Mankind hasn’t faced such a large-scale epidemic recently. For some people, it’s about fear of the uncertainty and the risk of death, whereas for others, it’s just another conspiracy theory. The truth is that, if asked “what is coronavirus?” not many can answer precisely at this moment.
One thing that we know for sure is that this outbreak is a test of solidarity. We have to act together scientifically, politically, financially, and medically to end this infection that does not respect borders or restrictions.
Research is an essential part of the fight against this common enemy. For this reason, here, we bring to the forefront the latest scientific facts on the natural history of the virus, coronavirus transmission, and diagnosis; epidemiological studies; clinical picture, infection prevention and control, research and development on candidate therapeutics and vaccines; and integration of social sciences into the outbreak response.
- Diseases can make anyone sick, regardless of their race or ethnicity.
- Coronavirus primarily binds to the receptors found in the lungs and small intestine.
- One person can infect 2-3 people.
- Experts project that around 40 to 70% of people worldwide will be infected with the virus within the current year.
- Two months after the outbreak started, 87% of the infected people were recovered or discharged, while the remaining 13% resulted in death.
- China, Italy, Spain, and South Korea were the first countries to lead in numbers of infected cases.
- After these countries, the USA, Germany, Spain, Switzerland, and Iran quickly rose in the number of new cases.
- It took CoVid-19 three months to infect more than a million people worldwide.
- The virus is more quickly spread through aerosolized droplets that saturate the air in places of high disease prevalence.
- The available data suggests that the recent outbreak with nCoV-19 has emerged from an animal reservoir.
- How will coronavirus infection evolve depends on the person’s immune response.
- In older people with chronic diseases such as diabetes, cardiovascular disease, respiratory issues, cancer, and more, the immune system may not be able to cope with the virus.
- Mortality is highest in people over 80 (14.8%).
- The timeline for a vaccine development can be compressed, but it still takes at least 12 months to create a compelling and safe vaccine.
- Someone who has completed quarantine or has been released from isolation does not pose a risk of infection to other people.
- Even with ideal restriction and quarantine measures, the spread of the virus may have been inevitable.
Coronaviruses belong to a large family of viruses responsible for diseases ranging from mild to more severe, such as:
- Middle Eastern Respiratory Syndrome (MERS-CoV), and
- Severe Acute Respiratory Syndrome (SARS-CoV).
The new coronavirus (nCoV-19) has emerged in China and has not been observed in humans until now.
And what’s even more intriguing, the experts believe that the already identified coronaviruses might only be the tip of the iceberg. This means that more novel and potentially severe zoonotic diseases are expected to be revealed in the future.
Corona viruses are zoonoses, which means they are transmitted from animals to humans. However, several known corona family members circulate only in animals.
Coronaviridae family is composed of single-strand RNA viruses, with genomes ranging from 26 to 32 kilobases in length. These viruses can infect several avian hosts and mammals, including bats, mice, dogs, and cats.
Due to the high rate of mutations and recombination events, their virulence can improve over time. This diversity leads to better replication in human cells and a greater capacity to cause disease.
Furthermore, the first cases of laboratory-confirmed nCoV-19 disease (COVID-19) defined the primary pathogenetic mechanism of the virus – pneumonia and acute respiratory distress syndrome (ARDS) that require intensive care treatment.
NCoV-19 binds to the receptor protein called ACE2, common also for the other SARS coronaviruses. This receptor is found in the human epithelia of the lung and small intestine, which explains the leading symptoms of the disease. It also reveals the pathogenesis and treatment options for the disease COVID-19.
The genetic analysis indicates that nCoV-19 shares nucleotide sequences with SARS-CoV (94.4%), the two bat-derived SARS-like coronaviruses (88%), SARS-CoV (79%) and MERS-CoV (50%).
There are four nCoV-19 types such as human coronavirus nl63, human coronavirus 229e, human coronavirus oc43, and human coronavirus hku1, which may differ slightly in their clinical picture and the target group of patients.
Since February 28th, more than 350 genome sequences of CoVid-19 virus have been determined and publicly disclosed.
In general, the virus genome detected in China resembles those currently studied in Europe.
According to a recent study, genome sequences between the 29 strains detected in China, were in 99.9% similar to those found in Japan, USA, and Finland.
