 COVID-19 AND ITS PATHOGENECITY

Submitted by: Tony Bernard

Course: B.Sc (H) Biotechnology.
Semester: III
Enrollment No: A0504419019
Batch: 2019-22
Submitted to: Dr.Nahid Siddiqui
 INTRODUCTION

 Corona virus has been found to mainly target the human respiratory system. In
December 2019 some patients were hospitalized with pneumonia of unknown
cause who were epidemiologically linked to a wet animal market in Wuhan,
China. The director general of WHO Dr. Tedros Adhanom Gebreyesus officially
declared that the disease caused by this new CoV was called the Novel Corona
Virus Induced Pneumonia or Corona Virus disease 2019 short for COVID-19. This
new virus has proved to be very contagious because of which it has spread
everywhere across the globe. During a meeting on January 30, 2020 as per the
international health regulations, the WHO declared the outbreak as a Public
Health Emergency Of International Concern. Corona virus includes a single
stranded RNA as its genetic material. They are found to cross barriers and
cause many diseases from cough and cold to severe ones just like the MERS and
SARS. This virus also includes a potential to grow and become a worldwide
epidemic which is of great public health risk. The threat of CoV pandemic has
also been raised to ‘Very High’ level by WHO. Now the full number of
confirmed cases worldwide is over 25 Lakhs and therefore the death toll has
crossed 1,50,000. Various measures are being taken all over the globe to stem
the possible adverse effects.
 SYMPTOMS
 There is usually an incubation period of a few days after which the symptoms of COVID-
19 occur. However recently people have been diagnosed COVID positive without
symptoms. It has been proved that a patient usually dies from COVID-19 infection after a
median of about fourteen days from the appearance of symptoms. This period depend on a
variety of factors such as the patient’s age as well as the immunity of the patient. People
above the age of 70 are more vulnerable to COVID-19 infection, though all age groups are
susceptible to the disease. The main symptoms at the start of COVID-19 are fever, cough
and fatigue though some people can also experience sputum production, haemoptysis,
diarrhea, dyspnoea and lymphopenia. Loss of smell and taste have also been reported
although not very common. Skin irritations like rashes and purple blue colors of fingers
have also been reported in infected people. The symptoms of covid-19 can mainly be
categorized into four: most common, somewhat common, rare and unusual. Fever and
cough are among the common symptoms. Sore throat, fatigue, aches, pains, shortness of
breath, and headache fall among the somewhat common symptoms. Runny or stuffy nose
and diarrhea are the rare symptoms. Unusual symptoms like gastrointestinal presentations,
acute cardiac myocarditis, acute liver and kidney injuries, neurological manifestations,
stroke or paralysis and silent or happy hypoxemia have also been reported recently. Chest
CT scans usually ships pneumonia although there were other diseases like RNAaemia,
severe cardiac injury and Respiratory Distress Syndrome that caused death.
 PATHOGENECITY
 The symptoms of COVID-19 vary from individual to individual while some also
remain asymptomatic. During the initial days of the viral outbreak the death
toll was very low in China. But with more and more people acquiring the
virus the death toll has increased significantly. The death rate ofCOVID-19 is
believed to be less than 4 %. Infected people had an increased leukocyte
number and high levels of Plasma Pro-inflammatory cytokines. One
confirmed COVID-19 case showed a patient with fever, cough, course
breathing sounds of both lungs and a body temperature of 39°C. COVID-19
was confirmed when the victim’s sputum showed positive Polymerase Chain
Reaction results. The victim also developed leucopenia with a high
neutrophil count. The blood C-reactive protein was also at a high value.
Erythrocyte sedimentation was very high and D-dimer were also noted. The
most common pathogenesis of COVID-19 were severe pneumonia and acute
cardiac injury along with RNAaemia.Additionally high levels of cytokines and
chemokines in blood were also observed. Some severe cases also showed
increased concentration of Pro-inflammatory cytokines that are believed to
increase the disease severity.

 Corona virus entry and replication.

 Antigen presentation in corona virus infdection.
 Humoral and Cellular immunity.
 HISTORY AND PHYSICAL
1 . Uncomplicated (mild) infection.
This is marked by health problems of upper respiratory tract like fever, cough, sore
throat, nasal congestion, headache and muscle pain.
 2. Moderate pneumonia.

The patient might not develop acute pneumonia however symptoms like cough and
shortness of breath are present.
 3. Severe pneumonia.

Severe dyspnea with fever, fast and shallow breathing and low oxygen content in the
body (hypoxia) will be present. But the fever symptom may be absent or mild even during
the severe forms of disease. Children may be affected with cyanosis. Radiologic imaging is
commonly used at this stage after clinical identification.
 4. Acute Respiratory Distress Syndrome (ARDS)

The condition at which respiratory failure begins is called ARDS. It causes hypoxia. On
the basis of degree of ARDS is categorized into three:
 Mild ARDS.
 Moderate ARDS.
 Severe ARDS.

Chest imaging procedures like CT and chest radiography are performed at this stage.
Echocardiography can also be helpful.
 5. Sepsis.

