Koronavirus kasalligi 2019 - Coronavirus disease 2019

Koronavirus kasalligi 2019 (COVID-19)
Boshqa ismlar	koronavirus 2019-nCoV o'tkir respirator kasallik Yangi koronavirus pnevmoniyasi[1][2] Yangi patogenlar bilan og'ir pnevmoniya[3]
Soxta rang elektron mikroskop koronavirus tasviri
Talaffuz	/kəˈroʊnəˌvaɪrəsdɪˈziːz/ /ˌkoʊvɪdnaɪnˈtiːn,ˌkɒvɪd-/[4]
Mutaxassisligi	Yuqumli kasallik
Alomatlar	Isitma, yo'tal, charchoq, nafas qisilishi, ta'm yoki hidning yo'qolishi; ba'zida hech qanday alomat yo'q[5][6]
Asoratlar	Zotiljam, virusli sepsis, o'tkir nafas yetishmasligi sindromi, buyrak etishmovchiligi, sitokinni chiqarish sindromi, nafas etishmovchiligi, Kavasaki kasalligi, bolalar multisistemli yallig'lanish sindromi, o'lim
Odatiy boshlanish	Infektsiyadan 2-14 kun (odatda 5)
Muddati	5 kundan 6 oygacha ma'lum
Sabablari	Og'ir o'tkir nafas olish sindromi koronavirus 2 (SARS-CoV-2)
Diagnostika usuli	rRT-PCR sinovlari, KTni tekshirish
Oldini olish	Qo'lni yuvish, yuz qoplamalar, karantin, ijtimoiy masofani saqlash[7]
Davolash	Semptomatik va qo'llab-quvvatlovchi
Chastotani	65,111,866[8] tasdiqlangan holatlar
O'limlar	1,504,303[8]

Qismi bir qator ustida
Covid-19 pandemiyasi
SARS-CoV-2 (virus) COVID-19 (kasallik)
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COVID-19 portali

Koronavirus kasalligi 2019 (COVID-19) yuqumli hisoblanadi kasallik sabab bo'lgan og'ir o'tkir nafas olish sindromi koronavirus 2 (SARS-CoV-2). Birinchi holat aniqlandi Vuxan, Xitoy 2019 yil dekabrda.

COVID-19ning umumiy simptomlariga isitma, yo'tal, charchoq, nafas olishda qiyinchiliklar va hidni yo'qotish va ta'mi. Alomatlar birdan o'n to'rt kungacha boshlanadi chalinish xavfidan keyin uchun virus. Ko'pgina odamlarda engil alomatlar bo'lsa, ba'zi odamlar rivojlanadi o'tkir nafas yetishmasligi sindromi (ARDS). ARDS tomonidan cho'ktirilishi mumkin sitokinli bo'ronlar,^[9] ko'p organ etishmovchiligi, septik shok va qon pıhtıları. Organlarga (xususan, o'pka va yurakka) uzoq muddatli zarar etkazilishi kuzatilgan. Kasallikning o'tkir bosqichidan keyin tuzalib ketgan, ammo bir qator ta'sirlarni boshdan kechirayotgan bemorlarning katta qismi haqida xavotir bor. uzoq KOVID - bir necha oydan keyin. Ushbu ta'sirlar orasida qattiq charchoq, xotirani yo'qotish va boshqa kognitiv muammolar, past darajadagi isitma, mushaklarning kuchsizligi va nafas olish mavjud.^{[10][11][12][13]}

COVID-19 ko'plab vositalar orqali tarqaladi, asosan tupurik va boshqa tanadagi suyuqliklar va chiqindilarni o'z ichiga oladi. Ushbu suyuqliklar paydo bo'lishi mumkin kichik tomchilar va aerozollar yuqtirgan odam nafas olayotganda, yo'talganda, aksirganda, qo'shiq aytganda yoki gapirganda tarqalishi mumkin. Virus to'g'ridan-to'g'ri aloqada ham tarqalishi mumkin va uning qanchalik tez-tez tarqalishi noma'lum fomitlar (ifloslangan yuzalar).^[14][15] Etkazib berishning aniq yo'li kamdan-kam hollarda aniq tasdiqlangan,^[16] ammo infektsiya asosan odamlar bir-biriga etarlicha uzoq vaqt yaqinlashganda sodir bo'ladi, bu "yaqin aloqa" deb nomlanadi.^[a] U yuqtirgan odam alomatlar (prepemptomatik) va undan oldin ikki kun oldin tarqalishi mumkin asemptomatik jismoniy shaxslar. Odamlar o'rtacha holatlarda o'n kungacha, og'ir holatlarda esa ikki hafta davomida yuqumli bo'lib qoladilar. Standart diagnostika usuli tomonidan real vaqtda teskari transkripsiya polimeraza zanjiri reaktsiyasi (rRT-PCR) a nazofarengeal tampon.

Profilaktika choralari o'z ichiga oladi ijtimoiy masofani saqlash, karantin, yo'tal va aksirishni yopuvchi yopiq joylarni shamollatish, qo'lni yuvish va yuvilmagan qo'llarni yuzdan uzoqroq tuting. The yuz maskalari yoki qoplamalarini ishlatish translyatsiya xavfini minimallashtirish uchun jamoat joylarida tavsiya etilgan.

Hozirda isbotlanganlar yo'q vaksinalar yoki maxsus muolajalar COVID-19 uchun, bir nechtasi ishlab chiqilmoqda. Menejment o'z ichiga oladi simptomlarni davolash, qo'llab-quvvatlovchi parvarish, izolyatsiya va tajriba tadbirlari.

Belgilari va alomatlari

COVID-19 belgilari^[20]

COVID-19 belgilari o'zgaruvchan, ammo odatda isitma va yo'tal kiradi.^[21][22] Xuddi shu infektsiyaga chalingan odamlarda turli xil alomatlar bo'lishi mumkin va ularning belgilari vaqt o'tishi bilan o'zgarishi mumkin. Masalan, bir kishi yuqori isitma, yo'tal va charchoqni ko'tarishi mumkin, boshqasi esa kasallik boshlanganda isitmasi ko'tarilib, bir hafta o'tgach nafas olish qiyinlashishi mumkin. Biroq, oldindan quloqlari, burunlari va tomoqlari bo'lmagan odamlarda (KBB ) buzilishlar, ta'mni yo'qotish bilan birlashtirilgan hidni yo'qotish bilan bog'liq COVID-19 bilan o'ziga xoslik 95% dan.^[23]

Yuqumli kasalliklarda odatdagidek, kechikish mavjud inkubatsiya davri, odam birinchi marta yuqtirgan payt va birinchi alomatlar paydo bo'lishi o'rtasida. The o'rtacha COVID-19 uchun inkubatsiya davri to'rt dan besh kungacha.^[24] Ko'pgina simptomatik odamlar ta'sirlanishidan keyin ikki-etti kun ichida alomatlarga duch kelishadi va deyarli barcha simptomatik odamlar o'n ikki kundan oldin bir yoki bir nechta alomatlarga duch kelishadi.^[24][25]

Taxminan har beshinchi odam ushbu virusni yuqtirgan, ammo biron bir vaqtda sezilarli alomatlar rivojlanmagan.^[26][27] Bular asemptomatik tashuvchilar sinovdan o'tishga moyil emaslar va ular kasallik tarqalishi mumkin.^[28][29][27] Boshqa yuqtirilgan odamlarda keyinchalik alomatlar paydo bo'ladi (chaqiriladi) oldindan simptomatik) yoki juda yumshoq alomatlarga ega, shuningdek virusni tarqatishi mumkin.^[30]

Sababi

COVID-19 ga infektsiya sabab bo'ladi og'ir o'tkir nafas olish sindromi koronavirus 2 (SARS-CoV-2) virusi.

