Recrudescence of COVID-19: A review of literature and Indian perspective

Abstract

: The present article aims to describe the sudden emergence of 2019 novel Corona virus its incidence and spread among the neighbouring countries and preventive measures that the World Health Organization and The Central Government of India is taking to ensure early detection and management of cases.
: The study is cumulative of the recent literature released by the Central Government of India DHR and ICMR, the Chinese scientists handling the samples and Interim measures on controlling the 2019n-Corona virus by World Health Organization and American National Institute of Health.
Inclusion criteriaArticles that discussed corona virus history and epidemiology. Case reports and Interim guidelines by WHO. Articles related to treatment of SARS and MERS in the past 10 years. The study was conducted at GIMS-VRDL, Department of Microbiology, Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka and articles were selected using PRISMA 2009 checklist. Exclusion criteria: Articles with no proves.
: In a short period of 58 days 2019n-CoV has affected more than 82138 people globally and caused 2801 casualties (2744 deaths in mainland China and 57 deaths in the neighbouring countries). The novel corona virus has challenged human technology and development with its undetected highly efficient spread and mutation rate. The role of WHO and ICMR in providing interim guidelines to health care professionals and Research Scientists in identification, isolation, specimen collection and management of affected cases is commendable. On 17 February UNICEF has appealed an estimate of 42.5 million USD to financially support the outbreak response. With growing numbers of cases the fight against the corona virus is still at stake, research needs to be conducted for better understanding different routes of spread including vertical transmission in humans and the detailed genomic sequence, for developing diagnostic kits and efficient anti corona virus drugs and vaccinations.

Full text

IP International Journal of Medical Microbiology and Tropical Diseases 2020;6(1):1–5
Content available at: iponlinejournal.com
IP International Journal of Medical Microbiology and Tropical Diseases
Journal homepage: www.innovativepublication.com
Review Article
Recrudescence of COVID-19: A review of literature and Indian perspective
Multazim M Pathan1,*, Nawaz Umar1, Neetu Vijay2, Sheeza I Patel3, Heeba M Pathan4,
Alfiya Pathan5, Shahanawaz S Mulani6, Shahdeba Tahseen Mulani7, Bushra Khan8
1Dept. of Microbiology, Gulbarga Institute of Medical Sciences, Sedam road, Kalaburagi, Karnataka, India
2DHR-ICMR, New Delhi, India
3Al Badar Rural Dental College and Hospital,, Kalaburagi,, Karnataka, India
4HKE’S Nijalingappa Institute of Dental Sciences and Research, Kalaburagi, Karnataka, India
5SDKS Dental College and Hospital, Nagpur, Maharashtra, India
6Aditya Dental College, Beed, Maharashtra, India
7Suhana Dental Clinic, Aurangabad, Maharashtra, India
8Govt. Hospital Parbhan, India
ARTICLE INFO
Article history:
Received 22-02-2020
Accepted 25-02-2020
Available online 26-04-2020
Keywords:
Kalaburagi
Karnataka and articles were selected
using PRISMA 2009 checklist
Exclusion criteria: Articles with no
proves Keywords: COVID19
zoonotic
outbreak
pandemic
DHRICMR
VRDL
preventive measures
areas for research
ABSTRACT
Aim: The present article aims to describe the sudden emergence of 2019 novel Corona virus its incidence
and spread among the neighbouring countries and preventive measures that the World Health Organization
and The Central Government of India is taking to ensure early detection and management of cases.
Setting and design: The study is cumulative of the recent literature released by the Central Government
of India DHR and ICMR, the Chinese scientists handling the samples and Interim measures on controlling
the 2019n-Corona virus by World Health Organization and American National Institute of Health.
Materials and Methods: Inclusion criteria:Articles that discussed corona virus history and epidemiology.
Case reports and Interim guidelines by WHO. Articles related to treatment of SARS and MERS in the
past 10 years. The study was conducted at GIMS-VRDL, Department of Microbiology, Gulbarga Institute
of Medical Sciences, Kalaburagi, Karnataka and articles were selected using PRISMA 2009 checklist.
Exclusion criteria: Articles with no proves.
Conclusion: In a short period of 58 days 2019n-CoV has affected more than 82138 people globally and
caused 2801 casualties (2744 deaths in mainland China and 57 deaths in the neighbouring countries). The
novel corona virus has challenged human technology and development with its undetected highly efficient
spread and mutation rate. The role of WHO and ICMR in providing interim guidelines to health care
professionals and Research Scientists in identification, isolation, specimen collection and management of
affected cases is commendable. On 17th February UNICEF has appealed an estimate of 42.5 million USD
to financially support the outbreak response. With growing numbers of cases the fight against the corona
virus is still at stake, research needs to be conducted for better understanding different routes of spread
including vertical transmission in humans and the detailed genomic sequence, for developing diagnostic
kits and efficient anti corona virus drugs and vaccinations.
© 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND
license (https://creativecommons.org/licenses/by/4.0/)
1. Introduction
Wuhan city in the Hubei province of China experienced
an increase in the number of pneumonia cases of unknown
aetiology in the month of December 2019. The incidence
* Corresponding author.
E-mail address: heebap@yahoo.com (M. M. Pathan).
was shared with the World Health Organisation China
country office on 31st December 2019.1A virus not like
anything seen before related to Middle East Respiratory
Syndrome (MERS) and Severe Acute Respiratory syndrome
(SARS) was arraigned. Although initially in the first week
of January it was estimated to affect only few cluster of
https://doi.org/10.18231/j.ijmmtd.2020.001
2581-4753/© 2020 Innovative Publication, All rights reserved. 1

