Introduction

In December 2019, the World Health Organization (WHO) had declared an outbreak of the febrile
respiration illness of unknown etiology from Wuhan, Hubei province of China. The outbreak was
epidemiologically linked to the Wuhan Seafood Wholesale Market involving the sale of seafood and
live animals.
It came into light on 31st December, 2019, when China informed the World Health Organization
(WHO) about the cluster of cases of the disease. On January 9, 2020, the WHO issued a statement
stating that Chinese researchers have made “preliminary determination” of the virus as a novel corona
virus in a person suffering from pneumonia. The researchers were able to identify the virus by
sequencing the genome of the virus by using a sample taken from an infected person. The disease was
officially named by the World Health Organization (WHO) on 11th February, 2020 as Corona
virus Disease-2019 (COVID-19). ‘Corona’ is Latin for “crown”, named for their crown like
appearance. The international committee on Taxonomy of Viruses (ICTV) has named the new corona
virus as “Severe Acute Respiratory Syndrome Corona virus 2” (SARS-CoV-2).
The new coronavirus pneumonia is characterized by fever, dry cough, muscle aches, sputum, and
shortness of breath, diarrhea, fatigue, and occasional gastrointestinal symptoms. Old age people, and
those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory
disease, and cancer are more likely to develop this disease. The illness also causes lung lesions and
pneumonia. COVID-19 is a zoonotic disease (a disease than can be transmitted from animals to
human) with an estimated 2%-5% mortality rate. Currently, there is no proper treatment or
vaccination for the virus yet. However, other measures have been introduced by different countries to
downtrend the spread of COVID-19 which includes nation’s lockdown, closure of schools,
universities, office, etc.
Moreover, the disease has also spread globally in countries like Thailand, Japan, Republic of Korea,
Vietnam, Germany, United States, Singapore and even our country India. As on February 6, 2020, a
total of 28,276 confirmed cases with 565 deaths globally were evidenced by WHO, involving at least
25 countries. The pathogen of the outbreak was later identified as a novel beta-coronavirus, named
2019 novel coronavirus (2019-nCoV).
As on 10th April 2020, more than 1.56 million cases have been diagnosed globally, with over 95,000
fatalities. In the 15 days to 10 April, over 1.03 million cases were reported.

Origin and Emergence of Corona Virus

According to WHO the pandemic coronavirus disease 19 (COVID-19) is caused by a coronavirus

named SARS-CoV-2. Coronaviruses are a family of viruses that can cause diseases from the most
common cold to highly severe diseases like Severe Acute Respiratory Syndrome (SARS) and the
Middle East Respiratory Syndrome (MERS). The mentioned viruses SARS and MERS were detected
in 2003 and 2012 respectively and have high mortality rates. These viruses were initially transmitted
from animals to people. Dromedary Camel is suspected as the intermediate host of MERS-CoV,
whereas the palm civet cats may have contributed the transmission of SARS-CoV into humans.
The family of coronaviruses (CoVs) are divided into four genera: Alpha-, Beta-, Gamma-, and Delta-
CoV. The CoVs that causes the disease to the human and also other animals are mostly belongs to the
Alpha- and Beta- category. As SARS-CoV was transmitted by first infecting the civet cats and then
infected the humans in 2002. Similarly, MERS-CoV infected the dromedary camels and then infected
humans in 2012. The new coronavirus – COVID-19, SARS-CoV and MERS-CoV belong to a large
family of coronaviruses, which are like brother and sisters. There are many similarities in their
genetic sequence, but they are not completely the same. The exact origin and the natural host of the
SARS-CoV-2 is unclear, but it is believed that the virus is zoonotic i.e., transmitted through wild
animals, which may be the Chinese chrysanthemum bat but it is not clear as how the intermediary
spreads from bats to humans. Till now according to the “new coronavirus infection pneumonia
diagnosis and treatment program (trial sixth edition)”, the source of infection are the patients who
have transmitted the new coronavirus pneumonia.

