key: cord-0696695-qud4bj12 authors: Pradhan, Deepak; Biswasroy, Prativa; Kumar naik, Pradeep; Ghosh, Goutam; Rath, Goutam title: A Review of Current Interventions for COVID-19 Prevention date: 2020-04-30 journal: Arch Med Res DOI: 10.1016/j.arcmed.2020.04.020 sha: 18886c48ec6c9e3c22ede8a0913aa62581811df4 doc_id: 696695 cord_uid: qud4bj12 Abstract The recent outbreak of CoVID-19 is declared as a global public health emergency of international concern by the World Health Organization (WHO). A fresh figure of 2268011 positive cases and 155185 death records (till April 18th 2020) across the worldwide signify the severity of this viral infection. CoVID-19 infection is a pandemic, surface to surface communicable disease with a case fatality rate of 3.4% as estimated by WHO up to March 3rd 2020. Unfortunately, the current unavailability of an effective antiviral drug and approved vaccine, worsen the situation more critical. Implementation of an effective preventive measure is the only option left to counteract CoVID-19. Further, a retrospective analysis provides evidence that contemplates the decisive role of preventive measures in controlling severe acute respiratory syndrome (SARS) outbreak in 2003. A statistical surveillance report of WHO reflects, maintaining a coherent infection, prevention and control guideline resulted in a 30% reduction in healthcare-associated infections. The effectiveness of preventive measures completely relies on the strength of surface disinfectants, the composition of hand sanitizer, appropriate material for the manufacture of personal protective equipment (PPE). This review enlightens the various preventive measures such as a suitable selection of surface disinfectants, appropriate hand sanitization, and empowering the PPE that could be a potential intervention to fight against CoVID-19. Viral infections remain a critical issue since the year 1000 when the poxvirus spread through a wide region of China (1) . The large death report in poxvirus infection is often linked to the black death bubonic plague, which kills 75-200 million people in the European continent during the period 1347-1351 (2) . In the year 1901 yellow fever caused by Flavivirus, a filterable agent reported as the first human infected virus responsible for the death of more than 50 million people (3) . Further, in the year 1918-1920 pandemic, Spanish flu (H1N1) is considered to be the greatest medical holocaust in that period affecting millions of people across the worlswide (4) . In the ascent of the timeline different viral infections show their significant impact and responsible for millions of deaths in different countries. A recent unprecedented outbreak of Coronaviruses in Wuhan city of China is declared as a global emergency by WHO. A statistical report suggests that, out of 195 countries, coronaviruses have been spread to 178 countries with the total case of 22,68,011 coronavirus infections, and a death record of 1,55,185 have been reported (till April 18 th 2020) (5) . In a comprehensive outlook, vaccination and antiviral drug therapy are given the foremost priority fight against viral infections. In the last few decades, a large vaccination programmed has been launched to fight against viral infections like polio, smallpox, and hepatitis, etc. A vaccine is assessed by its efficacy and its effectiveness. In the case of the influenza vaccine, effectiveness is lower than the efficacy. This is because influenza often misleads with other influenza-like illnesses and secondly wide diversification in the viral genome. The effectiveness of the viral vaccine is the major concern as a metanalysis report found that effectiveness against flu shows a maximum of 67% in 2012 and thereafter it reduces as mentioned in Figure 1 (6) . Havrix a viral vaccine licensed from USFDA in 1995 for the treatment of hepatitis A. The literature survey reports that 3-20% of acute hepatitis A is observed in previously vaccinated patients. Interestingly most of the relapse cases against hepatitis A vaccine have reported within a short duration of time (less than 3 weeks) (7) . The other major challenging factor for the development of a vaccine against RNA virus is its ultrafast mutation rate and critical adverse effects associated with it. For instance, initial trails of the Flu vaccine in 2009 show mild adverse effects like tenderness in muscles, pain at the injection site, headache, malaise, and muscle pain (8) . WHO recommended this vaccine for the different flu-like syndrome as there are no significant differences in their adverse effects. When vaccination covered to a large population, then severe side effects like anaphylaxis and febrile convulsions were noticed. Looking into the severity of adverse effects, GlaxoSmithKline recalls its vaccine from the market (9) . In the later part of 2009, a peripheral nervous system associated side effects i.e., Guillain Barr's syndrome was