INTRODUCTION TO COVID-19 PANDEMIC, GLOBAL OUTBREAK AND SCENARIO IN INDIA

COVID-19 pandemic affecting the nations globally, caused by a beta-corona virus named as SARS-CoV-2 affecting the lower respiratory tract and manifests as common cold and cough and leading to severe pneumonia in humans, fever being the most common listed side effect.COVID-19 spread is quick, through human to human touch or surface touch/ fomites, when an infected person coughs sneezes or speaks¹², passes on the respiratory droplets and by touching a contaminated surface.

In an India today report¹⁵ published on 24^th April 2020, a new potential symptom is seen by professionals in Italy, particularly infected kids, and young adults showed inflammation of toes and feet, and discoloration of the organ in Covid-19 infected patients. Talking of atypical symptoms, few have been reported with sudden loss of taste or smell.

The global outbreak has led to substantial morbidity and mortality¹³ nearly 4%, the incidences continue to rise exponentially among the countries affected by the pandemic is the U.S.A. being on top followed by Spain, Italy, and France. This pandemic has alarmed the countries resulting in the global alert which has prevented spread in countries¹³.

India being a developing nation with more than 1.3 billion people, with 15122 -active Cases, 3259- cured/discharged and 603 –Deaths, data¹⁰ reported on the site My Gov, Government of India on 21/04/2020. In India also, High death rates are seen among elderly¹¹ and in patients that had multiple illnesses, in a similar trend to that of data present on national and global sites. In terms of the numbers compared to many developed countries, it’s so early to conclude that India is doing fairly well in preventing the spread.

Perhaps, possible reasons for that could be a national lockdown, played a critical role in the community spread and aggressive contact tracing from various heavy public spots like airports, traveling histories. Complete eradication has a long way to go achieve the goal.

Figure 1 showing graphical representation of number of cases reported worldwide and deaths (see reference 9*)

MATERIAL AND METHODS:

Comprehensive systematic search was performed for articles in PubMed, World health organization and Google Scholar databases from 14 April 2020 till 24/04/2020, with the following keywords: "SARS-CoV-2", "COVID-19", "transmission", "clinical features", "diagnosis", "treatment", and “diabetes mellitus". Relevant articles that reported clinical characteristics patients were included in the analysis irrespective any design (randomized controlled trials, non-randomized controlled trials, case-control studies, cross-sectional studies). Articles were excluded if appropriate information was not reported.

Risk factors of COVID infection in vulnerable groups with co-morbid conditions /illness:

Co-morbidity is the presence of more than one health disorder in a person simultaneously, not necessarily these disorders will exist due to the same underlying causes¹¹, they may exist independent of each other, or maybe interlinked, conditions like retinopathy, and neuropathy is a co-morbid result of prolonged Diabetes. Patients suffering from already known pre-disposing fatal conditions such as diabetes, transplant recipients, cancers and other fatal diseases which have made them immuno-compromised¹³have already open arms to the entry of this virus infection. They will not be able to fight off this disease due to their vulnerability, thus they need to be more careful.

Among all the conditions, diabetes mellitus (12.1%) is the most common co-morbidities⁷in patients with ongoing COVID infection has been reported in a number of studies. Due to fluctuations in blood sugar levels, presence of diabetes complications, compromised immune system, sometimes elevated blood sugar; it will be easy for the virus to multiply harder to manage, leading to longer or delayed treatment.

Thus, making it a potential risk factor along with male sex, advanced age, and presence of other illnesses including hypertension, cardiovascular diseases, acute respiratory distress syndrome and cerebro-vascular diseases⁶along withdiabetes mellitushave led to raised mortality⁴. In another study, older age, hypertension, and obesity have been reported conditions which significantly increases the risk for hospitalization and death in COVID-19 patients².

Management of Therapeutic failures in COVID infected Diabetes Patients:

Special monitoring is required in patients with cardiac diseases, who are on treatment with angiotensin-converting enzyme increasing drugs, provides a higher risk for severe COVID-19 infection and, use of angiotensin-converting enzyme inhibitors is a topic of the debate itself, where no conclusive evidence has been concluded to support the discontinuation of angiotensin-converting enzyme inhibitors ¹ or angiotensin receptor blockers because of COVID-19 in people with diabetes. Therefore, should be monitored for angiotensin-converting enzyme modulating medications, such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers³.

Combinations of such conditions result in heavy pill intake/load to the patient which can cause drug-drug interaction, sometimes therapeutic failures as well all together. Therefore, to minimize the adverse outcomes, Routine Glucose monitoring, and careful consideration of drug interactions should be taken in cares from both sides, clinicians as well, patients.

Thus, it needs major concern and preventive measures as no treatment¹⁴ is available for the condition so far. Risk of infection rises when a patient suffers delayed Immune responses; hypoglycemia marks the potential underlying mechanisms of the association between diabetes and COVID-19. Prior counseling of patients with diabetes specifically older age groups, about specific preventive measures related to their disease management⁸ in case of infection by COVID-19. The prolonged effect of the virus has led to the isolation of infected patients⁵.

CONCLUSION:

COVID is still an unknown, unresolved enemy to humans; it has a lot to explore in terms of its severity and effect on all the medical conditions. Scare data is available on morbidity and mortality in COVID infected patients with the presence of other illnesses. A very few studies have shown the predicted significant risk factors as higher age, diabetes, and other co-morbidities. In diabetic patients, Patient education about self-care, medical adherence plays a great role, and awareness even for the mildest symptoms and reporting immediately should be encouraged. The ongoing pandemic, optimum diabetes care can be achieved only by adopting a collaborative approach to diabetes self-management practices.

Knowledge about predictors of COVID needs further research is the demand of the public health emergency to fill the void regarding this association, underlying pathophysiology mechanisms between the two and its clinical management.

ACKNOWLEDGEMENT:

The authors are grateful to the authorities of Department of Pharmacy, Lingaya’s Vidyapeeth, Faridabad and Indraprastha Apollo Hospital for the facilities.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

REFERENCES:

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Received on 30.04.2020 Modified on 10.05.2020

Research J. Pharm. and Tech 2020; 13(5):2530-2532.

DOI: 10.5958/0974-360X.2020.00450.3