A Review of Coronavirus Disease-2019 IJPSCR

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Available Online at www.ijpscr.info
International Journal of Pharmaceutical Sciences and
Clinical Research 2021; 1(3):330-341
REVIEW ARTICLE
A Review of Coronavirus Disease-2019
Singh Anamika1
, Carpenter Garima2
, Prerna Chaturvedi1
1
Department of Pharmaceutical Chemistry, Swami Vivekanand College of Pharmacy, Indore, Madhya Pradesh,
India, 2
Department of Pharmaceutics, Shri Govindram Seksaria Institute of Technology and Science, Indore,
Madhya Pradesh, India
Received: 20-04-2021; Revised: 27-05-2021; Accepted: 08-07-2021
ABSTRACT
There is a new public health crisis threatening the world with the emergence and spread of 2019 novel
coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus (SARS-CoV-2). The virus
originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei
Province, China in December 2019. There have been around 96,000 reported cases of coronavirus disease
2019.Thediseaseistransmittedbyinhalationorcontactwithinfecteddropletsandtheincubationperiodranges
from 2 to 14 day. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, and malaise,
among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities),
it may progress to pneumonia, acute respiratory distress syndrome, and multiorgan dysfunction. Many people
are asymptomatic. The case fatality rate is estimated to range from 2 to 3%. Diagnosis is by demonstration
of the virus in respiratory secretions by special molecular tests. Common laboratory findings include normal/
low white cell counts with elevated C-reactive protein. The computerized tomographic chest scan is abnormal
even in those with no symptoms or mild disease. Treatment is essentially supportive; role of antiviral agents
is yet to be established. Prevention entails home isolation of suspected cases and those with mild illnesses and
strict infection control measures at hospitals that include contact and droplet precautions. The virus spreads
faster than its two ancestors the SARS-CoV and Middle East respiratory syndrome coronavirus, but has lower
fatality. The global impact of this new epidemic is yet uncertain.
Keywords: Microbiology, Mode of spreading, Life cycle, Diagnosis, Prevention
INTRODUCTION
The first severe acute respiratory syndrome
coronavirus (SARS-CoV) outbreaks in China (in
2003), which spreads out in 29 countries so far
and infected about 9000 people with more than
10% mortality.[1]
Soon after five more human
coronaviruses (HCoV-229E, HCoV-HKU1,
HCoV-NL63, and HCoV-OC43) are found also
to be associated with a range of respiratory
symptoms, including high morbidity outcomes
*Corresponding Author:
Anamika Singh
E-mail: anamikarajni@gmail.com
such as pneumonia and bronchiolitis.[2]
In 2012,
another virus Middle East respiratory syndrome
coronavirus (MERS-CoV) was isolated from a
patientwithpneumoniainSaudiArabia.[3]
However,
very recent outbreak of a more SARS-associated
coronavirus (SARS-CoV-2) which one causes
coronavirus disease 2019 (COVID-19) disease, a
most concerned factor, nowadays, to human health.
Not only the health but also it caused a disaster in
human social, economic, and many other aspects of
life, being the disease is highly infectious and fatal
too. (Several Review by CDC, WHO, NIH, etc.).
In fact, SARS-CoV-2 is originated on December
26, 2019, at Wuhan city of China, and causes a life-
threatening pneumonia, and is the most pathogenic

Anamika, et al.: A review of corona virus 2019
IJPSCR/Jul-Sep-2021/Vol 1/Issue 3 331
human coronavirus identified so far. No statistical
data at this point would be perfect since the disease
progression as well as mortality rate is increasing at
an exponential rate. As of April 4, 2020, according
to CNN reports, the worldwide infected cases
are about 1,192,028; deaths 64,316. In the USA,
infected cases are 308,533 and death 8376. In this
review, we summarize the current knowledge on
human coronavirus COVID-19 (since now will be
mentioned a such) infection emphasizing on its
impact in human life.
Coronavirus disease 2019
Another name COVID, coronavirus
Virus strain SARS-COV-2
Location India
Arrival date March 21, 2020, 1 year 1 month
Confirmed cases 25,772,440
Active cases 3,129,878
Recovered 22,355,878
Death 287,122
Specialty Infection disease
Usual onset 2–14 days
Duration 5 days
Disease COVID-19
SIGNS AND SYMPTOMS
Symptoms of COVID-19 are variable, ranging
from mild symptoms to serve illness. Common
symptoms include headache, loss of smell and test,
nasal congestion and runny nose, cough, muscle
pain, sore throat, fever, diarrhea, and breathing
difficulties. People with the same infection may
have different symptoms, and their symptoms
may change overtime. Three common clusters of
symptoms have been identified one respiratory
symptoms cluster with cough, sputum, shortness
of breath, and fever a musculoskeletal symptoms
cluster with muscle joint pain, headache, and
fatigue a cluster of digestive symptoms and
abdominal pain, vomiting, and diarrhea. In people
without prior ear, nose, and throat disorder, loss
of taste combined with loss of smell is associated
with COVID-19.
