Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(05): 640-651
DOI: 10.4103/ijmpo.ijmpo_223_20
Review Article

COVID-19: A Review of the Pandemic with Emphasis on the Role of Imaging

Mohnish Bothra
Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Tahleel Altaf Shera
Department of Radiodiagnosis, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
,
Jyoti Bajpai
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Abhishek Mahajan
Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
   Permissions and Reprints

Abstract

Heretofore, the COVID-19 pandemic continues to expand costing not just lives but also significant impact on the global economy. More than 212 countries and territories across the globe have been affected till now, causing approximately 4,043,068 confirmed cases and 277,016 deaths, and the numbers are rising expeditiously. The common symptoms are fever, dry cough, fatigue, sputum production, shortness of breath, sore throat, and headache, but atypical symptoms affecting cardiovascular system, gastrointestinal system, and neurological manifestations are not so uncommon and have been reported. Various governing bodies such as the World Health Organization, the National Institute for Health and Care Excellence, and the Centers for Disease Control and Prevention have laid down guidelines and recommendations for the same. In this review article, we have propounded the established knowledge about the causative agent in terms of epidemiological features, the etiopathogenesis, signs and symptoms, methods used for diagnosis, and the latest insight into the treatment and prevention according to the recent published recommendations. The current guidelines and the state-of-the-art updates for various active health-care personnel; allied departments such as radiology and microbiology, and those for the community have also been discussed.

