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JOURNAL OF NISHTAR MEDICAL UNIVERSITY

CORONAVIRUS – The Future Are we Ready to live with a Deadly Disease?

J Nishtar Med Uni.  Vol. 1, No. 3, 2018                                                                                               Editorial                    

Professor Dr. Muhammad Azam Mushtaq

Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur

INTRODUCTION

Coronaviruses are a large family of Riboviruses which can infect mammals (specially bats) and birds. They derive their name from the Latin word ‘corona’ meaning ‘crown’ because of their characteristic appearance of having a fringe which resembles a crown under an electron microscope. 1

corona viruses are enveloped RNA viruses that can cause respiratory, enteric, hepatic and neurological symptoms 1

Six corona virus species are known to cause human diseases, four viruses 229E, OL43, NL63 and HKU1 are prevalent and cause common cold symptoms only, two other strains SARS cov and MERScov are zoonotic in origin and have been linked to fatal diseases in 2002 – 3 and 2012 respectively. 1&2

This Novel corona virus, now given the name as COVID – 2019 is closely related to above mentioned two strains but many features different as for example its rapid transmission from human to human and up till now indeterminate reservoir (Bat vs snake vs any other animal).

Its mortality is reported to be up to 3 percent up till now but it is premature to calculate the mortality at this point of time.

In humans, coronaviruses cause respiratory infections ranging from common cold to more severe and potentially lethal respiratory infections such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).3 The current coronavirus epidemic, which started from Wuhan – a city in the eastern Chinese province of Hubei – in December 2019, is caused by a strain of coronavirus that has previously not been identified in humans, hence it has been given the name ‘novel’ coronavirus or 2019-nCoV.

The respiratory infection caused by it is called COVID-19 (coronavirus disease-2019).4

ELECTRON MICROSCOPIC APPEARANCE OF 2019-NCOV

The exact source of COVID-19 has not yet been identified although it is very likely that an animal source from a live animal market in China was responsible for some of the first reported human infections. Since then, the most common mode of transmission is human to human through respiratory droplets generated by coughing or sneezing.

The clinical presentation of COVID-19 can range from mild symptoms such as a runny nose, sore throat, cough and fever to more serious and potentially lethal respiratory complications like pneumonia and respiratory failure. It has an incubation period of 2-14 days. 5&6

The high-risk population is very young children, elderly and those with cardiac, respiratory illnesses and other immunocompromising states.  Smoking is also identified as a risk factor for this viral illness.  in healthy population it causes only upper respiratory symptoms, although more serious disease and deaths have been reported in some immuno competent population as well. 6

At the time of writing this article (07.09.2020), COVID-19 has claimed more than 885,016 lives and infected 27,154,127 people whereas number of those recovered is 19,263,972 where as in Pakistan it has involved about 300,000 individuals and total deaths up till now are 6,342 and recovered 285,898 it has changed into a pandemic now involving all the globe and top most effected countries are USA, Italy, Brazil, Iran , India, Pakistan and China.

According to WHO the disease may run a second and even a third wave and the disease is unlikely to disappear totally until three or more years or until an effective vaccine is available in market which we may see in the near future, never the less we should learn to live with COVID-19 and related diseases in future acting upon SOPs not only to save our selves but our family and other people around us.

Wearing a medical mask can help limit the spread of COVID-19. However, using a mask alone is not guaranteed to stop infections and should be combined with other basic preventive measures including frequent hand washing with soap and water, preferably with Alcohol based hand sanitizers, respiratory hygiene such as covering mouth and nose with flexed elbow or tissue whilst coughing or sneezing (then discarding the tissue in a closed bin and washing hands) and avoiding close contact, keeping at least 1 meter (3 feet) distance between yourself and other people, particularly someone who is coughing/sneezing or has a fever.7

Hospital measures include active flu filtration points specially in emergency, Medical and pulmonology OPDs, and strict infectious disease control (IDC) measures.