Of people who show symptoms, 81% develop
only mild to moderate symptoms (up to mild
pneumonia), while 14% develop severe symptoms
and 81% develop only mild to moderate symptoms
(up to mild pneumonia), while 14% develop severe
symptoms (dyspnea, hypoxia, or more than 50%
lung involvement on imaging) and 5% of patients
suffer critical symptoms (respiratory failure, shock,
or multiorgan dysfunction).
At least a third of the people who are infected with
the virus do not develop noticeable symptoms at
any point in time. These asymptomatic carriers
tend not to get tested and can spread the disease
other infected people will develop symptoms
later, called “pre-symptomatic,” or have very mild
symptoms and can also spread the virus.
Asiscommonwithinfection,thereisadelaybetween
the moment a person first becomes infected and the
appearance of the first symptoms. The median delay
for COVID-19 is 4–5 days. Most symptomatic
people experience symptoms within 2–7 days after
exposure and almost all will experience at least
one symptom within 12 days. Most people recover
from the acute phase of the disease. However, some
people continue to experience a range of effect
for month after recovery named long COVID and
damage to organ has been observed.
EPIDEMIOLOGY
The outbreak was declared as “a public health
emergency of international concern” by the WHO
on January 30, 2020, and as a pandemic on March
11, 2020. As of April 28, 2020, there are 29 lakh
confirmed cases worldwide with 2 lakh confirmed
deaths. The United States have the highest number
of confirmed cases. The first case of COVID‑19 in
India was reported on January 30, 2020, with origin
from China. As of April 29, 2020, there are 22,629
active cases in India with 1007 deaths.[4]
Keeping in
mind the increasing number of COVID‑19 cases in
India, India observed a “Janata Curfew” on March
22,2020,asinsistedbyourhonorablePrimeMinister

Narendra Modi. Later, the PM of India announced
a nationwide lockdown for 21 days on March 24,
2020, so as to break the chain of transmission and
the lockdown was then extended till May 3.
MICROBIOLOGY
Coronavirus is spherical or pleomorphic, single-
stranded, enveloped RNA, and covered with
club-shaped glycoprotein. Coronaviruses are four
subtypes such as alpha, beta, gamma, and delta
coronavirus. Each of subtype coronaviruses has
many serotypes. Some of them were affect human
of other affected animals such as pigs, birds, cats,
mice, and dogs.
MODE OF SPREADING
Peoples can get the infection through close
contact with a person who has symptoms from the
virus includes cough hand sneezing. In general,
coronavirus was spread through airborne zoonotic
droplets. Virus was replicated ciliated epithelium
that caused cellular damage and infection at
infection site. According to a study published in
2019, angiotensin-converting enzyme 2 (ACE2),
a membrane exopeptidase in the receptor used by
coronavirus in entry to human cells.
COV-2019 CONFIRMED CASES
REPORT (DATE AND COUNTRY WISE)
SPREADING HISTORY OF NOVEL
CORONAVIRUS (2019-nCOV)
On December 31, 2019, China, East Asia, most
populated country in world was informed to the
WHO regarding pneumonia cases with unknown
etiology.TillJanuary3,2020,atotalof44pneumonia
cases were detected. On January 7, 2020, Chinese
research authorities were announced that they were
isolated new virus from sea food market in Wuhan
city; named as 2019-nCoV. On January 13, 2020,
Ministry of Public Health, Thailand, was reported
one patient imported from Wuhan,
China. On January 15, 2020, the Ministry of Health,
Labour and Welfare, Japan, was reported first case
imported from Wuhan, China. On January 20,
2020, National IHR Focal point from the Korea was
reported first case 2019-nCoV in Korea. On January
23,2020,theUnitedStatesofAmericawasconfirmed
first case of 2019-nCoV in the America. On January
24, 2020, Vietnam has reported first case of 2019-
nCoV with not travel history from China, while his
family member was the China traveler. Hence, it’s the
first incidence of human-to-human transmission of
coronavirus. On January 24, 2020, the Government
of Singapore was confirmed first case of 2019-nCoV.
On January 25, 2020, the Government of Australia,
Federal Democratic Republic of Nepal and French
republic were confirmed first of 2019-nCoV. Other
countries also were detected and reported the cases
of 2019-nCoV as on January 26, 2020 (Malaysia),
January 27, 2020 (Canada), January 28, 2020
(Cambodia, Germany, and Sri Lanka), January 29,
2020 (United Arab Emirates), January 30, 2020 (the
Philippines, India, and Finland), January 31, 2020
(Italy), February 1, 2020 (Russian Federation, Spain,
Sweden, and the United Kingdom), February 5, 2020
(Belgium), February 6, 2020 (Japan), and February
15, 2020 (Egypt).
