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Journal of Autoimmunity xxx (xxxx) xxxx
Journal of Autoimmunity
journal homepage: www.elsevier.com/locate/jautimm
Review article
A R T I C LE I N FO A B S T R A C T
Keywords: Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially
Coronavirus fatal disease that is of great global public health concern. Based on the large number of infected people that were
COVID-19 exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of
Wuhan city COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were sub-
Pneumonia
sequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of
Pathogenesis
COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or
reduce transmission should be applied in susceptible populations including children, health care providers, and
elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylo-
genetic analysis and future directions to control the spread of this fatal disease.
∗
Corresponding author. Department of Pharmacology and Experimental Neuroscience Durham Research Center, 8047 985880 Nebraska Medical Center Omaha,
NE, 68198-5880, USA
E-mail addresses: [email protected] (H.A. Rothan), [email protected] (S.N. Byrareddy).
https://doi.org/10.1016/j.jaut.2020.102433
Received 10 February 2020; Received in revised form 17 February 2020; Accepted 18 February 2020
0896-8411/ © 2020 Elsevier Ltd. All rights reserved.
Please cite this article as: Hussin A. Rothan and Siddappa N. Byrareddy, Journal of Autoimmunity,
https://doi.org/10.1016/j.jaut.2020.102433
H.A. Rothan and S.N. Byrareddy Journal of Autoimmunity xxx (xxxx) xxxx
Figure 1. The chronological incidence of COVID-19 infections and death cases in China. Infections with COVID-19 appears in December 2019. At the time of
preparing this manuscript, February 16, 2020 there have been 51,174 people who have contracted the infection in China, and more than 1666 people have died.
2
H.A. Rothan and S.N. Byrareddy Journal of Autoimmunity xxx (xxxx) xxxx
cases increased to 56 deaths [8]. The percentage of death among the 5. Phylogenetic analysis
reported 2684 cases of COVID-19 was approximately 2.84% as of Jan
25, 2020 and the median age of the deaths was 75 (range 48–89) years World Health Organisation (WHO) has classified COVID-19 as a β
[8]. CoV of group 2B [23]. Ten genome sequences of COVID-19 obtained
Patients infected with COVID-19 showed higher leukocyte numbers, from a total of nine patients exhibited 99.98% sequence identity [19].
abnormal respiratory findings, and increased levels of plasma pro-in- Another study showed there was 99.8–99.9% nucleotide identity in
flammatory cytokines. One of the COVID-19 case reports showed a isolates from five patients and the sequence results revealed the pre-
patient at 5 days of fever presented with a cough, coarse breathing sence of a new beta-CoV strain [5]. The genetic sequence of the COVID-
sounds of both lungs, and a body temperature of 39.0 °C. The patient's 19 showed more than 80% identity to SARS-CoV and 50% to the MERS-
sputum showed positive real-time polymerase chain reaction results CoV [5,19], and both SARS-CoV and MERS-CoV originate in bats [24].
that confirmed COVID-19 infection [14]. The laboratory studies showed Thus, the evidence from the phylogenetic analysis indicates that the
leucopenia with leukocyte counts of 2.91 × 10^9 cells/L of which COVID-19 belongs to the genus betacoronavirus, which includes SARS-
70.0% were neutrophils. Additionally, a value of 16.16 mg/L of blood CoV, that infects humans, bats, and wild animals [25].
C-reactive protein was noted which is above the normal range COVID-19 represents the seventh member of the coronavirus family
(0–10 mg/L). High erythrocyte sedimentation rate and D-dimer were that infects humans and has been classified under the orthocoronavir-
also observed [14]. The main pathogenesis of COVID-19 infection as a inae subfamily. The COVID-19 forms a clade within the subgenus sar-
respiratory system targeting virus was severe pneumonia, RNAaemia, becovirus [25]. Based on the genetic sequence identity and the phylo-
combined with the incidence of ground-glass opacities, and acute car- genetic reports, COVID-19 is sufficiently different from SARS-CoV and it
diac injury [6]. Significantly high blood levels of cytokines and che- can thus be considered as a new betacoronavirus that infects humans.
mokines were noted in patients with COVID-19 infection that included The COVID-19 most likely developed from bat origin coronaviruses.