Yuqish

Virusologiya

Ning tasviri SARSr-CoV virion

Og'ir o'tkir nafas olish sindromi koronavirus 2 (SARS-CoV-2) a roman og'ir o'tkir respirator sindrom koronavirus. Dastlab u pnevmoniyaga chalingan uch kishidan ajratilgan klaster Vuxandagi o'tkir nafas yo'llari kasalliklari.^[35] SARS-CoV-2 virusining barcha xususiyatlari bog'liqdir koronaviruslar tabiatda.^[36]

Inson tanasi tashqarisida virusni uy sovuni yo'q qiladi, bu esa uni yorib yuboradi himoya pufagi.^[37]

SARS-CoV-2 asl nusxasi bilan chambarchas bog'liq SARS-CoV.^[38] Hayvon bor deb o'ylashadi (zoonoz ) kelib chiqishi. Genetik tahlil shuni ko'rsatdiki, koronavirus genetik jihatdan nasl bilan to'planadi Betakoronavirus, subgenusda Sarbekovirus (nasab B) ikkita kaltakdan olingan shtammlar bilan birgalikda. Umuman olganda 96% bir xil genom boshqa koronavirus namunalariga daraja (BatCov RaTG13).^[39][40] SARS-CoV-2 tarkibidagi oqsillarga membrana glikoprotein (M), konvert oqsili (E), nukleokapsid oqsili (N) va boshoqli oqsil (S) kiradi. SARS-CoV-2 ning M oqsili SARS-CoV kalamushining M oqsiliga o'xshash 98,6% ga teng, SARS-CoV pangolin bilan 98,2% homologiyani saqlaydi va SARS-CoV ning M oqsili bilan 90% homologiyaga ega; Holbuki, MERS-CoV ning M oqsili bilan o'xshashlik atigi 38% ni tashkil qiladi. Silikon tahlillarida SARS-CoV-2 ning M oqsilida uch karra spiral to'plami borligi, bitta 3-transmembran domeni hosil bo'lganligi va SemiSWEET shakarni tashiydigan prokaryotik protein bilan homolog ekanligi aniqlandi.^[41]

Patofiziologiya

COVID-19 yuqori nafas yo'llariga (sinuslar, burun va tomoq) va pastki nafas yo'llariga (nafas olish naychasi va o'pka) ta'sir qilishi mumkin.^[42] O'pka COVID-19ga eng ko'p ta'sir qiladigan organlardir, chunki virus ferment orqali hujayralar hujayralariga etib boradi angiotensinni o'zgartiradigan ferment 2 (ACE2), bu juda ko'p II tip alveolyar hujayralar o'pka.^[43] Virusda "boshoq" deb nomlangan maxsus sirtli glikoprotein ishlatiladi (peplomer ) ACE2 ga ulanish va xost katagiga kirish uchun.^[44] Har bir to'qimadagi ACE2 zichligi ushbu to'qimadagi kasallikning og'irligi bilan bog'liq va ba'zilari ACE2 faolligini pasayishi himoya bo'lishi mumkin,^[45] ammo yana bir ko'rinish - bu ACE2 dan foydalanishni oshirish angiotensin II retseptorlari blokeridir dorilar himoya vositasi bo'lishi mumkin.^[46] Alveolyar kasallik rivojlanib borishi bilan nafas etishmovchiligi rivojlanishi mumkin va o'lim kelib chiqishi mumkin.^[47]

SARS-CoV-2 asab tizimiga hujum qila oladimi yoki yo'qmi noma'lum bo'lib qolmoqda. Virus aniqlanmagan CNS nevrologik muammolar bilan kasallangan KOVID-19 bemorlarining aksariyati. Ammo SARS-CoV-2 COVID-19 dan vafot etgan bemorlarning miyasida past darajada aniqlangan, ammo bu natijalarni tasdiqlash kerak.^[48] SARS-CoV-2 miya tomiriga ta'sir qilish orqali nafas etishmovchiligini keltirib chiqarishi mumkin, chunki boshqa koronaviruslar bosqini topilgan CNS. Otopsiyaning o'murtqa suyuqligida virus aniqlangan bo'lsa-da, uning MSSga aniq ta'sir qilish mexanizmi noma'lum bo'lib qolmoqda va birinchi navbatda miyada ACE2 darajasining pastligi hisobga olingan holda periferik nervlarning ishg'ol qilinishi mumkin.^[49][50][51] Virus, shuningdek, o'pkadan qonga kirib, qon-miya to'sig'idan o'tib, CNSga kirish uchun, ehtimol "troyan oti" mexanizmi orqali yuqtirilgan oq qon hujayrasi ichida bo'lishi mumkin.^[48]

Virus oshqozon-ichak organlariga ham ta'sir qiladi, chunki ACE2 tarkibida juda ko'p uchraydi bezli ning hujayralari oshqozon, o'n ikki barmoqli ichak va rektal epiteliy^[52] shu qatorda; shu bilan birga endoteliy hujayralar va enterotsitlar ning ingichka ichak.^[53]

Virus sabab bo'lishi mumkin o'tkir miokard shikastlanishi va surunkali zarar yurak-qon tomir tizimi.^[54] Xitoyning Uxan shahridagi kasalxonaga yotqizilgan yuqtirganlarning 12 foizida o'tkir yurak shikastlanishi aniqlandi,^[55] va og'ir kasalliklarda tez-tez uchraydi.^[56] Kasallikning rivojlanishida tizimli yallig'lanish reaktsiyasi va immunitet tizimining buzilishi tufayli yurak-qon tomir belgilarining darajasi yuqori, ammo miyokardning o'tkir shikastlanishi yurakdagi ACE2 retseptorlari bilan ham bog'liq bo'lishi mumkin.^[54] ACE2 retseptorlari yurakda yuqori darajada namoyon bo'ladi va yurak faoliyatida ishtirok etadi.^[54][57] Kasallikning yuqori darajasi tromboz va venoz tromboembolizm topilgan intensiv terapiya bo'limi (ICU) - COVID-19 infektsiyasiga chalingan bemorlar va yomon prognoz bilan bog'liq bo'lishi mumkin.^[58] Qon tomirlarining disfunktsiyasi va pıhtılarning shakllanishi (D-dimerning yuqori darajasi taklif qilganidek) o'lim, pıhtıların paydo bo'lishiga olib keladigan hodisalarda muhim rol o'ynaydi. o'pka emboliya va ishemik hodisalar miya ichida SARS-CoV-2 bilan kasallangan bemorlarda o'limga olib keladigan asoratlar qayd etilgan. Infektsiya zanjirni o'rnatishga o'xshaydi vazokonstriktiv reaktsiyalar tana ichida, ichidagi qon tomirlarining torayishi o'pka qon aylanishi virusli pnevmoniya bilan bir qatorda kislorodlanish kamayadigan mexanizm sifatida ham ta'kidlangan.^[59]

O'limning yana bir keng tarqalgan sababi bu bilan bog'liq bo'lgan asoratlar buyraklar.^[59] Dastlabki xabarlarga ko'ra, Xitoyda ham, Nyu-Yorkda ham kasalxonaga yotqizilgan bemorlarning 30 foizigacha buyraklari, shu jumladan ilgari buyrak muammosi bo'lmagan ba'zi odamlar shikastlanishgan.^[60]

KOVID-19 kasalligidan vafot etgan odamlarning otopsisida diffuz alveolyar zarar (DAD) va o'pkada limfotsitlar bo'lgan yallig'lanishli infiltratlar topildi.^[61]

Immunopatologiya

SARS-CoV-2 nafas yo'llarining ACE2 ekspresiyali epiteliya hujayralari uchun tropizmga ega bo'lsa-da, og'ir KOVID-19 bo'lgan bemorlarda tizimli giperinflammatsiya alomatlari mavjud. Klinik laboratoriya natijalari ko'tarilgan Il-2, Il-7, Il-6, granulotsit-makrofag koloniyasini stimulyatsiya qiluvchi omil (GM-CSF), interferon bilan induktsiya qilinadigan protein 10 (IP-10), monositli ximotraktor oqsil 1 (MCP-1), Makrofag yallig'lanishli oqsil 1-a (MIP-1a) va o'sma nekrozi omil-a (TNF-a) ning ko'rsatkichi sitokinni chiqarish sindromi (CRS) asosiy immunopatologiyani taklif qiladi.^[55]

Bundan tashqari, COVID-19 va o'tkir nafas yetishmasligi sindromi (ARDS) klassikaga ega sarum biomarkerlar CRS, shu jumladan ko'tarilgan C-reaktiv oqsil (CRP), laktat dehidrogenaza (LDH), Dim-dimer va ferritin.^[62]

Tizimli yallig'lanish natijaga olib keladi vazodilatatsiya, o'pka va yurakning yallig'lanishli limfotsitik va monotsitik infiltratsiyasiga imkon beradi. Xususan, patogen GM-CSF-sekretsiya T hujayralari yallig'lanishli IL-6-sekretsiyasini qabul qilish bilan bog'liqligi ko'rsatilgan monotsitlar va KOVID-19 kasallarida og'ir o'pka patologiyasi.^[63] Otopsiyada limfotsitik infiltratlar ham qayd etilgan.^[61]

Tashxis

A ning namoyishi nazofarengeal tampon uchun COVID-19 sinovi

AQSh CDC rRT-PCR COVID-19 uchun sinov to'plami^[64]

