LII:COVID-19 Testing, Reporting, and Information Management in the Laboratory/Overview of COVID-19 and its challenges

From LIMSWiki
Jump to navigationJump to search
-----Return to the beginning of this guide-----

1. Overview of COVID-19 and its challenges

Please note: Information during a pandemic changes, sometime rapidly, in regards to test methods, reported figures, and social situations. Efforts will be made to keep this guide up-to-date as best as possible given time constraints and resources.

1.1 COVID-19: The terminology

Novel Coronavirus SARS-CoV-2 (49640655213).jpg

A pneumonia-like outbreak was fully in process in Wuhan—located in the Hubei province of China—by December 2019. The World Health Organization (WHO) was notified by the end of the month that the cause could be a novel threat to the larger populace.[1] By the end of January 2020, the WHO had declared the growing viral threat a Public Health Emergency of International Concern (PHEIC), an act which includes with it a need "to implement a comprehensive risk communication strategy."[2] As the disease progressed beyond its Chinese origins, public confusion slowly grew regarding the terminology surrounding the disease. Leaders at the WHO and the Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses came to different naming conclusions, differing in their naming conventions while adding to the confusion.[3][4] In the end, "COVID-19" has ended up as the common disease name, caused by the SARS-CoV-2 virus, which is a member of the coronavirus family. Today, however, some still refer to the disease simply as "coronavirus," which is in error.

This isn't the first time a disease has had a different name from its associated virus. One should look back to 1982, when the U.S. Centers for Disease Control and Prevention (CDC) gave the name "acquired immune deficiency syndrome" or "AIDS" to the disease associated with the human immunodeficiency virus (HIV) (a member of the retrovirus family).[5] It took time for the layman to get used to the terminology, and even then some still ended up mistakenly referring to the disease as "HIV."

Consistent terminology is vital to communicating technical material to a global audience.[6][7] With that in mind, it's beneficial to ensure everyone is clear on the terms used. For purposes of this guide:

  • Coronavirus disease 2019 (otherwise known as COVID-19) is the respiratory disease being discussed in this guide.
  • SARS-CoV-2 is the virus responsible for COVID-19.
  • Coronavirus (or Coronaviridae) is a family of related viruses, of which SARS-CoV-2 is a member.
  • Severe acute respiratory syndrome (otherwise known as SARS) is a different respiratory disease, which surfaced in the early 2000s, caused by a related but different type of coronavirus (SARS-CoV or SARS-CoV-1).
  • Middle East respiratory syndrome (otherwise known as MERS) is a different respiratory disease, which surfaced in 2012, caused by a related but different type of coronavirus (MERS-CoV).

1.2 COVID-19: History and impact (so far)

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus, typically yielding varying levels of short- and long-term symptoms, including fever, cough, shortness of breath, loss of taste or smell, headaches, fatigue, joint pain, chest pain, heart palpitations, brain fog, and mood changes.[8][9] A majority of cases yield relatively mild symptoms, but some progress to life-threatening short- and long-term situations involving pneumonia, organ failure, cardiovascular complications, renal complications, neurological complications, and psychiatric issues.[9][10][11][12][13]

The first known case of COVID-19 dates back to November 2019, "according to government data seen by the South China Morning Post"[14], though additional research has suggested an even earlier timeline. A non-peer-reviewed report released by Harvard Medical School in June 2020 suggested that circumstantial evidence of higher traffic around hospitals even a month earlier may push the Wuhan timeline back further.[15] Stories of routinely analyzed wastewater samples from locations in Brazil[16] and Italy[17] may likewise indicate that the SARS-CoV-2 virus was circulating earlier than initially gauged. And June 2021 peer-reviewed research by Roberts et al. suggests the possibility of COVID-19 beginning to spread as early as early October.[18]

By the middle of December, infections were at 27, and by the end of the year the number was 266.[14] By that time, Chinese health authorities had been updated that the pneumonia-like symptoms of patients in China's Hubei province may have been the symptoms of a disease caused by a novel (new) coronavirus[14], and the WHO was notified.[1] At the start of 2020, that number grew to 381 known cases[14], jumping to more than 7,700 confirmed and 12,000 suspected cases by the end of January.[2] By that time, the WHO had convened a second meeting of its Emergency Committee to discuss the declaration of a PHEIC, saying the then-called "2019-nCoV" constituted a health emergency of international concern.[2] This spurred the publishing of WHO technical advice to other countries, with a focus on "reducing human infection, prevention of secondary transmission and international spread, and contributing to the international response."[2] However, at the same time, the virus was already beginning to spread in locations such as Australia[19], France[20], Germany[21] Italy[22], Japan[23], South Korea[24], Spain[25], the United Kingdom[26], and the United States.[27]

As the disease continued to spread in February 2020, naming conventions came together, with the WHO declaring the disease's name "COVID-19," short for "coronavirus disease 2019."[3][4] By the end of the month, the WHO warned a "very high" likelihood the virus's spread could turn into a full pandemic.[28] Less than two weeks later, on March 11, 2020, the WHO declared the outbreak of SARS-CoV-2 a pandemic, noting more than 118,000 confirmed cases and 4,000 deaths on all continents except Antarctica.[29] By November 2020, the pandemic had become more serious, in the U.S. in particular; hospitals became overwhelmed—the most recorded COVID-19 hospitalizations since the pandemic started[30]—and the pandemic became "a humanitarian crisis."[31] The U.S. FDA issued its first and second Emergency Use Authorization (EUA) for a COVID-19 vaccine, the Pfizer-BioNTech COVID-19 Vaccine[32] and Moderna COVID-19 Vaccine[33], in December 2020, giving hope that a much wider vaccine roll-out would happen by late winter and early spring of 2021 in the U.S.[34] However, concerns that wealthier residents and countries would largely lead the charge while leaving poorer residents and countries behind were heavily vocalized.[34][35]

