A presentation on the vaccines involved and the treatment strategies of COVID-19

1. Preventive vaccines and treatment strategies of COVID-19
A literature review submitted in partial fulfillment of Eighth semester of
BACHELOR OF PHARMACY
By
Shivani Baskey
(BPH/10052/2017)
Under the guidance of
Dr. Abhimanyu Dev
Assistant Professor
Department of Pharmaceutical Sciences and Technology
Birla Institute of Technology, Mesra
Ranchi- 835215 (Jharkhand)

2. CONTENTS
S.No. Topics
1. Introduction
2. Literature Review
3. Summary and Conclusion
4. Reference

3. INTRODUCTION

4. • On December 2019, the World Health Organization declared COVID-19 (corona virus disease 2019) as an
emergency of International concern.
• The first case of coronavirus pandemic 2019 was seen in Wuhan city of Hubei Territory China within the
month of December 2019.
• This virus is transmitted through contact with metabolism droplets instead of air. Common indications
incorporate fever, coughing, sniffling, and shortness of breath.
• The chemical structure of corona virus RNA comprises of 5’methylated head and 3’ polyadenylated tail,
through which RNA joins to the free ribosome of the host cell.
• The standard instruments to analyze is reverse transcriptase polymerase chain reaction (rRT-PCR) from a
throat swab or nasopharyngeal swab.
• Treatment of COVID-19 incorporates common treatment, oxygen therapy, symptomatic treatment and
treatment utilizing anti-viral drugs
• Immunomodulating herbs like Giloy, Indian goose berry, black cumin, turmeric, may be used to boost the
immune response of the body.

5. LITERATURE REVIEW

6. ORIGIN AND TRANSMISSION OF COVID-19
• Coronavirus disease is caused by severe acute respiratory syndrome (SARS).
• SARS was first identified on 16th April, 2003 in Asia and few other parts of the world.
• SARS-CoV-2 the causative agent of COVID-19 is similar to SARS-CoV-1.
• The genomic examination proves that SARS-CoV-2 is pathologically related to SARS bat like, hence bats
could be the primary reservoir.
• The intermediate source of transfer to humans is yet unknown but rapid human to human transfer is broadly
seen. It is for this reason that the WHO recommends to maintain a distance of one meter from each other.
• A single cough can release several thousand droplets which when comes in contact with other individuals or
encompassing surface causes the spread of infection.
• The infection may spread through the fecal matter of individuals hence proper washing of hands after visiting
the toilet is very important.

7. Fig: Transmission of COVID-19 to human host
Reproduced from: https://ejmo.org/10.14744/ejmo.2020.90853/pdf/
(Last accessed on 9.05.2021)

8. STRUCTURE OF CORONAVIRUS
• Coronavirus is a spherical enveloped virus consisting of
single strand of positive sense RNA (similar to host
mRNA) of approximately 26-32 Kb.
• It consists of club shaped projections from the viral
envelope resembling a crown & are made of a highly
glycosylated protein named spike protein.
• Three other structural proteins are envelope, membrane
and nucleocapsid proteins.
• The first 2/3rd of the genome consists of 2 large
overlapping open reading frames that encodes 16 non
structural proteins, including protease, RNA- dependent
RNA polymerase (prRdRp), RNA helicase, primase &
others that form the viral replicase complex, a platform to
propagate viral mRNA. These non structural proteins are
all potential target for therapies. Fig: Structure of coronavirus
Reproduced from:
https://www.ccjm.org/content/87/6/321
(Last accessed on 9.05.2021)

9. REPLICATION OF CORONAVIRUS
Fig: Overview of COVID-19, SARS-CoV-2 replication & therapeutic target
Reproduced from: https://www.ccjm.org/content/87/6/321 (Last accessed on
9.05.2021)

