Review of COVID-19: Epidemiology, Threat and Treatment

A REVIEW ON CORONA VIRUS (COVID-19)
Submitted to : MR. NAVEEN GARGPresented by: Gaurav Jain
Rajasthan Pharmacy College 1
B.Pharmacy Final Year
Enrollment No.- 2016/2158
Batch- 2016-2020
(Assistant professor of Pharmacology)

RAJASTHAN PHARMACY COLLEGE 2
Content
 Objective
 Introduction
 Epidemiological observations
 Threat of COVID-19
 Data Analytics
 Drugs and their Mechanism of Action
 Diagnostic Tests
 Research and development

 WHO Guidelines
 Do’s and Don’t do
 Conclusion
 Reference

OBJECTIVE
The major objectives of the study were as follows:
1. To enhance understanding of the evolving COVID-19 and the nature and impact of ongoing containment
measures;
2. To share knowledge on COVID-19 response and preparedness measures being implemented in countries
affected by or at risk of importations of COVID-19;
3. To generate recommendations for adjusting COVID-19 containment and response measures in China and
internationally; and
4. To establish priorities for a collaborative programmed of work, research and development to address critical
gaps in knowledge and response and readiness tools and activities.

INTRODUCTION
Coronaviruses are found in avian and mammalian species. They resemble each other in morphology and
chemical structure. Coronaviruses are capable of adapting to new environments through mutation and
recombination with relative ease and hence are programmed to alter host range and tissue tropism
efficiently. Therefore, health threats from coronaviruses are constant and long-term. Understanding the
virology of coronaviruses and controlling their spread have important implications for global health and
economic stability.
For example, the coronaviruses of humans and cattle are antigenically related. There is no evidence,
however, that human coronaviruses can be transmitted by animals. In animals, various coronaviruses
invade many different tissues and cause a variety of diseases, but in humans they are only proved to cause
mild upper respiratory infections, i.e. common colds.
On rare occasions, gastrointestinal coronavirus infection has been associated with outbreaks of diarrhoea
in children.

Taxonomy
Synonym: Corona virinae, SARS COV-2 and COVID-19 Realm: Riboviria
Family: Coronaviridae Subfamily: Orthocoronavirinae
Phylum: Incertaesedis Genus: Betacoronavirus
Order: Nidovirales Subgenus: Sarbecovirus
Suborder: Cornidovirineae
Species: Severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS)
related coronavirus.
Genera: Alphacoronavirus, Betacoronavirus, Gammacoronavirus, Deltacoronavirus
Individuum: SARS-CoVUrbani, SARS-CoVGZ-02, ARS-CoVPC4- 227, SARSr-CoVBtKY7/2,
SARS-CoV-2,
Wuhan-Hu-1, SARSr-CoVRatG13.

Representative Alphacoronavirus include:
 NL63 (hcov-nl63)
 Porcine transmissible gastroenteritis coronavirus (TGEV),
 PEDV, and
 Porcine respiratory coronavirus (PRCV).
Representative betacoronavirus include:
 SARS-CoV, .
 MERS-CoV,
 Bat coronavirus HKU4, mouse hepatitis coronavirus (MHV), bovine coronavirus (bcov), and
 Human coronavirus OC43.
Representative gamma-and deltacoronaviruses include
 Avian infectious bronchitis coronavirus (IBV) and
 Porcine deltacoronavirus (PdCV), respectively

Structure of COVID-19
They have the largest genome among all RNA viruses, typically ranging from 27 to 32 kb.
The genome is packed inside a helical capsid formed by the nucleocapsid protein (N) and further surrounded by an
envelope.
Associated with the viral envelope are at least three structural proteins: MES
The membrane protein (M)
The envelope protein (E) , involved in virus assembly, attachment to the host cell and studded with projecting
glycoproteins and surrounds a core consisting of matrix protein enclosed within which is a single strand of positive-sense
RNA associated with nucleoprotein. Also carry the main antigenic epitopes, particularly the epitopes recognized by
neutralizing antibodies. OC43 also possesses a hemagglutinin.
The spike protein (S) mediates virus entry into host cells.

