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PreviewAdvancedSpecial charactersHelpHeadingLevel 2Level 3Level 4Level 5FormatInsertLatinLatin extendedIPASymbolsGreekGreek extendedCyrillicArabicArabic extendedHebrewBanglaTamilTeluguSinhalaDevanagariGujaratiThaiLaoKhmerCanadian AboriginalRunesÁáÀàÂâÄäÃãǍǎĀāĂ㥹ÅåĆćĈĉÇçČčĊċĐđĎďÉéÈèÊêËëĚěĒēĔĕĖėĘęĜĝĢģĞğĠġĤĥĦħÍíÌìÎîÏïĨĩǏǐĪīĬĭİıĮįĴĵĶķĹĺĻļĽľŁłŃńÑñŅņŇňÓóÒòÔôÖöÕõǑǒŌōŎŏǪǫŐőŔŕŖŗŘřŚśŜŝŞşŠšȘșȚțŤťÚúÙùÛûÜüŨũŮůǓǔŪūǖǘǚǜŬŭŲųŰűŴŵÝýŶŷŸÿȲȳŹźŽžŻżÆæǢǣØøŒœßÐðÞþƏəFormattingLinksHeadingsListsFilesDiscussionReferencesDescriptionWhat you typeWhat you getItalic''Italic text''Italic textBold'''Bold text'''Bold textBold & italic'''''Bold & italic text'''''Bold & italic textDescriptionWhat you typeWhat you getReferencePage text.<ref>[https://www.example.org/ Link text], additional text.</ref>Page text.[1]Named referencePage text.<ref name="test">[https://www.example.org/ Link text]</ref>Page text.[2]Additional use of the same referencePage text.<ref name="test" />Page text.[2]Display references<references />↑ Link text, additional text.↑ Link text== Disease == {{Main|COVID-19}} === Variants === {{Main|Variants of SARS-CoV-2}} Several variants have been named by WHO and labelled as a [[variant of concern]] (VoC) or a [[variant of interest]] (VoI). Many of these variants have shared the more infectious [[D614G]]. As of May 2023, the WHO had downgraded all variants of concern to previously circulating as these were no longer detected in new infections.<ref>{{#invoke:cite web ||title=Weekly epidemiological update on COVID-19 – 25 May 2023 |url=https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---25-may-2023 |website=www.who.int |access-date=26 May 2023 }}</ref><ref name="CDC2">{{#invoke:cite web ||title=Statement on the update of WHO's working definitions and tracking system for SARS-CoV-2 variants of concern and variants of interest |url=https://www.who.int/news/item/16-03-2023-statement-on-the-update-of-who-s-working-definitions-and-tracking-system-for-sars-cov-2-variants-of-concern-and-variants-of-interest |website=www.who.int |access-date=26 May 2023 }}</ref> Sub-lineages of the Omicron variant (BA.1 – BA.5) were considered separate VoCs by the WHO until they were downgraded in March 2023 as no longer widely circulating.<ref name=CDC2/> [[File:WHO EN 3 Working Together 03Mar2021.webm|thumb|279x279px|[[World Health Organization]] video which describes how variants proliferate in unvaccinated areas]] {| class="wikitable" |+Variants of concern (past and present)<ref>{{#invoke:cite web ||title=Coronavirus Disease 2019 (COVID-19) |url=https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-classifications.html |website=Centers for Disease Control and Prevention |access-date=30 October 2022 |date=11 February 2020}}</ref><ref>{{#invoke:cite web ||title=Tracking SARS-CoV-2 variants |url=https://www.who.int/activities/tracking-SARS-CoV-2-variants |website=www.who.int |access-date=7 November 2022 }}</ref> ! Name !! Lineage !! Detected !! Countries !! Priority |- | [[SARS-CoV-2 Alpha variant|Alpha]] || [[Lineage B.1.1.7|B.1.1.7]] ||UK|| 190 || VoC |- | [[SARS-CoV-2 Beta variant|Beta]] || [[Lineage B.1.351|B.1.351]] ||South Africa|| 140 || VoC |- | [[SARS-CoV-2 Delta variant|Delta]] || [[Lineage B.1.617.2|B.1.617.2]] ||India|| 170 ||VoC |- |[[SARS-CoV-2 Gamma variant|Gamma]] || [[Lineage P.1|P.1]] ||Brazil|| 90 ||VoC |- |[[SARS-CoV-2 Omicron variant|Omicron]] || [[Lineage B.1.1.529|B.1.1.529]] || Botswana || 149 ||VoC |} === Signs and symptoms === {{Main|Symptoms of COVID-19}} [[File:Symptoms of coronavirus disease 2019 4.0.svg|400px|thumb|[[Signs and symptoms|Symptoms]] of COVID-19]] Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness.<ref name="CDC2020Sym"><!-- KEEP THIS NAMED REFERENCE -->{{#invoke:cite web||date=22 February 2021|title=Symptoms of Coronavirus|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|url-status=live|archive-url=https://web.archive.org/web/20210304195413/https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|archive-date=4 March 2021|access-date=4 March 2021|website=U.S. [[Centers for Disease Control and Prevention]] (CDC)}}</ref><ref name="Grant et al 2020">{{#invoke:cite journal || vauthors = Grant MC, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke EL, Wade RG | title = The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries | journal = PLOS ONE | volume = 15 | issue = 6 | pages = e0234765 | date = 23 June 2020 | pmid = 32574165 | pmc = 7310678 | doi = 10.1371/journal.pone.0234765 | bibcode = 2020PLoSO..1534765G | s2cid = 220046286 | doi-access = free }}</ref> Common symptoms include headache, [[Anosmia|loss of smell]] and [[Ageusia|taste]], [[Nasal Obstruction|nasal congestion]] and [[rhinorrhea|runny nose]], cough, [[muscle pain]], [[sore throat]], fever, [[diarrhea|diarrhoea]], and [[breathing difficulties]].