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The first step in delivering comprehensive care is to undertake a clinical assessment. Clinical assessment data which can be recorded using SNOMED CT includes:

These data elements are described below, with example SNOMED CT subsets for each.

Please note that all published concepts referred to on this page are included in SNOMED International's Global Patient Set (GPS), which is available to be used internationally under the Creative Commons Attribution 4.0 International License. Please refer to http://snomed.org/covid-19 for more information.

2.3.1 Symptoms 
Anchor
Symptoms
Symptoms

Symptoms represent physical or mental features which are regarded as an indication of a condition or disease, particularly those features that are apparent to the patient. This SNOMED CT subset of COVID-19 symptoms has been developed based on a range of literature, including relevant articles found in Pubmed 

Footnote ref
, research performed by Kings College London 
Footnote ref
n2
 , and a review of COVID-19 data collection forms (e.g. 
Footnote ref
n3
). Please note that this subset includes the concept 
Concept
t84387000 |Asymptomatic (finding)|
, which can be used to represent the absence of symptoms.

CV19-ASS-Symptoms
Concept idFully Specified Nameen-US Preferred TermEffective Time
21522001Abdominal pain (finding)Abdominal pain20050131
84387000Asymptomatic (finding)Asymptomatic20020131
131148009Bleeding (finding)Bleeding20050131
29857009Chest pain (finding)Chest pain20040731
43724002Chill (finding)Chill20020131
82272006Common cold (disorder)Common cold20030131
9826008Conjunctivitis (disorder)Conjunctivitis20040731
49727002Cough (finding)Cough20020131
3415004Cyanosis (finding)Cyanosis20020131
62315008Diarrhea (finding)Diarrhea20020131
3006004Disturbance of consciousness (finding)Disturbance of consciousness20020131
267036007Dyspnea (finding)Dyspnea20020131
271807003Eruption of skin (disorder)Eruption20020731
84229001Fatigue (finding)Fatigue20020131
103001002Feeling feverish (finding)Feeling feverish20020131
386661006Fever (finding)Fever20030131
25064002Headache (finding)Headache20100131
66857006Hemoptysis (finding)Hemoptysis20020131
248567008Indrawing of ribs during respiration (finding)Indrawing of ribs during respiration20020131
57676002Joint pain (finding)Joint pain20020131
79890006Loss of appetite (finding)Loss of appetite20020131
44169009Loss of sense of smell (finding)Loss of sense of smell20200131
36955009Loss of taste (finding)Loss of taste20020131
30746006Lymphadenopathy (disorder)Lymphadenopathy20020131
367391008Malaise (finding)Malaise20020131
68962001Muscle pain (finding)Muscle pain20020131
26544005Muscle weakness (finding)Muscle weakness20020131
68235000Nasal congestion (finding)Nasal congestion20020131
64531003Nasal discharge (finding)Nasal discharge20020131
422587007Nausea (finding)Nausea20070131
44077006Numbness (finding)Numbness20170731
162397003Pain in throat (finding)Pain in throat20020131
38880002Rigor (finding)Rigor20020131
91175000Seizure (finding)Seizure20020131
46742003Skin ulcer (disorder)Skin ulcer20020131
23924001Tight chest (finding)Tight chest20020131
282145008Unable to walk (finding)Unable to walk20080731
422400008Vomiting (disorder)Vomiting20180731
56018004Wheezing (finding)Wheezing20020131

2.3.2 Severity 
Anchor
Severity
Severity

Severity represents the quality of the condition - for example, 

Concept
t24484000 | Severe (severity modifier) (qualifier value) |
. Severity may be recorded for each symptom, or as a general statement of their disease state
Footnote ref
n4

CV19-ASS-Severity
Concept idFully Specified Nameen-US Preferred TermEffective Time
84387000Asymptomatic (finding)Asymptomatic20020131
255604002Mild (qualifier value)Mild20020131
6736007Moderate (severity modifier) (qualifier value)Moderate20020131
24484000Severe (severity modifier) (qualifier value)Severe20020131
442452003Life threatening severity (qualifier value)Life threatening severity20090731


2.3.3 Clinical Measurements 
Anchor
Measurements
Measurements

Clinical measurements involve the performance of physiological tests to diagnose and refine therapeutic management of an already established disease. The following clinical measurements (and related observables) can be used in the assessment of a COVID-19 patient.

