Loneliness is a complex and usually unpleasant emotional response to isolation. Loneliness typically includes anxious feelings about a lack of connection or communication with other beings, both in the present and extending into the future. As such, loneliness can be felt even when surrounded by other people and one who feels lonely, is lonely. The causes of loneliness are varied and include social, mental, emotional, and physical factors.

 

Research has shown that loneliness is prevalent throughout society, including people in marriages, relationships, families, veterans, and those with successful careers.[1] It has been a long explored theme in the literature of human beings since Classical antiquity. Loneliness has also been described as social pain—a psychological mechanism meant to motivate an individual to seek social connections.[2] Loneliness is often defined in terms of one's connectedness to others, or more specifically as "the unpleasant experience that occurs when a person's network of social relations is deficient in some important way".[3]

  

Contents

1Common causes

2Typology

2.1Feeling lonely vs. being socially isolated

2.2Transient vs. chronic loneliness

2.3Loneliness as a human condition

3Frequency

4Effects

4.1Mental health

4.2Physical health

4.3Physiological mechanisms link to poor health

5Treatments and prevention

6See also

7References

8External links

Common causes[edit]

People can experience loneliness for many reasons, and many life events may cause it, such as a lack of friendship relations during childhood and adolescence, or the physical absence of meaningful people around a person. At the same time, loneliness may be a symptom of another social or psychological problem, such as chronic depression.

 

Many people experience loneliness for the first time when they are left alone as infants. It is also a very common, though normally temporary, consequence of a breakup, divorce, or loss of any important long-term relationship. In these cases, it may stem both from the loss of a specific person and from the withdrawal from social circles caused by the event or the associated sadness.

 

The loss of a significant person in one's life will typically initiate a grief response; in this situation, one might feel lonely, even while in the company of others. Loneliness may also occur after the birth of a child (often expressed in postpartum depression), after marriage, or following any other socially disruptive event, such as moving from one's home town into an unfamiliar community, leading to homesickness. Loneliness can occur within unstable marriages or other close relationships of a similar nature, in which feelings present may include anger or resentment, or in which the feeling of love cannot be given or received. Loneliness may represent a dysfunction of communication, and can also result from places with low population densities in which there are comparatively few people to interact with. Loneliness can also be seen as a social phenomenon, capable of spreading like a disease. When one person in a group begins to feel lonely, this feeling can spread to others, increasing everybody's risk for feelings of loneliness.[4] People can feel lonely even when they are surrounded by other people.[5]

 

A twin study found evidence that genetics account for approximately half of the measurable differences in loneliness among adults, which was similar to the heritability estimates found previously in children. These genes operate in a similar manner in males and females. The study found no common environmental contributions to adult loneliness.[6]

 

Typology[edit]

Feeling lonely vs. being socially isolated[edit]

There is a clear distinction between feeling lonely and being socially isolated (for example, a loner). In particular, one way of thinking about loneliness is as a discrepancy between one's necessary and achieved levels of social interaction,[1] while solitude is simply the lack of contact with people. Loneliness is therefore a subjective experience; if a person thinks they are lonely, then they are lonely. People can be lonely while in solitude, or in the middle of a crowd. What makes a person lonely is the fact that they need more social interaction or a certain type of social interaction that is not currently available. A person can be in the middle of a party and feel lonely due to not talking to enough people. Conversely, one can be alone and not feel lonely; even though there is no one around that person is not lonely because there is no desire for social interaction. There have also been suggestions that each person has their own optimal level of social interaction. If a person gets too little or too much social interaction, this could lead to feelings of loneliness or over-stimulation.[7]

 

Solitude can have positive effects on individuals. One study found that, although time spent alone tended to depress a person's mood and increase feelings of loneliness, it also helped to improve their cognitive state, such as improving concentration. Furthermore, once the alone time was over, people's moods tended to increase significantly.[8] Solitude is also associated with other positive growth experiences, religious experiences, and identity building such as solitary quests used in rites of passages for adolescents.[9]

 

Loneliness can also play an important role in the creative process. In some people, temporary or prolonged loneliness can lead to notable artistic and creative expression, for example, as was the case with poets Emily Dickinson and Isabella di Morra, and numerous musicians[who?]. This is not to imply that loneliness itself ensures this creativity, rather, it may have an influence on the subject matter of the artist and more likely be present in individuals engaged in creative activities.[citation needed]

 

Transient vs. chronic loneliness[edit]

The other important typology of loneliness focuses on the time perspective.[10] In this respect, loneliness can be viewed as either transient or chronic. It has also been referred to as state and trait loneliness.

 

Transient (state) loneliness is temporary in nature, caused by something in the environment, and is easily relieved. Chronic (trait) loneliness is more permanent, caused by the person, and is not easily relieved.[11] For example, when a person is sick and cannot socialize with friends would be a case of transient loneliness. Once the person got better it would be easy for them to alleviate their loneliness. A person who feels lonely regardless of if they are at a family gathering, with friends, or alone is experiencing chronic loneliness. It does not matter what goes on in the surrounding environment, the experience of loneliness is always there.

 

Loneliness as a human condition[edit]

The existentialist school of thought views loneliness as the essence of being human. Each human being comes into the world alone, travels through life as a separate person, and ultimately dies alone. Coping with this, accepting it, and learning how to direct our own lives with some degree of grace and satisfaction is the human condition.[12]

 

Some philosophers, such as Sartre, believe in an epistemic loneliness in which loneliness is a fundamental part of the human condition because of the paradox between people's consciousness desiring meaning in life and the isolation and nothingness of the universe.[13] Conversely, other existentialist thinkers argue that human beings might be said to actively engage each other and the universe as they communicate and create, and loneliness is merely the feeling of being cut off from this process.

 

In his recent text, Evidence of Being: The Black Gay Cultural Renaissance and the Politics of Violence, Darius Bost draws from Heather Love's theorization of loneliness[14] to delineate the ways in which loneliness structures black gay feeling and literary, cultural productions. Bost limns, “As a form of negative affect, loneliness shores up the alienation, isolation, and pathologization of black gay men during the 1980s and early 1990s. But loneliness is also a form of bodily desire, a yearning for an attachment to the social and for a future beyond the forces that create someone’s alienation and isolation."[15]

 

Frequency[edit]

There are several estimates and indicators of loneliness. It has been estimated that approximately 60 million people in the United States, or 20% of the total population, feel lonely.[2] Another study found that 12% of Americans have no one with whom to spend free time or to discuss important matters.[16] Other research suggests that this rate has been increasing over time. The General Social Survey found that between 1985 and 2004, the number of people the average American discusses important matters with decreased from three to two. Additionally, the number of Americans with no one to discuss important matters with tripled[17] (though this particular study may be flawed[18]). In the UK research by Age UK shows half a million people more than 60 years old spend each day alone without social interaction and almost half a million more see and speak to no one for 5 or 6 days a week.[19] On the other hand, the Community Life Survey, 2016 to 2017, by the UK's Office for National Statistics, found that young adults in England aged 16 to 24 reported feeling lonely more often than those in older age groups.[20]

 

Loneliness appears to have intensified in every society in the world as modernization occurs. A certain amount of this loneliness appears to be related to greater migration, smaller household sizes, a larger degree of media consumption (all of which have positive sides as well in the form of more opportunities, more choice in family size, and better access to information), all of which relates to social capital.

 

Within developed nations, loneliness has shown the largest increases among two groups: seniors[21][22] and people living in low-density suburbs.[23][24] Seniors living in suburban areas are particularly vulnerable, for as they lose the ability to drive, they often become "stranded" and find it difficult to maintain interpersonal relationships.[25]

 

Loneliness is prevalent in vulnerable groups in society. In New Zealand the fourteen surveyed groups with the highest prevalence of loneliness most/all of the time in descending order are: disabled, recent migrants, low income households, unemployed, single parents, rural (rest of South Island), seniors aged 75+, not in the labour force, youth aged 15–24, no qualifications, not housing owner-occupier, not in a family nucleus, Māori, and low personal income.[26]

 

Americans seem to report more loneliness than any other country, though this finding may simply be an effect of greater research volume. A 2006 study in the American Sociological Review found that Americans on average had only two close friends in which to confide, which was down from an average of three in 1985. The percentage of people who noted having no such confidant rose from 10% to almost 25%, and an additional 19% said they had only a single confidant, often their spouse, thus raising the risk of serious loneliness if the relationship ended.[27] The modern office environment has been demonstrated to give rise to loneliness. This can be especially prevalent in individuals prone to social isolation who can interpret the business focus of co-workers for a deliberate ignoring of needs.[28]

 

Whether a correlation exists between Internet usage and loneliness is a subject of controversy, with some findings showing that Internet users are lonelier[29] and others showing that lonely people who use the Internet to keep in touch with loved ones (especially seniors) report less loneliness, but that those trying to make friends online became lonelier.[30] On the other hand, studies in 2002 and 2010 found that "Internet use was found to decrease loneliness and depression significantly, while perceived social support and self-esteem increased significantly"[31] and that the Internet "has an enabling and empowering role in people's lives, by increasing their sense of freedom and control, which has a positive impact on well-being or happiness."[32] The one apparently unequivocal finding of correlation is that long driving commutes correlate with dramatically higher reported feelings of loneliness (as well as other negative health impacts).[33][34]

 

Effects[edit]

Mental health[edit]

 

Loneliness by Hans Thoma (National Museum in Warsaw)

Loneliness has been linked with depression, and is thus a risk factor for suicide.[35] Émile Durkheim has described loneliness, specifically the inability or unwillingness to live for others, i.e. for friendships or altruistic ideas, as the main reason for what he called egoistic suicide.[36][unreliable source?] In adults, loneliness is a major precipitant of depression and alcoholism.[37] People who are socially isolated may report poor sleep quality, and thus have diminished restorative processes.[38] Loneliness has also been linked with a schizoid character type in which one may see the world differently and experience social alienation, described as the self in exile.[39]

 

While the long term effects of extended periods of loneliness are little understood, it has been noted that people who are isolated or experience loneliness for a long period of time fall into a “ontological crisis” or “ontological insecurity,” where they are not sure if they or their surroundings exist, and if they do, exactly who or what they are, creating torment, suffering, and despair to the point of palpability within the thoughts of the person.[40][41]

 

In children, a lack of social connections is directly linked to several forms of antisocial and self-destructive behavior, most notably hostile and delinquent behavior. In both children and adults, loneliness often has a negative impact on learning and memory. Its disruption of sleep patterns can have a significant impact on the ability to function in everyday life.[35]

 

Research from a large-scale study published in the journal Psychological Medicine, showed that "lonely millennials are more likely to have mental health problems, be out of work and feel pessimistic about their ability to succeed in life than their peers who feel connected to others, regardless of gender or wealth.”[42][43]

 

In 2004, the United States Department of Justice published a study indicating that loneliness increases suicide rates profoundly among juveniles, with 62% of all suicides that occurred within juvenile facilities being among those who either were, at the time of the suicide, in solitary confinement or among those with a history of being housed thereof.[40]

 

Pain, depression, and fatigue function as a symptom cluster and thus may share common risk factors. Two longitudinal studies with different populations demonstrated that loneliness was a risk factor for the development of the pain, depression, and fatigue symptom cluster over time. These data also highlight the health risks of loneliness; pain, depression, and fatigue often accompany serious illness and place people at risk for poor health and mortality.[44]

 

Physical health[edit]

Chronic loneliness can be a serious, life-threatening health condition. It has been found to be associated with an increased risk of stroke and cardiovascular disease.[45] Loneliness shows an increased incidence of high blood pressure, high cholesterol, and obesity.[46]

 

Loneliness is shown to increase the concentration of cortisol levels in the body.[46] Prolonged, high cortisol levels can cause anxiety, depression, digestive problems, heart disease, sleep problems, and weight gain.[47]

 

″Loneliness has been associated with impaired cellular immunity as reflected in lower natural killer (NK) cell activity and higher antibody titers to the Epstein Barr Virus and human herpes viruses".[46] Because of impaired cellular immunity, loneliness among young adults shows vaccines, like the flu vaccine, to be less effective.[46] Data from studies on loneliness and HIV positive men suggests loneliness increases disease progression.[46]

 

Physiological mechanisms link to poor health[edit]

There are a number of potential physiological mechanisms linking loneliness to poor health outcomes. In 2005, results from the American Framingham Heart Study demonstrated that lonely men had raised levels of Interleukin 6 (IL-6), a blood chemical linked to heart disease. A 2006 study conducted by the Center for Cognitive and Social Neuroscience at the University of Chicago found loneliness can add thirty points to a blood pressure reading for adults over the age of fifty. Another finding, from a survey conducted by John Cacioppo from the University of Chicago, is that doctors report providing better medical care to patients who have a strong network of family and friends than they do to patients who are alone. Cacioppo states that loneliness impairs cognition and willpower, alters DNA transcription in immune cells, and leads over time to high blood pressure.[2] Lonelier people are more likely to show evidence of viral reactivation than less lonely people.[48] Lonelier people also have stronger inflammatory responses to acute stress compared with less lonely people; inflammation is a well known risk factor for age-related diseases.[49]

 

When someone feels left out of a situation, they feel excluded and one possible side effect is for their body temperature to decrease. When people feel excluded blood vessels at the periphery of the body may narrow, preserving core body heat. This class protective mechanism is known as vasoconstriction.[50]

 

Treatments and prevention[edit]

There are many different ways used to treat loneliness, social isolation, and clinical depression. The first step that most doctors recommend to patients is therapy. Therapy is a common and effective way of treating loneliness and is often successful. Short-term therapy, the most common form for lonely or depressed patients, typically occurs over a period of ten to twenty weeks. During therapy, emphasis is put on understanding the cause of the problem, reversing the negative thoughts, feelings, and attitudes resulting from the problem, and exploring ways to help the patient feel connected. Some doctors also recommend group therapy as a means to connect with other sufferers and establish a support system.[51] Doctors also frequently prescribe anti-depressants to patients as a stand-alone treatment, or in conjunction with therapy. It may take several attempts before a suitable anti-depressant medication is found.[52]

 

Alternative approaches to treating depression are suggested by many doctors. These treatments include exercise, dieting, hypnosis, electro-shock therapy, acupuncture, and herbs, amongst others. Many patients find that participating in these activities fully or partially alleviates symptoms related to depression.[53]

  

Paro, a robot pet seal classified as a medical device by U.S. regulators

Another treatment for both loneliness and depression is pet therapy, or animal-assisted therapy, as it is more formally known. Studies and surveys, as well as anecdotal evidence provided by volunteer and community organizations, indicate that the presence of animal companions such as dogs, cats, rabbits, and guinea pigs can ease feelings of depression and loneliness among some sufferers. Beyond the companionship the animal itself provides there may also be increased opportunities for socializing with other pet owners. According to the Centers for Disease Control and Prevention there are a number of other health benefits associated with pet ownership, including lowered blood pressure and decreased levels of cholesterol and triglycerides.[54]

 

Nostalgia has also been found to have a restorative effect, counteracting loneliness by increasing perceived social support.[55]

 

A 1989 study found that the social aspect of religion had a significant negative association with loneliness among elderly people. The effect was more consistent than the effect of social relationships with family and friends, and the subjective concept of religiosity had no significant effect on loneliness.[56]

 

One study compared the effectiveness of four interventions: improving social skills, enhancing social support, increasing opportunities for social interaction, addressing abnormal social cognition (faulty thoughts and patterns of thoughts). The results of the study indicated that all interventions were effective in reducing loneliness, possibly with the exception of social skill training. Results of the meta-analysis suggest that correcting maladaptive social cognition offers the best chance of reducing loneliness.

 

en.wikipedia.org/wiki/Loneliness

 

Adam's Song" is a song recorded by the American rock band Blink-182 for its third studio album, Enema of the State (1999). It was released as the third and final single from Enema of the State on September 5, 2000 through MCA Records. "Adam's Song" shares writing credits between the band's guitarist Tom DeLonge and bassist Mark Hoppus, but Hoppus was the primary composer of the song. The track concerns suicide, depression and loneliness. It incorporates a piano in its bridge section, and was regarded as one of the most serious songs the band had written to that point.

 

Hoppus was inspired by the loneliness he experienced while on tour; while his bandmates had significant others to return home to, he was single. He was also influenced by a teen suicide letter he read in a magazine. The song takes the form of a suicide note, and contains lyrical allusions to the Nirvana song "Come as You Are". "Adam's Song" was one of the last songs to be written and recorded for Enema of the State, and it was nearly left off the album. Though Hoppus worried the subject matter was too depressing, his bandmates were receptive to its message. The song was produced by Jerry Finn.

 

"Adam's Song" peaked at number two on the US Billboard Hot Modern Rock Tracks chart; it was also a top 25 hit in Canada and Italy, but did not replicate its success on other charts. It received praise from music critics, who considered it a change of pace from the trio's more lighthearted singles. The single's music video, a hit on MTV, was directed by Liz Friedlander. Though the song was intended to inspire hope to those struggling with depression, it encountered controversy when a student of Columbine High School committed suicide with the track on repeat in 2000.

Character Creation

 

Moon Knight is a character appearing in American comic books published by Marvel Comics. Created by writer Doug Moench and artist Don Perlin, the character first appeared in Werewolf by Night #32 (August 1975).

 

The son of a rabbi, Marc Spector served as a Force Recon Marine and briefly as a CIA operative before becoming a mercenary alongside his friend Jean-Paul "Frenchie" DuChamp.

 

During a job in Sudan, Spector is appalled when ruthless fellow mercenary Raoul Bushman attacks and kills archeologist Dr. Alraune in front of the man's daughter and colleague, Marlene Alraune.

 

After fighting Bushman and being left for dead, a mortally wounded Spector reaches Alraune's recently unearthed tomb and is placed before a statue of the Egyptian moon god Khonshu. Spector apparently dies, then suddenly revives, fully healed.

 

He claims Khonshu wants him to be the "moon's knight", the left "Fist of Khonshu", redeeming his life of violence by now protecting and avenging the innocent.

 

While early stories imply Spector is merely insane, it is later revealed Khonshu is real, one of several entities from the Othervoid (a dimension outside normal time and space) once worshipped by ancient Earth people.

 

On his return to the United States, Spector invests his mercenary profits into becoming the crimefighter "Moon Knight", aided by Frenchie and Marlene Alraune, who becomes his lover and eventually the mother of his daughter.

 

Along with his costumed alter ego, he primarily uses three other identities to gain information from different social circles: billionaire businessman Steven Grant, taxicab driver Jake Lockley, and suited detective and police consultant Mr. Knight.

 

It is later revealed Moon Knight has dissociative identity disorder (DID) (incorrectly referred to as schizophrenia in some stories), and that the alter egos known as Grant and Lockley originally manifested during his childhood.

 

Other subsequent alter egos who do not assume the Moon Knight identity have emerged at other points during his adulthood, including a werewolf-fighting astronaut; impersonators of Khonshu, Spider-Man, Wolverine, Captain America, Iron Man, and Echo; and a red-haired little girl known as the Inner Child, introduced in the Ultimate Marvel continuity.

 

It is debated in different stories whether Spector has genuine DID due to childhood trauma or if his similar symptoms are the result of "brain damage" caused by his psychic connection to Khonshu, a connection compelling his personality to shift between the god's four major aspects.

 

Khonshu claims he created a psychic connection with Spector, Grant, and Lockley when the latter were young, decades before they became Moon Knight.

 

In most of his stories, Moon Knight has no supernatural abilities beyond occasional visions of mystic insight.

 

He relies on athletic ability, advanced technology, expert combat and detective skills, and a high tolerance for pain based on willpower, training, and experience. Since becoming Moon Knight, there have been multiple occasions when the character has died only to then be resurrected by Khonshu, implying he may now be effectively immortal until the moon god's protection is revoked (whether Khonshu has limitations on how often he can resurrect Spector is unknown).

 

For a time, Moon Knight's strength and resistance to injury could reach superhuman levels depending on the phases of the moon, but this ability later vanished, while the Moon Knight identity is occasionally depicted as an independent alter ego of the others.

 

The character has made appearances in various media outside of comics, including animated series and video games. Oscar Isaac portrays Marc Spector / Moon Knight, Steven Grant / Mr. Knight, and Jake Lockley in the Marvel Cinematic Universe live-action television series Moon Knight (2022).

 

Development

 

In an interview, Doug Moench recalled the character's genesis: "Somebody mentioned in the office and suggested using The Committee, and that I should bring The Committee back, and then I found out who The Committee were and thought, well they're really boring, I don't wanna use them. And then I thought, well wait a minute, how about if The Committee hires a mercenary to kill the Werewolf. And I thought, yeah that's a good idea, then I create this new character and it won't be these boring guys in business suits, it would be a flashy character. So, I said who is best to kill the Werewolf? Well, someone who uses silver weapons because silver hurts the Werewolf. And tied to the night, because the Werewolf only comes out at night, and I'll base this character on the Moon, because the Moon makes the Werewolf change, and this is going to be the opposite of the Werewolf, and as soon as I said the Moon I said, ooh I'll have a costume that's just like the Moon, just black and white, jet and silver, no color on the costume."

 

Don Perlin also commented on the creation of the character, "We were told we needed a costumed character in the book. So Doug and I created Moon Knight. I wanted the costume to be just black and white. Since he'd be on a color page, that would make him a little bit different. He had a silver baton he could use when he battled werewolves. See, he was hired to track down to kill the Werewolf."

 

Publication history

 

The character debuted in Werewolf by Night #32 (August 1975), written by Doug Moench with art by Don Perlin and Al Milgrom, as a mercenary hired by the Committee to capture the title character. The creative team gave Moon Knight moon-related symbols and silver weapons (a metal poisonous to a werewolf) to mark him as a suitable antagonist for the werewolf hero.

 

The two-part story continues into #33, when Moon Knight realizes Russell is a victim rather than a monster and decides to help him. A demonic vision of Moon Knight then appeared in Werewolf by Night #37 (March 1976).

 

Editors Marv Wolfman and Len Wein liked the character and decided to give him a solo story in Marvel Spotlight #28–29 (June/August 1976), again written by Doug Moench with art by Don Perlin. The story, along with Spectacular Spider-Man #22–23 (September/October 1978) written by Bill Mantlo, recast Moon Knight as a more heroic character.

 

His association with the evil Committee during his first appearance was retconned to be an undercover mission he undertook to learn more about the villains.

 

Moon Knight acted as a hero again in Marvel Two-in-One #52, written by Steven Grant with art by Jim Craig. In The Defenders #47–51, Moon Knight briefly joined the Defenders during their war against the Zodiac Cartel.

 

Moon Knight appeared in recurring backup stories in Hulk! Magazine #11–15, #17–18, and #20, as well as a black and white story in the magazine publication Marvel Preview #21, all written by Doug Moench. Artist Bill Sienkiewicz drew Moon Knight in Hulk! Magazine issues #13–15, 17–18, and #20, creating a new look for the character heavily influenced by the art of Neal Adams, who at that time was most popular for his work on Batman and Green Lantern/Green Arrow for DC Comics.

 

This, along with Moon Knight's methods and the atmosphere of his stories, cemented a perception among some readers that he was Marvel's version of Batman. The Hulk backups and Marvel Preview issue provided Moon Knight with a partial origin story and introduced his brother, recurring villain Randall Spector (who would later become Shadow Knight).

 

Origin

 

Born in Chicago, Illinois, Marc Spector was the rebellious son of an academic Jewish rabbi whose family had fled Europe in the 1930s to escape the Holocaust.

 

Marc could not understand why his father refused to fight against his people's persecution and grew disgusted with his pacifistic ways, viewing him as a coward.

 

Rejecting his father's faith, Marc started out as a heavyweight boxer before eventually joining the U.S. Marines, where he was trained as a commando. Shortly afterward, his skills led to his recruitment into the Central Intelligence Agency.

 

He worked with William Cross (who later became the villainous Crossfire) and his own brother, Randall Spector. However, Randall betrayed the CIA and was secretly smuggling and selling weapons. When Marc's lover discovered this and tried to turn him in, Randall brutally murdered her with a meat cleaver. In retaliation, Marc hunted Randall down, but during the fight, Randall was seemingly killed by an exploding grenade.

 

Fed up with the CIA, Marc went independent and became a fierce soldier of fortune, renowned for his willingness to do anything providing the job paid well enough. In Africa, he met a French mercenary, Jean-Paul "Frenchie" DuChamp, who would become one of Marc's closest friends and Marc's pilot.

 

While working for the terrorist Raoul Bushman, Marc became increasingly disturbed by Bushman's savagery and ruthlessness. For the first time in his life, his conscience had awakened, and it troubled him deeply. In Selima, Sudan, they stumbled across archaeologist Dr. Peter Alraune's excavation of an Egyptian Pharaoh's tomb. Believing there were gold and riches within, Bushman murdered Alraune to plunder the tomb.

 

Sickened by Bushman, Marc tried to do the decent thing and helped Alraune's daughter, Marlene, escape from Raoul's notice. Annoyed with Marc's betrayal, Bushman brutally beat Spector and abandoned him in the desert so he would suffer before he died.

 

Barely conscious, Spector staggered to the ancient tomb for shelter. Marlene was there with her father's men and brought Marc to rest near a statue of the moon god, Khonshu.

 

Weakened from his fight with Bushman and the elements of the desert, Marc Spector died. As Marlene cried over his cooling body, Spector suddenly returned to life, claiming that he had a vision that Khonshu had brought him back from the dead to be the Moon's Knight of Vengeance.

 

Spector removed the burial shroud from the statue of Khonshu and wrapped it around himself as a makeshift cloak, before confronting Bushman once again, and this time, he was victorious. Thus, Moon Knight was born.

 

Major Story Arcs

 

The Hero of the Night Rises

 

After defeating Bushman, Marc returned to the United States with Marlene and Frenchie along with the statue of Khonshu. He decided to continue his work to fight a war against evil and used his savings that he had collected during his mercenary days and invested it, turning it into a small fortune which he proceeded to finance and support his private war and set up shop in New York City.

 

In an effort to distance himself from his mercenary days, Marc created the persona of Steven Grant, a millionaire entrepreneur and high-roller whose jet setting personality enabled him to walk among the high rollers and elite of New York City. Realizing the value of these contacts as criminal activities are often plotted and planned at cocktail parties and boardrooms, Marc also decided to create a persona for lower level contacts and invented the identity of Jake Lockley, a New York cab driver. Through Lockley, he was able to make several contacts "on the streets" such as Bertrand Crawley and Gena Landers plus her sons Ricky and Ray.

 

Shortly after developing his costume and weapons along with a customized helicopter known the "Mooncopter", Frenchie posing as a French businessman made contact with a group of aristocrats known as "The Committee" who had plans to capture and retrieve Jack Russell, the Werewolf By Night whom they intended to use as a weapon to fulfill their desire to rule the city. Frenchie acting as the go-between, presented the Committee members with Marc Spector as a mercenary and ostentatiously revealed the Moon Knight costume and weapons which Frenchie claimed that he had created to battle Russell.