LIFE CYCLE OF CORONAVIRUS
Steps
1. Attachment and entry
2. Replicase protein expression
3. Replication and transcription
4. Assembly and release.

DIAGNOSIS
COVID-19 can provisionally be diagnosed on the
basis of symptoms and confirmed using reverse
transcription polymerase chain reaction (RT-PCR)
or other nucleic acid testing of infected secretion.
Along with laboratory testing, chest CT scan may
behelpfultodiagnoseCOVID-19inindividualwith
a high clinical suspicion of infection. Detection of
a past infection is possible with serological tests,
which detect antibodies to produce by the body in
response to the infection.
COVID-19 VIRALTESTING
There are various methods available for COVID-19
testing, and the decision to carry out a test on
suspected individuals should be made based on
clinical symptoms and epidemiological factors.
It would be beneficial if dental practices were
provided with fast COVID-19 detection kits to test
the high-risk and suspicious patients. This way,
they can take necessary precautions in reducing the
spread of the virus and also help the national health-
care system to track the possible infected cases and
gather data regarding the number of infected cases
in the country. Symptoms of respiratory illness
such as coughing and sneezing.
RT-PCR
As per the WHO guideline, the RT-PCR test should
be done in asymptomatic or mildly symptomatic
patients and those who have had contact with
COVID-19-positive cases. Screening protocols
and local guidelines for the patient evaluation
should be followed and complied with. A crucial
step in management of outbreak is fast collection
of samples and testing of the suspicious cases
utilizing nucleic acid amplification test (NAAT)
like RT-PCR. The RNA test for the detection of
SARD-CoV-2 genetic signature is used in this
method. A swab is normally utilized to gather
specimen from inside the nose or posterior part of
throat. The result of nucleic acid testing through
PCR, which is capable of detecting even a small
amount of RNA, can be communicated within
hours. The test is highly sensitive and specific, but
its accuracy depends on the quality of the samples
provided. The limitation of PCR testing is that it
can only identify patients with ongoing infection,
and those in the recovery phase may not have
detectable virus, hence, the test could be negative.
For the purpose of PCR testing, specimens should
be collected from upper respiratory tract using
nasopharyngeal and oropharyngeal swabs. In lower
respiratory tract, specimen should be collected from
the sputum (if present) or endotracheal aspirate or
bronchoalveolar lavage in severely symptomatic
patients. Having detected COVID-19 virus in the
bloodandstoolsofinfectedpatients,bloodandstool
collected from suspicious cases can also be used
for testing. The duration and frequency of shedding
of COVID-19 virus in stool and potentially in urine
is unknown. In deceased patients, autopsy material
from lung tissue would be a useful specimen, and
in recovering patients, paired serum can be used to
define cases as serological assays appear.
Collection, handling, and packaging of specimens
for virus detection are vital, and specimens must
be delivered to the laboratory as soon as possible.
If the specimen can be delivered quickly to the
nominated laboratory, they can be stored and
shipped at 2–8°C. In the case of delay, the use of
viral transport medium is necessary, and specimen
should be frozen at −20°C or ideally −70°C. It
should be noted that repeated freezing must be
avoided.
Serological or antibody testing
Another method of investigation in an ongoing
pandemicisserologicalsurveyofcaseswithnegative
NAAT assays but strong epidemiological link to
COVID-19. In these cases, paired serum samples
could support the diagnosis once validated serology
tests are available. The challenge of this test could
be the cross reactivity with other coronaviruses.
