Diagnosis

Further information: COVID-19 testing

Demonstration of a nasopharyngeal swab for COVID-19 testing

US CDC rRT-PCR test kit for COVID-19[64]

The WHO has published several testing protocols for the disease.[65] The standard method of
testing is real-time reverse transcription polymerase chain reaction (rRT-PCR).[66] The test is
typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal
swab or sputum sample may also be used.[67][68] Results are generally available within a few
hours to two days.[69][70] Blood tests can be used, but these require two blood samples taken two
weeks apart, and the results have little immediate value.[71] Chinese scientists were able to
isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the
world could independently develop polymerase chain reaction (PCR) tests to detect infection by
the virus.[72][73][74] As of 4 April 2020, antibody tests (which may detect active infections and
whether a person had been infected in the past) were in development, but not yet widely used.[75]
[76][77]
 Antibody tests may be most accurate 2–3 weeks after a person's symptoms start.[78] The
Chinese experience with testing has shown the accuracy is only 60 to 70%.[79] The US Food and
Drug Administration (FDA) approved the first point-of-care test on 21 March 2020 for use at the
end of that month.[80] The absence or presence of COVID-19 signs and symptoms alone is not
reliable enough for an accurate diagnosis.[81] Different clinical scores were created based on
symptoms, laboratory parameters and imaging to determine patients with probable SARS-CoV-
2 infection or more severe stages of COVID-19.[82][83]
Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods
for detecting infections based upon clinical features and epidemiological risk. These involved
identifying people who had at least two of the following symptoms in addition to a history of
travel to Wuhan or contact with other infected people: fever, imaging features of pneumonia,
normal or reduced white blood cell count, or reduced lymphocyte count.[84]
A study asked hospitalised COVID-19 patients to cough into a sterile container, thus producing
a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This
technique has the potential of being quicker than a swab and involving less risk to health care
workers (collection at home or in the car).[85]
Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in
individuals with a high clinical suspicion of infection but are not recommended for routine
screening.[86] [87] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and
posterior distribution are common in early infection.[86][88] Subpleural dominance, crazy
paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as
the disease progresses.[86][89]
In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-
confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically
diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.[90]

CT scan of rapid progression stage of COVID-19.

 

Chest X-ray showing COVID-19 pneumonia.

Pathology
The main pathological findings at autopsy are:[61]

 Macroscopy: pericarditis, lung consolidation and pulmonary oedema

 Lung findings:
o minor serous exudation, minor fibrin exudation
o pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes,
interstitial inflammation with lymphocytic infiltration and multinucleated giant
cell formation
o diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause
of acute respiratory distress syndrome (ARDS) and severe hypoxemia.
 o organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis
o plasmocytosis in BAL[91]
 Blood: disseminated intravascular coagulation (DIC);[92] leukoerythroblastic reaction[93]
 Liver: microvesicular steatosis

Prevention
See also: COVID-19 pandemic §  Prevention, flattening the curve, workplace hazard controls
for COVID-19, and cloth face mask

Without pandemic containment measures—such as social distancing, vaccination, and use of face masks—
pathogens can spread exponentially.[94] This graphic shows how early adoption of containment measures tends
to protect wider swaths of the population.

Progressively stronger mitigation efforts to reduce the number of active cases at any given time—"flattening the
curve"—allows healthcare services to better manage the same volume of patients. [95][96][97] Likewise, progressively
greater increases in healthcare capacity—called raising the line—such as by increasing bed count, personnel,
and equipment, helps to meet increased demand. [98]
Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of distancing
rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation. [96][99]

A COVID-19 vaccine is not expected until 2021 at the earliest.[100] The US National Institutes of
Health guidelines do not recommend any medication for prevention of COVID-19, before or after
exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial.[101][102] Without a vaccine,
other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying
to decrease and delay the epidemic peak, known as "flattening the curve".[96] This is done by
slowing the infection rate to decrease the risk of health services being overwhelmed, allowing
for better treatment of current cases, and delaying additional cases until effective treatments or
a vaccine become available.[96][99]
Preventive measures to reduce the chances of infection include staying at home, wearing a
mask in public, avoiding crowded places, keeping distance from others, ventilating indoor
spaces, washing hands with soap and water often and for at least 20 seconds, practising good
respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.[103][104]
[105][106][107]
 Those diagnosed with COVID-19 or who believe they may be infected are advised by
the CDC to stay home except to get medical care, call ahead before visiting a healthcare
provider, wear a face mask before entering the healthcare provider's office and when in any
room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash
hands with soap and water and avoid sharing personal household items.[108][109]

Personal protective equipment

For health care professionals who may come into contact with COVID-19 positive bodily fluids,
using personal protective coverings on exposed body parts improves protection from the virus.
[110]
 Breathable personal protective equipment[clarification needed] improves user-satisfaction and may offer
a similar level of protection from the virus.[110] In addition, adding tabs and other modifications to
the protective equipment may reduce the risk of contamination during donning and doffing
(putting on and taking off the equipment).[110] Implementing an evidence-based donning and
doffing protocol such as a one-step glove and gown removal technique, giving oral instructions
while donning and doffing, double gloving, and the use of glove disinfection may also improve
protection for health care professionals.[110]
Face masks
The World Health Organization (WHO) and most government health agencies (such as the
US Centers for Disease Control and Prevention (CDC), the UK National Health Service (NHS),
or the New Zealand Ministry of Health) recommend individuals wear non-medical face
coverings in public settings where there is an increased risk of transmission and where social
distancing measures are difficult to maintain.[111][112][113][114][115] This recommendation is meant to
reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is
complementary to established preventive measures such as social distancing.[112][116] Face
coverings limit the volume and travel distance of expiratory droplets dispersed when talking,
breathing, and coughing.[112][116] Many countries and local jurisdictions encourage or mandate the
use of face masks or cloth face coverings by members of the public to limit the spread of the
virus.[117][118][119][120]
Masks are also strongly recommended for those who may have been infected and those taking
care of someone who may have the disease.[121]

Social distancing

Social distancing measures on the castle of Kavala, Greece

Social distancing strategies aim to reduce contact of infected persons within large groups by
closing schools and workplaces, restricting travel, and cancelling large public gatherings.
[122]
 Distancing guidelines also include that people stay at least 2 metres (6.6 ft) apart.[123] After the
implementation of social distancing and stay-at-home orders, many regions have been able to
sustain an effective transmission rate ("Rt") of less than one, meaning the disease is in
remission in those areas.[124]

Hand-washing and hygiene