THE WORLD'S CORONA VIRUS JOURNAL

METY PUTRI PRATIWI

NIM. 216 240 026

FACULTY OF HEALTH SCIENCE

MUHAMMADIYAH PAREPARE UNIVERSITY

2020
 PRELIMINARY
A. BACKGROUND
At the beginning of 2020, the world was shocked by the outbreak of a new virus,
namely the new type of corona virus (SARS-CoV-2) and the disease is called Corona
virus disease 2019 (COVID), where this virus originated from Wuhan, China. It was
found at this time that it was confirmed that there were 65 countries that had
contracted this one virus. (WHO data, March 1, 2020).
The COVID-19 pandemic emerged when the virus was known to spread from
person to person in a short time and with symptoms such as high fever , cough,
shortness of breath, lack of appetite and weakness .
The COVID-19 outbreak was designated a global pandemic by the WHO on
March 11, 2020, with a 13-fold increase in the number of cases reported outside
China, over a few weeks. 1 It has affected more than 2.3 million people in 185
countries of the world. Of the total burden of the global, s ew in over 120 thousand
cases dikonfir masi and 5784 deaths were reported in EMRO on 18th April 2020.
KSA, with 7142 cases and 87 deaths, was the third countries in the region that will be
affected by the novel coronavirus or SARS-CoV-2 (severe acute respiratory
syndrome) CoV-2).
Case fatality rate (CFR) as a whole among all countries is 6.8%, but with modern
gi in Italy at 13.1%. The COVID-19 pandemic can become a category 3 pandemic,
depending on the reproductive number (R0) and the overall fatality ratio is far away
(Mansuri, Zalat, Khan, Alsaedi, & Ibrahim, 2020) .
Case COVID- 19 were reportedly found in 203 countries around the world in
early April 2020 with a total of 937 976 confirmed cases and 47 279 deaths. In the
Month April 2020, Indonesia has shown a number of cases and deaths were
confirmed in the outbreak COVID-19, and prevention strategies are needed for the
dissemination of the disease is more severe (Jackie et al., 2020).
Researchers at the Institute of Virology in Wuhan have carried out a
metagenomics analysis to identify the novel coronavirus as a potential etiology. They
call it the 2019 novel coronavirus (nCoV-2019) . (2) Furthermore, the US Centers for
Disease Control and Prevention (CDC) calls the coronavirus 2019 novel coronavirus
(2019-nCoV) and now the disease is popularly known as the coronavirus disease-19
(COVID- 19).
 Corona virus is a superdomain biota , virus kingdom . Corona viruses are the
largest group of viruses in the order Nidovirales. All viruses in the order Nidovirales
are nonsegmented positive-sense RNA viruses . Corona virus included in familia
Coronaviridae , sub familia Coronavirinae , genus Betacoronavirus, subgenus
Sarbecovirus.
Viruses were initially classified into groups based on serology but are now based
on phylogenetic groupings. It was further explained that the Sarbecovirus subgenus
includes Bat-SL-CoV , SARS-CoV and 2019-nCoV. Bat-SL-CoV was originally
found in Zhejiang, Yunan, Guizhou, Guangxi, Shaanxi and Hubei, China. Another
grouping shows that the beta group coronavirus includes Bat coronavirus (BcoV),
Porcine hemagglutinating encephalomyelitis virus (HEV), Murine hepatitis virus
(MHV ), Human coronavirus 4408 (HcoV-4408), Human coronavirus OC43 (HCoV-
OC43), Human HKU1 coronavirus (HCoV-HKU1), Severe acute respiratory
syndrome coronavirus (SARSCoV) and Middle Eastern respiratory syndrome
coronavirus (MERS-CoV) . (5)
The corona virus is round with a diameter of about 125 nm as described in the
study using cryo-electron microscopy . Corona virus particles contain four main
structural proteins, namely the S protein ( spike protein ) which is shaped like a nail,
M protein (membrane protein), E protein (envelope protein), and N protein
(nucleocapside protein). Protein S (~ 150 kDa), (7) protein M (~ 25-30 kDa), (8)
protein E (~ 8-12 kDa), (9) while protein N is contained in the nucleocapsid. (7)
 LITERATURE REVIEW