This method tests whether a suspected individual
has been infected by COVID-19 and has produced
antibodies. The Immunological Dent. J. 2020, 8,
53 7 of 18 reactions to the SARS-CoV-2 can take
several weeks to happen, and some studies show
that antibodies to COVID-19 may take 14 days to
appear. Therefore, a serology test before this period
may result in an unhelpful negative. Antibody test

requires a blood sample from the patient, and it
will look for the evidence of the virus in the body
by detecting antibodies produced by the immune
system in reaction to the infection. Body’s first
reaction to an infection is in the form of IgM as
it appears in the blood approximately within
5–10 days post-infection and reaches its peak at
day 21 of the infection. The time frame is vital,
because if a suspicious patient develops COVID-19
symptoms, it takes about a week for their body to
produce anti-COVID-19 IgM. Although for the
2019-nCoV, there is evidence of IgM presence in
the blood within a day of developing symptoms, it
will not be completely reliable as large quantities of
IgM are not available for detection. The PCR test
is reported to have a 66.7% detection rate within
the 1st
week of infection whereas antibody test has
38.3% detection rate. Therefore, the most reliable
test for an early infection would be combination
of antibody and PCR swab from suspicious
patients. The combining of the tests will result in
98.6% detection rate within the first 5.5 days post-
infection. Another type of antibody is IgG, which
proves that a person has had the viral infection,
and the body is now immune to the pathogen. This
test also needs blood sample from patients, and
IgG can be detected in the blood approximately
14 days after infection. If the patient becomes
reexposed to the virus, the IgG level is rapidly
raised within 48 h to fight the virus and prevent
a new infection. Therefore, if the serology test of
a patient only detects IgM, it indicates that they
are within the 1st
week of infection. The presence
of both IgM and IgG suggests that patient should
be in their 1st
month of infection and theoretically
immune to the virus and reinfection. IgA is another
parameter that can be measured to aid the detection
of infected COVID-19 cases. It is present in serum,
nasal mucus, saliva, breast milk, and intestinal
fluid, and it consists of around 10–15 percent of
human immunoglobins. Gou et al. examined the
humoral response of the host immune system
including IgA, IgM, and IgG responses by testing
208 plasma samples from 82 confirmed and 58
probable cases (qPCR negative but with clinical
symptoms) utilizing an ELISA-based assay. The
median duration of IgM and IgA detection was
5 days while IgG was detected on 14 days of
clinical manifestation of symptoms with a positive
rate of 85.4%, 92.7%, and 77.9%, respectively. The
findings suggested that the positive rates for IgM
were 75.6% and 93.1% in confirmed and probable
cases, respectively. It concluded that the detection
efficiency of IgM ELISA method was higher than
that of qPCR after 5.5 days of the symptoms’onset.
The combination of IgM ELISAassay and PCR test
significantly increased the positive detection rate
to 98.6% for each patient. This number is 51.9%
with a single PCR test. Thus, it can be concluded
that the immune response of the host body can be
utilized to increase the detection rate and diagnosis
of COVID-19 cases.
Medical imaging
The review of the relevant literature in medical
imaging suggests that chest radiographs have no
diagnostic value in early stages of the infection.
However, CTscan may present some findings even
before the onset of symptoms. Bilateral multilobar
ground-glass specificities associated with a
peripheral asymmetric and posterior distribution
is the typical feature of the CT in COVID-19-
positivecases.Astheinfectiondevelopssubpleural
dominance, crazy paving and consolidation can
be observed in most cases. A comparative study
conducted in Wuhan, the origin of COVID-19,
suggests that CT is significantly more sensitive
than PCR test; however, it is less specific as
many of its imaging characteristics overlap
with other types of pneumonia. The American
College of Radiology also recommends that CT
imaging should not be used as a first-line test to
screen potential COVID-19 cases. The Centre
for Disease Control in the U.S. recommendation
is to utilize PCR testing for initial screening of
suspected cases. In the UK, the Royal College of
Radiologists announced that the use of additional
chest CT to assess patients for the presence of
likely COVID-19 infection may have a role in
stratifying risk in patients presenting with acute
symptoms and requiring a CT of abdomen,
particularly those needing emergency surgery.
In the absence of rapid access to other forms of
COVID-19 testing, this is appropriate if it will
change the management of the patient. However,

a negative scan would not exclude COVID-19
infection, and as with all other current advice, this
may change in the future.
PATHOPHYSIOLOGY
COVID-19 can affect the upper respiratory tract
(sinuses, nose, and throat) and the lower respiratory
tract (windpipe and lungs). The lungs are the
organs most affected by COVID-19 because the
virus accesses host cells through the receptor for
the enzyme ACE2, which is most abundant on the
surface of type II alveolar cells of the lungs. The
virus uses a special surface glycoprotein called
a “spike” (peplomer) to connect to the ACE2
receptor and enter the host cell. Whether SARS-
CoV-2 is able to invade the nervous system remains
unknown, however it is clear that many people with
COVID-19 exhibit neurological or mental health
issues. The virus is not detected in the CNS of the
majority of COVID-19 people with neurological
issues. However, SARS-CoV-2 has been detected at
low levels in the brains of those who have died from
COVID-19, but these results need to be confirmed
loss of smell results from infection of the support
cells of the olfactory epithelium, with subsequent
damage to the olfactory neurons. SARS-CoV-2
could cause respiratory failure through affecting
the brain stem as other coronaviruses have been
found to invade the CNS. While virus has been
detected in cerebrospinal fluid of autopsies, the
exact mechanism by which it invades the CNS
remains unclear and may first involve invasion of
peripheral nerves given the low levels of ACE2 in
the brain. The virus may also enter the bloodstream
from the lungs and cross the blood–brain barrier
to gain access to the CNS, possibly within an
infected white blood cell. Tropism and multiple
organ injuries in SARS-CoV-2 infection. The
virus also affects gastrointestinal organs as ACE2
is abundantly expressed in the glandular cells of
gastric, duodenal, and rectal epithelium as well
as endothelial cells and enterocytes of the small
intestine. The virus can cause acute myocardial
injury and chronic damage to the cardiovascular
system.Anacutecardiacinjurywasfoundin12%of
infected people admitted to the hospital in Wuhan,
China, and is more frequent in severe disease.
