• Users Online: 143
  • Print this page
  • Email this page

Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 79-82

Coronavirus disease-19 (severe acute respiratory syndrome-coronavirus-2) is not just simple influenza: What have we learned so far?

1 Department of Pathology and Laboratory Medicine, College of Medicine, Riyadh, Saudi Arabia
2 Department of Medicine, University Sleep Disorders Center and Pulmonary Service; Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation, King Saud University, Riyadh, Saudi Arabia

Date of Submission12-Mar-2020
Date of Acceptance20-Mar-2020
Date of Web Publication02-Apr-2020

Correspondence Address:
Ali M Somily
Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNSM.JNSM_22_20

Rights and Permissions

How to cite this article:
Somily AM, BaHammam AS. Coronavirus disease-19 (severe acute respiratory syndrome-coronavirus-2) is not just simple influenza: What have we learned so far?. J Nat Sci Med 2020;3:79-82

How to cite this URL:
Somily AM, BaHammam AS. Coronavirus disease-19 (severe acute respiratory syndrome-coronavirus-2) is not just simple influenza: What have we learned so far?. J Nat Sci Med [serial online] 2020 [cited 2023 Mar 30];3:79-82. Available from: https://www.jnsmonline.org/text.asp?2020/3/2/79/281378

Since December 2019, the world is experiencing a global, rapidly evolving spread of a novel coronavirus (2019-nCoV). Scientists, public health practitioners, clinicians, and health officials are racing to understand more about the nature of this virus. Every day, there is a new discovery, but there are so many inquiries that need to be addressed and unknowns that need to be explored.

2019-nCoV emerged first in Wuhan, Hubei Province, China, which is a major transportation hub with a population of more than 11 million people.[1] The majority of the initially diagnosed 41 confirmed cases and admitted with pneumonia visited a local fish and wild animal market in the previous month.[2] The World Health Organization (WHO) named this virus (COVID-19), while the International Committee on Taxonomy of Viruses has renamed as severe acute respiratory syndrome-coronavirus (SARS-CoV-2).[3] Although calling the virus as “SARS-CoV-2” is probably more accurate, for simplicity, we will use the WHO name (COVID-19) in this editorial.

On January 30, 2020, the WHO declared the COVID-19 outbreak as the sixth public health emergency of international concern due to the fact that this virus is transmitted from human to human through droplets and direct or indirect contact, and carry a great potential to lead to pandemic disease.[4] Viral shedding of the virus from the upper respiratory tract can continue up to 1–3 weeks in symptomatic patients from the initial onset of symptoms.[5],[6] This virus can be shed in the stool of the asymptomatic patients up to 17 days of last exposure to the virus.[7] Asymptomatic patients or a presymptomatic carriers have the potential to transmit SARS-C0V-2 to others.[8] Contaminated inanimate surfaces surrounding the patients with COVID-19 in the hospital should not be overlooked as a major source of transmission of infection.[9]

At the time of writing this editorial, SARS CoV-2 has spread in 168 countries and the number of confirmed cases exceeded 270,000; more than 69.4% were outside China, and 30.6% of the cases were in China, with approximately 12,000 (4.2%) recorded deaths globally. The documented deaths in Italy secondary to COVID-19 infection were 4032, exceeding China with 3,261 deaths. Italy as well reported the highest number of confirmed cases outside China (n = 47, 021) followed by Spain (n = 19, 980), and then Iran (n = 19644).[10] These countries outside China with ongoing local transmission are documented to be a new focus on transmission of COVID-19 to neighboring countries in the Arabian Gulf countries, the Middle East, and Europe. The WHO, on March 11, 2020, stated that “after making the necessary assessment COVID-19 can be characterized as a pandemic.”

COVID-19 was found to be a positive-sense, single-stranded RNA virus belonging to the genus Betacoronavirus.[1] Several coronaviruses are known to cause human respiratory diseases like coronavirus 229E/NL63/OC43, which causes mainly mild upper respiratory tract infection in normal hosts. In contrast, others like SARS-CoV-1 and MERS-CoV can cause severe lower respiratory tract infection and acute respiratory distress syndrome (ARDS) as well as outbreaks similar to SARS CoV-2.[11] A recent genomic study of COVID-19 proposed bat or bat excreta as the source of the COVID-19 that contaminated food in markets[12] and rejected the other hypothesis of emergence as a result of a recent recombination event.[13] COVID-19 genomic sequence showed more than 80% similar identity of this virus to SARS-CoV-1 and only 50% identity to MERS-CoV.[11],[14]

Clinically, in a recent review of 1099 of laboratory-confirmed cases in China, fever was documented in 43% of the patients on admission and 93% during hospitalization, and cough in 67.8%, while only 3.8% had diarrhea.[15] The median incubation period was 4 days (interquartile range, 2–7); however, it may extend up to 14 days. Therefore, isolation of contacts of patients with COVID-19 should be put on quarantine for 14 days.

