corona virus ,pathophysiology of covid 19, diagnosis

1. C0VID-19 THE PANDEMIC
Likhit Akotkar
M . Pharma I
Department Of Pharmacology
BVDU Poona College Of Pharmacy , Pune.
CORONA VIRUS DISEASE

2. CONTENTS
• HISTORY
• INTRODUCTION
• SIGN & SYMPTOMS
• EPIDEMIOLOGY
• STRUCTURE OF CORONA VIRUS
• CAUSES
• PATHOPSHYIOLOGY
• DIAGNOSIS
• PREVENTION
• TREATMENT
• HOW CHINA RECOVERED
• ON GOING RESEARCH WORKS
• MYTHS & FACTS
• LOCKDOWN EFFECTS

3. HISTORY OF PANDEMICS
• The Black Death: 1346-1353
• American polio epidemic: 1916
• Spanish Flu: 1918-1920
• AIDS pandemic and epidemic: 1981
• H1N1 Swine Flu pandemic: 2009-2010
• West African Ebola epidemic: 2014-2016
• Zika Virus epidemic: 2015

4. PANDEMICS AFTER EVERY 100 YEAR

5. TERMINOLOGIES
• SARS – Severe acute respiratory syndrome
• MERS- Middle east respiratory syndrome
• TMPRSS- Transmembrane serine protease
• ACE2 – Angiotensin converting enzyme
• NGS – Next Gen sequencing
• CB-NAAT- cartridge based nucleic acid
amplification test.

6. HISTORY
• Coronavirus disease 2019 (COVID-19) is an infectious
disease caused by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). It was first identified in
December 2019 in Wuhan, China, and has since spread
globally, resulting in an ongoing pandemic. As of 24 May
2020, more than 5.31 million cases have been reported across
188 countries and territories, resulting in more than 342,000
deaths. More than 2.11 million people have recovered
• A 55-year-old individual from Hubei province in China
may have been the first person to have contracted COVID-
19, the disease caused by the new coronavirus spreading
across the globe. That case dates back to Nov. 17, 2019

7. HISTORY
• Following the pneumonia cases of unknown cause reported in Wuhan and considering the shared
history of exposure to Huanan seafood market across the patients, an epidemiological alert was
released by the local health authority on Dec 31, 2019, and the market was shut down on Jan 1,
2020. Meanwhile, 59 suspected cases with fever and dry cough were transferred to a designated
hospital starting from Dec 31, 2019. An expert team of physicians, epidemiologists, virologists, and
government officials was soon formed after the alert.
• Since the cause was unknown at the onset of these emerging infections, the diagnosis of pneumonia
of unknown cause in Wuhan was based on clinical characteristics, chest imaging, and the ruling out
of common bacterial and viral pathogens that cause pneumonia. Suspected patients were isolated
using airborne precautions in the designated hospital, Jin Yin-tan Hospital (Wuhan, China), and fit-
tested N95 masks and airborne precautions for aerosol-generating procedures were taken. This study
was approved by the National Health Commission of China and Ethics Commission of Jin Yin-tan
Hospital .
• Local centres for disease control and prevention collected respiratory, blood, and faeces specimens,
then shipped them to designated authoritative laboratories to detect the pathogen A novel
coronavirus, which was named 2019-nCoV, was isolated then from lower respiratory tract specimen
and a diagnostic test for this virus was developed soon after that.14 Of 59 suspected cases, 41 patients
were confirmed to be infected with 2019-nCoV. The presence of 2019-nCoV in respiratory
specimens was detected by next-generation sequencing or real-time RT-PCR methods.

