Pharmaspire
× About the Journal Scope of the Journal SPER Publications Editorial Board Abstracting and Indexing Articles in Press Current Issue Archives Submit Article Author Guidelines Advertise Join as Reviewer Contact Editorial Policies and Peer Review Process Journal Policies Publishing Ethics



Review Article
Year : 2020   |  Volume : 12   |  Issue : 3   |  Page : 89-95  

Novel coronavirus: Pathophysiology, symptoms, diagnosis, and management

Suyash Agnihotri, Saranjit Singh, Haamid Rasheed, Sukhbir Kaur

Correspondence Address:Department of Quality Assurance, ISF College of Pharmacy, Moga, Punjab, India

Source of Support: Nil, Conflict of Interest: None declared


DOI: 10.4103/2231-4040.197331

Abstract  

Epidemically increased evidence reveals that the novel coronavirus (COVID-19) virus belongs to the class of severe acute respiratory syndrome and the Middle East Respiratory Syndrome virus. Covid-19 was started from the Wuhan city of China in 2019, and now it gradually affecting the whole world. In this paper, the pathophysiology, symptoms, diagnosis and management of the Covid-19 is discussed briefly. Diagnostic methods used for Covid-19 are serology, and nucleic acid amplification test (NAAT). These tests are done as per the guidelines of World Health Organization (WHO).

Keywords: Novel coronavirus, severe acute respiratory syndrome, path physiology, serology, diagnostic methods, World Health Organization

How to cite this article:
Agnihotri S, Singh S, Rasheed H, Kaur S. Novel coronavirus: Pathophysiology, symptoms, diagnosis, and management. Pharmaspire 2020;12(3):89-95.

INTRODUCTION

syndrome (SARS), and the Middle East Respiratory Syndrome (MERS) are the class of virus belongs to Coronaviruses. SARS appeared in China in 2002 while MERS appeared in 2012 in Saudi Arabia. COVID 19 appeared in 2019 in China. The World Health Organization (WHO) declares COVID-19, a controllable pandemic. The spread of COVID-19 is becoming unbeatably infected by more than 3,870,958 people in 190 countries. The WHO continues to provide advice on precautionary practices and ways to stop the spread of the disease. Therefore, a coordinated global response is seriously required to draw up health systems to meet this unrivaled challenge.[1] Nations that have been unsuitable enough to have been revealing this disease already have, paradoxically, very helpful lessons to pass on. While the containment measures apply in China have at least for the moment-bring down new cases by more than 90%, this depletion is not the case in further countries, including India.[2] India had 59,765 confirmed cases, according to Health Ministry India, till May 9, 2020, and 1986 deaths. Only America has recorded more deaths due to this COVID-19 outbreak. The mean age of India was 60+ (63%) and 20–60 (27%) age groups and more than half of them (56%) were diabetic and almost (47%) have both hypertension and diabetes as well as some of them had cardiac disease also along with hypertension and diabetes. Renal disease, too, was reported in several of those who died.
On March 25, 2020, the Indian Government applied remarkable measures to limit viral transmission-including restricting movement in the region of Indian states that minimize the possibility that people who are not infected come into contact with people who are infected.[3] The resolution is certainly bravery and important, but it is enough. Our national health system’s capacity to efficaciously respond to the needs of those who are already infected and require an intensive care unit (ICU) for acute respiratory distress syndrome and largely due to SARS-COV-2 pneumonia is a matter of grave concern. Pointedly, the percentage of patients admitted to ICU reported day today in India.[4]
In the absence of any known efficacious therapy and because of the circumstances of a “public health emergency,” many drugs have been tried recently in the treatment for COVID-19 that includes a low-cost antimalarial drug chloroquine and its derivative hydroxychloroquine (HCQ), by the side of many other antiviral drugs.[5] HCQ has been approved in the treatment of Type 2 diabetes in India since 2014 as a third- or fourth-line drug. Trials on some of the patients showed better results for COVID-19 patients. Reports assemble as now suggested that some drugs could have the capability for the treating COVID-19.[6,7] There are five hospitals, two from Ahmadabad and one each from Chennai, Jodhpur, and Bhopal, which so far have been approved to conduct randomized controlled clinical trials under the WHO solidarity trial to find an effective treatment for COVID-19. The hospitals, including the All India Institutes of Medical Science in Jodhpur, Apollo Hospitals in Chennai, and B J Medical College and Civil hospitals in Ahmadabad, will be conducting clinical trials on four treatment protocols-redeliver, a combination of lopinavir and ritonavir, HCQ, and lopinavir and ritonavir with interferon beta-1a.

