Received: 14 April 2020 | Accepted: 28 July 2020

DOI: 10.1111/ijcp.13637

R E V I E W A R T I C LE
INFECTIOUS DISEASES

Review on the coronavirus disease (COVID-19)

pandemic: Its outbreak and current status

Dalia Almaghaslah1 | Geetha Kandasamy1 | Mona Almanasef1 |

Rajalakshimi Vasudevan1 | Sriram Chandramohan2

1
Department of Clinical Pharmacy,
College of Pharmacy, King Khalid Abstract
University, Abha, Saudi Arabia Background: In late December 2019 and on 1st January 2020, the
2
Department of Public health, Saudi
coronavirus (COVID-19) infecting humans was first identified in Wuhan,
Electronic University, Riyadh, Saudi
Arabia Hubei Province, China. Later cases have also been confirmed worldwide.

Correspondence
Coronaviruses are RNA viruses that are phenotypically and genotypically
Dalia Almaghaslah, Department of diverse. Globally, as of 6th April 2020, laboratory confirmed cases of
Clinical Pharmacy, College of
Pharmacy, King Khalid University,
COVID-19 reported to the World Health Organisation (WHO) amounted to
Alsamer Campus, Kingdom of Saudi 1 211 214, including 67 666 deaths.
Arabia, Abha 61441, Saudi Arabia.
Email: damoazle@[Link]
Aim: In the current study, we performed a literature review on
coronavirus outbreak to summarise details about the pathogenesis,
Funding information
This research did not receive any
epidemiology, diagnosis and the man- agement strategies for the disease
specific grant from funding agencies control.
in the public, commercial or not-for-
profit sectors. Pathogenesis: Coronaviruses are tremendously precise and mature only
in differ- entiated respiratory epithelial cells, as seen in both organ
cultures as well as human volunteers. This virus will cause the antiviral T-
cell response to be erratic, owing to the T-cell apoptosis activation,
triggering the immune system to collapse.
Transmission: The understanding of the transmission of COVID-19 risk is
incomplete. The transmission mainly occurs through the respiratory
droplets once an infected person sneezes, like the spread of flu and other
respiratory infectious agents.
Clinical presentation: Presentations of COVID-19 includes fever, cough,
shortness of breath, malaise and respiratory distress.
Treatment: There have been no approved vaccines available for COVID-
19 until today. The Ministry of Science and Technology in the People’s
Republic of China declared three potential antiviral medicines suitable for
treating COVID-19. Those three medicines are, namely, favilavir,
chloroquine phosphate and remdesivir. Hydroxychloroquine combined
with azithromycin enhances the reduction of the viral load in COVID-19
patients.
Conclusion: The corona virus transmits quicker than its two
predecessors the MERS- CoV and SARS-CoV, but has reduced casualty.
The global effects of this latest pan- demic are still unclear. Nevertheless,
considering that so far no vaccine has been available; preventive
approaches are the best way to fight against the virus.
Int J Clin Pract. 2020;74:e13637. © 2020 John Wiley & Sons | 1 of 9
Ltd
[Link]/journal/ijcp
[Link]
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1 | INTRODUC TION 211 214 confirmed cases in the world, distributed in 81

