Patients with post-COVID conditions may share some of the symptoms that occur in patients who experience: Symptom management approaches that have been helpful for these disorders may also benefit some patients with post-COVID conditions (e.g., activity management (pacing) forpost-exertional malaise). You can change the settings and get more information in the. Persistent Symptoms in Patients After Acute COVID-19. The research can be expanded to include a longer time frame, such as 6 months, to help me answer this question.. 2005 - 2023 WebMD LLC. People who belong to racial and ethnic minority populations have experienced a higher burden of COVID-19in part because of structural racism and longstanding disparities in social determinants of healthwhich has led to a higher incidence of post-COVID conditions in some of these same populations. NIT is routinely being used for the management of acute respiratory failure secondary to coronavirus disease-2019 (COVID-19) with variable outcomes. A case study reported in the peer-viewed journal Vaccine found that a patient who had Parkinsons Disease and who died after receiving his third Covid-19 vaccination had developed necrotizing encephalitis in the brain and spike proteins from the vaccine were present in the location of the inflammation.. Some people experience COVID-19 rebound after treating the initial disease with Paxlovid. JAMA. Are vaccines safe in patients with Long COVID? Signs of this potentially fatal complication. Dr. Arbaje mentioned that the study uses claims data, something the authors point out as well. As the swelling gets worse, your lungs fill with fluid and debris. Some of these types of conditions were also reported in patients following severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), two other life-threatening illnesses resulting from coronavirus infections. COVID-19 has an impact on multiple organs such as the heart,3kidneys,4and liver5but the primary system affected has been the respiratory system with most of the clinical manifestations including cough, sputum production, dyspnea, fever, fatigue, and in severe cases acute respiratory distress syndrome (ARDS) and respiratory failure.68The The study, which appears in the BMJ, lays the groundwork for further research to understand the long-term effects of COVID-19 on peoples health. The study suggests macrophages cells typically charged with protecting the lung can be infected by SARS-CoV-2 and can contribute to spreading the infection through the lung. When COVID pneumonia develops, it causes additional symptoms, such as: Shortness of breath Increased heart rate Low blood pressure What's more is that COVID Broadly, I think about post-acute sequelae of COVID-19 as two syndromes, although there is overlap, he explained. An intense conflagration in the lungs (regular pneumonia) has a higher risk of death. Int J Environ Res Public Health. For instance, how safely can we start rehabilitation interventions? Its a disease that comes on quickly and causes breathing problems. What is the latest research on the form of cancer Jimmy Carter has? Petersen LR, Sami S, Vuong N, et al. He wasn't on FaceBook so his views on the subject are unknown. All rights reserved. The absence of laboratory-confirmed abnormalities or the decision to forgo extensive laboratory testing should not lead to dismissing the possible impact of a patients symptoms on their daily function. The other broad category is those with milder infection not requiring hospitalization, and here, we have fewer answers. For patients who report previous infection with SARS-CoV-2, in addition to standard vital signs (i.e., blood pressure, heart rate, respiratory rate, pulse-oximetry, body temperature) and body mass index, healthcare professionals should evaluate ambulatory pulse-oximetry for individuals presenting with respiratory symptoms, fatigue, or malaise. In the Pneumocovid study, which involved more than 200 patients admitted to Hospital Clnic with serious COVID-19, approximately 25% of patients presented changes to respiratory function three months after being discharged from hospital. Additional diagnostic testing should be guided by findings from the patient history and physical examination and results of previous diagnostic testing, and may include a chest x-ray, pulmonary function tests, electrocardiogram, or echocardiogram for persistent or new respiratory or cardiac concerns, although additional studies and more clinical evidence is needed to support the utility of specific imaging tests for evaluation of post-COVID conditions. Cookies used to make website functionality more relevant to you. A person may be experiencing diabetes and hypertension and stroke and COVID-19 not just COVID-19 