Governmental reaction to the pandemic around the globe has varied significantly since the pandemic's declaration in March 2020. Some of that variance can be seen when reviewing the various policies implemented by the world's governments. The International Monetary Fund's policy tracker for COVID-19 response, for example, paints a picture of the laboratory testing, social, transportation, trade, and financial situations of each country. Reviewing the policy tracker reveals a diverse set of approaches from country to country, some significant and enduring, others limited and weak. [36] Another source for examining government reaction is through the collation of data on how governments have implemented technological tracking measures in the name of slowing the epidemic. Groups like Privacy International collate such information through their collective tracking project, which links to hundreds of news stories concerning the use of mobile phone data, drones, and other surveillance mechanisms for tracking and enforcing quarantines; geolocation tracking though phones; and the implementation of facial recognition technology as part of a COVID-19 mitigation strategy.[37] Other projects such as the University of Oxford's COVID-19 Government Response Tracker also paint a broad picture of governments' responses to the pandemic using a wide variety of indicators, including school closures, travel restrictions, and vaccination policies. The University of Oxford maintains a core working paper and monthly regional reports, painting a picture of more governments decreasing policy changes as vaccination roll-out continues.[38]

Citizen reaction to the pandemic has also varied. Local governments in China have been criticized[39][40], while the central government has, at least at times, been seen in positive light for its handling of the pandemic.[41][42][43] Some Indians have criticized their government for its police brutality during lockdowns[44], while some Italians have criticized their government for trivializing the situation for too long.[45] In the U.S.—and in other parts of the world—criticism has at times been significant concerning the United States government's response[46][47][48][49], though some governors have received praise for standing up for their state's citizens.[50][51][52] American's views of presidential handling of the COVID-19 crisis have varied. During President Trump's tenure, Americans increasingly expressed disapproval with the U.S. president's handling of the COVID-19 crisis, from 47.8% dissapproval on April 8 to 57.1% disasapproval by the end of his term.[53], which seemingly aligned with his attempts to downplay the existence of the COVID-19 virus.[54][55] Americans' perceptions of President Biden's handling of COVID-19 began strong, at above 60% approval, but has weakened over time to 52.9% as of September 2021, largely falling along partisan lines.[53]

It's difficult to truly quantitatively (or qualitatively) measure the impact of COVID-19 on the world, let alone the United States. From the start of the pandemic there have been significant job losses[56] and bankruptcies[57], to poor mental health impacts[58] and postponed cancer surgeries.[59] With time, some firmer numbers have become known, however. As of August 31, 2021, the number of global confirmed cases of COVID-19 was more than 216 million, with more than 4.5 million people dead.[60] As of July 2021, out of more than 320 vaccine candidates, 99 were still in clinical testing, 25 had reached Phase III efficacy studies, and 18 had received some form of formal approval.[61] Some 3.2 billion doses of vaccine had been administered globally as of July 2021 (with the caveat that only ~1% of people in low-income countries have received at least one dose), and nearly 11 billion doses were still needed to fully vaccinate 70% of the world's population.[62] Other statistics include:

  • "The global economy contracted by 3.5 percent in 2020 according to the April 2021 World Economic Outlook Report published by the IMF, a 7 percent loss relative to the 3.4 percent growth forecast back in October 2019."[63]
  • "At a global scale, the fiscal support [applied to COVID-19] reached nearly $16 trillion (around 15 percent of global GDP) in 2020."[63]
  • As of July 2021, some 10 percent of American adults have reported sometimes or often not having enough to eat in a given week, compared to 3.4 percent for the entirety of 2019.[64]
  • "An estimated 11.4 million [U.S.] adults living in rental housing—16 percent of adult renters—were not caught up on rent" as of the beginning of July 2021, with an additional 7.4 million estimated to not be caught up on mortgage payments.[64]
  • "Some 63 million [U.S.] adults—27 percent of all adults in the country—reported it was somewhat or very difficult for their household to cover usual expenses in the past seven days," as of the beginning of July 2021.[64]

Despite the remaining unknowns and difficulties facing societies everywhere, what has long been known and remains true, however, is that preventative measures such as wearing masks[65], getting vaccinated[61], and getting tested for exposure[66] remain vital in order to further limit the negative consequences of the pandemic.

1.3 Challenges of managing the disease in the human population

The graphical abstract from Li et al. 2020, showing general features of SARS-CoV-2, current knowledge of molecular immune pathogenesis, and diagnosis methods of COVID-19 based on present understanding of SARS-CoV and MERS-CoV viral infections

COVID-19 has presented numerous societal challenges, from supply line interruptions and economic sagging to overwhelmed healthcare systems and civil disorder. However, these are largely the social, economic, and political ripple effects of a disease that has brought with it a set of inherent attributes that make it more difficult to manage in human populations than say the flu.

