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SARS-CoV2

SARS and MERS - Where all started

Coronaviruses have been here for a long time amongst the most prevalent causes of the common cold, second only to rhinoviruses. They are named for their specific virion look with the Spike (S) glycoprotein covering the virion's surface. They are part of the Orthocoronavirinae subfamily which encompasses four different genera: SARS-CoV2 belongs to one of them - betacoronaviruses. Little attention was paid to them until the severe acute respiratory syndrome (SARS) outbreak in November 2002 in Guangdong Province (China) and the Middle East Respiratory Syndrome (MERS) in 2012 in Saudi Arabi. SARS infected over 8,000 people and killed almost 800 by late July 2003, according to the WHO. MERS has infected ~2,500 people and killed ~900 since the outbreak in September 2012. Both SARS and MERS are characterized by atypical pneumonia with high fever, chills, dizziness, headache, myalgia, cough, and breathing difficulties; the mortality rate for SARS is 10% and for MERS the number climbs up to 50%. Both diseases are zoonoses, which means they are transferred from animals: Asian raccoon dogs for SARS-CoV and bats and camels for MERS-CoV. People were scared, the world was shaken at its very foundations, but the worst was hidden in the shadows...
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MERS-CoV Virus, Credit: Medical News Today (https://www.medicalnewstoday.com/articles/262538)

SARS-CoV and MERS-CoV in numbers

                         SARS                                     MERS
Start                November 2002                September 2012
End                  July 2003                           N/A
Infected          8,098                                      2,442
Dead               774                                     842
Start site        China                                 Saudi Arabia
Mortality        15%                                     34.4%
Vaccine           None                                  None

SARS-CoV2
Statistics

Viruses are not considered to be living organisms because they 1) cannot make their own energy, 2) cannot produce their own proteins independently, 3) do not perform any kind of cellular division, 4) are obligate (definite) intracellular parasites (cannot replicate if no host is around). And yet, they wreak havoc with every new mutation and with every new environmental adaptation being responsible for millions of deaths of animals, including humans.

SARS-CoV2 is a betacoronavirus (SARS-CoV and MERS-CoV are betacoronaviruses, too) never isolated from human specimens before. The situation report No. 58 of the WHO from March 18 reported 191,127 confirmed cases of COVID-19 (the disease caused by SARS-CoV2) and 7807 deaths; situational report No. 68 from March 28 confirmed 571,678 infected patients and a total of 26,494 deaths. On March 11, the WHO officially announced a pandemic and assessed the risk as very high. By December 29, 2019, five Chinese patients from Wuhan, Hubei Province in China, were hospitalized with acute respiratory distress syndrome. By January 25, 2020, a total of 1975 cases of COVID-19 had been reported with 56 deaths in mainland China. By January 30, 19 other countries had confirmed the first cases of a novel respiratory infection, including Taiwan, the Republic of Korea, the United States, Canada, France, and Germany. The very same day human-to-human transition of SARS-CoV2 was determined. Only a week later, the number of cases rose to 31,161 with ~630 deaths. As of March 28, COVID-19 has affected 199 countries and territories on all 6 inhabited continents. At the moment of writing this paragraph 657,434 cases of COVID-19 have been confirmed with 30,420 deaths and 141,419 recovered patients. The mortality rate is between 10 to 27% for people aged above 85, and 1 to 3% for people aged 55-64 years, and below 1% for people aged 20-54 years. However, these statistics change drastically every day and we know that no one is safe and SARS-CoV2 knows no limits​. 

                                                                       What makes it so remarkably evil?

