Introduction

Early December, a human got infected with a completely new coronavirus (CoV), and by mid-December, an unusual pneumonia outbreak was detected in Wuhan, China. Whilst the world was preparing to celebrate the new year, Dr Li Wenliang posted a warning message to his colleagues about unusual pneumonia cases. On the 30th of January 2019, the World Health Organization (WHO) had declared a global health emergency. The responsible agent was identified through deep sequencing. Deep sequencing is a powerful technique that allows sequencing of billions of nucleotide in a single run. This new virus has temporarily been named 2019-nCoV; from the initial infection in 2019, where n stands for novel (new) and CoV means coronavirus. On the 11th of February, the name COVID-19 was chosen for the 2019-nCoV. COVI refers to coronavirus, D for disease, and 19 for the year of the outbreak. Do note that COVID-19 describes the disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) describes the virus.

Coronaviruses are pathogens under the family coronaviridae, seen later at the taxonomy and identification section. These coronaviridae viruses tend to cause respiratory, central nervous system, hepatic and gastrointestinal symptoms in humans. They can be transmitted to wild animals and use them as carriers or reservoirs. This is seen in the earlier outbreaks of Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS) in 2002/2003 and 2012 respectively. These outbreaks demonstrated an animal-human transmission and later human-human transmission.

It has been estimated that there are about 1.6 million viruses that scientists have not yet encountered and identified. At the moment only 3 000 have been adequately identified, that is only 0.19%. These viruses could easily infect an animal and then transmit to a human being; however, these are quite rare events. These random, sporadic and new coronavirus emergence will likely increase due to ecology and climate change, and through human expansion. These will bring animals and humans closer together and hence increase our interactions with carriers. With current technology, it would take about five years to create a new vaccine against a novel virus, but 2020 has shown that with international collaborative efforts, new vaccines can be dramatically sped up. None of the less, in the future scientist and technology innovations could bring this time down to only 16 weeks.

Let us dive first into understanding what a virus is, how do viruses transmit and infect people and what you should do if you ever get in contact with a virus with a focus on the new coronavirus, 2019-nCoV (COVID-19).

Definitions:

Epi: act as a prefix and is taken from Greek meaning “on, upon, at, by, near, over, on top of, toward, against, among”.

Pan: act as a prefix and is taken from Greek meaning “all, everything”.

Demic: from deme + ic. Deme, from the Greek word dêmos meaning “district, people, commons”. Ic, is a suffix meaning “of, pertaining to, resembling”.

Epidemic: affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time. We can then describe epidemic as “upon, people, pertaining to”.

Pandemic: occurring over a wide geographic area and affecting an exceptionally high proportion of the population. We can then describe epidemic as “all, people, pertaining to”.

Historical timeline of the 2019-nCoV (COVID-19):

This section was starting to get a bit long, see “The Historical Timeline of the Development of COVID-19”.

What is a virus?

Viruses are a strange concept. They are not alive, but at the same time, they are. However, most biologist says that they are not alive. They cannot maintain homeostasis, and they are not made up of cells, in fact, they are mainly protein structure encasing deoxyribonucleic acid (DNA) or ribonucleic acid (RNA). This protein shell is called a capsid, and some viruses do have a lipid bilayer surrounding the capsid. They do not have a nucleus, organelles and cytoplasm making homeostasis within the virus impossible. We could argue that a capsid or any lipid bilayer enveloping a virus helps in resisting the changes in the environment; however, the general idea is that there is no maintained homeostasis.

Viruses do not feed themselves, they do not have any pathways to create energy, and on their own, they cannot grow or replicate. So how do they reproduce? Since viruses do not have a nucleus and ribosomes, transcription and translation do not occur. Hence no protein is made, which means no structures is produced -> no division and no growth. This is where a virus gets intricate. A virus utilises its specific receptor on its capsid or lipid bilayer envelop to attach to the receptors of a specific host. The host, unlike the virus, has all the tools needed to create any proteins that are coded onto a DNA/RNA. When a virus attaches itself onto a host, it will release its DNA or RNA (depends on the virus techniques) into the host cell. The cell doesn’t know that this DNA/RNA is foreign, and starts producing all the structure to create a perfect copy of a virus. Hence, a copy of a virus doesn’t grow/shrink and doesn’t change in complexity (unless its DNA/RNA mutates and changes the structure of the new virus -> new strain -> new disease). Viruses do adapt to their environment due to the constant mistake while replicating its genome. This is extremely beneficial to become more potent, resistant and more adapted to its environment. Do viruses themselves use energy? It uses a lot of energy and metabolism from the host cell to create all the components needed for a new virus but does not use the energy themselves. Do viruses respond to their environment? Not like humans or animals, if we pock a virus with a hot rod, or use sound/light, a virus will most likely not run away from the danger/stimulus. More research needs to be done if a virus responds to either a dangerous stimulus or just a stimulus.