IL1-β, IL1RA, IL7, IL8, IL9, IL10, basic FGF2, GCSF, GMCSF, IFNγ, IP10, Another piece of evidence that supports the COVID-19 is of bat origin is
MCP1, MIP1α, MIP1β, PDGFB, TNFα, and VEGFA. Some of the severe the existence of a high degree of homology of the ACE2 receptor from a
cases that were admitted to the intensive care unit showed high levels diversity of animal species, thus implicating these animal species as
of pro-inflammatory cytokines including IL2, IL7, IL10, GCSF, IP10, possible intermediate hosts or animal models for COVID-19 infections
MCP1, MIP1α, and TNFα that are reasoned to promote disease severity [20]. Moreover, these viruses have a single intact open reading frame
[6]. on gene 8, which is a further indicator of bat-origin CoVs. However, the
amino acid sequence of the tentative receptor-binding domain re-
sembles that of SARS-CoV, indicating that these viruses might use the
4. Transmission same receptor [5].
Based on the large number of infected people that were exposed to 6. Therapeutics/treatment options
the wet animal market in Wuhan City where live animals are routinely
sold, it is suggested that this is the likely zoonotic origin of the COVID- The person-to-person transmission of COVID-19 infection led to the
19. Efforts have been made to search for a reservoir host or inter- isolation of patients that were administered a variety of treatments. At
mediate carriers from which the infection may have spread to humans. present, there are no specific antiviral drugs or vaccine against COVID-
Initial reports identified two species of snakes that could be a possible 19 infection for potential therapy of humans. The only option available
reservoir of the COVID-19. However, to date, there has been no con- is using broad-spectrum antiviral drugs like Nucleoside analogues and
sistent evidence of coronavirus reservoirs other than mammals and also HIV-protease inhibitors that could attenuate virus infection until
birds [10,18]. Genomic sequence analysis of COVID-19 showed 88% the specific antiviral becomes available [7]. The treatment that have so
identity with two bat-derived severe acute respiratory syndrome far been attempted showed that 75 patients were administrated existing
(SARS)-like coronaviruses [19,20], indicating that mammals are the antiviral drugs. The course of treatment included twice a day oral ad-
most likely link between COVID-19 and humans. Several reports have ministration of 75 mg oseltamivir, 500 mg lopinavir, 500 mg ritonavir
suggested that person-to-person transmission is a likely route for and the intravenous administration of 0·25 g ganciclovir for 3–14 days
spreading COVID-19 infection. This is supported by cases that occurred [26]. Another report showed that the broad-spectrum antiviral re-
within families and among people who did not visit the wet animal mdesivir and chloroquine are highly effective in the control of 2019-
market in Wuhan [13,21]. Person-to-person transmission occurs pri- nCoV infection in vitro. These antiviral compounds have been used in
marily via direct contact or through droplets spread by coughing or human patients with a safety track record. Thus, these therapeutic
sneezing from an infected individual. In a small study conducted on agents can be considered to treat COVID-19 infection [27]. Further-
women in their third trimester who were confirmed to be infected with more, there are a number of other compounds that are in development.