<ref name="CDC2020Sym"/> People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, [[sputum]], shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhoea.<ref name="ECDC">{{#invoke:cite web||title=COVID-19/csse_covid_19_data/csse_covid_19_time_series at master · CSSEGISandData/COVID-19|url=https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data/csse_covid_19_time_series|website=GitHub|access-date=18 January 2022}}</ref> In people without prior ear, nose, and throat disorders, [[hypogeusia|loss of taste]] combined with [[hyposmia|loss of smell]] is associated with [[COVID-19]] and is reported in as many as 88% of cases.<ref name="Krishnan">{{#invoke:cite journal ||last1=Krishnan |first1=A |last2=Hamilton |first2=JP |last3=Alqahtani |first3=SA |last4=Woreta |first4=TA |title=COVID-19: An overview and a clinical update. |journal=World Journal of Clinical Cases |date=6 January 2021 |volume=9 |issue=1 |pages=8–23 |doi=10.12998/wjcc.v9.i1.8 |pmid=33511168 |pmc=7809683 |doi-access=free}}</ref><ref>{{#invoke:cite journal ||last1=Docherty |first1=Annemarie B. |last2=Harrison |first2=Ewen M. |last3=Green |first3=Christopher A. |last4=Hardwick |first4=Hayley E. |last5=Pius |first5=Riinu |last6=Norman |first6=Lisa |last7=Holden |first7=Karl A. |last8=Read |first8=Jonathan M. |last9=Dondelinger |first9=Frank |last10=Carson |first10=Gail |last11=Merson |first11=Laura |last12=Lee |first12=James |last13=Plotkin |first13=Daniel |last14=Sigfrid |first14=Louise |last15=Halpin |first15=Sophie |last16=Jackson |first16=Clare |last17=Gamble |first17=Carrol |last18=Horby |first18=Peter W. |last19=Nguyen-Van-Tam |first19=Jonathan S. |last20=Ho |first20=Antonia |last21=Russell |first21=Clark D. |last22=Dunning |first22=Jake |last23=Openshaw |first23=Peter JM |last24=Baillie |first24=J. Kenneth |last25=Semple |first25=Malcolm G. |title=Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study |journal=BMJ |date=22 May 2020 |volume=369 |pages=m1985 |doi=10.1136/bmj.m1985 |pmid=32444460 |pmc=7243036 |url=https://www.bmj.com/content/369/bmj.m1985 |access-date=27 May 2023 |issn=1756-1833}}</ref><ref name="pmid32483687">{{#invoke:cite journal || vauthors = Niazkar HR, Zibaee B, Nasimi A, Bahri N | title = The neurological manifestations of COVID-19: a review article | journal = Neurological Sciences | volume = 41 | issue = 7 | pages = 1667–1671 | date = July 2020 | pmid = 32483687 | pmc = 7262683 | doi = 10.1007/s10072-020-04486-3 }}</ref> === Transmission === {{Main|Transmission of COVID-19}} The disease is mainly transmitted via the respiratory route when people inhale droplets and small airborne particles (that form an [[aerosol]]) that infected people exhale as they breathe, talk, cough, sneeze, or sing.<ref name="Wang_2021">{{#invoke:cite journal || vauthors = Wang CC, Prather KA, Sznitman J, Jimenez JL, Lakdawala SS, Tufekci Z, Marr LC | title = Airborne transmission of respiratory viruses | journal = Science | volume = 373 | issue = 6558 | date = August 2021 | pmid = 34446582 | pmc = 8721651 | doi = 10.1126/science.abd9149 | bibcode = | doi-access = free }}</ref><ref name="auto">{{#invoke:cite journal || vauthors = Greenhalgh T, Jimenez JL, Prather KA, Tufekci Z, Fisman D, Schooley R | title = Ten scientific reasons in support of airborne transmission of SARS-CoV-2 | journal = Lancet | volume = 397 | issue = 10285 | pages = 1603–1605 | date = May 2021 | pmid = 33865497 | pmc = 8049599 | doi = 10.1016/s0140-6736(21)00869-2 }}</ref><ref name="AR2021">{{#invoke:cite journal || vauthors = Bourouiba L | title = Fluid Dynamics of Respiratory Infectious Diseases | journal = Annual Review of Biomedical Engineering | volume = 23 | issue = 1 | pages = 547–577 | date = July 2021 | pmid = 34255991 | doi = 10.1146/annurev-bioeng-111820-025044 | hdl-access = free | s2cid = 235823756 | hdl = 1721.1/131115 }}</ref><ref name="auto1">{{#invoke:cite journal || vauthors = Stadnytskyi V, Bax CE, Bax A, Anfinrud P | title = The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 117 | issue = 22 | pages = 11875–11877 | date = June 2020 | pmid = 32404416 | pmc = 7275719 | doi = 10.1073/pnas.2006874117 | bibcode = 2020PNAS..11711875S | doi-access = free }}</ref> Infected people are more likely to transmit COVID-19 when they are physically close to other non-infected individuals. However, infection can occur over longer distances, particularly indoors.