Introductory Chapter: Lessons from SARS-CoV-2/COVID-19 after Two Years of Pandemic

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Exploiting the co-crystal ligands shape, features and structure-based approaches for identification of SARS-CoV-2 Mpro inhibitors

SARS-CoV-2 enters the host cell through the ACE2 receptor and replicates its genome using an RNA-Dependent RNA Polymerase (RDRP). The functional RDRP is released from pro-protein pp1ab by the proteolytic activity of Main protease (Mpro) which is encoded within the viral genome. Due to its vital role in proteolysis of viral polyprotein chains, it has become an attractive potential drug target. We employed a hierarchical virtual screening approach to identify small synthetic protease inhibitors. Statistically optimized molecular shape and color-based features (various functional groups) from co-crystal ligands were used to screen different databases through various scoring schemes. Then, the electrostatic complementarity of screened compounds was matched with the most active molecule to further reduce the hit molecules' size. Finally, five hundred eighty-seven molecules were docked in Mpro catalytic binding site, out of which 29 common best hits were selected based on Glide and FRED scores. Five best-fitting compounds in complex with Mpro were subjected to MD simulations to analyze their structural stability and binding affinities with Mpro using MM/GB(PB)SA models. Modeling results suggest that identified hits can act as the lead compounds for designing better active Mpro inhibitors to enhance the chemical space to combat COVID-19.Communicated by Ramaswamy H. Sarma.

PREHOST: Host prediction of coronaviridae family using machine learning

Coronavirus, a zoonotic virus capable of transmitting infections from animals to humans, emerged as a pandemic recently. In such circumstances, it is essential to understand the virus's origin. In this study, we present a novel machine-learning pipeline PreHost for host prediction of the family, Coronaviridae. We leverage the complete viral genome and sequences at the protein level (spike protein, membrane protein, and nucleocapsid protein). Compared with the current state-of-the-art approaches, the random forest model attained high accuracy and recall scores of 99.91% and 0.98, respectively, for genome sequences. In addition to the spike protein sequences, our study shows membrane and nucleocapsid protein sequences can be utilized to predict the host of viruses. We also identified important sites in the viral sequences that help distinguish between different host classes. The host prediction pipeline PreHost will cater as a valuable tool to take effective measures to govern the transmission of future viruses.

Acute-on-chronic liver failure in patients with severe acute respiratory syndrome coronavirus 2 infection

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on the lives of millions of people, especially those with other concomitant diseases, such as chronic liver diseases. To date, seven coronaviruses have been identified to infect humans. The main site of pathological action of these viruses is lung tissue. However, a substantial number of studies have proven that SARS-CoV-2 shows affinity towards several organs, including the gastrointestinal tract and the liver. The current state of evidence points to several proposed mechanisms of liver injury in patients with COVID-19 and their combination. Liver impairment is considered to be the result of the direct effect of the virus on the hepatic tissue cells, a systemic reaction consisting of inflammation, hypoxia and cytokine storm, drug-induced liver injury, with the possible contribution of a perturbed gut-liver axis. Reactivation of chronic hepatic disease could be another factor for liver impairment in patients with SARS-CoV-2 infection. Acute-on-chronic liver failure (ACLF) is a relatively new syndrome that occurs in 10%–30% of all hospitalized patients with chronic liver disease. It is crucial to recognize high-risk patients due to the increased morbidity and mortality in these cases. Several published studies have reported virus infection as a trigger factor for ACLF. However, to date, there are few relevant studies describing the presence of ACLF in patients with acute SARS-CoV-2 infection. In this minireview we summarize the current state of knowledge regarding the relation between ACLF and acute SARS-CoV-2 infection.

Excessive neutrophil recruitment promotes typical T-helper 17 responses in Coronavirus disease 2019 patients

Coronavirus disease 2019 (COVID-19) is caused by a recently identified virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease is a pandemic. Although the hallmarks of severe COVID-19 have been established, the underlying mechanisms that promote severe pathology have not been thoroughly studied. A better understanding of the immune response in severe COVID-19 patients may help guide the development of therapeutic strategies and predict immuno-pathogenicity. This study was set to determine the lymphocyte and cytokine profiles associated with COVID-19 severity. A total of 43 hospitalised COVID-19 patients were recruited for the study and whole blood samples were drawn from each patient. Complete blood counts, lymphocyte subset profiles and C-reactive protein statuses of patients were determined. Cytometric bead array was performed to analyse the cytokine profiles of each patient. The demographic characteristics showed that the median age of the patients was 48.72 years, with an interquartile range from 40 to 60 years, and 69.77% of the patients were male. COVID-19 patients exhibited significantly low CD4⁺ lymphocyte expansion and leucocytosis augmented by elevated neutrophil and immature granulocytes. Stratification analysis revealed that reduced monocytes and elevated basophils and immature granulocytes are implicated in severe pathology. Additionally, cytokine results were noted to have significant incidences of interleukin 17A (IL-17A) expression associated with severe disease. Results from this study suggest that a systemic neutrophilic environment may preferentially skew CD4⁺ lymphocytes towards T-helper 17 and IL-17A promotion, thus, aggravating inflammation. Consequently, results from this study suggest broad activity immunomodulation and targeting neutrophils and blocking IL-17 production as therapeutic strategies against severe COVID-19.

Evaluation of the relationship between IL-6 gene single nucleotide polymorphisms and the severity of COVID-19 in an Iranian population

Background

Emerged coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Disease severity is associated with elevated levels of proinflammatory cytokines, such as interleukin-6 (IL-6). Genetic polymorphisms in the regulatory regions of cytokine genes may be associated with differential cytokine production in COVID-19 patients. This study aimed to investigate the association between three potentially functional single-nucleotide polymorphisms (SNPs) in the promoter region of IL-6 and the severity of susceptibility to COVID-19 in an Iranian population.

Methods

In total, 346 individuals (175 patients with severe COVID-19 and 171 patients with mild COVID-19) were recruited for this cohort study. Genomic DNA was extracted from peripheral blood leukocytes of patients to determine the genotypes of three selected SNPs (rs1800795 (−174 G > C), rs1800796 (−572 G > C), and rs1800797 (−597 G > A)) in the promoter region of the IL-6 gene using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.

Results

There were no significant differences in the genotype or allele distribution of selected SNPs (rs1800795 (−174 G > C), rs1800796 (−572 G > C), and rs1800797 (−597 G > A)) in the promoter region of the IL-6 gene in patients with severe COVID-19 and patients with mild COVID-19.

Discussion

Our study indicated that these SNPs are not associated with COVID-19 severity in the Kurdish population from Kermanshah, Iran.

