Covid 19 means corona virus disease 2019. The name corona virus derived from latin corona, meaning crown or wrealth itself a harrowing from Greek kopwvnkorone.

The name was coined by June almeida and David Tyrrell who first observed and studied human corona virus.

Virus classification:

• Realm- Riboviria

• Kingdam- Orthornavirae

• Phylun- Pisuviricota

• Class- Pisoniviricetes

• Order- Nidovirales

• Family- Corona Viridae

• Sub Family- Orthocoronavirinae

Doctors currently recognize 7 types corona virus humans amang them four common types are:

• 229E(alpha corona virus)

• n263(alpha corona virus)

• oc43(beta corona virus)

• hk01(beta corona virus)

• Animal origins of human corona viruses 

• SARS- CoV

• SADS- CoV

• MERS- CoV

• 12-CoV229

Background

Corona virus disease (covid 19) is an infectious disease coused by a newly discovered corona virus most people infected with covid virus will and recover without requiring special treatment older people and thos with under lying medicinal problemes like cardiovascular disease, diabetes, chronic respiratory disease, cancer, are more likely to develop serious illness.

The best way to prevent and slow down transmission is to be well informed about corona virus the disease it couses and how it spreed. Protect your self and others from infection by wasting frequently and not touching your face. 

The covid 19 virus spreedprimerally through droplets of saliva or discharge form nose when an infected person coughs and sneeze so its respiratelyitiquetteeg. By coughing into a fixed elbow.

It is a contagious disease caused by severe acute respiratory syndrome coronavirus 2(SARS-COV-2)

Figure 1: Illustration of COVID-19 Virus Particles

Figure 2: Microscopic View of COVID-19 Virus

The first known case was identified in wuhan,china,in December 2019.the disease has since spread worldwide,leading,to an omgoing pandemic. It is onset of action 2-14 days from infection. Its duration of action 5days to 10+months (Figure 1).

It is diagnosted by rRT-PCR testing CT scan method. Its treatment aresymptomic and supportive.

Symptoms

Symptoms are variable but often include fever,cough, headache, fatigue, breathing difficulties, and loss of smell and taste. Symptoms may beging to fourteen days after expore to the virus. At least a third of people who are infected do not develope noticeable symptoms of those people who develope noticeable symptoms enough to be closed as patient most (81%) develop mild to moderate symptoms while (14%) develop severe symptoms or more than 50% lung imvolvment and 5% suffer critical symptoms older people are at a higher risk of developing severe symptoms. Same people are experienced to range of effect for months later observed multiyear studies are underway to further investigate the long-term effects of the disease (Figure 2).

Pathothysiology

Covid 19 can affect the upper respiratory tract and lower respiratory tract. The lungs are organe most affected by covid 19 because the organs access host cells via enzyme angiotensin converting enzyme 2 which is most abundant in type2 alveoler cells of the lungs. The virus uses a special surface glycoprotein called a spike to content to ACE2 in each tissue and enter host cell. The density of ACE2 iin each tissues correlates with severe of disease in that tissues decreasing ACE2 activity might be protective through another view is that increasing ACE2 using angiotensin 2 receptor hocker medications could be protective.

Diagnosis

It is diagnosted on basis of symptoms and confirmed using reverse transcription polymerase chain reacton or other nucleic acid testing on infected secreations. Along with labroratorytesting,chest CT-scans may be helpful to diagnostic covid19 in individuals with serological tests which detect antibodies produced by body in response to the infection.

Viral Testing

The test is typically done on respiratory sample obtained by nesophangeal swab, or sputum sample may also be used. Results are generally available within hours characteristics imaging features on chest radiograph and compound tomography of people who are symptomic include asymmetric peripheral ground glass oparcities without pleural effiusions.

Infections of Internal Organs

Macroscopy, pericarditis,lungconsodidation and pulmonary aedema.

