• MONISHA BANSAL Shaheed Udham Singh College of Pharmacy, Tangori 140306, Mohali (SAS Nagar), Punjab, India, USPS, Rayat-Bahra University, Mohali, 140104
  • MANPREET KAUR WALIA Shaheed Udham Singh College of Pharmacy, Tangori 140306, Mohali (SAS Nagar), Punjab, India, USPS, Rayat-Bahra University, Mohali, 140104


With the first case of a highly infectious virus named Coronavirus in Wuhan, China in December 2019, this deadly virus was declared a pandemic by WHO. COVID-19 was found to be very similar to patients infected with MERS-CoV and SARS-CoV. The virus was transmitted from bats to humans through some unidentified intermediary. Since its introduction in humans, it has infected 118000 people, killing 3583 till last week of May 2020 in India. The reported route of transmission is inhalation or direct contact with the infected surface or patients. This symptomatic disease includes symptoms such as cough, fever, sore throat, fatigue, and in some severe patients, it may cause multiple organ failure, pneumonia, severe or acute respiratory diseases. In some cases people may be asymptomatic till 14 d of infection. The patients with mild illness are usually isolated and others are prevented with protective measures such as medical mask, hand hygiene. In the present article, the epidemiology, route of transmission, clinical symptoms, prevention, management, treatment and role and responsibility of health workers is overviewed on the basis of published research and review articles and current state of knowledge.

Keywords: Coronavirus, COVID 19, SARS-CoV 2, Anti-viral drugs, Symptoms, Prevention


1. Christian MD, Poutanen SM, Loutfy MR, Muller MP, Low DE. Severe acute respiratory syndrome. Clin Infect Dis 2004;38:1420-7.
2. World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. Available from: table2004_04_21/en/. [Last accessed on 04 Apr 2020].
3. Biosafety and SARS incident in Singapore September: Report of the Review Panel on New SARS Case and Biosafety. World Health Organization. Singapore Ministry of Health; 2003.
4. Lau SK, Chan JF. Coronaviruses: emerging and re-emerging pathogens in humans and animals. Virol J 2015;12:1-3.
5. Zaki AM, Van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012;367:1814-20.
6. Lau SK, Woo PC, Li KS, Huang Y, Tsoi HW, Wong BH, et al. Severe acute respiratory syndrome coronavirus-like virus in Chinese horseshoe bats. Proc Natl Acad Sci USA 2005;102:14040-5.
7. Ge XY, Li JL, Yang XL, Chmura AA, Zhu G, Epstein JH, et al. Isolation and characterization of a bat SARS-like coronavirus that uses the ACE2 receptor. Nature 2013;503:535–8.
8. Cheng VC, Lau SK, Woo PC, Yuen KY. Severe acute respiratory syndrome coronavirus as an agent of emerging and re-emerging infection. Clin Microbiol Rev 2007;20:660-94.
9. Che XY, Di B, Zhao GP, Wang YD, Qiu LW, Hao W, et al. A patient with asymptomatic severe acute respiratory syndrome (SARS) and antigenemia from the 2003–2004 community outbreak of SARS in Guangzhou, China. Clin Infect Dis 2006;43:e1-e5.
10. Li W, Shi Z, Yu M, Ren W, Smith C, Epstein JH, et al. Bats are natural reservoirs of SARS-like coronaviruses. Science 2005;310:676-9.
11. Wang M, Yan M, Xu H, Liang W, Kan B, Zheng B, et al. SARS-CoV infection in a restaurant from palm civet. Emerg Infect Dis 2005;11:1860-5.
12. Ren W, Li W, Yu M, Hao P, Zhang Y, Zhou P, et al. Full-length genome sequences of two SARS-like coronaviruses in horseshoe bats and genetic variation analysis. J Gen Virol 2006;87:3355-9.
13. Marra MA, Jones SJ, Astell CR, Holt RA, Brooks Wilson A, Butterfield YS, et al. The genome sequence of the SARS-associated coronavirus. Science 2003;300:1399-404.
14. Kanaan Al-Tameemik, Kabakli R. Novel coronavirus (2019-nCoV): disease briefings. Asian J Pharm Clin Res 2020;13:22-7.
15. Majumdar A, Malviya N, Alok S. An overview on covid-19 outbreak: epidemic to pandemic. Int J Pharm Sci Res 2020;11:1958-68.
16. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol 2015;1282:1-23.
17. Barcena M, Oostergetel GT, Bartelink W, Faas FG, Verkleij A, Rottier PJ, et al. Cryo-electron tomography of mouse hepatitis virus: Insights into the structure of the coronavirion. Proc Natl Acad Sci USA 2009;106:582-7.
18. Neuman BW, Adair BD, Yoshioka C, Quispe JD, Orca G, Kuhn P, et al. Supramolecular architecture of severe acute respiratory syndrome coronavirus revealed by electron cryomicroscopy. J Virol 2006;80:7918-28.
