SARS-CoV-2, COVID 19 Useful information

SARS-COV-2, COVID-19 or Wuhan virus is the last RNA of the seven RNA viruses described whit affection in humans of the family Coronaviridae subfamily Orthocoronavirinae of the order Nidovirals, characterized from the other positively charged RNA viruses (can be translated directly without the need for reverse transcriptase Baltimore III-mRNA + classification) as having the largest genome, so its cycle and transmission is not entirely clear.

with a mortality of approximately 11% and 35% respectively, highlighting the high mortality that this group of viruses can have in humans [1,2]. Its name is derived from its microscopic shape similar to that of a solar corona and from the Latin corona, it has DOI: 10.26717/BJSTR.2020. 27.004484 20658 protecting it. There are also accessory proteins or that complement the replication and function of the virus such as the HE protein [1] ( Figure 1). In Colombia on March 29, was obtained the first SARS-CoV2 genome sequence that circulates in Colombia, SARS-CoV2 arrives in the country on February 26, 2020.

Viral Replication, Cycle and Assembly
The virus binds to the host cell by interacting with the Spike protein with the receptor of the cell to be infected, this receptor varies in the host, in humans two receptors have been described, the angiotensin-2 receptor (ACE2) and the human receptor of aminopeptidase-N N (hAPN). Once inside it deposits its RNA, moves to the ribosomes and from there begins the protein translation and finally its assembly as outlined in the Figure 2 [1]. The importance of knowing that one of the receptors is ACE-2 has largely explained the tropism that has had the virus by the respiratory system, cardiovascular and the possible explanation of their neurological commitment, They have even argued that the severity of the disease may be related to patients with cardiovascular disorders and the cytokine storm that it generates (IL-1B, IL-6, IL-12, IFN, IL-10, and MCP1) by a TH2 response [2,3] that are currently being worked on in clinical trials as blocking agents of this receptor in its therapy [4].

Where Did it Come From?
On 31 December 2019, an epidemiological alert was issued for an outbreak of pneumonia caused by a new strain of coronavirus that occurred in Wuhan in Hubei Province, China, with possible epicenter the Huanan wholesale seafood market, where wild animals were sold illegally (bats, badgers), which is considered to have originated from bats [2,5,6]

Time?
Transmission of the virus is by aerosols or drops, the secretions (saliva, feces, conjunctival) of the infected person or with exposure to an inert area or surface where the virus was [2,9], summarize as follows:

Person-To-Person
COVID-19 is transmitted by airway, fecal-oral and by contact of respiratory, conjunctival secretions, it has not been reported that sweat, seminal fluids or vaginal fluids transmit it.

At the Respiratory Level
The transmission is by inhalation of droplets containing the virus within a contact close to 6 feet or 2 meters away.

Contact with Surfaces, Contaminated or Inert Objects [10].
a) The droplets of 5 micrometers, maintain stability on the following surfaces or vehicles. b) In the air in aerosol mode 3h.
It is therefore that COVID-19 has high propagation efficiency,

Symptoms of COVID-19 Infection
The clinical spectrum of COVID-19 range from asymptomatic cases, mild rhinopharyngitis that account for approximately 80% of cases, to generating serious manifestations represented by 20% mainly pneumonia that will require hospitalization with some type of intervention, of which 5-8% will require intensive care in which Acute respiratory distress syndrome (ARDS) will be their most serious complication in a 46-60% of cases. But not everything is bleak as the resolution in mild cases is very high up to 80% [12,13], so being at home if you have mild symptoms is the best way to help the health team mitigate the pandemic. Generally, symptoms may appear within 2 to 14 days of exposure to the virus and the three most common symptoms are: 1) T fever 38 o C with axillary thermometer.
3) Shortness of breath or difficulty breathing. If the person has ANY of the following symptoms or warning signs, he or she should have prompt medical attention or consult the emergency department.
2) Persistent chest pain or pressure.
3) Impairment in consciousness or inability to awaken. 4) Bluish lips or face.

