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Panorama of Coronavirus Infection (COVID-19)

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Panorama of Coronavirus Infection (COVID-19)

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Two years have passed since the Coronavirus outbreak, but the emerging new variants still pose a challenge for both the public and doctors. Read on to know more.

Written by

Dr. Lochana .k

Medically reviewed by

Dr. Anshul Varshney

Published At March 12, 2020
Reviewed AtMarch 17, 2023

What Is Corona or COVID-19?

Corona is a virus that belongs to the vast range of virus families. It causes mild to severe symptoms. After an outbreak in China, the virus quickly spread around the world. The World Health Organization (WHO) identified SARS-CoV-2 as a new type of coronavirus that can trigger respiratory tract infection. Coronavirus affects the upper and lower respiratory tract, but some of the coronaviruses are not considered dangerous. Though there are different sources of transmission, mainly it occurs through direct contact with the person infected with corona or from animals. The transmission occurring from animals is called zoonotic transmission.

Has Outbreak of Coronavirus Become Pandemic?

The World Health Organization declared the coronavirus outbreak as a pandemic one (prevalence of a disease all throughout the country or world). The number of patients affected outside China has risen by 13-fold. Many health organizations have declared that Coronavirus is more deadly than flu. After Influenza this is the biggest pandemic disease reducing the population.

What Is the Disease Caused By Corona Named as?

The disease caused by the new coronavirus is named coronavirus disease (COVID-19). The Coronavirus Study Group of the International Committee on Taxonomy of Viruses named the virus severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2).

The Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS-CoV) are other variants of coronavirus.

What Are Its Causes?

  • The reason why corona has been able to spread rapidly is that it is an air-borne infection.

  • It can spread through the droplets expelled from cold and cough.

  • Coronavirus can stay on the surfaces of different objects and when you happen to touch them you have the possibility of getting infected.

  • Animals such as cat, camel, bat, snake, and rat are known to transmit the new coronavirus.

What Are the Emerging Variants of COVID-19?

Variants of COVID-19 are classified into four types, namely,

1.Variant being monitored. 2.Variant of interest. 3.Variant of concern. 4. Variant of high consequence. As of now, there are no variants under variants of the high consequence category. The variant being monitored of SARS-CoV-2 includes: 1.Alpha (B.1.1.7 and Q lineages). 2.Gamma (P.1 and descendent lineages). 3.Eta (B.1.525). 4.Beta (B.1.351 and descendent lineages). 5.Iota (B.1.526). 6. 1.617.3 7. Epsilon (B.1.427 and B.1.429). 8. Mu (B.1.621, B.1.621.1). 9. Kappa (B.1.617.1). 10. Zeta (P.2). The Delta (B.1.617.2 and AY lineages) variant falls under the variant of concern category.

What Are Its Causes?

The reason why corona has been able to spread rapidly is becauseit is an air-borne infection.

  • It can spread through the droplets expelled from cold and cough. Inhalation of the infected aerosols or direct contact of the infected air droplets with the eyes, nose, and mouth can cause it.

  • Coronavirus can stay on the surfaces of different objects, and when you happen to touch them, you have the possibility of getting infected.

  • Coronavirus can remain suspended in the air, travel for more than a meter, and cause the spread in poor-ventilated buildings or crowded indoors.

  • Animals such as cats, camels, bats, snakes, and rats transmit the new coronavirus.

What Are theRoutes of Transmission of COVID-19?

A survey conducted by the National Center for Biotechnology Information of the United States has explained the modes of transmission of the Coronavirus, which include:

A) Direct Transmission:

The direct transmission occurs in the following ways:

  • Aerosol Transmission - It is the most common transmission route. Aerosols are respiratory droplets released during a dental or surgical procedure and while an infected person coughs, sneezes, or talks.

  • Other Body Fluid Transmission - Gastrointestinal tract is another important transmission mode, with anal swabs showing positive reports for Coronavirus even after the respiratory tract showed a negative test report. Similarly, other body secretions like saliva, tears, semen, and urine have been reported to have positive test results, while negative reports were obtained in respiratory swabs.

  • Mother-To-Child Transmission - Transmission from mother to the fetus can happen in sporadic cases but is not entirely absent. Delivering the child in negative pressure isolation rooms helps in preventing this kind of transmission. Also, transmission from the mother can happen with breastfeeding.

B) Indirect Transmission:

  • Surface Transmission - Surfaces of the furniture and fixtures may get contaminated with the virus from the infected person. When a healthy individual touches these surfaces and then touches his eyes, nose, or mouth, the virus gets transmitted.

  • Transmission Through Objects Used by the Infected Person - Transmission of the virus can also occur using a thermometer, stethoscope, etc., used by an infected person.

When Is a Person Infectious?

1) Symptomatic Transmission - The transmission mainly occurs from a person who is experiencing symptoms. Preliminary data shows that COVID-19 gets primarily transmitted by symptomatic people through:

  • Close contact with respiratory droplets.

  • Direct contact with an infected person.

  • Contact with contaminated surfaces or objects, as most viruses can live for several hours where they land on.

  • Touching the mouth, nose, or eyes after having contact with an infected person or after touching the infected surfaces.

The person sheds maximum numbers of the COVID-19 virus through the nose and throat when an infected person coughs or sneezes near other people during the early course of the disease (first three days of symptoms).