19. Beniac DR, Andonov A, Grudeski E, Booth TF. Architecture of the SARS coronavirus prefusion spike. Nat Struct Biol 2006;13:751-2.
20. Delmas B, Laude H. Assembly of coronavirus spike protein into trimers and its role in epitope expression. J Virol 1990;64:5367-75.
21. Bosch BJ, van der Zee R, de Haan CA, Rottier PJ. The coronavirus spike protein is a class I virus fusion protein: structural and functional characterization of the fusion core complex. J Virol 2003;77:8801-11.
22. Collins AR, Knobler RL, Powell H, Buchmeier MJ. Monoclonal antibodies to murine hepatitis virus-4 (strain JHM) define the viral glycoprotein responsible for attachment and cell-cell fusion. Virol 1982;119:358-71.
23. Ingallinella P, Bianchi E, Finotto M, Cantoni G, Eckert DM, Supekar VM, et al. Structural characterization of the fusion-active complex of severe acute respiratory syndrome (SARS) coronavirus. Proc Natl Acad Sci USA 2004;101:8709-14.
24. Li F, Li W, Farzan M, Harrison SC. Structure of SARS coronavirus spike receptor-binding domain complexed with receptor. Science 2005;309:1864-8.
25. Liu S, Xiao G, Chen Y, He Y, Niu J, Escalante CR, et al. Interaction between heptad repeat 1 and 2 regions in spike protein of SARS-associated coronavirus: implications for virus fusogenic mechanism and identi?cation of fusion inhibitors. Lancet 2004;363:938-47.
26. Simmons G, Reeves JD, Rennekamp AJ, Amberg SM, Piefer AJ, Bates P. Characterization of severe acute respiratory syndrome associated coronavirus (SARS-CoV) spike glycoprotein-mediated viral entry. Proc Natl Acad Sci USA 2004;101:4240-5.
27. Tripet B, Howard MW, Jobling M, Holmes RK, Holmes KV, Hodges RS. Structural characterization of the SARS-coronavirus spike S fusion protein core. J Biol Chem 2004;279:20836-49.
28. Armstrong J, Niemann H, Smeekens S, Rottier P, Warren G. Sequence and topology of a model intracellular membrane protein, E1 glycoprotein, from a coronavirus. Nature 1984;308:751-2.
29. Godet M, L’Haridon R, Vautherot JF, Laude H. TGEV corona virus ORF4 encodes a membrane protein that is incorporated into virions. Virology 1992;188:666-75.
30. DeDiego ML, Alvarez E, Almazan F, Rejas MT, Lamirande E, Roberts A, et al. A severe acute respiratory syndrome coronavirus that lacks the E gene is attenuated in vitro and in vivo. J Virol 2007;81:1701-13.
31. Nieto Torres JL, Dediego ML, Verdia Baguena C, Jimenez Guardeno JM, Regla Nava JA, Fernandez Delgado R, et al. Severe acute respiratory syndrome coronavirus envelope protein ion channel activity promotes virus fitness and pathogenesis. PLoS Pathogens 2014;10:1004077.
32. Chang CK, Sue SC, Yu TH, Hsieh CM, Tsai CK, Chiang YC, et al. Modular organization of SARS coronavirus nucleocapsid protein. J Biomed Sci 2006;13:59–72.
33. Hurst KR, Koetzner CA, Masters PS. Identification of in vivo-interacting domains of the murine coronavirus nucleocapsid protein. J Virol 2009;83:7221-34.
34. Klausegger A, Strobl B, Regl G, Kaser A, Luytjes W, Vlasak R. Identification of a coronavirus hemagglutinin-esterase with a substrate specificity different from those of influenza C virus and bovine coronavirus. J Virol 1999;73:3737-43.
35. Cornelissen LA, Wierda CM, Van der Meer FJ, Herrewegh AA, Horzinek MC, Egberink HF, et al. Hemagglutinin-esterase, a novel structural protein of torovirus. J Virol 1997;71:5277-86.
36. Egloff MP, Ferron F, Campanacci V, Longhi S, Rancurel C, Dutartre H, et al. The severe acute respiratory syndrome-coronavirus replicative protein nsp9 is a single-stranded RNA-binding subunit unique in the RNA virus world. Proc Natl Acad Sci USA 2004;101:3792-6.
37. Fan Z, Peng K, Tan X, Yin B, Dong X, Qiu F, et al. Molecular cloning, expression, and puri?cation of SARS-CoV nsp13. Protein Expr Purif 2005;41:235-40.
38. Imbert I, Guillemot JC, Bourhis JM, Bussetta C, Coutard B, Egloff MP, et al. A second, non-canonical RNA-dependent RNA polymerase in SARS coronavirus. Embo J 2006;25:4933-42.