 

Although Marc was successful in defeating Russell, his suspicions were realized when he discovered the Committee's goals and proceeded to release Jack and defeat "The Committee" which earned him their undying enmity and established Moon Knight as a vigilante to be respected.

 

After thwarting a man calling himself Conquer-Lord, Moon Knight briefly joined the superhero team, The Defenders, to fight the Life Model Decoys of a villain group called Zodiac. He then went on to battle Cyclone alongside Spider-Man, and Crossfire with The Thing, as well as some solo missions against a terrorist group lead by a man named Lupinar, and even his own brother, Randall who had survived their previous encounter and had become a psychotic ax killer targeting women.

 

Afterwards, Moon Knight encountered villains that would become part of his own rogues gallery--such as the Midnight Man, Morpheus, Stained Glass Scarlet, and Black Spectre, just to name a few--and teamed-up with Spider-Man a few more times, as well as other heroes such as Daredevil, Iron Man, Power Man and Iron Fist.

 

Then, Marc received word that his father was dying and decided to try and patch things up with him. Unfortunately, his father passed away before he was able to return to Chicago and instead discovered that his father's body had been stolen by his father's former student, Zohar who used the deceased rabbi's body to focus for his mystical spells to punish Marc for his perceived sins against his dead mentor.

 

Although Moon Knight was able to overcome Zohar; the mental trauma combined with the act of juggling his different personas put a serious strain on Spector's mental health and he suffered a nervous breakdown and was deemed to be suffering from Multiple Personality Disoder (MPD) or as it later became renamed; Dissociative Identity Disorder (DID).

 

The Fist of Khonshu

 

After several months of recuperation for his mental health, Spector decided to retire as Moon Knight and with pressure from Marlene who greatly preferred his debonair and sophisticated Steven Grant persona, decided to give up both his Jake Lockley and Marc Spector identities. Marc became convinced that he only had a near-death experience and merely hallucinated the episode with Khonshu and even sold the idol of the Egyptian deity.

 

Marc however was plagued by strange dreams which convinced him that he had to return to the Valley of the Kings in Egypt.

 

Marlene however adamantly refused to follow him again in his downward spiral of violence and insanity and demanded that he not go, sure that he would once more take up the mantle of Moon Knight. When he did so anyways, she left their home and broke up with him.

 

On his pilgrimage in Egypt, Marc met three priests who proclaimed that the idol of Khonshu had fallen into hands of the avatar of Anubis, Ahmad Azis who intends to perform a ritual that would destroy the idol to strike back at Khonshu whom he believes is the sole thing stopping him from world domination.

 

Proclaiming Marc as the Fist of Khonshu, they gifted him with an assortment of mystical weaponry and supernatural strength and powers that waxed and waned with the light of the moon.

 

His strength renewed and his faith restored, Marc would once again take up the mantle of the Moon Knight and even more powerful than before would defeat Anubis' plot and rescue the idol of Khonshu.

 

Strangely enough, seconds after saving the idol from being destroyed; a sudden desert sandstorm comes and blinds Azis and causes the temple to collapse on him, killing him.

 

The Silver Avenger

 

When the the West Coast Avengers were trapped in ancient Egypt, Hawkeye made a pact with Khonshu and created an assortment of weapons that Khonshu would mystically enhance and would subsequently be gifted to Marc Spector in the 20th Century.

 

In exchange, Khonshu informed his avatar, Marc Spector of their situation; allowing Moon Knight to help rescue them and return the Avengers to the present. Moon Knight then joined the team as the 24th Avenger.

 

He possessed a rather tumultuous stint of membership even though he proved to play a critical role in defeating Dominus and later, the Examiner of the Silg race; he often had a habit of playing fast and loose with the rules such as his pursuit of Cornelius Van Lunt which may have driven the man to his death and possessed less-than-stellar teamwork due to his longtime career as a loner. Further, his tenure was complicated with a romantic relationship with fellow Avenger Tigra.

 

When it was discovered that Mockingbird had allowed the Phantom Rider to be killed after he had drugged and raped her, her husband Hawkeye denounced her which caused Mockingbird to resign. In response, Tigra and Moon Knight both chose to accompany her and form their own splinter group of Avengers. The trio would fight the High Evolutionary in the Evolutionary War alongside Bill Foster, as well as battle the Night Shift.

 

When the team sought help from Hellstorm for the Phantom Rider's haunting of Mockingbird, it was discovered that Khonshu was possessing Moon Knight and was the true source behind his supernatural lunar-based powers.

 

Hellstorm was able to convince the Egyptian God of the Moon to leave Spector's body and it was revealed that it was Khonshu, not Marc who wanted to join the Avengers West Coast. Unsure of how much of Khonshu's influence had on himself for the past few months led Marc to breaking off his relationship with Tigra and also abandoning his mystical weapons.

 

Marc Spector: Moon Knight

 

After the fallout of Khonshu's possession, Marc returned to New York and sought out Marlene and reforge his ties with Frenchie even though he was no longer certain he wishes to continue as Moon Knight anymore. However, the return of his old enemy Bushman who kidnaps Marlene prompts him to return as the Crescent Crusader.

 

However without Khonshu's supernatural influence, Spector was much more psychologically stable and did not resume his previous identities of Jake Lockley or Steven Grant. Instead, he refocused his financial empire and created his own company SpectorCorp while he dedicated himself towards more urban street crimefighting over the more cosmic, supernatural evil that he previously battled under Khonshu's influence.

 

Afterwards, Marc discovers that an old enemy, Midnight Man may still be alive only to discover that foe is deceased but his grown son now seeks to redeem his father's criminal lifestyle as a hero and has sought out his father's greatest enemy; Moon Knight to train him up to become a crimefighter.

 

Feeling a sense of obligation, Marc reluctantly agrees. Desperate to prove himself worthy, Midnight infiltrates the Secret Empire and is ultimately captured and is presumed deceased while dressed up as Moon Knight.

 

Midnight however survived his horrific wounds and is converted into a cyborg soldier for the Secret Empire. Believing that the Silver Avenger had abandoned him, Midnight came to believe that his condition was all Moon Knight's fault.

 

With Midnight acting as their field agent, he broke Thunderball out of jail which earned him the attention of Spider-Man and Darkhawk. He was able to escape but Spider-Man recognized Midnight from his previous encounter with Moon Knight and called in the Lunar Legionnaire.

 

Midnight was then sent to capture the New Warrior Nova and discovered that he was soon to be rendered obsolete as merely one of cyborg grunts while the Empire would rebuild superhumans to enhance their formidable attributes.

 

With the clandestine assistance of a sympathetic nurse, Lynn Church who disabled the Empire's control devices, Midnight turned on the Empire and sought to establish himself as their new leader. Alongside Spider-Man, Darkhawk, the Punisher, Night Thrasher, the freed Nova; Moon Knight aided in bringing down the Secret Empire as well as Midnight and Lynn Church who was actually a cyborg herself who had been using Midnight as the testbed of the most successful cybernetic implants for her own upgrades.

 

In another encounter with his brother who had taken up the costume of Shadowknight as a sort of twisted version of his Moon Knight identity, there was an explosion at Spector Mansion which crippled Frenchie, leaving him paralyzed from the waist down and forcing him to abandon his role as a Moon Knight's pilot.

 

As a consequence, Marc was forced to create the "Angelwing", a remote controlled aircraft for his activities. An increasingly formidable array of opponents also prompted him to upgrade his crimefighting equipment and accoutrements.

 

Marc also began actively recruiting specialized agents to assist him on his missions from psychological profiles, to expert thieves, and intelligence operatives in a think tank organization he dubbed "The Shadow Cabinet" that he kept in contact via holo-communicator rings.

 

Moon Knight would later become infected by the then-demonically possessed Hobgoblin with a demonic virus which prompted Marc to create a suit of armor which helped contain the virus while he sought a cure to his deteriorating physical condition and was only cured thanks to the mystical aid of Dr. Strange.

 

Infinity War and Crusade

 

When the Magus, the evil incarnation of Adam Warlock plan to gain absolute power, he created evil doppelgangers of both heroes and villains on earth. Moon Knight had to face his own evil self, manifested as Moonshade which he defeated.

 

After the War, the Goddess, the good incarnation of Adam Warlock recruited many heroes who are very spiritual, religious have had near-death experiences.

 

Because of Moon Knight's close affiliation with the moon god and his first resurrection to serve as the avatar of vengeance; the Goddess recruited Moon Knight to defend her as she purges the evil in the universe. Moon Knight was returned to normal when the Goddess was defeated by the combined efforts of Adam Warlock, Thanos and Professor X.

 

Soon afterwards in a battle against Seth the Immortal, Moon Knight sacrificed his life to save Marlene and Frenchie.

 

Resurrection War

 

Khonshu seemingly willed Moon Knight back to life in order to thwart the plans of his three greatest villains: Black Spectre, Raoul Bushman and Morpheus, who were all under the worship of Set, God of Darkness and Chaos.

 

Marc, questioning if his death was real or not, started experiencing dreams of the future in which Marc concludes that it is either Morpheus or Khonshu speaking to him once again. With the knowledge that he is the "white-light" of Khonshu, he sets out to thwart their plans, receiving help from Stained Glass Scarlet as well.

 

The two are able to defeat the trio and stop their plans of attacking a U.N. building that was holding a meeting at the time. Afterwords, Moon Knight went back to his crime-fighting once again.

 

He helped save the Black Panther from the Kingdom of the Dead and subsequently joined the Marvel Knights, a group of street level superheroes and vigilantes. However the team broke apart and went their separate ways including the Crescent Crusader.

 

Moon Fall

 

In an attempt to bring down the Moon Knight, the New Committee hired the The Profile to fully utilize his unusual talents to not simply defeat Moon Knight, but to break him.

 

As per his suggestion, they embarked on a long term strategy. First, they hired Bushman to attack the Lunar Legionnaire again. As part of their campaign, they wanted Bushman to physically cripple him and both of Marc's legs were severely fractured.

 

However, Bushman grew overconfident and was unprepared for Marc's brutal counterattack and then, in a fit of indescribable rage, Marc used one of his crescent darts to carve off Bushman's face, giving him a true death's head.

 

Unable to continue his career as Moon Knight, Marc began taking more and more painkillers and anti-psychotics, burning through his fortune and was no longer able to maintain his crumbling financial empire.

 

His manner had gotten to the point that he completely and irrevocably alienated those around him, especially Frenchie, who came to the conclusion that there was simply no course of action that he could take that could attempt to assist Marc in even the slightest way. After a heated argument with Marlene, Marc struck her and Marlene left.

 

His sanity apparently deteriorating as he is constantly "seeing" and "hearing" Khonshu talk to him and give him foul suggestions while Khonshu decided to use the guise of the deceased Bushman (without his face) to torment Moon Knight.

 

Knowing that he was both physically and psychologically weakened, the Committee overstepped themselves by hiring a thug to physically assault Frenchie and left him hospitalized.

 

Instead of breaking Marc, it reinvigorated him as he tracked down and savagely injured Frechie's assailant. Panicking, the Committee hired the Taskmaster to take out Moon Knight.

 

Taskmaster tortured Marc but he was aided by Marlene and defended by his butler, Samuels. This gave Marc the strength to defeat Taskmaster and destroy the Committee once more.

 

Soon afterwards, Marc learns that one of the struggling companies that he still retains ownership of has just made a significant technological breakthrough and he will once again be wealthy and begins to rebuild himself and life; finally getting himself out of his wheelchair and began physical therapy.

 

It is only afterwards that Marc makes an appalling discovery that Khonshu was responsible behind the entire affair. After Marc's latest resurrection, his reputation had taken a nose dive and so Khonshu decided to ensure that his Knight of Vengeance was firmly back in the saddle; nudging the Committee, bringing back Marlene at a critical moment, even arranging for Marc's wealth to be restored while reminding him who and what he is; Khonshu's Knight of Vengeance and bades him to go forth and do his work in Khonshu's name once more.

 

Although the Committee has gone underground, Marc locates the Profile who discovers that he was no match for Moon Knight, and ironically, became an informant for him instead.

 

Moon Knight takes back to the streets and attempts to be make up for lost time and would discover a string of murders were perpetrated by his former sidekick turned cyborg, Midnight who had survived their last encounter and had gone insane. Realizing that he had no choice, he was forced to kill his former sidekick Midnight.

 

The Waning Moon: Civil War and the Initiative

 

During the Civil War, Moon Knight chose to ally with neither side because, as he had said to Captain America, "The war is just like a game of capture the flag". Captain America retorted that he didn't want Moon Knight to join the fight because of his "methods" of bringing justice and Iron Man, seeing his history of psychotic tendencies and feeling some sense of obligation due to their past history as Avengers, decided that arresting him will just make his condition even worse.

 

When the Super-Human Registration Act became a law, Moon Knight felt that he didn't want the law to disrupt his work, so legally registered. Tony Stark assigned Marc to undergo a psychiatric examination, sure that he would fail. But when the psychiatrist placed Marc under deep hypnosis to talk to Marc's other personalities, Khonshu emerged and possesses Marc who then demoralized the psychiatrist and rebukes him.

 

After this the intimidated psychiatrist approved Marc's registration, but also did something quite peculiar--he bowed down before him and started worshiping him.

 

Afterwards, Marc claimed to the Profile that he had faked the whole possession and had employed the information given to him by the Profile to frighten the psychiatrist as a ruse to get his registration approved and proceeded to stalk the nights, bringing brutal justice to the thugs and gangs running around the city.

 

Unknown to Marc, the Black Spectre was recently released from jail and sought revenge against Moon Knight. The Black Spectre decided to turn to his life of crime again and frame Moon Knight for murder by killing his victims and carving a crescent moon on the victims head, which was Moon Knight's previous calling card. Due to public pressure, Iron Man immediately revoked Moon Knight's ID and told him he is no longer apart of the Initiative.

 

Looking to still bring justice on Black Specter, Marc finds out that he is going to release a stream of nanobots into a big parade in a plan to control the city. Moon Knight thwarts his plan and ends up throwing him off the roof of a building to his death. Outed by the government and with SHIELD searching for him, Spector moves underground.

 

With a warrant out for his arrest the, C.S.A. call in for the Thunderbolts to come and hunt down Moon Knight as a fugitive of the law. Iron Man strongly opposes the idea but is overruled on the matter. Moon Knight continues to lay low only to resurface in a black uniform and a with a few new bones to pick. SHIELD interrogates several of Marc's friends and contacts, although nothing comes out of them. Now is the time for the Thunderbolts to strike.

 

Several weeks later after having a run-in with the Thunderbolts, Moon Knight pleads with Khonshu for forgiveness for losing his faith at him, but the Lunar god will not have it and says that he has worshipers that actually follow him. Marc returned into his costume to help Frenchie, who was attacked by a gang. But little did he knew that the attack was used to set-up Moon Knight to be captured by the Thunderbolts. Moon Knight was then ambushed by Venom.

 

He was captured by the reformed villain team, but he got away when SHIELD came. Frenchie agreed to help Moon Knight while the Thunderbolts release Bullseye to kill him.

 

Moon Knight and Bullseye fight all throughout New York and the battle leads them to a warehouse, which was secretly planted with many explosives. Moon Knight sets it off and the warehouse explodes.

 

Later in a press conference Norman Osborn tells reporters about the Thunderbolts' success in eliminating Moon Knight while Iron Man condemns his team on the death of the vigilante.

 

However, it all was a ruse for Moon Knight to fake his death via a prepared escape tunnel. However, the events effectively killed the "Marc Spector" persona with the Jake Lockley persona now in control.

 

Lockley fled to Mexico to recuperate and is hired by a millionaire to search for his daughter who has been kidnapped by corrupt cops.

 

Little does Moon Knight know that the Punisher is also in the trail of the corrupt cops and is now out to bring them justice through a method he knows best, punishment.

 

Moon Knight then goes to fight off the Zapata Brothers (who were brought in by Alcantara after Jake killed his henchmen and took his condemned daughter) only to make a deal with them to take down Alcantara. Moon Knight then proceeds to launch a full-scale assault on Alcantara when he finds everyone is murdered except Alcantara himself until Toltec finds them and Moon Knight walks away as Toltec kills Alcantara. Moon Knight (having taken Alcantara's money and bought himself a condo) has seen on TV what Norman Osborn has become and vows to go back to the U.S. and bring him down.

 

Return with a Vengeance

 

Moon Knight has returned to New York to exact his revenge on Norman Osborn and did so by stopping a bank heist in progress without killing a single bank robber, much to the surprise of the police.

 

Khonshu is still convincing him to become the ruthless vigilante he was before, but Moon Knight continues to ignore the temptations of the deity and plans to redeem himself as well as reform into a new hero. News of Moon Knight's return circulated throughout the bustling city, with Norman Osborn denouncing him as a renegade and a menace while promising the public that Moon Knight will be dealt with for his acts of vigilance accordingly.

 

The Sentry appeared before Moon Knight and reminded him that he can never run from his past and that he will be tested for to prove himself as a hero, to which he replied that he will also be tested as well.

 

Moon Knight paid a visit to his criminal contact, the Profile and told him about the Slug and some stolen diamonds that he has. Moon Knight confronted the Slug and his henchmen for the diamonds, while Khonshu urges him to kill the villain but he was squashed in the floor.

 

Meanwhile, Norman Osborn has delegated the Hood on stopping Moon Knight. The Hood then had the Profile to track down and profile Moon Knight. The Profile thought of a plan to take down Moon Knight and it involves the grave of his late nemesis, Raoul Bushman.

 

Jake goes home and sees the news coverage about the jailbreak in Ravencroft. Jake suits up as Moon Knight and tells his butler to call his pilot for the Mooncopter, but he cannot reach him and Moon Knight decides to use his other vehicle, Angelwing.

 

When the hanger doors were opening, Moon Knight was surprised to see his old partner, Frenchie, dressed in a aviator suit and walking on a cane. Reunited with his friend, Frenchie flies the Mooncopter and drops Moon Knight inside the melee of the escaped convicts. In the middle of the chaos, Khonshu is still persuading Moon Knight to kill for him, but to no avail.

 

When Moon Knight called Frenchie to come back, he told him he can't because of an enormous flock of birds blanketing the sky, which was summoned by the Scarecrow. Frenchie then shoots a large net from the Mooncopter to catch the flock, neutralizing it.

 

Moon Knight then catches Scarecrow, but he then argues to him that Moon Knight should confront his old nemesis, Bushman. Moon Knight goes to his contact, Crawley for any word from the street,but they were suddenly attacked by Bushman.

 

After taunting him, Bushman fires a RPG to Moon Knight but it hits a corner of building, threatening it to collapse. Moon Knight rushed in to hold the building and Bushman left him to be beaten by his army of convicts from Ravencroft.

 

After beating the convicts with only his underwear and mask on, Moon Knight carves his symbol on all that he defeated on their strait jacket.

 

Spider-Man then swings by and he tried to convince Moon Knight to stop his heroics before he return back to his murderous ways, to which Moon Knight argued that his heroism doesn't fare better because Norman Osborn is still in power.

 

Moon Knight got a tip from Crawley goes in search for Bushman in one of OsCorp's warehouses. Moon Knight then infiltrates the warehouse and begins searching for Bushman to no avail, until he surprises Marc. After a much drawn out, grueling fight between Marc has Raoul pinned down and mounts him with his crescent dart in his hand as if to cut off Bushman's face again.

 

Though Bushman begs Marc not to take his face again, causing much hesitation for the hero before stopping his act. Marc left and let the authorities take care of him. Meanwhile, now that Marc has prevailed, The Profile left to the cavern of Khonshu, for reasons unknown.

 

Moon Knight finds that someone has forcibly enter a hospital. When he got there, he saw Deadpool about to kill a bed-ridden patient. Moon Knight stops him and they go into a brief scuffle until Deadpool gets thrown through a window and escapes. Moon Knight then finds out that the person he just rescued was a Ukrainian crime boss dying from cancer, that made him question himself about being a hero.

 

Deadpool then met up with his employer, a mother whose son was kidnapped by the crime boss' henchmen. Moon Knight goes to see Deadpool and after they talked, Moon Knight goes to a warehouse to rescue the employer's son. Moon Knight saves the boy and left the henchmen for the police, but soon Deadpool picked up where they left off in their previous encounter.

 

They fought in a carnival's hall of mirrors where the duel turned into a sword fight, which left Moon Knight left as the winner. When Jake was having nightmares in his sleep, he suddenly woke up rushed to get into the hospital but he was too late to save the crime boss from Deadpool's employer who killed him with an injection of potassium chloride, stopping the patient's heart.

 

Heroic Age

 

After the events of Dark Reign and Siege, Norman Osborn was deposed as America's "top cop" and his organization H.A.M.M.E.R. was disbanded. Captain Steve Rogers then forms the Secret Avengers as a group of superheroes to operate under a veil of secrecy, in addition to the main Avengers team.Moon Knight was approached by Steve Rogers and he asked him to join the Secret Avengers to find his redemption.

 

Moon Knight agrees to this and his first mission was to go after Captain Barracuda who was capturing Oil Tankers. Moon Knight proved himself to the team by saving them and the Tanker crew when Captain Barracuda used the Horn of Proteus to summon sea monsters and destroying the Oil Tanker.

 

Next, Moon Knight infiltrated Roxxon headquarters with fellow Avenger, Ant-Man. They then had to travel to Mars to rescue another teammate, Nova who was looking for the Serpent Crown. The team split up and Moon Knight was accompanied by Black Widow and Valkyrie to look for Nova.

 

When they found him he is wearing the Serpent Crown and he also detected their presence. He and Black Widow were knocked unconscious when they confronted Nova. After the threat on Mars, the team went back to Earth and continues their objective of finding out who is trying to steal the Serpent Crown and why they want it.

 

Shadowland

 

Moon Knight goes to his mansion and sleeps with Marlene, he wakes up and is taunted by Khonshu on going back to his murderous ways and to kill in his name. The other night, Marlene asks Jake out and reveals that she is pregnant, which he is happy about.

 

After days of being taunted by someone calling himself Shadow Knight, Jake gets a mission from Steve Rogers to infiltrate Shadowland as a prisoner. As the heroes and the Hand ninjas fight each other, Jake takes a white cowl and joins to the brawl.

 

Daredevil then attacks Marc from behind, but when Moon Knight begins to fight him, his mind is subsequently infiltrated by an unknown entity that has been inside Daredevil. Khonshu then appears and tells Moon Knight that in order to kill the creature, he will need the Sapphire Crescent, an artifact that was a part of the original sculpture of Khonshu.

 

Moon Knight asks for it, but Khonshu demands him to kill in his name, which Moon Knight declines to do. When he returns home to his mansion, he finds Marlene in a bloody pulp and is informed that Shadow Knight did this and that the baby she was carrying is now dead. Moon Knight then agrees to kill for Khonshu and he will start with Shadow Knight.

 

When he begins to fight him by crashing his glider, the crazed man reveals himself to be Randall Spector. The brothers fight it out but Randall escapes. Driven by revenge over what Randall had done to Marlene, Jake agrees to kill Randall in Khonshu's name. The deity then tells him the Sapphire Crescent's history and that is found in New Orleans.

 

Jake finds it in the possession of a fortune teller which he buys for a large sum. As Jake walks through a carnival, Randall steals it and the brothers again begin a scuffle in the middle of a Mardi Gras festival.

 

Shadow Knight begins to tell Moon Knight that he is doing this because he was sent by the acolyte of Khonshu, the Profile. Jake persuades him that he is being played for a fool by the Profile (working for Daredevil) but he will not have it all. When collateral damage begins to mount, Moon Knight takes control of the fight and corners Shadow Knight on a dock, but he is prepared to commit suicide and kill them all with dynamite.

 

Moon Knight then throws the Sapphire Crescent into Shadow Knight, slicing his throat and causing him to fall in the water below. Moon Knight then flies off back to Shadowland to face Daredevil and the Hand. Afterwards, the Lunar Legionnaire declares that Jake Lockley is dead and that he is now Marc Spector once again.

 

Move to the West Coast

 

Leaving New York and memories of Marlene behind him, Marc moved to West Coast where he is developing a Moon Knight television series, "The Legend of Khonshu".

 

Unable to cope with his past identities, Marc has instead developed a new batch of personalities in the form of other heroes including Spider-Man, Captain America, and Wolverine. Marc honestly believes that he has been asked specifically by these three heroes to once again take up the mantle of Moon Knight and frequently consults with them, unaware that he is hallucinating.

 

He later recruits an assistant Buck Lime, an ex-SHIELD agent who provides technological support for his activities.

 

Investigates an illegal deal going down in the docks, Moon Knight stumbles into a major case involving high-end technology being run by Mr. Hyde. Moon Knight engages Hyde in hand-to-hand combat but Hyde escapes, leaving behind a shipment of Ultron technology.

 

Marc later continues on to uncover more details about this new gang by subconsciously dressing as Spider-Man while attacking the new gang lead by Snapdragon. Overwhelmed by the Snapdragon's henchmen, Marc was rescued by Echo, who was undercover at the time and had to blow her cover in order to save Moon Knight.

 

Teaming up with Echo to continue their investigation together, Marc begins falling in love with her and tries to pursue a romantic relationship only for it to fail badly. After fighting the Night Shift, Marc and Echo discover that the leader of this gang is none other than Count Nefaria.

 

When Moon Knight and Echo target his bases of operations, Nefaria retaliates and kills Echo before demanding that Marc serve him. Apparently surrendering, Marc instead lures Nefaria into a trap and is later congratulated by Iron Man for a job well done.

 

Age of Ultron

 

Marc was involved with the 'Age of Ultron' crossover series, and is shown to be one of the few heroes left in the city of New York, after the Avengers' villain Ultron took power. He is working with Black Widow from an old hidden base left by Nick Fury, and their plans focus on destroying Ultron, before they are destroyed.

 

Return to New York

 

Using laundered old money, Marc returned to New York with a host of new equipment including an upgraded baton and an automated limousine. He also discovered with the help of a psychologist, Elisa Warsame, that he has never had DID (Dissociative Identity Disorder) but instead when Khonshu's consciousness colonized his own, it forced Marc's mind to adapt to it's four aspects which has resulted in brain damage.

 

Calling himself "Mr Knight" and wearing a white suit and mask, Marc now works with Detective Flint's Freak Beat to investigate weird crimes. When a more direct approach is needed Marc discards the Mr. Knight persona and instead will use the Moon Knight one with a new updated light armor.

 

Some of the investigations were into trained killers going after Gen. Lor of Akima, an East African micronation that was recently being recognized by the UN. Elisa had been using therapy sessions to recruit these killers having seen Gen. Lor's violence up close. Spector confronts her and believes she is trying to recruit him, only she was actually recruiting Khonshu. who abandons Spector.

