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COVID-19 is a zoonotic illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus was previously known as 2019 novel coronavirus. The first cases were seen in the city of Wuhan, China in December 2019, and have been linked to the Huanan Seafood Wholesale Market ^1,2,10. Person-to-person transmission occurs. The imaging findings are of pneumonia, often bilateral. No effective treatment or vaccine currently exists.

Terminology

On 11 February 2020, the World Health Organisation (WHO) officially renamed the clinical condition COVID-19 (a shortening of COronaVIrus Disease-19), which was announced in a tweet ¹⁵. Coincidentally, on the same day, the Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) ^16,22.

The WHO has expressed reservations about the official virus name in view of its closeness to the name SARS. It has publicly stated it will not be using it, instead using "COVID-19 virus" or the "virus that causes COVID-19", however the scientific community is already using SARS-CoV-2 and it is likely that this will be gradually accepted by the wider world ²².

The WHO had originally called this emerging zoonotic infectious illness "novel coronavirus-infected pneumonia (NCIP)" and the virus itself had been named 2019 novel coronavirus (2019-nCoV) ^1,2.

Epidemiology

As of 12 March 2020, over ~~87,500~~89,100 cases of COVID-19 have been confirmed worldwide, with the vast majority ~~(91~~(90%) in China, according to an online virus tracker created by the medical journal, The Lancet, and hosted by Johns Hopkins University ⁵. Although the percentage of confirmed cases outside China is steadily increasing, the epidemic in China seems to be plateauing.

Other countries with a large number of confirmed cases are ⁵:

South Korea: 4,335
Italy: 1,694
Iran: 978

The infection was declared a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 by the WHO ⁷. On 28 February 2020, the WHO increased the global risk assessment of COVID-19 to “very high” which is the highest level.

On 13 January 2020, the first confirmed case outside China was diagnosed, a Chinese tourist in Thailand ¹⁰. On 20 January, the first infected person in the United States was confirmed to be a man in the State of Washington who had recently returned from a visit to Wuhan ⁹. The disease has now been diagnosed in 6569 territories, including Macau and Hong Kong, in six continents ^5,13.

The mortality rate is about 2-3% ^2,5 with currently ~~2990~~3048 confirmed deaths (1 March 2020) ⁵. This includes ~~109~~136 confirmed deaths in ~~ten~~12 territories outside mainland China, including 4354 in Iran, 2934 in Italy and 1726 in South Korea ⁵.

In the largest study to date, a paper published by the Chinese Center for Disease Control and Prevention (CCDC) analysed all the cases diagnosed up to 11 February 2020, which came to 44,672 cases. Of these 1.2% were asymptomatic and 80.9% were classed as "mild". The overall mortality rate was found to be 2.3% ²⁵.

In an article examining the first 425 infected cases in Wuhan, 56% of the infectees were male and the median age was 59 years ¹². In this early cohort there were no children under 15 years old. Using this dataset, the group estimated that the R₀ (basic reproduction number) of the novel coronavirus was 2.2, that is each infected individual - on average - causes 2.2 new cases of the disease. The incubation period in this group has been calculated to be 5.2 days on average ¹².

A more recent study, for which researchers reviewed 12 studies of COVID-19, calculated the average R₀ to be higher at 3.28, with the authors estimating the likely R₀ to lie between 2 and 3 ³³.

NB: it is important to appreciate that the known epidemiological parameters of any new disease are likely to change as larger cohorts of infected people are studied, although this will only to some extent reflect a true change in the underlying reality of disease activity (as a disease is studied and understood humans will be simultaneously changing their behaviors to alter transmission or prevalence patterns).

Clinical presentation

Initial cases of COVID-19 presented as pneumonia, however it is now clear that some individuals, especially young children, remain asymptomatic, whilst others have mild upper respiratory tract symptoms only. Some also experience mild GI symptoms ¹⁸. However, its full spectrum of clinical effects remains to be determined ^1,2,13. Symptoms and signs are non-specific:

Diagnosis

The definitive test for SARS-CoV-2, the virus causing COVID-19, is the real-time reverse transcriptase polymerase chain reaction (RT-PCR) test, and is believed to be highly specific, but with a sensitivity as low as 60-70% ³². Thus false negatives are a real clinical problem and several negatives might be required in a single case to be confident about excluding the disease.

Therefore in many cases attempts have been made to use CT findings as a surrogate diagnostic test ³².

Laboratory tests

The most common ancillary laboratory findings in a study of 138 hospitalised patients were ¹³:

Mild elevations of inflammatory markers (CRP and ESR) and D-dimer are also seen.

