Novel Coronavirus

University Of Babylon
College Of Nursing
Community Health Nursing Department
2019-2020/ 2nd course
Epidemiology Assignment
novel coronavirus
Done By
AtyafMajeed Ahmed
The Fourth Stage
Evening study
Supervised By
Dr. Hassan Baay

TABLE OF CONTENTS
Abstract…………………………………………………………1
Introduction……………………………………………………..3
Symptoms…………………………………………………….....4
Pathogenesis ……………………………………………………4
Transmission……………………………………………………4
Therapeutics/treatment options………………………………....5
Future directions to control …………………………………….6
Recommendations………………………………………………7
References………………………………………………………7
Abstract
Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the
causative agent of a potentially fatal disease that is of great global public health
concern. Based on the large number of infected people that were exposed to the wet
animal market in Wuhan City, China, it is suggested that this is likely the zoonotic
origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the
isolation of patients that were subsequently administered a variety of treatments.
Extensive measures to reduce person-to-person transmission of COVID-19 have been
implemented to control the current outbreak. Special attention and efforts to protect or
reduce transmission should be applied in susceptible populations including children,
health care providers, and elderly people. In this review, we highlights the symptoms,
epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions
to control the spread of this fatal disease.
1.Introduction
Over the past two decades, coronaviruses (CoVs) have been associated with
significant disease outbreaks in East Asia and the Middle East. The severe acute
respiratory syndrome (SARS) and the Middle East respiratory syndromes (MERS)
began to emerge in 2002 and 2012, respectively. At present, a novel coronavirus, the
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the
Coronavirus Disease 2019 (COVID-19), has emerged in late 2019, which has posed a
global health threat with its ongoing pandemic in many countries and
territories.Health workers worldwide are currently making efforts to control further
disease.outbreaks caused by the novel CoV (originally named.Province, China, on
December 12 , 2019. On February , 2020, the World Health Organization (WHO)
announced the official designation for this current CoV- associated disease to be
“COVID-19”, caused by the SARS-CoV-2.CoVs belong to the family Coronaviridae
(subfamily Coronavirinae), the members of which infect a broad range of hosts,
producing symptoms and diseases ranging from a common cold to severe and
ultimately fatal illnesses such as SARS, MERS, and, as of present, COVID-19.the
same lineage of CoVs that causes SARS; however, this novel virus is genetically
distinct. Until 2020, six Newly evolved CoVs are thus posing a significant threat to
global public health. Over the past two decades, the current emergence of COVID-19
is the third CoV outbreak in humans .The COVID-19 that emerged in China spread
rapidly throughout the country and subsequently to other countries. Due to the
severity of this outbreak and the potential of spreading on an international scale,the
WHO declared a “global health emergency” on January 31 , 2020. Subsequently,
onMarch 11 , 2020, a pandemic situation was declared. At present, we are not in a
position to effectively treat COVID-19 since neither approved vaccines nor specific
antiviral drugs for treating human CoV infections are available. Most nations are
currently making efforts to prevent further spreading of this potentially deadly virus
by implementing preventive and control strategies.The emergence of novel CoVs may
have become possible because of multiple CoVs being maintained in their natural
host, which could have favored the probability of genetic recombination . High
genetic diversity and the ability to infect multiple host species are a result of high-
frequency mutations in CoVs, which occur due to instability of RNA-dependent RNA
polymerases along with higher rates of homologous RNA CoVs were known to infect
humans include HCoV-229E, HCoV-NL63, HCoV-OC43,is considered as one of the
seven members of the CoV family that infect humans and it belongs to HCoV-
HKU1, SARS-CoV, and MERS-CoV. Though SARS-CoV and MERS-CoV have
resulted in outbreakswith high mortality, others remain associated with mild upper-
respiratory tract illnesses.
2. Symptoms
The symptoms of COVID-19 infection appear after an incubation period of

