ANNQUESTJULY2020ISSN:2321-3043

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ExperiencingCOVID-19from pasttopresent/OverlookedCOVIDon

asurge

MansiGandhi,M.Sc.,PhDResearchScholar,DepartmentofChemistry,SchoolofAdvancedSciences, VelloreInstituteofTechnologyUniversity

Abstract

ThenovelstrainofCOVID-19hasmadea huge crisis with pneumonia likesymptomsidentifiedinSouthernChinaduringDecember2019.Thisvirushasoriginatedfrom familyofCoronaviridae,having a metagenomic RNA differentfrom previouscorona-baseddiseases.Ithas affected allthe spheres oflife,restricting of face-to-facecommunication, teaching being re-designedonline,shortagesofgoodsduetohoardingetc.Thisoutbreakhasledtorepurposing ofcertain drugs due touncertainty of medicalfacilities andimproper consultations lined up formultiple prescriptions.On the otherhand,medicalassistants are workingwithoutbreakforthedirectpatientcare.The health organizations are workingtogetherto curb the pandemic in allpossible methodologies. This articlegives an overview ofnCoV's origin,affect on the society, symptoms,medicationandpossibletreatment.

Keywords- nCoV-19, infection,metagenomic RNA, RT-PCR,financialcrisis.

Introduction

Theinfectiousdiseasesareonarisewith new diseases/ones gettingincorporated into the human system.Thesediseasesnamelyincludesevereacute respiratory syndrome(SARS) ,Middle East respiratory syndrome(MERS),Zikavirus,COVIDetc.poseanurgentthreatto globalhealth[1].Thecoronavirusisassociatedwithdistincttypesofinfectiousdiseasesontherun;SARSledtoaglobalpandemicin2002-2003followedbyMERSin2012.Despiteofhugeresearch and developmentinthearenaofhealthcareindustry,noveldiseases add uncertainty.COVID orCoronavirusdiseases19,isonesuchunprecedented globalcrisis outbreakfrom group of SARS-like cornovirus(origin-family ofCoronaviridae)alsonamedasWH-Human1coronavirus.Thename is based on its characteristicmorphology;itisanenvelopedviruswithicosahedral protein shell with clubshapedspikes.UponmetagenomicRNAsequencing,itwasfoundthatfamilyofviruscontainsanewRNAvirusstrain.[2]Further,phylogenetic viralgenome of29Knucleotides,thevirusaccountedfor89% nucleotide matching from genusBetacoronavirus, subgenusSarbecovirus.Itis caused by severeacuterespiratorysyndromecoronavirus2.ThisparticulargenusBetacoronavirushasbeenreportedinliteraturefoundinChinese Bats.[3]The identification ofSARS-likeCoV inbatshaveledtotheidea thatanimals actas hostofanaturalreservoiroftheseviruses[4].Itscausative pathogen is a phylogenicsisterto the severe acute respiratorysyndrome.Eventhough,ithas similarsequence identity and same cellreceptoras ofSARS-CoV,butithasSARS-like viralpneumonia and illness

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withasymptomaticinfection.[5–7]

The firstcase encountered forCOVID19emergedinWuhancity,HubeiProvince, China. Despite healthresponses for delaying the spread,severalcountrieswereconfrontedwithacriticalcarecrisis.Withinashortspan,thetransmissionescalatedtheoutbreakto the whole world affecting 215countries,with statistics of 39 lakhcases.TheworsthitcountriesincludeUSA accountingformaximum numberofcasesof12lakhfollowedbySpain2.5lakhandsimilarlyforItalyandUK.The huge count of patients led toshooting up the demand in hospitalbeds along with shortage ofmedicalequipment, personal protectionequipment(PPE)kitandventilators.Themode ofvirus transmission is fromhumantohumancontactorthroughtheaerosolsgeneratedinairbyapositivepatientand via contaminated objectsandsurfaces.

Scheme 1:Cartoonistillustration ofmajordrawbacksofCOVID-19 in thelifeofpeople.

Apartfrom curingthepeoplewithsuch pandemic,the staffthemselvesgotinfected overtheirdutiestreatingtheneedy,thuscreatingahugevoidinthehealthcareindustry[8].Thestaffhasbeenworkingonacontinuousshiftwithserious symptoms of insomnia. Anexample is the Wockhardt Hospitalwhere26 nursesand 3 doctorswerefoundtobeinfected,thusshuttingdownthe hospital and declaring it acontainmentzone.Later,strictinfectioncontrolmeasureswereadoptedsuchaswashing hands with both soap andsanitizers, wearing masks, gloves,wearing double layer of protectiveclothing and covers that wererecommendedbyTheCenterofDiseaseControland Prevention (CDC)in theUnitedStatesduringSARSoutbreak[9].In response to this,allvisas weresuspendedacrossbordersanddisablingofentranceturnstileswithinborders.Allkindsofpublictransportationwasshutexceptforconsumptiongoods.Further,World Health Organization (WHO),health emergency program chiefexecutive director Michael Ryanmotivatedcountriestofollow completeeconomicandsociallockdowntocurbthe disease.He even said,thatIndia(second mostpopulous country)hastremendouscapacityto dealwith theoutbreak and encourage the world intakingthepandemic.Parallely,WHO isalso providing consultancyto combatthepandemic.Ithassuppliedtestkitsandstandards(SOP’s)forthediagnosisandmanagementofthedisease.IthasalsodonatedPPEkitstothefrontlineworkersandtakenaninitiativetoupskillthem onthenecessaryprecautionsfortheirhealthwhilebeingincontactwith