2) Pre-symptomatic Transmission - During the incubation period, that is the time taken for the virus to cause symptoms. Some infected people can be contagious. This period is also called the pre-symptomatic period. A small number of cases have reported pre-symptomatic transmission.

3) Asymptomatic Transmission - Transmission from a person who exhibits no symptoms even after being infected with the virus is called asymptomatic transmission. There have been a few laboratory-confirmed infected patients who are truly asymptomatic.

Was Coronavirus Engineered in a Lab?

Based on the analysis of the data from the public genome sequence of SARS-CoV-2, researchers did not find any evidence suggesting that the virus was engineered in a lab.

Based on the genome sequence, scientists concluded the following two possible origins of the virus:

  1. The virus evolved through natural selection in a host (non-human) and then spread to humans. This is how both SARS and MERS spread to humans through direct exposure to civets and camels. It was proposed that bats are most likely the reservoir for SARS-CoV-2, as it closely resembles a similar bat coronavirus.

  1. This theory proposes that a non-infectious form of the virus spreads to humans from an animal host. In humans, this virus then evolved to its current infectious state.

What Are the Symptoms Of Corona?

The new coronavirus can affect different people in different ways. It results in respiratory illness that makes people develop mild to moderate symptoms. It may take one day to two weeks (14 days) to show the symptoms. The most common symptoms include:

  • High fever. The body temperature will increase at first to fight the virus.

  • Dry cough.

  • Fatigue (tiredness).

  • Loss of appetite.

  • Phlegm.

The other less common symptoms include:

  • Shivering and Sweating - As the body’s defense mechanism increases the temperature, the efforts to fight the virus may fail, and additional symptoms such as shivering and sweating may arise. This is the time you should begin to isolate yourself and stay at home.

  • Sore throat.

  • Muscle aches and pains.

  • Diarrhea.

  • Nausea or vomiting.

  • Headache.

  • Discoloration of toes or fingers.

  • Skin rashes.

  • Loss of smell or taste.

  • Eye infection (conjunctivitis).

  • Signs of stroke.

  • Face numbness or drooping.

  • Runny nose.

The severe symptoms are:

  • Shortness of breath.

  • Chest pain might develop.

  • Loss of speech.

  • Loss of movement.

  • Hospitalized people showed blood clots in theirlungs and arteries, including their legs.

The virus can lead to pneumonia, liver problems, respiratory failure, septic shock, and death. If you exhibit mild symptoms and are otherwise healthy, then self-isolate yourself and contact a COVID-19 testing center or hospital.

When Do the COVID-19 Symptoms Start to Appear?

After infection with the virus, the symptoms of COVID-19 start to appear within five to six days. While in some cases, it may even take up to 14 days for the symptoms to appear.

When to See a Doctor?

In case you develop the following warning signs or symptoms of COVID-19, get immediate medical attention:

  1. Breathing troubles.

  2. Persistent chest pain or pressure.

  3. Confusion.

  4. Lips and the face turn bluish.

  5. Loss of consciousness or inability to stay awake.

COVID-19 Versus Influenza:

Both COVID-19 and influenza (the flu) result in respiratory illness, but still, there are some differences between the two viruses and the way they spread.

How Are They Similar?

The disease presentation is similar. Such as both viruses:

  1. Cause asymptomatic or mild respiratory symptoms to severe infection and death.

  2. Are transmitted by contact with respiratory droplets.

This is why the same hand hygiene and good respiratory hygiene will help prevent both these infections.

How Are They Different?

The important difference is the speed of transmission. The serial interval (the period between two successive cases) for influenza is three days, and COVID-19 is 5 to 6 days. This means that the flu spreads faster than the new coronavirus. The median incubation period (the period for symptoms to show up after infection) for influenza is also shorter. Also, the common symptoms of COVID-19 and influenza help to differentiate between the diseases. The most common symptoms of COVID-19, such as chest pain and shortness of breath, are unfrequent and do not occur in influenza. Symptoms like diarrhea, fever, headache, and long-haul exhaustion seen in COVID cases are never seen with influenza.

For COVID-19, the reproductive number (the number of infections from one infected individual) is between 2 and 2.5, higher than influenza.

The majority of influenza transmission in the community is from children, whereas the initial data for COVID-19 shows that children are less susceptible than adults. The number of cases islow in the 0 to 19 age group. But with newly emerging variants, even children are known to get affected and transmit COVID-19 to adults.

The percentage of critical cases is more with COVID-19 as compared to the flu. The data shows that 80 % of infections are mild or show no symptoms, 15 % of infections are severe, and 5 % of patients become critical and require ventilation. The mortality rate for COVID-19 (3 to 4 %) is also higher than seasonal influenza (below 0.1 %).

People prone to severe infection for influenza are:

  1. Children.

  2. Pregnant women.

  3. Elderly.

  4. Those with chronic medical conditions or who are immunosuppressed.

Risk group for COVID-19 are:

  1. Older age.

  2. Those with underlying conditions (diabetes, lung disease, cancer, hypertension, etc.).

The World Health Organization (WHO) declared the coronavirus outbreaka pandemic (prevalence of disease all throughout the country or world). The number of patients affected outside China has risen by 13-fold. Many health organizations have declared that Coronavirus is more deadly than flu. After Influenza, this is the biggest pandemic disease reducing the population.

How Is COVID-19 Diagnosed?