9. The World Health Organization (WHO) on March 11, 2020, has declared the
novel coronavirus (COVID-19) outbreak a global pandemic .WHO Director-
General, Dr. Tedros Adhanom Ghebreyesus,
ACT NO. 3 OF 1897 1 [ 4th February, 1897.] An Act to
provide for the better prevention of the spread of
Dangerous Epidemic Diseases
• The first case of the COVID-19 pandemic in India was
reported on 30 January 2020, As of 24 May 2020,
the Ministry of Health and Family Welfare have
confirmed a total of 131,868 cases.
• Epidemic Diseases Act, 1897 have been invoked, and
educational institutions and many commercial
establishments have been shut down. India has suspended all
tourist visas, as a majority of the confirmed cases were
linked to other countries.
•

10. INTRODUCTION
1) The word coronavirus is more of an umbrella
term that refers to a group of viruses that cause
diseases like SARS, MERS and COVID-19
2) As is often the case in the scientific world,
coronavirus’ name is Latin. In the ancient language,
corona means crown.
3) As for the new disease caused by the coronavirus,
it was originally called novel coronavirus. In
February, the World Health Organization gave us the
name COVID-19

11. SIGN AND SYMPTOMS

12. PREVENTIONS
❖ To cover coughs and sneezes
❖ To wash hands regularly with hot water
❖ To avoid contact with infected people
❖ To maintain an appropriate distance from people
❖ To refrain from touching eyes, nose, and mouth In case of symptoms
❖ To follow advice given by your healthcare provider
❖ Use immune booster Arsenic album 30
❖ Turmeric milk as immune booster
STAY HOME STAY SAFE
To use face masks N95
“N” stands for. “Not resistant to oil,
”95 stands for- respirator blocks at least 95
percent of very small (0.3 micron) test particles.

13. PERSONAL PROTECTIVE EQUIPMENT
(PPE)
Ministry of Textiles and Ministry of Health and
Family Welfare have been working together in
this endeavour. Domestic manufacturers rose to
the occasion and so far 11 manufacturers have
cleared quality tests.
Orders for 21 lakh PPE coveralls have been
placed on them.
Currently they are supplying 6-7,000 coveralls
per day and this is expected to go up to 15,000
per day within the next week.
Synthetic blood penetration resistance test are
performed to check quality

14. Private Gov Approved PPE MFG Org.
JCT Mills Phagwara,
▪ Arvind Mills,
▪ Amare Safety,
▪ Mumbai based Sure Safety,
▪ Delhi-based Sai Synergy,Manchanda,
▪ Shree Healthcare, Chennai etc,
Government PPE MFG Org.
• DRDO- INMAS
• INDIAN RAILWAYS
• SITRA
• CSIR labs
• From 0, India now produces nearly 4.5 lakh PPE kits every
single day.
• In 60 days, the PPE industry in India has witnessed 56
times growth.
•

17. EPIDEMIOLOGY
AS ON DATE OF 25 MAY 2020
MALES ARE MORE PRONE TO
AFFECTED DUE TO CORONA
MALES 76%
FEMALES 24%
https://www.worldometers.info/coronavirus/#countries

19. CAUSES
Risk factors for COVID-19 appear to include:
•Recent travel from or residence in an area with ongoing community spread of COVID-19 as determined by CDC or WHO
•Close contact (within 6 feet, or 2 meters) with someone who has COVID-19 for more than 5 minutes or being coughed or
sneezed on by an infected person
1. Complications
2. Although most people with COVID-19 have mild to moderate symptoms, the disease can cause severe medical
complications and lead to death in some people. Older adults or people with existing chronic medical conditions are at
greater risk of becoming seriously ill with COVID-19.
3. Complications can include:
4. Pneumonia and trouble breathing
5. Organ failure in several organs
6. Heart problems
7. A severe lung condition that causes a low amount of oxygen to go through your bloodstream to your organs (acute
respiratory distress syndrome)
8. Blood clots
9. Acute kidney injury
10.Additional viral and bacterial infections
11.

