Mechanism, symptoms and diagnosis of COVID-19

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The research found that angiotensin‐converting enzyme 2 (ACE2) was the receptor for SARS‐CoV‐2. In the normal human lung, ACE2 is expressed on type I and II alveolar epithelial cells. Among them, 83% of the type II alveolar cells have ACE2 expression. Men had a higher ACE2 level in their alveolar cells than women. Asians have a higher level of ACE2 expression in their alveolar cells than the White and African American populations. The binding of SARS‐CoV‐2 on ACE2 causes an elevated expression of ACE2, which can lead to damages on alveolar cells. Damages to alveolar cells can, in turn, trigger a series of systemic reactions and even death. The research also confirmed that Asian males are more susceptible to SARS‐CoV‐2 infection. The receptor‐binding ability of SARS‐CoV‐2 is 10 to 20 times stronger than that of SARS‐CoV.

Scientists found that 98% of the patients in their study had fevers, of which 78% had a temperature higher than 38°C. They reported that 76% of the patients had coughs, 44% of patients experienced fatigue and muscle pain, and 55% of patients had dyspnea. A small number of patients also developed expectoration (28%), headaches (8%), hemoptysis (5%), and diarrhea (3%). Laboratory tests found that 25% of infected patients had leukopenia and 63% had lymphocytopenia. The level of aspartate aminotransferase was elevated in 37% of the patients. Myocarditis was diagnosed in 12% of the patients, and the level of hypersensitive troponin I was significantly increased in these patients. Abnormalities in chest computed tomography (CT) images were found in 100% of the patients. Grinding glass‐like and consolidation areas were found in 98% of the infected patients' bilateral lungs.

Zhu reported three cases of COVID‐19. Patient 1 was a 49‐year‐old female with a fever (body temperature 37 to 38°C) and had coughs accompanied by chest discomfort. Four days after the onset of the disease, her coughs and chest discomfort aggravated, but her fever subsided. Patient 2, a 61‐year‐old male, also developed fevers and coughs at the initial stage of the disease. Respiratory distress appeared 7 days after the onset of symptoms and worsened within the next 2 days. He was treated with mechanical ventilation. Patient 3 was a 32‐year‐old male whose symptoms were not described in the article. Patients 1 and 3 recovered and were discharged from hospital after treatment, but patient 2 died after 20 days of treatment.

Guan reported 1099 cases of 2019‐nCoV infection. They found that fevers (87.9%) and coughs (67.7%) were the most common symptoms. Diarrhea (3.7%) and vomiting (5.0%) were rare. Abnormalities in chest CT images were found in 96% of the SARS‐CoV‐2‐infected patients, and lymphopenia was observed in 82.1% of them.

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