My virus analogy is that I am in my house playing with legos and the mailman slips a post delivery into my home. I open the post, and I see that I have new instructions to create a really cool lego spaceship. I start building these spaceships but turns out I am creating way too many, which I can’t stop. I create so much that my house explodes! In my disbelief, I then see that these spaceships were the mailman all along and are now delivering more posts to my neighbourhood. I get so tired, along with my broken home, that I die from exhaustion and from weather exposure.

So, are viruses dead or alive? We can consider them as mostly dead. Are they parasites, androids, robot hackers or vampires? Biologists have called viruses as “obligate intracellular parasite” meaning that they are dependent on intracellular resources and cannot replicate outside their host cells. I like to think as a floating spaceship. They float, land on a planet, give information to the local engineers and create millions more spaceships. The planet dies, and the spaceships are off to find another world with local engineers.

Structure of a virus

The structure of a virus is crucial in determining its classification and identification. With a wide range of size and shape, as seen in figure 1, the general observation is that a virus is much smaller than a cell. This is equivalent to 100x smaller than a bacteria or 1000x smaller than a typical average cell. Their size range between 20 - 300 nanometers, with a few exceptions such as filoviruses that can go up to 1 400 nanometers. Hence, an electron microscope is going to be needed to see these organisms. A virion is a complete and infectious virus that contains DNA or RNA and is surrounded by a protective coat. The outer protective coat can either be a protein structure called a capsid (from the virus genome) or a lipid bilayer called a viral envelop, which is a modified layer that has been taken from the host. A virus can have both, that is a protein capsid structure on the inside with a lipid bilayer covering the capsid. This can be seen in figure 2 as the Human Immunodeficiency Virus (HIV) contains a capsid on the inside and a lipid bilayer on the outside. The main rule is that a virus must have a capsid structure protecting itself as the addition of a lipid bilayer must be an evolutionary development to some viruses. There are some disadvantages and advantages of having a lipid bilayer. An advantage of enveloped viruses is that they can easily be modified, adapt and evade recognition from the immune system. Some disadvantages of enveloped viruses are: being prone to heat/acid/base/detergent exposure, low survival rate outside the host, they must be transferred from host to host and are easier to sterilise.

There are generally four main types of structure with viruses, which is dictated on their capsid shape that creates a 3-dimensional structure. This can be seen in figure 1. These are helical, icosahedral (polyhedron with 20 faces), prolate and envelop-type. There is also the complex structure, where they do not have a distinct icosahedral structure or helical but posses extra structures. As an example, a complex structure virus would look like the Apollo Lunar Module.

Identification of a virus

Identifying viruses is crucial to understand how a virus works; hence we put them into a taxonomic system. For example, knowing its outer structure can dictate its survival rate outside the host. Knowing if a virus utilises the DNA/RNA system can dictate what medication to use and so on. Hence, how do we classify viruses? It is by using their size, 3-dimensional structure, DNA/RNA system, genome architecture and type of host. How a virus enters the cell is necessary for its identification, that is if a virus injects its DNA/RNA inside a host or utilise endocytosis by sneaking in and tricking the host cell receptors. This is known as “receptor-mediated endocytosis”. What is interesting about receptor-mediated endocytosis is that a virus with a capsid will get inside their host by forming an endosome and a virus that contains a capsid with an outer lipid bilayer will facilitate further the entry into the host without raising suspicion. The lipid bilayer will simply just fuse with the host lipid bilayer and releasing the virus inside; this is called direct fusion. The Baltimore class helps in classifying the type of genome and method of replication, hence a useful classification.

