The new COVID-19 disease is caused by a Novel Coronavirus (SARS-CoV2) probably originated in Wuhan, China. In mid-December 2019, the Wuhan health authorities detected few cases of an atypical pneumonia that eventually was discovered to be caused by a novel coronavirus. It probably jumped from an animal scam reservoir to a human during the first week of November 2019. COVID-19, a respiratory disease caused by the SARS-CoV-2 virus, was declared a pandemic by the World Health Organization on 11 March 2020. The rapid spread of the disease has taken the scientific and medical community by surprise.

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Binliang L., Fei M., Jiani W., Ying F., Hongnan M., Binghe X. Health management of breast cancer patients outside the hospital during the outbreak of 2019 Novel Coronavirus disease. EOP was responsible for the full conceptualization and he was in charge of drafting the document in all of the stages. KSR and LGB contributed with the Cancer and COVID-19 section and review all the manuscript.

Among the established risk factors for the development of ARDS is age greater than 65 years, diabetes mellitus and hypertension, in at least 40% of patients (Xu et al., 2020b). The assembly of virions is quickly ensued with the accumulation of new genomic RNA and structural components. Then, the transmembrane M protein, localized to the intracellular membranes of the ER – Golgi intermediate compartment , interacts with the other viral structural proteins to allow the budding of virions (Chen et al., 2020a; Huang et al., 2020a).

1. Chronology of the pandemic

Less research has been completed relating to humoral immunity compared to than cellular against coronaviruses. However, in view of COVID-19 patient sera portraying some cross-reactivity with SARS-CoV, but not with other coronavirus, it might imply that similar mounting of humoral responses could be expected (Zhu et al., 2020). The fact that COVID-19 convalescent sera shows potential as a therapeutic approach aligns with the theory that efficient B cell responses are mounted and lead to production of protective antibodies.

The use of the mask is not a substitute for handwashing and social distancing measures, as these ones together allow avoiding viral particles in aerosols or drops, as a low cost and accessible measure for general population (Cheng et al., 2020; WHO, 2020e). There is still non-specific information for the recommendation of masks, in general, having in several studies claims that surgical or cotton cloth masks do not prevent the spread of the SARS-CoV-2 virus (Bae et al., 2020). The evidence about the transmission of the virus in the asymptomatic period also changed the containment measures, suggesting the community use of masks.

Therefore, these findings do not establish a causal effect, and the efficacy of convalescent plasma remains unknown. The epidemiological evolution of the COVID-19 pandemic through phases has required the application of specific measures according to the time or phase in which the virus is found in each country. The evolution in the non-pharmacological measures has been as variable as the pharmacological ones, in such a way, since January to March, it was ensured that the use of face masks was limited only to people who had contact with epidemiological foci, not to healthy people (Feng et al., 2020a). This concept was also reinforced by CDC, in order to optimize the use of masks for health workforce. Definitely the course of the pandemic was changing rapidly, which also demanded the change from containment measures to mitigation. The recommendations in the current context remain regarding the use of a facial mask in the community, but its optimization is important for health professionals.

Following assembly and budding, virions are transported in vesicles and eventually released by exocytosis. The viral membrane contains the spike glycoprotein that forms the peplomers on the virion surface, giving the virus its “corona” – or crown-like morphology in the electron microscope. Within the virion interior lies a helical nucleocapsid comprised of the nucleocapsid protein complexed with a single positive-strand RNA genome of about 30 kb in length . Yuan Y., Cao D., Zhang Y., Ma J., Qi J., Wang Q. Cryo-EM structures of MERS-CoV and SARS-CoV spike glycoproteins reveal the dynamic receptor binding domains. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J. Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-infected pneumonia in Wuhan, China.

Table 4

The expression of genes induced by INF that stimulate the cellular antiviral state together with the recruitment of specific immune cells, are the basis for clinical trials in MERS-CoV and SARS-CoV viruses, the last being the most similar to SARS- CoV-2. Thus, PAHO has proposed INF as a probably effective treatment for patients with new infection . A phase 3 randomized controlled trial of IL-1 blockade in sepsis has shown significant survival benefit in patients with hyperinflammation, without apparent increased adverse events (Shakoory et al., 2016). Currently, a multicenter, randomized controlled trial of tocilizumab (IL-6 receptor blockade, licensed for cytokine release syndrome), is being trialed in patients with COVID-19 pneumonia presenting with high levels of IL-6 in China . Moreover, several clinical trials are exploring if the well-established antiviral (Savarino et al., 2003) and anti-inflammatory effects of hydroxychloroquine will be effective in treating patients with COVID-19 as has previously been suggested for SARS-CoV infection (Vincent et al., 2005). In contrast, Janus kinase inhibition has been proposed as a potential treatment in order to reduce both inflammation and cellular viral entry in COVID-19 (Richardson et al., 2020a).

