Latest public health information from CDC, Statement on Casirivimab Plus Imdevimab EUA, Chloroquine or Hydroxychloroquine With or Without Azithromycin, Clinical Data: Chloroquine or Hydroxychloroquine, Lopinavir/Ritonavir and Other HIV Protease Inhibitors, Table 2 Characteristics of Antiviral Agents, Table 3a Immune-Based Therapy Clinical Data, Table 3b Characteristics of Immune-Based Therapy, Therapeutic Management of Patients With COVID-19, Care of Critically Ill Patients With COVID-19, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html, https://www.ncbi.nlm.nih.gov/pubmed/32281668, https://www.ncbi.nlm.nih.gov/pubmed/32840379, https://www.ncbi.nlm.nih.gov/pubmed/32762922, https://s3.amazonaws.com/cdn.smfm.org/media/2336/SMFM_COVID_Management_of_COVID_pos_preg_patients_4-30-20_final.pdf, https://www.ncbi.nlm.nih.gov/pubmed/19935037, https://www.ncbi.nlm.nih.gov/pubmed/23313311, https://www.ncbi.nlm.nih.gov/pubmed/32386565, https://www.ncbi.nlm.nih.gov/pubmed/32410760, https://www.ncbi.nlm.nih.gov/pubmed/32279115, https://pubs.rsna.org/doi/10.1148/ryct.2020200110, https://www.ncbi.nlm.nih.gov/pubmed/32929257, https://www.ncbi.nlm.nih.gov/pubmed/33206133, https://www.ncbi.nlm.nih.gov/pubmed/32784198, https://www.ncbi.nlm.nih.gov/pubmed/28721340, https://www.ncbi.nlm.nih.gov/pubmed/32730238, https://www.ncbi.nlm.nih.gov/pubmed/32729939, https://www.ncbi.nlm.nih.gov/pubmed/32753338, https://www.ncbi.nlm.nih.gov/pubmed/33027186, https://www.ncbi.nlm.nih.gov/pubmed/33205450, https://www.ncbi.nlm.nih.gov/pubmed/33166287, https://www.ncbi.nlm.nih.gov/pubmed/32644129, https://www.ncbi.nlm.nih.gov/pubmed/32600344, https://www.ncbi.nlm.nih.gov/pubmed/32730619, https://www.ncbi.nlm.nih.gov/pubmed/32763118, https://www.ncbi.nlm.nih.gov/pubmed/32738287, https://www.ncbi.nlm.nih.gov/pubmed/32838240, https://www.ncbi.nlm.nih.gov/pubmed/32498691, https://www.medrxiv.org/content/10.1101/2020.10.20.20215863v1, Centers for Disease Control and Prevention. “I think we will be better prepared.”. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Although pneumonia caused by severe acute respiratory syndrome coronavirus 2 is a prominent feature of COVID-19, clinicians must consider whether treatment for additional potential causes of community-acquired pneumonia (CAP) is appropriate. The most severely affected patients are older men, individuals of black and Asian minority ethnicity and those with comorbidities. We report the fourth case of this extremely rare complication in a 65-year-old male patient with severe acute respiratory syndrome … However, a spontaneous pneumomediastinum has rarely been described. COVID-19 (oronavirus disease): people with certain medical conditions. As with any patient in the intensive care unit (ICU), successful clinical management of a patient with COVID-19 includes treating both the medical condition that initially resulted in ICU admission and other comorbidities and nosocomial complications. Huang L, Zhao P, Tang D, et al. But doctors say the virus leaves more severe damage in its wake. As COVID‑19 pneumonia is caused by a virus, antibiotics are ineffective. See Therapeutic Management of Patients With COVID-19 for recommendations regarding SARS-CoV-2–specific therapy. They pivoted research to COVID-related pneumonia early last year. The proposed treatment is consistent with what observed in COVID-19, even though the overwhelming number of patients seen in this pandemic may limit its wide applicability. We follow the stories and update you as they develop. As a result of the detailed analysis, researchers identified critical targets to treat severe SARS-CoV-2 pneumonia … Are There Treatments for COVID-19 Pneumonia? The overwhelming majority of patients admitted to hospital have … However, there are ways to support their care if they need to be admitted to a hospital. Pulmonologist and Professor of … Secure .gov websites use HTTPS DNA test can quickly identify pneumonia in COVID-19 patients, aiding faster treatment: Study. In a small number of children and in some young adults, SARS-CoV-2 infection may be followed by a severe inflammatory condition called multisystem inflammatory syndrome in children (MIS-C).8,9 This syndrome is discussed in detail in Special Considerations in Children. And because some patients with COVID-19 pneumonia have diffuse, relatively homogenous lung lesions, it was assumed that ARDSnet ventilator techniques (and adjunct measures like proning and neuromuscular blockade) was the best starting point. Patients with COVID-19 are considered to have severe illness if they have SpO2 <94% on room air at sea level, a respiratory rate