2Pathan et al. / IP International Journal of Medical Microbiology and Tropical Diseases 2020;6(1):1–5
patients in China the scientific community was expecting
the possibility of further human to human transmission and
the global spread due to international travel of undetected
and asymptomatic cases during the incubation period.
1.1. Setting and design
The study is cumulative of the recent literature released by
the WHO and Chinese scientists handling the samples and
Interim measures on controlling the 2019n-Corona virus and
by American National Institute of Health and World Health
Organization.
1.2. Inclusion criteria
1. Articles that discussed corona virus history and
epidemiology.
2. Case reports and Interim guidance by WHO
3. Articles related to SARS and MERS in the past 9
years.
1.3. Exclusion criteria
An article with no proves and dated before 2000. The
study was conducted at GIMS-VRDL, Department of
Microbiology, Gulbarga Institute of Medical Sciences,
Kalaburagi, Karnataka and studies were selected using
PRISMA 2009 checklist.
1.4. Data collection process
1. Search in Google.
2. Search in PubMed.
3. Evaluating the papers, divided them depending on the
inclusion and exclusion criteria.
4. Evaluating the articles and analysing them.
1.5. Data items
We searched through Google, PubMed, Pub Med Central,
CAS, Citebase, DOAJ, Embase, Embiology, MEDLINE,
OAIster, SCImago, SCOPUS, SOCOLAR and Zetoc by
using the keywords.
1.6. Spread of the novel virus
Within a period of 57 days the COVID-19 has affected more
than 82138 cases globally and has caused more than 2744
deaths in mainland China, followed by Iran 19, South Korea
13 and Italy 12 according to WHO situation reports and
Chinese Authorities. 2A history of travel to China or contact
with people arriving from China and affected countries
like Japan, Vietnam Korea, Thailand and United states
of America2and 20 more countries with confirmed cases
having fever, difficulty in breathing and severe coughing
before 1st of January or 15 days from onset of symptom have
been considered as suspected cases for Wuhan Corona virus.
The incubation period of COVID-19 is 0-14 days.3–5 11−14
According to a report released by WHO on 29th January
2020, the 2019n-corona virus now exceeds the number
of SARS affected individuals globally. 2According to the
situation report by WHO released on 19th February 2020
COVID-19 has spread to 25 countries. Within China the
Case Fatality Ratio (CFR) is 2.3% and the infection fatality
ratio IFR ranges between 0.3% and 1%.
In recent times two highly pathogenic corona virus
namely MERS and SARS caused mortality and morbidity
globally on a large scale. Both the virus had animals as
common reservoir and mode of spread was air droplets.
2019n-corona virus is no different from its virulent cousins.
The first case was detected from consumption of wild
animal meat brought from the wet seafood market in
Wuhan.6Recent reports suggest bats as a potential carrier
for the novel virus. With a high efficacy mutation rate
effects of 2019n-corona virus, infection and its extent of
spread is uncertain. Scientists believe that the numbers are
underestimated as more number of carriers would have been
exposed other than the sea food market in Wuhan city.
The complete city has been put on a lock down with the
Chinese officials announcing public holiday and restriction
on unnecessary travel and transport within and outside the
country.
Human Corona viruses (HCoV) are known to cause
disease in mammals and birds. It is a single stranded
enveloped RNA virus that is spherical or pleomorphic with
glycoprotein projections. With four subtypes namely Alpha,
Beta, Gamma and Delta, HCoV has 7 serotypes. The mode
of transmission is airborne through zoonotic droplets, and
the viral replication occurs in the ciliated epithelium.7
Once the glycoprotein attaches the ciliated epithelium they
penetrate the cells and replicate in a span of 3-4 days and
cause cellular damage and inflammatory reactions at the site
of infection.8
In 2002 Guangdong province of china, similar severe
type of atypical pneumonia caused global concern with
more than 12 countries affected by the viral infection due
to international travel.9Later this subtype Beta Corona
virus was named as SARS. In 2012 MERS emerged
as a potentially pathogenic corona virus and caused an
astounding 774 deaths and more than 8000 affected cases in
Saudi Arabia, Africa, European countries and America.10
1.7. Phylogenetic analysis so far
0n 29th January 2020, Roujian Lu et al from Chinese
Academy of Science collected bronchoalveolar lavage
sample from 10 positive cases from Huanan sea food market
and performed Sanger genomic sequencing to determine the
full length of COVID-19 phylogenetic analysis. They have
found that the 2019n-corona virus is closely related to bat-
SL-CoVZC45 and batSL-CoVZXC21 of SARS like corona
virus (88% identity) but since the subtype was found to be