AMG, DC, HSS and LU completed the clinical section of the manuscript, the therapeutic strategies and the gynecological and complication section of the manuscript. NG critically review the manuscript and ALC was partially responsible for the conceptualization of the study, the genetic aspects of the virus and he completed all the figures for this work. It should be noted that patients attending out-patient appointments for cancer have higher levels of anxiety, depression and other mental health problems than the general population. roinvesting broker Studies have shown that approximately 50% of malignant tumor survivors have a moderate to severe fear of tumor recurrence (Reiche et al., 2004). For this reason, psychologist surveillance of out-patients in quarantine or during hospitalization should be considered. Due to these findings, it has been proposed by many international entities that during the pandemic, for prevention, an individualized plan based on the patient’s specific conditions is required, with the aim to minimize the number of visits to health institutions.

Fuhai M., Haitao H., Yantao T. Surgical treatment strategy for digestive system malignancies during the outbreak of novel coronavirus pneumonia. Eccles R. An explanation for the seasonality of acute upper respiratory tract viral infections. Du L., He Y., Zhou Y., Liu S., Zheng B.-J., Jiang S. The spike protein of SARS-CoV — a target for vaccine and therapeutic development. Chan J.F.-W., Kok K.-H., Zhu Z., Chu H., To KK-W, Yuan S. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Al-amri S.S., Abbas A.T., Siddiq L.A., Alghamdi A., Sanki M.A., Al-Muhanna M.K. Immunogenicity of candidate MERS-CoV DNA vaccines based on the spike protein.

COVID-19 pneumonia presents as a clinical picture that, as previously stated, may be indistinguishable from other viral pneumonias. Any viruses that causes pneumonia must be included in the differential diagnosis of COVID-19. This includes influenza, parainfluenza, adenovirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, SARS-CoV, etc. From a cohort of 43 patients confirmed with COVID 19, these findings were classified as mild, moderate and severe disease (Gao et al., 2020).

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In COVID-19 symptomatic infection, the clinical presentation can range from mild to critical scenarios. The symptoms of a lower respiratory infection, pneumonia, is the most serious manifestation of COVID-19 infection. cycle analytics for traders The Center for Disease Control in China reported that during the last week of December 2019, the first cases of an atypical pneumonia were seen in Wuhan, the capital of Central China’s Hubei province.

10. Diagnosis methods to detect COVID-19

All of the clinical trials evidence, supporting or against the use of mentioned drugs are detailed in . Lopinavir and Ritonavir (LPV/r) are protease inhibitors, specifically in the action of 3CL protease of SARS COV-2, used in HIV treatment. They are included in re-purposing drugs for use in COVID-19 patients and also, they had antiviral activity in last SARS-CoV and MERS-CoV pandemics.

  • In a study describing 138 patients with COVID-19 pneumonia in Wuhan, the most common clinical characteristics at the onset of the disease were described.
  • The “cold-dry” set of climatic conditions endorses a greater survival of the virus outside human body, and, thus, results in better transmission (Lofgren et al., 2007; Lowen and Steel, 2014).
  • Recently, it received emergency use authorization from the US Food and Drug Administration for a point-of-care test for the detection of Novel Coronavirus (COVID-19), delivering positive results in as little as 5 minutes and negative results in 13 minutes .
  • Studies on SARS-CoV and MERS-CoV (Hajeer et al., 2016) presentation have identified several susceptibility and protection conferring HLA alleles.

MRNA as a transformative technology for vaccine development to control infectious diseases. Kuba K., Imai Y., Rao S., Gao H., Guo F., Guan B. A crucial role of angiotensin converting enzyme 2 in SARS coronavirus-induced lung injury. Grifoni A., Sidney J., Zhang Y., Scheuermann R.H., Peters B., Sette A. A sequence homology and bioinformatic approach can predict candidate targets for immune responses to SARS-CoV-2. Gao Y., Li T., Han M., Li X., Wu D., Xu Y. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19.

