimmune hepatitis
• Cystic fibrosis
• Diabetes, type 1 and 2
• Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
• HIV (Human immunodeficiency virus)
• Mental health conditions such as mood disorders and Schizophrenia spectrum disorders
• Obesity (defined as body mass index (BMI) of greater than 30 kg/m 2 or greater than 95th percentile in children)
• Pregnancy and recent pregnancy
• Smoking, current and former
• Solid organ or blood stem cell transplantation
• Tuberculosis
• Use of corticosteroids or other immunosuppressive medications ( CDC: Underlying Medical Conditions Associated with Higher Risk )

Therapeutic Management of Hospitalized Adults With COVID-19   Who Do Not Require Oxygen

• If patients are hospitalized for reasons other than COVID-19 illness and are not on oxygen, their management is similar to nonhospitalized patients. 
• If they are hospitalized for COVID-19 illness but do not require oxygen, the NIH advises against the use of dexamethasone or any other systemic corticosteroid.
• A prophylactic dose of anticoagulation should be given if there is no contraindication. 
• If they are hospitalized for COVID-19 illness, do not require oxygen, but are at high risk of progression to severe disease, they should be treated with remdesivir.
• The benefit of remdesivir is greatest when given early, ideally within ten days of symptom onset.
• Remdesivir should be given for 5 days or until hospital discharge. 

Therapeutic Management of Hospitalized Adults With COVID-19 Who Require Conventional Oxygen

• Conventional oxygen is defined as oxygen that is NOT high-flow nasal cannula, noninvasive mechanical ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO)
• For most patients in this cohort, the recommended treatment is dexamethasone plus remdesivir.
• Dexamethasone dose is 6 mg IV or oral (PO) once daily for up to 10 days or until hospital discharge (dexamethasone should not be continued at discharge). [83]  
• If the patient is on minimal oxygen, remdesivir monotherapy (without dexamethasone) should be used. 
• If remdesivir cannot be obtained or given, dexamethasone monotherapy is recommended.
• If dexamethasone is unavailable, corticosteroids such as prednisone, methylprednisolone, or hydrocortisone may be used.
• If the patient is already receiving dexamethasone but has rapidly increasing oxygen needs and/or signs of systemic inflammation, oral baricitinib or intravenous (IV) tocilizumab should be added to the treatment regimen as these agents have been shown to improve outcomes in rapidly decompensating patients. [85]
• Alternate immunomodulatory agents for this cohort include oral tofacitinib and IV sarilumab. These agents should only be used if baricitinib and tocilizumab are not available. 
• If the D-dimer level is above normal in this cohort of patients, they recommend therapeutic anticoagulation if the patient is not pregnant and has no increased risk of bleeding. Contraindications for therapeutic anticoagulation in these patients include a platelet count of less than 50 x10^9 /L, hemoglobin less than 8 g/dL, use of dual antiplatelet therapy, any significant bleeding within the past 30 days, a history of a bleeding disorder or an inherited or active acquired bleeding disorder. 
• For pregnant patients, a prophylactic dose of anticoagulation is recommended.

Therapeutic Management of Hospitalized Adults With COVID-19 who Require High-flow Nasal Cannula (HFNC) or Noninvasive Mechanical Ventilation (NIV)

• A meta-analysis study evaluating the effectiveness of HFNC compared to conventional oxygen therapy and NIV before mechanical ventilation reported that HFNC, when used before mechanical ventilation, could improve the prognosis of patients compared to conventional oxygen therapy and NIV. [86]  HFNC or NIV is associated with decreased dispersion of exhaled air, especially when used with good interface fitting, thus creating a low risk of nosocomial transmission of the infection. [87]  However, these treatment modalities are associated with a greater risk of aerosolization and should be used in negative-pressure rooms. [88]
• According to the NIH, dexamethasone plus oral baricitinib or dexamethasone plus IV tocilizumab are the preferred treatment regimens in these patients.
• Alternate immunomodulatory agents for this cohort include oral tofacitinib and IV sarilumab.
• Dexamethasone monotherapy is recommended if baricitinib, tocilizumab, or sarilumab cannot be obtained/given.
• Clinicians may consider adding remdesivir to corticosteroid and immunomodulator combination regimens in immunocompromised patients who require HFNC or NIV ventilation; however, using remdesivir without immunomodulators is not recommended.
• A prophylactic dose of anticoagulation is recommended in these patients. 
• If patients were started on a therapeutic dose of heparin while on conventional oxygen therapy, they should be switched to prophylactic dosing at this time unless they have another indication for full anticoagulation.