countries, and, of these cases, 67 666 cases died. Of the
According to WHO, in December 2019, several total cases, the United States of America has the largest
pneumonia cases of unknown aetiology were identified in number, with 307 318 cases, followed by 130 759 cases in
the city of Wuhan in cen- tral China. Towards the end of Spain, 128 948 cases in Italy, 95 391 cases in
December 2019, patients presenting with viral pneumonia
because of an unknown microbial agent were reported in
Wuhan, China. A novel coronavirus was subsequently
identified as the causative pathogen, provisionally
named 2019 novel coronavirus (2019-nCoV). On February
11th 2020, WHO an- nounced the rapidly spreading
coronavirus disease as COVID-19. As of 26th January 2020,
more than 2000 cases of COVID-19 infec- tion have been
confirmed, most of which involved people living in or
visiting Wuhan, and human-to-human transmission was
confirmed.1 The initial infected individuals mostly were
linked to exposures
to a seafood market in Wuhan. 2
In 2020, the Chinese
authorities reported 2835 confirmed cases in mainland
China, including 81 deaths. Additionally, 19 confirmed cases
were identified in Hong Kong, Macao and Taiwan, and 39
imported cases were identified in Thailand, Japan, South
Korea, United States, Vietnam, Singapore, Nepal, France,
Australia and Canada. The pathogen was soon iden- tified
as COVID-19, which is closely related to severe acute
respira- tory syndrome CoV (SARS-CoV).3
The Chinese authorities officially announced a novel
coronavi- rus, 2019-n CoV, as the causative agent. 4,5
Coronaviruses (CoV) are a family of viruses called
Coronaviridae. The subfamily Coronavirinae has three
genera, alphacoronavirus, betacoronavirus and gamma-
coronavirus. The subfamily Torovirinae has two genera,
torovirus and bafinivirus. CoV can lead to a range of
conditions as mild as the com- mon cold, fever and cough
and as severe as pneumonia, respiratory distress kidney
failure or even death.6 These viruses are zoonotic, that is,
they are transmitted between animals and humans. A cou-
ple of coronaviruses were previously identified: MERS-CoV,
which causes Middle East respiratory syndrome and was
transmitted from dromedary camels to humans, and SARS-
CoV, which causes severe acute respiratory syndrome and
was transmitted from civet cats to humans. 7,8 COVID-19 is
believed to have been transmitted zoonoti- cally, in a wet
market in Wuhan where game animals and meat were sold.9
However, common human coronaviruses including types
229E, NL63, OC43 and HKU1 cause mild to moderate upper
respiratory tract symptoms, sore throat, runny nose and
cough. Other symp- toms include fever, headache and
general feeling of being unwell. More severe conditions
affecting the lower respiratory tract, such as pneumonia
and bronchitis, are more common in people with car-
diopulmonary illnesses, immune compromised patients,
infants and older adults. These viruses are transmitted from
infected humans to others through air by coughing or
sneezing or close personal contact such as touching or
shaking hands.10
The outbreak of COVID-19 has resulted in a total of 1
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Germany, 83 005 cases in China, 69 607 cases in France, superfam- ily, are further classified according to their
58 226 cases in the Islamic Republic of Iran and 47 810 genera, alpha-, beta-,
cases in the United Kingdom. 11 However, the corona virus'
potential path is uncertain. An overview of this new corona
virus is given in this article. Despite the rapidly developing
awareness about this virus, readers are en- couraged to
refresh themselves periodically.
In the current research, we performed a detailed review
that was widely available to summarise pathogenesis and
ongoing epidemic, epidemiological facts, diagnosis,
disease control approaches and methods of prevention.

2 | METHODOLOGY

The literature search was performed using the following

electronic databases: EMBASE, PubMed and Google
Scholar. Hand search- ing of the reference lists of the
retrieved studies was performed to identify further
relevant publications. Terms and keywords used to
conduct the literature search included the following:
“COVID-19,” “Prevention,” “Pneumonia outbreak” and
“Coronavirus.” Alternative search terms were “2019-
nCoV,” “novel coronaviruses” and “sup- portive care.” The
filters were set to search for studies related to humans and
published in English. Attempts were made to identify all
literature related to COVID-19. Thus, no time limit was set
for the search. Screening of the titles and abstracts of the
retrieved studies was conducted to assess relevance.
Studies included in the current literature review involved
those covering the following important aspects: aetiology,
pathogenesis, mode of transmission, clinical di- agnosis,
special attention to sensitive populations, clinical manage-
ment and treatment; and early supportive therapy and
monitoring. Studies that do not cover any of the above-
mentioned items were excluded. Data were extracted only
from the full-text articles, WHO interim guidelines and also
from the Centres for Disease Control and Prevention (CDC).