Knowledge, awareness and practices of Pakistani professionals amid-COVID-19 outbreak

End of the year 2019 marks an unprecedented outbreak of a pandemic named COVID-19 caused by the SARS-CoV-2. It was first discovered in China and later spread to the whole world, currently inflicting almost 200 countries. After China, few other countries have emerged as potential epicenters of this disease including the US, Italy, Spain and Pakistan, as indicated by the World Health Organization (WHO). Since proper preventive and curative measures in the form of a vaccine or medication are currently unavailable throughout the world, the only remedy devised to stop the spread of this virus is self-isolation. Such a measure necessitates ample awareness and understanding among people to avoid actions that lead to the spread of this virus. Pakistan is the fifth-most populous country in the world (212.2 million) and has a record of contagious outbreaks in the past. Therefore, it is key to evaluate the general understanding regarding the cause, spread and control of this disease in Pakistani population and acquire data to anticipate the possible spread and persistence of this disease to design relevant preventive measures. We have attempted to collect such data from professionals who are susceptible to acquiring the infection due to an unavoidable exposure. Keeping in view the current lock down, we have relied on an internet based collection of data by filling a self-designed questionnaire that is responded to by 1132. Descriptive and Frequency Analysis were performed on the responses received using MS Excel and SPSS software. A total of 1132 individuals responded to the questionnaire among which include academic (45.8%), non-academic (20.8%), healthcare (7.8%), security (5.9%) and other (19.7%) professionals. The questionnaire addressed the level of basic information regarding the cause, spread, cure and prevention of this disease among professionals, in an attempt to provide directions for awareness campaigns at different levels in Pakistan and provide a model for similar outbreaks in the future.To our expectations, almost after a month of the coronavirus outbreak in Pakistan, above 50% to up to 90% of the recorded responses against every question showed ample understanding regarding the cause, spread and control of the disease which is an indicator of effective public awareness campaigns throughout the country largely based on media drive.

Influence of COVID-19 lockdown overlapping Chinese Spring Festival on household PM2.5 in rural Chinese homes

During the 2019 novel coronavirus (COVID-19) pandemic, many countries took strong lockdown policy to reduce disease spreading, resulting in mitigating the ambient air pollution due to less traffic and industrial emissions. However, limited studies focused on the household air pollution especially in rural area, the potential risk induced by indoor air pollution exposure was unknown during this period. This field study continuously measured real-time PM_2.5 levels in kitchen, living room, and outdoor in the normal days (Period-1) and the days of COVID-19 lockdown overlapping the Chinese Spring Festival (Period-2) in rural homes in China. The average daily PM_2.5 concentrations increased by 17.4 and 5.1 μg/m³ in kitchen and living room during Period-2, respectively, which may be due to more fuel consumption for cooking and heating caused by larger family sizes than those during the normal days. The ambient PM_2.5 concentration in rural areas in Period-2 decreased by 6.7 μg/m³ compared to the Period-1, less than the drop in urban areas (26.8 μg/m³). An increase of mass fraction of very fine particles in ambient air was observed during lockdown overlapping annual festival days, which could be explained by the residential solid fuel burning. Due to higher indoor air pollution level and longer time spent in indoor environments, daily personal exposure to PM_2.5 was 134 ± 40 μg/m³ in Period-2, which was significantly higher than that during in Period-1 (126 ± 27 μg/m³, p < 0.05). The increase of personal PM_2.5 exposure during Period-2 could potentially have negative impact on human health, indicating further investigations should be performed to estimate the health impact of global COVID-19 lockdown on community, especially in rural homes using solid fuels as the routine fuels.

To Procrastinate or Not to Procrastinate: A Retrospective Study of the Optimal Timing of Containing the Global Spread of the COVID-19 Pandemic

As global public health is under threat by the 2019-nCoV and a potential new wave of large-scale epidemic outbreak and spread is looming, an imminent question to ask is what the optimal strategy of epidemic prevention and control (P&C) measures would be, especially in terms of the timing of enforcing aggressive policy response so as to maximize health efficacy and to contain pandemic spread. Based on the current global pandemic statistic data, here we developed a logistic probability function configured SEIR model to analyse the COVID-19 outbreak and estimate its transmission pattern under different "anticipate- or delay-to-activate" policy response scenarios in containing the pandemic. We found that the potential positive effects of stringent pandemic P&C measures would be almost canceled out in case of significantly delayed action, whereas a partially procrastinatory wait-and-see control policy may still be able to contribute to containing the degree of epidemic spread although its effectiveness may be significantly compromised compared to a scenario of early intervention coupled with stringent P&C measures. A laissez-faire policy adopted by the government and health authority to tackling the uncertainly of COVID19-type pandemic development during the early stage of the outbreak turns out to be a high risk strategy from optimal control perspective, as significant damages would be produced as a consequence.

The role of 5-lipoxygenase in the pathophysiology of COVID-19 and its therapeutic implications

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, known as coronavirus disease 2019 (COVID-19) causes cytokine release syndrome (CRS), leading to acute respiratory distress syndrome (ARDS), acute kidney and cardiac injury, liver dysfunction, and multiorgan failure. Although several studies have discussed the role of 5-lipoxygenase (5-LOX) in viral infections, such as influenzae and SARS, it remains unexplored in the pathophysiology of COVID-19. 5-LOX acts on free arachidonic acid (AA) to form proinflammatory leukotrienes (LTs). Of note, numerous cells involved with COVID-19 (e.g., inflammatory and smooth muscle cells, platelets, and vascular endothelium) widely express leukotriene receptors. Moreover, 5-LOX metabolites induce the release of cytokines (e.g., tumour necrosis factor-α [TNF-α], interleukin-1α [IL-1α], and interleukin-1β [IL-1β]) and express tissue factor on cell membranes and activate plasmin. Since macrophages, monocytes, neutrophils, and eosinophils can express lipoxygenases, activation of 5-LOX and the subsequent release of LTs may contribute to the severity of COVID-19. This review sheds light on the potential implications of 5-LOX in SARS-CoV-2-mediated infection and the anticipated therapeutic role of 5-LOX inhibitors.

The presence of SARS-CoV-2 in raw and treated wastewater in 3 cities of Iran: Tehran, Qom and Anzali during coronavirus disease 2019 (COVID-19) outbreak

This study aimed to identifying the presence of SARS-CoV-2 RNA in raw and treated wastewater during the COVID-19 outbreak in Tehran, Qom and Anzali cities (Iran). From three wastewater treatment plants (WWTPs), 28 treated and untreated wastewater composite samples were collected from April 4 to May 2, 2020. In this study, polyethylene glycol 6000 (PEG 6000) was used through one-step real-time quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) for identification of RNA viruses. SARS-CoV-2 RNA was elicited from wastewater composite samples in all inlet samples taken from the three above mentioned cities. The results of outlet samples were as follows: 1) Results from Qom and East Anzali outlets showed no trace of SARS-CoV-2 RNA despite the difference in treatment disinfection method used (chlorine vs. ultraviolet (UV) disinfection). 2. In Tehran, SARS-CoV-2 RNA was not detected in any of the outlet samples taken from the modules disinfected by UV. Out of the four samples taken from the modules disinfected by chlorine, two were positive for the SARS-CoV-2 RNA which could have been caused by deficiencies in operation and maintenance. It can be concluded that meeting the standards of operation and maintenance (O&M) in WWTPs can considerably ensure that wastewater does not act as one of the roots of transmission for the disease.

