WHAT IS CORONAVIRUS?

Coronaviruses are a family of viruses that cause illness such as respiratory diseases
or gastrointestinal diseases. Respiratory diseases can range from the common cold
to more severe diseases e.g.

• Middle East Respiratory Syndrome (MERS-CoV)

• Severe Acute Respiratory Syndrome (SARS-CoV)

A novel coronavirus (nCoV) is a new strain that has not been identified in humans
previously. Once scientists determine exactly what coronavirus it is, they give it a
name (as in the case of COVID-19, the virus causing it is SARS-CoV-2).
Coronaviruses got their name from the way that they look under a microscope. The
virus consists of a core of genetic material surrounded by an envelope with protein
spikes. This gives it the appearance of a crown. The word Corona means “crown” in
Latin.
Coronaviruses are zoonotic, meaning that the viruses are transmitted between
animals and humans. It has been determined that MERS-CoV was transmitted from
dromedary camels to humans and SARS-CoV from civet cats to humans. The source
of the SARS-CoV-2 (COVID-19) is yet to be determined, but investigations are
ongoing to identify the zoonotic source to the outbreak.
COVID-19 (coronavirus disease 2019) is a disease caused by a virus named SARS-CoV-2
and was discovered in December 2019 in Wuhan, China. It is very contagious and has
quickly spread around the world.

COVID-19 most often causes respiratory symptoms that can feel much like a cold, a flu,
or pneumonia. COVID-19 may attack more than your lungs and respiratory system.
Other parts of your body may also be affected by the disease.

• Most people with COVID-19 have mild symptoms, but some people become
severely ill.
• Some people including those with minor or no symptoms may suffer
from post-COVID conditions — or “long COVID”.
• Older adults and people who have certain underlying medical conditions are at
increased risk of severe illness from COVID-19.
• Hundreds of thousands of people have died from COVID-19 in the United
States.
• Vaccines against COVID-19 are safe and effective. Vaccines teach our immune
system to fight the virus that causes COVID-19.

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CLINICAL PRESENTATION
Typically, Coronaviruses present with respiratory symptoms. Among those who will
become infected, some will show no symptoms. Those who do develop symptoms
may have a mild to moderate, but self-limiting disease with symptoms similar to the
seasonal flu. Symptoms may include:

• Respiratory symptoms
• Fever
• Cough
• Shortness of breath
• Breathing difficulties
• Fatigue
• Sore throat

A minority group of people will present with more severe symptoms and will need
to be hospitalized, most often with pneumonia, and in some instances, the illness
can include ARDS (Acute Respiratory Distress Syndrome), sepsis and septic shock.
Emergency warning signs where immediate medical attention should be sought
include:

• Difficulty breathing or shortness of breath

• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

Most common symptoms: Less common symptoms: Serious symptoms:

• fever • sore throat • difficulty breathing

• cough • headache or shortness of
• tiredness • aches and pains breath
• loss of taste or • diarrhoea • loss of speech or
smell. • a rash on skin, or mobility, or
discolouration of confusion
fingers or toes • chest pain
• red or irritated eyes

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HIGH RISK POPULATIONS

The virus that causes COVID-19 infects people of all ages. However, evidence to date
suggests that three groups of people are at a higher risk of getting severe COVID-19
disease:

• Older people (people over 70 years of age)

• People who are physically inactive
• People with serious chronic illnesses such as:
✓ Diabetes
✓ Cardiovascular disease
✓ Chronic respiratory disease
✓ Cancer
✓ Hypertension
✓ Chronic liver disease

The WHO has issued and published advice for high-risk groups (older people and
people with serious chronic illness) and community support. This is to ensure that
these high-risk populations are protected from COVID-19 without being isolated,
stigmatised, left in positions of increased vulnerability or unable to have access to
basic provisions and social care.

WHO advice for high-risk populations:

• When having visitors at your home, extend “1-meter greetings”, like a

wave, nod or bow.
• Request that visitors and those who live with you, wash their hands.
• Clean and disinfect surfaces in your home (especially those that people
touch a lot) on a regular basis.
• Limit shared spaces if someone you live with is not feeling well (especially
with possible COVID-19 symptoms).
• If you show signs and symptoms of COVID-19 illness, contact your
healthcare provider by telephone, before visiting your healthcare facility.
• Have an action plan in preparation for an outbreak of COVID-19 in your
community.
• When you are in public, practice the same preventative guidelines as you
would at home.
• Keep updated on COVID-19 through obtaining information from reliable
sources.