A. Definition of Corona virus

Corona virus is an RNA virus with a particle size of 120-160 nm. This virus
mainly infects animals, including bats and camels. Prior to the COVID-19 outbreak,
there were 6 types of corona viruses that can infect humans, namely alphacoronavirus
229E, alphacoronavirus NL63, betacoronavirus OC43, betacoronavirus HKU1, Severe
Acute Respiratory Illness Coronavirus (SARS-CoV), and Middle East Respiratory
Syndrome Coronavirus (MERS- CoV ).
Coronavirus which is the etiology of COVID-19 belongs to the genus
betacoronavirus. The results of phylogenetic analysis show that this virus is included
in the same subgenus as the coronavirus that caused the Severe Acute Respiratory
Illness (SARS) outbreak in 2002-2004, namely Sarbecovirus. On this basis, the
International Committee on Taxonomy of Viruses proposed the name SARS-CoV-2.
The structure of the viral genome has a pattern like that of the coronavirus in
general. The SARS-CoV-2 sequence has similarities with the coronavirus isolated in
bats, so the hypothesis arises that SARS-CoV-2 originated from bats which then
mutated and infected humans. Mammals and birds are thought to be intermediate
reservoirs.

B. Epidemiology
Since the first cases in Wuhan, there has been an increase in COVID-19 cases in
China every day and peaked between late January and early February 2020. Initially
most reports came from Hubei and surrounding provinces, then increased to other
provinces throughout China. As of January 30, 2020, there have been 7,736 confirmed
cases of COVID-19 in China, and 86 other cases were reported from various countries
such as Taiwan, Thailand, Vietnam, Malaysia, Nepal, Sri Lanka, Cambodia, Japan,
Singapore, Saudi Arabia, South Korea, Philippines, India, Australia, Canada, Finland,
France and Germany.
The first COVID-19 was reported in Indonesia on March 2, 2020, totaling two
cases. March 31, 2020 data shows that there are 1,528 confirmed cases and 136
deaths. The mortality rate for COVID-19 in Indonesia is 8.9%, this figure is the
highest in Southeast Asia.
 As of March 30, 2020, there were 693,224 cases and 33,106 deaths worldwide.
Europe and North America have been at the epicenter of the COVID-19 pandemic,
with cases and deaths already surpassing China. The United States is in the first place
with the most COVID-19 cases with the addition of 19,332 new cases on March 30,
2020 followed by Spain with 6,549 new cases. Italy has the highest mortality rate in
the world, at 11.3%.

C. Spread of coronavirus
Currently, the spread of SARS-CoV-2 from human to human is the main source
of transmission, so the spread has become more aggressive. SARS-CoV-2
transmission from symptomatic patients occurs via droplets that are released when
coughing or sneezing. In addition, it has been studied that SARS-CoV-2 can be viable
on aerosols (generated through a nebulizer) for at least 3 hours. WHO estimates the
reproductive number (R) of COVID-19 to be 1.4 to 2.5. However, another study
estimated the R to be 3.28.
Several case reports indicate suspected asymptomatic carrier transmission, but the
exact mechanism is not known. Cases related to transmission from asymptomatic
carriers generally have a history of chronic contact with a COVID-19 patient. Some
investigators have reported SARS-CoV-2 infection in neonates. However, vertical
transmission from pregnant women to the fetus has not been proven to be certain. If
this is the case, the data shows that the vertical transmission opportunities are
relatively small. The virological examination of amniotic fluid, umbilical cord blood
and breast milk in mothers who are positive for COVID-19 was found to be negative.
SARS-CoV-2 has been shown to infect the gastrointestinal tract based on biopsy
results on epithelial cells of the stomach, duodenum, and rectum. The virus can be
detected in the feces, and even 23% of patients reported that the virus was still
detected in the stool even though it was not detected in the airway samples. These two
facts confirm the possibility of fecal-oral transmission.
The stability of SARS-CoV-2 in inanimate objects is not much different from
SARS-CoV. Experiments conducted by vanDoremalen, et al. 23 showed that SARS-
CoV-2 was more stable on plastic and stainless steel (> 72 hours) than copper (4
hours) and cardboard (24 hours). Another study in Singapore found extensive
environmental pollution in the rooms and toilets of COVID-19 patients with mild
 symptoms. Viruses can be detected in door handles, toilet seats, light switches,
windows, cabinets, and ventilation fans, but not in air samples.