Therapeutic Management of Hospitalized Adults With COVID-19 who Require Mechanical Ventilation (MV)

• The management of this cohort is the same as those requiring HFNC or NIV, except that remdesivir is not recommended. 
• Remdesivir is most effective earlier in the course of the disease and in patients not on mechanical ventilation or ECMO.
• According to the NIH, one study showed a slight trend toward an increase in mortality in patients who received remdesivir while on mechanical ventilation or ECMO. [89]
• With this data in mind, the NIH recommends against using remdesivir in patients receiving MV or ECMO; however, if the patient was started on remdesivir and progressed to requiring mechanical ventilation or ECMO, they recommended continuing remdesivir to complete the treatment course. 

High-Titer COVID-19 Convalescent Plasma (CCP)

• The United States Food and Drug Administration (FDA) approved convalescent plasma therapy under a EUA for patients with severe life-threatening COVID-19. [90] [91]   Data from multiple studies evaluating the use of convalescent plasma in life-threatening COVID-19 has generated mixed results. Data from 3 small randomized control trials showed no significant differences in clinical improvement or overall mortality in patients treated with convalescent plasma versus standard therapy. [92] [93] [94]  
• According to the NIH, high-titer CCP is not recommended in immunocompetent individuals.
• However, the NIH states that some experts consider it appropriate for use in immunocompromised individuals. Therefore, the current NIH guidelines state that there is insufficient evidence for or against the use of high-titer CCP for treating COVID-19 in hospitalized or nonhospitalized patients who are immunocompromised.

Medications/Treatments That Should NOT Be Used for the Treatment of COVID-19 According to the Latest NIH Guidelines [ NIH COVID-19 Treatment Guidelines ]

• Chloroquine or hydroxychloroquine with or without azithromycin
• Lopinavir/ritonavir
• Azithromycin
• Doxycycline
• Fluvoxamine
• Inhaled corticosteroids
• Excess supplementation of vitamin C, vitamin D, and zinc
• Interferons alfa, beta, or lambda
• Nitazoxanide
• Bamlanivimab plus etesevimab
• Bebtelovimab
• Casirivimab plus imdevimab

Preexposure Prophylaxis for SARS-CoV-2 Infection

• According to the NIH guidelines, tixagevimab plus cilgavimab is authorized by the FDA for preexposure prophylaxis of SARS-CoV-2 in people who are not expected to mount an adequate immune response to COVID-19 vaccination; however, the prevalence of Omicron subvariants that are resistant to tixagevimab plus cilgavimab is noted to be increasing rapidly. 
• In the absence of alternative options, the NIH still recommends tixagevimab 300 mg plus cilgavimab 300 mg at this time.
• Tixagevimab and cilgavimab are potent anti-spike neutralizing monoclonal antibodies obtained from antibodies isolated from B cells of patients infected with SARS-CoV-2 that have demonstrated neutralizing activity against SARS-CoV-2 virus by binding to nonoverlapping epitopes of the viral spike-protein RBD. [95] [96] [97]  
• The EUA authorizes its use in adult and pediatric patients with no current evidence of SARS-CoV-2 infection and no recent exposure to SARS-CoV-2-positive individuals. They must be moderately or severely immunocompromised or be on immunosuppressive medications.
• Differential Diagnosis

The symptoms of the early stages of the disease are nonspecific. Differential diagnosis should include the possibility of a wide range of infectious and noninfectious respiratory disorders.

• Community-acquired bacterial pneumonia
• Viral pneumonia 
• Influenza infection
• Aspiration pneumonia
• Pneumocystis jirovecii pneumonia
• Middle East respiratory syndrome (MERS)
• Avian influenza A (H7N9) viral infection
• Avian influenza A (H5N1) viral infection
• Pulmonary tuberculosis

The prognosis of COVID-19 depends on various factors, including the patient's age, the severity of illness at presentation, preexisting conditions, how quickly treatment can be implemented, and response to treatment. The WHO currently estimates the global case fatality rate for COVID-19 is 2.2%. Results from a European multicenter prospective cohort study that included 4000 critically ill patients with COVID-19 reported a 90-day mortality of 31%, with higher mortality noted in geriatric patients and patients with diabetes, obesity, and severe ARDS. [98]

• Complications

COVID-19 is a systemic viral illness based on its involvement in multiple major organ systems.

