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Table of Contents
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 48-49

The 2019 novel coronavirus (COVID-19) outbreak: An update

Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Submission07-Feb-2020
Date of Acceptance26-Feb-2020
Date of Web Publication2-Jun-2020

Correspondence Address:
Alladi Mohan
Professor and Head, Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Alipiri Road, Tirupati 517 507, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JCSR.JCSR_10_20

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How to cite this article:
Mohan A, Pradeep V. The 2019 novel coronavirus (COVID-19) outbreak: An update. J Clin Sci Res 2020;9:48-9

How to cite this URL:
Mohan A, Pradeep V. The 2019 novel coronavirus (COVID-19) outbreak: An update. J Clin Sci Res [serial online] 2020 [cited 2020 Aug 15];9:48-9. Available from: http://www.jcsr.co.in/text.asp?2020/9/1/48/285706

The coronaviruses (CoVs) are enveloped non-segmented, single-stranded, positive-sense ribonucleic acid viruses. CoV derives its name from its resemblance of spike protein on its surface to the solar corona, hence, a name given to the family as Coronaviridae.[1] The 229E alpha CoV, NL63 alpha CoV, OC43 beta CoV and HKU1 beta CoV strains are known to account for 10%–30% of cases of seasonal cold. Following severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and MiddleEast respiratory syndrome CoV in 2012,[2] another zoonotic CoV called 2019 novel CoV (COVID-19) presented as pneumonia of unknown cause, first identified from Wuhan province, China. It was presumed to have occurred following exposure to the seafood market, and an epidemiological alert was released by local health authorities on 31 December 2019, with the shutdown of the market on 1st January 2020.[3] On 7th January 2020, the causative organism COVID-19 was isolated from the patients. The first fatal case was reported on 11th January 2020. Even though exposure to the seafood market served as an initial clue at the early stage, the significance of this observance came under review, as there was an exponential increase in the number of cases in Wuhan and other parts of China in persons with travel history to Wuhan suggesting human-to-human transmission.[4] Following that COVID-19 cases were detected in several other parts of the world with the first confirmed case from Thailand and then in Japan, South Korea and the USA. On 30 January 2020 the first confirmed case was documented from Thrissur, Kerala, in India, in a student who was studying at Wuhan University.[5] On on March 29, 2020 at 10 AM globally there were 575,444 cases with COVID-19 and 26,654 deaths;[6] in India, there were 867 cases with COVID-19 and 86 deaths.[7]

As along with other CoVs, fruit bats were considered as primary hosts with snakes predating on fruit bats being affected. Possible zoonotic spread from fruit bats and snakes was considered as the prime source of infection that had originated from the Wuhan seafood market where snakes were sold. In comparison with other zoonotic CoVs like SARS-CoV, in the first 28 days following detection of epidemic, there has been an exponential rise in number of case along with increased mortality, in spite of the fact that the World Health Organization (WHO) providing an alert since day 1, identification of virus within 1 week and other effective quarantine measures indicating the devastating nature of current epidemic. Based on genetic studies COVID-19 appears to behave more likely as that of SARS-CoV, which in case mutations and recombinations are more common, allowing the rapid systemic spread of virus.[8],[9]

Of the hospitalised patients, there is a male predominance with most of the patients belonging to the 5th decade of life.[3] In those affected with COVID-19, underlying co-morbidities were diabetes mellitus, hypertension, cardiovascular disease and chronic obstructive pulmonary disease. Fever was the most common symptom followed by cough, dyspnoea, myalgia and fatigue. Other less common symptoms were headache, haemoptysis and diarrhoea. From the onset of illness to hospitalisation, development of dyspnoea, acute respiratory distress syndrome (ARDS), need for mechanical ventilation, and intensive care unit (ICU) care requirement were 7, 8, 9 and 10.5 days, respectively.[3] In the patients requiring ICU care, salient laboratory parameters included leucopenia, prolonged prothrombin time and elevated D-dimer levels on admission.[3] Levels of serum aspartate aminotransferase and troponin I were also elevated in some patients. On computed tomography of chest bilateral multilobular and subsegmental consolidation was evident. Later imaging revealed bilateral ground-glass opacities with resolving consolidation.[3] The most common complications were ARDS, acute cardiac injury and secondary bacterial infections.[3]

Universal precautions such as practising respiratory hygiene (handwashing using alcohol-based hand rub or soap and water) maintaining a distance of at least 1 m between from persons, who are coughing, sneezing and have a fever, avoiding touching eyes, nose and mouth, avoiding contact with sick animals or spoiled animal products, practicing general hygiene measures when visiting live animal markets, wet markets or animal product markets and avoiding consumption of raw or undercooked animal products have all been advocated as effective preventive measures.[10]

