State of Libya

Ministry of Education and Scientific research

Tripoli Higher Institute of Medical Sciences-Ain Zara
Department of pharmacy

A Graduation project submitted to Tripoli High institute of Medical

Sciences in partial fulfillment of the requirements for the Degree
of Diploma in Pharmacy

Role of pharmacists against covid-19

virus
Submitted by; -
1- Ala Ali Aldabae
2- Badruldeen Mohammed Ateeg
3- Baseer hysayn Basheer
4- Mohammed Ibrahim Aborass
5- Mohammed Miftah Al-Balazi

Supervised by; - Dr. Hanan Mady

1
 ‫بسم هللا الرحمن الرحيم‬
‫يرفع هللا الذين امنوا منكم والذين أوتوا العلم (‬
‫)درجات‬

‫سورة المجادلة‬
‫‪11‬‬ ‫اآلية‬

‫‪2‬‬
 ‫اإلهداء‬
‫نهدى خالصة جهدنا إلى الينبوع الذي ال يمل العطاء‬
‫ودعوتها زادت لنا في الحياة إلى من انتظر هده اللحظة‬
‫بفارغ الصبر‬
‫)أمهاتنا(‬
‫إلى الذي لم يبخل بشيء من اجل دفعنا في طريق النجاح‬
‫))آبائنا‬
‫الي كل من سعدت برفقتهم ف الدروب الحياة وكل من كانو معي‬
‫علي طريق نجاح والخير‬
‫( أصدقائنا)‬
‫إلى كل من علمنا كلمات نبني بها المستقبل إلى كل من‬
‫ساهم في أنجاز هدا العمل‬
‫) )دكاترتنا} األعزاء‬
‫إليهم جميعا نهدى ثمرة هدا المشروع‬

‫شكر وتقدير‬

‫‪3‬‬
‫نش كر هللا تع الى على فض له أن وفقن ا خالل ه ذا العم ل العلمي‬
‫ونجد لزام ا ً عل ّي أن نتوج ه بالش كر والتق دير ألس تاذة المش رف‬
‫على بحثنا الدكتورة حنان ماضي‪.‬‬

‫ونتقدم بالشكر والتقدير لألساتذة أعضاء هيئة التدريس في معهد‬

‫طرابلس العالي للعلوم الطبية‬
‫وأخيراً نتوجه بالشكر لكل من ساهم من قريب أو بعيد في إتمام‬
‫هذا العمل المتواضع‪.‬‬

‫‪4‬‬
 Index

page Content sq
I ‫اآلية‬
II ‫االهداء‬
II ‫الشكر والتقدير‬
CHPTER ONE
8 Abstrct
10 Introduction about coved-19 1.1
11 Research Question 1.2
11 Aims of The Research `.3
11 Hypothesis of The Research 1.4
11 Transmission of Covid-19 1.5
12 Types of Existing Vaccines 1.6
5
 CHAPTER TWO
16 Antiviral 2.1
16 Clinical Management 2.2
17 Pharmacologic Interventions 2.3
17 Supportive Management 2.4
18-26 Medicines Uses to Help Treat Covid-19 2.5
27-31 Vitamins and Minerals That Strengthen Immunity 2.6
32-33 Benefits of Covid Vaccine 2.7
CHAPTER THREE
34 Research methodology 3.1
34 Research sample 3.2
34 Research limits 2.3
35-36 results 3.4
37 discussiion 3.4
38 conclusion 3.6
39-40 Recommendations From Pharmacists To Patients
Some Vegetable and Fruits That Help in Strengthening The Immune
41
System
42-43 Reference

List of figures

figure content Page

1.1 Dexamethasone
1.2 Vitamin C
1.3 Vitamin D3

6
 1.4 Zinc Sulphate
1.5 Hydroxychloroquine
1.6 Azithromycin
1.7 Anticoagulant (actyl salicylic acid)
1.8 Antipyretic (panadol tablet 500mg ,paracetamo)
1.9 Antiviral (remdesivir)
2.1 Distribution of Cases
2.2 Distribution of Cases
2.3
2.4 A graph showing the distribution of cases (men and woman)
A Table Showing The Distribution of Cases
2.5 According to (4.5.6) months, and The Cases of
Recovery and Deaths for The Three Cases

Abstract

Since its emergence in December 2019, corona virus disease 2019 (COVID-19)
has impacted several countries, affecting more than 90
thousand patients and making it a global public threat. The routes of transmission
are direct contact, and droplet and possible aerosol transmissions] 1[ .
We aim to publish the research summary information for all COVID-19 research
within 3 months of approval, so that the research community

and wider public can see information about studies taking place in relation to the
current pandemic. We are asking sponsors not to request deferral of the publication
of these research summaries ] 9[.

You can search for approved COVID-19 research by typing ‘COVID-19’ into the
search function on the left ] 9[. 
7
New research will be marked as [COVID-19] in the title. Existing research that has
added on a COVID-19 element will be marked as [COVID-19] with the
amendment date in the ‘research summary’ field ] 6[.

Transmission
The main mechanism of transmission for the virus is either inhalation of droplets or
direct contact with droplets. ] 6[

The majority of the transmission occurs from symptomatic persons,

Nevertheless, the asymptomatic transmission has also a role in the spread of
COVID-19The median duration of viral shedding was around three weeks
in survivors, while the SARS-CoV-2 was detectable till death in non-survivors.

