COVID-19

COVID-19 is the abbreviated name for coronavirus disease 2019, a respiratory disease caused by a novel coronavirus strain called SARS-CoV-2. COVID-19 was first detected in Wuhan City, China and the outbreak was declared a public health emergency of international concern on January 30, 2020 by the World Health Organization (WHO). On March 11, the WHO stated that the COVID-19 outbreak is characterized as a pandemic, meaning worldwide spread. Nonpharmaceutical interventions (NPIs) such as social distancing, quarantine, and school and workplace closure were put in place to slow the spread of the virus.

The SARS-CoV-2 virus, previously called 2019-nCoV, was described by researchers at the CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences by Peng Zhou and colleagues, led by Zheng-Li Shi. Notable variants of SARS-CoV-2 that have emerged include B.1.1.7 (UK variant), B.1.351 (South Africa variant) and P.1 (Brazil variant). These variants spread more quickly and all contain the mutation N501Y at a position where the virus interacts with receptor on the surface of lung cells to gain access.

Treatments in development for COVID-19 focus on three primary areas: symptoms, anti-inflammation, and anti-viral growth. Certain treatments (below) have been granted FDA emergency use authorization (EUA) for the treatment of COVID-19. EUA authorizations may allow unapproved medical products or the use of approved medical products for unapproved uses in an emergency to diagnose, treat, or prevent serious or life-threatening conditions or diseases. Potential drug and vaccine targets include proteins, enzymes, and processes that allow virus entry into cells or virus replication and immune system regulatory pathways.

Anti-inflammatory drugs used to treat COVID-19 in hospitalized patients include dexamethasone and other corticosteroids. Anticoagulation such as low-dose heparin and enoxaparin may also be given to hospitalized COVID-19 patients.

Antibiotics CANNOT prevent or treat COVID-19

Antibiotics work only against bacteria, not viruses. COVID-19 is caused by a virus, and therefore antibiotics should not be used for prevention or treatment. Some people who become ill with COVID-19 can also develop a bacterial infection as a complication. In this case, antibiotics may be recommended by a health care provider.

The SARS-CoV-2 virus gains entry into human cells through the spike (S) protein, also called S-glycoprotein, which binds to the ACE2 receptor of human cells. Spike proteins cover coronaviruses, the virus group which includes SARS-CoV-2, MERS, and SARS viruses, giving them their crown or corona appearance. Both the S-protein (S-glycoprotein) and the ACE2 receptor have protein modification called N-linked glycosylation that is important for the ability of the virus to gain entry and also plays a role in the virus evading immune detection.

Drugs that calm or modulate the immune system could potentially prevent complications such as acute respiratory disease syndrome and acute lung injury that occur when the immune system overreacts to an infection. Anticytokine therapies target the overproduction of proinflammatory cytokines, referred to as a cytokine storm, that can lead to severe complications such as vascular hyperpermeability and multiorgan failure. An adequate inflammatory response must be maintained for the body to clear the pathogen.

The following COVID-19 treatments are experimental or in development unless otherwise specified. Treatments may have emergency use authorization from the FDA while still in an experimental stage. Some drugs designed and approved to treat other diseases are being tested for COVID-19.

Remdesivir

Remdesivir received US FDA approval on October 22, 2020 for treatment of COVID-19. Remdesivir, a Nuc inhibitor drug that inhibits viral replication, was granted emergency use authorization by the FDA on May 1, 2020. Gilead announced the submission of their New Drug Application (NDA) for remdesivir to treat COVID-19 under the product name Veklury in August 2020. An expansion of the EUA issued on August 28, 2020 allowed Veklury to be provided to hospitalized patients irrespective of disease severity. Randomized clinical trials for remdesivir in treatment of hospitalized COVID-19 patients showed a decrease in recovery time compared with placebo.

Chloroquine

EUA for chloroquine phosphate and hydroxychloroquine sulfate was revoked on June 15, 2020 based on review of further scientific evidence.Hydroxychloroquine sulfate and chloroquine phosphate products were granted EUA authorization by the FDA on March 28, 2020. Chloroquine is a quinoline derivative and a drug in widespread use since 1945 for the treatment of malaria, autoimmune diseases, and other medical conditions. Chloroquine is being investigated to treat COVID-19 in the form of chloroquine phosphate or hydroxychloroquine sulfate which are sometimes referred to as chloroquine and hydroxychloroquine respectively.

