People are managed with supportive care, which may include fluid therapy, oxygen support, and supporting

other affected vital organs.[143][144][145] The CDC recommends those who suspect they carry the virus wear
a simple face mask.[28] Extracorporeal membrane oxygenation (ECMO) has been used to address the issue
of respiratory failure, but its benefits are still under consideration.[38][146] Personal hygiene and a healthy
lifestyle and diet have been recommended to improve immunity.[147] Supportive treatments may be useful in
those with mild symptoms at the early stage of infection.[148]

The WHO, the Chinese National Health Commission, and the United States' National Institutes of Health
have published recommendations for taking care of people who are hospitalised with
COVID‑19.[127][149][150] Intensivists and pulmonologists in the U.S. have compiled treatment
recommendations from various agencies into a free resource, the IBCC.[151][152]

Medications

Per the World Health Organization, as of April 2020, there is no specific treatment for COVID‑19.[7] On
1 May 2020, the United States gave emergency use authorization (not full approval) for remdesivir in people
hospitalized with severe COVID‑19 after a study suggested it reduced the duration of recovery.[32][153]
Researchers continue working on more effective treatments and many vaccine candidates are in
development or testing phases.

For symptoms, some medical professionals recommend paracetamol (acetaminophen) over ibuprofen for
first-line use.[154][155][156] The WHO and NIH do not oppose the use of non-steroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen for symptoms,[127][157] and the FDA says currently there is no evidence
that NSAIDs worsen COVID‑19 symptoms.[158]

While theoretical concerns have been raised about ACE inhibitors and angiotensin receptor blockers, as of
19 March 2020, these are not sufficient to justify stopping these medications.[127][159][160][161] One study
from 22 April found that people with COVID‑19 and hypertension had lower all-cause mortality when on
these medications.[162]

Steroids, such as methylprednisolone, are not recommended unless the disease is complicated by acute
respiratory distress syndrome.[163][164]

The Australasian Society of Clinical Immunology and Allergy recommends that tocilizumab be considered
an off-label treatment option for those with COVID‑19-related acute respiratory distress syndrome. It
recommends this because of its known benefit in cytokine storm caused by a specific cancer treatment, and
that cytokine storm may be a significant contributor to mortality in severe COVID‑19.[15]

Medications to prevent blood clotting have been suggested for treatment,[90] and anticoagulant therapy with
low molecular weight heparin appears to be associated with better outcomes in severe COVID‐19 showing
signs of coagulopathy (elevated D-dimer).[165]

Protective equipment

Precautions must be taken to minimise the risk of virus transmission, especially in healthcare settings when
performing procedures that can generate aerosols, such as intubation or hand ventilation.[167] For healthcare
professionals caring for people with COVID‑19, the CDC recommends placing the person in an Airborne
Infection Isolation Room (AIIR) in addition to using standard precautions, contact precautions, and airborne
precautions.[168]
The CDC outlines the guidelines for the use of personal protective
equipment (PPE) during the pandemic. The recommended gear is a
PPE gown, respirator or facemask, eye protection, and medical
gloves.[169][170]

When available, respirators (instead of face masks) are

preferred.[171] N95 respirators are approved for industrial settings
but the FDA has authorised the masks for use under an emergency
use authorization (EUA). They are designed to protect from airborne
particles like dust but effectiveness against a specific biological
agent is not guaranteed for off-label uses.[172] When masks are not
available, the CDC recommends using face shields or, as a last
resort, homemade masks.[173]

Mechanical ventilation

Most cases of COVID‑19 are not severe enough to require

mechanical ventilation or alternatives, but a percentage of cases
are.[174][175] The type of respiratory support for individuals with
COVID‑19 related respiratory failure is being actively studied for
people in the hospital, with some evidence that intubation can be
avoided with a high flow nasal cannula or bi-level positive airway
pressure.[176] Whether either of these two leads to the same benefit
for people who are critically ill is not known.[177] Some doctors The U.S. Centers for Disease Control
prefer staying with invasive mechanical ventilation when available and Prevention (CDC) recommends
because this technique limits the spread of aerosol particles four steps to putting on personal
protective equipment (PPE).[166]
compared to a high flow nasal cannula.[174]