Source:
Source of infection:

The first case of the novel coronavirus was discovered in the wholesale market of Wuhan, China,
where the original source of the infection was wild animals. Many wild animals carry pathogens
which then becomes the source of the transmission of the infection. The wild animals like bat, rat,
civet cat, badger, and many more are the common source of the coronavirus. It is theorized that the
Chinese Chrysanthemum bat may be the natural host of the new coronavirus pneumonia but it is still
unclear how the intermediary spreads from bats to human. As of now, according to WHO, it was
stated that the source of the infection- SARS-CoV-2, is mainly because of the infected persons with
the new coronavirus pneumonia. Apart from the infected persons, the patients who have
asymptomatic infection may also be the source of the infection.

Source of virus:

The new coronavirus belongs to the genus β. Its genetic characteristics are significantly different from
SARS-CoV and MERS-CoV. The current research shows that the new coronavirus is very much
similar with the SARS-like coronavirus which was found in bats by more than 85%. And with the
MARS-like coronavirus it is 50% similar. It is believed that the bats have the largest variety of
coronavirus and are considered to be the hosts of various coronavirus.

At present, it is believed that the primary host of the new coronavirus is may be a Chinese bat which
have transmitted the virus through an intermediate animal host that have caused an outbreak in the
market of Wuhan, China. As the first cases were linked with the seafood market of Wuhan, it is
currently believed that the original source of this coronavirus pneumonia is the Wuhan’s seafood
wholesale market in China.

Nature of Spread: COVID-19

It can be transmitted through Contact, including direct contact and indirect contact.

Direct contact transmission:

Here direct contact transmission refers to infections caused directly by pathogens without passing
through other objects in the middle.

Indirect contact transmission:

Indirect contact transmission refers to transmission caused by indirect contact with contaminated
items. Such as hands and daily necessities (bedding, toys, tableware, clothing, etc.) after being
contaminated with excreta from the source of infection (such as Feces may be spread, which cannot
be completely determined at present) or secretions (such as excreta accompanying coughing and
sneezing). Being touched by hands, and then touching the mucous membranes such as the nose,
mouth, eyes, etc., to enter the body. Therefore, it is important to wash hands.

Virus can also be spread through droplet transmission and aerosol transmission.

Droplet transmission:

Droplets can enter the susceptible mucosal surface through a certain distance (generally 1 to 2
meters). Because the droplets are large (greater than 5um), they will not be suspended in the air for a
long time. Daily face-to-face talking, coughing, and sneezing can cause droplets to spread. If there are
patients with suspected new corona virus around, remember to wear a mask and try to keep a distance
of more than 2 meters. Masks should be properly discarded after use, and hands should be thoroughly
washed with soap and running water after contact with patients.

Aerosol transmission:

Airborne particles, generally less than 5 um in diameter, can spread infectious particles after long
distance and long distance. Airborne pathogens can also spread through contact. It was speculated
that the SARS corona virus that was popular before could be spread by air. Viruses that hover over
clothing and skin in the form of aerosols can only enter the eyes, mouth, and nose through a very
small percentage. This amount of virus is unlikely to cause disease. Except in certain places in the
hospital (such as intubation operations), there is no need to worry too much about the spread of new
corona virus by aerosols. Opening windows and ventilating frequently to maintain indoor air flow is
still an important means of home protection.

How Does COVID-19 affect the lungs?

Categorization of patients’ cases:

Three type of cases has been noted in the people affected by Covid-19. These are:

Mild cases:

Most cases are mild. In this case, patients are suffering from fatigue, cough, muscle aches, fever and
chest discomfort. Such patients typically recover in about two weeks.

Moderate cases:

The limited cases are seen in this case. Patients often feel a shortness of breath, high fever, and
diarrheal illness. These type of patients are recovered after few days.

Severe cases:

In this case, patients suffer from Acute Respiratory Distress Syndrome (ARDS) in which the lungs
are filled up with fluid and restricted breathing. These types of patients are put on ventilators and they
take usually six weeks or even months. Mostly, these types of cases are seen in old people.
Covid-19 attacks on the lungs, heart, kidneys, liver. We know that all the parts of human body are
important, but Covid-19 primarily affects the lungs. So, we will deeply understand that how does it
affect the lungs?

