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It is important to mention that the proportion of severe cases is highly dependent on the study population and may be related to the epidemiological behavior of the infection in each country. In Italy, the average age of people infected with COVID-19 is between 60 and 65 years, and 16% of those hospitalized require admission to the intensive care unit . In a study describing 138 patients with COVID-19 pneumonia in Wuhan, the most common clinical characteristics at the onset of the disease were described. Some patients with initially mild symptoms had symptom progression over the course of one week (Chen et al., 2020b).
Therefore, current recommendations for PLWHs are to maintain antiretroviral therapy with the goal of controlling HIV as well as following the same standards of care as the general population to avoid acquiring a SARS-CoV-2 infection (Organización Panamericana de la Salud, 2020). The bacterial infective etiology with clinical and radiographic similarities to COVID-19 are mycoplasma and chlamydia. Etiology causing non-infectious lung lesions with similar features are those autoimmune diseases with lung involvement such as vasculitis, dermatomyositis and other pneumonitis.
When it comes to vaccine design and manufacturing, the main objectives are to ensure its safety, its efficacy in activating specific adaptive immune responses and the production of -ideally- long term memory. Thus, eliciting protective immune responses including neutralization antibodies and/or CTL generation is of paramount importance. In SARS-CoV-2 infection, the binding to cells carry trade forex is mainly done by ACE2 receptors to glycoprotein S ; this is a primary determinant in viral pathogenesis and immune response, being a process independent of the CD4 receptor, and therefore different from HIV. The virion assembly is different between these 2 viruses, being that SARS-CoV-2 does it in the endoplasmic reticulum and HIV does it by budding (Xiao et al., 2020).
In the United States, the FDA has accepted investigation of convalescent plasma in patients with severe or life-threatening COVID-19 through clinical trials and in emergencies. The difficulty in conducting these clinical trials lies in finding appropriate donors and establishing tests to confirm plasma neutralizing activity. Currently, more than 50 controlled clinical trials have been registered at , and none have reported preliminary results. Of the ongoing trials, 14 studies have large samples and high quality designs (more than 1000 patients, randomized and double-blind), and seek the primary outcome of impact on mortality and evident clinical improvement . Identifying targets for pharmacological use has been important to develop therapeutically drugs with roles in virus structure and infection process (Fig. 4).
This review summarized some drug repurposing agents previously known to has efficacy against other virus like SARS-CoV, MERS-CoV, influenza. Actually, exist some new drugs with high potential action on targets for COVID-19 therapeutics. It is important to notice that there is no specific treatment for the coronavirus approach. In context of the scientific evidence exposed and the particular clinical features of each patient, the reader will be able to make the best clinical and therapeutic decisions.
Overall, this data suggest that dysregulation of T cell mediated immune responses may play a pivotal role in COVID-19 pathogenesis and severity (Qin et al., 2020). Weiss S.R., Navas-Martin S. Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. Drosten C., Günther S., Preiser W., van der Werf S., Brodt H.-R., Becker S. Identification of a Novel Coronavirus in patients with severe acute respiratory syndrome. However, the accumulated experience from previous coronavirus what is envelope indicator vaccine designs and the sequence and structural similarity of SARS-CoV and SARS-CoV-2 are significant advantages in the current endeavor. Thorough studies conducted in SARS-CoV-specific T cells of SARS convalescent patients have shown that all memory T cell responses are directed at SARS-CoV structural proteins. T cell epitope mapping showed that CD8+ responses were targeting SARS-CoV membrane and Nucleocapsid proteins and CTL memory could last up to 11 years after infection (Ng et al., 2016).
You can also sign up for email updates on the SEC open data program, including best practices that make it more efficient to download data, and SEC.gov enhancements that may impact scripted downloading processes. To allow for equitable access to all users, SEC reserves the right to limit requests originating from undeclared automated tools. Your request has been identified as part of a network of automated tools outside of the acceptable policy and will be managed until action is taken to declare your traffic. See the quantity and duration of malware infections, along with other factors influence the overall assessment of an organization’s IP Reputation. Yang Y., Lu Q., Liu M., Wang Y., Zhang A., Jalali N. Epidemiological and clinical features of the 2019 Novel Coronavirus outbreak in China.
In patients with COVID-19 and shock with evidence of cardiac dysfunction and persistent hypoperfusion despite fluid resuscitation and norepinephrine use, dobutamine as inotropic is recommended. Given the development of refractory septic shock, the suggestion of the use of hydrocortisone in continuous infusion is maintained, as indirect evidence, this in favor of reducing the length of stay in the ICU and the resolution time of the shock (Møller et al., 2018). The clinical progression and disease severity in pediatric patients is markedly different from that of adults. Over 90% of affected children are asymptomatic or have mild to moderate disease (Dong et al., 2020b). The majority of serious cases in children are related to those with significant comorbidities such as heart disease, immunosuppression, etc.
