Prognosis of COVID-19

The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.[7]

See also: Mortality due to COVID-19
The severity of diagnosed COVID-19 cases in China[1]
Case fatality rates by age group:
  China, as of 11 February 2020[2]
  South Korea, as of 5 June 2020[3]
  Spain, as of 18 May 2020[4]
  Italy, as of 3 June 2020[5]
Case fatality rate in China depending on other health problems. Data through 11 February 2020.[2]
The number of deaths vs total cases by country and approximate case fatality rate[6]

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years.[8] They are likely to have milder symptoms and a lower chance of severe disease than adults; in those younger than 50 years the risk of death is less than 0.5%, while in those older than 70 it is more than 8%.[9][10][11] Pregnant women may be at higher risk for severe infection with COVID‑19 based on data from other similar viruses, like Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), but data for COVID‑19 is lacking.[12][13] In China, children acquired infections mainly through close contact with their parents or other family members who lived in Wuhan or had traveled there.[9]

Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful in early screening for severe illness.[14]

Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease.[15] The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 97% of people had at least one comorbidity with the average person having 2.7 diseases.[16] According to the same report, the median time between the onset of symptoms and death was ten days, with five being spent hospitalised. However, people transferred to an ICU had a median time of seven days between hospitalisation and death.[16] In a study of early cases, the median time from exhibiting initial symptoms to death was 14 days, with a full range of six to 41 days.[17] In a study by the National Health Commission (NHC) of China, men had a death rate of 2.8% while women had a death rate of 1.7%.[18] Histopathological examinations of post-mortem lung samples show diffuse alveolar damage with cellular fibromyxoid exudates in both lungs. Viral cytopathic changes were observed in the pneumocytes. The lung picture resembled acute respiratory distress syndrome (ARDS).[7] In 11.8% of the deaths reported by the National Health Commission of China, heart damage was noted by elevated levels of troponin or cardiac arrest.[19] According to March data from the United States, 89% of those hospitalised had preexisting conditions.[20]

The availability of medical resources and the socioeconomics of a region may also affect mortality.[21] Estimates of the mortality from the condition vary because of those regional differences,[22] but also because of methodological difficulties. The under-counting of mild cases can cause the mortality rate to be overestimated.[23] However, the fact that deaths are the result of cases contracted in the past can mean the current mortality rate is underestimated.[24][25] Smokers were 1.4 times more likely to have severe symptoms of COVID‑19 and approximately 2.4 times more likely to require intensive care or die compared to non-smokers.[26][27] According to a number of studies, air pollution is similarly associated with risk factors.[27] According to three scientific reviews, obesity contributes to an increased risk and poorer prognosis of COVID-19.[27][28][29]

Concerns have been raised about long-term sequelae of the disease. The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage.[30] This may also lead to post-intensive care syndrome following recovery.[31]