CV19-ASS-ClinicalMeasurements
Concept idFully Specified Nameen-US Preferred TermEffective Time
413384008Ability to perform cognitive activity (observable entity) Ability to perform cognitive activity20050131
442476006Arterial oxygen saturation (observable entity)Arterial oxygen saturation20090731
386725007Body temperature (observable entity)Body temperature20170131
75367002Blood pressure (observable entity)Blood pressure20170131
248592006Character of cough (observable entity)

Character of cough

20020131
364533002Color of skin (observable entity)Color of skin20020131
709017009Compliance behavior to safety precaution (observable entity)Compliance behavior to safety precaution20150731
263731006Coughing (observable entity)Coughing20020131
271626009Depth of respiration (observable entity)Depth of respiration20020131
226379006Food intake (observable entity) Food intake20020131
364075005Heart rate (observable entity)Heart rate20170131
103228002Hemoglobin saturation with oxygen (observable entity)Hemoglobin saturation with oxygen20020131
6942003Level of consciousness (observable entity)Level of consciousness20020131
440398005Level of fatigue (observable entity)Level of fatigue20090131
405161002Pain level (observable entity)Pain level20040131
248750004Peripheral blood flow (observable entity)Peripheral blood flow20020131
431314004Peripheral oxygen saturation (observable entity)Peripheral oxygen saturation
20080731
8499008Pulse, function (observable entity)Pulse20020131
248565000Respiratory effort (observable entity)Respiratory effort20020131
86290005Respiratory rate (observable entity)Respiratory rate20170131
248582003Rhythm of respiration (observable entity)Rhythm of respiration20020131
247433003Skin elasticity (observable entity)Skin elasticity20020131
248598005Sputum volume (observable entity)Sputum volume20020131
442349007Venous oxygen saturation (observable entity)Venous oxygen saturation20090731

2.3.4 Clinical Examination Findings 
Anchor
Observations
Observations

Clinical examination findings are the result of measuring, questioning, evaluating, or otherwise examining a patient in healthcare. The following clinical findings are positive or negative indications that signs are present in a COVID-19 patient.

CV19-ASS-ClinicalExaminationFindings
Concept idFully Specified Nameen-US Preferred TermEffective Time
288848001Able to breathe (finding)Able to breathe20080731
77427003Activity intolerance (finding)Activity intolerance20020131
20262006Ataxia (finding)Ataxia20020131
371632003Coma (disorder)Coma20020731
193894004Conjunctival hyperemia (finding)Conjunctival hyperemia20100131
58840004Decreased breath sounds (finding)Decreased breath sounds20020131
443371007Decreased level of consciousness (finding)Decreased level of consciousness20100131
9763007Expiratory wheezing (finding)Expiratory wheezing20020131
126664009Exudative pharyngitis (disorder)Exudative pharyngitis20020131
386661006Fever (finding)Fever20030131
442646005Imaging of lung abnormal (finding)Imaging of lung abnormal20090731
67750007Ineffective airway clearance (finding)Ineffective airway clearance20020131
70944005Impaired gas exchange (finding)Impaired gas exchange20080731
75252003Inspiratory crackles (finding)Inspiratory crackles20020131
419045004Loss of consciousness (finding)Loss of consciousness20060131
274710003Lung field abnormal (finding)Lung field abnormal20020131
91175000Seizure (finding)Seizure20020131
3424008Tachycardia (finding)Tachycardia20080731
271823003Tachypnea (finding)Tachypnea20020131
288849009Unable to breathe (finding)Unable to breathe20080731

Please refer to 2.3.1 Extension Concepts - Clinical Assessment for a list of known extension concepts.

2.3.5 Diagnosis and Certainty 
Anchor
Diagnosis
Diagnosis

A diagnosis is the identification of the nature of the illness, based on an examination of the symptoms, observations, measurements, test results and other investigation results. The following subset includes a range of diagnoses directly related to COVID-19.

CV19-ASS-Diagnosis
Concept idFully Specified Nameen-US Preferred TermEffective Time
1119302008Acute disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)Acute COVID-1920210131
189486241000119100Asymptomatic severe acute respiratory syndrome coronavirus 2 infection (finding)Asymptomatic SARS-CoV-220200731
840539006Disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)
COVID-1920200131
688232241000119100Disease caused by Severe acute respiratory syndrome coronavirus 2 absent (situation)Disease caused by Severe acute respiratory syndrome coronavirus 2 absent20200731
840544004Suspected disease caused by severe acute respiratory coronavirus 2 (situation)Suspected COVID-1920200131

Please refer to 2.3.1 Extension Concepts - Clinical Assessment for a list of known COVID-19 diagnosis extension concepts.

To represent the certainty of a positive COVID-19 diagnosis, the following subset may be used in conjunction with a diagnosis of 

Concept
t840539006 | COVID-19 |
.