 

Spector would be arrested and sent to an off-the-books special prison. Khonshu continued to visit Spector hoping to convince him to join Elisa's quest, however, Spector was able to convince Khonshu instead that he was being used and get his help escaping.

 

They discovered Gen. Lor actually led revolutionaries against Warsame's father, the former governor of Akima, who was in fact guilty of the crimes Elisa described. Elisa has been trying to restart the unrest in her home country so that she could take her father's seized fortune quietly.

 

Spector was able to save the general before Elisa could execute him.

 

Freak Beat

 

As part of Flint's task force, Moon Knight would go on many weird investigations. For one, he would try to fight off a gang of punk ghosts; but was unable to harm them. Khonshu reminded him of his various acquisitions of ancient Egyptian artifacts, including enchanted weapons and armor. Facing of against the ghosts again in a ornate armor with a bird skull mask he was able to fight and defeat them

 

Other investigations included a pack of dogs trained to attack the city's wealthy elite, a hotel full of benevolent ghosts and violent gang members, and a demon posing as the monster under the bed. Spector believes he is representing Khonshu by protecting those who travel at night, but Khonshu disapproves of Moon Knight's current fight for justice.

 

It appeared as if Khonshu was looking for new guardians to replace Spector and collect sacrifices for him. Spector took the fight to them only to discover a cult leader acting in Khonshu's name but without Khonshu's support.

 

Versus The Moon

 

Marc Spector and his allies (Frenchie, Crawley, Marlene, and Gena) mysteriously find themselves in a mental institution with no memory of how they got there. Their past lives come back to them slowly and in fragments, with Marc the most confused due to his multiple identities.

 

The doctor in charge, Dr. Emmett, was trying to convince Marc that he imagined his adventures as Moon Knight. However, Khonshu informs him that Dr. Emmet is in fact Ammut, the Egyptian god of judgement, and that the Egyptian pantheon is trying to take over New York. This convinces Marc and his allies to stage a successful breakout, at the cost of one of their souls. Crawley volunteers.

 

Unfortunately, Khonshu was lying. It was Khonshu who was setting up a New Egypt, and he has been breaking away at Marc's psyche so Khonshu could take Marc's body for himself. Marc refused and leapt from Khonshu's pyramid. When he awoke, New York was fine and he was his billionaire identity, Steven Grant.

 

As Steven, he is producing a movie about the Moon Knight. Marc Spector is cast as the leading man. Jake Lockley is a local cab driver, who is actually Moon Knight. They all seem like they are separate people now, but they are sharing memories.

 

Just as Steven started questioning it all, he is hit with a new identity. This one shared a name with Marc Spector, but he was a fighter pilot for a futuristic space force that protected the humans of a moon colony against werewolves that had taken over Earth.

 

These disparate identities are joined together by the primary Marc Specter to hash things out with fists and words until the real Marc was finally back in control and ready to face Khonshu. Marc first revisits Anubis, who aided in Marc's escape.

 

Marc made a new deal to save Anubis' wife Anput from the Overvoid in exchange for the return of Crawley's soul and passage back to Khonshu.

 

Khonshu throws everything he can at Marc, but Marc is able to fight through it. to Marc, that means he has proven he can be Moon Knight without Khonshu, but in his final confrontation, Marc doesn't throw a single punch. He acknowledges Khonshu (or at least this version of Khonshu in his mind) as "that thing in [his] mind that is wrong" and not the Egyptian god. By doing so, Marc expels this Khonshu from his mind and receives clarity. He is suspicious of the clarity, but it feels real enough for now.

 

Versus the Sun

 

With his identities at ease and working together, Moon Knight is slowly rebuilding his street cred. In his first big fight, he comes across a tall muscular tattooed man calling himself The Truth.

 

He is able to infect people with hard truths, but when Moon Knight lets Jake take over, The Truth can’t take his dark side. Jake ends up blinding him with two shurikens to the eyes.

 

Afterward, he gets a call from his on-again/off-again girlfriend, Marlene. She invites him over after they had some time apart, but it was a ruse by the Sun King, an avatar of Ra, looking to get back at Khonshu.

 

The Sun King’s plan was to use Marlene as bait but ended up introducing Moon Knight to his daughter. Unbeknownst to Marc, Jake had been meeting with Marlene in secret, fathering the child and helping to raise it. Moon Knight fought his way out with his daughter, Diatrice, but Sun King took Marlene.

 

The Sun King also recruited Bushman, his new gang, and The Truth to aid him in taking out Moon Knight. They collected Moon Knight from his apartment and sailed to Isla Ra, Sun King’s new city for the disenfranchised.

 

Here, Sun King is determined to fight Moon Knight to the death and prove his dominance. However, Moon Knight “out-crazies” Sun King, and Sun King’s insecurity disables his abilities.

 

So, Sun King submits, Bushman and the Truth abandon his quest, and Moon Knight becomes guardian to the disenfranchised Sun King had already given shelter too.

 

Age of Khonshu and The Phoenix Force

 

With the Phoenix Force oncoming due to the machinations of Mephisto, Khonshu instructed Moon Knight to steal the abilities of the present day mantle holders of a stone age team resembling the Avengers.

 

While briefly connected to the Phoenix, Marc was so shocked by his consideration of genocide to stop Mephisto that he returned the Avengers' abilities and allowed them to best him. Black Panther tried to convince him to team up with them, but he declined, thinking the Avengers were severely outmatched.

 

Unfortunately, trying to take over the world for Khonshu had lasting effects on Marc's personal life. Marlene and Diatrice cut him out of their lives, forcing Marc to come to a reluctant agreement with his Steve and Jake personalities.

 

He forced his other two personas into his subconscious and would not allow them to take hold of their body. This way, Marc believe he could have a new beginning.

 

Midnight Mission

 

With Khonshu locked up in Aesir by the Asgardians and his personalities presently pacified, Marc continued to keep up with his duty as the guardian of those who travel at night. He opened the Midnight Mission, an office where locals can come officially request his help, and started seeing a therapist (Andrea Sterman) by special request of the Avengers. He also got himself a new office assistant, Reese, who was also a vampire, and a new friendly rival, Hunter's Moon, who was loyal to Khonshu and chastised Marc's lack of faith.

 

Marc made a name for himself busting heads in his new neighborhood. This got the attention of a helpful Tigra, who was secretly working with Black Panther. It also got the attention of the mysterious and ambitious Zodiac, who saw a number of attempts on Marc's life as a game.

 

Zodiac cut Marc off from his riches and destroyed his office building, forcing Marc to enter a partnership with the sentient residence, The House of Shadows.

 

His feud with Zodiac would reach its peak when he attacked the Midnight Mission. It required all of Moon Knight's allies including Hunter's Moon, Rutherford Winner, and former Hydra agent, Soldier, who had swiped a spare Moon Knight costume for himself.

 

When Soldier died, Reese lashed out and almost killed Zodiac. Steven took control of Marc's body and stopped her from crossing the line.

 

Blood of the Fist

 

Jack Russell knew of a prophecy within the pages of the Darkhold that referred to a weapon that could be used to kill Khonshu, who he considered his oppressor and oppressor to all werewolves. "The Blood of the Fist, anointed by the Blood of the Fist" referring to the child of a Fist of Khonshu that would "forged by the King of All Wolves." The child would be Diatrice, the daughter of Marc Spector, but in order to turn her, he needed to become The King of All Wolves.

 

He challenged the leadership of every werewolf tribe in North America and won. He then defeated Wendigos in Canada to prove himself, but when he kidnapped Diatrice, Marlene went to the Midnight Mission to send Moon Knight after Jack.

 

With Hunter's Moon's help, the two of them tracked Jack and his followers, however, Diatrice's innocent naivety disarmed Jack. He still intended to go through with it, but the window of planetary alignment required was closing.

 

Once Moon Knight was able to interfere, he was capable of distracting him long enough for him to miss his opportunity. With no reason to continue, Jack relented and left with a dire warning from Marc to stay away from his family.

 

The Structure

 

When Zodiac shot through Reese and killed Soldier, enough DNA survived on the bullet to infect Soldier with Reese's vampiric curse.

 

This got the attention of Tutor, the vampire who had sired Reese and was running the vampire cult, The Structure. He believed that Soldier was the first of many, so he treated the Midnight Mission as a rival organization. After Moon Knight had a run-in with two assassins (Nemean and Grand Mal) hired by The Structure to take them out, Moon Knight started looking into vampire activity in the city.

 

With the help from a rival vampire leader, Lady Yulan, Moon Knight got the location of a vampire conclave being held by Tutor, bringing in vampires from all over the globe. Unfortunately, Hunter's Moon was attacked by the assassins, forcing Marc to take care of them first.

 

He had them pulled into the House of Shadows to be tortured. He would then drop them through the skylight of the conclave meeting place, while he and Tigra make a fancy entrance.

 

Soldier put his Hydra terrorist training to good use by rigging the fire suppression system to go off. Marc than proved himself to be a true priest of Khonshu by consecrating the water, transforming it into holy water and taking out nearly all of Tutor's followers.

 

They left one witness, a human familiar, to send a warning back to Dracula what happens when vampires mess with New York

 

City of the Dead

 

After Moon Knight failed to save a young boy named Khalil from the Egyptian-American street gang, Sons of the Jackal, Marc went to Hunter's Moon for help entering The Duat, the City of the Dead.

 

He pledged to find the soul of the boy and bring it back to his comatose body. He tracks members of the Jackals who came to Duat after their death and had the boys heart. They also increased their strength by summoning the power of the Horsemen of Apocalypse.

 

Overpowered, he was eventually joined by the Scarlet Scarab, a fallen mercenary friend made the guardian of Duat. They soon learned that the Sons of the Jackal were stealing the innocent hearts of children to weigh on the scales of justice, thus avoiding punishment for themselves.

 

Their leader, Jackal Knight, reveals himself to be Moon Knight's dead brother, Randall, the new host of Anubis. He has summoned a Legion of the Unliving made up of Moon Knight's dead enemies.

 

They had captured Khalil because he is the host of Osiris, and Randall wanted his power for his own. Once he had it, he was too strong for Marc to take on, even with Layla's help.

 

Thankfully, because the realm is psychoactive and can be shaped by the contents of a person's heart, Moon Knight was able to create four bodies: one for each of his three personalities and Khonshu.

 

This still wasn't enough to overpower Randall and his Legion. So, when Khalil awoke during the fight, he committed suicide, freeing Osiris' physical form to take the power back from Randall. In exchange, Osiris sent both Marc and Khalil back to the land of the living to live out the rest of their days.

 

The Ghost in the Telephone

 

The Midnight Mission was targeted by Sidney Sarnak, employed by a mysterious new player. Whoever they were, they were using Sarnak's ability of brainwashing people with sound.

 

First, they manipulated The Harlequin Hitman couple to go after Moon Knight's old Shadow Cabinet, to throw Moon Knight off his game. They also tested riot-inducing music at a club that Reese and Soldier just happened to be attending.

 

Spector finally got a lead when Dylan Brock needed his protection and mentioned the Venom symbiote had been off due to the sound manipulation around town. Using the symbiote to track Sarnak, Sarnak turned himself into the police rather than be interrogated by the Moon Knight.

 

Sick of playing games with Moon Knight, this new player revealed themself as a new Black Spectre. Using 8-Ball to lure Moon Knight to Hart Island, Black Spectre revealed his use of Cobra Project mind control, which Marc had dealing with during his mercenary days.

 

He also employed every thug and superhuman The Midnight Mission has defeated as a gauntlet for Marc to run, hoping to end Moon Knight once and for all. Fortunately, a guilty 8-Ball decided to betray Black Spectre and save Moon Knight.

 

Back at the mission, Hunter's Moon had caught another of Black Spectre's employees, Vibro. Marc was forced to interrogate him psychically because Badr had beat him into a coma. Inside his mind, the two Fists of Khonshu learned that Vibro had been drilling around Manhattan turning it into a giant tuning fork to use Sarnak's sound hypnosis on. Black Spectre's plan was to force Manhattan to tear itself apart

 

The Last Days of Moon Knight

 

With the knowledge from Vibro's mind, Moon Knight hatches a plan to take out the new Black Spectre once and for all. He tracks the Black Spectre to The Mount, a skyscraper in New York. 8-Ball, now Moon Knight's resident pilot, would fly Marc, Badr, and Tigra to The Mount in his Hover-Rack.

 

Soldier would already be on site doing recon, while Reese watches over the Mission. Unfortunately, Black Spectre was ready for them. The Hover-Rack would be shot out of the sky and crash into the building, and the heroes would be quickly separated by Black Spectre's goons.

 

8-Ball would be injured and stay with his airship. Tigra would be stuck when she steps on a land mine but be saved by Soldier, who had training in ordinance disarming. Badr would track down Sarnak and try to intimidate him into turning off the sound device, and Marc would take on Black Spectre, who eventually revealed himself to be Sigmund, a member of the Shadow Cabinet Marc thought had been killed.

 

Marc was shot many times and close to death, left to watch Sigmund's work. He was visited by Khonshu, who said he didn't have enough power while imprisoned to revive him.

 

Knowing this is the end (and with approval of his identities, Jake and Steve), Moon Knight rigged Sigmund's weapon to explode before it could have any effect on Manhattan, killing him in the process.

 

In his absence, his friends carry on the good work of the Midnight Mission.

 

Revived

 

When Blade was possessed by Varnae, the first vampire, he took over The Structure and filled the sky with darkforce. Under this permanent night, the vampires of Earth would attempt world domination.

 

With help from the Avengers, Hunter's Moon, Tigra, and Wrecker would be teleported to Asgard so they may free Khonshu. Once the god was freed, he raised his past priests from the dead, including Marc, to fight back against the vampire horde.

 

As the sky cleared, the vampires had changed. They no longer were weak against the sun, meaning Moon Knight and the Midnight Mission's job was just getting started. Once they had driven the vampires back into hiding, Marc needed his first break since being revived.

 

Khonshu would not have it. He demanded Marc kill the pretender: the Shroud. Marc decided to fool Khonshu. He fought Shroud, stopping his heart, fulfilling his debt to Khonshu, but he had Hunter's Moon prepared to revive Shroud, giving him the second chance Shroud was looking for.

 

Glitter

 

In Marc's absence, a new drug kingpin, Achilles Fairchild, had moved in on the Midnight Mission territory thanks to his magic drug, Glitter.

 

Powers and Abilities

 

Due to his multiple personalities, Moon Knight possesses formidable psychic resistance and most telepathic or mental attacks are less effective on him. It has also been noted by several people that Moon Knight possesses an extraordinary degree of pain tolerance and has casually ignored debilitating wounds and major injuries to keep fighting.

 

Throughout his varied careers as a boxer, marine, commando, and CIA agent, Moon Knight possesses a wide range of skills and abilities including military strategy and tactics, infiltration and stealth techniques, military interrogation and torture techniques, driver evasion techniques, and is a competent pilot who can fly most types of aircrafts.

 

He is an expert in a wide variety of military firearms including pistols, sniper rifles, and machine guns with a marksman rating. His military training and background makes him not only an unconventional hero, he can and will use drastic means and extreme violence to stop criminals.

 

Moon Knight is a highly skilled combatant who is equally adept in both unarmed and armed fighting techniques; he is a former heavyweight boxing champion who has comprehensive knowledge of the weak points of the human body.

 

Moon Knight's fighting style is brutal and straight to the point and combines techniques from Krav Maga, Dambe, Savate, Silat and FMA (Filipino Martial Arts) to put down his opponents as quickly and as painfully as possible. He also has advanced skills in Judo, Kung Fu and is an Olympic-class athlete, acrobat and gymnast.

 

Taskmaster claims that there is no one's fighting style that he hates copying more than Moon Knight's. This is because unlike most other fighters, Moon Knight prefers not to block or evade an attack or injury if it allows him the opportunity to counterattack his opponent; much like how some boxers will actually court their opponent to attack and trusting in their stamina and ability to take punishment.

 

He is also highly adept in various conventional and unconventional weaponry as well including shurikens and thrown projectiles, combat knives and swords, batons, truncheons, bo staffs, nunchucks, three-sectional staffs, longbows, chains, and bolos.

 

Thanks to his extensive experience in criminal investigations, Moon Knight has also picked up a surprising degree of skill as a detective including how to profile psychopathic behavior and a broad base knowledge of the criminal underworld.

 

When he became the Fist of Khonshu and was possessed by Khonshu, Moon Knight gained superhuman powers derived from the moon itself.

 

During this period, Moon Knight had enhanced strength, stamina, and reflexes based on the lunar phase of the moon. He was at his strongest during a full moon, as he could lift the weight of 2 tons and at normal strength when there is a no moon, where he could lift around 700 lbs.

 

He could also see magical beings that normal humans cannot see and possessed night vision as well. Moon Knight could also become invisible in a shadowed area and had a "healing factor" that allowed his wounds to quickly heal when shined in moonlight.

 

After the exorcism of Khonshu from his body, Moon Knight appears to have lost most of his powers but there is speculation that he may or may not retain some aspect of them. He still appears to receive prophetic visions and a connection to Khonshu but it is unknown just how much is actually Khonshu's influence or Marc Spector's own mental hallucinations.

 

Moon Knight has also shown that he can be revived by Khonshu. This may prove that Moon Knight is near immortal.

 

Weapons and Equipment

 

Thanks to his immense wealth, Marc Spector has financed the development of numerous weapons, armored costumes, devices, specialized vehicles, and equipment as Moon Knight.

 

Crescent Darts

 

Even though Moon Knight has utilized a wide variety of weapons throughout his career, his most widely utilized and best known are his crescent darts.

 

The crescent darts are sharpened metal throwing weapons similar in size to Japanese shurikens and visually appear to be based on the Gibbous moon. Moon Knight has often concealed a crescent dart in his hand and in the past has used them for close quarters combat; as his calling card; and during certain parts of his career--even using them as makeshift gruesome carving tools into his victims.

 

Moon Knight can hurl several of these darts simultaneously with impressive force and accuracy as well as performing deflection shots. In addition, he has utilized crescent dart throwers; mechanical devices mounted on his wrists that enable him to discharge a barrage of crescent darts at high velocities for better penetration and offensive spread patterns.

 

Over the years, he has employed crescent darts forged out of silver for anti-werewolf use; specially modified explosive crescent darts that detonated on impact; as well as ones forged out of unbreakable adamantium alloy that can cut through virtually anything.

 

⚡ Happy 🎯 Heroclix 💫 Friday! 👽

_____________________________

 

A year of the shows and performers of the Bijou Planks Theater.

 

Secret Identity: Marc Spector

 

Publisher: Marvel

 

First Appearance: Werewolf by Night #32 (August 1975)

 

Created by: Doug Moench (Writer)

Don Perlin (Artist)

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

 

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are more likely to have severe symptoms. At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[ Around 20% of those people will remain asymptomatic throughout infection, and the rest will develop symptoms later on, becoming pre-symptomatic rather than asymptomatic and therefore having a higher risk of transmitting the virus to others. Some people continue to experience a range of effects—known as long COVID—for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases. Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by reverse transcription loop-mediated isothermal amplification (RT-LAMP) from a nasopharyngeal swab.

 

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

 

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

 

SIGNS AND SYSTOMS

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

 

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease. Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.

 

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.

Most people recover from the acute phase of the disease. However, some people continue to experience a range of effects for months after recovery—named long COVID—and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

CAUSE

TRANSMISSION

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.

 

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation. The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.

 

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact. A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads. The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.

 

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.

 

The number of people generally infected by one infected person varies. Coronavirus disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.

 

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear. People remain infectious in moderate cases for 7–12 days, and up to two weeks in severe cases. In October 2020, medical scientists reported evidence of reinfection in one person.

 

VIROLOGY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.

 

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV. The structure of the M protein resembles the sugar transporter SemiSWEET.

 

The many thousands of SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).

 

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.

 

SARS-CoV-2 VARIANTS

Three known variants of SARS-CoV-2 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).

 

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant ‘VUI – 202012/01’ (the first Variant Under Investigation in December 2020) transmits more easily than other strains.

 

PATHOPHYSIOLOGY

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.

 

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed. SARS-CoV-2 could cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found people transferred to Intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains – without detected SARS-CoV-2 – and the olfactory bulbs from those who have died from COVID-19.

 

Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.

 

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.

 

IMMUNOPATHOLOGY

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

 

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 . Lymphocytic infiltrates have also been reported at autopsy.

 

VIRAL AND HOST FACTORS

VIRUS PROTEINS

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.

 

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.

 

HOST FACTORS

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.

 

The virus' effect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.

 

HOST CYTOKINE RESPONSE

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.

 

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.

 

DIAGNOSIS

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.

 

VIRAL TESTING

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.

 

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.

 

The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."

 

IMAGING

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.

 

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.

Coding

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.

 

PATHOLOGY

The main pathological findings at autopsy are:

 

Macroscopy: pericarditis, lung consolidation and pulmonary oedema

Lung findings:

minor serous exudation, minor fibrin exudation

pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL

Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction

Liver: microvesicular steatosis

 

PREVENTION

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.

 

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

 

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.

 

VACCINE

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

 

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates were in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 17 March 2021, 400.22 million doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca-Oxford anticipates producing 3 billion doses in 2021, Pfizer-BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidicea 500 million doses in 2021. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population.

 

SOCIAL DISTANCING

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

 

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.

 

SELF-ISOLATION

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.

Face masks and respiratory hygiene

 

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

 

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.

 

HAND-WASHING AND HYGIENE

Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.

 

SURFACE CLEANING

After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body cause infection. Current evidence indicates that contact with infected surfaces is not the main driver of Covid-19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticized as hygiene theater, giving a false sense of security against something primarily spread through the air.

 

The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).

 

On many surfaces, including as glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. As a general rule of thumb, the virus dies faster on porous surfaces than on non-porous surfaces.

However, this rule is not absolute, and of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.

 

Surfaces may be decontaminated with 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.

 

VENTILATION AND AIR FILTRATION

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.

 

HEALTHY DIET AND LIFESTYLE

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.

 

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms. This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.

 

TREATMENT

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

 

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.

 

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.

Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.

 

PROGNOSIS

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. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. 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. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.

 

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[191][192] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".

 

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.

 

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.

 

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.

See also: Impact of the COVID-19 pandemic on children

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.

 

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.

 

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.

 

COMPLICATIONS

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID-19 have elevated liver enzymes, reflecting liver injury.

 

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.

 

LONGER-TERM EFFECTS

Some early studies suggest that that 10 to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5-10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.

 

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[228] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.

 

People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis. Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.

 

IMMUNITY

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4-fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year. Nonetheless, on 3 March 2021, scientists reported that a much more contagious Covid-19 variant, Lineage P.1, first detected in Japan, and subsequently found in Brazil, as well as in several places in the United States, may be associated with Covid-19 disease reinfection after recovery from an earlier Covid-19 infection.

 

MORTALITY

Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.

 

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,685,770/121,585,388) as of 18 March 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

 

INFECTION FATALITY RATE

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.

 

CURRENT ESTIMATES

A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.

 

EARLIER ESTIMATES OF IFR

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[ On 2 July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).Antibody testing in New York City suggested an IFR of ~0.9%,[258] and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.

 

SEX DIFFERENCES

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

 

ETHNIC DIFFERENCES

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. Leaders have called for efforts to research and address the disparities. In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.

 

COMORBIDITIES

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), Ischemic Heart Disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

 

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.

 

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.

 

NAME

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus. In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma. The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.

 

HISTORY

The virus is thought to be natural and of an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats, and spread to humans through an intermediary wildlife host.

 

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1 December 2019.Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020 George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak.[ Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.

 

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.

 

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.

 

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.

 

Italy had its first confirmed cases on 31 January 2020, two tourists from China. As of 13 March 2020 the WHO considered Europe the active centre of the pandemic. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6 February 2020.

 

After 55 days without a locally transmitted case, Beijing reported a new COVID-19 case on 11 June 2020 which was followed by two more cases on 12 June. By 15 June there were 79 cases officially confirmed, most of them were people that went to Xinfadi Wholesale Market.

 

RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.

 

MISINFORMATION

After the initial outbreak of COVID-19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.

 

In September 2020, the U.S. CDC published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.

 

OTHER ANIMALS

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.

 

Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviors which increase the risk of transmission include kissing, licking, and petting the animal.

 

The virus does not appear to be able to infect pigs, ducks, or chickens at all.[ Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.

 

Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID-19 virus.

 

Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations. A vaccine for mink and other animals is being researched.

 

RESEARCH

International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.

 

As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.

Transmission and prevention research

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.

 

TREATMENT-RELATED RESEARCH

Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.

 

In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.

 

Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.

 

In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.

 

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.

 

WIKIPEDIA

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

 

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are more likely to have severe symptoms. At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[ Around 20% of those people will remain asymptomatic throughout infection, and the rest will develop symptoms later on, becoming pre-symptomatic rather than asymptomatic and therefore having a higher risk of transmitting the virus to others. Some people continue to experience a range of effects—known as long COVID—for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases. Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by reverse transcription loop-mediated isothermal amplification (RT-LAMP) from a nasopharyngeal swab.

 

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

 

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

 

SIGNS AND SYSTOMS

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

 

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease. Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.

 

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.

Most people recover from the acute phase of the disease. However, some people continue to experience a range of effects for months after recovery—named long COVID—and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

CAUSE

TRANSMISSION

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.

 

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation. The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.

 

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact. A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads. The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.

 

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.

 

The number of people generally infected by one infected person varies. Coronavirus disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.

 

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear. People remain infectious in moderate cases for 7–12 days, and up to two weeks in severe cases. In October 2020, medical scientists reported evidence of reinfection in one person.

 

VIROLOGY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.

 

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV. The structure of the M protein resembles the sugar transporter SemiSWEET.

 

The many thousands of SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).

 

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.

 

SARS-CoV-2 VARIANTS

Three known variants of SARS-CoV-2 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).

 

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant ‘VUI – 202012/01’ (the first Variant Under Investigation in December 2020) transmits more easily than other strains.

 

PATHOPHYSIOLOGY

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.

 

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed. SARS-CoV-2 could cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found people transferred to Intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains – without detected SARS-CoV-2 – and the olfactory bulbs from those who have died from COVID-19.

 

Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.

 

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.

 

IMMUNOPATHOLOGY

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

 

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 . Lymphocytic infiltrates have also been reported at autopsy.

 

VIRAL AND HOST FACTORS

VIRUS PROTEINS

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.

 

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.

 

HOST FACTORS

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.

 

The virus' effect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.

 

HOST CYTOKINE RESPONSE

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.

 

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.

 

DIAGNOSIS

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.

 

VIRAL TESTING

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.

 

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.

 

The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."