JSST kasallik uchun bir nechta sinov protokollarini nashr etdi.^[65] Sinovning standart usuli bu real vaqtda teskari transkripsiya polimeraza zanjiri reaktsiyasi (rRT-PCR).^[66] Sinov odatda a tomonidan olingan nafas olish namunalarida amalga oshiriladi nazofarengeal tampon; shu bilan birga, burun po'stlog'i yoki balg'am namunasi ham ishlatilishi mumkin.^[67][68] Natijalar odatda bir necha soatdan ikki kungacha mavjud.^[69][70] Qon testlaridan foydalanish mumkin, ammo buning uchun ikki hafta oralig'ida ikkita qon namunasi talab qilinadi va natijalar darhol ahamiyatga ega emas.^[71] Xitoylik olimlar koronavirus virusini ajratib olishdi va nashr etishdi genetik ketma-ketlik shuning uchun butun dunyo bo'ylab laboratoriyalar mustaqil ravishda rivojlanishi mumkin edi polimeraza zanjiri reaktsiyasi Virus bilan yuqtirishni aniqlash uchun (PCR) testlar.^[72][73][74] 2020 yil 4-aprel holatiga ko'ra^[yangilash], antikor testlari (faol infektsiyalarni aniqlashi mumkin va ilgari odam yuqtirganmi yoki yo'qmi) rivojlanish bosqichida bo'lgan, ammo hali keng qo'llanilmagan.^[75][76][77] Antikor testlari odamning alomatlari boshlanganidan 2-3 hafta o'tgach eng aniq bo'lishi mumkin.^[78] Sinovlarni o'tkazish bo'yicha Xitoy tajribasi buni ko'rsatdi aniqlik faqat 60 dan 70% gacha.^[79] AQSh Oziq-ovqat va dori-darmonlarni boshqarish (FDA) birinchisini tasdiqladi parvarish bo'yicha test shu oyning oxirida foydalanish uchun 2020 yil 21 martda.^[80] Faqatgina KOVID-19 belgilari va belgilarining yo'qligi yoki mavjudligi aniq tashxis qo'yish uchun etarli darajada ishonchli emas.^[81] SOVS-CoV-2 yuqumli kasalligi yoki KOVID-19 ning og'ir bosqichlari bo'lgan bemorlarni aniqlash uchun simptomlar, laboratoriya parametrlari va tasvirlash asosida turli xil klinik natijalar yaratildi.^[82][83]

Zhongnan Hospital tomonidan chiqarilgan diagnostika bo'yicha ko'rsatmalar Uxan universiteti yuqumli kasalliklarni aniqlashning klinik xususiyatlari va epidemiologik xavfga asoslangan usullarini taklif qildi. Uxanga sayohat qilish yoki boshqa yuqtirgan odamlar bilan aloqa qilish tarixidan tashqari quyidagi belgilarning kamida ikkitasi bo'lgan odamlarni aniqlashni o'z ichiga olgan: isitma, pnevmoniyaning ko'rish xususiyatlari, oq qon hujayralarining normal yoki kamayganligi yoki kamaytirilgan limfotsit hisoblash^[84]

Tadqiqotda kasalxonaga yotqizilgan COVID-19 kasallaridan steril idishda yo'talib, tupurik namunasini ishlab chiqarishni so'radi va RT-PCR yordamida o'n ikki bemorning o'n birida virusni aniqladi. Ushbu uslub tamponga qaraganda tezroq va sog'liqni saqlash xodimlari uchun kamroq xavf tug'dirishi mumkin (uyda yoki mashinada yig'ish).^[85]

Laboratoriya tekshiruvi bilan bir qatorda infektsiyaga yuqori klinik shubha bilan qaraydigan odamlarda COVID-19 ni tashxislashda ko'krak qafasining tomografiyasi foydali bo'lishi mumkin, ammo odatiy skrining uchun tavsiya etilmaydi.^[86][87] Ikki tomonlama multilobar shishadan yasalgan opakliklar periferik, assimetrik va orqa tarqalish bilan erta infektsiyada keng tarqalgan.^[86][88] Subplevral ustunlik, aqldan yulka (o'zgaruvchan alveolyar plomba bilan lobular septal qalinlashuv) va mustahkamlash kasallik rivojlanib borishi bilan paydo bo'lishi mumkin.^[86][89]

2019 yil oxirida JSST favqulodda vaziyatni tayinladi ICD-10 laboratoriya tomonidan tasdiqlangan SARS-CoV-2 infektsiyasidan o'lim uchun U07.1 va laboratoriya tomonidan tasdiqlangan SARS-CoV-2 infektsiyasiz klinik yoki epidemiologik tashxis qo'yilgan COVID-19 o'limidan U07.2 kasallik kodlari.^[90]

• 

  COVID-19 tez rivojlanish bosqichining KT tekshiruvi.

• 

  COVID-19 pnevmoniyasini ko'rsatadigan ko'krak qafasi rentgenogrammasi.

Patologiya

Otopsiyadagi asosiy patologik topilmalar:^[61]

• Makroskopiya: perikardit, o'pka konsolidatsiyasi va o'pka shishi
• O'pka topilmalari:
  • kichik seroz ekssudatsiya, kichik fibrin ekssudatsiya
  • o'pka shishi, pnevmotsit giperplaziya, katta atipik pnevmotsitlar, oraliq yallig'lanish bilan limfotsit infiltratsiya va ko'p yadroli ulkan hujayra shakllanish
  • diffuz alveolyar shikastlanish (DAD) diffuz bilan alveolyar ekssudatlar. DAD sababdir o'tkir nafas yetishmasligi sindromi (ARDS) va og'ir gipoksemiya.
  • tashkilot ning ekssudatlar yilda alveolyar bo'shliqlar va o'pka interstitsial fibrozisi
  • plazmotsitoz yilda BAL^[91]
• Qon: tarqalgan tomir ichi qon ivishi (DIC);^[92] leykoeritroblastik reaktsiya^[93]
• Jigar: mikrovezikulyar steatoz

Oldini olish

AQSh tomonidan infografik Kasalliklarni nazorat qilish va oldini olish markazlari (CDC), mikroblarning tarqalishini qanday to'xtatish kerakligini tavsiflaydi

Pandemiyani oldini olish choralarisiz, masalan, ijtimoiy masofani uzoqlashtirish, emlash va yuz niqoblaridan foydalanish - patogenlar beqiyos tarqalishi mumkin.^[94] Ushbu grafik, qamoqqa olish choralarini erta qabul qilish aholining keng qatlamlarini himoya qilishga intilishini ko'rsatadi.

A Covid-19 vaksinasi eng erta 2021 yilgacha kutilmaydi.^[95] AQSh Milliy sog'liqni saqlash institutlari ko'rsatmalarda, SARS-CoV-2 virusiga duchor bo'lishidan oldin yoki keyin, KOVID-19 ning oldini olish uchun biron bir dori-darmon tavsiya etilmaydi, klinik sinovdan tashqarida.^[96][97] Vaksinasiz, boshqa profilaktika choralarisiz yoki samarali davolash usullarisiz COVID-19 ni boshqarishning asosiy qismi epidemiyani "tekislash" deb nomlanuvchi epidemiyani engillashtirish va kechiktirishga harakat qilmoqda. egri chiziq ".^[98] Bu sog'liqni saqlash xizmatlarining haddan tashqari ko'payishi xavfini kamaytirish uchun infektsiya darajasini pasaytirish, hozirgi holatlarni yaxshiroq davolashga imkon berish va qo'shimcha davolanish usullari yoki vaktsina bo'lguncha qo'shimcha holatlarni kechiktirish orqali amalga oshiriladi.^[98][99]

Yuqtirish ehtimolini kamaytirishga qaratilgan profilaktika choralariga uyda qolish, jamoat joylarida niqob kiyish, odamlar ko'p bo'lgan joylardan qochish, atrofdagilar bilan masofani saqlash, ichki makonlarni ventilyatsiya qilish, qo'llarni sovun va suv bilan tez-tez va kamida 20 soniya yuvish, nafas olish gigienasini yaxshi saqlash kiradi. va yuvilmagan qo'llar bilan ko'zga, burunga yoki og'ziga tegishdan saqlanish.^{[100][101][102][103][104]} COVID-19 tashxisi qo'yilgan yoki ularga yuqtirgan bo'lishi mumkin deb hisoblaganlarga, CDC tomonidan tibbiy yordam olishdan tashqari, uyda qolish, tibbiyot xodimiga murojaat qilishdan oldin qo'ng'iroq qilish, tibbiyot muassasasiga kirishdan oldin va har qanday xonada yuz niqobini kiyish tavsiya etiladi. yoki boshqa odam bilan transport vositasini olib boring, yo'tal va hapşırmayı ro'molcha bilan yoping, muntazam ravishda qo'lingizni sovun va suv bilan yuving va shaxsiy uy-ro'zg'or buyumlarini almashishdan saqlaning.^[105][106]

Ijtimoiy masofani saqlash

Ijtimoiy masofani saqlash (jismoniy distansiya deb ham ataladi) kiradi infektsiyani nazorat qilish shaxslar o'rtasidagi yaqin aloqani minimallashtirish orqali kasallik tarqalishini sekinlashtirishga qaratilgan harakatlar. Usullariga karantinlar kiradi; sayohat qilish bo'yicha cheklanishlar; maktablar, ish joylari, stadionlar, teatrlar yoki savdo markazlarining yopilishi. Shaxslar uyda bo'lish, sayohatni cheklash, odam ko'p bo'lgan joylardan qochish, hech kim bilan aloqasiz salomlashish va o'zlarini boshqalardan uzoqlashtirish orqali ijtimoiy masofani uzoqlashtirish usullarini qo'llashlari mumkin.^[107] Hozirda ko'plab hukumatlar epidemiya ta'sirlangan hududlarda ijtimoiy uzoqlashishni buyurmoqdalar yoki tavsiya qilmoqdalar. Ayrim sohalarda masofaviy chora-tadbirlar bilan hamkorlik qilmaslik pandemiyaning yanada tarqalishiga yordam berdi.^[108]

