key: cord-278093-0twnkv93
authors: Perveen, Shagufta; Orfali, Raha; Azam, Shafiq; Aati, Hanan Y.; Bukhari, Khulud; Bukhari, Sara I.; Al-Taweel, Areej
title: Coronavirus nCOVID-19: A Pandemic Disease and the Saudi precautions
date: 2020-06-18
journal: Saudi Pharm J
DOI: 10.1016/j.jsps.2020.06.006
sha: 
doc_id: 278093
cord_uid: 0twnkv93

Now nCOVID-19 has a foothold in many countries, and the threat of a pandemic situation has risen. Recently a novel coronavirus (nCOVID-19) has first emerged in China, causing multiple symptoms in humans and closely related to those caused by SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The nCOVID-19 has reported in Wuhan city of China has recently infected over six million people and at least 0.4 million confirmed deaths all over the world, while 2.8 million people has recovered from this deadly virus. Many instances of this respiratory syndrome coronavirus infection have already reported in more than 216 countries and territories. In contrast, the majority of cases reported in the USA, Brazil, Russia, Spain, UK, Italy, France and many more countries. In today's context, the coronavirus is one of the significant issues faced by the world with plenty of cases. In these circumstances, rapid reviews which recommended by WHO (World Health Organization), and these recommendations are very significant, helpful and cover current data with different preventive measures developed by the Saudi CDC (Saudi Centre for Disease Prevention and Control). This review article describes the possible modes of transmission so that proper preventive actions should be taking. Importantly, this work mentioned the animal reservoir through which may infect humans, and it must be identified to break the transmission chain. In additions, this review paper briefly discussed the spread of the coronavirus in the Arabian Peninsula and what precaution measures are in place by each country to limit the spreading of this virus. Taking into consideration the preventive measures by pharmacists as part of health care professions, however, the number of infected people, especially those with close contact with nCOVID-19 patients, are rise day by day and currently seems unstoppable.

nCOVID-19 is the name of a new respiratory disease, abbreviated from coronavirus disease 2019, while n stand for new or novel and the causative agent of this disease is Severe Acute Respiratory Syndrome Coronavirus 2 (nCOVID-19).

Coronaviruses are a group of family-based viruses contains strains that roots potentially diseases in birds and mammals. It is the vast class of viruses that cause viral respiratory sickness extending from common cold symptoms to more severe lung diseases. In comparison to other members of coronaviruses ,which cause humans respiratory infections, SARS-CoV (first then it has spread to 216 different countries and territories all over the world, and it seems more deadly. However, nCOVID-19 is a novel strain, not identified in humans previously [1] . Coronaviruses have zoonotic origins from animals such as dromedary camels (Camelus dromedarius), civet cat (Paguma larvata) and bats [2] . From their reservoirs, and worlds alarming alert, and the emergency among different countries, especially Europe, America and Asian countries draw the attention of almost every human across the globe ( Figure   2 ). This review paper shows aggregate and consolidates the most critical issues related to the virus outbreaks' origin, sources of virus transmission, signs and symptoms as well as the radiographic features from affected subjects. Additionally, it illustrates some preventive measures taken by the Saudi government that can control further spread of the SARS-CoV-2. 

The first coronavirus case reported in China, Wuhan city among people who had visited a seafood and meat market, and it was highly suspected to be transmitted from animal to human and then transmitted from human to human or to pets or vice versa. Based on different studies, the virus might be originated in bats [6, 7] . However, no bats were found for sale purpose at the market, which confirmed that another unknown animal might help in the transmission of the virus to humans. Many of these coronaviruses primarily infect the individual workers in direct contact with animals, as reported previously. One study recommended pangolin or snake as maybe the transitional animal as there were sold in the seafood and meat market [8, 9, 10] . Many studies explore the potential virus reservoir by comparing the sequence analysis of Relative Synonymous Codon Usage (RSCU) among different animal species based on the SARS-CoV-2 genome sequence. Results suggested that SARS-CoV-2 is a recombinant virus between the bat coronavirus and unknown origin coronavirus that located within the viral glycoprotein spikes presented on cell surface [9] . One more research team applied algorithm for analysis of nCOVID-19 nucleotide sequencing to recognize other viruses' origins, and the results appeared that both bats and minks could be the latent host for nCOVID-19. Additionally, a study revealed that nCOVID-19 has most homogeneous genetic information with bat coronavirus and resembling snake codon usage bias [11] .