Rates of cardiovascular symptoms are high, due to
the systemic inflammatory response and immune
system disorders during disease progression, but
acute myocardial injuries may also be related to
ACE2 receptors in the heart. ACE2 receptors are
highly expressed in the heart and are involved in
heart function. A high incidence of thrombosis and
venous thromboembolism has been found people
transferred to intensive care unit with COVID-19
infections, and may be related to poor prognosis.
Blood vessel dysfunction and clot formation (as
suggested by high D-dimer levels caused by blood
clots) are thought to play a significant role in
mortality, incidences of clots leading to pulmonary
embolisms, and ischemic events within the brain
have been noted as complications leading to death
in people infected with SARS-CoV-2. Infection
appears to set off a chain of vasoconstrictive
responses within the body, constriction of blood
vessels within the pulmonary circulation has
also been posited as a mechanism in which
oxygenation decreases alongside the presentation
of viral pneumonia. Furthermore, microvascular
blood vessel damage has been reported in a small
number of tissue samples of the brains – without
detected SARS-CoV-2 – and the olfactory bulbs
from those who have died from COVID-19.
Another common cause of death is complications
related to the kidneys. Early reports show that up
to 30% of hospitalized patients both in China and
in New York have experienced some injury to their
kidneys, including some persons with no previous
kidney problems. Autopsies of people who
died of COVID-19 have found diffuse alveolar
damage, and lymphocyte-containing inflammatory
infiltrates within the lung.
PREVENTION
Preventive measure to reduce the chances of
infection includes getting vaccinated staying at
home, wearing a mask in public, avoiding crowded
place, keeping distance from others ventilating
indoor space, managing potential exposure duration
washing hand with soap and water often and for a
least 20 s practicing good respiratory hygiene, and

avoiding touching the eyes nose or mouth with
unwashed hand.
VACCINE
A COVID19 vaccine is a vaccine intended to
provide acquired immunity against SARSCoV2,
theviruscausingCOVID-19.BeforetheCOVID-19
pandemic, there was an established body of
knowledge about the structure and function of
coronaviruses causing diseases such as SARS and
MERS, which enabled accelerated development of
various vaccine technologies during early 2020.
On January 10, 2020, the SARS-CoV-2 genetic
sequence data were shared through GISAID, and
by March 19, the global pharmaceutical industry
announced a major commitment to address
COVID-19. In Phase III trials, several COVID19
vaccineshave demonstratedefficacyas high as 95%
in preventing symptomatic COVID19 infections.
As of April 2021, 15 vaccines are authorized by at
least one national regulatory authority for public
use: two RNA vaccines (Pfizer–BioNTech and
Moderna), six conventional inactivated vaccines
(BBIBP-CorV, CoronaVac, Covaxin, WIBP-CorV,
CoviVac, and QazVac), five viral vector vaccines
(Sputnik Light, Sputnik V, Oxford–AstraZeneca,
Convidecia, and Johnson and Johnson), and two
protein subunit vaccines (EpiVacCorona and RBD-
Dimer). In total, as of March 2021, 308 vaccine
candidates are in various stages of development,
with 73 in clinical research, including 24 in Phase
I trials, 33 in Phase I–II trials, and 16 in Phase III
development. Many countries have implemented
phased distribution plans that prioritize those
at highest risk of complications, such as the
elderly, and those at high risk of exposure and
transmission, such as health care workers. Single-
dose interim use is under consideration to extend
vaccination to as many people as possible until
vaccine availability improves. As of May 18, 2021,
1.53 billion doses of COVID19 vaccine have
been administered worldwide based on official
reports from national health agencies. AstraZeneca
anticipates producing 3 billion doses in 2021,
Pfizer–BioNTech 1.3 billion doses, and Sputnik
V, Sinopharm, Sinovac, and Johnson and Johnson
1 billion doses each. Modern targets producing
600 million doses and Convidecia 500 million
doses in 2021. By December 2020, more than
10 billion vaccine doses had been reordered by
countries, with about half of the doses purchased
by high-income countries comprising 14% of the
world’s population.
FACE MASKS AND RESPIRATORY
HYGIENE
Masks with an exhalation valve. The valves are a
weak point that can transmit the viruses’ outwards.