How COVID-19 Has Globalized: Unknown Origin, Rapid Transmission, and the Immune System Nourishment

The novel coronavirus disease (COVID-19) profoundly influences T-cell immunity. The counts of total T cells and T-cell subsets, especially CD4+ and CD8+ T cells, are decreased in patients with COVID-19. Also, the function of these cells becomes less effective as the expression of immune inhibitory receptors, such as Tim3 and PD-1, increases over time during the disease. Kinetic analyses show that the T-cell profile changes dynamically, so does the COVID-19 stages. As COVID-19 continues to deteriorate and progresses to severe/critical condition, the lymphocyte count steadily decreases. Therefore, the ability of COVID-19 to escape the immune system might lie in its power to profoundly diminish T-cell effective function, which is necessary for the establishment of a robust antiviral immunity. Also, COVID-19 is associated with increased numbers of monocytes and macrophages, and as the disease progresses from a mild form to a severe/critical condition, the macrophage population becomes denser. Monitoring the expression of cytokines associated with macrophage activation, mainly interleukin (IL)-6 and IL-10, indicates that the course of COVID-19 consists of two stages and the transition between disease stages occurs by the end of the first week after onset of symptoms. At the initial stage, the immune military recognizes the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as nonself and thus fires macrophages at the lungs against the virus. The first flame can control disease progression effectively. However, a trained immunocompetent system would maintain the fire of macrophages over an extended time. It lies in its immune memory in tissue-resident macrophages, especially alveolar macrophages, making a professionally trained immune system more likely to be feared by COVID-19 than an untrained immune system. In this manner, the trained immunocompetent system commits such a failure that causes the lungs to come down rapidly. The fact that younger age groups, including neonates and children, are less susceptible to COVID-19 than older age groups reflects that the natural affinities of the immune system that has not been trained thoroughly would be standard in combatting against COVID-19 whereas the higher affinities of the trained immune system for rapid activation of immune responses might raise faults - the lungs come down.

SARS-CoV-2 spillover transmission due to recombination event

In late 2019, a novel Coronavirus emerged in China. Perceiving the modulating factors of cross-species virus transmission is critical to elucidate the nature of virus emergence. Using bioinformatics tools, we analyzed the mapping of the SARS-CoV-2 genome, modeling of protein structure, and analyze the evolutionary origin of SARS-CoV-2, as well as potential recombination events. Phylogenetic tree analysis shows that SARS-CoV-2 has the closest evolutionary relationship with Bat-SL-CoV-2 (RaTG13) at the scale of the complete virus genome, and less similarity to Pangolin-CoV. However, the Receptor Binding Domain (RBD) of SARS-CoV-2 is almost identical to Pangolin-CoV at the aa level, suggesting that spillover transmission probably occurred directly from pangolins, but not bats. Further recombination analysis revealed the pathway for spillover transmission from Bat-SL-CoV-2 and Pangolin-CoV. Here, we provide evidence for recombination event between Bat-SL-CoV-2 and Pangolin-CoV that resulted in the emergence of SARS-CoV-2. Nevertheless, the role of mutations should be noted as another influencing factor in the continuing evolution and resurgence of novel SARS-CoV-2 variants.

COVID-19 Prevention Behaviors among Health Staff: Data from a Large Survey in the West of Iran

Background: Hospital staffs are at high risk of Novel Coronavirus (2019-nCoV preventive behaviors play a peculiar role in the reduction of the incidence and mortality of this infection. Therefore, the present study aimed to assess the prevention behaviors of COVID-19 among health staff based on the Extended Parallel Model (EPPM) in western Iran.

Study design: It was a cross-sectional study.

Methods: The present study was performed in the west of Iran in April 2020. In total, 1,664 cases were enrolled in this study via multi-stage sampling. The data were collected using a questionnaire, including the demographic characteristics of participants and EPPM constructs. All analyses were conducted in Stata software (version 14) at a 5% significant level.

Results: As evidenced by the obtained results, 1,523 (91.53%), 1,226 (73.68%), 1,526 (91.71%), 893 (53.67%), and 862 (51.86%) of health staff wear gloves, use masks, avoid contact with others, maintain a good distance from other people, and wash their hands frequently with water and soap, respectively. In terms of using gloves and avoiding contacts with others, participants with high perceived threat had higher odds of observing health behaviors (OR= 3.14, 95% CI: 2.08, 4.73; P<0.001) and (OR= 3.1, 95% CI: 2.04, 4.69; P<0.001), respectively. In all categories of EPPM, the participants with high efficacy had higher odds of exhibiting health behaviors, compared to those with low efficacy (P<0.001).

Conclusion: The results of the present study demonstrated that health workers are expected to be at the highest level of threat and efficiency. Moreover, the findings emphasized the effectiveness of the recommended strategies in the prevention of COVID-19 disease.

Assessment of general awareness among Pakistani students regarding COVID-19 outbreak

At the end of 2019, a novel infectious agent known as severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) originated from Hubei, China; from where it spread to other regions of the globe. In March 2020, World health organization (WHO) expressed fears that Pakistan might emerge as the next epicenter of corona virus infectious disease 2019 (COVID-19). Since proper preventive and curative measures are currently unavailable, only remedy is self-isolation which necessitates ample awareness among people. In this regard, Pakistan faces a unique challenge as it is a populous country with a record of contagious outbreaks in the past. Therefore, it is crucial to evaluate the general understanding regarding the cause, spread, control and psychological consequences of this pandemic in Pakistani population, especially in the youth that represents over 60% of the population. In this study, we have collected and analyzed responses related to awareness and attitude of students through a self-designed questionnaire. In total 1822 responses were collected and subjected to descriptive and frequency analysis. Outcomes of the survey suggest that majority of the respondents are well aware of the disease outbreak, complications and its mode of transmission. It is also evident from the obtained responses that youth of the country is willing to opt the precautionary measures and avoid mass gatherings.

Cutaneous Manifestations in Patients With COVID-19: Clinical Characteristics and Possible Pathophysiologic Mechanisms

The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections soon led to a pandemic with serious health, economic, political, and cultural repercussions across the globe. The disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19), is a multisystemic disease that requires a multidisciplinary approach involving specialists from all fields and levels of care. In this article, we review the literature on the diverse cutaneous manifestations associated with COVID-19. We also describe the pathophysiologic mechanisms proposed to date and their possible association with these manifestations. Finally, we propose a system for classifying the cutaneous manifestations of COVID-19 according to their underlying pathophysiologic mechanisms and prognosis.

Supplementation with vitamin D in the COVID-19 pandemic?

The coronavirus disease 2019 (COVID-19) pandemic was declared a public health emergency of international concern by the World Health Organization. COVID-19 has high transmissibility and could result in acute lung injury in a fraction of patients. By counterbalancing the activity of the renin-angiotensin system, angiotensin-converting enzyme 2, which is the fusion receptor of the virus, plays a protective role against the development of complications of this viral infection. Vitamin D can induce the expression of angiotensin-converting enzyme 2 and regulate the immune system through different mechanisms. Epidemiologic studies of the relationship between vitamin D and various respiratory infections were reviewed and, here, the postulated mechanisms and clinical data supporting the protective role of vitamin D against COVID-19-mediated complications are discussed.