Any patient with above mentioned symptoms and travel by him or his relatives to china and other affected countries(in the early part of the pandemic) or a strong suspect even without travel history as it could be vague, should be masked immediately and isolated, the main danger of the disease is that an A symptomatic individual can transmit the disease to a high risk patient in his surroundings with a fatal outcome for those who are at high risk so the person having no disease apparently can transmit the fatal disease to his loved ones it is there for utmost important to take care of immunocompromised and elderly and to avoid contact with them even if you are perfectly alright.

  Treatment is mainly supportive, with no specific antivirals but certain are under trial. Remdesivir, an investigational drug, that has shown efficacy in practical models of sever acute respiratory syndrome (SARS)and middle east respiratory syndrome corona virus (MERS-COV) is under trial in china and Pakistan 7

Clinical trials of the antivirals lopinavir and ritonavir are also being studied on large scales in china and USA. 7& 8Some other Medications like hydroxychloroqin, Ivermectin, Azithromycin, doxycycline and tocilizumab and Dexamethasone are also being used in different settings with varied results.

At the time of this writing many knowledge gaps remain that must be bridged,  for Example,  the transmissibility of the virus and full extent of the outbreak remain uncertain but what is known clearly is that there is high prevalence and wide distribution of corona viruses,  their large genetic diversity and frequent recombination of their genomes, the increasing  human – animal interface,  novel corona viruses are likely to emerge and re-emerge from time to time in humans due to  frequent cross – species infection and occasion spill over. 9

It is the need of the hour therefore, that humans be prepared for any such infections with increasing public awareness  through seminars, walks and media awareness programs about protective measures especially coughing and sneezing etiquettes,  general cleanliness,  use of face masks which protects not only against many respiratory infections as well as effects of pollution, develop new antivirals and vaccines,  try to limit animal to man  spill over by implementing strict protective measures while handling animals.10, 11 & 12

An effective plan (both short term and long term) for this as well as future infective diseases is needed to be present in our country as well to handle such a situation before hands.

ACKNOWLEDGEMENT

I am thankful to my friend class fellow (Nishtarian) Dr Khalid Naeem Shahzad Wattford General Hospital, west Hertfordshire Hospitals NHS trust UK for his valuable support extended to me for writing this article.

REFERENCES

  • Master PS, Perlman S.Coronaviridae. In: Knipe DM, Howley PM, eds. Fields virology. 6thed. Lippincott Williams & Wilkins, 2013:825-58
  • Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol 2019;17:182-192
  • Zhong NS, Zheng BJ, LI YM, et al. Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People’s Republic of China, in February, 2003. Lancet 2003;362:1353-1358.
  • KsiazekTg, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348:1953-1966.
  • World Health Organization (WHO) Emergency Committee. Statement on the second meeting of the international health Regulations (2005) Emergency Committee regarding the outbreak of Novel coronavirus (2019-nCOV), Geneva:WHO; 30 January 2020.Available from
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  • Coronavirus;  Common Symptoms, Preventive Measures, & How to Diagnose it. Caringly Yours. 28 January 2020. Retrieved 28 January 2020.
  • Geller C, Varbanov M, Duval RE (November 2012). “ Human coronaviruses: insights into environmental resistance and its influence on the development of new antiseptic strategies. Viruses. 4 (11): 3044-3068. Doi:10.3390/v4113044 PMC 3509683. PMID23202515.
  • Transmission of Novel Coronavirus (2019-nCoV) CDC www.cdc.gov31    January2020 Retrived 1 February 2020.
  • Lau Sk, lee P, Tsang Ak, Yip CC Tse H, Lee RA, So LY, Lau YL, Chan KH, Woo PC, Yuen KY (November 2011) “Molecular epidemiology of human coronavirus OC43 reveals evolution of different geno types over time and recent emergence of a Novel Genotype due to Natural recombination”. Journal of virology. 85(21):11325-11337.Doi:10.1128/JVL.05512-11 PMC 3194943.pmid21849456.
  • “Tracking Coronavirus: Map, Data and timeline”. BNO news. 10 February 2020 archived from the original on 28 January 2020 retrieved 10 February 2020.
  • Gao Gf. From “A”IV to “Z”IKV: attacks from emerging and re-emerging pathogens.cell 2018;172:1157-1159

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