3 | AETIOLOGY

The aetiologic source responsible for the cluster of

pneumonia cases in Wuhan was clearly identified as a
novel betacoronavirus (same family as SARS-CoV and
MERS-CoV) through next-generation se- quencing (NGS)
from cultured virus or from several pneumonia pa- tients’
samples. Electron microscopic imaging shows a virus with
a crown morphology, which gives it the name coronavirus.
Genetic amplification assays were established as a result
of sequence infor- mation and used by laboratories linked
with the China Centre for Disease Control (CCDC) to
identify numerous cases in the future.12

4 | VIROLOGY

Coronaviruses, a family of viruses within the nidoviruses

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gamma- and deltacoronaviruses (α-, β-, γ- and δ-). Among different receptors. For 229E and OC43, amino peptidase-N
those, alpha and beta species are capable of contaminating (AP-N) and a sialic acid containing receptor, respectively,
only mam- mals, whereas the other two genera can infect were known to function in this role. After the virus
birds and could also infect mammals.13,14 Two of these
genera belong to human coro- naviruses (HCoVs): α-
coronaviruses, which comprise human coro- navirus 229E
(hcov229E) and human coronavirus NL63 (hcovNL63), and
β-coronaviruses, which are human coronavirus HKU1,
human coronavirus OC43, MERS-COV (known as Middle East
respiratory syndrome coronavirus) and SARS-CoV (referred
to as severe acute respiratory syndrome coronavirus).15
The severe acute respiratory syndrome CoV-2 (SARS-
CoV-2) is now named novel COVID-19 (coronavirus disease
2019).16 Genome sequencing and phylogenetic research
revealed that the COVID-19- causing coronavirus is a beta-
coronavirus that belongs to the same subtypes as SARS
virus, but still exists in a variant group. The re- ceptor-
binding gene region appears to be very similar to that of
the SARS-CoV and it is believed that the same receptor
would be used for cell entry.17

4.1 | Virion structure and its genome

Coronaviruses are structurally enveloped, belonging to the

positive- strand RNA viruses category that has the largest
known genomes of RNA. The structures of the coronavirus
are more spherical in shape, but their structure has the
potential to modify their morphology in response to
environmental conditions, being pleomorphic. The cap-
sular membrane which represents the outer envelope
usually has glycoprotein projection and covers the nucleus,
comprising a matrix protein containing a positive-strand
RNA. Since the structure pos- sesses 5'-capped and 3'-
polyadenylated ends, it remains identical to the cellular
mRNAs.18 The structure is comprised of hemagglutinin
esterase (HE) (present only in some beta-coronaviruses),
spike (S), small membrane (E), membrane (M) and
nucleocapsid (N), as shown (Figure 1). The envelope
containing glycoprotein is responsible for attachment to the
host cell, which possesses the primary anti-genic epitopes
mainly those recognised by neutralising antibodies. The
spike S-protein being in a spike form is subjected to a
structural rear- rangement process so that fusing the outer
membrane of the virus with the host-cell membrane
becomes easier.19,20 Recent SARS-CoV work has also shown
that the membrane exopeptidase ACE enzyme (angiotensin-
converting enzyme) functions as a COVID-19 receptor to
enter the human cell.21

4.2 | Viral replication

Usually replication of coronavirus occurs within the

cytoplasm and is closely associated with endoplasmic
reticulum and other cellular membrane organelles. Human
coronaviruses are thought to invade cells, primarily through
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incomplete.16 In addition, while the newer patients had no

FI G U R E 1 Virion structure and its genome

enters the host cell and uncoating process occurs, the

genome is transcribed, and then, translated. A
characteristic feature of replica- tion is that all mRNAs
form an enclosed group of typical 3′ ends; only the special
portions of the 5′ ends are translated. In total, about 7
mRNAs are produced. The shortest mRNA codes and the
others can express the synthesis of another genome
segment for nucleopro- tein. At the cell membrane, these
proteins are collected and genomic RNA is initiated as a
mature particle type by burgeoning from inter- nal cell
membranes.22,23