Pathan et al. / IP International Journal of Medical Microbiology and Tropical Diseases 2020;6(1):1–5 3
Sarbecovirus of the genus Beta coronavirus, hence can be
considered a new human infecting betacorona virus.11 The
report also revealed that 2019n-corona virus has a similar
receptor binding domain structure as that of SARS-CoV
and that it has the capability of binding to the angiotensin
converting enzyme receptor in humans.
1.8. Indian perspective
The Central Government of India through the Department of
Health and Research (DHR) and Indian Council of Medical
Research (ICMR)has taken immediate steps as part of the
preparedness of Viral Research and Diagnostic Laboratories
across the country for dealing with the COVID-19. The
Ministry of Health and Family Welfare made literature
available regarding the clinical management, surveillance
and sample collection from suspected cases. All cases with
Severe Acute Respiratory Illness (SARI) with a history
of fever, coughing and difficulty in breathing requiring
hospitalization with no other aetiology explaining the
clinical presentation are to be considered a potential case.
Added to the fact a history of travel to Wuhan city of China
or affected countries by the patient or his/her relatives in
contact within 14 days prior to symptoms are to be screened
with precaution. Health care workers in direct contact with
treating severe acute respiratory illness cases also need to
take necessary precautions as advised by the Department of
Health and Research. Use of Personal Protective Equipment
(PPE) including head cap, N95 masks, eye wear, face
shields, full sleeve high collar apron, gowns, double gloves,
and shoe covers are mandatory while treating or during
sample collection of suspected cases. On 19th January
2020 The Department of Health and Research, New Delhi
released the form for specimen collection and transport to
National Institute of Virology Pune and suggested to adhere
to WHO Interim guidelines for preventive steps during
sample collection and transport. Specimen type for 2019n
Corona virus include nasopharyngeal / oropharyngeal swab,
bronchoalveolar lavage, tracheal/nasopharyngeal aspirate,
sputum, serum and tissue biopsy/ autopsy from lungs. The
sample need to be transported in Viral Transport medium
maintaining the temperature at 4 degree Celsius if sent
within 48 hours and -70 degree Celsius if sent within 5 days.
1.9. Estimating the spread
On 31st January WHO announced 2019n-corona virus as
an global epidemic. With increasing number of cases each
day passing the awareness and preparedness for the health
care worker and concerned nursing staff is very important
to avoid further spread of the viral infection. There have
been efforts to estimate the number of cases affected by
the COVID-19. Natsuko Imai Anne et al have suggested
a formula to calculate the estimated number of cases
including undetected to date.11
Diagram 1: Territories and areas with confirmed cases of
COVID-19 as on 25/02/202012
Diagram 2: Epidemic curve of COVID-19 outside China
showing date of onset of symptom and likely exposure
locations.12
Diagram 3: Images of corona virus13
The formula takes into account the following entities:
C=No
PI{OW/CW )/MT (IP+OS)}
C (Total number of cases), NO (number of cases detected
overseas), P1 (daily probability of international travel), IT
(daily probability of international travel), MT(mean time to
detect a case), OW(daily outbound international travellers
from Wuhan), CW(catchment population of Wuhan airport),
MT(mean time to detection) IP (incubation period), OS