However, COVID-19 is not the flu, and it is indeed worse in its effects than the flu, contrary to many people's perceptions. Yes, COVID-19 and the flu have some symptom overlap. Yes, COVID-19 and the flu have some transmission type overlap. But from there it diverges. COVID-19 and SARS-CoV-2 is different in that it is more prone to be transmitted to others during the presymptomatic phase. And the body of evidence has grown since early on in the pandemic[67] that SARS-CoV-2 is transmittable predominately via an airborne route[68][69][70][71], though transmission from contaminated surfaced or physical intimacy are also believed possible.[72][73] Hospitalization rates are higher, perhaps up to 10 times higher than the flu, and hospital stays are longer with COVID-19. People are dying more often from COVID-19 too, up to 10 times more often than people stricken with the flu.[74][75][76] And while flu vaccines are largely the norm around the world, and COVID-19 vaccines are gradually becoming more available, those who willing choose to not get the vaccine have a massively higher chance of dying from COVID-19 (as of August 2021, more than 99 percent of all deaths from COVID-19 are found with the unvaccinated[77], compared to some 80% of children who die from the flu while unvaccinated[78]).

Other aspects of the disease that make it difficult to manage include:

  • Median incubation period: According to research published in Annals of Internal Medicine, the median (i.e., the central tendency, which is less skewed than average[79]) incubation period is 5.1 days (Note that as new variants arrive, incubation times my change; the delta variant is thought to have an incubation period of four days, for example.[80]), with 97.5% of symptomatic carriers showing symptoms within 11.5 days. The authors found this to be compatible with U.S. government recommendations of monitored 14-day self-quarantines if individuals were at risk of exposure.[81] However, many people continue to not take mask-wearing—and vaccination—seriously, and thus unmasked presymptomatic (and asymptomatic) carriers are thus largely more prone to spreading the virus.[82][83] This has become even more precarious with the highly contagious delta variant, which can be spread even by the vaccinated, highlighting that "measures such as masks and hand hygiene which can reduce transmission are important for everyone, regardless of vaccination status."[84]
  • Presymptomatic and asymptomatic virus shedding: As mentioned in the previous point, carriers can be contagious during the presymptomatic phase of the disease, even while remaining symptom-free.[82][83][85][86] (The latest comprehensive research, from August 2021, appears to indicate that 35.1 percent of infected people may go without any recognizable symptoms after infection occurs.[87]) This contagion is a result of what's called viral shedding, when the virus moves from cell to cell following successful reproduction. When the virus is in this state, it can be actively found in a carrier's body fluids, excrement, and other sources. Depending on the virus, the virus can then be introduced to another person via those sources. In the case of COVID-19, the core route of transmission appears to be through the air via aerosolized and other forms of water droplets, though saliva and other bodily constituents pose a transmission hazard due to shedding (see previous bulletpoint). Early in the pandemic, uncertainty about transmission routes of viral shedding, along with mixed messages early on about masks and their effectiveness for COVID-19[88][89][90], caused problems. Today we know that masks and social distancing—when appropriate—are an even stronger necessity to limit community transmission of the disease from presymptomatic and asymptomatic individuals, even for those who are vaccinated.[84]
  • Understanding of high viral loads and infectious doses: Respiratory diseases such as influenza, SARS, and MERS see a correlation between the infectious dose amount and the severity of disease symptoms, meaning the higher the infectious dose, the worse the symptoms.[91] Similarly, viral load—a quantification of viral genomic fragments—also tends to correlate with clinical symptoms.[92] However, even with the breakthroughs in COVID research since the start of the pandemic, we are still in the investigative stages of definitively determining if that similarly holds true to COVID-19.[91][93][94] Research early on indicated, for example, there is little difference between the viral load of those with mild or no COVID-19 symptoms and those with more severe symptoms.[91] However, Pujadas et al. suggested a link between high viral load and overall mortality rate.[95] Research later in 2020 has suggested more of a positive correlation between severity of symptoms and viral load[96][97], as has a July 2021 study published in Science.[98] However, more research must be performed to better understand how the viral load infectious dose plays a role in transmission. Given the continued unknowns in this realm, wearing masks and getting vaccinate help minimize exposure and remain the best defense against the worst outcomes of the disease.[91]
  • Cardiovascular issues: Coronaviruses and their accompanying respiratory infections are known to complicate issues of the cardiovascular system, which in turn may "increase the incidence and severity" of infectious diseases such as SARS and COVID-19.[99][100][101] While the exact cardiac effect COVID-19 has on patients is still unknown, suspicion is those with "hypertension, diabetes, and diagnosed cardiovascular disease" may be more prone to having cardiovascular complications from the disease.[102][103] Current thinking is SARS-CoV-2 either attacks heart tissues, causing myocardial dysfunction, or inevitably causes heart failure through a "cytokine storm,"[99][100][102][103][104][105][106], an overproduction of signaling molecules that promote inflammation by white blood cells (leukocytes).[107][108] What's scary is that like the 1918 Spanish flu, SARS, and other epidemics, some otherwise healthy patients' immune responses are entirely overreactive, leading to acute respiratory distress syndrome (ARDS) or heart failure.[106][105][109] Additionally, as the disease has progressed, medical professionals have noted two additional cardiovascular issues. First, an atypical amount of blood clotting has shown up in some infected patients, which may be related to overreactive immune systems, autoantibodies, and underlying health conditions.[110][111] Second, what is being called pediatric multisystem inflammatory syndrome (PMIS) or multisystem inflammatory syndrome in children (MIS-C) has shown up in children after the infection has passed, characterized by inflamed blood vessels and toxic shock syndrome.[112][113][114] While research is ongoing to determine whether these seemingly hyperactive cardiovascular responses are directly linked to the virus[115] or if virus-independent immunopathology is responsible[116], these uncertainties only emphasize the level of difficulty of properly treating COVID-19.
  • Other systemic and bodily issues: As the pandemic has progressed, researchers have discovered SARS-CoV-2 appears to negatively impact other organs and systems in the human body, including the renal system, digestive system, endocrine system, neurological system, and even the reproductive system.[106][8][117][118][119] Another bodily issue that appears to remain for a subset of post-recovery COVID-19 patients is fatigue. The University of Minnesota's Center for Infectious Disease Research and Policy reports on an observational study published in PLOS One' that showed more than half of people who recovered from their COVID-19 infection still dealt with the lingering effects of fatigue at a median of 10 weeks after recovery. The study reports no link between the persistent fatigue and severity of symptoms, need for hospitalization, concentration of laboratory biomarkers, and age.[120] These systemic and body issues have added further complication to an already complicated disease, making extended treatment planning difficult. The long-term affects of these and other organ system injuries remains to be fully understood.
  • Mental health concerns: The mental health toll of the pandemic is becoming increasingly apparent as it wears on. A June 2020 CDC survey of 5,412 U.S. adults (regardless of infection status) "found that 40.9% of respondents reported 'at least one adverse mental or behavioral health condition,' including depression, anxiety, posttraumatic stress, and substance abuse, with rates that were three to four times the rates one year earlier." More than 10 percent of respondents also indicated they had seriously considered suicide in a time period thirty days prior to responding.[121] From an inability to grieve communally with loved ones, to income loss, increased anxiety, and long periods of social isolation, these increasing numbers are not surprising, particularly in light of research on previous pandemics.[121][122] Without proper treatment, these conditions may worsen into prolonged grief disorder, only exasperating a growing mental health crisis.[121] Further, at least one study suggests that those who contract COVID-19 may be at a greater risk of developing some sort of mental illness within 90 days, including anxiety, depression, and insomnia. This effect may be worse for those who already have a history of mental health illness.[123] Mitigating the effects of these mental health concerns will require further study, greater funding, expanded screening, and improved focus on community methods of dealing with tragedy and loss.[121]