So far, the scientists determined that the virus has natural origin, and retains its evolutionary reproduction paths. In other words, it has not been chemically altered in any way. However, the coronavirus species is proven to be susceptible to human-related mutations.
So far, Spanish scientists detected nine mutations of the virus, while the ones in Brazil found sixteen differing genome variables.
At the end of 2019, The World Health Organization (WHO) identified the zoonotic coronavirus, tentatively labeled as 2019-nCoV, as the causative agent of the viral pneumonia outbreak in Wuhan, China. It is not yet known whether temperature changes during seasonal transitions may affect the spread of the virus, like they do for other infections, such as influenza.
However, the infection continues to spread. One hundred million people have been restricted to the area around Wuhan, but the infection has spread to other countries.
Despite the apparent ineffectiveness of the measures to stop this human SARS coronavirus from spreading, or at least to prevent the social and economic damage, repression continues to escalate.
Under the political pressure to “shut down” the virus, the Chinese government announced that employees in Hubei Province would go door to door, test people for fever, look for other symptoms of virus presence, and then send all potential quarantine cases to be tested for the virus.
But even with ideal restriction and quarantine measures, the spread of the virus may have been inevitable.
Testing people who are already extremely ill is not a good strategy, given that those who feel well and do not show any coronavirus disease symptoms can spread the virus.
Italy, Iran, and South Korea are already among the countries reporting the rapidly increasing number of confirmed COVID-19 infections. These countries are also attempting to implement the repression measures that have been proven ineffective. After all, dealing with a pandemic will require opening borders, not closing them.
Experts’ pessimistic projections include the possibility that around 40 to 70% of people worldwide will be infected with the virus within the next year. But this does not mean that everyone will suffer serious illnesses.
In most people, mild or asymptomatic reactions will occur. As with influenza, which is often life-threatening for people with chronic illnesses, immunodeficiencies, and in the elderly, most cases will resolve themselves without medical attention.
Since late January, when the epidemics took off, the coronavirus infection rates are exponentially growing. Until May 27th, 2020:
- 5,701,498 coronavirus cases were officially declared worldwide,
- 352,607 deaths were reported,
- 2,445,444 people recovered from the infection.
In currently active cases:
- 2,850,355 have a mild condition,
- 53,095 (2%) a critical, in contrast to 4% of critically ill patients in the previous month.
The numbers are changing dramatically:
The new coronavirus definition states that it is an airborne respiratory virus.
This means that the infection is spread by droplets containing the virus released into the air by the infected people during sneezing, coughing, and talking.
Coronavirus can also be transmitted by touching virus-infected surfaces and then touching your eyes, mouth, or nose.
In other words, touching contaminated surfaces such as door handles, elevator knobs, stair railings, public transport pick-up points, and then your face, can lead to the infection. Since it is not yet clear how long the virus can persist on the surfaces, it is recommended to avoid touching them and to wash your hands frequently.
As far as we know, the concentration of aerosolized droplets is much higher in environments with high disease prevalence, such as hospitals and help centers.
The viral particles, when inhaled or even digested by another person, are the most probable causes of coronavirus infection.
How to Keep Safe?
It is essential to practice excellent hygiene by using masks, sneezing and coughing in the elbow/sleeve fold, together with washing your hands frequently and disinfecting surfaces.
The use of alcoholic solutions and bleach on the body cannot affect the virus that has already invaded the body. At the same time, these solutions can damage your skin, mucous membranes (eyes, mouth, nose) and your clothes, so it is not recommended to spray them on your body.
Washing your hands before preparing and consuming food is another good preventative measure for the spread of the virus.
The question “is coronavirus contagious” can be answered with a resounding “yes,” beyond any doubt. Based on the sometimes lacking coronavirus symptoms in humans, even when infected, it is assumed that the nCoV-19 is characterized by relatively low pathogenicity.
There is increasing data about the biological and epidemiological features of the virus, but still, we do not have all the answers.
The transmissibility seems moderate to low as well – one person can infect 2-3 people. When the transmission rate drops below 1, we can talk about the control of the outbreak.
The previous two epidemics concerning the representatives of the coronavirus family were more severe symptom-wise than the current outbreak.
