COVID-19 pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Coronavirus disease 2019 (COVID-19) is caused by, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus named for the similarity of its symptoms to those caused by the severe acute respiratory syndrome. Unlike SARS-CoV, transmission of COVID-19 takes place during the prodromal period when those infected are mildly ill and are carrying on with their usual activities. This contributes to the spread of infection. The main pathogenesis of COVID-19 is severe pneumonia, RNAemia, combined with the incidence of ground-glass opacities, and acute cardiac injury. Person-to-person transmission occurs primarily via direct contact or through droplets spread by coughing or sneezing from an infected individual.

Pathophysiology

Pathogenesis

Transmission and Infectivity

  • The fact that large number of infected people were exposed to the wet animal market in Wuhan City where live animals are routinely sold, it is suggested that COVID-19 is likely of zoonotic origin.[26]
  • Initial reports identified two species of snakes that could be the culprit reservoir of COVID-19. However, there is no consistent evidence of coronavirus reservoirs except mammals and birds.[27]
  • Genomic sequence analysis of SARS-CoV-2 has shown 88% identity with two bat-derived SARS-like coronaviruses, indicating mammals as the most likely link between the virus and humans.[28]
  • Between the two types of the virus (L and S), the L type is more prevalent (~70%) than the S type (~30%).[29]
  • The L type, derived from the SARS-CoV-2 ancestral S type, is found to have a higher transmission rate than the S type and has accumulated a significantly higher number of derived mutations. This hints towards a more aggressive nature of the L type.
  • The rapid spread of the disease and the occurrence of cases among people who did not visit the wet animal market in Wuhan hint at the fact that person-to-person transmission is actively taking place.[30][31]
  • Person-to-person transmission occurs primarily via direct contact or through droplets spread by coughing or sneezing from an infected individual.
  • A recent pilot study has shown that some patients' stool specimens tested positive to SARS-CoV-2 and some patients who tested positive to rectal swabs had detectable virus in the gastrointestinal tract, saliva, or urine.
  • The epidemic can double in the number of affected individuals every 7 days and every patient can infect 2.2 other individuals on average (R0).[32]
  • The mean R0 ranges from 2.2 to 3.58.

Associated Conditions

Reference

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