  1. 1.0 1.1 Hui, D.S.; Azhar, E.I.; Madani, T.A. et al. (2020). "The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—The latest 2019 novel coronavirus outbreak in Wuhan, China". International Journal of Infectious Diseases 91: 264–66. doi:10.1016/j.ijid.2020.01.009. PMID 31953166. 
  2. 2.0 2.1 2.2 2.3 World Health Organization (30 January 2020). "Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)". World Health Organization. Retrieved 06 September 2021. 
  3. 3.0 3.1 Enserink, M. (12 February 2020). "Update: ‘A bit chaotic.’ Christening of new coronavirus and its disease name create confusion". Science. Retrieved 06 September 2021. 
  4. 4.0 4.1 Jiang, S.; Shi, Z.; Shu, Y. et al. (2020). "A distinct name is needed for the new coronavirus". The Lancet 395 (10228): 949. doi:10.1016/S0140-6736(20)30419-0. PMID 32087125. 
  5. Oppenheimer, G.M. (1992). "Chapter 2: Causes, Cases, and Cohorts: The Role of Epidemiology in the Historical Construction of AIDS". In Fee, E.; Fox, D.M.. AIDS: The Making of a Chronic Disease. University of California Press. pp. 49–83. ISBN 0520077784. Retrieved 31 March 2020. 
  6. Kohl, J.R. (2008). The Global English Style Guide: Writing Clear, Trnaslatable Documentation for a Global Market. SAS Institute. ISBN 9781599946573. 
  7. Megathlin, B.A.; Langford, R.S. (1991). "Controlling the Unruly: Terminology". 1991 Proceedings 38th International Technical Communication Conference: WE22–WE24. 
  8. 8.0 8.1 Centers for Disease Control and Preventions (22 February 2021). "Symptoms of Coronavirus". Centers for Disease Control and Preventions. Retrieved 06 September 2021. 
  9. 9.0 9.1 Centers for Disease Control and Preventions (12 July 2021). "Long-Term Effects of COVID-19". Centers for Disease Control and Preventions. Retrieved 06 September 2021. 
  10. Wadman, M.; Couzin-Frankel, J.; Kaiser, J. et al. (17 April 2020). "How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes". Science. doi:10.1126/science.abc3208. Retrieved 06 September 2021. 
  11. Chinese Center for Disease Control and Prevention (2020). "The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China". Chinese Journal of Epidemiology 41 (2): 145–51. doi:10.3760/cma.j.issn.0254-6450.2020.02.003. PMID 32064853. 
  12. Elezkurtaj, S.; Greuel, S.; Ihlow, J. et al. (2021). "Causes of death and comorbidities in hospitalized patients with COVID-19". Scientific Reports 11: 4263. doi:10.1038/s41598-021-82862-5. PMC PMC7895917. PMID 33608563. 
  13. Taquet, M.; Geddes, J.R.; Husain, M. et al. (2021). "6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: A retrospective cohort study using electronic health records". The Lancet Psychiatry 8 (5): 416–27. doi:10.1016/S2215-0366(21)00084-5. PMC PMC8023694. PMID 33836148. 
  14. 14.0 14.1 14.2 14.3 Ma, J. (13 March 2020). "Coronavirus: China’s first confirmed Covid-19 case traced back to November 17". South China Morning Post. Retrieved 31 March 2020. 
  15. Folmer, K.; Margolin. J. (8 June 2020). "Satellite data suggests coronavirus may have hit China earlier: Researchers". ABC News. Retrieved 07 July 2020. 
  16. Chen, S. (3 July 2020). "‘Earlier signs of coronavirus’ in sewage samples in Brazil". South China Morning Post. Retrieved 07 July 2020. 
  17. Kelland, K. (19 June 2020). "Italy sewage study suggests COVID-19 was there in December 2019". Reuters. Retrieved 07 July 2020. 
  18. Roberts, D.L.; Rossman, J.S.; Jarić, I. (2021). "Dating first cases of COVID-19". PLoS Pathogens 17 (6): e1009620. doi:10.1371/journal.ppat.1009620. PMC PMC8224943. PMID 34166465. 
  19. Hunt, G. (25 January 2020). "First confirmed case of novel coronavirus in Australia". Australian Department of Health. Retrieved 31 March 2020. 
  20. Jacob, E. (24 January 2020). "Coronavirus: trois premiers cas confirmés en France, deux d’entre eux vont bien". Le Figaro. Retrieved 31 March 2020. 
  21. Der Spiegel (28 January 2020). "Bayerische Behörden bestätigen ersten Fall in Deutschland". Retrieved 31 March 2020. 
  22. Severgnini, C. (30 January 2020). "Coronavirus, primi due casi in Italia «Sono due cinesi in vacanza a Roma» Sono arrivati a Milano il 23 gennaio". Corriere della Sera. Retrieved 31 March 2020. 
  23. Sim, W. (16 January 2020). "Japan confirms first case of infection from Wuhan coronavirus; Vietnam quarantines two tourists". The Straits Times. Retrieved 31 March 2020. 