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the infected patients. Anotherorganization, 'Oxford COVID-19GovernmentResponseTracker'gaveareportfrom over73countriesshowingthatIndiangovernmenthasstringentlyresponded with emergencypoliciesintackling the situation, followed byemergency investments in vaccineresearch,healthcaresystem andfiscalmeasures.Scheme1isabasiccartoonillustration with major drawbackssufferedbypeopleduringthepandemic.

Countrieshavealsostrengthenedtheir diplomatic bonds during thisconsequentialeventof21stcenturybydonatingkits,masksandothermedicalnecessitiestocountriesinneedduringthecrisis.USannounced$174milliontoaid allthe affected countries.WhileChina donated 1 lakh personalprotection equipment’s (PPE)kits toIndia.Insupporttoall,Indiahassent88health professionals to UAE andEmirates.Allovertheworld,nationsareunderstanding the criticality of thesituationandshareahelpinghandtoall.Notjustcountries,allorganizationsthatareparticipatingareaddingfrom theirend.Differentpublishinginstitutesarehelpingwithcreatinghubsforguidelines,expertadviceandlatestdetailsovertheinternetlikeElsevier,Nature(ScientificReports),BMC,etcwithgivinganopenplatform for published papers. TheSouth Asian Association forRegionalCooperation (SAARC),a geo-politicalunionjointlyallocated740millionfundsasCOVID-19EmergencyFund.

Apartfrom responseofcountries,theelectronicmediaplayedanintenserole initiating various applications forspreadoftheprecautions.WorldHealthProgram started a smartphoneWhatsappapplicationportaltoanswerthequeriesaboutthedisease,Aarogya

Setu anotherinitiative ofMinistry ofElectronicsandInformationTechnology,Indiaassistingthesamecause.OtheragencieslikeWorldBanklaudedearlydevelopmentofapps,whileAppleandGooglealsoannouncedsuchsoftwarebuilding fortracing the movementofpeopleinordertocombatthesituation.

Thepandemichasalsocausedatragiceffectontheglobaleconomies.Thereisaclearimpactonthemarketsworldwide wherein different stockexchangesare recording theirall-timelow.According to UN DepartmentofEconomicandSocialAffairs,pandemichasdisruptedtheglobalsupplychainsandoveralleconomicaltradeoverseaswith screeching haltto the tourismindustry. The global economy isexpected to shrink down by1% withworkers facing bleak prospectofjobsecurity.World Economic ForecastingModelhasestimatedmajordevelopingnations to witness the worstgrowthscenario.Accordingtoonesuchreport,Indiaisamongthe15worsteconomieswithanimpactof$348milliononitstrade.

LiteratureandBackground

SARS was originated from family ofcoronavirus,thatoriginatedaround2002particularly in Beijing, China. Thediseasespread quitequicklyaffecting29countrieswith8,000 people.WhileMERS was from the same family,identified in Saudi Arabia around2012.Theputativerecombinationintheevolutionofsarbecoviruses,theeventsinvolves four genome sequencesnamely; bat SARS like CoV Rp3,CoVZC45,CoVZXC21 and SARS-CoVTor2.Wherein,batSARSlikeCoV andSARS-CoV arecapableofdirecthumantransmission[10,11].

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This infection was firstaccounted by health authorities ofWuhaninstituteofVirology,whenacaseof pneumonia associated with newcoronaviruscameup.Theinstitutewasthe firstto investigate the analysis,identification and name the geneticsequencewithapublicdatabase[12].ByFebruary 2020,institute applied thepatentforusing'remdesivir'drugthatinhibitedin-vitrogrowthofvirus[13].

The patients have reporteddiverse symptoms incurring suddenfever, cough or sore throat, chesttightness,weakness,etc.Along withabruptchanges in lab testing ofC-protein, aspertase aminotransferase,lactic dehydrogenase,creatinine alongwithotherbiochemicalbloodanalysis.Afew patients showed mild hypoxamiaandlymphoponia.Thus,basedonabovethere were combination ofantibiotic,antiviral and glucocorticoid therapy.Severity was observed later withrespiratoryfailure and ultimatelyhighflow ofnon-invasiveventilatorsarethelastresortforadministrationofpatients.Later,broncho-alveloarfluid(BALF)wascollectedtopursueaetiologicalagentscornered to this disease via meta-transcriptomicsequencingandgenomesequencing was assigned GenBankaccession numberMN908947.Basedon screened sequences, 30Knucleotideswerecloselysimilartobat-SARS like coronavirus i.e. batSL-CoVZC45(GenBank accession numberMG772933).[14] Further based ongenomic sequencing,the evolutionaryrelationship was credited to thephylogenetictree.

