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Clinical Case Reports, Research & Trials ISSN : 2581-6756
Panorama of Events amidst the Pandemic (COVID19)
  • *K.Divya ,

    K.Divya, Department of Pharmacology, Vishnu Institute of Pharmaceutical Education and Research, Narsapur, Medak, Telangana; Email: [email protected]

  • G.Vamshi ,

    Department of Pharmacology Institute of Pharmaceutical Education and Research, Narsapur, Medak, Telangana,

  • T.Vijay kumar ,

    Department of Pharmacology Institute of Pharmaceutical Education and Research, Narsapur, Medak, Telangana,

  • B.Kishore ,

    Department of Pharmacology Institute of Pharmaceutical Education and Research, Narsapur, Medak, Telangana,

  • Dr.K.Ramanjaneyulu ,

    Department of Pharmacology Institute of Pharmaceutical Education and Research, Narsapur, Medak, Telangana,

Received: 08-02-2021

Accepted: 20-04-2021

Published: 22-04-2021

Citation: *K.Divya, G.Vamshi, T.Vijay kumar, B.Kishore, Dr.K.Ramanjaneyulu (2021) Panorama of Events amidst the Pandemic (COVID19), Clin Cas Repo Rese & Trials 6:01-10

Copyrights: © 2021, K.Divya et al,

Abstract

The virus is thought to be natural and has an animal origin through spillover infection. There are a plenty of coronaviruses, most of which circulate among animals including pigs, camels, bats, and cats. Sometimes these viruses jump to humans—a spill over event—and can cause disease, as happened with Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and now COVID-19. The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province, China in December 2019. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some (usually the elderly), it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. Many people are asymptomatic.

Introduction

Corona virus disease (COVID-19) is a pandemic infectious disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) [1]. Corona virus was first identified in December, 2019, Wuhan, China [2]. Coronaviruses are found in avian and mammalian species. They resemble each other in chemical structure &morphology: for example, the coronaviruses of humans and cattle are antigenically related [3]. The first member of the coronavirus family was discovered in the early 1930’s [4]. As of October 2020, more than 7.49 million cases of COVID-19 have been reported. More than 3.7 million people have recovered [5].

Origin of COVID-19

On 31st December, 2019 many viral pneumonial cases were reported with unknown cause in Wuhan, Hubei Province, China [6-7].Most of the cases had a same exposure to the Huanan wholesale sea food Market, which is much popular in trading live animals.The respiratory samples of the affected patients were sent to reference labs for investigation. On 31st December, 2019 China reported the outbreak to the WHO (World Health Organization).The Huanan sea food market was closed on 1st January [8]. WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC)—7,818 cases confirmed globally; affecting 19 countries in five WHO regions on 30 January [9-10].The virus is thought to be Zoonotic origin [11]. Official publications from the WHO reported that the earliest onset of symptoms as 8 December 2019 [12]. On January 7th the cause was known and is identified as Corona Virus, which has more than 95% of the similarities with the Bat Corona Virus and more than 70% of the similarities with the SARS CoV [6-7]. The spread of Virus was almost by human-to-human transmission [13-14], the number of cases increased exponentially where the people who has no contact with Huanan Market tested positive through man to man transmission [15] .The first death case was reported on 11th Jan 2020. While in this period, cases in other countries gradually increased and were reported in people who returned from Wuhan. Gradually by 20th Jan, 2020, the health care workers were tested positive when they were treating the infected patients. The 11 million population of Wuhan was placed under lock down with no entry and exit from the city, very soon this lock down was extended to other cities of China by 23rd January, 2020. Airports in different countries along with India, has set up screening mechanism to detect Symptomatic people returning from China and put them under isolation for 14 days to test the virus [16].

Virology

Structure: Coronaviruses are large, roughly spherical, particles with bulbous surface projections [17]. Covid-19 size ranges from 80 to 120 nm and possess a 5' capped, single-strand positive sense RNA genome, with a length between 26.2 and 31.7 kb, the longest amongst all RNA viruses. The genome is composed of 6-10 open reading frames. Coronaviruses are classified in four different genera, alpha-, beta-, gamma-, and delta-CoV historically based on serological analysis and now on genetic studies [18-19].

The average diameter of the virus particle is around 125nm. The diameter of the envelope is 85nm and the spikes are 20nm long [20-21].The viral envelope is a lipid bilayer in which the Membrane(M), Spike(S) structural proteins , Envelope(E) are anchored [22].

