Last Updated on February 12, 2020 by Sagar Aryal
In the past two decades, we have witnessed epidemic and pandemic, severe respiratory tract illnesses, whose etiological pathogens are viruses. They include H5N1 influenza in 1997, severe acute respiratory syndrome (SARS) in 2003 and pandemic H1N1 influenza in 2009, epidermic MERS-CoV in 2012 and just recently the emergence of the novel coronavirus, SARS-CoV-2 Acute Respiratory Disease. These sequence of the viral respiratory illness outbreaks has brought to perspective the urgency in emergency response to outbreaks.
During an outbreak of a severe infection, the implementation of Infection Prevention and Control measures are key to ensuring they are contained and if guarded by surveillance and monitoring programs, they can be controlled, reducing infectivity and spread. Though these programs may be effective, they may not control the mechanisms related to the clinical significance caused by these viral pathogens, on those affected and infected.
A need to understand these viruses further in their pathogenesis mechanisms, immunopathologies, genomic sequences are elements of current research to enhance the development of drugs for treatment and vaccine development. Management and control of infection is the current mechanism of preventing further infections.
Therefore, the WHO, CDC, Chinese Government and authorities of countries affected are working together to ensure patients get effective and accessible care. The hurdle facing the current health situation is the lack of an antiviral drug that can be used to treat the viral infection.
2019 Novel Coronavirus (SARS-CoV-2 Acute Respiratory Disease) is a coronavirus belonging to the genus betacoronavirus, which was identified as the cause of an outbreak of a series of respiratory illnesses first detected in Wuhan, China.
The SARS-CoV-2 Acute Respiratory Disease virus has been labeled as a cousin to the SARS-CoV because of its close genomic resembles the novel coronavirus estimated at 76%. in addition, it has a range of similarities in symptom manifestations
Just like SARS-CoV, the SARS-CoV-2 has enhanced international research Collaboration enabling prompt dissemination of new data and information that is rapidly being shared to enhance clinical research on the treatment of the virus.
Statistically, the death toll is higher as compared to that of SARS-CoV of 2002-2003 but there is also a significant increase in the number of recoveries i. e 17,393 cases of infection confirmed globally 362 deaths (361 in China and 1 in the Philippines)and 487 recoveries as of 2nd February 2020, according to the Chinese Authorities.
This virus causes a cluster of pneumonia infections with patients presented with symptoms ranging from acute illness to progressively severe respiratory illnesses and the mortality rates higher among older individuals with underlying diseases.
Manifestations are mild and/or progressive in some cases to severe symptoms that can eventually lead to death. These include:
- Fever associated with flu-like symptoms of coughing, sneezing, headache, sore throat
- Shortness of breath and breathing difficulties
- Diarrhea after the virus colonizes the epithelial lining of the gastrointestinal tract
- General body weakness and myalgia (fatigue)
Severe symptoms include:
- Hemoptysis, lymphopenia, associated with complications of severe acute respiratory distress syndrome
- Acute cardiac injury, due to lymphopenia
- Lung Inflammatory injury
- Acute Kidney injury
- Septic shock
- Bilateral pneumonia under computed tomography (CT) scan.
The progressive infection causes multi-organ damage which may lead to death.
There is on-going research being conducted by several laboratories all over the world on developing new antiviral drugs against the novel coronavirus because currently there is no specific treatment that has been proven and confirmed by Scientific Research, for use.
When the outbreak was initially reported by the WHO, the initial treatment that was given the first patients was corticosteroids. Corticosteroids act to reduce anti inflammations caused by severe pneumonia episodes, an original treatment given to patients who first contracted the H1N1 viral infection.
As the understanding of the disease progressed, the CDC started testing existing treatments for pneumonia to manage the patients’ pneumonia-like symptoms.
Currently, the anti-novel coronavirus Remdesivir is under clinical trial by several medical institutions, aiming at studying the safety and effectiveness of the drug. Remdesivir is an antiviral drug, a novel nucleotide analog prodrug, that was initially produced to treat ebola but its efficiency was lower, as compared to other drugs. However, the producing company Gilead has proved that the drug has efficiency against MERS, and practically when it was administered to the first patient in the USA with the COVID-19, he showed improvement on the first day of administration.
Investigations into the effectiveness of existing broad-spectrum antivirals, such as protease inhibitors
- Saquinavir and
- Lopinavir and Carfilzomid
- Anti-respiratory syncytial virus drugs, anti-schizophrenia drugs, immunosuppressants
- Traditional Chinese medicinal drugs e. g Polygonum cuspidatum.
- RNA polymerase inhibitor redelivers, triazavirin, interferon-beta, which have shown some level of effectiveness in animal models against MERS-CoV, are also under investigation for the treatment of SARS-CoV-2 Acute Respiratory Disease.