10. TREATMENT STRATEGY OF COVID-19
S.No. Blockade of entry Blockade of replication Booster of innate
immunity
Enhancer of anti viral
innate immunity
1. Anti spike antibody
• Convulsant serum
• Vaccine against spike
Interference with RdRP
(replicase)
• Remdesivir
IFN-1,IFN-2 and MDA 5 Early treatment with IFN
or IFN inducer. Blockade
of IFN antagonist.
2. Inhibitor of S1 and S2
cleavage
• Anti-TMPRSS-2
agents like Camostat
Mesylate
Viral protease inhibitors
• Ribavirin
3. Endocytosis inhibitor
• Chloroquine
• Hydroxychloroquine

11. PREVENTIVE VACCINES FOR COVID-19
Covishield
Manufactured by Serum Institute of India
Composition:-
• L-Histidine
• L-Histidine hydrochloride monohydrate
• Magnesium chloride hexahydrate
• Polysorbate 80
• Ethanol
• Sucrose
• Sodium chloride
• Disodium edetate (EDTA)
• Water for injection
Covaxin
Manufactured by Bharat BioTech in collaboration
with Indian Council of Medical Research (ICMR)-
National Institute of Virology (NIV)
• Inactivated coronavirus
• Aluminum hydroxide gel
• TLR7/8 agonist
• 2-Phenoxyethanol
• Phosphate buffer saline

12. • Oxygen therapy: COVID-19 virus targets lungs therefore chances of hypoxia increase. Nasal catheters, mask
oxygen should be provided. Noninvasive or intrusive mechanical ventilation should be given to the patients.
• Symptomatic treatment: Antipyretic drug treatment should be given to patients with temperature
exceeding 38.5 °C. Warm water bath and antipyretic patches are preferred to lower the temperature. Drugs
like Ibuprofen (orally) 5-10mg/kg each time, acetaminophen (orally) 10-15 mg/kg each time can be
administered. In case of children suffering from convulsions or seizure anti sedatives needs to be
administered.
• General treatment: Patients confirmed with COVID-19 must be given satisfactory calories and water to
decrease the chances of dehydration .Water electrolyte balance and homeostasis needs to be kept up in
conjunction with checking crucial signs and oxygen immersion. Keeping the respiratory tract clear and supply
oxygen in extreme cases, measuring blood count, urine tests, blood biochemical record counting liver and
kidney capacities should be checked at regular interval. Myocardial enzyme range, chest imaging and blood
gas examination should be performed.

13. SYMPTOMS OF COVID-19
Most common indications of COVID-
19
Other less common
indications that may affect
some patients
Symptoms of severe COVID-
19 disease
Other less common
symptoms
Fever Loss of taste and smell Shortness of breath Irritability
Dry Cough Nasal congestion Loss of appetite Confusion
Fatigue Conjunctivitis (also known as
red eye)
Confusion Reduced consciousness
(occasionally related to
seizures)
Sore throat Persistent pain in the chest Anxiety
Head ache High temperature( above 38℃) Depression
Muscle or joint pain Sleep disorders
Different kind of skin rashes Excessive and uncommon
neurological headaches along
with strokes, mild
inflammations, delirium and
nerve damage
Nausea, vomiting and diarrhea
Chills and dizziness

14. DIAGNOSIS OF COVID-19
I. Collection of specimen
a. Upper respiratory specimen
b. Lower respiratory specimen
c. Simplified optimized specimen collection
d. Fecal specimen
e. Post mortem specimen
f. Serum specimen
II. Nucleic acid amplification testing (NAAT)
a. Reverse transcriptase polymerase chain reaction (rRT-PCR)
b. Transcription mediated amplification (TMA)
c. Loop mediated amplification tests