Modes of Transmission of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) and Factors Influencing on the Airborne Transmission: A Review

The multiple modes of SARS-CoV-2 transmission including airborne, droplet, contact, and fecal-oral transmissions that cause coronavirus disease 2019 (COVID-19) contribute to a public threat to the lives of people worldwide. Herein, different databases are reviewed to evaluate modes of transmission of SARS-CoV-2 and study the effects of negative pressure ventilation, air conditioning system, and related protection approaches of this virus. Droplet transmission was commonly reported to occur in particles with diameter >5 µm that can quickly settle gravitationally on surfaces (1-2 m). Instead, fine and ultrafine particles (airborne transmission) can stay suspended for an extended period of time (≥2 h) and be transported further, e.g., up to 8 m through simple diffusion and convection mechanisms. Droplet and airborne transmission of SARS-CoV-2 can be limited indoors with adequate ventilation of rooms, by routine disinfection of toilets, using negative pressure rooms, using face masks, and maintaining social distancing. Other preventive measures recommended include increasing the number of screening tests of suspected carriers of SARS-CoV-2, reducing the number of persons in a room to minimize sharing indoor air, and monitoring people's temperature before accessing a building. The work reviews a body of literature supporting the transmission of SARS-CoV-2 through air, causing COVID-19 disease, which requires coordinated worldwide strategies.

COVID-19 Pandemic: A Compressive Review on Gender, Herd Immunity, and Physiological Mechanisms

BACKGROUND

Researchers and scientists experienced the spread and aid recovery of the COVID-19 pandemic with a condition of great uncertainty. With limited understanding of SARS-CoV-2, current attempts at controlling its spread are focused on the suppressing approach (to reduce a sustained endogenous transmission) and the mitigating approach (to reduce the growth rate of the epidemic). On the one hand, while there has been no firm explanation, many governments have considered immunity passport and herd immunity for paths out of restrictive physical distancing measures imposed to control the spread of SARS-CoV-2 but were not successful.

PURPOSE OF REVIEW

Herein, we attempted to systematize the lessons and shreds of evidence related to the spectrum of illness, the physiological mechanisms of host susceptibility, herd immunity, immunity passport, gender disparities, and severe challenges and uncertainties posed by the COVID-19 pandemic. We hope that the insights provided in this review will help raise the effectiveness of the treatment policies and preventive measures required to end the pandemic.

RECENT FINDINGS

The use of immunity passports is suggested to certify an individual at low risk of acquiring or transmitting SARS-CoV-2. But, an individual might nevertheless carry the virus at similar levels and for a similar duration to those previously uninfected, with an unchanged potential for transmission. Vaccine-induced herd immunity is a complex issue inherent to a vaccine and the population receiving the vaccine. The central epidemiological questions about are as follows: what proportion of the population should be vaccinated to meet elimination (in a local program), eradication (in a global program) or a defined level of control? How is this affected by demographic factors (such as gender)? What is the best age at which to immunize? Besides, although age-dependent mortality risk is estimated to be higher for men and older people, such interpretation across gender, age groups, and countries, however, must be accepted with caution at present.

SUMMARY

COVID-19 has taught us that health is the basis of global wealth and international solidarity is an essential response and a superior approach to isolationism. Hence, we must be clear about what the alternatives are when evaluating the merits of different ways of tackling this pandemic both in the short term as well as in the long term.

An effective drug against COVID-19: reality or dream?

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is well known as a novel member of the coronavirus family which caused a sudden outbreak of Coronavirus disease-2019 (COVID-19) in China that quickly developed into a global pandemic. No effective approaches are found as yet for the therapy and epidemiological control of this new virus. We searched the literature in PubMed, Scopus, Web of Knowledge, Google Scholar, and MeSH, for articles and abstracts describing SARS-CoV-2, COVID-19, pneumonia, clinical trials, drug, treatment, and medicine.Areas covered: The present study aimed to comprehensively overview the current literature on effective anti-SARS-CoV-2 drugs.Expert opinion: Since the beginning of this pandemic disease, many studies have been conducted to find effective drugs to prevent COVID-19, because there are no specific drugs for the treatment of this disease. Most of these drugs with the antiviral potential effect toward COVID-19 are already used as the treatment of other infectious diseases. Some drugs that show the promising therapeutic potential in the initial clinical studies include remdesivir as an inhibitor of RNA-dependent RNA polymerase and favipiravir as an inhibitor of virus replication. Currently, remdesivir received the FDA authorizes to use as an experimental drug for emergency use in COVID-19 patients.

Cutaneous Manifestations in Patients With COVID-19: Clinical Characteristics and Possible Pathophysiologic Mechanisms

La infección por SARS-CoV-2 se ha convertido rápidamente en una pandemia con importantes implicaciones en ámbitos sanitarios, económicos, políticos y culturales en todo el planeta. La enfermedad que produce, llamada COVID-19, es considerada actualmente una patología florida y de obligatorio manejo multidisciplinario por todas las especialidades médicas y de servicios de salud.

Este artículo presenta una revisión bibliográfica de las variadas manifestaciones cutáneas a causa de la COVID-19. Posteriormente, se mencionan los diversos engranajes fisiopatológicos que se han postulado hasta el momento y su posible relación con los hallazgos de la enfermedad en la piel. Por último, se propone una clasificación de las manifestaciones cutáneas según mecanismos fisiopatológicos de base y pronóstico de la enfermedad.

Variety of radiological findings in a family with COVID-19: a case report

Introduction

In December 2019, a case series of pneumonia associated with seafood and wet animal market was reported as coronavirus disease 2019 (COVID-19) in Wuhan, Hubei, China. The COVID-19 less frequently affects the pediatric group, and asymptomatic children are commonly reported. This feature is important due to the potential transmissibility of COVID-19 through these cases. There is a variety of atypical clinical symptoms and imaging manifestations among children infected with COVID-19.

Case presentation

We report two sisters with COVID-19 pneumonia who had close contact with their 77-year-old grandmother. Their grandmother expired with a confirmed diagnosis of COVID-19. The older sister (15 years old) firstly presented with severe cough, fever, dyspnea, diarrhea, and lymphopenia. A chest computed tomography (CT) scan showed atypical lobar pneumonic infiltration only in the left lower lobe. The younger sister (6 years old) was affected the following day with milder symptoms (i.e., fever and cough). Her chest CT scan demonstrated typical mild generalized patchy ground-glass opacity with interlobular septal thickening scattered in both lungs. The CT presentation of their grandmother showed typical bilateral white lungs with crazy paving appearance. The standard regimen for both sisters was administrated, and the patients’ respiratory conditions improved after 5 days of treatment. Both cases were discharged with good general conditions.

Conclusion

Children are considered potentially important causes of COVID-19 transmission. The symptoms in children are milder, and clinicians should be aware of taking a definite history of infected family members. Atypical clinical symptoms and imaging features are more common in children than adults; therefore, it is necessary to identify the typical and atypical imaging patterns of COVID-19 pneumonia in the pediatric population.

A systematic review on recent trends in transmission, diagnosis, prevention and imaging features of COVID-19

As the new cases of COVID-19 are growing every daysince January 2020, the major way to control the spread wasthrough early diagnosis. Prevention and early diagnosis are the key strategies followed by most countries. This study presents the perspective of different modes of transmission of coronavirus,especially during clinical practices and among the pediatrics. Further, the diagnostic methods and the advancement of the computerized tomography have been discussed. Droplets, aerosol, and close contact are thesignificantfactors to transfer the infection to the suspect. This study predicts the possible transmission of the virus through medical practices such as ophthalmology, dental, and endoscopy procedures. With regard to pediatric transmission, as of now, only afew child fatalities had been reported. Childrenusually respond to the respiratory virus; however, COVID-19 response ison the contrary. The possibility of getting infected is minimal for the newborn. There has been no asymptomatic spread in children until now. Moreover, breastfeedingwould not transmit COVID-19, which is encouraging hygiene news for the pediatric. In addition, the current diagnostic methods for COVID-19 including Immunoglobulin M (IgM) and Immunoglobulin G (IgG)and chest computed topography(CT) scan, reverse transcription-polymerase chain reaction (RT-PCR) andimmunochromatographic fluorescence assay, are also discussed in detail. The introduction of artificial intelligence and deep learning algorithmhas the ability to diagnose COVID-19 in precise. However, the developments of a potential technology for the identification of the infection, such as a drone with thermal screening without human intervention, need to be encouraged.

