key: cord-1048168-ar1qosrt
authors: Awais, Sayema; Hussain Shahb, Sayed Fida; Sarwar Shahc,d, Syed Ghulam
title: A Commentary on “A comparative overview of COVID-19, MERS and SARS: Review article” (International Journal of Surgery 2020; 81:1-8)
date: 2020-09-11
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.08.049
sha: 8fec5386556d0c17379cda5b5cd31e449e99451a
doc_id: 1048168
cord_uid: ar1qosrt

nan

Transmission most likely took place through consumption of meat, milk or serum of the host animal and/or by direct contact [1] . Nosocomial transmission was the dominant route of transmission for all three of the viruses; considerable secondary transmission through asymptomatic patients was also reported [9] . Reproduction factor (R 0 ) for SARS was 3, for MERS 0.8-1.3 [10] and for SARS-CoV-2 up to 2.5 at the beginning of the epidemic [11] . The timing of peak viral loads in MERS was during the second week of infection, on the 10 th day in case of SARS-CoV and during the first week for SARS-CoV-2, viral load being higher in severe cases for all three viruses [12] .

The clinical spectrum of all three viral infections is similar with a prodrome of non-specific symptoms the most frequent being fever and dry cough, followed by muscle aches, chills and shortness of breath while some patients present with nausea, vomiting and diarrhea [13] . Severity of Coronavirus infections is greater with older age, and co-morbidities like diabetes, chronic heart disease, and hypertension. While complicated cases of SARS and COVID 19 manifested rapid progression to ARDS, severe MERS cases were more likely to present extra pulmonary organ dysfunction as well as the need for treatment with vasopressors [13] .

To date, only symptomatic support is the mainstay of treatment for all three types of coronavirus infections. Antibiotics are given to guard against superimposed bacterial infections or complications. Studies regarding the efficacy of ribavirin, alone or in combination with interferon or glucocorticoids have reported conflicting results [14, 15] . Remdesivir, although effective against SARS-CoV and MERS-CoV, still lacks evidence from clinical trials for its effectiveness against COVID 19 [16] . In vitro experiments report chloroquine effectiveness in the prevention and control of SARS-CoV infection while randomized controlled trials show hydroxychloroquine effectiveness in shortening recovery time for COVID 19 pneumonia [17] .

Convalescent plasma transfusions have been found effective in improving prognosis in early stages of SARS with similar results reported in five critically ill patients with COVID 19. However, risks due to infection transmission to transfusion personnel, strict criteria for donor selection and limited evidence from Randomized Controlled Trials restrict its use [18] . A number of vaccines against

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