Ground glass appearance on chest CT scan was found reported in 56.4% of the patients and lymphopenia was the major hematological finding (83.2%).[15] Among all patients presented, mild disease was seen in 81%, severe in 14%, and only 5% had critically severe illness.[16] Another study reported the following organs function failure, ARDS (17%), acute respiratory injury (8%), acute renal injury (3%), and septic shock (4%).[17] The patients admitted to the intensive care units (ICUs) were more likely to be elderly patients with underlying comorbid chronic medical disorders.[18] Children can be infected with COVID-19, and they usually present with a milder disease; however, they might act as carriers and spread the infection to close contacts.[19]

The reported mortality rate of patients with COVID-19 pneumonia ranges from 4.3%-14.6%.[18],[20] The fatality rate reported by the Chinese Center for Disease Control and Prevention among all patients with COVID-19 was 2.3%, which is much lower than the rate of previous studies from Wuhan that reported a fatality rate of 3.28%, and higher than the recently reported fatality rate from Beijing 0.9%.[16],[17],[20],[21],[22] The possible explanation for the high fatality in initial studies from Wuhan is the inclusion of only sick patients presented to the health-care facilities, rather than including all cases confirmed with COVID-19 infection. The WHO on March 4, 2020, estimated that the global COVID-19 death rate is 3.4%. It has been proven that mortality rate varies significantly with highest mortality rate among patients ≥80 years of age 14.8%, 70-79 years (8%), 60-69 years 3.6%, 50-59 years 1.3%, < 50 years 0.4%.[16]

Furthermore, the investigators suggested that the development of a new variation in the functional sites in the receptor-binding domain (RBD) of the spike seen in COVID-19 due the viral evolution as a result of mutation, selection and recombination evolve into two major types (L-type and S-type), each has different (Single Nucleotides Polymorphisms) SNPs. The L-type is the one that spread quickly initially during the outbreak in Wuhan (70%) and was associated with more severe disease, and decreased in early January, while Type S is the ancestral version (30%) that spreads afterward and is less aggressive. Some patients have been found to be infected by both types.[23]

All suspected cases of COVID-19 should be tested using the recommended molecular method recommended by the WHO.[24] A negative nasopharyngeal/oropharyngeal sample result should not be used to rule out COVID-19 infection. It is known that the target functional receptor of these viruses is angiotensin-converting enzyme 2 (ACE2) that is mainly located on Type 1 and Type 2 alveolar cells.[25] It is recommended that all results be interpreted in concordance with the clinical suspicion and epidemiological link.[26]

Serological tests for COVID-19 may detect the infection in patients with symptoms or asymptomatic patients. The fact that these tests (IgM, IgG) might take from few days to a couple of weeks after the development of symptoms in order to be detected, and the issue of cross-reactivity with other viruses make their clinical utility in the management of acutely ill patients surrounded by limitation and skepticism. However, serological tests, in general, have superior value in epidemiological studies in the hospital setting and the community for contact tracing and to estimate the burden of the disease.[27],[28] Currently, there are no approved specific antiviral treatments or vaccination for COVID-19.[29] However, several treatment options have recently been used for the treatment of patients with COVID-19 pneumonia in Wuhan, China, including; ganciclovir, oseltamivir, and lopinavir/ritonavir, twice a day for a duration ranging from 3 to 14 days in 75% of the patients.[17],[18],[20] Other promising drugs are remdesivir, chloroquine, and tocilizumab, and clinical trials on these medications are going on in the USA, Europe, and China.[30],[31]

Recently, studies demonstrated clinical and virologic benefits of chloroquine and hydroxychloroquine in patients with COVID-19 compared to controls.[30],[31] Based on limited in-vitro and anecdotal data, chloroquine and hydroxychloroquine are currently recommended for the treatment of hospitalized COVID-19 patients in several countries. Both drugs have known safety profiles; the main side effect is cardiotoxicity (prolonged QT syndrome) after prolonged use in patients with hepatic or renal impairment and those who are immunosuppressed. However, both drugs were reportedly well-tolerated in COVID-19 patients. Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of COVID-19 infection, and treatment of patients with mild, moderate, and severe infection. A randomized, controlled, non-blinded study in hospitalized patients with severe COVID-19 showed no benefits of treatment lopinavir/ritonavir beyond the standard care.[32],[33],[34] Several academic centers and many biopharmaceutical companies are currently working to develop a vaccine for COVID-19. Several potential targets, including DNA, mRNA, proteins, and adenovirus vectors, have been identified. We hope that with global collaboration among all international medical centers and sharing the knowledge and expertise, a new development of an effective vaccine for COVID-19 will evolve soon.[35] Recently, the US National Institute of Allergy and Infectious Diseases announced phase I human trial to develop (mRNA-1273 to express viral spike protein) vaccine for COVID-19.[36]