Keywords

Coronavirus - COVID-19 - imaging - nCOV - pandemic - radiologist - SARS-CoV-2


Publication History

Received: 10 May 2020

Accepted: 25 June 2020

Article published online:
17 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 https://who.sprinklr.com/. Available from: [Last accessed on 2020 Apr 09]
  • 2 Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. J Med Virol 2020; 92: 418-23
    CrossrefPubMedGoogle Scholar
  • 3 Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR. et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: Estimation and application. Ann Intern Med 2020; 172: 577-82
    CrossrefPubMedGoogle Scholar
  • 4 Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol 2020; 92: 441-7
    CrossrefPubMedGoogle Scholar
  • 5 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20
    CrossrefPubMedGoogle Scholar
  • 6 World Health Organization. Coronavirus Disease (COVID-19) Outbreak. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Available from: [Last accessed on 2020 Apr 21]
    Google Scholar
  • 7 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html. Available from: [Last accessed on 2020 Apr 08]
  • 8 Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020; 24: 91-8
    CrossrefPubMedGoogle Scholar
  • 9 Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: An analysis based on decade-long structural studies of SARS coronavirus. J Virology 2020; 94
    Google Scholar
  • 10 Jaimes JA, Millet JK, Stout AE, André NM, Whittaker GR. A tale of two viruses: The distinct spike glycoproteins of feline coronaviruses. Viruses 2020; 12: 83
    CrossrefPubMedGoogle Scholar
  • 11 Tyrrell DA, Myint SH. Coronaviruses. In: Baron S. editor Medical Microbiology. 4th ed. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. https://www.ncbi.nlm.nih.gov/books/NBK7782/. Ch. 60 Available from: [Last accessed on 2020 Apr 08]
    Google Scholar
  • 12 People Who Are at Higher Risk for Severe Illness, CDC. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html. Available from: [Last accessed on 2020 Apr 08]
    Google Scholar
  • 13 Kattan J, Kattan C, Assi T. Do checkpoint inhibitors compromise the cancer patients' immunity and increase the vulnerability to COVID-19 infection?. Immunotherapy 2020; 12: 351-4
    CrossrefPubMedGoogle Scholar
  • 14 World Health Organization. Report of the Who-China Joint Mission on Coronavirus Disease 2019 (Covid-19); 2020. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Available from: [Last accessed on 2020 Apr 08]
    Google Scholar
  • 15 Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X. et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci 2020; 63: 706-11
    CrossrefPubMedGoogle Scholar
  • 16 Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health 2020; 25: 278-80
    CrossrefPubMedGoogle Scholar
  • 17 Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020; 17: 259-60
    CrossrefPubMedGoogle Scholar
  • 18 Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z. et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; DOI: 10.1542/peds.2020.0702.
    CrossrefPubMedGoogle Scholar
  • 19 Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatrica 2020; 109: 1088-95
    CrossrefPubMedGoogle Scholar
  • 20 https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html. Available from: [Last accessed on 2020 Apr 08]
  • 21 https://www.cdc.gov/coronavirus/2019-nCoV/lab/lab-biosafety-guidelines.html. Available from: [Last accessed on 2020 Apr 08]
  • 22 Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H. et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382: 929-36
    CrossrefPubMedGoogle Scholar
  • 23 Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). In: StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK554776/. Available from: [Last updated 2020 Jul 04]
    Google Scholar
  • 24 Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M. et al. Radiological Society of North America Expert consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA-Secondary Publication. J Thorac Imaging 2020; 35: 219-27
    Google Scholar
  • 25 Wong HY, Lam HY, Fong AH, Leung ST, Chin TW, Lo CS. et al. Frequency and distribution of chest radiographic findings in COVID-19 positive patients. Radiology 2019; 201160
    Google Scholar
  • 26 American College of Radiology. ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection. https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection. Available from: [Last accessed on 2020 Jul 28]
    Google Scholar
  • 27 Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X. et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020; 295: 202-7
    CrossrefPubMedGoogle Scholar
  • 28 Kong W, Agarwal PP. Chest imaging appearance of COVID-19 infection. Radiology Cardiothoracic Imaging 2020; 2: e200028
    CrossrefPubMedGoogle Scholar
  • 29 Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N. et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020; 295: 200463
    CrossrefPubMedGoogle Scholar
  • 30 Pan F, Ye T, Sun P, Gui S, Liang B, Li L. et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology 2020; pii: 200370
    Google Scholar
  • 31 Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TML. et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 2020; 200823
    Google Scholar
  • 32 Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020; 215: 87-93
    CrossrefPubMedGoogle Scholar
  • 33 Ng MY, Lee EY, Yang J, Yang F, Li X, Wang H. et al. Imaging profile of the COVID-19 infection: radiologic findings and literature review. Radiology 2020; 2: e200034
    Google Scholar
  • 34 Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X. et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: A longitudinal study. Radiology 2020; 200843
    Google Scholar
  • 35 Huang L, Han R, Ai T, Yu P, Kang H, Tao Q, Xia L. Serial quantitative chest CT assessment of COVID-19: Deep-learning approach. Radiology 2020; 2: e200075
    Google Scholar
  • 36 Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H. et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020; 295: 210-7
    CrossrefPubMedGoogle Scholar
  • 37 Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W. et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020; 200642
    Google Scholar
  • 38 Wen Z, Chi Y, Zhang L, Liu H, Du K, Li Z. et al. Coronavirus disease 2019: Initial detection on chest CT in a retrospective multicenter study of 103 Chinese subjects. Radiology: Cardiothoracic Imaging 2020; 2
    Google Scholar
  • 39 Inui S, Fujikawa A, Jitsu M, Kunishima N, Watanabe S, Suzuki Y. et al. Chest CT findings in cases from the cruise ship “Diamond Princess” with coronavirus disease 2019 (COVID-19). Radiology 2020; 2: e200110
    Google Scholar
  • 40 Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P. et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020; 200432
    Google Scholar
