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Definition
Coronaviruses are a family of RNA viruses that are capable of infecting humans and other animals, and causing respiratory, cardiovascular, neurological, renal, hepatic and haematological diseases (Weiss and Leibowitz, 2011; Yin and Wunderink, 2018).
As certain aspects of the information regarding COVID-19 are constantly evolving and changing, several sections within this page contain links to external webpages, which are regularly monitored and updated. This allows us to provide you with not only the core clinical information, but all up to date guidance regarding this disease.
Transmission
The origins of SARS-Cov-2 have been extensively researched and debated. Most of the scientific evidence supports natural emergence, as more than half of the early cases were connected to the Huanan market (Gostin and Gronvall, 2023), suggesting animal to human transmission.
The infection is thought to spread via droplets expelled from the respiratory tract, through coughing and sneezing, as is the case
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Symptoms
Like many other diseases, the symptoms of COVID-19 vary greatly (Table 1), and can range from the affected individual being asymptomatic or having mild symptoms, to more serious complications and, in some cases, death.
| Table 1. Common and less common symptoms of COVID-19 | |
| Common symptoms | Less common symptoms |
|
dry cough fever cough (new continuous cough) loss of or change to sense of smell or taste muscle aches (myalgia) fatigue |
diarrhoea sputum production headaches shortness of breath (dyspnoea) respiratory distress |
| From: NHS, 2020; Centers for Disease Control and Prevention, 2021 | |
The following National Institute for Health and Care Excellence page provides information on the clinical assessment and management of a patients who may have COVID-19: https://www.nice.org.uk/guidance/ng191
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Risk factors
Anyone can get infected and manifest symptoms of COVID-19; however, the success of the COVID-19 vaccination programme has meant that the requirement for shielding and identifying people as clinically extremely vulnerable is no longer necessary (UK Health Security Agency, 2023a).
There are a number of conditions which place people at greater risk of serious complications, and possibly death, should they develop symptoms (Public Health England, 2023). These include all people aged 70 years or over, irrespective of whether they have any medical conditions, and people below the age of 70 years who have any of the following conditions:
- chronic respiratory diseases (for example chronic obstructive pulmonary disease, chronic asthma, emphysema)
- chronic kidney disease
- diabetes (types 1 and 2)
- chronic neurological diseases (for example multiple sclerosis, motor neurone disease, Parkinson's disease)
- spleen problems (for example sickle cell disease or splenectomy)
- chronic liver disease
- learning difficulties
- lowered immunity occurring as a result of chemotherapy,
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Complications
Long-term symptoms of COVID-19 (long COVID)
This is an unpleasant condition with a range of symptoms which develop or continue after an acute COVID-19 infection. It includes both ongoing symptomatic COVID-19 (from 4-12 weeks) and post-COVID-19 syndrome (12 weeks or more) (National Institute for Health and Care Excellence (NICE), 2022).
The following link provides guidance on how nurses can support those experiencing long-term symptoms of COVID-19: https://www.nursinginpractice.com/clinical/respiratory/long-covid-top-tips-managing-the-long-term-effects-of-covid-19/
Incidence
Any patient with COVID-19 may go onto develop long COVID regardless of the severity of the initial infection and the intensity of the treatment received (Crook et al, 2021).
An estimated 1.9 million people living in private households in the UK (2.9% of the population) were experiencing self-reported long COVID in 2023 (Office for National Statistics, 2023). Long COVID symptoms adversely affected the day-to-day activities of 1.5 million people (79% of those with self-reported long COVID), with 381 000 (20%)
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Treatment
NICE (2023) has made recommendations for people at high risk of progression to severe COVID-19 on the use of nirmatrelvir and ritonavir, remdesivir and molnupiravir.
Nirmatrelvir and ritonavir
Consider a 5-day course of nirmatrelvir and ritonavir for adults with COVID-19 who:
- do not need supplemental oxygen for COVID-19, AND
- are within 5 days of symptom onset, AND
- are thought to be at high risk of progression to severe COVID-19 (NICE, 2023)
Remdesivir
Consider a 3-day course of remdesivir for young people aged 12-17 years who weigh at least 40 kg, and adults with COVID-19 who:
- do not need supplemental oxygen for COVID-19, AND
- are within 7 days of symptom onset, AND
- are thought to be at high risk of progression to severe COVID-19 (NICE, 2023)
Molnupiravir
Consider a 5-day course of molnupiravir for adults with COVID-19 who:
- do not need supplemental oxygen for COVID-19,
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 2: Procedures for the planning, provision and management of person-centred nursing care
9. Use evidence-based, best practice approaches for meeting needs for care and support with the prevention and management of infection, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
9.1 observe, assess and respond rapidly to potential infection risks using best practice guidelines
11.7 administer injections using intramuscular, subcutaneous, intradermal and intravenous routes and manage injection equipment
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Resources
Baden LR, El Sahly HM, Essink B et al. COVE Study Group. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5):403-416. https://doi.org/10.1056/NEJMoa2035389
Centers for Disease Control and Prevention. Long COVID or post-COVID conditions. 2021. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/ (accessed 12 January 2024)
Crook H, Raza S, Nowell J, Young M, Edison P. Long COVID-mechanisms, risk factors and management. BMJ. 2021;374:n1648. https://doi.org/10.1136/bmj.n1648
Di Mascio D, Khail A, Saccone G et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynaecol. 2020;2(2):100107. https://doi.org/10.1016/j.ajogmf.2020.100107
Folegatti PM, Ewer KJ, Aley PK et al; Oxford COVID Vaccine Trial Group. Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. Lancet. 2020;396(10249):467–478. https://doi.org/10.1016/S0140-6736(20)31604-4
Greenhalgh T, Knight M, A’Court C et al. Management of
post-acute COVID-19 in primary care. BMJ. 2020;370:m3026. https://doi.org/10.1136/bmj.m3026
Grein J, Ohmagari N, Shin D et al. Compassionate use of remdesivir for patients with severe Covid-19. N Engl J Med. 2020;382(24):2327–2336.
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