By: Darien Lee, PharmD Candidate c/o 2021
Wuhan, the most populous city in Central China, has a population of over 11 million people. The city is one of China’s largest transportation and manufacturing centers with dozens of railways and roads as well as thousands of technological enterprises and institutions, respectively. In late December 2019, Chinese physicians discovered multiple pneumonia cases in Wuhan in association with a seafood market that sells live and dead animals.1 This situation relates to a prior zoonotic viral outbreak known as the severe acute respiratory syndrome (SARS) epidemic in 2002, in which the infection started in a similar type of animal market. Similar to SARS, the zoonotic viral infection in Wuhan (COVID-19) is classified as a coronavirus that primarily originates from bats. As of March 2, 2020, the countries at highest risk of being exposed to the disease include China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia, Macau, Italy, Cambodia, Laos, Myanmar, and Vietnam.2 The World Health Organization (WHO) has declared the coronavirus a pandemic; the number of confirmed cases of COVID-19 surpasses one hundred thousand worldwide with over one thousand cases in the United States.3
COVID-19 shares many characteristics that are similar to the flu. Many medical offices have coronavirus testing kits that look for signs of the infection in nasal secretions, blood, or other body fluids.4 People who have the highest risk of getting very sick from this disease include older adults and those who have serious chronic medical conditions like asthma or any respiratory condition, heart disease, and diabetes.5 The median estimated incubation period is five to six days.2 A clinical report on the cases of 41 patients hospitalized in Wuhan for COVID-19 revealed that the most common symptoms were fever, cough, and fatigue.1 Fifty-five percent of patients developed dyspnea and 29 percent of patients demonstrated acute respiratory distress syndrome.1 Another study focusing on 99 patients at Jinyintan Hospital in Wuhan revealed that reports on imaging techniques showed bilateral pneumonia in 75 percent of the cases.1
Currently, there are no vaccines or treatments for COVID-19. Similar to the SARS epidemic, COVID-19 must be controlled through public health measures. Syndromic surveillance, isolation of patients, and quarantine of contacts are important measures that will play a role in preventing further transmission of this disease.1 Many governments worldwide have authorized lockdowns on endemic areas including Wuhan, all Italian cities and parts of Germany.1 As hospitals admit more patients, it is apparent that a greater focus needs to be placed on protecting healthcare workers from nosocomial infections; N95 masks, goggles, and protective gowns are required for adequate protection from the virus.1 For the general public, handwashing, cough/sneezing etiquette, and wearing masks when visiting public places are recommended.1 In the event that a person suspected of having COVID-19 is undergoing testing and is not critically ill, it is recommended that the person remains in self-quarantine—staying indoors for 14 days from the date of contact with a confirmed case or return from endemic areas, avoiding contact with people, and separating themselves from the rest of their household.2
Although there are currently no FDA-approved treatments for COVID-19, Chinese researchers have already conducted in-vitro efficacy tests against the coronavirus.1 The most effective drugs that demonstrate inhibition of the virus include the nucleotide analog remdesivir and the anti-malaria compound chloroquine.1,6 Out of 7 antiviral drugs tested, the in-vitro tests showed that remdesivir (EC50 = 0.77 μM; CC50 > 100 μM; SI > 129.87) and chloroquine (EC50 = 1.13 μM; CC50 > 100 μM, SI > 88.50) displayed the highest inhibitory responses and safety index at a low micromolar concentration range.6 Remdesivir functions on a post-virus entry level; it interferes with viral RNA transcription by incorporating itself into nascent viral RNA chains, resulting in pre-mature termination.6 On the other hand, chloroquine inhibits infection by interfering with viral/cell fusion and glycosylation of cellular receptors for SARS-CoV-2.6 China is currently in the enrollment phase for two randomized, placebo controlled clinical trials testing the therapeutic efficacy of remdesivir in patients with mild or moderate COVID-19 and patients with severe disease, respectively.6
The COVID-19 pandemic has not only affected our communities on a physical level, but on a psychological level as well. Although social media is often considered one of mankind’s greatest achievements, it can also be our greatest downfall. News of COVID-19 originating and spreading from Asian countries has, in some areas, caused a mass panic. There have been growing reports of xenophobia and stigma against people of Asian descent, people who have traveled abroad, emergency responders, and healthcare professionals.7 It is important that we do our part to curb the stigma associated with COVID-19 by remaining calm and knowledgeable of the situation at hand. António Guterres, Secretary-General of the United Nations, has stated, “As we fight the virus, we cannot let fear go viral.”
For more information and updates on the COVID-19 outbreak, please visit the CDC, WHO, and NYC Department of Health websites or call the novel coronavirus hotline at 1-888-364-3065. If you are sick with COVID-19 or suspect you are infected with the virus, stay at home, limit contact with others, and practice good hygiene habits. If your illness is worsening (i.e., difficulty breathing), call your doctor or seek emergency medical help right away.
SOURCES:
- Brüssow H. The Novel Coronavirus – A Snapshot of Current Knowledge. Microb Biotechnol. 2020. doi: 10.1111/1751-7915.13557. Accessed 03/12/2020.
- Razai MS, Doerholt K, Ladhani S, Oakeshott P. Coronavirus disease 2019 (covid-19): a guide for UK GPs. BMJ. 2020;368:m800. doi: 10.1136/bmj.m800. Accessed 03/12/2020.
- People at Risk for Serious Illness from COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html. Published 03/10/2020. Accessed 03/12/2020.
- WHO statement on cases of COVID-19 surpassing 100 000. World Health Organization. https://www.who.int/news-room/detail/07-03-2020-who-statement-on-cases-of-covid-19-surpassing-100-000. Published 03/07/2020. Accessed 03/12/2020.
- Coronavirus Testing. MedlinePlus. https://medlineplus.gov/lab-tests/coronavirus-testing/. Published 03/03/2020. Accessed 03/12/2020.
- Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269-271. doi: 10.1038/s41422-020-0282-0. Accessed 03/12/2020.
- Stigma and Resilience. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/about/related-stigma.html. Published 03/03/2020. Accessed 03/12/2020.