Recognition of COVID-19 disease from X-ray images by hybrid model consisting of 2D curvelet transform, chaotic salp swarm algorithm and deep learning technique

The novel coronavirus disease 2019 (COVID-19), detected in Wuhan City, Hubei Province, China in late December 2019, is rapidly spreading and affecting all countries in the world. Real-time reverse transcription-polymerase chain reaction (RT-PCR) test has been described by the World Health Organization (WHO) as the standard test method for the diagnosis of the disease. However, considering that the results of this test are obtained between a few hours and two days, it is very important to apply another diagnostic method as an alternative to this test. The fact that RT-PCR test kits are limited in number, the test results are obtained in a long time, and the high probability of healthcare personnel becoming infected with the disease during the test, necessitates the use of other diagnostic methods as an alternative to these test kits. In this study, a hybrid model consisting of two-dimensional (2D) curvelet transformation, chaotic salp swarm algorithm (CSSA) and deep learning technique is developed in order to determine the patient infected with coronavirus pneumonia from X-ray images. In the proposed model, 2D Curvelet transformation is applied to the images obtained from the patient's chest X-ray radiographs and a feature matrix is formed using the obtained coefficients. The coefficients in the feature matrix are optimized with the help of the CSSA and COVID-19 disease is diagnosed by the EfficientNet-B0 model, which is one of the deep learning methods. Experimental results show that the proposed hybrid model can diagnose COVID-19 disease with high accuracy from chest X-ray images.

The effects of regional climatic condition on the spread of COVID-19 at global scale

The pandemic outbreak of the novel coronavirus epidemic disease (COVID-19) is spreading like a diffusion-reaction in the world and almost 208 countries and territories are being affected around the globe. It became a sever health and socio-economic problem, while the world has no vaccine to combat this virus. This research aims to analyze the connection between the fast spread of COVID-19 and regional climate parameters over a global scale. In this research, we collected the data of COVID-19 cases from the time of 1st reported case to the 5th June 2020 in different affected countries and regional climatic parameters data from January 2020 to 5th June 2020. It was found that most of the countries located in the relatively lower temperature region show a rapid increase in the COVID-19 cases than the countries locating in the warmer climatic regions despite their better socio-economic conditions. A correlation between metrological parameters and COVID-19 cases was observed. Average daylight hours are correlated to total the COVID-19 cases with a coefficient of determination of 0.42, while average high-temperature shows a correlation of 0.59 and 0.42 with total COVID-19 cases and death cases respectively. The finding of the study will help international health organizations and local administrations to combat and well manage the spread of COVID-19.

COVID-19 Infection: Concise Review Based on the Immunological Perspective

The outbreak of coronavirus disease 2019 (COVID-19) has posed a serious threat to public health. There is an urgent need for discovery methods for the prevention and treatment of COVID-19 infection. Understanding immunogenicity together with immune responses are expected to provide further information about this virus. We hope that this narrative review article may create new insights for researchers to take great strides toward designing vaccines and novel therapies in the near future. The functional properties of the immune system in COVID-19 infection is not exactly clarified yet. This is compounded by the many gaps in our understanding of the SARS-CoV-2 immunogenicity properties. Possible immune responses according to current literature are discussed as the first line of defense and acquired immunity. Here, we focus on proposed modern preventive immunotherapy methods in COVID-19 infection.

COVID-19: una revisión de la evidencia en el ámbito pediátrico

En el contexto de la pandemia por COVID-19, es importante la selección y el uso adecuado de los conocimientos nuevos y de aquellos adquiridos en situaciones históricas similares, para garantizar una correcta toma de decisiones en cuanto a la prevención, manejo y tratamiento de esta enfermedad en la población pediátrica. Desde inicios del 2020, la atención se ha focalizado en el control de la pandemia y en el manejo de los pacientes con esta enfermedad, cuya mayoría se encuentra en la población adulta. Sin embargo, recientemente se han observado cursos más severos de la enfermedad en pacientes pediátricos y lo que inicialmente se consideraba como una patología inofensiva ha generado mayores alertas en esta población por la presencia de complicaciones severas. Por lo anterior, la presente revisión busca determinar las últimas estrategias de prevención, diagnóstico y tratamiento avaladas y soportadas por la evidencia científica, de manera que se aporten las herramientas necesaria para garantizar un manejo adecuado y disminuir, en la medida de lo posible, los desenlaces fatales en la población pediátrica. 

Coronavirus Disease 2019-COVID-19

SUMMARYIn recent decades, several new diseases have emerged in different geographical areas, with pathogens including Ebola virus, Zika virus, Nipah virus, and coronaviruses (CoVs). Recently, a new type of viral infection emerged in Wuhan City, China, and initial genomic sequencing data of this virus do not match with previously sequenced CoVs, suggesting a novel CoV strain (2019-nCoV), which has now been termed severe acute respiratory syndrome CoV-2 (SARS-CoV-2). Although coronavirus disease 2019 (COVID-19) is suspected to originate from an animal host (zoonotic origin) followed by human-to-human transmission, the possibility of other routes should not be ruled out. Compared to diseases caused by previously known human CoVs, COVID-19 shows less severe pathogenesis but higher transmission competence, as is evident from the continuously increasing number of confirmed cases globally. Compared to other emerging viruses, such as Ebola virus, avian H7N9, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 has shown relatively low pathogenicity and moderate transmissibility. Codon usage studies suggest that this novel virus has been transferred from an animal source, such as bats. Early diagnosis by real-time PCR and next-generation sequencing has facilitated the identification of the pathogen at an early stage. Since no antiviral drug or vaccine exists to treat or prevent SARS-CoV-2, potential therapeutic strategies that are currently being evaluated predominantly stem from previous experience with treating SARS-CoV, MERS-CoV, and other emerging viral diseases. In this review, we address epidemiological, diagnostic, clinical, and therapeutic aspects, including perspectives of vaccines and preventive measures that have already been globally recommended to counter this pandemic virus.

Coronavirus Disease 2019-COVID-19

SUMMARYIn recent decades, several new diseases have emerged in different geographical areas, with pathogens including Ebola virus, Zika virus, Nipah virus, and coronaviruses (CoVs). Recently, a new type of viral infection emerged in Wuhan City, China, and initial genomic sequencing data of this virus do not match with previously sequenced CoVs, suggesting a novel CoV strain (2019-nCoV), which has now been termed severe acute respiratory syndrome CoV-2 (SARS-CoV-2). Although coronavirus disease 2019 (COVID-19) is suspected to originate from an animal host (zoonotic origin) followed by human-to-human transmission, the possibility of other routes should not be ruled out. Compared to diseases caused by previously known human CoVs, COVID-19 shows less severe pathogenesis but higher transmission competence, as is evident from the continuously increasing number of confirmed cases globally. Compared to other emerging viruses, such as Ebola virus, avian H7N9, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 has shown relatively low pathogenicity and moderate transmissibility. Codon usage studies suggest that this novel virus has been transferred from an animal source, such as bats. Early diagnosis by real-time PCR and next-generation sequencing has facilitated the identification of the pathogen at an early stage. Since no antiviral drug or vaccine exists to treat or prevent SARS-CoV-2, potential therapeutic strategies that are currently being evaluated predominantly stem from previous experience with treating SARS-CoV, MERS-CoV, and other emerging viral diseases. In this review, we address epidemiological, diagnostic, clinical, and therapeutic aspects, including perspectives of vaccines and preventive measures that have already been globally recommended to counter this pandemic virus.

