Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): a global pandemic and treatment strategies

Abstract

The emergence and rapid spread of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a potentially fatal disease, is swiftly leading to public health crises worldwide. The origin of SARS-CoV-2 infection was first reported in people exposed to a seafood market in Wuhan City, China in December 2019. It has been suggested that the infection is likely to be of zoonotic origin and transmitted to humans through a not-yet-known intermediary. As of 22 May 2020, the World Health Organization reported that there were approximately 4,995,996 confirmed cases and 327,821 deaths. SARS-CoV-2 is transmitted via inhalation or direct contact with droplets from infected people. It has an incubation period ranging from 2 to ≥14 days. The rate of spread of SARS-CoV-2 is greater than that for severe acute respiratory syndrome coronavirus and Middle East respiratory coronavirus. The symptoms are similar to influenza (i.e. breathlessness, sore throat and fatigue) and infected cases are isolated and treated. Infection is mild in most cases, but in elderly (>50 years) patients and those with cardiac and respiratory disorders, it may progress to pneumonia, acute respiratory distress syndrome and multi-organ failure. People with strong immunity or those who have developed herd immunity are asymptomatic. The fatality rate ranges from 3% to 4%. Recommended methods for diagnosis of COVID-19 are molecular tests (e.g. polymerase chain reaction) on respiratory secretions, chest scan and common laboratory diagnosis. Currently, treatment is essentially supportive, and the role of antiviral agents is yet to be established as a vaccine is not yet available. This review will focus on epidemiology, symptoms, transmission, pathogenesis, ongoing available treatments and future perspectives of SARS-CoV-2.

Keywords: Antiviral agents; Biosensor; Chloroquine; Coronavirus; SARS-CoV-2; Severe acute respiratory syndrome.

Graphical abstract

Fig. 1

(A) World map of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic (source: World Health Organization, accessed on 22 May 2020, time: GMT+5.30). (B) Occurrence of SARS-CoV-2 across different states of India on 22 May 2020. (C) One-month data of active, cured and deceased cases of SARS-CoV-2 across India on 22 May 2020 (source: Ministry of Health and Family Welfare, Government of India, accessed on 22 May 2020, time: GMT+5.30; https://www.covid19india.org/).

Fig. 2

Percentage of cases of coronavirus disease 2019 in 11 main countries affected. Dates are: India (30 January–25 April 2020); USA (30 January–26 April 2020); Spain (31 January–25 April 2020); Italy (29 January–25 April 2020); Germany (28 January–25 April 2020); UK (31 January–25 April 2020); France (24 January–25 April 2020); Iran (19 January–25 April 2020); China (11 January–26 April 2020); Russia (31 January–25 April 2020); and Australia (25 January–26 April 2020) .

Fig. 3

Schematic representation of the genesis and transmission of severe acute respiratory syndrome coronavirus-2 in humans.

Fig. 4

Proposed antiviral mechanism of action of ivermectin against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In the absence of ivermectin, IMP α/β1 binds to the coronavirus cargo protein in the cytoplasm, and crosses the membrane barrier through the nuclear pore complex into the nucleus where the complex dissociates and the viral cargo infects and reduces the host cell's antiviral response. In the presence of ivermectin, ivermectin binds to and destabilizes the IMP α/β1 heterodimer, preventing the binding of IMP α/β1 to the viral protein; this prevents the cargo protein from crossing the membrane barrier to enter the nucleus, thereby preventing infection and improving the antiviral response .

Fig. 5

BenevolentAI knowledge graph integrating biomedical data from existing structured and unstructured sources. Constructed on the basis of a fleet of algorithms to establish new relationships suggesting new treatment methods for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). AAK1, AP2-associated protein kinase-1; JAK 1/2, Janus kinase 1/2; GAK, cyclin-G-associated kinase , .