D. Pathogenesis
The pathogenesis of SARS-CoV-2 is still not widely known, but it is thought that
it is not that different from the more widely known SARS-CoV. In humans, SARS-
CoV-2 primarily infects cells in the airways that line the alveoli. SARS-CoV-2 will
bind to the receptors and make entry into the cell. The glycoproteins contained in the
envelope spike of the virus bind to the cellular receptor in the form of ACE2 on
SARS-CoV-2. Inside the cell, SARS-CoV-2 duplicates genetic material and
synthesizes the required proteins, then forms new virions that appear on the cell
surface.
Similar to SARS-CoV, in SARS-CoV-2 it is suspected that after the virus enters
the cell, the viral RNA genome will be released into the cell cytoplasm and translated
into two polyproteins and structural proteins. Subsequently, the viral genome will
begin to replicate. The glycoproteins in the newly formed viral envelope enter the
membrane of the endoplasmic reticulum or Golgi cells. There is the formation of a
nucleocapsid which is composed of the RNA genome and nucleocapsid proteins. Viral
particles will grow into the endoplasmic reticulum and Golgi cells. In the final stage,
the vesicles containing virus particles will combine with the plasma membrane to
release new viral components.
In SARS-CoV, Protein S is reported as a significant determinant of virus entry
into host cells. It is known that the entry of SARS-CoV into the cell begins with the
fusion of the viral membrane and the plasma membrane of the cell. In this process, S2
protein 'plays an important role in the proteolytic cleavage process which mediates the
membrane fusion process. Apart from membrane fusion, there are also clathrin-
dependent and clathrin-independent endocytosis which mediate the entry of SARS-
CoV into host cells.
Viral and host factors play a role in SARS-CoV infection.35 The cytopathic
effect of the virus and its ability to overpower the immune response determine the
severity of the infection. Immune system dysregulation then plays a role in tissue
damage in SARS-CoV-2 infection.
Inadequate immune response results in viral replication and tissue damage. On
the other hand, excessive immune response can cause tissue damage. The immune
 response caused by SARS-CoV-2 is also not fully understood, but can be learned from
the mechanisms found in SARS-CoV and MERS-CoV. When the virus enters the cell,
the viral antigen will be presented to antigen presentation cells (APC). The
presentation of viral antigens mainly depends on the major histocompatibility complex
(MHC) class I molecules.
However, MHC class II also contributed. Antigen presentation further stimulates
the body's humoral and cellular immune response mediated by virus-specific T and B
cells . In the humoral immune response, IgM and IgG are formed against SARS-CoV.
IgM against SAR-CoV is gone by the end of week 12 and IgG can last long term. The
results of a study on patients who had recovered from SARS showed that after 4 years
there could be found CD4 + and CD8 + memory T cells that were specific to SARS-
CoV, but the number decreased gradually in the absence of an antigen.
Viruses have mechanisms to evade the host immune response. SARS-CoV can
induce the production of double membrane vesicles that do not have pattern
recognition receptors (PRRs) and replicate in these vesicles so that they cannot be
recognized by the host. The IFN-I line was also inhibited by SARS-CoV and MERS-
CoV. Antigen presentation is also inhibited in MERS-CoV infection.