COVID-19 convalescent plasma

Convalescent plasma to treat COVID-19 was issued EUA on August 23, 2020. At this time convalescent plasma had been used to treat 60,000 COVID-19 patients. Randomized clinical trials for COVID-19 convalescent plasma are ongoing. Convalescent plasma is donated from individuals that have recovered from COVID-19 and contains antibodies against COVID-19.

Baricitinib in combination with remdesivir

The FDA issued an EUA on November 19, 2020 for the combination treatment of baricitinib together with the FDA approved drug remdesivir for treatment of suspected or laboratory confirmed COVID-19 in hospitalized adults and pediatric patients two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorpeal membrane oxygenation (ECMO).

Monoclonal antibodies

Monoclonal antibodies manufactured to target the SARS-CoV-2 spike protein and inhibit the attachment of virus and entry into human cells have received EUA under conditions when patients are not hospitalized or receiving oxygen therapy. The following are approved under EUA as single or combination monoclonal antibodies for treatment of COVID-19 by intravenous delivery: Bamlanivimab (Eli Lilly), casirivimab and imdevimab (Regeneron) and bamlanivimab and etesevimab (Eli Lilly). In clinical trials, bamlanivimab alone or the casirivimab and imdevimab combination were found to reduce the risk of hospitalization. Bamlanivimab/etesevimab was found to reduce risk of hospitalization or death.

The following COVID-19 vaccines have received government regulatory approval in different parts of the world (as of March 2021).

• Comirnaty (BNT162b2) – mRNA-based vaccine developed by Pfizer, BioNTech and Fosun Pharma

• Moderna COVID-19 Vaccine (mRNA-1273) – mRNA-based vaccine developed by Moderna, BARDA and NIAID

• COVID-19 Vaccine AstraZeneca (AZD1222, Covishield) – Adenovirus vaccine developed by BARDA and Operation Warp Speed (OWS)

• Sputnik V (Gam-COVID-Vac) – Recombinant adenovirus vaccine (rAd26 and rAd5) developed by the Gamaleya Research Institute, Acellena Contract Drug Research and Development

• COVID-19 Vaccine Janssen (JNJ-78436735; Ad26.COV2.S) – Non-replicating viral vector developed by Janssen Vaccines (Johnson & Johnson)

• CoronaVac – Inactivated vaccine (formalin with alum adjuvant) developed by Sinovac

• BBIBP-CorV – Inactivated vaccine developed by the Beijing Institute of Biological Products; China National Pharmaceutical Group (Sinopharm)

• EpiVacCorona – Peptide vaccine developed by the Federal Budgetary Research Institution State Research Center of Virology and Biotechnology

• Convidicea (Ad5-nCoV) – Recombinant vaccine (adenovirus type 5 vector) developed by CanSino Biologics

• Covaxin – Inactivated vaccine developed by Bharat Biotech and Indian Council of Medical Research (ICMR)

• Unnamed inactivated vaccine developed by the Wuhan Institute of Biological Products and China National Pharmaceutical Group (Sinopharm)

• CoviVac – Inactivated vaccine developed by Chumakov Federal Scientific Center for Research and Development of Immune and Biological Products

• ZF2001 – Recombinant vaccine developed by Anhui Zhifei Longcom Biopharmaceutical and the Institute of Microbiology of the Chinese Academy of Sciences

The FDA issued a guidance document for Emergency Use Authorization for COVID-19 vaccines in October 2020, which states that before seeking emergency approval, vaccine makers should follow trial participants for at least two months to rule out major side effects. CDC director Robert Redfield, vaccine developers, and the FDA stated that a COVID-19 vaccine is unlikely to be widely available until the middle of 2021.

The following groups have COVID-19 vaccines in Phase 3 clinical trials (updated October 2020)

• Beijing Institute of Biological Products/Sinopharm

• University of Oxford/AstraZeneca for ChAdOx1 nCoV-19, adenovirus containing spike protein
• Sinovac for CoronaVac, whole inactivated SARS-CoV-2
• Sinopharm, whole inactivated SARS-CoV-2
• Gamaleya Research Institute
• Wuhan Institute of Biological Products/Sinopharm
• BioNTech/Fosun Pharma/Pfizer for BNT162b2
• Moderna/NIAID for mRNA-1273
• CureVac
• Janssen Pharmaceutical Companies of Johnson & Johnson/NIAID/BARDA for JNJ-78436735
• Novavax for NVX-CoV2373, bioengineered spike protein
• CanSino Biologics/Beijing Institute of Biotechnology/Petrovax for Ad5-nCoV

Bacillus Calmette-Guérin (BCG) vaccination (typically given at birth and/or during childhood) was intended to target tuberculosis caused by the bacteria Mycobacterium tuberculosis and has been reported to also protect against various other infectious diseases. BCG vaccine is under investigation for benefits against SARS-CoV-2. The WHO stated that there is no evidence that BCG protects people from coronavirus infection.

