INTRODUCTION:

SARS-Co-V-2 is a severe acute respiratory syndrome-Coronavirus-2¹. COVID-2019 is a Coronavirus disease-2019 caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-Co-V-2). A Severe respiratory illness is well-knownas a new coronavirus in Wuhan city, China, in December 2019^2-4. WHO announcesit isa global pandemic in February 2020 and tried to awareness of people worldwide; health workers are trying hard to provide health care services to the entire virus-infected cases by following infection control measures and providing supportive care.

Clinical trials are in progress for the development of vaccination and control and prevent⁵.

History of SARS-CoV-2:

The newly emerging coronavirus is primarily named the 2019 novel corona. It is now renaming COVID. The virus caused by this disease is a severe acute respiratory syndrome- coronavirus-2 or SARS-CoV-2¹. Finally, the identified virus is a highly contagious respiratory pathogen. International committee on virus taxonomy named a coronavirus in the new group of coronaviridae in the year 1975^6,7.

Structure of SARS-CoV-2:

The coronavirus 125nm in diameter with a spherical shaperecorded by the Cryo-electron tomography and cryo-electronmicroscopy of the virology^8,9. The highlighted characteristics of coronaviruses are club-shaped spike projections that are budding from the virus surfaces of the virion. The helically symmetric nucleocapsidsandcommonly present in the negative-sense RNA are uncommon in the corona's positive-sense RNA viruses¹⁰. The coronavirus consist of four structural proteins are mentioned they are:Spike(S), Membrane (M), Envelope (E),Nucleocapsid (N). All proteins are coded inside the viral genome 's3' end. The S-protein controls the signal sequence of the N-terminals to reach the ER. The M-protein is the main abundant structural protein present in the virion. It is an integral part of its shape and is a little protein with three transmembrane domains¹⁰. In the virion, the M-protein exists as a dimer; it may adopt for promoting membrane curvature and nucleocapsid binding of two different configurations¹¹.

The E-protein is identified in a small amount within the virion. It is having a general structural design but widely divergent. It is commonly considering a transmembrane protein¹². The E-protein essential for the pathogenesis and not necessary for the viral multiplication mechanism of ion channels in the SARS-CoV¹³. The N-protein is recognized with a single protein nucleocapsid. It has two separate domains, namely an N-terminal domain (NTD) and a C-terminal domain (CTD); they are competent of binding to RNA in vitro but use numerous modes to bind RNA by each domain¹⁴. Hemagglutinin-esterase (HE)recognized in a subset of β-coronaviruses. It acts as a protein and binds sialic acids to surface glycoproteins, and has acetyl esterase activity. These mechanisms had helped to enlarge the access of S protein-mediated cells multiply the virus in the mucosa¹⁵. The viral 3-chymotrypsin-like cysteine protease (3CL^pro) is a reserve in SARS-CoV-2, identified by the many examined types of research recognized on a SARS-CoV-2 structural basis¹⁶. SARS-CoV-2 has relevant characteristics towards bat-SARS coronavirus 3CL^prowith 99.02% of identity found from the many investigations¹⁷.

Causes of SARS-CoV-2 spread:

Lacking physical distancing among people, direct contact with infected patients, failure of personal hygiene measures, unable to follow isolation measures, increased viral load in immune-compromised patients,lack of awareness over the disease or virus, failure of drug management¹⁸.

Mode of transmission of SARS-CoV-2:

The viral pathogen may spread from different sources. They are:Direct contacts with the virus it infected persons, infected animal source, exposure to droplet contamination, airborne spread with pathogens, fomite spread (infected objects, used instruments), exposure to contaminated fecal particles, contamination of infected blood, maternal transmissions towards the fetus¹⁹.

Pathogenesis of SARS-CoV-2:

In earlier days, coronavirus is limited to cause mild respiratory illness only among people. The familiar coronaviruses are α- coronaviruses (HCoV-229E and HCoV-NL63) and β-coronaviruses (HCoV-OC43 and HCoV-HKU1). The essential characteristics of the viruses are differentiation in susceptibility to genetic factors^20,21 .In 2002-2003, the severe acute respiratory syndrome (SARS) pandemichererecognized with the causative agent with a 2b β-coronavirus species of SARS-CoV^22,23. The known information of SARS-CoVoriginated from the bats, from serological evidence of past CoV infections. Primarily, the SARS-CoV infected epithelial cells of the lungs^24,25. The pro-inflammatory cytokines activated from the infected cells of the lungs are the causative factors for the development of respiratory disease²⁶. The most predominantly identified two immunogenic proteins during the lung infections by the virus are the S protein and the SARS-CoV-2 N proteins only¹⁴.

Signs and symptoms of SARS-CoV-2:

Fever with chills,coughing, breathlessness, hypoventilation of the lungs, fatigue, general body weakness, muscle pain, headache, nausea or vomiting, sore throat, runny nose, diarrhea, loss of smell (anosmia), loss of taste(ageusia), hyperpyrexia, haemoptysis, sputum production, chest tightness^27,28 .

