Panorama of Coronavirus Infection (COVID-19)

What are the symptoms of corona?

Fever

Cold

Cough

Sore throat

Breathing difficulty

Headache

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. Your 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 lungs and arteries, including in 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 to See a Doctor?

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

• Breathing troubles.
• Persistent chest pain or pressure.
• Confusion.
• Lips and the face turn bluish.
• Loss of consciousness or inability to stay awake.

COVID-19 Vs. Influenza:

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

How Are They Similar?

The disease presentation is similar. Such as both viruses:

• Cause asymptomatic or mild respiratory symptoms to severe infection and death.
• 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 that of 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 disease. The most common symptoms of COVID-19, such as chest pain and shortness of breath, are very rare and do not occur in influenza, and 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, which is higher than for influenza.

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 are low in the 0-19 age group. Further studies in China also suggest that adults infect children, rather than the opposite.

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 are critical and require ventilation. The mortality rate for COVID-19 (3 to 4 %) is also higher than seasonal influenza (below 0.1 %).

People that are more prone for severe infection for influenza are:

• Children
• Pregnant women.
• Elderly.
• Those with chronic medical conditions or who are immunosuppressed.

And that for COVID-19 are:

• Older age.
• Those with underlying conditions (diabetes, lung disease, cancer, hypertension, etc.).

Has the outbreak of corona become pandemic?

The World Health Organization declared the Coronavirus (COVID-19) 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 (COVID-19) is more deadly than flu. After Influenza this is the biggest pandemic disease reducing the population.

How Many Cases Are Confirmed?

How Can We diagnose?

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 studied. In nasal aspiration method, a saline solution is inserted into the nose and the sample is removed with mild suction. Tracheal aspirate is collected using a bronchoscopy instrument that goes into the lungs. Sputum test collects samples when the sputum is expelled during coughing or sneezing.

The FDA approved the following two 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 - A newer test that detects specific proteins of the new coronavirus. This test can produce results in minutes and are 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 negative. 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) to diagnose the status of lungs. Thermal scanners are used in many places to determine the increased temperature in humans. However, this will not detect people with infection.

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.

Recently, plasma (a blood component) of recovered COVID-19 patients is being used to treat critically ill COVID-19 patients. Antibodies present in the plasma are believed to boost the virus-fighting ability of the patient. Antibody testing is being done now to check if recovered COVID-19 patients are eligible to donate plasma.

What can we do for prevention?

• 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. Elbow bump is a way of greeting a person informally by touching two people’s elbow. This culture came into practice during the outbreaks of flu.
• One can use a face mask. But, if you do not have the symptoms of the coronavirus, then it is not advisable to use face masks as they attract more polluted substances.
• Practice hand hygiene. Washing hands with soap, water, and any other alcoholic rubs are 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.
  
• Covering mouth and nose while coughing and sneezing will help. The infected clothes or handkerchief should be disposed properly.
• Meat and eggs should be cooked completely.
• Disinfect the objects that are constantly used and then wipe the objects properly.
• 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?

• If you have to take care of the infected person, it is wise to wear a face mask. Before wearing it, make sure you wash your hands with alcohol based cleansers.
• If the mouth mask is not used correctly, it can become a source of infection rather than a 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.
• Never reuse these 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?

There has been a huge challenge for health care workers 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 has very much reduced because many factories in China are shutting 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 gets disrupted, it has been a difficult situation 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 are also facing great downfall. Multinational companies that were dependent on Chinese consumers had to totally close down their company. The economic value has become very uncertain and the stock market value has decreased. A decline in economic growth has occurred in two ways.

• The first reason is that consumers all over the world, especially consumers from China and the United States 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 have reduced dramatically. They fear that buying new goods will increase their exposure to the virus.
• The second one is that travel to China and the United States have become very minimal. Many Chinese passengers are not traveling to the United States for business purposes. Tickets to China were canceled on a mass level during the virus outbreak. The revenue from air travel has put downward pressure on economic growth. Americans panic very much about Coronavirus (COVID-19) and they have reduced so much of their expenditure.

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.

• If you have traveled recently from China, Iran, South Korea or Italy in the past two weeks, it is advised to stay indoors so that you do not infect others. Do not use public transportation as there will be many citizens and so the chances of getting and spreading of infection might increase.
• Travel if it is really important. Avoid traveling for adventures until the fear of the virus has subsided.

What Is the Treatment?

Approved Medicines for COVID-19

• 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 conclusions 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 will speed 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, 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.

• Dexamethasone - A randomized clinical trial in the UK is studying to see if Dexamethasone are effective against COVID-19. Dexamethasone is a corticosteroid (steroid) that are 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 when 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 when compared to those who took none (32% vs. 40%).
• 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.
• 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. Research is still going on if it can be used in combination for treatments. 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.
• 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.
• 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.