Lungs

• Minor serous exudation and minor fibrin exudation

• Pulmonary edema, pneumocyte injury, and interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

• Diffuse alveolar damage (DAD) as the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia

• Organization of exudates in alveolar cavities and pulmonary interstitial fibrosis

• Plasmocytosis in bronchoalveolar lavage (BAL)

Blood and vesseles

Disseminated Intravascular Coagulation (DIC), Leukoerythroblastic Reaction, Endotheliitis, and Hemophagocytosis.

• Heart: Cardiac muscle cell necrosis

• Liver: Microvascular steatosis

• Brain: Infraction

• Nose: Shedding of olfactory epithelium

• Kidneys: Acute tubular damage

• Spleen: White pulp depletion

Treatment

There is no specific,effective treatment of cure for coronavirus disease,the disease caused by the SARSCORONAVIRUS. Which include treatment to relive symptoms, fluid therapy, oxygen support and prone positioning as needed and medication to support care include such as paracetamol or NSAIDS to relive symptoms proper intake of fluids rest and nasal breathing. Good personal hygine and a heathy diet are also recommended that those ho suspect they are carrying the virus isolate them self at home and wear a face mast in those with low oxygen level use of the glucocorticoid dexamethasome is strongly recommaeded as it can reduce risk of death 

Injection

Indicated for adults and paediatrics patients aged 12years who weigh >40kg for treatment of covid for treatment of covid-19 requiring hospitalization.

Day 1 loading dose-200 mg IV infused over 30-120 min. then day 2 and therefore -100mg IV q-day.

Treatment Duration

• Not requiring invasive mechanical ventilation and extraoorporeal membrane oxygenation 5days of cilical improvement not demonstrated treatment may be extended upto 10days total 

• Requires insolve mechanical ventilation and Ecmo 10days

Dosage Modifications

Renal Impairement: Pharmacokinatic have not been evaluated in patients with renal impairment.

Beta-cyclodextrin sodium salt expient in the concentrated soln is really dered and accumulates in patient with decreased renal function.

Hepatic Impairment

Not evaluated unknown if dosage adjustment requirement.

Dosing Consideration

Laboratory Tests

• Obtain before iniatating in all patient and while receiving as clinically appropriate 

• Detemine EGFR

• Perform hepatic laboratory testing

• Determine prothrombin time

NTH

pharmacological management if covid19 based on disease severity

Medscopecovid 19 References Aare Available

Coronavirus Disease 2019: Aovel coronavirus resource centre.

At a time when the Indian hospitals are running short of oxygen supply and drugs such as remedisiver as imperitive to know why this drug is so important in the treatment o critical covid-19 positive patients. Remedisiver is given to patients who have moderate or moderate progressive towards severe covid-19 infection.

Remedisiver was the 1^st drug approved by the USFDA for treating the SARS-COV-2 viruses.

It was claimed to be effective in the severe and critical stages of covid-19 but it was also understand to be hepatotoxic meaning damaging to the liver cells.

According to WHO study,remedisiver fairs to prevent death among patients but may reduce the lenth of hospital stay by1-3 days.

As per experts,this drug should be admistered on patients who are severely ill and have suffered multi-organ dysfunction.

It can be however,be used between the second and tenth day of infection to improve its effectiveness among patients who have a moderate or progressing towards severe infection. The doctor explain ideal course is six doses over five days (1^st day 200mg followed by 100mg for the next 4days)and should not be overused,meanwhile officials of the district health department in naida said on Thursday that new guidline have been issued regarding usage of remedisivir.

The guidelines will soon be circular to private hospital as well as doctors,with aim to bring drown unnecessary usage of remedisiverand also curb the black-marketing of the drug.according to guidline any hospital prescribing antiviral medication to patient will have to also give in writing that it does not have any dose of drug left in its stock if asks their family members to procedure the jab from elsewhere officials said.

What was Remedisivir  Used for in the Past

Before the approval of FDA and emergency use authorization,remedisivir was considered as an investigational drug.it was not used for treatment of any special conditions,but the medicine was used for the potential treatment of various diseases (Figure 3).

At first,this was used for treatment of hepatitis later in2014, it was studied as possible treatment of ebolavirus. Researcher have found that this is effective against severe acute respiratory syndrome but the research was conducted in test tubes and on animals,not in humans.

