#32 RIVERA, DANA IZABEL L.

1FMT MT_636 LEC OLA

1. What is the etiologic agent or cause of COVID-19 SARS?

SARS-CoV2 is a novel coronavirus and is identified as the cause or causative agent of

coronavirus disease 2019 (COVID-19) that began in Wuhan, China in late 2019 and spread
worldwide (Tesini, 2020).

According to Cascella, Rajnik, Cuomo, Dulebohn, & Di Napoli (2020), “CoVs are

positive-stranded RNA viruses with a crown-like appearance under an electron microscope
(coronam is the Latin term for crown) due to the presence of spike glycoproteins on the envelope.
The subfamily Orthocoronavirinae of the Coronaviridae family (order Nidovirales) classifies into
four genera of CoVs: Alphacoronavirus (alphaCoV), Betacoronavirus (betaCoV),
Deltacoronavirus (deltaCoV), and Gammacoronavirus (gammaCoV). SARS-CoV-2 belongs to
the betaCoVs category. It has round or elliptic and often pleomorphic form, and a diameter of
approximately 60–140 nm. Like other CoVs, it is sensitive to ultraviolet rays and heat.
Furthermore, these viruses can be effectively inactivated by lipid solvents including ether (75%),
ethanol, chlorine-containing disinfectant, peroxyacetic acid and chloroform except for
chlorhexidine.” Figure 1 below shows the illustration of the stricture of the human coronavirus.

From Journal of Advanced Research [Figure], by Shereen, Khan, Kazmi, Bashir, & Siddique, 2020.

(https://doi.org/10.1016/j.jare.2020.03.005)
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2. Mode of Transmission

Tesini (2020) states that early COVID-19 cases linked to a live animal market in Wuhan,
China, suggests an animal-to-human transmission of the virus. This is the followed by person-to-
person spread through contact with infected secretions, mainly via contact with large respiratory
droplets to the mucus membranes of the mouth, eyes, and nose. Figure 2 shows the transmission
of the virus from animal-to-human to human-to-human.

Centers for Disease Control and Prevention (CDC) states that this may happen between
people who are in close contact with one another (within about 6 feet) where respiratory droplets
come from coughing and sneezing and enter the lungs. Aerosol transmission is also possible in
case of protracted exposure to elevated aerosol concentrations in closed spaces (Cascella et al.,
2020). It can also be acquired through contact with a contaminated surface. However, it is still
unclear whether infection can be acquired by the fecal-oral route or if aerosols (small respiratory
droplets) play in the transmission. It is also unclear how readily this virus spreads from person to
person, although it appears more transmissible than SARS and is more like that of influenza
(Tesini, 2020).

According to CDC, COVID-19 seems to be spreading easily and sustainably in the

community (“community spread”) in some affected geographic areas where people are the most
contagious when they are symptomatic, but some may still spread it before they show symptoms
or are still asymptomatic.

Figure 2. Transmission of SARS-CoV-2

#32 RIVERA, DANA IZABEL L. 1FMT MT_636 LEC OLA

From Journal of Advanced Research [Figure], by Shereen, Khan, Kazmi, Bashir, & Siddique, 2020.

(https://doi.org/10.1016/j.jare.2020.03.005)
3. What are the target tissues and organs of this disease? Describe the changes that happen to
these tissues and organs. Please use illustrations to answer this. Make it simple and easy to
understand.

The target organs and tissues of the virus include the: (1) lungs, specifically the alveoli;
(2) the brain, specifically the hypothalamus, and (3) blood vessels which affects the systemic
circulation, and eventually multiple organs. These will be further discussed below.

Lung epithelial cells are the primary target of the virus (Rothan & Byrareddy, 2020).
According to Xiaowei, Geng, Peng, Meng, & Lu (2020), SARS-CoV-2 has an S protein (spike
glycoprotein) which binds to the angiotensin-converting enzyme 2 (ACE2) as a receptor to enter
in these cells (Figure 3).

As shown in Figure 3,
the viral RNA is released
into the cytoplasm, uses
the host’s ribosomes, and
is translated into proteins
for the viral genome to
replicate. The newly
formed envelope
glycoproteins are inserted
into the membrane of the
endoplasmic reticulum or
Golgi where the viral
particles germinate into
the endoplasmic
reticulum-Golgi
intermediate compartment
(Xiaowei et al., 2020). At last, the vesicles containing the virus particles then fuse with the
plasma membrane to release the virus.
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Figure 3. How SARS-CoV-2 enters and replicates in the lungs

While the virus enters the cells and the alveoli, its antigen will be presented to the antigen
presentation cells (APC), the central part of the body’s anti-viral immunity. However, there is still
lack of information regarding the virus’ antigen presentation (Xiaowei et al., 2020). Aroused by
the presence of a viral invader, our bodies step up to fight the disease by flooding the lungs with
immune cells to clear away the damage and repair the lung tissue (National Geographic, 2020).
As shown in Figure 4, this triggers a cytokine storm, a deadly uncontrolled systemic
inflammatory response resulting from the release of large amounts of pro-inflammatory cytokines
(IFN-a, IL-6, IL-18, etc.). This cytokine storm causes a violent attack by the immune system to
the body where the immune system goes haywire and those cells kill anything in their way,
including your healthy tissue like the ones used for gas exchange and the surfactants that
prevent the collapse of the lungs by maintaining the surface tension of the alveoli. Patients get
more damage instead where even more debris clogs up the lungs, and pneumonia worsens.
Then lung damage continues to build—which can result in respiratory failure (National
Geographic, 2020). This is Acute respiratory distress syndrome (ARDS) which is a lung
condition that prevents enough oxygen from getting to the lungs and into the blood, and is the
main death caused by COVID-19 (Xiaowei et al., 2020).