The longest observed duration of viral shedding in survivors was 37 days,

implying longer isolation of cases for preventing the viral spread

Family cluster transmission via close and unprotected exposure directly to droplets
or indirectly with fomites in the immediate environment is the

8
 Chapter One

1.1 Introduction about coved 19

In short, also known as 2019-nCoV, is a zoonotic septic respiratory disease

caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This
virus is very close to the SARS virus. The new virus was first detected in the
Chinese city of Wuhan in 2019, and has since spread around the world, causing the
global coronavirus pandemic. Since the beginning of the pandemic until today
more than 185,663,348 million cases of coronavirus have been reported in all
countries of the world, resulting in more than 4,012,659 million deaths. The ratio of
the number of deaths to the number of diagnosed injuries is estimated at 3.4%, but
it varies according to age and the presence of other diseases] 1[.
In November 2020, the FDA granted emergency use authorization to two
monoclonal antibody treatments (bamlanivimab, made by Eli Lilly; and a
9
combination of casirivimab and imdevimab, made by Regeneron). Both treatments
have been approved for non-hospitalized adults and children over age 12 with mild
to moderate COVID-19 symptoms who are at risk for developing severe COVID-
19
or being hospitalized for it. In these patients, the approved treatments can reduce
the risk of hospitalization and emergency room visits] 1[.

These therapies must be given intravenously (by IV) soon after developing
symptoms.] 1[.
If you are recovering at home, these measures can help reduce symptoms] 2[:
While you don't need to stay in bed, you should get plenty of rest.] 2[.
Stay well hydrated] 2[.
To reduce fever and ease aches and pains, take acetaminophen. Be sure to follow
directions. If you are taking any combination cold or flu medicine, keep track of all
There is no cure yet for Covid-19. Only one treatment, a drug called Remdesivir,
Has been abroved by f.d.a for the disease and resrach suggests it may
provide only a modest benefit to patients. The F.D.A. has granted emergency use
authorization to other treatment ] 3[.

1.2 Research Question: -

1- What is the corona virus and How is it transmitted?
2- What is the treatment protocol used in isolation centers inside Tripoli?
3- What are the most, important vaccines used now, according to WHO?
4- The most indications for protection from infection with the virus?

1.3 Aims of the research: -

1-Learn about the corona virus, it is causes and means of prevention.

2- learn about the treatment protocol used in isolation centers in Libya.
10
 3- learn about the most important treatment and medicines used to treat cases
infected with the virus.
4- learn about the existing vaccinations in the world and the vaccinations that
were given in Libya and compare them.
5- learn about the most important foods that help prevent corona virus.

1.4 Hypothesis of the research in Tripoli: -

1- The transition of covid-19 is quick.
2- Risk of hospitalization and emergency room visits.
3- Drugs used to reduce symptoms of covid-19.
4- Studying of wide range of potential treatment.

1.5 Transmission of covid-19

No Live COVID-19 viruses are not used in the COVID-19 vaccines currently
under development in the United States. As a result, these vaccines cannot cause
you to get COVID-19 and the vaccine will not cause you to excrete any of its
components ]1[.
Keep in mind that it will take a few weeks for your body to build up immunity
after getting the COVID-19 vaccine. In light it is possible to get infected with the
virus that causes Covid-19 before or immediately after vaccination ] 3[.
The World Health Organization has so far approved the Pfizer vaccine for
emergency use, but besides it there are also the Moderna AstraZeneca Sputnik and
Sino pharma vaccines, which have been approved by many countries for use in the
vaccination campaigns launched since December ] 4[
According to the European Medicines Agency (EMA), the US Food and Drug
Administration (FDA) and the World Health Organization (WHO) vaccines
approved so far are safe and save lives ] 5[.

1.6 Types of existing vaccines ; -

11
1.The vaccine of the Russian Aesthetics Institute
The vaccine, called Sputnik V, was developed by the Aesthetic Institute in
Moscow. The Russian vaccine is based on adenovirus vectors, and human
adenoviruses are among the easiest and simple to modify, and therefore their spread
as vectors has expanded] 9[..
"Vectors" are carriers that can deliver genetic material from another virus into a
cell. The genetic material of the adenovirus that causes infection is removed, while
a gene carrying a code that "codes" for a protein from another virus, and in the
current case of the emerging corona virus, and its scientific name "SARS Cove 2"
enters] 9[..
This new added ingredient helps the immune system respond and produce
antibodies that protect it from infection] 9[..

2. AstraZeneca-Oxford Vaccine
This vaccine was developed by the British laboratory AstraZeneca and the
University of Oxford "AstraZeneca-Oxford" and the technology it uses is "viral
vector" in which another virus is used less virulent that is converted to be added to
a part of the Corona virus, and it is inserted The modified virus is transferred to the
of individuals which in turn produce a typical protein for "SARS Cove 2" which
would prompt their immune systems to recognize it The Oxford-AstraZeneca
vaccine uses adenoviruses as a viral vector in a technology similar to the Russian
vaccine] 9[..
3.Pfizer-Biontech Vaccine
Developed by the American company Pfizer and its German Partner Bio NTech, it
works on messenger RNA technology, or mRNA, a molecule that tells our cells
what to make] 9[..
This vaccine is injected into the body and it introduces this molecule that controls
the mechanism for manufacturing a specific coronavirus antigen "spike" a very
special tip on its surface that allows it to stick to human cells for penetration This
spike will then be detected by the immune system which will produce the
antibodies and these antibodies will remain for a certain period of time] 9[..
4. Moderna Vaccine