observed (10) . Chris Shaw, a neuroscientist at the University of British Colombia expressed the concern that adverse effects may not necessary to appears immediately rather it may take a timeline of 5-10 years as observed in Gulf war syndrome on exposure to the Anthrax vaccine (11) . Henceforth, it is a very critical challenging aspect to access the effectiveness of the viral vaccine, especially against RNA viruses. The second priority is given to antiviral treatment to curb viral infections. There is a lot of antiviral therapeutics available in the global market to fight against viral infections. The recent outbreak of influenza in the year 2008, the two most popular neuraminidase inhibitors Oseltamivir and Zanamivir have been prescribed to control seasonal influenza worldwide. However, the treatment is most effective when prescribed as early as possible after the symptoms developed. The effectiveness of the drug markedly reduces after 48 h of administration. Looking into the antiviral potential, adverse effects such as gastrointestinal associated problems, respiratory problems musculoskeletal symptoms were compromised. After more than eight years of global dominance, the cases of drug resistance have been reported in various scientific documents. In the initial phase of the clinical trial in 2008, drug resistance and population surveillance were very low and further shows highest percentage resistance of 1.9% in the year 2013-2014 influenza season, as compared to the 2012-2013 and 2014-2015 seasons where drug resistance estimated as 0.6 and 0.5%, respectively (12) . In comparison to the other microbial infections (bacterial and fungal), developing an antiviral therapy is always remain a tough assignment to the scientific community. The primary reasons are the highly complex structural ambiguity and unable to identify the viral targets that make the process more complicated to design a selective and effective antiviral therapy (13) . Currently, the unavailability of effective antiviral drug therapy in the global market worsens the situation to a greater extent. Lacking in the concrete information regarding the mode transmission, contact precautions should be an ideal approach to reduce the risk of transmission of newly emerging COVID-19 infection. As per WHO guidelines, infection prevention and control (IPC) is a practical, evidence-based approach to prevent patients and health workers from being harmed by avoidable infections. Statistics revealed that maintaining effective IPC resulted in a >30% reduction in healthcare-associated infections (HAIs) (14) . Hence, considering the global emergency of CoVID-19 infections, preventive care is the only option left to restrict its spreadability. Infections associated with coronavirus may spread by contact, droplet, and airborne transmission. These transmissions will be minimized by taking an appropriate preventive major. The foundation of preventive major against viral infection is initiated with the routine practice of using an effective soap/hand sanitizer/rub, personal protective equipment (suitable mask, eye/face protector, and gowns). For instance, the use of antiseptic hand soaps provides a greater reduction in the number of microbes over a short period as compared with regular soaps (15) . In addition, alcohol base sanitizer restricts the viral growth by precipitating the surface proteins that break the chain of transmission of coronavirus. Moreover, the strength of alcohol is the key factor that determines the biocidal potentiality of the sanitizers/rub. Historical evidence confined the case of coronavirus existence since 1960s in the patient with common cold-like symptoms (16) . Tyrrell and Bynoe found a virus obtained in a culture media containing an infected human embryonic tracheal organ and named as B814. At for an epidemic/pandemic infections across the worldwide by the research community as mentioned in Figure 2 (17, 18) . CoVID-19 is an enveloped, positive-sense, single-stranded RNA virus with the largest genomic configuration of 26-32 Kb amongst all RNA viruses (19) . Coronavirus is a zoonotic virus in which the bat tends to be the most suitable primary host to transmit viral infections. The scientific report predicted that disturbing the natural habitat appears to be stressed in the animal and makes them shed even more viruses in their biofluid like saliva, urine, and feces. These biofluids and feces in our surrounding makes CoVID-19 suitable for spreading the infection through the surface (20). To curb this pandemic infection of CoVID-19, preventive care will play a significant role. The current review emphasizes the various critical aspects associated with the selection of different preventive gadgets such as surface disinfectant, hand hygiene, personal protective equipment that constrain the global spreadability of CoVID-19 infections. The major preventive gadgets include an effective surface