SARS first recognized in Guangdong, China, November 2002, and then spread to more than thirty countries which began with 8000 cases and 774 deaths. It was the first new epidemic disease in the 21 st century. The host of this epidemic disease was thought to be a civet cat; however, during seven months since the occurrence, it was under controlled [12] . (Table 1) [13, 14] . Spanish influenza was also an epidemic which its outbreak from 1918 to 1919, and it was the most devastating epidemic on record, which killed between 50 to 100 million people around the world. Several measures applied during that era, such as Fresh air, sunlight, standards hygiene and face masks in order to reduce mortality rates. Ebola virus was also an epidemic disease which first outbreaks in Ebola River, Zaire 1976. The 2013-2016 outbreaks were in Guinea then rapidly extend to West Africa with more than 10000 deaths (Table 1) . 

All over the world scientists are working to find out the different spreading routes of these viruses. In general, the common way is through respiratory droplets which may transfer from the patient through coughing and sneezing. Further tests have also confirmed the presence of these viruses in patients' stool, suggesting that it can be spread through the excretory product.

Currently, it is entirely unclear whether people can also become infected by touching contaminated surfaces or objects.

Older people and people with long term medical issues are more susceptible to be infected with this virus. These critical chronic health problems such as lungs diseases, sickle cell disease, liver disease, heart problems, kidney disease, cancer, high blood pressure, HIV and diabetes are more likely to get the risk of serious sickness. Pregnant women (current or recent) and the person with weak immunity are also at a higher risk of severe illness due to this virus. Additionally, smokers are at great risk of disease because smoking reduces the natural protection against this type of viruses.

Social distancing or self-quarantine is one of the best tools to mitigate the spread of the nCOVID-19. In 1918, two different states of America detected a few cases of influenza among civilians of Philadelphia and Saint Louis. Both of the cities were planning for a massive military parade, which was the city's largest parade ever. The head of Philadelphia city decided to continue the events which were the big reason for quickly spreading the virus and made it a worldwide pandemic. After three days, every bed in Philadelphia's hospitals were filled with sick and dying patients, infected by this deadly virus. While the head of the St. Louis city decided to cancel its parade, closed all schools, playgrounds, libraries, courtrooms and churches around the entire city; the public gathering was also banned. After a month, more than ten thousand people in Philadelphia passed-away due to flu while deaths toll at Saint-Louis was not exceed 700 cases. These precautions demonstrate the advantage of cancelling events, massgatherings and distancing social dissociation routines.

The fatality cases rates are intended by dividing total deaths from a disease by the number of cases. It is expressed as a percentage (%) and used as a measure of disease severity. were died. So, the total CFR due to SARS is 9.55 % which is higher than the current nCOVID-19 and MERS. Most nCOVID-19 cases occurred in health care facilities; however, the routes of direct or indirect transmission of these remain unidentified. Up till now, not any specific treatment or any vaccine is available. However, serious attempts to develop preventive therapy and different researches in many laboratories are ongoing with the hope of some great findings [15] .

nCOVID-19 has similarities and differences with flu in terms of effects and symptoms. But it is a contagious viruses which can spread rapidly and usually caused high fever and shortness breath (Table 2) .

Common symptoms of air pollution/common cold/Flu Vs nCOVID-19. Allah's Messenger ‫)ﷺ(‬ said: '(There is) no 'Adwa (no contagious disease is conveyed without

Allah's permission). nor is there any bad omen (from birds), nor is there any Hamah, nor is there any bad omen in the month of Safar, and one should run away from the leper as one runs away from a lion.'' [17] However, it is one of the fundamental facts for preventing these viruses from spreading further.