12
 This vaccine was developed by the American company Moderna and Moderna's
vaccine uses the same "messenger‫ـ‬RNA" technology as the Pfizer-Biotech vaccine ] 9[

5. Novavax Vaccine ]
The vaccine was developed by the US company Novavax. It relies on inserting a
modified gene into a virus called a bacterial virus (baculovirus) and allowing it to
infect insect cells and then the spike proteins from these cells were assembled into
nanoparticles which while they look like the Corona virus but they cannot
reproduce. or causing COVID-19] 9[..
These nanoparticles are injected into the body by the vaccine where they trigger the
formation of the immune system in response to the antibody, and if the body
encounters the Corona virus in the future the immune system will be able to repel
it] 9[..
6.Sinopharma Company Vaccine
Developed by the Chinese company, Sino pharm and based on an inactivated
“inert” virus Sino pharm developed it in cooperation with the Wuhan Institute of
Virology and the Institute of Biological Products, according to a report in Deutsche
Welle ] 9[.
In the inactivated vaccine technology infectious agents from the emerging corona
virus are treated - chemically or through heat - to lose their danger but while
preserving their ability to produce an immune response and this is the most
traditional form of vaccination] 9[.

1.7 This table compares potency, number of doses,

temperature, storage and price

Number Temperature needed Price per

The manufacture company Potency
of doses for storage serving
The vaccine of the Russian Regular refrigerator from
Two 92% 10$
Aesthetics Institute 2 to 8 degrees Celsius

Regular refrigerator from

AstraZeneca-Oxford Vaccine Two 90%-62% 4$
2 to 8 degrees Celsius

13
 70 degrees Celsius below
Pfizer-Biontech Vaccine Two 95% 20$
zero

20 degrees Celsius below

Moderna Vaccine Two 95% 33$
zero
Regular refrigerator from
Novavax Vaccine Two 90% 16$
2 to 8 degrees Celsius

Regular refrigerator from The price ranges

Sinopharma Company Vaccin Two 79%
2 to 8 degrees Celsius from 30$ to 70$

Regular refrigerator from

Johnson & Johnson vaccine One 70% 10$
2 to 8 degrees Celsius

CHAPTER TWO

14
2.1 Antiviral Treatment [11]

 No approved treatment.
 Remdesivir: authorized by FDA to be used.
 Hydroxyl chloroquine: banned by many countries.
 ATZ, Lopinavir / Ribavirin: useless.
 ACEI and ARBS.
 Tucilizumab: IL-6 and IL-1 inhibitors.
 Steroids are relative contraindication.
 Favipiravir.
 Thalidomide.
 Plasmapheresis.
 Convalescent plasma.
 BCG vaccination.
 Cannabis, not all cannabis, mouthwash and throat gargle products as
prevention.

15
 - Anti-viral therapy
 for ICU COVID 19 patients you may consider:
 Hydroxychlorquine no more used
 Favipiravir
 1600mg BD for D1 then 600mg for D2 –D14
 Teratogenic
 Consider IFN b if no clinical response
 In cases of Cytokine crisis consider toclizomab after IL6 level has
obtained
 Plasmapheresis may have considered as bridge to toclizomamb] 7[.

2.2 Clinical Management

• Antifungals: 15%
• Antiviral treatment: 76%
• Convalescent plasma.
• Anticoagulation in patients with high D. dimmer.

2.3 Pharmacologic Interventions

 recommends the investigational antiviral agent remdesivir for treatment of
COVID-19 in hospitalized] 8[.
 patients with SpO 94% on room air or those who require supplemental
oxygen] 8[.
 recommends remdesivir for treatment of COVID-19 in patients who are on
mechanical ventilation or ECMO] 8[.
 recommends using dexamethasone (at a dose of 6 mg per day for up to 10
days) in patients with] 8[.
 COVID-19 who are mechanically ventilated (AI) require supplemental
oxygen but who are not mechanically ventilated (BI) ] 7[.
 recommends against using dexamethasone in patients with COVID-19 who
do not require supplemental oxygen (AI) ] 7[.
 There are insufficient data for the Panel to recommend either for or against
any other immunomodulatory therapy in patients with severe COVID-19
disease or t0 use empiric broad spectrum antimicrobial therapy in the
absence of another indication] 7[.

16
2.4 Supportive Management
 Steroid
1) methylprednisolone 0.75-1.5 mg / kg iv once a day] 10[.
2) The dosage should be halved every 3 to 5 days if medical conditions of patients
are improved] 10[.

 Antibiotic
1) Ceftriaxone 1gm, 12hr azithromycin 500mg 1st day then 250mg once up to 4th
day ] 10[.
2) Consider Antibiotic Escalation in case of secondary bacterial infection] 10[.

 Other Drugs
1) Bronchial secretion Management] 10[.
2) Bisolvon, hypertonic saline] 10[.
3) N acytile cysteine] 10[.
4) inhalation delivered by MDI. ] 10[.
5) Vitamin c 1 grams IV. ] 10[.
6) 200 mg thiamine IV q12hrs. ] 10[.
7) Zinc 75 -100mg /day. ] 10[.
8) Enoxaparin. ] 10[.
9) Mg 2gm stat keep mg at 2-2.4 Milmo. ] 10[.