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Diagram 4: On the left, a cell layer not damaged by the
viruses. On the right, a cell layer with a visible cytopathic
effect (CPE); the cells infected by the virus have been
destroyed.14
Fig. 1: Image of corona virus emerging from surface of the host
cell15
(mean time from onset of symptoms to detection)
2. Summary
The main aim of the Central Government of India is to
prevent further spread of the COVID-19 through promotion
of respiratory hygiene. Department of Health Research
has instructed all physicians that all suspected cases need
to be isolated in separate wards and if placed in the
same ward kept at a distance of 1meter. All health care
workers attending the patients need to well trained and
wear Personal Protective equipment at all times. Record
of the health care personal entering the ward need to
be maintained and the number of people visiting the
ward need to be minimized to the lowest. The relatives
accompanying the patient also need to be screened.
Hospitals need to take care of environmental cleaning and
regular disinfection of surfaces in contact with suspected
COVID-19 cases by use of sodium hypochlorite and 70
per cent alcohol. The specimen best suited for detection as
described by ICMR is oropharyngeal swab, nasopharyngeal
swab and bronchoalveolar lavage (if possible), should be
collected in viral transport media supplied by National
Institute of Virology Pune and maintaining in a cold
chain of 4 degrees if sent within 48 hours and -70
degree Celsius if sent within 5 days to NIV Pune for
molecular detection through Real Time Polymerase chain
reaction. With the current knowledge in perspective and
no specific drugs or vaccinations recommended by WHO,
physicians and research scientists from Chinese authorities
found cases responding well to anti HIV drugs like
Lopinavir/Nelfinavirin combination with Ribavir. National
Institute of Health USA is working closely with vaccine
developer companies in Wuhan using genetic sequences of
the 2019n-CoV/ COVID-19. Further knowledge on genomic
sequencing is necessary for developing diagnostic kits and
vaccinations for the 2019n-CoV. Also reporting of cases and
their management needs to be shared with researchers to be
able to contribute, in control measures via an explicit line
list and thorough history and management of such cases.
Research on COVID-19 will focus on serological analysis,
development of specific treatments, vaccination and viral
pathogenesis.
3. Financial support and sponsorship
The research has been funded by the Department of
Health Research and Indian Council of Medical Research
Government of India, New Delhi under the Viral Research
and Diagnostic Laboratories scheme set up at the
Department of Microbiology, Gulbarga Institute of Medical
Sciences, Kalaburagi, Karnataka, India.
4. Acknowledgement
This work was supported and funded by DHR-ICMR
Govt of India, New Delhi under the Viral Research and
Diagnostic Laboratory scheme. We would like to thank
Dr Kavita Patil Director GIMS, Kalaburagi for providing
necessary infrastructure and facilities to conduct the study.
We would also like to thank Dr Umesh SR Principal GIMS,
Kalaburagi for his guidance. We would like to thank Dr
Sidhartha Giri Scientist E, DHR-ICMR New Delhi for an
excellent technical coordination for the VRDL project.
5. Source of funding
None.
6. Conflict of interest
None.
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Author biography
Multazim M Pathan Medical Research Scientist
Nawaz Umar Professor and HOD
Neetu Vijay Scientist C
Sheeza I Patel Dental Practitioner
Heeba M Pathan BDS Intern
Alfiya Pathan Tutor
Shahanawaz S Mulani Associate Professor
Shahdeba Tahseen Mulani Dental practitioner
Bushra Khan Resident Medical Officer
Cite this article: Pathan MM, Umar N, Vijay N, Patel SI, Pathan HM,
Pathan A, Mulani SS, Mulani ST, Khan B. Recrudescence of
COVID-19: A review of literature and Indian perspective .IP Int J
Med Microbiol Trop Dis 2020;6(1):1-5.