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COVID-19 VARIANTS

Viruses constantly change through mutation. When a virus has one or more new
mutations it’s called a variant of the original virus. Currently, the Centers for Disease
Control and Prevention has identified two variants of the virus (SARS-CoV-2) that causes
coronavirus disease 2019 (COVID-19) as variants of concern.
• Delta (B.1.617.2). This variant is nearly twice as contagious as earlier variants
and might cause more severe illness. The greatest risk of transmission is
among unvaccinated people. People who are fully vaccinated can get vaccine
breakthrough infections and spread the virus to others. However, it appears
that vaccinated people spread COVID-19 for a shorter period than do
unvaccinated people. While research suggests that COVID-19 vaccines are
slightly less effective against the delta variant, the Pfizer-BioNTech, Moderna
and Janssen/Johnson & Johnson COVID-19 vaccines still appear to provide
protection against severe COVID-19.
• Omicron (B.1.1.529). This variant might spread more easily than other
variants, including delta. But it’s not yet clear if omicron causes more severe
disease. It’s expected that people who are fully vaccinated likely can get
breakthrough infections and spread the virus to others. However, the COVID-
19 vaccines are expected to be effective at preventing severe illness. This
variant also reduces the effectiveness of some monoclonal antibody
treatments.
The alpha, gamma and beta variants continue to be monitored but are spreading at
much lower levels in the U.S. The mu variant is also being monitored.
To strengthen protection against COVID-19 and circulating variants,
the CDC recommends additional primary shots and booster shots of COVID-19 vaccines
in specific instances:
• Additional primary shot. The CDC recommends an additional shot of
an mRNA COVID-19 vaccine for some people with weakened immune
systems, such as those who have had an organ transplant. People with
weakened immune systems might not develop enough immunity after
vaccination with two doses of an mRNA COVID-19 vaccine. An additional dose
might improve their protection against COVID-19.
The third dose should be given at least 28 days after a second dose of
an mRNA COVID-19 vaccine. The additional primary shot should be the same
brand as the other two mRNA COVID-19 vaccine doses you were given. If the
brand given isn’t known, either brand of mRNA COVID-19 vaccine can be
given as a third dose.

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 • Booster shot. If you are age 12 or older, have been given both doses of the
Pfizer-BioNTech COVID-19 vaccine and it’s been at least 5 months, you should
get a single booster shot. Teens ages 12 to 17 should only get the Pfizer-
BioNTech COVID-19 vaccine booster. For people age 18 or older, the Pfizer-
BioNTech or Moderna COVID-19 vaccine boosters are preferred in most
situations.
If you are age 18 or older, have been given both doses of the Moderna COVID-
19 vaccine and it’s been at least 5 months, you should get a single booster
shot. The Pfizer-BioNTech or Moderna COVID-19 vaccine boosters are
preferred in most situations.
If you are age 18 or older, have been given one dose of the Janssen/Johnson
& Johnson COVID-19 vaccine and it’s been at least 2 months, you should get a
single booster shot. The Pfizer-BioNTech or Moderna COVID-19 vaccine
boosters are preferred in most situations.
Pregnant women can also get a booster shot.
People who have a moderately or severely weakened immune system should get an
additional primary shot and a booster shot.

TRANSMISSION OF COVID-19

COVID-19 spreads when an infected person breathes out droplets and very small
particles that contain the virus. These droplets and particles can be breathed in by
other people or land on their eyes, noses, or mouth. In some circumstances, they
may contaminate surfaces they touch. People who are closer than 6 feet from the
infected person are most likely to get infected.

COVID-19 is spread in three main ways:

• Breathing in air when close to an infected person who is exhaling small droplets
and particles that contain the virus.
• Having these small droplets and particles that contain virus land on the eyes, nose,
or mouth, especially through splashes and sprays like a cough or sneeze.
• Touching eyes, nose, or mouth with hands that have the virus on them.

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Transmission can occur more easily in the “Three C’s” (the risk of COVID-19
spreading is higher in places where these “3Cs” overlap):

1. Crowded places with many people nearby;

2. Close-contact settings, especially where people have conversations very
near each other;
3. Confined and enclosed spaces with poor ventilation.

The incubation period of COVID-19 is currently understood to be between 2 to 14

days. This means that if a person remains well after 14 days after being in contact
with a person with confirmed COVID-19, they are not infected.

DIAGNOSTIC PROCEDURES

A COVID-19 diagnostic testing kit has been developed and is available in clinical
testing labs. The gold standard for testing for COVID-19 is Reverse Transcription
Polymerase Chain Reaction (RT-PCR). However, current data suggest that RT-PCR is
only 30-70% effective for acute infection, this may be due to incorrect use of lab kits
or not enough virus in the blood at the early stages of testing. Plus, the availability
of testing will vary from country to country.

The CDC recommends that any person who may have had contact with a person
who is suspected of having COVID-19 and develops a fever and respiratory
symptoms listed above are advised to call their healthcare practitioner to determine
the best of course of action. The main criteria for testing are:

• Location
• Age
• Medical history and risk factors
• Exposure to the virus and contact history
• Duration of symptoms

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If the above criteria are met it is advised that the following testing procedure is
followed:

• Collect and test upper respiratory tract specimens, using a nasopharyngeal

swab.
• If available testing of lower respiratory tract specimens.
• If a productive cough is evident then a sputum specimen should be
collected.
• For patients who are receiving invasive mechanical ventilation, a lower
respiratory tract aspirate or broncho-alveolar lavage sample should be
collected.
Imaging may be useful in identifying patients with COVID-19 which is especially
relevant in places with good access to imaging technology but poor access to
reliable and quick laboratory testing. Chest X-rays are not especially sensitive for
COVID-19, but chest CT gives a much more detailed view appears to have good
sensitivity in initial stages of the disease. However, chest CT or X-ray is not currently
recommend as a diagnostic method as they can easily be confused with other
infections such as H1N1, SARS, MERS and seasonal flu. Lung ultrasound is also
emerging as a valuable diagnostic testing procedure. According to the CDC, even if a
chest CT or X-ray suggests COVID-19, viral testing is the only specific method for
diagnosis.