There are specific laboratory tests to detect coronavirus. They are swab test, nasal and tracheal aspirate test, sputum test, and hematological tests. In the swab test, a cotton swab is placed inside the nose or throat, and the sample is studied. In the nasal aspiration method, a saline solution is inserted into the nose, and the sample is removed with mild suction. The tracheal aspirate is collected using a bronchoscopy instrument that goes into the lungs. The sputum test collects samples when the sputum is expelled during coughing or sneezing.

Antigen tests and antibody tests are the two tests that help in the diagnosis of COVID-19. The antigen tests help in diagnosing an active infection, while antibody tests diagnose past infections.

Antigen Tests:

The FDA approved the following two antigen tests to diagnose COVID-19:

Molecular Test or PCR Test - Here, polymerase chain reaction (PCR) is used to detect the genetic material of the new coronavirus. The healthcare worker will first collect a sample using a cotton swab from the nasal secretions, throat, or saliva. When carried out correctly, the PCR test is very accurate. The rapid PCR method to detect the virus seems to have some glitches.

Antigen Test - This is a newer test that detects specific proteins of the new coronavirus. This test can produce results in minutes and is less expensive. It is practical to use this test for a larger population. It is highly accurate in detecting antigens in the blood, and there is an increased risk of false negatives. A false negative is when an infected person shows negative antigen test results, which is why this test is not as sensitive as molecular tests. If needed, the doctor will confirm a negative antigen test by conducting a molecular test.

Chest radiography or computed tomography (CT) is used to diagnose the status of the lungs. Thermal scanners are used in many places to determine the increased temperature in humans. However, this will not detect people with infections.

Saliva Test:

Instead of using a deep nasal swab to collect a sample for testing, Andrew Brooks developed a new test that only requires the patient to spit into a cup. According to new research (Yale School of Public Health), saliva samples give more accurate and consistent results. This study also found that saliva testing can show actual results for people with a mild infection, who sometimes test negative with nasal swabs.

The test method used now involves uncomfortable deep nasal swabs, which makes the patient cough or sneeze. This increases the risk of the healthcare provider collecting the sample getting infected. As both swab tests and PPE are limited, the new saliva test can help immensely. The FDA has approved a few home testing kits, where you have to either take a nasal swab or collect your saliva. This sample has to be mailed to the lab. Avoid buying unapproved home tests, as they might give inaccurate results. This method will increase patient access to testing for the new coronavirus.

Antibody Test for COVID-19:

A new test called antibody testing or serology testing is done to detect immunoglobulins in the blood. It is usually done after a person recovers from COVID-19. Here, the antibodies produced by your body against the SARS-CoV-2 are tested in the collected blood sample. These antibodies are produced by your immune system to fight and kill the virus.

A positive antibody test result shows that you most likely were infected with the new coronavirus previously and that you have immunity. But, according to the World Health Organization (WHO), the presence of antibodies does not necessarily mean that you are immune and cannot get reinfected with the virus. Information about the level of immunity and how long it lasts are still not known. This test might not give accurate results if done too early. As it takes time for the immune response to build in the body, the test will only detect antibodies after several days of getting infected.

While plasma (a blood component) of recovered COVID-19 patients was once used in high-risk patients to prevent the severity of the disease, recent studies report a lack of efficacy.

Is the Home Test a Reliable Test to Diagnose COVID-19?

Home tests or self-tests provide quick results and can be done at the convenience of your home. However, they do not provide appropriate results at all times. For reliable results, use authorized test kits approved by the FDA. These self-kits are helpful in diagnosing an active infection, and they can be availed with or without a prescription.

1) Samples Used for Testing:

Nasal swabs are taken from the anterior portion or nasal mid-turbinate position.

Salivary specimens.

2) Performing the Test:

Before doing the test, wash your hands with soap and water.

Then, open the box and collect your nasal or salivary sample as instructed by the manufacturer.

Send the collected sample to a testing facility or follow the manufacturer’s instructions and complete the home test.

Make sure to take the test as per the instructions and collect the sample appropriately else it might produce inaccurate or error results.

3) Test Report:

If you get a positive report, follow the self-isolation guidelines properly and contact your healthcare provider at the earliest opportunity and get yourself treated.

When you have the symptoms and get a negative test report even after following the instructions correctly, it means you do not have an active COVID-19 infection. However, the chances of false-negative results are present with home tests. Also, taking the test too early can produce negative test results. In such cases, do take the subsequent test within two to three days to confirm it. Certain test kits contain more than one kit to

What Is the Mortality Rate?

Till now, 4,366 cases have had mortality. Over 65,972 known cases are recovered. Almost 70% of the cases are showing recovery and it is a good sign.

What Can Be Done to Prevent COVID-19 ?

