In December 2019, a new pathogen COVID-19 was identified in Wuhan, Hubei Province, China that caused pneumonia and death [1, 2]. COVID-19 is one of the positive-strand RNA viruses that genetically are similar to the acute respiratory syndrome virus (SARS-COV) and the Middle East respiratory syndrome (MERS-COV) [1, 3, 4]. Following the spread of the virus to other countries such as South Korea, Italy, Iran, and Japan and reporting a death in infected people there the World Health Organization (WHO) declared it as a pandemic and named it COVID-19[3, 5]. Until the date of writing this scientific research, according to WHO, 35,027,546 cases of COVID-19 have been confirmed, including 1,034,837 death[6]. COVID-19 and SARS have many close clinical characters [3]. The spread and contagion of the virus happen through large droplets created during sneezing and coughing of asymptomatic and asymptomatic patients[7]. The virus can survive on different surfaces such as metal, glass, or plastic for up to 9 days and infect people by touching the nose, eyes, and mouth [5, 7]. After contact with the virus, symptoms may appear within 2 to 14 days [8]. The transmission rate of SARS-CoV-2 is high between families and friends who had close contact with patients or asymptomatic carriers even with a low infective dose [9].
Elderly persons with comorbidities or underlying diseases such as diabetes, hypertension, or cardiovascular diseases (CVD), are at serious and greater risk because these diseases may weaken the immune system [3, 9, 10]. Although everyone is at risk, the average age of patients was between 47–59 years old, of which women make up 41.9–45.7% of patients[7, 9], COVID-19 has various clinical features, from an asymptomatic state to acute respiratory distress syndrome until multi-organ dysfunction[7]. Common clinical symptoms of COVID-19 fever, nonproductive cough, dyspnea with or without diarrhea, myalgia, fatigue, usually normal or reduced leukocyte amounts, and radiographic data of pneumonia, which are similar to the symptoms of SARS-CoV and MERS-CoV contagions [1, 4, 7]. The most and main common symptom for screening is fever [3]. Pneumonia and kidney failure may happen in severe cases which lead to death [10]. In the second week, the infection progresses to hypoxemia, respiratory problems, and acute respiratory distress syndrome (ARDS), which leads to the need for mechanical ventilation in the intensive care unit (ICU) with isolated services[1]. Patients should drink plenty of fluids and electrolytes and appropriate oxygen therapy or treatment should be provided through the oxygen mask, nasal cannula, or high flow nasal oxygen therapy. In this situation, checking some parameters like heart rate, blood pressure, pulse oxygen saturation, and respiratory rate is essential[10].
COVID-19 diagnostic tests are varied and include nucleic acid detection, CT scan, immune identification technology, Real-Time-PCR, ELISA, blood culture [4, 10]. CT imaging normally appearances infiltrate ground-glass opacities (GGOs), and subsegmental consolidation [7] single or numerous agglomerated or scattered patchy GGOs segregated by grid-like condensed or honeycomb-like interlobular septa and pulmonary consolidation with air bronchogram. The results may differ according to disease phase, patient age, and immune status at the time of imaging [10]. For identification, High-Resolution Computed Tomography (HRCT) is more sensitive than chest x-ray[11] and this is necessary for quick diagnosis and assessment of COVID-19 patientʼs severity, discovering lung deformities, clinical classification, finding of pulmonary problems, and follow-up after discharge[4, 12].