<ref name="Wang_2021" /><ref name="Miller_2021">{{#invoke:cite journal || vauthors = Miller SL, Nazaroff WW, Jimenez JL, Boerstra A, Buonanno G, Dancer SJ, Kurnitski J, Marr LC, Morawska L, Noakes C | title = Transmission of SARS-CoV-2 by inhalation of respiratory aerosol in the Skagit Valley Chorale superspreading event | journal = Indoor Air | volume = 31 | issue = 2 | pages = 314–323 | date = March 2021 | pmid = 32979298 | pmc = 7537089 | doi = 10.1111/ina.12751 }}</ref> === Cause === {{Main|Severe acute respiratory syndrome coronavirus 2}} [[File:Coronavirus virion structure.svg|thumb|right|Illustration of SARS-CoV-2 [[virion]]]] SARS‑CoV‑2 belongs to the broad family of viruses known as [[coronavirus]]es.<ref name="Fox2020">{{#invoke:cite journal ||vauthors=Fox D |title=What you need to know about the novel coronavirus |journal=Nature |date=January 2020 |pmid=33483684 |doi=10.1038/d41586-020-00209-y|s2cid=213064026 }}</ref> It is a [[Positive-sense single-stranded RNA virus|positive-sense single-stranded RNA]] (+ssRNA) virus, with a single linear RNA segment. Coronaviruses infect humans, other mammals, including livestock and companion animals, and avian species.<ref name="V'kovskik:21">{{#invoke:cite journal ||vauthors=V'kovski P, Kratzel A, Steiner S, Stalder H, Thiel V |title=Coronavirus biology and replication: implications for SARS-CoV-2 |journal=Nature Reviews. Microbiology |volume=19 |issue=3 |pages=155–170 |date=March 2021 |pmid=33116300 |pmc=7592455 |doi=10.1038/s41579-020-00468-6}}</ref> Human coronaviruses are capable of causing illnesses ranging from the [[common cold]] to more severe diseases such as [[Middle East respiratory syndrome]] (MERS, fatality rate ≈34%). SARS-CoV-2 is the seventh known coronavirus to infect people, after [[Human coronavirus 229E|229E]], [[Human coronavirus NL63|NL63]], [[Human coronavirus OC43|OC43]], [[Human coronavirus HKU1|HKU1]], [[Middle East respiratory syndrome-related coronavirus|MERS-CoV]], and the original [[Severe acute respiratory syndrome coronavirus|SARS-CoV]].<ref name="NEJM-Novel">{{#invoke:cite journal ||vauthors=Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W |title=A Novel Coronavirus from Patients with Pneumonia in China, 2019 |journal=The New England Journal of Medicine |volume=382 |issue=8 |pages=727–733 |date=February 2020 |pmid=31978945 |pmc=7092803 |doi=10.1056/NEJMoa2001017}}</ref> === Diagnosis === {{Main|COVID-19#Diagnosis}} [[File:2020Sept26-BioFire-Waldron-HR.jpg|thumb|right|A nurse at [[McMurdo Station]] sets up the polymerase chain reaction (PCR) testing equipment, in September 2020.]] The standard method of testing for presence of SARS-CoV-2 is a [[nucleic acid test]],<ref name="20200130cdc">{{#invoke:cite web||date=30 January 2020|title=2019 Novel Coronavirus (2019-nCoV) Situation Summary|url=https://www.cdc.gov/coronavirus/2019-ncov/summary.html|url-status=live|archive-url=https://web.archive.org/web/20200126210549/https://www.cdc.gov/coronavirus/2019-nCoV/summary.html|archive-date=26 January 2020|access-date=30 January 2020|website=U.S. [[Centers for Disease Control and Prevention]] (CDC)}}</ref> which detects the presence of viral RNA fragments.<ref name="WHO_InterimGuidance">{{#invoke:cite web ||title=Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans |work=[[World Health Organization]] (WHO) |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance |access-date=14 March 2020 |archive-url=https://web.archive.org/web/20200315044138/https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance |archive-date=15 March 2020 |url-status=live}}</ref> As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited."<ref name="2k0iS">{{#invoke:cite journal || vauthors = Bullard J, Dust K, Funk D, Strong JE, Alexander D, Garnett L, Boodman C, Bello A, Hedley A, Schiffman Z, Doan K, Bastien N, Li Y, Van Caeseele PG, Poliquin G | title = Predicting Infectious Severe Acute Respiratory Syndrome Coronavirus 2 From Diagnostic Samples | journal = Clinical Infectious Diseases | volume = 71 | issue = 10 | pages = 2663–2666 | date = December 2020 | pmid = 32442256 | pmc = 7314198 | doi = 10.1093/cid/ciaa638 | doi-access = free }}</ref> The test is typically done on respiratory samples obtained by a [[nasopharyngeal swab]]; however, a nasal swab or sputum sample may also be used.