|Year : 2021 | Volume
| Issue : 4 | Page : 311-320
A current novel perspective approach for coronavirus disease-2019 pandemic outbreak
Md Faruque Ahmad1, M Ali2, Abdul Rahman A. Alsayegh1, Sarfaraz Ahmad3, Nawazish Alam3, Shadma Wahab4, Md Sajid Ali5, Md Tanwir Athar6
1 Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Abha, Kingdom of Saudi Arabia
2 Department of Pharmacognosy, College of Pharmacy, Jazan University, Abha, Kingdom of Saudi Arabia
3 Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Abha, Kingdom of Saudi Arabia
4 Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia
5 Department of Pharmaceutics, College of Pharmacy, Jazan University, Abha, Kingdom of Saudi Arabia
6 Scientific Research Center, Prince Sultan Military Medical City, Riyadh; College of Dentistry and Pharmacy, Buraydah Colleges, Al-Qassim, Kingdom of Saudi Arabia
|Date of Submission||09-Feb-2021|
|Date of Decision||03-Mar-2021|
|Date of Acceptance||19-Jul-2021|
|Date of Web Publication||20-Oct-2021|
Dr. Md Tanwir Athar
Scientific Research Center, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; College of Dentistry and Pharmacy, Buraydah Colleges, Al-Qassim
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Coronavirus disease-2019 is a serious health threat around the globe. Across the world, approximately 142 million people were infected, and three million deaths happened. The fast propagation is also associated with constant anxiety, mental stress, and discomfort in public and health-care professionals. Lack of approved drugs regimen to combat the pandemic challenge concretely is a challenging project for all who are committed to developing remedial assistance. However, the successful development of three vaccines gives a solid roadmap to combat this disease. In this review, we highlighted the current development and challenges of this pandemic.
Keywords: Corona vaccine, coronavirus, coronavirus disease-2019, epidemiology, pathogenesis, virology
|How to cite this article:|
Ahmad MF, Ali M, Alsayegh AR, Ahmad S, Alam N, Wahab S, Ali MS, Athar MT. A current novel perspective approach for coronavirus disease-2019 pandemic outbreak. J Adv Pharm Technol Res 2021;12:311-20
|How to cite this URL:|
Ahmad MF, Ali M, Alsayegh AR, Ahmad S, Alam N, Wahab S, Ali MS, Athar MT. A current novel perspective approach for coronavirus disease-2019 pandemic outbreak. J Adv Pharm Technol Res [serial online] 2021 [cited 2022 Jan 19];12:311-20. Available from: https://www.japtr.org/text.asp?2021/12/4/311/328628
| Introduction|| |
World Health Organization (WHO) confirmed that viral infections are emerging as a serious public health threat. Currently, the virus, coronavirus disease-2019 (COVID-19) has affected so many countries, areas, or territories over 142 million people infected across the world. This disease is caused by a severe acute respiratory syndrome (SARS) that is commonly known as SARS-coronavirus-2 (CoV2). The disease is first started from the city of Wuhan in China in December-2019. Starting from the first identification, it was spread rapidly and a number of cases and death were reported. As of January 30, 2020, the WHO confirmed this outbreak as an international public health emergency. On March 11, 2020, the WHO declared COVID-19 as a pandemic. It has been observed in COVID-19 characteristics that average patients ages are 49–56 years, the mean incubation period is 5.2 days, and the median time of 14 days is noted from the first symptom to death. Male are more than female in hospitalized patients from 54% to 73%. However in the second wave, children are also getting affected by this pandemic. Still, the elders are more susceptible to this disease than the younger. Characteristics of COVID-19 is in [Figure 1].
|Figure 1: An outline highlighting its viral characteristic, animal host, incubation time, and clinical manifestation of coronavirus disease-2019 virus|
Click here to view
| Epidemiology|| |
Pandemic COVID-19 has been spread out globally. As of December 31, the local health authority announced epidemiological alerts and markets were closed all the sudden measures adopted on January 1, 2020. Further, 41 hospitalized patients were identified and confirmed COVID-19 infection on 2nd January. The National Health Commission of China confirmed the death of 17 patients of COVID-19 on January 22, 2020. On January 25, 20202, a total number of 1975 cases and 56 death were confirmed from Mainland China. On January 30, 2020, the cases of this disease increased to 7734. As of February 12, 2020, Taiwan centers for disease control also announced the data comprising the records of 28 countries having 45,167 cases a global update. As of February 23, 2020, it was reported that the number of cases increased 1879 times in comparison to January 10, 2020.