Coronavirus Disease 2019-COVID-19

SUMMARYIn recent decades, several new diseases have emerged in different geographical areas, with pathogens including Ebola virus, Zika virus, Nipah virus, and coronaviruses (CoVs). Recently, a new type of viral infection emerged in Wuhan City, China, and initial genomic sequencing data of this virus do not match with previously sequenced CoVs, suggesting a novel CoV strain (2019-nCoV), which has now been termed severe acute respiratory syndrome CoV-2 (SARS-CoV-2). Although coronavirus disease 2019 (COVID-19) is suspected to originate from an animal host (zoonotic origin) followed by human-to-human transmission, the possibility of other routes should not be ruled out. Compared to diseases caused by previously known human CoVs, COVID-19 shows less severe pathogenesis but higher transmission competence, as is evident from the continuously increasing number of confirmed cases globally. Compared to other emerging viruses, such as Ebola virus, avian H7N9, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 has shown relatively low pathogenicity and moderate transmissibility. Codon usage studies suggest that this novel virus has been transferred from an animal source, such as bats. Early diagnosis by real-time PCR and next-generation sequencing has facilitated the identification of the pathogen at an early stage. Since no antiviral drug or vaccine exists to treat or prevent SARS-CoV-2, potential therapeutic strategies that are currently being evaluated predominantly stem from previous experience with treating SARS-CoV, MERS-CoV, and other emerging viral diseases. In this review, we address epidemiological, diagnostic, clinical, and therapeutic aspects, including perspectives of vaccines and preventive measures that have already been globally recommended to counter this pandemic virus.

SARS-CoV-2/COVID-19 and advances in developing potential therapeutics and vaccines to counter this emerging pandemic

A novel coronavirus (SARS-CoV-2), causing an emerging coronavirus disease (COVID-19), first detected in Wuhan City, Hubei Province, China, which has taken a catastrophic turn with high toll rates in China and subsequently spreading across the globe. The rapid spread of this virus to more than 210 countries while affecting more than 25 million people and causing more than 843,000 human deaths, it has resulted in a pandemic situation in the world. The SARS-CoV-2 virus belongs to the genus Betacoronavirus, like MERS-CoV and SARS-CoV, all of which originated in bats. It is highly contagious, causing symptoms like fever, dyspnea, asthenia and pneumonia, thrombocytopenia, and the severely infected patients succumb to the disease. Coronaviruses (CoVs) among all known RNA viruses have the largest genomes ranging from 26 to 32 kb in length. Extensive research has been conducted to understand the molecular basis of the SARS-CoV-2 infection and evolution, develop effective therapeutics, antiviral drugs, and vaccines, and to design rapid and confirmatory viral diagnostics as well as adopt appropriate prevention and control strategies. To date, August 30, 2020, no effective, proven therapeutic antibodies or specific drugs, and vaccines have turned up. In this review article, we describe the underlying molecular organization and phylogenetic analysis of the coronaviruses, including the SARS-CoV-2, and recent advances in diagnosis and vaccine development in brief and focusing mainly on developing potential therapeutic options that can be explored to manage this pandemic virus infection, which would help in valid countering of COVID-19.

A large number of COVID-19 interventional clinical trials were registered soon after the pandemic onset: a descriptive analysis

BACKGROUND AND OBJECTIVE

There is a pressing need for evidence-based interventions to address the devastating clinical and public health effects of the coronavirus disease 2019 (COVID-19) pandemic. The number of registered trials related to COVID-19 is increasing by the day. The objective of this study was to describe the characteristics of the currently registered interventional clinical trials related to COVID-19.

METHODS

We searched the World Health Organization's International Clinical Trials Registry Platform on May 15th, 2020. We included any entry that is related to COVID-19. We abstracted and then descriptively analyzed the following characteristics of the registered trials: study design, status, phase, primary endpoints, experimental interventions, and geographic location among other qualifiers.

RESULTS

We identified 1,308 eligible registered trials. Most trials were registered with ClinicalTrials.gov (n = 703; 53.7%) and the Chinese Clinical Trial Registry (n = 291; 22.2%). The number of participants to be enrolled across these trials was 734,657, with a median of 110 participants per trial. The most commonly studied intervention category was pharmacologic (n = 763; 58.3%), with antiparasitic medications being the most common subcategory. Although over half of the trials were already recruiting, we identified published peer-reviewed results for only 8 of those trials.

CONCLUSION

There is a relatively large number of registered trials but with very few results published so far. Although our findings suggest an appropriate initial response by the research community, the real challenge will be to get these trials completed, published, and translated into practice and policy.

[Laparoscopic surgery in the COVID-19 era]

Coexistence with COVID-19 infection (coronavirus disease 2019) in all hospital and health care settings is a current challenge of adaptation, as well as the creation of new protocols and care models. At present, there are still many unknowns about this infection, and much more unknown is the impact into the surgical field. Although evidence regarding the effect of SARS-CoV-2 and laparoscopic surgery is scarce, laparoscopy has been considered the method of choice by different scientific societies for most indications in gynaecology during the COVID-19 pandemic. This is due to the advantages over the open route. There is less morbidity and hospital stay, and in addition, as it involves autonomous and contained surgical procedures with respect to smoke release. Moreover, the instruments and the setting in the operating room mean that there can be safe distance from the surgeon and other staff to the patient. Overall, the main recommendations in laparoscopic surgery during the COVID era include: the use of Personal Protective Equipment for operating room personnel, and the adoption of safety measures to reduce CO2 exposure and surgical smoke release.

Mysterious Virus: A Review on Behavior and Treatment Approaches of the Novel Coronavirus, 2019-nCoV

At the end of the year 2019, the novel coronavirus (2019-nCoV) was spreading in Wuhan, China, and the outbreak process has a high speed. It was recognized as a pandemic by the World Health Organization (WHO) on 11 March 2020. Coronaviruses are enveloped and single-stranded RNA that have several families including Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The pathogenesis mechanism and disease outcomes of SARS and MERS are now clear to some extent, but little information is available for 2019-nCoV. This newly identified corona virus infection represents flu-like symptoms, but usually the first symptoms are fever and dry cough. There has been no specific treatment against 2019-nCoV up to now, and physicians only apply supportive therapy. In the present article, we made an attempt to review the behavior of the virus around the world, epidemiology, a pathway for influx into the host cells, clinical presentation, as well as the treatments currently in use and future approaches; nitazoxanide may be our dream drug. We hope that this review has a positive impact on public knowledge for helping to deal with the 2019-nCoV and move one step forward toward its treatment in the near future.