Mechanical ventilation had been performed in 79% of critically ill

people in hospital including 62% who previously received other treatment. Of these 41% died, according to
one study in the United States.[178]

Severe cases are most common in older adults (those older than 60 years,[174] and especially those older
than 80 years).[52] Many developed countries do not have enough hospital beds per capita, which limits a
health system's capacity to handle a sudden spike in the number of COVID‑19 cases severe enough to
require hospitalisation.[179] This limited capacity is a significant driver behind calls to flatten the curve.[179]
One study in China found 5% were admitted to intensive care units, 2.3% needed mechanical support of
ventilation, and 1.4% died.[38] In China, approximately 30% of people in hospital with COVID‑19 are
eventually admitted to ICU.[5]

Acute respiratory distress syndrome

Mechanical ventilation becomes more complex as acute respiratory distress syndrome (ARDS) develops in
COVID‑19 and oxygenation becomes increasingly difficult.[180] Ventilators capable of pressure control
modes and high PEEP[181] are needed to maximise oxygen delivery while minimising the risk of ventilator-
associated lung injury and pneumothorax.[182] High PEEP may not be available on older ventilators.

There is high mortality in people ventilated with COVID-19, thought to be due to cytokine storm. Blockade
of the IL-6 system is recommended by Australasian Society for Immunology and Allergy to be considered
early in severe disease, and is included for consideration in a number of national guidelines.[15]
 Options for ARDS[180]
Therapy Recommendations
High-flow nasal oxygen For SpO2 <93%. May prevent the need for intubation and ventilation

Tidal volume 6mL per kg and can be reduced to 4mL/kg

Keep below 30 cmH2O if possible (high respiratory rate (35 per minute) may be
Plateau airway pressure
required)
Positive end-expiratory
Moderate to high levels
pressure
Prone positioning For worsening oxygenation
Fluid management Goal is a negative balance of 0.5–1.0L per day
Antibiotics For secondary bacterial infections
Glucocorticoids Not recommended

Experimental treatment

Research into potential treatments started in January 2020,[183] and several antiviral drugs are in clinical
trials.[184][185] Remdesivir appears to be the most promising.[130] Although new medications may take until
2021 to develop,[186] several of the medications being tested are already approved for other uses or are
already in advanced testing.[187] Antiviral medication may be tried in people with severe disease.[143] The
WHO recommended volunteers take part in trials of the effectiveness and safety of potential treatments.[188]

The FDA has granted temporary authorisation to convalescent plasma as an experimental treatment in cases
where the person's life is seriously or immediately threatened. It has not undergone the clinical studies
needed to show it is safe and effective for the disease.[189][190][191]

Information technology

In February 2020, China launched a mobile app to deal with the disease outbreak.[192] Users are asked to
enter their name and ID number. The app can detect 'close contact' using surveillance data and therefore a
potential risk of infection. Every user can also check the status of three other users. If a potential risk is
detected, the app not only recommends self-quarantine, it also alerts local health officials.[193]

Big data analytics on cellphone data, facial recognition technology, mobile phone tracking, and artificial
intelligence are used to track infected people and people whom they contacted in South Korea, Taiwan, and
Singapore.[194][195] In March 2020, the Israeli government enabled security agencies to track mobile phone
data of people supposed to have coronavirus. According to the Israeli government, the measure was taken to
enforce quarantine and protect those who may come into contact with infected citizens. The Association for
Civil Rights in Israel, however, said the move was "a dangerous precedent and a slippery slope".[196] Also in
March 2020, Deutsche Telekom shared aggregated phone location data with the German federal government
agency, Robert Koch Institute, to research and prevent the spread of the virus.[197] Russia deployed facial
recognition technology to detect quarantine breakers.[198] Italian regional health commissioner Giulio
Gallera said he has been informed by mobile phone operators that "40% of people are continuing to move
around anyway".[199] The German Government conducted a 48-hour weekend hackathon, which had more
than 42,000 participants.[200][201] Three million people in the UK used an app developed by King's College
London and Zoe to track people with COVID‑19 symptoms.[202][203] The president of Estonia, Kersti
Kaljulaid, made a global call for creative solutions against the spread of coronavirus.[204]
Psychological support