Complications

In a study of 138 patients who had been hospitalised, 26% were admitted to the intensive care unit (ICU). The ICU patients tended to be older with more comorbidities ¹³. Common sequelae were:

acute respiratory distress syndrome (ARDS)
acute cardiac injury
secondary infections
sepsis

Pathology

Aetiology

SARS-CoV-2 was confirmed as the cause of COVID-19 on 9 January 2020 (2019-nCoV was the name of the virus at that time) ¹⁴. It is a member of the Betacoronavirus genus, one of the genera of the Coronaviridae family of viruses. Coronaviruses are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease.

The natural animal host of SARS-CoV-2 remains undetermined, and although the closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus ^11,19,26, the disease can also be transmitted by snakes ²⁴.

Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the common cold.

Transmission

COVID-19 is primarily transmitted in a similar way to the common cold, that is face to face, either from sneezing/coughing or close contact with infected individuals' bodily secretions ¹⁹.

Orofaecal spread was seen with the SARS epidemic, yet it remains unclear if SARS-CoV-2 can be transmitted in this way ¹⁹.

Vertical transmission

A recent retrospective study of nine pregnant patients infected by SARS-CoV-2 did not show any evidence of intrauterine infection ²¹.

Radiographic features

The primary findings of COVID-19 on chest radiograph and CT are those of a pneumonia ^{3,6,13,17,27,28,32}. 75% of cases have presented with bilateral pneumonia ⁶.

CT

The primary findings on CT have been reported as ^13,17,27,28:

ground glass opacities (GGO) in all hospitalised patients
crazy paving appearance (GGOs and inter-/intra-lobular septal thickening)
air space consolidation

The ground-glass and/or consolidative opacities are usually bilateral, peripheral and basal ³².

Atypical CT findings

These are only seen in a small minority of patients, and should raise ~~the prospect of~~concern for superadded bacterial pneumonia or other diagnosis ³².:

mediastinal lymphadenopathy ¹⁷
pleural effusions
multiple tiny pulmonary nodules
- unlike many other viral pneumonias

Temporal CT changes

In one study, 18 of 21 patients (86%) with non-complicated COVID-19 pneumonia, in whom the temporal progression of the CT appearances in COVID-19 were studied, severity of lung abnormalities peaked at 10 days post symptom onset, with a gradual tail-off after this time ¹⁷. In another study of thirty six patients, HRCT showed rapid changes over time with fibrous stripes appearing upon improvement in the disease course ²⁴.

Treatment and prognosis

No specific treatment or vaccine exists for COVID-19 (as of March 2020). Therefore in the meantime, resources have been concentrated on public health measures, to prevent further interhuman transmission of the virus. This has required a multipronged approach and for individuals includes meticulous personal hygiene, fitted masks, and the avoidance of large crowds/crowded environments ¹¹.

In healthcare facilities, concerted efforts are required to effect rapid diagnosis, quarantine infected cases and provide effective supportive therapies. This will encompass empirical treatments with antibiotics, antivirals, steroids and supportive measures. Mechanical ventilation and extracorporeal membrane oxygenation (ECMO) have also been used where clinically necessary.

Whilst specific antiviral therapies for SARS-2-CoV do not currently exist, the combination of the protease inhibitors, ritonavir and lopinavir, or a triple combination of these antiviral agents with the addition of ribavirin, showed some success in the treatment of SARS ²⁰, and early reports suggest similar efficacy in the treatment of COVID-19 ²³. Remdesivir, a drug originally developed to treat Ebola virus and shown to be effective against MERS-CoV and SARS-CoV, showed promising in vitro results against SARS-CoV-2 ²⁹ and is being tested in humans ³⁰.

Vaccines for the coronaviruses have been under development since the SARS outbreak, but none are yet available for human patients ^11,26. A phase I trial in humans of a potential vaccine against MERS-CoV has already been performed in the UK ²⁶.

Prognosis

Progressive deterioration of imaging changes despite medical treatment is thought to be associated with poor prognosis ²⁷.

In the earliest studies, mortality rate was estimated as 3%, although later data, suggests it as being slightly closer to 2% ^2,5. In a study of the first 44,672 diagnosed cases in mainland China, the fatality rate was found to be 2.3% ²⁵.

In a Chinese study looking at 138 hospitalised patients only, in-hospital mortality was higher at 4.3% ¹³.