The cases were rapidly increased in aberrant ways throughout the world. At the time of data collection for the manuscript on April 12, 2021, the WHO reported confirmed cases 142,557,268 including 3,037,398 deaths globally. [Figure 2] and [Figure 3] showed the pattern of the global case of COVID infection and related deaths. The COVID-19 spread to 219 countries, areas, and territories. The WHO also revealed recorded statistics on a continent wise, which comprised as 49,564,187 in Europe, 60,006,538 in America, 8,609,860 in Eastern Mediterranean, 2,258,194 in Western Pacific, 18,562,170 in South East Asia, and 3,236,379 in Africa [Figure 4]. However, after the start of the vaccination program in the world, a total of 889,827,023 vaccine doses has also been administered to the world population until April 21, 2021.
|Figure 2: Worldwide accumulative cases of coronavirus disease-2019 pandemic (March–April 2021) as per the WHO report|
Click here to view
|Figure 3: Worldwide accumulative deaths of coronavirus disease-2019 pandemic (March–April 2021) as per World Health Organization report|
Click here to view
|Figure 4: The cases of corona pandemic in World Health Organization region. Data showed that America is most affected by this disease (42.19%) followed by Europe (34.85%), South-East Asia (13.05%), Eastern Mediterranean (6.05%), Africa (2.28%), and Western Pacific (1.59%)|
Click here to view
| Virology|| |
COVID-19 virus is a single-stranded RNA virus 30–32 kb genome having a lot of natural roots. The current strain of the virus comprising four subtypes as alpha (α), beta (β), gamma (γ), and delta (δ) categories where α and β were reported to have enough virulence capacities to infect human beings. The structural proteins of the new virus include spike, nucleocapsid, envelope, and membrane, which constitute a complete structure and mechanistic cascades towards binding and proliferation [Figure 5].
|Figure 5: A schematic diagram of coronavirus disease virion showing RNA (single stranded) containing protein N, embedded inside membrane protein (m) with a projection of spike glycoprotein (s) and hemagglutinin-esterase dimer. The figure is made with BioRender (https://biorender.com/)|
Click here to view
The appearance of the virus is round in shape, having a diameter of 60–100 nm with deactivating properties either by ultraviolet or heating at 56°C. The virus is believed to be killed after application of the usual disinfectant. Observational studies confirm the stability of the virus on plastic and stainless steel surfaces.
Cellular entry of virus and receptor interaction
Coronavirus and its interaction with the renin–angiotensin–aldosterone system are believed to have a reliable step toward the infection. This interaction between coronavirus and angiotensin-converting enzyme-2 (ACE-2) is also considered a potential stage of infection. The primary role of ACE is converting angiotensin I to produce Ang-(1–9). Moreover, it is also available for binding with the spike protein of CoVs. The binding is due to the presence of N-terminal peptidase domain and C-terminal collectrin domain. COVID-19 is also expressed in other nucleoproteins, polyprotein, and a number of membrane proteins that include RNA polymerase, papain-like protease, and accessory proteins.
| Clinical Manifestations and Diagnosis|| |
COVID-19 manifestations have been varied from asymptomatic or minor symptoms to severe complaint and finally, they cause death of the patient. Fever, cough, body ache, muscle fatigue myalgia, and dyspnea are the most common symptom while headache, malaise, diarrhea, and rhinitis were reported in this disease.
Diagnosis of COVID-19 is being carried out through laboratory investigations. The onset of fever, cough, and dyspnea could be primary symptoms for the diagnosis of this disease. The probability of COVID-19 is augmented if patients traveled from the community transmission area or had interacted with a COVID patient as well as the suspected cases in the earlier 14 days. Finally, the suspicious case can be confirmed by performing the various confirmatory tests [Table 1].
