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COVID-19 Pandemic

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This transmission electron microscope image shows SARS-CoV-2—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S. Virus particles are shown emerging from the surface of cells cultured in the lab. The spikes on the outer edge of the virus particles give coronaviruses their name, crown-like.

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. It has since spread worldwide, leading to an ongoing pandemic.

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Around one in five infected individuals do not develop any symptoms.[1] While most people have mild symptoms, some people develop acute respiratory distress syndrome (ARDS). ARDS can be precipitated by cytokine storms,[2] multi-organ failure, septic shock, and blood clots. Longer-term damage to organs (in particular, the lungs and heart) has been observed. There is concern about a significant number of patients who have recovered from the acute phase of the disease but continue to experience a range of effects—known as long COVID—for months afterwards. These effects include severe fatigue, memory loss and other cognitive issues, low-grade fever, muscle weakness, and breathlessness.[3][4][5][6]

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person.[10][11] Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission.[11] The exact route of transmission is rarely proven conclusively,[12] but infection mainly happens when people are near each other for long enough. It can spread as early as two days before infected persons show symptoms, and from individuals who never experience symptoms. People remain infectious for up to ten days in moderate cases, and two weeks in severe cases. Various testing methods have been developed to diagnose the disease. The standard diagnosis method is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and various countries have initiated mass vaccination campaigns.

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

Treatments

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Remdesivir
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As of late October, 2020, remdesivir was the only drug in the United States approved by the FDA with a specific indication to treat COVID-19.[13][14][15]

In November 2020, the World Health Organization (WHO) made a conditional recommendation against treatment with remdesivir for hospitalized patients, regardless of severity (based on data from the Solidarity Trial).[16]

Immunotherapy
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In January 2021 in the United Kingdom, the National Health Service issued guidance that the immune modulating drugs tocilizumab and sarilumab were beneficial when given promptly to people with COVID-19 admitted to intensive care, following research which found a reduction in the risk of death by 24%.[17]

Baricitinib
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In November 2020, the FDA granted Emergency use authorization (EUA)[b] for the drug baricitinib to be given to certain people hospitalised with suspected or confirmed COVID-19, but only in conjunction with remdesivir.[18] In a single clinical trial, this combination therapy was shown to have a small, but statistically significant effect on patient outcomes compared to administration of remdesivir alone.[19] Use of baricitinib was restricted to adults and children two years of age or older requiring supplemental oxygen, mechanical ventilation, or ECMO.[18]

Dexamethasone
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In September 2020, the European Medicines Agency (EMA) endorsed the use of dexamethasone in adults and adolescents (from twelve years of age and weighing at least 40 kg) who require supplemental oxygen therapy.[20]

Pfizer Vaccine
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The Pfizer BioTech COVID-19 Vaccine is used or the prevention of 2019 coronavirus disease (COVID-19) for individuals 16 years of age and older. The most commonly reported side effects, which typically lasted several days, were pain at the injection site, tiredness, headache, muscle pain, chills, joint pain, and fever. Of note, more people experienced these side effects after the second dose than after the first dose, so it is important for vaccination providers and recipients to expect that there may be some side effects after either dose, but even more so after the second dose. [21] The vaccine is shot in the muscle of the upper left arm, and is taken in two doses, 21 days apart. The FDA approved the vaccine on December 11, 2020.[21]

Moderna Vaccine
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mRNA-1273, more commonly known as the Moderna COVID-19 vaccine, is a COVID-19 vaccine developed by the National Institute of Allergy and Infectious Diseases (NIAID), the Biomedical Advanced Research and Development Authority (BARDA), and Moderna. It is administered by two 0.5 mL doses given by intramuscular injection given four weeks apart.

On 18 December 2020, mRNA-1273 was issued an Emergency Use Authorization by the United States Food and Drug Administration (FDA). It was authorized for use in Canada on 23 December 2020, in the European Union on 6 January 2021, and in the United Kingdom on 8 January 2021.

