Corona Virus Disease (COVID-19) and Medicinal Experts

Corona Virus Disease (COVID-19) and Medicinal Experts  

Why do the virus and the disease have different names?

Viruses and the diseases they cause often have different names. For example, HIV is the virus that causes AIDS, Measles diseases is caused by the virus known as rubella. There are different processes and purposes for naming viruses and diseases. Viruses are named based on their genetic structure to facilitate the development of diagnostic tests, vaccines and medicines. Virologists and the wider scientific community do this work, so viruses are named by the International Committee on Taxonomy of Viruses (ICTV). 

Diseases are named to enable discussion on disease prevention, spread, transmissibility, severity and treatment. Human disease preparedness and response is W.H.O’s role, so diseases are officially named by W.H.O in the International Classification of Diseases (ICD).

ICTV announced “severe acute respiratory syndrome corona virus 2 (SARS-CoV-2)” as the name of the new virus on 11 February 2020.  This name was chosen because the virus is genetically related to the corona virus responsible for the SARS outbreak of 2003. 

W.H.O announced “COVID-19” as the name of this new disease on 11 February 2020.

Corona Viruses

Corona viruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). A novel corona virus (nCoV) is a new strain that has not previously been identified in humans. Corona viruses are zoonotic, meaning they are transmitted between animals and people.

Common signs of infection include respiratory symptoms, fever, and cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and death.

Modes of transmission definitions

Mode of transmission	Definition	Examples of the agents
Airborne	Transmission of disease caused by dissemination of droplet nuclei that remain infectious when suspended in air over long distance (>1 m) and time.	Pulmonary tuberculosis, measles, chickenpox
Opportunistic airborne	Transmission of droplet nuclei at short range during special circumstances, such as the performance of aerosol-generating procedures associated with pathogen transmission.	SARS-Corona virus, influenza
Droplet	Droplets are generated from an infected (source) person primarily during coughing, sneezing and talking. Transmission occurs when these droplets, containing microorganisms, are propelled a short distance (usually <1 m)	Adenovirus, respiratory syncytial virus, influenza, SARS-Coronavirus

    

                          

Key recommendations based on case severity and risk factors, irrespective of transmission scenario

Case severity, risk factors                            Recommendations

                  Mild                                  Patients should be instructed to self-isolate and contact                                                                            COVID- 19 information line for advice on testing and referral.

    Moderate, with no risk factors     Test suspected COVID-19 cases according to diagnostic strategy.                                                            Isolation/ cohorting in:

                                                          Health facilities, if resources allow.
                                                          Community facilities (e.g. stadiums, gymnasiums, hotels) with                                                              access to rapid health advice (i.e. adjacent COVID-19                                                                            designated health post/EMT-type 1, telemedicine).
                                                          Self-isolation at home.

 

     Moderate, with risk factors            Patients should be instructed to self-isolate and call COVID-19 hotline for emergency referral as soon as possible.

       

     Severe                                            Hospitalization for isolation (or cohorting) and inpatient treatment.

     

     Critical                                           Test suspects COVID-19 cases according to diagnostic strategy.

What are the medicines being considered for the novel corona virus pandemic?

According to the World Health Organization (WHO), SARS-CoV-2 virus has caused the world’s largest pandemic. Over half-a-million people are under lockdown, over six lakh are infected and nearly 29,000 dead globally. In India, the numbers stand at a shade below 1,000 cases and 24 deaths.( as on March 28) With the rise in cases, India has now joined the world in the search for drugs to treat COVID-19. Earlier this week, India approved the use of the anti-malarial drug, hydroxychloroquine, as a preventive medication for people at high risk, such as health workers and immediate contacts of a person who has tested positive for COVID-19.

 Why COVID-19 patients are dying?

Emerging data from China and Italy show that COVID-19 patients have severe blood-clotting disorders that lead to respiratory failure and death. Where as in India, COVID-19 deaths have been seen in mostly the elderly population with other health issues including diabetes.

What are the drugs available?

WHO is looking at some of what doctors and researchers believe are the most promising therapies including a combination of two HIV drugs, Lopinavir and Ritonavir(used in India also for an Italian patient in Rajasthan),anti-malaria medications, Chloroquine and Hydroxychloroquine, and an experimental antiviral compound called Remdesivir.

What does the research say so far?

The drug, Remdesivir developed to treat Ebola and related viruses, is being tested on COVID-19 patients. W.H.O in his research material has released: “Remdesivir works by shutting down the viral replication; it has been confirmed by the New England Journal of Medicine also. The international health community has maintained that of the drugs in the trials, Remdesivir has the best potential and the drug shows that it can be used in high doses without causing toxicities.

Chloroquine and Hydroxychloroquine are Anti-malarial drugs which are being looked at in India and the ICMR has said that it is currently studying the drug action in the Indian population with respect to COVID-19. A study on 20 COVID-19 patients in France who were given hydroxychloroquine showed a significant reduced viral load in nasal swabs. But hydroxychloroquine, in particular, is known to have a variety of side-effects on the heart.

Agencies are also looking at unapproved drugs that have performed well in animal studies with the other two deadly corona viruses, which cause Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

 Is Plasma Therapy a ray of hope?

The world health community is also looking at Plasma or Antibody Therapy (plasma extracted from those who have recovered from COVID-19) for COVID-19 with China using it recently on its patients. W.H.O had recommended its use against Ebola, and issued protocols for its use to treat M.E.R.S but its clear-cut benefit treat COVID-19 cases is still under investigation. According to a paper published in the Journal of American Medical Association — the preliminary findings have raised the possibility that convalescent plasma transfusion may be helpful in the treatment of critically ill patients with COVID-19 and ARDS, but this approach requires evaluation in randomized clinical trials.

Meanwhile, the British Medical Journal has reported that the U.S. Food and Drug Administration has approved the use of plasma from recovered patients to treat people who are critically ill with COVID-19, ‘provided that doctors get approval over the telephone.’ The article added: The method has been used in the past to treat diseases such as polio, measles, and mumps and the 1918 Flu Epidemic.

The PAST POSITIVES

•       Pneumonic Plague, 1994
•        Avian Influenza A(H5N1) 2005-06
•        Pandemic Influenza A(H1N1) Swine Flu, 2009
•      Nipah, 2001, 2018-19
•      Zika,2018

It was in 2013 that the government expanded the network of public health laboratories to enhance capacity for diagnosis and detection of viruses. Over the years, more than a hundred Virus Research and Diagnostic Laboratories (VRDLs) have been established throughout the country. It’s a measure of the technological progress India has made, with lessons learnt from every major out-breaks, that it now takes less than three hour to identify the virus in case of COVID-19.