Corona Virus “Ghastly pandemic” – A comprehensive literature
Dr Avineet Kaur1, Dr Harnoor Singh Sandhu2, Dr Reshma Dodwad3 Dr AnupamaVithalKumar Betigeri 4, Dr VithalKumarMalleshi Betigeri5, Dr Ashish Gupta6
1 MDS, Senior Lecturer, Department of Periodontology and Oral Implantology, Swami Devi Dyal Dental College and Hospital Golpura, Barwala (Haryana) India
2 MBBS, Emergency Medical Officer, Department of Emergency, Gian sagar Medical College and Hospital Banur , Rajpura (Punjab) India
3 MDS, Reader, Department of Pedodontics and Preventive Dentistry, Krishna Devaraya College of Dental Sciences, Bangalore (Karnataka) India
4 MD, HOD. Department of Physiology, Manav Rachna Dental College Faridabad, (Haryana) India
5 MS, Mch Professor Department of Cardiothoracic and Vascular Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education, New Delhi India
6 MBBS Private Practitioner
Corresponding author:-Dr Avineet Kaur , Email:- [email protected]
ABSTRACT
Coronaviruses consist of enveloped viruses. The easily transmittable coronavirus disease 19 (COVID-19) is a viral infection originating from Wuhan, China. The World Health Organisation (WHO) announced that the SARS-Cov-2 virus caused a global pandemic, resulting in certain consequences of which are currently evident however there will continue to be consequences even after the pandemic has finished.
Keywords:
Coronavirus, Pandemic, Bats, Infection, respiratory infections
Introduction
Coronaviruses (CoV) are a member of the genus Coronaviridae. CoVs are pleomorphic in nature.
Peplomers consist of 80-160 nM in size and 27-32 kb with positive polarity which are contained by RNA viruses which are crown shaped. Coronaviruses are zoonotic pathogens with high mutation rates that exist in humans and animals causing infections related to respiration, the gastrointestinal system, hepatics and neurology.1,2,3
In the province of Guangdong China in 2002 and 2003 for the first time a highly pathogenic virus called SARS was found in humans. When this infection had spread further both as CoV OC43 and CoV 229E even mild infections caused symptoms in populations with weakened immune systems.3,4,5,6,7 On December 12, 2019, the first unknown case of pneumonia was detected and other coronaviruses were investigated. On January 7th, 2020, a new type of Coronavirus named the novel Coronavirus was isolated and declared by Chinese authorities. The virus was titled as the Novel Coronavirus by WHO January 12th, 2020 and COVID-19 on February 11th, 2020. On February 12th, 2020, a total of 43.103 COVID-19 cases and 1.018 deaths had been declared.8 This was the third outbreak of a Coronavirus in the first two decades of the 21st century, thus human to human transmission occurs and ensuing to an increase in global concerns on the topic. On March 11th, 2020, the COVID-19 pandemic caused 80955 cases of COVID-19 as well as 3162 deaths in China. Meanwhile with 1130 deaths in 113 other countries WHO worried about the surging number of cases. In the following perspectives of the pandemic will be highlighted as well as the pathological indications of COVID-19. Various new therapeutic methods are still emerging, some of which are overviewed. 9
Epidemiology
In December 2019, many new pneumonia cases were recorded in Wuhan which were linked to the Huanan Seafood Market, the main origin for COVID-19. A pneumonia case of COVID- 19 was first discovered on December 12th, 2019 and the other 27 viral cases were officially declared on 31st of December 2019.10,11 Finally On 22nd of January 2020, it was declared that the novel CoV originated from wild bats. The virus was imported from different sources and easily able to proliferate in the crowded market. The pandemic began during one of the most culturally significant times of year in Chinese culture, the Spring Festival in which nearly 3 billion people travel within China. These conditions were highly responsible for causing favorable mediums for the transmission of the contagious disease. Earlier in the spring season the Spring Festival of China occurred from January 17th to February 23rd in 2003, when SARS spread. Similarly, this festival occurred between January 10th and February 18th in 2020 when the COVID-19 epidemic began its spread. The center of the COVID-19 epidemic is Wuhan with a population of 10 million. 9
