As I am sure you all have, I too have been bored and so I figured Id quickly

compile a snapshot of some real info on the virus with facts directly from
World Health Organization, the CDC, as well as pharmaceutical trade news
sources such as Chemical & Engineering News. I hope it helps and is good
info. I must mention I take it as a given that countries including China and
USA “tailor” what we are told and gear it towards satisfying and steering
the masses and is considering the implications, restrictions and costs of
actions necessary on such a large scale. People are prone to behave in a mob
mentality and do some stupid things when they don’t “know” what else to do.
We have to be smart and demand the information to make sound decisions
we need to demand the first step. We need tests. . What I mean is clear in
the following example that’s all over the news- PPE personal protection
equipment and specifically Face Masks.( Ok lets work it out) There is a
massive shortage in the USA and Trumps govt. thru news says they don’t
help the common person and that they are for health workers. Keep in mind
the WHO recommends using them as does common sense and besides the
mechanical protection the mere fact that its on your face makes you more
conscious and less likely to touch your face. The truth is that unlike others
such as Korea we don’t have TESTING. No testing means you don’t know who
has it and when you’re a health worker in a hospital setting you are required
to treat ALL as infected or you run the risk of contaminating everyone. And
so you use PPE and changing out with each and every patient. I wont get
started on the topic of TESTING…. Suffice it to say its step one.Anyway
there is some hopeful news. The WHO will look at the potential benefits of
remdesivir, the HIV antivirals lopinavir and ritonavir, interferon beta added
to treatment with lopinavir and ritonivir, and the antimalarial chloroquine.
One of the great things is that all information is available if you know where
to look as the world is really rallying together and all data is being shared
openly in hopes scientists and doctors will collaboratively find a solution.
Below , attached I have included good info that I recommend looking at or at
least having as it includes a couple official Manuals (guidance) or
“instructions” 1. for doctors on how to treat you and exactly what will happen
to you and how you will be cared for if you contract the virus. 2. for how to
treat someone for someone at home.
In my opinion the world is changing forever and the figures you hear on the
news are not to be relied on too much – remember when Trump said
passengers from cruise ship to not be allowed on shore cause that would
increase “his numbers” of people sick in USA? Exactly- in short – this is the
new way of life, not 2 weeks or till end of April/ Yes it will slow down come
summer but what they don’t say is at same time it will follow the weather
and increase in Africa until next winter where it will have gone around and
come back probably mutated meaning just like the flu it requires yearly
immunization.

What is a coronavirus?
Coronaviruses (CoVs) are a large family of viruses, several of which cause
respiratory diseases in humans, from the common cold to more rare and
serious diseases such as the Severe Acute Respiratory Syndrome (SARS)
and the Middle East respiratory syndrome (MERS), both of which have high
mortality rates and were detected for the first time in 2003 and 2012,
respectively.

CoVs are divided into four genera: alpha-, beta-, gamma- and delta-CoV. All
CoVs currently known to cause disease in humans belong to the alpha- or the
beta-CoV. Many of these CoVs can infect several animal species as well.
SARS-CoV infected civet cats and infected humans in 2002 and MERS-CoV
is found in dromedary camels and infected humans in 2012. A virus that is
regularly transmitted from an animal to a human is called a zoonotic virus.
When a virus passes from animals to humans for the first time it is called a
spillover event.

What's different about

coronavirus (COVID-19)?
 While coronaviruses are common, coronavirus (COVID-19) is a new strain of
coronavirus that had previously not been identified in humans. SARS-CoV-2,
the virus responsible for COVID-19, belongs to a group of genetically
related viruses that includes SARS-CoV and a number of other CoVs isolated
from bat populations. MERS-CoV also belongs to this group but is less closely
related. The key features of COVID-19 are respiratory symptoms with a
fever and cough. Also diarrhea and stomach problems .
New study explores whether dampening IL-6 could
address serious coronavirus infections

by Lisa M. Jarvis

MARCH 18, 2020 | APPEARED IN  VOLUME 98, ISSUE 11

with the world in the grips of the novel coronavirus, drug

companies are launching studies of existing drugs with the
potential to alleviate the most serious cases of the related
respiratory disease COVID-19. The latest trials to be launched
focus on Sanofi and Regeneron’s Kevzara (sarilumab) and
Roche’s Actemra (tocilizumab), both rheumatoid arthritis
treatments that block a cytokine called IL-6.