TheWHO and the US CDC recommend individuals
wear non-medical face coverings in public settings
where there is an increased risk of transmission and
where social distancing measures are difficult to
maintain. This recommendation is meant to reduce
the spread of the disease by asymptomatic and pre-
symptomatic individuals and is complementary
to established preventive measures such as social
distancing. Face coverings limit the volume and
traveldistanceofexpiratorydropletsdispersedwhen
talking, breathing, and coughing. A face covering
without vents or holes will also filter out particles
containing the virus from inhaled and exhaled air,
reducing the chances of infection. However, if the
mask includes an exhalation valve, a wearer that is
infected (maybe without having noticed that, and
asymptomatic) would transmit the virus outward
through it, despite any certification they can have.
Hence, the masks with exhalation valve are not for
the infected wearers and are not reliable to stop
the pandemic in a large scale. Many countries and
local jurisdictions encourage or mandate the use of
face masks or cloth face coverings by members of

the public to limit the spread of the virus. Masks
are also strongly recommended for those who
may have been infected and those taking care of
someone who may have the disease. When not
wearing a mask, the CDC recommends covering
the mouth and nose with a tissue when coughing or
sneezing and recommends using the inside of the
elbow if no tissue is available. Proper hand hygiene
after any cough or sneeze is encouraged. Health-
care professionals interacting directly with people
who have COVID-19 are advised to use respirators
at least as protective as NIOSH-certified N95 or
equivalent, in addition to other personal protective
equipment.
AVOIDING CROWDED INDOOR SPACES
AND VENTILATION
Crowded indoor spaces should be avoided.
When indoors, increasing the rate of air change,
decreasing recirculation of air, and increasing the
use of outdoor air can reduce transmission. The
WHO recommends ventilation and air filtration in
public spaces to help clear out infectious aerosols.
Exhaled respiratory particles can build-up within
enclosed spaces with inadequate ventilation. The
risk of COVID-19 infection increases especially in
spaces where people engage in physical exertion
or raise their voice (e.g. exercising, shouting, and
singing) as this increases exhalation of respiratory
droplets. Prolonged exposure to these conditions,
typically more than 15 min, leads to higher risk of
infection.
HAND WASHING AND HYGIENE
Thorough hand hygiene after any cough or sneeze
is required.[5-8]
The WHO also recommends that
individuals wash hands often with soap and
water for at least 20 s, especially after going to
the toilet or when hands are visibly dirty, before
eating and after blowing one’s nose. When soap
and water are not available, the CDC recommends
using an alcohol-based hand sanitizer with at least
60% alcohol. For areas where commercial hand
sanitizers are not readily available, the WHO
provides two formulations for local production. In
these formulations, the antimicrobial activity arises
from ethanol or isopropanol. Hydrogen peroxide
is used to help eliminate bacterial spores in the
alcohol; it is “not an active substance for hand
antisepsis.” Glycerol is added as a humectant.
SOCIAL DISTANCING
Social distancing (also known as physical
distancing) includes infection control actions
intended to slow the spread of the disease by
minimizing close contact between individuals.
Methods include quarantines; travel restrictions;
and the closing of schools, workplaces, stadiums,
theaters, or shopping centers. Individuals may
apply social distancing methods by staying at home,
limiting travel, avoiding crowded areas, using
no contact greetings, and physically distancing
themselves from others. Many governments are
now mandating or recommending social distancing
in regions affected by the outbreak. Outbreaks have
occurred in prisons due to crowding and an inability
to enforce adequate social distancing. In the United
States, the prisoner population is aging and many
of them are at high risk for poor outcomes from
COVID-19 due to high rates of coexisting heart
and lung disease, and poor access to high-quality
health care.
SURFACE CLEANING
After being expelled from the body, coronaviruses
can survive on surfaces for hours to days. If a
person touches the dirty surface, they may deposit
the virus at the eyes, nose, or mouth where it can
enter the body and cause infection. Evidence
indicates that contact with infected surfaces is
not the main driver of COVID-19, leading to
recommendations for optimized disinfection
procedures to avoid issues such as the increase
of antimicrobial resistance through the use of
inappropriate cleaning products and processes.
Deep cleaning and other surface sanitation have
been criticized as hygiene theatre, giving a false
sense of security against something primarily
spread through the air. The amount of time that
the virus can survive depends significantly on the

type of surface, the temperature, and the humidity.
Coronaviruses die very quickly when exposed to
the UV light in sunlight. Like other enveloped
viruses, SARS-CoV-2 survives longest when the
temperature is at room temperature or lower, and
when the relative humidity is low (50%). On
many surfaces, including as glass, some types
of plastic, stainless steel, and skin, the virus can
remain infective for several days indoors at room
temperature, or even about a week under ideal
conditions. On some surfaces, including cotton
fabric and copper, the virus usually dies after a
few hours. As a rule of thumb, the virus dies faster
on porous surfaces than on non-porous surfaces.