|Table 1: Diagnostic test for severe acute respiratory syndrome coronavirus 2 (severe acute respiratory syndrome-coronavirus-2)|
Click here to view
| Pathogenesis|| |
The adherence of COVID-19 virus to ACE-2 receptors in type II pneumocytes forms a complex which stimulates inflammation in the lower respiratory tract. This complex is progressed by type 2 transmembrane enzyme protease (TMPRSS2) in a proteolytic manner leading to the disruption and cleaved out of ACE-2, finally, to activate the s-spike protein. The virus genome is uncoated, transcribed, and translated. Studies suggest that the binding patterns and the mode to trigger up the inflammatory cascade are almost common as in the case of earlier strain (SARS-CoV and novel SARS-CoV-2). This membrane inoculation causes diseased cell outcomes and termination of the cilium normalcy at particular sites. Later on, some specific inflammatory mediators were released. These mediators further stimulate macrophages to release the multiple cytokines interleukin (IL) 1, IL6, and tumor necrosis factor-α. These cytokines get transferred into the bloodstream and cause excessive capillary permeability through the dilatation of smooth muscles [Figure 6]. This vasodilation and increased permeability allow leaking out the plasma and other fluids in interstitial spaces of alveoli leading to alveolar edema hence alveolar collapse and hypoxemia. Due to the release of inflammatory mediators, the multiple organs get influenced to show the abnormalities in the prodromal phase as the major clinical symptoms of high fever, dry cough, high blood pressure, fatigue, myalgia, diarrhea, dyspnea, lymphopenia, RNAaemia, respiratory distress syndrome, secondary superinfections, and acute cardiac injuries.
| Treatment and Management|| |
At the time of preparing this manuscript, there is still no specific treatment available for COVID-19. Despite the facts of minimal recoveries and having no choice, the Food and Drug Administration approved chloroquine and hydroxychloroquine (an antimalarial drug) to be effective somehow as the remedial approach. The treatment is symptomatic; major treatment interventions are mechanical ventilation, hemodynamic support, and oxygen therapy for patients with severe infection. One of the antiviral (lopinavir 400 mg or ritonavir 100 mg BD) treatment approaches has been recommended and aerosol formulation of alpha-interferon twice daily proposed. Other drugs that are widely used around the world to control the complications are fingolimod, methylprednisolone, chloroquine phosphate, hydroxychloroquine sulfate, bevacizumab, leronlimab, ivermectin, and sarilumab. Corona-infected patients can be managed with rehydration therapy, respiratory inhalation therapy, and providing aid to the affected vital organs.
Awareness and dedication can only minimize the spread rate of COVID-19 by strengthening the trust within the communities without having any fear of failure. Strategic recommendations also include the isolation protocols along with the proper use of N95 or FFP3 masks, eye-protective glass, apron, and gloves to prevent the pathogens move [Figure 7].
|Figure 7: An illustration showing the mode of transmission, clinical symptoms and preventive and safety measures for coronavirus disease-2019. The figure is made with BioRender (https://biorender.com/)|
Click here to view
| Social Distancing Impact|| |
Due to the corona pandemic, several countries have declared a state emergency, including developed countries, even having the best infrastructure of the health-care system, which has raised concerns about lasting impacts on civil liberties. Worldwide with social distancing, the most affected system is educational institutes that leads to almost closure of universities, schools, and colleges, which negatively impact learning outcomes. The impact was more distressing for underprivileged children and their families, causing intersperse learning, inadequate nutrition, infant care problems, and subsequent economic expenditure to family members who could not work. This pandemic also affected the financial markets.
| Psychological Impact|| |
This pandemic has a severe psychological impact including a significant degree of mental stress, fear, anxiety, and worry in most of the public, health caregivers, as well as in a specific group of comorbid diseased populations. Stress during this pandemic can comprises concern and fear about health and health condition of relatives, changing and diet practices, trouble in sleeping or concentration, deterioration of chronic health issues, and deteriorating psychological health situations, increase consumption of alcohol, tobacco, or other drugs.
| Vaccine Development|| |
Research scientists throughout the world have been struggling to develop powerful vaccines against COVID-19. Inactivated or weakened virus vaccine, protein-based vaccines, RNA and DNA vaccines, and viral vector vaccines are the types of potential vaccines that are in development. Several vaccines are currently available to overcome this pandemic which include Pfizer-BioNTech, Sinopharm (China), Johnson and Johnson, Novavax (UK), Astrazeneca, Sinovac (China), CanSinoBio, and Gamaleya Research Institute (Russia) [Table 2]. The vaccine for the COVID-19 was first started in December 2020 and until February 15, 2021, 175.3 million vaccine doses have been given. The emergency use licenses were also issued for some vaccines such as Pfizer, AstraZeneca/Oxford, and vaccine developed by Johnson and Johnson. The side effects of the vaccines have also been reported. Thirty-three suspected adverse drug reactions have been found in Norway including some fatal responses after the use of BioNTech and Pfizer vaccines as per the Norwegian Medicines Agency.