5) Hemoptysis (cough with blood).
What Symptoms Does the Medical Literature Report?
From the population of Wuhan described by Huang et al [2], Wang et al [14] and Zhu et al [11], Guan et al [15] and Zhou et al [16] described that the symptoms and characteristics of the patients were: Demographics a) Similar rate in men and women (54% men).  If we make a timeline like the one shown in Figure 3 regarding the development of symptoms since the onset of the disease it is described that admission to the hospital occurred on average at 7 days (1-8 days), dyspnea at day 8 (0-0 9 (0-14 days), need for mechanical ventilation 9-10 days (7-17 days) and admission to ICU on day 10-11 ( 8-17 days) , gives us a picture to be able to evaluate the clinical evolution of these patients indicating that the course is stationary between 7-10 and after that time you can see the progression or improvement of the picture, it should be noted that the severity can be present from the beginning of the symptoms.
Regarding hospitalization time in non-complicated cases were on average 10-12 days and in ICU 8-10 days [2,11,14,15,16] (Figure 3). It should be noted that, although not all of the following laboratories were statistically significant, having elevated D-dimer, lymphopenia, elevated LDH, CK-MB and elevated liver function was seen more in ICU patients, with an average admission SOFA of 5 points , indicating that these laboratories might indicate that patients would be more likely to have a more severe disease, emphasizing that lymphopenia could be considered a marker of this disease from baseline [2,11,14].

Procalcitonin (PCT) and COVID-19
The Huang and Wang studies (2.8) did not report PCT elevation, suggesting that if it rises in these patients it may be a sign of bacterial infection, which was seen at 25% (PCT %-0.5 ng/ml) in the Huang series and 75% in Wang's respectively, indicating that the PCT may have the identification of bacterial infection in these cases.

Radiologically
Lung abnormalities can be identified in 86% of patients from the first day of admission to the hospital, where extensive pulmonary involvement is evident in chest x-ray in more than two quadrants, the most common patterns on pulmonary tomography finds were [2,14,11,15,17]. pleural effusion, lymphadenopathies, cavitation's, three in bud.

POCUS and COVID-19
Little have been reported from the POCUS (Point of care ultrasound) experience, in which pulmonary ultrasound with microconvex, convex or sectoral probe have been used to identify different patterns, in which pattern B, interstitial pattern, consolidation pattern has been described, it is important that, if this tool is available and no CT scanner is available, ultrasound is used.

Place of Destination and Complications
Among Huang and Wang's studies, the average number of patients who were hospitalized were mostly in general rooms 65-70% and 25-30% in the ICU with age variation as outlined in  Table 2).

Cardiovascular involvement and COVID-19
Coronaviruses have tropism and extensive cardiovascular disease in case of SARS and MERS with spectra of myocardial injury and acute or chronic heart failure, the various manifestations that have been reported in the Cases of Wuhan of COVID-19 reflect this same pattern [2,11,14,15], a pattern manifested with development of arrhythmias, acute heart injury manifested with elevated troponin and CPK-Mb, even reporting that some patients consulted in the emergency room not for respiratory symptoms but by cardiovascular symptoms given by palpitations and chest pain [3] showing SARS-CoV2 may have clinical outcomes such as acute viral myocarditis , shock and acute heart failure [3,18]. It is important to consider the role of cardiology societies in managing patients with cardiovascular disease and COVID-19, in which Driggin and colleagues make an impeccable summary [6].

Used Therapies Reported in Literature
The experience that is had in the use of therapies is based on the report of the different series and therefore find levels of AI evidence, it will be very difficult, and we will guide ourselves with the recommendations of Class C i.e. expert concept and evidence level II-III, which will be case reports, case series and some small

Prognosis
At the moment unlike their relatives SARS and MERS who had a mortality of 11% and 35% respectively [2], COVID-19 mortality has been variable in WHO statistics, with 4.3% in Wuhan, China up to 8% in Italy with an average of 4.5% [12], of course these data must be constantly being monitored, but it is not a negligible mortality to be assessed in relation to population size, mentioning that the main patients at risk of mortality were those with cardiovascular comorbidity or have advanced age. An example of this is Colombia with an estimated population of approximately 50,000,000 habitants with a serious estimate of infection [17]. In Wuhan case studies, mortality in ICU averaged 38% and non-ICU 15% studies [2,9,11].