<ref name="CDC2020Testing">{{#invoke:cite web||date=11 February 2020|title=Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19)|url=https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html|url-status=live|archive-url=https://web.archive.org/web/20200304165907/https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html|archive-date=4 March 2020|access-date=26 March 2020|website=U.S. [[Centers for Disease Control and Prevention]] (CDC)}}</ref><ref name="20200129cdc">{{#invoke:cite web||date=29 January 2020|title=Real-Time RT-PCR Panel for Detection 2019-nCoV|url=https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-detection-instructions.html|url-status=live|archive-url=https://web.archive.org/web/20200130202031/https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-detection-instructions.html|archive-date=30 January 2020|access-date=1 February 2020|website=U.S. [[Centers for Disease Control and Prevention]] (CDC)}}</ref> The WHO has published several testing protocols for the disease.<ref>{{#invoke:cite web||title=Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases|url=https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117|url-status=live|archive-url=https://web.archive.org/web/20200317023052/https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117|archive-date=17 March 2020|access-date=13 March 2020|website=[[World Health Organization]] (WHO)}}</ref> === Prevention === [[File:How to Contain COVID-19 icon (COVID19.GOV.PH).svg|thumb|left|170px|Common measures implemented to prevent the spread of the virus]] {{Further|COVID-19#Prevention|Face masks during the COVID-19 pandemic|Social distancing measures related to the COVID-19 pandemic}} Preventive measures to reduce the chances of infection include getting vaccinated, staying at home or spending more time outdoors, avoiding crowded places, keeping distance from others, wearing a mask in public, ventilating indoor spaces, managing potential exposure durations, washing hands with soap and water often and for at least twenty seconds, practicing good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.<ref name="cdc-prev">{{#invoke:cite web ||title=COVID-19: How to protect yourself and others |url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html|date=26 January 2023 |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=3 February 2023}}</ref><ref name="who2023">{{#invoke:cite web ||title=Advice for the public on COVID-19 – World Health Organization |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public |website=www.who.int |access-date=27 May 2023 }}</ref> Those diagnosed with COVID-19 or who believe they may be infected are advised by healthcare authorities 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.<ref>{{#invoke:cite web ||title=Isolation |url=https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html |website=Centers for Disease Control and Prevention |access-date=27 May 2023 |date=11 May 2023}}</ref><ref>{{#invoke:cite web ||title=Infection prevention and control and preparedness for COVID-19 in healthcare settings – sixth update |url=https://www.ecdc.europa.eu/en/publications-data/infection-prevention-and-control-and-preparedness-covid-19-healthcare-settings |website=www.ecdc.europa.eu |access-date=27 May 2023 |date=9 February 2021}}</ref><ref>{{#invoke:cite web ||title=People with symptoms of a respiratory infection including COVID-19 |url=https://www.gov.uk/guidance/people-with-symptoms-of-a-respiratory-infection-including-covid-19 |website=GOV.UK |access-date=27 May 2023 |date=10 June 2022}}</ref> ==== Vaccines ==== {{Main|COVID-19 vaccine}} {{See also|History of COVID-19 vaccine development|Deployment of COVID-19 vaccines}} [[File:Elderly Slovak woman receiving her third Covid-19 vaccine 02.jpg|thumb|An elderly woman receiving a COVID-19 vaccination in [[Slovakia]]]] A COVID-19 [[vaccine]] is intended to provide [[acquired immunity]] against [[severe acute respiratory syndrome coronavirus 2]] (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ([[COVID-19]]). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of [[coronavirus]]es causing diseases like [[severe acute respiratory syndrome]] (SARS) and [[Middle East respiratory syndrome]] (MERS). This knowledge accelerated the development of various [[vaccine platform]]s during early 2020.<ref name="pmid33341119">{{#invoke:cite journal ||vauthors=Li YD, Chi WY, Su JH, Ferrall L, Hung CF, Wu TC |date=December 2020 |title=Coronavirus vaccine development: from SARS and MERS to COVID-19 |journal=Journal of Biomedical Science |volume=27 |issue=1 |page=104 |doi=10.1186/s12929-020-00695-2 |pmc=7749790 |pmid=33341119|doi-access=free}}</ref> The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic and severe illness.