approximately 5.2 day]. The period from the onset of COVID-19 symptoms to death
ranged from 6 to 41 days with a median of 14 days. This period is dependent on the
age of the patient and status of the patient's immune system. It was shorter among
patients >70-years old compared with those under the age. The most common
symptoms at onset of COVID-19 illness are fever, cough, and fatigue, while other
symptoms include sputum production, headache, hemoptysis, diarrhea, dyspnoea, and
lymphopenia]. Clinical features revealed by a chest CT scan presented as pneumonia,
however, there were abnormal features such as RNA Anemia, acute respiratory
distress syndrome, acute cardiac injury, and incidence of grand-glass opacities that led
to death. In some cases, the multiple peripheral ground-glass opacities were observed
in sub pleural regions of both lung] that likely induced both systemic and localized
immune response that led to increased inflammation. Regrettably, treatment of some
cases with interferon inhalation showed no clinical effect and instead appeared to
worsen the condition by progressing pulmonary opacities.COVID-19 showed some
unique clinical features that include the targeting of the lower airway as evident by
upper respiratory tract symptoms like rhinorrhoea, sneezing, and sore throat]. In
addition, based on results from chest radiographs upon admission, some of the cases
show an infiltrate in the upper lobe of the lung that is associated with increasing
dyspnea with hypoxemia.experienced similar GI distress. Therefore, it is important to
test faecal and urine samples to exclude a potential alternative route of transmission,
specifically through health care workers, patients etc.
3.Pathogenesis
Patients infected with COVID-19 showed higher leukocyte numbers, abnormal

respiratory findings, and increased levels of plasma pro-inflammatory cytokines. One
of the COVID-19 case reports showed a patient at 5 days of fever presented with a
cough, coarse breathing sounds of both lungs, and a body temperature of 39.0 °C. The
patient's sputum showed positive real-time polymerase chain reaction results that
confirmed COVID-19 infection]. The laboratory studies showed leucopenia with
leukocyte counts of 2.91 × 10^9 cells/L of which 70.0% were neutrophils.
Additionally, a value of 16.16 mg/L of blood C-reactive protein was noted which is
above the normal range (0–10 mg/L). High erythrocyte sedimentation rate and D-
dimer were also observed.The main pathogenesis of COVID-19 infection as a
respiratory system targeting virus was severe pneumonia, RNA anemia, combined
with the incidence of ground-glass opacities, and acute cardiac injury. Significantly
high blood levels of cytokines and chemokine were noted in patients with COVID-19
infection that included IL1-β, IL1RA, IL7, IL8, IL9, IL10, basic FGF2, GCSF,
GMCSF, IFNγ, IP10, MCP1, MIP1α, MIP1β, PDGFB, TNFα, and VEGFA. Some of
the severe cases that were admitted to the intensive care unit showed high levels of
pro-inflammatory cytokines including IL2, IL7, IL10, GCSF, IP10, MCP1, MIP1α,
and TNFα that are reasoned to promote disease severity.
4 Transmission
Several reports have suggested that person-to-person transmission is a likely route for
spreading COVID-19 infection. Person-to-person transmission occurs primarily via
direct contact or through droplets spread by coughing or sneezing from an infected
individual. In a small study conducted on women in their third trimester who were
confirmed to be infected with the coronavirus, there was no evidence that there is
transmission from mother to child. However, all pregnant mothers underwent cesarean
sections, so it remains unclear whether transmission can occur during Normal delivery
. This is important because pregnant mothers are relatively more susceptible to
infection by respiratory pathogens and severe pneumonia.
The binding of a receptor expressed by host cells is the first step of viral infection
followed by fusion with the cell membrane. It is reasoned that the lung epithelial cells
are the primary target of the virus.
5.Therapeutics/treatment options
The person-to-person transmission of COVID-19 infection led to the isolation of