However, this rule is not absolute, and of the many
surfaces tested, two with the longest survival times
are N95 respirator masks and surgical masks, both
of which are considered porous surfaces. The CDC
says that in most situations, cleaning surfaces with
soap or detergent, not disinfecting, are enough to
reduce risk of transmission. The CDC recommends
that if a COVID-19 case is suspected or confirmed
at a facility such as an office or day care, all
areas such as offices, bathrooms, common areas,
and shared electronic equipment such as tablets,
touch screens, keyboards, remote controls, and
ATM machines used by the ill persons should
be disinfected. Surfaces may be decontaminated
with 62–71% ethanol, 50–100% isopropanol,
0.1% sodium hypochlorite, 0.5% hydrogen
peroxide, and 0.2–7.5% povidone-iodine. Other
solutions, such as benzalkonium chloride and
chlorhexidine gluconate, are less effective.
Ultraviolet germicidal irradiation may also be used.
A datasheet comprising the authorized substances
to disinfection in the food industry (including
suspension or surface tested, kind of surface, use
dilution, disinfectant, and inoculum volumes) can
be seen in the supplementary material of.
SELF-ISOLATION
Self-isolation at home has been recommended for
those diagnosed with COVID-19 and those who
suspect they have been infected. Health agencies
have issued detailed instructions for proper self-
isolation. Many governments have mandated or
recommendedself-quarantineforentirepopulations.
The strongest self-quarantine instructions have been
issued to those in high-risk groups. Those who may
have been exposed to someone with COVID-19 and
those who have recently travelled to a country or
region with the widespread transmission have been
advised to self-quarantine for 14 days from the time
of last possible exposure.
HEALTHY DIET AND LIFESTYLE
The Harvard T.H. Chan School of Public Health
recommends a healthy diet, being physically active,
managing psychological stress, and getting enough
sleep. There is no good evidence that Vitamin D status
hasanyrelationshipwithCOVID-19healthoutcomes.
MECHANISM OF ACTION FOR
COVID-19
Human has long been infected by coronavirus as it is
one of those responsible for the common cold. It is a
contagious viral infection that can be spread through
inhalation or ingestion of viral droplets as a result
coughing and sneezing and touching infected surface
are primary sources of infection. The coronavirus
genome is comprised of ∼30,000 nucleotides. It
encodes four structural proteins, nucleocapsid (N)
protein, membrane (M) protein, spike (S) protein
and envelop (E) protein, and several non-structural
proteins (nsp) [Figure 1]. The capsid is the protein
shell, inside the capsid, there is nuclear capsid or
N-protein which is bound to the virus single positive
strand RNA that allows the virus to hijack human
cells and turn them into virus factories. The N
protein coats the viral RNA genome which plays
a key role in its replication and transcription. The
N-terminal of the N protein which is binding to
genomic and sub-genomic RNAs in MHV and
IBV virions and process the viral replication and
transcription. This is one of the important open
research problems developing of an effective drug
targeting to prevent the contacts between N-terminal
of N-protein and single-positive RNA strand which
can stop viral replication and transcription. Sarma
et al. (2020) reported that two important class of
compounds, theophylline and pyrimidone drugs as
possible inhibitors of RNAbinding to the N terminal

The mechanism of viral entry and replication
and RNA packing in the human cell is mapped.
The coronavirus spike (S) protein attaches to
ACE2 receptors that are found on the surface of
many human cells, including those in the lungs
allowing virus entry. The coronavirus S protein is
subjected to proteolytic cleavages by host proteases
(i.e. trypsin and furin), in two sites located at the
boundary between the S1 and S2 subunits (S1/
S2 site). In a later stage happens the cleavage
of the S2 domain (S2′ site) to release the fusion
peptide. This event will trigger the activation of
the membrane fusion mechanism. Searching for
antibodies can find support on molecular targeting
which can utilize the structural information (a
sequence) of the binding region which is found
in angiotensin-converting enzyme 2 receptor. In
this way, this protocol could device a treatment to
block the viral entry. Typically, human cell ingests
the virus in a process called endocytosis. Once
entered the cytoplasm, it has been suggested most
likely that COVID-19 employs a unique three-step
method for membrane fusion, involving receptor
binding and induced conformational changes in
spike (S) glycoprotein followed by cathepsin L
proteolysis through intracellular proteases and
further activation of membrane fusion mechanism
within endosomes (Simmons et al., 2005).
Then, the endosome opens to release virus to the
cytoplasm, and uncoating of viral nucleocapsid
(N) is started through proteasomes which typically
can hydrolyze endogenous proteins, but they are
also capable of degrading exogenous proteins such
as the SARS nucleocapsid protein (Wang et al.,
2010). A different two-step mechanism has been
suggested (Li, 2016) and in this case, the virion
binds to a receptor on the target host cell surface
through its S1 subunit and the spike is cleaved by
host proteases (Hasan et al., 2020) and then it is
expected the fusion at low pH between viral and
host target membranes through S2 subunit. Finally,
the viral genetic material a single-stranded RNA
is fully released into the cytoplasm. There takes
place the replication and transcription processes
which are mediated by the so-called replication/
transcription complex (RTC). Such complex is
encoded in the viral genome and it is made of nsp.