 

IMAGING

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.

 

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.

Coding

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.

 

PATHOLOGY

The main pathological findings at autopsy are:

 

Macroscopy: pericarditis, lung consolidation and pulmonary oedema

Lung findings:

minor serous exudation, minor fibrin exudation

pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL

Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction

Liver: microvesicular steatosis

 

PREVENTION

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.

 

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

 

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.

 

VACCINE

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

 

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates were in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 17 March 2021, 400.22 million doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca-Oxford anticipates producing 3 billion doses in 2021, Pfizer-BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidicea 500 million doses in 2021. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population.

 

SOCIAL DISTANCING

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

 

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.

 

SELF-ISOLATION

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.

Face masks and respiratory hygiene

 

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

 

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.

 

HAND-WASHING AND HYGIENE

Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.

 

SURFACE CLEANING

After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body cause infection. Current evidence indicates that contact with infected surfaces is not the main driver of Covid-19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticized as hygiene theater, giving a false sense of security against something primarily spread through the air.

 

The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).

 

On many surfaces, including as glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. As a general rule of thumb, the virus dies faster on porous surfaces than on non-porous surfaces.

However, this rule is not absolute, and of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.

 

Surfaces may be decontaminated with 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.

 

VENTILATION AND AIR FILTRATION

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.

 

HEALTHY DIET AND LIFESTYLE

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.

 

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms. This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.

 

TREATMENT

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

 

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.

 

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.

Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.

 

PROGNOSIS

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. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. 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. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.

 

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[191][192] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".

 

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.

 

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.

 

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.

See also: Impact of the COVID-19 pandemic on children

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.

 

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.

 

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.

 

COMPLICATIONS

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID-19 have elevated liver enzymes, reflecting liver injury.

 

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.

 

LONGER-TERM EFFECTS

Some early studies suggest that that 10 to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5-10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.

 

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[228] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.

 

People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis. Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.

 

IMMUNITY

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4-fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year. Nonetheless, on 3 March 2021, scientists reported that a much more contagious Covid-19 variant, Lineage P.1, first detected in Japan, and subsequently found in Brazil, as well as in several places in the United States, may be associated with Covid-19 disease reinfection after recovery from an earlier Covid-19 infection.

 

MORTALITY

Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.

 

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,685,770/121,585,388) as of 18 March 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

 

INFECTION FATALITY RATE

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.

 

CURRENT ESTIMATES

A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.

 

EARLIER ESTIMATES OF IFR

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[ On 2 July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).Antibody testing in New York City suggested an IFR of ~0.9%,[258] and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.

 

SEX DIFFERENCES

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

 

ETHNIC DIFFERENCES

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. Leaders have called for efforts to research and address the disparities. In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.

 

COMORBIDITIES

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), Ischemic Heart Disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

 

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.

 

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.

 

NAME

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus. In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma. The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.

 

HISTORY

The virus is thought to be natural and of an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats, and spread to humans through an intermediary wildlife host.

 

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1 December 2019.Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020 George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak.[ Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.

 

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.

 

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.

 

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.

 

Italy had its first confirmed cases on 31 January 2020, two tourists from China. As of 13 March 2020 the WHO considered Europe the active centre of the pandemic. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6 February 2020.

 

After 55 days without a locally transmitted case, Beijing reported a new COVID-19 case on 11 June 2020 which was followed by two more cases on 12 June. By 15 June there were 79 cases officially confirmed, most of them were people that went to Xinfadi Wholesale Market.

 

RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.

 

MISINFORMATION

After the initial outbreak of COVID-19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.

 

In September 2020, the U.S. CDC published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.

 

OTHER ANIMALS

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.

 

Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviors which increase the risk of transmission include kissing, licking, and petting the animal.

 

The virus does not appear to be able to infect pigs, ducks, or chickens at all.[ Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.

 

Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID-19 virus.

 

Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations. A vaccine for mink and other animals is being researched.

 

RESEARCH

International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.

 

As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.

Transmission and prevention research

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.

 

TREATMENT-RELATED RESEARCH

Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.

 

In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.

 

Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.

 

In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.

 

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.

 

WIKIPEDIA

ST-01

Auto derma

Micro Needle Roller Anti Aging Skin Therapy

Product description: New Auto Microroller Motorized Roller Needle Skin Theraphy MY-M From Korea Derma is the latest skin therapy system. Treat wrinkles, acne, scars, and burn scars.

New Auto Microroller Motorized Roller Needle Skin...

 

www.lovbeauty.net/auto-derma-pen-stamp-electric-micro-nee...

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

 

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are more likely to have severe symptoms. At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[ Around 20% of those people will remain asymptomatic throughout infection, and the rest will develop symptoms later on, becoming pre-symptomatic rather than asymptomatic and therefore having a higher risk of transmitting the virus to others. Some people continue to experience a range of effects—known as long COVID—for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases. Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by reverse transcription loop-mediated isothermal amplification (RT-LAMP) from a nasopharyngeal swab.

 

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

 

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

 

SIGNS AND SYSTOMS

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

 

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease. Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.

 

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.

Most people recover from the acute phase of the disease. However, some people continue to experience a range of effects for months after recovery—named long COVID—and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

CAUSE

TRANSMISSION

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.

 

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation. The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.

 

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact. A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads. The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.

 

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.

 

The number of people generally infected by one infected person varies. Coronavirus disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.

 

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear. People remain infectious in moderate cases for 7–12 days, and up to two weeks in severe cases. In October 2020, medical scientists reported evidence of reinfection in one person.

 

VIROLOGY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.

 

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV. The structure of the M protein resembles the sugar transporter SemiSWEET.

 

The many thousands of SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).

 

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.

 

SARS-CoV-2 VARIANTS

Three known variants of SARS-CoV-2 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).

 

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant ‘VUI – 202012/01’ (the first Variant Under Investigation in December 2020) transmits more easily than other strains.

 

PATHOPHYSIOLOGY

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.

 

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed. SARS-CoV-2 could cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found people transferred to Intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains – without detected SARS-CoV-2 – and the olfactory bulbs from those who have died from COVID-19.

 

Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.

 

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.

 

IMMUNOPATHOLOGY

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

 

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 . Lymphocytic infiltrates have also been reported at autopsy.

 

VIRAL AND HOST FACTORS

VIRUS PROTEINS

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.

 

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.

 

HOST FACTORS

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.

 

The virus' effect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.

 

HOST CYTOKINE RESPONSE

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.

 

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.

 

DIAGNOSIS

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.

 

VIRAL TESTING

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.

 

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.

 

The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."

 

IMAGING

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.

 

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.

Coding

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.

 

PATHOLOGY

The main pathological findings at autopsy are:

 

Macroscopy: pericarditis, lung consolidation and pulmonary oedema

Lung findings:

minor serous exudation, minor fibrin exudation

pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL

Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction

Liver: microvesicular steatosis

 

PREVENTION

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.

 

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

 

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.

 

VACCINE

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

 

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates were in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 17 March 2021, 400.22 million doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca-Oxford anticipates producing 3 billion doses in 2021, Pfizer-BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidicea 500 million doses in 2021. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population.

 

SOCIAL DISTANCING

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

 

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.

 

SELF-ISOLATION

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.

Face masks and respiratory hygiene

 

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

 

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.

 

HAND-WASHING AND HYGIENE

Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.

 

SURFACE CLEANING

After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body cause infection. Current evidence indicates that contact with infected surfaces is not the main driver of Covid-19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticized as hygiene theater, giving a false sense of security against something primarily spread through the air.

 

The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).

 

On many surfaces, including as glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. As a general rule of thumb, the virus dies faster on porous surfaces than on non-porous surfaces.

However, this rule is not absolute, and of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.

 

Surfaces may be decontaminated with 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.

 

VENTILATION AND AIR FILTRATION

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.

 

HEALTHY DIET AND LIFESTYLE

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.

 

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms. This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.

 

TREATMENT

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

 

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.

 

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.

Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.

 

PROGNOSIS

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. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. 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. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.

 

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[191][192] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".

 

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.

 

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.

 

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.

See also: Impact of the COVID-19 pandemic on children

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.

 

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.

 

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.

 

COMPLICATIONS

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID-19 have elevated liver enzymes, reflecting liver injury.

 

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.

 

LONGER-TERM EFFECTS

Some early studies suggest that that 10 to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5-10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.

 

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[228] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.

 

People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis. Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.

 

IMMUNITY

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4-fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year. Nonetheless, on 3 March 2021, scientists reported that a much more contagious Covid-19 variant, Lineage P.1, first detected in Japan, and subsequently found in Brazil, as well as in several places in the United States, may be associated with Covid-19 disease reinfection after recovery from an earlier Covid-19 infection.

 

MORTALITY

Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.

 

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,685,770/121,585,388) as of 18 March 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

 

INFECTION FATALITY RATE

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.

 

CURRENT ESTIMATES

A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.

 

EARLIER ESTIMATES OF IFR

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[ On 2 July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).Antibody testing in New York City suggested an IFR of ~0.9%,[258] and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.

 

SEX DIFFERENCES

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

 

ETHNIC DIFFERENCES

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. Leaders have called for efforts to research and address the disparities. In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.

 

COMORBIDITIES

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), Ischemic Heart Disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

 

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.

 

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.

 

NAME

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus. In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma. The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.

 

HISTORY

The virus is thought to be natural and of an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats, and spread to humans through an intermediary wildlife host.

 

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1 December 2019.Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020 George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak.[ Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.

 

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.

 

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.

 

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.

 

Italy had its first confirmed cases on 31 January 2020, two tourists from China. As of 13 March 2020 the WHO considered Europe the active centre of the pandemic. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6 February 2020.

 

After 55 days without a locally transmitted case, Beijing reported a new COVID-19 case on 11 June 2020 which was followed by two more cases on 12 June. By 15 June there were 79 cases officially confirmed, most of them were people that went to Xinfadi Wholesale Market.

 

RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.

 

MISINFORMATION

After the initial outbreak of COVID-19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.

 

In September 2020, the U.S. CDC published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.

 

OTHER ANIMALS

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.

 

Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviors which increase the risk of transmission include kissing, licking, and petting the animal.

 

The virus does not appear to be able to infect pigs, ducks, or chickens at all.[ Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.

 

Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID-19 virus.

 

Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations. A vaccine for mink and other animals is being researched.

 

RESEARCH

International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.

 

As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.

Transmission and prevention research

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.

 

TREATMENT-RELATED RESEARCH

Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.

 

In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.

 

Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.

 

In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.

 

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.

 

WIKIPEDIA

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

 

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are more likely to have severe symptoms. At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[ Around 20% of those people will remain asymptomatic throughout infection, and the rest will develop symptoms later on, becoming pre-symptomatic rather than asymptomatic and therefore having a higher risk of transmitting the virus to others. Some people continue to experience a range of effects—known as long COVID—for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases. Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by reverse transcription loop-mediated isothermal amplification (RT-LAMP) from a nasopharyngeal swab.

 

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

 

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

 

SIGNS AND SYSTOMS

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

 

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease. Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.

 

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.

Most people recover from the acute phase of the disease. However, some people continue to experience a range of effects for months after recovery—named long COVID—and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

CAUSE

TRANSMISSION

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.

 

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation. The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.

 

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact. A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads. The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.

 

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.

 

The number of people generally infected by one infected person varies. Coronavirus disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.

 

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear. People remain infectious in moderate cases for 7–12 days, and up to two weeks in severe cases. In October 2020, medical scientists reported evidence of reinfection in one person.

 

VIROLOGY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.

 

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV. The structure of the M protein resembles the sugar transporter SemiSWEET.

 

The many thousands of SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).

 

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.

 

SARS-CoV-2 VARIANTS

Three known variants of SARS-CoV-2 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).

 

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant ‘VUI – 202012/01’ (the first Variant Under Investigation in December 2020) transmits more easily than other strains.

 

PATHOPHYSIOLOGY

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.

 

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed. SARS-CoV-2 could cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found people transferred to Intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains – without detected SARS-CoV-2 – and the olfactory bulbs from those who have died from COVID-19.

 

Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.

 

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.

 

IMMUNOPATHOLOGY

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

 

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 . Lymphocytic infiltrates have also been reported at autopsy.

 

VIRAL AND HOST FACTORS

VIRUS PROTEINS

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.

 

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.

 

HOST FACTORS

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.

 

The virus' effect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.

 

HOST CYTOKINE RESPONSE

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.

 

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.

 

DIAGNOSIS

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.

 

VIRAL TESTING

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.

 

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.

 

The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."

 

IMAGING

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.

 

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.

Coding

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.

 

PATHOLOGY

The main pathological findings at autopsy are:

 

Macroscopy: pericarditis, lung consolidation and pulmonary oedema

Lung findings:

minor serous exudation, minor fibrin exudation

pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL

Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction

Liver: microvesicular steatosis

 

PREVENTION

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.

 

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

 

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.

 

VACCINE

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

 

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates were in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 17 March 2021, 400.22 million doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca-Oxford anticipates producing 3 billion doses in 2021, Pfizer-BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidicea 500 million doses in 2021. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population.

 

SOCIAL DISTANCING

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

 

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.

 

SELF-ISOLATION

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.

Face masks and respiratory hygiene

 

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

 

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.

 

HAND-WASHING AND HYGIENE

Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.

 

SURFACE CLEANING

After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body cause infection. Current evidence indicates that contact with infected surfaces is not the main driver of Covid-19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticized as hygiene theater, giving a false sense of security against something primarily spread through the air.

 

The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).

 

On many surfaces, including as glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. As a general rule of thumb, the virus dies faster on porous surfaces than on non-porous surfaces.

However, this rule is not absolute, and of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.

 

Surfaces may be decontaminated with 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.

 

VENTILATION AND AIR FILTRATION

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.

 

HEALTHY DIET AND LIFESTYLE

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.

 

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms. This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.

 

TREATMENT

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

 

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.

 

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.

Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.

 

PROGNOSIS

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. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. 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. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.

 

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[191][192] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".

 

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.

 

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.

 

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.

See also: Impact of the COVID-19 pandemic on children

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.

 

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.

 

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.

 

COMPLICATIONS

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID-19 have elevated liver enzymes, reflecting liver injury.

 

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.

 

LONGER-TERM EFFECTS

Some early studies suggest that that 10 to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5-10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.

 

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[228] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.

 

People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis. Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.

 

IMMUNITY

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4-fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year. Nonetheless, on 3 March 2021, scientists reported that a much more contagious Covid-19 variant, Lineage P.1, first detected in Japan, and subsequently found in Brazil, as well as in several places in the United States, may be associated with Covid-19 disease reinfection after recovery from an earlier Covid-19 infection.

 

MORTALITY

Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.

 

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,685,770/121,585,388) as of 18 March 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

 

INFECTION FATALITY RATE

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.

 

CURRENT ESTIMATES

A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.

 

EARLIER ESTIMATES OF IFR

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[ On 2 July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).Antibody testing in New York City suggested an IFR of ~0.9%,[258] and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.

 

SEX DIFFERENCES

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

 

ETHNIC DIFFERENCES

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. Leaders have called for efforts to research and address the disparities. In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.

 

COMORBIDITIES

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), Ischemic Heart Disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

 

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.

 

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.

 

NAME

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus. In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma. The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.

 

HISTORY

The virus is thought to be natural and of an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats, and spread to humans through an intermediary wildlife host.

 

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1 December 2019.Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020 George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak.[ Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.

 

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.

 

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.

 

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.

 

Italy had its first confirmed cases on 31 January 2020, two tourists from China. As of 13 March 2020 the WHO considered Europe the active centre of the pandemic. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6 February 2020.

 

After 55 days without a locally transmitted case, Beijing reported a new COVID-19 case on 11 June 2020 which was followed by two more cases on 12 June. By 15 June there were 79 cases officially confirmed, most of them were people that went to Xinfadi Wholesale Market.

 

RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.

 

MISINFORMATION

After the initial outbreak of COVID-19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.

 

In September 2020, the U.S. CDC published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.

 

OTHER ANIMALS

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.

 

Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviors which increase the risk of transmission include kissing, licking, and petting the animal.

 

The virus does not appear to be able to infect pigs, ducks, or chickens at all.[ Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.

 

Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID-19 virus.

 

Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations. A vaccine for mink and other animals is being researched.

 

RESEARCH

International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.

 

As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.

Transmission and prevention research

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.

 

TREATMENT-RELATED RESEARCH

Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.

 

In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.

 

Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.

 

In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.

 

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.

 

WIKIPEDIA

thenextweb.com/insider/2011/09/17/the-future-of-fitness-a...

 

Fitness will be Gamified

 

Fitocracy

 

Fitocracy founders Brian Wang and Richard Talens used to be “really

out of shape, video game addicts”. Talens was “super fat” and Wang was

“super skinny”. While in college, they realized they had to make a

lifestyle change and thus became “addicted to fitness”. Inspired by

their experience, the two started building a new platform that tracks

workouts and turns personal fitness into a social game.

 

Fitocracy is a fitness social network that requires you to manually

enter your work-out in order to gain points and move through the

system. People give each other “Props,” that are equivalent to a

Facebook Like. In the future, the team will hook up with applications

like Nike Plus and RunKeeper, intending to be the point aggregator

that sits on top of all that aggregated data. The best thing about

Fitocracy is that you can log anything, so that I can compete with

people even if I’m practicing yoga and they’re lifting weights. Well,

you can log almost anything…

 

Talens, who hits the gym 3 days a week and spends all of his time

doing big, heavy lifting believes fitness is inherently social and

that success is best attained when we can keep each other motivated.

In June, Fitocracy hit 16,000 users with 6,000 more on the waiting

list. Fitocracy will be opening in Beta next month but we’ve got

invites for you right here. Use the code “THENEXTWEB”.

 

Earndit

 

I scheduled a call with Earnditfounder Andres Moran last week, and it

was free! If I had been using his fitness rewards platform, which he

launched last September 2010, a 15 minute video chat with Moran would

cost me 50 points! Call it a journalist’s perk.

 

Moran is the founder of Earndit, a rewards platform for fitness

enthusiasts with 25,000 users. Earndit was one of RunKeeper’s first

API integration partners, and its service has been a huge hit with the

RunKeeper community, according to Jason Jacobs of RunKeeper. Earndit

also integrates with Foursquare, Fitbit, Nike Plus, Every Trail and

Garmin. I signed up for Earndit, and I’m a fan.

 

All this time I could’ve been earning points upon my check-ins at yoga

studios and gyms! 15 points each time, 20 points if you’re the mayor.

Earndit has dozens of reward partners so you can trade your points for

perks like online personal trainers, retail gift cards, boxes of

energy bars and gym credits.

 

“This space of tracking and verifiable data is blowing up for us,”

says Moran. “The mere act of measuring our activities will make me

more active. When you see a graphical or numerical output of your

activity, you see how lazy you really are sometimes. It really prompts

you to change that. It’s a slap in the face. And as they say, it’s

hard to change that which you cannot measure.”

 

Keas

 

Adam Bosworth, the former head of Google Health, has finally launched

his consumer health start-up, Keas, “a game that keeps you healthy”.

Users pick 3 goals a week, which can range from hitting the gym,

eating less carbs to reducing stress. Keas users then receive points

for accomplishing goals and taking health quizes. The social program

is targeting the entreprise level and working with HR departments to

become a corporate wellness program. So if your company signs up for

it you can receive additional rewards, including cash.

 

Keas’ initial launch partners include Healthwise, Google Health,

Microsoft HealthVault, Quest Diagnostics and Dr. Alan Greene. In a

June interview with TechCrunch, Keas said the reason Google Health

never really took off was because Google Health never asked, “What

could they do that people would want?” Instead. “They basically

offered a place to store data… People don’t want to store data, they

want to have fun.”

 

Fitness is Food

 

Lollihop

 

The brand new San Francisco based startup, Lollihop offers a monthly

subscription service of healthy, organic snacks tied to educational

online content. Founder Suzanne Xie launched the site this week to

make it easier for people to eat healthy on a regular basis. Lollihop

ships out healthy food much like Birchbox sends out beauty products.

It’s a delightful present every month in your mailbox, a package

filled with nutritional snacks from brands like Terra, Lara Bar and

Kind, hand picked from ex-Whole Food buyers.

 

Xie has been tasting snacks for months in preparation for launch. “The

first 10 snacks I tasted, I thought, ‘This is the best job ever,’ but

about 50 snacks later I said, ‘OK, this is the worst job ever’,” she

says laughing.

 

“Nutrition is a huge part of fitness,” says Xie. ”If you don’t have

time to work out, everything you put in your body is crucial. Today,

kids consume 40% of their total calories in snack form, for adults its

30%; we’re trying to make sure those snacks are healthy.”

 

Coming soon, Lollihop will have a Hunch-like personalization element

that will ask you simple questions like, Are you a vegetarian, vegan

etc. When you wake up in the morning, how do you feel? What kind of

sleep are you getting? Working with a nutritionist, Lollihop will be

able to better recommend snacks and offer tailored health content to

suit your needs.

 

Fitness is Better Health Care

 

ZocDoc

 

ZocDoc is one of the most structurally intelligent and powerful

technologies spearheading our health care revolution. ZocDoc allows

patients to find nearby doctors who accept their insurance, read

verified reviews written by real patients, and instantly book an

appointment with a local medical professional online or via the free

iPhone App. ZocDoc is a free service for patients, while doctors pay a

subscription fee of $250 per doctor per month. Typically with one or

two new patients, the service pays for itself. On average, doctors

using ZocDoc see an additional 100 patients on a monthly basis.

 

“I believe patients will increasingly turn to technology for their

healthcare needs. As the lines blur between mobile devices and medical

devices, as telemedicine blossoms and health information continues to

proliferate online, people will naturally rely on these tools. And I

think they’ll find their doctors and schedule appointments online, as

they can with ZocDoc, because the ease and convenience of doing so

represents a real paradigm shift.”

 

-Cyrus Massoumi, co-founder & CEO of ZocDoc

 

ZocDoc is strategically based in New York City, where there are more

doctors per capita than any other city in the world, according to

Oliver Kharraz, MD, co-founder and COO of ZocDoc. Before expanding

nationally, ZocDoc took a hyperlocal approach, making sure their

product worked in downtown Manhattan. They are now set to aggressively

expand across the nation in 2011 with hopes to move into international

territories the following year.

 

Massive Health

 

Aza Raskin, 26-year-old son of noted human-computer interface expert

Jef Raskin has had a strong, laudable career thus far. He founded

Humanized Inc. where he created the language-based service-oriented

Enso software. In 2008, he and other Humanized employees were hired by

Mozilla where he was appointed Creative Lead for Firefox. He left

Mozilla late last year to begin Massive Health and tackle health

issues like obesity, oronary heart disease and diabetes. Raskin will

apply cognitive psychology, design principles and tighter feedback

loops to our own health through Massive Health, what could be this

century’s health Renaissance, “where products and services are

redesigned to be responsive to human needs and considerate of human

frailties.”

 

While Massive Health is still in its early stages, Raskin writes, “Why

is it that we live surrounded by beautiful technology, but as soon as

we get sick we’re left out in the cold? We’re working to fix that. We

believe that people should be treated like people, not patients.”

 

How to live forever

 

To some life extensionists, experimental gerontologists, longevists,

or whatever you want to call them, people like Cambridge professor

Aubrey deGray (pictured above at the 2009 Singularity Summit in NYC),

believe the idea of living forever is a real biological

possibility…and we’re not talking about cryonics or mind uploads.

 

The Methuselarity, (named after the Methuselarity flies) is commonly

defined as the point where we achieve the “Longevity Escape Velocity”

in the rate of progress of our anti-aging efforts. DeGray identifies

aging as a problem of pathology and metabolism. After seeing a great

amount of success with life extension in Methuselarity flies, deGray

believes that by experimenting with calorie restriction to extend our

metabolism, cell therapies to combat cell atrophy and genetic

stimulations, we will be able to extend our natural lifespan by 30

years very soon, but one day we will be able to live forever. He also

believes that once we begin to extend our lifespans, the ability to do

so will occur at an exponential rate. For example, he believes that

the first 1,000 year old is probably less than 20 years younger than

the first 150-year-old and that the first 10 to the N year old is

probably less than 2 years younger than the first 1,000 year old.

 

Last year, the MacArthur Research Network on an Aging Society released

a study that said Americans living in the next 40 years will be much

older than our government’s current predictions. The study not only

brings up the topic of length of life, but quality of life. Dr. Steven

Joyal, Vice President of Science and Medical Affairs for the Life

Extension Foundation, the largest non-profit organization engaged in

cutting-edge research to enhance human health says,

 

We are at the forefront of longevity revolution. Advancements in

nanotechnology, gene therapy, artificial intelligence, and stem cell

research will enable infants born today to be as functional and

productive when they are one hundred and twenty years of age as people

aged twenty or thirty today.

 

In a study by Stanford University researchers learned that maintaining

an active lifestyle will add 16 years to your active life. That’s 16

years of productivity and healthy joy that might have been spent

dealing with disabilities, heart issues, diabetes, etc. The bottom

line is that understanding and prioritizing your health is crucial to

a balanced lifestyle, whether it’s running, biking, swimming, yoga,

eating right, taking long walks or just daily meditation.

 

Moving forward starts with data aggregation and awareness to better

understand the health of humanity. In 2-3 years time, we will layer

technology and smart algorithms to enable us to make smarter choices

more easily. While you might feel uncomfortable about sharing massive

amounts of your personal data, think of it like this: In sharing

ourselves and our data, we become vulnerable, yes, but it’s allowing

us to form a human community once again.

 

Linkedin founder Reid Hoffman is noted for his theories surrounding

Web 3.0, which combine our real identities with the massive amounts of

active and passive data we are generating. Amazon, for example, can

make smart recommendations to you based on what you buy and what

people with similar shopping experiences buy. Now, imagine a system

that operates like that around your health that will make the world

healthier as more aspects of our lives are tied into the platform.

 

Today you are more aware. Until we reach the Methuselarity, or figure

out a way to live forever by technological means, you’ve got one and a

half billion heartbeats on this Earth. Treat them well.

Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships. The term erectile dysfunction does not encompass other erection-related disorders, such as priapism.