15. RT-PCR
RT-PCR is a diagnostic technique suggested by the United States Centre for Disease Control and Prevention (CDC) to detect
the specific portion of SARS-CoV-2 genome. It identifies and opens up region of nucleoside coding genomes, S1 and S2. The
test is considered to be positive when both the sections are identified. The test is considered to be uncertain when only one
strand is detected. And the test is negative when both the portions are not detected.3
Rapid diagnostic testing based on antigen detection
It detects the viral portion (antigen) in SARS-CoV-2. It is a lateral flow immune assay (LFI) that is finished within half an
hour. The sensitivity of antigen detection is less as compared to RT-PCR. Antigen rapid diagnostic testing includes a plastic
cassette with samples and buffer wells, a nitrocellulose matrix strip with a test line along with antibody particularly for
conjugated target antigen-antibody complexes and a control line particularly for conjugate anti-body. In case of SARS-CoV-2
virus nucleocapsid proteins is taken in the target analyte because of its abundance. The respiratory specimen is collected and
applied to the test strip and within 10 minutes to half an hour the outcome are studied by the staff. Ag-RDTs gives best results
in patients with excessive viral load i.e. Ct value or genomic virus copies per ml.

16. IMMUNOMODULATING HERBS
Name Botanical name Active constituents Cytokines Uses
Giloy (Gilu) Tinospora cordifolia Polysaccharides,
phenols, diterpenoids,
steroids and
sesquiterpenes.
1,4- alpha D- glucan
actuates macrophages,
NFkB translocation
and cytokines
generation helps in
boosting the immune
system.
Used in case of fever,
blood purification,
immune boosting,
analgesic, and anti-
inflammatory benefits.
Saffron (Zaffran) Crocus sativus Safranol, crocin and
picrocrocin. It consists
of nearly 150 volatile
components. Saffron
has 63% sugar, 12%
proteins, 5% fats , 5%
minerals, 10% water
and few fibers.
Anti-aging, anti
inflammatory, anti
oxidant, anti microbial,
antiviral and free
radical scavenging
property. It is a
immune booster and
acts on both humoral
and cellular immunity

17. Name Botanical name Active constituents Cytokines Uses
Turmeric (Chobzard) Curcuma longa Curcumin, dihydro
curcumin and hexa-
hydrocurcumin, cineol,
phellandrene, borneol,
zingiberene and
distinctive
sesquiterpenes have
been found in turmeric.
IFN-α, TNF-α, IL-
2,6,8,12,13,15 and a
few chemokines
According to the
Unani system of
medicine it is utilized
as pain releasing, anti-
pyretic and blood
purifier. Curcumin also
acts well in acute
respiratory distress
syndrome, COPD’S,
intense lung problems
and pulmonary
fibrosis.
Neem Azadirachta indica Nimbin, nimbidin,
nimbolide, limonoids,
sitosterol, and
quercetin.
Inflammation occurs
due to the activation of
cyclooxygenase
pathway and inhibits
the cyclooxygenase 1
and 2 (COX 1, COX 2)
there by reducing
inflammation. It also
interferes with IL-1,
COX-2 stimulation and
anti- pyretic effects.
Scientific studies have
proven its anti-
oxidant, anti-
inflammatory, immune
modulatory, anti -
bacteria, anti- fungal,
anti- pyretic and anti-
cancer like activities.

18. Name Botanical name Active constituents Cytokines Uses
Cinnamon (Dalchini) Cinnamomum zeylanicum Cinnamic acids,
cinnamaldehyde,
cinnamate and different
fundamental oils like
eugenol, trans
cinnamaldehyde, cinnamyl
acetate, caryophyllene
oxide, L- borneol, E-
nerilidol, B-
caryophyllene, - thugene, -
cubebene, - terpinol and
terpinolene.
Administration of
cinnamon bark decreases
the systemic level of IFN-
alpha but not of IL-4 or
IL-2. In vitro cinnamon
bark inhibits anti-CDK-3 ,
stimulates IFN-alpha and
IL-4 at the mRNA and
secreted protein level
It is used in treating
respiratory ailments like
cough and asthma besides
having antiseptic,
cardiotonic, aphrodisiac
and phlegmagogue
actions.
Ginger
(Adrak)
Zingiber officinalis gingerol, zingiberene,
shogaol, gingerdione,
hexa- hydro curcumin,
paradol and gingerenone A
Ginger administration
altogether diminish C-
reactive proteins (CRP),
TNF- alpha, serum level
but not IL-6.
The rhizomes have been
utilized for centuries
within the treatment of
anorexia, tooting, high
blood pressure, joint pain,
and common cold.