Coronavirus Prevention

  1. Vaccines have brought about a sigh of relief to slow down the pace of the aggressively spreading Coronavirus. So, get yourself vaccinated with the COVID-19 vaccines that have been approved by the World Health Organization. Follow the local guidance while getting your vaccine. Getting a vaccination is essential for all frontline workers and individuals with pre-existing conditions who are at an increased risk of contracting the disease.
  2. Avoiding physical contact with everyone is a basic measure of prevention. But still, avoiding contact with everyone can be challenging sometimes. In such cases, it would be dignified for a person to give a wave of hand and elbow bump instead of a handshake or hug. An elbow bump is a way of greeting a person informally by touching two people’s elbows. This culture came into practice during the outbreaks of flu.
  3. Use face masks that have more than two layers of washable and breathable fabric to cover your nose and mouth. Make sure the mask completely covers your nose and mouth with a snug fit and without any gaps.
  4. Practice hand hygiene. Washing hands with soap, water, and any other alcoholic rubs is essential. Wipe the wet hands with a clean and dry towel. Soap and water might not be available all the time, so it is best to carry a hand sanitizer with a minimum of 60 % alcohol content in it. Develop the habit of washing hands thoroughly before and after eating food. It is highly essential to clean your hands after using restrooms.
  5. Covering mouth and nose while coughing and sneezing will help. The infected clothes or handkerchief should be disposed properly.
  6. Meat and eggs should be cooked completely.
  7. Disinfect the objects that are constantly used and then wipe the objects properly.
  8. Health care personnel should depend on more protective equipment. The use of facemasks is mandatory for the doctor and nurse who is taking care of the patient.

How to Use Face Masks?

  • Before wearing masks, make sureto wash both the handswith alcohol-based cleansers.

  • If the mouth mask is not used correctly, it can become a source of infection rather than acting asa protecting guard.

  • Hold the metal strip on top of the mask and place it on your nose bridge.

  • Put on the elastics behind the ears or tie the strings. It should cover your nose, mouth, and chin.

  • To remove the mask, remove the elastics securely. Do not touch the front of the mask as there are high chances of contamination.

  • After removing the mask, discard it in a closed bin or wash it thoroughly, disinfect, and dry it under the sun.

  • Never reuse disposable masks.

  • If you accidentally touch the front portion of the mask, wash your hands thoroughly.

  • If the mask becomes humid or wet during usage, replace the mask.

What Are the Common Misconceptions Around Corona?

Myth 1 - Spraying alcohol and chlorine all over the body kills the new coronavirus.

Fact - Applying alcohol or chlorine throughout the body will not kill the virus that has already entered the body. Using such chemicals can be harmful to the skin and clothes.

Myth 2 - Mosquito bites can transmit the new coronavirus.

Fact - Mosquito bites are always annoying, but there has been no evidence that supports thatthey can cause coronavirus.

Myth 3 - Coronavirus only affects older adults.

Fact - Coronavirus does not love people of particular age groups. It can randomly affect everyone. If there is a pre-existing health issue in an individual, then it becomes a risk factor.

Myth 4 - I can get infected through my pet.

Fact - Pets are really fun to play with, but after playing with them, it is mandatory to wash hands with proper handwashing techniques. As of now, there is no evidence that coronavirus can be transmitted from them. But still, we can protect ourselves from other infections.

Myth 5 - Extremely high or low temperatures and standing under the sun will prevent the new coronavirus.

Fact - Boiling water at 100 degrees Celsius can kill germs, but that does not mean remaining in a hot place protects you. Too cold or too hot weather conditions cannot kill the new coronavirus. Similarly, taking a hot water bath cannot kill or remove the virus.

Myth 6 - The coronavirus spreads through toys and goods that are coming from China.

Fact - It is not true as the viruses staying on the surface cannot travel all through the expenditure.

Myth 7 - An infected person has to live with the infection for life.

Fact - Not true at all. You can recover from this infection, and the virus will be eliminated from the body.

Myth 8 - If I hold my breath for 10 seconds or more without any difficulties means that I am free of COVID-19.

Fact - The only sure way to tell that if you are infected is by laboratory tests.

Myth 9 - An ultraviolet disinfection lamp will kill the new coronavirus.

Fact - Never use UV lamps to sterilize your hands or body as it can lead to skin irritation.

Myth 10 - Pneumonia vaccines can help prevent COVID-19.

Fact - As this virus is so new and different, the present vaccines used for pneumonia will not help in preventing COVID-19.

Myth 11 - By wearing gloves, you do not need to wash your hands often.

Fact - Wearing gloves cannot be used as an alternative for washing hands. Wearing gloves only increases the risk of transmission from one surface to another. Also, ineffective removal and disposal of gloves increase the risk of spread.

Myth 12 - Using hand sanitizers often creates antibiotic resistance.

Facts - No. Pathogens do not develop resistance to sanitizers like it develops for other antiseptics and antibiotics.

Myths 13 - Using alcohol-based sanitizer causes skin problems.

Facts - Only a small amount of alcohol is absorbed into the skin. Also, to prevent the occurence of skin dryness, most products contain emollients. Bleaching of skin and contact dermatitis are infrequent side effects of using an alcohol-based sanitizer.

What Is the Impact of COVID-19on the Economy?

There has been a huge challenge for health care workers since the outbreak of COVID-19, and this challenge has increased to greater volumes due to the demand for gloves, masks, goggles, gowns, aprons, face shields, and respirators.

The economic growth had very much reduced because many factories in China shut down. In the northern part of Italy, a major firm that makes automotive parts across European countries had to shut down. As the supply chain got disrupted, it became difficult for the United States and other developing countries to substitute for the loss of supply. Not only factories, but many software and smartphone manufacturing companies also faced a great downfall. Multinational companies that were dependent on Chinese consumers had to totally close down their companies. The economic value had become very uncertain, and the stock market value also decreased. A decline in economic growth had occurred in two ways.