Operation Warp Speed (OWS) is a partnership between the US Department of Health and Human Services, which includes the CDC, FDA and NIH, and the Biomedical Advanced Research and Development Authority (BARDA) and the Department of Defense (DoD). The goal of OWS is to produce and deliver 300 million doses of safe and effective vaccines. Initial doses aim to be available by January 2021 and OWS has a broader strategy to accelerate development, manufacturing, and distribution of COVID-19 countermeasures.

OWS funded Janssen, Moderna, AstraZeneca, Novavax, Pfizer, Sanofi and GlaxoSmithKline, supporting COVID-19 vaccine development and large-scale manufacturing. OWS funded Regeneron, supporting their COVID-19 anti-viral antibody treatment. Task orders with Emergent BioSolutions,Texas A&M University, and FUJIFILM are aimed to advance US manufacturing capabilities. Grand River Aseptic Manufacturing (GRAM) in Michigan, USA received a contract with OWS for fill and finish manufacturing of critical vaccines and therapeutics.

Exothera is a contract development and manufacturing organization (CDMO), launched by Univercells in March 2020, which plans to work on vaccines for COVID-19 through supporting vaccine innovators and providing manufacturing services.

In Canada, vaccine production may take place at the Human Health Therapeutics Research Centre in Montreal. The Canadian government has signed deals with Moderna, Pfizer/BioNTech, Novavax, and Janssen to reserve millions of doses of COVID-19 vaccine.

Microneedle vaccine patch

Vaxess Technologies is developing a COVID-19 vaccine that can be delivered with their drug patch delivery system (MIMIX) allowing self-administration of vaccines or therapeutics without the need for refrigerated storage or syringes. The system uses silk protein fibroin to stabilize and allow the vaccine to be stored and transported at room temperature. The vaccine and MIMIX system combination is a skin patch that can be administered at home. Silk-based tips are embedded into the skin. Over a period of weeks the fibroin protein controls the rate that the vaccine is released and diffuses into the body.

Vernardi, a biotech startup, has VaxiPatch technology under development in a partnership with BARDA. VaxiPatch was invented by Daniel R. Henderson, CEO of Vernardi and will undergo preclinical testing at University of California, Davis.

BARDA also funded research at University of Connecticut under Assistant Professor Thanh Duc Nguyen and Associate Professor Steve Szczepanek to develop their vaccine microneedle patch for COVID-19.

Oral delivery

Esperovax is partnered with BARDA for development of their oral cellular delivery technology called Egress RDTM mRMA which can allow for lower cost, self-administration of vaccines.

COVID-19 diagnostic testing is performed with sputum, nose, and throat swabs. In early March 2020, governments restricted COVID-19 testing to central health agencies or a few accredited laboratories for a real-time reverse-transcription PCR (RT-PCR)-based protocol selected by the WHO. Reverse transcription means a reverse transcriptase enzyme is used to convert RNA template to cDNA before PCR amplification, which produces a large number of copies of the cDNA. Real-time PCR is sometimes called quantitative PCR (qPCR or qRT-PCR). Tests that use PCR are also referred to as nucleic acid amplification tests (NAAT) as they amplify deoxyribonucleic acid (DNA). The COVID-19 real-time RT-PCR test detects the presence of the E gene of SARS-CoV-2, coding for the envelope surrounding the viral shell and the gene for the enzyme RNA-dependent RNA polymerase. Once samples are received in a laboratory, it takes 24-48 hours for results. The tests were confirmed to be accurate with whole genome sequencing. The US Centers for Disease Control and Prevention (CDC) has an RT-PCR assay that includes primers for the nucleocapsid phosphoprotein in the virus shell and for the RNA-dependent RNA polymerase gene. In the UK, COVID-19 testing is done by accredited laboratories. In the US COVID-19 testing was initially done exclusively by the CDC which later began sending out RT-PCR test kits to state health laboratories. Some clinical tests on sale in the US were made available under CLIA waivers, which regulate the facility where the tests are conducted, rather than the tests themselves. The FDA announced on February 29 that CLIA-certified labs do not need to obtain emergency use authorization (EUA).