Viruses are strange regarding their nucleic acids. They only contain that specific nuclei acid which is: double-strand DNA, double-strand RNA, single-strand DNA and single-strand RNA. The dsDNA and ssRNA are seen in a normal human cell but seeing dsRNA and ssDNA is odd and unique. These nucleic acid are not floating around randomly but are stored neatly inside the capsid (protein coat) as a stable structure.

As seen below, in figure 3, the viruses are classified into RNA/DNA -> their capsid symmetry -> whether they are enveloped or naked (only capsid present) -> genome architecture along with the Baltimore class.

Coronavirus: 2019-nCoV, newly named COVID-19

Introduction

Coronaviruses are part of a large family of viruses, coronaviridae, that display common cold and flu-like symptoms, but resembles more to MERS and SARS symptoms. The coronavirus strain in Wuhan has recently been identified as COVID-19 from its processor name 2019-nCoV. The coronavirus gets its name from its protein spikes structure (glycoprotein S), which looks like a crown in characteristic. Crown in Latin is corona, hence the name coronavirus. Structurally, coronaviruses are enveloped viruses that contain a helical +ssRNA. Genetically the COVID-19 is similar to Severe Acute Respiratory Syndrome-related coronavirus (SARS-CoV) and to the bat coronaviruses identified in 2013. It was thought that the initial infections were at the market place; hence the COVID-19 is thought to be zoonotic origin. It is most likely that the bat is the origin of this virus, but these are just speculations. New data suggest the COVID-19 started before December with an unknown origin/location and made its way to the market place.

The COVID-19 is a contagious virus and when contracted causes a respiratory infection, which will most likely cause pneumonia. The complications can cause organ failure and death. Coronaviruses are capable of causing common cold to SARS and Middle East respiratory syndrome (MERS) symptoms. Human to human interaction has been confirmed to spread the virus.

Taxonomy & Identification

Virus:

• Riboviria (realm),

• Incertae sedis (phylum),

• Nidovirales (order),

• Cornidovirineae (suborder),

• Coronaviridae (family),

• Orthocoronavirinae (subfamily),

• Betacoronavirus (genus),

• Sarbecovirus (subgenus),

• 2019-nCoV (species); its official name is COVID-19.

The COVID-19 shares the same subgenus, sarbecovirus, with Severe Acute Respiratory Syndrome-related coronavirus (SARS-CoV) and shares the same genus, betacoronavirus, with Bat-SARS-like, Murine coronavirus, MERS-CoV and eight other viruses.

The COVID-19 has been classified as positive-sense single-stranded RNA (+ssRNA) virus and belong to Group IV in the Baltimore classification, seen in figure 3. Coronaviruses generally have about 30 kilobases (kb where 1 kb is 1000 base pairs) as these help in describing the length of the DNA/RNA.

So what does +ssRNA or group IV in the Baltimore classification mean? The COVID-19 display single-stranded RNA genetic material. Depending on the polarity of the RNA, it can either be a positive-sense or negative-sense; in this case, the COVID-19 has a positive-sense. Having a +ssRNA technique allows the injected RNA into the host cell to act both as a messenger RNA and genome. This allows the messenger RNA to be directly translated into proteins by using the host’s ribosome and create copies of the virus.

What is the advantage over a negative-sense RNA genetic material? Well, the negative-sense uses a different technique where the injected negative viral RNA is complementary to the messenger RNA. Hence, it needs to be converted first to a positive RNA by using the enzymes within the host. This enzyme is the RNA polymerase, and the conversion must be done before translation. Interestingly, the negative viral RNA is technically not infectious by itself.

Structure of 2019-nCoV (COVID-19)

The Centers for Disease Control and Prevention (CDC) have illustrated the COVID-19 in figure 4. Notice its distinct spikes that give these viruses its name (corona in Latin for crown). These spikes are the glycoproteins S (red in figure 4) and are located outside the virus. The glycoproteins S binds to the virus via a C-terminal transmembrane. The C-terminal end allows the S protein to be inserted into the virus membrane and anchor itself. The glycoproteins S also interacts with the M glycoproteins (orange in figure 4). The N-terminus of the S proteins then interacts with the host plasma membrane for anchoring. The M glycoprotein helps the virus to fuse into the cell host and in the making of antigenic protein. It was also noted that the M proteins help in the regenerating the virus within the host.

