Novel Coronavirus (2019-NCOV) Outbreak: A Mini Review

The SARS pandemic produces new avenues to discover and anticipate the variations made in SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) and how human angiotensin converting enzyme 2 receptor ideally becomes congenial with “S” region of this virus and in consequence ofits spread in human species all over the globe. At the end of 2019, the earliest wave of SARS-CoV-2 transmission was notified from Wuhan-Hubei China and thereafter spread globally. COVID-19 infection got widespread and upto now, 2,776,224 active cases, 334,058 deceased and 2,078,505-recovered cases have been reported. Morbidity and mortality rate vary in every region which pondered the researcher to look into the linkage between a different variant of the SARS-CoV-2 with disease severity along with other determining factors like climatic changes, diagnostic techniques


INTRODUCTION
As 2019 approached to the closure, pneumonia with unidentified etiology associated with Coronavirus disease-2019 (COVID-19) appeared in Wuhan, China.It is an extremely transmissible disease and within a short period of time it spread from China to other countries. 1Now COVID-19 has become a serious pandemic issue. 2 Till March 2020 around 2,665,408 cases of COVID-19 and 320,192 deaths have been reported. 3Its mode of spread is via person to person transmission and tentatively named 2019-nCoV that was officially declared as an 1.
Allah Rakha 1-5 Department of Forensic Sciences University of Health Sciences, Lahore -Pakistan.
Corresponding Author: Rahat Abdul Rehman Assistant Professor, Department of Forensic Sciences University of Health Sciences, Lahore-Pakistan.Email: dnatypist@gmail.cominternational public health emergency by WHO, on 31 st January 2020. 4Later on, 11 th February 2020, the Coronavirus Study Group of the International Committee on Taxonomy of Viruses officially announced it as SARS-CoV-2 "severe acute respiratory syndrome Coronavirus 2".Moreover, on the same day, the World Health Organization proclaimed the SARS-CoV-2 virus causing "COVID-19"as global pandemic. 5,6In order to control and prevent its wide spread, the awareness about this new virus is needed anxiously.

Origins of 2019-nCoV
To date, the origin of COVID-19 is still suspicious.
Although it was first reported from China and so suspected that it may transfer from the Wuhan sea food market to Chinese who worked or visited there, no exported cases had any link ages to the market, indicating person to person spread or by animal sources.Social media is also reported that China's seafood market sold marmots, birds, snakes and even bats.However, environmental isolates were positive for novel Coronavirus but no specific animal linkage has been established. 7Initially on the basis of codon usage of snake samples drawn from the Wuhan market, it was proposed that snakes might be a possible source of spread but this proclamation has been disputed by Robertson and his colleagues. 8However, research on the possible intermediate animal model is continued to identify the source of 2019-nCoV.

Virology
Coronaviruses are enveloped, single-stranded, nonsegmented positive sense RNA virus, having large genome size, with high a frequency of mutation and genomic recombination.

Transmission Dynamics
The preliminary estimation of the basic reproductive rate (R0) for COVID-19 is 2.2 (95% CI, 1.4 to 3.9). 13Despite the fact there remains some uncertainty; fomites are thought to be the principle source of viruses.Different strains of Coronaviruses remain viable for days on uncleaned surfaces. 14ecently, a Chinese researcher reported the presence of the virus in a fecal sample of COVID-19 confirmed patient; however, the SARS-COV-2 virus was also detected within the fecal sample of symptomatic COVID-19 patients while the blood sample tested negative. 15Several studies have shown effective person to person transmission of SARS-CoV-2 virus even in the presence of isolation facilities. 16,17Health care facilities are very severe threat for the transmission of virus.Recently 41% of patients acquired infection from hospitals including 29% medical staff.So, it seems that asymptomatic individuals have the potential to spread COVID-19 infection. 18

Treatment Options
It has been reported that remdesivir (antiviral drug) and Chloroquine (old antimalarial drug) inhibits the development of SARS-CoV-2 in vitro. 22he clinical trial performed on COVID-19 Chinese patients revealed that Chloroquine considerably affects the clinical outcomes and viral clearance. 23hinese specialists suggest that patients identified from mild to severe instances of COVID-19 pneumonia be curated with 500 mg Chloroquine twice daily for ten days. 24iomedica -Vol.36, COVID19-S2, 2020 Hydroxy Chloroquine (an analogue of Chloroquine) has been confirmed to have antiviral activity for SARS-CoV-2 in vitro. 25During long-term use, Hydroxychloroquine clinical safety profile is superior to that of Chloroquine and permits higher daily dose 26 however fewer concerns about drugdrug interactions. 27

Guidelines to Prevent the Expansion of Disease
In order to curb the human to human transmission of SARS-CoV-2, the substantial policies and measures need to be taken to govern the ongoing epidemic outbreak.Specific SOPs and guidelines especially for hand washing and sanitization should be practically applied in most susceptible individuals together with children, elderly peoples and hospital staff.Guideline literature was published for medical and health care staff, scientists, researchers, and the public. 28All affected countries including Pakistan have implemented major preventive measures by travel screening to control the spread of SARS-CoV-2. 29The COVID-19 early death rate increased in elderly people especially the immunocompromised individuals that cause fast progression of virus infection.Sanitizers for cleaning hands and surfaces should meet the WHO criteria in public service station. 30hysical contact with wet contaminated items can potentially serve as an alternate mean of the virus transmission.

LIMITATIONS OF STUDY
The manuscript is a narrative review.Protocols and guidelines pertaining to systematic review are not applicable.