This assessment proved the scientific evidence that supports the restriction on travelling during the expansion of epidemic diseases mentioned in the Hadith. Carriers of this virus travelled to anywhere without any clinical check-up or incubation stay during the last three months from

China, Iran and Italy to the globe, which made an alarming situation of spread, severity and inaction for the world. Shortly after that, more than one hundred twenty thousand cases were reported; among these eighty thousand found only in China.

The Arabian Peninsula is the largest peninsula on earth and located in western of Asia continent. can work together to sharing expertise in this field where many infections are zoonotic and mutual advantage to prevent the coronavirus spread [17] [18] [19] . Multiple studies demonstrate a normal chest X-ray in nCOVID-19 patients or pneumonic consolidation could be seen. final results of chest CT, depending on the severity and days of illness [21, 22] . In most of the cases, it includes bilateral lung involvement, rounded ground-glass opacities and peripheral distribution. While, it may include bronchial wall thickening, consolidation, linear opacities and crazy paving pattern. However, there is no evidence of cavitation, or pleural effusion have found in any patient (Figure 4) .

In one study, 18 of 21 patients (86%) with non-complicated nCOVID-19 pneumonia, in whom the temporal progression of the CT appearances in nCOVID-19 was studied, the severity of lung abnormalities peaked at 10 days post symptom onset, with a gradual tailoff after this time [21] . In another study of thirty-six patients, HRCT showed rapid changes over time with fibrous stripes appearing upon improvement in the disease course [22] . Another study represented different stages of disease processes on chest CT scan from days of symptom onset. Accordingly, the disease divided into three categories, 

The Saudi Centre for Disease Prevention and Control plays an essential role in preventing the spread of nCOVID-19 by continuous monitoring the number of cases by assisting the risks, develop awareness programs and plans to eradicate nCOVID-19.

The centre develops certain measures for communities, and the public to prevent the disease from spreading in schools, colleges, workplace and mosques (Table 4 ). The centre took the responsibility of reducing the death and disability rates by spreading awareness and positive impact on the health behaviours of individuals and societies.

Also, to enable all society segments to control their health, prevent all causes of nCOVID-19 through the guidance they developed on nCOVID-19 surveillance in healthcare and community settings [25] . ‫ﺗﻮﻛﻠﻨﺎ‬ ‫ﻭﺗﻄﺒﻴﻖ‬ ‫ﺍﻟﺪﺍﺧﻠﻴﺔ‬ ‫ﻭﺯﺍﺭﺓ‬ Table 4 Saudi CDC recommended preventive measures for the public and communities. 

In order to control further spread of the nCOVID-19 virus, people who are infected or suspected to curry the disease should be isolated from others and follow up on their treatment course under restricted infection-controlled precautions.

The Saudi CDC listed guidelines for Standard measures established by the WHO for nCOVID-19, which mainly concern on hand, respiratory and food hygiene practice:

1-Frequently hand hygiene using alcohol-based hand rub or detergents and water.

2-Covering mouth and nose are essential when coughing and sneezing. Take on consideration to dispose of any used tissue, immediately.

3-If you have respiratory problems, wear a medical mask and clean your hands after disposing of the face mask.

4-If you have fever, cough and difficulty breathing, directly seek medical care or contact the Saudi MOH (Ministry of health) hot line 937 and share previous travel history.

5-When visiting crowded area, maintain social distance (not less than 1 meter) from individuals with respiratory problems (e.g. sneezing and coughing).

6-Before touch your nose, mouth and eyes wash your hands.

7-When visiting animal and meet markets, especially in places currently recorded cases of a novel coronavirus; avoid direct contact with live animals.

The Saudi CDC guidelines, mainly concern on health workers who are in close contact with nCOVID-19 Patients, According to the WHO findings on this virus. It transmitted between people through close contact and droplets; not the airborne transmission.