  1. The first reason is that consumers all over the world who had been working in factories and companies, lost their jobs. Because of this poor income, it is difficult for their family to invest in all their demands. The rate at which they purchase new products and eat foods reduced dramatically. Peoplepanic very much about coronavirus, and hadreduced so much of their expenditure. Also, buying new goods was greatly reduced because of the fear of virus exposure.The second one is traveling to different countries for means of business or tourism has become very minimal.. The revenue from air travel has put downward pressure on economic growth.. This is because of the fear of exposure, economic downfall, and prevailing travel restrictions between different nations.

In an effort to revive the economic downfall and with the arrival of vaccines, the Governments all over the world slowly eased their lockdown and travel restrictions.

Economic Advice:

Spreading of the virus through goods and toys made in China is not true. If you feel a particular area is infected with the new coronavirus, it is ideal to wipe it with disinfectant. After cleaning, make sure you wash your hands with soap and water.

Travel Advice:

  • If you have traveled recently to areas that have considerably high cases, it is advised to stay indoors so that you do not infect others. Do not use public transportation as there will be many citizens, so getting and spreading of infection might increase.

  • Travel if it is really important. Before planning for a trip, do make sure to get yourself vaccinated. Avoid unnecessarytravelto highly infected placesuntil the fear of the virus has subsided.

What Is the Treatment?

Approved Medicines for COVID-19:

1) Remdesivir (Veklury)

Remdesivir is an antiviral intravenous (IV) infusion drug. On October 22nd, 2020, for patients above 12 years of age, Remdesivir (Veklury) was approved to treat hospitalized COVID patients, and it is currently the only medicine authorized by the FDA. The approval was based on the conclusion that hospitalized patients who received Remdesivir recovered faster. High doses of intravenous (IV) vitamin C were given to some critically sick patients with COVID-19, hoping that it wouldspeed recovery. It is not a regular part of treatment for this new infection, and there is no clear or reliable scientific proof that it works for COVID-19 infections. Remdesivir is also being investigated in sequence with other medications. A study published that hospitalized COVID-19 patients who received both Remdesivir and Baricitinib (Olumiant) recovered about one day faster than those who only got Remdesivir (7 to 8 days). When using both medications together, patients had a 30% higher chance of clinical recovery at day 15. Patients who got both drugs were also less likely to require ventilation or die on day 29 than those who only got Remdesivir (23% vs. 28%). On November 19th, 2020, the FDA granted a EUA for Baricitinib to be used in sequence with Remdesivir for patients hospitalized with COVID-19 who require extra oxygen or breathing assistance. The NIH currently promotes using Baricitinib with Remdesivir,only if corticosteroids (such as Dexamethasone) cannot be used. At this time, Remdesivir is the only medication approved by the FDA to treat COVID-19 and is not 100% effective, and it can only be used for certain hospitalized patients. Patients who are hospitalized may also receive supportive care (such as oxygen).

Drugs With Emergency Use Authorization (EUA):

FDA can issue an emergency use authorization (EUA) to help people and increase the availability of medications. Having a EUA does not mean that the FDA has approved the medication or product. A new potential treatment is provided by EUA when there are no other options available, as EUA makes it easier for the patients to receive the treatment.

1) Dexamethasone

A randomized clinical trial in the UK is studying to see if Dexamethasone iseffective against COVID-19. Dexamethasone is a corticosteroid (steroid) used to treat various health conditions, such as autoimmune conditions and allergic reactions. Researchers found the death rate lowered in COVID-19 patients who got a daily dose of Dexamethasone orally or through IV compared to patients who did not take the drug.The medication seemed to be helpful for patients who were on a ventilator. The lower death rates were due to the intake of one of the three different corticosteroids such as Dexamethasone, Hydrocortisone, or Methylprednisolone compared to those who took none (32% vs. 40%).

2) Bamlanivimab and Etesevimab

For patients 12 years of age and above, the Bamlanivimab and Etesevimab combination was approved to be used by the FDA on February 9th, 2021.. Clinical data has proposed that the combined usage of these drugs has reduced the disease progression to severe and also has reduced the risk of hospitalization. Patients who were infused with this combination had a low viral load in their bodies on day 11. These results do not seem to occur with Bamlanivimab alone. The death rate and hospitalization were less at day 29 for patients who got both Bamlanivimab and Etesevimab when compared to those who did not.

3) Bamlanivimab (LY-CoV555)

Bamlanivimab blocks the SARS-CoV-2 virus from entering the body and prevents infecting human cells. Patients with COVID-19 who got Bamlanivimab are less prone to infection. The FDA issued a EUA for Bamlanivimab on November 9th, 2020, to treat mild or moderate COVID-19 patients above 12 years of age who are at high risk of hospitalization. Bamlanivimab should not be used for patients who are already hospitalized for COVID-19, and it should be done in an outpatient setting via an intravenous (IV) infusion. The NIH has stopped the study of Bamlanivimab in hospitalized patients due to potential quality control issues.

4) Casirivimab and Imdevimab (REGN-COV2)

REGN-COV2 is called an antibody cocktail as it is made up of two monoclonal antibodies, Casirivimab and Imdevimab. It was reported that REGN-COV2 reduced viral load and relieved symptoms sooner in patients with COVID-19 who were not hospitalized.Patients who have more viruses in the body but do not have their own antibodies are the most benefited.The FDA issued a EUA for Casirivimab and Imdevimab to be used together to treat mild or moderate COVID-19 in patients on November 21st, 2020, who are above 12 years of age and at high risk of hospitalization. They should be given through IV infusion in an outpatient setting.