Individuals may experience distress from quarantine, travel restrictions, side effects of treatment, or fear of
the infection itself. To address these concerns, the National Health Commission of China published a
national guideline for psychological crisis intervention on 27 January 2020.[205][206]

The Lancet published a 14-page call for action focusing on the UK and stated conditions were such that a
range of mental health issues was likely to become more common. BBC quoted Rory O'Connor in saying,
"Increased social isolation, loneliness, health anxiety, stress, and an economic downturn are a perfect storm
to harm people's mental health and wellbeing."[207][208]

Prognosis
The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms,
resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover
within two weeks, while those with severe or critical diseases may take three to six weeks to recover.
Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.[43]

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4%
aged 10–19 years.[22] They are likely to have milder symptoms and a lower chance of severe disease than
adults; in those younger than 50 years the risk of death is less than 0.5%, while in those older than 70 it is
more than 8%.[215][216][217] Pregnant women may be at higher risk for severe infection with COVID‑19
based on data from other similar viruses, like Severe acute respiratory syndrome (SARS) and Middle East
respiratory syndrome (MERS), but data for COVID‑19 is lacking.[218][219] In China, children acquired
infections mainly through close contact with their parents or other family members who lived in Wuhan or
had traveled there.[215]

Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful in early screening
for severe illness.[220]

Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension,
diabetes mellitus, and cardiovascular disease.[221] The Istituto Superiore di Sanità reported that out of 8.8%
of deaths where medical charts were available, 97% of people had at least one comorbidity with the average
person having 2.7 diseases.[222] According to the same report, the median time between the onset of
symptoms and death was ten days, with five being spent hospitalised. However, people transferred to an
ICU had a median time of seven days between hospitalisation and death.[222] In a study of early cases, the
median time from exhibiting initial symptoms to death was 14 days, with a full range of six to 41 days.[223]
In a study by the National Health Commission (NHC) of China, men had a death rate of 2.8% while women
had a death rate of 1.7%.[224] Histopathological examinations of post-mortem lung samples show diffuse
alveolar damage with cellular fibromyxoid exudates in both lungs. Viral cytopathic changes were observed
in the pneumocytes. The lung picture resembled acute respiratory distress syndrome (ARDS).[43] In 11.8%
of the deaths reported by the National Health Commission of China, heart damage was noted by elevated
levels of troponin or cardiac arrest.[44] According to March data from the United States, 89% of those
hospitalised had preexisting conditions.[225]

The availability of medical resources and the socioeconomics of a region may also affect mortality.[226]
Estimates of the mortality from the condition vary because of those regional differences,[227] but also
because of methodological difficulties. The under-counting of mild cases can cause the mortality rate to be
overestimated.[228] However, the fact that deaths are the result of cases contracted in the past can mean the
current mortality rate is underestimated.[229][230] Smokers were 1.4 times more likely to have severe
symptoms of COVID‑19 and approximately 2.4 times more likely to require intensive care or die compared
to non-smokers.[231]

Concerns have been raised about long-

term sequelae of the disease. The Hong
Kong Hospital Authority found a drop of
20% to 30% in lung capacity in some
people who recovered from the disease,
and lung scans suggested organ
damage.[232] This may also lead to post-
intensive care syndrome following
recovery.[233]

The severity of diagnosed COVID-19 cases in China[209]