-COVID-19 is a <a href="/articles/zoonosis">zoonotic</a> illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus was previously known as 2019 novel coronavirus. The first cases were seen in the city of Wuhan, China in December 2019, and have been linked to the Huanan Seafood Wholesale Market 1,2,10. Person-to-person transmission occurs. The imaging findings are of <a href="/articles/pneumonia">pneumonia</a>, often bilateral. No effective treatment or vaccine currently exists.<h4>Terminology</h4>On 11 February 2020, the <a href="/articles/world-health-organisation-who">World Health Organisation (WHO)</a> officially renamed the clinical condition COVID-19 (a shortening of COronaVIrus Disease-19), which was announced in a tweet 15. Coincidentally, on the same day, the Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) 16,22.The WHO has expressed reservations about the official virus name in view of its closeness to the name SARS. It has publicly stated it will not be using it, instead using "COVID-19 virus" or the "virus that causes COVID-19", however the scientific community is already using SARS-CoV-2 and it is likely that this will be gradually accepted by the wider world 22.The WHO had originally called this emerging zoonotic infectious illness "novel coronavirus-infected pneumonia (NCIP)" and the virus itself had been named 2019 novel coronavirus (2019-nCoV) 1,2.<h4>Epidemiology</h4>As of 1 March 2020, over 87,500 cases of COVID-19 have been confirmed worldwide, with the vast majority (91%) in China, according to an online virus tracker created by the medical journal, The Lancet, and hosted by Johns Hopkins University 5. Although the percentage of confirmed cases outside China is steadily increasing, the epidemic in China seems to be plateauing. The infection was declared a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 by the WHO 7. On 28 February 2020, the WHO increased the global risk assessment of COVID-19 to “very high” which is the highest level.On 13 January 2020, the first confirmed case outside China was diagnosed, a Chinese tourist in Thailand 10. On 20 January, the first infected person in the United States was confirmed to be a man in the State of Washington who had recently returned from a visit to Wuhan 9. The disease has now been diagnosed in 65 territories, including Macau and Hong Kong, in six continents 5,13. The mortality rate is about 2-3% 2,5 with currently 2990 confirmed deaths (1 March 2020) 5. This includes 109 confirmed deaths in ten territories outside mainland China, including 43 in Iran, 29 in Italy and 17 in South Korea 5.In the largest study to date, a paper published by the Chinese Center for Disease Control and Prevention (CCDC) analysed all the cases diagnosed up to 11 February 2020, which came to 44,672 cases. Of these 1.2% were asymptomatic and 80.9% were classed as "mild". The overall mortality rate was found to be 2.3% 25. In an article examining the first 425 infected cases in Wuhan, 56% of the infectees were male and the median age was 59 years 12. In this early cohort there were no children under 15 years old. Using this dataset, the group estimated that the <a href="/articles/r0-basic-reproduction-number">R0 (basic reproduction number)</a> of the novel coronavirus was 2.2, that is each infected individual - on average - causes 2.2 new cases of the disease. The <a href="/articles/incubation-period">incubation period</a> in this group has been calculated to be 5.2 days on average 12.A more recent study, for which researchers reviewed 12 studies of COVID-19, calculated the average R0 to be higher at 3.28 33.NB: it is important to appreciate that the known epidemiological parameters of any new disease are likely to change as larger cohorts of infected people are studied, although this will only to some extent reflect a true change in the underlying reality of disease activity (as a disease is studied and understood humans will be simultaneously changing their behaviors to alter transmission or prevalence patterns).<h4>Clinical presentation</h4>Initial cases of COVID-19 presented as <a href="/articles/pneumonia">pneumonia</a>, however it is now clear that some individuals, especially young children, remain asymptomatic, whilst others have mild upper respiratory tract symptoms only. Some also experience mild GI symptoms 18. However, its full spectrum of clinical effects remains to be determined 1,2,13. Symptoms and signs are non-specific:<ul>
+COVID-19 is a <a href="/articles/zoonosis">zoonotic</a> illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus was previously known as 2019 novel coronavirus. The first cases were seen in the city of Wuhan, China in December 2019, and have been linked to the Huanan Seafood Wholesale Market 1,2,10. Person-to-person transmission occurs. The imaging findings are of <a href="/articles/pneumonia">pneumonia</a>, often bilateral. No effective treatment or vaccine currently exists.