 

The majority of ED cases are attributed to physical risk factors and predictive factors. These factors can be categorized as vascular, neurological, local penile, hormonal, and drug-induced. Notable predictors of ED include aging, cardiovascular disease, diabetes mellitus, high blood pressure, obesity, abnormal lipid levels in the blood, hypogonadism, smoking, depression, and medication use. Approximately 10% of cases are linked to psychosocial factors, encompassing conditions such as depression, stress, and problems within relationships.[14] ED is reported in 18% of males aged 50 to 59 years, and 37% in males aged 70 to 75.[14]

 

Treatment of ED encompasses addressing the underlying causes, lifestyle modification, and addressing psychosocial issues.[4] In many instances, medication-based therapies are used, specifically PDE5 inhibitors such as sildenafil.[13] These drugs function by dilating blood vessels, facilitating increased blood flow into the spongy tissue of the penis, analogous to opening a valve wider to enhance water flow in a fire hose. Less frequently employed treatments encompass prostaglandin pellets inserted into the urethra, the injection of smooth-muscle relaxants and vasodilators directly into the penis, penile implants, the use of penis pumps, and vascular surgery.[4][15]

 

Signs and symptoms

ED is characterized by the persistent or recurring inability to achieve or maintain an erection of the penis with sufficient rigidity and duration for satisfactory sexual activity.[14] It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months."[4]

 

Psychological impact

ED often has an impact on the emotional well-being of both males and their partners.[14] Many males do not seek treatment due to feelings of embarrassment. About 75% of diagnosed cases of ED go untreated.[16]

 

Causes

Causes of or contributors to ED include the following:

 

Diets high in saturated fat are linked to heart diseases, and males with heart diseases are more likely to experience ED.[7][8] By contrast, plant-based diets show a lower risk for ED.[17][18][19]

Prescription drugs (e.g., SSRIs,[20] beta blockers, antihistamines,[21][22][23] alpha-2 adrenergic receptor agonists, thiazides, hormone modulators, and 5α-reductase inhibitors)[3][4]

Neurogenic disorders (e.g., diabetic neuropathy, temporal lobe epilepsy, multiple sclerosis, Parkinson's disease, multiple system atrophy)[3][4][5]

Cavernosal disorders (e.g., Peyronie's disease)[3][24]

Hyperprolactinemia (e.g., due to a prolactinoma)[3]

Psychological causes: performance anxiety, stress, and mental disorders[6]

Surgery (e.g., radical prostatectomy)[25]

Ageing: after age 40 years, ageing itself is a risk factor for ED, although numerous other pathologies that may occur with ageing, such as testosterone deficiency, cardiovascular diseases, or diabetes, among others, appear to have interacting effects[1][26]

Kidney disease: ED and chronic kidney disease have pathological mechanisms in common, including vascular and hormonal dysfunction, and may share other comorbidities, such as hypertension and diabetes mellitus that can contribute to ED[9]

Lifestyle habits, particularly smoking, which is a key risk factor for ED as it promotes arterial narrowing.[27][28][29] Due to its propensity for causing detumescence and erectile dysfunction, some studies have described tobacco as an anaphrodisiacal substance.[30]

COVID-19: preliminary research indicates that COVID-19 viral infection may affect sexual and reproductive health.[31][32]

Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply.[25] ED is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life.[33]

 

ED can also be associated with bicycling due to both neurological and vascular problems due to compression.[34] The increased risk appears to be about 1.7-fold.[35]

 

Concerns that use of pornography can cause ED[36] have little support[37][38] in epidemiological studies, according to a 2015 literature review.[39] According to Gunter de Win, a Belgian professor and sex researcher, "Put simply, respondents who watch 60 minutes a week and think they're addicted were more likely to report sexual dysfunction than those who watch a care-free 160 minutes weekly."[40][41]

 

In seemingly rare cases, medications such as SSRIs, isotretinoin (Accutane) and finasteride (Propecia) are reported to induce long-lasting iatrogenic disorders characterized by sexual dysfunction symptoms, including erectile dysfunction in males; these disorders are known as post-SSRI sexual dysfunction (PSSD), post-retinoid sexual dysfunction/post-Accutane syndrome (PRSD/PAS), and post-finasteride syndrome (PFS). These conditions remain poorly understood and lack effective treatments, although they have been suggested to share a common etiology.[42]

 

Rarely impotence can be caused by aromatase being active. See Androgen replacement therapy.

Pathophysiology

Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former involves the peripheral nerves and the lower parts of the spinal cord, whereas the latter involves the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of the smooth muscles of the corpora cavernosa (the main erectile tissue of the penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[2]

 

Diagnosis

In many cases, the diagnosis can be made based on the person's history of symptoms. In other cases, a physical examination and laboratory investigations are done to rule out more serious causes such as hypogonadism or prolactinoma.[4]

 

One of the first steps is to distinguish between physiological and psychological ED. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED.[4] Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is, when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.[43][44] Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED.[4]

 

Another factor leading to ED is diabetes mellitus, a well known cause of neuropathy.[4] ED is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease, such as coronary artery disease and peripheral vascular disease.[4] Screening for cardiovascular risk factors, such as smoking, dyslipidemia, hypertension, and alcoholism, is helpful.[4]

 

In some cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in males and is relatively easily curable.[33]

 

The current – as of April 2025[45] – edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) lists Erectile Disorder (ICD-10-CM code: F52.21) as a diagnosis.[46] According to the DSM, it "is the more specific DSM-5 diagnostic category in which erectile dysfunction persists for at least 6 months and causes distress in the individual."[46] The ICD-10, to which the DSM refers regarding Erectile dysfunction,[46] lists it under Failure of genital response (F52.2).[47] The latest edition of the ICD – namely, the ICD-11 – lists the condition as Male erectile dysfunction (HA01.1).

 

Ultrasonography

 

Transverse ultrasound image, ventral view of the penis. Image obtained after induction of an erection, 15 min after injection of prostaglandin E1, showing dilated sinusoids (arrows).[48]

Penile ultrasonography with doppler can be used to examine the erect penis. Most cases of ED of organic causes are related to changes in blood flow in the corpora cavernosa, represented by occlusive artery disease (in which less blood is allowed to enter the penis), most often of atherosclerotic origin, or due to failure of the veno-occlusive mechanism (in which too much blood circulates back out of the penis). Before the Doppler sonogram, the penis should be examined in B mode, in order to identify possible tumors, fibrotic plaques, calcifications, or hematomas, and to evaluate the appearance of the cavernous arteries, which can be tortuous or atheromatous.[48]

 

Erection can be induced by injecting 10–20 μg of prostaglandin E1, with evaluations of the arterial flow every five minutes for 25–30 min (see image). The use of prostaglandin E1 is contraindicated in patients with predisposition to priapism (e.g., those with sickle cell anemia), anatomical deformity of the penis, or penile implants. Phentolamine (2 mg) is often added. Visual and tactile stimulation produces better results. Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial.[48]

 

Before the injection of the chosen drug, the flow pattern is monophasic, with low systolic velocities and an absence of diastolic flow. After injection, systolic and diastolic peak velocities should increase, decreasing progressively with vein occlusion and becoming negative when the penis becomes rigid (see image below). The reference values vary across studies, ranging from > 25 cm/s to > 35 cm/s. Values above 35 cm/s indicate the absence of arterial disease, values below 25 cm/s indicate arterial insufficiency, and values of 25–35 cm/s are indeterminate because they are less specific (see image below). The data obtained should be correlated with the degree of erection observed. If the peak systolic velocities are normal, the final diastolic velocities should be evaluated, those above 5 cm/s being associated with venogenic ED.[48]

 

Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.[48]

Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.[48]

 

Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection (A, B, and C, respectively). The cavernous artery flow remains below the expected levels (at least 25–35 cm/s), which indicates ED due to arterial insufficiency.[48]

Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection (A, B, and C, respectively). The cavernous artery flow remains below the expected levels (at least 25–35 cm/s), which indicates ED due to arterial insufficiency.[48]

Other workup methods

Penile nerves function

Tests such as the bulbocavernosus reflex test are used to ascertain whether there is enough nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger in the anus.[49]

Nocturnal penile tumescence (NPT)

It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion[quantify] of males who have no sexual dysfunction nonetheless do not have regular nocturnal erections.[citation needed]

Penile biothesiometry

This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.[50]

Dynamic infusion cavernosometry (DICC)

Technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.[citation needed]

Corpus cavernosometry

Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[51] In Digital Subtraction Angiography (DSA), the images are acquired digitally.[citation needed]

Magnetic resonance angiography (MRA)

This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. The doctor may inject into the patient's bloodstream a contrast agent, which causes vascular tissues to stand out against other tissues, so that information about blood supply and vascular anomalies is easier to gather.[citation needed]

Erection Hardness Score

This section is an excerpt from Erection Hardness Score.[edit]

The Erection Hardness Score (EHS) is a single-item Likert scale used to assess the subjective hardness of the penis as reported by the patient. It ranges from 0 (indicating the penis does not enlarge) to 4 (indicating the penis is completely hard and fully rigid). Developed in 1998, the EHS is widely used in clinical trials and is recognized for its ease of administration and strong association with sexual function outcomes. It has been validated across various causes of erectile dysfunction and in patients treated with phosphodiesterase type 5 inhibitors (PDE5), showing robust psychometric properties and responsiveness to treatment.[52]

Treatment

 

One ad from 1897 claims to restore "perfect manhood. Failure is impossible with our method".[53] Another "will quickly cure you of all nervous or diseases of the generative organs, such as Lost Manhood, Insomnia, Pains in the Back, Seminal Emissions, Nervous Debility, Pimples, Unfitness to Marry, Exhausting Drains, Varicocele and Constipation".[53] The U.S. Federal Trade Commission warns that "phony cures" exist even today.[54]

Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing ED during midlife.[10] Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex.[12] Medications by mouth and vacuum erection devices are first-line treatments,[10]: 20, 24  followed by injections of drugs into the penis, as well as penile implants.[10]: 25–26  Vascular reconstructive surgeries are beneficial in certain groups.[55] Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex.[56]

 

Medications

See also: List of investigational sexual dysfunction drugs

The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken by mouth.[10]: 20–21  As of 2018, sildenafil is available in the UK without a prescription.[57] Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for ED.[58] Penile injections, on the other hand, can involve one of the following medications: papaverine, phentolamine, and prostaglandin E1, also known as alprostadil.[10] In addition to injections, there is an alprostadil suppository that can be inserted into the urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour.[12] Medications to treat ED may cause a side effect called priapism.[12]

 

Prevalence of medical diagnosis

In a study published in 2016, based on US health insurance claims data, out of 19,833,939 US males aged ≥18 years, only 1,108,842 (5.6%), were medically diagnosed with erectile dysfunction or on a PDE5I prescription (μ age 55.2 years, σ 11.2 years). Prevalence of diagnosis or prescription was the highest for age group 60–69 at 11.5%, lowest for age group 18–29 at 0.4%, and 2.1% for 30–39, 5.7% for 40–49, 10% for 50–59, 11% for 70–79, 4.6% for 80–89, 0.9% for ≥90, respectively.[59]

 

Focused shockwave therapy

Focused shockwave therapy involves passing short, high frequency acoustic pulses through the skin and into the penis. These waves break down any plaques within the blood vessels, encourage the formation of new vessels, and stimulate repair and tissue regeneration.[60][61]

 

Focused shockwave therapy appears to work best for males with vasculogenic ED, which is a blood vessel disorder that affects blood flow to tissue in the penis. The treatment is painless and has no known side effects. Treatment with shockwave therapy can lead to a significant improvement of the IIEF (International Index of Erectile Function).[62][63][64]

 

Testosterone

Men with low levels of testosterone can experience ED. Taking testosterone may help maintain an erection.[65] Males with type 2 diabetes are twice as likely to have lower levels of testosterone, and are three times more likely to experience ED than non-diabetic men.[65]

 

Pumps

Main article: penis pump

A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.[11]

 

Vibrators

Main article: Vibrator (sex toy)

The vibrator was invented in the late 19th century as a medical instrument for pain relief and the treatment of various ailments. Sometimes described as a massager, the vibrator is used on the body to produce sexual stimulation. Several clinical studies have found vibrators to be an effective solution for Erectile Dysfunction.[66][67] Examples of FDA registered vibrators for erectile dysfunction include MysteryVibe's Tenuto[68] and Reflexonic's Viberect.[69]

 

Surgery

Main article: Penile implant

Often, as a last resort, if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[10]: 26  Some sources show that vascular reconstructive surgeries are viable options for some people.[55]

 

Alternative medicine

The Food and Drug Administration (FDA) does not recommend alternative therapies to treat sexual dysfunction.[70] Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products.[71][72][73][74][75] The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.[76] A 2021 review indicated that ginseng had "only trivial effects on erectile function or satisfaction with intercourse compared to placebo".[77]

 

History

Further information: Impotence and marriage

Further information: Medicalisation of sexuality

 

An unhappy wife is complaining to the qadi about her husband's impotence. Ottoman miniature.

Attempts to treat the symptoms described by ED date back well over 1,000 years. In the 8th century, males of Ancient Rome and Greece wore talismans of rooster and goat genitalia, believing these talismans would serve as an aphrodisiac and promote sexual function.[78] In the 13th century, Albertus Magnus recommended ingesting roasted wolf penis as a remedy for impotence.[78] During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677.[79][80]

 

The first major publication describing a broad medicalization of sexual disorders was the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1952.[81] In the early 20th century, medical folklore held that 90-95% of cases of ED were psychological in origin, but around the 1980s research took the opposite direction of searching for physical causes of sexual dysfunction, which also happened in the 1920s and 30s.[82] Physical causes as explanations continue to dominate literature when compared with psychological explanations as of 2022.[83]

 

Treatments in the 80s for ED included penile implants and intracavernosal injections.[82] The first successful vacuum erection device, or penis pump, was developed by Vincent Marie Mondat in the early 1800s.[78] A more advanced device based on a bicycle pump was developed by Geddings Osbon, a Pentecostal preacher, in the 1970s. In 1982, he received FDA approval to market the product.[84] John R. Brinkley initiated a boom in male impotence treatments in the U.S. in the 1920s and 1930s, with radio programs that recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff.

 

Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience showing his papaverine-induced erection.[85] The current most common treatment for ED, the oral PDE5 inhibitor known as sildenafil (Viagra) was approved for use for Pfizer by the FDA in 1998, which at the time of release was the fastest selling drug in history.[81][86][87] Sildenafil largely replaced SSRI treatments for ED at the time[88] and proliferated new types of specialised pharmaceutical marketing which emphasised social connotations of ED and Viagra rather than its physical effects.[89][90]

 

Anthropology

Anthropological research presents ED not as a disorder but, as a normal, and sometimes even welcome sign of healthy aging. Wentzell's study of 250 Mexican males in their 50s and 60s found that "most simply did not see decreasing erectile function as a biological pathology".[91] The males interviewed described the decrease in erectile function "as an aid for aging in socially appropriate ways".[91] A common theme amongst the interviewees showed that respectable older males shifted their focus toward the domestic sphere into a "second stage of life".[91] The Mexican males of this generation often pursued sex outside of marriage; decreasing erectile function acted as an aid to overcoming infidelity thus helping to attain the ideal "second stage" of life.[91] A 56-year-old about to retire from the public health service said he would now "dedicate myself to my wife, the house, gardening, caring for the grandchildren—the Mexican classic".[91] Wentzell found that treating ED as a pathology was antithetical to the social view these males held of themselves, and their purpose at this stage of their lives.

 

In the 20th and 21st centuries, anthropologists investigated how common treatments for ED are built upon assumptions of institutionalized social norms. In offering a range of clinical treatments to 'correct' a person's ability to produce an erection, biomedical institutions encourage the public to strive for prolonged sexual function. Anthropologists argue that a biomedical focus places emphasis on the biological processes of fixing the body thereby disregarding holistic ideals of health and aging.[92] By relying on a wholly medical approach, Western biomedicine can become blindsided by bodily dysfunctions which can be understood as appropriate functions of age, and not as a medical problem.[93] Anthropologists understand that a biosocial approach to ED considers a person's decision to undergo clinical treatment more likely a result of "society, political economy, history, and culture" than a matter of personal choice.[92] In rejecting biomedical treatment for ED, males can challenge common forms of medicalized social control by deviating from what is considered the normal approach to dysfunction.

 

Lexicology

The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of ED within medicine is covered by andrology, a sub-field within urology. Research indicates that ED is common, and it is suggested that approximately 40% of males experience symptoms compatible with ED, at least occasionally.[94] The condition is also on occasion called phallic impotence.[95] Its antonym, or opposite condition, is priapism.[96][97]

 

en.wikipedia.org/wiki/Erectile_dysfunction

 

Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended.[3] There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent).[3] Most cases are ischemic.[3] Ischemic priapism is generally painful while nonischemic priapism is not.[3] In ischemic priapism, most of the penis is hard; however, the glans penis is not.[3] In nonischemic priapism, the entire penis is only somewhat hard.[3] Very rarely, clitoral priapism occurs in women.[4]

 

Sickle cell disease is the most common cause of ischemic priapism.[3] Other causes include medications such as antipsychotics, SSRIs, blood thinners and prostaglandin E1, as well as drugs such as cocaine.[3][5] Ischemic priapism occurs when blood does not adequately drain from the penis.[3] Nonischemic priapism is typically due to a connection forming between an artery and the corpus cavernosum or disruption of the parasympathetic nervous system resulting in increased arterial flow.[3] Nonischemic priapism may occur following trauma to the penis or a spinal cord injury.[3] Diagnosis may be supported by blood gas analysis of blood aspirated from the penis or an ultrasound.[3]

 

Treatment depends on the type.[3] Ischemic priapism is typically treated with a nerve block of the penis followed by aspiration of blood from the corpora cavernosa.[3] If this is not sufficient, the corpus cavernosum may be irrigated with cold, normal saline or injected with phenylephrine.[3] Nonischemic priapism is often treated with cold packs and compression.[3] Surgery may be done if usual measures are not effective.[3] In ischemic priapism, the risk of permanent scarring of the penis begins to increase after four hours and definitely occurs after 48 hours.[3][6] Priapism occurs in about 1 in 20,000 to 1 in 100,000 males per year.[3]

 

Classification

Priapism is classified into three groups: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic.[3] The majority of cases (19 out of 20) are ischemic in nature.[3]

 

Some sources give a duration of four hours as a definition of priapism, but others give six. Per the University Hospital Schleswig Holstein, "The duration of a normal erection before it is classifiable as priapism is still controversial. Ongoing penile erections for more than 6 hours can be classified as priapism."[7]

 

In women

Priapism in women (continued, painful erection of the clitoris) is significantly rarer than priapism in men and is known as clitoral priapism or clitorism.[4] It is associated with persistent genital arousal disorder (PGAD).[8] Only a few case reports of women experiencing clitoral priapism exist.[4]

 

Signs and symptoms

Complications

Because ischemic priapism causes the blood to remain in the penis for unusually long periods of time, the blood becomes deprived of oxygen, which can cause damage to the penile tissue. Such damage can result in erectile dysfunction or disfigurement of the penis.[9] In extreme cases, if the penis develops severe vascular disease, the priapism can result in penile gangrene.[10]

 

Low-flow priapism

Causes of low-flow priapism include sickle cell anemia (most common in children), leukemia, and other blood dyscrasias such as thalassemia and multiple myeloma, and the use of various drugs, as well as cancers.[11] A genome-wide association study on Brazilian patients with sickle cell disease identified four single nucleotide polymorphisms in LINC02537 and NAALADL2 significantly associated with priapism.[12]

 

Other conditions that can cause priapism include Fabry's disease, as well as neurologic disorders such as spinal cord lesions and spinal cord trauma (priapism has been reported in people who have been hanged; see death erection).

 

Priapism can also be caused by reactions to medications. The most common medications that cause priapism are intra-cavernous injections for the treatment of erectile dysfunction (papaverine, alprostadil). Other medication groups reported are antihypertensives (e.g. Doxazosin), antipsychotics (e.g., chlorpromazine, clozapine), antidepressants (most notably trazodone), anti-convulsant and mood stabilizer drugs such as sodium valproate.[13] Anticoagulants, cantharides (Spanish Fly) and recreational drugs (alcohol, heroin and cocaine) have been associated. Priapism is also known to occur from bites of the Brazilian wandering spider.[14]

 

High-flow priapism

Causes of high-flow priapism include:

 

blunt trauma to the perineum or penis, with laceration of the cavernous artery, which can generate an arterial-lacunar fistula.[11]

Anticoagulants (heparin and warfarin).

Antihypertensives (i.e., hydralazine, guanethidine and propranolol).

Hormones (i.e., gonadotropin releasing hormone and testosterone).

Diagnosis

The diagnosis is often based on the history of the condition as well as a physical exam.[3]

 

Blood gas testing the blood from the cavernosa of the penis can help in the diagnosis.[3] If the low-flow type of priapism is present, the blood typically has a low pH, while if the high-flow type is present, the pH is typically normal.[3] Color Doppler ultrasound may also help differentiate the two.[3] Testing a person to make sure they do not have a hemoglobinopathy may also be reasonable.[3]

 

Ultrasonography

 

Color Doppler ultrasound demonstrating a hypoechoic collection that corresponds to hematoma with arteriovenous fistula secondary to traumatic injury of the penis due to impact with bicycle handlebars, resulting in high-flow priapism[11]

Penile ultrasonography with Doppler is the imaging method of choice, because it is noninvasive, widely available, and highly sensitive. By means of this method, it is possible to diagnose priapism and differentiate between its low- and high-flow forms.[11]

 

In low-flow (ischemic) priapism the flow in the cavernous arteries is reduced or absent. As the condition progresses, there is an increase in echogenicity of the corpora cavernosa, attributed to tissue edema. Eventually, changes in the echotexture of the corpora cavernosa can be observed due to the fibrotic transformation generated by tissue anoxia.[11]

 

In high-flow priapism normal or increased, turbulent blood flow in the cavernous arteries is seen. The area surrounding the fistula presents a hypoechoic, irregular lesion in the cavernous tissue.[11]

 

Treatment

Medical evaluation is recommended for erections that last for longer than four hours. Pain can often be reduced with a dorsal penile nerve block or penile ring block.[3] For those with nonischemic priapism, cold packs and pressure to the area may be sufficient.[3]

 

Pseudoephedrine

Orally administered pseudoephedrine is a first-line treatment for priapism.[15] Erection is largely a parasympathetic response, so the sympathetic action of pseudoephedrine may serve to relieve this condition. Pseudoephedrine is an alpha-agonist agent that exerts a constriction effect on smooth muscle of corpora cavernosum, which in turn facilitates venous outflow. Pseudoephedrine is no longer available in some countries.

 

Aspiration

For those with ischemic priapism, the initial treatment is typically aspiration of blood from the corpus cavernosum.[3] This is done on either side.[3] If this is not sufficiently effective, then cold normal saline may be injected and removed.[3]

 

Medications

If aspiration is not sufficient, a small dose of phenylephrine may be injected into the corpus cavernosum.[3] Side effects of phenylephrine may include: high blood pressure, slow heart rate, and arrhythmia.[3] If this medication is used, it is recommended that people be monitored for at least an hour after.[3] For those with recurrent ischemic priapism, diethylstilbestrol (DES) or terbutaline may be tried.[3]

 

Surgery

Distal shunts, such as the Winter's,[clarification needed] involve puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside. Winter's shunts are often the first invasive technique used, especially in hematologically induced priapism, as it is relatively simple and repeatable.[16]

 

Proximal shunts, such as the Quackel's,[clarification needed] are more involved and entail operative dissection in the perineum where the corpora meet the spongiosum while making an incision in both and suturing both openings together.[17] Shunts created between the corpora cavernosa and great saphenous vein called a Grayhack shunt can be done though this technique is rarely used.[18]

 

As the complication rates with prolonged priapism are high, early penile prosthesis implantation may be considered.[3] As well as allowing early resumption of sexual activity, early implantation can avoid the formation of dense fibrosis and, hence, a shortened penis.

 

Sickle cell anemia

In sickle cell anemia, treatment is initially with intravenous fluids, pain medication, and oxygen therapy.[19][3] The typical treatment of priapism may be carried out as well.[3] Blood transfusions are not usually recommended as part of the initial treatment, but if other treatments are not effective, exchange transfusion may be done.[19][3]

 

History

Persistent semi-erections and intermittent states of prolonged erections have historically been sometimes called semi-priapism.[20]

 

Terminology

The name comes from the Greek god Priapus (Ancient Greek: Πρίαπος), a fertility god, often represented with a disproportionately large phallus.[21

 

en.wikipedia.org/wiki/Priapism

Prominent Hair Restoration Expert Dr. Alan J. Bauman Features Drug-free ‘LaserCap’ for Thinning Hair on New Lifetime Show

Alan J. Bauman, M.D. discussed hair loss and advancements in low-level laser therapy with Suzanne Somers on October 3rd.

 

Boca Raton, Florida

 

October 3rd, 2012 --Suzanne Somers the eponymous host of Lifetime Channel’s, The Suzanne Show discussed hair loss and new alternative treatments for patients with prominent hair loss expert, Dr. Alan. J. Bauman. Watch the segment: www.youtube.com/watch?v=hMCOl1E4gIg

 

The new talk show, featuring Suzanne Somers, who is known in the medical community as a passionate healthcare advocate, includes health tips, wide ranging education segments, and discussions on top critical health issues. Since over 50 million American men and 30 million women suffer from hair loss, and spend over $2 billion each year on treatments, the topic is a natural fit for the show, which focuses on educating viewers on how to live a healthy, full and ageless life and will likely be a recurring theme in future shows.

 

“We’re excited about the opportunity to discuss hair loss with The Suzanne Show and hope that viewers are empowered by the new drug-free and non-invasive technologies available to treat and prevent hair loss,” said Dr. Bauman, who has treated more than 15,000 hair loss suffers since 1997. “Our goal is to help consumers understand that hair loss is no longer inevitable,” says Dr. Bauman who points out on the show that there exists a wide range of non-invasive treatment options for the millions of men and women who suffer from hair loss.

 

The Suzanne Show strategically partners with physicians and health experts who share Suzanne’s beliefs in progressive medicine and integrative health therapies. When Dr. Alan Bauman had the opportunity to meet Suzanne Somers at a major international medical conference, they discussed his holistic, multi-therapy approach to the treatment of hair loss that meshed, according to Dr. Bauman, “perfectly with Suzanne’s philosophy and direction of the show.” Says, Dr. Bauman, “Suzanne and I both agreed that her audience would appreciate the benefits of this new advanced technology as a way to treat hair loss.”

 

As a nationally recognized expert in the field of hair restoration, Dr. Bauman discussed the drug-free LaserCap, the first device of its kind and the latest breakthrough in laser therapy for the scalp. The "hands-free” device offers the power of a clinical laser therapy unit in a cordless, rechargeable, discreet treatment device that literally 'fits under your hat' for non-chemical, non-invasive, pain-free treatment almost anywhere, anytime.

 

“The LaserCap is unique among low level laser therapy devices because it doesn't require the patient to stand in front of a mirror for 10-15 minutes, manually 'combing' the area, as with hand-held comb lasers,” commented Bauman. “This is an exciting new tool for hair loss sufferers as it allows them a discreet treatment option that can easily be combined with exercise, work or even grocery shopping. And it works.”

