Coronavirus disease (COVID-19)

Corona viruses (CoV) belong to the family of virulent viruses which cause severe respiratory disease - from common cold to Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A new type novel Coronavirus (nCoV) strain has been linked to the outbreak from 2019 which has not been identified in humans.

Epidemic Origin: It has been established from the available data that Coronavirus is zoonotic (transmitted between animals and humans) . There are 7 strains of Viruses which cause respiratory disease. The common cold causing Viruses belong to the 4 strains while 2 others (SARS-CoV and MERS-CoV) result in the deadly infections - SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The last strain in this group causes Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-CoV-2). The disease it causes is known as Covid-19, so named after the year it started to manifest.

The SARS-CoV transmuted from bats to Civet cats and then to humans in China, while the MERS-CoV mutated from dromedary camels (Arabian camels) to humans in middle east.
As of now, the source of the SARS-CoV-2 has not been identified except that it originated in Wuhan, China.

The SARS-CoV-2 Virus spreads through 3 possible ways:

• Direct Contact: Contact transmission results when a person touches any object that contains a live virus on it (fomite). Generally , 90 % of the virus is rendered inactive by the Ultraviolet (UV) rays present in sunlight.
  
• Droplets: Small particles of mucus, saliva emanating from a person when s/he speaks or coughs. Generally large droplets drop down and rarely travel more than a meter or so.
  
• Airborne transmission: Minute droplets, which come from an affected person when he sneezes, coughs or speaks, turn aerosol and can float suspended in the air for hours indoors under the right conditions. Humidity, other aerosolized contents, air movement and air density may play a role in the transmission of infection indoors. Increasing ventilation rate can lower the spread of this aerosol transmission.
  

Symptoms: it is not necessary for the patient to develop all symptoms immediately. Some may be ill for some time and then lapse into pneumonia. Or they may some symptoms initially and then become carriers themselves as they may not show debilitating symptoms further on.

Covid-19 symptoms as shown below, are typical and may indicate the progress of the infection. These symptoms have been collated from different authoritative research sources.

• 1. Fever typically high - 100 degree F or above
  
• 2. Cough
  
• 3. Breathing difficulties
  
• 4. Shortness of breath
  
• 5. body ache
  
• 6. Fatigue
  
• 7. Bowl abnormalities - Diarrhea leading to bowl ischemia or cholestasis - obstruction of bile flow resulting in obstructive jaundice.
  

The prognosis is grim for patients over 80 years of age. A study in China shows that the mortality rate for this group of patients is 14.8 % whereas for the overall population the mortality rate is 2.3 %. The lower respiratory tract infection may progress to pneumonia, acute respiratory syndrome, organ failure and death. There is some evidence that suggests that patients with type A blood group are 50 % more likely to require oxygen or ventilators as their genetic profile appears to make them susceptible to complications arising out of Covid-19 infection.

Normally our body immune system fights the pathogen as it enters our body. But during the process, the disease flares up in some cases and the same immune system tends to overact resulting in a condition called as cytokine storm which - if uncontrolled may lead to death. Some times this cytokine storm may be controlled with interleukin-6 (IL-6) inhibitor drugs.

Researchers found a mutated SARS-CoV-2 virus in China and Germany, called as D614G which appears more virulent than the earlier strain. It was thought that infection rate has increased rapidly due to mutation that changed the properties of the virus.

Treatment: As it is a viral infection, there is no direct medication targeted at this Virus. Other than normal care, there is very little option available to treat the disease. Antibiotics may be prescribed to treat secondary infection if any.

The ongoing research to control the Covid-19 infection has tentatively identified some drugs which may have some benefit. The following drugs may show some benefit:

• Ivermectin - A type of anthelmintics normally used to treat strongyloidiasis (threadworm, roundworm infestation) in animals or onchocerciasis (river blindness due to a type of roundworm infestation).
  