<ref>{{#invoke:cite journal || vauthors = Subbarao K |date=July 2021 |title=The success of SARS-CoV-2 vaccines and challenges ahead |journal=Cell Host & Microbe |volume=29 |issue=7 |pages=1111–1123 |doi=10.1016/j.chom.2021.06.016 |pmc=8279572 |pmid=34265245}}</ref> The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19.<ref>{{#invoke:cite web ||url=https://www.buzzfeednews.com/article/danvergano/mrna-covid-vaccine-success |title=COVID-19 Vaccines Work Way Better Than We Had Ever Expected. Scientists Are Still Figuring Out Why. |date=5 June 2021 | vauthors = Vergano D |website=[[BuzzFeed News]] |access-date=24 June 2021}}</ref><ref>{{#invoke:cite journal || vauthors = Mallapaty S, Callaway E, Kozlov M, Ledford H, Pickrell J, Van Noorden R | title = How COVID vaccines shaped 2021 in eight powerful charts | journal = Nature | volume = 600 | issue = 7890 | pages = 580–583 | date = December 2021 | pmid = 34916666 | doi = 10.1038/d41586-021-03686-x | s2cid = 245262732 | bibcode = 2021Natur.600..580M }}</ref> As of March 2023, more than 5.5 billion people had received one or more doses<ref>{{#invoke:cite news|| vauthors = Holder J |date=29 January 2021 |title=Tracking Coronavirus Vaccinations Around the World |work=The New York Times |url= https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html |access-date=23 December 2021|issn=0362-4331}}</ref> (11.8 billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine was the most widely used.<ref>{{#invoke:cite news||author=The Visual and Data Journalism Team|title=Covid vaccines: How fast is progress around the world?|work=BBC News|url=https://www.bbc.com/news/world-56237778|access-date=18 August 2021}}</ref> According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020 to 8 December 2021.<ref>{{#invoke:cite journal ||vauthors=Watson OJ, Barnsley G, Toor J, Hogan AB, Winskill P, Ghani AC |date=June 2022 |title=Global impact of the first year of COVID-19 vaccination: a mathematical modelling study |journal=[[The Lancet Infectious Diseases]] |volume=22 |issue=9 |pages=1293–1302 |doi=10.1016/s1473-3099(22)00320-6 |pmc=9225255 |pmid=35753318 |doi-access=free |title-link=doi}}</ref><ref>{{#invoke:cite web ||date=24 June 2022 |title=COVID-19 vaccines saved nearly 20 million lives in a year, study says |url=https://www.cbsnews.com/news/covid-19-vaccine-saved-nearly-20-million-lives-in-a-year-study-says/ |url-status=live |archive-url=https://web.archive.org/web/20220629025146/https://www.cbsnews.com/news/covid-19-vaccine-saved-nearly-20-million-lives-in-a-year-study-says/ |archive-date=29 June 2022 |access-date=27 June 2022 |website=[[CBS News]]}}</ref> On 8 November 2022, the first recombinant protein-based COVID-19 vaccine (Novavax's booster [[Nuvaxovid]]) was authorized for use in adults in the United Kingdom. It has subsequently received endorsement/authorization from the WHO, US, European Union, and Australia.<ref>{{#invoke:cite journal ||last1=Hammershaimb |first1=E. Adrianne |last2=Tapia |first2=Milagritos D. |title=Can protein vaccines for COVID-19 win over the vaccine-hesitant? |journal=Expert Review of Vaccines |date=31 December 2023 |volume=22 |issue=1 |pages=210–212 |doi=10.1080/14760584.2023.2182293 |pmid=36803364 |s2cid=257069394 |url=https://www.tandfonline.com/doi/full/10.1080/14760584.2023.2182293 |access-date=27 May 2023 |issn=1476-0584}}</ref><ref>{{#invoke:cite journal ||last1=Parums |first1=DV |title=Editorial: First Approval of the Protein-Based Adjuvanted Nuvaxovid (NVX-CoV2373) Novavax Vaccine for SARS-CoV-2 Could Increase Vaccine Uptake and Provide Immune Protection from Viral Variants. |journal=Medical Science Monitor |date=1 March 2022 |volume=28 |pages=e936523 |doi=10.12659/MSM.936523 |pmid=35228506 |pmc=8897963 }}</ref> On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines.<ref>{{#invoke:cite web ||title=WHO releases first data on global vaccine market since COVID-19 |url=https://www.who.int/news/item/09-11-2022-who-releases-first-data-on-global-vaccine-market-since-covid-19 |website=www.who.int |access-date=12 November 2022 }}</ref> On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company [[CanSino Biologics#COVID-19 vaccine development|CanSino Biologics]], in the city of Shanghai, China.<ref>{{#invoke:cite news ||last1=Graham |first1=Flora |title=Daily briefing: China reports first roll-out of inhalable COVID-19 vaccine |url=https://www.nature.com/articles/d41586-022-03548-0 |access-date=27 May 2023 |journal=Nature |publisher=Springer Nature |date=1 November 2022 |doi=10.1038/d41586-022-03548-0}}</ref> === Treatment === {{Main|Treatment and management of COVID-19}} [[File:Respiradores da USP utilizados do Incor (50119127303).jpg|thumb|A critically ill patient receiving invasive ventilation in the intensive care unit of the [[Heart Institute, University of São Paulo]] in July 2020. Due to a shortage of mechanical ventilators, a [[resuscitator|bridge ventilator]] is being used to automatically actuate a [[bag valve mask]].]] For the first two years of the pandemic, no specific and effective treatment or cure was available.