The FDA issued a policy on March 16, 2020 to accelerate the availability of COVID-19 diagnostic tests, which includes the following: each state takes responsibility for tests developed and used by their laboratories and labs developing tests engage directly with state authorities; the FDA does not intend to object to the distribution of tests after validation and during preparation of an EUA request; recommendations are provided for developers of serological tests which identify antibodies or proteins in the blood in response to infection.

Many diagnostic or screening methods are in development and still need verification. The aim is to develop diagnostic tests that could be deployed more widely in hospitals and clinics, and with quicker turn-around times. The purpose of diagnostics and screening is not only for patient isolation but also for overall monitoring of the spread of COVID-19. The Foundation for Innovative New Diagnostics (FIND) is a global non-profit organization concerned with the development and delivery of diagnostics for diseases that affect poor populations. FIND is collaborating with the WHO and a third-party referral laboratory to conduct an independent evaluation of SARS-CoV-2 diagnostic tests in order to verify manufacturers' claims and establish diagnostic accuracy. Results will be shared with the global health community.

As of April 2020, the majority of COVID-19 nucleic acid tests use real-time RT-PCR that targets ORF1b, ORF8, nucleocapsid (N), spike (S) protein, RNA-dependent RNA polymerase (RdRP) or envelope (E) genes of SARS-CoV-2. Samples tested are usually swabs from the upper respiratory system but it is possible to use serum, stool, ocular secretions, or saliva. There are nucleic acid amplification tests that use CRISPR and isothermal amplification.

Multiple variants of SARS-CoV-2 have been documented globally throughout the pandemic. On November 30, 2021, the US government SARS-CoV-2 Interagency Group (SIG) classified Omicron as a Variant of Concern (VOC). This classification was based on the following:

• Detection of cases attributed to Omicron in different countries, including among people without travel history.

• Transmission and replacement of the Delta variant in South Africa.

• The number and locations of substitutions in the spike protein.

• Data available for other variants with lower substitutions in the spike protein that portray a reduction in neutralization by sera from vaccinated or convalescent individuals.

• Data available for other variants with lower substitutions in the spike protein that show minimized susceptibility to specific monoclonal antibody treatments.

This variant was first Identified in India. The attributes include increased transmissibility, almost all lineages designated as Delta are susceptible to Emergency Use Authorization (EUA) monoclonal antibody treatments and reduction in neutralization by post-vaccination sera.

This variant was first identified in South Africa. The attributes include potential increased transmissibility, potential reduction in neutralization by some EUA monoclonal antibody treatments, and potential reduction in neutralization by post-vaccination sera.

Besides detecting viral RNA, other diagnostic tests detect viral protein or antibodies produced by a person infected with SARS-CoV-2, using antibody-based methods or serological tests such as ELISA and lateral flow immunoassay. Rapid antigen tests are point-of-care tests where antibodies are used as probes to detect viral protein. Antibodies produced by a person exposed to the virus are detected in blood samples using serological tests, also called antibody tests. Antibodies are still found in patients after they recover from the illness.

The US FDA issued an EUA for the serology point-of-care (POC) test, Assure COVID-19 IgG/IgM Rapid Test Device, in July 2020 for certain laboratories and reissued the EUA in September 2020 for use with fingerstick blood samples in POC settings like a doctor’s office or urgent care centers, without the need for sending samples to a central lab. The WHO supports the use of tests for SARS-CoV-2 antibodies at a population level or in specific groups to help understand the risk associated with infection and gather data about the percentage of people with detectable COVID-19 antibodies. It is not known if people with SARS-CoV-2 antibodies are immune to secondary infections. Antibody tests can check if a person has previously been infected with SARS-CoV-2 but are not recommended to diagnose current infection because it may take 1-3 weeks for the body to produce detectible antibodies.