AQSh davlat organlari va sog'liqni saqlash tashkilotlari tomonidan tavsiya etilgan yig'ilishning maksimal hajmi tezda 250 kishidan (agar mintaqada ma'lum bo'lgan COVID-19 tarqalmagan bo'lsa) 50 kishiga, keyin esa 10 kishiga qisqartirildi. Kokran Tadqiqot shuni ko'rsatdiki, boshqa sog'liqni saqlash choralari bilan erta karantin pandemiyani cheklashda samarali, ammo mahalliy sharoit o'zgarib turishi sababli eng yaxshi siyosat qabul qilish va tinchlantirish noaniq.^[107]

Keksa kattalar va diabet, yurak kasalliklari, nafas olish yo'llari kasalliklari kabi asosiy tibbiy kasalliklarga chalingan odamlar gipertoniya va buzilgan immunitet tizimlari jiddiy kasalliklar va asoratlar xavfi ortib borishi va CDC tomonidan jamoat tarqalishi mumkin bo'lgan joylarda iloji boricha uyda bo'lishni maslahat bergan.

2020 yil mart oyining oxirida JSST va boshqa sog'liqni saqlash organlari "ijtimoiy distansiya" atamasini "jismoniy distansiya" bilan almashtira boshladilar, buning maqsadi ijtimoiy aloqalarni saqlab qolish bilan jismoniy aloqalarni kamaytirishdir. deyarli yoki masofada. "Ijtimoiy uzoqlashish" atamasidan foydalanish odamlarning to'liq shug'ullanishi kerak bo'lgan oqibatlarga olib keldi ijtimoiy izolyatsiya, ularni muqobil vositalar bilan aloqada bo'lishga undash o'rniga. Ba'zi organlar pandemiya bo'yicha jinsiy salomatlik bo'yicha ko'rsatmalar ishlab chiqdilar, unda faqat siz yashaydigan va virusi yoki alomatlari bo'lmagan odam bilan jinsiy aloqa qilish bo'yicha tavsiyalar mavjud.^[109][110]

O'z-o'zini izolyatsiyalash

O'z-o'zini izolyatsiyalash uyda COVID-19 tashxisi qo'yilganlar va ular yuqtirgan deb taxmin qilganlar uchun tavsiya etilgan. Sog'liqni saqlash idoralari o'zlarini to'g'ri izolyatsiya qilish bo'yicha batafsil ko'rsatmalar berishdi.

Ko'pgina hukumatlar butun aholi uchun o'z-o'zini karantin qilishni buyurdilar yoki tavsiya qildilar. O'z-o'zini karantin bo'yicha eng kuchli yo'riqnomalar yuqori xavfli guruhlarga kiritilgan.^[111] COVID-19 bilan kasallanganlarga va yaqinda keng tarqalgan yuqumli kasallik bilan bir mamlakatga yoki mintaqaga sayohat qilganlarga, o'zlarini karantin bilan kasallanishni oxirgi mumkin bo'lgan paytdan boshlab 14 kun davomida tavsiya qilishdi.

Yuz maskalari va nafas olish gigienasi

JSST va AQSh CDClari jismoniy shaxslarni tavsiya qiladi tibbiy bo'lmagan yuz qoplamalaridan foydalaning yuqish xavfi yuqori bo'lgan va ijtimoiy masofani cheklash choralarini saqlab qolish qiyin bo'lgan jamoat joylarida.^[112][113] Ushbu tavsiya asemptomatik va simptomatikgacha bo'lgan shaxslar tomonidan kasallik tarqalishini kamaytirishga qaratilgan va ijtimoiy distansiya kabi belgilangan profilaktika choralarini to'ldiradi.^[113][114] Yuzni qoplash gaplashayotganda, nafas olayotganda va yo'talayotganda tarqalgan ekspiratuar tomchilarning hajmi va harakatlanish masofasini cheklaydi.^[113][114] Yuz qoplamalari, shuningdek, nafas olayotgan havodagi virus zarralarini filtrlaydi va foydalanuvchiga yuqish ehtimolini kamaytiradi.^[115] Ko'pgina mamlakatlar va mahalliy yurisdiktsiyalar virus tarqalishini cheklash uchun jamoat a'zolari tomonidan yuz maskalari yoki mato yuzlarini ishlatishni rag'batlantiradi yoki majbur qiladi.^[116][117]

Niqoblar, shuningdek, yuqtirganlarga va kasallikka chalingan odamga g'amxo'rlik qilayotganlarga ham qat'iyan tavsiya etiladi.^[118] Niqob kiymagan holda, CDC yo'talayotganda yoki hapşırırken og'iz va burunni ro'mol bilan qoplashni tavsiya qiladi va agar to'qima bo'lmasa, tirsakning ichki qismidan foydalanishni tavsiya qiladi. Har qanday yo'tal yoki aksirishdan keyin qo'llarni to'g'ri gigiena qilish tavsiya etiladi. COVID-19 bemorlari bilan bevosita aloqada bo'lgan sog'liqni saqlash mutaxassislaridan foydalanish tavsiya etiladi respiratorlar hech bo'lmaganda himoya qilish NIOSH - sertifikatlangan N95 yoki boshqasiga qo'shimcha ravishda ekvivalenti shaxsiy himoya vositalari.^[119]

Qo'l yuvish va gigiena

Niqob kiymagan holda, CDC, WHO va NHS yo'talayotganda yoki hapşırırken og'iz va burunni ro'mol bilan qoplashni tavsiya qiladi va agar to'qima bo'lmasa, tirsakning ichki qismidan foydalanishni tavsiya qiladi.^{[101][120][121]} Har qanday yo'tal yoki aksirishdan keyin qo'llarni to'g'ri gigiena qilish tavsiya etiladi.^[101][120] JSST shuningdek, odamlarga qo'llarini kamida 20 soniya davomida sovun va suv bilan yuvishni, ayniqsa, hojatxonaga borganidan keyin yoki qo'llari ko'rinadigan darajada iflos bo'lganida, ovqatlanishdan oldin va burnini puflaganidan keyin yuvishni tavsiya qiladi.^[121] CDC spirtli ichimliklarni iste'mol qilishni tavsiya qiladi qo'lni tozalash vositasi kamida 60% alkogol bilan, lekin faqat sovun va suv tayyor bo'lmaganda.^[120] Tijorat qo'llarni tozalash vositalari mavjud bo'lmagan joylarda JSST mahalliy ishlab chiqarish uchun ikkita formulani taqdim etadi. Ushbu formulalarda antimikrobiyal faollik kelib chiqadi etanol yoki izopropanol. Vodorod peroksid yo'q qilishga yordam berish uchun ishlatiladi bakteriyalar sporalari spirtli ichimliklarda; u "qo'l uchun faol moddalar emas antiseptik ". Glitserol a sifatida qo'shiladi namlovchi.^[122]

Yuzaki tozalash

Yuzalar bir qator eritmalar bilan zararsizlantirilishi mumkin (zanglamas po'latdan yasalgan sirt uchun dezinfektsiyalovchi ta'siridan keyin bir daqiqa ichida), shu jumladan 62-71 foiz etanol, 50-100 foiz izopropanol, 0,1 foiz natriy gipoxlorit, 0,5 foiz vodorod peroksid va 0,2-7,5 foizni tashkil etdi povidon-yod. Kabi boshqa echimlar benzalkonyum xlorid va xlorheksidin glyukonat, unchalik samarasiz. Ultraviyole germitsid nurlanishi ham ishlatilishi mumkin.^[123] CDC, agar ofis yoki kunduzgi tibbiyot muassasalarida COVID-19 kasalligiga shubha qilingan yoki tasdiqlangan bo'lsa, ofislar, hammom, umumiy foydalanish joylari, planshetlar, sensorli ekranlar, klaviaturalar, masofadan boshqarish pultlari kabi umumiy jihozlar, kasallar tomonidan ishlatiladigan bankomat mashinalari dezinfektsiya qilinishi kerak.^[124]

Shamollatish va havoni filtrlash

JSST tavsiya qiladi shamollatish va havo filtratsiyasi yuqumli kasalliklarni bartaraf etishga yordam beradigan jamoat joylarida aerozollar.^{[125][123][126]}

Sog'lom ovqatlanish va turmush tarzi

The Garvard T.H. Chan jamoat salomatligi maktabi COVID-19 ga texnik xizmat ko'rsatishni tavsiya qiladi immunitet tizimi har qachongidan ham muhimroq. Shuning uchun, a sog'lom ovqatlanish, bo'lish jismoniy faol, boshqarish psixologik stress va etarlicha uxlash juda muhim.^[127] To'q tanli odamlar, ayniqsa, a xavfi ostida D vitamini etishmasligi bu immunitet tizimini buzishi mumkin.^[128]

