Learning Issues

Covid-19 History

A novel coronavirus (termed 2019-nCoV) was reported in December 2019 from genomic screening of clinical samples from patients with viral pneumonia in Wuhan, China.

Through the use of next-generation sequencing, a new, humaninfecting coronavirus, provisionally called 2019 novel coronavirus (2019- nCoV), was identified.

Subsequently, on February 11, 2020, outbreak or disease previously known as “novel coronavirus” or 2019-nCoV was officially renamed as C-O-V-I-D-19 or COVID-19 and causal virus was named as “Severe acute respiratory syndrome-related coronavirus 2” or SARS-CoV-2

Since 31 December 2019 and as of week 2021-2, 94 582 873 cases of COVID-19 (in accordance with the applied case definitions and testing strategies in the affected countries) have been reported, including 2 036 713 deaths.


Virus Replication

Attachment

Viral proteins on the capsid or phospholipid envelope interact with specific receptors on the host cellular surface. This specificity determines the host range (tropism) of a virus.

Penetration

The process of attachment to a specific receptor can induce conformational changes in viral capsid proteins, or the lipid envelope, that results in the fusion of viral and cellular membranes. Some DNA viruses can also enter the host cell through receptor-mediated endocytosis.

Uncoating

The viral capsid is removed and degraded by viral enzymes or host enzymes releasing the viral genomic nucleic acid.

Replication

After the viral genome has been uncoated, transcription or translation of the viral genome is initiated. It is this stage of viral replication that differs greatly between DNA and RNA viruses and viruses with opposite nucleic acid polarity. This process culminates in the de novo synthesis of viral proteins and genome.

Assembly

After de novo synthesis of viral genome and proteins, which can be post-transrciptionally modified, viral proteins are packaged with newly replicated viral genome into new virions that are ready for release from the host cell. This process can also be referred to as maturation.

Virion Release

There are two methods of viral release: lysis or budding. Lysis results in the death of an infected host cell, these types of viruses are referred to as cytolytic. An example is variola major also known as smallpox. Enveloped viruses, such as influenza A virus, are typically released from the host cell by budding. It is this process that results in the acquisition of the viral phospholipid envelope. These types of virus do not usually kill the infected cell and are termed cytopathic viruses.

Coronavirus Structure

Protein Structural

Non-Protein Structural

Spike

Membrane

Envelope

Lipid bilayer

S1

N-Terminal Domain

C-Terminal Domain

strong affinity for human ACE2 (hACE2

Nucleotide

29,904 bp positive-sense non-segmented RNA genome

receptor-binding domain (RBD)

S2

heptad repeat regions and the fusion peptide

SARS-CoV2 Taxonomy

Coronaviruses are enveloped, icosahedral symmetric particles, approximately 80–220 nm in diameter containing a non-segmented, single-strand, positive-sense RNA genome of about 26–32 kb in size

Kingdom

Orthornavirae

Phyllum

Pisuviricota

Class

Pisoniviricetes

Ordo

Nidovirales

Family

Coronaviridae

Genus

Betacoronavirus

Species

Severe Acute Respiratory Syndrome Related Coronavirus

SARS-CoV2 Transmissions

Droplets

Airborne

Fomite

Fecal-oral

Bloodborne

Mother-to-child

Animal-to-human

Pathogenesis of COVID-19

Following viral transmission, SARS-CoV-2 attaches to the surface of the epithelial membrane of the oral cavity, the mucosal membranes of the conjunctiva or the otic canal. ACE 2 protein, which is highly expressed on multiple human cells including type II alveolar cells (AT2), oral, esophageal, ileal epithelial cells, myocardial cells, proximal tubule cells of the kidneys as well as urothelial cells of the bladder is believed to mediate the internalization of SARS-CoV2.

The spike (S) protein of SARS-CoV2 is cleaved by a cellular enzyme named furin at the S1/S2 site. This cleavage is essential for viral entry to the lung cells. The activated S protein is primed by the TMPRSS2 and finally attaches ACE 2 receptors to enter the host cells. The genetic sequence of SARS-CoV-2 is homologous with the SARS-CoV, and the structure of (S) protein of these viruses is highly similar. They both use the same receptor to enter the host cell; however, SARS-CoV-2 binds ACE 2 receptors with tenfold higher affinity.

Pathophysiology of Covid-19

Viral Proliferation in cellsoftissues with more ACE-2 receptors

Calgary-Guide-COVID19-Ver3

Diagnosis of COVID-19

Suspect

at least 3 clinical manifestations + Epidemiological history

Probable

at least 3 clinical manifestations + Epidemiological history + Chest X-Ray shows pneumonia

Confirmed

at least 3 clinical manifestations + Epidemiological history + Chest X-Ray shows pneumonia + PCR (+)


Therapy

Non-pharmacology

Pharmacology

Lopinavir/Ritonavir

Protease inhibitor

Provided good results against SARS-CoV decreased the viral load significantly and provided good results in COVID-19 patients

Arbidol

Inhibits membrane fusion

Lopinavir/ritonavir plus arbidol combination improved significantly the conditions of patients suffering from COVID-19 pneumonia

Interferon therapy

Inhibits many stages of virus replication: viral entry, transcription, replication, translation, assembly

Steroid treatment (Methylprednisolon)

Commonly used for the treatment of SARS patients suffering from severe pneumonia.

Oxygen

Ventilator

Education

Social distancing

Wearing mask

Increased immune balance

Nutrition

Nutritions balance

Fruit, vegetables

Food that contains fibers

Prevention

vaccine

Social distancing

Mask

Complications

Pneumonia and trouble breathing.

Organ failure

A severe lung condition that causes a low amount of oxygen to go through your bloodstream to your organs (acute respiratory distress syndrome)

Prognosis

If possible, the patients should be treated with mixed inhalation of hydrogen and oxygen (H2/O2: 66.6/33.3%). Patients with severe cases of COVID-19 rapidly progressed to ARDS, causing multiple organ failures and even death. Therefore, respiratory symptoms need to be treated urgently.

Islamic perspective of covid-19

And We will surely test you with something of fear and hunger and a loss of wealth and lives and fruits, but give good tidings to the patient, Who, when disaster strikes them, say, "Indeed we belong to Allah, and indeed to Him we will return." Those are the ones upon whom are blessings from their Lord and mercy. And it is those who are the [rightly] guided. [Quran 2:155-57]

DD of COVID19

influenza

Chlamydia pneumoniae

Human metapneumovirus (HmPV)