SARS-CoV and MERS-CoV infections exhausted people for hours, no asymptomatic cases were reported, and the mortality reached 40%. These patients were unable to go out, work, or travel around the country and worldwide. For this reason, the outbreaks were confined to regional epidemics and did not spread worldwide. To sum up, less than 1,000 people were killed by the SARS and MERS epidemics.
The new coronavirus is a beta coronavirus, and like the other coronavirus types, MERS-CoV and SARS-CoV, it has origins in bats. There is enough data available, suggesting that the recent outbreak with nCoV-19 has emerged from an animal reservoir.
It was noted that in Wuhan, Hubei Province, China, the origin of the outbreak, many affected people had visited seafood and live-animal markets, suggesting the initial animal-to-person spread. This was probably the first step in the evolution of the new coronavirus. Then, the infection started to spread from person to person, since most of the patients with coronavirus disease symptoms were not exposed to animal markets. This spread was reported outside Hubei and in countries outside China.
Subsequently, the community spread turns out to be the leading way of infection, meaning that some infected people don’t know how or where they became exposed.
Although COVID-19 has killed nearly three times as many people so far, it is not as deadly as the previous coronaviruses or seasonal flu.
By affecting people slightly or asymptomatically (over 82% of cases), it allows them to move freely around the world, reaching even more people. It is assumed that the transfer of the virus from animals to humans was intended for the virus to be more widespread, and this does not include killing the human host.
What happens to our body when infected with nCoV-19 has not yet been fully explained. However, the typical biological behavior of other coronaviruses and how the immune system copes with them have been described.
The immune system is the first to get triggered. Considering the variability of these viruses, they can also suppress the secretion of some interferons in the body. These molecules are a part of the body’s innate protection against microorganisms, especially viruses. In this way, viruses try to counteract and block the immune system.
In fact, how the human SARS coronavirus infection will evolve depends on the person’s immune response. Moreover, the outcome and recovery also depend on other factors such as the infected person’s age, sex, and accompanying chronic diseases.
The clinical course of the infection could also be unfavorable for some young and healthy people in whom the immune system overreacts and spills many immune molecules into the bloodstream. The uncontrolled immune response, or the so-called “cytokine storm,” causes systemic inflammation and damage to organs, which belongs to the severe human Coronavirus symptoms, usually leading to death. This may have caused the death of 34-year-old Chinese doctor Li Wenliang, who was the first to alarm the world about the new virus.
Interestingly, Chinese doctors have registered more than 200 cases of re-infection with the new coronavirus in Wuhan, which may be due to insufficient immunological memory.
It seems that the nCoV-19 does not produce lasting immunity or, in some people, despite the resolve of the infection, the immune response has not been sufficiently effective.
Still, the anti-coronavirus antibodies are studied – are they protective, and what are the levels that wouldn’t allow reinfection? Other factors that can influence immunity are immunodeficiencies, malnutrition (especially with proteins), immunosuppressive therapy, etc.
The main signs of infection are respiratory symptoms, accompanied with fever, coughing, and difficulty breathing. In patients with more severe corona disease, the virus can cause pneumonia, severe acute respiratory syndrome (SARS), kidney failure, and even death.
The fever is usually presented as a high temperature (over 38◦С).
The initial pneumonia is characterized by a severe dry cough and difficulty breathing, but this is generally observed after a week (5-13 days on average). For these complaints, about 20% of patients will need hospital treatment.
The statistics show that 80% of cases are fortunately mild, with many asymptomatic patients. The majority of patients only have Coronavirus fever symptoms or flu-like symptoms, and they can recover at home. On the other hand, 13.8% of infected people develop severe symptoms with pneumonia and shortness of breath. Almost 5% of patients are critical, requiring life-supporting procedures due to respiratory failure, septic shock, and multi-organ failure.
It is worth mentioning that, unlike the common cold, the typical coronavirus symptoms do not include a runny nose, sneezing, or sore throat. Nevertheless, about 5% of patients were described with these symptoms. However, when we compare rhinovirus vs coronavirus infections, the similarities are fewer than the differences.
When suspecting COVID-19 infection, it is also essential to take into account the additional factors such as traveling to the epidemic regions in the last 14 days, or having close contact with an infected person.
The potential complications of the new coronavirus infection may include MERS, SARS, pneumonia that does not meet standard antibiotic treatment, and death. Infection with Coronavirus during human pregnancy can cause complications such as are premature birth, miscarriage, other health problems, or death at birth.