• Patients with advanced age and comorbid conditions such as obesity, diabetes mellitus, chronic lung disease, cardiovascular disease, chronic kidney disease, chronic liver disease, and neoplastic conditions are at risk of developing severe COVID-19 and its associated complications. The most common complication of severe COVID-19 illness is progressive or sudden clinical deterioration leading to acute respiratory failure and ARDS or multiorgan failure leading to death.
• Patients with COVID-19 illness are also at increased risk of developing prothrombotic complications such as pulmonary embolisms, myocardial infarctions, ischemic strokes, and arterial thrombosis. [55]
• Cardiovascular system involvement results in malignant arrhythmias, cardiomyopathy, and cardiogenic shock.
• GI complications such as bowel ischemia, transaminitis, gastrointestinal bleeding, pancreatitis, Ogilvie syndrome, mesenteric ischemia, and severe ileus are often noted in critically ill patients with COVID-19. [99]
• Acute renal failure is the most common extrapulmonary manifestation of COVID-19 and is associated with an increased mortality risk. [69]
• A meta-analysis study of 14 studies evaluating the prevalence of disseminated intravascular coagulation (DIC) in hospitalized patients with COVID-19 reported that DIC was observed in 3% (95%: 1%-5%, P <0.001) of the included patients. Additionally, DIC was noted to be associated with severe illness and was a poor prognostic indicator. [100]
• More recent data have emerged regarding prolonged symptoms in patients who have recovered from COVID-19 infection, termed "post-acute COVID-19 syndrome." A large cohort study of 1773 patients performed 6 months after hospitalization with COVID-19 revealed that most exhibited at least one persistent symptom: fatigue, muscle weakness, sleep difficulties, or anxiety. Patients with severe illness also had an increased risk of chronic lung issues. [101]
• A retrospective cohort study that included 236,379 patients reported substantial neurological (intracranial hemorrhage, ischemic stroke) and psychiatric morbidity (anxiety disorder, psychotic disorder) 6 months after being diagnosed with COVID-19. [102]
• Secondary invasive fungal infections such as COVID-19-associated pulmonary aspergillosis and rhino-cerebro-orbital mucormycosis have increasingly been reported as complications in patients recovering from COVID-19. Risk factors for developing secondary fungal infection include comorbid conditions such as uncontrolled diabetes, associated lymphopenia, and excessive use of corticosteroids.
• Deterrence and Patient Education

The NIH COVID-19 Treatment Guidelines recommend COVID-19 vaccination as soon as possible for all eligible individuals. The CDC’s Advisory Committee on Immunization Practices (AI) determines eligibility eligibility. Four vaccines are authorized or approved in the United States to prevent COVID-19. According to the NIH guidelines, the preferred vaccines include:[ NIH COVID-19 Treatment Guidelines ]

• mRNA vaccine BNT162b2 (Pfizer-BioNTech)
• mRNA-1273 (Moderna)
• Recombinant spike protein with matrix-M1 adjuvant vaccine NVX-CoV2373 (Novavax)

The adenovirus vector vaccine Ad26.COV2.S (Johnson & Johnson/Janssen) is less preferred due to its risk of serious adverse events.[ NIH COVID-19 Treatment Guidelines ]

A primary series of COVID-19 vaccination is recommended for everyone older than 6 months in the United States. Bivalent mRNA vaccines that protect against the original SARS-CoV-2 virus strain and Omicron subvariants are recommended at least 2 months after receiving the primary vaccine series or a booster dose.[ NIH COVID-19 Treatment Guidelines ] 

• Enhancing Healthcare Team Outcomes

SARS-CoV-2 and its variants continue to cause significant morbidity and mortality worldwide. Prevention and management of this highly transmissible respiratory viral illness require a holistic and interprofessional approach that includes physicians' expertise across specialties, nurses, pharmacists, public health experts, and government authorities. There should be open communication among the clinical providers, pharmacists, and nursing staff while managing patients with COVID-19. Each team member should strive to keep abreast of the latest recommendations and guidelines and be free to speak up if they notice anything that does not comply with the latest tenets for managing COVID patients; there is no place for a hierarchy in communication that prohibits any team member from voicing their concerns. This open interprofessional approach will yield the best outcomes. 