19. PREVENTION AND PRECAUTION OF COVID-19
Measures to protect one own self
• Regular washing of hands with soap and water for at least
20 seconds and use hand sanitizers with not less than 60%
alcohol after visiting public places or after sneezing or
coughing.
• Avoid touching nose, eyes or mouth with unwashed
hands.
• Maintenance of social distancing , a distance of 1 meter or
about 3 feet between one another.
• Wearing of masks as the cough or sneeze of a person can
release small droplets of the virus and the other person
may breathe them.
• Mass gathering and large public events should be avoided.
Measures to protect others
• Coughing, sneezing, fever or difficulty in breathing should be
immediately reported to the consulting doctor.
• It is advisable to stay at home when feeling unwell.
• Covering mouth while sneezing and coughing is a must.
• Disposal of tissue papers in trash and regular washing of
hands with antiseptic soaps and water after sneezing or
coughing.
• Face masks are a must around other people.
• Sharing bedding, dishes, glasses and other household should
be avoided. If possible separate bathrooms and toiles should
be used.
• Apply disinfectants every day on things that are touched often
like dishes, phones, tables, doorknobs, lights, switches etc.

20. SUMMARY AND
CONCLUSION

21. The outbreak of coronavirus disease was a highly uncertain and unpredicted one. The total health, social and economic impact
can only be assessed when the pandemic ends. Any country suffering with COVID-19, is unprepared and in case of low
financial income countries lack of resources for affording an infectious agent emergency are often seen. In case of high
financial income countries may face a catastrophic perspective. Through this review we conclude that COVID-19 can affect
without discrimination though people with comorbidities like diabetes, hypertension, cardiovascular disorder and respiratory
disorders are more likely to get affected. Taking proper precautions like regular washing of hands, using hand sanitizer,
wearing masks and avoiding social gathering are very important. A person must immediately get tested on showing common
symptoms like fever, dry cough, and fatigue. The episode of COVID-19 widespread was highly unpredictable hence proper
study and research are under process. There are companies that have come forward with several vaccines. No specific vaccine
or treatment is the only proof to cure COVID-19 till date yet oxygen therapies and drugs like lopinavir/ritonavir, Ribavirin,
chloroquine etc. are being used. At this junction when physique and immune system of a person is being tested by the virus, it
is very important to have strong immunity to fight against COVID-19. There are several herbs present in nature that can be
used to boost our immunity. These herbs have got additional properties like anti-inflammations, anti-oxidant, anti-microbial
and anti-viral so they can be used as a primary or adjuvant therapy for prevention and cure of COVD-19 infection.

22. REFERENCE

23. • Ahmad, S. (2020). A Review of COVID-19 (Coronavirus Disease-2019) Diagnosis, Treatments and
Prevention. Eurasian Journal of Medicine and Oncology, 4(2), 116–125.
• Bergmann, C. C., & Silverman, R. H. (2020). COVID-19: Coronavirus replication, pathogenesis, and
therapeutic strategies. Cleveland Clinic Journal of Medicine, 87(5), 1–7.
• Bhat, S. A., Rather, S. A., Iqbal, A., Qureshi, H. A., & Islam, N. (2020). Immunomodulators for Curtailing
COVID-19: a Positive Approach. Journal of Drug Delivery and Therapeutics, 10(3-s), 286–294
• Centres for Disease Control and Prevention. (2021). Nucleic Acid Amplification Tests (NAATs) | CDC.
• World Health Organization W.H.O, Advice for the public. Retrieved from
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public.
• Evans, R. W. (2001). Diagnostic testing for headache. Medical Clinics of North America, 85(4), 865–885.
• Centres for Disease Control and Prevention. (2021). Nucleic Acid Amplification Tests (NAATs) | CDC.
Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/lab/naats.html
• Vinh DB, Zhao X, Kiong KL, et al. Overview of COVID-19 testing and implications for otolaryngologists.
Head & Neck. 2020; 42:1629-1633

24. THANK YOU