alone. The timeline of COVID-19 symptoms will vary between people, but some studies suggest certain symptoms may appear at certain stages of the condition. Continuity of care is important in the management of post-COVID conditions. The lungs are the organ most commonly affected by COVID-19, with a spectrum of severe effects. Dr. Arbaje said that the study would help doctors pay attention to a patients perspective and the disease journey they are on. Methods Seventy-two patients The study suggests macrophages cells typically charged with protecting the lung can be infected by SARS-CoV-2 and can contribute to spreading the infection through the lung. Various investigations in this field, which are still being carried out, will determine the real impact of the after-effects of this disease, especially those that persist in the mid- and long-term, in other words, 6 and 12 months after the serious illness caused by COVID. In this study, the The CDC states that well-fitting respirator masks (like N95s and KN95s) provide better protection than other masks. Laboratory testing should be guided by the patient history, physical examination, and clinical findings. We cant look at causation, which is fine for this kind of study because they are open about it, and I think this study is meant to lead to other studies.. These and other measures can also be found in thehealth measures toolboxand American Academy of Physical Medicine & Rehabilitationsfunctional assessments, along with assessment tools for other rehabilitation needs (e.g., bowel and bladder function, pain, activities of daily living, cognition, mobility, sleep). Maybe someone was going to have a stroke or a heart attack 10 years from now, but COVID-19 because its such a heavy hit to the immune system, its a huge stressor to the body may accelerate what was already coming down the pike, said Dr. Arbaje. Objective laboratory or imaging findings should not be used as the only measure or assessment of a patients well-being; normal laboratory or imaging findings do not invalidate the existence, severity, or importance of a patients post-COVID symptoms or conditions. COVID-19 vaccinationshould be offered to all eligible people, regardless of their history of SARS-CoV-2 infection. Long-term respiratory effects can occur Healthcare professionals should use caution when conducting exercise capacity testing with some patients, especially those withpost-exertional malaise(i.e., the worsening of symptoms following even minor physical or mental exertion, with symptoms typically worsening 12 to 48 hours after activity and lasting for days or even weeks). WebMD does not provide medical advice, diagnosis or treatment. It damages the cells and tissue that line the air sacs in your lungs. The World Health Organization renamed the virus COVID-19 for coronavirus disease 2019. 2021 Mar 1. doi:10.2139/ssrn.3769978, Al-Aly Z, Xie Y, Bowe B. High-dimensional characterization of post-acute sequalae of COVID-19. Healthcare providers should inquire about any unprescribed medications, herbal remedies, supplements, or other treatments that patients may be taking for their post-COVID conditions and evaluate for drug interactions. Stock image from the attention at COVID cases in the Emergencies Area. Post-intensive care syndrome: impact, prevention, and management. This can make it harder for them to swap oxygen and carbon dioxide. Its something that were starting to learn has longer-term effects beyond the respiratory component.. You can get pneumonia as a complication of viral infections such as COVID-19 or the flu, or even a common cold. In patients with normal chest x-rays and normal oxygen saturation, computed tomography (CT) imaging of the chest might have lower yield for assessing pulmonary disease. Causes behind painful breathing, fluid buildup. The Johns Hopkins Post-Acute COVID-19 Team (PACT): A Multidisciplinary, Collaborative, Ambulatory Framework Supporting COVID-19 Survivors. 2021 March 11; 21253225. This study will help us develop treatments to reduce the severity of COVID-19 in those who develop it.. COVID-19 is a respiratory disease, one that especially reaches into your respiratory tract, which includes your lungs. MMWR Morb Mortal Wkly Rep. 2021 Apr 30;70(17):644-650. doi: 10.15585/mmwr.mm7017e3, Lund LC, Hallas J, Nielsen H, Koch A, Mogensen SH, Brun NC, Christiansen CF, Thomsen RW, Pottegrd A. Post-acute effects of SARS-CoV-2 infection in individuals not requiring hospital admission: a Danish population-based cohort study. People with COVID-19 pneumonia will often also have symptoms of COVID-19, Dr. Casciari said. Lancet. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition A cohort study. Health Care Utilization and Clinical Characteristics of Nonhospitalized Adults in an Integrated Health Care System 28-180 Days After COVID-19 Diagnosis Georgia, May 2020-March 2021. Case study found that a patient who had Parkinson's Disease and who died after receiving third Covid-19 vaccination had developed necrotizing encephalitis in the brain, and spike proteins from the vaccine were present in the location of the inflammation. Based upon ours and similar studies that have been published, the picture of [long COVID] is becoming more clear., New research looking at the data of 85 people who died with COVID-19 found that most of these were older males with underlying chronic health. Methods Seventy-two patients hospitalized with severe COVID-19 pneumonia who were discharged or died between 5 January 2020 and 3 March 2020 at Huangshi Infectious Disease Hospital were included. doi:10.3390/ijerph17165844, Akinbami LJ, Petersen LR, Sami S, et al. treat severe SARS-CoV-2 pneumonia and lessen its damage. And when the immune system receives such a hit, I think it may have less ability, defenses, or physiological reserve to do its other duties, like monitoring for cancer cells, monitoring for the things it normally does., So COVID-19 may accelerate what was already coming if we have tendencies that were coming our way, or it may create new injuries that the body then has to deal with. Autoimmune conditions can also occur after COVID-19. Chest. First authors are Rogan Grant, Luisa Morales-Nebreda and Nikolay Markov. Shortness of breath (dyspnea) or trouble breathing. What do we do? Those are still questions, but now, were asking how we help people recover, how we help them long-term, how we deal with the disability that occurs afterward and how we restructure our healthcare system to deal with a large number of people coming with all these sequelae that this study is starting to highlight. Dr. Alicia Arbaje, So I think this study is important, because it can help for planning purposes to help us see longer-term what we may need. A wide variety of health effects can persist after the acute COVID-19 illness has resolved (e.g., pulmonary fibrosis, myocarditis). WebCOVID-19Common questionWhat does COVID-19 pneumonia cause?The pneumonia that COVID-19 causes tends to take hold in both lungs. Give your provider a complete list of all medicines you have taken recently. Survivor support groups are connecting people, providing support, and sharing resources with survivors and others affected by COVID-19. Post-acute effects of SARS-CoV-2 infection in individuals not requiring hospital admission: a Danish population-based cohort study. 2021 Jan-Dec;12:21501327211010994. doi:10.1177/21501327211010994, Brigham E, OToole J, Kim SY, et al. 2021 Jan 30. doi:10.1093/cid/ciab080. 2020 Aug 11;324(6):603-605. doi:10.1001/jama.2020.12603, Cellai M, OKeefe JB. If youre in a high-risk group for COVID-19 pneumonia, take these steps to prevent infection: While there are COVID vaccines now available, they donot protect you from pneumonia. At the pulmonary level, it is known that a significant percentage of patients who have had a serious form of the illness present changes to respiratory function after three months of being discharged from hospital. Nat Med. Reasons for these wide-ranging estimates include: CDC posts data on post-COVID conditions and provides analyses, the most recent of which can be found on the U.S. Census Bureaus Household Pulse Survey. Doctors are still studying whether these effects are permanent or might heal Lung Ultrasound is a useful tool to monitor the resolution of COVID-associated lung inflammation in an outpatient setting. Characterization of Prolonged COVID-19 Symptoms in an Outpatient Telemedicine Clinic. People who get pneumonia may also have a condition called acute respiratory distress syndrome (ARDS). These patients are very sick. CDC considers post-COVID conditions to be present if recovery does not occur after the 4-week acute phase even though many patients continue to recover between 4 and 12 weeks. Am J Med. sensation of an irregular heartbeat exhaustion that comes on easily Kidney disease frequent need to urinate urine thats foamy or bloody swollen ankles Chron Respir Dis. Scientists took cells from patients lung fluid and looked at the RNA and the proteins those cells express, enabling them to identify how these immune cells drive inflammation. 2020 Sep 7:e13700. Dr. Arbaje also highlighted some of the limitations of the study. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Pulmonary lesions can be observed in x-ray images of some patients admitted due to COVID. All rights reserved. Some of these effects are similar to those from hospitalization for other respiratory infections or other conditions. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management. J Gen Intern Med. Instead of rapidly infecting large regions of the lung, the virus causing COVID-19 sets up shop in multiple small areas of the lung. Notwithstanding the limitations acknowledged by the authors, validation of our observations as clinicians allows us to continue to advocate for measures to protect this population, said Dr. Estores. These effects can include severe weakness and. Weara face mask if you have to go out. Gommers, K.M. CDC uses the 4-week timeframe in describing post-COVID conditions to emphasize the importance of initial clinical evaluation and supportive care during the initial 4 to 12 weeks after acute COVID-19. Attributes and predictors of long COVID. 2005 - 2023 WebMD LLC. As a result, when the COVID-19 pandemic hit, they were prepared to collect fluid from the lungs of these patients in a safe and systematic manner and compare it with fluid collected from other ICU patients with pneumonia collected before the pandemic. Older adults and people who have other health conditions like heart disease, cancer, and diabetes may have more serious symptoms. Those who are 85 or older are at the highest risk. Pneumonia caused by COVID-19 can result in significant respiratory after-effects. Doctors call this ground glass.. Already, researchers at Northwestern and elsewhere are anticipating mechanisms by which this RNA virus, which mutates quickly, will evade current vaccines, Singer said. 2021 May 10. doi:10.1016/S1473-3099(21)00211-5, Carf A, Bernabei R, Landi F, et al. Multi-year studies will be crucial in understanding post-COVID conditions. Readmission and Death After Initial Hospital Discharge Among Patients With COVID-19 in a Large Multihospital System. The omicron subvariant of COVID-19, BA.5, became one of the dominant strains of the virus in the fall of 2022 in the U.S. At that time, it was the most easily spread strain to date and is able to evade immunity from COVID infection and vaccination. Most older adults are under traditional Medicare, which would be more representative if the study had focused in that space. During the initial years of the COVID-19 pandemic, the incidence of invasive pneumococcal disease (IPD) due to Streptococcus pneumoniae declined substantially in multiple countries. Post-COVID syndrome: Incidence, clinical spectrum, and challenges for primary healthcare professionals. Huisman, H. Endeman: Incidence of thrombotic complications in critically ill ICU patients with COVID-19, 04.13.2020. Some people had a cough even after they recovered from COVID-19. In fact, three months after leaving the hospital about 70 percent of those in the study continued to have abnormal lung scans, an indication that the lungs are still damaged and trying to heal. Analysis of Risk Factors on Readmission Cases of COVID-19 in the Republic of Korea: Using Nationwide Health Claims Data. Br J Sports Med. A high percentage of patients who have suffered serious illness as a result of COVID-19, for example pneumonia, continue to experience after-effects from the disease months after being discharged. Effects of COVID-19 illness or hospitalization can include tracheal stenosis from prolonged intubation, severe weakness, and muscle atrophy. In the present study, the researchers wanted to better understand the likelihood of older adults developing health conditions following a SARS-CoV-2 infection, which experts generally refer to as sequelae. You might also have more serious pneumonia. Clinician Outreach and Communication Activity (COCA). Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration United States, 2020. For information about antibody testing, see Using Antibody Tests for COVID-19. Readmissions among patients with COVID-19. Laboratory and imaging studies can often be normal or nondiagnostic in patients experiencing post-COVID conditions and symptoms may improve or resolve during the first few months after acute infection in some patients, further supporting an initial conservative approach to diagnostic testing. Dr. Irene M. Estores, director of the Integrative Medicine Program at the University of Florida Health, said the findings confirm previous work in this area. 2021 May;8(5):416-427. doi:10.1016/S2215-0366(21)00084-5, Barker-Davies RM, OSullivan O, Senaratne KPP, et al. At the pulmonary level, a recent article analyses patients discharged from intensive care units after suffering a serious illness. 