The E glycoproteins (yellow in figure 4) are small proteins where the N-terminus is anchored on the surface of the viruse. E glycoproteins play a critical role in assembling and developing the shape of the virus within the host.

The nucleocapsid-proteins (N-protein), which is a phosphoprotein located between the RNA helix (not seen in figure 4 but seen at the core with RNA in figure 5). Its major role is to bind the RNA and have a flexible structure of the viral genomic RNA. The N-protein also helps with the replication and transcription of coronaviruses as well as the virus structure. Hence, coronaviruses have a helical RNA structure.

Hemagglutinin esterase (light grey/whitish figure 4) is a glycoprotein and is present on the surface membrane of some betacoronavirus (genus). Hemagglutinin esterase (HE) has three different and essential activities, and these are: receptor binding activity, receptor hydrolysis (esterase) activity, and membrane fusion activity. Hence, HE aids as an invading mechanism. Finally, notice that the COVID-19 has an envelop and is not “naked”. Within its core, the capsid is present with the positive-sense RNA genetic material lying safe, protected and structurally stable. Below in figure 5 demonstrates the COVID-19 and its different components. All these components are extremely well adapted and efficient to detect and enter a host.

Mode of action

Due to COVID-19 being part of the coronaviridae (family) and orthocoronavirinae (subfamily), we can speculate it has a similar mode of action to other coronaviruses especially SARS as they both share the same subgenus, sarbecovirus. Based on the CDC structure of the COVID-19 virus and likeness to SARS, its introduction, replication and transcription should occur the following way:

1. Through the glycoprotein S spikes, the COVID-19 binds onto a receptor situated on the outer cell membrane of the host cell. A conformational structure change should occur when the virus interacts with the receptors. Now the entry is not definitively known; however, it has been speculated that the virus either binds with the host cell membrane releasing +ssRNA into the cytoplasm of the host cell or goes through as a whole structure (a process called endocytosis). If the virus does enter through endocytosis, it will eventually release its +ssRNA and somehow escape its fate with a lysosome from being destroyed.

2. Once inside the host cytoplasm, the coronavirus will initiate its replication process. Based on coronaviruses trend, the non-segmented RNA consists of seven genes. Gene 1 consists of the non-structural proteins with the replicase genes, and gene 2-7 consists of nonessential accessory proteins and structural proteins.

3. Since the coronavirus utilises the positive-sense single-stranded RNA technique, the production can immediately start in the cytoplasm where new proteins and genomes are created. As seen in figure 6, the positive-strand goes to the ribosome and starts producing other protein structures that are specific for the virus. A virus polymerase can be seen as this enzyme synthesise a negative-strand where it serves as a template.

4. The negative-strand, serving as a template, along with the virus polymerase transcribes positive RNAs that are subgenomic. Subgenomic positive RNAs are portions of the viral RNA that may be skipped during translation, which results in different proteins that are being created from the same mRNA. This is demonstrated in figure 6 as a blue strand going to further ribosomes to create nucleocapsid-proteins (N-protein) and M glycoprotein. Note that the negative-strand can also be used to create new positive-stranded RNA genomes, seen as a red strand where it will eventually meet up with the N-protein and create a stable nucleocapsid.

5. The M glycoproteins are integrated into the outer phospholipid bilayer of the endoplasmic reticulum (ER: a double membrane organelle that produces, process, and transport proteins/lipids). The hemagglutinin esterase and glycoproteins S, seen in figure 6 as HE and S, are added in the inner phospholipid bilayer of the ER. When the nucleocapsid is ready structurally, it will advance and poke at the M glycoprotein location. Budding will occur until the outer and inner phospholipid bilayer of the ER swap, causing a newly enveloped virus inside the ER.

6. A new envelop called secretory vesicles is created from the Golgi apparatus. The secretory vesicle surrounds the newly enveloped virus and is transported to the host cell membrane. Exocytosis occurs, releasing new viruses into the extracellular space. The host cell undergoes apoptosis or either explodes. This is due to: the amount of viruses being made, the lack of space available within the host cell, the ribosomes and other proteins being made and used, the host metabolism being utilised, and the priority of assembling the virus (due to higher affinity on the virus genome) puts a lot of strain onto the host cell.