20. VIROLOGY – COVID 19
Corona virus belongs to
Realm -roboviria
Phylum - incertae sedis
Order -nidovirals
Family -coronaviridae
Size -120–140 nm in size
SARS COV- 2 particles
arebosphericle and has
proteins called spikes
S - SPIKE
N- NEUCLEOCAPSID
E- ENVELOPE
M- MEMBRANE
HE- HAEMAGLUTIN ESTERASE

22. ▪ Enveloped virion
▪ Positive sense
▪ Single stranded
▪ Largest RNA virus
▪ 80-160 nanometer in diameter
▪ Genome ranges 26-34kbs
PROPERTIES OF CORONA
probably represent avian species
(III) -coronavirus(deltaCoV),
(IV) -coronavirus (gammaCoV)
There are four genera of CoVs
probably present in bats and rodents
(I) -coronavirus(alphaCoV),
(II) -coronavirus (betaCoV),

23. CORONAVIRIDAE
DELTA-CORONAGAMMA-CORONABETA-CORONAALPHA-CORONA
Human CoV/NL63
TGEV/PEDV
(gastro/diarrheal
PRCV- Respiratory
SARS-CoV2
MERS-COV
MHV-MOUSE
HEPATITIS COV
IBV- BRONCHITIS PDCV-PORCINE

24. IBV- BRONCHITIS
PDCV-PORCINE
Human
CoV/NL63
ACE2
TGEV/PEDV
(gastro/diarrheal
APN
PRCV-
Respiratory APN
SARS-CoV2
ACE2
MERS-COV
DPP4
CEACAM
MHV-MOUSE
HEPATITIS COV
SUGAR
SUGAR
VIRUSES & RECEPTORS

25. CIVET
CAMEL
PANGOLIN
BAT
BAT
BAT
SARS- COV1
2003
SARS- COV2
2019
MERS-COV
2012

27. In contrast, SARS-CoV, Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-
CoV-2 are classified to β coronaviruses.
PATHOPHYSIOLOGY
They are largely divided into four genera; α, β, γ, and δ based on their genomic structure. α
and β coronaviruses infect only mammals .
Human coronaviruses such as 229E and NL63 are responsible for common cold and croup and
belong to α coronavirus.

28. PATHOPHYSIOLOGY

29. PATHOPHYSIOLOGY
S1 – SPIKE PROTEIN
ECTODOMAIN
N TERMINAL DOMAIN
FUNCTION AS HEAD
S2– HAEMAGLUTININ ESTERASE
ENDODOMAIN
C TERMINAL DOMAIN
FUNCTION AS TAIL
BINDING FUSION
ACE2 RECEPTORS LOCATIONS

30. PATHOPHYSIOLOGY WITH TARGETS

34. After replication virus invade
alveolar cells in called
pneumocytes - 2
Activation of inflammatory
Mediators
Macrophages, interferons
-Cytokines
-TNF-ALPHA
-IL-1
-IL6
-IL8
-chemokines
Also stimulates nerve endings
For COUGH REFLEX (early
stage)
TNF-ALPHA
-IL-1 - this both are
proinflammatory cytokines
vascular permeability
vascular adhesion
receptor for neutrophile
at site of enjury
IL-8 stimulate neutrophiles
due to vascular permeability
causes leakage of fluid in
interstitial space which
results in Pulmonary
Oedema.
Lead to – DYSPNEA
HYPOXIA

35. Due to increase in wbc in
serum , neutrophils try to
engulf virus and remove
biproduct as a chemicals
Lead to damage alveolar
cells
Results secretion of surfactant
surface tension of 02-blood
congestion
BREATHLESS OR
TIGHTNESS IN CHEST
FEVERTIGHTNESS IN CHEST
WBC acts on arachidonic acid
pathway
WBC acts on arachidonic acid
pathway
Leukotriens
Bronchoconstriction
Prostaglandins
IL8
TNF-ALPHA
FEVER

36. HEART
Due to hypoxia decrease O2
blood supply
Sense by chemoreceptor in
aorta
Stimulates cardiorespiratory
centres in brain
TACHYCARDIA
LIVER
IL6
Stimulates hepatocytes
To release CRP
In blood test
Show inflammation in artries
Fibrinogen and hepsidin
KIDNEY
Biliary nitrogen
Creatinine