Menejment

Prognoz

Xitoyda tashxis qo'yilgan COVID-19 holatlarining og'irligi^[146]

Yosh guruhi bo'yicha o'lim ko'rsatkichlari:

  Xitoy, 2020 yil 11-fevral holatiga ko'ra^[147]

  Janubiy Koreya, 2020 yil 17-iyul holatiga ko'ra^[148]

  Ispaniya, 2020 yil 18-may holatiga ko'ra^[149]

  Italiya, 2020 yil 3-iyun holatiga ko'ra^[150]

Mamlakatlar bo'yicha o'limlarning umumiy soni va o'limning taxminiy darajasi^[151]

COVID-19 ning zo'ravonligi har xil. Kasallik alomatlari kam yoki umuman bo'lmagan engil kursni olishi mumkin, masalan, kabi boshqa keng tarqalgan yuqori nafas yo'llari kasalliklari umumiy sovuq. Yengil holatlar odatda ikki hafta ichida tiklanadi, og'ir yoki o'ta og'ir kasalliklarga chalinganlarni tiklash uchun uch-olti hafta vaqt ketishi mumkin. O'lganlar orasida alomat paydo bo'lishidan o'limigacha bo'lgan vaqt ikki haftadan sakkiz haftagacha bo'lgan.^[39] Italiya Istituto Superiore di Sanità simptomlarning paydo bo'lishi va o'lim o'rtasidagi o'rtacha vaqt o'n ikki kun, etti kishi kasalxonaga yotqizilganligi haqida xabar berdi. Biroq, ICUga yuborilgan odamlarning kasalxonaga yotqizilishi va o'limi o'rtasida o'n kunlik o'rtacha vaqti bor edi.^[152] Kasalxonaga yotqizilganida protrombin vaqtining uzayishi va S-reaktiv oqsil darajasining ko'tarilishi COVID-19 ning og'ir kechishi va YDUga o'tish bilan bog'liq.^[153][154]

Ba'zi dastlabki tadqiqotlar shuni ko'rsatadiki, COVID-19 bilan kasallangan odamlarning 10% dan 20% gacha bo'lgan tajribasi bo'ladi alomatlar bir oydan ko'proq davom etadi.^[155][156] Kasallikning og'ir kasalligi bilan kasalxonaga yotqizilganlarning aksariyati uzoq muddatli muammolar, shu jumladan charchoq va nafas qisilishi haqida xabar berishadi.^[157] 2020 yil 30 oktyabrda JSST rahbari Tedros "odamlarning katta qismi uchun COVID virusi uzoq muddatli jiddiy ta'sirlarni keltirib chiqaradi" deb ogohlantirdi. U vaqt o'tishi bilan o'zgarib turadigan COVID-19 simptomlarining keng spektrini "haqiqatan ham tegishli" deb ta'rifladi. Ular charchoq, yo'tal va nafas qisilishi, yallig'lanish va asosiy organlarning shikastlanishi, shu jumladan o'pka va yurak, shuningdek nevrologik va psixologik ta'sirlardan iborat. Alomatlar ko'pincha bir-biriga to'g'ri keladi va tanadagi har qanday tizimga ta'sir qilishi mumkin. Yuqtirilgan odamlarda tsiklik charchoq, bosh og'rig'i, bir necha oy to'la charchash, kayfiyat o'zgarishi va boshqa alomatlar qayd etilgan. Tedros shuning uchun ham ta'kidladi podaning immuniteti "axloqiy jihatdan vijdonan va amalga oshirib bo'lmaydigan".^[158]

Kasalxonani qayta yotqizish nuqtai nazaridan 106000 kishining taxminan 9% kasalxonaga yotqizilganidan keyin 2 oy ichida qaytib kelishlari kerak edi. Qayta qabul qilish o'rtacha kasalxonaga birinchi tashrif buyurganidan beri 8 kunni tashkil etdi, kasalxonaga bir necha bor murojaat qilishning sabablari sifatida aniqlangan bir necha xavf omillari mavjud. Ular orasida keksa yosh (65 yoshdan yuqori) va diabet, KOAH, yurak etishmovchiligi yoki surunkali buyrak kasalligi kabi surunkali holat mavjud.^[159][160]

Ga binoan ilmiy sharhlar chekuvchilar chekish bilan solishtirganda intensiv terapiyani talab qiladi yoki o'ladi,^[161][162] havoning ifloslanishi xuddi shunday xavf omillari bilan bog'liq,^[162] va ilgari yurak va o'pka kasalliklari^[163] va shuningdek semirish COVID-19 ning sog'liq uchun xavfini oshirishga yordam beradi.^{[162][164][165]}

Bundan tashqari, ular bor deb taxmin qilinadi immunitet tanqisligi SARS-CoV-2 dan og'ir kasal bo'lib qolish xavfi yuqori.^[166] Kasalxonaga yotqizilgan buyrak transplantatsiyasi oluvchilarida COVID-19 infektsiyasini ko'rib chiqqan tadqiqotlarning birida o'lim darajasi 11% ni tashkil qildi.^[167]

Bolalar qayd etilgan holatlarning ozgina qismini tashkil qiladi, ularning taxminan 1% 10 yoshgacha va 4% 10-19 yoshda.^[168] Ehtimol, ular kattalarga qaraganda engilroq alomatlarga ega va og'ir kasalliklarga duchor bo'lish ehtimoli pastroqdir.

Evropada o'tkazilgan ko'p millatli kasalxonaga yotqizilgan bolalar tadqiqotlari Lanset 2020 yil 25 iyunda kasalxonaga yotqizilgan bolalarning taxminan 8% intensiv terapiyaga muhtojligini aniqladi. Ushbu 582 bolaning to'rttasi (0,7%) vafot etdi, ammo o'limning haqiqiy darajasi "sezilarli darajada past" bo'lishi mumkin, chunki tibbiy yordamga murojaat qilmagan engil holatlar tadqiqotga kiritilmagan.^[169]

O'lim darajasi yoshga juda bog'liq. 50 yoshdan kichiklarda o'lim xavfi 0,5% dan kam, 70 yoshdan kattalarda esa 8% dan yuqori.^{[170][171][172]} CDC tahliliga ko'ra, Qo'shma Shtatlarda yosh guruhlari bo'yicha o'lim xavfi 0,003%, 0,02%; 0-19, 20-49, 50-69 va 70 va undan yuqori yosh guruhlari uchun mos ravishda 0,5% va 5,4%.^[173][174]

Genetika kasallik bilan kurashish qobiliyatida ham muhim rol o'ynaydi. Masalan, aniqlanmaydigan mahsulot I turdagi interferonlar yoki ishlab chiqarish avtomatik antikorlar bularga qarshi COVID-19 kasalligi ancha kasal bo'lishi mumkin.^[175][176] Genetik skrining interferon effektori genlarini aniqlashga qodir.^[177]

Homilador ayollar kabi shunga o'xshash boshqa viruslar ma'lumotlari asosida og'ir KOVID-19 yuqtirish xavfi yuqori bo'lishi mumkin og'ir o'tkir respirator sindrom (SARS) va Yaqin Sharq respirator sindromi (MERS), ammo COVID-19 uchun ma'lumotlar etishmayapti.^[178][179]

Qo'shni kasalliklar

COVID-19 dan vafot etganlarning aksariyati oldindan mavjud bo'lgan (asosiy) sharoitlar, shu jumladan gipertoniya, qandli diabet va yurak-qon tomir kasalliklari.^[226] Qo'shma Shtatlarning mart oyidagi ma'lumotlariga ko'ra, kasalxonaga yotqizilganlarning 89% oldindan mavjud bo'lgan holatlarga ega.^[227] Italiya Istituto Superiore di Sanità 8,8% o'lim holatlari qayerda ekanligi haqida xabar berdi tibbiy xaritalar mavjud edi, odamlarning 96,1% kamida bittasiga ega edi qo'shma kasallik o'rtacha 3,4 kasallikka chalingan odam bilan.^[152] Ushbu hisobotga ko'ra, eng keng tarqalgan qo'shma kasalliklar gipertoniya (O'limning 66%), 2-toifa diabet (O'limning 29,8%), yurak ishemik kasalligi (O'limning 27,6%), atriyal fibrilatsiya (O'limning 23,1%) va surunkali buyrak etishmovchiligi (O'limning 20,2%).