Origin, Virology and Pathogenesis
Coronavirus belongs to a subfamily orthocoronavrinae of the coronaviridae family. Among two- thirds of RNA genome encodes viral polymerase (RdRp), two large nonstructuralpolyproteins and RNA synthesis materials.While other one-third of the genome encodes four structural proteins and the other helper proteins. The spike protein is the first to interact with a human sensitive cells. Thus leading to the expression of the genes takes place once entry into the cell occurs where genomic encoding starts.13,14 Various changes occur including gene exchange, gene insertion, deletion or recombination are frequent among CoVs. The CoVs family is rapidly multiplying and expanding. Four genera of 38 unique species were found by The International Committee on Taxonomy of Viruses (ICTV) .1516
Once they enter the cell, the viral RNA manifests itself. Genomic RNA is encapsulated and polyadenylated. Further polyproteins are split by proteases thus resulting in RNA production both by transcription and replication. During replication, full-length (-) RNA copies of the genome are produced. When transcription occurs, a subset of 7-9 sub-genomic RNAs are produced by those encoding all structural proteins. Virions are then released which can infect intestines, liver cells, kidney cells, T lymphocytes, as well as the lower respiratory tract. Collapse of the immune system takes place as the virus makes antiviral T –cell response which leads to the stimulation of T-cell apoptosis .17,18
Sources and Modes of Transmission
CoVs have been defined as a novel respiratory tract virus from samples which were collected in 1962. 19 The family of viruses include several animal species such as cattle, cats, camels, and bats.14,15,16,17
Various literature depicts that bat CoVs are of the gene source of alpha-CoV and beta-CoVs, while most bird CoVs are of the gene source of gamma-CoVs and delta-CoVs. 12 After the first outbreak, few number of cases were increased. Human-to-human transmission was significant as those patients who were affected had no history of contact with humans in Wuhan, despite this there was a rise in the number of cases. COVID-19 spread to populations outside of China, including those in Thailand by January 13th, 2020 and then throughout Asia.20
Transmission occurs when a person who has the infection sneezes. The sneeze produces droplets and it is these droplets that settle in the lungs, nasal mucosa or mouth with inhaled air. 21
Clinical manifestations
Symptoms of COVID 19 resemble primarily to the symptoms seen in SARS and MERS. In most cases those infected with COVID-19 recovered in a period of two weeks. Acute respiratory distress syndrome (ARDS) progressed in many patients which led to an occurrence of septic shock and multiple organ failure. Males are most commonly susceptible to COVID-19 because of the X chromosome and sex hormones which plays a role in immunity. Symptoms are usually mild fever, dry cough, and shortness of breath. Whereas some of the afflicted have prominent respiratory and gastrointestinal symptoms. Patients were who asymptomatic were left to not quarantine. 9
Clinical Progression
COVID-19 can present dramatically differently from patient to patient. Various symptoms of COVID-19 have been observed clinically from respiratory infection to septic shock. Symptoms like fever, shortness of breath, cough, were also seen in SARS CoV and MERS CoV. 20 In COVID-19 intestinal issues as a symptom were rarely reported. In another study of 99 patients, diarrhea, chest pain, and nausea-vomiting were observed .22
Radiographically or thorax CT imaging, it is observed bilateral multiple lobular and subsegmental consolidation areas.23,24 In addition patients also presented dyspnea along with abnormal thorax CT compatible. Other complications include secondary infections such as ARDS, pneumothorax, acute heart damage, bilateral multiple lobular and subsegmental consolidation areas. 25 All these symptoms were presented in patients of whom were hospitalized into intensive care units.