5 | PATHOGENESIS

Coronaviruses are tremendously precise and mature in

most of the airway epithelial cells as observed through
both in vivo and in vitro experiments. There is an
enhanced nasal secretion observed along with local
oedema because of the damage of the host cell, which fur-
ther stimulates the synthesis of inflammatory mediators.
In addition, these reactions can induce sneezing, difficulty
breathing by causing airway inhibition and elevate
mucosal temperature. These viruses, when released,
chiefly affect the lower respiratory tract, with the signs
and symptoms existing clinically. Also, the virus further
affects the intestinal lymphocytes, renal cells, liver cells
and T-lymphocytes. Furthermore, the virus induces T-cell
apoptosis, causing the reaction of the T-cell to be erratic,
resulting in the immune system’s complete collapse.24,25

5.1 | Mode of transmission

In fact it was accepted that the original transmission

originated from a seafood market, which had a tradition of
selling live animals, where the majority of the patients had
either worked or visited, although up to now the
understanding of the COVID-19 transmission risk remains
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exposure to the market and still got the virus from the specimen samples from the suspected in- dividual is
humans pre- sent there, there is an increase in the outbreak considered to be one of the main principles for control- ling
of this virus through human-to-human transmission, with and managing the outbreak of the disease in a country.
the fact that it has become widespread around the globe. The
This confirms the fact similar to the previous epidemics,
including SARS and MERS, that this coronavirus exhibited
potential human-to-human transmission, as it was recently
declared a pandemic by WHO.26
Respiratory droplets are the major carrier for
coronavirus trans- mission. Such droplets can either stay in
the nose or mouth or enter the lungs via the inhaled air.
Currently, it is known that COVID-19’s transmission from
one person to another also occurs through touch- ing either
an infected surface or even an object. With the current
scant awareness of the transmission systems however,
airborne safety measures with a high-risk procedure have
been proposed in many countries. Transmission levels, or
the rates from one person to another, reported differ by
both location and interaction with in- volvement in infection
control. It is stated that even asymptomatic individuals or
those individuals in their incubation period can act as
carrier of SARS-CoV2.27,28 With the data and evidence
provided by the CDC, the usual incubation period is
probably 3 to 7 days, some- times being prolonged up to
even 2 weeks, and the typical symptom occurrence from
incubation period to infection takes an average of
12.5 days.29

6 | CLINIC AL DIAGNOSIS

The symptoms of COVID-19 remain very similar to those of

the other respiratory epidemics in the past, which include
SARS and MERS, but here the range of symptoms includes
mild rhinitis to septic shock. Some intestinal disturbances
were reported with the other epidemics, but COVID-19 was
devoid of such symptoms. When examined, unilateral or
bilateral involvement compatible with viral pneumonia is
observed in the patients, and bilateral multiple lobular and
sub-segmental consolidation areas were observed in
patients hospitalised in the intensive care unit. Comorbid
patients showed a more severe clinical course than
predicted from previous epidemics. Diagnosis of COVID-19
includes the complete history of travel and touch, with
laboratory testing. It is more preferable to choose
serological screening, which can help to analyse even the
asymptomatic infections; several serological tests are in
progress for SARS-CoV-2.14,30