Clinical providers managing COVID-19 patients on the frontlines should keep themselves periodically updated with the latest clinical guidelines about diagnostic and therapeutic options available in managing COVID-19, especially considering the emergence of new SARS-CoV-2 variants, which could significantly impact morbidity and mortality. Continued viral surveillance of new variants is crucial at regular intervals with viral genomic sequencing, given the possibility that more highly transmissible, more virulent, and treatment-resistant variants could emerge that can have a more catastrophic effect on global health in addition to the current scenario. A multi-pronged approach involving interprofessional team members can improve patient care and outcomes for this potentially devastating disease and help the world end this pandemic.

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Covid 19, Corona Replication Contributed by Rohan Bir Singh, MD

Clinical Presentation of Patients with CoVID-19 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

SARS- CoV 2 Structure Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Transmission Cycle of SARS CoV 2 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Single-stranded RNA genome of SARS-CoV2 Contributed by Rohan Bir Singh, MD; Made with Biorender.com

Disclosure: Marco Cascella declares no relevant financial relationships with ineligible companies.

Disclosure: Michael Rajnik declares no relevant financial relationships with ineligible companies.

Disclosure: Abdul Aleem declares no relevant financial relationships with ineligible companies.

Disclosure: Scott Dulebohn declares no relevant financial relationships with ineligible companies.

Disclosure: Raffaela Di Napoli declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Cascella M, Rajnik M, Aleem A, et al. Features, Evaluation, and Treatment of Coronavirus (COVID-19) [Updated 2023 Aug 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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15 Best Free Covid Coronavirus & Virus PowerPoint PPT Templates 2024

Whether you need to make a Covid-related or any other medical presentation, one thing is certain. It’s much faster to start with a coronavirus PowerPoint template than trying to do it from scratch. 

Luckily, there are plenty of free and premium Covid and virus-themed PPT templates available online that you can use as a starting point. 

The Best Source for COVID Coronavirus and Virus PowerPoint Templates (With Unlimited Use)

Envato Elements is the best place to find premium coronavirus, Covid, and virus PowerPoint templates with professional designs. Envato Elements is a subscription-based marketplace. It gives you access to thousands of creative assets — for a single monthly fee:

• premium PowerPoint templates for all your presentation needs
• stock photos and royalty-free music that you can use in your presentations
• fonts, icons, and more to customize your presentation

Explore Virus PowerPoint Templates Now

Envato Elements gives you the best bang for your buck if you need PowerPoint templates and other design assets regularly. Unlike our premium templates, free PowerPoint designs often lack features and customization options.

Top 5 Premium Covid and Coronavirus PowerPoint Templates From Envato Elements for 2024

Before we show you the best free PowerPoint templates with virus themes, here are the top premium coronavirus PowerPoint templates from Envato Elements:

1. Delta Corona Virus PowerPoint Template

First, we've got the Delta Corona Virus PowerPoint template with a modern and clean design. This Covid slides template features 80+ slides. They've got all the necessary content ideas for you to create an engaging presentation.

The template also comes with handmade infographic elements. It was designed in HD resolution and comes in dark and light versions.

2. Covid-19 Virus - Medical PowerPoint Template

The Covid-19 is a medical PowerPoint template with more than 70 unique and modern slides. This Covid presentation template has a gorgeous duotone color scheme, but you can easily customize it to match your brand. You’ll also find unique mockup devices, image placeholders, infographic elements, and more. The template comes in widescreen resolution. 

3. Covirus - Disease & Virus PowerPoint Template

Here’s a unique and trendy Covid and virus PowerPoint template that'll make creating your presentation a breeze. The template comes with 33 unique slides. You can customize colors, fonts, and even the slide layout to create the perfect presentation. You’ll also find image and media placeholders, vector-based icons, and mockup devices. 