Below is a video that shows, in brief, the mode of action of the COVID-19. Even though the COVID-19 is new and the mode of action is unknown, we can speculate through its 3-dimensional structure form (released by the CDC) that its mode of action should resemble to other coronaviruses, especially SARS.

Medical Animation explaining Coronavirus Mechanism of Action

How does 2019-nCoV (COVID-19) spreads

Currently, a lot about the COVID-19 is unknown, however, comparing to the SARS and other coronaviruses we can speculate on how it is transferred and spread within a population. The 3-dimensional structure of the COVID-19 can also indicate how the virus would hold against its environment, such as how prone it is to protein denaturation. These environmental factors would be from heat, acid, base, water, sunlight, oxidation agents and chemical agents. The available information can give clues to how long the COVID-19 survives or stay in the air, which can then speculate the projection of the infection in a population and its R-naught.

R-naught of the COVID-19

The R-naught (R0), a mathematical equation, describes how a pathogen infects and reproduce. Essentially, it is the average of people being contaminated by one person. This applies to a population that has never been exposed or vaccinated against that particular pathogen. Hence, the population needs to be vulnerable to that specific disease. This applies to the 2019-nCoV (COVID-19) outbreak.

• If the R0 is less than 1, then the person contaminating another person is less than 1. Hence, the disease will decline and eventually die out.

• If the R0 is equal to 1, then the person contaminating another person is 1. The disease will be stable and will carry on; however, there will be no outbreaks, epidemic or pandemic.

• If the R0 is more than 1, then the person contaminating another person is more than 1. This would indicate an outbreaks, epidemic or pandemic situation.

Measles had an R0 of 18! Back when measles have never been identified/seen, if 1 person is confirmed with measles, then he/she infects 18 other people. These other 18 people will infect 18 people on their own; resulting in an additional 324 newly infected. 1 -> 18 (19 people in total, 1+18) -> 324 (343 people in total, 1+18+324) -> 5 832 (6 175people in total, 1+18+324+5 832). After 2 more cycles, we exceed 1.8 million. Figure 7 below demonstrates the R0 from the initial infected person and its potential to infect other people.

The COVID-19 R0 is estimated by the World Health Organization (WHO) to be between 1.4 to 2.5, which is similar to SARS during its early stage. Other studies have shown higher values such as 3.9. However, it is difficult to estimate or calculate an R0 as there are many different variables and missing data or data uncertainties.

What is known about its TRANSMISSION

This is based on previous coronaviruses such as SARS and MERS, unless confirmed from what we know about COVID-19:

• COVID-19 has been confirmed to be transmitted from person to person from within 2 meters.

• It is transmitted by air droplets from an infected person by sneezing, coughing and being in contact with nose discharge and saliva droplets. This is similar to other respiratory pathogens such as influenza. These air droplets could land on a person’s mouth/nose or could be inhaled entirely.

• It is found that children do not significantly contribute to the COVID-19 pandemic.

• Currently, COVID-19 can infect a person by being on the surface of an object and then transmitted to the mouth, nose or eyes. WHO mentions that the COVID-19 may survive for a few hours on object surfaces to up to 9 days. The use of disinfectants can kill the virus, which ceases the virus to infect people. You may use: 70% alcohol, 0.5% hydrogen peroxide, 0.1% sodium hypochlorite for 1 minute and other 0.05-0.2% benzalkonium chloride.

• It is thought that at your sickest (most symptomatic) is when a person is at its highest contagious state. This typically true for respiratory diseases. WHO mentions that it could be possible for people who are infected and are not currently showing any signs of the COVID-19, are infectious.

• The animal source for the COVID-19 has not yet been identified. Seeing its genetic resemblance to bats it is most likely coming from an animal market in China or where wild animals live. Pets at home should not pose any risks regarding the COVID-19 as the WHO stated that there is no evidence of infecting or spreading the COVID-19.

Symptoms of the 2019-nCoV (COVID-19)

If you come in contact, the COVID-19 can have a range of illness from mild symptoms to people dying from it. The CDC has mentioned that the symptoms appear between 2-14 days (mean 5-6 days) after exposure based on MERS virus incubation period.

