Data from different publications up to 6th Feb 2020

1. 2019-nCov Dr Siddhartha Goutam
3rd yr PGT
Dept. of Pharmacology

2. Introduction :
• Family - Coronaviridae
• Genus - Betacoronavirus
• enveloped viruses
• positive-sense single-stranded RNA genome
• nucleocapsid of helical symmetry
• Zoonotic in origin

3. Corona virus

4. • There are seven strains of human coronaviruses:
• Human coronavirus 229E (HCoV-229E)
• Human coronavirus OC43 (HCoV-OC43)
• SARS-CoV
• Human coronavirus NL63 (HCoV-NL63, New
Haven coronavirus)
• Human coronavirus HKU1
• Middle East respiratory syndrome
coronavirus (MERS-CoV), previously known
as novel coronavirus 2012 and HCoV-EMC.
• Novel coronavirus (2019-nCoV),also known as
Wuhan pneumonia or Wuhan coronavirus

5. 2019-nCoV
• On 31 December 2019, WHO was informed of a
cluster of cases of pneumonia of unknown cause
detected in Wuhan City, Hubei Province of China
• On January 7, 2020, Chinese researchers shared
the full genetic sequence of 2019-nCoV
• On January 30, 2020, the World Health
Organization declared the coronavirus outbreak
a Global Public Health Emergency
• Currently 28 countries, with cases more than
28,280 and death around 565 (CFR – 2%)

6. Suspected Transmission
• Initially from – Bat (Betacorona virus)
• Person to person transmission
– Droplet - vertical transmission (?)
– Contact
• Transmission rate – 3 to 4 (from 1 case)
• Estimated Incubation period – 2 to 14 days
• “The researchers estimate that in the early stages
of the Wuhan outbreak (from December 1, 2019
to January 25, 2020) each person infected with
2019-nCoV could have infected up to 2-3 other
individuals on average, and that the epidemic
doubled in size every 6.4 days. During this
period, up to 75,815 individuals could have been
infected in Wuhan”. ( The Lancet ; Jan 31,2020)

7. Signs & Symptoms
Fever Sore throat
Cough Rhinorrhoea
Shortness of breath Chest pain
Muscle ache Diarrhoea
Confusion Nausea & Vomiting
Headache

8. Diagnosis
• Nasopharyngeal and oropharyngeal swab or
Broncho alveolar lavage
• Real time RT-PCR (in Pune)
• Other non-specific
– ↓ Lymphocytes
– ↑AST, ALT, LDH
– ↓ O2 saturation
• Chest X-ray
– feature of Atypical pneumonia

9. Treatment
• Supportive treatment
• O2 inhalation
• Bronchodilator
• Anti-viral drugs
• Antibiotics
• Ventilator care (if necessary)

10. Case 1 : First Case of 2019 Novel
Coronavirus in the United States
• On January 19, 2020, a 35-year-old man
presented to an urgent care clinic in Snohomish
County, Washington, with a 4-day history of
cough and subjective fever
• He had returned to Washington State on January
15 after traveling to visit family in Wuhan, China
• On January 20, 2020, the CDC confirmed that the
patient’s nasopharyngeal and oropharyngeal
swabs tested positive for 2019-nCoV by real-time
reverse-transcriptase–polymerase-chain-reaction
(rRT-PCR) assay

11. • Treatment during this time was largely
supportive.
• 650 mg of acetaminophen every 4 hours and
600 mg of ibuprofen every 6 hours.
• 600 mg of guaifenesin for his continued cough
• 6 liters of normal saline over the first 6 days of
hospitalization.
• Day 6 – features of Atypical pneumonia seen
on chest X-ray
• Oxygen
• Inj Vancomycin and Inj Cefipime
• Intravenous remdesivir (a novel
nucleotide analogue prodrug in
development) on Day 7

12. • On hospital day 8, the patient’s clinical
condition improved. Supplemental oxygen was
discontinued, and his oxygen saturation values
improved to 94 to 96% while he was breathing
ambient air.
• The previous bilateral lower-lobe rales were
no longer present.
• His appetite improved, and he was
asymptomatic aside from intermittent dry
cough and rhinorrhea.
• But he remained under observation

13. Some other treatment methods
• In late January 2020, Chinese medical
researchers expressed an intent to start
clinical testing on remdesivir, chloroquine, and
lopinavir/ritonavir, all of which seemed to
have "fairly good inhibitory effects" on 2019-
nCoV at the cellular level in exploratory
research.
• On 2 February 2020, doctors in Thailand
claimed to have treated a patient successfully
with a combination of lopinavir/ritonavir and
the influenza drug oseltamivir

14. Vaccine
• Sadly no vaccine till date
• In China, the Chinese Center for Disease Control and
Prevention is developing a vaccine against the novel
coronavirus.
• The United States National Institutes of Health (NIH) is
cooperating with Moderna to create an RNA vaccine
matching a spike of the coronavirus surface, and is
hoping to start production by May 2020
• Australia, the University of Queensland is investigating
the potential of a molecular clamp vaccine that would
genetically modify viral proteins to make them mimic
the coronavirus and stimulate an immune reaction
• The Imperial College Faculty of Medicine in London has
funding to develop a vaccine and take it to animal
testing, a phase of research it expects to complete by
mid-February 2020

15. MYTHS

16. Conspiracy Theories

18. • Close contact is defined as:
a) being within approximately 6 feet (2 meters),
or within the room or care area, of a 2019-nCoV
case for a prolonged period of time while not
wearing recommended personal protective
equipment or PPE (e.g., gowns, gloves, NIOSH-
certified disposable N95 respirator, eye
protection); close contact can include caring for,
living with, visiting, or sharing a health care
waiting area or room with a 2019-nCoV case
– or –
b) having direct contact with infectious secretions
of a 2019-nCoV case (e.g., being coughed on)
while not wearing recommended personal
protective equipment.

19. Concluding Facts:
• I – ingestion of properly cooked meat
• M – mask (proper type, proper way)
• S – Sanitation (hand wash and other)
• O – outlook for any cases (contact/travel hist)
• R – reach for help (contact proper authority)
• R – reassured (low death rate)
• Y – yet to develop specific medicine or vaccine

20. REFERENCES:
• WHO
• The Lancet
• NEJM
• JAMA
• ELSEVIER
• NATURE
• CDC.gov