<ref name="BMJLivingReview">{{#invoke:cite journal || vauthors = Siemieniuk RA, Bartoszko JJ, Ge L, Zeraatkar D, Izcovich A, Kum E, Pardo-Hernandez H, Qasim A, Martinez JP, Rochwerg B, Lamontagne F, Han MA, Liu Q, Agarwal A, Agoritsas T, Chu DK, Couban R, Cusano E, Darzi A, Devji T, Fang B, Fang C, Flottorp SA, Foroutan F, Ghadimi M, Heels-Ansdell D, Honarmand K, Hou L, Hou X, Ibrahim Q, Khamis A, Lam B, Loeb M, Marcucci M, McLeod SL, Motaghi S, Murthy S, Mustafa RA, Neary JD, Rada G, Riaz IB, Sadeghirad B, Sekercioglu N, Sheng L, Sreekanta A, Switzer C, Tendal B, Thabane L, Tomlinson G, Turner T, Vandvik PO, Vernooij RW, Viteri-García A, Wang Y, Yao L, Ye Z, Guyatt GH, Brignardello-Petersen R | title = Drug treatments for covid-19: living systematic review and network meta-analysis | journal = BMJ | volume = 370 | pages = m2980 | date = 31 March 2021 | pmid = 32732190 | pmc = 7390912 | doi = 10.1136/bmj.m2980 }}</ref><ref name="cdcmuseum">{{#invoke:cite web ||title=CDC Museum COVID-19 Timeline |url=https://www.cdc.gov/museum/timeline/covid19.html |website=Centers for Disease Control and Prevention |access-date=27 May 2023 |date=15 March 2023}}</ref> In 2021, the European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) approved the oral antiviral [[Protease inhibitor (pharmacology)|protease inhibitor]], [[Paxlovid]] (nirmatrelvir plus the HIV antiviral [[ritonavir]]), to treat adult patients.<ref>{{#invoke:cite news||date=17 December 2021|title=EMA CHMP advises use of Pfizer's Covid-19 oral antiviral Paxlovid|url=https://www.pharmaceutical-technology.com/news/ema-chmp-pfizer-paxlovid/|url-status=live|access-date=18 December 2021|newspaper=Pharmaceutical Technology|archive-url=https://web.archive.org/web/20211218175759/https://www.pharmaceutical-technology.com/news/ema-chmp-pfizer-paxlovid/ |archive-date=18 December 2021 |last1=Priyan |first1=Vishnu }}</ref> FDA later gave it an EUA.<ref>{{#invoke:cite web||title=Paxlovid LOA 12222021 {{!}} FDA|url=https://www.fda.gov/media/155049|access-date=23 December 2021|website=www.fda.gov}}</ref> Most cases of COVID-19 are mild. In these, supportive care includes medication such as [[paracetamol]] or [[NSAID]]s to relieve symptoms (fever,<ref>{{#invoke:cite journal || vauthors = Islam MA, Kundu S, Alam SS, Hossan T, Kamal MA, Hassan R | title = Prevalence and characteristics of fever in adult and paediatric patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis of 17515 patients | journal = PLOS ONE | volume = 16 | issue = 4 | pages = e0249788 | date = 6 April 2021 | pmid = 33822812 | pmc = 8023501 | doi = 10.1371/journal.pone.0249788 | s2cid = 233173405 | doi-access = free | bibcode = 2021PLoSO..1649788I }}</ref> body aches, cough), adequate intake of oral fluids and rest.<ref name="cdcmuseum" /><ref>Multiple sources: * {{#invoke:cite journal || vauthors = Wang Y, Wang Y, Chen Y, Qin Q | title = Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures | journal = Journal of Medical Virology | volume = 92 | issue = 6 | pages = 568–576 | date = June 2020 | pmid = 32134116 | pmc = 7228347 | doi = 10.1002/jmv.25748 | doi-access = free }} * {{#invoke:cite journal || vauthors = Martel J, Ko YF, Young JD, Ojcius DM | title = Could nasal nitric oxide help to mitigate the severity of COVID-19? | journal = Microbes and Infection | volume = 22 | issue = 4–5 | pages = 168–171 | date = May 2020 | pmid = 32387333 | pmc = 7200356 | doi = 10.1016/j.micinf.2020.05.002 }} * {{#invoke:cite news || title=Coronavirus recovery: breathing exercises|url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-recovery-breathing-exercises|access-date=30 July 2020|website=hopkinsmedicine.org|publisher=Johns Hopkins Medicine}}</ref> Good personal hygiene and a [[healthy diet]] are also recommended.<ref>{{#invoke:cite journal || vauthors = Wang L, Wang Y, Ye D, Liu Q | title = Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence | journal = International Journal of Antimicrobial Agents | volume = 55 | issue = 6 | page = 105948 | date = June 2020 | pmid = 32201353 | pmc = 7156162 | doi = 10.1016/j.ijantimicag.2020.105948 }}</ref> [[Supportive care]] in severe cases includes treatment to [[Symptomatic treatment|relieve symptoms]], [[Fluid replacement|fluid therapy]], [[oxygen support]] and [[prone positioning]], and medications or devices to support other affected vital organs.