|Table 2: Coronavirus disease-2019 candidate vaccines in clinical evaluation|
Click here to view
| Conclusion|| |
More than 15 months passed of this pandemic, some nonpharmacological approaches have been adopted to combat the symptoms of the disease. As a result of this, only social distancing, quarantine, and isolation methods are advised to keep away from the infections. It also leads to a negative impact on the psychological behavior of human beings.
The scientific community has led to the development more than 40 vaccines that are undergoing the clinical trials, including more than 10 in phase III trials and three of them is ended with the positive results. The world is expecting that this vaccination program will be a significant measure to eradicate this pandemic. Other challenges that still need to be addressed are the multiple variants of this virus that is emerging day by day.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). In: StatPearls. FL, USA: StatPearls Publishing; 2020.
Chan JF, Kok KH, Zhu Z, Chu H, To KK, Yuan S, et al.
Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect 2020;9:221-36.
Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al.
The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health–The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;91:264.
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.
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.
Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV). Biosci Trends 2020;14:69-71.
Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol 2020;92:441-7.
Weiss SR, Leibowitz JL. Coronavirus pathogenesis. Adv Virus Res 2011:81:85-164.
Wu F, Zhao S, Yu B, Chen YM, Wang W, Hu Y, et al.
Complete genome characterisation of a novel coronavirus associated with severe human respiratory disease in Wuhan, China. BioRxiv 2020. https://doi.org/10.1101/2020.01.24.919183
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.
Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al
. Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses 2020;12:1-17.
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al.
Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020;382:1564-7.
Vaduganathan M, Vardeny O, Michel T, McMurray JJ, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with COVID-19. N Engl J Med 2020;382:1653-9.
Donoghue M, Hsieh F, Baronas E, Godbout K, Gosselin M, Stagliano N, et al
. A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9. Circ Res 2000;87:E1-9.
Xu X, Chen P, Wang J, Feng J, Zhou H, Li X, et al.
Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci 2020;63:457-60.
Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al.
Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020;69:1002-9.
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al.
Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020;296:E32-40.
Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al
. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med 2005;11:875-9.
Glowacka I, Bertram S, Müller MA, Allen P, Soilleux E, Pfefferle S, et al.
Evidence that TMPRSS2 activates the severe acute respiratory syndrome coronavirus spike protein for membrane fusion and reduces viral control by the humoral immune response. J Virol 2011;85:4122-34.
Mousavizadeh L, Ghasemi S. Genotype and phenotype of COVID-19: Their roles in pathogenesis. J Microbiol Immunol Infect 2021;54:159-63.
Rabi FA, Al Zoubi MS, Kasasbeh GA, Salameh DM, Al-Nasser AD. SARS-CoV-2 and Coronavirus Disease 2019: What We Know So Far. Pathogens 2020;9:1-14.
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.
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.
Ratia K, Pegan S, Takayama J, Sleeman K, Coughlin M, Baliji S, et al
. A noncovalent class of papain-like protease/deubiquitinase inhibitors blocks SARS virus replication. Proc Natl Acad Sci U S A 2008;105:16119-24.
Fisher D, Heymann D. Q and A: The novel coronavirus outbreak causing COVID-19. BMC Med 2020;18:57.
Alexander N, Gibbons K, Marshall S, Rodriguez M, Sweitzer J, Varma K. Implementing Principles of Reimagine Minnesota in a Period of Remote Teaching and Learning: Education Equity in the Age of COVID-19; Minneapolis Foundation, MN, US, 2020.
Ahmad MD, Wahab S, Ali Ahmad F, Intakhab Alam M, Ather H, Siddiqua A, et al
. A novel perspective approach to explore pros and cons of face mask in prevention the spread of SARS-CoV-2 and other pathogens. Saudi Pharm J 2021;29:121-33.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al.
Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res 2020;17:1729.
Torjesen I. Covid-19: Norway investigates 23 deaths in frail elderly patients after vaccination. BMJ 2021;372:n149.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2]