Eng muhim nafas olish qo'shma kasalliklar ga ko'ra CDC, ular: o'rtacha yoki og'ir Astma, oldindan mavjud KOAH, o'pka fibrozi, kistik fibroz.^[228] Dalillardan kelib chiqqan meta-tahlil bir nechta kichik ilmiy ishlarning chekish bemorning yomon natijalari bilan bog'liq bo'lishi mumkinligini ko'rsatadi.^[229][230] Agar mavjud bo'lgan nafas yo'llari bilan kasallangan odamga KOVID-19 yuqtirilsa, u og'ir alomatlar xavfi yuqori bo'lishi mumkin.^[231] COVID-19, shuningdek, odamlar uchun katta xavf tug'diradi opioidlarni noto'g'ri ishlatish va metamfetaminlar, giyohvand moddalarni iste'mol qilish o'pkaning shikastlanishiga olib kelishi mumkin bo'lgan darajada.^[232]

2020 yil avgust oyida CDC ogohlantirdi sil kasalligi infektsiyalar og'ir kasallik yoki o'lim xavfini oshirishi mumkin. JSST nafas olish alomatlari bilan og'rigan bemorlarni ikkala kasallik bo'yicha tekshiruvdan o'tkazishni tavsiya qildi, chunki COVID-19 uchun ijobiy test qo'shma infektsiyalarni istisno eta olmaydi. Ba'zi prognozlarga ko'ra, pandemiya sababli sil kasalligini aniqlashni kamaytirish, 2025 yilga kelib 6,3 million qo'shimcha sil kasalligi va 1,4 million sil bilan bog'liq o'limga olib kelishi mumkin.^[233]

Asoratlar

Murakkabliklar o'z ichiga olishi mumkin zotiljam, o'tkir nafas yetishmasligi sindromi (ARDS), ko'p organ etishmovchiligi, septik shok va o'lim.^{[72][234][235][236][237]}

Yurak-qon tomir asoratlari yurak etishmovchiligini, aritmiya, yurak yallig'lanishi va qon pıhtıları.^[238]

COVID-19 bilan kasallangan odamlarning taxminan 20-30% jigar fermentlarining ko'tarilishi jigar shikastlanishini aks ettiradi.^[97][239]

Nevrologik namoyishlar kiradi soqchilik, qon tomir, ensefalit va Gilyen-Barre sindromi (o'z ichiga oladi vosita funktsiyalarini yo'qotish ).^[240][241] INFEKTSION so'ng, bolalar rivojlanishi mumkin bolalar multisistemli yallig'lanish sindromi, shunga o'xshash alomatlarga ega Kavasaki kasalligi, bu o'limga olib kelishi mumkin.^[242][243] Juda kamdan-kam hollarda o'tkir ensefalopatiya paydo bo'lishi mumkin va bu COVID-19 tashxisi qo'yilgan va aqliy holati o'zgarganlarda ko'rib chiqilishi mumkin.^[244]

Uzoq muddatli ta'sir

Ba'zi dastlabki tadqiqotlar^[155][245] COVID-19 bilan kasallangan har 5 kishidan 1 nafari va 10 kishidan 1 nafari bir oydan uzoq davom etadigan alomatlarga duch kelishini tavsiya eting. Kasallikning og'ir kasalligi bilan kasalxonaga yotqizilganlarning aksariyati uzoq muddatli muammolar, shu jumladan charchoq va nafas qisilishi haqida xabar berishadi.^[157]

2020 yil 30 oktyabrda JSST rahbari Tedros "odamlarning katta qismi uchun COVID virusi uzoq muddatli jiddiy ta'sirlarni keltirib chiqaradi" deb ogohlantirdi. U vaqt o'tishi bilan o'zgarib turadigan COVID-19 simptomlarining keng spektrini "haqiqatan ham tegishli" deb ta'rifladi. Ular charchoq, yo'tal va nafas qisilishi, yallig'lanish va asosiy organlarning shikastlanishi, shu jumladan o'pka va yurak, shuningdek nevrologik va psixologik ta'sirlardan iborat. Alomatlar ko'pincha bir-biriga to'g'ri keladi va tanadagi har qanday tizimga ta'sir qilishi mumkin. Infektsiyalangan odamlar charchoqning davriy tutilishlari, bosh og'rig'i, bir necha oy to'liq charchash, kayfiyatning o'zgarishi va boshqa alomatlar haqida xabar berishgan. Tedros shuning uchun ham ta'kidladi podaning immuniteti "axloqiy jihatdan vijdonan va amalga oshirilmaydigan".^[246]

Immunitet

The immunitet reaktsiyasi odamlar tomonidan CoV-2 virusi kombinatsiyasi sifatida yuzaga keladi hujayra vositachiligidagi immunitet va antikor ishlab chiqarish,^[247] boshqa infektsiyalarning ko'pchiligida bo'lgani kabi.^[248] Ammo, noma'lum bo'lib qolmoqda immunitet kasallikdan qutulgan odamlarda uzoq davom etadi.^{[yangilanishga muhtoj ][249]} COVID-19 dan qutulish, keyinchalik koronavirus uchun ijobiy testlar o'tkazilgan holatlar haqida xabar berilgan. In some of these cases, the RNA from the first and second infections indicates a different strain of the virus.^{[250][251][252][253]} Some reinfection cases are believed to be lingering infection rather than reinfection,^[253] yoki yolg'on ijobiy due to remaining, non-infectious RNA fragments.^[254] Some other coronaviruses circulating in people are capable of reinfection after roughly a year.^[255]

Tarix

The virus is thought to be natural and has an animal origin,^[36] orqali spillover infection.^[256] The first known human infections were in Vuxan, Xubey, Xitoy. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in Lanset, reported the earliest date of onset of symptoms as 1 2019 yil dekabr.^{[257][258][259]} Official publications from the WHO reported the earliest onset of symptoms as 8 2019 yil dekabr.^[260] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020.^[261][262] According to official Chinese sources, these were mostly linked to the Xuanan dengiz mahsulotlari ulgurji bozori, which also sold live animals.^[263] 2020 yil may oyida, Jorj Gao, direktori Xitoy kasalliklarni nazorat qilish va oldini olish markazi, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but it was not the site of the initial outbreak.^[264] Traces of the virus have been found in wastewater that was collected from Milan va Turin, Italy, on 18 December 2019.^[265]

There are several theories about where the first case (the so-called sabr nol ) originated.^[266] According to an unpublicised report from the Chinese government, the first case can be traced back to 17 November 2019; the person was a 55-year-old citizen in the Hubei province.^{[iqtibos kerak ]} There were four men and five women reported to be infected in November, but none of them were "patient zero".^{[iqtibos kerak ]} By December 2019, the spread of infection was almost entirely driven by human-to-human transmission.^[147][267] The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December^[268] and at least 266 by 31 December.^[269] 24 dekabrda, Vuxan markaziy kasalxonasi yubordi a bronxoalveolyar yuvish suyuqligi (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus.^[270] 26 dekabr kuni noma'lum sabab bo'lgan pnevmoniya klasteri kuzatildi va uni Xubey viloyat kasalxonasida vrach Chjan Tszian tomonidan davolanib, 27 dekabr kuni Vuxan Tszixan CDCga xabar berishdi.^[271] On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. That evening, the Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause".^[272] Eight of these doctors, including Li Venliang (punished on 3 Yanvar),^[273] were later admonished by the police for spreading false rumours, and another, Ai Fen, was reprimanded by her superiors for raising the alarm.^[274]

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases^{[275][276][277]}—enough to trigger an investigation.^[278]

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days.^[279] In early and mid-January 2020, the virus spread to other Xitoy viloyatlari, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange.^[39] On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenchjen.^[280] Later official data shows 6,174 people had already developed symptoms by then,^[281] and more may have been infected.^[282] Hisobot Lanset on 24 January indicated human transmission, strongly recommended shaxsiy himoya vositalari for health workers, and said testing for the virus was essential due to its "pandemic potential".^[55][283] On 30 January, the WHO declared the coronavirus a Xalqaro xavotirda jamoat salomatligi.^[282] By this time, the outbreak spread by a factor of 100 to 200 times.^[284]

On 31 January 2020, Italy had its first confirmed cases, two tourists from China.^[285] As of 13 March 2020, the Jahon Sog'liqni saqlash tashkiloti (WHO) considered Europe the active centre of the pandemic.^[286] On 19 March 2020, Italy overtook China as the country with the most deaths.^[287] By 26 March, the United States had overtaken China and Italy with the highest number of confirmed cases in the world.^[288] Bo'yicha tadqiqotlar coronavirus genomes indicates the majority of COVID-19 cases in Nyu York came from European travellers, rather than directly from China or any other Asian country.^[289] Retesting of prior samples found a person in France who had the virus on 27 December 2019^[290][291] and a person in the United States who died from the disease on 6 2020 yil fevral.^[292]

On 11 June 2020, after 55 days without a locally transmitted case,^[293] Beijing reported the first COVID-19 case, followed by two more cases on 12 June.^[294] By 15 June 79 cases were officially confirmed.^[295] Most of these patients went to Xinfadi ulgurji bozori.^[293][296]

Possible earlier cases

Research in Italy on samples from 959 volunteers in an experimental lung cancer treatment undertaken from September 2019 have shown COVID-19 anti-bodies in 14% of the samples. National Cancer Institute in Milan director Giovanni Apolone suggests that the major outbreak in Italy could have been caused because COVID-19 was wide spread in Italy from Summer 2019.^[297]

Epidemiologiya

Several measures are commonly used to quantify mortality.^[298] These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health.^[299]

The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.3% (1,504,303/65,111,866) as of 4 December 2020.^[8] The number varies by region.^[300]

Other measures include the o'lim darajasi (CFR), which reflects the percentage of tashxis qo'yilgan individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percentage of kasallangan individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time-bound and follow a specific population from infection through case resolution. Many academics have attempted to calculate these numbers for specific populations.^[301]

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing.^[302][303] In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.^[302]

Total confirmed cases over time

Total deaths over time

Total confirmed cases of COVID-19 per million people^[304]

Total confirmed deaths due to COVID-19 per million people (spring 2020)^[305]

INFEKTSION o'lim darajasi

INFEKTSION o'lim darajasi or infection fatality ratio (IFR) is distinguished from o'lim darajasi (CFR). The CFR for a disease is the proportion of deaths from the disease compared to the total number of people tashxis qo'yilgan with the disease (within a certain period of time). The IFR, in contrast, is the proportion of deaths among all the kasallangan jismoniy shaxslar. IFR, unlike CFR, attempts to account for all asymptomatic and undiagnosed infections.