  24. Jin-woo, S. (24 January 2020). "신종 코로나바이러스 한국인 첫환자 확인". Retrieved 31 March 2020. 
  25. Linde, P. (31 January 2020). "Sanidad confirma en La Gomera el primer caso de coronavirus en España". El País. Retrieved 31 March 2020. 
  26. Ball, T.; Wace, C. (31 January 2020). "Hunt for contacts of coronavirus-stricken pair in York". The Times. Retrieved 31 March 2020. 
  27. Holshue, M.L.; DeBolt, C.; Lindquist, S. et al. (2020). "First Case of 2019 Novel Coronavirus in the United States". New England Journal of Medicine 382 (10): 929–36. doi:10.1056/NEJMoa2001191. PMID 32004427. 
  28. Mulier, T. (28 February 2020). "WHO Raises Global Risk for Coronavirus to Very High". Bloomberg. Retrieved 31 March 2020. 
  29. Gumbrecht, J.; Howard, J. (11 March 2020). "WHO declares novel coronavirus outbreak a pandemic". CNN Health. Retrieved 31 March 2020. 
  30. Dall, C. (11 November 2020). "US hits record for COVID-19 hospital cases". CIDRAP News. Center for Infectious Disease Research and Policy - University of Minnesota. Retrieved 12 November 2020. 
  31. Maxouris, C. (12 November 2020). "As the holidays get closer, Covid-19 hospitalizations and deaths are happening at a faster rate". CNN Health. Retrieved 12 November 2020. 
  32. "FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine". U.S. Food and Drug Administration. 11 December 2020. Retrieved 06 September 2021. 
  33. "FDA Takes Additional Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for Second COVID-19 Vaccine". U.S. Food and Drug Administration. 18 December 2020. Retrieved 06 September 2021. 
  34. 34.0 34.1 Thomas, K.; Robbins, R. (3 February 2021). "Vaccine News Gives Hope for Spring, if Enough People Get the Shots". The New York Times. Retrieved 06 September 2021. 
  35. Bahar, D. (11 February 2021). "Rich countries have a moral obligation to help poor countries get vaccines, but catastrophic scenarios are overrated". Brookings. Retrieved 06 September 2021. 
  36. International Monetary Fund (5 November 2020). "Policy Responses to COVID-19". International Monetary Fund. Retrieved 12 November 2020. 
  37. Privacy International (8 October 2020). "Tracking the Global Response to COVID-19". Privacy International. Retrieved 12 November 2020. 
  38. Blavatnik School of Government (August 2021). "COVID-19 Government Response Tracker". University of Oxford. Retrieved 06 September 2021. 
  39. Wu, H.; Cheng, L. (26 January 2020). "Chinese provincial press conference on coronavirus inspires anger, criticism". Reuters. Retrieved 25 April 2020. 
  40. She, Z. (21 January 2020). "武汉"万家宴":他们的淡定让人没法淡定". The Beijing News. Archived from the original on 28 January 2020. Retrieved 25 April 2020. 
  41. Johnson, I. (13 March 2020). "China Bought the West Time. The West Squandered It". The New York Times. Retrieved 25 April 2020. 
  42. Richie, R. (28 March 2020). "Rodney Richie: Don’t be quick to blame Chinese for obscuring viral contagion". Waco Tribune-Herald. Retrieved 25 April 2020. 
  43. Bowman, N. (18 March 2020). "Bill Gates estimates at least 6-10 weeks before coronavirus is quelled in US". MYNorthwest. Retrieved 25 April 2020. 
  44. PTI (27 March 2020). "Coronavirus: Bollywood celebrities criticise police brutality during lockdown". Deccan Herald. Retrieved 25 April 2020. 
  45. Horowitz, J.; Bubola, E.; Povoledo, E. (21 March 2020). "Italy, Pandemic’s New Epicenter, Has Lessons for the World". The New York Times. Retrieved 25 April 2020. 
  46. Science News Staff (1 April 2020). "The United States leads in coronavirus cases, but not pandemic response". Science. Retrieved 06 September 2021. 
  47. Luscombe, R. (22 March 2020). "Trump tries to blunt criticism of Covid-19 response as US cases pass 33,000". The Guardian. Retrieved 25 April 2020. 
  48. Perry, M.; Kelland, K.; Nebehay, S. et al. (14 April 2020). "Factbox: Global Reaction to Trump Withdrawing WHO Funding". Reuters. Retrieved 25 April 2020. 
  49. Melton, M.; (3 April 2020). "Criticizing America over COVID-19 Response". Providence. Retrieved 25 April 2020. 
  50. Clay, J. (31 March 2020). "BBC praises Gov. DeWine's leadership during coronavirus pandemic". ABC6 On Your Side. Retrieved 25 April 2020. 
  51. Renbaum, B. (20 March 2020). "Glendening Praises Hogan's Response to COVID-19". Maryland Reporter. Retrieved 20 March 2020. 