COVID-19: therapeutic approaches description and discussion

COVID-19 emerged in December 2019 in China, and since then, has disrupted global public health and changed economic paradigms. In dealing with the new Coronavirus, SARS-CoV-2, the world has not faced such extreme global fragility since the "Spanish flu" pandemic in 1918. Researchers globally are dedicating efforts to the search for an effective treatment for COVID-19. Drugs already used in a clinical setting for other pathologies have been tested as a new therapeutic approach against SARS-CoV-2, setting off a frenzy over the preliminary data of different studies. This work aims to compile and discuss the data published thus far. Despite the potential effects of some antivirals and antiparasitic against COVID-19, clinical studies must confirm real effectiveness. However, non-pharmacological approaches have proven to be the most efficient strategy to date.

Contributions of Latin American researchers in the understanding of the novel coronavirus outbreak: a literature review

This article aimed to give the visibility of Latin American researchers' contributions to the comprehension of COVID-19; our method was a literature review. Currently, the world is facing a health and socioeconomic crisis caused by the novel coronavirus, SARS-CoV-2, and its disease COVID-19. Therefore, in less than 4 months, researchers have published a significant number of articles related to this novel virus. For instance, a search focused on the Scopus database on 10 April 2020, showed 1,224 documents published by authors with 1,797 affiliations from 80 countries. A total of 25.4%, 24.0% and 12.6% of these national affiliations were from China, Europe and the USA, respectively, making these regions leaders in COVID-19 research. In the case of Latin America, on 10 April 2020, we searched different databases, such as Scopus, PubMed and Web of Science, finding that the contribution of this region was 2.7 ± 0.6% of the total publications found. In other words, we found 153 publications related to COVID-19 with at least one Latin American researcher. We summarized and processed the information from these 153 publications, finding active participation in topics like medical, social and environmental considerations, bioinformatics and epidemiology.

Analysis of Outbreak and Global Impacts of the COVID-19

Corona viruses are a large family of viruses that are not only restricted to causing illness in humans but also affect animals such as camels, cattle, cats, and bats, thus affecting a large group of living species. The outbreak of Corona virus in late December 2019 (also known as COVID-19) raised major concerns when the outbreak started getting tremendous. While the first case was discovered in Wuhan, China, it did not take long for the disease to travel across the globe and infect every continent (except Antarctica), killing thousands of people. Since it has become a global concern, different countries have been working toward the treatment and generation of vaccine, leading to different speculations. While some argue that the vaccine may only be a few weeks away, others believe that it may take some time to create the vaccine. Given the increasing number of deaths, the COVID-19 has caused havoc worldwide and is a matter of serious concern. Thus, there is a need to study how the disease has been propagating across continents by numbers as well as by regions. This study incorporates a detailed description of how the COVID-19 outbreak started in China and managed to spread across the globe rapidly. We take into account the COVID-19 outbreak cases (confirmed, recovered, death) in order to make some observations regarding the pandemic. Given the detailed description of the outbreak, this study would be beneficial to certain industries that may be affected by the outbreak in order to take timely precautionary measures in the future. Further, the study lists some industries that have witnessed the impact of the COVID-19 outbreak on a global scale.

Successful recovery of COVID-19 pneumonia in a patient from Colombia after receiving chloroquine and clarithromycin

BACKGROUND

COVID-19 pandemics is a challenge for public health and infectious diseases clinicians, especially for the therapeutical approach that is not yet adequately defined. Amid this situation, investigational agents are being used, including chloroquine. We report here the clinical features and therapeutic course of the first reported patient with confirmed COVID-19 pneumonia that recovered in Colombia, after the use of chloroquine and clarithromycin.

CASE PRESENTATION

A 34-year-old male, returning from Spain, presented with complaints of fever, and cough, and class-II obesity, being hospitalized. The respiratory viruses and bacteria tested by FilmArray^® PCR were negative. Two days later, clarithromycin was started because the patient was suspected as community-acquired pneumonia. At the third day, the rRT-PCR confirmed the SARS-CoV-2 infection. A day later, chloroquine was started because of that. His chest computed tomography was performed and showed bilateral multifocal ground-glass opacities with consolidation, which suggested viral pneumonia as a differential diagnosis. Progressively his clinical condition improved and at day 9, patient rRT-PCR for SARS-CoV-2 became negative. The patient was discharged and isolated at home per 14 days.

CONCLUSIONS

Our patient improved significantly. This and other COVID-19 cases are urgently demanding results from clinical trials that support evidence-based therapeutical approaches to this pandemic and the clinical management of patients, especially those at critical care.

Endoscopia digestiva en tiempos de covid-19: Resumen de recomendaciones

La situación actual de pandemia por COVID-19, ha puesto en evidencia las debilidades y necesidades no atendidas del sector salud en Colombia. Salieron a la luz las inequidades de un sistema económico y social, que desde hace varios años venía disminuyendo la protección laboral, económica y jurídica del talento humano en salud del país, que en estos momentos se ven enfrentando una batalla difícil, ante un enemigo todavía poco conocido.

Is Pakistan prepared for the COVID-19 epidemic? A questionnaire-based survey

COVID‐19 is a pandemic that began in China in December 2019. World health organization (WHO) has expressed fears that Pakistan might emerge as the next epicenter of this pandemic. We hypothesize that at present the Pakistani masses are not prepared to face any threat of a looming epidemic. The main aim of this study was to evaluate the basic knowledge of educational and health care workers (HCWs) regarding COVID‐19, its control, and prevention. Knowledge about origin, symptoms, and spread of viral infection was assessed. In this cross‐sectional survey, a self‐designed questionnaire was distributed among 302 HCWs including physicians (10.9%), nurses (1.32%), lab staff (1.65%), and academic individuals including faculty and students (86.42%) of different organizations. Results were analyzed using the χ² test. Obtained results validate our null hypothesis that Pakistani masses are not well aware of the COVID‐19 and strategies for the prevention and control of infection. The study concluded that individuals belonging to the front‐line workers and high literacy groups are not prepared for the alarming situation in the country. Effectual implementation of infection control programs should be practiced, and it depends on awareness, training, and cooperation of individuals.

Pakistan is facing a looming threat of COVID‐19 epidemic.

Strict measures need to be taken to avert the threat of COVID‐19.

Vigilant training sessions should be carried out for front‐line workers.