Diagnostic investigations for SARS-CoV-2:

Globally, many people are affectedby the SARS-CoV-2. Early detection of the virus helps in the prevention of viral spreading. The virus can detect by undergoing various patient investigations²⁹. They are:

RT-PCR (Real-time polymerase chain reaction):

The study examined the collection of specimens from the throat or air passages with a–invasive method to identify the viral replication of SARS-CoV-2³⁰.

Viral antibodies detections:

It is a type of serological investigation, helps to detect the immune responses towards the viral pathogens. Ex.IgM and IgG,Enzyme-linked immune sorbent assays (ELISA), Chemoluminescence assays (CLA), Lateral flow assays (LFA)³⁰.

Possible Radiological investigations, findings on SARS-CoV-2:

Chest X-ray (CXR), Chest computed tomography (CT) scan.Typical findings of chest X-ray and chest computed tomographyare bilateral pneumonia, unilateral pneumonia, and multiple mottling and ground-glass opacities, Bilateral multiple consolidations identified in severe cases.Common recalled chest computed tomography (CT) scan findings arePneumonia, Multiple ground-glass opacities, Bilateral patchy shadowing, Interstitial tissue abnormalities, Focal or multifocal ground-glass opacities, Interlobular or intralobularseptal thickening, Expansion of bilateral lung consolidation lesions, Pulmonary cavity lesions, Pleural effusion, Lymphadenopathy these reported rarely³¹.

Management of SARS-CoV-2.:

SARS-CoV-2 cases are treating currently by supportive or symptomatic management only due to lack of exact effectiveantiviral drugs, which directly can affect human targeting coronaviruses²⁹.

General home care management on SARS-CoV-2:

Consultation of a physician if symptoms appear on COVID-19, following regular medical checkups, consumption of medications as per physician orders, consumption of appropriate diet, performing regular active exercises, keeping distance from the active cases as possible³².

Hospital supportive care for SARS-Cov-2:

Emergency, Hospital supportive care had given to the patients as per symptoms identified as dyspnea, pyrexia, cough, and cold and sore throat. Acetaminophen, the drug of choice for the mild treating fever, Antiviral drugs of Oseltamivir or Tamiflu administered to suppress the viral replications in active cases of COVID-19 patients. Respiratory complications treated by Continuous support with oxygen administration and severe pneumonia cases are assisting with mechanical ventilation to support the patient's breathing pattern³³.

The supportive standard respiratory supportive measures are as follows:

Administration of oxygen is mention as per the need of the patient to use a face mask, mechanical ventilation supports if the patient is unable to maintain respiration, supportive with Bi-pap or C-pap machine, ABG analysis if required and should be followed, nebulization and chest physiotherapy, assistive with suctioning procedure if needs, drug administration as a condition of the patient, continuous monitoring of the patient to assist in patient demands, performance of necessary investigations to the patient is daily, nasogastric tube feeds used to meet the nutritional status of the patient, psychological support to the family members, health education guide provided on disease prevention activities³³.

Drug management for SARS-CoV-2:

There are no exact proven drugs for controlling the virus and respiratory complications caused by virus replications. More than 70antiviral medications and their combinations with high potentiality are under supportive management. Remdesivir is an injectable drug of choice under the classification of broad-spectrum antiviral drug is an efficient drug for treating the viral load³⁴.

Some selected potential drugs using in the Treatment against SARS-CoV-2 are:

Hydroxychloroquine – effective against COVID-19^35,36; Chloroquine- Immunomodulating drugs^37,38; Azithromycin- Active reducing of viral load in COVID-19 affected patients^39,40; Human immunoglobulin-Antibodies and proteins provide defense against the pathogens^41,42; Remdesivir- controls the coronavirus replication^43,44; Arbidol (Umifenovir) - Blocking of the virus into the host cell^45,46; Oseltamivir- Helps in blocking the release of viral particles from the host cell^47,48; Lopinavir-ritonavir -Inhibiting HIV-1 protease for protein cleavage, assist in non-infectious, immature viral particles^49,50; Darunavir-cobicistat combination-HIV protease inhibitor^51,52; Recombinant human interferon α2β-Inhibits MERS-CoV and SARS-CoV^53,54; Xiyanping- Its having the significant actions of antiviral and antibacterial effects^55,56; Thalidomine- It degrades the messenger RNA in blood cells and reduces tumor necrosis factor (TNFα )^57,58; Vitamin-C- Antioxidant and reduces oxidative stress, inflammation, improves vasopressor synthesis and immune cell function^59,60; Methylprednisolone-prolongs the survival time of the clinical cases^61,62; Bromhexine hydrochloride-Transmembrane protease inhibitor, responsible for activation of S-glycoprotein of MERS-CoV and SARS-CoV^63,64; Bevacizumab-Suppresses the edema in COVID-19 patients by reducing the levels of vascular endothelial growth factor (VEGF)^65,66; Fingolimod-Immunology modulator used in multiple sclerosis⁶⁷; Baricitnib-Binding to AP₂– associated protein kinase 1 (AAK₁)⁶⁸; Lithium-probably by reducing apoptosis and inhibition of glycogen synthase kinase three β (GSK-3 β)⁶⁹; Angiotensin-converting enzyme inhibitors and angiotensin receptor inhibitors- Rebalancing Renin-Angiotensin-Aldosterone system (RAAS)(might reduce the pulmonary inflammatory response and mortality)⁷⁰; cytopathic effects in cell culture are Completely inhibition of by Cepharanthine, selamectin, and mefloquine⁷¹; Qingfei paid decoction-Controlling of COVID-19 symptoms⁷²; Pirfenidone-Anti-inflammatory and antioxidant by inhibiting IL-1β and IL-4⁷³.