5) Sotrovimab

It has been approved by FDA for emergency use in adult and pediatric patients of age 12 years with mild to moderate infection and who have the risk of progression to severe infection that might cause hospitalizations and sometimes death.

6) Propofol-Lipuro

Its use has been for emergency use in patients to induce a sedative effect in suspected or confirmed COVID-19 patients above the age of 16 years and under mechanical ventilation.

Treatments That Are Also Being Used, but Are Not Recommended:

1) Hydroxychloroquine and Chloroquine

Hydroxychloroquine and Chloroquine are used to treat malaria and autoimmune conditions like rheumatoid arthritis and lupus for many decades. Initially, a few studies suggested that they may help treat hospitalized patients with mild cases of COVID-19. However, the current general agreement from national health institutions is that Hydroxychloroquine and Chloroquine do not prevent or treat COVID-19. The NIH recommends against their use for COVID-19.

2) Tocilizumab (Actemra) and Other IL-6 Inhibitors

Tocilizumab is an IL-6 inhibitor, and it works by blocking interleukin-6 (IL-6), a protein involved in our natural immune responses. IL-6 is a cytokine that normally alerts other cells to activate the immune system, but too much activation can cause issues. COVID-19 patients can be at risk of cytokine storms as their bodies' immune systems ramp up to fight off the infection. Tocilizumab helps to calm down the immune system by blocking IL-6 and is believed to also help with managing cytokine storms. Tocilizumab did not give any change in the health conditions of COVID-19 patients with early-stage pneumonia. Also, a study found that Tocilizumab did not help hospitalized COVID patients. There was a decrease in the death rate for patients who took Tocilizumab within the first 2 days of going to the ICU. It also does not help patients who need a breathing tube. The National Health Service (NHS) said that Tocilizumab and Sarilumab lowered the risk of death as Kevzara (Sarilumab) works similarly to Tocilizumab, and if given within 24 hours of being in the ICU, it shortens the hospitalizations by up to 10 days. The NIH does not warrant the use of IL-6 inhibitors for ICU patients.

3) Kinase Inhibitors

Kinase inhibitors help with cytokine storms and have antiviral activity. Kinase inhibitors are used for cancer treatments and inflammatory conditions. Researchers found that Kinase inhibitors did not help reduce death rates with Baricitinib (Olumiant), Ruxolitinib (Jakafi), and Tofacitinib (Xeljanz). The NIH did not want to use kinase inhibitors for COVID-19 because they did not fight against the infection.

4) Interferons

Interferons are signaling proteins that tell the body a virus is present. IFN-α and IFN-β have antiviral activity against the SAR-CoV-2 virus. The NIH does not want interferons for COVID-19 as they did not show any benefits against coronavirus.

5) Kaletra (lopinavir/Ritonavir)

Kaletra is a combination of two antiviral drugs Lopinavir and Ritonavir. Patients who have already received the antiviral drugs have a defensive mechanism against SARS and MERS. So the usage of Kaletra in COVID-19 is reduced. Kaletra, in combination with Interferon beta-1b and Ribavirin, reduced the infection in 7 days than those who only got only Kaletra which took 12 days to clear the virus.

6) Ivermectin

Ivermectin is available as an oral medication, lotion, or cream. Ivermectin can stop SARS-CoV-2 from replicating. Studies have been reported with the medical charts of 280 COVID-19 patients hospitalized in Florida between March and May 2020. Patients who were given Ivermectin had a lower death rate. In March 2021, the FDA stated that Ivermectin should not be used to treat COVID-19 as there are risks with using Ivermectin, even for approved uses. The NIH does not recommend using Ivermectin for COVID-19.

7) Convalescent Plasma

For treating patients with COVID-19, the FDA issued an Emergency Investigational New Drug application on March 24th, 2020, for the use of convalescent plasma. Convalescent plasma from people who recovered from COVID-19 is collected as it can help fight the coronavirus infection. Then it is transfused into someone with an active coronavirus infection. The death rate was lower for patients who got convalescent plasma within 3 days of diagnosis and with higher antibody levels. The emergency use authorization is no longer available for the low-titers convalescent plasma therapy since April 21, 2021.

Nobody should take any of these drugs as a way to prevent or treat this infection, unless prescribed by a registered doctor. It can cause serious damage to your body and can also be potentially fatal.

Are There Vaccines Against COVID-19?

Approved Vaccines For COVID-19:

1. Moderna (National Institutes of Health)

In March 2020, a two-dose mRNA vaccine (mRNA-1273) was started testing, and on April 30, 2020, it was approved for emergency use by the WHO. This vaccination is given in 2 doses at a period of 28 days. Typical side effects were noted during the clinical trials, which were mild, and these kinds of effects were noted in the first seven days after vaccination. Emergency use authorization has been granted for the Moderna vaccine in India since June 2021.

2. BioNTech, Pfizer, and Fosun Pharma

The pharmaceutical company Pfizer, in collaboration with BioNTech (a German biotech company) and Fosun Pharma, produced a two-dose mRNA vaccine (Tozinameran or BNT162b2). The vaccine was 90 % effective after administering it to adults on 9th November 2020. The FDA then reported that the Pfizer vaccine gave some protection after the first dose and almost full protection after the second dose on 8th December 2020, and on 11th December 2020, this vaccine was given EUA by the FDA. Reports have shown an allergic reaction in a healthcare worker. The vaccine is recommended in people who are over 16 years of age. Subsequently, it was approved for use in the 12 to 15-year age group and for emergency use in the pediatric population in the 5 to 11-year age group.