How was Remedisivir Used to Fight Covid-19

Remedisivir was not approved by FDA for treating certain condition looking at the present scenarious the FDA had issued an emergency to use remedisivir for the treatment of covid-19 at the begeining of may,the doctors were able to gives this to patients who were admitted with severe covid-19.

After evaluating the data remedisivir had expanded its emergency use of authorization patients hospitalized with covid-19 weregivenremedisivir in october  FDA changes the status of remedisivir from emergency use to an FDA approved drug.

Figure 3: Antiviral Therapy for COVID-19: Remdesivir

Table 1: Recommended Dosage and Dosage in Pediatric Patients

Brand name of remedisivir: Veklury

Table 2: Covid-19 Vaccines All Over the World

Side Effects of Remedisivir

Some of common side effects of remedisivir are

• Yellow eyes

• Dark urine

• Pain in the upper stomach

Some of the adverse effects of the remedisivir are

• Nausea 

• Pain

• Bleeding

• Swelling near the placewhereremedisivir is injected

If you have any of those serious symptoms immediately contact your doctor for further assistance in any case,due to remedisivir if you get any kind of reaction in your body try avoiding it.

A doctor advised to take the medicines by seeing your problems and the benefits of this medicine are greater than side effects majority of the people who use this medicine help immediately if you get any serious remedisivir side effects.

Precautions

Before taking remedisiver talk to your doctor if you allergic to any kind of medications. Talk to your doctor if you are taking any prescribe or none to prescribe medications,vitamins,nutritional supplements and any kind of herbal products. Talk to your doctor if you are having liver or any kidney diseases (Table 1-2).

Before taking it tell your doctor if you are pregnant or planning for pregnancy.

How to Take Remedisiver

Remedisivir comes in the form of solution and powder to be mixed with the liquid and infused into vein by doctor or nurse in the hospitls. It is given once in a day for 5 to 10 days. The treatment lenth depend on how long dose your body takes to respond to the medications.

The drug help in preventing from producing particular enzyme that is necessary for the virus for replicating itself. Once this is done the virus will no longer be able to spread within body.

Missed Dose

Missing one or two dose of remedisivirwont show any effect on your body. The skipped dose causes no problem. But with some medications,itwont work if you don’t take the dosage on time.  If you miss a dose some sudden chemical change may effectyour body, in some cases, your doctor advise you to take the prescribed medicine as soon as possible if you have missed the dose.

Overdose

Overdose of drug can be accidental. If you have taken more than the prescribed remedisivir there is a chance of getting a harmfull effect omn your body functions,overdose of medicine can lead to some medical emergency.

Warning for Serious Health Conditions

• Pregnancy: research has shown that remedisivir medications are safe during pregnancy but pregnant women have largly been excluded from the clinical trials for covid-19 treatment options

• Breastfeeding: Remedisiviris given through injections,so infants will not likely absorb clinically important amounts of drug from milk

Storage

Diect contact with heat,air and light may damage your medicines. The exposure of medicine may cause some harmful effects. The medicine must be kept in safe place and out of childrens reach.

Mainly the drug should be kept at room temperature between 68 f and 77f (20to25degree)

Before taking remedisivir to consult your doctor. In case of your face any problem or get anyside effects after taking remedisivir rush immediately to your nearby hospital consult your doctor fot better treatment.

Mutants of Covid-19

A new mutant variant of the coronavirus has been detected from samples collected in india. Scientist are cheking if are a variant,where two mutations come together in thwsamrvirus,may be more infectious or less affected by vaccines.Mutants are of two types

• Double mutant

• Triple mutant 

A new double mutant variant,where two mutations are come together in the same virus,may be more ingectious or less affected by vaccines.

Some 10,787samples from18 indian states also showed up771 cases of known variant 736 of the UK, 34 of the south Africa and 1 brazalian.

Officials may be variants are not linked to spike in caes in india.

India reported 47,262cases and 275 deaths on Wednesday the sharpest daily rise this year.