2.5 Medicines Uses to Help Treat Covid-19:

1. Dexamethasone

figure (1-1)

17
Dexamethasone is a long-acting synthetic corticosteroid that blocks the release of
substances used in inflammation including staglandins, quinine, histamine, and
lipolysis enzymes, and it also alters the body's immune system. Alternative
medicine, you can use it in alternative medicine, you can use it in alternative
medicine. It can be taken orally or intravenously. Invest in a day and last for three
days. It has been shown to be effective in treating some severe cases of COVID-19.
] 3[.

In patients hospitalized with Covid-19, use of dexamethasone reduced 28-day

mortality among those receiving either gaseous mechanical ventilation or oxygen
alone in a randomized manner but not among those not receiving respiratory
support
The NIH COVID-19 treatment guidelines recommend the use of dexamethasone in
certain people hospitalized with severe COVID-19. The recommendation was
based on results from the RECOVERY trial. In the study, ] 3[.
more than 6000 patients hospitalized with COVID-19 randomly received either
dexamethasone or standard treatment. ] 3[.
Patients who required supplemental oxygen or ventilators and who received
dexamethasone were less likely to die within 28 days than those who received
standard care1. Dexamethasone did not have a benefit in patients who did not need
respiratory support. ] 3[.

2.Vitamin C

figure (1-2)

Vitamin C (Ascorbic Acid) is a water-soluble vitamin that is thought to have

beneficial effects in patients with severe and critical illnesses. It is an antioxidant
and free radical scavenger that has anti-inflammatory properties, influences cellular
immunity and vascular integrity, and serves as a cofactor in the generation of
endogenous catecholamines.1,2 Because humans may require more vitamin C in
1

18
states of oxidative stress, Vitamin C supplementation has been evaluated in
numerous disease states, including serious infections and sepsis. Because SARS-
CoV-2 infection may cause sepsis and acute respiratory distress syndrome (ARDS),
the potential role of high doses of vitamin C in ameliorating inflammation and
vascular injury in patients with COVID-19 is being studied. ] 3[.
Vitamin C is a vitamin that is found in a variety of foods and is also sold as a
supplement. Vitamin C is also called ascorbic acid and is used to prevent and treat
scurvy. It is also considered one of the important types of vitamins for human
health and some types of animals because it helps in tissue re-growth and
production of neurotransmitter enzymes. ] 3[.
Vitamin C is also required in the functioning of many enzymes necessary for the
functions of the immune system. It also acts as an antioxidant. There is currently no
evidence that vitamin C prevents colds. ] 3[.

On the other hand, there are some studies that prove that regular doses of vitamin C
can reduce the duration of a cold. It is not clear whether supplementation with this
vitamin affects the effects of cancer, dementia, or cardiovascular disease. ] 3[.

3.Vitamin D3

figure (1-3)

It is a vitamin from the group of fat-soluble secosteroids. Vitamin D in humans is

unique in that it can be taken in sunlight (vitamin D3) or ercocalciferol (vitamin
D2)
Some studies have shown that people who are in hospital with severe COVID-19
also have low levels of vitamin D (vitamin D deficiency). However, the risk factors
19
for developing severe COVID-19 are the same as those for developing vitamin D
deficiency, so it is difficult to tell if vitamin D deficiency itself is a risk factor for
severe COVID-19. Risk factors include general ill-health, a poor diet, and pre-
existing health conditions, such as diabetes, and liver and kidney disease.] 3[.
Vitamin D is important for healthy bones, teeth and muscles. It helps to regulate
blood sugar, the heart and blood vessels, and the lungs and airways. It also has a
role in boosting the body’s immune system. These are areas affected by COVID-
19, so giving vitamin D to people with COVID-19 might help them to recover more
quickly or have the disease less severely. ] 3[.

4. Zinc Sulphate

Figure (1-4)

Increased intracellular zinc concentrations efficiently impair replication in a

number of RNA viruses.1 Zinc has been shown to enhance cytotoxicity and induce
apoptosis when used in vitro with a zinc ionosphere (e.g., chloroquine).
Chloroquine has also been shown to enhance intracellular zinc uptake in
vitro.2 The relationship between zinc and COVID-19, including how zinc deficiency
affects the severity of COVID-19 and whether zinc supplements can improve
clinical outcomes, is currently under investigation.3 Zinc levels are difficult to
measure accurately, as zinc is distributed as a component of various proteins and
nucleic acids. ] 3[.

20
5.Hydroxychloroquine

Figure (1-5)

It is a medicine used to prevent and treat certain types of malaria. It is specifically

used on the skin for sensitive malaria. Other uses include rheumatoid arthritis,
lupus erythematosus, and delayed cutaneous porphyria. It is taken orally. It is also
an experimental treatment for Coronavirus 2019 (COVID-19). ] 3[.
WHO does not recommend hydroxychloroquine as a treatment for COVID-19.

This recommendation is based on 30 trials with more than 10 000 COVID-19

patients. Hydroxychloroquine did not reduce mortality, the need for or duration of
mechanical ventilation. Taking hydroxychloroquine to treat COVID-19 may
increase the risk of heart rhythm problems, blood and lymph disorders, kidney
injury, liver problems and failure. ] 3[.
However, hydroxychloroquine and chloroquine are safe for use in patients with
autoimmune diseases or malaria (not COVID-19). ] 3[..

