COVID-19 Pandemic
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. It has since spread worldwide, leading to an ongoing pandemic.
Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Around one in five infected individuals do not develop any symptoms.[1] While most people have mild symptoms, some people develop acute respiratory distress syndrome (ARDS). ARDS can be precipitated by cytokine storms,[2] multi-organ failure, septic shock, and blood clots. Longer-term damage to organs (in particular, the lungs and heart) has been observed. There is concern about a significant number of patients who have recovered from the acute phase of the disease but continue to experience a range of effects—known as long COVID—for months afterwards. These effects include severe fatigue, memory loss and other cognitive issues, low-grade fever, muscle weakness, and breathlessness.[3][4][5][6]
The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person.[10][11] Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission.[11] The exact route of transmission is rarely proven conclusively,[12] but infection mainly happens when people are near each other for long enough. It can spread as early as two days before infected persons show symptoms, and from individuals who never experience symptoms. People remain infectious for up to ten days in moderate cases, and two weeks in severe cases. Various testing methods have been developed to diagnose the disease. The standard diagnosis method is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.
Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and various countries have initiated mass vaccination campaigns.
Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.
Treatments
Remdesivir
As of late October, 2020, remdesivir was the only drug in the United States approved by the FDA with a specific indication to treat COVID-19.[13][14][15]
In November 2020, the World Health Organization (WHO) made a conditional recommendation against treatment with remdesivir for hospitalized patients, regardless of severity (based on data from the Solidarity Trial).[16]
Immunotherapy
In January 2021 in the United Kingdom, the National Health Service issued guidance that the immune modulating drugs tocilizumab and sarilumab were beneficial when given promptly to people with COVID-19 admitted to intensive care, following research which found a reduction in the risk of death by 24%.[17]
Baricitinib
In November 2020, the FDA granted Emergency use authorization (EUA)[b] for the drug baricitinib to be given to certain people hospitalised with suspected or confirmed COVID-19, but only in conjunction with remdesivir.[18] In a single clinical trial, this combination therapy was shown to have a small, but statistically significant effect on patient outcomes compared to administration of remdesivir alone.[19] Use of baricitinib was restricted to adults and children two years of age or older requiring supplemental oxygen, mechanical ventilation, or ECMO.[18]
Dexamethasone
In September 2020, the European Medicines Agency (EMA) endorsed the use of dexamethasone in adults and adolescents (from twelve years of age and weighing at least 40 kg) who require supplemental oxygen therapy.[20]
Pfizer Vaccine
The Pfizer BioTech COVID-19 Vaccine is used or the prevention of 2019 coronavirus disease (COVID-19) for individuals 16 years of age and older. The most commonly reported side effects, which typically lasted several days, were pain at the injection site, tiredness, headache, muscle pain, chills, joint pain, and fever. Of note, more people experienced these side effects after the second dose than after the first dose, so it is important for vaccination providers and recipients to expect that there may be some side effects after either dose, but even more so after the second dose. [21] The vaccine is shot in the muscle of the upper left arm, and is taken in two doses, 21 days apart. The FDA approved the vaccine on December 11, 2020.[21]
Moderna Vaccine
mRNA-1273, more commonly known as the Moderna COVID-19 vaccine, is a COVID-19 vaccine developed by the National Institute of Allergy and Infectious Diseases (NIAID), the Biomedical Advanced Research and Development Authority (BARDA), and Moderna. It is administered by two 0.5 mL doses given by intramuscular injection given four weeks apart.
On 18 December 2020, mRNA-1273 was issued an Emergency Use Authorization by the United States Food and Drug Administration (FDA). It was authorized for use in Canada on 23 December 2020, in the European Union on 6 January 2021, and in the United Kingdom on 8 January 2021.
Johnson and Johnson vaccine
The Johnson & Johnson COVID-19 vaccine is a human adenovirus viral vector COVID-19 vaccine developed by Janssen Pharmaceuticals, a subsidiary of American company Johnson & Johnson (J&J).[22]
AstraZeneca Vaccine
The Oxford–AstraZeneca COVID-19 vaccine, codenamed AZD1222 and marketed as Covishield in India, is a COVID-19 vaccine developed by Oxford University and AstraZeneca given by intramuscular injection, using as a vector the modified chimpanzee adenovirus ChAdOx1. One dosing regimen showed 90% efficacy when a half-dose was followed by a full-dose after at least one month, based on mixed trials with no participants over 55 years old. Another dosing regimen showed 62% efficacy when given as two full doses separated by at least one month.
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