E. Pathophysiology
Most Coronaviruses infect animals and circulate in animals. Coronavirus causes a
large number of diseases in animals and its ability to cause serious illness in animals
such as pigs, cows, horses, cats and chickens. Coronaviruses are called zoonotic
viruses, which are viruses that are transmitted from animals to humans. Many wild
animals can carry pathogens and act as vectors for certain infectious diseases.
Bats, bamboo mice, camels and ferrets are the usual hosts for the Coronavirus.
Coronavirus in bats is a major source of severe acute respiratory syndrome (SARS)
and Middle East respiratory syndrome (MERS) (PDPI, 2020).
Coronaviruses can only reproduce through their host cells. Viruses cannot live
without host cells. The following is the cycle of the Coronavirus after finding host
cells according to their tropism. First, the attachment and entry of the virus to the host
cell is mediated by Protein S on the surface of the virus. S protein is the main
determinant in infecting its host species as well as its tropical determinant (Wang,
2020).
 In the SARS-CoV study, S protein binds to a receptor on the host cell, namely the
ACE-2 enzyme (angiotensin-converting enzyme 2). ACE-2 can be found in the oral
and nasal mucosa, nasopharynx, lung, stomach, small intestine, large intestine, skin,
thymus, bone marrow, spleen, liver, kidney, brain, pulmonary alveolar epithelial cells,
small intestine enterocytes, endothelial cells arterial anchovies, and smooth muscle
cells. After successful entry, the translation of the replication of the gene from the
viral genome RNA is then entered. Furthermore, replication and transcription are
synthesized by RNA viruses through translation and assembly of the viral replication
complex. The next stage is the assembly and release of vi rus (Fehr, 2015).
After transmission, the virus enters the upper airway and then replicates in upper
airway epithelial cells (carrying out its life cycle). After that it spreads to the lower
airway. In acute infection, the virus sheds from the airway and the virus can continue
to shed for some time in the gastrointestinal cells after healing. The incubation period
of the virus until the disease appears is around 3-7 days (PDPI, 2020).

F. Clinical Manifestations
COVID-19 infection can cause mild, moderate or severe symptoms. The main
clinical symptoms that appear are fever (temperature> 380C), cough and difficulty
breathing. In addition, it can be accompanied by severe shortness of breath, fatigue,
myalgia, gastrointestinal symptoms such as diarrhea and other respiratory symptoms.
Half of the patients developed shortness of breath within one week. In severe cases
worsening is rapid and progressive, such as ARDS, septic shock, intractable metabolic
acidosis and bleeding or dysfunction of the coagulation system within days.
In some patients, the symptoms appear mild, even without fever. Most patients
have a good prognosis, with a small proportion in critical condition and even die. The
following clinical syndromes can appear if infected. (PDPI, 2020).
The following clinical syndromes can appear if infected.
a. No Complications
This condition is the lightest condition. Symptoms that appear are non-specific
symptoms. The main symptoms still appear such as fever, cough, may be
accompanied by sore throat, nasal congestion, malaise, headache, and muscle
aches. It should be noted that in elderly patients and patients immunocompromises
the presentation of symptoms to be atypical or atypical. In addition, in some cases
it was found not accompanied by fever and relatively mild symptoms. In this
 condition the patient does not have symptoms of complications including
dehydration, sepsis or shortness of breath.

b. Mild pneumonia
The main symptoms can appear such as fever, cough and shortness of breath.
However, there was no sign of severe pneumonia. In children with mild pneumonia
characterized by coughing or difficulty breathing .
c. Severe pneumonia. In adult patients:
Symptoms that appear include fever or suspected respiratory infection. Signs that
appear are tachypnea (respiratory rate:> 30x / minute), severe respiratory distress
or patient oxygen saturation <90% of the outside air.

G. Diagnosis
In the history, there are three main symptoms: fever, dry cough (a small amount
ofphlegm) and difficulty breathing or shortness of breath.
a. Patient under surveillance or suspected cases / possible
1. Someone who has :
a) Fever (≥380C) or history of fever        
b) Cough or runny nose or sore throat       
c) Mild to severe pneumonia based on clinical and / or radiological features. (in
immunocompromised patients the presentation may be atypical) AND is
accompanied by at least one of the following conditions:
 Have a history of travel to China or affected regions / countries within
14 days before symptoms develop
 Health care workers who are sick with the same symptoms after treating
patients with severe acute respiratory infections (ARI) with no known
cause / etiology of the disease, regardless of history of departure or
residence.
2. Patients with acute respiratory infections of mild to severe severity and one of
the following within 14 days before symptom onset :
a) Close contact with patients with confirmed cases or probable COVID-19,         
b) History of contact with infectious animals (if the animal has been
identified),       
 c) B ekerja or visiting health care facilities with confirmed or probable cases of
infection COVID-19 in China or regions / countries are infected.        
d) Have a history of travel to Wuhan and have fever (temperature ≥380C) or a
history of fever.       
b. People in Monitoring
A person who has fever symptoms or a history of fever without pneumonia
who has a history of travel to China or affected regions / countries, and does not
have one or more exposure history including :
 History of close contact with confirmed cases of COVID-19
 Work or visit health facilities that are associated with confirmed COVID-19
patients in China or affected regions / countries (according to disease
progression )
 Have a history of contact with infectious animals (if infectious animals have
been identified) in China or the affected region / country (according to disease
progression
c. Probable Case
Patients under surveillance who are screened for COVID-19 but inconclusive or
inconclusive or someone with a positive result of pan-coronavirus or beta
coronavirus.
d. Confirmed case
A person who is laboratory confirmed with COVID-19.

