Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), was first reported in Wuhan, Hubei, China, and has spread to more than 200 other countries around the world. COVID-19 is a highly contagious disease with continuous human-to-human transmission. The origin of the virus is unknown. Airway manipulations and intubations, which are common during anesthesia procedures may increasingly expose anesthesia providers and intensive care unit team members to SARS-CoV-2. Through a comprehensive review of existing studies on COVID-19, this article presents the epidemiological and clinical characteristics of COVID-19, reviews current medical management, and suggests ways to improve the safety of anesthetic procedures. Owing to the highly contagious nature of the virus and the lack of therapeutic drugs or vaccines, precautions should be taken to prevent medical staff from COVID-19.
LiQGuanXWuP, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199-1207.
2.
The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020 [in Chinese]. China CDC Weekly. 2020;2:113-122.
3.
RotheCSchunkMSothmannP, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382:970-971.
4.
WeiMYuanJLiuYFuTYuXZhangZJ. Novel coronavirus infection in hospitalized infants under 1 year of age in China [published online February 14, 2020]. JAMA. doi:10.1001/jama.2020.2131
5.
World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Published January 30, 2020. Accessed April 8, 2020.
World Health Organization Emergency Dashboard. Coronavirus (COVID-19). https://who.sprinklr.com/. Accessed April 8, 2020.
9.
TranKCimonKSevernMPessoa-SilvaCLConlyJ.Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7:e35797.
ChenXLiuYGongY, et al. Perioperative management of patients infected with the novel coronavirus: recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists [published online March 26, 2020]. Anesthesiology. doi:10.1097/ALN.0000000000003301
12.
ChenNZhouMDongX, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-513.
13.
ZhouPYangXLWangXG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270-273. doi:10.1038/s41586-020-2012-7
14.
LuRZhaoXLiJ, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395:565-574.
15.
ZhuNZhangDWangW, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-733.
16.
WuFZhaoSYuB, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579:265-269.
17.
XiaoKZhaiJFengY, et al. Isolation and characterization of 2019-nCoV-like coronavirus from Malayan pangolins [published online February 20, 2020]. bioRxiv. doi:10.1101/2020.02.17.951335
18.
JiWWangWZhaoXZaiJLiX.Cross-species transmission of the newly identified coronavirus 2019-nCoV. J Med Virol. 2020;92:433-440.
GuanWJNiZYHuY, et al. Clinical characteristics of coronavirus disease 2019 in China [published online February 28, 2020]. N Engl J Med. doi:10.1056/NEJMoa2002032
21.
WangDHuBHuC, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China [published online February 7, 2020]. JAMA. doi:10.1001/jama.2020.1585
22.
HuangCWangYLiX, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
23.
ChanJFWYuanSKokKH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395:514-523.
24.
PanXChenDXiaY, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. Lancet Infect Dis. 2020;20:410-411.
25.
SunKChenJViboudC.Early epidemiological analysis of the coronavirus disease 2019 outbreak based on crowdsourced data: a population-level observational study. Lancet Digit Health. 2020;2:PE201-PE208. doi:10.1016/S2589-7500(20)30026-1
26.
WuJTLeungKBushmanM, et al. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China [published online March 19, 2020]. Nat Med. doi:10.1038/s41591-020-0822-7
27.
LuCWLiuXFJiaZF.2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395:e39.
28.
XiaJTongJLiuMShenYGuoD. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection [published online February 26, 2020]. J Med Virol. doi:10.1002/jmv.25725
29.
ZhouYZengYTongYChenCZ. Ophthalmologic evidence against the interpersonal transmission of 2019 novel coronavirus through conjunctiva [published online February 12, 2020]. medRxiv. doi:10.1101/2020.02.11.20021956
30.
HolshueMLDeBoltCLindquistS, et al; Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382:929-936. doi:10.1056/NEJMoa2001191
31.
YongZCaoCShuangliZ, et al. Isolation of 2019-nCoV from a stool specimen of a laboratory-confirmed case of the coronavirus disease 2019 (COVID-19) [in Chinese]. China CDC Weekly. 2020;2:123-124.
32.
ZhangHKangZGongH, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes [published online January 31, 2020]. bioRxiv. doi:10.1101/2020.01.30.927806
33.
PanYZhangDYangPPoonLLMWangQ.Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis. 2020;20:411-412. doi:10.1016/S1473-3099(20)30113-4
34.
