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Clinical course and management of COVID-19 in the era of widespread population immunity

Nature Reviews Microbiology volume 22, pages 75–88 (2024)Cite this article

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Abstract

The clinical implications of COVID-19 have changed since SARS-CoV-2 first emerged in humans. The current high levels of population immunity, due to prior infection and/or vaccination, have been associated with a vastly decreased overall risk of severe disease. Some people, particularly those with immunocompromising conditions, remain at risk for severe outcomes. Through the course of the pandemic, variants with somewhat different symptom profiles from the original SARS-CoV-2 virus have emerged. The management of COVID-19 has also changed since 2020, with the increasing availability of evidence-based treatments in two main classes: antivirals and immunomodulators. Selecting the appropriate treatment(s) for patients with COVID-19 requires a deep understanding of the evidence and an awareness of the limitations of applying data that have been largely based on immune-naive populations to patients today who most likely have vaccine-derived and/or infection-derived immunity. In this Review, we provide a summary of the clinical manifestations and approaches to caring for adult patients with COVID-19 in the era of vaccine availability and the dominance of the Omicron subvariants, with a focus on the management of COVID-19 in different patient groups, including immunocompromised, pregnant, vaccinated and unvaccinated patients.

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Fig. 1: Illness course and severity spectrum for unvaccinated individuals with Wuhan-Hu-1 virus.
Fig. 2: Clinical course of disease in relation to viral load.
Fig. 3: Clinical manifestations of COVID-19 in different patient groups.
Fig. 4: The four scenarios for repeated SARS-CoV-2 PCR positivity.

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Acknowledgements

The authors thank all individuals infected with COVID-19 who agreed to allow their medical team to share their data with their permission; and the medical staff who looked after the participants and all researchers for their efforts in collecting the data that informed our understanding of COVID-19.

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  1. These authors contributed equally: Eric A. Meyerowitz, Jake Scott.

Authors and Affiliations

  1. Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY, USA

    Eric A. Meyerowitz

  2. Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Palo Alto, CA, USA

    Jake Scott

  3. Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Aaron Richterman

  4. Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK

    Victoria Male

  5. Division of Infection and Global Health Research, School of Medicine, University of St Andrews, St Andrews, UK

    Muge Cevik

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Meyerowitz, E.A., Scott, J., Richterman, A. et al. Clinical course and management of COVID-19 in the era of widespread population immunity. Nat Rev Microbiol 22, 75–88 (2024). https://doi.org/10.1038/s41579-023-01001-1

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