Effective use of disinfectants on SARS-CoV-2:

The evidenced reminder on endemic human coronavirus strain (HCoV-) 229E identified that it may progress infectious on various categories of materials approximately for two hours to 9 days.SARS-CoV-2 specifies a longer persistence with higher inocula as received from the other comparative evidence^74-78. Biocidal agents are used to control surface transmission, and contamination isefficient in controllingthe infection. Examples are:Ethanol – 78%-95%, 2-propanol-70%-100%, Glutardialdehyde-0.5%-2.5%, Formaldehyde-0.7%-1%, Povidone-iodine -0.23%-7.5%, Sodium hypochlorite -0.21%^79.80.

Vaccinations progress on SARS-Cov-2:

The vaccination process is an essential step for controlling and preventing the disease spreads. Mainly, multiple nucleic acid-based vaccines have been proposed based on the S-protein coding sequence⁸¹.

mRNA-127:

It is a synthetic strand of mRNA that encodes the perfusion-stabilized viral spike protein. It is probably to elicit an antiviral response towards the spike protein of SARS-CoV-2. It is made from an inactivated pathogen or small subunits of live pathogens and proves safe for humans⁸¹.

INO-4800:

The vaccine developed by inoviopharmaceuticals.It is a genetic vaccine, can be administered to human cells and translated into proteins to elicit immune responses^82,83.

ChAdOx1 nCov-19:

This vaccine was developed by the Oxford University. It is the combination of a non-replicating adenovirus vector and the genetic sequence of the S-protein of SARS-CoV-2⁸⁴.

Stabilized subunit vaccines:

The University of Queensland uses molecular clamp technology to develop vaccination.These vaccines achieved their capacity to induce the production of neutralizing antibodies and recognize immune responses⁸⁵.

Nanoparticle-Based vaccines:

These vaccines are the potential to protect humans against respiratory viruses.Novavax, Inc. is developing by nanoparticle-based vaccine obtained from the coronavirus S protein antigens⁸⁶.

Preventive measures for SARS-CoV-2:

Early identification of the virus-infected active cases is as early as possible, for an infected case, maintenance of isolation practices, we are developing and implementing virus-controlling measures, all are taking awareness among people towards the nature of the disease,to prevent viral spreads, do early screening of the people, various investigations are performing among people to identify the suspected cases, we are encouraging the hygiene measures by the people,among the people, maintenance the possible physical distancing, instructing to follow the respiratory fitness exercises, maintenance of environmental hygiene, avoidance of mass gathering to control virus spreads,we are trying to live in highly ventilated areas,maintenance of minimum 6feet distance among people while communicating,regularly carry performance of fumigation in the infected areas,use the sterilization and disinfection measures on instruments used for the infected patients,proper consumption of diet,performance of physical exercises,psychological support the virus-infected cases,to spread the virus and its prevention, take a vaccination^87-89.

CONCLUSION:

SARS-CoV-2 is an extensively increasing respiratory pathogen and has brought COVID-19 Disease since December 2019 and became a vast pandemic globally. Due to this Disease, people are suffering worldwide due to various problems on health, especially respiratory illness. Some countries are facing more issues due to lack of health facilities related to the shortage of mechanical ventilators, failure to meet the increased demand on oxygen supplementation, with no proper disease management protocols on drug management, scarcity of vaccination trials, restriction on mobility of the people, failure of controlling of disease or virus spreading, etc. All these contributing factors created survival fear and anxiety among people over the globe in a shorter period. So, every person should have a minimum of familiar information on the disease that may help the disease's decreased spreading and bring good progress to complete eradication of the disease.

AUTHORS CONTRIBUTIONS:

All authors equally contributed, to prepare and approve the final article of the manuscript.

Manuscript drafting of an article done by URK, Manuscript grammar editing work done by KVV&GN, Reference managing carried by AK&BW, Software management work processed by KD&AJT

CONFLICTING OF INTEREST:

There is no conflict of interest in the manuscript by the authors

ACKNOWLEDGMENT:

We are sincerely grateful to the Arsi University, College of Health Sciences, Asella, Ethiopia.

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Received on 10.05.2021 Modified on 22.01.2022

Research J. Pharm. and Tech 2023; 16(1):441-446.

DOI: 10.52711/0974-360X.2023.00075