Category A agents (cholera, plaque).

Patients should be placed in separate rooms or cohorted

together. Negative pressure rooms are not generally needed. The rooms and surfaces and
equipement should undergo regular decontamination preferaly with sodium hypochlorite.
Healthcare workers should be provided with fit tested N95 respirators and protective suits and
goggles. Airborne transmission precaution should be taken during aerosol generating procedures
such as intubation, suction and tracheostomies. All contacts including healthcare workers should be
monitored for development of symptoms of COVID-19. Patients can be discharged from isolation
once they are afebrile for atleast 3d and have two consecutive negative molecular tests at 1 d
sampling interval. This recommendation is different from pandemic flu where patients were.

CoV lethal challenge. Such antibodies may play a crucial role in enhancing protective humoral
responses against the emerging CoVs by aiming appropriate epitopes and fujnctions of the S protein.
The croos-neutralization ability of SARS-CoV RBD-specific neutralizing Mabs considerably relies on
the resemblance between their RBDs ; therefore, SARS-CoV RBD-specific antibodies could cross-
neutralized SL-CoVs, i.e., bat-SL-CoV straim WIVI (RBD with eight amino acid differences from SARS-
CoV) but not bat-SL-CoV straim SHC014 (24 amino acid differences) (200).

Approriate RBD-specific Mabs can be recognized by a relative analysis of RBD of SARS-CoV-2 to that
of SARS-CoV, and cross-neutralizing SARS-CoV RBD-specific Mabs could be explored for their
effectiveness against COVID-19 and further need to be assessed clinically. The U.S. biotechnology
company Regeneron is attempting to recognize potent and specific Mabs to combat COVID-19. An
ideal therapeutic option suggested for SARS-CoV-2 (COVID-19) is the combination therapy comprised
of Mabs and the drug remdesivir (COVID-19) (201). The SARS-CoV-specific human Mab CR3022 is
found to bind with SARS-CoV-2 RBD, indicating its potential as a therapeutic agent.

Other clinical trilas in different phases are still ongoing elsexhere.

Immunomodulatory agents. SARS-CoV-2 triggers a strong immune response which may cause
cytokine storm syndrome. Thus, immunomodulatory agents that inhibit the excessive inflammatory
response may be a potential adjujnctive therapy for COVID-19. Dexamethasone is a cortcosteroid
often used in a wide range of condition to relieve inflammation through its anti-inflammatory and
immunosuppressant effects. Recently, the RECOVERY trial found dexamethasone reduced mortality
by about one third in hospitalized patients with COVID-19 who received invasive mechanical
ventilation and by one fifth in patients receiving oxygen. By contrast, no benefit was found in patients
without respiratory support.

Tocilizumab and sarilumab, two tupes of interleukin-6 (IL-6) rereceptor-specific antibodies previously
used to treat various types of arthritis, including rheumatoid arthritis, and cytokine release
syndrome, showed effectiveness in the treatment of severe COVID-19 by attenuating the cytokine
storm in a small uncontrolled trial. Bevacizumab is an anti-vasvular endothelial growth factor (VEGF)
medication that could potentially reduce pulmonary oedema in patients with severe COVID-19.
Eculizumab is a specific monoclonal antibody that inhibits the proiflammatory complement proteil
levels suggesting its potential to be an option for the treatement of severe COVID-19.

Been used based on the experience with SARS and MERs. In a historical control study in patients with
SARS, patient treated with lopinavirritonavir with ribavirin had better outcomes as compred to those
given ribavirin alone .

In the case series of 99 hospitalized patients with COVID-19 infection from Wuhan, oxygen was gievn
to 76%, non-invasive ventilation in 13%, mechanical ventilation in 4%, extracorporeal membrane
antifungals in 15%, glucocorticoids in 19% and intravenous immunoglobulin therapy in 27%. Antiviral
therapy consisting of oseltamivir, ganciclovir and lopinavirritonavir was given to 75% of the patients.
The duration of non-invasive ventilation was 4-22 d [median 9 d]

Extended to other cities of Hubei province. Cases of COVID-19 in countries outside China were
reported in those with no history of travel to China suggesting that local human-to-human
transmission was occuring in these countries. Airports in different countries including India put in
screening mechanisms to detect symptomatic people returning from China and placed them in
isolation and testing hem for COVID-19. Soos it was apparent that the infection could be transmited
from asymptomatic people and also before onset of symptoms. Therefore, countries including India
who evacuated their citizens from Wuhan through special flights or had travellers returning from
China, placed all people symptomatic or otherwise in isolation for 14 d and tested for the virus.

Cases continued to increase exponentially and modelling studies.

13 CONVALESCENT PLASMA THERAPY

Guo Yanhong, an official with the National Health Commission (NHC), stated that convalescent
plasma therapy is a significant method for treating severe COVID-19 patients. Among the COVID-19
patients currently receiving convalescent plasma therapy in the virus-hit Wuhan, one has been
discharged from hospital, as reported by Chinese science authorities on Monday, 17th February 2020
in Bejing. The first dose of convalescent plasma from a COVID-19 patient was collected on 1st and 9th
February 2020 from a severely ill patient who was given treatment at a hospital in Jiangxia District in
Wuhan. The presence of the virus in patients is minimised by the antibodies in the convalescent
plasma. Guiqiang stated that donating plasma may cause minimal harm to the donor and that there
is nothing to be worried about. Plasma donors must be cured patients and discharged from hospital.
Only plasma is used, whereas red blood cells (RBC), white blood cells (WBC) and blood platelets are
transfused back into the donor’s body. Wang alleged that donor’s plasma will totally improve to its
initial state after one or 2 weeks from the day of plasma donation of around 200 to 300 millilitres.