patients that were administered a variety of treatments. At present, there are no
specific antiviral drugs or vaccine against COVID-19 infection for potential therapy of
humans. The only option available is using broad-spectrum antiviral drugs like
Nucleoside analogues and also HIV-protease inhibitors that could attenuate virus
infection until the specific antiviral becomes available.The treatment that have so far
been attempted showed that 75 patients were administrated existing antiviral drugs.
The course of treatment included twice a day oral administration of 75 mg
oseltamivir, 500 mg lopinavir, 500 mg ritonavir and the intravenous administration of
0·25 g ganciclovir for 3–14 days [26]. Another report showed that the broad-spectrum
antiviral remdesivir and chloroquine are highly effective in the control of 2019-nCoV
infection in vitro. These antiviral compounds have been used in human patients with a
safety track record. Thus, these therapeutic agents can be considered to treat COVID-
19 infection. Furthermore, there are a number of other compounds that are in
development. These include the clinical candidate EIDD-2801 compound that has
shown high therapeutic potential aganist seasonal and pandemic influenza virus
infections and this represents another potential drug to be considered for the treatment
of COVID-19 infection. Along those lines, until more specific therapeutics become
available, it is reasonable to consider more broad-spectrum antivirals that provide
drug treatment options for COVID-19 infection include Lopinavir/Ritonavir,
Neuraminidase inhibitors, peptide (EK1), RNA synthesis inhibitors. It is clear
however, that more research is urgently needed to identify novel chemotherapeutic
drugs for treating COVID-19 infections. In order to develop pre-and post-exposure
prophylaxis against COVID-19, Several groups of scientists are currently working
hard to develop a nonhuman primate model to study COVID-19 infection to establish
fast track novel therapeutics and for the testing of potential vaccines in addition to
providing a better understanding of virus-host interactions.
6.Future directions to control the spread of the disease.
Extensive measures to reduce person-to-person transmission of COVID-19 are

required to control the current outbreak. Special attention and efforts to protect or
reduce transmission should be applied in susceptible populations including children,
health care providers, and elderly people. A guideline was published for the medical
staff, healthcare providers, and, public health individuals and researchers who are
interested in the 2019-nCoV .The early death cases of COVID-19 outbreak occurred
primarily in elderly people, possibly due to a weak immune system that permits faster
progression of viral infection .The public services and facilities should provide
decontaminating reagents for cleaning hands on a routine basis. Physical contact with
wet and contaminated objects should be considered in dealing with the virus,
especially agents such as faecal and urine samples that can potentially serve as an
alternative route of transmission. countries have implemented major prevention and
control measures including travel screenings to control further spread of the virus.
Epidemiological changes in COVID-19 infection should be monitored taking into
account potential routes of transmission and subclinical infections, There remains a
considerable number of questions that need to be addressed. These include, but are not
limited to, details about who and how many have been tested, what proportion of
these turned positive and whether this rate remains constant or variable. Very few
pediatric cases have so far been reported; is this due to lack of testing or a true lack of
infection/susceptibility? Of the ones that have so far been tested, how many have
developed severe disease and how many were tested positive but showed no clinical
sign of disease? There are some basic questions that would provide a framework for
which more specific and detailed public health measures can be implemented.
Recommendations
 Wash hands constantly.

 Always clean surfaces.
 Investigate the correct information about the disease.
 Avoid traveling if you have a fever or cough.
 Stay away from crowded places.
 staying at home.
 Insulation at home.
 Immediate detection.
 Not to panic and fear.
References:_
Rothan, Hussin A., and Siddappa N. Byrareddy. "The epidemiology and pathogenesis
of coronavirus disease (COVID-19) outbreak." Journal of autoimmunity (2020):
102433.
Rothan, H. A., & Byrareddy, S. N. (2020). The epidemiology and pathogenesis of
coronavirus disease (COVID-19) outbreak. Journal of autoimmunity, 102433
ROTHAN, Hussin A.; BYRAREDDY, Siddappa N. The epidemiology and
pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of autoimmunity,
2020, 102433.

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University Of Babylon

Community Health Nursing Department

2019-2020/ 2nd course

Dr. Hassan Baay

Future directions to control …………………………………….6

The symptoms of COVID-19 infection appear after an incubation period of

Patients infected with COVID-19 showed higher leukocyte numbers, abnormal

The person-to-person transmission of COVID-19 infection led to the isolation of

Extensive measures to reduce person-to-person transmission of COVID-19 are

 Wash hands constantly.

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