6. Azithromycin

figure (1-6)

(Azithromycin) is a macrolide antibiotic used to treat a number of bacterial

infections, including otitis media, streptococcal pharyngitis, pneumonia, traveler's
diarrhea, and some other intestinal infections. It can also be used for a number of
sexually transmitted diseases including chlamydia and gonorrhea infections. It can
21
also be used to combat malaria, along with other medications. It can be taken orally
or intravenously as a single daily dose. ] 3[.
presents in vitro activity against SARS-CoV-2 and could act in different points
of the viral cycle. Its immunomodulatory properties include the ability to
downregulate cytokine production, maintain epithelial cell integrity or prevent
lung fibrosis. Azithromycin use was associated with a reduction in mortality and
ventilation days in other viral infections. These properties could be beneficial
throughout the COVID-19. However, the evidence of its use is scarce and of
low quality. Azithromycin has been assessed in retrospective observational
studies mainly in combination with hydroxychloroquine, which has shown to
provide no benefit. This macrolide presents a well-known safety profile.
Upcoming clinical trials will determine the role of azithromycin in the COVID-
19 (including the stage of the disease where it offers the greatest benefits and
the effect of its combination with other drugs). ] 3[.
7. Anticoagulant (Acetylsalicylic acid)

figure (1-7)

The SARS-COV-2 virus infection, commonly known as Covid-19, is associated

with a high risk of deep venous thrombosis and pulmonary embolism an enhanced
immunological response („cytokine storm “) during infection with Covid-19 often

22
leads to enhanced platelet activation, thrombotic microangiopathy [and clotting in
addition. ] 6[.
The activated platelets also contribute to neutrophil activation Prophylactic therapy
with anticoagulants is often included in the therapy. ] 6[.
Arterial thromboembolism was reported during some cases of the disease Testing
the effect of acetylsalicylic acid (ASA) was suggested by Viola et al. for Covid-19
pneumonia This is based on their previous study that ASA treatment ameliorated
the course of community-acquired pneumonia and increased the 30-day survival
Treatment with ASA was also proposed by modulatory effect on prostaglandin
synthesis and thus being a possibility to accelerate the resolution of the
inflammation ASA was also reported to have direct antiviral effects, for example
by up-regulation of type I interferon There are expert-based recommendations to
continue the use of antiplatelet therapy that were started earlier for other indications
However, as of now, the evidence regarding the effect of ASA or other antiplatelet
therapy on Covid-19’s severity or outcome is lacking. ] 3[.

23
Finger (1.7) shows anticoagulation protocol coved-19 patients

24
8. Antipyretic (Paracetamol)

figure (1-8)

Paracetamol is being suggested, for more than 60 years, messages begin around
the world.
Paracetamol is recommended by public health authorities, including the World
Health Organization (WHO), for rapid symptomatic treatment of mild to moderate
pain and fever reduction in COVID-19. ] 3[.
There are important factors which may be confounders in assessing causality of
ibuprofen with possibly worse COVID-19 illness. First, fever has been shown to be
beneficial toward a reduction in the duration of viral illness and the mortality
associated with illness Outside of reducing patient discomfort, there is little
evidence to support administration of antipyretics to reduce fever results in better
overall outcomes in previously healthy patients [ To the contrary, in several studies,
the use of antipyretics has been associated with an increase in mortality and
morbidity It is therefore a concern of whether these agents may suppress the
natural mechanism of the body to fight infection. ] 3[.
Secondly, there is evidence to support that ibuprofen is superior to acetaminophen
in reducing fever. In a randomized controlled trial in children comparing ibuprofen
and acetaminophen at equipotent doses, ibuprofen provided a larger temperature
decrease and a longer duration of response Meta analyses have also shown that
ibuprofen has a larger temperature reduction effect compared to acetaminophen in
children and in adults Thus, a superior antipyretic effect may be related to
ibuprofen more effectively hindering the beneficial effect of fever in COVID-19
viral illness. ] 3[

25
9. Antiviral (Remdesivir):

figure (1-9)

is a new antiviral drug in the class of nucleotide analogues , it was developed by

Gilead sciences for the treatment of Ebola virus disease and Marburg virus
infection although it was later also found to show antiviral activity against other
single-stranded RNA viruses such as human respiratory syncytial virus , Nipa virus
infection , Heneba virus, and MERS coronavirus (including MERS-virus). ] 4[.

SARS Remdesivir is currently being tested for the treatment of COVID-19, and it
has received FDA approval for emergency treatment for those hospitalized with
severe symptoms. ] 4[.

The drug may have an effect on the time it takes a patient to recover from illness
and is given by intravenous injection . ] 4[.

side and harmful effects of this treatment may include respiratory weakness , organ
dysfunction , low potassium level , low albumin level , low red blood cell count , as
well as low blood platelets count , in addition to the effect of the treatment on the
gastrointestinal tract. ] 4[.

2.6 Vitamins and minerals that strengthen immunity:

-

26
1.Vitamin E
Vitamin E has many functions in the body. It is based on the following:
fatty acid protection.
Maintain muscle and red blood cells.
An important antioxidant in the body that protects the body from infections and
diseases.
Vitamin E can be obtained by eating eggs, nuts, seeds, and whole grains. ] 11[.
2.Vitamin K
Vitamins that should not be lacking in the body, one of which is vitamin K, as the
benefits of the vitamin are as follows:
Control of blood clotting.
Protection from blood clotting.
Reducing bone density loss.
Vitamin K can be obtained from foods such as spinach, broccoli, green leafy
vegetables, and liver. ] 11[.
3.Vitamins B complex
Vitamins that the body should not lack in the body, one of the vitamins of the B
group, which includes the following:
A-Vitamin B1 (Thiamine)
Vitamin B1 levels must be maintained in the body because it works on the
following:
Improve metabolism.
Maintain proper digestion.
Protects the nerves and supports them to carry out their functions.
Vitamin B1 can be obtained by eating legumes, nuts, seeds, and whole grains. ] 11[.