3.Gamaleya Research Institute

It is a Russian institute, which developed a vaccine (Sputnik V or Gam-COVID-Vac) that has two ingredients, a recombinant adenovirus type (rAd26) and type 5 (rAd5) vectors. The vaccine received a "conditional registration certificate" in August 2020. The clinical trial in Russiainvolved 40,000 volunteers. In the UAE, India, Venezuela, and Belarus, clinical trials wereannounced. The vaccine showed an immune response with mild side effects on phase I and II trials. After the phase III clinical trial, the Sputnik V vaccinewas91.4 % efficient against mild cases, and its vaccine efficacy against severe cases of Coronavirus is 100 %. Data and Safety Monitoring Board (DSMB) recommended a shift to phase III from phase II after assuring the safety standards.. Although not approved by the WHO, Sputnik V has been approved for usage in India after a nod from the Central Drugs Standard Control Organization of India and is being manufactured by Dr.Reddy’s laboratories. Sputnik V depends on the virus's genetic instructions for developing the spike protein. Sputnik V uses double-stranded DNA, unlike the Pfizer-BioNTech and Moderna vaccines, which build the instructions in a single-stranded RNA.

4. AstraZeneca and the University of Oxford (Covishield in India)

AstraZeneca and the University of Oxford announced the development of a recombinant adenovirus vaccine (AZD1222) in April 2020. It was based on a chimpanzee adenovirus that takes coronavirus proteins in the body. In August 2020, phase III clinical trials began in Brazil, the U.S., and South Africa. When a volunteer developed transverse myelitis (a spinal inflammatory disorder), the study was halted in September 2020. A week later, the trials restarted in the U.K. and Brazil, and the FDA authorized the U.S. trial to resume in October 2020. In November 2020, the vaccine produced a strong immune response in a clinical trial involving participants over 70 years of age. But, the data released on 8th December 2020 showed that the vaccine was only 70 % effective. The efficiency was identified to be around 62% when administered in two separate and full doses. An increase in efficiency was achieved up to 90% when the vaccine was given a half dose followed by a full dose. Leaving a more extended gap between the first and second doses improves the jab's overall effectiveness (it was seen in a sub-group who were given the vaccine this way), and it was observed to be 70 % effective after the first dose.

5. Bharat Biotech, Indian National Institute of Virology, and Indian Council of Medical Research

In October 2020, the inactivated virus vaccine (BBV152 or Covaxin) produced by the Indian company Bharat Biotech in collaboration with the Indian National Institute of Virology, began the phase III trial. The report on Phase I trials showed the vaccine to be safe and produce antibodies against SARS-CoV-2. In phase III trials, more than 26,000 participants were involved, and now Covaxin wasdeclared the first official vaccine in India. This whole virion-inactivated COVID-19 vaccine candidate confirmed a temporary vaccine efficiency of 81% in its Phase 3 clinical trial. The trials comprised 25,800 subjects, the largest ever conducted in India, in conjunction with the Indian Council of Medical Research. Also, WHO had issued the emergency use listing for Covaxin on November 3, 2021.

6.Sinovac Biotech

An inactivated SARS-CoV-2 vaccine (CoronaVac) was developed by a Chinese company. The phase III trials began in Brazil, Indonesia, and Turkey. The vaccine was granted emergency approval by the Chinese government for use on individuals at high risk of developing severe COVID-19 infection. The United Arab Emirates, which supported the Sinopharm vaccine earlier, said that the vaccine was 86 % effective, according to interim results of its stage three trial. A clinical phase III trial conducted in Brazil after 14 days of getting the vaccine suggested that the vaccine is 51 % effective for symptomatic infection and 100 % effective against severe infections and those which require hospitalization. Sinovac said that the COVID-19 vaccine is safe in children between the ages of 3 to 17.

7. Wuhan Institute of Biological Products and Sinopharm

An inactivated virus vaccine BBIBP-CorV, is being tested by the Chinese company Sinopharm and developed by the Wuhan Institute of Biological Products. As the phase I clinical trial showed positive results, phase III trials began first in UAE and then in Morocco and Peru, which showed an efficacy of 86 %. Bahrain and UAE have already approved the vaccine for use.

8. Johnson & Johnson

In February 2021, the U.S. Food and Drug Administration announced an emergency use authorization (EUA) for the third vaccine for the restriction of coronavirus disease 2019 (COVID-19) induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The EUA supports the Janssen COVID-19 Vaccine to be administered (single-shot) in the U.S. for use in people who are above 18 years of age. Thailand also cleared Johnson & Johnson's single-shot COVID-19 vaccine for local emergency use, the third manufacturer to win the approval. This vaccine was found to be 66.3 % effective in the clinical trials and has been very effective after two weeks of vaccination. Emergency use authorization was granted for this vaccine in India on August 2021, but still, it has not started its administration.

What Are the Approved COVID-19 Vaccines in Children?

1. Pfizer-BioNTech:

In children between the ages of 12 and 17 years, the vaccine is given in two doses at a period of three weeks. The dosage of the vaccine is 30 micrograms. In the case of children between 5 to 11 years, 10 micrograms of the vaccine are given in two doses three weeks apart.