Case fatality rates (%) by age and country
Age
Country 0–9 10–19 20–29 30–39 40–49 50–59 60–69 70–79 80–89 90+
Argentina as of 7 May[32] 0.0 0.0 0.1 0.4 1.3 3.6 12.9 18.8 28.4
Australia as of 4 June[33] 0.0 0.0 0.0 0.0 0.1 0.2 1.1 4.1 18.1 40.8
Canada as of 3 June[34] 0.0 0.1 0.7 11.2 30.7
     Alberta as of 3 June[35] 0.0 0.0 0.1 0.1 0.1 0.2 1.9 11.9 30.8
     Br. Columbia as of 2 June[36] 0.0 0.0 0.0 0.0 0.5 0.8 4.6 12.3 33.8 33.6
     Ontario as of 3 June[37] 0.0 0.0 0.1 0.2 0.5 1.5 5.6 17.7 26.0 33.3
     Quebec as of 2 June[38] 0.0 0.1 0.1 0.2 1.1 6.1 21.4 30.4 36.1
Chile as of 31 May[39][40] 0.1 0.3 0.7 2.3 7.7 15.6
China as of 11 February[2] 0.0 0.2 0.2 0.2 0.4 1.3 3.6 8.0 14.8
Colombia as of 3 June[41] 0.3 0.0 0.2 0.5 1.6 3.4 9.4 18.1 25.6 35.1
Denmark as of 4 June[42] 0.2 4.1 16.5 28.1 48.2
Finland as of 4 June[43] 0.0 0.0 <0.4 <0.4 <0.5 0.8 3.8 18.1 42.3
Germany as of 5 June[44] 0.0 0.0 0.1 1.9 19.7 31.0
     Bavaria as of 5 June[45] 0.0 0.0 0.1 0.1 0.2 0.9 5.4 15.8 28.0 35.8
Israel as of 3 May[46] 0.0 0.0 0.0 0.9 0.9 3.1 9.7 22.9 30.8 31.3
Italy as of 3 June[47] 0.3 0.0 0.1 0.3 0.9 2.7 10.6 25.9 32.4 29.9
Japan as of 7 May[48] 0.0 0.0 0.0 0.1 0.3 0.6 2.5 6.8 14.8
Mexico as of 3 June[49] 3.3 0.6 1.2 2.9 7.5 15.0 25.3 33.7 40.3 40.6
Netherlands as of 3 June[50] 0.0 0.2 0.1 0.3 0.5 1.7 8.1 25.6 33.3 34.5
Norway as of 4 June[51] 0.0 0.0 0.0 0.0 0.3 0.4 2.2 9.0 22.7 57.0
Philippines as of 4 June[52] 1.6 0.9 0.5 0.8 2.4 5.5 13.2 20.9 31.5
Portugal as of 3 June[53] 0.0 0.0 0.0 0.0 0.3 1.3 3.6 10.5 21.2
South Africa as of 28 May[54] 0.3 0.1 0.1 0.4 1.1 3.8 9.2 15.0 12.3
South Korea as of 15 June[55] 0.0 0.0 0.0 0.2 0.2 0.7 2.6 10.1 25.6
Spain as of 17 May[4] 0.2 0.3 0.2 0.3 0.6 1.4 4.9 14.3 21.0 22.3
Sweden as of 5 June[56] 0.5 0.0 0.2 0.2 0.6 1.7 6.6 23.4 35.6 40.3
Switzerland as of 4 June[57] 0.6 0.0 0.0 0.1 0.1 0.6 3.4 11.6 28.2
United States
     Colorado as of 3 June[58] 0.2 0.2 0.2 0.2 0.8 1.9 6.2 18.5 39.0
     Connecticut as of 3 June[59] 0.2 0.1 0.1 0.3 0.7 1.8 7.0 18.0 31.2
     Georgia as of 3 June[60] 0.0 0.1 0.5 0.9 2.0 6.1 13.2 22.0
     Idaho as of 3 June[61] 0.0 0.0 0.0 0.0 0.0 0.4 3.1 8.9 31.4
     Indiana as of 3 June[62] 0.1 0.1 0.2 0.6 1.8 7.3 17.1 30.2
     Kentucky as of 20 May[63] 0.0 0.0 0.0 0.2 0.5 1.9 5.9 14.2 29.1
     Maryland as of 20 May[64] 0.0 0.1 0.2 0.3 0.7 1.9 6.1 14.6 28.8
     Massachusetts as of 20 May[65] 0.0 0.0 0.1 0.1 0.4 1.5 5.2 16.8 28.9
     Minnesota as of 13 May[66] 0.0 0.0 0.0 0.1 0.3 1.6 5.4 26.9
     Mississippi as of 19 May[67] 0.0 0.1 0.5 0.9 2.1 8.1 16.1 19.4 27.2
     Missouri as of 19 May[68] 0.0 0.0 0.1 0.2 0.8 2.2 6.3 14.3 22.5
     Nevada as of 20 May[69] 0.0 0.3 0.3 0.4 1.7 2.6 7.7 22.3
     N. Hampshire as of 12 May[70] 0.0 0.0 0.4 0.0 1.2 0.0 2.2 12.0 21.2
     Oregon as of 12 May[71] 0.0 0.0 0.0 0.0 0.5 0.8 5.6 12.1 28.9
     Texas as of 20 May[72] 0.0 0.5 0.4 0.3 0.8 2.1 5.5 10.1 30.6
     Virginia as of 19 May[73] 0.0 0.0 0.0 0.1 0.4 1.0 4.4 12.9 24.9
     Washington as of 10 May[74] 0.0 0.2 1.3 9.8 31.2
     Wisconsin as of 20 May[75] 0.0 0.0 0.2 0.2 0.6 2.0 5.0 14.7 19.9 30.4
Estimated prognosis by age and sex based on cases from France and Diamond Princess ship[76]
Percent of infected people who are hospitalized
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
Female 0.2
(0.1–0.3)		 0.6
(0.3–0.9)		 1.1
(0.7–1.8)		 1.6
(0.9–2.4)		 3.2
(1.9–4.9)		 6.2
(3.7–9.6)		 9.6
(5.7–14.8)		 23.6
(14.0–36.4)		 3.2
(1.9–5.0)
Male 0.2
(0.1–0.3)		 0.7
(0.4–1.1)		 1.4
(0.9–2.2)		 1.9
(1.1–3.0)		 3.9
(2.3–6.1)		 8.1
(4.8–12.6)		 13.4
