Abstract
COVID-19 represents the latest pandemic caused by the SARS-CoV-2 coronavirus. Coronaviruses are RNA viruses that cause a largely viral mediated immune-related syndrome similar to the SARS epidemic. Following metagenomic sequencing, SARS-CoV-2 closely resembles SARS-CoV (79% similarity) and MERS-CoV virus (50% similarity). Despite this, clinical observations have found varying degrees of infectivity and pathogenesis amongst these viruses. Phylogenetic origins of SARS-CoV-2 have found connections to bats and pangolins as possible zoonotic reservoirs. It enters the host cells via the receptor binding site of the ACE-2 receptor. Upon entering the host cells, cytopathic effects and interruption of respiratory cilia occur with a resultant cascade of pro-inflammatory cytokines and chemokines. Common clinical features of COVID-19 include fever, cough and fatigue. COVID-19 infected patients also present with various gastrointestinal, gustatory, dermatologic, ocular, cardiovascular, neurologic and coagulopathic manifestations. Dyspnea, sore throat, nasal congestion, musculoskeletal pain, headaches and chills were also observed. Emerging data supports that COVID 19 has disproportionately affected specific ethnic groups, particularly racial minorities for various health and institutional reasons. It is estimated around 5% of all cases are severe, presenting with respiratory failure, shock, acute respiratory syndrome and arrhythmias. Co-infection with other pathogens was also seen with various other viruses such as rhinoviruses, respiratory syncytial virus and other coronaviruses. COVID-19 is able to spread asymptomatically and causes slightly different manifestations in pregnant ladies and the pediatric populations. ARDS in COVID-19 patients is suspected to be a unique clinical entity as lung function testing found high driving pressures with abnormally low lung compliance and low lung recruitability. This requires a unique approach to ventilating COVID-19 ARDS patients. In conclusion, new emerging data will require healthcare professionals to adapt and more studies are required to overcome this critical pandemic.
Highlights
Coronavirus disease 2019, better known as COVID-19, has presented itself as the defining health challenge in modern history
By March 11th 2020, the World Health Organization (WHO) announced that the COVID-19 outbreak could be characterized as a pandemic
We provide a detailed and recent review into the evidence available on the etiopathogenesis and clinical presentation of COVID-19 to better aid clinicians and spur new avenues for high quality studies in the future
Summary
Coronavirus disease 2019, better known as COVID-19, has presented itself as the defining health challenge in modern history. These differences are mostly concentrated in the non-structural proteins and spike protein S used for cell binding and entry These findings again make COVID-19 very similar genetically to the SARS-CoV pandemic of 2003 and the bat SARS-like virus that was isolated from Intermediate Horseshoe bats mentioned earlier. Upon genomic examination of all 3 viruses, there were 5 key amino acids on the binding site of the SARS-CoV-2 virus that were completely indistinguishable from the Pangolin CoV, while the BatCoV RaTG13 has 4 differing mutations (Zhang et al, 2020a) Coronaviruses such as the SARS-CoV and MERS-CoV have been shown in the past to have other intermediate hosts such as civets and camels and it is expected that SARS-CoV-2 is likely to be similar (Azhar et al, 2014; Guan et al, 2003).
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