<ref>Multiple sources: * {{#invoke:cite journal||vauthors=Fisher D, Heymann D|date=February 2020|title=Q&A: The novel coronavirus outbreak causing COVID-19|journal=BMC Medicine|volume=18|issue=1|page=57|doi=10.1186/s12916-020-01533-w|pmc=7047369|pmid=32106852|doi-access=free}} * {{#invoke:cite journal||vauthors=Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, Xiao W, Wang YN, Zhong MH, Li CH, Li GC, Liu HG|date=May 2020|title=Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province|journal=Chinese Medical Journal|volume=133|issue=9|pages=1025–1031|doi=10.1097/CM9.0000000000000744|pmc=7147277|pmid=32044814|doi-access=free}} * {{#invoke:cite journal||vauthors=Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, Jiang B|date=March 2020|title=Comorbidities and multi-organ injuries in the treatment of COVID-19|journal=Lancet|publisher=Elsevier BV|volume=395|issue=10228|pages=e52|doi=10.1016/s0140-6736(20)30558-4|pmc=7270177|pmid=32171074|doi-access=free}}</ref> More severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid [[dexamethasone]] is recommended to reduce mortality.<ref>Multiple sources: * {{#invoke:cite journal || vauthors = | title = Update to living WHO guideline on drugs for covid-19 | journal = BMJ | volume = 371 | pages = m4475 | date = November 2020 | pmid = 33214213 | doi = 10.1136/bmj.m4475 | s2cid = 227059995 | doi-access = free }} * {{#invoke:cite web || title=Q&A: Dexamethasone and COVID-19|url=https://www.who.int/news-room/q-a-detail/q-a-dexamethasone-and-covid-19|access-date=11 July 2020|publisher=World Health Organization}} * {{#invoke:cite web || title=Home|url=https://covid19evidence.net.au/|access-date=11 July 2020|website=[[National COVID-19 Clinical Evidence Taskforce]]}}</ref> [[Noninvasive ventilation]] and, ultimately, admission to an [[intensive care unit]] for [[mechanical ventilation]] may be required to support breathing.<ref name="NIHGuidelines2020">{{#invoke:cite web || title=COVID-19 Treatment Guidelines|url=https://www.covid19treatmentguidelines.nih.gov/|access-date=18 January 2021|website=nih.gov|publisher=National Institutes of Health}}</ref> [[Extracorporeal membrane oxygenation]] (ECMO) has been used to address the issue of respiratory failure.<ref name="Guan Ni Hu Liang p.">{{#invoke:cite journal || vauthors = Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DS, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS | title = Clinical Characteristics of Coronavirus Disease 2019 in China | journal = The New England Journal of Medicine | volume = 382 | issue = 18 | pages = 1708–1720 | date = April 2020 | pmid = 32109013 | pmc = 7092819 | doi = 10.1056/nejmoa2002032 | publisher = Massachusetts Medical Society | doi-access = free }}</ref><ref name="Henry 2020 p.">{{#invoke:cite journal || vauthors = Henry BM | title = COVID-19, ECMO, and lymphopenia: a word of caution | journal = The Lancet. Respiratory Medicine | volume = 8 | issue = 4 | pages = e24 | date = April 2020 | pmid = 32178774 | pmc = 7118650 | doi = 10.1016/s2213-2600(20)30119-3 | publisher = Elsevier BV }}</ref> Existing drugs such as [[hydroxychloroquine]], [[lopinavir/ritonavir]], and [[ivermectin]] are not recommended by US or European health authorities, as there is no good evidence they have any useful effect.<ref name="BMJLivingReview" /><ref name="Kim Read Fauci p=2149">{{#invoke:cite journal || vauthors = Kim PS, Read SW, Fauci AS | title = Therapy for Early COVID-19: A Critical Need | journal = JAMA | volume = 324 | issue = 21 | pages = 2149–2150 | date = December 2020 | pmid = 33175121 | doi = 10.1001/jama.2020.22813 | publisher = American Medical Association (AMA) | s2cid = 226301949 | doi-access = free | author-link3 = Anthony Fauci }}</ref><ref name="NIHGuidelinesTherapeuticManagement">{{#invoke:cite web || title=COVID-19 Treatment Guidelines|url=https://www.covid19treatmentguidelines.nih.gov/therapeutic-management|access-date=18 January 2021|website=nih.gov|publisher=National Institutes of Health}}/</ref> The antiviral [[remdesivir]] is available in the US, Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for use with mechanical ventilation, and is discouraged altogether by the [[World Health Organization]] (WHO),<ref name="Hsu p=m4457">{{#invoke:cite journal || vauthors = Hsu J | title = Covid-19: What now for remdesivir? | journal = BMJ | volume = 371 | pages = m4457 | date = November 2020 | pmid = 33214186 | doi = 10.1136/bmj.m4457 | s2cid = 227060756 | doi-access = free }}</ref> due to limited evidence of its efficacy.