39. Joseph JS, Saikatendu KS, Subramanian V, Neuman BW, Brooun A, Griffith M, et al. Crystal structure of nonstructural protein 10 from the severe acute respiratory syndrome coronavirus reveals a novel fold with two zinc-binding motifs. J Virol 2006;80:7894-901.
40. Minskaia E, Hertzig T, Gorbalenya AE, Campanacci V, Cambillau C, Canard B, et al. Discovery of an RNA virus 335 exoribonuclease that is critically involved in coronavirus RNA synthesis. Proc Natl Acad Sci USA 2006;103:5108-13.
41. Ricagno S, Egloff MP, Ulferts R, Coutard B, Nurizzo D, Campanacci V, et al. Crystal structure and mechanistic determinants of SARS coronavirus nonstructural protein 15 de?ne an endoribonuclease family. Proc Natl Acad Sci USA 2006;103:11892-7.
42. Su D, Lou Z, Sun F, Zhai Y, Yang H, Zhang R, et al. Do-decamer structure of severe acute respiratory syndrome coronavirus nonstructural protein nsp10. J Virol 2006;80:7902-8.
43. Sutton G, Fry E, Carter L, Sainsbury S, Walter T, Nettleship J, et al. The nsp9 replicase protein of SARS-coronavirus, structure and functional insights. Structure 2004;12:341-53.
44. Von Grotthuss M, Wyrwicz LS, Rychlewski L. mRNA cap-1 methyltransferase in the SARS genome. Cell 2003;113:701-2.
45. Zhai Y, Sun F, Li X, Pang H, Xu X, Bartlam M, et al. Insights into SARS-CoV transcription and replication from the structure of the nsp7-nsp8 hexadecamer. Nat Struct Mol Biol 2005;12:980-6.
46. Ge XY, Li JL, Yang XL, Chmura AA, Zhu G, Epstein JH, et al. Isolation and characterization of a bat SARS-like coronavirus that uses the ACE2 receptor. Nature 2013;503:535-8.
47. Webster RG. Wet markets-a continuing source of severe acute respiratory syndrome and in?uenza. Lancet 2004;363:234-6.
48. Woo PC, Lau SK, Yuen KY. Infectious diseases emerging from Chinese wet-markets: zoonotic origins of severe respiratory viral infections. Curr Opin Infect Dis 2006;19:401-7.
49. World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. Scientific Brief 2020.
50. Infection prevention and control of epidemic-and pandemic-prone acute respiratory infections in health care. World Health Organization; 2014.
51. Liu J, Liao X, Qian S, Yuan J, Wang F, Liu Y, et al. Community transmission of severe acute respiratory syndrome coronavirus 2, Shenzhen, China, 2020. Emerg Infect Dis 2020;26. DOI:10.3201/eid2606.200239.
52. Chan W, Yuan S, Hang Kok K, Kai-Wang K, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:P514-523.
53. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207.
54. Huang C, Wang Y, Li X, Zhao J, Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
55. Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M, et al. Active monitoring of persons exposed to patients with confirmed covid-19-United States, January-February 2020. MMWR Morb Mortal Wkly Rep 2020;69:245-6.
56. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 16-24 February 2020. World Health Organization; 2020.
57. Guo Y, Cao Q, Hong Z, Tan Y, Chen S, Jin H, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (covid-19) outbreak–an update on the status. Mil Med Res 2020;7:1-10.
58. Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from asymptomatic patient. JAMA. 2020.
59. Rabenau HF, Cinatl J, Morgenstern B, Bauer G, Preiser W, Doerr HW. Stability and inactivation of SARS coronavirus. Med Microbiol Immunol 2005;194:1-6.
60. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (Covid-19)–China. China CDC Weekly 2020;2:113-22.
61. Madjid M, Safavi Naeini P, Solomon S, Vardeny O. Potential effects of coronaviruses on the cardiovascular system. A Review, JAMA Cardiol 2020;1286:E1-E10.
62. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is the faecal-oral transmission of SARS-CoV 2 possible? Lancet Gastroenterol Hepatol 2020;5:335-7.
63. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020;382:929-36.
64. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020.
65. Coronavirus disease 2019 (COVID-19). Centres for Disease Control and Prevention; 2020.
66. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovas Res 2020. DOI:10.1093/cvr/cvaa078
67. Kui L, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J 2020;133:1025-31.
68. Wang J, Qi H, Bao L, Li F, Shi Y. A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units. Lancet Child Adolesc Health 2020;4:258-9.
69. World Health Organization. Infection prevention and control during health care when COVID-19 is suspected: Interim guidance. World Health Organization; 2020.
70. World Health Organization. Advice on the use of masks in the community, during home care, and in health care settings in the context of covid-19: interim guidance; 2020.