CV19-ASS-DiagnosisPresentCertainty
Concept idFully Specified Nameen-US Preferred TermEffective Time
410605003Confirmed present (qualifier value)Confirmed present20040731
410592001Probably present (qualifier value)Probably present20040731
415684004Suspected (qualifier value)Suspected20050131


To represent the certainty of the absence of COVID-19, the following subset may be used in conjunction with a diagnosis of 

Concept
t688232241000119100 | Disease caused by severe acute respiratory syndrome coronavirus 2 absent (situation) |
.


CV19-ASS-DiagnosisAbsentCertainty
Concept idFully Specified Nameen-US Preferred TermEffective Time
410594000Definitely NOT present (qualifier value)Definitely NOT present20040731
410593006Probably NOT present (qualifier value)Probably NOT present20040731

2.3.6 Clinical History 
Anchor
History
History

The clinical history concepts are used to record information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information, with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient.

CV19-ASS-ClinicalHistory
Concept idFully Specified Nameen-US Preferred TermEffective TimeIn GPS

292508471000119105

History of disease caused by severe acute respiratory syndrome coronavirus 2 (situation)

History of SARS-CoV-2

20200731-

2.3.7 Secondary Conditions and Complications 
Anchor
Complications
Complications

A secondary condition is any additional health condition that occurs as a result of the natural progression or expected outcome of the primary condition. A complication is "a disorder caused by another disorder, procedure or event, which is not a natural progression or expected outcome of its cause 

Footnote ref
n5
.

The following subset includes SNOMED CT clinical findings that may be recorded as either secondary conditions or complications

Footnote ref
n6
. Clinical judgement is required to determine whether these conditions are expected outcomes or unexpected complications of COVID-19. 

Viral infection of bloodstream
CV19-ASS-SecondaryConditionsAndComplications
Concept idFully Specified Nameen-US Preferred TermEffective Time

138389411000119105

Acute bronchitis caused by severe acute respiratory syndrome coronavirus 2 (disorder)

Acute bronchitis caused by SARS-CoV-220200731
870590002Acute hypoxemic respiratory failure due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)
Acute hypoxemic respiratory failure due to disease caused by Severe acute respiratory syndrome coronavirus 2
20200731
870589006Acute kidney injury due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)
Acute kidney injury due to disease caused by Severe acute respiratory syndrome coronavirus 2
20200731
373895009Acute respiratory distress (finding)Acute respiratory distress20020731
67782005Acute respiratory distress syndrome (disorder)Acute respiratory distress syndrome20020131
674814021000119106

Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)

Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2

20200731
64779008Blood coagulation disorder (disorder)Blood coagulation disorder20020731
119731000146105Cardiomyopathy due to disease caused by Severe acute respiratory syndrome virus 2 (disorder)
Cardiomyopathy due to disease caused by Severe acute respiratory syndrome virus 2
20200731
62914000Cerebrovascular disease (disorder)Cerebrovascular disease20020131
1119304009Chronic post-COVID-19 syndrome (disorder)Chronic post-COVID-19 syndrome20210131
119741000146102Conjunctivitis due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)
Conjunctivitis due to disease caused by Severe acute respiratory syndrome coronavirus 2
20200731
710027002Cytokine-associated toxicity (disorder)Cytokine release syndrome
20150731
419099009Dead (finding)Dead20060131
128053003Deep venous thrombosis (disorder)Deep venous thrombosis20020131
34095006Dehydration (disorder)Dehydration20020131
67406007Disseminated intravascular coagulation (disorder)Disseminated intravascular coagulation20020131
3006004Disturbance of consciousness (finding)Disturbance of consciousness20020131
119981000146107Dyspnea caused by Severe acute respiratory syndrome coronavirus 2 (disorder)Dyspnea caused by Severe acute respiratory syndrome coronavirus 220200731
1240561000000108Encephalopathy due to disease caused by Severe acute respiratory syndrome virus 2 (disorder)
Encephalopathy due to disease caused by Severe acute respiratory syndrome virus 2
20200731
119751000146104Fever caused by Severe acute respiratory syndrome coronavirus 2 (disorder)Fever caused by Severe acute respiratory syndrome coronavirus 220200731
25374005Gastroenteritis (disorder)Gastroenteritis20020131
56265001Heart disease (disorder)Heart disease20020131
80394007Hyperglycemia (disorder)Hyperglycemia20020131
389086002Hypoxia (disorder)Hypoxia20030131
70944005Impaired gas exchange (finding)Impaired gas exchange20080731
1240541000000107Infection of upper respiratory tract caused by Severe acute respiratory syndrome coronavirus 2 (disorder)
Infection of upper respiratory tract caused by Severe acute respiratory syndrome coronavirus 2
20200731
90708001Kidney disease (disorder)Kidney disease20020731

