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| REVIEW ARTICLE |
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| Year : 2021 | Volume
: 16
| Issue : 2 | Page : 413-415 |
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Informative draft on COVID-19: A pandemic outbreak
Aishwarya Gupta, Nitin Bhola, Rajanikant Kambala
Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| Date of Submission | 16-Dec-2020 |
| Date of Decision | 08-Feb-2021 |
| Date of Acceptance | 18-May-2021 |
| Date of Web Publication | 18-Oct-2021 |
Correspondence Address:
Dr. Aishwarya Gupta
DMIMS Campus, Shalinitai Hostel, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha - 442 004, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_451_20
In 2019, number of cases diagnosed with coronavirus pneumonia aroused in China. Number of studies were done that showed clinical characteristics of this disease. The aim of this brief informative draft is to summarize the clinical features, virulence, transmission, and various treatment modalities for the treatment of the disease. Also the various protective measures for the general population and health care professionals to prevent the growing pandemicity and control the outbreak of the condition.
Keywords: Coronavirus pneumonia, COVID-19, SARS-CoV-2
How to cite this article:
Gupta A, Bhola N, Kambala R. Informative draft on COVID-19: A pandemic outbreak. J Datta Meghe Inst Med Sci Univ 2021;16:413-5 |
| Introduction | |  |
Number of cases having idiopathic pneumonia were found in Wuhan, China, in December 31, 2019, making the topic of discussion worldwide.[1] A novel coronavirus (SARC-CoV-2) was found from the samples of lower respiratory tract of the affected patients.[2] In February 2020, the virus was named as COVID, differentiating it from betacoronaviruses (computed tomography acute respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERS-CoV] which have lethal effect on human population.[3],[4] Some studies hypothesized that coronavirus have ability to form bond with the recetor (ACE-2), as betacoronaviruses (SARS-CoV) in humans.[5]
The patients of elder age group (<65 years) are at higher risk of death, whereas one study in February 2020, concluded that patients having early symptoms of coronavirus are more prone to death.[6],[7] The patients admitted in intensive care unit or having comorbidities are susceptible to this disease.[8] Further studies proved that lymphopenia is the most common cause as the virus depletes the immune call and impairs the functioning of immune system in body.[1],[2],[9],[10] Many studies showed that the COVID infection has a nosocomial transmission and more common in familial clustering.[2],[9],[11] Due to the mobilization of the immune system, “cytokine storm” formed.[12] An in vitro study on mice with SARS-CoV proved that along with the downregulation expression of angiotensin-converting enzyme ACE2, the cardiac system get affected after the respiratory system.[13] As diffusion of coronavirus takes place by droplet transmission, aerosol formation during clinical procedures represents a huge issue, exposing the professionals as during the pandemicity.[14]
| Clinical Characteristics | | |
The clinical features are still not fully discovered. The initial symptoms include pyrexia, dry cough, tiredness, dyspnea, headache, nausea, sore throat, vomiting, and diarrhea. Patients having conditions such as HTN, DM, CKD, cardiovascular and cerebral disorders, malignancy, and chronic liver disease are more prone to this disease. Various treatment options are suggested. The drug therapy includes antiviral therapy, corticosteroids mainly glucocorticoids, immunoglobulin injections, O2 inhalation therapy, continuous renal replacement therapy (CRRT), noninvasive and invasive mechanical ventilation, and extracorporeal membrane oxygenation. Some complications such as hypoxia, shock, acute respiratory distress syndrome, lymphopenia, arrhythmia, acute kidney and liver injury, and cardiac arrest were noted during hospitalization were The level of serum procalcitonin (≥0.5 ng/ml) suggestive of acute infection.
