Features, Evaluation and Treatment Coronavirus (COVID-19)

Features, Evaluation
and Treatment
Coronavirus
(COVID-19)
Mankind has observed various pandemics throughout the history where some of were more
disastrous than the others to the humans. We are observing a very tough time once again fighting an
invisible enemy; the novel COVID-19 coronavirus. There are many speculations of the whole world
regarding this pandemic that globally challenge the humanity.
How did coronavirus start and where did it come from? Was it really Wuhan’s animal market? In the
public mind, the origin story of coronavirus seems well fixed: in late 2019 someone at the new world-
famous Huanan seafood market in Wuhan was infected with a virus from an animal.
The rest is part of an awful history still in the making, with Covid-19 spreading from that first cluster
in the capital of China’s Hubei province to a pandemic that has killed about 211,000 people so far. But there
is uncertainty about several aspects of the Covid-19 origin story that scientists are trying hard to unravel,
including which species passed it to a human. They’re trying hard because knowing how a pandemic starts is
a key to stopping the next one.
According to the World Health Organization (WHO), viral diseases continue to emerge and represent
a serious issue to public health. In the last twenty years, several viral epidemics such as the severe acute
respiratory syndrome coronavirus (SARS-CoV) in 2002 to 2003, and H1N1 influenza in 2009, have been
recorded. Most recently, the Middle East respiratory syndrome coronavirus (MERS-CoV) was first
identified in Saudi Arabia in 2012.
In a timeline that reaches the present day, an epidemic of cases with unexplained low respiratory
infections detected in Wuhan, the largest metropolitan area in China's Hubei province, was first reported to
the WHO Country Office in China, on December 31, 2019. Published literature can trace the beginning of
symptomatic individuals back to the beginning of December 2019. As they were unable to identify the
causative agent, these first cases were classified as "pneumonia of unknown etiology." The Chinese Center
for Disease Control and Prevention (CDC) and local CDCs organized an intensive outbreak investigation
program. The etiology of this illness is now attributed to a novel virus belonging to the coronavirus (CoV)
family.
On February 11, 2020, the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, announced
that the disease caused by this new CoV was a "COVID-19," which is the acronym of "coronavirus disease
2019". In the past twenty years, two additional coronavirus epidemics have occurred. SARS-
CoV provoked a large-scale epidemic beginning in China and involving two dozen countries with
approximately 8000 cases and 800 deaths, and the MERS-CoV that began in Saudi Arabia and has
approximately 2,500 cases and 800 deaths and still causes as sporadic cases.
This new virus seems to be very contagious and has quickly spread globally. In a meeting on January
30, 2020, per the International Health Regulations (IHR, 2005), the outbreak was declared by the WHO a
Public Health Emergency of International Concern (PHEIC) as it had spread to 18 countries with four
countries reporting human-to-human transmission. An additional landmark occurred on February 26, 2020,
as the first case of the disease, not imported from China, was recorded in the United States.
Initially, the new virus was called 2019-nCoV. Subsequently, the task of experts of the International
Committee on Taxonomy of Viruses (ICTV) termed it the SARS-CoV-2 virus as it is very similar to the one
that caused the SARS outbreak (SARS-CoVs).
The CoVs have become the major pathogens of emerging respiratory disease outbreaks. They are a
large family of single-stranded RNA viruses (+ssRNA) that can be isolated in different animal species.
[1] For reasons yet to be explained, these viruses can cross species barriers and can cause, in humans, illness
ranging from the common cold to more severe diseases such as MERS and SARS. Interestingly, these latter
viruses have probably originated from bats and then moving into other mammalian hosts — the Himalayan
palm civet for SARS-CoV, and the dromedary camel for MERS-CoV — before jumping to humans. The
dynamics of SARS-Cov-2 are currently unknown, but there is speculation that it also has an animal origin.
The potential for these viruses to grow to become a pandemic worldwide seems to be a serious
public health risk. Concerning COVID-19, the WHO raised the threat to the CoV epidemic to the "very
high" level, on February 28, 2020. Probably, the effects of the epidemic caused by the new CoV has yet to
emerge as the situation is quickly evolving. On March 11, as the number of COVID-19 cases outside China
has increased 13 times and the number of countries involved has tripled with more than 118,000 cases in
114 countries and over 4,000 deaths, WHO declared the COVID-19 a pandemic.
World governments are at work to establish countermeasures to stem possible devastating effects.
Health organizations coordinate information flows and issues directives and guidelines to best mitigate the
impact of the threat. At the same time, scientists around the world work tirelessly, and information about the
transmission mechanisms, the clinical spectrum of disease, new diagnostics, and prevention and therapeutic
strategies are rapidly developing. Many uncertainties remain with regard to both the virus-host interaction
and the evolution of the epidemic, with specific reference to the times when the epidemic will reach its peak.
At the moment, the therapeutic strategies to deal with the infection are only supportive, and
prevention aimed at reducing transmission in the community is our best weapon. Aggressive isolation
measures in China have led to a progressive reduction of cases in the last few days. In Italy, in geographic
regions of the north, initially, and subsequently throughout the peninsula, political and health authorities are
making incredible efforts to contain a shock wave that is severely testing the health system.
TRANSMISSIONS
According to World Health Organization, the first cases of the CoVID-19 disease were linked to
direct exposure to the Huanan Seafood Wholesale Market of Wuhan, the animal-to-human transmission was
presumed as the main mechanism. Nevertheless, subsequent cases were not associated with this exposure
mechanism. Therefore, it was concluded that the virus could also be transmitted from human-to-human,
and symptomatic people are the most frequent source of COVID-19 spread. The possibility of transmission
before symptoms develop seems to be infrequent, although it cannot be excluded. Moreover, there are
suggestions that individuals who remain asymptomatic could transmit the virus. This data suggests that the
use of isolation is the best way to contain this epidemic.
As with other respiratory pathogens, including flu and rhinovirus, the transmission is believed to
occur through respiratory droplets from coughing and sneezing. Aerosol transmission is also possible in case
of protracted exposure to elevated aerosol concentrations in closed spaces. Analysis of data related to the
spread of SARS-CoV-2 in China seems to indicate that close contact between individuals is necessary. The
spread, in fact, is primarily limited to family members, healthcare professionals, and other close contacts.
Based on data from the first cases in Wuhan and investigations conducted by the China CDC and
local CDCs, the incubation time could be generally within 3 to 7 days and up to 2 weeks as the longest time
from infection to symptoms was 12.5 days (95% CI, 9.2 to 18). This data also showed that this novel
epidemic doubled about every seven days, whereas the basic reproduction number (R0 - R naught) is 2.2. In
other words, on average, each patient transmits the infection to an additional 2.2 individuals. Of note,
estimations of the R0 of the SARS-CoV epidemic in 2002-2003 were approximately 3.

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Features, Evaluation

regarding this pandemic that globally challenge the humanity.

a key to stopping the next one.

identified in Saudi Arabia in 2012.

countries reporting human-to-human transmission. An additional landmark occurred on February 26, 2020,

that caused the SARS outbreak (SARS-CoVs).

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