4. Secure Virus 19 Medical PowerPoint Template

This coronavirus PPT has twenty-five unique slides. It can help you deliver a comprehensive presentation. Finding the right color scheme for your business won't be a problem. Included are over ninety color schemes that are fully customizable.

You'll find much-needed infographics, vectors, and charts as well. Download this complete Covid PowerPoint template.

5. Covid Virus - Medical PowerPoint Template

This Covid presentation template gives you the power to create an eye-catching presentation. Included are forty-six slides that feature modern designs. Many graphics are included to help you deliver a compelling presentation to your audience. Free web fonts are included, and you can drag and drop in images of your choice to any slide.

The premium templates mentioned are some of the highest quality available. If you're on a budget, you may not be able to afford the premium templates. In this next section, we'll go over the top free PowerPoint templates virus. 

15 Top Free Covid Coronavirus & Virus PowerPoint Templates to Download

Before looking for a free Covid PowerPoint template on the web, check Envato's free offerings first. Try out various premium template files (not always PowerPoint files) at no cost to you.

Here's the deal: 

With that in mind, here are the best free coronavirus and virus PowerPoint templates that you can find and download online for your presentation: 

1. Free Social Distance PowerPoint Template

With the help of this coronavirus PowerPoint template for free, you’ll have no problem explaining social distancing rules. The Covid PowerPoint template includes four pre-designed slides.

2. Medicine Health Care PowerPoint Templates

Try this medicine and healthcare PowerPoint template if you’re looking for a modern template. Use it to present all the necessary information about Coronavirus or any other medical emergency.

3. Medical Laboratory PowerPoint Templates

Here’s a free template virus that would be perfect for any type of virus research presentation. The template comes with individual slides as well as section covers. It includes 25 slides.

4. Coronavirus Pandemic PowerPoint Templates

Share important findings and information about Coronavirus or any other virus with this modern template. It comes with three master slides that you can customize.

5. Covid-19 Coronavirus PowerPoint Templates  

This free Covid PowerPoint template has a dark green background with virus icons. Use it to quickly create a presentation. The template comes with three master slides designed in several resolutions.

6. Infection PowerPoint Templates

Use this fun infection PowerPoint template to create a presentation about virus research or to provide more information about a specific virus. The Coronavirus PPT includes three master slides that you can duplicate to create your presentation.

7. Free COVID-19 Vaccine PowerPoint Template

With the help of this free PowerPoint template with a virus theme, you can easily share all the information people need to know about Covid-19 vaccines. The Covid vaccine theme PowerPoint comes with four slides.

8. Free COVID-19 Presentation Template

Use this Covid presentation template to create a presentation that shares information about the virus and how to fight it. The template has four master slides that you can copy as many times as you need.

9. Free Covid PowerPoint Template

Here’s a minimal and simple COVID PowerPoint template. It features an image that shows the virus spreading all over the world. It also contains four master Covid PowerPoint slides that you can copy for your presentation. 

10. Free COVID PowerPoint Background

Consider this free COVID PowerPoint background for your presentation. It features an image of a word game spelling out coronavirus, pandemic, and virus. 

11. Medical Illustrated. Free PowerPoint Template & Google Slides Theme

Here’s another minimal and clean PowerPoint template. Use it for any type of medical presentation. The Covid presentation template comes with 25 slides.

12. Blue Medical. Free PowerPoint Template & Google Slides Theme

The blue color in this medical and virus PowerPoint template conveys professionalism. It comes with 25 covid PowerPoint slides.

13. Medical Virus. Free PowerPoint Template & Google Slides Theme

This coronavirus PowerPoint template for free can be used for sharing information about the virus and how to prevent the spread. The template comes with 25 slides that you can duplicate, re-order, and delete as you see fit.

14. Free COVID-19 Health System Capacity Curve PowerPoint

Use this free Covid-19 PowerPoint template to showcase the virus's effect on the health system capacity. The template includes several different slide variations.

15. Coronavirus PowerPoint Template

Use this coronavirus PowerPoint template for free to create informative presentations about coronavirus measures, treatments, and protection. It comes with several slides, including section cover and agenda slides. 

How to Make a Coronavirus Presentation in PowerPoint

1. Choose the Right Slides

Not all the slides in the template will work for your presentation. Go through each slide and pick the ones that pertain to your presentation. For the slides, you don't want to use, left-click the slide and choose Delete Slide .