37. TREATMENT (DRUGS)
TMPRSS2 INHIBITORS (SERINE PROTEASE)
OR FUSION INHIBITORS
-Nafamostat mesylate (UCT)
-Camostat mesylate (APPROVED)
ACE-2 INHIBITORS
OR BINDING INHIBITORS
-SSAA09E2 (UCT)
V-ATPase INHIBITORS
OR LYSOZOMAL INHIBITORS
- Hydroxychlorquine (HCQ)
RNA DEPENDENT RNA
POLYMERASE INHIBITORS
-Remdesvir
-Favipiravir
PROTEASE INHIBITORS
-Ritonavir
-Lopinavir
ACE-2 INHIBITORS
OR BINDING INHIBITORS
-SSAA09E2 (UCT)
Aquilegia chrysantha
Phytopharmaceutical
drug (UCT)-2020
IMMNOSUPPRESSANT
-TOCILIZUMAB
-LENZILUMAB

38. AQCH is derived from tropical,
climbing shrub cocculus hirsutus, which
is used in Asia for its apparent medicinal
properties.
AQCH, which is being developed
for dengue, has shown broad
antiviral effect in in-vitro studies
and hence is being tested as a
potential treatment option for
COVID-19
Sun Pharma received approval from
the Drugs Controller General of
India (DCGI) for the AQCH trial in
April,
AQCH
Phyto
pharmaceutical
drug
(UCT)-2020

39. PLASMA CONVALESCENT THERAPY

40. VACCINES
IISC Banglore
PUNE
GURGAON
AHMEDABAD
HYDERABAD
HYDERABAD
PUNE
AHMEDABAD
MUMBAI
All vaccnies under clinical trial
ChAdOx1 nCoV-19,

41. ChAdOx1 nCoV-19
vaccine

42. DIAGNOSIS- RTPCR

43. COVID GUN
B) Development of new, faster more sensitive and cheaper diagnostic
test: CRISPR/ Cas based paper diagnostic test (FELUDA) FNCAS9 Editor-Linked
Uniform Detection Assay: A CRISPR/ Cas -based paper diagnostic test has been developed by
CSIR. The FELUDA methodology has been developed in CSIR-IGIB for detecting single
nucleotide variants in RNA or DNA.
C) Development of RT-LAMP diagnostic kit:CSIR-IIIM has partnered with Reliance
Industries Limited (RIL) to develop and scale-up a new Reverse Transcriptase-Loop Mediated
Isothermal Amplification (RT-LAMP).
D) Large scale sample testing using Next Generation Sequencing (NGS): Next-
generation sequencing (NGS) allows for analyzing a large number of viral sequences from infected
patients. CSIR- SYNGENE
E) Serology based Diagnostic Tests : CSIR-CCMB and CSIR-IICB are working towards
developing these tests.

44. F) Shipping Container-based Diagnostic Labs: To increase the testing capacity in the country, along with
HP, Shipping Container-based Diagnostic Labs (Self Contained, -ve pressure, TrueNat MicroPCR, etc.)
have been developed and are being deployed in Delhi (2 nos) and Chennai (2 nos).
G) Bio-repositories for SARS-CoV-2: Three CSIR labs, CSIR-CCMB in Hyderabad, CSIR-IGIB in Delhi and
CSIR-IMTech Chandigarh have been designated bio-repositories for SARS-CoV-2 viral samples. This will
help in the development of indigenous diagnostics, therapeutics and vaccines and research to better
understand the COVID19 disease in the Indian scenario. .
H) IR TEMPRATURE SENSOR GUN WORKS ON IR EMMISSION OF POINTING OBJECT
AND NOT AFFCTED BY SURROUNDING, TEMP MANY OF THE SUSPECTS BY COVID
CHECKED FEVER BY THIS DEVICE

45. ICMR APPROVED TRUENAT FOR
DIAGNOSIS OF COVID19
ICMR APPROVED CB-NAAT FOR
DIAGNOSIS OF COVID19 Cartridge based Nucleic
acid amplification test

47. WHO IS AT MORE RISK ?
Death due to covid19
Death 27%
Death 73%
• XX chromosome contains "a
large number of immune-
related genes." And since
women have two of these,
• More estrogen level to show
anti-inflammatory property.
• Less Smoking
• Less social exposure
• Less ACE-2 Expression
• Less alcohol consumptions
• XY chromosome contains "a
LESS number of immune-
related genes.
• LOW estrogen level to show
anti-inflammatory property.
• MORE Smoking
• MORE social exposure
• MORE ACE-2 Expression
• MORE alcohol consumptions