As seen on Figure 4, when these cytokines reach the capillaries and blood vessels, it
causes vasodilation and increase in permeability that decreases Oxygen levels (hypoxemia).
Because of this, the following things could happen (Figure 4): (1) Fluid from the capillaries may
accumulate around the alveoli together with the decrease in surfactants, it causes alveolar edema,
hypoxemia, and difficulty in breathing or shortness of breath as one of its symptoms; (2)
Hypoxemia may stimulate chemoreceptors that would trigger the Sympathetic Nervous System
(SNS) to increase heart rate and respiratory rate; (3) Cytokines may reach the Central Nervous
System (CNS), specifically the hypothalamus that triggers it to increase the body temperature
which is expressed as fever; (4) And as the cytokines reach the systemic circulation, it can cause
Systemic inflammatory response syndrome (SIRS) wherein it also causes vasodilation and
increase permeability along the blood vessels of the different parts of the body. When this
happens, it lowers the blood pressure, followed by the decrease in blood volume, decrease in the
perfusion of blood to the different body organs, ultimately leading to Multisystem Organ Failure
(MSOF) or death in severe cases (Xiaowei et al., 2020). Because of these, patients with COVID-
#32 RIVERA, DANA IZABEL L. 1FMT MT_636 LEC OLA

19 show clinical manifestations like fever, cough, dyspnea, myalgia, fatigue, normal or decreased
leukocyte counts, and radiographic evidence of pneumonia where patients develop pneumonia in
both lungs, accompanied by shortness of breath (National Geographic, 2020).
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Figure 4. Effects of SARS-CoV-2 to target tissues and organs

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4. Why are the elderly, immunocompromised and with underlying disease are at higher risk
for COVID-19?

Infectious disease specialist Alan Taege, MD. of Cleveland Clinic (2020) states that although the
virus causes only mild symptoms in most people, it can lead to severe illness, including pneumonia and
death in others especially the elderly people, immunocompromised, or people with underlying disease.
Cleveland Clinic (2020) further explains that, “When people are immunocompromised, their body has a
reduced ability to fight off and recover from infections. This could be because they have a certain chronic
condition that affects the immune system, or because of certain medications they are taking.” For
example, some treatments and medications used for autoimmune conditions or after an organ transplant
weaken a person’s immune response, making the person more vulnerable to contracting and experiencing
the severe symptoms of the virus.

References

Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S., & Di Napoli, R. (2020, March 20). Features,
Evaluation and Treatment Coronavirus (COVID-19). National Center for Biotechnology
Information. https://www.ncbi.nlm.nih.gov/books/NBK554776/
Tesini, B. (2020). Coronaviruses and Acute Respiratory Syndromes (COVID-19, MERS, and SARS) -
Infectious Diseases. MSD Manual Professional Edition.
https://www.msdmanuals.com/professional/infectious-diseases/respiratory-viruses/coronaviruses-
and-acute-respiratory-syndromes-covid-19,-mers,-and-sars
Coronavirus Disease 2019 (COVID-19) - Transmission. (2020, March 24). Centers for Disease Control
and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html
FAQs: What You Should Know About COVID-19 and Chronic Medical Conditions. (2020, March 24).
Health Essentials from Cleveland Clinic. https://health.clevelandclinic.org/faqs-what-you-should-
know-about-covid-19-and-chronic-medical-conditions/
Here’s what coronavirus does to the body. (2020, February 18). National Geographic.
https://www.nationalgeographic.com/science/2020/02/here-is-what-coronavirus-does-to-the-
body/
Rothan, H., & Byrareddy, S. (2020). The epidemiology and pathogenesis of coronavirus disease (COVID-
19) outbreak. Journal of Autoimmunity. https://doi.org/10.1016/j.jaut.2020.102433
Shereen, M., Khan, S., Kazmi, A., Bashir, N., & Siddique, R. (2020). COVID-19 infection: Origin,
transmission, and characteristics of human coronaviruses. Journal of Advanced Research.
https://doi.org/10.1016/j.jare.2020.03.005
Xiaowei, L., Geng, M., Peng, Y., Meng, L., & Lu, S. (2020). Molecular immune pathogenesis and
diagnosis of COVID-19. Journal of Pharmaceutical Analysis.
https://doi.org/10.1016/j.jpha.2020.03.001