the coronavirus, there was no evidence that there is transmission from These include the clinical candidate EIDD-2801 compound that has
mother to child. However, all pregnant mothers underwent cesarean shown high therapeutic potential aganist seasonal and pandemic in-
sections, so it remains unclear whether transmission can occur during fluenza virus infections and this represents another potential drug to be
vaginal birth. This is important because pregnant mothers are relatively considered for the treatment of COVID-19 infection [28]. Along those
more susceptible to infection by respiratory pathogens and severe lines, until more specific therapeutics become available, it is reasonable
pneumonia (https://www.thelancet.com, DOI:https://doi.org/10. to consider more broad-spectrum antivirals that provide drug treatment
1016/S0140-6736(20)30360-3). options for COVID-19 infection include Lopinavir/Ritonavir, Neur-
The binding of a receptor expressed by host cells is the first step of aminidase inhibitors, peptide (EK1), RNA synthesis inhibitors. It is clear
viral infection followed by fusion with the cell membrane. It is reasoned however, that more research is urgently needed to identify novel che-
that the lung epithelial cells are the primary target of the virus. Thus, it motherapeutic drugs for treating COVID-19 infections. In order to de-
has been reported that human-to-human transmissions of SARS-CoV velop pre-and post-exposure prophylaxis against COVID-19, there is an
occurs by the binding between the receptor-binding domain of virus urgent need to establish an animal model to replicate the severe disease
spikes and the cellular receptor which has been identified as angio- currently observed in humans. Several groups of scientists are currently
tensin-converting enzyme 2 (ACE2) receptor [20,22]. Importantly, the working hard to develop a nonhuman primate model to study COVID-
sequence of the receptor-binding domain of COVID-19 spikes is similar 19 infection to establish fast track novel therapeutics and for the testing
to that of SARS-CoV. This data strongly suggests that entry into the host of potential vaccines in addition to providing a better understanding of
cells is most likely via the ACE2 receptor [20]. virus-host interactions.
3
H.A. Rothan and S.N. Byrareddy Journal of Autoimmunity xxx (xxxx) xxxx
7. Future directions to control the spread of the disease novel coronavirus causing severe pneumonia in human: a descriptive study, Chinese
Med J (2020), https://doi.org/10.1097/CM9.0000000000000722.
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COVID-19 are required to control the current outbreak. Special atten- 497–506, https://doi.org/10.1016/S0140-6736(20)30183-5.
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[9] H. Nishiura, S.M. Jung, N.M. Linton, R. Kinoshita, Y. Yang, K. Hayashi, et al., The
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admitted water drop by drop, until the sound had died away. For
these inventions and for his steam steering gears the judges made
an award.
Our foreign judges were enthusiastic about them; Horatio Allen
had fought Mr. Sickels during his whole business life and would
never allow a Sickels cut-off to be applied in the Novelty Iron Works.
For example, the directors of the Collins steamship line adopted the
Sickels cut-off, but it was put on only two of their ships, the “Arctic”
and the “Baltic,” the engines of which were built at the Allaire works.
The “Atlantic” and “Pacific,” which were engined at the Novelty
Works, did not have it, Mr. Allen absolutely refusing to allow it. To my
surprise Mr. Allen signed this award with a cordial expression of
admiration of Mr. Sickels’ genius; he had softened in his old age.
The following is a copy of this award.
INTERNATIONAL EXHIBITION, 1876.
REPORT ON AWARDS.
“Group No. XX.
“Catalogue No. 1027.
“Product, Models of Improvements in Steam-engines.
“Name and address of exhibitor, Frederick E. Sickels.
“The undersigned, having examined the products herein
described, respectfully recommend the same to the United States
Centennial Commission for Award for the following reasons, viz:
“These exhibits possess great historical interest.
“In the year 1842 Mr. Sickels patented the trip or liberating cut-off,
an invention which, in a variety of forms, has come into use
wherever steam-engines are made. In applying this invention to
poppet valves, Mr. Sickels prevented these valves from striking their
seats by his invention of the dash-pot, in which he availed himself of
the incompressibility, the indestructibility and the divisibility of water,
and which is now employed for this purpose in all such applications.
“In 1848 he patented an improvement in the method of controlling
motive power, by which method steam is applied at the present time
to various uses, notable among which is the steering of steam
vessels, the steersmen turning the wheel precisely as in steering by
hand, but all the force being exerted by the steam.
“Charles T. Porter,
“Reporting Judge.