PATHOLOGY OF COVID-19

The COVID-19 is also known as the SARS virus [Figure 1]. Pathology of the Covid-19 till now is known, explained below in the three steps [Figure 2].[8-12]


6602109a-39b4-4573-9f99-9e2a93e37eaa.jpg

TRANSMISSION OF COVID-19

People get the infection through close contact that has the symptoms from the virus, which includes cough and sneezing. Mostly coronavirus spread from the air-born zoonotic droplets.[13] Covid-19 replicates in the epithelium that caused cellular damage and infection at the injection site.[14] According to the study published in 2019, angiotensin-converting enzyme 2, a membrane exopeptidase in receptor used by the coronavirus in entry to human cells.

SYMPTOMS OF COVID-19

Signs and symptoms of Covid-19 may appear or seen from 2 to 14 days after the exposure. Time after exposure and before having symptoms is called the incubation period. The most common symptoms found in the patients of Covid-19 are summarized in Figure 3. The rest of the symptoms are found in very few patients or the patient who are older, or they are suffering from other diseases.[15]

DIAGNOSTIC, TESTING OF COVID-19

It is difficult to find the diagnostic method of COVID-19 in the earlier days of infection, but now there are the various diagnostic methods developed by the WHO. The following recommendations have been made regarding diagnostic, testing, and reporting are mentioned below.

  • Take nasopharyngeal swab for Covid-19, reverse transcriptasepolymerase chain reaction testing (PCR). Check with your facility regarding test characteristics, including sensitivity and specificity[18,19]
  • Differentiating Covid-19 from other circulating respiratory viruses is important particularly influenza, consider testing of usual respiratory pathogens, coinfection has also been reported.[20]

The tests which are performed in the patients of Covid-19 are NAAT and Serology. Table 1 [21,23] states that what the diagnostic tests are performed of the patients of the Covid-19 and also tells about the type of samples which are taken from the patients at needed by the desired time.

TYPES OF COVID-19 TESTING

There are the basic three types of tests that are performed or done for the Covid-19 testing; they are the molecular test, antibody test, and antigen test. These are mentioned in Table 2:

MANAGEMENT OF COVID-19 PATIENTS

Covid-19 management and prevention are being controlled by the infection prevention control (IPC), which is a critical part of the clinical management of patients and should be initiated at the point of entry of the patient to the hospital.[24] Standard precautions should always be routinely applied in all areas of health care facilities. Standard precautions should be taken, which include hand hygiene, use of PPE to avoid direct contact with patients’ blood, body fluids, secretions, and non-intact skins.[25] IPC has also implemented the infection prevention and control measures for patients with suspected or confirmed COVID-19 infection in Table 3.

Present scenario of testing strategy in India

  • All asymptomatic people who have undertaken international travel, they all should stay in home quarantine for 14 days[28]
  • People should be tested only if they become symptomatic (fever, cough, difficulty in breathing, etc.)[29]
  • If the test result of the symptomatic people is positive, then they should be isolated and treated[30]
  • All contacts of laboratory positive cases should stay in home quarantine for 14 days[31]
  • They should be tested only if they become symptomatic, if the test result is positive, then they should be isolated and treated[30]
  • Healthcare workers managing Covid-19 should be tested only if they become symptomatic.[32]

Discharge protocol

The discharge protocol of the patient of Covid-19 is mentioned in Flow Chart 1:[33]

Preventive measures against Covid-19

During this pandemic, a person should keep themselves safe and their family too. Hence, there are the various preventive measures which should be performed by the peoples to protect themselves safe from the Covid-19. Some of the measures are mentioned in Table 4.[34,35]