  52. "Glowing coverage of Cuomo also raises difficult questions". Columbia Journalism Review. 27 March 2020. Retrieved 25 April 2020. 
  53. 53.0 53.1 Bycoffe, A.; Groskopf, C.; Mehta, D. (11 November 2020). "How Americans View The Coronavirus Crisis And Trump's Response". FiveThirtyEight. Retrieved 12 November 2020. 
  54. Collinson, S. (24 June 2020). "Fauci warns of disturbing trend as Trump ignores viral surge". CNN Politics. Retrieved 07 July 2020. 
  55. Hellmann, J. (6 July 2020). "Trump downplaying sparks new criticism of COVID-19 response". The Hill. Archived from the original on 07 July 2021. Retrieved 06 September 2021. 
  56. Rothwell, J.; Van Drie, H. (27 April 2020). "The effect of COVID-19 and disease suppression policies on labor markets: A preliminary analysis of the data". Brookings. The Brookings Institute. Retrieved 28 April 2020. 
  57. Rosenberg, J.M. (26 April 2020). "A flood of business bankruptcies likely in coming months". Associated Press. Retrieved 06 September 2021. 
  58. Ting, V. (26 April 2020). "Coronavirus: suicide experts warn of pandemic’s impact on mental health, with Hong Kong’s jobless, poor and elderly most at risk". South China Morning Post. Retrieved 28 April 2020. 
  59. Colaianni, A. (22 April 2020). "“For Now, We Wait”: Postponing Cancer Surgery During the Coronavirus Crisis". The New Yorker. Retrieved 28 April 2020. 
  60. World Health Organization (31 August 2021). "COVID-19 Weekly Epidemiological Update - 31 August 2021" (PDF). World Health Organization. Retrieved 06 November 2021. 
  61. 61.0 61.1 Tregoning, J.S.; Flight, K.E.; Highman, S.L. et al. (2021). "Progress of the COVID-19 vaccine effort: viruses, vaccines and variants versus efficacy, effectiveness and escape". Nature Reviews Immunology: 1–11. doi:10.1038/s41577-021-00592-1. PMC PMC8351583. PMID 34373623. 
  62. Padma, T.V. (2021). "COVID vaccines to reach poorest countries in 2023 — despite recent pledges". Nature 595: 342–43. doi:10.1038/d41586-021-01762-w. PMID 34226742. 
  63. 63.0 63.1 Yeyati, E.L.; Filippini, F. (8 June 2021). "Social and economic impact of COVID-19". Brookings. Retrieved 06 September 2021. 
  64. 64.0 64.1 64.2 Center on Budget and Policy Priorities (9 August 2021). "Tracking the COVID-19 Recession’s Effects on Food, Housing, and Employment Hardships". COVID Hardship Watch. Retrieved 06 September 2021. 
  65. Falcon, R. (7 August 2021). "Do face masks work? Here are 49 scientific studies that explain why they do". KXAN. Retrieved 06 September 2021. 
  66. Scott, D. (1 September 2021). "Why can’t America fix its Covid-19 testing problems?". Vox. Retrieved 06 September 2021. 
  67. Achenach, J.; Johnson, C.Y. (29 April 2020). "Studies leave question of ‘airborne’ coronavirus transmission unanswered". The Washington Post. Retrieved 01 May 2020. 
  68. Van Beusekom, M. (6 July 2020). "Global experts: Ignoring airborne COVID spread risky". Center for Infectious Disease Research and Policy. University of Minnesota. Retrieved 07 July 2020. 
  69. Ducharme, J. (7 July 2020). "The WHO Says Airborne Coronavirus Transmission Isn't a Big Risk. Scientists Are Pushing Back". Time. Retrieved 07 July 2020. 
  70. Penn Medicine (2 August 2020). "COVID-19 Transmission: Droplet or Airborne? Penn Medicine Epidemiologists Issue Statement". Penn Physician Blog. Retrieved 23 August 2020. 
  71. Greenhalgh, T.; Jimenez, J.L.; Prather, K.A. et al. (2021). "Ten scientific reasons in support of airborne transmission of SARS-CoV-2". Lancet 397 (10285): 1603–5. doi:10.1016/S0140-6736(21)00869-2. PMC PMC8049599. PMID 33865497. 
  72. "Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments". Centers for Disease Control and Prevention. 5 April 2021. Retrieved 06 September 2021. 
  73. Winter, E.; Datil, A. (27 May 2021). "VERIFY: Yes, vaccinated people can transmit COVID-19 through kissing". WUSA9 - Verify. Retrieved 06 September 2021. 
  74. Huang, P. (20 March 2020). "How The Novel Coronavirus And The Flu Are Alike ... And Different". NPR: Goats and Soda. Retrieved 01 April 2020. 
  75. Resnick, B.; Animashaun, C. (18 March 2020). "Why Covid-19 is worse than the flu, in one chart". Vox. Retrieved 01 April 2020. 
  76. Kumar, V. (27 March 2020). "COVID-19 has been compared to the flu. Experts say that's wrong". ABC News. Retrieved 01 April 2020. 