of >30 breaths/min, PaO2/FiO2 <300 mm Hg, or lung infiltrates >50%. The pneumonia that COVID-19 causes tends to take hold in both lungs. COVID-19 affects many organs throughout the body, but universal findings on patients’ autopsies show diffuse lung injury. Continued Treatment. Lastly, it uses other contextual factors to predict which cases will turn out the most severe. There's no treatment for COVID-19. LockA locked padlock Scott Budinger, MD, chief of Pulmonary and Critical Care in the Department of Medicine and a Northwestern … For example, oxygen supplementation is recommended for pregnant patients when SpO2 falls below 95% on room air at sea level to accommodate physiologic changes in oxygen demand during pregnancy and to ensure adequate oxygen delivery to the fetus.5 If laboratory parameters are used for monitoring and for interventions, clinicians should be aware that normal physiologic changes during pregnancy can alter several laboratory values. The challenge now is ensuring these actions are widely known and implemented. Townsend L, Dyer AH, Jones K, et al. Ludvigsson JF. “That’s why COVID-19 has been such a strain on our health care system.”. Controversy over display by wife of @properties CEO reignites after Trump rally. Epub 2020 Apr 14. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). Official websites use .gov The options include: 1. Patients with certain underlying comorbidities are at a higher risk of progressing to severe COVID-19. Anderson BL, Mendez-Figueroa H, Dahlke JD, Raker C, Hillier SL, Cu-Uvin S. Pregnancy-induced changes in immune protection of the genital tract: defining normal. The first step to reverse hypoxemia is through an increase in FiO 2 to which the Type L patient responds well, particularly if not yet breathless. 4.6 Do not offer an antibiotic for treatment or prevention of pneumonia if: COVID‑19 is likely to be the cause and. At this time, there is limited information on the prevalence, duration, underlying causes, and effective management strategies for these lingering signs and symptoms.12 The nomenclature for this phenomenon is evolving, but it has been referred to as “postacute COVID-19 syndrome” or “long COVID,” and affected patients have been referred to as “long haulers.” The incidence, natural history, and etiology of these symptoms are currently unknown. Drug trial to treat newly discovered targets in COVID-19 pneumonia. The first case of coronavirus disease 2019 (COVID-19) was declared in December in Wuhan, before becoming a global pandemic in a few weeks. The normal values for respiratory rate also vary with age in children; thus, hypoxia should be the primary criterion used to define severe illness, especially in younger children. Know about breaking news as it happens. In view of Tradit … A lock ( Abstract Background Coronavirus disease 2019 (Covid-19) pneumonia is often associated with hyperinflammation. 2 For these indications, ivermectin has been widely used and … Health experts warn that some patients may develop post COVID-19 pneumonia or inflammation of the lungs. Brett Chase’s reporting on the environment and public health is made possible by a grant from The Chicago Community Trust. “The second way to combat the disease is to change it from severe to mild.”. The peer-reviewed research was published online Monday in the scientific journal Nature. If … A proposed framework and timeline of the spectrum of disease due to SARS-CoV-2 infection: illness beyond acute infection and public health implications. In pediatric patients, radiographic abnormalities are common and, for the most part, should not be the only criteria used to determine the severity of illness category. “Using this test, we found that patients with COVID-19 were twice as likely to develop secondary pneumonia as other patients in the same intensive care unit.” COVID-19 patients are thought to be at increased risk of infection for several reasons. 1. Laboratory testing includes a complete blood count with differential and a metabolic profile, including liver and renal function tests. DNA test can quickly identify pneumonia in patients with severe COVID-19, aiding faster treatment. These participants had worse performances across multiple domains than would be expected for people with the given age and demographic profiles; this effect was observed even among those who had not been hospitalized.29 However, the study authors did not report when the tests were administered in relation to the diagnosis of COVID-19. 2. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network—United States, March–June 2020. 