Case studies

India

In India, the patient was detected with Covid-19 in Kerala’s Trissur district and was kept in an isolation ward while the many other peoples are under observation. The condition of women patient was stable, the women now in the isolation ward at the general hospital in Trissur, is likely to be shifted to the Medical College Hospital. Health officials are awaiting a result of one more test-gene sequencing only after which it can be stated that the patient was affected with the Covid-19.[36] Three others who had returned from China are kept in the isolation wards in Trissur. The four students returned from China; one has been tested positive. Of the total 1053 people who were under observation after traveling to China, as many as 247 arrived in the state.[37]

Japan

On January 15, 2020, the case of Covid-19 was reported by the Ministry of Health, Labor and Welfare, Japan from Wuhan, Hubei, China. The patient was male, age 30–39 years living in Japan.[36] The patient had traveled to Wuhan, China, in December and had a fever on January 3, 2020, while staying in Wuhan. He has indicated that he was in close contact with a person with pneumonia. On January 6, 2020, he returned to Japan and tested negative for influenza when he visited a local clinic on the same day. On January 10, 2020, due to his continuous symptoms of cough, sore throat, and fever, when he visited a local hospital and was found to have abnormal chest X-ray with infiltrates.[38] He was admitted to the hospital on the same day and remained fevered. On January 14, 2020, the doctor notified the case to a local public health authority under the surveillance system for “unidentified serious infectious illness.” The sample was collected and sent to the National Institute of Infectious Disease (NIID), and at NIID, PCR testing and sequencing was performed, which identified a very small amount of Covid-19 RNA on January 15, 2020.[39]

The spread of Covid-19 in India

Covid-19 registered cases and the registered deaths in the different states of India, as per the report of the Ministry of Health and Family Welfare, May 14, 2020, is mentioned in Table 5.

CONCLUSION

Covid-19 is a deadly disease that is first witnessed in Wuhan city of China. After that, this disease is now spreading the nearly whole world and it has also shown its harsh effect in some of the top economic countries. The infection is transmitted through droplet infection. The symptoms that are mostly found in the patients are fever, dry cough, and fatigue. The various tests that are performed to check the patients for Covid-19 infection are, according to the WHO, are NAAT and serology. Till now, no clinically proven medicine is made for the treatment of Covid-19. The measures to stay away from the disease are just to take precautions and do not come in contact with the infected person.

ACKNOWLEDGMENT

The authors are grateful to the Chairman and Department of Quality Assurance, ISF College of Pharmacy, Moga, Punjab, India, for providing necessary facilities to complete the research work.