<h4>Terminology</h4>On 11 February 2020, the <a href="/articles/world-health-organisation-who">World Health Organisation (WHO)</a> officially renamed the clinical condition COVID-19 (a shortening of COronaVIrus Disease-19), which was announced in a tweet 15. Coincidentally, on the same day, the Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses renamed the virus "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) 16,22.The WHO has expressed reservations about the official virus name in view of its closeness to the name SARS. It has publicly stated it will not be using it, instead using "COVID-19 virus" or the "virus that causes COVID-19", however the scientific community is already using SARS-CoV-2 and it is likely that this will be gradually accepted by the wider world 22.The WHO had originally called this emerging zoonotic infectious illness "novel coronavirus-infected pneumonia (NCIP)" and the virus itself had been named 2019 novel coronavirus (2019-nCoV) 1,2.<h4>Epidemiology</h4>As of 2 March 2020, over 89,100 cases of COVID-19 have been confirmed worldwide, with the vast majority (90%) in China, according to an online virus tracker created by the medical journal, The Lancet, and hosted by Johns Hopkins University 5. Although the percentage of confirmed cases outside China is steadily increasing, the epidemic in China seems to be plateauing. Other countries with a large number of confirmed cases are 5:<ul>
+<li>South Korea: 4,335</li>
+<li>Italy: 1,694</li>
+<li>Iran: 978</li>
+</ul>The infection was declared a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 by the WHO 7. On 28 February 2020, the WHO increased the global risk assessment of COVID-19 to “very high” which is the highest level.On 13 January 2020, the first confirmed case outside China was diagnosed, a Chinese tourist in Thailand 10. On 20 January, the first infected person in the United States was confirmed to be a man in the State of Washington who had recently returned from a visit to Wuhan 9. The disease has now been diagnosed in 69 territories, including Macau and Hong Kong, in six continents 5,13. The mortality rate is about 2-3% 2,5 with currently 3048 confirmed deaths (1 March 2020) 5. This includes 136 confirmed deaths in 12 territories outside mainland China, including 54 in Iran, 34 in Italy and 26 in South Korea 5.In the largest study to date, a paper published by the Chinese Center for Disease Control and Prevention (CCDC) analysed all the cases diagnosed up to 11 February 2020, which came to 44,672 cases. Of these 1.2% were asymptomatic and 80.9% were classed as "mild". The overall mortality rate was found to be 2.3% 25. In an article examining the first 425 infected cases in Wuhan, 56% of the infectees were male and the median age was 59 years 12. In this early cohort there were no children under 15 years old. Using this dataset, the group estimated that the <a href="/articles/r0-basic-reproduction-number">R0 (basic reproduction number)</a> of the novel coronavirus was 2.2, that is each infected individual - on average - causes 2.2 new cases of the disease. The <a href="/articles/incubation-period">incubation period</a> in this group has been calculated to be 5.2 days on average 12.A more recent study, for which researchers reviewed 12 studies of COVID-19, calculated the average R0 to be higher at 3.28, with the authors estimating the likely R0 to lie between 2 and 3 33.NB: it is important to appreciate that the known epidemiological parameters of any new disease are likely to change as larger cohorts of infected people are studied, although this will only to some extent reflect a true change in the underlying reality of disease activity (as a disease is studied and understood humans will be simultaneously changing their behaviors to alter transmission or prevalence patterns).<h4>Clinical presentation</h4>Initial cases of COVID-19 presented as <a href="/articles/pneumonia">pneumonia</a>, however it is now clear that some individuals, especially young children, remain asymptomatic, whilst others have mild upper respiratory tract symptoms only. Some also experience mild GI symptoms 18. However, its full spectrum of clinical effects remains to be determined 1,2,13. Symptoms and signs are non-specific:<ul>
~~-<li>myalgia</li>~~
+<li><a title="Myalgia" href="/articles/myalgia">myalgia</a></li>
-</ul><h6>Diagnosis</h6>The definitive test for SARS-CoV-2, the virus causing COVID-19, is the real-time reverse transcriptase polymerase chain reaction (RT-PCR) test, and is believed to be highly specific, but with a sensitivity as low as 60-70% 32. Thus false negatives are a real clinical problem. Therefore in many cases attempts have been made to use CT findings as a surrogate diagnostic test 32.Laboratory testsThe most common ancillary laboratory findings in a study of 138 hospitalised patients were 13:<ul>
+</ul><h6>Diagnosis</h6>The definitive test for SARS-CoV-2, the virus causing COVID-19, is the real-time reverse transcriptase polymerase chain reaction (RT-PCR) test, and is believed to be highly specific, but with a sensitivity as low as 60-70% 32. Thus false negatives are a real clinical problem and several negatives might be required in a single case to be confident about excluding the disease.Therefore in many cases attempts have been made to use CT findings as a surrogate diagnostic test 32.<h6>Laboratory tests</h6>The most common ancillary laboratory findings in a study of 138 hospitalised patients were 13:<ul>
-</ul>Mild elevations of <a href="/articles/inflammatory-marker">inflammatory markers</a> (<a href="/articles/c-reactive-protein-1">CRP</a> and <a href="/articles/erythrocyte-sedimentation-rate">ESR</a>) and <a href="/articles/d-dimer-1">D-dimer</a> are also seen.<h5>Complications</h5>In a study of 138 patients who had been hospitalised, 26% were admitted to the <a href="/articles/intensive-care-unit-icu">intensive care unit (ICU)</a>. The ICU patients tended to be older with more comorbidities 13.<ul>