Case fatality rates by age group:

China, as of 11 February 2020[210]
South Korea, as of 20 May 2020[211]
Spain, as of 18 May 2020[212]
Italy, as of 14 May 2020[213]
Case fatality rate in China depending on other health problems.
Data through 11 February 2020.[210]

The number of deaths vs total cases by country and approximate

case fatality rate[214]
 Case fatality rates (%) by age and country
0– 10– 20– 30– 40– 50– 60– 70– 80–
Age 90+
9 19 29 39 49 59 69 79 89

Argentina as of 7 May[234] 0.0 0.0 0.1 0.4 1.3 3.6 12.9 18.8 28.4

Australia as of 20 May[235] 0.0 0.0 0.0 0.0 0.1 0.2 1.0 4.2 17.7 40.8

Canada as of 19 May[236] 0.0 0.1 0.7 7.7 25.3

Chile as of 17 May[237] 0.0 0.5 0.8 3.4 10.4 22.3

China as of 11 February[210] 0.0 0.2 0.2 0.2 0.4 1.3 3.6 8.0 14.8

Colombia as of 20 May[238] 0.0 0.0 0.3 0.4 1.7 3.6 11.0 19.5 28.1 38.3

Denmark as of 19 May[239] 0.2 4.1 16.6 27.6 48.1

Finland as of 29 May[240] 0.0 0.0 0.2 0.8 3.8 18.1 41.1

Germany as of 21 May[241] 0.0 0.0 0.1 1.9 19.2 30.3

Israel as of 3 May[242] 0.0 0.0 0.0 0.9 0.9 3.1 9.7 22.9 30.8 31.3

Italy as of 27 May[243] 0.2 0.0 0.1 0.3 0.9 2.7 10.6 25.8 32.0 29.2

Japan as of 7 May[244] 0.0 0.0 0.0 0.1 0.3 0.6 2.5 6.8 14.8

Mexico as of 24 May[245] 3.0 0.7 1.2 2.7 7.3 13.8 23.0 30.6 34.3 32.7

Netherlands as of 20 May[246] 0.0 0.2 0.1 0.3 0.5 1.7 8.1 25.5 32.7 33.9

Norway as of 20 May[247] 0.0 0.0 0.0 0.0 0.3 0.4 2.0 9.2 22.9 57.1

Philippines as of 20 May[248] 3.1 1.2 0.5 1.1 3.3 6.7 15.4 22.4 33.0

Portugal as of 20 May[249] 0.0 0.0 0.0 0.0 0.3 0.8 3.4 10.1 19.4

South Korea as of 24 May[211] 0.0 0.0 0.0 0.2 0.2 0.8 2.8 10.9 26.3

Spain as of 17 May[212] 0.2 0.3 0.2 0.3 0.6 1.4 4.9 14.3 21.0 22.3

Sweden as of 20 May[250] 0.7 0.0 0.3 0.3 0.8 2.1 7.2 23.5 34.6 39.0

Switzerland as of 20 May[251] 0.0 0.0 0.0 0.1 0.1 0.6 3.3 11.5 27.9

United States

Colorado as of 20 May[252] 0.0 0.2 0.2 0.2 0.8 1.9 6.3 17.7 38.6

Connecticut as of 20 May[253] 0.2 0.1 0.1 0.4 0.9 2.2 7.6 20.0 36.1

Idaho as of 20 May[254] 0.0 0.0 0.0 0.0 0.0 0.5 3.0 9.2 30.5

Indiana as of 20 May[255] 0.2 0.1 0.3 0.7 1.9 7.2 16.9 28.3

Kentucky as of 20 May[256] 0.0 0.0 0.0 0.2 0.5 1.9 5.9 14.2 29.1

Maryland as of 20 May[257] 0.0 0.1 0.2 0.3 0.7 1.9 6.1 14.6 28.8

Massachusetts as of 20
0.0 0.0 0.1 0.1 0.4 1.5 5.2 16.8 28.9
May[258]