Some coronaviruses also encode an envelope-associated hemagglutinin-esterase protein (HE).
Among these structural proteins, the spike forms large protrusions from the virus surface, giving coronaviruses the
appearance of having crowns (hence their name; corona in Latin means crown). In addition to mediating virus entry,
the spike is a critical determinant of viral host range and tissue tropism and a major inducer of host immune
responses.

Replication of SARS COV-2

Drugs and their Mechanism of Action

Coronavirus Incubation Period:
 2 - 14 days (officially by WHO)
 Possible outliers: 0 - 27 days (may vary greatly)

Transmission or Journey of SARS COV-2

Routes of transmission
COVID-19 is transmitted via droplets and fomites during close unprotected contact between an infector and infectee.
Airborne spread has not been reported for COVID-19 and it is not believed to be a major driver of transmission based on
available evidence; however, it can be envisaged if certain aerosol- generating procedures are conducted in health care
facilities.

Epidemiological observations.

Household transmission
In China, human-to-human transmission of the COVID-19 virus is largely occurring in families. The Joint Mission
received detailed information from the investigation of clusters and some household transmission studies, which are
ongoing in a number of Provinces.
Among 344 clusters involving 1308 cases (out of a total 1836 cases reported) in Guangdong Province and Sichuan
Province, most clusters (78%-85%) have occurred in families.
Household transmission studies are currently underway, but preliminary studies ongoing in Guangdong estimate the
secondary attack rate in households ranges from 3-10%.
Contact Tracing
China has a policy of meticulous case and contact identification for COVID-19. For example, in Wuhan more than 1800
teams of epidemiologists, with a minimum of 5 people/team, are tracing tens of thousands of contacts a day. Contact follow
up is painstaking, with a high percentage of identified close contacts completing medical observation. Between 1% and 5%
of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location. For example:
 As of 17 February, in Shenzhen City, among 2842 identified close contacts, 2842 (100%) were traced and 2240 (72%)
have completed medical observation. Among the close contacts, 88 (2.8%) were found to be infected with COVID-19.

Demographic characteristics
Among 55,924 laboratory confirmed cases reported as of 20 February 2020, the median age is 51 years (range 2 days-100
years old; IQR 39-63 years old) with the majority of cases (77.8%) aged between 30– 69 years. Among reported cases,
51.1% are male, 77.0% are from Hubei and 21.6% are farmers or laborers by occupation.
Zoonotic origins
COVID-19 is a zoonotic virus. From phylogenetics analyses undertaken with available full genome sequences, bats appear
to be the reservoir of COVID-19 virus, but the intermediate host(s) has not yet been identified. However, three important
areas of work are already underway in China to inform our understanding of the zoonotic origin of this outbreak.
These include early investigations of cases with symptom onset in Wuhan throughout December 2019, environmental
sampling from the Huanan Wholesale Seafood Market and other area markets, and the collection of detailed records on the
source and type of wildlife species sold at the Huanan market and the destination of those animals after the market was
closed.

Threat of COVID-19

How dangerous is the virus?
There are three parameters to understand in order to assess the magnitude of the risk posed by this novel
coronavirus:
 Transmission Rate (Ro) - number of newly infected people from a single case.
For comparison, the Ro for the common flu is 1.3 and for SARS it was 2.0.
 Case Fatality Rate (CFR) - percent of cases that result in death.
CFR = deaths at day.x / cases at day.x-{T}
(where T = average time period from case confirmation to death)
 Determine whether asymptomatic transmission is possible.