 

In the lipid layer the ratio of E: M: S is 1:20:300 [23]. On an average a Corona virus particle has 74 spikes on the surface [24]. The surface spikes of corona virus are homotrimers of the S protein, which is composed of an S1 and S2 subunit.The homotrimeric S protein is a Class I fusion protein which involves in the Receptor Binding and Membrane Fusion between the Host cell and Virus. The S1 subunit forms the head of the spike and the S2 subunit forms the stem. The Envelope and the Membrane protein are important in forming viral envelope and also maintaining its Structure shape [25].

 

 

 

Figure 1: Structure of Corona Virus

According to an analysis of 103 cases, 2 strains of the new corona viruses are spreading around the world i.e., L strain and S strain. The team from the Peking University in Beijing reported 2 types of virus strains and found common mutations at two locations on the genome :72 were considered to be the “L-type” and 29 were classed “S-type”.

L-type is more prevalent and it is “more aggressive” than the S-type.

A separate analysis by the team suggests that the L-type was derived from the older S-type. The first strain is likely to have emerged around the time the virus jumped from animals to humans. The second emerged soon after that, says the team. Both are involved in the virus outbreak [26].

 

Mechanism of COVID-19: Coronaviruses like COVID-19 infect human cells as follows:

SARS-CoV-2 spike (S) glycoprotein binds to the cell membrane protein angiotensin-converting enzyme 2 (ACE2) to enter human cells.COVID-19 has been shown to bind to ACE2 via the S protein on its surface. The S protein is cleaved into subunits, S1 and S2 during infection .S1 contains the receptor binding domain (RBD) which allows coronaviruses to directly bind to the peptidase domain (PD) of ACE2. S2 then likely plays a role in membrane fusion.

 

Chinese researchers have now used cryogenic electron microscopy (cryo-EM) to study the structure of the ACE2 when it is bound to one of its typical ligands, the amino acid transporter B0AT1 and also how the COVID-19 RBD may bind to the ACE2-B0AT1 complex. These structures have previously not been identified and could aid in producing antivirals or a vaccine that can block coronavirus infection by targeting ACE2.ACE2 needs to dimerise to be active. The resultant homodimer has two PDs, able to bind to two COVID-19 S protein trimers simultaneously. A previous study found COVID-19 S proteins form trimers with two of the RBDs facing one direction (down) and the other facing the opposite way (up) [27].

Signs and Symptoms

The Incubation period of Covid-19 usually ranges from 1 to 14 days and is most commonly 5 days [28-29]. While some infected persons have no symptoms and are called Asymptomatic or Presystematic carriers [30]. Common symptoms of Covid-19 include Fever, Cough, Fatigue, Loss of appetite, shortness of breath, sputum production & muscle and joint pains [31-33].Other common symptoms include sneezing, runny nose, sore throat, diarrhoea [34].

 

Figure 2: Symptoms of Covid-19
Other Emergency symptoms include difficulty in breathing, persistent chest pain, sudden confusion, and bluish face or lips [35]. If the Corona virus persists for longer time it may develop complications like Pneumonia, Sepsis, Septic shock, acute respiratory distress syndrome and Kidney failure [36].

Viral Transmission & Spread

Covid-19 spreads between people more efficiently when they are in close contact with a distance of (two metres or six feet) mostly via small droplets produced while coughing, sneezing or talking [37-39]. Droplets exhaled from the infected person reach the lungs of non-infected person and settle there and cause the infection [40]. The droplets are relatively heavy and do not travel far through the air instead they fall to the surfaces.When the contaminated virus falls on the surface or floor the amount of active virus decreases with time [39-40].
If the people touch those contaminated areas and then touch their eyes, mouth, nose without washibng their hands then he is supposed to get infected [37]. Saliva and sputum carries major amounts of the virus [40]. Corona virus is not a sexually transmitted infection, it can transmit via intimate contact, kissing, faecal and oral routes [41-42]. 

 

Figure 3: Covid-19 transmission through droplets

 

Figure 4: Covid- 19 spread

 

Diagnosis Laboratory Testing
WHO has released several testing protocols to diagnose the Covid-19 [43]. Real-time reverse transcription polymerase chain reaction (rRT-PCR) is the standard method of testing Corona virus, which is done on Respiratory samples obtained by a nasopharyngeal swab and this test shows quick result within a few hours to two days [44-48]. A study reported that the hospitalised COVID 19 patients are asked to cough into a sterile container and then collecting a saliva sample and detected the virus in eleven of twelve patients using RT-PCR [40].