YoungBEOngSWXKalimuddinS, et al; Singapore 2019 Novel Coronavirus Outbreak Research Team. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore [published online March 3, 2020]. JAMA. doi:10.1001/jama.2020.3204
35.
WrappDWangNCorbettKS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367:1260-1263. doi:10.1126/science.abb2507
36.
XuYLiXZhuB, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding [published online March 13, 2020]. Nat Med. doi:10.1038/s41591-020-0817-4
37.
XuXWWuXXJiangXG, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:m606.
ChenHGuoJWangC, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395:809-815. doi:10.1016/S0140-6736(20)30360-3
40.
HoehlSRabenauHBergerA, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. N Engl J Med. 2020;382:1278-1280.
41.
ZouLRuanFHuangM, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382:1177-1179.
42.
BaiYYaoLWeiT, et al. Presumed asymptomatic carrier transmission of COVID-19 [published online February 21, 2020]. JAMA. doi:10.1001/jama.2020.2565
43.
MizumotoKKagayaKZarebskiAChowellG.Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020;25. doi:10.2807/1560-7917.ES.2020.25.10.2000180
44.
QiuJ. Covert coronavirus infections could be seeding new outbreaks [published online March 20, 2020]. Nature. doi:10.1038/d41586-020-00822-x
45.
PingWZhiyongLYeCYingQHuijieCXiangdongA.Investigation of a cluster of 2019 novel coronavirus disease (COVID-19) with possible transmission during the incubation period—Shenyang City, China 2020 [in Chinese]. China CDC Weekly. 2020;2:125-127.
46.
LanLXuDYeG, et al. Positive RT-PCR test results in patients recovered from COVID-19 [published online February 27, 2020]. JAMA. doi:10.1001/jama.2020.2783
47.
YangXYuYXuJ, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published online February 24, 2020]. Lancet Respir Med. doi:10.1016/S2213-2600(20)30079-5
48.
ZhouYHouYShenJHuangYMartinWChengF.Network-based drug repurposing for novel coronavirus 2019-nCoV/SARS-CoV 2. Cell Discov. 2020;6:14.
49.
Johns Hopkins University & Medicine. Johns Hopkins Coronavirus Resource Center. https://coronavirus.jhu.edu/. Accessed March 25, 2020.
LiuYYangYZhangC, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63:364-374. doi:10.1007/s11427-020-1643-8
RothanHAByrareddySN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak [published online February 26, 2020]. J Autoimmun. doi:10.1016/j.jaut.2020.102433
55.
ChenJQiTLiuL, et al. Clinical progression of patients with COVID-19 in Shanghai, China [published online March 19, 2020]. J Infect. doi:10.1016/j.jinf.2020.03.004
56.
LescureFXBouadmaLNguyenD, et al. Clinical and virological data of the first cases of COVID-19 in Europe: a case series [published online March 27, 2020]. Lancet Infect Dis. doi:10.1016/S1473-3099(20)30200-0
57.
ShiHHanXJiangN, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20:425-434. doi:10.1016/S1473-3099(20)30086-4
58.
DongLHuSGaoJ.Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther. 2020;14:58-60.
59.
WangMCaoRZhangL, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30:269-271.
60.
ShirakiKDaikokuT. Favipiravir, an anti-influenza drug against life threatening RNA virus infections [published online February 22, 2020]. Pharmacol Ther. doi:10.1016/j.pharmthera.2020
61.
GaoJTianZYangX.Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14:72-73.
62.
FanHHWangLQLiuWL, et al. Repurposing of clinically approved drugs for treatment of coronavirus disease 2019 in a 2019-novel coronavirus (2019-nCoV) related coronavirus model [published online March 6, 2020]. Chin Med J (Engl). doi:10.1097/CM9.0000000000000797
MengLQiuHWanL, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience [published online March 26, 2020.]. Anesthesiology. doi:10.1097/ALN.0000000000003296
68.
WaxRSChristianMD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients [published online February 12, 2020]. Can J Anaesth. doi:10.1007/s12630-020-01591-x
69.
RadonovichLJJrSimberkoffMSBessesenMT, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA. 2019;322:824-833. doi:10.1001/jama.2019.11645
70.
CabriniLLandoniGZangrilloA.Minimise nosocomial spread of 2019-nCoV when treating acute respiratory failure. Lancet. 2020;395:685. doi:10.1016/S0140-6736(20)30359-7
Centers for Disease Control and Prevention. Interim US guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html. Accessed April 8, 2020.