2021 Apr 28. doi: 10.1093/cid/ciab338, Hernandez-Romieu AC, Leung S, Mbanya A, et al. Compared with the 2020 comparison group, the new or persistent conditions that showed the greatest risk were respiratory failure, fatigue, high blood pressure, memory issues, kidney injury, mental health-related diagnoses, hypercoagulability which occurs when the blood clots more easily and cardiac rhythm disorders. doi:10.1111/ijcp.14357, Rando HM, Bennett TD, Byrd JB, et al. It then hijacks the lungs' own immune cells and uses them to spread across the lung over a period of many days or even weeks, like multiple wildfires spreading across a forest. We have already published a similar analysis in a cohort of 1864-year-olds, and we are completing work on a pediatric population. This study showed that many of the sequelae were respiratory complications, but there were cardiovascular, hypercoagulable, clotting disorders, and fatigue as well. ICD-10-CM coding guidance can be found at 2022 ICD-10-CM Guidelines [583 KB, 115 pages], pages 30-31 (Section I.C.1.g.1.m). That matches with my own clinical practice I practice in a hospital setting, and I have noticed both patients coming in with exacerbations of their underlying disease after COVID-19, but also after vaccination. Dr. Cohen said he and his colleagues have plans to continue the research. Medical treatments plus Dr. Estores was not involved in the study. So I think this study begins to shift the frame of how we look at illnesses in older people, said Dr. Arbaje. This is where oxygen goes into your blood and carbon dioxide comes out. A Multidisciplinary NHS COVID-19 Service to Manage Post-COVID-19 Syndrome in the Community. Researchers are actively studying the prevalence, mechanism, duration, and severity of symptoms following acute SARS-CoV-2 infection, as well as risk factors associated with post-COVID conditions. The lining can become irritated and inflamed. 8 Pneumonia can cause serious health complications, including: 9 Pleural disorders (the pleura is the tissue that covers your lungs and lines the inside of your chest cavity) Your doctor might recommend cough medicine and pain relievers that reduce fever. Accessed at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/1april2021, Chevinsky JR, Tao G, Lavery AM, et al. How to regain your strength after pneumonia. About 1 out of 6 people who contract Covid-19 becomes seriously ill and develop difficulty breathing." Accessed at: https://www.medrxiv.org/content/10.1101/2021.03.11.21253225v2. All rights reserved. American Academy of Pediatrics. Accessed at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/, Greenhalgh T, Knight M, ACourt C, et al. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. At the same time, people in these groups might have less access to the primary healthcare and treatment options that are needed by people suffering from post-COVID conditions. Experts answer your questions. Understanding the magnitude of this impact and the specific organ systems that can be affected by the post-acute sequelae of COVID-19 is critically important information.. van der Meer, M.S. WebCOVID-19Common questionWhat does COVID-19 pneumonia cause?The pneumonia that COVID-19 causes tends to take hold in both lungs. Your lungs and airways swell and become inflamed. Still, it can support your overall health, especially if youre older or have a weak immune system. Sequelae in Adults at 6 Months After COVID-19 Infection. COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler: Looking for Clarity in the Haze of the Pandemic. 2021 Apr;134(4):462-467.e1. Methods To do this, Dr. Cohen and his colleagues looked at the health insurance records of 133,366 older adults in the United States. 2021 Apr;27(4):626-631. doi:10.1038/s41591-021-01292-y, Lund LC, Hallas J, Nielsen H, et al. As the infection travels your respiratory tract, your immune system fights back. [This could include] public health infrastructure, disability, rehabilitation, considering what policies might be put into place to support people who have this illness, or the caregivers who are now needing to take off work or maybe quit to care for people with long-term disability, suggested Dr. Arbaje. 2021 May 4. doi:10.1016/j.arcmed.2021.03.010, Cabrera Martimbianco AL, Pacheco RL, Bagattini M, et al. If COVID-19 spreads to the lungs, it can cause pneumonia. The symptoms of COVID-19 pneumonia are similar to the symptoms of other types of pneumonia and can include: fever chills cough, which may or may not be Lambert N, Survivor Corps, El-Azab SA, et al. As a result, important information about what was killing patients with severe COVID-19 was missing. Where clinically indicated, symptom management and a comprehensive rehabilitation plan can be initiated simultaneously with laboratory testing for most patients. At the end of each branch are tiny air sacs called alveoli. More specialized (e.g., cardiac MRI) imaging studies might merit consultation with specialists. Ideally, healthcare professionals, in consultation with the relevant specialists, should develop a comprehensive management plan based on their patients presenting symptoms, underlying medical and psychiatric conditions, personal and social situations, and their treatment goals. WebMD does not provide medical advice, diagnosis or treatment. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Creating a comprehensive rehabilitation plan may be helpful for some patients, and might include physical and occupational therapy, speech and language therapy, or vocational therapy, as well as neurologic rehabilitation for cognitive symptoms. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Healthcare professionals should also consider the possibility of SARS-CoV-2 reinfection, especially in persons with new or worsening post-COVID conditions, see Guidance for SARS-CoV-2 Reinfection. Bacteria or viruses like influenza that cause pneumonia can spread across large regions of the lung within hours. The authors already mention the effect of increased medical attention that can subsequently increase the reported rates of this condition. Optimizing management of underlying medical conditions might include counseling on lifestyle components such as nutrition, sleep, and stress reduction (e.g., meditation). Exercise capacity tests should be scheduled for a dedicated follow-up appointment so that patients can prepare additional home supports. Ir J Med Sci. 2020 Jun;56(3):339-344. doi: 10.23736/S1973-9087.20.06298-X. In the most serious cases, you may need to go to the hospital for help breathing with a machine called a ventilator. Pulmonology Department at Hospital Clnic de Barcelona. Lancet Infect Dis. At this time, no laboratory test can definitively distinguish post-COVID conditions from other conditions with different etiologies, in part due to the heterogeneity of post-COVID conditions. One study described that more than half of patients who had to be admitted to hospital due to the SARS-CoV-2 virus continued to present symptoms two months after the start of the illness, with fatigue and dyspnoea (a feeling of shortness of breath) being the most common. Sixty-Day Outcomes Among Patients Hospitalized With COVID-19. CDC twenty four seven. People experiencing homelessness or housing instability as well as people in correctional facilities may also experience challenges accessing healthcare and other support services. We aimed to investigate the clinical effects of intravenous glucocorticoid (GC) therapy for severe COVID-19 pneumonia. Severe illness due to the wild-type SARS-CoV-2 and the previous variants often involves the infection and inflammation of the lungs. Lee SH, Shin HS, Park HY, et al. A high number of cases have been documented with persistent symptoms following the acute phase, without any clear relation to the severity of the illness. And its hard to figure out what that is.. So I think the study is important, because it helps us begin to think of COVID-19 as having a broader effect than maybe one might have thought of before., [Another] reason this is significant is that it honors the patients disease or illness journey. Point Prevalence Estimates of Activity-Limiting Long-Term Symptoms among U.S. In terms of causation, or at least speculating around what might account for it, I think and again, this is speculation that there may be two things to keep in mind. These patients have a systemic inflammatory response that is quite severe, and many of the post-acute sequelae are a consequence of the organ damage that occurs from this process.. Most patients appear to recover from acute COVID-19 illness within four weeks. Functional testing can also be helpful to quantitatively document clinical status over time. UChicago Medicine: COVID-19: What we know so far about the 2019 novel coronavirus., Mayo Clinic: Coronavirus disease 2019 (COVID-19), Pneumonia., Loma Linda University Health: Coronavirus disease 2019 (COVID-19)., CDC: Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) -- United States, February 12-March 16, 2020, Coronavirus Disease 2019 (COVID-19): People who are at higher risk for severe illness, Coronavirus Disease 2019 (COVID-19): How to Protect Yourself.Symptoms of Coronavirus, About Cloth Face Coverings,Types of Masks and Respirators., World Health Organization: Coronavirus disease 2019 (COVID-19): Situation Report 46., Cleveland Clinic: Heres the Damage Coronavirus (COVID-19) Can Do to Your Lungs., American Journal of Roentgenology: Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia, Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study., UpToDate: Coronavirus disease 2019 (COVID-19): Management in hospitalized adults, Coronavirus disease 2019 (COVID-19): Clinical Features..