Process:

According to the Centres for Diseases Control and Prevention (CDC), the virus can spread person-to-
person within 6 feet through respiratory droplets produced when an infected person coughs or
sneezes. It is also possible for the virus to remain on a surface or object, be transferred by touch and
enter the body through the mouth, nose or eyes.

It is a respiratory virus and thus it enters through the respiratory tract, we think primarily through the
nose. But it might be able to get in through the eyes and mouth because that’s how other respiratory
viruses behave. When the virus enters the body, it begins to attack.
It can take two to 14 days for a person to develop symptoms after initial exposure to the virus. The
average is about five days.

Once inside the body, it begins infecting epithelial cells in the lining of the lung. A protein on the
receptors (In cell biology, receptors are a structure on the surface of a cell or inside a cell that
selectively receives and binds a specific substance.) of the virus can attach to a host cell's receptors
and penetrate the cell. Inside the host cell, the virus begins to replicate until it kills the cell. 

This first takes place in the upper respiratory tract, which includes the nose, mouth, larynx and
bronchi. The patient begins to experience mild version of symptoms: dry cough, shortness of breath,
fever and headache and muscle pain and tiredness, comparable to the flu some patients have reported
gastrointestinal symptoms such as nausea and diarrhea, however it's relatively uncommon. 
Symptoms become more severe once the infection starts making its way to the lower respiratory tract.

In critical cases, the virus rambling down the windpipe and entering the lower respiratory tract,
where it seems to prefer growing. The lungs are the major target of this virus.

As the virus continues to replicate and journeys further down the windpipe and into the lung, it can
cause more respiratory problems like bronchitis and pneumonia.

Pneumonia is characterized by shortness of breath combined with a cough and affects tiny air sacs in
the lungs, called alveoli. The alveoli are where oxygen and carbon dioxide are exchanged.

When pneumonia occurs, the thin layer of alveolar cells is damaged by the virus. The body reacts by
sending immune cells to the lung to fight it off and that results in the linings becoming thicker than
normal. As they thicken more and more, they essentially blocked the little air pocket, which is what
you need to get the oxygen to your blood.
So it is basically a war between the host response and the virus. Depending who wins this war, we
have either good results where patients recover or bad results where they don’t.

Restricting oxygen to the bloodstream deprives other major organs of oxygen including the liver,
kidney and brain. 

In a small number of severe cases that can develop into acute respiratory distress syndrome (ARDS),
which requires a patient be placed on a ventilator to supply oxygen. 

However, if too much of the lung is damaged and not enough oxygen is supplied to the rest of the
body, respiratory failure could lead to organ failure and death. 
Similarities and dissimilarities of SARS-COV-2 from other Corona viruses:

Similarities:
There is lots of similarity between SARS-COV-2 and other corona viruses.
1. Both are respiratory illnesses caused by coronaviruses are believed to have
originated in bats, jumping to humans via an intermediate animal host.
2. These are spread through respiratory droplets, when a person with the virus coughs
or sneezes, or by contact with the contaminated objects or surfaces.
3. They have similar stability in the air and on various surfaces and can lead to
potentially serious illness.
4. All Coronaviruses have similar structure. This structure contains:
(i) A glycosylated, cell-surface protein called spike protein or S.
(ii) The S protein has two distinct functional domains, termed S1 and S2, both of which are
necessary for a Corona virus to successfully enter a cell.
Dissimilarities:
(i) All strains of Coronaviruses use a spike protein to bind to the human cell. The spike
protein in the new virus cell is different from what the other strains in the coronavirus
family. For one, its spike protein has a site on it that is activated by an enzyme called
furin, which other SARS-CoV viruses don’t.
(ii) Furin is found in a lot of human tissue, including lungs, liver and the small intestine. This
means that the SRAS-CoV-2 can attach itself to multiple organs. It is also possible that
possessing such an activation site has enabled the virus to spread more efficiently between
humans.
(iii) The other big difference is the way that this spike protein behaves. Using a cryo-
electron microscopy process, scientists found that the spike protein of SARS-CoV-2 binds
10 times more tightly to human tissue than the spike protein of SARA-CoV.