6.1 | Laboratory testing for coronavirus disease

2019 (COVID-19) in suspected human cases

The assessment of the patients with COVID-19 should be

based on the clinical features and also epidemiological
factors. The screening protocols must be prepared and
followed per the native context.31 Collecting and testing of
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suspected cases must be screened thoroughly in order to specimens, viral sequencing is also quite useful in
detect the virus with the help of nucleic acid amplification monitoring the viral genomic muta- tions, which plays a
tests such as reverse transcription polymerase chain very significant role in influencing the perfor- mance of the
reaction (RT-PCR). If a country or a particular region does medical countermeasures inclusive of the diagnostic
not have the facility to test the specimens, the specimens
of the suspected individual should be sent to the nearest
reference laboratories per the list provided by WHO.32
It is also recommended that the suspected patients be
tested for the other respiratory pathogens by performing
the routine labora- tory investigation per the local
guidelines, mainly to differentiate from other viruses that
include influenza virus, parainfluenza virus, adenovirus,
respiratory syncytial virus, rhinovirus, human metap-
neumovirus and SARS coronavirus. It is advisable to
distinguish COVID-19 from other pneumonias such as
mycoplasma pneumonia, chlamydia pneumonia and
bacterial pneumonia.33 Several published pieces of
literature based on the novel coronavirus reported in China
declared that stool and blood samples can also collected
from the suspected persons in order to detect the virus.
However, respiratory samples show better viability in
identifying the virus, in comparison with the other
specimens.34-36

6.2 | Nucleic acid amplification tests (NAAT)

for
COVID-19 virus

The gold standard method of confirming the suspected

cases of COVID-19 is carried out by detecting the unique
sequences of virus RNA through reverse transcription
polymerase chain reaction (RT- PCR) along with nucleic
acid sequencing if needed. The various genes of virus
identified so far include N, E, S (N: nucleocapsid pro- tein,
E: envelope protein gene, S: spike protein gene) and RdRP
genes (RNA-dependent RNA polymerase gene).32

6.3 | Serological testing

Serological surveys are also considered to be one of the

most effec- tive ones in facilitating outbreak investigation
and it also helps us to derive a retrospective assessment of
the disease by estimating the attack rate.32 According to
the recent literature, paired serum samples can also help
clinicians to diagnose COVID-19 in case of false negative
results in NAAT essays.37 The literature also declared that
the com- mercial and non-commercial serological tests are
under consideration in order to support the practising
clinicians by assisting them in diag- nosis. Similarly, there
are studies published on COVID-19 which are comprised of
the serological data on clinical samples.38,39

6.4 | Viral sequencing

Apart from confirming the presence of virus in the

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test. Genomic sequencing of the virus can also help further COVID-19 are considered persons under investigation (PUI)
in devel- oping several studies related to molecular and should be temporarily separated from the mother and
epidemiology. 32
isolated.46

6.5 | Specimen collection and storage

A Nasopharyngeal and oropharyngeal swab should be

collected using Dacron or polyester flocked swabs. It should
be transported to the laboratory at a temperature of 4°C
and stored in the labora- tory between 4 and −70°C on the
basis of the number of days and, in order to increase the
viral load, both nasopharyngeal and oropharyn- geal swabs
should be placed in the same tube. Bronchoalveolar lav-
age and nasopharyngeal aspirate should be collected in a
sterile container and transported similarly to the laboratory
by maintain a temperature of 4°C.
Sputum samples, especially from the lower respiratory
tract, should be collected with the help of a sterile container
and stored, whereas tissue from a biopsy or autopsy should
be collected using a sterile container along with saline.
However, both should be stored in the laboratory at a
temperature that ranges between 4 and −70°C. Whole
blood for detecting the antigen, particularly in the first week
of illness, should be collected in a collecting tube and stored
in the laboratory between 4 and −70°C. Urine samples
must also be col- lected using a sterile container and stored
in the laboratory at a tem- perature that ranges between 4
and −70°C.32

