Coronavirus Disease 2019 (COVID-19): A Perspective from China

Abstract

In December 2019, an outbreak of severe acute respiratory syndrome coronavirus 2 infection occurred in Wuhan, Hubei Province, China, and spread across China and beyond. On February 12, 2020, the World Health Organization officially named the disease caused by the novel coronavirus as coronavirus disease 2019 (COVID-19). Because most patients infected with COVID-19 had pneumonia and characteristic CT imaging patterns, radiologic examinations have become vital in early diagnosis and the assessment of disease course. To date, CT findings have been recommended as major evidence for clinical diagnosis of COVID-19 in Hubei, China. This review focuses on the etiology, epidemiology, and clinical symptoms of COVID-19 while highlighting the role of chest CT in prevention and disease control.

Figure 1:

Countries, territories, or areas with confirmed cases of Coronavirus Disease 2019 (COVID-19). a: The geographic location of patients with confirmed COVID-19 in China, February 19, 2020. b: Countries, territories or areas with reported confirmed COVID-19, February 19, 2020. Note.—Data in Panel a is from World Health Organization, National Health Commission of the People’s Republic of China; Panel b is adapted from Ref. .

Figure 2a:

Tendency chart of confirmed cases, new cases, and deaths of Coronavirus Disease 2019 (COVID-19) a: The tendency chart of confirmed patients from Hubei to the areas outside Hubei in China and countries outside China. b: The tendency chart of new cases of confirmed patients and deaths in China. Note.—Data are from World Health Organization, National Health Commission of the People’s Republic of China. The patients were laboratory-confirmed cases before February, 17, 2020; and included clinically diagnosed cases then.

Figure 2b:

Tendency chart of confirmed cases, new cases, and deaths of Coronavirus Disease 2019 (COVID-19) a: The tendency chart of confirmed patients from Hubei to the areas outside Hubei in China and countries outside China. b: The tendency chart of new cases of confirmed patients and deaths in China. Note.—Data are from World Health Organization, National Health Commission of the People’s Republic of China. The patients were laboratory-confirmed cases before February, 17, 2020; and included clinically diagnosed cases then.

Figure 3:

Chest radiography of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia A 53-year-old female had fever and cough for 5 days. Multifocal patchy opacities can be seen in both lungs (arrows).

Figure 4a:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Solitary rounded ground-glass opacity (GGO) pattern. A 51-year-old woman presenting without fever had close contact with patients with lab-confirmed COVID-19. a, Baseline axial unenhanced chest CT acquired 6 days before the first positive RT-PCR test showed a rounded GGO in the left lung upper lobe (arrow). b. Follow-up chest CT 4 days later showed the size increase of the lesion (arrow).

Figure 4b:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Solitary rounded ground-glass opacity (GGO) pattern. A 51-year-old woman presenting without fever had close contact with patients with lab-confirmed COVID-19. a, Baseline axial unenhanced chest CT acquired 6 days before the first positive RT-PCR test showed a rounded GGO in the left lung upper lobe (arrow). b. Follow-up chest CT 4 days later showed the size increase of the lesion (arrow).

Figure 5:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Patchy GGO pattern. A 58-old-year man with close contact history presenting without fever. Axial unenhanced chest CT showed patchy pure GGO (arrow).

Figure 6a:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Crazy paving pattern. A 69-old-year woman presenting with fever, cough, and muscle soreness with Wuhan exposure history. a, Axial unenhanced chest CT acquired on January 26, 2020 showed patchy GGO with typical crazy paving pattern (arrow). b, Axial unenhanced chest CT acquired on January 31, 2020 showed multiple subpleural distributed GGOs (arrows).

Figure 6b:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Crazy paving pattern. A 69-old-year woman presenting with fever, cough, and muscle soreness with Wuhan exposure history. a, Axial unenhanced chest CT acquired on January 26, 2020 showed patchy GGO with typical crazy paving pattern (arrow). b, Axial unenhanced chest CT acquired on January 31, 2020 showed multiple subpleural distributed GGOs (arrows).

Figure 7:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia Consolidation pattern. A 17-year-old male presented with fever (38.1°C, 100.58°F), cough for three days, and Wuhan exposure history. Axial unenhanced chest CT acquired on January 27, 2020 showed multiple pure consolidation lesions (arrows) in the middle lobe of right lung and upper lobe of left lung.

Figure 8a:

CT findings of severe type confirmed Coronavirus Disease 2019 (COVID-19) pneumonia A 43-year-old man presented with no fever and Wuhan exposure history. Axial unenhanced chest CT was acquired on the same day as reverse-transcription–polymerase-chain-reaction. a-b. Two thin slice axial unenhanced chest CT images showed diffusely subpleural distributed ground-glass opacities (arrows). Images provided by courtesy of Dr. Wei Chen, Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang, China.

Figure 8b:

CT findings of severe type confirmed Coronavirus Disease 2019 (COVID-19) pneumonia A 43-year-old man presented with no fever and Wuhan exposure history. Axial unenhanced chest CT was acquired on the same day as reverse-transcription–polymerase-chain-reaction. a-b. Two thin slice axial unenhanced chest CT images showed diffusely subpleural distributed ground-glass opacities (arrows). Images provided by courtesy of Dr. Wei Chen, Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang, China.

Figure 9a:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia showing disease progression A 48-year-old woman presented with high fever (39.1 °C, 102.38℉) and Wuhan exposure history. a-b, On January 23, 2020, baseline axial unenhanced chest CT showed ground-glass opacity (GGO) with consolidation in lower lobe of right lung with typical air bronchogram (Panel a, arrow) and one pure GGO (Panel b, arrow) in the upper lobe of left lung. c-d, Three days later, follow-up axial unenhanced chest CT showed the disease progression, appearing as increased extent and consolidation (arrows) compared with baseline chest CT.

Figure 9b:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia showing disease progression A 48-year-old woman presented with high fever (39.1 °C, 102.38℉) and Wuhan exposure history. a-b, On January 23, 2020, baseline axial unenhanced chest CT showed ground-glass opacity (GGO) with consolidation in lower lobe of right lung with typical air bronchogram (Panel a, arrow) and one pure GGO (Panel b, arrow) in the upper lobe of left lung. c-d, Three days later, follow-up axial unenhanced chest CT showed the disease progression, appearing as increased extent and consolidation (arrows) compared with baseline chest CT.

Figure 9c:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia showing disease progression A 48-year-old woman presented with high fever (39.1 °C, 102.38℉) and Wuhan exposure history. a-b, On January 23, 2020, baseline axial unenhanced chest CT showed ground-glass opacity (GGO) with consolidation in lower lobe of right lung with typical air bronchogram (Panel a, arrow) and one pure GGO (Panel b, arrow) in the upper lobe of left lung. c-d, Three days later, follow-up axial unenhanced chest CT showed the disease progression, appearing as increased extent and consolidation (arrows) compared with baseline chest CT.

Figure 9d:

CT findings of confirmed Coronavirus Disease 2019 (COVID-19) pneumonia showing disease progression A 48-year-old woman presented with high fever (39.1 °C, 102.38℉) and Wuhan exposure history. a-b, On January 23, 2020, baseline axial unenhanced chest CT showed ground-glass opacity (GGO) with consolidation in lower lobe of right lung with typical air bronchogram (Panel a, arrow) and one pure GGO (Panel b, arrow) in the upper lobe of left lung. c-d, Three days later, follow-up axial unenhanced chest CT showed the disease progression, appearing as increased extent and consolidation (arrows) compared with baseline chest CT.