Johnson and Johnson vaccine
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The Johnson & Johnson COVID-19 vaccine is a human adenovirus viral vector COVID-19 vaccine developed by Janssen Pharmaceuticals, a subsidiary of American company Johnson & Johnson (J&J).[22]

AstraZeneca Vaccine
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The Oxford–AstraZeneca COVID-19 vaccine, codenamed AZD1222 and marketed as Covishield in India, is a COVID-19 vaccine developed by Oxford University and AstraZeneca given by intramuscular injection, using as a vector the modified chimpanzee adenovirus ChAdOx1. One dosing regimen showed 90% efficacy when a half-dose was followed by a full-dose after at least one month, based on mixed trials with no participants over 55 years old. Another dosing regimen showed 62% efficacy when given as two full doses separated by at least one month.

  1. ^ "Transmission of COVID-19". European Centre for Disease Prevention and Control. Retrieved 2020-12-06.
  2. ^ Ye Q, Wang B, Mao J (June 2020). "The pathogenesis and treatment of the 'Cytokine Storm' in COVID-19". The Journal of Infection. 80 (6): 607–613. doi:10.1016/j.jinf.2020.03.037. PMC 7194613. PMID 32283152.
  3. ^ Yelin D, Wirtheim E, Vetter P, Kalil AC, Bruchfeld J, Runold M, et al. (September 2020). "Long-term consequences of COVID-19: research needs". The Lancet. Infectious Diseases. 20 (10): 1115–1117. doi:10.1016/S1473-3099(20)30701-5. PMC 7462626. PMID 32888409.
  4. ^ "What are the long-term symptoms of COVID-19?". HMRI. 4 August 2020. Retrieved 8 September 2020.
  5. ^ "COVID-19 (coronavirus): Long-term effects". Mayo Clinic. 18 August 2020. Retrieved 8 September 2020.
  6. ^ "What are the long-term health risks following COVID-19?". NewsGP. Royal Australian College of General Practitioners (RACGP). 24 June 2020. Retrieved 8 September 2020.
  7. ^ "Coronavirus Disease 2019 (COVID-19)". U.S. Centers for Disease Control and Prevention (CDC). Retrieved 22 October 2020.
  8. ^ "Quarantine for coronavirus (COVID-19)". Australian Government Department of Health. Retrieved 25 September 2020.
  9. ^ "How COVID-19 Spreads". U.S. Centers for Disease Control and Prevention (CDC). 18 September 2020. Archived from the original on 19 September 2020. Retrieved 20 September 2020.
  10. ^ "Coronavirus disease (COVID-19): How is it transmitted?". World Health Organization (WHO). Retrieved 2020-12-06.
  11. ^ a b "Coronavirus Disease 2019 (COVID-19)". U.S. Centers for Disease Control and Prevention (CDC). 2020-02-11. Retrieved 2020-12-06.
  12. ^ "Transmission of SARS-CoV-2: implications for infection prevention precautions". World Health Organization (WHO).
  13. ^ "FDA Approves First Treatment for COVID-19" (Press release). 22 Oct 2020. Retrieved 11 Dec 2020.
  14. ^ Li G, De Clercq E (March 2020). "Therapeutic options for the 2019 novel coronavirus (2019-nCoV)". Nature Reviews. Drug Discovery. 19 (3): 149–150. doi:10.1038/d41573-020-00016-0. PMID 32127666.
  15. ^ Veklury: Summary Review (PDF). U.S. Food and Drug Administration (FDA) (Report). Retrieved 22 October 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  16. ^ "Therapeutics and COVID-19: living guideline". WHO. 20 Nov 2020. Retrieved 11 Dec 2020.
  17. ^ "Arthritis drugs effective in improving survival in sickest COVID-19 patients". National Institute of Health Research. 7 January 2021.
  18. ^ a b "Coronavirus (COVID-19) Update: FDA Authorizes Drug Combination for Treatment of COVID-19" (Press release). FDA. 19 November 2020. Retrieved 4 December 2020.
  19. ^ "Fact Sheet for Healthcare Providers Emergency Use Authorization (EUA) of Baricitinib" (PDF). Indianapolis: Ely Lilly and Company. 19 November 2020. Retrieved 4 December 2020.
  20. ^ "EMA endorses use of dexamethasone in COVID-19 patients on oxygen or mechanical ventilation". European Medicines Agency (EMA) (Press release). 18 September 2020. Retrieved 21 September 2020. Text was copied from this source which is European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  21. ^ a b https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/pfizer-biontech-covid-19-vaccine
  22. ^ Saltzman J (12 March 2020). "Beth Israel is working with Johnson & Johnson on a coronavirus vaccine". The Boston Globe.


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