71. World Health Organization. Home care for patients with covid-19 presenting with mild symptoms and management of their contacts: interim guidance. World Health Organization; 2020.
72. Coronavirus disease (Covid-19) advice for the public: myth busters. World Health Organization; 2020.
73. Agostini ML, Andres EL, Sims AC, Graham RL, Sheahan TP, Lu X, et al. Coronavirus susceptibility to the antiviral remdesivir (gs-5734) is mediated by the viral polymerase and the proofreading exoribonuclease. mBio 2018;9:e00221–18.
74. Aguiar A, Murce E, Cortopassi W, Pimentel A, Almeida M, Barros D, et al. Chloroquine analogs as antimalarial candidates with potent in vitro and in vivo activity. Int J Parasitol Drugs Drug Resist 2018;8:459-64.
75. Savarino A, Boelaert J, Cassone A, Majori G, Cauda R. Effects of chloroquine on viral infections: an old drug against today's diseases. Lancet Infect Dis 2003;3:722–7.
76. Vincent MJ, Bergeron E, Benjannet S, Erickson BR, Rollin PE, Ksiazek TG, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J 2005;2:69.
77. Golden EB, Cho HY, Hofman FM, Louie SG, Schonthal AH, Chen TC. Quinoline-based antimalarial drugs: a novel class of autophagy inhibitors. Neurosurg Focus 2015;38:E12.
78. Arabi YM, Shalhoub S, Mandourah Y, Al-Hameed F, Al-Omari A, Al Qasim E, et al. Ribavirin and interferon therapy for critically ill patients with middle east respiratory syndrome: a multicenter observational study. Clin Infect Dis 2019;70:1837-44.
79. Poutanen SM, Low DE, Henry B, Finkelstein S, Rose D, Green K, et al. Identi?cation of severe acute respiratory syndrome in Canada. N Engl J Med 2003;348:1995-2005.
80. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348:1986-94.
81. Koren G, King S, Knowles S, Phillips E. Ribavirin in the treatment of SARS: a new trick for an old drug? CMAJ 2003;168:1289-92.
82. Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan Yeung M, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348:1977-85.
83. Hsu LY, Lee CC, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in singapore: clinical features of index patient and initial contacts. Emerg Infect Dis 2003;9:713-7.
84. Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater toronto area. JAMA 2003;289:2801-9.
85. Samuel CE. Antiviral actions of interferons. Clin Microbiol Rev 2001;14:778-809.
86. Cinatl J, Morgenstern B, Bauer G, Chandra P, Rabenau H, Doerr HW. Treatment of SARS with human interferons. Lancet 2003;362:293-4.
87. Loutfy M, Blatt L, Ward S, Ward S, Wolff B, Lho H, et al. Interferon alfacon-1 plus corticosteroids in severe acute respiratory syndrome: a preliminary study. JAMA 2003;290:3222-8.
88. Zhao Z, Zhang F, Xu M, Huang K, Zhong W, Cai W, et al. Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China. J Med Microbiol 2003;52:715-20.
89. Peiris J, Chu C, Cheng V, Chan KS, Hung IF, Poon LL, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003;361:1767-72.
90. Tsang K, Zhong NS. SARS: pharmacotherapy. Respirol 2003;8:S25-30.
91. Arabi YM, Asiri AY, Assiri AM, Aziz Jokhdar HA, Alothman A, Balkhy HH, et al. Treatment of Middle East respiratory syndrome with a combination of lopinavir/ritonavir and interferon-?1b (MIRACLE trial): statistical analysis plan for a recursive two-stage group sequential randomized controlled trial. Trials 2020;21:8.
92. Chu CM, Cheng VC, Hung IF, Wong MM, Chan KH, Chan KS, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004;59:252-6.
93. Lim J, Jeon S, Shin HY, Kim MJ, Seong YM, Lee WJ, et al. Case of the index patient who caused tertiary transmission of covid-19 infection in Korea: the application of lopinavir/ritonavir for the treatment of covid-19 infected pneumonia monitored by quantitative RT-PCR. J Korean Med Sci 2020;35:e79.
94. Wang Z, Chen X, Lu Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends 2020;14:64-8.
95. Chan KS, Lai ST, Chu CM, Tsui E, Tam CY, Wong MM, et al. Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study. Hong Kong Med J 2003;9:399-406.
96. World Health Organization. Coronavirus disease (covid-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health: Interim guidance. World Health Organization; 2020.
97. Singhal T. A review of coronavirus disease-2019 (covid-19). Indian J Pediatr 2020;87:281-6.
98. Choudhury J, Mahapatra A. Knowledge of hand hygiene practices among health-care workers in neonatal and pediatric intensive care unit of a tertiary care hospital of odisha. Asian J Pharm Clin Res 2017;10:272-4.
62 Views | 33 Downloads
How to Cite
Review Article(s)