In real time PCR, cycle threshold (Ct) is the number of cycles for the fluorescent signal to exceed background level. Ct levels are inversely proportional to the amount of target nucleic acid, which is the amount of SARS-CoV-2 virus present—also known as viral load. Higher viral load and lower Ct has been correlated with disease severity, lung lesions with margins not easily differentiated, and changes in follow-up CT (computed tomography) in patients with COVID-19 pneumonia. Patients with severe COVID-19 have been reported to have a higher viral load and longer virus-shedding period compared with mild disease.Another research study from China showed no correlation between viral load and disease severity. Viral loads in nasal swabs between symptomatic and asymptomatic individuals were not significantly different in an Italian study. In addition to real-time RT-PCR, digital PCR (digital RT-PCR) has been applied to studies on viral load to study disease progression.

For more information on diagnostics and screening, see COVID-19 testing.

Integrated DNA Technologies (IDT) is manufacturing virus detection panels and positive and negative controls for COVID-19 treatment and vaccine development.

Sequencing the genetic code of SARS-CoV-2 from different patient samples is used to understand how the virus changes over time. For example, how it moved from a disease affecting animals to a human disease and how it became infectious in humans. Besides SARS-CoV-2, sequencing of related viral genomes from different contexts such as wild animal populations would be part of this line of research. Such research can prevent future outbreaks. By understanding the conditions that enabled SARS-CoV-2 to appear, a future virus may be prevented from following similar path.

• Arbor Biosciences offering free kits for sequencing virus samples
• GenapSys provides affordable next-generation sequencing machines
• Illumina and IDbyDNA collaborated to provide next-generation sequencing workflows focused in microbiology and infectious disease
• NVIDIA offers NVIDIA Parabricks Genomics Analysis Toolkit which provides GPU-accelerated genomic analysis
• MGI Tech Co., Ltd. provides DNBSEQ-T7, a sequencing platform that can generate 1-6Tb of high quality data per day

Folding@home launched a program in March 2020 to assist researchers around the world who are working on finding a cure and learning more about the COVID-19 outbreak. The initial wave of projects have been used to simulate potentially druggable protein targets from the SARS-CoV-2 virus, and the related SARS-CoV virus, of which there is much more data available.

Other distributed computing projects include:

• Rosetta@Home
• Neocortix Cloud Services provides ARM support to Coronavirus distributed computing applications
• BOINC
• SETI@home

• Adaptive Biotechnologies

Herd immunity threshold estimates of around 10-20% were calculated when variation in individual susceptibility or exposure were taken into account for their mathematical modelling. Individual variation means that the presence of individuals that are more susceptible or more exposed are infected and removed from the susceptible subpopulation earlier and intensifies the deceleration in incidence. If the population were homogeneous or were vaccinated randomly, HIT would be estimated to be around 65-80%.

• C-reactive protein (CRP)
• Patients with severe COVID-19 show lymphopenia (lymphocytopenia) with drastically reduced numbers of CD4+ T cells, CD8+ T cells, B cells and natural killer (NK) cells.
• Gatehouse Bio

• Allen Institute for Artifical Intelligence (AI2) distributing the COVID-19 Open Research Dataset (CORD-19) to encourage application of natural language processing

Southwest Research Institute (SwRI) has virtual screening software which it used to evaluate two million drug compounds against SARS-CoV-2. SwRI is partnering with Texas Biomedical Research Institute and their Rhodium software can scan 250,000 drug compounds using machine learning techniques.

Oak Ridge National Laboratory (ORNL) used its supercomputer to identify 77 small-molecule compounds as potential SARS-CoV-2 drugs which are likely to bind the novel coronavirus main spike protein which could prevent it from infecting cells.

Insilico Medicine is using an AI-based drug discovery pipeline to identify drug molecules that could target 3C-like protease. 3C-like protease is a SARS-CoV-2 protein that is a target for potential drugs because it has a central role in the viral replication cycle. A portion will be tested by Insilico Medicine and the remainder of the potentially useful structures will be published on the company website and available to the public (https://insilico.com/ncov-sprint/).

According to available evidence, the SARS-CoV-2 virus is transmitted between people through close contact and droplets produced by sneezing and coughing. The SARS-CoV-2 virus was initially reported to not be transmitted by airborne transmission, but hundreds of scientists urged organizations such as the WHO to address airborne transmission in an open letter outlining emerging evidence, culminating in a National Academies workshop on airborne transmission of COVID-19. Preventative measures include the following: hand sanitizing with alcohol-based sanitizers or soap and water; avoiding touching eyes, nose and mouth; coughing or sneezing into elbow or tissue; wearing a medical mask if you have symptoms and hand hygiene after disposing of a mask; and maintaining a social distance of 1 m from individuals with respiratory symptoms. In indoor environments, ventilation, filtration, and air disinfection have been suggested to decrease potential airborne transmission. See COVID-19 transmission dynamics and COVID-19 protocols for more information on disease transmission and mitigation strategies respectively, which include nonpharmaceutical interventions (NPIs) .