7 | PREGNANCY

Currently, there is a paucity of knowledge and data related

to the consequences of COVID-19 during pregnancy. 40-42
However, preg- nant women seem to have a high risk of
developing severe infec- tion and complications during the
recent 2019-nCoV outbreak.41-43 This speculation was based
on previous available scientific reports on coronaviruses
during pregnancy (SARS-CoV and MERS-CoV) as well as the
limited number of COVID-19 cases. 41-43 Analysing the clinical
features and outcomes of 10 newborns (including two sets
of twins) in China, whose mothers are confirmed cases of
COVID- 19, revealed that perinatal infection with 2019-nCoV
may lead to adverse outcomes for the neonates, for
example, premature labour, respiratory distress,
thrombocytopenia with abnormal liver function and even
death.44 It is still unclear whether or not the COVID-19
infection can be transmitted during pregnancy to the foetus
through the transplacental route.42 A recent case series
report, which as- sessed intrauterine vertical transmission
of COVID-19 infection in nine infants born to infected
mothers, found that none of the infants tested positive for
the virus.45 Likewise, there was no evidence of intrauterine
infection caused by vertical transmission in the SARS and
MERS epidemics.43
The CDC asserts that infants born to mothers with
confirmed
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7.1 | Breastfeeding and infant care exposure to COVID-19 during outbreaks.53

The data available to date is limited and cannot confirm

whether or not COVID-19 can be transmitted through
breast milk.40 Assessing the presence of COVID-19 in
breast milk samples from six patients showed negative
result.45 The CDC points out that in case of a con- firmed
or suspected COVID-19 infection, the decision of
whether or how to start or continue breastfeeding should
be made by the mother in collaboration with the family
and healthcare practition- ers.47 Careful precautions need
to be taken by the mother to prevent transmitting the
disease to her infant through respiratory droplets during
breastfeeding. This includes wearing a facemask and
practis- ing hand hygiene before feeding the baby. In
addition, it is advisable that breast pumps are cleaned
properly after each use and, if pos- sible, a healthy
individual is available to feed the expressed breast milk to
the infant.42

7.2 | Children and elderly population

On the basis of the available reports, COVID-19 among

children ac- counted for 1-5% of the confirmed cases, and
this population does not seem to be at higher risk for the
disease than adults. There is no difference in the COVID-
19 symptoms between adults and children. However, the
available evidence indicated that children diagnosed with
COVID-19 have milder symptoms than the adults, with a
low mortality rate.48,49 On the contrary, older people who
are above the age of 65 years are at higher risk for a
severe course of disease. In the United Stated,
approximately 31-59% of those with confirmed COVID-19
between the ages of 65 and 84 years old required hospi-
talisation, 11-31% of them required admission to the
intensive care unit, and 4-11% died.50

8 | PRE VENTION

The WHO and other agencies such as the CDC have

published pro- tective measures to mitigate the spread of
COVID-19. This involves frequent hand washing with
handwash containing 60% of alcohol and soap for at least
20 seconds. Another important measure is avoiding close
contact with sick people and keeping a social dis- tance of
1 metre always to everyone who is coughing and sneez-
ing. Not touching the nose, eyes and mouth was also
suggested. While coughing or sneezing, covering the
mouth and nose with a cloth/tissue or the bent elbow is
advised. Staying at home is rec- ommended for those who
are sick, and wearing a facial mask is advised when going
out among people. Furthermore, it is recom- mended to
clean and sterilise frequently touched surfaces such as
phones and doorknobs on a daily basis. 51,52 Staying at
home as much as possible is advisable for those who are
at higher risk for severe illness, to minimise the risk of
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9 | VACCINES 12 | E ARLY SUPPORTIVE THER APY AND

MONITORING
The strange coronavirus outbreak in the Chinese city of
Wuhan, now termed COVID-19, and its rapid transmission, Management of patients with suspected or documented
threatens people around the world. Because of its pandemic COVID-
nature, the National Institutes of Health (NIH) and 19 consists of ensuring appropriate infection control
and
pharmaceutical companies are involved in the devel- opment
of COVID-19 vaccines. Xu Nanping, China’s vice-minister of
science and technology, announced that the first vaccine is
expected to be ready for clinical trials in China at the end of
April 2020.54 There is no approved vaccine and treatment
for COVID-19 infections.
Vaccine development is sponsored and supported by the
Biomedical Advanced Research and Development Authority
(BARDA), a compo- nent of the Office of the Assistant
Secretary for Preparedness and Response (ASPR). Sanofi
will use its egg-free, recombinant DNA tech- nology to
produce an exact genetic match to proteins of the virus.55

10 | RECOMBINANT SUBUNIT VACCINE

Clover Biopharmaceuticals is producing a recombinant

subunit vac- cine based on the trimeric S-protein of COVID-
19.55 The oral recom- binant vaccine is being expanded by
Vaxart in tablet formulation, using its proprietary oral
vaccine platform.