+</ul>Mild elevations of <a href="/articles/inflammatory-marker">inflammatory markers</a> (<a href="/articles/c-reactive-protein-1">CRP</a> and <a href="/articles/erythrocyte-sedimentation-rate">ESR</a>) and <a href="/articles/d-dimer-1">D-dimer</a> are also seen.<h5>Complications</h5>In a study of 138 patients who had been hospitalised, 26% were admitted to the <a href="/articles/intensive-care-unit-icu">intensive care unit (ICU)</a>. The ICU patients tended to be older with more comorbidities 13. Common sequelae were:<ul>
-</ul><h4>Pathology</h4><h5>Aetiology</h5>SARS-CoV-2 was confirmed as the cause of COVID-19 on 9 January 2020 14. It is a member of the Betacoronavirus genus, one of the genera of the Coronaviridae family of viruses. <a href="/articles/human-coronavirus-1">Coronaviruses</a> are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease. The natural animal host of SARS-CoV-2 remains undetermined, and although the closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus 11,19,26, the disease can also be transmitted by snakes 24. Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the <a href="/articles/sars">severe acute respiratory syndrome coronavirus (SARS-CoV)</a> and <a href="/articles/middle-east-respiratory-syndrome-coronavirus-mers-cov-infection">Middle East respiratory syndrome coronavirus (MERS-CoV)</a>, both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the <a href="/articles/common-cold">common cold</a>. <h5>Transmission</h5>COVID-19 is primarily transmitted in a similar way to the common cold, that is face to face, either from sneezing/coughing or close contact with infected individuals' bodily secretions 19. Orofaecal spread was seen with the <a href="/articles/severe-acute-respiratory-syndrome-1">SARS</a> epidemic, yet it remains unclear if SARS-CoV-2 can be transmitted in this way 19.<h6>Vertical transmission</h6>A recent retrospective study of nine pregnant patients infected by SARS-CoV-2 did not show any evidence of intrauterine infection 21.<h4>Radiographic features</h4>The primary findings of COVID-19 on <a href="/articles/chest-radiograph">chest radiograph</a> and <a href="/articles/ct-chest-summary">CT</a> are those of a pneumonia 3,6,13,17,27,28,32. 75% of cases have presented with bilateral pneumonia 6.<h5>CT</h5>The primary findings on CT have been reported as 13,17,27,28:<ul>
+</ul><h4>Pathology</h4><h5>Aetiology</h5>SARS-CoV-2 was confirmed as the cause of COVID-19 on 9 January 2020 (2019-nCoV was the name of the virus at that time) 14. It is a member of the Betacoronavirus genus, one of the genera of the Coronaviridae family of viruses. <a href="/articles/human-coronavirus-1">Coronaviruses</a> are enveloped single-stranded RNA viruses, that are found in humans, many other mammals and birds. These viruses are responsible for pulmonary, hepatic, CNS and intestinal disease. The natural animal host of SARS-CoV-2 remains undetermined, and although the closest animal coronavirus by genetic sequence is a bat coronavirus, and this is the likely ultimate origin of the virus 11,19,26, the disease can also be transmitted by snakes 24. Hitherto, six coronaviruses have been known to be responsible for human diseases, two are zoonoses, the <a href="/articles/sars">severe acute respiratory syndrome coronavirus (SARS-CoV)</a> and <a href="/articles/middle-east-respiratory-syndrome-coronavirus-mers-cov-infection">Middle East respiratory syndrome coronavirus (MERS-CoV)</a>, both of which may sometimes be fatal. The remaining four viruses are widespread in human society, causing the <a href="/articles/common-cold">common cold</a>. <h5>Transmission</h5>COVID-19 is primarily transmitted in a similar way to the common cold, that is face to face, either from sneezing/coughing or close contact with infected individuals' bodily secretions 19. Orofaecal spread was seen with the <a href="/articles/severe-acute-respiratory-syndrome-1">SARS</a> epidemic, yet it remains unclear if SARS-CoV-2 can be transmitted in this way 19.<h6>Vertical transmission</h6>A recent retrospective study of nine pregnant patients infected by SARS-CoV-2 did not show any evidence of intrauterine infection 21.<h4>Radiographic features</h4>The primary findings of COVID-19 on <a href="/articles/chest-radiograph">chest radiograph</a> and <a href="/articles/ct-chest-summary">CT</a> are those of a pneumonia 3,6,13,17,27,28,32. 75% of cases have presented with bilateral pneumonia 6.<h5>CT</h5>The primary findings on CT have been reported as 13,17,27,28:<ul>
-</ul>The ground-glass and/or consolidative opacities are usually bilateral, peripheral and basal 32.<h6>Atypical CT findings</h6>These are only seen in a small minority of patients, and raise the prospect of superadded bacterial pneumonia or other diagnosis 32.<ul>
+</ul>The ground-glass and/or consolidative opacities are usually bilateral, peripheral and basal 32.<h6>Atypical CT findings</h6>These are only seen in a small minority of patients, and should raise concern for superadded bacterial pneumonia or other diagnosis 32:<ul>
~~-<li>multiple tiny pulmonary nodules</li>~~
+<li>multiple tiny pulmonary nodules<ul><li>unlike many other <a title="Viral pneumonias" href="/articles/viral-respiratory-tract-infection-1">viral pneumonias</a>
+</li></ul>
+</li>