2. Add In Your Content

Now it's time to add in your presentation's content. Have a document open with all the text you want to use for each slide. Then copy and paste the text to each slide.

Each slide has text placeholders. Double-click the placeholder text and select all the text. You can then paste in your text.

3. Add In Your Images

Next, we'll add in our images to make the presentation more visually appealing. Just like the text, there are also image placeholders. To add in your images, click the image icon on each slide. Your computer files pop up. Choose the image you want to add. 

4. Add in Animations

To help add professional polish to your presentation, we'll add in animations. Choose the top menu header that says Animations . From there, choose the animation that you want to have on your slides. To see what each animation looks like, choose the Preview button on the far left side of the menu.

5. Proofread Your Presentation

Often this step is skipped. We get caught up in making our design look perfect and forget to proofread our presentation. Having grammatical errors and misspelled words is the quickest way to make your presentation look unprofessional. Take the time to go over every slide in your presentation before calling it done.

5 Quick Tips To Make Virus-Themed PPT Presentations in 2024

You’ve just seen the best free and premium coronavirus slideshow templates. Now, here are a few quarantine PowerPoint ideas that'll help you design a standout presentation: 

1. Stand Out With Custom Icons and Illustrations

Custom icons and illustrations make your presentation more memorable. Not to mention, they'll make your presentation stand out. The Covid-19 PowerPoint template features modern custom vector graphics that you can use as inspiration.

2. Keep the Text to a Minimum

Don’t overwhelm your audience by adding a lot of text on your slides. This can cause them to read the slide before you’re done presenting it and they may become disengaged. Instead, keep the text to a minimum of one to three bullet points per slide.

3. Use a Professional Color Scheme

You don’t have to shy away from color in your presentation. Make sure that your color scheme is professional and doesn’t contain any clashing colors. You can draw inspiration from this modern Coronavirus Medical PowerPoint template from Envato Elements.

4. Use Charts for Complex Data and Statistics

If you've got a lot of complex data and statistics, consider using charts and infographic elements to represent them. This will make it easier for your audience to understand and absorb the information.

5. Customize the Slides With Your Photos

Using stock photos is a great way to make your presentation more memorable. But you can achieve an even better effect by including photos of you, your team, and your employees. A template like the Corona Virus PowerPoint Template has plenty of image placeholders for you to use.

Discover More Top PowerPoint Template Designs

If you want to see even more PowerPoint template examples or if you need to create a different type of presentation, look at the following template roundups:

Common PowerPoint Questions Answered (FAQ)

If you're creating a Coronavirus PPT presentation and you're not familiar with PowerPoint, you may have some questions. We've got you covered! Here are some common PowerPoint questions and their answers:

1. I'm New to PowerPoint, What Should I Know?

PowerPoint is a powerhouse presentation software. But learning just the basics of the software enables you to create a complete presentation. Check out our ultimate PowerPoint guide to learn these basics.

2. How Should I Design My Slides?

The visual hierarchy of the slides dictates the design. The arrangement of the elements on your page and how they're placed has the biggest effect on what your audience remembers. Your slide's colors, typography, and images used are major contributors to the design of your slides. 

3. Can I Collaborate on One Presentation?

PowerPoint Online makes collaboration possible. This makes it easy to delegate separate tasks that need to be completed for the presentation. For an in-depth guide on how to collaborate as a team, view the article below.

4. What Colors Should I Use In My Coronavirus PPT?

The colors that work well are blue and red. Red helps highlight the urgency and danger of the virus and blue helps build trust with your audience. If your business has a set of brand colors, then you can use these colors as well. 

5. Can I Print Out My Slides?

Yes, you can! Print out your slides may be necessary depending on where you're presenting. Check out the tutorial below for a complete guide on how to print out your slides.

Learn More About Making Great PowerPoint Presentations in 2024

The tips we shared above are only a small selection of what makes a great presentation. If you want to learn more about designing and writing great PowerPoint presentations , check out the tutorials below: 

Create a Coronavirus Presentation Quickly With Templates

If you need to create a presentation about Coronavirus or any other type of medical presentation, there's no shortage of free PowerPoint templates with a virus theme to choose from. But, if you want to make your presentation look more unique, don’t forget to check out premium templates. 