It is from this that the recommendations for the rational use of masks arise since in some countries the massive use of N95 masks was reported, masks indicated for the use of medical personnel (Feng et al., 2020b). Regarding to this non pharmaceutical recommendations, the studies suggest to priories the resources on vulnerable population, in endemic areas, older people, adult with comorbidities and health workforce. Studies are still needed on the duration of the protective effect of the masks and above all the possibility of their reuse for resource optimization. Meanwhile the most important recommendation continues to be its use in addition to hand hygiene and social distancing (Feng et al., 2020b).
In China, reportedly 80.9% of COVID-19 infections are mild [with flu-like symptoms] and recover at home without hospital intervention. Recovery from the onset of symptoms in mild cases is approximately 2 weeks and, with severe or critical illness, 3–6 weeks. Yong C.Y., Ong H.K., Yeap S.K., Ho K.L., Tan W.S. Recent advances in the vaccine development against middle east respiratory syndrome-coronavirus. Wong S.F., Chow K.M., Leung T.N., Ng W.F., Ng T.K., Shek C.C. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Wong C., Lam C., Wu A., Ip W., Lee N., Chan I. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome.
HFNC use should be closely monitored and patients cared for in an environment where intubation can be facilitated in case of decompensating. If this were undertaken in an uncontrolled environment it increase the risk of nosocomial infection of health providers (Hui et al., 2019; Loh et al., 2020; Wax and Christian, 2020). Regarding SARS-nCoV infection in pregnant women, there is currently limited evidence about the effect of the virus on the mother or fetus.
Munshi L., Del Sorbo L., Adhikari N.K.J., Hodgson C.L., Wunsch H., Meade M.O. Prone position for acute respiratory distress syndrome. Matthay M.A., Aldrich J.M., Gotts J.E. Treatment for severe acute respiratory distress syndrome from COVID-19. Gorbalenya A.E. Severe acute respiratory syndrome-related coronavirus – the species and its viruses, a statement tio markets of the Coronavirus Study Group. However, important safety considerations should be taken into account before releasing a new vaccine in the market. Previous studies on macaque models have shown that a vaccine-induced anti-Spike protein antibody at the acute stage of SARS-CoV infection can provoke severe acute lung injury (Liu et al., n.d.).
Both drugs have some interactions with other drugs, also they share an adverse event with others in prolonging the QT interval. The principal and secondary outcomes evaluated in clinical trials in COVID-19 are diverse from time to clinical recovery TTCR, mortality reduction, to changes from baseline in some organ function blood markers, among the most important. Mullins et al. carried out a bibliographic review of all the evidence collected until March 10, 2020, relating to any pregnant women with coronavirus diagnosed during her pregnancy or puerperium. Twenty-three studies were included but there is a high probability that reported cases overlap. Delivery of 30 newborns was reported, 27 by Caesarean section 3 by vaginal delivery (Mullins et al., n.d.).
An example illustrating the rapid reaction of the scientific community to the SARS-CoV-2 outbreak is that of the biopharmaceutical company Moderna, the first vaccine manufacturer that entered in Phase I clinical trials for one candidate vaccine for COVID-19. On the night of Saturday, January 11, 2020, in the headquarters of the National Institute of Allergies and Infectious Diseases of USA Barney Graham, Deputy Director of the Vaccine Research Center, received the SARS-CoV-2 sequence. During the weekend his group analyzed the data and on Monday, 13 of January he discussed his observations with a group of investigators of the biopharmaceutical company Moderna.
The spectrum of symptoms of COVID19 infection are characteristic of a mild disease in most of the cases, however, it is important to point that the progression could lead to a severe respiratory distress. Importantly, COVID-19 convalescent sera were shown to hold promise as a passive immune therapy alternative to facilitate disease containment . To the best of our knowledge, at least one pharmaceutical company, Takeda, is preparing to purify antibody preparations from COVID-19 convalescent sera against SARS-CoV-2 . Like SARS-CoV and other coronaviruses, SARS-CoV-2 likely enters target cells through receptor-mediated endocytosis, where fusion of the virus envelops the endosome membranes and leads to the release of the viral nucleocapsid into the cytosol of the infected cell (Knoops et al., 2008). Zeng Q.-L., Yu Z.-J., Gou J.-J., Li G.-M., Ma S.-H., Zhang G.-F. Effect of convalescent plasma therapy on viral shedding and survival in COVID-19 patients.
Vaccination strategies employed, delivery platforms used, and current development status are presented if official data are provided. According to the investigative mission of the WHO in China, the case-fatality rate ranged from 5.8% in Wuhan to 0.7 % in the rest of China. Immunological factors may also influence outcomes, as in childhood we are most exposed to frequent challenges including recent seasonal viruses such as RSV in the winter months. Most likely, it is multifactorial and depends on factors from both the host and the virus itself (Xia et al., 2020). The most common tests for COVID-19 involve taking a swab from a patient’s nose and throat and checking these swabs for the genetic footprint of the virus.
These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Yu J., Ouyang W., Chua M.L.K., Xie C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel coronavirus-infected pneumonia in Wuhan, China JAMA 2020.