 

In recent years, low-level laser therapy has become more accepted in the treatment of hair loss, evidenced by FDA clearances of one specific brand of comb-laser, an in-office clinical device and a dramatic increase in prescriptions by hair restoration physicians.

 

“Laser therapy has become a valuable tool for patients with hair loss, and allows patients a drug-free and side effect-free option,” explained Bauman, who has treated thousands of patients with laser therapy in his Boca Raton, FL offices for more than ten years.

 

About LaserCap and Low Level Laser Therapy:

 

•Laser therapy is a non-chemical, non-invasive way to help men and women grow thicker and healthier looking hair.

•LaserCap fits into and under any hat, which when put on, gives patients complete coverage of their scalp.

•LaserCap has over 220 diodes, making it the most powerful portable laser therapy device for the scalp.

•In addition to LaserCap, there are numerous other products currently out on the market, such as laser combs and brushes, helmets and in-office clinical laser 'hoods.'

 

Laser therapy, like other non-invasive hair growth treatments, is no ‘miracle cure,’ but it is an important tool in the treatment of damaged hair, thinning hair and hair loss. For more information on what kind of results you might achieve with laser therapy or how laser therapy can be added to your 'multi-therapy' hair restoration regimen, please visit www.baumanmedical.com or www.lasercap.info or call 1-877-BAUMAN-9 or +1 561-394-0024.

  

ABOUT DR. ALAN BAUMAN:

Alan J. Bauman, M.D., founder of Bauman Medical Group in Boca Raton, Florida, is a full-time board-certified and internationally renowned hair transplant surgeon whose pioneering work has been featured extensively in the national and international print and television media, such as Newsweek, The New York Times, Cosmo, Vogue, Allure, Men's Health, Today Show, The Early Show, Good Morning America, Extra, Access Hollywood and Dateline NBC.

 

Dr. Bauman’s Radio Show: “Live Hair on the Air” – www.LiveHair.TV

Dr. Bauman has recently launched his own half-hour radio show, “Live Hair on the Air, (www.LiveHair.TV) that currently airs on multiple Clear Channel radio stations in Florida. Co-hosted by one of South Florida’s top radio personalities, Kevin Rolston, the front man of WILD 95.5 FM’s the “Kevin, Virginia, Jason” morning show, who recently underwent a live on air hair transplant from Dr. Bauman that was streamed to a global audience of nearly 75,000 viewers from 22 countries. The high production value radio show, complete with song parodies and assorted comedy elements about hair loss from around the web, popular culture and television, is not just informative and educational but fun and entertaining. As reported in the nation’s leading radio industry trade magazine, “Jockline,” Rolston is the first disc jockey/radio announcer in the country to undergo a live on air hair transplant. (www.LiveHair.tv)

 

Dr. Bauman is recognized within the medical profession as top U.S. medical expert on the treatment of hair loss in men and women. A board-certified hair restoration surgeon, Dr. Bauman was the first to demonstrate ‘live’ the FUE method of hair transplantation at the 2003 International Society of Hair Restoration Surgery Orlando Live Surgery Workshop and the first to demonstrate the NeoGraft FUE device at the ISHRS Orlando Live Surgery Workshop in 2010. His practice is divided equally between male and female patients, and Dr. Bauman provides state-of-the-art diagnostic procedures and a multi-therapy approach to the medically treatable condition of hair loss. Dr. Bauman is a member and often a featured speaker at the American Academy of Anti-Aging Medicine and the International Society of Hair Restoration Surgery Annual Scientific Meetings.

Prominent Hair Restoration Expert Dr. Alan J. Bauman Features Drug-free ‘LaserCap’ for Thinning Hair on New Lifetime Show

Alan J. Bauman, M.D. discussed hair loss and advancements in low-level laser therapy with Suzanne Somers on October 3rd.

 

Boca Raton, Florida

 

October 3rd, 2012 --Suzanne Somers the eponymous host of Lifetime Channel’s, The Suzanne Show discussed hair loss and new alternative treatments for patients with prominent hair loss expert, Dr. Alan. J. Bauman. Watch the segment: www.youtube.com/watch?v=hMCOl1E4gIg

 

The new talk show, featuring Suzanne Somers, who is known in the medical community as a passionate healthcare advocate, includes health tips, wide ranging education segments, and discussions on top critical health issues. Since over 50 million American men and 30 million women suffer from hair loss, and spend over $2 billion each year on treatments, the topic is a natural fit for the show, which focuses on educating viewers on how to live a healthy, full and ageless life and will likely be a recurring theme in future shows.

 

“We’re excited about the opportunity to discuss hair loss with The Suzanne Show and hope that viewers are empowered by the new drug-free and non-invasive technologies available to treat and prevent hair loss,” said Dr. Bauman, who has treated more than 15,000 hair loss suffers since 1997. “Our goal is to help consumers understand that hair loss is no longer inevitable,” says Dr. Bauman who points out on the show that there exists a wide range of non-invasive treatment options for the millions of men and women who suffer from hair loss.

 

The Suzanne Show strategically partners with physicians and health experts who share Suzanne’s beliefs in progressive medicine and integrative health therapies. When Dr. Alan Bauman had the opportunity to meet Suzanne Somers at a major international medical conference, they discussed his holistic, multi-therapy approach to the treatment of hair loss that meshed, according to Dr. Bauman, “perfectly with Suzanne’s philosophy and direction of the show.” Says, Dr. Bauman, “Suzanne and I both agreed that her audience would appreciate the benefits of this new advanced technology as a way to treat hair loss.”

 

As a nationally recognized expert in the field of hair restoration, Dr. Bauman discussed the drug-free LaserCap, the first device of its kind and the latest breakthrough in laser therapy for the scalp. The "hands-free” device offers the power of a clinical laser therapy unit in a cordless, rechargeable, discreet treatment device that literally 'fits under your hat' for non-chemical, non-invasive, pain-free treatment almost anywhere, anytime.

 

“The LaserCap is unique among low level laser therapy devices because it doesn't require the patient to stand in front of a mirror for 10-15 minutes, manually 'combing' the area, as with hand-held comb lasers,” commented Bauman. “This is an exciting new tool for hair loss sufferers as it allows them a discreet treatment option that can easily be combined with exercise, work or even grocery shopping. And it works.”

 

In recent years, low-level laser therapy has become more accepted in the treatment of hair loss, evidenced by FDA clearances of one specific brand of comb-laser, an in-office clinical device and a dramatic increase in prescriptions by hair restoration physicians.

 

“Laser therapy has become a valuable tool for patients with hair loss, and allows patients a drug-free and side effect-free option,” explained Bauman, who has treated thousands of patients with laser therapy in his Boca Raton, FL offices for more than ten years.

 

About LaserCap and Low Level Laser Therapy:

 

•Laser therapy is a non-chemical, non-invasive way to help men and women grow thicker and healthier looking hair.

•LaserCap fits into and under any hat, which when put on, gives patients complete coverage of their scalp.

•LaserCap has over 220 diodes, making it the most powerful portable laser therapy device for the scalp.

•In addition to LaserCap, there are numerous other products currently out on the market, such as laser combs and brushes, helmets and in-office clinical laser 'hoods.'

 

Laser therapy, like other non-invasive hair growth treatments, is no ‘miracle cure,’ but it is an important tool in the treatment of damaged hair, thinning hair and hair loss. For more information on what kind of results you might achieve with laser therapy or how laser therapy can be added to your 'multi-therapy' hair restoration regimen, please visit www.baumanmedical.com or www.lasercap.info or call 1-877-BAUMAN-9 or +1 561-394-0024.

  

ABOUT DR. ALAN BAUMAN:

Alan J. Bauman, M.D., founder of Bauman Medical Group in Boca Raton, Florida, is a full-time board-certified and internationally renowned hair transplant surgeon whose pioneering work has been featured extensively in the national and international print and television media, such as Newsweek, The New York Times, Cosmo, Vogue, Allure, Men's Health, Today Show, The Early Show, Good Morning America, Extra, Access Hollywood and Dateline NBC.

 

Dr. Bauman’s Radio Show: “Live Hair on the Air” – www.LiveHair.TV

Dr. Bauman has recently launched his own half-hour radio show, “Live Hair on the Air, (www.LiveHair.TV) that currently airs on multiple Clear Channel radio stations in Florida. Co-hosted by one of South Florida’s top radio personalities, Kevin Rolston, the front man of WILD 95.5 FM’s the “Kevin, Virginia, Jason” morning show, who recently underwent a live on air hair transplant from Dr. Bauman that was streamed to a global audience of nearly 75,000 viewers from 22 countries. The high production value radio show, complete with song parodies and assorted comedy elements about hair loss from around the web, popular culture and television, is not just informative and educational but fun and entertaining. As reported in the nation’s leading radio industry trade magazine, “Jockline,” Rolston is the first disc jockey/radio announcer in the country to undergo a live on air hair transplant. (www.LiveHair.tv)

 

Dr. Bauman is recognized within the medical profession as top U.S. medical expert on the treatment of hair loss in men and women. A board-certified hair restoration surgeon, Dr. Bauman was the first to demonstrate ‘live’ the FUE method of hair transplantation at the 2003 International Society of Hair Restoration Surgery Orlando Live Surgery Workshop and the first to demonstrate the NeoGraft FUE device at the ISHRS Orlando Live Surgery Workshop in 2010. His practice is divided equally between male and female patients, and Dr. Bauman provides state-of-the-art diagnostic procedures and a multi-therapy approach to the medically treatable condition of hair loss. Dr. Bauman is a member and often a featured speaker at the American Academy of Anti-Aging Medicine and the International Society of Hair Restoration Surgery Annual Scientific Meetings.

Prominent Hair Restoration Expert Dr. Alan J. Bauman Features Drug-free ‘LaserCap’ for Thinning Hair on New Lifetime Show

Alan J. Bauman, M.D. discussed hair loss and advancements in low-level laser therapy with Suzanne Somers on October 3rd.

 

Boca Raton, Florida

 

October 3rd, 2012 --Suzanne Somers the eponymous host of Lifetime Channel’s, The Suzanne Show discussed hair loss and new alternative treatments for patients with prominent hair loss expert, Dr. Alan. J. Bauman. Watch the segment: www.youtube.com/watch?v=hMCOl1E4gIg

 

The new talk show, featuring Suzanne Somers, who is known in the medical community as a passionate healthcare advocate, includes health tips, wide ranging education segments, and discussions on top critical health issues. Since over 50 million American men and 30 million women suffer from hair loss, and spend over $2 billion each year on treatments, the topic is a natural fit for the show, which focuses on educating viewers on how to live a healthy, full and ageless life and will likely be a recurring theme in future shows.

 

“We’re excited about the opportunity to discuss hair loss with The Suzanne Show and hope that viewers are empowered by the new drug-free and non-invasive technologies available to treat and prevent hair loss,” said Dr. Bauman, who has treated more than 15,000 hair loss suffers since 1997. “Our goal is to help consumers understand that hair loss is no longer inevitable,” says Dr. Bauman who points out on the show that there exists a wide range of non-invasive treatment options for the millions of men and women who suffer from hair loss.

 

The Suzanne Show strategically partners with physicians and health experts who share Suzanne’s beliefs in progressive medicine and integrative health therapies. When Dr. Alan Bauman had the opportunity to meet Suzanne Somers at a major international medical conference, they discussed his holistic, multi-therapy approach to the treatment of hair loss that meshed, according to Dr. Bauman, “perfectly with Suzanne’s philosophy and direction of the show.” Says, Dr. Bauman, “Suzanne and I both agreed that her audience would appreciate the benefits of this new advanced technology as a way to treat hair loss.”

 

As a nationally recognized expert in the field of hair restoration, Dr. Bauman discussed the drug-free LaserCap, the first device of its kind and the latest breakthrough in laser therapy for the scalp. The "hands-free” device offers the power of a clinical laser therapy unit in a cordless, rechargeable, discreet treatment device that literally 'fits under your hat' for non-chemical, non-invasive, pain-free treatment almost anywhere, anytime.

 

“The LaserCap is unique among low level laser therapy devices because it doesn't require the patient to stand in front of a mirror for 10-15 minutes, manually 'combing' the area, as with hand-held comb lasers,” commented Bauman. “This is an exciting new tool for hair loss sufferers as it allows them a discreet treatment option that can easily be combined with exercise, work or even grocery shopping. And it works.”

 

In recent years, low-level laser therapy has become more accepted in the treatment of hair loss, evidenced by FDA clearances of one specific brand of comb-laser, an in-office clinical device and a dramatic increase in prescriptions by hair restoration physicians.

 

“Laser therapy has become a valuable tool for patients with hair loss, and allows patients a drug-free and side effect-free option,” explained Bauman, who has treated thousands of patients with laser therapy in his Boca Raton, FL offices for more than ten years.

 

About LaserCap and Low Level Laser Therapy:

 

•Laser therapy is a non-chemical, non-invasive way to help men and women grow thicker and healthier looking hair.

•LaserCap fits into and under any hat, which when put on, gives patients complete coverage of their scalp.

•LaserCap has over 220 diodes, making it the most powerful portable laser therapy device for the scalp.

•In addition to LaserCap, there are numerous other products currently out on the market, such as laser combs and brushes, helmets and in-office clinical laser 'hoods.'

 

Laser therapy, like other non-invasive hair growth treatments, is no ‘miracle cure,’ but it is an important tool in the treatment of damaged hair, thinning hair and hair loss. For more information on what kind of results you might achieve with laser therapy or how laser therapy can be added to your 'multi-therapy' hair restoration regimen, please visit www.baumanmedical.com or www.lasercap.info or call 1-877-BAUMAN-9 or +1 561-394-0024.

  

ABOUT DR. ALAN BAUMAN:

Alan J. Bauman, M.D., founder of Bauman Medical Group in Boca Raton, Florida, is a full-time board-certified and internationally renowned hair transplant surgeon whose pioneering work has been featured extensively in the national and international print and television media, such as Newsweek, The New York Times, Cosmo, Vogue, Allure, Men's Health, Today Show, The Early Show, Good Morning America, Extra, Access Hollywood and Dateline NBC.

 

Dr. Bauman’s Radio Show: “Live Hair on the Air” – www.LiveHair.TV

Dr. Bauman has recently launched his own half-hour radio show, “Live Hair on the Air, (www.LiveHair.TV) that currently airs on multiple Clear Channel radio stations in Florida. Co-hosted by one of South Florida’s top radio personalities, Kevin Rolston, the front man of WILD 95.5 FM’s the “Kevin, Virginia, Jason” morning show, who recently underwent a live on air hair transplant from Dr. Bauman that was streamed to a global audience of nearly 75,000 viewers from 22 countries. The high production value radio show, complete with song parodies and assorted comedy elements about hair loss from around the web, popular culture and television, is not just informative and educational but fun and entertaining. As reported in the nation’s leading radio industry trade magazine, “Jockline,” Rolston is the first disc jockey/radio announcer in the country to undergo a live on air hair transplant. (www.LiveHair.tv)

 

Dr. Bauman is recognized within the medical profession as top U.S. medical expert on the treatment of hair loss in men and women. A board-certified hair restoration surgeon, Dr. Bauman was the first to demonstrate ‘live’ the FUE method of hair transplantation at the 2003 International Society of Hair Restoration Surgery Orlando Live Surgery Workshop and the first to demonstrate the NeoGraft FUE device at the ISHRS Orlando Live Surgery Workshop in 2010. His practice is divided equally between male and female patients, and Dr. Bauman provides state-of-the-art diagnostic procedures and a multi-therapy approach to the medically treatable condition of hair loss. Dr. Bauman is a member and often a featured speaker at the American Academy of Anti-Aging Medicine and the International Society of Hair Restoration Surgery Annual Scientific Meetings.

Prominent Hair Restoration Expert Dr. Alan J. Bauman Features Drug-free ‘LaserCap’ for Thinning Hair on New Lifetime Show

Alan J. Bauman, M.D. discussed hair loss and advancements in low-level laser therapy with Suzanne Somers on October 3rd.

 

Boca Raton, Florida

 

October 3rd, 2012 --Suzanne Somers the eponymous host of Lifetime Channel’s, The Suzanne Show discussed hair loss and new alternative treatments for patients with prominent hair loss expert, Dr. Alan. J. Bauman. Watch the segment: www.youtube.com/watch?v=hMCOl1E4gIg

 

The new talk show, featuring Suzanne Somers, who is known in the medical community as a passionate healthcare advocate, includes health tips, wide ranging education segments, and discussions on top critical health issues. Since over 50 million American men and 30 million women suffer from hair loss, and spend over $2 billion each year on treatments, the topic is a natural fit for the show, which focuses on educating viewers on how to live a healthy, full and ageless life and will likely be a recurring theme in future shows.

 

“We’re excited about the opportunity to discuss hair loss with The Suzanne Show and hope that viewers are empowered by the new drug-free and non-invasive technologies available to treat and prevent hair loss,” said Dr. Bauman, who has treated more than 15,000 hair loss suffers since 1997. “Our goal is to help consumers understand that hair loss is no longer inevitable,” says Dr. Bauman who points out on the show that there exists a wide range of non-invasive treatment options for the millions of men and women who suffer from hair loss.

 

The Suzanne Show strategically partners with physicians and health experts who share Suzanne’s beliefs in progressive medicine and integrative health therapies. When Dr. Alan Bauman had the opportunity to meet Suzanne Somers at a major international medical conference, they discussed his holistic, multi-therapy approach to the treatment of hair loss that meshed, according to Dr. Bauman, “perfectly with Suzanne’s philosophy and direction of the show.” Says, Dr. Bauman, “Suzanne and I both agreed that her audience would appreciate the benefits of this new advanced technology as a way to treat hair loss.”

 

As a nationally recognized expert in the field of hair restoration, Dr. Bauman discussed the drug-free LaserCap, the first device of its kind and the latest breakthrough in laser therapy for the scalp. The "hands-free” device offers the power of a clinical laser therapy unit in a cordless, rechargeable, discreet treatment device that literally 'fits under your hat' for non-chemical, non-invasive, pain-free treatment almost anywhere, anytime.

 

“The LaserCap is unique among low level laser therapy devices because it doesn't require the patient to stand in front of a mirror for 10-15 minutes, manually 'combing' the area, as with hand-held comb lasers,” commented Bauman. “This is an exciting new tool for hair loss sufferers as it allows them a discreet treatment option that can easily be combined with exercise, work or even grocery shopping. And it works.”

 

In recent years, low-level laser therapy has become more accepted in the treatment of hair loss, evidenced by FDA clearances of one specific brand of comb-laser, an in-office clinical device and a dramatic increase in prescriptions by hair restoration physicians.

 

“Laser therapy has become a valuable tool for patients with hair loss, and allows patients a drug-free and side effect-free option,” explained Bauman, who has treated thousands of patients with laser therapy in his Boca Raton, FL offices for more than ten years.

 

About LaserCap and Low Level Laser Therapy:

 

•Laser therapy is a non-chemical, non-invasive way to help men and women grow thicker and healthier looking hair.

•LaserCap fits into and under any hat, which when put on, gives patients complete coverage of their scalp.

•LaserCap has over 220 diodes, making it the most powerful portable laser therapy device for the scalp.

•In addition to LaserCap, there are numerous other products currently out on the market, such as laser combs and brushes, helmets and in-office clinical laser 'hoods.'

 

Laser therapy, like other non-invasive hair growth treatments, is no ‘miracle cure,’ but it is an important tool in the treatment of damaged hair, thinning hair and hair loss. For more information on what kind of results you might achieve with laser therapy or how laser therapy can be added to your 'multi-therapy' hair restoration regimen, please visit www.baumanmedical.com or www.lasercap.info or call 1-877-BAUMAN-9 or +1 561-394-0024.

  

ABOUT DR. ALAN BAUMAN:

Alan J. Bauman, M.D., founder of Bauman Medical Group in Boca Raton, Florida, is a full-time board-certified and internationally renowned hair transplant surgeon whose pioneering work has been featured extensively in the national and international print and television media, such as Newsweek, The New York Times, Cosmo, Vogue, Allure, Men's Health, Today Show, The Early Show, Good Morning America, Extra, Access Hollywood and Dateline NBC.

 

Dr. Bauman’s Radio Show: “Live Hair on the Air” – www.LiveHair.TV

Dr. Bauman has recently launched his own half-hour radio show, “Live Hair on the Air, (www.LiveHair.TV) that currently airs on multiple Clear Channel radio stations in Florida. Co-hosted by one of South Florida’s top radio personalities, Kevin Rolston, the front man of WILD 95.5 FM’s the “Kevin, Virginia, Jason” morning show, who recently underwent a live on air hair transplant from Dr. Bauman that was streamed to a global audience of nearly 75,000 viewers from 22 countries. The high production value radio show, complete with song parodies and assorted comedy elements about hair loss from around the web, popular culture and television, is not just informative and educational but fun and entertaining. As reported in the nation’s leading radio industry trade magazine, “Jockline,” Rolston is the first disc jockey/radio announcer in the country to undergo a live on air hair transplant. (www.LiveHair.tv)

 

Dr. Bauman is recognized within the medical profession as top U.S. medical expert on the treatment of hair loss in men and women. A board-certified hair restoration surgeon, Dr. Bauman was the first to demonstrate ‘live’ the FUE method of hair transplantation at the 2003 International Society of Hair Restoration Surgery Orlando Live Surgery Workshop and the first to demonstrate the NeoGraft FUE device at the ISHRS Orlando Live Surgery Workshop in 2010. His practice is divided equally between male and female patients, and Dr. Bauman provides state-of-the-art diagnostic procedures and a multi-therapy approach to the medically treatable condition of hair loss. Dr. Bauman is a member and often a featured speaker at the American Academy of Anti-Aging Medicine and the International Society of Hair Restoration Surgery Annual Scientific Meetings.

via

 

Smooth, supple skin all over your body is one of the modern beauty standards. The indicators of an aging skin cell can be seen all over the body. They emerge in a variety of ways, such as cellulite on the thighs. Derma roller becomes a must-have skin care product in the routines of most women with other cosmetic treatments.

 

So does a microneedle roller work for cellulite? Yes! Micro needling has effectively diminished the appearance of cellulite on the body. Most patients are astonished to hear that the same therapy they use on their faces helps blur the evidence of a scar, fine lines, wrinkles, and acne scars can also promote smoother skin and cellulite reduction. Skin needling is a non-surgical, non-invasive therapy for everyone.

 

Does Micro Needle Roller Work for Cellulite?

 

The derma roller can be a savior for ladies who have cellulite deposits on their thighs, buttocks, arms, and abdomen. Cellulite can also occur in other parts of the body, but those four are the most common. This unattractive cellulite can keep anyone from wearing a favorite dress, flaunting the arms, or even having fun at the beach in a sultry bikini.

 

Derma roller works by stimulating elastin and inducing collagen production in your skin through the pores. Although it may appear questionable, the science behind derma rolling therapy demonstrates that this simple procedure can produce noticeable improvements in a few amount of time.

 

Dermarolling therapy can treat skin problems such as uneven skin tone, deep scars, dryness and dullness, hyperpigmentation, acne pits, stretch mark, early aging, crow's feet, and cellulite quickly and effectively. Anyone can still benefit from the microneedling device's magic by improving skin texture. The skin condition will continue looking as lovely as it does now in the years to follow.

 

Furthermore, anyone can use this fine needle or body roller in the comfort of their home. Scheduled treatments at a clinic are no longer needed because anyone can now perform the procedure independently. Doing some research is still necessary to become familiar with these skincare products and utilize them properly. However, these are minor inconveniences relative to the prices of professional therapy.

 

Melt Away Your Cellulite Today at the Cellulite Treatment Center of NJ

 

BUTTON

 

Micro Needle Roller Techniques for Cellulite Reduction

 

Skin needling is incredibly simple to do. Anyone may treat the cellulite and witness noticeable results after a few treatments if you use this 4-Directions Technique. The following is how it works:

 

Roll up and down four times.

 

Raise the derma roller and roll left and right four times.

 

Lift the microneedle roller again and roll it diagonally from top right to bottom left four times.

 

Finally, roll it four times diagonally from top left to bottom right.

 

Carry on in the same method as before. Apply the same level of pressure in a different direction. Please take it slowly and carefully.

 

Roll the derma roller by segments. Divide the area into quarter-size parts. It's best to microneedle roll in sections to completely cover the area of treatment. Before moving to the next portion, roll four rounds of skin needling in four different directions.

 

Since uneven layers of fat cells in the connective tissue cause cellulite formation, recurring sessions are advisable in achieving noticeable changes.

 

Treating the cellulite with a body derma roller causes the skin to thickens as it reaches the dermis, preventing the fats from protruding.

 

Derma rolling should be done once a week for optimal results.

 

Does Micro Needle Roller Eliminate Cellulite Completely?

 

Microneedling alone may not entirely remove cellulite. For more desirable results, combine derma rolling treatment with topical retinoid cream. However, skin needling plus hyaluronic acid and Vitamin A serum can increase collagen production. They help in skin regeneration that is perfect for sensitive skin.

 

Vitamin A promotes the formation of collagen, which results in less skin dimpling and a thicker epidermis. Vitamin A help enhance skin elasticity.

 

Keep in mind that retinol is the most efficient type of Vitamin A. Since it is acidic, it has the potential to induce skin irritation. Some users experienced a burning feeling on their skin after using it.

 

However, not everyone will have this effect. It depends on how the skin reacts. To avoid this, test it first on the skin if it causes irritation or redness.

 

As a result, be careful not to overuse Retinoin on the skin. To avoid any adverse reactions, use only the prescribed formulations. Retinoid is not advisable for women who are planning to become pregnant, pregnant, or are breastfeeding.

 

Derma roller can also treat hair loss problems. This microneedle roller help mend the affected hair follicles and regrow hair after unclogging pores, removing germs and old dead cells. Make sure not to share the derma roller with anyone for hygiene reasons. Always clean the roller before and after using.

 

Bottomline

 

Derma Rollers are at-home treatments that can help reduce scars, wrinkles, and improve the appearance of our skin. Regular use may help lessen the look of several of these skin disorders. Medical treatments for cellulite or stretch mark scars are always best for long-term results.

 

When using the body derma roller, make sure to know the proper techniques. Microneedle rollers work better with moisturizers and serums. For maintaining the quality of the body rollers, make sure to clean and store them carefully. A high-quality titanium derma roller with fine needles no longer 5mm thick is advisable for beginners.

 

Dermarolling therapy is a good alternative in getting rid of irregular cellulite. It is better to use the microneedle roller with Vitamin A serum or anti cellulite cream to achieve faster effects!

 

QWO is another effective way to eliminate cellulite. It's a highly recommended treatment for adult women with moderate to severe cellulite in their buttocks and other body areas. QWO is a long-lasting injection that targets cellulite in particular body areas. It contains collagen, which significantly improves skin texture. This may not be beneficial for everyone due to the chance of allergies. It is always best to talk to a specialist if this treatment is suitable.