When the coronavirus infects a cell, it dumps its genetic payload

—a single strand of RNA containing the recipes for making the
proteins it needs to replicate—into its host. The immune system
mobilizes to kill infected cells before too many copies of the
virus can be made. But sometimes, that defense mechanism
overreacts. Not only are sick cells killed, but healthy ones, too,
and a lot of them, explains Naimish Patel, Sanofi’s global head of
development for immunology and inflammation.

“On average, most patients do develop their own response

against the virus and recover from it, but some patients just have
a very brisk response and get really sick,” says Patel, who is a
pulmonologist by training.

C&EN has made this story and all of its coverage of the

coronavirus epidemic freely available during the outbreak to
keep the public informed. To support our journalism, become
a member of ACS or sign up for C&EN's weekly newsletter.

Doctors in China noted that in some of those really sick patients,

viral levels dropped, but levels of IL-6, one of the distress signals
used to call the immune system to action, remained high. A small
study tested whether Actemra could stop the immune over-
reaction.

“The initial results from tocilizumab’s China study were

remarkable—75% of patients (15 out of 20) reduced their need for
supplemental oxygen within days after receiving tocilizumab,”
SVB Leerink stock analyst Geoffrey Porges wrote in a note to
clients.

“The initial results from tocilizumab’s China study were

remarkable—75% of patients (15 out of 20) reduced their need for
supplemental oxygen within days after receiving tocilizumab,”
SVB Leerink stock analyst Geoffrey Porges wrote in a note to
clients.

Although those results come with caveats—for example, the

study lacked control arms and was very small—it was enough to
prompt Sanofi and Regeneron to explore the use of Kevzara in
COVID-19.

The study will first enroll 50 to 60 people who meet certain

criteria: they must have lab-confirmed COVID-19 that is
considered severe, or have multiple affected organs, and they
must have pneumonia and a fever. Patients will be given either a
low dose of Kevzara, a high dose, or a placebo.

“The initial results from tocilizumab’s China study were

remarkable—75% of patients (15 out of 20) reduced their need for
supplemental oxygen within days after receiving tocilizumab,”
SVB Leerink stock analyst Geoffrey Porges wrote in a note to
clients.

Although those results come with caveats—for example, the

study lacked control arms and was very small—it was enough to
prompt Sanofi and Regeneron to explore the use of Kevzara in
COVID-19.

The study will first enroll 50 to 60 people who meet certain

criteria: they must have lab-confirmed COVID-19 that is
considered severe, or have multiple affected organs, and they
must have pneumonia and a fever. Patients will be given either a
low dose of Kevzara, a high dose, or a placebo.

On March 19, Roche said it was collaborating with the US

Biomedical Advanced Research and Development Authority to
launch a Phase III study of Actemra in hospitalized patients with
severe COVID-19 pneumonia. The trial, which will enroll 330
people around the world, is expected to start in early April.

Several other trials are also under way to test drugs or drug
candidates against COVID-19. Gilead Sciences’ remdesivir, which
was discovered during the 2014 Ebola outbreak in West Africa, is
the most advanced. The antiviral, which is not yet approved in
any countries, is being tested in four Phase III studies—two in
China and two in the US. Data from one of the China studies are
expected to be reported in April.

And this week, Chinese researchers reported encouraging results

from a study of Fujifilm’s favipiravir, which is approved in Japan
to treat the flu. According to media reports, an official from China’s
Science and Technology Ministry said the trial of 340 people with
COVID-19 suggests the antiviral can shorten the time it takes for
the body to clear the virus from 11 days to 4.

On March 18, the World Health Organization said it was launching

a large, multinational trial to test four drug candidates’ efficacy
against COVID-19. It has taken the unusual step to tease out
better evidence of the value of older therapies being tried in
smaller, often unblinded studies. “Multiple, small trials with
different methodologies may not give us the clear, strong
evidence we need about which treatments help to save lives,”
Director-General Tedros Adhanom Ghebreyesus said during a
press conference. The WHO study will look at the potential
benefits of remdesivir, the HIV antivirals lopinavir and ritonavir,
interferon beta added to treatment with lopinavir and ritonivir,
and the antimalarial chloroquine.
Coronavirus disease (COVID-19) technical
guidance: Patient management

Clinical management of severe acute

respiratory infection when COVID-19 is
suspected
This document is intended for clinicians taking care of hospitalised adult and
paediatric patients with severe acute respiratory infection (SARI) when a nCoV
infection is suspected. It is not meant to replace clinical judgment or specialist
consultation but rather to strengthen clinical management of these patients and
provide to up-to-date guidance. Best practices for SARI including IPC and
optimized supportive care for severely ill patients are essential.  

