COVID-19 Is a Multifaceted Challenging Pandemic Which Needs Urgent Public Health Interventions

Abstract

Until less than two decades ago, all known human coronaviruses (CoV) caused diseases so mild that they did not stimulate further advanced CoV research. In 2002 and following years, the scenario changed dramatically with the advent of the new more pathogenic CoVs, including Severe Acute Respiratory Syndome (SARS-CoV-1), Middle Eastern respiratory syndrome (MERS)-CoV, and the new zoonotic SARS-CoV-2, likely originated from bat species and responsible for the present coronavirus disease (COVID-19), which to date has caused 15,581,007 confirmed cases and 635,173 deaths in 208 countries, including Italy. SARS-CoV-2 transmission is mainly airborne via droplets generated by symptomatic patients, and possibly asymptomatic individuals during incubation of the disease, although for the latter, there are no certain data yet. However, research on asymptomatic viral infection is currently ongoing worldwide to elucidate the real prevalence and mortality of the disease. From a clinical point of view, COVID-19 would be defined as "COVID Planet " because it presents as a multifaceted disease, due to the large number of organs and tissues infected by the virus. Overall, based on the available published data, 80.9% of patients infected by SARS-CoV-2 develop a mild disease/infection, 13.8% severe pneumonia, 4.7% respiratory failure, septic shock, or multi-organ failure, and 3% of these cases are fatal, but mortality parameter is highly variable in different countries. Clinically, SARS-CoV-2 causes severe primary interstitial viral pneumonia and a "cytokine storm syndrome", characterized by a severe and fatal uncontrolled systemic inflammatory response triggered by the activation of interleukin 6 (IL-6) with development of endothelitis and generalized thrombosis that can lead to organ failure and death. Risk factors include advanced age and comorbidities including hypertension, diabetes, and cardiovascular disease. Virus entry occurs via binding the angiotensin-converting enzyme 2 (ACE2) receptor present in almost all tissues and organs through the Spike (S) protein. Currently, SARS-CoV-2 infection is prevented by the use of masks, social distancing, and improved hand hygiene measures. This review summarizes the current knowledge on the main biological and clinical features of the SARS-CoV-2 pandemic, also focusing on the principal measures taken in some Italian regions to face the emergency and on the most important treatments used to manage the COVID-19 pandemic.

Keywords: COVID-19; COVID-19 planet; SARS-CoV-2; cytokine storm syndrome; endothelitis; hyperinflammation; thromboembolism.

Figure 1

Angiotensin-converting enzyme 2 (ACE2) expression is also found in respiratory and pulmonary tract cells (alveolar monocytes and macrophages), with the possibility of severe acute respiratory distress syndrome (ARDS) and in heart, kidneys, brain, endothelium, liver, in which organ failure and thromboembolism may occur.

Figure 2

Frequency of COVID-19 clinical features divided into age groups (scale: 0–3; 0 = not observed, 3 = frequently observed).

Figure 3

Number of oropharyngeal swab (OPS)/nasopharyngeal swab (NPS) per 1,000,000 inhabitants in Italian regions (period March–April 2020) Elaborazione GIMBE dati Protezione Civile—https://coronavirus.gimbe.org/ [88].

Figure 4

Number of deaths and NPS/OPS in Veneto and Lombardy during the COVID-19 pandemic.