 

Thaw Away Your Cellulite at the Cellulite Treatment Center of NJ Now

 

Cellulite Treatment NJ offers a depth of expertise with the most up-to-date cellulite removal techniques, integrating them with traditional procedures for an effective treatment that will leave your skin as smooth as you've always imagined. Set up an appointment with us today to learn more about our cellulite treatments and other options.

 

Melt Away Your Cellulite Today at the Cellulite Treatment Center of NJ

 

BUTTON

 

cellulitetreatmentcenterofnj.com/micro-needle-roller-for-...

The other day I drove a neighbor - a dear friend - to his appointment for his first cataract surgery. As you are reading this today, I will be driving his wife to her appointment for the very same surgery.

 

When waiting to meet him later post-surgery - the clinic was located at the University of Waterloo School of Optometry and Vision Science - I happened to spot a group of students huddled around tables in the main building, studying and talking, Presuming to myself that they were in the program, I wondered what types of rapid advances they would see in their field of vision science by the time they are in their 40s, 50s, and 60s.

 

We can only begin to imagine because we are already living in a time in which the science fiction of our yesterday has become our reality.

 

Cataract surgery itself is remarkably routine; I had it done almost a decade ago as an alternative to LASIK. Essentially, a small incision is made in the eye; the old lens is sucked out, and a new permanent lens is implanted. What happens, though, when that lens replacement itself becomes a hyperconnected, microchip-based intelligent vision system? What happens when we can truly give eyesight to the blind? What happens if we have full bionic eye implants that link to the optical nerve? What happens when we have heads-up-display technology integrated into said bionic eyeball so that we can enhance our vision with HUD stuff, just like we see in a modern-day airliner?

 

These are the things a futurist thinks about. What seems crazy is becoming routine. And after all, we can read about such advances in the news all the time.

 

With that in mind, consider the tremendous advances that have occurred in the science and technology of medicine overall. This is a grab bag of a few of those trends that I wrote about just a few years ago. Many are becoming real at a pace that is, I always say, staggering: our science fiction past is already in our future and is rapidly becoming a part of our today.

 

- technology is taking over medicine. BIo-connectivity devices such as remote blood pressure monitoring devices allow for the virtualization of many health care services ("bedless hospitals") at a much lower cost

 

- Google and other companies are working on a contact lens that will monitor blood sugar/glucose for diabetes patients. We are going to witness a flood of wearable healthcare monitoring technology.

 

- we will soon see 'smart medical implants. This will include a contact lens, surgically implanted, that will feature storage, a battery, sensors, and other electronics to aid in vision

 

- smart pharma with connected pills will one day be here; we will have ingestible pharmaceuticals that will report on how well particular treatments might be working. There's been a lot of work in this area, and many high-profile failures - but it will soon be common.

-

we will soon see a computer chip that will diagnose infectious diseases through continuous bloodstream monitoring

 

- 3D printing technologies now allow us to provide customized hip replacements and other medical implants, or the printing of prosthetics for amputees

 

- digital twin technology is already allowing surgeons to prototype forthcoming surgeries - thereby taking on with greater confidence more complicated routines

 

- smart packaging allows the development of pharmaceutical/drug products that will aid in the use of the product

 

- digital mobile technologies are allowing many people to 'get closer to their health, by monitoring, gaining a better understanding and actively managing chronic conditions such as blood pressure and diabetes

 

- wearable sensor technologies (such as the contact lens mentioned above) allow for continuous monitoring of medical conditions

personalized medicine and pharmacogenetics provide for more targeted drug and medical therapies

 

- patient-generated data and shared patent-edited medical records are providing for more consultative medical relationships

 

- 'frugal innovation' is leading to such ideas as smartphone-based medical imaging capabilities

 

- continued rapid advances in the cost collapse of genomic medicine have driven the acceleration of Moore's Law

 

- AI advances led to an ongoing decrease in the cost of medical diagnosis, including pathology slides, x-rays, retina scans, and more

 

- continued advances in anti-aging strategies are accelerating, aligning with the continued longevity of baby boomers who chose to live a healthy lifestyle

 

- inexpensive medical tests often referred to as a "lab-in-your-pocket" devices are going mainstream

 

- the 'exercise is medicine' trend which recognizes real methods to reverse the staggering cost of lifestyle disease

robotic technology advances providing opportunities for those who have lost hands or limbs

 

There are a lot of big ideas and bold solutions.

 

Science fiction is science fact!

 

Read the original post: jimcarroll.com/2022/11/daily-inspiration-you-are-already-...

 

#motivationalquote #inspirationalquote #futurist

  

--

 

Futurist Jim Carroll wrote a little book in 1996 called Good Health Online after a bout with Bell's Palsy. Many of the predictions in the book about the evolving world of healthcare, medicine and doctor/patient relationships became true in the years to come. Sadly, a blog post he wrote in 2017, 'The Emerging Healthcare Reality Crisis," also predicted with stunning accuracy, the anti-science mindset that emerged during Covid.

Prominent Hair Restoration Expert Dr. Alan J. Bauman Features Drug-free ‘LaserCap’ for Thinning Hair on New Lifetime Show

Alan J. Bauman, M.D. discussed hair loss and advancements in low-level laser therapy with Suzanne Somers on October 3rd.

 

Boca Raton, Florida

 

October 3rd, 2012 --Suzanne Somers the eponymous host of Lifetime Channel’s, The Suzanne Show discussed hair loss and new alternative treatments for patients with prominent hair loss expert, Dr. Alan. J. Bauman. Watch the segment: www.youtube.com/watch?v=hMCOl1E4gIg

 

The new talk show, featuring Suzanne Somers, who is known in the medical community as a passionate healthcare advocate, includes health tips, wide ranging education segments, and discussions on top critical health issues. Since over 50 million American men and 30 million women suffer from hair loss, and spend over $2 billion each year on treatments, the topic is a natural fit for the show, which focuses on educating viewers on how to live a healthy, full and ageless life and will likely be a recurring theme in future shows.

 

“We’re excited about the opportunity to discuss hair loss with The Suzanne Show and hope that viewers are empowered by the new drug-free and non-invasive technologies available to treat and prevent hair loss,” said Dr. Bauman, who has treated more than 15,000 hair loss suffers since 1997. “Our goal is to help consumers understand that hair loss is no longer inevitable,” says Dr. Bauman who points out on the show that there exists a wide range of non-invasive treatment options for the millions of men and women who suffer from hair loss.

 

The Suzanne Show strategically partners with physicians and health experts who share Suzanne’s beliefs in progressive medicine and integrative health therapies. When Dr. Alan Bauman had the opportunity to meet Suzanne Somers at a major international medical conference, they discussed his holistic, multi-therapy approach to the treatment of hair loss that meshed, according to Dr. Bauman, “perfectly with Suzanne’s philosophy and direction of the show.” Says, Dr. Bauman, “Suzanne and I both agreed that her audience would appreciate the benefits of this new advanced technology as a way to treat hair loss.”

 

As a nationally recognized expert in the field of hair restoration, Dr. Bauman discussed the drug-free LaserCap, the first device of its kind and the latest breakthrough in laser therapy for the scalp. The "hands-free” device offers the power of a clinical laser therapy unit in a cordless, rechargeable, discreet treatment device that literally 'fits under your hat' for non-chemical, non-invasive, pain-free treatment almost anywhere, anytime.

 

“The LaserCap is unique among low level laser therapy devices because it doesn't require the patient to stand in front of a mirror for 10-15 minutes, manually 'combing' the area, as with hand-held comb lasers,” commented Bauman. “This is an exciting new tool for hair loss sufferers as it allows them a discreet treatment option that can easily be combined with exercise, work or even grocery shopping. And it works.”

 

In recent years, low-level laser therapy has become more accepted in the treatment of hair loss, evidenced by FDA clearances of one specific brand of comb-laser, an in-office clinical device and a dramatic increase in prescriptions by hair restoration physicians.

 

“Laser therapy has become a valuable tool for patients with hair loss, and allows patients a drug-free and side effect-free option,” explained Bauman, who has treated thousands of patients with laser therapy in his Boca Raton, FL offices for more than ten years.

 

About LaserCap and Low Level Laser Therapy:

 

•Laser therapy is a non-chemical, non-invasive way to help men and women grow thicker and healthier looking hair.

•LaserCap fits into and under any hat, which when put on, gives patients complete coverage of their scalp.

•LaserCap has over 220 diodes, making it the most powerful portable laser therapy device for the scalp.

•In addition to LaserCap, there are numerous other products currently out on the market, such as laser combs and brushes, helmets and in-office clinical laser 'hoods.'

 

Laser therapy, like other non-invasive hair growth treatments, is no ‘miracle cure,’ but it is an important tool in the treatment of damaged hair, thinning hair and hair loss. For more information on what kind of results you might achieve with laser therapy or how laser therapy can be added to your 'multi-therapy' hair restoration regimen, please visit www.baumanmedical.com or www.lasercap.info or call 1-877-BAUMAN-9 or +1 561-394-0024.

  

ABOUT DR. ALAN BAUMAN:

Alan J. Bauman, M.D., founder of Bauman Medical Group in Boca Raton, Florida, is a full-time board-certified and internationally renowned hair transplant surgeon whose pioneering work has been featured extensively in the national and international print and television media, such as Newsweek, The New York Times, Cosmo, Vogue, Allure, Men's Health, Today Show, The Early Show, Good Morning America, Extra, Access Hollywood and Dateline NBC.

 

Dr. Bauman’s Radio Show: “Live Hair on the Air” – www.LiveHair.TV

Dr. Bauman has recently launched his own half-hour radio show, “Live Hair on the Air, (www.LiveHair.TV) that currently airs on multiple Clear Channel radio stations in Florida. Co-hosted by one of South Florida’s top radio personalities, Kevin Rolston, the front man of WILD 95.5 FM’s the “Kevin, Virginia, Jason” morning show, who recently underwent a live on air hair transplant from Dr. Bauman that was streamed to a global audience of nearly 75,000 viewers from 22 countries. The high production value radio show, complete with song parodies and assorted comedy elements about hair loss from around the web, popular culture and television, is not just informative and educational but fun and entertaining. As reported in the nation’s leading radio industry trade magazine, “Jockline,” Rolston is the first disc jockey/radio announcer in the country to undergo a live on air hair transplant. (www.LiveHair.tv)

 

Dr. Bauman is recognized within the medical profession as top U.S. medical expert on the treatment of hair loss in men and women. A board-certified hair restoration surgeon, Dr. Bauman was the first to demonstrate ‘live’ the FUE method of hair transplantation at the 2003 International Society of Hair Restoration Surgery Orlando Live Surgery Workshop and the first to demonstrate the NeoGraft FUE device at the ISHRS Orlando Live Surgery Workshop in 2010. His practice is divided equally between male and female patients, and Dr. Bauman provides state-of-the-art diagnostic procedures and a multi-therapy approach to the medically treatable condition of hair loss. Dr. Bauman is a member and often a featured speaker at the American Academy of Anti-Aging Medicine and the International Society of Hair Restoration Surgery Annual Scientific Meetings.

  

Oily skin with blackheads (acne) is the most common skin problem of youth. With the end of the transition age, most acne passes on its own, but some of this disease may persist until the age of 30 or even older. In this article we’ll discuss about acne causes, signs, treatment and natural home remedies.

 

Content of Article:

 

This terrible word acne – what does it mean?

 

What affects the appearance of acne?

 

What are the underlying causes of acne?

 

How to properly perform hardware care in the case of problem skin?

 

This Terrible Word Acne – What Does It Mean?

 

Adolescence (or, as it is also called, puberty) is very often characterized by oily problem skin, acne, and inflammatory formations. All these phenomena in cosmetology are called the word “acne”. Usually, with the normalization of the hormonal background, the disease disappears, but it is not uncommon for the problem of acne to persist throughout life. The most common manifestations of this problem are purulent inflammatory processes, acne, enlarged pores and comedones. Another danger is the consequences of the disease-scars, infiltrates, post-acne spots. In addition, the presence of acne is a serious cause of complexes, depression, and low self-esteem. That is why acne treatment should be timely and comprehensive, you can not let the situation take its course.

 

What Affects the Appearance of Acne?

 

The main cause of such a disease as acne is excessive production of sebum (sebum). In normal skin, the secretion of the sebaceous glands does not exceed a certain level, after which the fat is removed through the skin ducts to the surface of the skin. This is necessary to protect the upper layer of the skin from negative environmental factors: sun, dust, drying, etc. However, if the production of sebum exceeds the norm, a phenomenon known as “fatty seborrhea”occurs. This is mainly observed in the areas of the skin with the largest number of sebaceous glands – on the face, neck, back and chest.

 

Various forms of seborrhea are known, but most often you can find a mixed type of seborrhea, which is expressed in the appearance of an unsightly Shine on the surface of the skin, the expansion of the pores that remove the sebaceous secret. Due to improper functioning, the skin becomes thick in places, flaking appears, blood circulation worsens – the skin acquires an uncharacteristic bluish hue. In this case, the chemical composition of the sebaceous secretions may change, which leads to a deterioration of the sebaceous glands and ducts. The pores are forced to increase in diameter, and dirt accumulates in them, which leads to the formation of comedones and blackheads. Too much sebum is a medium for the development of harmful micro-organisms and bacteria, resulting in reduced skin protection, purulent pimples and inflammatory infiltrates.

 

As a rule, everyone has faced such an unpleasant phenomenon as oily skin, acne, but usually these phenomena pass by themselves and rarely become a serious problem. But if the process becomes a disease, then it is necessary to fully treat acne, both with a dermatologist and at home. To begin with, it is necessary to determine the causes of acne in order to fight the problem at the root.

 

What are the Underlying Causes of Acne?

 

An inherited factor that often causes acne the level of sebum production by the endocrine glands.

 

An imbalance of sex hormones, which is most intensively manifested in the transition age, but may be important during pregnancy, menopause.

 

Diseases of the digestive system, an irrational diet with an excess of sweet, fatty, spicy, overweight, a lack of vitamins and trace elements – all this can provoke the development of acne.

 

Reduced immunity due to various factors also leads to deterioration of the skin and sebaceous glands.

 

In case of severe course of the disease, complex treatment of acne is necessary, which is prescribed by a dermatocosmetologist. As prescribed, peels, ozonation, various types of sanding are performed, as well as various medications of a medicinal nature are taken.

 

If you detect a mild form of acne after consulting with a cosmetologist, you can combine both professional methods of acne treatment and home care. In this case, it is necessary to use anti-acne cosmetics in combination with hardware methods to combat acne. That is, it is necessary to properly care for the skin in order to prevent both the development of a severe degree of disease and to prevent negative consequences. The company “Constellation of Beauty” provides all the necessary tools and devices for competent and professional care of oily skin problems at home.

 

How to Care Skin Problem with Beauty Gadgets?

 

Stage 1: Preparation

 

To properly prepare the skin for subsequent cleansing, you need to use a steam sauna for the face to open the pores, soothe and moisturize the skin. Usually, a sauna for the face is equipped with a special container where liquid is poured, in addition to water, it can be herbal solutions. Steam saunas for home use Gezatone help to cope with deep cleansing of the skin, but they are not used for pustular inflammatory processes.

 

If heat exposure is contraindicated, you can replace the steaming stage with galvanic desincrustation. As a result of this galvanic cleansing, the pores open, and the sebum is better removed. In a home environment, it is not difficult to carry out such preparation for cleaning using portable home electroplating devices, such as m777 and M777 Gezatone. Positively charged ions remove spasm from the pores, normalize their diameter, split the sebum, contributing to easy skin cleansing.

 

Stage 2: Cleansing

 

For self-cleaning the skin at home, several methods can be used, let’s look at the most popular of them:

 

Brushing-brush cleaning of the skin, removes the upper keratinized layer of skin and removes dirt. This type of cleaning is ideal for mild acne, suitable for daily use, and can be combined with cosmetics.

 

Vacuum cleaning of the skin is a deep removal of dirt from the pores, which is much less traumatic than manual mechanical cleaning of the face. Vaccum does not stretch the skin, does not cause bruises and spots on the skin, does not require a recovery period. For home use, the optimal device is Super Wet Cleaner, which is easy to use and suitable for cleaning even adolescent skin. Immediately before the procedure, a cleanser can be applied to the skin to increase the effectiveness of the effect.

 

Ultrasonic peeling provides a delicate and deep cleaning of the pores using high-frequency vibrations. Thanks to this intensive action, the pores are completely cleared, the skin surface is freed from epithelial particles, and fat is emulsified. Ultrasonic skin cleaning can be performed at home using compact devices HS-2307I and Biosonic Kus-2000.

 

Stage 3: Skin Restoration

 

To relieve the skin from the effects of rashes, eliminate congestion and smooth out scars after acne, the ideal tool is ultrasonic massage. This anti-acne effect can be carried out by peeling devices switched to the micro-massage mode, or by special massage devices such as m355 SuperLifting, m115 Ultra-Tonic, M350 Super Sonic Gezatone. Intensive tissue massage guarantees a de-fibrous effect, which leads to the elimination of infiltrates, micro-scars, and resorption of scar tissue.

 

Stage 4: Anti-Inflammatory Therapy

 

Acne treatment and control of the consequences is impossible without local darsonvalization procedures. A course of procedures with darsonval increases blood circulation, restores the activity and diameter of the pores, reduces the production of sebaceous secretions, which leads to a stable and visible result. When exposed to darsonval currents on the skin, ozone is released, which inhibits the microbial flora, so that darsonvalization can be used even in acute inflammation.

 

Portable models of darsonvals are very convenient for individual use, acne treatment with their help becomes the most effective and efficient. The most convenient for regular use on the face, body and even hair is the Gezatone BT118 model with 4 attachments, which are designed for complex correction of acne, cellulite, varicose veins and many other problems.

 

Stage 5: Regular Cosmetic Care

 

Problematic, mixed skin needs full care, and it needs properly selected cosmetics. For procedures 2-3 times a week, Beauty Style cosmetic masks for problem skin are ideal. Anti-inflammatory masks “Pure Silver” and “Strawberry and sage” will not only relieve inflammation, but also perfectly moisturize the skin, restore its freshness and even tone.

 

The most important thing in the treatment of acne is to know the acne causes and apply a comprehensive approach, use different methods, and then the result will be obvious.

 

Most Popular

 

Acne, Causes

 

Acne Causes, Signs, Treatment and Home Remedies

 

June 9, 2020

 

Acne, Home Remedies

 

Acne Apple Cider Vinegar – A Natural Remedy

 

June 9, 2020

 

Acne

 

What is Acne and It’s Treatment?

 

June 9, 2020

 

Acne

 

Acne – Behaviors and Treatments

 

June 9, 2020

 

Tips

 

How to Take Care of My Skin Under Mask?

 

June 9, 2020

 

Types of Acne

 

How to Prevent and Treat Hormonal Acne?

 

June 9, 2020

 

Home Remedies

 

Waiting for the Summer? Its Finally Coming

 

June 9, 2020

 

Acne, Treatment

 

How to Get Rid of Acne on the Back?

 

June 9, 2020

 

Tips

 

How to Prevent Wrinkles – Expert Advice

 

June 6, 2020

 

Home Remedies

 

Nutritional Supplements – 15 Most Effective Nutritional Supplements

 

June 6, 2020

 

Home Remedies

 

Natural Skin Care Secrets for Radiant Glowing Skin

 

June 6, 2020

 

Treatment, Types of Acne

 

Fungal Acne – The Fastest Way to Treat Fungal Acne

 

June 5, 2020

 

Treatment

 

How to Get Rid of Acne Fast?

 

June 5, 2020

 

Acne, Home Remedies

 

Acne on Face – The Fastest Way to Cure It

 

June 3, 2020

 

The post Acne Causes, Signs, Treatment and Home Remedies appeared first on Acne Vulgaris.

 

via Acne Vugaris ift.tt/2XL2aIU

Prominent Hair Restoration Expert Dr. Alan J. Bauman Features Drug-free ‘LaserCap’ for Thinning Hair on New Lifetime Show

Alan J. Bauman, M.D. discussed hair loss and advancements in low-level laser therapy with Suzanne Somers on October 3rd.

 

Boca Raton, Florida

 

October 3rd, 2012 --Suzanne Somers the eponymous host of Lifetime Channel’s, The Suzanne Show discussed hair loss and new alternative treatments for patients with prominent hair loss expert, Dr. Alan. J. Bauman. Watch the segment: www.youtube.com/watch?v=hMCOl1E4gIg

 

The new talk show, featuring Suzanne Somers, who is known in the medical community as a passionate healthcare advocate, includes health tips, wide ranging education segments, and discussions on top critical health issues. Since over 50 million American men and 30 million women suffer from hair loss, and spend over $2 billion each year on treatments, the topic is a natural fit for the show, which focuses on educating viewers on how to live a healthy, full and ageless life and will likely be a recurring theme in future shows.

 

“We’re excited about the opportunity to discuss hair loss with The Suzanne Show and hope that viewers are empowered by the new drug-free and non-invasive technologies available to treat and prevent hair loss,” said Dr. Bauman, who has treated more than 15,000 hair loss suffers since 1997. “Our goal is to help consumers understand that hair loss is no longer inevitable,” says Dr. Bauman who points out on the show that there exists a wide range of non-invasive treatment options for the millions of men and women who suffer from hair loss.

 

The Suzanne Show strategically partners with physicians and health experts who share Suzanne’s beliefs in progressive medicine and integrative health therapies. When Dr. Alan Bauman had the opportunity to meet Suzanne Somers at a major international medical conference, they discussed his holistic, multi-therapy approach to the treatment of hair loss that meshed, according to Dr. Bauman, “perfectly with Suzanne’s philosophy and direction of the show.” Says, Dr. Bauman, “Suzanne and I both agreed that her audience would appreciate the benefits of this new advanced technology as a way to treat hair loss.”

 

As a nationally recognized expert in the field of hair restoration, Dr. Bauman discussed the drug-free LaserCap, the first device of its kind and the latest breakthrough in laser therapy for the scalp. The "hands-free” device offers the power of a clinical laser therapy unit in a cordless, rechargeable, discreet treatment device that literally 'fits under your hat' for non-chemical, non-invasive, pain-free treatment almost anywhere, anytime.

 

“The LaserCap is unique among low level laser therapy devices because it doesn't require the patient to stand in front of a mirror for 10-15 minutes, manually 'combing' the area, as with hand-held comb lasers,” commented Bauman. “This is an exciting new tool for hair loss sufferers as it allows them a discreet treatment option that can easily be combined with exercise, work or even grocery shopping. And it works.”

 

In recent years, low-level laser therapy has become more accepted in the treatment of hair loss, evidenced by FDA clearances of one specific brand of comb-laser, an in-office clinical device and a dramatic increase in prescriptions by hair restoration physicians.

 

“Laser therapy has become a valuable tool for patients with hair loss, and allows patients a drug-free and side effect-free option,” explained Bauman, who has treated thousands of patients with laser therapy in his Boca Raton, FL offices for more than ten years.

 

About LaserCap and Low Level Laser Therapy:

 

•Laser therapy is a non-chemical, non-invasive way to help men and women grow thicker and healthier looking hair.

•LaserCap fits into and under any hat, which when put on, gives patients complete coverage of their scalp.

•LaserCap has over 220 diodes, making it the most powerful portable laser therapy device for the scalp.

•In addition to LaserCap, there are numerous other products currently out on the market, such as laser combs and brushes, helmets and in-office clinical laser 'hoods.'

 

Laser therapy, like other non-invasive hair growth treatments, is no ‘miracle cure,’ but it is an important tool in the treatment of damaged hair, thinning hair and hair loss. For more information on what kind of results you might achieve with laser therapy or how laser therapy can be added to your 'multi-therapy' hair restoration regimen, please visit www.baumanmedical.com or www.lasercap.info or call 1-877-BAUMAN-9 or +1 561-394-0024.

  

ABOUT DR. ALAN BAUMAN:

Alan J. Bauman, M.D., founder of Bauman Medical Group in Boca Raton, Florida, is a full-time board-certified and internationally renowned hair transplant surgeon whose pioneering work has been featured extensively in the national and international print and television media, such as Newsweek, The New York Times, Cosmo, Vogue, Allure, Men's Health, Today Show, The Early Show, Good Morning America, Extra, Access Hollywood and Dateline NBC.

 

Dr. Bauman’s Radio Show: “Live Hair on the Air” – www.LiveHair.TV

Dr. Bauman has recently launched his own half-hour radio show, “Live Hair on the Air, (www.LiveHair.TV) that currently airs on multiple Clear Channel radio stations in Florida. Co-hosted by one of South Florida’s top radio personalities, Kevin Rolston, the front man of WILD 95.5 FM’s the “Kevin, Virginia, Jason” morning show, who recently underwent a live on air hair transplant from Dr. Bauman that was streamed to a global audience of nearly 75,000 viewers from 22 countries. The high production value radio show, complete with song parodies and assorted comedy elements about hair loss from around the web, popular culture and television, is not just informative and educational but fun and entertaining. As reported in the nation’s leading radio industry trade magazine, “Jockline,” Rolston is the first disc jockey/radio announcer in the country to undergo a live on air hair transplant. (www.LiveHair.tv)

 

Dr. Bauman is recognized within the medical profession as top U.S. medical expert on the treatment of hair loss in men and women. A board-certified hair restoration surgeon, Dr. Bauman was the first to demonstrate ‘live’ the FUE method of hair transplantation at the 2003 International Society of Hair Restoration Surgery Orlando Live Surgery Workshop and the first to demonstrate the NeoGraft FUE device at the ISHRS Orlando Live Surgery Workshop in 2010. His practice is divided equally between male and female patients, and Dr. Bauman provides state-of-the-art diagnostic procedures and a multi-therapy approach to the medically treatable condition of hair loss. Dr. Bauman is a member and often a featured speaker at the American Academy of Anti-Aging Medicine and the International Society of Hair Restoration Surgery Annual Scientific Meetings.

Prominent Hair Restoration Expert Dr. Alan J. Bauman Features Drug-free ‘LaserCap’ for Thinning Hair on New Lifetime Show

Alan J. Bauman, M.D. discussed hair loss and advancements in low-level laser therapy with Suzanne Somers on October 3rd.

 

Boca Raton, Florida

 

October 3rd, 2012 --Suzanne Somers the eponymous host of Lifetime Channel’s, The Suzanne Show discussed hair loss and new alternative treatments for patients with prominent hair loss expert, Dr. Alan. J. Bauman. Watch the segment: www.youtube.com/watch?v=hMCOl1E4gIg

 

The new talk show, featuring Suzanne Somers, who is known in the medical community as a passionate healthcare advocate, includes health tips, wide ranging education segments, and discussions on top critical health issues. Since over 50 million American men and 30 million women suffer from hair loss, and spend over $2 billion each year on treatments, the topic is a natural fit for the show, which focuses on educating viewers on how to live a healthy, full and ageless life and will likely be a recurring theme in future shows.