11 | CLINIC AL MANAGEMENT AND

TRE ATMENT

In severe COVID-19 cases, treatment should be given to

support vital organ functions. People who think they may
have been ex- posed to COVID-19 should contact their
healthcare provider imme- diately. Healthcare personnel
should care for patients in an Airborne Infection Isolation
Room (AIIR). Precautions must be taken by the healthcare
professional, such as contact precautions and airborne
precautions with eye protection.56
Individuals with a mild clinical presentation may not
require pri- mary hospitalisation. Close monitoring is
needed for the persons infected with COVID-19. Elderly
patients and those with prevailing chronic medical
conditions such as lung disease, heart failure, can- cer,
cerebrovascular disease, renal disease, diabetes, liver
disease and immunocompromising conditions and
pregnancy are risk factors for developing severe illness.
Management includes implementation of prevention and
control measures and supportive therapy to man- age the
complications, together with advanced organ support.57
Corticosteroids must be avoided unless specified for
chronic obstructive pulmonary disease exacerbation or
septic shock, as it is likely to prolong viral replication as
detected in MERS-CoV patients.58
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supportive care. WHO and the CDC posted clinical Technology from the People’s Republic of China declared
guidance for COVID-19.59 three potential antiviral medi- cines suitable for treating
Immediate therapy of add-on oxygen must be started COVID-19. Those three medicines are,
for pa- tients with severe acute respiratory infection (SARI)
and respira- tory distress, shock or hypoxaemia. Patients
with SARI can be given conservative fluid therapy only
when there is no evidence of shock. Empiric antimicrobial
therapy must be started to manage SARI. For patients with
sepsis, antimicrobials must be administered within 1 hour
of initial assessments. The WHO and CDC recommend that
glucocorticoids not be used in patients with COVID-19
pneumonia except where there are other indications
(exacerbation of chronic obstructive pulmonary disease). 59
Patients’ clinical deterioration is closely observed with
SARI; however, rapidly progressive respiratory failure and
sepsis require immediate supportive care interventions
comprising quick use of neuromuscular blockade and
sedatives, hemodynamic management, nutritional support,
maintenance of blood glucose levels, prompt assessment
and treatment of nosocomial pneumonia, and prophy- laxis
against deep venous thrombosis (DVT) and gastrointestinal
(GI) bleeding.60 Generally, such patients give way to their
primary illness to secondary complications like sepsis or
multiorgan system failure.48

13 | CONVALESCENT PL ASMA THER

APY

Guo Yanhong, an official with the National Health

Commission (NHC), stated that convalescent plasma
therapy is a signifi- cant method for treating severe
COVID-19 patients. Among the COVID-19 patients currently
receiving convalescent plasma ther- apy in the virus-hit
Wuhan, one has been discharged from hospi- tal, as
reported by Chinese science authorities on Monday, 17th
February 2020 in Beijing. The first dose of convalescent
plasma from a COVID-19 patient was collected on 1st and
9th February 2020 from a severely ill patient who was
given treatment at a hos- pital in Jiangxia District in
Wuhan. The presence of the virus in pa- tients is minimised
by the antibodies in the convalescent plasma. Guiqiang
stated that donating plasma may cause minimal harm to
the donor and that there is nothing to be worried about.
Plasma donors must be cured patients and discharged
from hospital. Only plasma is used, whereas red blood cells
(RBC), white blood cells (WBC) and blood platelets are
transfused back into the donor's body. Wang alleged that
donor’s plasma will totally improve to its initial state after
one or 2 weeks from the day of plasma donation of
around 200 to 300 millilitres.61