Therefore, additional precautions for those workers should be taken includes gloves, medical masks, goggles/face shield, gowns, as well as respirators (e.g. N95 or FFP2) and

the way how to put on, how to remove and how to dispose of it properly. Pharmacists play a great role in the health society with their different responsibilities. In this review, we explain much more details of measures that should be taken with the pharmacists in Saudi Arabia. The following are types of pharmacies which have high risk exposure to the virus and certain precautions to be implemented to protect themselves and prevent health care transmission;

Community pharmacists are the health professionals most dealing with the public. They supply medicines for those with health-related problems, checking the pharmaceutical stocks (medicines, sterilizers and masks…etc). They also provide the patients at the time of dispensing their prescriptions with counselling. They inform the public, health professions and patients. Those pharmacists could consider as a link between the general public and health professionals in primary health care. Noticeably, the possibility of exposure of community pharmacist to nCOVID-19 exists, since they could interact with suspected patients; therefore, the first-line pharmacist should follow the precautions listed in (Table 3) to protect them as well.

KSA ministries and higher official authorities took immediate and prompt action from the beginning of this pandemic for fighting against the deadly virus through a variety of actions. In the beginning, more than hundred billion riyals SR was provided by the KSA worldwide. Also, establishing six regional laboratory all over the KSA to conduct 50,000

tests per day and mobile laboratory to conduct 10,000 tests per day [26] .

Hospital pharmacists are responsible for managing the stocks of medication supply used in the hospital and are accountable for manufacturing, purchasing and quality testing for (Table 5) .

Pharmacist and the pharmacy workforce can play an essential role in reducing the transmission of novel nCOVID-19 virus. These precautions could take place by the following: 

Because of the similarity in the symptoms between nCOVID-19, flu and common cold viruses, which includes fevers, coughing and sometimes severe lung infections, and because that common colds and flu are seasonal, which drop down in summer and spring.

Many people expressed their hope that the new virus could decrease it spread during spring and summer, and accordingly, the number of infected cases will decrease.

However, there is no scientific evidence yet since the virus is still new and early to approve that.

If the traveller suffers from symptoms indicating an acute respiratory illness before or after travel, the travellers must seek medical attention and inform the travel history of their health care provider. WHO standards recommended methods to prevent many diseases by cleaning hands with alcohol or rubbing hands with soap and water, as well as healthy nutritional practices. Also, when sneezing or coughing, the nose and mouth should be covered with elbow or tissue and then throw the tissue away immediately, and hands should wash very well. Avoid close contact with anyone who suffers from a fever and cough, and any person who suffers from fever, cough and difficulty breathing should seek medical care early and report his previous travel record of those who provide him with medical care.

Advice to conduct an exit check at international airports and ports in the affected areas, with the aim of early detection of travellers with symptoms for further evaluation and treatment, thus preventing the export of the disease. Exit screening includes an examination of signs and symptoms (fever above 38 degrees, coughing), passengers with symptoms of respiratory infection advise to leave the affected areas and directing travellers with symptoms for further medical examination, followed by a test for nCoVID-19, keeping confirmed cases under isolation and treatment. Encourage examination at local airports, railway stations and long-distance bus stations as necessary. 

This manuscript has discussed various elements regarding the nCOVID-19 infection and its correlation with other coronaviruses diseases, control, and the role of the different approaches in containing and preventing the spread of this disease. Saudi governments imposed aggressive actions to control disease spreading. Additionally, forcing people to stay at home and by developing certain regulations on nCOVID-19 surveillance in healthcare and community settings through the Saudi CDC. Pharmacists as members in the health organizations and following the Saudi CDC preventive measures is mandatory to protect themselves and others. On the contrary, it should turn into a movement, having supporting organizations worldwide, for better control of emerging diseases, including nCOVID-19 as numbers of nearly contact patients increases day by day.

The authors declare they have no conflicts of interest.

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The authors would like to extend their sincere appreciation to the Deanship of Scientific