On 31 January, Tedros Ghebreyesus, Director-General of WHO declared COVID-2019 as a 'global health emergency'.[11] Declaring a 'public health emergency of international concern' is the WHO's highest level of alarm – A step reserved for events that pose a risk to multiple countries requiring a coordinated international response.[11]

In developing countries such as India, where tertiary health care and ICU care facilities are not widely available, accessible and affordable, the potentially lethal consequences of outbreaks like the current COVID-19 outbreak can be devastating. Criteria for diagnostic testing have been defined.[12],[13],[14],[15] After obtaining approval from the Drug Controller General of India, ICMR has advocated the use of a combination of lopinavir and ritonavir to be used if the CoV infections become a public health emergency.[14] Recently directives for use of hydroxychloroquine for prophylaxis for health care workers have been issued.[16] Capacity building in critical care should be planned in the long term.

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There are no conflicts of interest.

  References Top

Coronavirus. Available from: https://www.who.int/health-topics/coronavirus. [Last accessed on 2020 Feb 02].  Back to cited text no. 1
de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: Recent insights into emerging coronaviruses. Nat Rev Microbiol 2016;14:523-34.  Back to cited text no. 2
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 3
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23.  Back to cited text no. 4
Ministry of Health and Family Welfare, Government of India. Update on Novel Coronavirus: One Positive Case Reported in Kerala. Available from: https://pib.gov.in/PressReleseDetail.aspx?PRID=1601095. [Last accessed on 2020 Jan 30].  Back to cited text no. 5
Coronavirus disease (COVID-19) Situation Dashboard. Available from: https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd. [Last accessed on 2020 Mar 29].  Back to cited text no. 6
Ministry of Helath and Family elfare, Government of India. Latest updates. Available at URL: https://www.mohfw.gov.in/. [Last accessed on 2020 Mar 29].  Back to cited text no. 7
Zhou P, Yang X-L, Wang XG, Hu B, Zhang L, Zhang W, et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in 2 humans and its potential bat origin. Nature 2020;519:270-3. Available from: https://www.nature.com/articles/s41586-020-2012-7_reference.pdf. [Last accessed on 2020 Feb 05].  Back to cited text no. 8
Gu J, Gong E, Zhang B, Zheng J, Gao Z, Zhong Y, et al. Multiple organ infection and the pathogenesis of SARS. J Exp Med 2005;202:415-24.  Back to cited text no. 9
Novel Coronavirus (COVID-19) Advice for the Public. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. [Last accessed on 2020 Feb 02].  Back to cited text no. 10
Statement on the Second Meeting of the International Health Regulations. Emergency Committee Regarding the Outbreak of Novel Coronavirus (COVID-19); 2005. Available from: https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(COVID-19). [Last accessed on 2020 Jan 31].  Back to cited text no. 11
Ministry of Health, Family Welfare, Government of India. Specimen Collection, Packaging and Transport Guidelines for 2019 Novel Coronavirus (COVID-19). Available from: https://mohfw.gov.in/diseasealerts/novel-corona-virus. [Last accessed on 2020 Feb 02].  Back to cited text no. 12
Indian Council of Medical Research. Department of Health Research. Strategy of COVID19 testing in India (17/03/2020). Available at URL: https://icmr.nic.in/sites/default/files/upload_documents/Strategy_COV. ID19_testing_India.pdf. [Last accessed on 2020 Mar 29].  Back to cited text no. 13
Ministry of Health, Family Welfare, Government of India. Travel Advisory to Travelers Visiting China. Available from: https://mohfw.gov.in/diseasealerts/novel-corona-virus. [Last accessed on 2020 Feb 02].  Back to cited text no. 14
Battling the epidemic: India Readies Treatment Protocol for Coronavirus. Available from: https://economictimes.indiatimes.com/news/politics-and-nation/battling-the-epidemic-india-readies-treatment-protocol-for-coronavirus/articleshow/73949011.cms. [Last accessed on 2020 Feb 05].  Back to cited text no. 15
Recommendation for empiric use of hydroxy-chloroquine for prophylaxis of SARS-CoV-2 infection. Available at URL: https://icmr.nic.in/sites/default/files/upload_documents/HCQ_Recommendation_22March_final_MM_V2.pdf. [Last accessed on 2020 Mar 29].  Back to cited text no. 16


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