14 | ANTIVIR AL THER APY

COVID-19 is an infectious disease caused by SARS-CoV-2,

which is also termed the novel coronavirus and is diligently
associated with the SARS virus. The Ministry of Science and
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namely, Favilavir, chloroquine phosphate and remdesivir. A outpatient set- ting. Management of such patients should
clinical trial was conducted to test the efficacy of those focus on prevention of transmission to others, and monitoring
three drugs, and the results proved that out of the three for clinical deterioration, which should prompt
medicines above only Favilavir is effective in treating the hospitalisation. Interim recommendations on
patients with novel coronavirus. The re- maining two drugs
were effective in treating malaria.62
Likewise a study carried out in the United States by the
National Institute of Health proved that remdesivir is
effective in treating the Middle East respiratory syndrome
coronavirus (MERS-CoV), which is also a type of
coronavirus that was transmitted from monkeys. The drug
remdesivir was also used in the United States for treating
the patients with COVID-19. There has been a proposal to
use the combination of protease inhibitors lopinavir-
ritonavir for treating the patients affected by COVID-19.62
It is also evident that remdesivir was effective in treating
the pa- tients who were infected with Ebola virus. Per this
evidence, China has already started testing the efficacy of
remdesivir in treating the patients with COVID-19,
especially in Wuhan, where the outbreak occurred.
Chloroquine, which is an existing drug which is currently
used in treating malaria cases, was given to more than 100
patients who were affected with novel coronavirus to test
its efficacy.62
A multicentric study was conducted in China to test the
effective- ness of remdesivir in treating the patients with
COVID-19. Thus, the results of the clinical trial proved that
remdesivir has a considerably acceptable level of efficacy
for treating the patients with COVID-
19. Therefore, the National Health Commission of the
People's Republic of China decided to include remdesivir
in the Guidelines for the Prevention, Diagnosis and
Treatment of Pneumonia Caused by COVID-19.62
Chloroquine and hydroxychloroquine are existing anti-
malaria drugs also given to more than 30 patients infected
with COVID-19 in Guangdong province and Hunan province
to test their effective- ness and efficacy. Thus, the results of
the clinical trial showed that the patients who were given
chloroquine had a significant reduc- tion in their body
temperature. The clinical trial also showed bet- ter
recovery among the patients who were given chloroquine
and hydroxy chloroquine.63-65 Hydroxychloroquine treatment
is signifi- cantly associated with viral load reduction as well
as disappearance in COVID-19 patients. Further, the
outcome is reinforced by azithro- mycin. The role of
lopinavir and ritonavir in the treatment of COVID- 19 is
uncertain. A potential benefit was suggested by preclinical
data, but additional data has failed to confirm it.
Tocilizumab is an immunomodulating agent used as adjunct
therapy in some protocols based on a theoretical
mechanism and limited preliminary data.66

15 | HOME C ARE

Home management may be appropriate for patients with

mild in- fection who can be adequately isolated in the
ALMAGHASLAH ET | 13 of
AL. 18
home management of patients with COVID-19 can be 10. World Health Organization. Laboratory testing for 2019
found on the WHO and CDC websites. 67 novel coro- navirus (2019-nCoV) in suspected human
cases. Interim guidance.

16 | CONCLUSION
The corona virus (COVID-19) spreads at an alarming rate
all over the world. The outbreak of the virus has
confronted the world's eco- nomic, medical and public
health infrastructure. Elderly and immu- nocompromised
patients also are susceptible to the virus's mortal impacts.
Currently, there is no documented cure for the virus and
no vaccine has been created, although some treatment
protocols have been promising. Therefore, the virus can
be controlled with the appropriate prevention strategies.
Also, attempts have to be made to formulate systematic
strategies to prevent such future zoonotic outbreaks.

DISCLOSURE
The authors declare no conflict of interest.

ORCID
Dalia Almaghaslah [Link]
Geetha Kandasamy [Link]

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