 

“We’re excited about the opportunity to discuss hair loss with The Suzanne Show and hope that viewers are empowered by the new drug-free and non-invasive technologies available to treat and prevent hair loss,” said Dr. Bauman, who has treated more than 15,000 hair loss suffers since 1997. “Our goal is to help consumers understand that hair loss is no longer inevitable,” says Dr. Bauman who points out on the show that there exists a wide range of non-invasive treatment options for the millions of men and women who suffer from hair loss.

 

The Suzanne Show strategically partners with physicians and health experts who share Suzanne’s beliefs in progressive medicine and integrative health therapies. When Dr. Alan Bauman had the opportunity to meet Suzanne Somers at a major international medical conference, they discussed his holistic, multi-therapy approach to the treatment of hair loss that meshed, according to Dr. Bauman, “perfectly with Suzanne’s philosophy and direction of the show.” Says, Dr. Bauman, “Suzanne and I both agreed that her audience would appreciate the benefits of this new advanced technology as a way to treat hair loss.”

 

As a nationally recognized expert in the field of hair restoration, Dr. Bauman discussed the drug-free LaserCap, the first device of its kind and the latest breakthrough in laser therapy for the scalp. The "hands-free” device offers the power of a clinical laser therapy unit in a cordless, rechargeable, discreet treatment device that literally 'fits under your hat' for non-chemical, non-invasive, pain-free treatment almost anywhere, anytime.

 

“The LaserCap is unique among low level laser therapy devices because it doesn't require the patient to stand in front of a mirror for 10-15 minutes, manually 'combing' the area, as with hand-held comb lasers,” commented Bauman. “This is an exciting new tool for hair loss sufferers as it allows them a discreet treatment option that can easily be combined with exercise, work or even grocery shopping. And it works.”

 

In recent years, low-level laser therapy has become more accepted in the treatment of hair loss, evidenced by FDA clearances of one specific brand of comb-laser, an in-office clinical device and a dramatic increase in prescriptions by hair restoration physicians.

 

“Laser therapy has become a valuable tool for patients with hair loss, and allows patients a drug-free and side effect-free option,” explained Bauman, who has treated thousands of patients with laser therapy in his Boca Raton, FL offices for more than ten years.

 

About LaserCap and Low Level Laser Therapy:

 

•Laser therapy is a non-chemical, non-invasive way to help men and women grow thicker and healthier looking hair.

•LaserCap fits into and under any hat, which when put on, gives patients complete coverage of their scalp.

•LaserCap has over 220 diodes, making it the most powerful portable laser therapy device for the scalp.

•In addition to LaserCap, there are numerous other products currently out on the market, such as laser combs and brushes, helmets and in-office clinical laser 'hoods.'

 

Laser therapy, like other non-invasive hair growth treatments, is no ‘miracle cure,’ but it is an important tool in the treatment of damaged hair, thinning hair and hair loss. For more information on what kind of results you might achieve with laser therapy or how laser therapy can be added to your 'multi-therapy' hair restoration regimen, please visit www.baumanmedical.com or www.lasercap.info or call 1-877-BAUMAN-9 or +1 561-394-0024.

  

ABOUT DR. ALAN BAUMAN:

Alan J. Bauman, M.D., founder of Bauman Medical Group in Boca Raton, Florida, is a full-time board-certified and internationally renowned hair transplant surgeon whose pioneering work has been featured extensively in the national and international print and television media, such as Newsweek, The New York Times, Cosmo, Vogue, Allure, Men's Health, Today Show, The Early Show, Good Morning America, Extra, Access Hollywood and Dateline NBC.

 

Dr. Bauman’s Radio Show: “Live Hair on the Air” – www.LiveHair.TV

Dr. Bauman has recently launched his own half-hour radio show, “Live Hair on the Air, (www.LiveHair.TV) that currently airs on multiple Clear Channel radio stations in Florida. Co-hosted by one of South Florida’s top radio personalities, Kevin Rolston, the front man of WILD 95.5 FM’s the “Kevin, Virginia, Jason” morning show, who recently underwent a live on air hair transplant from Dr. Bauman that was streamed to a global audience of nearly 75,000 viewers from 22 countries. The high production value radio show, complete with song parodies and assorted comedy elements about hair loss from around the web, popular culture and television, is not just informative and educational but fun and entertaining. As reported in the nation’s leading radio industry trade magazine, “Jockline,” Rolston is the first disc jockey/radio announcer in the country to undergo a live on air hair transplant. (www.LiveHair.tv)

 

Dr. Bauman is recognized within the medical profession as top U.S. medical expert on the treatment of hair loss in men and women. A board-certified hair restoration surgeon, Dr. Bauman was the first to demonstrate ‘live’ the FUE method of hair transplantation at the 2003 International Society of Hair Restoration Surgery Orlando Live Surgery Workshop and the first to demonstrate the NeoGraft FUE device at the ISHRS Orlando Live Surgery Workshop in 2010. His practice is divided equally between male and female patients, and Dr. Bauman provides state-of-the-art diagnostic procedures and a multi-therapy approach to the medically treatable condition of hair loss. Dr. Bauman is a member and often a featured speaker at the American Academy of Anti-Aging Medicine and the International Society of Hair Restoration Surgery Annual Scientific Meetings.

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

Under the pressure of a fast-paced lifestyle nowadays, male erectile dysfunction is becoming more and more common, and the occurrence tends to trend toward the younger population.In recent years, stem cells have been used in the treatment of ED, and more and more cases have shown that stem cells can effectively improve ED in men.

 

The Beneficial Effects Of Stem Cell Therapy On Erectile Dysfunction

 

As the stem cells enter the body, their homing effect could help them reach the lesions of the male reproductive system accurately and stem cells could completely repair the damaged tissue from all aspects. Stem cells can promote the vascular regeneration and nerve repair of the corpus cavernosum. At the same time, stem cells can also increase the blood supply speed and volume of the dorsal penile artery to the corpus cavernosum, therefore enhancing the hardness and size of the penis during erection. In addition, the new cells differentiated from stem cells can play the role of secreting male hormones like normal testicular cells, which can maximize sperm motility and enhance testicular function. The patient’s overall physical condition will also be improved, thus becoming healthier, younger, and more energetic, all together stem cell therapy will significantly improve the quality of life.

 

Stem cell therapy has significant effects in the following aspects:

 

Regulates hormone levels to normal status

 

Restores erectile function

 

Increases sexual desire

 

Increases hardness and size of the penis during erection

 

Improves sperm motility

 

Improves sex experience

 

Improves sleep quality and reduces anxiety

 

Anti-aging

 

Improves overall immune system function

 

The Conditions Of Erectile Dysfunction That Stem Cell Therapy Can Treat

 

When ED occurs, patients will have obvious symptoms, including, physical and psychological ones, and we can judge whether they have ED based on these symptoms. When conventional treatment methods can’t achieve a good enough therapeutic effect, stem cell therapy will be a good choice, as the following symptoms can be well improved by stem cell therapy:

 

Difficulty during erection

 

Short erection time

 

Low sexual desire

 

Pain during sex

 

Ejaculation disorder

 

Depression

 

Listlessness, low mood

 

Sore back and weak limbs/legs

 

A large number of preclinical studies and clinical cases have shown that stem cell treatment for ED is safe and effective, and stem cells have become the most advanced means of treating ED caused by various reasons!

 

Learn More About Erectile Dysfunction

 

Erectile dysfunction (ED) refers to the inability of men to consistently achieve or maintain a sufficient erection to complete satisfactory sexual intercourse, which usually lasts for more than 3 months. ED is one of the most common sexual dysfunctions in men. It is a chronic disease that affects physical and mental health. It not only affects the life quality of patients and their partners but also may be an early symptom and danger signal of cardiovascular disease.

 

Penile erection is a series of complex and coordinated physiological processes, which is the result of the interactions among multiple factors such as neuroendocrine regulation, hemodynamic changes, and psychological effects. Abnormality in any of them may lead to erectile dysfunction. Nowadays, the number of ED patients is increasing globally and more and more young people are suffering from the disease. A study carried out in Massachusetts focusing on male aging found that among 1290 randomly selected men aged between 40 and 70, the prevalence of ED was 52%, ED has become one of the most concerning diseases that threaten men’s health.

 

Risk Factors For Erectile Dysfunction

 

Generally, intermittent, or occasional ED is common and experienced by many men, usually caused by stress or emotional changes, which is not very concerning. But frequent ED is to be watched out for. Any behavior that may damage cardiovascular or neural system health increases the risk of ED, an unhealthy lifestyle can also lead to ED.

 

The most common risk factors for ED include:

 

Arteriosclerosis (atherosclerosis)

 

Diabetes

 

Side effects from prostate surgery

 

Taking certain medications (especially those for high blood pressure or depression)

 

ED can also be caused by:

 

Low testosterone level

 

Smoking, alcohol consumption, or drug use such as cocaine

 

High-stress level, anxiety, depression, and overwork

 

Neurological disorders such as stroke, multiple sclerosis, and spinal cord injury

 

Cardiovascular diseases

 

Overweight or obesity

 

Advantages Of Stem Cell Therapy For Erectile Dysfunction

 

For ED patients, conventional methods of treating ED include mechanical devices, medications, and prosthesis implantation. Compared with those treatment methods, the SQ1 stem cell medical center utilizes intravenous infusion or locally targeted transplantation to introduce stem cells into the patient’s body. On one hand, stem cells repair damaged tissues and organs, on the other hand, they can regulate the patients’ immune system.

 

In our clinic, we use stem cells with a positive testosterone receptor, which increases the levels of endogenous and exogenous testosterone. Compared with conventional treatment methods, stem cell therapy has unique advantages:

  

Stem cell therapy

Conventional treatment

Curative Treatment or diseases management

Stem cell therapy is a new treatment for ED, stem cells can reach various organs and tissues that affect male erection function. Stem cells will repair all damaged parts and promote angiogenesis and nerve repair in the corpus cavernosum, therefore enabling patients to eliminate their dependence on drugs and achieve a spontaneous erection.

 

Including a mechanical device and medication therapy, mechanical devices can help achieve an erection but are not able to maintain it, medication can only help to temporarily achieve an erection, the dosage will increase over time, and drug resistance may occur.

 

Those treatments temporarily improve the erection function but cannot completely cure ED.

 

Dosage

After 3-6 months of stem cell therapy, the patients can stop taking medications completely and achieve a spontaneous erection.

 

Stem cell experts will customize an individualized treatment plan based on your current physical condition to decide the number and source of stem cells for the therapy, as well as how many cycles of stem cell therapy are needed.

 

Patients who are taking medications will find the dosage increases slowly and gradually, and the effect is less and more limited over time, patients may develop drug resistance gradually, and need to take a larger dose or switch to another medication to achieve a normal erection.

 

Side-effects

No side effects, because the stem cells come from the body itself, their immunogenicity is extremely low, stem cells are produced under very strict quality control, and there are guaranteed no side effects.

 

Stem cell transplantation, while treating ED, can also repair or enhance the function of other systems such as the immune and neural systems. Stem cells can secrete a variety of anti-inflammatory cytokines, which prevent potential inflammation reactions in advance and improve overall health status.

 

Many side effects are rooted in conventional therapies. Mechanical device therapy can cause problems such as abrasions and edema. Long-term usage of medications can lead to permanent erectile dysfunction, cardiovascular disease, headache, dizziness, glaucoma, and even infertility. Those side effects can cause irreversible damage to the body.

 

Surgery is also an option for patients who wish not to take medications. But surgery procedure carries an innate risk of infection and prosthesis dysfunction, additionally, another surgery is needed to replace the prosthesis after its expiration date.

 

Convenience

Stem cell therapy is performed by stem cell experts and requires specialized laboratories to process stem cells and medical equipment to extract and inject stem cells, After the treatment, the patient does not need to receive repeated or frequent treatment, patients can return to a high-quality life.

 

The patients treated by medication will require regular maintenance of drugs. And the effect can only be achieved sometime after drug intake. The patients are not able to perform spontaneous erection and are prone to drug dependence and drug resistance development.

 

Longevity

After the stem cells are transplanted into to patient’s body, they will repair damaged organs and tissues of men, and completely restore the erectile function of the male patient. The effect is long-lasting. In patients with ED treated by us previously, they all reported no signs of erectile dysfunction. Those patients were also able to return to normal sexual activities during the subsequent one-year follow-up period.

 

The effect of the medication is short-term. It is necessary to take the medication or use a mechanical device to cooperate with medication before sex. The effectiveness is generally half an hour to one hour.

 

How Can Stem Cells Therapy For Erectile Dysfunction Work

 

Clinical studies and patient cases have shown that stem cells can repair and regenerate the reproductive system, delay the aging of reproductive organs, and restore the sexual function of male patients. Stem cells work primarily through the following mechanisms:

 

Multi-directional differentiation potential: With self-replication and multi-directional differentiation potential, stem cells can produce new cells to replace damaged or dead cells. Stem cells promote angiogenesis and nerve repair in the corpus cavernous and regenerate small blood vessels, repair damaged or blocked arterioles and capillaries, and therefore improve vascular microcirculation and fundamentally increase the speed and volume of blood flow into the corpus cavernous, resulting in a faster erection response and increased penile hardness.

 

Paracrine effect: Stem cells can secrete a variety of bioactive growth factors such as nerve growth factor (NGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), and brain-derived growth factor (BDNF) after being infused into the body. Among them, NGF, IGF, and BDNF have the effect of promoting neuron regeneration, and VEGF promotes angiogenesis. Taking all together, stem cells will promote nerve repair and angiogenesis at the injured site. thereby reducing the fibrosis of cavernous tissue, while inhibiting other inflammatory diseases that may affect erectile function, including prostatitis, nephritis, etc.

  

Immunomodulatory effect: Stem cell therapy regulates and produces cytokines to repair damaged tissue cells, and inhibit the immune response from damaged cell proliferation, thus fundamentally eliminating the basis for the disease.

 

SQ1 Stem Cell Services

During the whole treatment process, we’ll provide complete and first-class medical services to you. And to ensure your treatment effect, you can consult your doctor any time after the treatment.

www.sq1stemcell.com/stem-cell-therapy-for-erectile-dysfun...

  

Smooth, clean and healthy skin is one of the main criteria for beauty. Some people have good skin by nature, but most of us have at least once in our lives encountered what is delicately called “imperfections” in advertising. Everyone knows how just one small pimple can affect self-esteem. And there are dozens of such inflammations and they do not want to disappear. Therefore, it is necessary to treat acne. But how to cure acne?

 

Acne is an inflammation of the sebaceous glands. The sebaceous glands are necessary for our skin, thanks to their activity, it always remains hydrated, and the secret of the sebaceous glands protects the skin from the external environment. But sometimes this system crashes. The ducts of the sebaceous glands are clogged with dead cells, the gland becomes inflamed and a comedone or painful pimple appears.

 

Acne is a common problem. In one form or another, acne occurs in 60-80% of young people and girls aged 12 to 24 years. However, acne can also appear in adults.

 

How to Cure Acne and Get Rid of It?

 

Often, the cause of acne is a change in the hormonal background. Therefore, acne is a common sign of puberty. But it’s not just hormones that are responsible for acne. Stress, an unbalanced diet, and taking certain medications can trigger the appearance of a rash. These factors alone do not lead to acne, but they can be the trigger if you have a predisposition to acne.

 

It is not so difficult to cure acne, although it takes a long time. Today, cosmetologists have everything necessary to get rid of this skin disease. However, many people prefer to self-medicate, which often only makes the situation worse.

 

It is necessary to understand some of the myths associated with this disease.

 

Myth # 1. Sun Baths Help Against Acne.

 

This theory is true, but only partially. Under the influence of ultraviolet light, the skin does become a little drier. But sunburn increases the number of dead cells on the surface of the skin, they clog the ducts of the sebaceous glands and acne eventually becomes even more. Tan is a great way to get rid of a couple of small pimples and get a few dozen large ones in a week. To avoid unpleasant consequences, a couple of days after taking a sun bath, you should plan a scrub or mild peeling.

 

Myth # 2. Acne Can Be Cured by Frequent Washing.

 

We have to disappoint purists and perfectionists: in the fight against acne on the face, too frequent “wet cleaning” can cause harm. Repeated washing and peels injure the skin and destroy its healthy microflora. Micro-cracks appear on the dry skin, which get bacteria. Weakened, it cannot resist these microorganisms, and its condition worsens. Wash with acne should not be more than twice a day, using delicate products that do not have an aggressive effect on the problem skin.

 

Myth # 3. Blackheads need to be removed manually before they become large.

 

This is what more than one generation of teenagers and their parents did, which they probably later regretted. The fact is that when a pimple is squeezed out, only part of it comes to the surface, and the remaining contents in the skin provoke the appearance of deep inflammation. In addition, this method injures the skin and the sebaceous gland channel. This prevents the secret from coming out, so rashes on the site of the destroyed pimple will occur again and again. The result is acne and scars, which are expensive and unpleasant to remove.

 

Facial cleansing (mechanical or hardware) is recommended to trust professional cosmetologists and dermatologists. This procedure requires thorough septic treatment of the hands, disinfection of tools (for example, UNO spoons, loops, Vidal needles), ultrasound and contact devices for cleaning the pores.

 

Acne Treatment

 

Most often, acne appears on the face, chest and back — where there are a lot of sebaceous glands and the pores are the widest. Acne is a disease that should be treated by a specialist. The method of treating acne depends on the severity of the disease. So, cosmetologists distinguish three forms of acne:

 

Light: no more than ten closed or open blackheads without signs of inflammation;

 

Average: 10 to 40 acne elements with minor signs of inflammation;

 

Severe: more than 40 inflamed acne elements.

 

A mild form of acne is well treated with external remedies — gels, special creams and ointments. In moderate to severe forms, drugs for local therapy are combined with medications that need to be taken orally. Sometimes antibiotics are prescribed that can destroy bacteria and relieve inflammation, and if the problem is a hormonal imbalance, hormones. Taking such drugs should be prescribed by a doctor, since both antibiotics and hormonal drugs have a serious impact on the body as a whole.

 

After the acne disappears, you will need a course of cosmetic procedures to return the skin to a healthy color and smoothness. Acne often leaves scars and spots of hyper-pigmentation. Laser therapy and other modern cosmetic procedures are able to cope with them.

 

How to Cure Acne Using Home Remedies

 

Mild forms of acne can be overcome without resorting to the use of medications. Pharmacies and stores sell many types of gels, lotions and creams designed to solve this skin problem. As a rule, such products contain benzoyl peroxide, resorcinol, salicylic acid, oxides and salts of sulfur and zinc. The chemicals included in such products have different degrees of effectiveness and may have undesirable side effects. For example, the use of resorcinol, which until relatively recently was the main anti-heat “weapon”, is now in doubt. A number of products use the antimicrobial action of benzoyl peroxide. Among the time-tested cosmetic ingredients, we can note sulfur and zinc, which are actively used, for example, by LIBREDERM. The manufacturer has developed a special collection of products based on sulfur and organic zinc salts – “Seracin”.

 

Sulfur and zinc reduce the intensity of fat production by skin pores, suppress the development of bacteria, and have a local anti-inflammatory effect. Additional “helpers” in the composition of funds from the collection “Seracin” – azelaic acid, brown algae extract, Centella asiatica, burdock root and others.

 

A special series against acne and blackheads from LIBREDERM is represented by means for washing and cleansing the skin (gel, foam, scrub, lotion, tonic), as well as creams, masks and patches for basic care, moisturizing and matting the skin. Special attention should be paid to the new seracin products with an additional component — azelaic acid. So, the night cream “Azelain-Forte Antiakne” with 5% azelaic acid in the composition helps to reduce excess sebum production, inflammation and growth of abnormal melanocytes, that is, reduces the risk of acne and traces of them. The cream can noticeably improve the condition of problem oily skin.

 

If regular use of hygiene cosmetics becomes a habit, then such a problem as acne can soon be forgotten — the skin will be pleased with its cleanliness, even tone and healthy appearance.

 

Specific Immunotherapy

 

Immunotherapy is prescribed when the relationship between the clinical manifestations of acne and the work of the immune system. Weakened protective functions of the body can affect the reproduction of bacteria that provoke the disease. Inadequate work of the immune system can also cause the development of the disease.

 

For the treatment of acne and acne rashes on the face, drugs belonging to the group of cytokines or cytomedines are often used.

 

Using these tips and prevention can help you to cure acne. If you like this article please share it to your friends and loved ones who want to know how to cure acne through simple behavioral changes and natural remedies.

 

POPULAR

 

Treatment

 

How to Cure Acne and What Is the Best Remedy ?

 

June 10, 2020

 

Acne, Causes

 

Causes of Acne Apart from Hormonal Imbalance

 

June 9, 2020

 

Acne

 

Acne Around the Mouth: What Is the Cause of Their Appearance?

 

June 9, 2020

 

Acne, Types of Acne

 

Pimples on the Temple: Causes and Treatment

 

June 9, 2020

 

Acne, Causes

 

Acne Causes, Signs, Treatment and Home Remedies

 

June 9, 2020

 

Acne, Home Remedies

 

Acne Apple Cider Vinegar – A Natural Remedy

 

June 9, 2020

 

Acne

 

What is Acne and It’s Treatment?

 

June 9, 2020

 

Acne

 

Acne – Behaviors and Treatments

 

June 9, 2020

 

Tips

 

How to Take Care of My Skin Under Mask?

 

June 9, 2020

 

Types of Acne

 

How to Prevent and Treat Hormonal Acne?

 

June 9, 2020

 

The post How to Cure Acne and What Is the Best Remedy ? appeared first on Acne Vulgaris.

 

via Acne Vugaris ift.tt/2BT0RiJ

Hi-Tech H2 Eye is an advanced eye massager device which offers hydrogen fog steam to the eyes when used with the Basic or Pro Hydrogen Inhalation Machines. It can also be independently used for moisturizing the eyes and treating the eyes with a relaxing hot compress.

 

Delivered worldwide with shipping included in the price of purchase. Learn more and order online:

pemf-devices.com/product/hydrogen-eye-massager-h2-eye/

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

Web Link:

advancedhomewellness.com/light-therapy-treat-seasonal-aff...

 

Product Links

advancedhomewellness.com/product-category/light-therapy/

 

advancedhomewellness.com/product/humancharger-jet-lag-hea...

 

advancedhomewellness.com/product/zoo-med-reptisun-5-0-uvb...

 

advancedhomewellness.com/product/zoo-med-combo-tropical-u...

 

advancedhomewellness.com/product/naturebright-suntouch-pl...

 

advancedhomewellness.com/product/norlanya-red-light-thera...

 

advancedhomewellness.com/product/pain-relief-therapy-tend...

 

advancedhomewellness.com/product/anti-aging-red-led-light...

 

advancedhomewellness.com/product/100pcs-x-super-bright-5m...

  

Using Light Therapy to Treat Seasonal Affective Disorder, Jet Lag, Chronic Fatigue, Brain Fog & Depression; Improve Mitochondria ATP Cellular Function and Greatly Boost Energy, Focus & Mood

 

Light therapy provides lots of interesting and effective options for using simple modern technology to improve our circadian rhythm and get better sleep, improve our cellular energy production and greatly boost our overall energy levels, mood and focus.

 

Today we are exploring ways to use light frequencies to hack our circadian rhythm during the winter months and when travelling long distances, in order to get deeper sleep, have more energy and greatly improve our cellular functioning.

 

New research into the way our skin, eyes and even our brain can directly intake different spectrums of light is providing us with lots of options for maintaining optimal sleep cycles and energy levels, from very simple and inexpensive light bulbs to more high tech devices that are still very affordable, especially considering their effectiveness.

 

Of course, the absolute most effective light therapy of all is free: sunlight. And if we can manage to get more sunlight into our bodies during the winter months, then this is the most effective and most affordable option. But its also the least practical for most people, right?

 

Sunbathing in the cold is really not most people’s cup of tea, though it combining cold exposure with sunbathing does have amazing health benefits. The amount of sunlight our bodies directly intake is really a major factor in why so many people feel great in the summer, but easily get sick and depressed in the winter.

 

I used to have these symptoms until I came to understand that these symptoms were really being caused by both the altered circadian rhythm set by the reduced light cycle, as well as the reduction in the amount of light my body was able to intake during the winter.

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

With Light Sources and Solar Storms strategic partnership, collagen low pressure lamps, skin rejuvenation is no longer a myth, but a matter of having the right knowledge combined with the right application device. The global anti-aging market is booming. In fact, many consider it to be recession proof. Light therapy anti-aging skincare with UV-free collagen fluorescent lamps are the new affordable and rejuvenating alternative to invasive techniques, such as plastic surgery or laser treatments.

DCIM\105GOPRO

 

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France

On October 13, 2012 renowned hair transplant surgeon and Course Director, Dr. Pierre Bouhanna, hosted the second International Hair Surgery Master Class (IHSMC) meeting in Paris, France in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA). In attendance were well over 100 physicians and hair loss experts who listened to a potpourri of lectures on the medical and surgical treatment of hair loss. Lectures included the psychological impact of hair loss, basics of medical treatments such as minoxidil, finasteride, laser therapy and nutrition, as well as the latest in hair transplantation techniques and procedures. It was a “quick trip” but one with a well-respected international expert faculty and lots of new information on the treatment of hair loss. A few short hours of Paris sightseeing was possible the day before and the evening after the conference was over.

 

Some of the highlights of the 2012 IHSMC program included:

Guidelines for ageing male and female hair loss and alopecia (Ralph Trueeb, Switzerland)

Digital Measurements and Phototrichograms (Gilbert Amgar, France)

Guidelines for diagnostic evaluation in AGA in men, women, adolescents (Ulrike Blume-Peytavi, Germany)

PRP and growth factors in hair treatment 3 years experience (Fabrio Rinaldi, Italy)

Alopecia and women hair transplantation (Pierre Bouhanna, France)

Eyelash Transplant Techniques (Eric Bouhanna, France)

Combining FUE and strip harvesting (Marcio Crisostomo, Brazil)

New Devices in Laser Therapy and Hair Growth (Alan J. Bauman, USA)

FUE Mega-Sessions and Big FUE cases (Alan J. Bauman, USA)

FUE Trends: the minimally-invasive hair transplant revolution (Alan J. Bauman, USA)

Evolution of automation in hair transplants and latest FUE developments (Marc Divaris, France)

 

The 2nd Annual IHSMC was held in conjunction with the 8th European Masters of Anti-Aging Medicine Congress (EMAA) at the Palais des Congrès de Paris, 2 place Porte Maillot, 75017 Paris, France