In February, the World Health Organization reported estimates of IFR between 0.3% and 1%.^[306][307] 2 kuni July, The WHO's Chief Scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%.^[308][309]

The CDC estimated for planning purposes that the IFR was 0.65% and that 40% of infected individuals are asymptomatic, suggesting a fatality rate among those who are symptomatic of 1.1% (.65/60) (as of 10 July).^[310][311] Studies incorporating data from broad serology testing in Europe show IFR estimates converging at approximately 0.5–1%.^[312] Ga ko'ra Oksford universiteti Dalillarga asoslangan tibbiyot markazi (CEBM), random antibody testing in Germany suggested a national IFR of 0.4% (0.1% to 0.9%).^{[313][314][315]}

Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).^[316] Antibody testing in New York City suggested an IFR of ~0.9%,^[317] and ~1.4%.^[318] Yilda Bergamo viloyati, 0.6% of the population has died.^[319]

Jinsiy farqlar

Early reviews of epidemiologic data showed greater impact of the pandemic and a higher mortality rate in men in China and Italy.^{[1][320][321]} The Xitoy kasalliklarni nazorat qilish va oldini olish markazi reported the death rate was 2.8% for men and 1.7% for women.^[322] Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders.^[323][324] One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors.^[325] Jinsga asoslangan immunologik tafovutlar, ayollar va erkaklarda sigaretaning kamroq tarqalganligi, yoshroq davrda gipertoniya kabi kasalliklarni rivojlantirishi ayollarga qaraganda erkaklarda o'limning yuqori bo'lishiga yordam berishi mumkin edi.^[326] In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men.^[327] 2020 yil aprel oyidan boshlab AQSh hukumati COVID-19 infektsiyasining jinsiy aloqador ma'lumotlarini kuzatmayapti.^[328] Tadqiqotlar shuni ko'rsatdiki, Ebola, OIV, gripp va SARS kabi virusli kasalliklar erkaklar va ayollarga turlicha ta'sir qiladi.^[328]

Etnik tafovutlar

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans.^[330] Structural factors that prevent African Americans from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as public transit and health care. Greater prevalence of lacking tibbiy sug'urta and care and of underlying conditions such as diabet, gipertoniya va yurak kasalligi also increase their risk of death.^[331] Similar issues affect Tug'ma amerikalik va Lotin tili jamoalar.^[330] According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults.^[332] The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water.^[333] Leaders have called for efforts to research and address the disparities.^[334]

In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Qora, Osiyo, and other ethnic minority background.^{[335][336][337]}

Ism

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus",^{[338][339][340]} with the disease sometimes called "Wuhan pneumonia".^[341][342] In the past, many diseases have been named after geographical locations, such as the Ispan grippi,^[343] Yaqin Sharq nafas olish sindromi va Zika virusi.^[344]

2020 yil yanvar oyida Jahon Sog'liqni saqlash tashkiloti recommended 2019-nCov^[345] and 2019-nCoV acute respiratory disease^[346] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent ijtimoiy tamg'a.^{[347][348][349]}

The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020.^[350] WHO chief Tedros Adhanom Ghebreyesus explained: CO for toj, VI for virus, D. uchun kasallik and 19 for when the outbreak was first identified (31 December 2019).^[351] The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.^[350]

Noto'g'ri ma'lumotlar

Boshlang'ichdan keyin avj olish of COVID-19, noto'g'ri ma'lumotlar va dezinformatsiya regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.^{[352][353][354]}

Boshqa hayvonlar

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis. A domestic cat in Liège, Belgium, tested positive after it started showing symptoms (diarrhoea, vomiting, shortness of breath) a week later than its owner, who was also positive.^[355] Tigers and lions at the Bronx hayvonot bog'i in New York, United States, tested positive for the virus and showed symptoms of COVID-19, including a dry cough and loss of appetite.^[356] Minks at two farms in the Netherlands also tested positive for COVID-19.^[357] In Denmark, as of October 31, 2020, 175 mink farms had seen COVID-19 infection in mink, and also USA; Finland, Sweden and Spain have seen infections in mink.^[358][359]

A study on domesticated animals inoculated with the virus found that cats and parrotlar appear to be "highly susceptible" to the disease, while dogs appear to be less susceptible, with lower levels of viral replication. The study failed to find evidence of viral replication in cho'chqalar, o'rdaklar, and chickens.^[360]

As of August 2020, dozens of domestic cats and dogs had tested positive, though according to the U.S. CDC, there was no evidence they transmitted the virus to humans.^[361] CDC guidance recommends potentially infected people avoid close contact with pets.^[361]

On 4 November 2020, Prime Minister of Denmark Mette Frederiksen dedi a mutated coronavirus was being transmitted to humans via minks, tied primarily to mink farms yilda Shimoliy Yutland.^[362]

Tadqiqot

Remdesivir is the only drug that has been approved with a specific indication to treat COVID-19.^[363] In Australia and the European Union, remdesivir (Veklury) is ko'rsatilgan for the treatment of COVID-19 in adults and adolescents aged twelve years and older with body weight at least 40 kilograms (88 lb) with pneumonia requiring supplemental oxygen.^{[364][365][366]} International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers.^[367][368] In March, the World Health Organization initiated the "Solidarity Trial " to assess the treatment effects of four existing antiviral compounds with the most promise of efficacy.^[369] The World Health Organization suspended hydroxychloroquine from its global drug trials for COVID-19 treatments on 26 May 2020 due to safety concerns. It had previously enrolled 3,500 patients from 17 countries in the Solidarity Trial.^[370] France, Italy and Belgium also banned the use of hydroxychloroquine as a COVID-19 treatment.^[371]

Remdesivir was approved for medical use in the United States in October 2020.^[372][373] It is the first treatment for COVID-19 to be approved by the U.S. Oziq-ovqat va dori-darmonlarni boshqarish (FDA).^[373] It is indicated for use in adults and adolescents aged twelve years and older with body weight at least 40 kilograms (88 lb) for the treatment of COVID-19 requiring hospitalization.^[373]

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission,^[374] diagnosis and prognosis of infection,^[375] estimation of the impact of interventions,^[376][377] or allocation of resources.^[378] Modelling studies are mostly based on epidemiological models,^[379] estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19,^[380] retrofits of crowd movement models to study occupant exposure,^[381] mobility-data based models to investigate transmission,^[382] or the use of macroeconomic models to assess the economic impact of the pandemic.^[383]

There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.^[384] To minimise the harm from noto'g'ri ma'lumotlar, medical professionals and the public are advised to expect rapid changes to available information, and to be attentive to retractions va boshqa yangilanishlar.^[385]

Vaktsina

Dori vositalari

At least 29 Phase II–IV efficacy trials in COVID-19 were concluded in March 2020, or scheduled to provide results in April from hospitals in China.^[397][398] There are more than 300 active clinical trials underway as of April 2020.^[97] Seven trials were evaluating already approved treatments, including four studies on gidroksixlorokin yoki xlorokin.^[398] Qayta qilingan antiviral preparatlar make up most of the research, with nine Phase III trials on remdesivir across several countries due to report by the end of April.^[397][398] Other candidates in trials include vazodilatatorlar, kortikosteroidlar, immune therapies, lipoik kislota, bevacizumab va rekombinant angiotensin-converting enzyme 2.^[398]

The COVID-19 Clinical Research Coalition has goals to 1) facilitate rapid reviews of clinical trial proposals by ethics committees and national regulatory agencies, 2) fast-track approvals for the candidate therapeutic compounds, 3) ensure standardised and rapid analysis of emerging efficacy and safety data and 4) facilitate sharing of clinical trial outcomes before publication.^[399][400]