Case Definition (Colombian Guides-National Institute of Health)
Following guidelines similar to those of WHO, the National

Case 3 Criteria: Surveillance of severe acute respiratory infection (SARI) in hospitalized patient
Person with acute respiratory infection (ARI) with a history of fever and cough no more than 10 days of evolution, requiring inhospital management, samples should be taken for COVID-19.

Case Criterion 4: Probable death by COVID-19
All deaths from severe acute respiratory infection with clinical picture of unknown etiology.

Case Criterion 5: Asymptomatic case
Narrow contact of confirmed case COVID-19 that has not developed symptoms in the first 7 days after the last unprotected exposure.

Case classification
Several revisions are there to classify severity, this review will take the classification of the Handbook of COVID-19 Prevention and Treatment, made by Chinese authors who handled COVID-19 infection [13], which offer simple criteria and the severity classification data have been taken based on them [15], however, there are other guidelines such as those of WHO [4].

Mild Cases 80%
Clinical symptoms are mild, and no manifestations of pneumonia can be found in imaging.

Moderate Cases
Patients have symptoms such as fever and respiratory tract symptoms and may have manifestations of pneumonia in the images.

Severe Cases 14%
a) Adults who meet any of the following criteria

4)
Patients who more than 50% of lung injuries progressed within 24-48h. 2) It has a great possibility of recovery through active antivirals, cytokine anti-storm and supportive treatment. 2) The risk of mortality increases significantly.

Addressing and Diagnostic Tools
The first step is the triage system in which the physician trained to identify these patients, does so and provide them with a conventional eye cap, gloves and refer it to the designated isolation area for those patients where drop and contact protection must be present. If the patient is stable and without an alarm sign, he or she may be referred home and contacts his health insurance or National health institute (INS) for sampling, if the patient with alarm signs will be hospitalized, the samples for COVID-19 established by nasal swab or pharyngeal, basic blood chemistry studies will be taken: blood count, clotting times, liver function, renal function,  [19,20]. In case the patient arrives with indication of orotracheal intubation (see below) it should be referred to the intensive care unit or isolation unit designated in order to perform the procedure and mitigate the biological risk.

What Protective Measures to Take?
In general, the most important protective measures to be taken are:

c) Patients with probable, suspected or confirmed cases
should be isolated using aerosol and contact protection measures

1)
The sick must wear a mask.

2)
Have a default route for the patient to minimize patient exposure with the medium. The following illustrations from reference 12 illustrate how-to put-on PPE and how to remove them, remember to be patient, and follow the steps (Figure 6). 2) It is not established if there is vertical transmission since all deliveries were by caesarean section.

3)
None of the maternal ones died or severe SDRA development.

4)
There were no postpartum complications of the newborn or alterations in APGAR.
b) WHO recommends the support measure as the leading therapy in this group of patients [17]?

Treatment
There is currently no specific treatment or proven vaccine for

Isolation and Biosecurity Measures
a) It is the first tool to be implemented with isolation of the patient with droplets and contact, in a unit where only those cases are, to mitigate hospital transmission.
b) Implement special routes for these patients.

2)
Currently several experts consider it if available as a first line, their evidence in combination with other therapies such as antimalarials have shown an impact on outcomes described above [23].

3)
Interactions: Relevant since it has CYP3A4 system.

4)
Adverse events: hypotension during infusion, not in patients with CHILD C or TFG < 30 mL/min/1.73 m 2 .

5)
Ongoing studies: NCT04252664, NCT04257656.  In the FAZHU hospital experience the scheme used was 500mg BID for 2 days, then 500 mg day for 5 days [13].

Competing Interests
The author declare that they have no competing interests.