- Access the document

https://apps.who.int/iris/rest/bitstreams/1272156/retrieve

Home care for patients with suspected novel

coronavirus (nCoV) infection presenting with
mild symptoms and management of contacts
WHO has developed this rapid advice note to meet the need for
recommendations on the safe home care for patients with suspected novel
coronavirus (2019-nCoV) infection presenting with mild symptoms and public
health measures

related to management of asymptomatic contacts.

- Access the document

https://apps.who.int/iris/rest/bitstreams/1272288/retrieve

Clinical Presentation
Incubation period

The incubation period for COVID-19 is thought to extend to 14 days, with a

median time of 4-5 days from exposure to symptoms onset.  One study
1-3

reported that 97.5% of persons with COVID-19 who develop symptoms will
do so within 11.5 days of SARS-CoV-2 infection.3

Presentation

The signs and symptoms of COVID-19 present at illness onset vary, but
over the course of the disease, most persons with COVID-19 will
experience the following : 1,4-9

 Fever (83–99%)
 Cough (59–82%)
 Fatigue (44–70%)
 Anorexia (40–84%)
 Shortness of breath (31–40%)
 Sputum production (28–33%)
 Myalgias (11–35%)

Atypical presentations have been described and older adults and persons
with medical comorbidities may have delayed presentation of fever and
respiratory symptoms.  In one study of 1,099 hospitalized patients, fever
10,11

was present in only 44% at hospital admission but later developed in 89%
during hospitalization.  Headache, confusion, rhinorrhea, sore throat,
1

hemoptysis, vomiting, and diarrhea have been reported but are less
common (<10%).  Some persons with COVID-19 have experienced
1,4-6

gastrointestinal symptoms such as diarrhea and nausea prior to developing

fever and lower respiratory tract signs and symptoms.  Anosmia or ageusia
9

preceeding the onset of respiratory symptoms has been anecdotally

reported, but more information is needed to understand its role in
identifying COVID-19.

Several studies have reported that the signs and symptoms of COVID-19 in
children are similar to adults and are usually milder compared to adults.
12-

 For more information on the clinical presentation and course among

16

children, see Information for Pediatric Healthcare Providers.

Asymptomatic and Pre-Symptomatic Infection

Several studies have documented SARS-CoV-2 infection in patients who

never develop symptoms (asymptomatic) and in patients not yet
symptomatic (pre-symptomatic).  Since asymptomatic persons are not
13,15,17-25

routinely tested, the prevalence of asymptomatic infection and detection of

pre-symptomatic infection is not well understood. One study found that as
many as 13% of RT-PCR-confirmed cases of SARS-CoV-2 infection in
children were asymptomatic.  Another study of skilled nursing facility
13

residents infected with SARS-CoV-2 from a healthcare worker

demonstrated that half were asymptomatic or pre-symptomatic at the time
of contact tracing evaluation and testing.  Patients may have abnormalities
25

on chest imaging before the onset of symptoms.  Some data suggest that
19,20

pre-symptomatic infection tended to be detected in younger individuals

and was less likely to be associated with viral pneumonia. 19,20

Although transmission of SARS-CoV-2 from asymptomatic or pre-

symptomatic persons has been reported , risk of transmission is thought
17,21,22

to be greatest when patients are symptomatic. Viral RNA shedding,

measured indirectly by RT-PCR cycle threshold values, is greatest at the
time of symptom onset and declines over the course of several days to
weeks.  The exact degree of SARS-CoV-2 viral RNA shedding that confers
26,27

risk of transmission is not yet clear.

Clinical Course

Illness Severity

The largest cohort of >44,000 persons with COVID-19 from China showed
that illness severity can range from mild to critical : 28

 Mild to moderate (mild symptoms up to mild pneumonia): 81%

 Severe (dyspnea, hypoxia, or >50% lung involvement on imaging):
14%
 Critical (respiratory failure, shock, or multiorgan system dysfunction):
5%

In this study, all deaths occurred among patients with critical illness and
the overall case fatality rate was 2.3%.  The case fatality rate among
28
patients with critical disease was 49%.  Among children in China, illness
28

severity was lower with 94% having asymptomatic, mild or moderate

disease, 5% having severe disease, and <1% having critical disease.  Only 13

one (<0.1%) death was reported in a person <18 years old.  Among U.S. 13

COVID-19 cases with known disposition, the proportion of persons who

were hospitalized was 19%.  The proportion of persons with COVID-19
29

admitted to the intensive care unit (ICU) was 6%. 29

Clinical Progression

Among patients who developed severe disease, the medium time to

dyspnea ranged from 5 to 8 days, the median time to acute respiratory
distress syndrome (ARDS) ranged from 8 to 12 days, and the median time
to ICU admission ranged from 10 to 12 days.  Clinicians should be aware
5,6,10,11

of the potential for some patients to rapidly deteriorate one week after
illness onset. Among all hospitalized patients, a range of 26% to 32% of
patients were admitted to the ICU.  Among all patients, a range of 3% to
6,8,11