Video on Treatment Trials for nCoV (Remdesivir, Chloroquine)
Update: Progress in Vaccine Development
The isolation of the virus and gene sequencing were among the first incentives that lead to Agencies and Health Organisations initiate the process of vaccine development.
With the availability of the gene sequences for the SARS-CoV-2 which was made public by the WHO and Chinese authorities, made it possible to move to the next phase of vaccine development, without the need for a sample of the virus.
Organizations like the National Institute of Allergy and Infectious Disease under the umbrella of the National Institute of Health, with several funding organizations, have been given the mandate to develop a viable vaccine within three months, to begin testing for safety and efficiency.
Some scientists have a concept of preparing an RNA vaccine from the surface viral spikes of the virus, which will not expose people to the virus.
In addition, some scientists have come up with a concept of modifying the virals surface proteins i. they intend to add a gene to the viral proteins with the aim of stabilizing the virus but equally, to trick the body into attacking the virus as a foreign body, this will enable the body to produce antibodies against it, thus providing immune responses that will confer immune memory. This approach has been specially called the Molecular Clamp Vaccine Approach. This approach is focused on producing more vaccines against many other pathogens.
Other vaccines that had previously been in development for MERS-CoV and SARS-CoV are also being pursued to be adapted against the novel coronavirus, considering the genetic similarities of these viruses. These include:
- Use of a library of Monoclonal antibodies that have proved to have the potency to treat and prevent the novel Coronavirus.
- Study on the Effectiveness of Sofosbuvir, a drug for Hepatitis C, on its ability to treat the novel Coronavirus.
Video on the Progress in Vaccine Development
Currently, the WHO has declared the COVID-19 Acute Respiratory Disease, viral outbreak a Public Health Emergency of International Concern (PHEIC), due to the increased number of cases in and out of China and the drastic measures several countries have taken in regard to traveling restrictions to and out of China.
As these cases are reported and updated to the global authorities, there is an increase in infected patients registered daily, with no designated treatment against the infection. The agency has given recommendations on how to manage this infection majorly advocating for a point of care supportive systems i.e Early Supportive care.
((Supportive care is care that focuses on relieving symptoms caused by serious illness, without treating the underlying cause of the disease (www.ofshealthcare.org). It involves giving supportive therapy and close monitoring of patients.))
According to the World Health Organisation (WHO), these are the recommended guidelines to be followed by caregivers and health care workers including Practitioners, Clinicians, and laboratory technicians.
- Early screening of patients to detect the presence of the virus, is key in reducing spread. Immediately screening is done and the presence of virus confirmed, the patients should be sorted and quarantined when necessary. This will enhance the implementation of Infection, Prevention Control Mechanisms.
- This is then followed by management of the symptoms by giving supportive therapy and monitoring of symptoms
- Laboratory diagnosis by acquiring and collecting the right samples by trained personnel ONLY.
- management of symptoms especially those of Hypoxemic Respiratory failure and acute respiratory distress syndrome (ARDS) and septic shock
- Prevention of complications and the use of specific and recommended anti-nCoV treatments
- Pregnant patients should be given special health care support
- Maintaining basic hand and respiratory hygiene.
- Avoid close contact, with anyone showing symptoms such as coughing and sneezing.
- Avoid contact with farm or wild animals such as bats.
- The consumption of raw or undercooked animal products should be avoided.
- People can stay at home if they are sick.
- Cleaning and disinfecting frequently touched objects and surfaces.
NOTE WITH CAUTION: Detection of a possible cause of an emerging pathogen causing severe acute respiratory disease should be reported immediately to local, sub local and national health care authorities for immediate action. This includes animal and human infections.
The COVID-19 Acute Respiratory Disease is a novel virus that has surfaced back memories of SARS and MERS.
This has created an opportunity to immensely investigated, their mechanisms of infectivity, spread and persistence and they are being better understood. Several questions remain unanswered, yes, but the essence of research is to find lasting solutions to problems that seem difficult to resolve, momentarily.
Outbreaks have become a phenomenon that has united nations and in particular, the outbreak of the novel coronavirus has brought together countries like China, the USA, Britain, Australia, etc, and institutions of research, scientists and researchers from all over the world. Even manufacturing companies and stakeholders are tirelessly seeking to work to manufacture treatments and find means of preventing a second occurrence of these infections by investigating and funding projects to give a leeway to the unanswered questions. With this kind of support, there is hope that solutions will eventually be found and cub this infection. Epidemiologically, patient recovery has been on the rise and that’s a positive element into the treatment of the virus.
Lastly, this is a review from various authors put together in simplicity and to give hope that a lot is being done to find a treatment and a vaccine/vaccines for the COVID-19 Acute Respiratory Disease.
NOTE: We are all affected and infected in one way or another, we remain hopeful and trust the work of the institutions dedicated to finding lasting solutions.
”You never know how strong you are until being strong is the only choice you have” by Cayla Mills.
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Treatment, Vaccine and Management of COVID-19 (SARS-CoV-2)