  • 41 Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S. et al. The role of chest imaging in patient management during the COVID-19 pandemic: A multinational consensus statement from the Fleischner society. Radiology 2020; 296: 172-80 DOI: 10.1148/radiol.2020201365.
    CrossrefPubMedGoogle Scholar
  • 42 Hope MD, Raptis CA, Shah A, Hammer MM, Henry TS. six signatories. A role for CT in COVID-19? What data really tell us so far. Lancet 2020; 395: 1189-90
    PubMedGoogle Scholar
  • 43 Soldati G, Smargiassi A, Inchingolo R, Buonsenso D, Perrone T, Briganti DF. et al. Is there a role for lung ultrasound during the COVID-19 pandemic?. J Ultrasound Med 2020; 39: 1459-62
    CrossrefPubMedGoogle Scholar
  • 44 Chaari A, Bousselmi K, Assar W, Kumar V, Khalil E, Kauts V. et al. Usefulness of ultrasound in the management of acute respiratory distress syndrome. Int J Crit Illn Inj Sci 2019; 9: 11-5
    CrossrefPubMedGoogle Scholar
  • 45 Poggiali E, Dacrema A, Bastoni D, Tinelli V, Demichele E, Mateo Ramos P. et al. Can lung US help critical care clinicians in the early diagnosis of novel coronavirus (COVID-19) pneumonia?. Radiology 2020; 295: E6
    CrossrefPubMedGoogle Scholar
  • 46 Peng QY, Wang XT, Zhang LN. Chinese Critical Care Ultrasound Study Group. Findings of lung ultrasonography of novel coronavirus pneumonia during the 2019-2020 epidemic. Intensive Care Med 2020; 46: 849-50
    CrossrefPubMedGoogle Scholar
  • 47 Huang Y, Wang S, Liu Y, Zhang Y, Zheng C, Zheng Y. et al. A preliminary study on the ultrasonic manifestations of peripulmonary lesions of non-critical novel coronavirus pneumonia (COVID-19). SSRN Electronic J 2020; DOI: 10.2139/ssrn.3544750.
    Google Scholar
  • 48 Soldati G, Smargiassi A, Inchingolo R, Buonsenso D, Perrone T, Briganti DF. et al. Proposal for international standardization of the use of lung ultrasound for patients with COVID-19. J Ultrasound Med 2020; 39: 1413-9
    CrossrefPubMedGoogle Scholar
  • 49 World Health Organization. Clinical Management of Severe Acute Respiratory Infection When Novel Coronavirus (2019-nCoV) Infection is Suspected: Interim Guidance 2020. World Health Organization; 2020. 28 January [Last accessed on 2020 Apr 08]
    Google Scholar
  • 50 CDC. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. Available from: [Last accessed on 2020 Apr 08]
  • 51 FDA. https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus-disease-2019-covid-19. Available from: [Last accessed on 2020 Apr 08]
  • 52 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control. Available from: [Last accessed on 2020 Apr 08]
  • 53 https://icmr.nic.in/content/covid-19. Available from: [Last accessed on 2020 Apr 08]
  • 54 Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14: 72-3
    CrossrefPubMedGoogle Scholar
  • 55 Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020; 30: 269-71
    CrossrefPubMedGoogle Scholar
  • 56 Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P. et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020; DOI: 10.1093/cid/ciaa237.
    CrossrefPubMedGoogle Scholar
  • 57 Colson P, Rolain JM, Lagier JC, Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents 2020; 55: 105932
    CrossrefPubMedGoogle Scholar
  • 58 World Health Organization. Coronavirus: Landscape Analysis of Therapeutics as of 17 February, 2020. https://www.who.int/blueprint/priority-diseases/key-action/Table_of_therapeutics_Appendix_17022020.pdf?ua=1. Available from: [Last accessed on 2020 Apr 08]
    Google Scholar
  • 59 Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care 2020; 57: 279-83
    CrossrefPubMedGoogle Scholar
  • 60 ESICM, SCCM. Surviving Sepsis Campaign Rapid Guidelines of the Management of Critically ill Adults with Coronavirus Disease 2019 (pre-publication). https://www.esicm.org/ssc-covid19-guidelines/. Available from: [Last accessed on 2020 Apr 08]
    Google Scholar
  • 61 Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC. et al. Remdesivir for the treatment of Covid-19 – Preliminary report. N Engl J Med. May 22, 2020
  • 62 Chan KW, Wong VT, Tang SC. COVID-19: An update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative Chinese-Western medicine for the management of 2019 novel coronavirus disease. Am J Chin Med 2020; 48: 737-62
    CrossrefPubMedGoogle Scholar
  • 63 US Food and Drug Administration. Investigational New Drug (IND) or Device Exemption (IDE) Process (CBER). US Food and Drug Administration. https://www.fda.gov/biologicsbloodvaccines/developmentapprovalprocess/investigationalnewdrugindordeviceexemptionideprocess/default.htm. Available from: [Last accessed on 2020 Apr 08]
    Google Scholar
  • 64 World Health Organization. Clinical Management of Severe Acute Respiratory Infection When Novel Coronavirus (nCoV) Infection is Suspected. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. Available from: [Last accessed on 2020 Apr 08]
    Google Scholar
  • 65 Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP. et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Med Res 2020; 7: 4
    CrossrefPubMedGoogle Scholar
  • 66 Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?. Lancet Respir Med 2020; 8 DOI: 10.1016/s2213-2600(20)30116-8.
    CrossrefPubMedGoogle Scholar
  • 67 Gautret P, Lagier JC, Parola P, Meddeb L, Mailhe M, Doudier B. et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrobial Agents 2020; pii: 105949
    PubMedGoogle Scholar
  • 68 Bajpai J, Tsang J. Novel coronavirus infection – Knowns and unknowns with particular reference to oncology – Combating against COVID-19 with “COVID.”. Indian Journal of Medical and Paediatric Oncology 2020; 41: 116
    Article in Thieme ConnectGoogle Scholar
  • 69 The American Cancer Society Cancer Action Network: COVID-19 Pandemic Impact on Cancer Patients and Survivors Survey Findings Summary; 2020. https://www.kff.org/other/state-indicator/total-population/. Available from: [Last accessed on 2020 Apr 19]
    Google Scholar
  • 70 American Society of Clinical Oncology: COVID-19 Patient Care Information | ASCO; 2020. https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19. Available from: [Last accessed on 2020 Apr 19]
    Google Scholar
  • 71 COVID-19 Provider & Practice Information, ASCO. https://www.asco.org/asco-coronavirus-information/provider-practice-preparedness-covid-19. Available from: [Last accessed on 2020 Apr 09]
    Google Scholar
  • 72 Mailankody S, Bajpai J. Intelligent adaptation to the changing surroundings amidst the COVID-19 pandemic for sarcomas and melanomas. Cancer Res Stat Treatment 2020; 3: 110
    Google Scholar
  • 73 Sequence for Donning Personal Protective Equipment. https://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf. Available from: [Last accessed on 2020 Apr 08]
    Google Scholar
  • 74 COVID-19: Lockdown Across India, in line with WHO Guidance. UN News; 24 March 2020. [Last accessed on 2020 Apr 08]
    Google Scholar