In an article in the Lancet, out of 99 patients with the COVID-19, these symptoms presented itself (but are not limited to):

• Fever,

• Cough,

• Sore throat,

• Rhinorrhoea (excessive mucous secretion from the nose),

• Muscle-ache,

• Headache,

• Fatigue,

• Confusion,

• Shortness of breath,

• Breathing difficulties,

• Chest pain,

• Diarrhoea and vomiting.

The mean age was 55.5 years (SD 13.1), including 67 men and 32 women. The imaging examination showed 75% of the patient demonstrated bilateral pneumonia and 14% had multiple mottling (irregular pattern) and ground-glass opacity (spots in the lungs mostly associated with pneumonia). 17% (17) of the patient developed acute respiratory distress syndrome, and 11 out of the 17 died due to multiple organ failure. The older population with pre-existing conditions are more at risk and vulnerable to the COVID-19.

What happens when it is critical?

A subgroup of patients with severe COVID-19 may have a cytokine storm syndrome. A cytokine storm syndrome is where the immune system reacts way too violently and causes detrimental damage in the body. Imagine the airforce carpet bombing a city of civilians to kill a few terrorist, see Knowable Magazine. Respiratory failure from acute respiratory distress syndrome (ARDS) is the leading cause of morality. This is due to secondary Haemophagocytic Lymphohistiocytosis (sHLH) where there is fever, hepatosplenomegaly (large liver and spleen), cytopenia (lower blood cell counts), and progressive multiple-organ failure. Secondary HLH, initiated by COVID-19, causes hyper-inflammatory syndrome characterised by a fulminant hypercytokinaemia with multi organ failure. Occurs between 3.7-4.3% of all cases of sepsis.

Prevention, Treatment and Vaccines for the 2019-nCoV (COVID-19)

Prevention

Through observation of how coronaviruses act, the COVID-19 is transmitted by air droplets from sneezing or coughing. Since a vaccine has not been made or currently available, these prevention techniques are useful:

• To avoid being in contact with air droplets, avoid crowded areas that are considered by officials to be dangerous regarding the COVID-19. This does not mean staying at home with paranoia; remember to be alert and educated — not anxious.

• Wash your hands thoroughly with soap and keep a good hygiene. This includes washing your hands before eating a meal or after sneezing, coughing and using the bathroom. The virus must not come into contact with a mucous membrane, so avoid touching your mouth, eyes and nose.

• When sneezing or coughing, use a tissue and throw the used tissue away.

• Keep a normal social distance; remember that 2 meters are enough to be infected from someone who has COVID-19.

• If you are sick and unwell, stay at home and monitor your condition. It is always good to have someone with the person who is sick and have a phone nearby in case of emergency.

• Clean regularly object surface that is used frequently, use disinfectant if you have to. This could be a light-switch or door handles.

• Clean your phones as phone screens have a high amount of micro-organisms.

• Face-masks: the CDC recommends healthy people not to wear face-masks. The reasoning behind this decision is that surgical masks are not as efficient as the N95 masks used in hospitals. People may increase the transmission by touching their mask to which they would touch other people making things worse. Only wear a face-mask if you are sick or showing symptoms of the COVID-19. That way, the chance to infect healthy people is minimised. Below in figure 8 is a poster from the CDC.

Treatment & vaccines

As of my latest research (25/11/2021), there are no cures for COVID-19 and will most likely never be one. This is something that is not new in the world of medicine. Treating the symptoms is currently a priority as treatments in hospital focuses on the vital organs and stabilising the patients.

Latest medication approved (from the FDA) is:

• Veklury (Remdesivir), an antiviral drug approved for use in adults and pediatric patient.

Other types of medications that are approved (from the FDA emergency use authorization program):

• SARS-COV-2-targeting Monoclonal Antibodies 

• Antiviral Drugs 

• Immune Modulators 

• Sedatives 

• Renal Replacement Therapies  

Latest vaccination approved (highly dependent on geopolitics) are:

• Oxford–AstraZeneca

• Pfizer–BioNTech

• Janssen

• Moderna

• Sinopharm BIBP

• Sputnik V

The list is not fully complete.