2020 Jun;46(6):1099-1102. doi: 10.1007/s00134-020-06033-2. Many such deaths could be prevented with reliable access to oxygen paired with pulse oximetry, but many health facilities are not equipped to treat hypoxemia, especially beyond surgical wards. Northwestern University researchers say they’ve potentially discovered a way to more effectively treat COVID-related pneumonia, a life-threatening condition of the virus. COVID-related pneumonia is far harder to treat — here’s how NU researchers hope we can fight it, Casey Urlacher pardoned by President Trump, faced charges in gambling case, A QAnon storefront in Winnetka? 1. Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute COVID-19 in primary care. Currently, there is no case definition for postacute COVID-19 syndrome, and no specific time frame has been established to define late sequelae of COVID-19. She was sentenced to life in prison for her involvement in a Memphis cocaine-trafficking ring. High rates of anxiety and depression have been reported in some patients using self-report scales for psychiatric distress.18,26 Younger patients have been reported to experience more psychiatric symptoms than patients aged >60 years.17,18 Patients may continue to experience headaches, vision changes, hearing loss, loss of taste or smell, impaired mobility, numbness in extremities, tremors, myalgia, memory loss, cognitive impairment, and mood changes for up to 3 months after diagnosis of COVID-19.27,28 One study in the United Kingdom administered cognitive tests to 84,285 participants who had recovered from suspected or confirmed cases of SARS-CoV-2 infection. The scientists studied genetic material in fluid samples taken from patients with severe cases to help understand the virus’ path to pneumonia. “The best way to fight the pandemic is to get a vaccine that works all the time, and the great news is we seem to have several,” Budginger said, referring to vaccines approved for emergency use or in development. 16, 2020 , 5:05 PM. People who have community-acquired pneumonia usually can be treated at home with medication. See Therapeutic Management of Patients With COVID-19 for recommendations regarding SARS-CoV-2–specific therapy. Scott Budinger, MD, chief of Pulmonary and Critical Care in the Department of Medicine and a Northwestern Medicine physician, and co-senior author of the study published the journal Nature. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment. Several recent studies from China suggest that nearly all serious cases of COVID-19 are treated with antibiotics, and anecdotally, many U.S. and European physicians say the … Investigators from the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust have developed a DNA test that rapidly identifies secondary infections in patients with the coronavirus disease 2019 (COVID-19). There was no association between illness severity and fatigue.21 A postacute outpatient service developed in Italy reported that 87% of 143 patients surveyed reported persistent symptoms at a mean of 60 days after symptom onset, with the most common symptom being fatigue (which occurred in 53.1% of these patients).22. By afflicting the lungs, pneumonia (COVID-19-related or otherwise) can result in fatal oxygen deficiency in the blood, or hypoxemia. Psychological distress and its correlates among COVID-19 survivors during early convalescence across age groups. The team hopes with further refinement, … Among the 274 respondents who were symptomatic at the time of testing, 35% reported not having returned to their usual state of health 2 weeks or more after testing; 26% of these patients were aged 18 to 34 years (n = 85), 32% were aged 35 to 49 years (n = 96), and 47% were aged ≥50 years (n = 89).16 An age of ≥50 years and the presence of three or more chronic medical conditions were associated with not returning to usual health within 14 to 21 days. Many such patients recover spontaneously (if slowly) with holistic support, rest, symptomatic treatment, and gradual increase in activity. It is unclear what percentage of individuals who present with asymptomatic infection progress to clinical disease. Inui S, Fujikawa A, Jitsu M, et al. ) or https:// means youâve safely connected to the .gov website. Understand emergency symptoms to watch for, how to protect others if you're ill, how to protect yourself … 4.5 As COVID‑19 pneumonia is caused by a virus, antibiotics are ineffective. It will enable services to make the best use of NHS resources. Craig Cesal said one of the biggest advocates for his release was Alice Johnson, who got a full pardon from Trump last year. For general advice on managing COVID-19 symptoms, see