 

Figure 5: Demonstration of Nasopharyngeal swab
Imaging
Chest CT Scans are also helpful to diagnose the disease. Bilateral multilobular ground-glass opacities with a peripheral, asymmetric and posterior distribution are common in early infection [49]. Subpleural Subpleural dominance, crazy paving and consolidation may appear as the disease progress [50].
 

 

Figure 6: A CT scan of a person with COVID 19 shows light patches in the lungs

Pathophysiology
The organs which are mostly affected by the Covid-19 are the Lungs because the virus access the host cells via Angiotensin converting Enzyme 2which is abundant mostly in Type II alveolar cells of the Lungs [51]. SARS-CoV-2 may also cause respiratory failure through affecting the brainstem as other coronaviruses have been found to invade the central nervous system (CNS). [52]. Covid-19 can also cause acute myocardial injury and the cardiovascular system damage [53].A high incidence of Thrombosis and Thromboembolism is observed in ICU patients with corona infections [54].
The common cause of death in covid-19 affected patient’s complications related to Kidneys [55].
Autopsies of people who died of Corona infections have revealed lymphocyte-containing inflammatory infiltrates within the lung & diffuse alveolar damage (DAD) [56].

Prevention
Since there are no treatments for the disease, prevention is very Crucial [57]. The strategies for preventing transmission of the disease include Washing Hands, to keep the surface clean, Face masks, Maintain social distancing, Self isolation.

 

Figure 7: Safety Precautions
To prevent the disease, hand washing is recommended. The Centers for Disease Control and Prevention (CDC) recommends that people wash hands often with soap and water for at least 20 seconds, especially after going to toilet, before eating, after coughing, sneezing, blowing one’s nose etc., [58]. CDC also recommends using an Alcohol based Sanitizer with atleast 60% alcohol by volume [59].The WHO advised people to avoid touching their eyes, nose and mouth without washing properly [60-61].
Surface Cleaning
Surfaces must be decontaminated with a number of solutions, including Ethanol (62-71%), Isopropanol, sodium hypochlorite, hydrogen peroxide etc.,
Benzalkonium chloride and chlorhexidine gluconate are less effective [62].CDC recommends if a Covid-19 case is suspected at an Office or Home all areas should be disinfected properly to prevent virus transmission [63].

 

 

Figure 8: Face Masks
Face Masks
Face masks do not completely cure the virus but they act as Safety measure to prevent droplet transmission from one person to another person. Surgical masks are probably recommended for infected patients to minimize the travel distance of Droplets while talking,coughing,sneezing [64].

 

 

 

Figure 9: Social Distancing
Social distancing also called as Physical distancing is mainly employed to control viral infection and to slow the spread of virus by minimizing contact with the individuals.
Social distancing can be achieved by various methods like quarantine, journey restrictions, closing of schools, workplaces, theatres, stadiums, shopping centres etc, Individuals Can Also Employ Social Distancing Methods By Self Isolation I.E, Staying At Home, Avoid Travel And Crowded Areas [65-67].

 

Figure 10: Self Isolation
 

Self-Isolation 
Self-isolation is recommended for those who are diagnosed with Covid-19 and those who suspect that they are infected .Those who has been exposed to a Covid-19 patient and those who travelled to other countries are kept at isolation for atleast 14 days [68-70].
 

Treatment
Currently no medication is available to treat Corona virus disease and no cure is available till date. Antibiotics are not effective against viral infections. Researches are still going on to make a Vaccine which can eradicate Corona virus.
The U.S. Food and Drug Administration have granted permission to use other medicines to treat Corona virus as there are no options available. Two malarial drugs- Hydroxychloroquine and Chloroquine and an Antiviral drug- Remdesivir were approved to treat Corona virus. [71].

Conclusion

This new Corona virus pandemic outbreak has challenged the Medical, Economic, Educational and Public health infrastructure of various Countries. Time alone will tell how the virus will impact our lives here in India. More so, future outbreaks of viruses and pathogens of zoonotic origin are likely to continue. Therefore, apart from curbing this outbreak, efforts should be made to devise comprehensive measures to prevent future outbreaks of zoonotic origin.

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