Urgent collaboration and cooperation among all health care sectors, public health, and governments are required globally.[37] It is very important to communicate the epidemiological and clinical data and the risk of COVID-19 infection to health-care workers and the general population, and to activate public health education based on evidence sound scientific information to prevent misinformation that might lead to distress and anxiety of the public.[38] The effective approach to the control of COVID-19 is to limit human-to-human transmission through practicing evidence-based community measures, i.e., rigorous hand hygiene with alcohol based or water and soap, cough etiquette, and face masks only for persons with upper respiratory tract infection.[39] Additionally, distant social measures and international travel based following the country recommendation based on the risk assessment to minimize the social and economic impact of these measures.[40] Infection prevention and control (IPC) measures should be implemented strictly in all health-care facilities to prevent the spread of the infection to vulnerable patients and to protect the health-care workers. Clear protocols for all IPC measures should be in place, i.e., early identification of the suspected cases, early and proper isolation, wearing the appropriate personal protective equipment (PPE), effective terminal cleaning of the room after each COVID-19 patient transfer, educational campaigns, and audits as well as efficient communication with public health.[41]

There is a misconception among some practitioners and the general public that COVID-19 infection will diminish and disappear during summer. However, there are no data to support that COVID-19 is a seasonal infection. Therefore, all recommended prevented measures should continue during summer until the WHO or other national and international health authorities announce information about the behavior of COVID-19 during summertime.

In summary, COVID-19 is an emerging virus considered as a global public health emergency, which requires a collaborative higher level of responsive measures from all countries. Efficient communication, collaboration, and cooperation in implementing scientific evidence-based measures on the personal, national, and international levels are crucial. Urgent clinical trials on potential drugs for COVID-19 are required, and the development of an efficient and safe vaccine is a public health priority. More research is urgently needed to better understand the epidemiology, transmission, pathogenesis, and clinical severity of the COVID-19 infection.

