Five questions and answers regarding 2019-nCoV AKA The Coronavirus

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With the world attention on the coronavirus outbreak, and as it continous to spread across China and other parts of the world, a flurry of early research is drawing a clearer picture of how the pathogen behaves and the key factors that will determine whether it can be contained.

While the virus is a serious public health concern, the risk to most people outside China remains very low (at the moment).

We took the chance to sit down with our Senior Scientist Ramakrishnan Kumar to sort out five of the most common questions and answers about 2019-nCoV also known as the Coronavirus.

1. Where does the coronavirus come from?

Ramakrishnan B.Kumar: In the early 1960s, a new strain of a virus causing respiratory diseases in chicken and humans was reported. The early Transmission Electron Microscopy (TEM) images showed a virus particle whose outer membranes are decorated with proteins; the appearance of the protuberant surface of the virus has a stark similarity with the corona of the sun as it can be seen in Figure 1. Hence scientists named this species of the virus as coronavirus. Zoonotic by nature, coronavirus can infect a wide range of species from avian to mammals and can be transmitted between species, causing respiratory tract ailment in infected species. This ailment has a wide spectrum starting from the common cold to fatal infections (in immunocompromised humans).

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Figure 1: Negative stain TEM images showing corona virus from Chicken (Scale :100 nm)

2. Is the 2020 Coronavirus outbreak the first to be reported?

Ramakrishnan B.Kumar: Two remarkable coronavirus outbreaks in the 21st century have happened before 2020. The first one is the severe acute respiratory syndrome-related coronavirus (SARS-CoV) in 2002. SARS-CoV belongs to Betacoronavirus (subgenus Sarbecovirus) and the scientists hypothesize that it had originated from Bats. This virus later evolved and infected several species including Chinese ferret badgers and raccoon dogs before reaching humans. The main route of infection in humans was through ingestion or by processing meat of these infected exotic animals and later the disease spread between humans.

The second reported outbreak is the Middle East respiratory syndrome-related coronavirus (MERS-CoV) in 2012. This virus also belongs to Betacoronavirus (subgenus Merbecovirus) and the first report of infected humans came from Saudi Arabia. Similar to SARS-CoV, this virus could have been originated from Bats and passed on to camels and then to humans. Close contact between humans leads to human to human transmission of MERS-CoV.

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Figure 2: Comparison of different CoV outbreaks in 21st century.

3. Which type of coronavirus was reported in the City of Wuhan in 2020?

Ramakrishnan B.Kumar: A sudden rise of patients with pneumonia in the city of Wuhan in China puzzled and worried the health care authorities. The scientists managed to isolate and sequence a new strain of coronavirus. This new strain shares a 70 % genome similarity with SARS-CoV. This new virus was named as the 2019 novel coronavirus (2019-nCoV)

4. How did it all start?

Ramakrishnan B.Kumar: All the initial infected patients were working or associated with someone working in the seafood wholesale market. This market sells several exotic types of meat including bats, snakes, and ferrets, etc. The scientists suspect the snakes and kraits sold for consumption are probably the initial hosts of viral transmission. Several teams of scientists are working to understand how the transmission route works. The main infection route for 2019-nCoV is through water droplets and by human to human transmission in close contact. In general, the major risk poses to the health care workers, who are in direct contact with the infected patients, to senior citizens and to immunocompromised people, which are more likely to be easily infected with the coronavirus.

5. What are the next steps?

Ramakrishnan B.Kumar: Scientists are in the race against time to better understand the 2019-nCoV. Knowledge of the proportion of infected people who become severely ill or need critical care is of key importance to the public authorities. This will allow them to offer rapid care to the infected and prevent further infection of the virus. In this outbreak, the biopharma companies and several governments are combining their efforts to increase the response to the virus's actions. Reuters reports that the reintroduction and use of Remdesivir (from Gilead Sciences) for treating 2019-nCoV is being considered. Remdesivir is an antiviral drug used for treating the Ebola virus, Marburg virus, Paramyxovirus, Pneumovirus, and Coronavirus infections. The drug has already been tested in humans but showed little efficacy against Ebola. Remdesivir blocks MERS and SARS coronavirus in vitro and displayed efficacy in a murine model of the disease. The company is now in discussion with clinicians in China and the US to test the drug against 2019-nCoV. While this drug being tested, HIV drug lopinavir in combination with ritonavir (Kaletra) is being administrated to treat patients infected with coronavirus in China. Interferon-alpha treatment (nebulized) is also recommended. The spreading of the virus is exponential, the numbers of infected/mortality are updated by the hour. Every new piece of scientific information is of importance for the scientist to move an inch towards remedy for these infected patients and to prevent further crisis.

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Figure 3: Dashboard screenshot from Johns Hopkins University - Live tracking of the Coronavirus as of Jan 29, 2020 9 pm EST

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