Stop by Envato Elements if you know you’ll be needing PowerPoint templates and other creative assets on the regular or if you've got multiple brands to promote. 

Editorial Note: This post has been updated with contributions from Daniel Strongin . Daniel is a freelance instructor for Envato Tuts+.

• Registry Operations
• Reporting Guidelines
• COVID-19 Abstraction Guidance

COVID-19 Presentations

COVID-19 Abstraction Guidance by Margaret (Peggy) Adamo, RHIT, CTR

Access the presentation slides (PDF, 1.2 MB)

Coronavirus-Disease 19 (COVID-19) & SARS-CoV-2 Testing by Alison Van Dyke, MD, PhD

Access the presentation slides (PDF, 4.6 MB)

• Press Release

August 14, 2024

Bma to open latoya ruby frazier’s acclaimed installation more than conquerors in november 2024.

This is the first time the artwork celebrating Baltimore’s Community Health Workers will be shown in the community that inspired it

BALTIMORE, MD (August 14, 2024)—The Baltimore Museum of Art (BMA) announced today the November opening of LaToya Ruby Frazier’s acclaimed installation More Than Conquerors: A Monument for Community Health Workers of Baltimore, Maryland 2021-2022. Featuring a series of portraits and related narratives mounted on 18 socially distanced, stainless-steel IV poles, the large-scale installation captures and celebrates the essential work of community health workers in Baltimore during the rollout of the COVID-19 vaccine. Powerful and evocative, the installation monumentalizes the Community Health Workers’ efforts and offers an alternative approach to monument-making that challenges us to consider the nature of how and who we honor. The work was originally commissioned for the 58th Carnegie International, where it won the Carnegie Prize.

The BMA acquired More Than Conquerors: A Monument for Community Health Workers of Baltimore, Maryland 2021-2022 in spring 2023, with the generous support of the Glenstone Museum, and its forthcoming presentation marks the first time that it will go on view at the museum and in Baltimore. Open from November 3, 2024 through March 23, 2025, the installation is part of Turn Again to the Earth , a series of initiatives unfolding at the BMA focused on modeling commitments to sustainability and fostering dialogue about environmental issues. Turn Again to the Earth includes 10 exhibitions, the development of the BMA’s sustainability plan, and a Baltimore city-wide eco-challenge.

“We are thrilled to launch the exhibition portion of Turn Again to the Earth with the presentation of LaToya Ruby Frazier’s compelling and deeply resonant installation More Than Conquerors . The presentation is a singular opportunity to honor some of Baltimore’s most important and under-sung heroes in our museum and to consider the complex relationships between environment, health, and social inequities,” said Asma Naeem, the BMA’s Wagner Wallis Director. “We look forward to engaging our audiences with LaToya’s incredible artistry, to celebrating the everyday stories in our community, and to spurring conversations about timely issues that impact our lives.”

More Than Conquerors is an outgrowth of Frazier’s long-standing relationship with Dr. Lisa Cooper, Bloomberg Distinguished Professor at Johns Hopkins University School of Medicine and Bloomberg School of Public Health and Director of the Johns Hopkins Center for Health Equity. The two first connected during a 2015 conversation hosted by The Contemporary and the Baltimore School for the Arts that explored the power of art, science, and medicine to address environmental racism. Frazier was awarded a commission for the 58th Carnegie International during the pandemic and when she experienced an incident of medical injustice while trying to obtain a COVID-19 vaccination, she became inspired to develop a project that both revealed the depth of healthcare inequity and celebrated those individuals on the frontlines working for change.

Since the 1970s, Community Health Workers (CHWs) have served as an essential resource to underserved communities, helping individuals overcome challenges to healthcare access and providing advocacy in discussions with those working in healthcare systems and state health departments. CHWs played a critical part in the rollout of the COVID-19 vaccine, sharing information, encouraging acceptance of the treatment, and providing access and support. Despite their importance within communities in Baltimore and cities across the country, CHWs were among the unsung heroes of the pandemic and their daily efforts were necessary to ensure medical justice and healthcare equity. With the support of practitioners and educators at Johns Hopkins University as well as other healthcare advocates, Frazier connected with Tiffany Scott, co-founder and Chair of the Maryland Community Health Worker Association, and a group of CHWs actively involved in vaccination efforts between 2020 and 2021. More Than Conquerors reveals their portraits, stories, and voices, creating a poignant monument to their tireless efforts and recognizing their invaluable contributions to the lives of countless people and the health of many communities.