  References Top

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.  Back to cited text no. 1
Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-2.  Back to cited text no. 2
Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses – A statement of the Coronavirus Study Group; bioRxiv 2020.02.07.937862. [doi: https://doi.org/10.1101/2020.02.07.937862].  Back to cited text no. 3
World Health Organization. Naming the Coronavirus Disease (COVID-2019) and the Virus that Causes it. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it. [Last accessed on 2020 March 11].  Back to cited text no. 4
Kim JY, Ko JH, Kim Y, Kim YJ, Kim JM, Chung YS, et al. Viral load kinetics of SARS-CoV-2 infection in first two patients in Korea. J Korean Med Sci 2020;35:e86.  Back to cited text no. 5
Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382:1177-9. [doi: 10.1056/NEJMc2001737].  Back to cited text no. 6
Tang A, Tong ZD, Wang HL, Dai YX, Li KF, Liu JN, et al. Detection of novel coronavirus by RT-PCR in stool specimen from asymptomatic child, China. Emerg Infect Dis 2020;26 (6).  Back to cited text no. 7
Tong ZD, Tang A, Li KF, Li P, Wang HL, Yi JP, et al. Potential presymptomatic transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg Infect Dis 2020;26(5).  Back to cited text no. 8
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020;104:246-51.  Back to cited text no. 9
World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report – 61. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200321-sitrep-61-covid-19.pdf?sfvrsn=f201f85c_2. [Last accesed on 2020 Mar 22].  Back to cited text no. 10
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020;395:565-74.  Back to cited text no. 11
Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nat 2020;579:270-3.  Back to cited text no. 12
Paraskevis D, Kostaki EG, Magiorkinis G, Panayiotakopoulos G, Sourvinos G, Tsiodras S. Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event. Infect Genet Evol 2020;79:1-4.  Back to cited text no. 13
Ren LL, Wang YM, Wu ZQ, Xiang ZC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: A descriptive study. Chin Med J (Engl) 2020. [Epub ahead of print].  Back to cited text no. 14
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. DOI: 10.1056/NEJMoa2002032.  Back to cited text no. 15
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA 2020:E1-E4.  Back to cited text no. 16
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 17
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9. doi:10.1001/jama.2020.1585.  Back to cited text no. 18
Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci 2020. doi: https://doi.org/10.1101/2020.02.20.20025619.  Back to cited text no. 19
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 20
Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, et al. Characteristics of COVID-19 infection in Beijing. J Infect 2020;80:401-6. pii: S0163-4453 (20) 30101-8.  Back to cited text no. 21
Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med 2020;1-4. pii: taaa021.  Back to cited text no. 22
Tang X, Wu C, Li X, Song Y, Yao X, Wu X, et al. On the origin and continuing evolution of SARS-CoV-2. Nat Sci Rev 2020. Available from: https://doi.org/10.1093/nsr/nwaa036. [Last accessed 2020 Mar 22].  Back to cited text no. 23
World Health Organization. Novel Coronavirus (2019-nCoV) Technical Guidance: Laboratory Testing for 2019-nCoV in Humans. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus 2019/technical-guidance/laboratory-guidance. [Last accessed 2020 Mar 22].  Back to cited text no. 24
Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by novel coronavirus from 75 Wuhan: An analysis based on decade-long structural studies of SARS. J Virol 2020. pii: JVI.00127-20. doi:10.1128/JVI.00127-20.  Back to cited text no. 25
Winichakoon P, Chaiwarith R, Liwsrisakun C, Salee P, Goonna A, Limsukon A, et al. Negative nasopharyngeal and oropharyngeal swab does not rule out COVID-19. J Clin Microbiol 2020. pii: JCM.00297-20. doi:10.1128/JCM.00297-20.  Back to cited text no. 26
Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, Wang YY, et al. Molecular and serological investigation of 2019-nCoV infected patients: Implication of multiple shedding routes. Emerg Microbes Infect 2020;9:386-9. doi:10.1080/22221751.2020.1729071.  Back to cited text no. 27
Available from: https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html. [Last accessed on 2020 Mar 20].  Back to cited text no. 28
World Health Organization. Clinical Management of Severe Acute Respiratory Infection When Novel Coronavirus (nCoV) Infection is Suspected; 2020. Available from: https://www.who.int/publications-detail/clinical-management-of-severeacute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-issuspected (). [Last accessed on 2020 Feb 17].  Back to cited text no. 29
Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020;30:269-71.  Back to cited text no. 30
Colson P, Rolain JM, Raoult D. Chloroquine for the 2019 novel coronavirus SARS-CoV-2. Int J Antimicrob Agents 2020;55:105923.  Back to cited text no. 31
Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 2020;6:16. https://doi.org/10.1038/s41421-020-0156-0.  Back to cited text no. 32
Gautreta P, Lagiera JC, Parola P, Hoanga VT, Meddeb L, Mailhea M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. In Press 17 March 2020 – DOI: 10.1016/j.ijantimicag.2020.105949.  Back to cited text no. 33
Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. New Eng J Med 2020.  Back to cited text no. 34
Prompetchara E, Ketloy C, Palaga T. Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pac J Allergy Immunol 2020.  Back to cited text no. 35
MedCityNews. Moderna ShipsFirst Batch of COVID-19 Vaccine for Phase I Trial; Study Page Posted Online. Available from: https://medcitynews.com/2020/02/moderna-ships- first-batch-of-covid-19-vaccine-phase-i-trial-study-page-posted-on-clinicaltrials-gov/. [Last accessed on 2020 Mar 22].  Back to cited text no. 36
Yoo JH. The fight against the 2019-nCoV outbreak: An arduous march has just begun. J Korean Med Sci 2020;35:e56.  Back to cited text no. 37
Xiao Y, Torok ME. Taking the right measures to control COVID-19. Lancet Infect Dis 2020. pii: S1473-3099 (20) 30152-3.  Back to cited text no. 38
European Centre for Disease Prevention and Control. Outbreak of Novel Coronavirus Disease 2019 (COVID-19): Increased Transmission Globally – Fifth Update; 2020. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/RRA-outbreak-novel-coronavirus-disease-2019-increase-transmission-globally-COVID-19.pdf. [Last accessed on 2020 Mar 22].  Back to cited text no. 39
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html. [Last accessed 2020 Mar 22].  Back to cited text no. 40
World Health Organization. Coronavirus Disease (COVID-19) Technical Guidance: Infection Prevention and Control/WASH. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control. [Last accessed 2020 Mar 22].  Back to cited text no. 41

This article has been cited by
1 The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19
Haitham Jahrami,Ahmed S. BaHammam,Haifa AlGahtani,Ahmed Ebrahim,MoezAlIslam Faris,Kawthar AlEid,Zahra Saif,Eman Haji,Ali Dhahi,Hussain Marzooq,Suad Hubail,Zainab Hasan
Sleep and Breathing. 2020;
[Pubmed] | [DOI]
2 COVID-19 in Croatia
Franjic S
Asploro Journal of Biomedical and Clinical Case Reports. 2020; 3(2): 106
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article

 Article Access Statistics
    PDF Downloaded439    
    Comments [Add]    
    Cited by others 2    

Recommend this journal