As of March 25, 2020, 414 179 cases and 18 440 deaths due to coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had been reported worldwide. The epidemic began in mainland China, with a geographical focus in the city of Wuhan, Hubei. However, on Feb 26, 2020, the rate of increase in cases became greater in the rest of the world than inside China. Substantial outbreaks are occurring in Italy (69 176 cases), the USA (51 914 cases), and Iran (24 811 cases), and geographical expansion of the epidemic continues.
Clinical studies of hospitalised patients have shown that, at onset of COVID-19, patients frequently show symptoms associated with viral pneumonia, most commonly fever, cough, sore throat, myalgia, and fatigue. The case definition adopted in China and elsewhere includes further stratification of cases as severe (defined as tachypnoea [≥30 breaths per min], oxygen saturation ≤93% at rest, or PaO2/FiO2 ratio <300 mm Hg) and critical (respiratory failure requiring mechanical ventilation, septic shock, or other organ dysfunction or failure that requires intensive care). According to the report from the WHO–China Joint Mission on COVID-19, 80% of the 55 924 patients with laboratory-confirmed COVID-19 in China to Feb 20, 2020, had mild-to-moderate disease, including both non-pneumonia and pneumonia cases, while 13·8% developed severe disease and 6·1% developed to a critical stage requiring intensive care. In a study of clinical progression in 1099 patients, those at highest risk for severe disease and death included people over the age of 60 years and those with underlying conditions, including hypertension, diabetes, cardiovascular disease, chronic respiratory disease, and cancer.