Minnesota as of 13 May[259] 0.0 0.0 0.0 0.1 0.3 1.6 5.4 26.9

Mississippi as of 19 May[260] 0.0 0.1 0.5 0.9 2.1 8.1 16.1 19.4 27.2

Missouri as of 19 May[261] 0.0 0.0 0.1 0.2 0.8 2.2 6.3 14.3 22.5

Nevada as of 20 May[262] 0.0 0.3 0.3 0.4 1.7 2.6 7.7 22.3
 N. Hampshire as of 12
0.0 0.0 0.4 0.0 1.2 0.0 2.2 12.0 21.2
May[263]

Oregon as of 12 May[264] 0.0 0.0 0.0 0.0 0.5 0.8 5.6 12.1 28.9

Texas as of 20 May[265] 0.0 0.5 0.4 0.3 0.8 2.1 5.5 10.1 30.6

Virginia as of 19 May[266] 0.0 0.0 0.0 0.1 0.4 1.0 4.4 12.9 24.9

Washington as of 10 May[267] 0.0 0.2 1.3 9.8 31.2

Wisconsin as of 20 May[268] 0.0 0.0 0.2 0.2 0.6 2.0 5.0 14.7 19.9 30.4
 Estimated prognosis by age and sex based on cases from France and Diamond Princess ship[269]
Percent of infected people who are hospitalized
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
9.6 23.6
0.2 0.6 1.1 1.6 3.2 6.2 3.2
Female (5.7– (14.0–
(0.1–0.3) (0.3–0.9) (0.7–1.8) (0.9–2.4) (1.9–4.9) (3.7–9.6) (1.9–5.0)
14.8) 36.4)

8.1 13.4 45.9

0.2 0.7 1.4 1.9 3.9 4.0
Male (4.8– (8.0– (27.3–
(0.1–0.3) (0.4–1.1) (0.9–2.2) (1.1–3.0) (2.3–6.1) (2.4–6.2)
12.6) 20.7) 70.9)

7.1 11.3 32.0

0.2 0.6 1.3 1.7 3.5 3.6
Total (4.2– (6.7– (19.0–
(0.1–0.3) (0.4–1.0) (0.8–2.0) (1.0–2.7) (2.1–5.4) (2.1–5.6)
11.0) 17.5) 49.4)

Percent of hospitalized people who go to Intensive Care Unit

0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
11.9 16.6 20.7 23.1 18.7 14.3
16.7 8.6 4.2
Female (10.9– (15.6– (19.8– (22.2– (18.0– (13.9–
(14.4–19.2) (7.5–9.9) (4.0–4.5)
13.0) 17.7) 21.7) 24.0) 19.5) 14.7)

19.2 26.9 33.4 37.3 30.2 23.1

26.9 14.0 6.8
Male (17.6– (25.3– (32.0– (36.0– (29.2– (22.6–
(23.2–31.0) (12.2–15.9) (6.5–7.2)
20.9) 28.5) 34.8) 38.6) 31.3) 23.6)

15.9 22.2 27.6 30.8 24.9 19.0

22.2 11.5 5.6
Total (14.6– (21.0– (26.5– (29.8– (24.1– (18.7–
(19.2–25.5) (10.1–13.2) (5.3–5.9)
17.3) 23.5) 28.7) 31.8) 25.8) 19.44)

Percent of hospitalized people who die

0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
10.1 16.7 25.2 14.4
0.5 0.9 1.5 2.6 5.2
Female (9.5– (16.0– (24.4– (14.0–
(0.2–1.1) (0.5–1.3) (1.2–1.9) (2.3–3.0) (4.8–5.6)
10.6) 17.4) 26.0) 14.9)