Prevention

Since at the time there are no zpproved treatments for this infection, prevention is crucial. Several
properties of this virus make prevention difficult namely, non-specific features of the disease, the
infectivity even before onset of symptoms in the incubation period, transmission from asymptomatic
people, long incubation period, tropism for mucosal surfaces such as the conjunctiva, prolonged
duration of the illness and transmission even after clinical recovery.

Isolation of confirmed or suspected cases with mild illness at home is recommended. The ventilation
at home should be good with sunlight to allow for asked to wear a simple surgical mask and practice
cough hygiene.

Prongs, face mask, high flow nasal cannula (HFNC) or non-invasice ventilation is indicated.
Mechanical ventilation and even extra corporeal membrane oxygen support may be needed. Renal
replacement therapy may be needed in some. Antibiotics and antifungals are required if co-infections
are suspected or proven. The role of corticosteroids is unproven ; while current international
consensus and WHO advocate against their use, Chinese quidelines do recommend short term
therapy with low-to-moderate dose corticosteroids in COVID-19 ARDS. DFetailed guidelines for
critical care management for COVID-19 have been published by the WHO. There is, as of now, no
approved treatment for COVID-19. Antiviral drugs such as ribavirin, lopinavir-ritonavir have been
used based on the experience with SARS and MERs. In a historical
 including IL2, IL7, IL10, GCSF, IP10, MCP1, MIP1A, and TNFa. The median time from onset of
symptoms to dyspnea was 5 d, hospitalization 7 d and dacute respiratory distress syndrome (ARDS) 8
d. The need for intensive care admission was in 25-30% of affected patients in published series.
Complications witnessed included acute lung injury, ARDS, shock and acute kidney injury. Recovery
started in the 2nd or 3rd wk. The medidan duration of hospital stay in those who recovered was 10 d.
Adverse outcomes and death are more common in the elderly and those with underlying co-
morbidities (50-75% of fatal cases). Fatality rate in hospitalized adult patients ranged from 4 to 11%.
The overall case fatality rate is estimated to range between 2 and 3%. Interestingly, disease in
patients outside Hubei province has been

this emerging virus will establish a niche in humans and coexist with us for a long time. Before
clinically approved vaccines are widely available, there is no better way to proytect us from SARS-
CoV-2 than personal preventive behaviours such as social distancing and wearing masks,and public
health measures, including active testing, case tracing and restrictions on social gatherings. Despite a
flood of SARS-CoV-2 research published every week, current knowledge of this novel coronavirus is
just thye tip of the iceberg. The animal origin and cross-species infection route of SARS-CoV-2 are yet
to be uncoverred. The molecular mechanisms of SARS-CoV-2 infection pathogenesis and virus-host.

Interestingly, disease in patients outside Hubei province has been reported to be milder than those
from Wuhan. Similarly, the severity and case fatality rate in patients outside China has been reported
to be milder. This may either be due to selection bias wherein the cases repoting from Wuhan
included only the severe cases or due to predisposition of the higher expression of ACE 2 receptors on
the respiratory mucosa. Disease in neonates, infants and children has been also reported to be
significantly milder than their adult counterparts. In a series of 34 children admitted to a hospital in
Shenzhen, China between January 19th and February 7th, there were 14 males and 20 females. The
median age was 8 y 11 mo and in 28 children the infection was linked to a family member and 26.

Only a matter of the time before another zoonotic coronavirus results in an epidemic by jumping the
so-called species barrier. The host spectrum of coronavirus incresased when a novel coronavirus,
namely, SWI, was recognized in the liver tissue of a captive beluga whale (Delphinapterus leucas). In
recentdecades, several novel coronavirus were identified from different animal species. Bats can
harbor these viruses without manifesting any clinical disease but are persistently infected. They are
the only mammals with the capacity for self-powered flight, which enables them to migrate long
distances, unlike land mammals. Bats are distributed worldwilde and also account for about a fifth of
all mammalian species. This makes them the ideal reservoir host for many viral agents and also the
source of novel coronavirus that have yet to be identified. It has become a necessity to study the
diversity of coronavirus in the bat population to prevent future outbreaks that could jeopardize
livestock and public health. The repeated outbreaks caused by bat-origin coronavirus calls for the
development of efficient molecular surveillance strategies for studying Betacoronavirus among
animals, especially in the Rhinolophus bat family. Chinese bats have high commercial value, since
they are used in

SARS- or MERs-CoV outbreak. However, there has been concern regarding the impact of SARS-CoV-
2/COVID-19 on pregnancy. Researchers have mentioned the probability of in utero transmission of
novel SARS-CoV-2 from COVID-19-infected mothers to their neonates in China based upo the rise in
IgM and IgG antibody levels and cyhtokine values in the blood obtained from newborn infants
immediately postbirth ; however, RT-PCR failed to confirm the presence of SARS-CoV-2 genetic
material in the infants. Recent studies show that at least in some cases, preterm delivery and its
consequences are associated with the virus. Nonetheless, some cases have raised doubts for the
likelihood of vertical transmission.

COVID-19 infection was associate with pneumonia, and some developed acute respiratory distress
syndrome (ARDS). The blood biochemistry indexes, such as albumin, lactate dehydrogenase. C-
reactive protein, lymphocytes (percent), and neutrophils (percent) give an idea about the disease
severity in COVID-19 infection. During COVID-19, patients may present leukocytosis, leukopenia with
lymphopenia, hypoalbuminemia, and an increase of lactate dehydrogenase, asparate transaminase,
alamine aminotransferase, bilirubin, and, especially, D-dimer

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