  77. Most, D. (13 August 2021). "Myths vs. Facts: Making Sense of COVID-19 Vaccine Misinformation". The Brink. Retrieved 06 September 2021. 
  78. "61,000 people died in the worst flu season of the past decade. COVID-19 has killed eight times that many". USAFacts. 29 July 2021. Retrieved 06 September 2021. 
  79. National Water and Climate Center. "Median vs. Average to Describe Normal". U.S. Department of Agriculture. Retrieved 01 April 2020. 
  80. Kochvar, G.; Shah, A. (16 August 2021). "Delta variant questions answered". Northwest Community Healthcare. Retrieved 06 September 2021. 
  81. Lauer, S.A.; Grantz, K.H.; Bi, Q. et al. (2020). "The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application". Annals of Internal Medicine. doi:10.7326/M20-0504. PMC PMC7081172. PMID 32150748. 
  82. 82.0 82.1 Mandavilli, A. (31 March 2020). "Infected but Feeling Fine: The Unwitting Coronavirus Spreaders". The New York Times. Retrieved 01 April 2020. 
  83. 83.0 83.1 Mock, J. (26 March 2020). "Asymptomatic Carriers Are Fueling the COVID-19 Pandemic. Here’s Why You Don’t Have to Feel Sick to Spread the Disease". Discover. Retrieved 01 April 2020. 
  84. 84.0 84.1 Subbaraman, N. (2021). "How do vaccinated people spread Delta? What the science says". Nature 596: 327–28. doi:10.1038/d41586-021-02187-1. PMID 34385613. 
  85. Yuen, K.-S.; Fung, S.-Y.; Chan, C.-P.; Jin, D.-Y. (2020). "SARS-CoV-2 and COVID-19: The most important research questions". Cell & Bioscience 10: 40. doi:10.1186/s13578-020-00404-4. PMC PMC7074995. PMID 32190290. 
  86. Diamond, F. (17 March 2020). "Asymptomatic Carriers of COVID-19 Make It Tough to Target". Infection Control Today. Retrieved 06 September 2021. 
  87. Sah, P.; Fitzpatrick, M.C.; Zimmer, C.F. et al. (2021). "Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis". PNAS 118 (34): e2109229118. doi:10.1073/pnas.2109229118. PMID 34376550. 
  88. Greenfieldboyce, N. (28 March 2020). "WHO Reviews 'Current' Evidence On Coronavirus Transmission Through Air". NPR. Retrieved 01 April 2020. 
  89. Chicago Sun Times Editorial Board (31 March 2020). "Ignore the mixed messages and wear that mask". Chicago Sun Times. Retrieved 01 April 2020. 
  90. Mulholland, J. (29 March 2020). "To mask or not to mask: mixed messages in a time of crisis". RFI. Retrieved 01 April 2020. 
  91. 91.0 91.1 91.2 91.3 Geddes, L. (27 March 2020). "Does a high viral load or infectious dose make covid-19 worse?". New Scientist. Retrieved 01 April 2020. 
  92. Hijano, D.R.; Brazelton de Cardenas, J.; Maron, G. et al. (2019). "Clinical correlation of influenza and respiratory syncytial virus load measured by digital PCR". PLoS One 14 (9): e0220908. doi:10.1371/journal.pone.0220908. PMC PMC6720028. PMID 31479459. 
  93. Liu, Y.; Yan, L.-M.; Wan, L. et al. (2020). "Viral dynamics in mild and severe cases of COVID-19". The Lancet Infectious Diseases. doi:10.1016/S1473-3099(20)30232-2. PMID 32199493. 
  94. Joynt, G.M.; Wu, W.K.K. (2020). "Understanding COVID-19: what does viral RNA load really mean?". The Lancet Infectious Diseases. doi:10.1016/S1473-3099(20)30237-1. 
  95. Pujadas, E.; Chaudhry, F.; McBride, R. et al. (2020). "SARS-CoV-2 viral load predicts COVID-19 mortality". The Lancet Respiratory Medicine. doi:10.1016/S2213-2600(20)30354-4. 
  96. Fajnzylber, J.; Regan, J.; Coxen, K. et al. (2020). "SARS-CoV-2 viral load is associated with increased disease severity and mortality". Nature Communications 11: 5493. doi:10.1038/s41467-020-19057-5. PMC PMC7603483. PMID 33127906. 
  97. "SARS-Cov-2 Viral Load as an Indicator for COVID-19 Patients’ Hospital Stay". medRxiv. 2020. doi:10.1101/2020.11.04.20226365. 
  98. Jones, T.C.; Biele, G.; Mühlemann, B. et al. (2021). "Estimating infectiousness throughout SARS-CoV-2 infection course". Science 373 (6551): abi5273. doi:10.1126/science.abi5273. PMID 34035154. 
  99. 99.0 99.1 Madjid, M.; Safavi-Naeini, P.; Solomon, S.D. (2020). "Potential Effects of Coronaviruses on the Cardiovascular System". JAMA Cardiology. doi:10.1001/jamacardio.2020.1286. PMID 32219363. 
  100. 100.0 100.1 Xiong, T.-Y.; Redwood, S.; Prendergast, B.; Chen, M. (2020). "Coronaviruses and the cardiovascular system: acute and long-term implications". European Heart Journal: ehaa231. doi:10.1093/eurheartj/ehaa231. PMID 32186331. 