The RTC is believed to induce double-membrane
domain of N protein of coronavirus, thus opening
new avenues for in vitro validations.
Figure 1: (a) Schematic representation of the genome
organization and functional domains of S protein for COVID-19.
The single-stranded RNAgenomes of COVID-19 encode two
large genes, the ORF1a and ORF1b genes, which encode 16
non-structural proteins (nsp1–nsp16). The structural genes
encode the structural proteins, spike (s), envelope (e), membrane
(m), and nucleocapsid (n). The accessory genes denoted in
shades of green. The structure of S protein is shown beneath the
genome organization. The S protein is consisting of the S1 and
S2 subunits. The S1/S2 cleavage sites are highlighted by dotted
lines. In the S protein, cytoplasm domain (CP); fusion peptide
(FP); heptad repeat (HR); receptor-binding domain (RBD);
signal peptide (SP); and transmembrane domain (TM) are shown
(b) the viral surface proteins, spike, envelope, and membrane, are
embedded in a lipid bilayer. The single-stranded positive-sense
viral RNAis associated with the nucleocapsid protein. The M
protein is most abundant in the viral surface and it is believed
to be the central organizer for the coronavirus assembly. The
S protein is integrated over the surface of the virus, it mediates
attachment of the virus to the host cell surface receptors and
fusion between the viral and host cell membranes to facilitate
viral entry into the host cell (Kirchdoerfer et al.). The E protein is
a small membrane protein composed ~76 to 109 amino acid and
minor component of the virus particle, it plays an important role
in virus assembly, membrane permeability of the host cell, and
virus-host cell interaction (Gupta et al., 2020).Alipid envelop
encapsulates the genetic material. Hemagglutinin-esterase dimer
(HE) has been located on the surface of the viral. The HE protein
may be involved in virus entry, is not required for replication,
but appears to be important for infection of the natural host-cell
(Lissenberg et al., 2005). State-of-the-art cryo-EM experiments
have revealed the full structure of the spike (s) protein in the
close (pdb id: 6VXX) (Walls et al., 2020) and open (pre-fusion)
states (pdb id: 6VYB) (Wrapp et al., 2020). Such glycoprotein
is made of three identical chains with 1273 amino acid each and
it is composed by two well-defined protein domain regions: S1
and S2 subunits which are associated to cell recognition and the
fusion of viral and cellular membranes, respectively. The latter
process occurs through different protein conformational changes
that remain still uncharacterized.

structures in the cytoplasm of the infected cell
(Van Hemert et al., 2008). Following the positive
RNA genome is translated to generate replicase
proteins from open reading frame 1a/b (ORF 1a/b)
[Figure 1]. These proteins use the genome as a
template to generated full-length negative sense
RNAs, which subsequently serve as templates in
generating addition full-length genomes. Structural
viral proteins, M, S, and E are synthesized in the
cytoplasm and then inserted into the endoplasmic
reticulum (ER) [Figure 2], and transfer to ER-
Golgi intermediate compartment (ERGIC)
(Masters, 2006; Song et al., 2004). Furthermore, in
the cytoplasm, nucleocapsids are formed from the
encapsulation of replicated genomes by N protein,
and as a result, they coalesce within the ERGIC
membrane in order to self-assembly into new
virions. Finally, novel virions are exported from
infected cells by transport to the cell membrane in
smooth-walled vesicles and then secreted through
a process called exocytosis so that can infect other
cells. In the meantime, the stress of viral production
on the ER eventually leads to cell death. However,
the mechanism of action for novel COVID-19 is
still unknown (Masters, 2006).[9-29]
The schematic diagram of the mechanism of
COVID-19 entry and viral replication and viral
RNA packing in the human cell.
CONCLUSION
There are hundreds of coronaviruses, most of which
circulate in animals. Only seven of these viruses
infect human and four of them cause symptoms
of the common cold. However, 3 times in the past
20 years a coronavirus have jumped from animals
to human to cause severe disease. COVID-19,
a new and sometimes deadly respiratory illness
that is believed to have originated in a live animal
market in China, has spread rapidly throughout
that country and the world. The new coronavirus
was first detected in Wuhan, China in December
2019. Tens of thousands of people were infected in
China, with the virus spreading easily from person
to person in many parts of country. Health officials
in the United States and around the world are
working to contain the spread of the virus through
public health measure such as social distancing,
contact tracing, testing, quarantines, and travel
restrictions. Scientist is working to find medication
to treat the disease and to develop a vaccine. Public
health measure like ones implemented in China
and now around the world will hopefully blunt the
spread of the virus while treatment and a vaccine is
developed to stop it.
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