B-. Vitamin B2 (Riboflavin)

Vitamin B2 is an essential vitamin as it works on the following:
27
Improve energy metabolism.
Enhance adrenal gland functions.
Support the power of sight.
Contribute to maintaining healthy skin.
Vitamin B2 is found in whole grains, lean meats, poultry, dairy products, and
mushrooms.
C-. Vitamin B3 (Niacin)
Vitamins that the body should not lack, one of which is vitamin B3, which helps in
the following:
- energy metabolism.
- Promote natural growth.
- Reducing harmful cholesterol levels in the body.
- Vitamin B3 can be obtained by eating: lean meat, poultry, seafood, milk,
eggs, legumes, and whole grains.

D-. Vitamin B12 (Cobalamin)

The importance of vitamin B12 lies in the following:
Increased production of red blood cells and DNA.
Contribute to reducing the risk of macular degeneration in the eye.
Vitamin can be obtained by eating: eggs, cheese, milk, butter, chicken, and beef. ]
11[.

4. Iron
Iron is one of the important minerals in the human body, and it has a major role in
the process of transporting oxygen from the lungs to all parts of the body by
hemoglobin, which is found in red blood cells, and constitutes two-thirds of the
source of iron inside the body, and this means that iron deficiency affects various
body functions, starting with Brain functions and the end of the immune system
and its ability to fight infection. ] 9[.
Iron comes from two sources, one of which is animal, which is known as heme
iron, such as: red meat, fish, poultry, egg yolk, and liver. The other is vegetarian
and is known as non-heme iron, which is difficult for the body to absorb like. ] 9[.
5. Potassium
28
Potassium is one of the most important nutrients for the body, and the most
important element to reduce anxiety and stress and control blood pressure, and is
concentrated in the following;
1.Stimulating nervous activity
Potassium plays an important role in stimulating brain function at a normal level, as
higher levels of potassium allow more oxygen to reach the brain, thus stimulating
neural activity and increasing cognitive ability. ] 11[.
.2 control blood sugar
A low potassium level causes a drop in blood sugar, which leads to sweating,
headache, weakness and nervousness. The intake of potassium and sodium chloride
provides immediate relief in such cases, and the diabetic patient should maintain
the level of potassium in the blood at normal levels. ] 11[.
3.Reduce muscle disorders
The contraction and relaxation of the muscles require a sufficient concentration of
potassium. Most of the potassium ions in the human body are found in muscle
cells. It maintains optimal muscle and nerve function, as well as rapid reflexes. ] 11[.
4.Preventing cramps
Muscle cramps result from a low level of potassium in the blood, and this condition
can be prevented by eating a banana daily. ] 11[.
5.Promote bone health
There are certain qualities in potassium that benefit the various acids in the body,
which helps to maintain and keep calcium, and eating fruits and vegetables high in
potassium leads to an increase in bone mineral density, which further strengthens it
and extends its life. ] 11[.
6.Calcium
Calcium is essential for overall health. The calcium needed by the human body can
be obtained from many types of food and, if necessary, can be obtained by taking
nutritional supplements. ] 11[.
But it is also necessary, as with any of the nutrients, whether vitamins, minerals or
salts, to make sure not to overdo or reduce calcium, as it should be eaten in
moderation and according to what the body needs. ] 11[.

29
The body needs calcium for blood circulation, to move muscles, and to secrete
hormones. Calcium also helps transmit messages from the brain to other parts of
the body. It is also a key part of healthy teeth and bones, which makes them strong
and dense. ] 11[.
And if the amounts of calcium consumed are less than what the body needs, it
withdraws its needs from the “calcium depot” in the body, which is the bones, and
thus becomes weak and brittle over time. ] 11[.
Calcium sources: -
The human body does not produce calcium, so it depends on food to get it
•Milk, cheese and yogurt/yogurt.
• Kale, spinach and broccoli.
•White beans.
• sardines . ] 11[.
*Calcium and Vitamin D Relationship: -
The body needs vitamin D to absorb calcium, which means that it will not take full
advantage of a calcium-rich diet if there is a vitamin D deficiency. ] 11[.
7. Magnesium
Magnesium These mineral particles are minerals that people need to consume in
relatively large amounts of at least 100 milligrams per day, and low levels of
magnesium in the body have been linked to diseases such as osteoporosis, high
blood pressure, clogged arteries, genetic heart disease, and diabetes. ] 11[.
We will present the benefits of magnesium on the health of the body as follows:
.1 Strengthen bone health
Magnesium may directly and indirectly improve bone health.
Magnesium helps regulate calcium and vitamin D levels, two important nutrients
for bone health, which are essential for healthy bone formation. ] 11[.

2.Promote cardiovascular health

Magnesium plays an important role in heart and muscle health, as a magnesium
deficiency can increase a person's risk of cardiovascular disease.
30
People with congestive heart failure also have low levels of magnesium. ] 11[.
3.Magnesium also plays an important role in regulating high blood pressure,
that is, it protects against high blood pressure, which positively affects the health of
the heart and blood vessels.
- Magnesium sources
It is possible to focus on eating magnesium from its natural sources, and it is
possible to find magnesium in the following foods:
- Spinach.
- Nuts.
- The banana.
- Dark chocolate.
- Avocado.
- Fish.
- Oatmeal.
- Some vegetables and fruits that strengthen the immune system. ] 11[.