Myocardial injury tends to affect COVID‐19 severity and mortality. A meta-analysis

showed patients with high cardiac troponin I (>13.75 ng/L) and aspartate
aminotransferase levels (>27.72U/L) combined with either advanced age (>60 years)
was more likely to develop adverse outcomes. Evaluating cardiac injury biomarkers
may assist in identifying patients at the highest risk and leading to specific
therapeutic intervention.

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ANTIBODIES OF COVID-19

The science of antibodies is called “serology.” Antibody tests, also called “serology
tests,” identify antibodies in blood samples. While other parts of the immune system
also contribute to protection, it is easiest to test for antibodies.

As of August 2021, more than 80 antibodies have been granted FDA emergency use
authorization (EUA) to detect antibodies to SARS-CoV-2. Scientists are using these
antibody tests to learn more about the level of antibodies needed to protect people
from COVID-19 (threshold of protection) and how long this protection lasts. Antibody
tests are not currently recommended by FDA for routine, widespread use in making
individual medical decisions while this information is being gathered and evaluated. If
you have questions about whether an antibody test is right for you, talk with your
healthcare provider or your state or local health department.

Not all antibody tests identify the same antibodies. Some antibody tests are more or
less sensitive to specific sections of the antibody protein than others. This means that
different antibody tests might not have the same results, even when they are both
testing for antibodies to SARS-CoV-2. Scientists use these differences in tests to help
answer different research questions about how immune systems respond to the virus
that causes COVID-19 and to improve our understanding of COVID-19.

Antibodies to SARS-CoV-2, the virus that causes COVID-19, can be detected in the blood
of people who have recovered from COVID-19 or people who have been vaccinated
against COVID-19. Getting a vaccine is safer than getting COVID-19, and vaccination
against COVID-19 is recommended for everyone 5 years of age and older. If someone
has already had COVID-19, vaccination against COVID-19 increases their body’s antibody
response, which improves their protection.

It is important to remember that some people with antibodies to SARS-CoV-2 may

become infected after vaccination (vaccine breakthrough infection) or after recovering
from a past infection (reinfected). Based on what we know right now, risk of reinfection
is low for at least the first 6 months following an infection with the virus that causes
COVID-19 diagnosed by a laboratory test. When someone who is fully vaccinated gets
COVID-19, it is called a vaccine breakthrough infection. No vaccine is 100% effective, so
some breakthrough infections are expected. The risk of infection, severe illness,
hospitalization, and death are all much lower for vaccinated people compared to people
who are unvaccinated. When reinfections or breakthrough infections happen, having
antibodies plays an important role in helping prevent severe illness, hospitalization, and
death.

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A positive antibody test result can help identify someone who has had COVID-19 in the
past or has been vaccinated against COVID-19. Antibody tests are not used if you have
symptoms of COVID-19 or for diagnosing a current case of COVID-19. This is because it
takes most people with a healthy immune system 1 to 3 weeks after getting COVID-19
to develop antibodies. A viral test is recommended to identify a current infection with
the virus that causes COVID-19. More information about the role and uses of antibody
testing is available.

Most people who have a positive antibody test result can continue with normal
activities, including work, but they should still take steps to protect themselves and
others, including getting vaccinated.

For many diseases, including COVID-19, antibodies are expected to decrease or “wane”
over time. After a long enough period of time, your level of antibodies can decrease
below a level that provides effective protection. This level is called the “threshold of
protection.” When antibodies decrease below the threshold of protection, you may
become more vulnerable to severe illness. We do not yet know what the threshold of
protection for antibodies is for the virus that causes COVID-19 or how long it takes these
antibodies to wane. Even after antibodies wane, your immune system may have cells
that remember the virus that can act quickly to protect you from severe illness if you
become infected. These topics are being researched by scientists all over the world.

REFERENCES:

World Health Organization. (n.d.). Coronavirus. World Health Organization. Retrieved January
20, 2022, from https://www.who.int/health-topics/coronavirus#tab=tab_3

Centers for Disease Control and Prevention. (n.d.). About covid-19. Centers for Disease Control
and Prevention. Retrieved January 20, 2022, from
https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19.html

Mayo Foundation for Medical Education and Research. (2022, January 11). Covid-19 variants:
What's the concern? Mayo Clinic. Retrieved January 20, 2022, from
https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/covid-
variant/faq-20505779

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