Several existing medications are being evaluated for the treatment of COVID-19,^[363] shu jumladan remdesivir, xlorokin, gidroksixlorokin, lopinavir/ritonavir, and lopinavir/ritonavir combined with interferon beta-versiyasi.^[369][401] There is tentative evidence for efficacy by remdesivir, and on 1 May 2020, the United States Oziq-ovqat va dori-darmonlarni boshqarish (FDA) gave the drug an favqulodda vaziyatlarda foydalanish uchun avtorizatsiya (EUA) for people hospitalized with severe COVID-19.^[402] On 28 August 2020, the FDA broadened the EUA for remdesivir to include all hospitalized patients with suspected or laboratory-confirmed COVID-19, irrespective of the severity of their disease.^[403] III bosqich klinik tadqiqotlar for several drugs^{[qaysi? ]} are underway^{[qachon? ]} in several countries, including the US, China, and Italy.^{[363][397][404]}

There are mixed results as of 3 April 2020, as to the effectiveness of hydroxychloroquine as a treatment for COVID-19, with some studies showing little or no improvement.^[405][406] One study has shown an association between hydroxychloroquine or chloroquine use with higher death rates along with other side effects.^[407][408] A retraction of this study by its authors was published by Lanset 4 kuni Iyun 2020.^[409] The studies of chloroquine and hydroxychloroquine with or without azitromitsin have major limitations that have prevented the medical community from embracing these therapies without further study.^[97] On 15 June 2020, the FDA updated the fact sheets for the emergency use authorization of remdesivir to warn that using chloroquine or hydroxychloroquine with remdesivir may reduce the antiviral activity of remdesivir.^[410]

In June, initial results from a randomised trial in the United Kingdom showed that deksametazon reduced mortality by one third for patients who are critically ill on ventilators and one fifth for those receiving supplemental oxygen.^[411] Because this is a well tested and widely available treatment this was welcomed by the WHO that is in the process of updating treatment guidelines to include dexamethasone or other steroids.^[412][413] Based on those preliminary results, dexamethasone treatment has been recommended by the Milliy sog'liqni saqlash institutlari for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.^[414]

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19.^[415] The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence).^[415] The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence).^[415] The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.^[416][417]

2020 yil sentyabr oyida Evropa dorilar agentligi (EMA) endorsed the use of dexamethasone in adults and adolescents from twelve years of age and weighing at least 40 kilograms (88 lb) who require supplemental oxygen therapy.^[418] Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.^[418]

In November 2020, a US National Institutes of Health clinical trial evaluating the safety and effectiveness of hydroxychloroquine for the treatment of adults with coronavirus disease 2019 (COVID-19) has formally concluded that the drug provides no clinical benefit to hospitalized patients.^[419]

In November 2020, the U.S. Oziq-ovqat va dori-darmonlarni boshqarish (FDA) issued an emergency use authorization for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID-19.^[420] Bamlanivimab is authorized for people with positive results of direct SARS-CoV-2 viral testing who are twelve years of age and older weighing at least 40 kilograms (88 lb), and who are at high risk for progressing to severe COVID-19 or hospitalization.^[420] This includes those who are 65 years of age or older, or who have certain chronic medical conditions.^[420]

Sitokin bo'roni

A sitokin bo'roni can be a complication in the later stages of severe COVID-19. A cytokine storm is a potentially deadly immune reaction where a large amount of pro-inflammatory cytokines and chemokines are released too quickly; A cytokine storm can lead to ARDS and multiple organ failure.^[421] Data collected from Jin Yin-tan Hospital in Wuhan, China indicates that patients who had more severe responses to COVID-19 had greater amounts of pro-inflammatory cytokines and chemokines in their system than patients who had milder responses; These high levels of pro-inflammatory cytokines and chemokines indicate presence of a cytokine storm.^[422]

Tokilizumab has been included in treatment guidelines by China's Milliy sog'liqni saqlash komissiyasi after a small study was completed.^[423][424] It is undergoing a Bosqich II non-randomised trial at the national level in Italy after showing positive results in people with severe disease.^[425][426] A bilan birlashtirilgan serum ferritin blood test aniqlash uchun sitokin bo'roni (also called cytokine storm syndrome, not to be confused with sitokinni chiqarish sindromi ), it is meant to counter such developments, which are thought to be the cause of death in some affected people.^[427] The interleykin-6 retseptorlari antagonisti tomonidan tasdiqlangan Oziq-ovqat va dori-darmonlarni boshqarish (FDA) to undergo a Phase III clinical trial assessing its effectiveness on COVID-19 based on retrospective case studies for the treatment of steroid-refractory cytokine release syndrome induced by a different cause, CAR T cell terapiya, 2017 yilda.^[428] Hozirgi kungacha,^{[qachon? ]} there is no randomised, controlled evidence that tocilizumab is an efficacious treatment for CRS. Prophylactic tocilizumab has been shown to increase serum IL-6 levels by saturating the IL-6R, driving IL-6 across the qon-miya to'sig'i, and exacerbating neurotoxicity while having no effect on the incidence of CRS.^[429]

Lenzilumab, an anti-GM-CSF monoklonal antikor, is protective in murine models for CAR T cell-induced CRS and neurotoxicity and is a viable therapeutic option due to the observed increase of pathogenic GM-CSF secreting T-cells in hospitalised patients with COVID-19.^[430]

The Feinstein Institute ning Northwell sog'liqni saqlash announced in March a study on "a human antibody that may prevent the activity" of IL-6.^[431]

Passive antibodies

Transferring purified and concentrated antikorlar tomonidan ishlab chiqarilgan immunitet tizimlari of those who have recovered from COVID-19 to people who need them is being investigated as a non-vaccine method of passiv immunizatsiya.^[432][433] Viral neutralization is the anticipated ta'sir mexanizmi by which passive antibody therapy can mediate defence against SARS-CoV-2. The spike protein of SARS-CoV-2 is the primary target for neutralizing antibodies.^[434] As of 8 August 2020, eight neutralizing antibodies targeting the spike protein of SARS-CoV-2 have entered clinical studies.^[435] It has been proposed that selection of broad-neutralizing antibodies against SARS-CoV-2 and SARS-CoV might be useful for treating not only COVID-19 but also future SARS-related CoV infections.^[434] Other mechanisms, however, such as antikorga bog'liq bo'lgan hujayra sitotoksikligi va / yoki fagotsitoz, may be possible.^[432] Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.^[432]

The use of passive antibodies to treat people with active COVID-19 is also being studied. This involves the production of convalescent serum, which consists of the liquid portion of the blood from recovered patients and contains antibodies specific to this virus, which is then administered to current patients.^[432] This strategy was tried for SARS with inconclusive results.^[432] A Cochrane review in October 2020 found insufficient evidence to recommend for or against this treatment in COVID-19, due in large part to the methodology of the clinical trials conducted so far.^[433] Specifically, there are no trials yet conducted for which the safety of convalescent serum administration to people with COVID-19 can be determined, and the differing outcomes measured in different studies limits their use in determining efficacy.^[433]

Laminoid antibodies

Peru announced in April 2020, that it would begin working toward creating a vaccine, with the pharmaceutical company Farvet and Universidad Peruana Cayetano Heredia (UPCH) announcing plans to jointly develop a vaccine in Chincha.^[436] Peru's Experimental Station for Scientific Research and Genetic Improvement of Alpakalar belonging to the Inca Group, selected on 5 June 2020 four alpacas for the development of a new vaccine that it had been developing in conjunction with Farvet and UPCH. They also indicated that alpacas have the ability to generate some types of antibodies known as "nanobodies", which are very small and have a greater potential to treat pathogens.^[437] Ga binoan Andina, research from the United States, Belgium, and Chile showed that antibodies from laminoid animals could possibly be formulated into inhaler or injection treatments for those infected with coronaviruses, with Teodosio Huanca of Peru's National Institute of Agricultural Innovation (INIA) National Camelid Program stating that Peruvian camelidae share the same genetic roots and antibodies.^[438]

On 7 August, the Peruvian National Institute of Health (INS) announced that it would begin the development of a possible treatment for COVID-19 using "recombinant nanoantibodies" from a llama named "Tito".^[439] According to the INIA, Peru holds "the only germplazma bank of South American camelids in the world, with 1,700 samples of alpacas and 1,200 of llamas".^[439]

BCG vaktsinasi

Researchers have studied the BCG vaktsinasi salohiyat uchun o'ziga xos bo'lmagan protection against COVID-19 after observing that mortality and severity of disease has been lower in developing countries. The WHO cautions that there are many factors that could impact these observations such as testing rate and kasallik yuki.^[440] In randomised controlled trials BCG has shown non-specific protection against other respiratory infections.^[441]

There is currently not enough evidence to support a conclusion that BCG vaccine is effective to protect against COVID-19.^[442] The University of Exeter announced the BRACE trial, a large international trial to study whether BCG vaccination reduces the impact of COVID-19 in healthcare workers.^[443][444] A similar study was announced in the Netherlands.^[441]

Shuningdek qarang

• Koronavirus kasalliklari, a group of closely related syndromes
• X kasallik, a WHO term

Izohlar

Adabiyotlar