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11","thumbnail":"https://prod-images-static.radiopaedia.org/images/52192468/201b87f9902cce6732917d2f292bd3_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52197348,"studyId":86280,"caseSlug":"covid-19-pneumonia-rapidly-progressive","caption":"Case 12","thumbnail":"https://prod-images-static.radiopaedia.org/images/52197348/df1053d3e8896b53ef140773e10e26_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52197350,"studyId":86277,"caseSlug":"covid-19-pneumonia-21","caption":"Case 13","thumbnail":"https://prod-images-static.radiopaedia.org/images/52197350/58cb9263f16e94305c730685358e4e_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52198251,"studyId":86299,"caseSlug":"covid-19-pneumonia-22","caption":"Case 14","thumbnail":"https://prod-images-static.radiopaedia.org/images/52198251/f24a7e3635ec4daf4b9ed18ec1a794f50e6c78764eae871cf5ce5f93514cfb16_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52213036,"studyId":86359,"caseSlug":"covid-19-pneumonia-23","caption":"Case 15: at day 13","thumbnail":"https://prod-images-static.radiopaedia.org/images/52213036/b08b025a70a7e0d7318ad1232a1ff7_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52216853,"studyId":86382,"caseSlug":"covid-19-pneumonia-evolution-over-a-week-1","caption":"Case 16: radiological evolution over 2 weeks","thumbnail":"https://prod-images-static.radiopaedia.org/images/52216853/4d844df58f10acb17fc50351fd9440_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52213151,"studyId":86360,"caseSlug":"covid-19-pneumonia-24","caption":"Case 17 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52213151/a092a272b78ce7c23e6a490721b750_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52143675,"studyId":85902,"caseSlug":"covid-19-pneumonia-10","caption":"Case 18: with unilateral air space consolidation","thumbnail":"https://prod-images-static.radiopaedia.org/images/52143675/8dcf3c619d4758f020bb7c2b1f6ea0_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52221946,"studyId":86412,"caseSlug":"covid-19-pneumonia-28","caption":"Case 19: bilateral and peripheral alveolar consolidations","thumbnail":"https://prod-images-static.radiopaedia.org/images/52221946/8e98ec22ee304b4fb7b5434276bb79_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52221785,"studyId":86410,"caseSlug":"covid-19-pneumonia-27","caption":"Case 20 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52221785/78331427ccc2886655edf78d6a7c3e_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52222131,"studyId":86413,"caseSlug":"covid-19-infection-exclusive-gastrointestinal-symptoms","caption":"Case 21: exclusive gastrointestinal symptoms","thumbnail":"https://prod-images-static.radiopaedia.org/images/52222131/0cc8ac00ad4d2c3e8ea3ed4a9c776a_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":52236703,"studyId":86520,"caseSlug":"covid-19-pneumonia-35","caption":"Case 22","thumbnail":"https://prod-images-static.radiopaedia.org/images/52236703/01df189b50ec310cefdd8525478305_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52233361,"studyId":86496,"caseSlug":"covid-19-pneumonia-34","caption":"Case 23","thumbnail":"https://prod-images-static.radiopaedia.org/images/52233361/96918c7d8c4cb054412fb758f03e47_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52237607,"studyId":86526,"caseSlug":"covid-19-pneumonia-36","caption":"Case 24","thumbnail":"https://prod-images-static.radiopaedia.org/images/52237607/9f7898846817b524a3aa27fbdc2e25_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52236227,"studyId":86517,"caseSlug":"covid-19-pneumonia-38","caption":"Case 25","thumbnail":"https://prod-images-static.radiopaedia.org/images/52236227/eba338205bda0cb569f436880b9972_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52237473,"studyId":86525,"caseSlug":"covid-19-pneumonia-ct-abdomen-2","caption":"Case 26: on CT 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29","thumbnail":"https://prod-images-static.radiopaedia.org/images/52232380/da8b9198cc02641aaf0f9307e0603d_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52233109,"studyId":86494,"caseSlug":"covid-19-pneumonia-30","caption":"Case 30","thumbnail":"https://prod-images-static.radiopaedia.org/images/52233109/9cd3c1fcd0a55edaf256e4f6ab72af_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52254733,"studyId":86625,"caseSlug":"covid-19-pneumonia-40","caption":"Case 31 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52254733/b2b57d9a37b3583569176b8a011955_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52240880,"studyId":86561,"caseSlug":"covid-19-pneumonia-49","caption":"Case 32 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52240880/9451607643d1cd9c4570cdb1c48593_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52252311,"studyId":86708,"caseSlug":"covid-19-pneumonia-43","caption":"Case 