<ref name="BMJLivingReview" /> === Prognosis === {{Further|COVID-19#Prognosis| Long COVID}} The severity of COVID-19 varies. It may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the [[common cold]]. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization.<ref name="pmid33087398">{{#invoke:cite journal || vauthors = Doshi P | title = Will covid-19 vaccines save lives? Current trials aren't designed to tell us | journal = BMJ | volume = 371 | pages = m4037 | date = October 2020 | pmid = 33087398 | doi = 10.1136/bmj.m4037 | s2cid = 224817161 }}</ref> 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. Prolonged [[prothrombin]] time and elevated [[C-reactive protein]] levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to [[intensive care unit]]s (ICU).<ref>{{#invoke:cite journal ||last1=Baranovskii |first1=DS |last2=Klabukov |first2=ID |last3=Krasilnikova |first3=OA |last4=Nikogosov |first4=DA |last5=Polekhina |first5=NV |last6=Baranovskaia |first6=DR |last7=Laberko |first7=LA |title=Prolonged prothrombin time as an early prognostic indicator of severe acute respiratory distress syndrome in patients with COVID-19 related pneumonia. |journal=Current Medical Research and Opinion |date=January 2021 |volume=37 |issue=1 |pages=21–25 |doi=10.1080/03007995.2020.1853510 |pmid=33210948 |pmc=7738209 }}</ref><ref>{{#invoke:cite journal || vauthors = Christensen B, Favaloro EJ, Lippi G, Van Cott EM | title = Hematology Laboratory Abnormalities in Patients with Coronavirus Disease 2019 (COVID-19) | journal = Seminars in Thrombosis and Hemostasis | volume = 46 | issue = 7 | pages = 845–849 | date = October 2020 | pmid = 32877961 | pmc = 7645834 | doi = 10.1055/s-0040-1715458 }}</ref> Between 5% and 50% of COVID-19 patients experience [[long COVID]],<ref>{{#invoke:cite journal ||vauthors=Ledford H |date=June 2022 |title=How common is long COVID? Why studies give different answers |url=https://www.nature.com/articles/d41586-022-01702-2 |url-status=live |journal=Nature |volume=606 |issue=7916 |pages=852–853 |bibcode=2022Natur.606..852L |doi=10.1038/d41586-022-01702-2 |pmid=35725828 |archive-url=https://web.archive.org/web/20221008182108/https://www.nature.com/articles/d41586-022-01702-2 |archive-date=8 October 2022 |access-date=13 August 2022 |s2cid=249887289}}</ref> a condition characterized by long-term [[sequela|consequences]] persisting after the typical convalescence period of the disease.<ref>{{#invoke:cite web||date=11 February 2020|title=Post-COVID Conditions|url=https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html|access-date=12 July 2021|website=Centers for Disease Control and Prevention }}</ref><ref>{{#invoke:cite journal ||date=12 May 2022 |title=Researching long COVID: addressing a new global health challenge |url=https://evidence.nihr.ac.uk/themedreview/researching-long-covid-addressing-a-new-global-health-challenge/ |journal=NIHR Evidence |doi=10.3310/nihrevidence_50331 |s2cid=249942230}}</ref> The most commonly reported clinical presentations are [[fatigue]] and memory problems, as well as [[malaise]], headaches, [[shortness of breath]], loss of smell, [[muscle weakness]], low fever and [[cognitive dysfunction]].<ref name="ref1">{{#invoke:cite journal ||title=Clinical characteristics of COVID-19 |website=www.ecdc.europa.eu |date=10 June 2020 |url=https://www.ecdc.europa.eu/en/covid-19/latest-evidence/clinical |access-date=26 May 2023 }}</ref><ref>{{#invoke:cite journal ||last=Leviner |first=Sherry |date=7 May 2021 |title=Recognizing the Clinical Sequelae of COVID-19 in Adults: COVID-19 Long-Haulers |journal=The Journal for Nurse Practitioners |volume=17 |issue=8 |pages=946–949 |doi=10.1016/j.nurpra.2021.05.003 |issn=1555-4155 |pmc=8103144 |pmid=33976591}}</ref><ref>{{#invoke:cite news ||title=Nearly half of people infected with COVID-19 experienced some 'long COVID' symptoms, study finds |work=[[University of Michigan]] |url=https://medicalxpress.com/news/2022-04-people-infected-covid-experienced-covid.html |access-date=15 May 2022}}</ref><ref>{{#invoke:cite journal ||last1=Chen |first1=Chen |last2=Haupert |first2=Spencer R. |last3=Zimmermann |first3=Lauren |last4=Shi |first4=Xu |last5=Fritsche |first5=Lars G. |last6=Mukherjee |first6=Bhramar |date=16 April 2022 |title=Global Prevalence of Post COVID-19 Condition or Long COVID: A Meta-Analysis and Systematic Review |journal=The Journal of Infectious Diseases |volume=226 |issue=9 |pages=1593–1607 |doi=10.1093/infdis/jiac136 |pmc=9047189 |pmid=35429399}}</ref> Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. 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