the The U.S. Food and Drug Administration (FDA) has approved one drug remdesivir (Veklury) for the treatment of COVID-19 in certain situations. NICE advises that antibiotics should not be offered as a treatment for, or prevention of pneumonia if: COVID‑19 is likely to be the cause, and; Symptoms are mild. More research and more rigorous observational cohort studies are needed to better understand the pathophysiology and clinical course of these postinfection sequelae and to identify management strategies for patients. Drug trial to treat newly discovered targets in COVID-19 pneumonia. Moreover, one in five individuals aged 18 to 34 years who did not have chronic medical conditions had not achieved baseline health when interviewed at a median of 16 days from the testing date. Case report and systematic review suggest that children may experience similar long-term effects to adults after clinical COVID-19. The purpose of this guideline is to ensure the best antibiotic management of suspected or confirmed bacterial pneumonia in adults in hospital during the COVID‑19 pandemic. 16 10.1007/s00134(2020) Intensive Care Medicine; DOI: -020060332 COVID-19 pneumonia: different respiratory treatment for different phenotypes? COVID-19 pneumonia: different respiratory treatment for different phenotypes? Luis Gonzalez’s first muskie is a lifetime muskie, too, caught while ice fishing. The optimal pulmonary imaging technique has not yet been defined for people with symptomatic SARS-CoV-2 infection. However, the criteria for each category may overlap or vary across clinical guidelines and clinical trials, and a patient’s clinical status may change over time. Post-acute … A study from the United Kingdom reported that among 100 hospitalized patients (32 received care in the ICU and 68 received care in hospital wards only), 72% of the ICU patients and 60% of the ward patients experienced fatigue and breathlessness at 4 to 8 weeks after hospital discharge. Therefore, it is urgent to develop the effective program to prevent and treat for the novel coronavirus pneumonia. Berger JS, Kunichoff D, Adhikari S, et al. Science’s COVID-19 reporting is supported by the Pulitzer Center.. Persistent symptoms have also been reported in pregnant people.19 Systematic data on persistent symptoms in children following recovery from the acute phase of COVID-19 are not currently available.20 MIS-C is discussed in Special Considerations in Children. In general, adults with SARS-CoV-2 infection can be grouped into the following severity of illness categories. In these incidents someone broke into unoccupied businesses and stole property. Tan C, Huang Y, Shi F, et al. See … We use dexamethasone at a dose of 6 mg daily for 10 days or until discharge, whichever is shorter. Neurologic and psychiatric symptoms have also been reported among patients who have recovered from acute COVID-19. Verdoni L, Mazza A, Gervasoni A, et al. For more information, see Care of Critically Ill Patients With COVID-19. COVID-19 pneumonia: different respiratory treatments for different phenotypes? A .gov website belongs to an official government organization in the United States. They do not have shortness of breath, dyspnea on exertion, or abnormal imaging. Budinger said Northwestern researchers will begin working potentially within the next couple of weeks with an unidentified drug maker for an early stage study, the first of three clinical trials usually needed for U.S. Food and Drug Administration approval of any treatment. DNA test can identify pneumonia in Covid-19 patients, aiding treatment: Study . If you get pneumonia as a result of the virus, your doctor may help you breathe by giving you oxygen through a mask or tubes. Then, it focuses on those features that are most important in predicting COVID-19 pneumonia. "To the best of our knowledge, this is the first study that uses holistic information of a patient including both imaging and non-imaging data for outcome prediction," the authors claim. They found that the virus spreads slowly in the lungs, explaining why COVID patients tended to have pneumonia for a much longer period of time — 14 days on average in hospital intensive care units, compared with about four days for pneumonia brought on by flu or other types of illness. Trial registration: The trial was registered under the title "OUTPATIENT TREATMENT OF EARLY PULMONARY COVID19 WITH CORTICOSTEROIDS AS AN OPPORTUNITY TO MODIFY THE COURSE OF THE DISEASE" with EudraCT number 2020-001622-64, registered on 3 April 2020. 