Brief Discussion aboutMedication,PrecautionsandCure

Distinct methods were adopted todefinethevirustransmission,initiallyaninfrared thermometerasapreliminarytesting.Chinacamewithaconcepttoinitiallystartthescreeningofpatientsusing a triage workflow concept toanalysethedisease.Thetriageprocesshelpedinguidingthepatientstofollowafour-leveltriage during hospitalvisits.Peopleweresegregatedbasedonthehistory of visiting certain places,orcontactedtheconfirmedpositivecasesandpeoplewithanyfeverorrespiratoryconcerns into high riskexposure andlow riskexposuregroups[15].Anothertheoreticalconceptofpredictionmodelswereestablishedforthediagnosisandprognosis ofinfection[16].Scheme 2showsthemethodologydevelopedforsensingofvirus.

Scheme2:MethodologyofCOVID-19testingatdifferentdiagnosticcenters.

Furtherdiagnosis is done using deeplearning of genomic sequences i.e.estimation of C index. While otherapproachistodeterminedirectbilirubinand alanine transaminase. Evenchances in lung periphery on chestcomputed tomography (CT) scan,normalor reduced white blood cellcountwereindicativeofpositivesample.Nucleicacidtestingwasalsosuggestedoverthetimeaftercontinuoussetbacksoccurredduetorapidtestingkitsand

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paper-strip based tests giving falsenegative response. In total,thirteenprediction models were proposed tosupportdiagnosisofSARS-CoV[16].Butout of all, quantitative RT-PCR(EnhancedRealTimePolymeraseChainReaction)wasthemostdiscriminativeand reliable one[17]. The drawbackduring evaluations is basicallya highrisk ofbias.Muddled and confusionthoughtsdueto correctexamining ofpatients has marginalized thecommunity due to limitations oftherapy[18,19].Physicaldistancing isthe sole preventive measure andprecaution adopted by the globalplatform[20].Scheme3isadescriptivefigure accounting necessaryprecautionsto befollowed duringthecrisishour.

Scheme 3: Measures to safeguardindividualsfrom thediseaseoutbreak.

Initiallytreatmentisbeinggivenwithacombinationofanti-malaria,anti-HIV,anti-swineflumedicationstocurethe patients of COVID. Anothertreatmentinvolveduseofanegativeiongeneratorinitiatedby'Airon'thathelpsin removing 99% ofviralload.Serumplasmatherapyisanotherapproachthatis extracted from cured patients ofinvolving antibodies againstthe virus,butthetechniqueisquiteexpensiveandhas begun its animaltrials.Yet,norobust evidence to supportconvalescent plasma as a routinetreatment has been laid. Use of'hydroxychloroquine' is the basicmedicine support for the cheapertreatment.Thedrugconsumptionmay

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helptocurebutevidencesupportingitsrobustnessandadverseoutcome,ifnotmonitoredwithintimeframecanresultinmistrustamongcommunities.

Research officials areconcentrating on development of asupporting vaccine. Zydus Cadila,pharmaceuticalcompanyisworkingonreplicatingtheviralvectorandusingitinasDNA plasmidvaccine.WhileBharatBiotechandFluGen,biggiantindustriesareexpecting ajointcollaborationfornasalvaccinetrail.Scheme4showsasum up effects ofbeing quarantineduring the pandemic and its positiveoutlookonthesociety.

Scheme 4: Benefits of Quarantineimplementedduetothepandemic.

Conclusion

Initiallybafflingdecisionwasmadeinconcern ofoutbreakafterthesuddenoccurrenceofapandemicinhaphazardfashion. A systematic approach isnecessaryto curb theinfection along

withnecessarypoliciestobeappraisedbyvariousgovernmentalorganizationsintheworld.Tomitigatetheburdenonhealthcaresystems,itisquitevitalforeffective diagnosis and prognosis.Providing psychotropic medication forthe pandemichasjeopardized due tolackofpsychopharmacologyand onlypolicies are being put forward forquarantine.During such a disastroussituation of pandemic,internationallycountrieshavestrengthened theirtieswith helping each otherwith medicalsupplies, medical manpower andmotivatingthem tofightagainstCOVID-19.Thesoleintentionofallmajorhealthorganizationsistoprotecttheirpeoplefrom pandemicviaempiricaland pre-emptivemeasures.Nevertheless,thereis a long way to go in completelyachievingthediseasecontrol.

AUTHORINFORMATION

CorrespondingAuthor

MansiGandhi*,Emails;mansigandhi.mg@gmail.com;mansi.gandhi@vit.ac.in;Phone:+91-8860409051

GandhiMansi:0000-0002-5266-4960

ACKNOWLEDGMENTIwouldliketothanktheIndianCouncilofMedicalResearchfortheawardofherseniorresearch fellowship (2019-4952).Iwould thank my Guide Mr.Rajagopal Desikan and ResearchAdvisorDr.AnnamalaiSenthilKumarforgivingmeaplatform towork.

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