Masks can be used as personal protective equipment (PPE) to keep the wearer of the mask from breathing in SARS-CoV-2 virus. Masks are also used as a respiratory source control where the aim is the protect others from exposure to exhaled viral particles. Standards, protocols, and methods for testing masks are found on the Mask Testing Protocols page.

Health care setting

The WHO has guidelines that recommend health care workers cover their mouth and nose with surgical masks, and the CDC put out instructions for health care workers to wear N95 masks (N95 respirators). N95 masks are thicker and fit more snugly around the mouth and nose, blocking smaller particles than surgical masks. Both types of masks help prevent the spread of droplets from a cough or sneeze from reaching the mask-wearer’s mouth or nose. During the SARS coronavirus outbreak, a study found that any type of mask or respirator reduces the risk of infections in health care workers by 85 percent. The CDC recommends that health care workers wear a respirator, also called an N95 mask, when around potential COVID-19 patients, which filters out more particles than a surgical mask. The CDC has a list of N95 masks approved by the National Institute for Occupations Safety and Health (NIOSH).

Infected patients who wear surgical masks are less likely to spread infection to others. The CDC instructed hospitals to request that patients wear a surgical mask if they have a fever or respiratory illness, have recently traveled to Wuhan, or have come in contact with someone who traveled there.

Masks for the general public

The purchasing of protective face masks by the public is feared to cause a shortage for health care workers during the COVID-19 pandemic. In addition to healthcare workers, a shortage of protective masks threatened to slow scientific research on treatments and vaccines to SARS-CoV-2 since personnel need to be protected from the pathogens in the lab. For healthy asymptomatic individuals who are not healthcare workers or caring for patients at home, face masks were not initially recommended by the WHO. The WHO stated on February 27, 2020, “The capacity to expand PPE production is limited, and the current demand for respirators and masks cannot be met, especially if the widespread, inappropriate use of PPE continues," referring to surges in global demand driven by misinformation, panic buying, and stockpiling. The WHO changed their stance in June 2020 to state that those over sixty or with medical conditions should wear a medical-grade mask when in public when physical distancing is not possible and that the general public should wear three-layer fabric masks in those situations. The WHO advised governments to encourage mask wearing on public transport, in shops, or other confined areas.

The CDC initially recommended that the general public not wear face masks unless they were sick or caring for a person who is sick. However, on April 3, 2020, the CDC recommended that the general public voluntarily wear a facial covering when out in a public space where social distancing guidelines are difficult to maintain. The CDC published guides for how to make a variety of face masks using common materials. 2013 Research on influenza transmission suggests that homemade facial coverings and masks made from household items like 100% cotton t-shirts, scarves, and tea towels can block some aerosolized bacteria and viruses, but they are not as effective as commercially available surgical masks. The paper states that "an improvised mask should be viewed as the last possible alternative if a supply of commercial face masks is not available, irrespective of the disease against which it may be required for protection."

Various countries or regions of countries mandated masks to be worn in public spaces to slow the spread of COVID-19. In the United States a nation-wide, federal-level mask order is not possible due to the sovereignty of US. Accordingly, US states specify their own local policies and regulations around wearing masks. Some states require that masks be worn in certain public settings (such as inside businesses) while others have enacted no such requirements.

For more information, see Surgical mask.

For medical staff, in addition to masks, personal protective equipment (PPE) includes faceshields, gowns, bouffant caps, and gloves. For more information go to Personal protective equipment.

Hand washing is recommended over the use of hand sanitizer, but alcohol-based hand sanitizers provide some benefit against the spread of SARS-CoV-2 and are recommended for use when hand washing is not available. Both hand washing and alcohol-based hand sanitizers target viral envelopes. The increased purchasing of hand sanitizer during the COVID-19 pandemic has led to a shortage of alcohol-based hand sanitizer. Numerous distilleries in Canada and the US have begun manufacturing hand sanitizer.