“Approval of Group Judges,
Horatio Allen, Chas. E. Emery, Emil Brugsch,
F. Reuleaux, N. Petroff.”
James Moore
After our work was finished and I had gone home the awards were
made public; to my astonishment the award to Mr. Sickels was not
among them, so I wrote to General Walker, who was our medium of
communication with the Commission, asking the reason for this
omission. He replied that the award had been thrown out by the
Committee of Revision. “Committee of Revision!” I had never heard
of such a thing. I asked for an explanation and I learned that the
judges did not make awards, they only recommended them; the
awards were made by the Commission after they had passed the
scrutiny of the Committee of Revision. Well, who were the
Committee of Revision? I learned that the Commission consisted of
two commissioners from each State appointed by the Governor; Mr.
Corliss was a commissioner from Rhode Island. At a meeting of the
commissioners Mr. Corliss proposed the novel scheme of a
Committee of Revision, to which the action of the judges should be
submitted for approval before the awards were made. The idea
seemed to please the members of the Commission, as tending to
magnify their own importance, and it was adopted; as a matter of
usual courtesy Mr. Corliss was made chairman of the committee,
and the committee threw out the award to Mr. Sickels. I made careful
inquiry and could never learn that the Committee of Revision threw
out any other award, so it seemed evident that with the throwing out
of this award to Mr. Sickels the object of its existence was
accomplished.
In the Corliss valve system the liberation of the valve was the
fundamental idea; this was applied by him to valves moving in the
direction parallel with their seats. It not being necessary to arrest
their motion at any precise point, they were caught by air cushions at
any points after they had covered their ports. Mr. Corliss had
appropriated the liberating idea, according to “the good old rule, the
simple plan, that they may take who have the power, and they may
keep who can,” and all this machinery had been devised by him to
prevent the historical fact that the liberating idea had been invented
by Mr. Sickels from appearing in the records of the exhibition. By all
this enormous expenditure of ingenuity and influence he succeeded
in giving to this fact a prominence and importance which it would
never otherwise have had, besides advertising his efforts to
suppress it.
Mr. Horatio Allen’s life-long aversion to Mr. Sickels was caused by
professional jealousy. Mr. Allen conceived himself to be an inventor,
and for years had been cherishing a cut-off invention of his own. The
original firm was Stillman, Allen & Co., and for years Mr. Stillman had
prevented the Novelty Iron Works from being sacrificed to Mr. Allen’s
genius, but later Mr. Allen had obtained supreme control of these
works by an affiliation with Brown Brothers, the bankers, his principal
stockholders, and Mr. Stillman sold out his interest and retired from
the firm. Mr. Allen, having a clear field, now determined to put his
invention on the new steamer of the Collins line, the “Adriatic,” and
American engineers were amused at the display of this amazing
absurdity on the largest possible scale. In this construction there
were four valves; each valve was a conical plug about six feet long
and had four movements; first it was withdrawn from its seat a
distance of three inches so that it could be rotated freely, then it was
rotated first to draw off the lap. Up to this point theoretically the port
had not been opened, but the steam had been blowing into the
cylinder or out of it, as the case might be, through these enormous
cracks; the valves then rotated further to produce the opening
movement, for either admission or release; the rotation was then
reversed until it reached its original position, then the fourth
movement brought it to its seat. It is probable that the ship would
have gone to sea working steam after this ridiculous fashion, if the
complicated mechanism required to produce the four movements
had not broken down at the trial of the engines at the dock, beyond
the power of Mr. Allen’s genius to remedy; so the valves had to be
removed and the Stevens valves and Sickels cut-off were substituted
for them. The story that any sane man ever designed a four-motion
steam-engine valve, and that he made the first application of it on
the largest steamship, except the Great Eastern, then in the world, is
such a tax on credulity, that I was glad to find the following
corroboration of it in a letter to “Power,” from which I copy the
essential portion.
Emil Brugsch