CORONAVIRUSES

ABSHIR M. HIRSI S.H.O

MENTOR: MR. EILU EMANUEL

Introduction
Coronaviruses (CoV) are a large family of viruses that cause illness
ranging from the common cold to more severe diseases.
These are viruses that have been circulating human body and animals
for long time.
 Coronaviruses belong to the family Coronaviridae family in the
Nidovirales order.
They can be classified into four
genera: Alphacoronavirus, Betacoronavirus, Gammacoronavirus,
and Deltacoronavirus.
 Alpha- and betacoronaviruses infect mammals, gammacoronaviruses
infect avian species, and deltacoronaviruses infect both mammalian
and avian species
…
Common corona viruses that infect human and cause pandemics:
 HCoV-229E,
 HCoV-NL63,
 HCoV-HKU1,
 HCoV-OC43
Recent coronaviruses that have emerged in to human population
 SARS CoV-1:, 8098 cases, 774 deaths (2002 – 2003)
 MERS CoV: 2521 cases, 866 total deaths (2012)
 SARS CoV-2: 2019- present
…
• SARS CoV-1, ,MERS, SARS CoV-2 likely all emerged from bat and were
transferred to humans by intermediate host.
SEVERE ACUTE RESPIRATORY
SYNDROME CORONAVIRUS 2 (SARS
CoV-2)
In late December 2019, a cluster of patients was admitted to hospitals
with an initial diagnosis of pneumonia of an unknown etiology.

These patients were epidemiologically linked to a seafood and wet

animal wholesale market in Wuhan, Hubei Province, China.
…
The pathogen has been identified as a novel coronavirus. Initially
tentatively named 2019 novel coronavirus (2019-nCoV), the virus
has now been named SARS-CoV-2 by the International Committee
of Taxonomy of Viruses (ICTV).
This virus can cause the disease named coronavirus disease 2019
(COVID-19).
The SARS-CoV-2 belongs to the same coronavirus group
(Betacoronavirus) as SARS and MERS viruses that caused two of the
more severe epidemics in recent years.
…
As with SARS and MERS, this new coronavirus, 2019-nCoV, is
believed to be of zoonotic origin, but may also be transmitted through
the respiratory tract, by direct contact, and possibly via patients
excreta which may contain the living virus.
 Epidemiology of COVID-19
In December 2019, Wuhan City, Province of China, became the center of an
outbreak of novel contagious coronavirus disease (COVID-19) of unknown
etiology.
It appears that an infected animal may have first transmitted the virus to humans
at a seafood market.
Soon, a secondary source of infection was found to be human-to-human
transmission of the COVID-19 virus. It became clear that the COVID-19
infection occurs among close contacts and exposure to the virus.
…
Recent studies showed that people and the population with poor
immune function such as diabetes, cardiovascular disease, chronic
respiratory disease, cancer, renal, and hepatic dysfunction are at higher
risk for severe COVID-19 than children who might be less likely to
become infected or, if so, may show milder symptoms or even
asymptomatic infection
Latest update of COVID-19 as per today
8th apr 2021
WORLD WIDE
Total cases: 133M
Recovered: 75.4M
Deaths: 2.8M

UGANDA
Total cases: 40,734
Recovered: 15,147
Deaths: 334
Morphology of SARS-CoV-2

Coronaviruses (CoVs) are enveloped single-stranded positive sense

RNA viruses
The structure of SARS-CoV-2 is found to be similar to SARS-CoV
with virion size ranging from 70 to 90 nm. Spike, membrane, and
envelope surface viral proteins of coronavirus are embedded in host
membrane-derived lipid bilayer encapsulating the helical nucleocapsid
comprising viral RNA
Structure of SARS-CoV-2. SARS-CoV-2 has surface viral proteins, namely, spike glycoprotein
(S), which mediates interaction with cell surface receptor ACE2. The viral membrane
glycoprotein (M) and envelope (E) of SARS-CoV-2 are embedded in host membrane-derived
lipid bilayer encapsulating the helical nucleocapsid comprising viral RNA
 Pathogenesis
SARS-CoV-2 binds to ACE 2, the host target cell receptor. Active replication and
release of the virus in the lung cells lead to non-specific symptoms such as fever,
myalgia, headache, and respiratory symptoms.
The virus causes transient damage to the cells in the olfactory epithelium, leading
to olfactory dysfunction, which may explain temporary loss of taste and smell
commonly seen in covid-19.
 The distribution of ACE 2 receptors in different tissues may explain the sites of
infection and patient symptoms. For example, the ACE 2 receptor is found on the
epithelium of other organs such as the intestine and endothelial cells in the kidney
and blood vessels, which may explain gastrointestinal symptoms and
cardiovascular complications.
What happens after the virus damages
type 2 pneumocytes
Release of specific inflammatory mediators which stimulate
macrophages to release cytokines (IL-1, IL-6,TNF-alpha.