It represents a severe organ dysfunction caused by the uncontrollable response of the

host to the infection. Sepsis is marked by Hypoxia, Severe dyspnea, malfunctioning of
kidneys with reduced urine output, tachycardia and altered mental status. Low platelet
count and increased bilirubin may also occur. Sepsis is followed by a septic shock which is
associated with increased mortality, circulatory and metabolic abnormalities. Vasopressors
are often administered to keep up the optimum blood pressure.
 
 EVALUATION
 Many countries are depending on various methods to find out who should undergo
testing. In most countries people under investigation are being tested for Corona
virus. Also most people with COVID-19 infection will develop fever, cough, sneeze
etc which is also a key to perform testing. People under investigation must take
special care, Isolate themselves and also utilize prevention measures since they
are at a high infection risk. Also a person who did have close contact with a
confirmed COVID-19 victim or travel history from countries infected with COVID-19
should also have testing performed. The secretions of the upper and lower
respiratory tract are used for testing. These samples are stored at low
temperatures and their genetic content is amplified through reverse Polymerase
Chain Reaction. Then the genetic material is searched for the genetic code of CoV.
In case the test result is positive, a test is again performed for confirmation. The
first and most important step of diagnosis is chest imaging. The laboratory findings
of people infected with COVID-19 were quite complex with many disorders
including high creatinine, low platelet count and increased D-dimer. People
infected will give a positive result during chest radiography. Lung ultrasound has
been recently developed and is widely used over chest radiography because of its
low cost and limited amount of radiation. People living in different countries face
many differences in the availability of the test.
 TREATMENT
 No vaccine has been discovered for COVID-19 yet and no treatment is present in the
current scenario specifically against the virus. Oxygen therapy is the most
importantly followed treatment for patients with severe disease. The treatment is
mainly based on the symptoms expressed by the victim. Mechanical ventilation
might also be needed and the circulation blood volume should be restored to
prevent septic shock. Several anti-viral drugs like hydroxychloroquine and ritonavir
are also helpful although they are not fully effective and approved.
[Hydroxychloroquine can treat auto immune disorders and inhibits heme Polymerase
because of which it is of extensive use. Recently hydroxychloroquine have been
administered along with azithromycin. A very recent study shows that plasma
collected from appropriate people who have overcome COVID-19 infection may also
be used for treatment. In some cases nitric oxide is also given to people with lung
disorders. A big question still remains whether the presently available medications
could be effective to treat COVID-19.[It must be noted that even after the discovery
of a suitable vaccine there would be a lot of hardships to manufacture large
quantities and to transport them to treat such a large population. Some vaccines
under study include the live attenuated vaccine and SARS-COV-2 vaccine.
Remdesivir is a drug that is effective against RNA viruses. It inhibits RNA Polymerase
and thus could be useful for treatment. Favipiravir used for the treatment of
influenza is also being studied to treat COVID-19. It is an oral pill which inhibits RNA
Polymerase. Various other anti-viral medicines and antibiotics are still investigated
for the treatment of SARS-CoV-2. An antibody used to treat rheumatoid arthritis is
also being studied and used. In case the disease reaches extreme severity organ
support is also needed in addition to respiratory support.
 IMPACT OF COVID-19 ON
ENVIRONMENT
 The Corona virus pandemic has decreased air pollution drastically in all countries of the world.
With no vehicles on the roads, no flights in air and no emission from factory exhausts the
mankind for once can have a safer environment free of pollution and fresh air to breathe. Since
there are no but the disadvantage is that a number of information report by the media could get
outdated in just a couple of hours does the media and journalist should try their best to update
the new information by keeping in touch with various health departments and organizations
since covid-19 has affected the economy to including sectors like trade market and tourism its
impact has also become a matter of international concern with so many journalist trying to keep
up with any new information. Since there are no automobiles, there is no emission of nitrogen
dioxide from vehicle exhausts. Recently the Himalayan mountain ranges could be viewed from
Jalandhar city of Punjab, India indicating increased air quality, reduce smog and an increased
visibility. Also the wildlife worldwide is experiencing a state of freedom after the lockdown has
been issued. Even the quality of water has been improved in different parts of the world due to
decreased means of water transport. The air quality index has significantly improved after the
lockdown. Also the levels of microscopic particulate matter has shown a significant decrease.
The lockdown has decreased the burning of fossil fuels and has thus reduced the emission of
greenhouse gases, thus being a solution to global warming. On this year’s Earth Day people all
over the world can breathe fresher than the previous year’s Earth Day. The Global carbon
dioxide emission has also been decreased due to the lockdown.[A few Metropolitan cities of
India which were among the top polluted cities of the world are now clean with fresh and safe
environment. It must be noted that this cleanliness of the environment might be a temporary
state since all the nations would be focusing on building up their economy after the lockdown.
This might make conditions worse than the previous scenario with higher air pollution, carbon
dioxide emission and increased global warming. All factories will start running at full force and
the roads would be filled with automobiles and skies with flights. This sudden change could have
a great impact on the environment after the lockdown.
THANK YOU!