H. Supporting investigation
1. Radiological examination: chest X-ray, chest CT scan, chest ultrasound. Imaging
may show: bilateral opacity, subsegmental consolidation, lobar or pulmonary
collapse or nodules, groundglass appearance .
2. Upper and lower airway specimen examination
 Upper airway with throat swab (nasopharynx and oropharynx)
 Lower airway (sputum, bronchial rinse, LAB, when using an endotracheal
tube it can be an endotracheal aspirate )
3. Bronchoscopy
4. FUNCTION pleural according to the conditions
5. Blood chemistry tests
 6. Culture of microorganisms and sensitivity testing of airway material (sputum,
bronchial rinses, pleural fluid) and blood. Blood culture for bacteria is performed,
ideally before antibiotic therapy. However, do not delay antibiotic therapy
by waiting for blood culture results)
7. Stool and urine examination (to investigate possible transmission).

I. General Management
1. Isolate in all cases
In accordance with clinical symptoms that appear, both mild and moderate.
2. Implementation of infection prevention and control (PPI)
3. Chest X-ray series to assess disease progression
4. Oxygen supplementation
Immediate oxygen therapy for patients with, respiratory distress, hypoxemia or
shock. The first oxygen therapy is about 5L / minute with a target SpO2 of ≥90%
in nonpregnant patients and ≥ 92-95% in pregnant patients
5. Recognize severe hypoxemic respiratory failure
6. Fluid therapy
Conservative fluid therapy is given if there is no evidence of shock. Patients with
SARI should be considered in their fluid therapy, because if the fluid is too
aggressive it can exacerbate the condition of respiratory distress or oxygenation.
Monitoring of fluid and electrolyte balance
7. Empiric antibiotic administration
8. Symptomatic therapy
Symptomatic therapy is given such as antipyretics, cough medicine and others if
necessary.Pemberian kortikosteroidsistemik tidak rutin diberikan pada tatalaksana
pneumonia viral atau ARDS selain ada indikasi lain.
9. Administration of systemic corticosteroids is not routinely given to the
management of viral pneumonia or ARDS in addition to other indications.
10. Watch closely
11.Understand the patient's comorbidities
 REFERENCES

Handayani, D., Hadi, DR, Isbaniah, F., Burhan, E., & Agustin, H. (2020). Corona Virus
Disease 2019. Indonesian Journal of Respirology , 40 (2), 119-129.

Ilpaj, SM, & Nurwati, N. (2020). Analysis of the Effect of Death Rates Due to Covid-19
on Mental Health in Indonesia. Focus: Journal of Social Work , 3 (1), 16-28.

Parwanto, MLE (2020). Corona virus (2019-nCoV) causes COVID-19. Journal of

Biomedicine and Health , 3 (1), 1-2.

Ramadhan, IL (2020). Strategies to prevent the spread of covid-19 in prisons. JUSTITIA:

Journal of Law and Humanities , 7 (3), 518-522 .

Syafrida, S., & Hartati, R. (2020). Together fighting the covid 19 virus in Indonesia.
SALAM: Journal of Social and Cultural Affairs Syar-I , 7 (6), 495-508.

Susilo, A., Rumende, CM, Pitoyo, CW, Santoso, WD, Yulianti, M., Herikurniawan, H., ...
& Chen, LK (2020). Coronavirus Disease 2019: A Review of Recent Literature.
Indonesian Journal of Internal Medicine , 7 (1), 45-67.

Utami, RA, Mose, RE, & Martini, M. (2020). Knowledge, Attitudes and Community
Skills in Prevention of COVID-19 in DKI Jakarta. Journal of Holistic Health , 4
(2), 68-77.

Yuliana, Y. (2020). Corona virus diseases (Covid-19): A literature review. Wellness And
Healthy Magazine , 2 (1), 187-192.