  101. Driggin, E.; Madhavan, M.V.; Bikdeli, B. et al. (2020). "Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic". Journal of the American College of Cardiology. doi:10.1016/j.jacc.2020.03.031. PMID 32201335. 
  102. 102.0 102.1 Otto, M.A. (26 March 2020). "Cardiac symptoms can be first sign of COVID-19". The Hospitalist. Retrieved 01 April 2020. 
  103. 103.0 103.1 Clerkin, K.J.; Fried, J.A.; Raikhelkar, J. et al. (2020). "Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease". Circulation. doi:10.1161/CIRCULATIONAHA.120.046941. PMID 32200663. 
  104. Mehta, P.; McAuley, D.F.; Brown, M. et al. (2020). "COVID-19: Consider cytokine storm syndromes and immunosuppression". The Lancet 395 (10229): P1033–34. doi:10.1016/S0140-6736(20)30628-0. PMID 32192578. 
  105. 105.0 105.1 Mandavilli, A. (1 April 2020). "The Coronavirus Patients Betrayed by Their Own Immune Systems". The New York Times. Retrieved 01 April 2020. 
  106. 106.0 106.1 106.2 Weidmann, M.D.; Otori, J.; Rai, A.J. (2020). "Laboratory Biomarkers in the Management of Patients With COVID-19". American Journal of Clinical Pathology: aqaa205. doi:10.1093/ajcp/aqaa205. PMID 33107558. 
  107. Tisoncik, J.R.; Korth, M.J.; Simmons, C.P. et al. (2012). "Into the eye of the cytokine storm". Microbiology and Molecular Biology Reviews 76 (1): 16–32. doi:10.1128/MMBR.05015-11. PMC PMC3294426. PMID 22390970. 
  108. Yang, L.; Xie, X.; Tu, Z. et al. (2021). "The signal pathways and treatment of cytokine storm in COVID-19". Signal Transduction and Targeted Therapy 6: 255. doi:10.1038/s41392-021-00679-0. PMC PMC8261820. PMID 34234112. 
  109. Basilio, P. (26 March 2020). "A new potential risk of COVID-19: Sudden cardiac death". MDLinx. Retrieved 06 September 2021. 
  110. Rettner, R. (23 April 2020). "Mysterious blood clots in COVID-19 patients have doctors alarmed". LiveScience. Retrieved 28 April 2020. 
  111. Hampton, T. (2021). "Autoantibodies May Drive COVID-19 Blood Clots". JAMA 325 (5): 425. doi:10.1001/jama.2020.25699. PMID 33528515. 
  112. Moyer, M.W. (19 May 2020). "What We Know About the Covid-Related Syndrome Affecting Children". The New York Times. Retrieved 19 May 2020. 
  113. Fischer, K. (18 May 2020). "What to Know About PMIS, the COVID-19-Linked Syndrome Affecting Children". Healthline. Retrieved 19 May 2020. 
  114. MacMillan, C. (14 July 2021). "Researchers Continue to Find Clues About MIS-C". Yale Medicine. Yale University. Retrieved 06 September 2021. 
  115. Manne, B.K.; Denorme, F.; Middleton, E.A. et al. (2020). "Platelet Gene Expression and Function in COVID-19 Patients". Blood: blood.2020007214. doi:10.1182/blood.2020007214. 
  116. Dorward, D.A.; Russell, C.D.; Um, I.H. et al. (2020). "Tissue-specific tolerance in fatal Covid-19". medRxiv. doi:10.1101/2020.07.02.20145003. 
  117. Mayo Clinic Staff (7 October 2020). "COVID-19 (coronavirus): Long-term effects". Mayo Clinic. Retrieved 12 November 2020. 
  118. Budson, A.E. (8 October 2020). "The hidden long-term cognitive effects of COVID-19". Harvard Health Blog. Retrieved 12 November 2020. 
  119. Ma, C.; Cong, Y.; Zhang, H. (2020). "COVID-19 and the Digestive System". American Journal of Gastroenterology 115 (7): 1003–6. doi:10.14309/ajg.0000000000000691. PMC PMC7273952. PMID 32618648. 
  120. Van Beusekom, M. (11 November 2020). "Half of recovered COVID-19 patients report lingering fatigue". CUDRAP News & Perspective. University of Minnesota. Retrieved 18 November 2020. 
  121. 121.0 121.1 121.2 121.3 Simon, N.M.; Saxe, G.N.; Marmar, C.R. (2020). "Mental Health Disorders Related to COVID-19–Related Deaths". JAMA 324 (15): 1493–94. doi:10.1001/jama.2020.19632. PMID 33044510. 
  122. Savage, M. (28 October 2020). "Coronavirus: The possible long-term mental health impacts". BBC Worklife. Retrieved 18 November 2020. 
  123. Kelland, K. (9 November 2020). "Study Shows COVID-19 Patients at Greater Risk of Mental Health Problems". Insurance Journal. Retrieved 18 November 2020. 

-----Go to the next chapter of this guide-----

Citation information for this chapter

Chapter: 1. Overview of COVID-19 and its challenges

Edition: Fall 2021

Title: COVID-19 Testing, Reporting, and Information Management in the Laboratory

Author for citation: Shawn E. Douglas

License for content: Creative Commons Attribution-ShareAlike 4.0 International

Publication date: September 2021