2. Covaxin of Bharat Biotech:

Emergency use of the Covaxin vaccine is approved in India for children aged between 2 to 18 years.

3. Moderna Vaccine:

This mRNA vaccine is approved by Canada to be used in children between 12 to 17 years of age, and it is to be given in two doses at an interval of one month.

4. ZyCOV-D:

It is a selective needleless DNA vaccine that has been approved for usage in susceptible children above the age of 12 years. It was granted emergency use authorization in India from August 2021.

What Is Home Quarantine?

In a health care center, the term quarantine refers to a duration of time when a person is isolated from other people in order to avoid the spreading of a particular disease. In home quarantine, all the individuals are ordered to stay at home by their respective nations to prevent the spreading of disease.

Home quarantine also includes a person whoisnot affected. This is done to prevent excessive transmission in the community. In a non-clinical setup, home quarantine also includes isolation of someone who is suspected to be infected (might be with COVID-19). It extends for a period of 14 days.

What Are the Safety Measures to Be Followed at Home?

  • Maintain a distance of one meter from family members.

  • If any member of family returned from travel, it is important to allocate a specific separate room for them. This will include separate bathrooms and restrooms. They should wear a mask all the time. Provide separate soap, towels, utensils, drinking glasses and bedding for the suspected person. Only the assigned member should look after the affected individual. They should check the temperature of an isolated person regularly. If he develops any symptoms, then report immediately to the hospital.

  • Stay in well-ventilated rooms.

  • Kids, the elderly, and pregnant women should stay totally away from the affected people.

  • In places where sanitation facilities are not available, use alcohol-based sanitizers for a duration of 20 seconds.

  • At home, use soap and water to wash your hands regularly.

  • Avoid touching eyes, nose, and mouth without washinghands.

  • Use the non-dominant hand. If a person is a right-hander, use the left hand for opening doors, transportation, and bathrooms. This practice will prevent the individuals from touching their face, as they tend to touch nose and mouth with dominant hand. If someone is a left-hander, then use right hand.

  • Use disposable gloves and masks only.

Frequently Asked Questions

1.

Can I Possibly Get Covid-19?

The outbreak of COVID-19 is increasing and many regions are in danger zones. Avoiding travel to these regions can help you. Avoid social gatherings and crowded places. Also, there is no proper finding that younger or older people can get it. So mothers of babies do not have to worry about it.

2.

Should I Consider Covid-19 Seriously?

The first thing to do for any outbreak of disease is to stay calm. Creating too much panic and obsession with a disease is not good for your mental health. Since it has caused the death of a huge number, it is common for a person to develop fear. Just a thorough hand-washing with proper soap or scrubs can do the needful.

3.

Is There Any Vaccine for Coronavirus?

Till now, there is no particular vaccine for COVID-19. However, those showing symptoms should be admitted to the hospital and should be given proper care.

4.

What Is the Incubation Period for Covid-19?

The incubation period is the time for which the symptoms take to arise. It takes around one day to two weeks.

5.

Is Receiving a Package From the Affected Area Safe?

You can very well send and receive parcels. The possibility of a virus being contaminated over the area is very less. Also, the virus cannot be proved to stay for a long period of time in the same place. The contamination through goods traveling from such long distances may not be true.

6.

What Are the Things I Should Follow?

Avoid smoking. Wearing multiple masks will increase the risk of infection. Taking antibiotic medication is not going to act against this viral disease. Washing hands regularly is a must-do thing.

7.

What Is the Source of Coronavirus?

Bats are known to be the main source of these viruses. Many species of animals are known to be the cause of COVID-19. The virus -Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is known to get transmitted from animals living in desert-like camels, and the Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1) is known to get transmitted from civet cats.

8.

Are Children More Affected by Covid-19?

A large study was conducted in China for children under 18 years of age. Only 2% of them were affected. So, it might be that younger people are not easily affected. People who are already having Pneumonia or any other health condition are known to be affected more.

9.

Does the Influenza Vaccine Protect Against Covid-19?

Influenza and Coronavirus are two different viruses. The seasonal influenza vaccine is not known to protect against COVID-19.

10.

Will A Vaccine for Coronavirus Be Available?

Many pharmaceutical companies are doing a wide range of research to find a solution for the novel Coronavirus. This may take up to a month’s time as it has to go for extensive research and testing for it to be fully beneficial and safe.

11.

What Should I Do If I Recently Returned From Travel?

Travelers should avoid contacting healthy people after the return. Initially, they have to keep an eye on their health status for 14 days. If they notice any symptoms, they should call a doctor online or through telephone. If the symptoms get severe, it is vital for the patient to visit the hospital and take the respective health protocols.

12.

Can Vitamin D Reduce the Risk of Getting COVID-19?

Some research shows that healthy levels of vitamin D and taking vitamin D supplements keep the immune system healthy and protect against various respiratory illnesses. Vitamin D is needed for the proper functioning of the immune system, and it protects the body against microorganisms. This vitamin is so essential that its deficiency increases the risk of respiratory illnesses such as asthma, tuberculosis, COPD, etc.

Based on this, vitamin D might even protect us from COVID-19, but there is no evidence to support this claim. However, as various studies have linked healthy levels of vitamin D in protecting against viral and bacterial respiratory infections, it is best to get your vitamin D levels tested and start vitamin D supplements.
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Dr. Anshul Varshney
Dr. Anshul Varshney

Internal Medicine

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