14.8 24.6 37.1 21.22

0.7 1.3 2.2 3.8 7.6
Male (14.1– (23.7– (36.1– (20.8–
(0.3–1.5) (0.8–1.9) (1.7–2.7) (3.4–4.4) (7.0–8.2)
15.6) 25.6) 38.2) 21.7)

12.6 21.0 31.6 18.1

0.6 1.1 1.9 3.3 6.5
Total (12.0– (20.3– (30.9– (17.8–
(0.3–1.3) (0.7–1.6) (1.5–2.3) (2.9–3.7) (6.0–7.0)
13.2) 21.8) 32.4) 18.4)

Percent of infected people who die – infection fatality rate (IFR)

0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
0.001 0.005 0.02 0.04
0.2 0.6 1.6 5.9 0.5
Female (<0.001– (0.002– (0.01– (0.02–
(0.1–0.3) (0.4–1.0) (1.0–2.5) (3.5–9.2) (0.3–0.7)
0.002) 0.009) 0.03) 0.07)

0.001 0.008 0.03 0.07 17.1

0.3 1.2 3.3 0.8
Male (<0.001– (0.004– (0.02– (0.04– (10.1–
(0.2–0.5) (0.7–1.9) (2.0–5.1) (0.5–1.3)
0.003) 0.02) 0.05) 0.1) 26.3)

0.001 0.007 0.02 0.06 0.2 10.1

0.9 2.4 0.7
Total (<0.001– (0.003– (0.01– (0.03– (0.1– (6.0–
(0.5–1.4) (1.4–3.7) (0.4–1.0)
0.002) 0.01) 0.04) 0.09) 0.36) 15.6)

Numbers in parentheses are 95% credible intervals for the estimates.

Existing respiratory problems

When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk
for severe symptoms.[270] COVID-19 also poses a greater risk to people who misuse opioids and
methamphetamines, insofar as their drug use may have caused lung damage.[271]

Immunity

It is unknown (as of April 2020) if past infection provides effective and long-term immunity in people who
recover from the disease.[272][273] Some of the infected have been reported to develop protective antibodies,
so acquired immunity is presumed likely, based on the behaviour of other coronaviruses.[274] Cases in which
recovery from COVID‑19 was followed by positive tests for coronavirus at a later date have been
reported.[275][276][277][278] However, these cases are believed to be lingering infection rather than
reinfection,[278] or false positives due to remaining RNA fragments.[279] An investigation by the Korean
CDC of 285 individuals who tested positive for SARS-CoV-2 in PCR tests administered days or weeks after
recovery from COVID-19 found no evidence that these individuals were contagious at this later time.[280]
Some other coronaviruses circulating in people are capable of reinfection after roughly a year.[281][282]

History
The virus is thought to be natural and has an animal origin,[75] through spillover infection.[283] The actual
origin is unknown, but the first known cases of infection happened in China. By December 2019, the spread
of infection was almost entirely driven by human-to-human transmission.[210][284] A study of the first 41
cases of confirmed COVID‑19, published in January 2020 in The Lancet, revealed the earliest date of onset
of symptoms as 1 December 2019.[285][286][287] Official publications from the WHO reported the earliest
onset of symptoms as 8 December 2019.[288] Human-to-human transmission was confirmed by the WHO
and Chinese authorities by 20 January 2020.[289][290]

Epidemiology
Several measures are commonly used to quantify mortality.[291] These numbers vary by region and over
time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the
initial outbreak, and population characteristics such as age, sex, and overall health.[292]

The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a
given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 6.2%
(362,238/5,867,727) as of 29 May 2020.[9] The number varies by region.[293]

Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who
die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals
(diagnosed and undiagnosed) who die from a disease. These statistics are not time-bound and follow a
specific population from infection through case resolution. Many academics have attempted to calculate
these numbers for specific populations.[294]

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social
distancing.[295][296] In the United States, the prisoner population is aging and many of them are at high risk
for poor outcomes from COVID‑19 due to high rates of coexisting heart and lung disease, and poor access
to high-quality healthcare.[295]