Una nueva zoonosis viral de preocupación global

Los coronavirus (CoV) en sentido amplio son un grupo de virus de ARN de cadena simple con envoltura. Estos pertenecen a la subfamilia Orthocoronavirinae, familia Coronaviridae, en el orden Nidovirales. Se clasifican en cuatro géneros: alfa, beta, gamma y Deltacoronavirus. Los dos primeros pueden infectar al ser humano (1,2). Los CoV son agentes patógenos que pueden ser transmitidos a los animales y al hombre; tienen una distribución mundial (3-5). La infección por CoV en animales particularmente en bovinos, cerdos, perros, entre otros, es conocida desde hace muchas décadas; estos al infectarse pueden presentar diarrea; de modo especial las aves desarrollan compromiso respiratorio semejante a una bronquitis. Los coronavirus, singularmente los de tipo beta, son zoonóticos es por ello que una completa vigilancia epidemiológica debería incluir también a los animales ya que son hospedadores susceptibles (6). Lo último hace parte de las iniciativas de “One Health”, que promueve y fomenta el estudio integrado de la salud humana, animal y ambiental (7).   En estas patologías virales el papel de la cadena de transmisión animal-humano es de importancia, pero, como se ha observado con varios virus del género Betacoronavirus, también se da una transferencia entre humanos (1,8). En los humanos los CoV pueden originar diferentes enfermedades, desde resfriados frecuentes, hasta otras más graves como el síndrome respiratorio agudo grave (causado por el SRAG-CoV) y el síndrome respiratorio del oriente medio (causado por el MERS-CoV) (Figura 1). El SARS fue identificado por primera vez a finales del 2002 en Guangzhou (Guangdong, China), cuando provocó 8.422 casos y 916 muertes en 29 países de los cincos continentes, por consiguiente, se denominó la primera pandemia del siglo xxi (2,9,10).  Se destacan los que afectan a los humanos, en particular, los tres que pueden producir una patología severa y se incluye su origen geográfico en Asia. Fuente: creación propia   En investigaciones posteriores se demostró evidencias que el SARS-CoV se originó a partir de la transmisión del gato civeta del Himalaya (Civettictis civetta). Sin embargo, pueden existir otras especies de animales, principalmente murciélagos y mapaches, (Paguna larvata) que albergan el virus (8,11).   Por otra parte, el MERS-CoV originado en Arabia Saudita en el año 2012, rápidamente se extendió a varios países, notificándose en el continente asiático, africano, europeo y americano. Posterior a la identificación del virus, se confirmaron los vínculos epidemiológicos entre los casos de los humanos y los camellos (Figura 2), que dieron como resultado el aislamiento del virus (12-14). Previo a estos CoV, se han identificado otros cuatro más que generalmente, causan enfermedad respiratoria leve o moderada, como son HCoV-NL63, HCoV-229E, HCoV-OC43 y HCoV-HKU1 (Figura 1) (5,9,15-17). En pacientes inmunosuprimidos como aquellos con infección por VIH/SIDA, pueden evolucionar, incluso, hasta la muerte, como se ha reportado recientemente en Sucre: un caso de coinfección con virus sincitial respiratorio humano (VSR) (18). Un nuevo coronavirus, designado como 2019-nCOV, surgió en Wuhan, China, a finales del año 2019, causando manifestaciones respiratorias, digestivas y sistemáticas que afectan la salud humana. El susodicho virus pertenece a la familia Betacoronavirus, puede infectar neumocitos tipos 2 y células epiteliales bronquiales ciliadas. Adicionalmente, hasta el momento los datos plantean que los murciélagos son la causa inicial del brote actual de CoV (2019nCoV), que se originó en un “mercado húmedo o de alimentos marinos” (19-21). Este nuevo coronavirus, al 21 de febrero del 2020, ha causado ya casi 77.000 casos de infección y más de 2.200 muertes (< 3 %). Estudios realizados han demostrado que son virus de ARN monocatenarios fáciles de mutar, lo cual aumenta la diversidad de especies y le da la capacidad de adaptarse rápidamente a nuevos hospedantes. Estos animales podrían amplificar el virus y propagarlo a través de las secreciones y heces. Los casos de SARS-CoV y 2019-nCOV son ocasionados por el contacto con animales obtenidos en un mercado. La Organización Mundial de la Salud declaró al problema como una emergencia sanitaria de preocupación internacional y, además, le denominó “Enfermedad por Coronavirus 2019” (COVID-19). Posteriormente, el Grupo de Estudio de Coronavirus le asignó al virus el nombre de SARS-CoV2 (2,22,23). El enfoque de intervención de COVID-19 debe hacerse bajo la óptica de One Heatlh (7), esto si se tiene en cuenta que un animal tan importante como el murciélago (24), tenga pocos estudios de prevalencia para identificar la presencia del SARS-CoV2. Si se fortalece la vigilancia de estos animales podemos intervenir de manera importante, su ocurrencia en la población de humanos susceptibles, esto se puede lograr al entender que este COVID-19 es una enfermedad zoonótica. Hay que fortalecer los sistemas de salud pública de los países integrando la comprensión de las relaciones entre el animal-hospedador, humano-susceptible y medio ambiente, un manejo único interdisciplinario, buena comunicación y coordinación, con unas políticas de salud pública robustas (25). Por último, se ha realizado un gran esfuerzo para identificar los coronavirus en las poblaciones animales, con el fin de entender y controlar el riesgo de transmisión zoonótica. Lo que ha dado lugar al descubrimiento de numerosas especies en diferentes animales. El SARS-CoV2 es una zoonosis viral que, al 16 de febrero del 2020, no se ha confirmado en Colombia ni América Latina, sin embargo, múltiples casos sospechosos se han investigado y todos han sido descartados. Por esto, los profesionales de la salud, especialmente, los de la medicina humana y veterinaria, deben estar atentos ante esta nueva zoonosis viral que se originó en animales, pero que se transmite también entre seres humanos, principalmente por vía respiratoria (2).

Self-Perceived Stress During the Quarantine of COVID-19 Pandemic in Paraguay: An Exploratory Survey

Introduction: Any viral pandemic is a global health and mental health issue. The World Health Organization and mental health associations have warned that the current COVID-19 pandemic will lead to a drastic increase of stress-related conditions and mental health issues globally. Materials and Methods: An online web-based survey has been launched from 10 to 15 April 2020 in Paraguay in order to collect information regarding the stress related to the quarantine during the COVID-19 pandemic. It has been spread through social media ("WhatsApp," "Twitter," and "Facebook"). Two thousand two hundred and six Paraguayan citizens, over 18 years of age, completed the survey voluntarily. Socio-demographics as well as ratings at Self-perceived Stress Scale have been collected and analyzed. Results: Two thousand two hundred and six subjects (74.12% men) aged between 18 and 75 with an average of 34 ± 11 years old completed the survey. 12.42% (276 subjects) of sample reported a preexisting diagnosis of mental disorder, and 175 participants (7.93%) reported an increase of preexisting symptoms with the onset of COVID-19 quarantine. 41.97% of them had anxiety and 54.38% did not receive any specific treatment. The general population rated 18.10 ± 5.99 at Self-perceived Stress Scale, which indicates a moderate level of self-perceived stress. Significant association was found between higher levels of stress and female sex, being single, or reporting preexisting mental disorder, above all anxiety and depression (p < 0.01). In fact, in 63.87% of mentally ill subjects (n = 175), the quarantine has worsened symptoms of preexisting mental disorders. Conclusion: This study suggests a stressful impact of COVID-19 pandemic, with the majority of participants reporting a moderate level of self-perceived stress. We suggest mental health services to provide a phone-based or web-based support to the general population in order to contrast the psychological impact of the pandemic. This approach may improve the accessibility to mental healthcare services in Paraguay, especially in times of social distancing.

Epidemic preparedness for COVID-19: A major challenge!

Epidemic outbreaks and biological disasters pose serious challenges to the country due to enormous population and weak public health system; to combat the same, we need epidemic preparedness. The steps of epidemic preparedness embrace and incorporate to anticipate, prevent, prepare, detect, and respond. The four stages of the present epidemic COVID-19 have been described. The requirement of proper coordination among the epidemiologist, clinician, laboratory personnel, and health educator is sum and substance of it. Levels for epidemic preparedness inculcate preparation at four levels including central, state, local, and health facility. The impact of epidemic has adverse health, social, as well as economic implications.