key: cord-0846381-zeelhwuv
authors: Ahmad, Md Faruque; Ali, M; Alsayegh, Abdul Rahman A.; Ahmad, Sarfaraz; Alam, Nawazish; Wahab, Shadma; Ali, Md Sajid; Athar, Md Tanwir
title: A current novel perspective approach for coronavirus disease-2019 pandemic outbreak
date: 2021-10-20
journal: J Adv Pharm Technol Res
DOI: 10.4103/japtr.japtr_159_21
sha: 51672fe14005e0a74eaec6ccd6e7762f6d55962d
doc_id: 846381
cord_uid: zeelhwuv

Coronavirus disease-2019 is a serious health threat around the globe. Across the world, approximately 142 million people were infected, and three million deaths happened. The fast propagation is also associated with constant anxiety, mental stress, and discomfort in public and health-care professionals. Lack of approved drugs regimen to combat the pandemic challenge concretely is a challenging project for all who are committed to developing remedial assistance. However, the successful development of three vaccines gives a solid roadmap to combat this disease. In this review, we highlighted the current development and challenges of this pandemic.

World Health Organization (WHO) confirmed that viral infections are emerging as a serious public health threat. Currently, the virus, coronavirus disease-2019 (COVID- 19) has affected so many countries, areas, or territories over 142 million people infected across the world. [1] This disease is caused by a severe acute respiratory syndrome (SARS) that is commonly known as SARS-coronavirus-2 (CoV2). [2] The disease is first started from the city of Wuhan in China in December-2019. Starting from the first identification, it was spread rapidly and a number of cases and death were reported. [3] As of January 30, 2020, the WHO confirmed this outbreak as an international public health emergency. [4] On March 11, 2020, the WHO declared COVID-19 as a pandemic. [5] It has been observed in COVID-19 characteristics that average patients ages are 49-56 years, the mean incubation period is 5.2 days, and the median time of 14 days is noted from the first symptom to death. Male are more than female in hospitalized patients from 54% to 73%. However in the second wave, children are also getting affected by this pandemic. Still, the elders are more susceptible to this disease than the younger. Characteristics of COVID-19 is in Figure 1 . [6] EPIDEMIOLOGY Pandemic COVID-19 has been spread out globally. As of December 31, the local health authority announced epidemiological alerts and markets were closed all the sudden measures adopted on January 1, 2020. Further, 41 hospitalized patients were identified and confirmed COVID-19 infection on 2 nd January. [7] The National Health Commission of China confirmed the death of 17 patients of COVID-19 on January 22, 2020. On January 25, 20202, a total number of 1975 cases and 56 death were confirmed from Mainland China. [8] On January 30, 2020, the cases of this disease increased to 7734. As of February 12, 2020, Taiwan centers for disease control also announced the data comprising the records of 28 countries having 45,167 cases a global update. [9] As of February 23, 2020, it was reported that the number of cases increased 1879 times in comparison to January 10, 2020. [10] The cases were rapidly increased in aberrant ways throughout the world. At the time of data collection for the manuscript on April Figure 4 ]. [11] However, after the start of the vaccination program in the world, a total of 889,827,023 vaccine doses has also been administered to the world population until April 21, 2021.

COVID-19 virus is a single-stranded RNA virus 30-32 kb genome having a lot of natural roots. [12] The current strain of the virus comprising four subtypes as alpha (α), beta (β), gamma (γ), and delta (δ) categories where α and β were reported to have enough virulence capacities to infect human beings. [13] The structural proteins of the new virus include spike, nucleocapsid, envelope, and membrane, which constitute a complete structure and mechanistic cascades towards binding and proliferation [ Figure 5 ]. [14] Physiochemical properties

The appearance of the virus is round in shape, having a diameter of 60-100 nm with deactivating properties either by ultraviolet or heating at 56°C. The virus is believed to be killed after application of the usual disinfectant. [15] Observational studies confirm the stability of the virus on plastic and stainless steel surfaces. [16] 

Coronavirus and its interaction with the renin-angiotensinaldosterone system are believed to have a reliable step toward the infection. This interaction between coronavirus and angiotensin-converting enzyme-2 (ACE-2) is also considered a potential stage of infection. [17] The primary role of ACE is converting angiotensin I to produce Ang-(1-9). Moreover, it is also available for binding with the spike protein of CoVs. The binding is due to the presence of N-terminal peptidase domain and C-terminal collectrin domain. [18] COVID-19 is also expressed in other nucleoproteins, polyprotein, and a number of membrane proteins that include RNA polymerase, papain-like protease, and accessory proteins. [19] 

COVID-19 manifestations have been varied from asymptomatic or minor symptoms to severe complaint and finally, they cause death of the patient. Fever, cough, body ache, muscle fatigue myalgia, and dyspnea are the most common symptom while headache, malaise, diarrhea, and rhinitis were reported in this disease. [20] Diagnosis Diagnosis of COVID-19 is being carried out through laboratory investigations. [21] The onset of fever, cough, and dyspnea could be primary symptoms for the diagnosis of this disease. The probability of COVID-19 is augmented if patients traveled from the community transmission area or had interacted with a COVID patient as well as the suspected cases in the earlier 14 days. Finally, the suspicious case can be confirmed by performing the various confirmatory tests [ Table 1 ].