(8.0–20.7)		 45.9
(27.3–70.9)		 4.0
(2.4–6.2)
Total 0.2
(0.1–0.3)		 0.6
(0.4–1.0)		 1.3
(0.8–2.0)		 1.7
(1.0–2.7)		 3.5
(2.1–5.4)		 7.1
(4.2–11.0)		 11.3
(6.7–17.5)		 32.0
(19.0–49.4)		 3.6
(2.1–5.6)
Percent of hospitalized people who go to Intensive Care Unit
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
Female 16.7
(14.4–19.2)		 8.6
(7.5–9.9)		 11.9
(10.9–13.0)		 16.6
(15.6–17.7)		 20.7
(19.8–21.7)		 23.1
(22.2–24.0)		 18.7
(18.0–19.5)		 4.2
(4.0–4.5)		 14.3
(13.9–14.7)
Male 26.9
(23.2–31.0)		 14.0
(12.2–15.9)		 19.2
(17.6–20.9)		 26.9
(25.3–28.5)		 33.4
(32.0–34.8)		 37.3
(36.0–38.6)		 30.2
(29.2–31.3)		 6.8
(6.5–7.2)		 23.1
(22.6–23.6)
Total 22.2
(19.2–25.5)		 11.5
(10.1–13.2)		 15.9
(14.6–17.3)		 22.2
(21.0–23.5)		 27.6
(26.5–28.7)		 30.8
(29.8–31.8)		 24.9
(24.1–25.8)		 5.6
(5.3–5.9)		 19.0
(18.7–19.44)
Percent of hospitalized people who die
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
Female 0.5
(0.2–1.1)		 0.9
(0.5–1.3)		 1.5
(1.2–1.9)		 2.6
(2.3–3.0)		 5.2
(4.8–5.6)		 10.1
(9.5–10.6)		 16.7
(16.0–17.4)		 25.2
(24.4–26.0)		 14.4
(14.0–14.9)
Male 0.7
(0.3–1.5)		 1.3
(0.8–1.9)		 2.2
(1.7–2.7)		 3.8
(3.4–4.4)		 7.6
(7.0–8.2)		 14.8
(14.1–15.6)		 24.6
(23.7–25.6)		 37.1
(36.1–38.2)		 21.22
(20.8–21.7)
Total 0.6
(0.3–1.3)		 1.1
(0.7–1.6)		 1.9
(1.5–2.3)		 3.3
(2.9–3.7)		 6.5
(6.0–7.0)		 12.6
(12.0–13.2)		 21.0
(20.3–21.8)		 31.6
(30.9–32.4)		 18.1
(17.8–18.4)
Percent of infected people who die – infection fatality rate (IFR)
0–19 20–29 30–39 40–49 50–59 60–69 70–79 80+ Total
Female 0.001
(<0.001–0.002)		 0.005
(0.002–0.009)		 0.02
(0.01–0.03)		 0.04
(0.02–0.07)		 0.2
(0.1–0.3)		 0.6
(0.4–1.0)		 1.6
(1.0–2.5)		 5.9
(3.5–9.2)		 0.5
(0.3–0.7)
Male 0.001
(<0.001–0.003)		 0.008
(0.004–0.02)		 0.03
(0.02–0.05)		 0.07
(0.04–0.1)		 0.3
(0.2–0.5)		 1.2
(0.7–1.9)		 3.3
(2.0–5.1)		 17.1
(10.1–26.3)		 0.8
(0.5–1.3)
Total 0.001
(<0.001–0.002)		 0.007
(0.003–0.01)		 0.02
(0.01–0.04)		 0.06
(0.03–0.09)		 0.2
(0.1–0.36)		 0.9
(0.5–1.4)		 2.4
(1.4–3.7)		 10.1
(6.0–15.6)		 0.7
(0.4–1.0)
Numbers in parentheses are 95% credible intervals for the estimates.

Existing respiratory problems
  • Most critical respiratory comorbidities according to the CDC, are: moderate or severe Asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis.[77] Current evidence stemming from meta - analysis of several smaller research papers, also suggest that smoking can be assosiated with worse patient outcomes [78][79]
  • When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms.[80] COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.[81]

Immunity

It is unknown (as of April 2020) if past infection provides effective and long-term immunity in people who recover from the disease.[82][83] Some of the infected have been reported to develop protective antibodies, so acquired immunity is presumed likely, based on the behaviour of other coronaviruses.[84] Cases in which recovery from COVID‑19 was followed by positive tests for coronavirus at a later date have been reported.[85][86][87][88] However, these cases are believed to be lingering infection rather than reinfection,[88] or false positives due to remaining RNA fragments.[89] An investigation by the Korean CDC of 285 individuals who tested positive for SARS-CoV-2 in PCR tests administered days or weeks after recovery from COVID-19 found no evidence that these individuals were contagious at this later time.[90] Some other coronaviruses circulating in people are capable of reinfection after roughly a year.[91][92]

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