Increasing the level of hand cleanliness to 60% in places with a high concentration of people, like all airports in the world would have a reduction of 69% in the impact of a potential disease spreading (Nicolaides et al., 2019). Five different non-pharmaceutical interventions implemented individually and in combination as public health measures reduced contact rates in the population and therefore reduce virus transmission (Ferguson et al., 2020). 2, there are several therapeutic options, initially increasing positive expiratory pressure by 2–3 cmH2O every 15 to 30 minutes to improve oxygen saturation to 88–90%, maintaining a plateau of less than 30 cm H2O. Recruitment maneuvers are probably of little value but could be used in selected cases in the presence of a physician to control hemodynamics. If there is considerable asynchrony with positive pressure ventilation, accompanied by an increase in plateau pressure and refractory hypoxemia, deep sedation should be used followed by prompt institution of neuromuscular block.

14. COVID-19 in pregnant women

Several SARS-CoV-2 targeted serological tests are commercially available or in development (FIND, n.d.). A recently developed kit, reported a sensitivity of 88.66% and specificity of 90.63% (Li et al., 2020) using SARS-CoV-2 IgG-IgM combined antibody rapid test (Li et al., 2020). During this lag period, infected and non-infected individuals will both result in a negative output.

Table 6

Walls A.C., Park Y.-J., Tortorici M.A., Wall A., McGuire A.T., Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Vincent M.J., Bergeron E., Benjannet S., Erickson B.R., Rollin P.E., Ksiazek T.G. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Spiegel M., Pichlmair A., Mühlberger E., Haller O., Weber F. The antiviral effect of interferon-beta against SARS-Coronavirus is not mediated by MxA protein. Neuman B.W., Kiss G., Kunding A.H., Bhella D., Baksh M.F., Connelly S. A structural analysis of M protein in coronavirus assembly and morphology. Møller M.H., Granholm A., Junttila E., Haney M., Oscarsson-Tibblin A., Haavind A. Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure.

Table 2

The former includes antiviral Type I interferons , and macrophage and neutrophil activation that leads to pro-inflammatory cytokine production and NK cells. Yoshikawa T., Hill T., Li K., Peters C.J., Tseng C.-T.K. Severe acute respiratory syndrome coronavirus-induced lung epithelial cytokines exacerbate SARS pathogenesis by modulating intrinsic functions of monocyte-derived macrophages and dendritic cells. Keicho N., Itoyama S., Kashiwase K., Phi N.C., Long H.T., Van Ban V. Association of human leukocyte antigen class II alleles with severe acute respiratory syndrome in the Vietnamese population.

Among other findings, descriptive studies have reported considerable elevations of lactate dehydrogenase and ferritin as well as alteration in aminotransferases; although elevation ranges for these parameters have not been established (Guan et al., 2020b). Early recognition is essential to classify cases as potential cases and initiate one of the most important measures to contain the pandemic, isolation. The Massachusetts General Hospital has suggested additional factors that can be considered risk for severe COVID 19 infection, detailed in Table 5. The CRISPR-based SHERLOCK technique for the detection of COVID-19 and the DETECTR prototype rapid detection diagnosis kit using CRISPR to detect the SARS-COV-2 in human samples have been described (Broughton et al., 2020). Even though COVID-19 can be diagnosed using qPCR as the gold standard, inadequate access to reagents and equipment has slowed disease detection even in developed countries such as the US. Like other coronaviruses, SARS-CoV-2 is an enveloped virus with roughly spherical or moderately pleomorphic virions of approximately 60 to 140 nm in diameter (Fig. 3a) (Yan et al., 2020).

The management of pregnant patients with COVID-19, in general, follows the same principles as for the wider population. It is vital to consider that the mother, fetus and, subsequently, the newborn are always considered a high-risk population. Management should include early isolation, oxygen therapy if necessary, avoid fluid overload, empirical antibiotic therapy , maternal fetal monitoring, Doppler ultrasound is recommended within obstetric surveillance.

Ruan Q., Yang K., Wang W., Jiang L., Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Richardson P., Griffin I., Tucker C., Smith D., Oechsle O., Phelan A. Baricitinib as potential treatment for 2019-nCoV acute respiratory disease. Ng O.-W., Chia A., Tan A.T., Jadi R.S., Leong H.N., Bertoletti A. Memory T cell responses targeting the SARS coronavirus persist up to 11 years post-infection. Kirchdoerfer R.N., Cottrell C.A., Wang N., Pallesen J., Yassine H.M., Turner H.L. Pre-fusion structure of a human coronavirus spike protein.

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