Cytokines reach endothelial cells to dilate and cause increased

capillary permeability, causing fluid to leak interstitial spaces, which
increases alveolar edema drown out the surfactant alveolar
collapse
…
Inflammatory mediators will cause neutrophils to come in (leak in)
to destroy the virus. Neutrophils release NO and protease, as they
are killing the virus they will also damage both type 1 and 2
pneumocytes which will lead formation of consolidation which will
alter gas exchange and lead, alveolar collapse and hypoxia.

IL-1, IL-6, TNF alpha travel to hypothalamus which will increase

body temperature (fever)
…
Consequences of hypoxia:
Hypoxia (Decreased PO2 levels) stimulate chemoreceptors which cause
sympathetic nervous system stimulation

Heart rate
Respiratory rate
Work of breathing
..
In severe cases:
Inflammatory mediators cause vasodilation

Decrease total peripheral resistance

Reduce blood pressure and CO
Hypoperfusion
Kidney and liver damage
Septic shock
Risk factors associated with the development of severe disease,
admission to intensive care unit, and mortality

Older age
Hypertension
Cardiovascular disease
Chronic obstructive pulmonary disease
Diabetes
Obesity
Malignancy
Clinical features
Most common symptoms:
• fever
• dry cough
• Tiredness
Less common symptoms:
• aches and pains
• sore throat
• diarrhoea
• conjunctivitis
• headache
•
Diagnosis
There are 3 types of tests that may be utilized to determine if an
individual has been infected with SARS-CoV-2:
Viral nucleic acid (RNA) detection
Viral antigen detection
Detection of antibodies to the virus
NOTE:
Viral tests (nucleic acid or antigen detection tests) are used to assess
acute infection, whereas antibody tests provide evidence of prior
infection with SARS-CoV-2.
…

Images:
CXR
• ground glass opacity
Chest CT
• Highly sensitive
• Ground glass opacity
• Areas of consolidation
• “crazy-paving” pattern
Ultrasound
• Pleural thickening
…
Mortality rate predictors:
• CRP
• ESR
• IL-6
• D-dimers
• Feritin
• Tropinins
• Procalcitonin ( elevated when there is bacterial super infection)
Vaccines:
1. Moderna
2. Pfizer
The above vaccines are made in the US. There is injection of mRNA into
the cells, which tells cells to produce proteins that generate immune
response.
Efficacy: they are against the disease >94 % and protect severe cases 100%
Storage: -20°C (Moderna), -70°C (Pfizer)
3. Astrazeneca/Oxford: There is injection of DNA into cells to make
protein antigen to stimulate immune cells.
Efficacy: >90% protects the disease and 100% severe cases
Storage: 2-8°C
4. The Johnson & Johnson vaccine: uses double-stranded DNA.
The researchers added the gene for the coronavirus spike protein to another
Management
Medications:
Antiviral agents Eg. Remdesivir
Immunomodulators and Other Investigational Therapies
Eg. Interleukin (IL) inhibitors, Janus kinase inhibitors, and interferons
are just a few of the drugs that are in clinical trials.
 Investigational Drugs for ARDS/Cytokine Release
Neurokinin-1 (NK-1) receptor antagonists
Investigational Immunotherapies
Eg.Bucillamine
Investigational Antibody-Directed Therapies
 Role of Vitamin D in Covid-19
A growing number of concordant reports support a protective role for vitamin
D in reducing at least the risk/severity of respiratory tract infections (RTIs),
especially in the influenza and COVID-19 context.
Vitamin D and mechanisms to decrease viral infections
To reduce the risk of viral infections, vitamin D uses three pathways:
1. physical barrier
2. cellular natural immunity
3. adaptive immunity
 Vitamin D in COVID-19: to reduces the risk it increases cellular immunity by
decreasing the cytokine storm
Prevention
General measures for prevention of viral respiratory infections
include the following:
Handwashing with soap and water for at least 20 seconds. An alcohol-
based hand sanitizer may be used if soap and water are unavailable.
Individuals should avoid touching their eyes, nose, and mouth with
unwashed hands.
Individuals should avoid close contact with sick people.
Sick people should stay at home (eg, from work, school).
Coughs and sneezes should be covered with a tissue, followed by
disposal of the tissue in the trash.
REFERECE
• UpToDate
END