Treatments That Are Also Being Used, but Are Not Recommended

• 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.
• 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 the 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.
• 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.
• 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.
• 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.
• 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.
  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

• Moderna (National Institutes of Health) - In March 2020, a two-dose mRNA vaccine (mRNA-1273) was started testing. 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.
• 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 the 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.
• 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 ongoing clinical trial in Russia involves 40,000 volunteers. In the UAE, India, Venezuela, and Belarus, clinical trials have been announced. The vaccine showed an immune response with mild side effects on phase I and II trials. The Sputnik V vaccine is 91.4 % efficient with mild side effects, 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. Phase III approval for conducting trials in India was approved recently. 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.
• 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.
• 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 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 has been declared 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.
• 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 this month, said that the vaccine was 86% effective, according to interim results of its stage three trial. Sinovac said that the COVID-19 vaccine is safe in children between the ages of 3 to 17.
• 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.
• 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.

Treatments That Are Also Being Used, but Are Not Recommended

• 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.
• 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 the 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.
• 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.
• 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.
• 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.
• 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.
  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.

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 who are not 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 your family members.
• If any member of your 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, 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 your eyes, nose, and mouth without washing your hands.
• Use your non-dominant hand. If you are a right-hander, use your left hand for opening doors, transportation, and bathrooms. This practice will prevent yourselves from touching your face, as you tend to touch your nose and mouth with your dominant hand. If you are a left-hander, then use your right hand.
• Use disposable gloves and masks only. Do not re-use it.

• Educate the kids about Coronavirus, its causes, and symptoms in a way they better understand.
• Monitor the activities of kids.
• Ask them to follow proper sanitation methods and emphasize on regular handwashing with soap and water. Avoid giving alcohol-based sanitizers to children
• Do not allow them to play with the neighboring kids. Teach them about the importance of social distancing.
• Engage the kids to involve in indoor games.
• Help them bathe twice.
• Avoid touching your eyes, nose, and mouth without washing your hands.
• Isolate the pet animals at home and do not allow the children the play with them
• Parents should make sure the children are eating only fresh foods.
• Do not allow the children to go to dusty places.

How Important Is Social Distancing?

• When there is an outbreak, and it is known to spread through direct contact with others, it is a wise decision to maintain a distance from others. This practice will reduce physical contact with others.
• Shaking hands should be avoided completely.
• Use the alternative method to greet people.
• Avoid social gatherings, functions, movie theatres, malls, restaurants, religious places, and marriages.

All fabrics can be contaminated by respiratory droplets that may contain the coronavirus. Scientists say that the droplets will dry over time, and the virus might become inactive, but all this depends on the humidity and temperature.

Preliminary information about the COVID-19 virus suggests that it can survive on someone's dress or skin for a few hours to many days. So, make sure you wash and disinfect your hands and clothes properly.

The spread of other strains of coronaviruses did wane during summer, as people are more exposed to sun rays, which can kill viruses. But, according to the CDC, it is still not known whether the spread of COVID-19 will be affected by hot temperatures. Investigations are on to learn more about this virus.

WHO recommends machine washing patient's dress, bedsheets, and all the linens used by him or her with warm water (60 to 90° C) with laundry detergent. The clothes should then be dried under sunlight.

If washing machines are not available, then clothes have to be soaked in hot water and soap and use a stick to stir the clothes in water and avoid splashing. Then the clothes should be soaked in 0.05 % chlorine for around 30 minutes. After which the linens should be properly rinsed and then dried under sunlight.

It is still not clear whether the new Coronavirus (COVID-19) spreads through eating food touched or contaminated by an infected person. The virus has been detected in the stool of some infected people, so currently, the possibility of the infection being transmitted through infected food cannot be ruled out. So, it is better to discard the food than to risk it.

The virus will most likely be killed during cooking, which is not true for raw fruits and salads.

We do not know the exact temperature at which the virus dies, so reheating it would not be the best idea.

UV-C ultraviolet light is being used to disinfect hospital equipment, walls, floors, currency, and mobile phones, as the other strains of coronaviruses have shown to be sensitive. But it is still not certain if UV lights can kill the novel coronavirus. Avoid using UV light to disinfect your skin, as it can irritate it.

According to the company, Dettol has been effective against other strains of coronaviruses. As COVID-19 is structurally similar to these strains, they expect it to be 99.99 % effective also. But only after health authorities release the new strain will Dettol test its efficacy. 1:2 diluted mixture of Dettol can be used as a sanitizer and disinfectant.

Salt or saltwater might not disinfect fruits and vegetables, but it will help remove 75 to 80 % pesticide residues.

According to the CDC, a person infected with the new Coronavirus (COVID-19) is most contagious when he or she shows the most symptoms (symptomatic). But, there have been reports of the virus spreading from infected people even before they start showing signs.