• Interleukin 7 (IL-7) drug that increases the number of T lymphocyte - (T cells) which is primarily responsible for killing the pathogen. Normal blood count of T cells is 2000-4000 per micro liter of blood. But in a serious case of this virus, the blood count of T cells drops to an abnormally low level of even 200 per micro liter.
  

ICAM Protocol :
A pharmacist, Ms.Carlette Norwood Williams has developed a treatment protocol with the acronym - ICAM. This proposed treatment option is not a new discovery. The individual line of medicine has been used all along. But the idea of synergy of using a combination of effective drugs has been suggested in this protocol.

• I - Immunosupport : primarily with the use of Vitamin C and Zinc
  
• C - Corticosteroid : To reduce inflammation of tissues with the use of Methylprednisolone
  
• A - Anticoagulant : To stop blood clotting with the use of blood thinners like Enoxaparin
  
• M - Macrolide : Antibiotic to fight against secondary lung infection from the Macrolide family such as Azithromycin and Clarithromycin which have higher level of lung penetration
  

It is better to prevent the infection in the first place.

Vaccines: Vaccines are our major tools in the fight against the virus by priming our body immune systems to defeat the pathogen. Though many vaccines have been approved for emergency use, their efficacies against the target virus vary. Messenger RNA vaccines (mRNA) contain specific instructions as a messenger to produce a spike protein. This technique of using instruction set instead of inactivated pathogen to create an immune response is better as you can modify the set of instructions in the future if the virus mutates. It also mitigates the risk associated with using inactivated virus.

Prevention: Primarily the Virus spreads through droplets and body fluids. Avoid any crowded area if possible. Avoid contact with anyone who shows symptoms of respiratory illness - cough, sneeze and running nose. Allow at least 3 feet of space between you and the infected person. Wash your hands with soap thoroughly. Remember the germicide in the soap takes at least 30 seconds to work. So wash your hands for at least 30-45 seconds and then rinse.

Use alcohol based hand sanitizer to disinfect your hands before you touch your face/eyes/nose/mouth. Cook your food including meat at high heat thoroughly. Wash your hands and tools/implements in the kitchen well. Always use different cutting board and knife for vegetables and meat. Do not use the same cutting board or knife which was used to cut raw meat to cut cooked food.

Your pets - dogs and cats are safe as long as they remain indoors or move in restricted area. It has not been established that normal pets pose any threat unless you are in a severely affected area. Use the standard precaution of washing your hands thoroughly after you come in contact with your pets.

PCR - Polymerase Chain Reaction

Polymerase Chain Reaction is a technique to amplify small segments of DNA for molecular and genetic analysis. These amplified DNA can be used by laboratory procedures. The entire cycling process of PCR is automated and can be completed in just a few hours - guided by a temperature altering system known as thermocycler.

The polymerase chain reaction (PCR) test can measure the presence of viral nucleic acids in the patient’s blood even when there is no detectable antibody. Numerous copies of a gene are made by separating the 2 strands of DNA containing the gene segment, marking its location, using DNA polymerase to make multiple copies. PCR test is used to evaluate false negative results to the ELISA and Western blot tests.The PCR test can detect the presence or absence of antigens by determining whether cells have the genes for the antigens.

PCR test is becoming first choice of techniques for the detection of many bacteria/virus - from Anthrax to SARS-CoV-2. PCR technique is a major tool in the ongoing fight against the Covid-19 pandemic. It helped to positively match the specific coronavirus present in the lung tissue, blood and feces of infected animals to the exposure virus.
Even most mapping techniques in the Human Genome Project (HGP) relied on PCR.

Reverse Transcription Polymerase Chain Reaction (RT-PCR): Reverse Transcription Polymerase Chain Reaction is a method of polymerase chain reaction amplification of nucleic acid sequences that uses RNA as the template for transcribing the corresponding DNA using reverse transcriptase. It (RTPCR) relies on chemical analysis of the substance in the body that transmits genetic information (RNA) to:

• Evaluate the effectiveness of cancer therapies
  
• Identify mutations consistent with the presence of Ewing’s sarcoma
  
• Reveal cancer that recurs after treatment has been completed