disinfectant, hand hygiene, personal protective equipment (suitable mask, eye and face protector). Coronavirus infection is a surface to surface, airborne, contagious disease characterized by fever, shortness of breath and coughing. Surfaces of both animate and inanimate may play a prominent role in the spreading of CoVID-19 infection. Inanimate surfaces are the most prone site for the transmission of CoVID-19 infection from one to another. Depending upon the nature of the surface, pH, temperature and relative humidity of the surrounding, virus persistence time varies from 1-9 d (21). The persistence time in different inanimate subjects is mentioned in Figure 3 . The highly risk exposed surface areas need to be mopped frequently with a suitable disinfectant. The characteristic feature of an ideal disinfectant must have low contact time with significant antiviral activity. Currently, the United States Environmental Protection Agency (USEPA) recommended some disinfectants against CoVID-19 as mentioned in Table 1 (22). In general, quaternary ammonium compounds, hydrogen peroxide, alcohol (ethanol, isopropyl alcohol, phenol), aldehyde, hypochlorous acid, octanoic acid, citric acid conjugate with silver ions, sodium hypochlorite, sodium bicarbonate, etc. are the key ingredient responsible for the virucidal activity. Alcohols, ethanol (78-95%) and iso-propanol (70-100%) have been used as an effective disinfectant as they show potent virucidal activity with a negligible toxic effect on human skin. All lipid enveloped virus gets inactivated within 2 min. The mechanism of action alcohol-based disinfectant is poorly understood however, surface protein precipitation may be one of the key mechanisms that are responsible for the virucidal activity. Besides this, quaternary ammonium compounds (QACs) are most widely integrated into the surface disinfectant formulation. QACs consist of central nitrogen as a cationic portion surrounded by the negatively charged halogen anion portion. QACs are classified according to the nature of alkyl groups (R groups) which includes the number of nitrogen atoms, branching of the carbon chain, and the presence of aromatic groups. Variations in the chain length, nuclear size, and basicity of the complex decide the antimicrobial potentiality. For instance, an increase in the chain length from C 12 -C 16 show the greatest antimicrobial activity. These agents are membrane activating groups as they directly interact with the cytoplasmic membrane of bacteria and yeast (23). The presence of long nonpolar tail makes them effective against a lipid-containing virus such as CoVID-19 (i.e., phospholipid layering). The long chain of hydrocarbon act as permeability enhancer that influences the surface-active properties whereas the cationic portion binds to negatively charged nucleic acids condensed inside the capsid leads to virucidal activity (24). Other major class of disinfectant includes halogen compounds i.e., hypochlorous acid, hypochlorite ions. Sodium hypochlorite solutions can be prepared by absorbing chlorine in sodium hydroxide solution to give a mixture of hypochlorous acid (HOC1) and sodium hypochlorite (NaOCl) and as mentioned below. HOCl + NaOH NaOCl + H Table 2 . However important precautions must be taken into consideration while using frequent alcohol-based hand sanitizer. The oil secreted from the sebaceous gland of the skin surface is composed of free fatty acids, specifically lauric acid and sapienic acid, that possess the inherent antiviral activity (35) . Preventing the exponential spreadability of CoVID-19 infection is completely relies on the use of an effective PPE which includes face masks/respirators, gloves, goggles/face shields, and gowns (40) . The However, the percentage retaining mechanical strength after subsequent washing is an interesting fact that needs to be evaluated (51) . Due course of time, the health department of different countries and WHO provides various preventive health care memos in the public domain that could help to restrict the spreadability of CoVID-19 infection worldwide and are mentioned in Figure 3 (52, 53) . Smallpox: disease, transmission and symptoms Mortality risk and survival in the aftermath of the medieval Black Death Human viruses: discovery and emergence A definition for influenza pandemics based on historial records Infection prevention and control of epidemic-and pandemic-prone acute respiratory infections in health care. Infection Prevention and Control of Epidemic-and Pandemic-Prone Acute Respiratory Infections in Health Care Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis Laboratory diagnosis of hepatitis A Influenza vaccines: Evaluation of the safety profile The Influence of Vaccine on Febrile Seizure Post Vaccination Guillain Barre Syndrome: A Case Report Aluminum adjuvant linked to Gulf War illness induces motor neuron death in mice Influenza viruses -antiviral therapy