The genetic code of virus work like its instruction manual mutations in viruses are common but most of them are insignificant and do not cause any change its ability to transmit serious infection. But some mutations like once in UK or south Africa variant lineages,can make virus more infectious and in some cases even deadlier.

Viologist shahid jannel explained that a double mutations in key areas of the viruses spike protein may increase these risk and allow the virus to escape the immune system.

The government said that an analysis of the samples collected from Indians western Maharashtra state showed on in fraction of sample with E484 and L45R mutations,compaired with December lat year.

Such double mutations confer immune escape and increased infectivity the health ministry said in a statement.

Triple Mutant Coronavirus Viarant Discovered in India

Vinod scaria,a scientist at the council of research institute of genomic and integrative biology in new delhi, rolled out a twitter thread detailing discovery of new mutant coronavirus with distint set of genetic and immune escape variants, Intial sequence of variant B.1.618 were found in west bangal.

The announcement comes immediately on the back of discovery of a wide spread new double mutant variant B.1.617 detected in delhi,Maharashtra and some other places. The double variant was reported to have much increased trassmissibility and ability to bypass the immune response.

Speaking to expert NDTV described the new variant as a triple mutant meaning three different covid strains combining to form a new variant. This is more transmissible variant. It is making bts of people sick very quickly said Madhukar pai,professor of epidermiology at mcaill university reported the publication. We have to keep tweaking vaccines for that we need sequencing on war footing.

The Indian express reported that two of triple mutant varieties have new mutation in spike protein and have been found in samples collected from Maharashtra,delhi,west Bengal and chattisgarh all second surge states.

Scaria said that properties of B.1.618 has been growing significantly in recent months in the state of west bangal,along with double variant B.1.617.

Figure 4: COVID-19 Immunization Using COVAXIN

COVAXIN

• Covaxin is an inactivated virus-based covid-19 vaccine developed by BHARAT BIOTECH in collaboration with Indian Councial Of Medical Research (ICMR) National Institute Of Virology (NIV)

• This vaccine is developed using whole virion inactivated verocell,derived platform technology. Inactivated vaccine do not replicate and are therefore unlike to revert and cause pathological effect (Figure 4)

• Covaxin include with immune potentiotors,also known as vaccine adjuvants,which are added to vaccine to increase and boost its immunigenecity

• It is 2 dose vaccination regimen given28 days apart

• It ready to use liquid presentation in multi dose vials, stable at 2-8 c

• The vaccine received DCGI approved for phase 1 and 2 human clinical trials in July 2020

• Safety and immunogenicity of covaxin in volunteers aged >18years

• 25800 participants>2400 volunteers were above 60 years of age and >4500 with combined conditions

• Covaxin demonstrate 78% vaccine efficacy against severe covid-19 disease was 100% with an impact on reduction in hostitalizations

Global Acceptance of Covaxin

• Bharat biotech has been approved by several countries across world for procurement of covaxin

• Suplies from government to government in following countries to take place : magnolia,Myanmar,srilanka,phillippines,Bahrain,oman,maldives,and Mauritius

How it Works

Covaxin works by teaching the immune system to make antibodies against SARS-COV-2 coronavirus. The antibodies attach to virualproteins,such as so called spike protein that study its surface.

• The researches drew off inactivated viruses and mixed them with tiny amount of aluminium based compound called an adjuvant. Adjuvant stimulant immune system to boost its response to a vaccine

• Another type of immune cell called B cell, may also encounters the inactivated coronavirus. B cell have surface protein in a huge variety of shapes and few might have right shape to latch onto coeonavirus

SINOVAC

It is  also known as coronavac,covid-19 vaccine. It is an inactivated vaccine virus covid-19 developed by the chienese company sinovac biotech.