- 8.zinc
- helps regulate cell production in the human body's immune system. Zinc is

- concentrated in the strongest muscles in the body, especially in white and red
blood cells

- The human body contains more than 300 different enzymes that require zinc

- for the body to function in its normal activities. Researchers believe that the

- human body needs about 3,000 out of 100,000 proteins in the body, which are
mostly zinc.
- The average person needs 2-3 grams of zinc at any given time, knowing that

- the human body has organs that secrete zinc, such as the salivary gland
- prostate gland and pancreas. Even cells involved in the activity of the

- immune system secrete zinc. A study showed that nearly two billion people in

31
 - the developed world suffer from zinc deficiency, and a study conducted by

- AIIMS in 3 hospitals in Delhi on newborns and children showed that out of

- two children are born with zinc deficiency, and this deficiency leads to
developmental problems and weak immunity[ 6]

2.7benefits of covid-vaccine ; -

1.Prevents you from contracting COVID-19 or from becoming seriously ill or

dying from COVID-19. ] 4[.
2. It prevents you from transmitting the COVID-19 virus to others. ] 4[.
3.The number of vaccinated community members’ increases against COVID-19 -
which slows the spread of the disease and contributes to herd immunity (so-called
herd immunity). ] 4[.
4.Preventing COVID-19 from spreading and replication, the two processes that
allow it to form a mutation that may be better able to resist VA vaccine. ] 4[.

32
 CHAPTER THREE

3.1 Resarch methodology:

The Curriculum Used Explanatory Quantitative research with Statically data.

3.2 Sample Research:

A visit to the Maitika Medical Isolation Center, the files of corona disease were
reviewed, and statistics of the disease were taken within 3 months 4,5,6 at 2021
33
The treatment protocol used in the center and the determination of the recovery rate
in each month.
A number of 33,325, how they were infected, their common signs and symptoms,
the protocol of treatment, and the rate of death. The number of women were 22,050
and the number of men were 11,875.

3.3 Search limits:

Spatial boundaries: Maitika Medical Isolation Center, Souq Tolata Isolation
Center we did not get any information about Number of cases.
Time limits: The study was carried out in the time period 1-4 -2021 to 30-6-2021.

Results
The number 33,925 has been studied, As in the following table: -

Cases Number of cases %

Male 11,875 35%
Female 22,050 65%
Figure 2.3

34
 ‫توزيع عدد الحاالت بين الرجال و النساء‬
25000

22050
20000

15000

11875
10000

5000

0
male (35%) female (65%)

1 ‫سلسلة‬

Figure (2.4)

-A graph showing the distribution of cases (men and woman):

 A Table Showing The Distribution of Cases According

to (4.5.6) months, and The Cases of Recovery and
Deaths for The Three Cases:

) 4.5.6 ( ‫توزيع عدد الحاالت لي ثالثة اشهر‬

6 ‫شهر‬ 5 ‫شهر‬ 4 ‫شهر‬
17,582 8,564 7,779 ‫عدد الحاالت الكلي‬
15,327 8,935 6,158 ‫عدد حاالت الشفاء‬
351 188 107 ‫عدد الوفيات‬
35
Figure 2.5

6 ‫شهر‬

5 ‫شهر‬

4 ‫شهر‬

‫عدد الوفيات‬ ‫عدد الشفاء‬ ‫عدد الحاالت الكلي‬

0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000

Figure (2.6)

3.4 Discussion
 Through the study, it was noted that the number of cases of women were
more than that of men, may be due to the defiency of vitamin D because
women over 45 stayed at home longtime.
 It was noted that the total number of cases was increasing in the months
April and June, while in the month of May, the lowest number of cases was,

36
 due to the government imposed a bon and renewal of preventive precautions,
obligating people to wear masks in markets, shops and businesses and
reducing the number of employees in government department.
 It was noted that the rate of deaths in the end of June was increasing, because
the emergence of the delta mutant in the neighboring countries of Libya
(Tunisia) at a time when the control of communicable and endemic diseases
did not announce the arrival of the mutated gyrus delta to Libya.
 It was noted that the number of recovery cases increased by a large
percentage in the beginning of June.
 It was noted that the number of recovery cases increased gradually in the last
three months.
 During May, it was the best and promising in terms of results number of
cases and number of recovery cases, as a result of people is response to the
precautionary measures.
 It was noted that at the end of June there was a very noticeable increase in
the number of positive cases and the number of deaths as a spread of mutated
delta.
 Also, the arrival of the vaccine, that is Libya and people demand for
vaccination contributed significantly to the decrease in the number of injuries
and deaths, Where the number three million cases from the arrival of the
vaccinations to Libya until this time.

37
 3.5 Conclusion

 We conclude from this study that the therapeutic protocol followed in Tripoli
is identical to the therapeutic protocol in the countries of the world, as
approved by WHO, as the new mutant of covid-19 is less virulent of covid-
19 that started in the city of yuhan in china, but this is faster spread like the
Indian delta mutant spread during the study period.

 The arrival of vaccines to most countries of the world is considered the most
important way to eliminate this virus, reduce its spread and end the corona
pandemic.