and resistance The Mutational Robustness of Influenza A Virus Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital Prevention and control of infections in the home The history and epidemiology of Middle East respiratory syndrome corona virus COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges Coronavirus disease 2019 (COVID-19): current status and future perspectives The toxic effects of formaldehyde on the nervous system The role of surface disinfection in infection prevention Collective properties of viral infectivity Virucidal Activity of World Health Organization-Recommended Formulations Against Enveloped Viruses, Including Zika, Ebola, and Emerging Coronaviruses Chemical disinfection of virus-contaminated surfaces Feed additives decrease survival of delta coronavirus in nursery pig diets Development and virucidal activity of a novel alcohol-based hand disinfectant supplemented with urea and citric acid Efficacy of ethanol against viruses in hand disinfection Lipids and the Permeability and Antimicrobial Barriers of the Skin Determination of the fatty acid composition of saponified vegetable oils using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry The Effects of Cold Saponification on the Unsaponified Fatty Acid Composition and Sensory Perception of Commercial Natural Herbal Soaps Free fatty acids induce ER stress and block antiviral activity of interferon alpha against hepatitis C virus in cell culture Antiviral activity of palmitic acid via autophagic flux inhibition in zebrafish (Danio rerio) Accessed April 41. WHO. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations Rational use of face masks in the COVID-19 pandemic United States Food and Drug Administration. N95 Respirators and Surgical Masks (Face Masks) Particle Size-Selective Assessment of Protection of European Standard FFP Respirators and Surgical Masks against Particles-Tested with Human Subjects United States Food and Drug Administration Structural basis for human coronavirus attachment to sialic acid receptors The Enhanced and Tunable Sustained Release of Pesticides Using Activated Carbon as a Carrier Facing ubiquitous viruses: when hand washing is not enough Powdered gloves: Time to bid adieu Face shields for infection control: A review Ford is using airbag material to make reusable hospital gowns for Covid-19 responders Combating Devastating COVID -19 by Drug Repurposing Patients Based on Feline Infectious Peritonitis Strategies: Central Nervous System Invasion and Drug Coverage Comparative assessment of antimicrobial efficacy of different hand sanitizers: An in vitro study PureHands Orange Hand Sanitizer 60% Alcohol Godrej Protekt Instant Hand Sanitizer 3M Science applied to life. 3M TM Avagard CHG Handrub Big basket. Savlon Hand Sanitizer Gel Mountain Falls. Mountain Falls Hand Hygiene 3M Science applied to life. 3M TM Particulate Respirator RP88020 Prestige Ameritech N95 Respirator Aero Pro AP0028 NIOSH N95 Surgical Mask Atlanta Healthcare Cambridge N95 Mask Critical Cover ® AlphaAir® Masks SANDEL ® Respiratory face masks Dokodemo. PM2.5-Blocking Three Dimensional High-Adhesion Face Masks 5 Masks Oxypure N99 Tested Washable Designer Pollution Masks Men/Women/Kids Size Isopropyl Alcohol, PEG-12 Dimethicone, Caprylyl Glycol, Glycerin, Isopropyl Myristate, Tocopheryl Acetate, Fragrance (Parfum) (54) 2. Dettol UK, China Denatured Alcohol-69.4% w/w, Water PEG/PPG17/6 copolymer, Propylene glycol, Acrylate /C10-30 alkyl acrylate, cross polymer, Tetrahydroxpropyl ethylenediamine, Perfume (55) 3. Lifebuoy India Ethyl alcohol 95% Himalaya India Dhanyaka 0.30mg, ushira 0.30, Nagaramusta 0.25mg Denatured with Isopropyl Alcohol 3% (w/w)) 64% (w/w), Water, Glycerin, Acrylates/C10-30 Alkyl Acrylate Crosspolymer Propan-1-ol, Mecetronium ethyl sulfate, glycerol, Tetradecane-1-ol, Fragrances Savlon India Ethanol IP 66.5% V/V, Isopropyl Alcohol I.P 3.5% V/V, Permitted Colours Used Fragrance, Glycerin, Isopropyl Alcohol, Isopropyl Myristate Isopropyl myristate, Tocopheryl acetate, Acrylates/C10-30 alkyl acrylate cross polymer, fragrance • The recent outbreak of CoVID-19 infection is the greatest medical catastrophe in the timeline of epidemic/pandemic infection worldwide.• Unavailability of effective antiviral drugs and approved vaccines, supportive care may be the prevailing alternative to fight against CoVID-19.• Surface disinfectant, hand sanitization, Personal protective equipment (PPE) are the three major pillars of preventive care.• The effectiveness of preventive care completely relies on the selection of suitable disinfectants, strength of alcohol in hand sanitizer, materials integrated for the manufacture of PPE.• However, toxicity associated with prolong use disinfectants, percentage reduction in the protectiveness (filtration efficiency, breathability, etc.) after each wash of reusable PPE are the potential interventions that need to be critically investigated.