Diagnosis of n-CoV 19 infection is based on a case history of travel, contact along and the utilization of diagnostic tools including serology, viral culture, and molecular methods. Other diagnostic methods include molecular methods such as RT-PCR or real-time PCR. Respiratory samples like sputum, deep tracheal aspirate, nasopharyngeal aspirate, oropharyngeal swabs, or broncho alveolar lavage are taken to assist in diagnosis as appropriate or required. It has been observed that lower respiratory tract samples can offer drastically higher viral load. 24
Emerging of Coronavirus from SARS to MERS
SARS-CoV during 2002-2003 had a considerable number of cases which spread from China to other parts of the world resulting in 8000 people being infected and ultimately a mortality rate of 10%26 . MERS-CoV, during 2012 originated in the Arabian Peninsula and spread to 27 countries with an observed 35.6% mortality rate.21 COVID-19 that began in Wuhan had a mortality of 2%.
SARS-CoV affects the younger population whereas MERS-CoV affects humans who are above 50 years, COVID-19 by comparison infects humans both above the age of 50 and below.20
Treatment Methods and Precautionary Measures
While new therapeutic drugs are marketed various double-blind studies are still needed to test the efficacy of the new drugs that are available. Medical interventions can be categorized into following categories: coronavirus specific treatments, general treatments, and antiviral treatments.
General treatments include immunity enhancers, nutritional interventions, and traditional Chinese medicine. Several immunity boosting agents such as interferon, intravenous gamma globulin and thymosin are recommended. Similarly, chloroquine “chinese old medicine” for curing malaria had proved to be useful. Interestingly Gao et al 2020.Sul et al 2004 found that human monoclonal antibodies could neutralize SARS CoV.
Hoffmann 2020 outlined a cellular protease TMPRSS2 for nCoV that goes into cells and thus the spread of the virus takes place. Various drugs such as lopinavir/ritonavir and abidol showed a clinical improvement in an infection of COVID-19.9 Numerous precautionary measures can be taken including the timely publication of epidemic information which eliminates the causative agent of infection as well as early diagnosis, supportive treatments, and isolation. All these measures have the added benefit of enabling the avoidance of unnecessary anxiety. 27
By comparison, the CDC recommends various basic measures such as avoiding contact with patients and hand washing with disinfectant solutions. Precautionary measures such as hand sanitizers, provisions of medicine, the proper use of personal protective equipment, masks and hospital necessities should be made for protection of all patients as well as healthcare professionals.28
Conclusion
This review provides a brief description of the current COVID-19 situation and illustrates the impact on public health and its emergency preparedness. Safety measures such as prevention, precautions and vaccination are some of the methods for COVID-19 prevention.
Acknowledgement
This paper would not have been possible without the extraordinary support of my family and my co-authors.I would also like to show my gratitude to my wonderful parents, brothers, family, friends and especially Kimiko Mori-Chhapyan.
References
[1] Woo PC, Huang Y, Lau SK, Yuen KY. Coronavirus genomics and bioinformatics analysis.
Viruses 2010;2:1804–20.
[2] Drexler JF, Gloza-Rausch F, Glende J, Corman VM, Muth D, Goettsche M, et al. Genomic characterization of severe acute respiratory syndrome-related coronavirus in European bats and classification of coronaviruses based on partial.RNA-dependent RNA polymerase gene sequences. J Virol. 2010;84:11336–49.
[3] Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia.
Respirology 2018;23:130–7.
[4] Peiris JSM, Lai ST, Poon L, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. The Lancet .2003;361:1319–25.
[5] Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012;367:1814–20.
[6] Seven days in medicine: 8-14 Jan 2020. BMJ.2020;368:m132.31948945.
[7] Assiri A, Al-Tawfiq JA, Al- Rabeeah AA, Al-Rabiah FA, Al-Hajjar S, Al-Barrak A, et al.
Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis 2013;13:752–61, doi:http://dx.doi.org/10.1016/S1473- 3099(13)70204-4.
[8] European Centre for Disease Prevention and Control data. Geographical distribution of 2019- nCov cases. Available online: (https://www.ecdc.europa.eu/en/geographical-distribution-2019- ncov-cases) (accessed on 05 February 2020)
[9] Xie M, Chen Q. Insight into 2019 novel coronavirus - An updated interim review and lessons from SARS-CoV and MERS-CoV. Int J Infect Dis. 2020 May;94:119-124. doi:
10.1016/j.ijid.2020.03.071. Epub 2020 Apr 1. PMID: 32247050; PMCID: PMC7118633.