17% developed ARDS compared to a range of 20% to 42% for hospitalized

patients and 67% to 85% for patients admitted to the ICU.  Mortality
1,4-6,8,11

among patients admitted to the ICU ranges from 39% to 72% depending
on the study.  The median length of hospitalization among survivors was
5,8,10,11

10 to 13 days. 1,6,8

Risk Factors for Severe Illness

Age is a strong risk factor for severe illness, complications, and death. 1,6,8,10,11,28-

 Among more than 44,000 confirmed cases of COVID-19 in China, the case
31

fatality rate was highest among older persons: ≥80 years: 14.8%, 70–79
years: 8.0%, 60–69 years: 3.6%, 50–59 years: 1.3%, 40–49 years: 0.4%, <40
years: 0.2%.  Early U.S. epidemiologic data suggests that the case fatality
28,32

was highest in persons aged ≥85 years (range 10%–27%), followed by 3%–
11% for ages 65–84 years, 1%–3% for ages 55–64 years, and <1% for ages
0–54 years. 29

Patients with no reported underlying medical conditions had an overall

case fatality of 0.9%, but case fatality was higher for patients with
comorbidities: 10.5% for those with cardiovascular disease, 7.3% for
diabetes, and approximately 6% each for chronic respiratory disease,
hypertension, and cancer.  Heart disease, hypertension, prior stroke,
32

diabetes, chronic lung disease, and chronic kidney disease have all been
associated with increased illness severity and adverse
outcomes.  Accounting for differences in age and prevalence of
1,6,10,11,28,32

underlying condition, mortality associated with COVID-19 in the United

States was similar to China. 29,30,33

Medications

It has been hypothesized that angiotensin-converting enzyme (ACE)

inhibitors or angiotensin receptor blockers (ARBs) may increase the risk of
SARS-CoV-2 infection and COVID-19 severity.  ACE inhibitors and ARBs
34

increase the expression of angiotensin-converting enzyme 2 (ACE2). SARS-

CoV-2 uses the ACE2 receptor to enter into the host cell. There are no data
to suggest a link between ACE inhibitors or ARBs with worse COVID-19
outcomes. The American Heart Association (AHA), the Heart Failure Society
of America (HFSA), and the American College of Cardiology (ACC) released
a statement recommending continuation of these drugs for patients
already receiving them for heart failure, hypertension, or ischemic heart
disease.35

It has also been hypothesized that non-steroidal anti-inflammatory drugs

(NSAIDs) may worsen COVID-19. There are no data suggesting an
association between COVID-19 clinical outcomes and NSAID use. More
information can be found at Healthcare Professionals: Frequently Asked
Questions and Answers.

Reinfection

There are no data concerning the possibility of reinfection with SARS-CoV-

2 after recovery from COVID-19. Viral RNA shedding declines with
resolution of symptoms, and may continue for days to weeks.  However,
11,26,27

the detection of RNA during convalescence does not necessarily indicate

the presence of viable infectious virus. Clinical recovery has been correlated
with the detection of IgM and IgG antibodies which signal the
development of immunity. 36,37

Diagnostic Testing
Diagnosis of COVID-19 requires detection of SARS-CoV-2 RNA by reverse
transcription polymerase chain reaction (RT-PCR). Detection of SARS-CoV-
2 viral RNA is better in nasopharynx samples compared to throat
samples.  Lower respiratory samples may have better yield than upper
27,38

respiratory samples. . SARS-CoV-2 RNA has also been detected in stool

27,38

and blood.  Detection of SARS-CoV-2 RNA in blood may be a marker of

12,26,37,39

severe illness.  Viral RNA shedding may persist over longer periods among
40

older persons and those who had severe illness requiring hospitalization.
(median range of viral shedding among hospitalized patients 12–20
days).
11,26,27,36,41

Infection with both SARS-CoV-2 and with other respiratory viruses has
been reported, and detection of another respiratory pathogen does not
rule out COVID-19. 42

For more information about testing and specimen collection, handling and
storage, visit Evaluating and Testing Persons for Coronavirus Disease 2019
(COVID-19) and Frequently Asked Questions on COVID-19 Testing at
Laboratories.

Sanofi, Regeneron test arthritis drug against

COVID-19