If you think you are infected with the COVID-19, contact the emergency healthcare professionals and mention the possibility that it could be the COVID-19. Take precaution not to infect anybody. The CDC recommends these steps if you believe you are infected with the COVID-19: What to do if you are sick with 2019 Novel Coronavirus (2019-nCoV).

Conclusion: stay alert and educated — not anxious.

What is the future holding for us?

It has been mentioned that between 50-70% of the population may get exposed and infected by the COVID-19. Out of these, 20% will need to go into critical care for up to 28 days. These include precious resources and technology, such as ventilation systems. The problem is the capacities within the healthcare system. Any pandemics runs the risk to exceed the healthcare system, to which it must be acknowledged. Since we are most likely going to get COVID-19, the strategy is to delay and flatten the curve (the curve being the number of people with COVID-19 versus time). Instead of a spike of a curve, there needs to be a broad and low curve to keep the healthcare facilities running within its limits. Field hospital units could be created, such as the Mobile Army Surgical Hospitals (MASH), which was popularised from the TV serine M*A*S*H. Isolation, decrease group gathering activities, and basic hygiene can help a population by delaying the virus transmission for the hospitals to work efficiently. Below figure 9 demonstrates those curves.

In the meantime

• Stay up to date and be calm about the situation; use reliable information such as the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) websites.

• Avoid misleading titles from certain websites that utilise absurd keyword to attract clicks.

• Keep good hygiene techniques and have someone to look after you if you are sick. If you suspect the COVID-19, get in touch with your healthcare professional.

• Stay at home if you are sick and wear a mask to minimise exposure on other people.

• Stay healthy! Drink water, eat good food, exercise when you can, look after your mental health and have a decent night sleep.

• Finally, stay alert and educated — not anxious.

Some amazing resources

• Our World in Data: Latest Publications, Health, Demographic Changes and more.

• Kurzgesagt – In a Nutshell: Sources Corona.

• Below is a video made by Kurzgesagt – In a Nutshell: The Coronavirus Explained & What You Should Do. Published on the 20 Mar 2020.

Published 15th February 2020. Last reviewed 1st December 2021.

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Tortora GJ, Derrickson B. Principles of Anatomy & Physiology. 14th ed. New York, United States: John Wiley & Sons Inc; 2014. ISBN: 978-1-118-34500-9.

Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30185-9/fulltext#seccestitle10. DOI: https://doi.org/10.1016/S0140-6736(20)30185-9. Published January 24, 2020. Accessed February 12, 2020.

WHO Authors. Novel coronavirus (2019-nCoV). World Health Organization website. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Updated January 31, 2020. Accessed February 1, 2020.

Figures

Figure 4. Alissa Eckert, Dan Higgins. Public Health Image Library (PHIL). Centers for Disease Control and Prevention. https://phil.cdc.gov/Details.aspx?pid=23312. Published 2020. Accessed February 5, 2020.

Figure 6. Crenim. Coronavirus. Wikipedia: The Free Encyclopaedia. https://en.wikipedia.org/wiki/Coronavirus#Replication. Created April 30, 2008. Accessed February 10, 2020.

Figure 7. Vanessa Ramirez. What Is R0? Gauging Contagious Infections. Healthline website. https://www.healthline.com/health/r-nought-reproduction-number. Reviewed June 24, 2016. Accessed February 11, 2020.

Thumbnail art was taken and modified from the BBC video titled “What are viruses? And how do they spread?”. Authored by Michelle Roberts. Coronavirus: Hong Kong to slash border travel as virus spreads. BBC News website. https://www.bbc.com/news/world-asia-china-51279726. Updated January 29, 2020. Accessed January 29, 2020.

Additional source of Information:

• Coalition for Epidemic Preparedness Innovations (CEPI): New Vaccines.

• GenBank: Full genome of the 2019-nCoV.

• GISAID: Promotes international sharing of all virus sequences.

• International Committee on Taxonomy of Viruses (ICTV).

• National Institutes of Health.

• Self-study course from the CDC: Principles of Epidemiology in Public Health Practice: An Introduction to Applied Epidemiology and Biostatistics. https://www.cdc.gov/csels/dsepd/ss1978/index.html.