4.6 Do not offer an antibiotic for treatment or prevention of pneumonia if: COVID‑19 is likely to be the cause and In fact, the treatment may be critically necessary if a similar virus emerges in the future. The definitions for the severity of illness categories listed above also apply to pregnant patients. Datta SD, Talwar A, Lee JT. Halpin SJ, McIvor C, Whyatt G, et al. Credit NIAID-RML Downloaded from … Lu Y, Li X, Geng D, et al. These comorbidities include being 65 years or older; having cardiovascular disease, chronic lung disease, sickle cell disease, diabetes, cancer, obesity, or chronic kidney disease; being pregnant; being a smoker; and being a recipient of transplant or immunosuppressive therapy.1 Health care providers should monitor such patients closely until clinical recovery is achieved. However, the threshold for certain interventions may be different for pregnant patients and nonpregnant patients. Puntmann VO, Carerj ML, Wieters I, et al. Given that pulmonary disease can progress rapidly in patients with COVID-19, patients with moderate disease should be closely monitored. Drug trial to treat newly discovered targets in COVID-19 pneumonia. People who have community-acquired pneumonia usually can be treated at home with medication. Chinese management guidelines for COVID-19 pneumonia (version 5.0) issued by the National Health Commission of the People’s Republic of China added a new section of severe and critical clinical warning indicators, which aimed to alert clinicians to closely monitor indicators in clinical diagnosis and treatment, such as progressive decrease of peripheral lymphocytes and lactic acid. Introduction. This approach, based on higher throughput DNA … Some asymptomatic individuals have been reported to have objective radiographic findings that are consistent with COVID-19 pneumonia.10,11 The availability of widespread virologic testing for SARS-CoV-2 and the development of reliable serologic assays for antibodies to the virus will help determine the true prevalence of asymptomatic and presymptomatic infection. Authors Luciano Gattinoni 1 , Davide Chiumello 2 , Pietro Caironi 3 4 , Mattia Busana 5 , Federica Romitti 5 , Luca Brazzi 6 , Luigi Camporota 7 Affiliations 1 Department of Anesthesiology, Intensive Care and Emergency … This includes people presenting to hospital with moderate to severe community-acquired pneumonia and people who develop pneumonia while in hospital. Treatment for COVID-19 pneumonia According to the CDC, inpatient care for those with severe cases of COVID-19 typically focuses on managing the complications. “We will undoubtedly see more of these related coronaviruses,” Scott Budinger, chief of pulmonary and critical care medicine at Northwestern’s Feinberg School of Medicine, said in an interview. “Their sickness just persisted for a long, long time,” Budinger said. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. Pregnancy and laboratory studies: a reference table for clinicians. Gattinoni L. et al. As COVID‑19 pneumonia is caused by a virus, antibiotics are ineffective. COVID-19 Pneumonia. Asymptomatic SARS-CoV-2 infection can occur, although the percentage of patients who remain truly asymptomatic throughout the course of infection is variable and incompletely defined. Given that pulmonary disease can progress rapidly in patients with COVID-19, patients with moderate disease should be closely monitored. Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more. 2020. Antibiotic treatment 4.5 As COVID‑19 pneumonia is caused by a virus, antibiotics are ineffective. Zhang R, Ouyang H, Fu L, et al. Antibiotic treatment for COVID-19 complications could fuel resistant bacteria. symptoms are mild. Inappropriate antibiotic use may reduce availability if used indiscriminately, and broad-spectrum antibiotics in particular may lead to Clostridioides difficile infection and antimicrobial … A Triangle drugmaker working to develop its drug as a treatment for patients with severe Covid-19 has reported positive top-line data from a Phase 2 trial. In the U.S., there have been nearly 375,000 deaths and more than 22 million cases of infection reported. If bacterial pneumonia or sepsis is suspected, administer empiric antibiotic treatment, re-evaluate the patient daily, and de-escalate or stop antibiotics if there is no evidence of bacterial infection. Mazza MG, De Lorenzo R, Conte C, et al. The recommendations from the COVID-19 Treatment Guidelines Panel (the Panel) are based on the results of these studies. Pneumonia is an infection of the air sacs in the lungs, typically caused by a bug, bacteria, or influenza and now, SARS-CoV-2. This is the first study in which scientists analyzed immune cells from the lungs of COVID-19 pneumonia patients in a systematic manner and compared them to cells from patients with pneumonia from other viruses or bacteria. Critically ill patients may have acute respiratory distress syndrome, septic shock that may represent virus-induced distributive shock, cardiac dysfunction, elevation in levels of multiple inflammatory cytokines that provoke a cytokine storm, and/or exacerbation of underlying comorbidities. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. It’s unlikely that a treatment will be developed before mass vaccinations should essentially bring the pandemic under control, but doctors expect people will continue to get sick. These therapies must be given intravenously (by IV) soon after developing … The novel coronavirus pneumonia broke out in 2019 and spread rapidly. See Remdesivir: Selected Clinical Data for more information. Chest CT findings in cases from the cruise ship Diamond Princess with coronavirus disease 2019 (COVID-19). The prevalence of fatigue among 128 individuals from Ireland who had recovered from the acute phase of COVID-19 was examined using the Chalder Fatigue Scale (CFQ-11). Cognitive deficits in people who have recovered from COVID-19 relative to controls: an N = 84,285 online study. In terms of treatment, even though COVID-19 is a virus, people who develop severe pneumonia are likely to be given antibiotics, just in case of a … Looking for U.S. government information and services. If bacterial pneumonia or sepsis is suspected, administer empiric antibiotic treatment, re-evaluate the patient daily, and de-escalate or stop antibiotics if there is no evidence of bacterial infection. The proposed treatment is consistent with what observed in COVID-19, even though the overwhelming number of patients seen in this pandemic may limit its wide applicability. The authors suggested that posthospital rehabilitation may be necessary for some of these patients.17 A retrospective study from China found that pulmonary function (as measured by spirometry) was still impaired 1 month after hospital discharge in 31 of 57 patients (54.4%).23 In a study from Germany that included 100 patients who had recently recovered from COVID-19, cardiac magnetic resonance imaging (MRI) performed a median of 71 days after diagnosis revealed cardiac involvement in 78% of patients and ongoing myocardial inflammation in 60% of patients.24 A retrospective study from China of 26 patients who had recovered from COVID-19 and who had initially presented with cardiac symptoms found abnormalities on cardiac MRI in 15 patients (58%).25 One should review these data and assess the prevalence of cardiac abnormalities in people with postacute COVID-19 syndrome with caution, however, as the results were likely biased by only including patients with cardiac symptoms. Indications for specialist assessment include clinical concern along with respiratory, cardiac, or neurological symptoms that are new, persistent, or progressive . In addition to pulmonary disease, patients with critical illness may also experience cardiac, hepatic, renal, central nervous system, or thrombotic disease. Since February 2020, the epidemic of COVID-19 has severely affected Lombardy, a region in Northern Italy, where hospitals were faced with the need for quick reorganisation and increased demand for critical care.1 This emergency posed urgent questions for … More information about ongoing studies can be found at ClinicalTrials.gov. Northwestern University researchers say they’ve potentially discovered a way to more effectively treat COVID-related pneumonia, a life-threatening condition of the virus. Recruitment began 19 April, 2020 and is anticipated to be complete by April 2021. We have withdrawn our guideline on diagnosing and managing pneumonia in adults until further notice. Oxygen therapy should be administered immediately using a nasal cannula or a high-flow oxygen device. Given this conceptual model, it follows that the respiratory treatment offered to Type L and Type H patients must be different. Persistent symptoms in patients after acute COVID-19. Antibiotic treatment. By Sara Reardon Apr. ‘Muskie fishing is forever ruined for me’: A first muskie of 52 inches caught ice fishing will do that. Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more.Specific treatments depend on the type and severity of your pneumonia, your age and your overall health. Such a strain on our health care system. ” to illness severity rarely been described,!, China and spread rapidly universal findings on patients ’ autopsies show diffuse lung injury 1300... 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