| Virulence | | |
Coronaviruses are huge entity affecting respiratory, enteric, hepatic, and neurologic diseases. Specifically, SARS-CoV and MERS-CoV affected the human epidemics in 2003 and 2012, respectively, having mortality rates 10% and 40% respectively. Both bind to ACE-2 receptor. The coronavirus mainly affects lower respiratory tract and binds to angiotensin receptors present on the cells called pneumocytes. The inflammatory cytokine is induced by the viruses multiple organ dysfunction and damage occurs due to “cytokine storm.” Activation of chemokines from vascular endothelial cells induced by the virus and leading to the condition.
| Transmission and Precaution | | |
Fomites remain as a main source of infectious particles. It has been proved that on uncleaned surface, the coronaviruses persist for longer time. Furthermore, the RNA virus was detected in the stool specimen of negative tested individual. The current study showed the orofecal virus transmission. Whereas, further studies are needed, as it remains asymptomatic for longer duration. Handwashing is the main protocol followed otherwise. Usage of masks, gowns, and gloves and glasses for protection of eyes are also recommended to prevent the transmission of coronavirus.
| Treatment Outcome | | |
A confirmatory treatment is yet not discovered for COVID. Treatment modalities include CRRT, invasive and noninvasive mechanical ventilation, and ECMO. Firstly reported case was treated with drugs like remdesivir, baricitinib, and ritonavir.
The use of steroids was found not to be significant.[15] Some carbapenems (P < 0.001) and linezolid (P = 0.040) have better prognosis. Arbidol seems to improve prognosis. Some molecules such as prulifloxacin, nelfinavir, bictegravir, nelfinavir as having high binding potential with virus can be used as for treatment.[16] Some in vitro studies showed remdesivir, baricitinib, and chloroquine effectively inhibit SARS-CoV-2.[17],[18] More studies are required for the better outcome of patient.
| Summary | | |
Despite symptomatic variations in COVID-19 patients, epidemic travel history plays an important role to diagnose the condition like COVID and other flu-like syndromes. Timely evaluation, early diagnosis, and protective measures are the key to defeat the worldwide spreading pandemicity of disease. Symptomatic treatment is given until the confirmatory treatment come in market. Many clinical trials for vaccines and medications are going underway. Further studies are needed to provide the disease-free environment for the health of individuals.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  |
| 2. | Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33. |
| 3. | Zhong NS, Zheng BJ, Li YM, Poon, Xie ZH, Chan KH, et al. Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003. Lancet 2003;362:1353-8. |
| 4. | Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012;367:1814-20. |
| 5. | Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020;395:565-74. |
| 6. | Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81. |
| 7. | Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: Retrospective case series. BMJ 2020;368:m606. |
| 8. | Cao JL, Hu XR, Cheng W, Yu L, Tu WJ, Liu Q. Clinical features and short-term outcomes of 18 patients with corona virus disease 2019 in intensive care unit. Intensive Care Medicine 2020;46:851-3.[doi: 10.1007/s00134-020-05987-7]. |
| 9. | Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9. |
| 10. | Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13. |
| 11. | Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in wuhan, china, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207. |
| 12. | Ming Y, Jinming Z, Zheng Z, More than Pneumonia, the Potential Occurrence of Multiple Organ Failure in 2019 Novel Coronavirus Infection; February 5, 2020. Available from: http://dx.doi.org/10.2139/ssrn0.3532272. [Last accessed on 2020 Sep 16]. |
| 13. | Oudit GY, Kassiri Z, Jiang C, Liu PP, Poutanen SM, Penninger JM, et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest 2009;39:618-25. |
| 14. | Cabrini L, Landoni G, Zangrillo A. Minimise nosocomial spread of 2019-nCoV when treating acute respiratory failure. Lancet 2020;395:685. |
| 15. | Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet 2020;395:473-5. |
| 16. | |
| 17. | Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020;30:269-71. |
| 18. | Richardson P, Griffin I, Tucker C, Smith D, Oechsle O, Phelan A, et al. Baricitinib as potential treatment for 2019-nCoV acute respiratory disease. Lancet 2020;395:e30-1. |
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