48. DISEASE RELATED DEATHS
BIRTH RATE DEATH RATE
26 932 586 births per
year
9 778 073 deaths per
year
19.3 births/1,000
population
7.3 deaths/1,000
population
73,787 births per day 26,789 deaths per day
3,074 births each hour 1,116 deaths each hour
51 births each minute 19 deaths each minute
8 lakh deaths in
india every month
Due to any reason
heart
Lungs
cancer
Road accident
suicide
2,666 APPROX deaths in
india every month
Only one Reason
COVID19

49. Elisa granato in uk was the first patient
to inject covid vaccine for trial

50. On going research works
IIT Delhi and @AIST Japan, working on
natural compounds from Ashwagandha and
propolis for last several years, explored the
possibility of some of their bio-actives to
interact with SARS-CoV-2
NIPER- GUWAHATI 3D ANTIMICROBIAL
FACE SHIELD.

51. CSIR and Cadila have received regulatory approval for
clinical trials to evaluate efficacy of an existing gram-
negative sepsis drug, called Sepisvac for COVID19 patients.

53. COMPLICATIONS
Israel's biological institute claims to have found antidote to coronavirus
The Los Alamos team, assisted by scientists at Duke University and the
University of Sheffield in England, identified 14 mutations. Those mutations
occurred among the nearly 30,000 base pairs of RNA that other scientists say
make up the coronavirus’s genome. The report authors focused on a mutation
called D614G, which is responsible for the change in the virus’ spikes.
1)Difficult to differentiate symptoms of pneumonia and covid 19
2)Spreading is more effective than treatment
3)No available drug , vaccines .

54. EFFECT ON PREGNANCY
•A study of nine pregnant women who were infected with COVID-19
and had symptoms showed that none of their babies was affected by
the virus. The virus was not present in amniotic fluid, the babies’
throats, or in breast milk.
•Another study of 38 women infected with COVID-19 found that none of
the newborns tested positive for the disease.
•Two case reports of infants born to mothers infected with SARS-CoV-2
demonstrated that the infants had elevated levels of antibodies to the
virus but did not demonstrate any clinical evidence of infection with the
virus
The risk of passing the infection to a fetus appears to be very low.
Currently there is no evidence of any fetal malformations or effects due
to maternal infection with COVID-19.

55. GOVERNMENT INITIATIVES
IN RESEARCH

56. MYTHS AND FACTS

61. in March found no signs it had been
engineered. "By comparing the available
genome sequence data for known coronavirus
strains, we can firmly determine that Sars-
CoV-2 originated through natural processes,"
MYTHS THAT CORONA VIRUS CAME FROM
SCIENTIFIC AND RESEARCH PROCEDURES IN LAB

62. HOW CHINA RECOVERED
76 DAYS OF STRICT
LOCKDOWN
THERMAL
SENSOR TO ALL
HOME GUARDS
DEPLOYED DRONES
ALL OVER CHINA
MAINLY IN
CONTAINMENT
TECHNICAL
ASSOCIATION
WITH
ALIBABA
CLOSE
CONTACT
APP
HOSPITAL
IN JUST 10
DAYS

63. Q & A discussions

64. REFERENCES
1) Ye Yi, Philip N.P. Lagniton, Sen Ye, Enqin Li and Ren-He Xu
International Journal of Biological Sciences
2020; 16(10): 1753-1766. doi: 10.7150/ijbs.45134
1) Wikipedia/covid19
2) Yu-Tao Xiang 1, Wen Li 2, Qinge Zhang 3, Yu Jin 2, Wen-Wang
Rao 2, Liang-Nan Zeng 4, Grace K I Lok 5, Ines H I
Chow 2, Teris Cheung 6, Brian J Hall 7 ncbi
https://www.medindia.net/patients/calcul
ators/pop_clock.asp

65. THANK YOU