Fatality rate can change as a virus can mutate, according to epidemiologists. For comparison, the case fatality
rate for SARS was 10%, and for MERS 34%

AGE DEATH RATE
confirmed cases
DEATH RATE
all cases
80+ years old 21.9% 14.8%
70-79 years old
60-69 years old 8.0%
40-49 years old
1.30.4%
30-39 years old
10-19 years old
0.2%
0-9 years old
no fatalities 0.2%

Comparison with other viruses
For comparison, the case fatality rate with seasonal flu in the United States is less than 0.1% (1 death per every
1,000 cases).
Mortality rate for SARS was 10%, and for MERS 34%.
Virus Death Rate
Wuhan Novel Coronavirus (2019-nCoV) 2%*
SARS 9.6%
MERS 34%
Swine Flu 0.02%

Data Analytics
Symptoms observed in hospitalized patients with COVID-19
These findings refer to hospitalized patients, therefore generally representing serious or critical cases.
The majority of cases of COVID-19 (about 80%) is mild. Findings from the Wang et al study published on JAMA
and based on 138 hospitalized patients
Common Symptoms Include :
(Wuhan’s Study)
Fever 98.6%
Fatigue 69.6%
Dry cough 59.4%

Full list of symptoms from the Wang study:

Findings from the Chen et al study published on The Lancet
and based on 99 hospitalized patients
Signs and symptoms at admission (Chen et al study)
Fever 83%
Cough 82%
Shortness of breath 31%
Muscle ache 11%
Confusion 9%
Headache 8%
Sore throat 5%
Rhinorrhoea (runny nose) 4%
Chest pain 2%
Diarrhea 2%
Nausea and vomiting 1%
More than one sign or symptom 90%
Fever, cough, and shortness of breath 15%

Findings from the Huang et al study published on The Lancet and based on 41 hospitalized patients
98%
76%
44%
28%
8%
5% 3%
0%
20%
40%
60%
80%
100%
120%
Fever Cough Myalgia (muscle
pain)
or Fatigue
Sputum production
(coughing up
material)
Headache Haemoptysis
(coughing up blood)
Diarrhea
Series 1

DIAGNOSTIC TESTS

RESEARCH AND DEVELOPMENT

 Additional effort should be made to find the animal source, including the natural reservoir and any intermediate
amplification host, to prevent any new epidemic foci or resurgence of similar epidemics.
 Efforts should be made to consistently evaluate existing and future diagnostic tests for detection of COVID-19 using a
harmonized set of standards for laboratory tests and a biorepository that can be used for evaluating these tests
 Consider the establishment of a centralized research program in China to oversee that portfolio and ensure the most
promising research (vaccines, treatments, pathogenesis) are adequately supported and studied first; program staff dedicated
to the clinical research would work at the clinical research site(s) to decrease the research workload of the clinicians at the
site.
 Consider including one or more sites within China in the ongoing and future multi- center, international trials; Chinese
investigators should be actively engaged in international trials
 Continue to develop additional animal models, making every effort to ensure these mimic human infection and virus
transmission as closely as possible
 Conduct studies to determine which of the commonly used forms of PPE are most effective in controlling the spread of
COVID-19.

WHO GUIDLINESS
Recommendations

For uninfected countries
1. Prepare to immediately activate the highest level of emergency response mechanisms to trigger the all-of- government and
all-of society approach that is essential for early containment of a COVID-19 outbreak;
2. Rapidly test national preparedness plans in light of new knowledge on the effectiveness of non- pharmaceutical measures
against COVID-19; incorporate rapid detection, largescale case isolation and respiratory support capacities, and rigorous
contact tracing and management in national COVID-19 readiness and response plans and capacities;
3. Immediately enhance surveillance for COVID-19 as rapid detection is crucial to containing spread; consider testing all
patients with atypical pneumonia for the COVID-19 virus, and adding testing for the virus to existing influenza
surveillance systems;
4. Begin now to enforce rigorous application of infection prevention and control measures in all healthcare facilities,
especially in emergency departments and outpatient clinics, as this is where COVID-19 will enter the health system;and
5. Rapidly assess the general population’s understanding of COVID-19, adjust national health promotion materials and
activities accordingly, and engage clinical champions to communicate with the media.

For the public
1. Recognize that COVID-19 is a new and concerning disease, but that outbreaks can managed with the right response and
that the vast majority of infected people will recover;
2. Begin now to adopt and rigorously practice the most important preventive measures for COVID-19 by frequent hand
washing and always covering your mouth and nose when sneezing or coughing;
3. Continually update yourself on COVID-19 and its signs and symptoms (i.e. fever and dry cough), because the strategies
and response activities will constantly improve as new information on this disease is accumulating every day; and
4. Be prepared to actively support a response to COVID-19 in a variety of ways,
including the adoption of more stringent ‘social distancing’practices and helping the high-risk elderly population.