• It was in phase3 clinical trial in brazil,chile,Indonesia,thePhilippines,and turkey

• It relies on traditional technology similar to BBIBP-CORV and  BBV152 other, inactivated viruses

• Coronavac does not need to be frozen, raw material for formulating new doses could be transported and refrigerated at 2-8c temperature at which flu vaccines are kept

• It is administered by intramuscular injection

• Coornavac is 67-75 % effective against covid-19

• In April,sinovac had a production capacity of 2 million doses a year and had delievered 300 million total doses

• It is currenty being manufactured at several facilities in china,with planned manufracture in brazil in September 2021 and eventually in EGYPT

How SINOVAC Works Against Covid-19

• Sinovac works by teaching immune system to make antibodies against SARS-COV-2 coronavirus. The antibodies attach to viral protein,such its surface

• The researches grew large stocks of the coronavirus in monkey kidney cells

• Then they daused virus with chemical called beta-propiolactone, the compound disabled coronavirus by bonding to their genes. The inactivated coronavirus could no longer replicate but their protein including spike remained impact

NOVAVAX

It is an American biotechnology company based in Gaithersburg. It is protein based prior to 2020,company scientist developed experimental vaccines for ebola virus and other emerging infectious disease.

Codename for NOVAVAX:

• NVX-CoV2373 OR

• SARS-COV 2hrs protein 

Nanoparticle with matrix M1 adjuvant is covid-19 vaccine candidate  developed by novavax and coalition for epidemic innovations and is undergoing trials in india under brand name NOVAVAX.

• Novavax vaccine is 89% effective at preventing covid-19 in people who received two doses of vaccine 21days apart

• Novavax vaccine id developed by US and is stable at 2 to 8c

Figure 5: Novavax: Coronavirus Vaccine for COVID-19 Protection

How it works

The novavax candidate require two shots spaced three weeks apart but candidate NVX.Co.V2373 actully works differently than other covid-19 vaccines that have made it this far. Its protein subunit vaccine which means that is uses a lab-made version of SARS-CoV-2 spike protein. This spike protein alone cant make anyone sick,but to make sure that body still generate protective antibodies against it, novavax has inserted an ingredient called adjuvant which act as hypeman for immune system to signal it to spring into action.

Sputnik. V 

• Sputinik.v is an adenovirus viral vector vaccine for covid-19 developed by gameleya research institute of epidemiology and microbiology. It was registered on 11august 2020 by Russia ministry of health as covid vaccine

• ‘V’ in its name is the letter and not the roman numeral

• Sputinik.v is a two part vaccine against SARS-CoV-2

• It is viral vector based on adenovirus DNA in coronavirus gene is inserted. Adenovirus is used as a container to deliever coronavirus gene to cells and start synthesizing new coronavirus envelope proteins introducing immune system to a potential enemy

How Sputinik.V Works

It is two component vaccine in which adenovirus serotypes 5 and 26 are used. A fragment of tissue type plasminogen activactor is not used,lenth and s.proteinsputinik.v vaccine is produced with HEK293 cell line (Figure 6).

Sputinik.V Vaccine History

In may2020,the Russian state institute gamaleya national research centre of epidemiology and microbiology announced that it had developed the vaccine,which does not have any side effects. The first vaccination leads to humeral cellular immunity and once a second vaccination is administered memory cells are formed on February 2021, the lancet published a new study safety and efficacy of anrAD 26 and rAD25 vector based heterologous prime boost covid-19 vaccine an iterin analysis of a randomized controlled phase3 trial in Russia. This peer reviewed article concluded phase 3 trial of gam covid-19 and was well tolerated on large cohort. On April 13 2021, researches from argentina based CONICET under co-ordination of ministry of health of province of Buenos airs announced 94% of people who received single dose of sputinik.v produce specific antibodies.

Figure 6: Sputnik V Coronavirus Vaccine

Figure 7: Covishield Vaccine (ChAdOx1 nCoV-19)

Astrazeneca / Covishield

• Covishield vaccine that aims to protect against covid-19

• Manufacturer= astrazeneca,serum institute of india

• Research name of covishield= AZD1222 (chad0x1)

• It is non-replicating viral vector type of vaccine

• It is administered by intramuscular injection

Effectiveness

• Based on data provided by manufacturer the astrazeneca oxford vaccine has shown to be 65%effectiveness in an ongoing large scale clinical trials (Figure 7)

• A widely used covid-19 vaccine that atleast 50% effective could help control the pandemic

Most Common Dide Effects of COVISHIELD

• Pain or tenderness at injection side

• Headache

• Tiredness

• Muscle pain

• Fever

• Naushea

Figure 8: Janssen COVID-19 Vaccine Johnson and Johnson

Who Should Get Covishield Vaccine

It is approved for persons who complete 18 years of age.