[10] Imperial College London. Report 2: estimating the potential total number of novel coronavirus cases in Wuhan City, China. Jan 2020. https://www.imperial.ac.uk/mrc- globalinfectiousdisease-analysis/news--wuhan-coronavirus.
[11] World Helath Organization, 2019- nCoV Situation Report-22 on 12 February, 2020.
https://www.who.int/docs/defaultsource/coronaviruse/situation-reports/
[12] Gralinski L, Menachery V. Return of the Coronavirus: 2019-nCoV, Viruses 2020;12:135.
[13] Luk HK, Li X, Fung J, Lau SK, Woo PC. Molecular epidemiology,evolution and phylogeny of SARS coronavirus. Infection, Genetics and Evolution 2019;71:21–30.
[14] Coronavirinae in ViralZone. Available online: https://viralzone.expasy.org/785 (accessed on 05 February 2019).
[15] Subissi L, Posthuma CC, Collet A, Zevenhoven-DobbeJC,Gorbalenya AE, Decroly E, et al.
One severe acute respiratorysyndrome coronavirus protein complex integrates processiveRNA polymerase and exonuclease activities. ProcNatlAcadSci USA 2014;111:E3900–E3909
[16] Lambeir AM, Durinx C, Scharpe S, De Meester I. Dipeptidylpeptidase IV from bench to bedside: An update on structural properties, functions, and clinical aspects of the enzyme DPP IV. Crit Rev Clin Lab Sci 2003;40:209–94.
[17] Chu H, Zhou J, Wong BH, Li C, Cheng ZS, Lin X, et al. Productive replication of Middle East respiratory syndrome coronavirus in monocyte-derived dendritic cells modulates innate immune response. Virology 2014;454–455:197–205.
[18] Zhou J, Chu H, Li C, Wong BH, Cheng ZS, Poon VK, et al. Active replication of Middle East respiratory syndrome coronavirus and aberrant induction of inflammatory cytokines and chemokines in human macrophages: Implications for pathogenesis.J Infect Dis 2014;209:1331–42.
[19] Hamre D, Procknow JJ. A new virus isolated from the human respiratory tract. Proceedings of the Society for Experimental Biology and Medicine 1966;121:190–3.
[20] Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al.The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health -The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;264–6.
[21] Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an .Asymptomatic Contact in Germany, 30.01.2020.
[22] Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020, publish onlined Jan 29, https://doi.org/10.1016/ S0140- 6736(20)30211-7.
[23] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; published online Jan 24. HYPERLINK
"https://doi.org/10.1016/S01406736(20)301835" https://doi.org/10.1016/ S0140–
6736(20)30183–5.
[24] Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N England J Medicine.Publishonlined Jan 29. DOI: 10.1056/NEJMoa2001017
[25] Wang C, Horby PW, Harden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020, publish onlined Jan 24, https://doi.org/10.1016/S0140-6736(20)30185-9.
[26] WHO. Emergencies preparedness, response. Pneumonia of unknown origin – China. Disease
outbreak news. Available online: https:// HYPERLINK "http://www.who.int/csr/don/12- january-2020-novel-coronavirus-china/en/" www.who.int/csr/don/12-january-2020-novel- coronavirus-china/en/ (accessed on 05 February 2020)
[27] Sahin AR, Erdogan A, MutluAgaoglu P, Dineri Y, Cakirci AY, Senel ME, et al. 2019 Novel Coronavirus (COVID-19) Outbreak: A Review of the Current Literature. EJMO 2020;4(1):1-7.
[28] 2019 Novel Coronavirus.Prevention and Treatment. Available online:
https://www.cdc.gov/coronavirus/2019-ncov/about/ prevention-treatment.html (accessed on 05 February 2020)