3.6 Recommendations from pharmacists to patients

 Do not go out without wearing a mask.
 Wash hands thoroughly with soap and do some massage to them frequently.
 Covering the mouth and nose with a tissue while coughing and sneezing, and
if the tissue is not available we cover the mouth and nose with the elbow.
 Avoid touching the mouth and nose.
 Maintain a distance of three steps between you and people who show
symptoms of cold and flu.
 Cancel the unnecessary trips abroad.
38
 When you return from abroad, spend the first fourteen days at home.
 Ensure that the areas where you are located are well ventilated.
 Clean the surfaces used, such as door handles, electrical sockets and sinks,
with water and detergents (alcohol) every day.
 Do not share personal items, towels with other.
 Avoid direct contact, handshakes and hugs.
 Many doctors, nurses, paramedics, and others take on additional
responsibilities and risks as their day-to-day roles evolve on a daily basis.
Healthcare workers across the country have pretty much taken this in and
they truly deserve these heroic titles.
 However, the pivotal healthcare professional sometimes overlooked during
this pandemic is the pharmacist. It can be said that pharmacists and
pharmacy technicians have sacrificed, adapted and persevered just as much
as any other healthcare professional in the wake of COVID-19.
 The pharmacist must provide patients with oral and written instructions, in
the local language, about the safe administration of their medication and the
list of medications. Providing this type of education at the ward level has not
been a current practice in the hospital system.
 Patients in the control group received only standard care. The evaluation
pharmacist interviewed control group patients to obtain their drug histories at
discharge and reviewed drug therapy retrospectively to identify drug-related
problems. This pharmacist did not provide any feedback to the medical
teams present and did not provide any education during the hospital stay or
upon discharge.

 After discharge from the hospital, the evaluation pharmacist must conduct
monthly interviews, for a period of six months, to determine any drug-related
readmissions. The pharmacist should use a pre-tested questionnaire to
document readmission information. The pharmacist must identify potential
causes of drug-related reintroduction as either adverse drug reactions, drug
mismatch at discharge prescription (resulting in drugs inadvertently
continuing, changing, stopping, or restarting), and therapeutic failure
(including non-compliance poor patient knowledge about medications and
dose-reduced at discharge) or dispensing errors. We excluded drug-related
readmissions that began after patients were discharged from.

39
 Some vegetable and fruits that help in strengthening
the immune system: -

40
Vitamin C helps the body repair tissues and maintain healthy skin and blood
vessels, It is also an important antioxidant, a substance that prevents cell orange
deterioration and improves immune function
Allicin It is a compound released when garlic is chopped or crushed. "Allicin and
the antioxidants inside garlic help fight infection and support the immune system," Garlic
Sovront says..
Ginger has antioxidant and anti-inflammatory properties. ginger
The immune benefits of turmeric are linked to curcumin, the ingredient that gives
it its dark yellow color It has the ability of the immune system by activating some turmeric
immune-related cells
Red peppers are particularly beneficial for immune health and are part of a healthy
Red pepper
quarantine diet due to their content of vitamins A and C
It fights infections, prevents infection, and heals damaged tissues. Cinnamon is
Cinnamon
rich in immune-boosting antioxidants
Basil has antioxidant-rich properties and is full of vitamins and has been shown to
basil
have the ability to boost immunity.
Its health benefits, as it supports the respiratory, nervous, cardiovascular and
thyme
immune systems; It protects against carcinogens and infections

Reference
1. Li F. Structure, Function, and Evolution of Coronavirus Spike Proteins. Annu
Rev Virol. 2019;12(26):237-61.
2. European Centre for Disease Prevention and Control (ECDC).
primerscan.ecdc.europa.eu.
Stockhom: ECDC; [7 April, 2020]. Available from.
3. Luo W, Majumder MS, Liu D, Poirier C, Mandl KD, Lipsitch M, et al. The role
of absolute humidity on transmission rates of the COVID19 outbreak. medRxiv.
2020:2020.02.12.20022467.

41
4. Bukhari Q, Jamee Y, Will Coronavirus Pandemic Diminish by Summer? . Will
coronavirus pandemic diminish by summer? SSRN. 2020.
5. J. W, Tang K, Feng K, Lin X, Lv W, Chen K, et al. High Temperature and High
Humidity Reduce the Transmission of COVID-19. SSRN. 2020.
6. Cheng VCC, Wong SC, Chen JHK, Yip CCY, Chuang VWM, Tsang OTY, et al.
Escalating infection control response to the rapidly evolving epidemiology of the
Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong.
Infection Control & Hospital Epidemiology. 2020:1-24.
7. Zimmermann P, Curtis N. Coronavirus Infections in Children Including
COVID19: An Overviewof the Epidemiology, Clinical Features, Diagnosis,
Treatment and Prevention Options in Children. The Pediatric Infectious Disease
Journal. 2020;39(5):355-68.
8.World Health Organization (WHO). Report of the WHO-China Joint Mission on
Coronavirus Disease 2019 (COVID-19). Geneva: WHO; 2020 [1 March, 2020].
Available from:
9. World Health Organization (WHO). Cinical management of severe acute
respiratory infection (SAR) when COVID-19 disease is suspected -Interim
guidance. Geneva: World Heath Organization (WHO), 2020 13/03/2020. Report
No.: WHO/2019-nCoV/clinica/2020.4.
10. Backer JA, Klinkenberg D, Walinga J. Incubation period of 2019 novel
coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28
January 2020. Eurosurveillance. 2020;25(5).
11. Istituto Superiore diSanità (ISS). Integrated surveillance of COVID19 in Italy:
(Ordinanza n. 640 del 27/02/2020). [21 April, 2020]. Available from

42