The Mortality Rate of COVID-19
Let us note that infection with the new coronavirus is not a death sentence. In fact, on average, about 98% of people who become infected will recover completely. The average mortality rate ranges between 2-3%, depending on the age, sex, the region of infection, and the presence of other serious diseases.
Currently, it is challenging to determine the actual mortality rate, as it is believed that not all the infected have sought medical attention and been registered. As a standard, the Coronavirus causes high mortality among hospitalized patients. The augmented death rate was also reported in Wuhan (3.1%) and Hubei (4.9%), while in Europe, it is around 0.9%.
Mortality is highest in people over 80 (14.8%) because, in addition to the weaker immune system, they usually have several chronic conditions. For patients over 65, the mortality rate is also above 10%. Regardless of age, the presence of chronic respiratory, cardiovascular disease (including high blood pressure), cancer, or diabetes increases the risk of death after infection to 6-10.5%.
On the other hand, for people between the ages of 10-60, the mortality rate is significantly lower, estimated at 0.2-0.4%, unless we are talking about Coronavirus and severe acute respiratory syndrome.
Interestingly, in men, the mortality rate is around 2.8% on average, compared to 1.7% in women.
It is believed that many factors can play a role here, such as hormones, smoking, etc. Males usually have a more severe reaction to COVID-19, according to the preliminary data. Another explanation is related to the receptor through which the virus enters the cells. The encoding gene for the receptor is located on the X chromosome.
But this observation can also be due to the greater number of smokers among men, which increases the risk of respiratory complications. Estrogens were shown to act protectively during the infection.
COVID-19 vs. Flu: Mortality Comparison
At the current stage of the COVID-19 pandemic, the actual mortality rate is impossible to estimate.
So far, the data shows that the crude mortality ratio, or the number of deaths divided by the reported cases, is around 3-4%.
In contrast to COVID-19, the seasonal flu usually kills fewer people, with a mortality rate below 0.1%.
However, the infection mortality rate is a much precise parameter, which is calculated by dividing the number of reported deaths with the number of all infected with microorganism sars coronavirus people. In line with this, after the pandemic is over, it would be feasible to estimate the real mortality rate, and it is expected to be lower than what the current figures show.
When comparing mortality, it is important to take into account the differences in access to healthcare services and the quality of care of different regions.
The risk groups for each virus vary. In essence, children are more susceptible to severe flu infections, as well as pregnant women, immunocompromised patients, people with underlying chronic medical conditions, and the elderly.
Officially, the risk groups for severe COVID are mainly older people and those with underlying chronic conditions. However, children and pregnant women have not presented severe cases so far.
During the epidemic, it turns out that cases in children are rare. Kids are more resistant to coronavirus infection, in contrast to their vulnerability to other infections, like flu. However, the data on coronavirus disease in children are insufficient to conclude more. But no deaths have been reported in children under the age of 9.
The most vulnerable people remain the elderly, especially those over 80. Additional risk factors are gender and accompanying severe chronic conditions. Recent data from China suggest that those with chronic diseases are most likely to develop severe reactions.
Older people are also more prone to complications during this outbreak of respiratory syndrome Coronavirus, such as severe untreatable pneumonia and shortness of breath, as well as respiratory failure, septic shock, and multiorgan failure – leading to death.
The mortality rate for people with cardiovascular disease is 10.5%. This percentage is 7.3% for patients with diabetes and about 6% for patients with chronic respiratory disease, hypertension, or cancer. Pregnant women are also a vulnerable group, with complications such as preterm birth.
Genetic and environmental factors can also influence the severity of infections. While genetic factors are still being studied in mice, smoking and polluted air are synergic harmful factors for the coronavirus infection.
The only way to protect against the infection right now is prevention. The WHO and other official sources of information have issued recommendations for compliance with high personal hygiene:
- Frequent and thorough washing of hands with water and soap;
- Use of disinfectants;
- Proper wear of the protective mask and change at short intervals;
- Avoiding travel to the regions with high infection rates;
- Avoiding close contact with people showing signs of respiratory infection (fever, coughing, sneezing);
- Staying at home if feeling sick.