880529761000119102

Lower respiratory infection caused by Severe acute respiratory syndrome coronavirus 2 (disorder)

Lower respiratory infection caused by SARS-CoV-2

20200731
866151004Lymphocytopenia due to Severe acute respiratory syndrome coronavirus 2 (disorder)
Lymphocytopenia due to Severe acute respiratory syndrome coronavirus 2
20200731
59455009Metabolic acidosis (disorder)Metabolic acidosis20020131
57653000Multiple organ failure (disorder)Multiple organ failure20020131
1240531000000103Myocarditis due to disease caused by Severe acute respiratory syndrome virus 2 (disorder)
Myocarditis due to disease caused by Severe acute respiratory syndrome virus 2
20200731
1240521000000100Otitis media due to disease caused by Severe acute respiratory syndrome virus 2 (disorder)
Otitis media due to disease caused by Severe acute respiratory syndrome virus 2
20200731
184297005183676005Patient died Died in hospital (finding)Patient died Died in hospital20020131

882784691000119100

Pneumonia caused by Severe acute respiratory syndrome coronavirus 2 (disorder)

Pneumonia caused by SARS-CoV-2

20200731
1119303003Post-acute COVID-19 (disorder)Post-acute COVID-1920210131
870591003Rhabdomyolysis due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)
Rhabdomyolysis due to disease caused by Severe acute respiratory syndrome coronavirus 2
20200731
302846007Rhabdomyoma (disorder)Rhabdomyoma20040731
308906005Secondary bacterial pneumonia (disorder)Secondary bacterial pneumonia20160131
91302008Sepsis (disorder)Sepsis20200131
870588003Sepsis due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)
Sepsis due to disease caused by Severe acute respiratory syndrome coronavirus 2
20200731
76571007Septic shock (disorder)Septic shock20050131
415623008Stress ulcer (disorder)Stress ulcer20050131
238149007Systemic inflammatory response syndrome (disorder)Systemic inflammatory response syndrome20020131

866152006

Thrombocytopenia due to Severe acute respiratory syndrome coronavirus 2 (disorder)
Thrombocytopenia due to Severe acute respiratory syndrome coronavirus 2
20200731
429340002Traumatic injury of skeletal muscle (disorder)Traumatic injury of skeletal muscle20080131
75570004Viral pneumonia (disorder)Viral pneumonia20130731
1017214008Viremia caused by Severe acute respiratory syndrome coronavirus 2 (disorder)SARS-CoV-2 viremia20210131

Please refer to 2.3.1 Extension Concepts - Clinical Assessment for a list of known extension concepts.





2.3.8 Potential Risk Factors 
Anchor
RiskFactors
RiskFactors

Potential risk factors are the patient conditions which may influence the course or outcomes of the COVID-19 disease. The following clinical findings may be recorded as potential risk factors

Footnote ref
n3
 
Footnote ref
n7
 
Footnote ref
n8
.

CV19-ASS-RiskFactors
Concept idFully Specified Nameen-US Preferred TermEffective Time

78648007

At risk for infection (finding)

At risk for infection

20020131
27624003Chronic disease (disorder)Chronic disease20020131
49601007Disorder of cardiovascular system (disorder)Disorder of cardiovascular system20020131
414029004Disorder of immune function (disorder)Disorder of immune function20190131
235856003Disorder of liver (disorder)Disorder of liver20020131
118940003Disorder of nervous system (disorder)Disorder of nervous system20020131
50043002Disorder of respiratory system (disorder)Disorder of respiratory system20020131
722499006Electronic cigarette user (finding)Electronic cigarette user20170131
8517006Ex-smoker (finding)Ex-smoker20020131
80141007Hemoglobinopathy (disorder)Hemoglobinopathy20020131
107921000119107History of immune disorder (situation)History of immune disorder20150731
90708001Kidney disease (disorder)Kidney disease20020731
363346000Malignant neoplastic disease (disorder)Malignant neoplastic disease20020131
75934005Metabolic disease (disorder)Metabolic disease20020131
414825006Neoplasm of hematopoietic cell type (disorder)Neoplasm of hematopoietic cell type20050131
414915002Obese (finding)Obese20050131
370388006Patient immunocompromised (finding)Patient immunocompromised20020731
370391006Patient immunosuppressed (finding)Patient immunosuppressed20020731
77386006Pregnant (finding)Pregnant20020131
77176002Smoker (finding)Smoker20020131


Similarly, procedures performed on the patient within a clinically relevant timeframe may also influence the course or outcomes of the COVID-19 disease. The following procedures may be recorded as potential risk factors 

Footnote ref
n8
.