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Credit: https://www.worldometers.info/coronavirus/
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Credit: https://www.worldometers.info/coronavirus/

SARS-CoV2
​Biology

Every coronavirus is an enveloped virion with the longest positive-sense ribonucleic acid (+RNA) functioning as its genome. The positive-sense RNA gives all coronaviruses the advantage of directly transcribing their genome part into proteins inside the host's cells and replicating the genome. The genome of SARS-CoV2 is 29,891 nucleotides long that encodes non-structural and structural proteins. The non-structural proteins serve multiple biochemical roles, including cutting the mRNA (messenger RNA, the nucleic acid chains that become translated into proteins inside the ribosomes) into smaller pieces and replication enzymes. There are four main structural proteins encoded by SARS-CoV2:
  1. Spike glycoprotein (S)
  2. Membrane protein (M)
  3. Envelope protein (E)
  4. Nucleocapsid protein (N 
These proteins are needed to enclose viral genome into a protein coat (capsid) and form a protecting membrane - envelope. It has been shown by several laboratories that Spike (S) binds to angiotensin-converting enzyme 2 (ACE2) cellular receptor which mediates the fusion between the virus and the plasma membrane. Spike is a large transmembrane glycoprotein composed of two subunits: S1 and S2. The S1 subunit contains a receptor binding domain (RBD) that acts as a bridge connecting the virus with our cells. Almost every day, new publications emerge reporting unique mutations affecting the RBD domain in Spike and how these could affect 1) the virulence (the severity of a microbe's infection and/or tissue damage) of SARS-CoV2 and 2) the effectiveness of vaccines development. 
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COVID-19
What you need to know about the disease

Symptoms
I. Prevailing symptoms:
  1. Fever (over 100°F)
  2. Cough
  3. Breathing difficulties
II. Other:
  1. Tiredness
  2. Nasal congestion
  3. Runny nose
  4. Sore throat
  5. Diarrhea 
  6. Anosmia (lack of sense of smell)
  7. Dysgeusia (lack of sense of taste)
  8. Conjuctivitis (pink eye condition)
  9. Gastrointestinal symptoms
III. Asymptomatic:
There is no direct number on how many people can be the asymptomatic carriers ​

Transmission

  1. Direct person-to-person contact (within 1-2 meters)
  2. Coughing or sneezing droplets
  3. Indirect contact with:
    1. Immediate environment of the patient
    2. Objects used by or used on the infected patient

Social distancing and self-quarantine as well as the isolation of infected patients are necessary to flatten the curve of the spread of COVID-19, which is to slow the rate of new infections by taking protective measures. The basic measures you can take and yet save other people's lives are the Five Things. 

Symptoms appear 2 to 14 days since the contact with a sick patient. 

People are most contagious when they are most symptomatic.
Some people can spread the virus before showing any symptoms, although this has not been proven empirically yet. 

CDC.gov: 'The virus that causes COVID-19 seems to be spreading easily and sustainably in the community ("community spread) in some affected geographic areas.'

In some groups of patients (data not known yet), re-infection has occurred. 

IMPORTANT: The onset and duration of viral shedding and period of infectiousness are not yet known. 
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Credit: Rothan, H. A., & Byrareddy, S. N. (2020). The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity, 102433.
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Groups of risk                                                                   COVID-19 is not a flu!    

  • People aged > 65 years
  • People with concomitant diseases:
    • Serious heart conditions
    • Patients with chronic lung disorders
    • Diabetics 
    • Patients with renal and liver diseases
  • Pregnant women (no precise data on this one!)
  • Immunocompromised patients:
    • HIV/AIDS patients
    • Patients after transplantations
    • Immune-deficiency disorders
    • Oncology patients
    • People treated with corticosteroids
  • People living in nursing homes
  • People prone to poor hygiene 
Remember that COVID-19 IS NOT A FLU! 

The flu is a viral disease caused by Influenza viruses of the Orthomyxoviridae family, whereas coronaviruses make up their own family, Coronaviridae. The only thing that coronaviruses and flu viruses have in common is that they use RNA as their genomic material. The flu can manifest with similar prodromal symptoms, such as fever, coughing, malaise, sore throat. Pneumonia can be one of the complications of the flu, but never as deadly and as dangerous as the acute respiratory syndrome caused by SARS-CoV2. 

Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) spoke on March 16 during the World Economic Forum and when calling for urgent action to ramp up efforts against COVID-19, he said 'We have a simple message for all countries: test, test, test.'
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