Other useful recommendations to prevent the spread of infection, except regular hand washing, are covering the mouth and nose during sneezing and coughing, and thorough cooking of food (especially meat and eggs). Since there is no specific treatment of Coronavirus, all of these measures are the best ways of prevention.
If you do not live in an area where the virus is actively spreading, or if you have not traveled to affected areas or been in close contact with someone who has symptoms, is feeling unwell, or has been in the risk regions, the chances of getting sick are very low.
However, it is understandable to feel stressed and disturbed by the situation. The more informed you are, the more appropriate measures you can take to protect yourself.
Additional preventive measures are avoiding public transport, not coughing and sneezing in the hands, performing immediate hand hygiene after touching public surfaces, and only being in enclosed places with proper ventilation, especially if you notice anybody showing coronavirus or cold symptoms.
Symptoms of rhinovirus and coronavirus are distinct since it is assumed that nCoV-19 doesn’t affect the nose.
It is good to mention that masks should be worn by symptomatic people and people who provide medical care to sick people. It is essential to prevent the spread of nCoV-19 by taking additional measures, including canceling sport, cultural, scientific, and other types of events that could attract many people.
There is currently no specific treatment for the infection. Therefore, the recommended treatment remains to be only symptomatic. For this reason, prevention is the only way to protect against the spread of the virus.
However, for patients with severe clinical presentation, treatment options include intensive care in order to support vital organ functions. In line with this, people who think they may have been exposed to nCoV-19 should contact their healthcare provider immediately.
They will be instructed on how to proceed. If the chance of coronavirus infection is low, the patient will be advised to stay at home and seek medical help only in case of shortness of breath or other signs of complications.
The good news is that after the rapid identification of the virus and revealing its genome, this information was shared with all scientists around the world. The global scientific community is now working together to create a vaccine, the Chinese government has introduced extreme repression measures, including coronavirus isolation precautions, and the WHO has declared a state of emergency of international importance.
The concern with the coronavirus comes from the fact that it is not clear for how long the virus will be active and spreading.
At the present moment, the global race against time is the creation of an effective coronavirus vaccine injection – one of the most evident strategies to save lives in the years to come.
At the moment, a company has developed a product that uses small portions of the virus’s RNA to introduce them to the immune system and build immunity against the whole virus.
This is the first promising step, but technically, it’s far from a vaccine. Like other medicine, vaccines require a lengthy testing process to see if they are safe and effective.
Although genetic sequencing is now high-speed, vaccine making is as much of an art as it is science. It is necessary to find precisely the viral sequence that will lead to the creation of an effective and lasting immunological memory. The coronavirus vaccine schedule depends on these factors but also many others. For example, it should not cause a sharp inflammatory response, such as “flu-like symptoms.”
Before being widely administered, such a vaccine should be tested in a laboratory, then on animals, and finally on humans.
Several biotech companies are working on this project at the same time, as well as academic institutes. The timeline for a vaccine development can be compressed, but it still takes at least 12-18 months to create a compelling and safe vaccine.
The challenges will then include other problems such as manufacturing and logistics, which can also be difficult due to the limited workforce (especially as China’s leading manufacturer) and closed international borders.
Even though there is no specific coronavirus infection treatment, the vaccine is a hope. However, this process can cost hundreds of millions of dollars – money that NIH, biotech companies, and universities don’t have. Neither do they have the facilities and technologies for mass production and distribution of the vaccine. Thus, if you’ve been wondering, “is there a vaccine for just coronavirus?” there probably won’t be one available any time soon.
Coronaviruses can also be particularly challenging from a medical point of view. Due to their similarities to the flu viruses and the possibility of mutations, vaccines will also need to be in constant development, just like the flu shots. It may be too late to create a vaccine for this epidemic. Some experts believe that vaccine testing should have started with severe acute respiratory syndrome coronavirus epidemic.
Currently, there is a vaccine being tested in Seattle, USA. The scientists at Moderna Inc. used already available knowledge about similar viruses to create a CoVid-19 vaccine at unprecedented pace. The testing started on March 16th 2020.
The Progress in the Making of the Vaccine
The humanitarian and economic crises that came subsequential to the COVID-19 pandemic are intensely fueling global research activity, especially for developing an effective vaccine against SARS-CoV-2.
The Coalition for Epidemic Preparedness Innovations (CEPI) supports the next-generation vaccine technology platforms; thus, human clinical testing started on the 16th of March, which is unprecedentedly rapid.