REFERENCES
  1. Thomson S, Foubister T, Mossialos E. Financing Health Care in the European Union: Challenges and Policy Responses. Geneva: World Health Organization, Regional Office for Europe; 2009.
  2. Simms MC, Myers SL. The Economics of Race and Crime. United States: Transaction Publishers; 1988.
  3. Tatem AJ, Rogers DJ, Hay SI. Global transport networks, and infectious disease spread. Adv Parasitol 2006;62:293-343.
  4. Levy MM, Baylor MS, Bernard GR, Fowler R, Franks TJ, Hayden FG, et al. Clinical issues and research in respiratory failure from severe acute respiratory syndrome. Am J Respir Crit Care Med 2005;171:518-26.
  5. Singh AK, Singh A, Shaikh A, Singh R, Misra A. Chloroquine and hydroxychloroquine in the treatment of COVID-19 with or without diabetes: A systematic search and a narrative review with a special reference to India and other developing countries. Diabetes Metab Syndr 2020;14:241-6.
  6. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak-an update on the status. Mil Med Res 2020;7:1-10.
  7. Favalli EG, Ingegnoli F, De Lucia O, Cincinelli G, Cimaz R, Caporali R. COVID-19 infection and rheumatoid arthritis: Faraway, so close? Autoimmun Rev 2020;19:102523.
  8. Ou X, Liu Y, Lei X, Li P, Mi D, Ren L, et al. Characterization of spike glycoprotein of SARS-CoV-2 on virus entry and its immune cross-reactivity with SARS-CoV. Nat Commun 2020;11:1-12.
  9. Zhou Y, Lu K, Pfefferle S, Bertram S, Glowacka I, Drosten C, et al. A single asparagine-linked glycosylation site of the severe acute respiratory syndrome coronavirus spike glycoprotein facilitates inhibition by mannose-binding lectin through multiple mechanisms. J Virol 2010;84:8753-64.
  10. Li H, Liu L, Zhang D, Xu J, Dai H, Tang N, et al. SARS-CoV-2 and viral sepsis: Observations and hypotheses. Lancet 2020;395:1517-20.
  11. Ji HL, Zhao R, Matalon S, Matthay MA. Elevated plasmin (ogen) as a common risk factor for COVID-19 susceptibility. Physiol Rev 2020;100:1065-75.
  12. Fung SY, Yuen KS, Ye ZW, Chan CP, Jin DY. A tug-of-war between severe acute respiratory syndrome coronavirus 2 and host antiviral defence: Lessons from other pathogenic viruses. Emerg Microbes Infect 2020;9:558-70.
  13. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433.
  14. Zhou D, Dai SM, Tong Q. COVID-19: A recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. J Antimicrob Chemother 2020;75:1667-70.
  15. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020;17:259-60.
  16. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: An observational cohort study. Lancet Infect Dis 2020;20:698-96.
  17. Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci 2020;63:706-11.
  18. Li Z, Yi Y, Luo X, Xiong N, Liu Y, Li S, Sun R, Wang Y, Hu B, Chen W, Zhang Y. Development and clinical application of a rapid IgM‐IgG combined antibody test for SARS‐CoV‐2 infection diagnosis. J Med Virol 2020;2020:25727.
  19. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 2020;92:589-94.
  20. Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr 2020;87:281-6.
  21. World Health Organization. Laboratory Testing for Coronavirus Disease 2019 (COVID-19) in Suspected Human Cases: Interim Guidance. Geneva: World Health Organization; 2020.
  22. Lieberman D, Shleyfer E, Castel H, Terry A, Harman-Boehm I, Delgado J, et al. Nasopharyngeal versus oropharyngeal sampling for isolation of potential respiratory pathogens in adults. J Clin Microbiol 2006;44:525-8.
  23. Winichakoon P, Chaiwarith R, Liwsrisakun C, Salee P, Goonna A, Limsukon A, et al. Negative nasopharyngeal and oropharyngeal swabs do not rule out COVID-19. J Clin Microbiol 2020;58:e00297-20.
  24. Hopman J, Allegranzi B, Mehtar S. Managing COVID-19 in low-and middleincome countries. JAMA 2020;323:1549-50.
  25. World Health Organization. Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-care Settings, with Focus on Ebola. Geneva: World Health Organization; 2014.
  26. World Health Organization. Considerations for Quarantine of Individuals in the Context of Containment for Coronavirus Disease (COVID-19): Interim Guidance. Geneva: World Health Organization; 2020.
  27. World Health Organization. Protocol for Assessment of Potential Risk Factors for Coronavirus Disease 2019 (COVID-19) Among Health Workers in a Health Care Setting. Geneva: World Health Organization; 2020.
  28. Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep 2015;9:547-53.
  29. Day MJ. Covid-19: Identifying and isolating asymptomatic people helped eliminate virus in Italian village. BMJ 2020;368:m1165.
  30. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM, et al. Infectious diseases society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643-54.
  31. Ghinai I, McPherson TD, Hunter JC, Kirking HL, Christiansen D, Joshi K, et al. First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet 2020;395:1137-44.
  32. Hellewell J, Abbott S, Gimma A, Bosse NI, Jarvis CI, Russell TW, et al. Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. Lancet Glob Health 2020;8:e488-96.
  33. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020;46:846-8.
  34. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19), in Statpearls. Treasure Island, FL: StatPearls Publishing; 2020.
  35. Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: A scoping review. Infect Dis Poverty 2020;9:1-12.
  36. Bhattacharya S, Sharma P, Mathur H, Rasheed H, Singh S, Rajput G, et al. Recent apprise on coronavirus and its terrible insinuations. Virusdisease 2020;31:1-7.
  37. Wyndham DJ. Misdiagnosis or miscarriage of justice? Dr. Norman haire and the 1919 influenza epidemic at newcastle hospital. Health Hist 2000;2:3-26.
  38. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.
  39. Khan N, Naushad M. Effects of Corona Virus on the World Community. SSRN Electron J 2020;2020:2139.