An analysis of twenty two studies concluded that human coronaviruses such as SARS, MERS, and endemic human coronaviruses (HCoV) can persist on surfaces like metal, glass or plastic for up to nine days. The study found that the viruses can be inactivated within one minute by surface disinfection procedures with 64-71% ethanol, 0.5% hydrogen peroxice, or 0.1% sodium hypchlorite. Biocidal agents such as 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate were found to be less effective.

The botanical oil Citriodiol and other compounds that contain p-menthane-3,8-diol (PMD) show antiviral properties against SARS-CoV-2.

VHP is commonly used to decontaminate rooms, and it has been shown to be effective in sterilizing N95 masks without degradation in performance. The systems usually use about 1000ppm VHP, so some amount of evaporation is needed to allow the levels to drop below the NIOSH recommended level of 1ppm.

Chai Bio will release a test that can be used with swabbing of areas like door handles and hard surfaces in the environment for SARS-CoV-2 testing. The test is intended for detection of the novel coronavirus in schools, senior centers, first responders, hackerspaces and community labs, public health departments, and in individuals. The BeagleBoard.org Foundation is working with Chai to make machines and test kits available in communities and makerspaces through board donations and has interest in promoting the technology around the world.

Droplet digital PCR (ddPCR) was used to test for SARS-CoV-2 viral RNA in aeorsols collected on gelatin filters in patient and medical staff areas at Renmin Hospital of Wuhan University, Wuchang Fangcang Field Hospital, and public areas in Wuhan.

UV sanitizers use ultraviolet C (UVC) light, which kills bacteria and viruses.

CleanSlate UV is a Toronto-based company that produces devices that sanitize items with UV light. Their UV light devices are used in hospitals to for staff to sanitize stethoscopes, badges, and phones.

PhoneSoap is a Utah-based company that produces UV devices for cleaning and charging items such as phones, smart watches, keys, and tablets.

Xenex Disinfection Services is a company that provides ultraviolet disinfectant robots. Their technologies kill bacteria, viruses, and other microorganisms in hospital rooms, emergency departments, and ambulances. They have provided robot systems to Japan, Thailand, Singapore, South Korea, Italy, and Houston.

Conventional UVC light sources are a hazard to humans due to being carcinogenic and cataractognic. Far-UVC light generated by filtered excimer lamps emitting in the range of 207-222 nm wavelength inactivates bacteria and viruses without harming exposed mammalian skin. Far-UVC has strong absorbance in biological materials and cannot penetrate the outer layer of human skin, nor the outer tear layer on the outer surface of the eye. Far-UVC can traverse and inactivate bacteria and viruses because they are typically at dimensions of microns or smaller. UVC was shown to inactivate airborne aerosolized H1N1 influenza viruses by researchers at Columbia University in 2018. The authors propose the use of very low dose-rate far-UVC overhead light in indoor public locations as a tool to reduce the spreading of airborne-mediated microbial diseases.

UVD Robots developed by the Denmark-based company UVD Robots ApS are UV disinfecting robots that have been deployed in hospitals in China to help reduce the spread of the novel coronavirus. UV-C light is emitted to kill viruses and bacteria.

XAG is an agricultural technology company with agricultural robots and drones that have been adapted for testing scenarios to spray disinfectant to reduce the spread of COVID-19 and have been deployed in Guangzhou. High concentrated disinfectants can be sprayed from drone nozzles or robot jet sprayers and diluted with moisture in the air and potential targets include hospitals and schools.

Sonovia is a textile company that is developing an anti-pathogen fabric that was sent to labs in China to be tested for use as a preventative measure against spread of COVID-19.

There are a number of antimicrobial coatings that are effective against certain viruses but have not yet been tested against SARS-CoV-2.

Multilevel Antimicrobial Polymer (MAP-1) developed at Hong Kong University of Science and Technology (HKUST) with Chiaphua Industries kills viruses, bacteria and spores. MAP-1 can be made into hand sanitizers, paints, coatings, and incorporated into air and water filters, clothing, and surgical masks.

BioCote—an antimicrobial coating company.

NanoSeptic self-cleaning surfaces

GAC and Geely Automobile Holdings are upgrading their in-vehicle air filtration systems to match effectiveness of an N95 mask to protect passengers form viral outbreaks.