Until the 8th of April, 115 vaccine candidates, of which 78 confirmed, are included in the global COVID-19 vaccine R&D landscape.
Amongst the different vaccine technologies being evaluated, the most promising are:
- DNA and RNA-based,
- Virus-like particles,
- Peptide-based, including coronavirus E protein vaccine approach,
- Viral vectors,
- Recombinant protein,
- Live-attenuated, or
- Inactivated virus.
The most advanced vaccine candidates have already been put into clinical development:
- Moderna (mRNA-1273),
- CanSino Biologicals (Ad5-nCoV),
- Inovio (INO-4800),
- Shenzhen Geno-Immune Medical Institute (LV-SMENP-DC and pathogen-specific aAPC).
Other developers also declare initiating human testing in 2020.
The global efforts for COVID-19 development follow the trends of the vast scale and speed of the pandemic. Therefore, an effective vaccine is expected to be available sooner than usual.
However, under emergency use, the official vaccine can be expected not before the beginning of 2021.
This fast-paced cure tracking demonstrates the fundamental step of jumping over the traditional pathway for vaccine development, which usually takes over ten years on average.
The Outlook for the Current Outbreak with the nCoV-19
The world is responding to the epidemic at an unprecedented speed and mobilizing resources. Still, fear plays a critical role in the social and economic consequences. Some experts have made various assumptions, as it is believed that, as temperatures rise, the virus’s viability in the environment will decrease. However, given the behavior of the virus and its characteristics, it is likely that seasonal warming won’t manage to restrict the spread of the virus in the coming months.
Since the development of vaccines and anti-coronaviral drugs for coronavirus treatment in humans is still ongoing, the official prognosis of the experts is for a pandemic. However, there are still preventive measures such as avoiding unnecessary traveling, airport stay, use of public transport, directed and unprotected close and physical contact with patients who have been diagnosed or suspect to have contracted a virus.
More information regarding healthcare topics, you can find on healthcareers.co.
If we assume that this virus is similar to the other coronaviruses, the new coronavirus may stay “alive” on surfaces from a few hours to a couple of days. However, this also depends on the type of surface and environmental factors.
Regardless, surfaces have to be cleaned routinely with disinfectants. It is also essential to wash hands thoroughly and use alcohol-based hand sanitizer after touching potentially hazardous surfaces. Avoid touching your eyes, mouth, or nose.
When inside the organism, the virus may take 14 days on average to cause infection and about a few days to be cleared. However, the severe illnesses related to the virus can last weeks.
Coronaviruses are responsible for two main diseases – Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome. The nCoV symptoms range from mild, similar to the common cold, to more severe, such as those mentioned above. The disease, caused by the new coronavirus, is called COVID-19.
Also known as SARS-CoV, it is a virus discovered in 2003. Its origin is linked to animals – thought to be bats, and then civet cats. However, the animal reservoir is still unknown, and the animal-based transmission rates have been misinterpreted globally, as there is evidence that suggests that the virus can be transmitted from human to animals.
SARS-CoV causes Severe Acute Respiratory Syndrome. The new coronavirus was firstly denoted as SARS-CoV-2, and later renamed to nCoV-19.
Middle East Respiratory Syndrome (MERS)-CoV can be transmitted between humans. However, the non-sustained human-to-human transmissions were observed mainly in healthcare settings. MERS-CoV is especially dangerous for people with underlying chronic medical conditions such as diabetes, renal and liver failure, chronic lung and cardiovascular disease, and compromised immune systems.
Except for general hygiene measures, food hygiene practices should also be observed. For instance, you should avoid consuming raw camel milk or meat that has not been properly cooked.
Initial testing recommendations for nCoV-19 are for people who have visited affected regions of the world or have had contact with someone who has been diagnosed with the disease. The standard test is based on the detection of RNA of the virus by real-time PCR. However, diagnostic tests are not done routinely, and they are not sufficient for making the diagnosis.
During the new coronavirus outbreak, it is essential to follow true information and reject fake news.
The good news is that most people who become infected will experience mild symptoms and recover completely. However, for others, it can be severe and fatal. For these reasons, it is critical to know the answer to “what is coronavirus?” and take preventive measures that can protect both you and those close to you.