33 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52252311/221a595119abcd1cc91b930f34060e_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52252310,"studyId":86631,"caseSlug":"covid-19-pneumonia-43","caption":"Case 34 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52252310/d7b08174f3f6151654408d34fb8593_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52286551,"studyId":86789,"caseSlug":"covid-19-pneumonia-52","caption":"Case 35","thumbnail":"https://prod-images-static.radiopaedia.org/images/52286551/6b87133a40a8a4532adf09cacd4657_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52298708,"studyId":86914,"caseSlug":"covid-19-pneumonia-56","caption":"Case 36","thumbnail":"https://prod-images-static.radiopaedia.org/images/52298708/3f71d082fe2b5a944b74890b6d0f2f_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52298472,"studyId":86913,"caseSlug":"covid-19-pneumonia-55","caption":"Case 37","thumbnail":"https://prod-images-static.radiopaedia.org/images/52298472/9a015368b7df8a8fdf1b94ce57d4ac_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52144300,"studyId":85903,"caseSlug":"covid-19-pneumonia-11","caption":"Case 38","thumbnail":"https://prod-images-static.radiopaedia.org/images/52144300/59da2d56def0e71162e58297487fad_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52298341,"studyId":86912,"caseSlug":"covid-19-pneumonia-54","caption":"Case 39 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52298341/7508066ca6d477788bff6cc3718cc3_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52296787,"studyId":86884,"caseSlug":"covid-19-pneumonia-53","caption":"Case 40 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/52296787/9382428c49dcd870d705e87fdb97ac_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52289131,"studyId":86811,"caseSlug":"post-intubation-pneumomediastinum-and-pneumothorax-background-covid-19-pneumonia","caption":"Case 41: post-intubation pneumomediastinum and pneumothorax with COVID-19 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44","thumbnail":"https://prod-images-static.radiopaedia.org/images/52303001/8e12dc985075caacc502f4911006e6_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52307073,"studyId":86987,"caseSlug":"covid-19-pneumonia-62","caption":"Case 45","thumbnail":"https://prod-images-static.radiopaedia.org/images/52307073/38cddebf4af53f3fedb09382690849_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52306583,"studyId":86985,"caseSlug":"early-stage-covid-19-pneumonia-1","caption":"Case 46: mild","thumbnail":"https://prod-images-static.radiopaedia.org/images/52306583/e21992d32cd6b8a2839aa52ffa0150_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52306813,"studyId":86986,"caseSlug":"covid-19-pneumonia-61","caption":"Case 47","thumbnail":"https://prod-images-static.radiopaedia.org/images/52306813/e1c90b0a302b323f5ce7f41b8205e5_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52307997,"studyId":86991,"caseSlug":"covid-19-pneumonia-63","caption":"Case 48","thumbnail":"https://prod-images-static.radiopaedia.org/images/52307997/6b86db9b42cf41fc0d7bca9d80dfee_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52310925,"studyId":87014,"caseSlug":"covid-19-pneumonia-64","caption":"Case 49","thumbnail":"https://prod-images-static.radiopaedia.org/images/52310925/ff8e3e4e11c0a697211a145c7e5442_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52311116,"studyId":87015,"caseSlug":"covid-19-pneumonia-mild","caption":"Case 50: mild","thumbnail":"https://prod-images-static.radiopaedia.org/images/52311116/89296bc5c3a3828510c684932858c1_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52311316,"studyId":87017,"caseSlug":"covid-19-pneumonia-66","caption":"Case 51","thumbnail":"https://prod-images-static.radiopaedia.org/images/52311316/60a4164955bda9af96ecebdfca1139_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52306123,"studyId":86983,"caseSlug":"covid-19-pneumonia-59","caption":"Case 52","thumbnail":"https://prod-images-static.radiopaedia.org/images/52306123/b787c7dd6c38586c98aad314115c6c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52306364,"studyId":86984,"caseSlug":"covid-19-pneumonia-60","caption":"Case 53","thumbnail":"https://prod-images-static.radiopaedia.org/images/52306364/b9c3ef54f14af9464b177ce100952c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52314331,"studyId":87049,"caseSlug":"covid-19-pneumonia-70","caption":"Case 54","thumbnail":"https://prod-images-static.radiopaedia.org/images/52314331/0c73464dd96e9cc99096b45895528d_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52314213,"studyId":87045,"caseSlug":"covid-19-pneumonia-68","caption":"Case 