Coronavirus is a 21st century threat.
In the new millennium, humanity is faced with previously unknown infectious diseases. Plague and typhus were replaced by dangerous viruses. And their appearance is an integral part of our world. Therefore, humanity must learn to resist these threats.
The COVID-19 pandemic is the next international emergency after H5N1 avian influenza (2007), H1N1pdm swine influenza A (2009), severe acute respiratory syndrome (SARS-nCoV, 2002), Middle East coronavirus syndrome (MERS) -CoV, 2015), Ebola (2014-2015), Zika (2016).
Coronavirus infection is an acute viral disease with a predominant lesion of the upper respiratory tract, caused by an RNA genomic virus of the genus Betacoronavirus of the Coronaviridae family.
Coronaviruses (Latin Coronaviridae) are a family of about 40 types of RNA-containing complexly organized viruses with a supercapsid. The International Committee on Virus Taxonomy has assigned the official name to the causative agent of the infection – SARS-CoV-2. The main target cells for coronaviruses are the cells of the alveolar epithelium, in the cytoplasm of which the virus replicates. The action of the virus causes an increase in the permeability of cell membranes and increased transport of albumin-rich fluid into the interstitial tissue of the lung and the lumen of the alveoli. In this case, the surfactant is destroyed, which leads to the collapse of the alveoli, as a result of a sharp violation of gas exchange, an acute respiratory distress syndrome develops.
The immunosuppressive state of the patient contributes to the development of opportunistic bacterial and mycotic infections of the respiratory tract. Immunity for infections caused by members of the coronavirus family is not persistent and re-infection is possible.
Bats are the natural reservoir of the SARS-CoV-2 virus. Mammals eating bats can serve as an additional reservoir. The main source of infection for humans is an infected person, including those at the end of the incubation, prodromal period (the beginning of virus isolation from target cells) and during clinical manifestations.
Ways of transmission of infection are airborne (the release of the virus when coughing, sneezing, talking), contact-household (through water, food and objects (door handles, smartphone screens), fecal-oral. The risk of transmitting the virus from hands to the mucous membranes of the eyes , nasal and oral cavity proven.
Susceptibility to the pathogen is high in all population groups. The risk groups for a severe course of the disease and the risk of death include people over 60 years old, patients with chronic diseases (diseases of the respiratory system, cardiovascular system, cancer). Mortality varies from 2 to 4%. The SARS-CoV-2 virus is characterized by low resistance in the environment. Dies under the influence of ultraviolet radiation, disinfectants, when heated to 40 ° C for 1 hour, to 56 ° C in 30 minutes. On the surface of objects at 18-25оС it remains viable from 2 to 48 hours. The incubation period for COVID-19 ranges from 2 to 14 days, on average 5 days.
Среди первых симптомов COVID-19 отмечено повышение температуры тела (90% случаев); кашель (сухой или с небольшим количеством мокроты – 80% случаев); ощущение сдавленности в грудной клетке (20%); одышка (55%); миалгии и утомляемость (44%); кашель с выделением мокроты (28%); редко наблюдаются головные боли (8%), кровохарканье (5%), диарея (3%), тошнота. В начале инфекции повышение температуры тела может отсутствовать.
To date, there is no evidence of the effectiveness of using any drugs for COVID-19. Patient management is mainly focused on providing syndromic care: humidified oxygen insufflation, non-invasive and invasive ventilation of the lungs, infusion therapy. Combined treatment with low doses of systemic corticosteroids and antiviral drugs, the use of inhalation with interferon proposed as part of intensive therapy for COVID-19 [ ].
