key: cord-0922997-btiy6jhr authors: Sharma, Atul; Tiwari, Swapnil; Deb, Manas Kanti; MARTY, Jean Louis title: Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2): A global pandemic and treatments strategies date: 2020-06-10 journal: Int J Antimicrob Agents DOI: 10.1016/j.ijantimicag.2020.106054 sha: 012d92195e5ea54772fbe23e7468257eb6adada6 doc_id: 922997 cord_uid: btiy6jhr The emergence and rapid spread of novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a potentially fatal disease is swiftly evolving public health crises worldwide. The origin of SARS-CoV-2 infection was first reported in people exposed to wet animal market in Wuhan City, China in December 2019. It was suggested that the infection is likely to be of zoonotic origin and transmitted to human through yet unknown intermediary. As of (22/05/2020), there are around 4,995,996 confirmed cases reported by WHO with 327,821 deaths. SARS-CoV-2 infection is transmitted via inhalation or direct contact of infected people's droplets. It has an incubation period ranging from 2 to 14 days or more. The rate of spread of SARS-CoV-2 is more than partially resembled coronavirus (SARS-CoV and MERS). The symptoms are similar to influenza like, breathlessness, sore throat and fatigue therefore, infected person is isolated and administrated with effective treatments. Infection is mild in most but in elderly (>50 years) and those with cardiac and respiratory disorder, it may progress to pneumonia, acute respiratory distress syndrome, and multi organ failure. People with strong immunity or those developed herd immunity are asymptomatic. Fatality rate ranges to 3-4% on case basis. Diagnosis of SARS-CoV-2 is recommended in respiratory secretions by special molecular tests like PCR, chest scan and common laboratory diagnosis. Currently, the existing treatment is essentially supportive and role of antiviral agents is yet to be established as there is no vaccination or therapy available. This review focuses on epidemiology, symptoms, transmission, pathogenesis, ongoing available treatments and future perspectives of SARS-CoV-2. to act as an mRNA for translation of the replicase polyproteins and strong affinity to bind 114 with human cell receptors that differentiates it from other CoVs [21] . These CoVs are known 115 to cause a variety of diseases in mammals and birds ranging from enteritis in cows and pigs 116 and upper respiratory disease in chickens to potentially lethal human respiratory infections CoV and >95% homology with the bat CoV. The environmental sample was also reported to 128 be positive from the Huanan seafood market [23] . It was observed that the number of cases 129 increasing exponentially, however, some cases did not have direct exposure to live animal 130 seafood market which suggested that the human-to-human transmission has occurred [24] . infection to the death, the period ranges from 6-41 days with average rate of 14 days [31] . 162 This period is dependent on the several factors such as age and health. The period is shorter 163 for patients with comorbidities and above 70 years [31] . 164 Diagnosis and treatment program (6 th version) published by the National Health injury, RNAaemia, and grand-glass opacities that lead to death have also been reported [24] . 172 The major notable symptoms are presence of multiple peripheral ground glass opacities in 173 subpleural regions of both lungs which induce the both systemic and localized immune 174 response leading to increased inflammation [33] . Importantly, there are similarities in the 175 symptoms between SARS-CoV-2 and earlier reported βCoVs such as dry cough, fever, 176 dyspnoea, and bilateral ground-glass opacities investigated through chest CT scans [24] . 177 However, SARS-CoV-2 exhibited some inimitable clinical features targeting the lower 178 respiratory region as evident by upper respiratory tract symptoms like rhinorrhoea, sneezing, 179 and sore throat [29, 34] . 180 Additionally, from investigation of chest radiographs of patients, an infiltrate in the upper 181 lobe of the lung which is associated with increasing dyspnoea with hypoxemia was observed. respiratory droplets, smaller airborne aerosol (<5 µm) and direct surface contacts to the 211 transmissibility of SARS-CoV-2 still need to be evaluated to enable an effective control over 212 transmission and infection. 213 The faecal transmission routes should also be considered, as the SARS-CoV-2 virus has Recently, a small study was conducted by Chen et al., on pregnant women who were 236 confirmed to be infected with the SARS-CoV-2. Though no evidence for transmission of viral 237 infection from mother to child has been found, still the cloud of uncertainty persists [41] . 238 Understanding of this factor is highly important as pregnant mothers are relatively more Figure. The spike protein helps to establish a contact with the human 253 cell and it has region which recognize the ACE2 receptor in human cell especially respiratory 254 cell. As virion binds with ACE2 protein, an another TMPRSS2 protein (on exterior cell wall) 255 help to open the spike protein and cleave the membrane and allowing entry of virion particle. After that, virion releases its RNA strand, which is translated into protein and further form 257 more RNA strands. During cell development (Fig.3) , one strand of virion enters the Golgi 258 bodies and evolving new virion those come out of cell where membrane and envelop proteins intrigued. One virion particle has ability to make several hundred new virions in the way and 260 each capable to infect new cell. Pathogenesis of SARS-CoV-2 producing acute respiratory disorder and pneumonia like 262 symptoms seems to be particularly complex and responsible for initiating an excessive In addition to several antiviral agents, CQ and HCQ have been proposed as treatments that Table 1 . and Wi-N were also comparable. This study predicted that these natural compounds possess 648 the potential to inhibit the enzymes essential for virus survival and will helps in initial 649 screening of anti-SARS-CoV-2 drugs. The Importance of Understanding the 753 One Health: The Human-Animal-Environment Interfaces in Emerging Infectious 755 Diseases: The Concept and Examples of a One Health Approach Zika… 759 what next? 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