55","thumbnail":"https://prod-images-static.radiopaedia.org/images/52314213/308cc9a9c2a292e40ebbb63bc3c4e2_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52238424,"studyId":86540,"caseSlug":"covid-19-pneumonia-rapidly-progressive-2","caption":"Case 56: rapidly 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59","thumbnail":"https://prod-images-static.radiopaedia.org/images/52320337/f95d56c3815ce6a7efd530f74f0de5_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52347055,"studyId":87461,"caseSlug":"covid-19-pneumonia-75","caption":"Case 60","thumbnail":"https://prod-images-static.radiopaedia.org/images/52347055/213a7402eac2f2ddc57a3a88ca1288_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52351834,"studyId":87486,"caseSlug":"covid-19-pneumonia-45","caption":"Case 61","thumbnail":"https://prod-images-static.radiopaedia.org/images/52351834/aa2c1a6a484ce7aedd53709cfc9579_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52333508,"studyId":87161,"caseSlug":"covid-19-pneumonia-78","caption":"Case 62","thumbnail":"https://prod-images-static.radiopaedia.org/images/52333508/3a7a000f136a331916ab25645c5004_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52366910,"studyId":87677,"caseSlug":"covid-19-pneumonia-80","caption":"Case 63","thumbnail":"https://prod-images-static.radiopaedia.org/images/52366910/14d81f378173b86cc53f21d2d67040_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52419934,"studyId":87991,"caseSlug":"early-stage-covid-19-pneumonia-4","caption":"Case 64: early stage","thumbnail":"https://prod-images-static.radiopaedia.org/images/52419934/7081807bc119bf30645e67567c2743_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52354709,"studyId":87517,"caseSlug":"covid-19-pneumonia-with-superadded-bacterial-infection-1","caption":"Case 65: with superadded bacterial 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68","thumbnail":"https://prod-images-static.radiopaedia.org/images/52379267/7c38367c2b495ceb35e78027ad336a_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52385287,"studyId":87846,"caseSlug":"covid-19-pneumonia-84","caption":"Case 69","thumbnail":"https://prod-images-static.radiopaedia.org/images/52385287/4e71e0f261b2d543e1aa597a697577_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52403451,"studyId":87917,"caseSlug":"covid-19-pneumonia-88","caption":"Case 70","thumbnail":"https://prod-images-static.radiopaedia.org/images/52403451/12c8fcf50208ead88ed27ad30164ee_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52416743,"studyId":87957,"caseSlug":"covid-19-pneumonia-89","caption":"Case 71","thumbnail":"https://prod-images-static.radiopaedia.org/images/52416743/6356848f0c5ab27258bb02b59ccc57_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52420179,"studyId":87992,"caseSlug":"early-stage-covid-19-pneumonia-5","caption":"Case 72: early stage","thumbnail":"https://prod-images-static.radiopaedia.org/images/52420179/c626eb529754e772bdc618f1d777b1_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52420531,"studyId":87993,"caseSlug":"covid-19-pneumonia-96","caption":"Case 73","thumbnail":"https://prod-images-static.radiopaedia.org/images/52420531/bf1ceec74b2f41a172c2063d582558_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52354015,"studyId":87500,"caseSlug":"covid-19-pneumonia-77","caption":"Case 74","thumbnail":"https://prod-images-static.radiopaedia.org/images/52354015/f66dae1947ea767ca8b21a3c0b0118_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52420739,"studyId":87994,"caseSlug":"early-stage-covid-19-pneumonia-6","caption":"Case 75: early stage","thumbnail":"https://prod-images-static.radiopaedia.org/images/52420739/65d26fd660c014cc00f7cb6654491b_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52420902,"studyId":87996,"caseSlug":"covid-19-pneumonia-98","caption":"Case 76","thumbnail":"https://prod-images-static.radiopaedia.org/images/52420902/df67ef2c41b568b7281005ff5beb83_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52421212,"studyId":87997,"caseSlug":"covid-19-pneumonia-99","caption":"Case 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92","thumbnail":"https://prod-images-static.radiopaedia.org/images/52527747/0dd647f4911312e8cf6ac99d1f92b1_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52517963,"studyId":88824,"caseSlug":"covid-19-pneumonia-122","caption":"Case 93","thumbnail":"https://prod-images-static.radiopaedia.org/images/52517963/843d4c110109669834788cab62a803_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":52568054,"studyId":89249,"caseSlug":"covid-19-pneumonia-126","caption":"Case 94","thumbnail":"https://prod-images-static.radiopaedia.org/images/52568054/f3d077ff53b7ef6048841f88c83239_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":52655473,"studyId":89817,"caseSlug":"covid-19-pneumonia-radiological-resolution-1","caption":"Case 95: with radiological 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