Also, more than 85% of patients received antiviral drugs, including oseltamivir (75 mg orally every 12 hours), ganciclovir (0.25 g every 12 hours intravenously) and lopinavir / ritonavir combination (400/100 mg twice daily), remdesivir … The latter is known for its effectiveness in preventing the MERS-CoV coronavirus infection. An old antimalarial drug, chloroquine phosphate, has been reported to be effective in treating COVID-19 associated pneumonia due to its antiviral and anti-inflammatory activity. During the last outbreak of SARS-COV, traditional Chinese medicine was widely used and is currently being used in China. The five most commonly used herbs are Astragali Radix (Astragalus), Glycyrrhizae Radix Et Rhizoma (Licorice), Saposhnikoviae Radix (Shoemaker), Atractylodes macrocephala (Spindle), and Lonicerae Japonicae Flos (Japanese honeysuckle) [ ].
In the absence of clear treatment protocols, many therapy options have been tried in the treatment of COVID-19. Some of these treatments look promising. Currently, more than 150 clinical trials of various treatments for COVID-19 infection are underway in more than ten medical institutions in China.
To date, the recommendations of the FDA and the Italian Society of Infectious and Tropical Diseases for the clinical management of patients with atypical pneumonia associated with coronaviruses include ribavirin, lopinavir + ritonavir, interferon preparations, chloroquine, remdesivir, pathogenetic and symptomatic therapy.
Pathogenetic therapy should ensure the maintenance of water and electrolyte balance. Those. patients with mild to moderate severity of the disease need to drink a sufficient amount of liquid (2.5-3.5 liters per day or more, if there are no contraindications). In case of severe intoxication, as well as in case of abdominal discomfort, nausea and / or vomiting, edema syndrome that prevents the use of fluids, enterosorbents are indicated (colloidal silicon dioxide, polymethylsiloxane polyhydrate, and others). In patients in serious condition (resuscitation and intensive care units), if indicated, infusion therapy is performed.
Symptomatic treatment includes:
– relief of fever;
– complex therapy of rhinitis and / or rhinopharyngitis (moisturizing / elimination drugs, nasal decongestants);
– complex therapy of bronchitis (mucoactive, bronchodilator and other drugs).
Antipyretics are prescribed at temperatures above 38.0-38.5 ° C. With poor tolerance of febrile syndrome, headaches, increased blood pressure and severe tachycardia (especially in the presence of ischemic changes or rhythm disturbances), antipyretics are also used at lower numbers. The safest drug is paracetamol.
For the local treatment of rhinitis, pharyngitis, with nasal congestion and / or nasal discharge, they begin with saline agents for topical use based on sea water (isotonic, and with congestion – hypertonic). If they are ineffective, nasal decongents are indicated. In case of ineffectiveness or severe symptoms, various antiseptic solutions can be used.
Nonspecific prevention of coronavirus infection include
measures in relation to the source of infection: isolation of patients in boxed rooms / wards of an infectious diseases hospital; care and treatment; discharge after a double negative test result for the SARS-CoV-2 coronavirus;
measures aimed at the mechanism of transmission of the pathogen:
– observance of the rules of personal hygiene (wash hands with soap, use disposable napkins when sneezing and coughing, touch your face only with clean napkins or washed hands);
– the use of disposable medical masks, which must be changed every 2 hours;
– use of protective clothing for health workers;
– carrying out disinfection measures;
– disposal of class B medical waste;
– evacuation of patients with special vehicles;
activities aimed at a susceptible contingent:
– elimination therapy, which is irrigation of the nasal mucosa with isotonic sodium chloride solution, reduces the number of both viral and bacterial pathogens of infectious diseases.
– the use of drugs for topical use with barrier functions.
Carrying out anti-epidemic, including isolation-restrictive and disinfection measures, informing the population about ways to protect against infection are the most significant measures to prevent the spread of dangerous infections and are widely used in the world in the fight against epidemics.
But studying the features of this epidemic will allow analyzing the shortcomings of ensuring the biological safety of the population and developing treatment tactics.
1) Liu Y, Li J, Feng Y. Critical care response to a hospital outbreak of the 2019- nCoV infection in Shenzhen, China. Crit Care. – 2020. – 24:56
2) A. C. Cunningham, H. P. Goh, D. Koh Treatment of COVID-19: old tricks for new challenges//Critical Care. – 2020. – 24:91