The adherence of COVID-19 virus to ACE-2 receptors in type II pneumocytes forms a complex which stimulates inflammation in the lower respiratory tract. [23] This complex is progressed by type 2 transmembrane enzyme protease (TMPRSS2) in a proteolytic manner leading to the disruption and cleaved out of ACE-2, finally, to activate the s-spike protein. [24] The virus genome is uncoated, transcribed, and translated. [25] Studies suggest that the binding patterns and the mode to trigger up the inflammatory cascade are almost common as in the case of earlier strain (SARS-CoV and novel SARS-CoV-2). [26] This membrane inoculation causes diseased cell outcomes and termination of the cilium normalcy at particular sites. [27] Later on, some specific inflammatory mediators were released. These mediators further stimulate macrophages to release the multiple cytokines interleukin (IL) 1, IL6, and tumor necrosis factor-α. These cytokines get transferred into the bloodstream and cause excessive capillary permeability through the dilatation of smooth muscles [ Figure 6 ]. This vasodilation and increased permeability allow leaking out the plasma and other fluids in interstitial spaces of alveoli leading to alveolar edema hence alveolar collapse and hypoxemia. Due to the release of inflammatory mediators, the multiple organs get influenced to show the abnormalities in the prodromal phase as the major clinical symptoms of high fever, dry cough, high blood pressure, fatigue, myalgia, diarrhea, dyspnea, lymphopenia, RNAaemia, respiratory distress syndrome, secondary superinfections, and acute cardiac injuries. [7] TREATMENT AND MANAGEMENT At the time of preparing this manuscript, there is still no specific treatment available for COVID-19. Despite the facts of minimal recoveries and having no choice, the Food and Drug Administration approved chloroquine and hydroxychloroquine (an antimalarial drug) to be effective somehow as the remedial approach. [28] The treatment is symptomatic; major treatment interventions are mechanical ventilation, hemodynamic support, and oxygen therapy for patients with severe infection. One of the antiviral (lopinavir 400 mg or ritonavir 100 mg around the world to control the complications are fingolimod, methylprednisolone, chloroquine phosphate, hydroxychloroquine sulfate, bevacizumab, leronlimab, BD) treatment approaches has been recommended and aerosol formulation of alpha-interferon twice daily proposed. [29] Other drugs that are widely used ivermectin, and sarilumab. Corona-infected patients can be managed with rehydration therapy, respiratory inhalation therapy, and providing aid to the affected vital organs. [30] Awareness and dedication can only minimize the spread rate of COVID-19 by strengthening the trust within the communities without having any fear of failure. [31] Strategic recommendations also include the isolation protocols along with the proper use of N95 or FFP3 masks, eye-protective glass, apron, and gloves to prevent the pathogens move [ Figure 7 ]. [32] 

Due to the corona pandemic, several countries have declared a state emergency, including developed countries, even having the best infrastructure of the health-care system, which has raised concerns about lasting impacts on civil liberties. Worldwide with social distancing, the most affected system is educational institutes that leads to almost closure of universities, schools, and colleges, which negatively impact learning outcomes. The impact was more distressing for underprivileged children and their families, causing intersperse learning, inadequate nutrition, infant care problems, and subsequent economic expenditure to family members who could not work. This pandemic also affected the financial markets.

This pandemic has a severe psychological impact including a significant degree of mental stress, fear, anxiety, and worry in most of the public, health caregivers, as well as in a specific group of comorbid diseased populations. Stress during this pandemic can comprises concern and fear about health and health condition of relatives, changing and diet practices, trouble in sleeping or concentration, deterioration of chronic health issues, and deteriorating psychological health situations, increase consumption of alcohol, tobacco, or other drugs. [33] VACCINE DEVELOPMENT given. The emergency use licenses were also issued for some vaccines such as Pfizer, AstraZeneca/Oxford, and vaccine developed by Johnson and Johnson. The side effects of the vaccines have also been reported. Thirty-three suspected adverse drug reactions have been found in Norway including some fatal responses after the use of BioNTech and Pfizer vaccines as per the Norwegian Medicines Agency. [34] CONCLUSION More than 15 months passed of this pandemic, some nonpharmacological approaches have been adopted to combat the symptoms of the disease. As a result of this, only social distancing, quarantine, and isolation methods are advised to keep away from the infections. It also leads to a negative impact on the psychological behavior of human beings.

The scientific community has led to the development more than 40 vaccines that are undergoing the clinical trials, including more than 10 in phase III trials and three of them is ended with the positive results. The world is expecting that this vaccination program will be a significant measure to eradicate this pandemic. Other challenges that still need to be addressed are the multiple variants of this virus that is emerging day by day.

Nil.

There are no conflicts of interest.

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