How Ebola, Nipah viruses different from Covid-19:

Characteristics Coronavirus Ebola Nipah

Definition A viral disease of the
respiratory system caused
by a betacoronavirus.
Country where China
discovered
Incubation period 2 days to 14 days
Diagnosis Real-time
RT-PCR
Symptoms Shortness of breath, cough,
fever, and development of
pneumonia symptoms.
Transmission Suspected zoonosis but
animal host not known at
this time; transmitted
among people via
respiratory secretions.
Treatment Treating the symptoms,
giving extra oxygen or using
a ventilator; a few antivirals
have shown some promise.
Morality Estimates 2% at the present
time.
A virus that causes A virus that causes
haemorrhagic fever and fever, headaches and
is caused by a filovirus. is caused by a sick
animal.
Democratic Republic of Malaysia
Congo
2 to 20 days 5 to 14 days
ELISA and ELISA and
RT-PCR RT-PCR
Headache, fever, muscle Respiratory and
aches, jaundice, nausea, neurologic
abdominal pain, bleeding complications.
and coma
Zoonosis possibly Zoonosis possibly
transmitted from people transmitted via
eating bats or other bush unprotected exposure
animals; it is spread by to secretions from the
body fluids between pigs, or unprotected
people contact with the tissue
of a sick animal.
Pain medications, fluid Intensive supportive
therapy, and addition of care; no drugs or
platelets. Vaccines and vaccines specific for
antivirals are being Nipah virus infection
tested.
When untreated is 70% When untreated is
or more. 75% or more.
 Drugs used in COVID-19

There is no specific treatment for coronavirus (COVID-19). But there are some drugs which are seen to be
useful in some corona cases. Some of them are chloroquine and favilavir.

The first COVID-19 vaccine in China is expected to be ready for clinical trials by the end of April,
according to Xu Nanping, China’s vice-minister of science and technology.

Chloroquine approved for emergency use by US FDA

The US Food and Drug Administration (FDA) approved limited emergency use for chloroquine and
hydroxychloroquine as a treatment for COVID-19.
The President of the United States, Donald Trump, had announced on 19 March that chloroquine and
hydroxychloroquine/Plaquenil, used to treat malaria and arthritis, were approved by the FDA to be
tested as a treatment for COVID-19.
Chloroquine is being tested in various clinical trials conducted by government agencies and academic
institutions. Other antivirals drugs are also planned to be fast-tracked for testing for coronavirus.

Favilavir, the first approved coronavirus drug in China

The National Medical Products Administration of China has approved the use of Favilavir, an anti-
viral drug, as a treatment for coronavirus. The drug has reportedly shown efficiency in treating the
disease with minimal side effects in a clinical trial involving 70 patients. The clinical trial is being
conducted in Shenzhen, Guangdong province.

Precautions for protecting us against corona

Precautions from Corona virus:

There are lot of precautions which are issued by WHO and the government of every country which is
suffering from this virus.
(i) Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them
with soap and water. Washing your hands with soap and water kills viruses that may be on
your hands. Alcohol based hand rubs are preferred because it contains varying amounts
and types of alcohol, often between 60% and 95% and usually isopropyl alcohol, ethanol
(ethyl alcohol) or n-propanol. Also alcohol has the capacity to kill the most of the germs.
Alcohol attacks and destroys the envelope protein that surrounds some viruses, including
coronaviruses. This protein is vital for a virus’s survival and multiplication. But a hand rub needs
to be at least 60% alcohol in order to kill most viruses.

(ii) Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing
or sneezing. When someone coughs or sneezes they spray small liquid droplets from their
nose or mouth which may contain virus. If you are too close, you can breathe in the
droplets, including the COVID-19 virus if person coughing is already infected
(iii) Avoid touching eyes, nose and mouth. Hands touch many surfaces and can pick up
viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth.
From there, the virus can enter your body and can make you sick.
(iv)Make sure you, and the people around you, follow good respiratory hygiene. This means
covering your mouth and nose with your bent elbow or tissue when you cough or sneeze.
Then dispose of the used tissue immediately. Droplets spread virus. By following good
respiratory hygiene you protect the people around you from viruses such as cold, flu and
COVID-19.
(v) If you have a fever, cough and difficulty in breathing, then immediately contact to the
doctor and follow the directions which are given by the doctor and isolate yourself for at
least one week.