Coronavirus Dos and Don’ts
To help curb the coronavirus pandemic, here is a list of do’s and don’ts that we must all observe –
Do’s
1. Do wash your hands with soap and water or alcoholic hand sanitizer frequently, especially if you are using public
facilities like transportation and washrooms.
2. Do avoid contact with anyone who looks sick.
3. Do use a disposable napkin or a handkerchief to cover your face when you cough or sneeze..
4. Coronavirus is wreaking havoc globally. But you can stop it in its tracks if you follow the precautions strictly. So,
observe personal hygiene and request your loved ones to do the same to stay safe and protected.

Don’ts
1. Don’t be part of a large gathering. If you are within just a few feet of an infected person, you could contract the virus.
2. Don’t touch your face, nose, mouth or eyes with unwashed hands.
3. Don’t hide your symptoms for fear of being quarantined.
4. Don’t travel abroad especially to countries that are reeling under the coronavirus outbreak.

Protect yourself from getting sick:
(1)wash your hands often with soap and water for at least 20 seconds
(2)avoid touching your eyes, nose, or mouth with unwashed hands
(3)avoid close contact with people who are sick.
Protect others when you are sick: (1) stay home while you are sick
(2)avoid close contact with others
(3)cover your mouth and nose when coughing or sneezing
(4)clean and disinfect objects and surfaces.

There is no vaccine to protect you against human coronaviruses and there are no specific treatments for illnesses
caused by human coronaviruses. Most people with common human coronavirus illness will recover on their own.
However, to relieve your symptoms you can:
(1)take pain and fever medications (Caution: do not give aspirin to children)
(2)use a room humidifier or take a hot shower to help ease
(3)a sore throat and cough
(4)drink plenty of liquids
(5)stay home and rest. If you are concerned about your symptoms, contact your healthcare provider.
SELF QUARANTINE

CONCLUSION
Common human coronaviruses, including types 229E, NL63, OC43 and HKU1, usually cause mild to moderate upper-
respiratory tract illnesses, like the common cold. Most people get infected with one or more of these viruses at some
point in their lives.
Symptoms of common human coronaviruses: (1) runny nose (2) sore throat (3) headache (4) fever (5) cough (6)
general feeling of being unwell. Human coronaviruses can sometimes cause lower- respiratory tract illnesses, such as
pneumonia or bronchitis. This is more common in people with cardiopulmonary disease, people with weakened
immune systems, infants, and older adults.
Common human coronaviruses usually spread from an infected person to others through:
(1)the air by coughing and sneezing .
(2)close personal contact, like touching or shaking hands.
(3)touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your
hands.

REFERENCE
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Myint, “Medical Microbiology”, 4th edition, Chapter 60; Coronaviruses.
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communication and management". Social Science & Medicine, 2006; 63(12): 3113–23.
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Alan; Yu, Wai-Cho; Lee, Nelson; Hui, David S. C; Lai, Sik-To; Hon, Ellis K. L; Li, Chi-Kong; Sung, Joseph J. Y; Tam,
John S. Emerging Infectious Diseases, 2004; 10(5):
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5. Perlman, Stanley; Dandekar, Ajai A. "Immunopathogenesis of coronavirus infections: Implications for SARS". Nature
Reviews Immunology, 2005; 5(12): 917–27.
6. Jiang, Shibo; Lu, Lu; Du, Lanying. "Development of SARS vaccines and therapeutics is still needed". Future Virology,
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Callaway, Justin; Cavitt, Sheana; Kamrud, Kurt; Alterson, Harold; Smith, Jonathan; Harcourt, Jennifer L; Miao,
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"Therapy with a Severe Acute Respiratory Syndrome–Associated Coronavirus–Neutralizing Human Monoclonal
Antibody.

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