Aurabeat Sanitizing Air Purifier is certified to eliminate >99.9% of airborne COVID-19, has been certified by the US-based not-for-profit research organization MRIGlobal, and is cleared by the FDA.

For information about fraudulent COVID-19 products, see Food and Drug Administration.

Equipment used for airway management includes endotracheal tubes, introducers, and stylets.

For more information, see Medical ventilator.

For more information, see Oxygen concentrator.

For more information, see Respiratory care.

Critical COVID-19 cases may also show multiorgan and systemic manifestations such as sepsis, septic shock, and multiple organ dysfunction (MOD). In addition to respiratory support, extracorporeal membrane oxygenation (ECMO) may be necessary. ECMO is a machine similar to a heart-lung by-pass machine used in open-heart surgery. The device pumps and oxygenates the patient’s blood outside the body so the heart and lungs can rest.

BlueDot is an AI company that tracks, contextualizes, and anticipates infectious disease risks. BlueDot’s system identified an article in Chinese on Dec. 31, 2019 about “pneumonia of unknown cause” and issued an alert to its clients almost one week before the U.S. Centers for Disease Control and Prevention and the World Health Organization issued their public alerts. BlueDot’s analysis of the likely destinations for spread of 2019-nCoV (SARS-CoV-2) in the Journal of Travel Medicine.

A GitHub repository and web-based dashboard to visualize and track SARS-CoV-2 reported cases has been made available by the Center for Systems Science and Engineering at Johns Hopkins University. The primary source for the dashboard is DXY, an online resource run by members of the medical community in China.

HealthMap has released an interface for SARS-CoV-2.

Zoe, a health science company headquartered in London, originally started as a nutrition science company and has now launched a COVID-19 symptom tracker and online dashboard for the United Kingdom. The company says it has gathered data from over 1 million volunteer contributors.

Metabiota is an epidemic tracker for providing risk analysis for the impact of epidemics on animal and human health.

A shared electronic list of SARS-CoV-2 cases is available through crowdsourcing and automated information retrieval.

American Enterprise Institute offers live tracking and updates of state level strategies for 2019-nCov through their @COVID2019action Twitter, and they offer news and analysis on the measures that states and individuals can or are taking to combat infection and spread.

The COVID Tracking Project is a nonprofit online organization focused on tracking and collection data on SARS-CoV-2 and any testing and results of testing in the United States and related territories. They offer raw data spreedsheets and an API through their site.

GISAID is a nonprofit organization dedicated to the collection of influenza-related data and genome sequencing who are working to study and track the sequencing of SARS-CoV-2 and related clinical and epidemiological data.

Nextstrain is working to collect and incorporate all available data on SARS-CoV-2 genomes and provide analysis and situation reports. They are also building a database on the genomic epidemiology of SARS-CoV-2 with data provided from GISAID.

Worldometer offers a live tracker for SARS-CoV-2-related data, including case reports, death rates, countries, incubation, age, symptoms, and news.

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• LitCovid
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Drive-through clinics in Goyang, South Korea allow people to stay in their cars as samples are taken from their noses and throats from staff in protective clothing. Samples are tested on site and the user receives a phone call or text message of their result and placed in isolation. The UK is also opening COVID-19 drive-throughs.

Verily, a subsidiary of Alphabet, the parent company of Google, is developing plans for a website for Americans to find screening tests for COVID-19 and direct them to drive through clinics.

Corona 100m is an app in South Korea that alerts users if they are within 100m of a location the government marked as a high-risk area for COVID-19. The app uses public government data and can see the date a patient was confirmed with the disease, demographic data, and their location history.

The Japanese medical advice company Agree offers a free app for a limited time that allows users in Japan to consult with doctors about their symptoms, which prevents overtaxing medical centers.

Apple is evaluating coronavirus apps to help prevent the spread of misinformation and have reportedly rejected apps that are not from recognized institutions like governments or hospitals.

GYANT is an AI-enabled Healthcare chatting application for diagnosis. In March 2020, Gyant launched a free COVID-19 Emergency Response Assistant. It uses AI chat to check for COVID-19 symptoms and pertinent risk factors, then navigates patients to appropriate health system resources and care settings.

On March 13th, 2020, K Health (an AI-powered health app) began offering free virtual primary care for COVID-19, including unlimited access to U.S. doctors free for 14 days.

Curai Health, Carbon Health, and Babylon Health are digital health care providers that offer Covid-19 assessments via mobile or desktop.