Who Should Not Get Covishield Vaccine

If you had severe allergic reaction of any ingredient of this vaccine.

What are Ingredients in Covishield

• L-histamine, l-histidine hydrochloride monohydrate,

• Magnesiumchloride hexahydrate polysorbate80

• ethanol, sucrose, sodiumchloride, disodiumeditate, water for injection (Figure 8)

Johnson and Johnson / Janseen

The janseen or johnson and johson covid-19 vaccine that was developed by janseen in leiden,netherland and Belgian company janseen pharmaceuticals, subsidiary of American company j and j. It is viral vector type of vaccine.

• The terms of EVA allow of vaccine while more data gathered,company plans file for biologics license application(BLA) with FDA in 2021

• It is only single dose type of vaccine

Manufacturing and Supply Chain

The j and j vaccine single dose is compatible with standard vaccine storage and distribution channels with ease of delievary to remote areas.

• The vaccine is estimated to remain stable for 2 years at 4c and maximum of 3 months at routine

• The company will ship vaccines using same cold chain technologies it uses today to transport treatment for immunological disorder

Moderna

• Codename-mRNA-1273

• It is developed by moderna,theunited state national institute of allery and infection

• Diseases and biomedical advanced researches and development authority

• It is used in people aged 18 years abd older to provide protection against infection by SARS-Co-2 virus,which cause covid-19

Figure 9: COVID-19 se Bachav ke Liye Moderna Vaccine

Figure 10: COVID-19 se Bachav ke Liye Pfizer Vaccine

• It is designed to be administered as two 0.5ml doses given by intramuscular injection at an interval of four weeks apart

Trade Names

• Moderna covid-19

• Vaccine moderna

• M-RNA-1273

• Cx-024414

• Moderna

The moderna covid-19 vaccine is authorized for use at some level in 45 countries including united state, Canada, Europeanunion, unitedkingdom, Israel and Singapore (Figure 9).

• Nn15 march 2021, moderna 2^nd covid-19 vaccine started phase1 clinical trials

Pfizer-Biontech

It is covid-19 vaccine has not been approved or licensed by US food and drug administered on (FDA) but has been authorization to prevent coronavirus disease (Figure 10).

For use in individuals 12 years of age.

• Name=BNT162b2

• Pfizer vaccine manufactured by Inc and biontech

• It is mRNA type of vaccine

• It is 2 shots of vaccine,21days apart

Percent of Vaccination All Over the World

• More than 1.63 billion vaccine doses have been administered world wide,equal to 21 doses for every 100 people

• There is already a stark gap between vaccination programs in different countries,with some yet to report a single dose

• The data is complied from government sources by our world in data project at university of oxford. A vaccinated person refers to someone who has received at least one dose of vaccine and a fully vaccinated person has received all require doses of vaccine

• For Pfizer-biontechvaccine,a person who is fully vaccinated has received two doses

• While vaccine doses remain relatively scare globally,most countries have focused their early vaccination efforts on priority group like clinically vulnerable people in their 60s,70s,and older and front line workers like doctors and nurses

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2. UNICEF. Coronavirus disease information centre. www.unicef.org.

3. Remdesivir dosing, indications. Medscape. www.reference.medscape.com.

4. New guideline for remdesivir and its effectiveness in COVID-19 treatment. DNA India. www.dnaindia.com.

5. Remdesivir side effects, dosage, precautions, warnings. Medicover Hospitals. www.medicoverhospitals.in.

6. Coronavirus double mutant COVID variant found in India. BBC. www.bbc.com.

7. Triple mutant coronavirus variant discovered in India? The Week. www.theweek.in.