Collaborators

Community Health Workers: La Kerry B. Dawson, Tracy Barnes-Malone, Karen Dunston, Kenya Ferguson, Griselda Funn, Erica Hamlett, Donnie Missouri, Veda Moore, Kendra N. Lindsey, Evelyn Nicholson, Helen Owhonda, Gregory Rogers, Wilfredo Torriente, and Latish Walker.

Dr. Lisa Cooper; Dr. Chidinma Ibe, Nico Dominguez Carrero, and Alison Trainor of the Johns Hopkins Center for Health Equity; Dr. Anika L. Hines of the Johns Hopkins Center for Health Equity and Virginia Commonwealth University; Mrs. Tiffany Scott, co-founder and Chair of the Maryland Community Health Worker Association; and Reverend Debra Hickman, President and CEO of Sisters Together and Reaching, Inc. (STAR) and co-chair of the Johns Hopkins Center for Health Equity’s Community Advisory Board.

LaToya Ruby Frazier

LaToya Ruby Frazier’s (b. 1982, Braddock, PA) practice engages with social justice movements, cultural change, and the American experience through a wide range of media, including photography, video, performance, installation, and books. She often uses collaborative storytelling that captures the voices and stories of individuals represented in her artworks. Her prior projects have addressed topics of industrialism, rust belt revitalization, environmental justice, access to healthcare, access to clean water, workers’ rights, the nature of family, and communal history. Her work has been the subject of numerous solo exhibitions at institutions across the U.S. and Europe and her work is held in many public art collections. In May 2024, the Museum of Modern Art in New York opened the first museum survey dedicated to her work, titled LaToya Ruby Frazier: Monuments of Solidarity . In 2024, TIME named her among the 100 most influential people of the year. Other recent accolades include the 2020–21 National Geographic Storytelling Fellowship and a commission for the Carnegie Museum 58th Carnegie International.

Turn Again to the Earth

Turn Again to the Earth refers to a series of major initiatives at the BMA that model commitments to environmental sustainability and foster discourse on climate change and the role of the museum. Unfolding over the remainder of 2024 and throughout 2025, the interrelated efforts include an evaluation of internal BMA practices for environmental impacts and the creation of a sustainability plan for the museum; a series of exhibitions and public programs that capture the relationships between art and the environment across time and geography; and a citywide eco-challenge that invites Baltimore and regional partners to engage in environment-related conversations and enact their own plans for a more sustainable future. Following months of climate-driven protests at museums across the U.S. and abroad, the BMA’s environmental initiatives offer opportunities for more productive dialogues and actions within the museum context. As the museum celebrates its 110th anniversary, it is fitting that it considers its future in part through the lens of this critical subject. The title for the series of initiatives is inspired by the writing of environmental activist Rachel Carson, who spent most of her life in Maryland.

About the Baltimore Museum of Art

Founded in 1914, the Baltimore Museum of Art (BMA) inspires people of all ages and backgrounds through exhibitions, programs, and collections that tell an expansive story of art—challenging long-held narratives and embracing new voices. Our outstanding collection of more than 97,000 objects spans many eras and cultures and includes the world’s largest public holding of works by Henri Matisse; one of the nation’s finest collections of prints, drawings, and photographs; and a rapidly growing number of works by contemporary artists of diverse backgrounds. The museum is also distinguished by a neoclassical building designed by American architect John Russell Pope and two beautifully landscaped gardens featuring an array of modern and contemporary sculpture. The BMA is located three miles north of the Inner Harbor, adjacent to the main campus of Johns Hopkins University, and has a community branch at Lexington Market. General admission is free so that everyone can enjoy the power of art.

Press Contacts

Anne Brown Baltimore Museum of Art Senior Director of Communications [email protected] 410-274-9907

Sarah Pedroni Baltimore Museum of Art Communications Manager [email protected] 410-428-4668

Alina Sumajin PAVE Communications [email protected] 646-369-2050