CV19-ASS-ProcedureRiskFactors
Concept idFully Specified Nameen-US Preferred TermEffective Time
367336001Chemotherapy (procedure)Chemotherapy20020131
788751009Corticosteroid and corticosteroid derivative therapy (procedure)Corticosteroid and corticosteroid derivative therapy20200131
234336002Hemopoietic stem cell transplant (procedure)Hemopoietic stem cell transplant20050131
86553008Immunosuppressive therapy (procedure)Immunosuppressive therapy20020131
76334006Immunotherapy (procedure) Immunological therapy20020131
108290001Radiation oncology AND/OR radiotherapy (procedure)Radiation oncology AND/OR radiotherapy20020131
312235007Radiolabeled antibody therapy (procedure)Radiolabeled antibody therapy20020131
265764009Renal dialysis (procedure)Renal dialysis20020131
313039003Solid organ transplant (procedure)Solid organ transplant20060731

2.3.9 Comorbidities 
Anchor
Comorbidity
Comorbidity

Comorbidities are additional medical conditions of concern. The following SNOMED CT subset can be used to record comorbidities.

CV19-ASS-Comorbidities

Intensional Definition:

Intensional Definition:
Scg expression
ShowFormatinline
< 64572001 | Disease (disorder) |


2.3.10 Exposure 
Anchor
Exposure
Exposure

An exposure event is when an individual comes into close contact with an infected person's contaminated droplets, carried in the air or on contaminated hands, surfaces or other objects. The subset below includes SNOMED CT events for recording exposure to COVID-19.

CV19-ASS-ExposureEvent
Concept idFully Specified Nameen-US Preferred TermEffective Time
840546002Exposure to severe acute respiratory syndrome coronavirus 2 (event)Exposure to SARS-CoV-220200131
897036007Occupational exposure to Severe acute respiratory syndrome coronavirus 2 (event)Occupational exposure to SARS-CoV-220210131

An exposure finding is the result of an observation or evaluation that relates to the patient's exposure to an infection. The subset below includes SNOMED CT findings relating to COVID-19 exposure.

CV19-ASS-ExposureFinding
Concept idFully Specified Nameen-US Preferred TermEffective Time
870577009At increased risk of exposure to severe acute respiratory syndrome coronavirus 2 (finding)At increased risk of exposure to severe acute respiratory syndrome coronavirus 220200731

Please refer to 2.3.1 Extension Concepts - Clinical Assessment for a list of known extension concepts.

2.3.11 Covid-19 and Viral Co-Infections 
Anchor
Infections
Infections

The following organism should be used when recording the organism causing COVID-19 infections.

CV19-ASS-Organism
Concept idFully Specified Nameen-US Preferred TermEffective Time
840533007Severe acute respiratory syndrome coronavirus 2 (organism)SARS-CoV-220200131


The following organisms can be used to record the cause of related viral co-infections.

CV19-ASS-ViralCoInfections

Definition:

Intensional Definition:
Scg expression
ShowFormatinline
<< 49872002 |Virus (organism)| MINUS 840533007 | Severe acute respiratory syndrome coronavirus 2 (organism) |









Footnote block
  1. Articles found using the Pubmed query "https://pubmed.ncbi.nlm.nih.gov/?term=covid+19&filter=pubt.review"
  2. COVID Symptom Tracker Research Updates
  3. COVID-19 Case Reporting Forms, including:
    COVID-19 Case Report Form, CDC, US
    Novel Coronavirus (COVID-19) Case Record Form, Global COVID-19 Clinical Platform, World Health Organization
    COVID-19 Hospitalisation in England Surveillance System (CHESS) Daily Reporting, NHS, UK
  4. Coronavirus: what are asymptomatic and mild COVID-19?, Patient.info
    Coronavirus: what are moderate, severe and critical COVID-19?, Patient.info
  5. SNOMED CT Editorial Guide, SNOMED International
  6. Clinical papers, including:
    COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission
    COVID-19 and the Cardiovascular System
    Caution on Kidney Dysfunctions of COVID-19 Patients
    Holistic care for patients with severe coronavirus disease 2019: An expert consensus
  7. Rhabdomyolysis as Potential Late Complication Associated with COVID-19
    Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: A Retrospective Case Series Study
    Dysregulation of Immune Response in Patients with COVID-19 in Wuhan, China
  8. CHESS Daily Reporting, NHS, UK
  9. COVID-19 - High Risk Shielded Patient List Identification Methodology - Clinical Inclusion Criteria, NHS, UK