key: cord-275253-6pwqa8zk authors: Shetty, Sameep S; Merchant, Yash; Shabadi, Nikita; Aljunid, Sharifah Tahirah title: 10 “C” in COVID19 date: 2020-05-29 journal: Oral Surg DOI: 10.1111/ors.12527 sha: doc_id: 275253 cord_uid: 6pwqa8zk World war “C”(1) has set in against an invisible virus. The routes of transmission include *Contact of contaminated objects,*Circulating droplets in the air called aerosols disseminated through *Cough, sneeze, ocular secretions(2) from an infected individual. World war "C" 1 has set in against an invisible virus. The routes of transmission include *Contact of contaminated objects,*Circulating droplets in the air called aerosols disseminated through *Cough, sneeze, ocular secretions 2 from an infected individual. The outbreak response steps are based on the 4 "C" principle:  Contact tracing -data analytics using smart apps  Contact the suspects, test them, containment when in doubt  Contact and treat positive patients  Constant proactive steps: Hand Hygiene, sanitization, sensitization and awareness of the general population, social distancing, deep breathing exercises to reboot the immune system. The cataclysm of covid19 is due to the cytokine storm in the lungs that leads to acute respiratory distress, high contagiousness, reverse transmission, temporal patterns of shedding, high reproductive no (R0:2.2-2.7), stochasticities in the initial phase of the outbreak, low surveillance intensity, carnal origin and its constant transformation into the human host of all age groups 3 . The contrast in the degree of hypoxia ("silent hypoxia") and the pattern of infections in high-risk individuals who are unable to mount a stable immune response with modest symptoms explains the lethal spectrum of the novel coronavirus. The WHO has warned against countries issuing immunity passport, perhaps due to the fear of the second wave of pandemic and insufficient evidence of an immune shield post-treatment. Collapsing economy and health care system: We are now in the nascent phase of emolument and remuneration reduction which may deteriorate to loss of employment across all sectors. This could further leap into the next phase and herald a tsunami of the economy if left unchecked. The 'burn out' of health care workers as they multiply their efforts to combat COVID19 and the increased risk to succumb to infection may accelerate the progression and death of non-COVID ailments. The overlooked "C": Immuno-compromised oncology patients are at a relatively higher risk. The dynamics of SARS-CoV is indeed altered by the atomic-level liaison between the spike protein This article is protected by copyright. All rights reserved receptor-binding domain (RBD) and the host receptor ACE2 which is overexpressed in tobacco consumers. There are several reports on COVID-19 that can directly result in many cardiovascular complications, including fulminant myocarditis, myocardial injury, heart failure, and arrhythmia 5, 6 . The global shortage of drugs due to the pandemic and diversifying the use of common drugs to test its efficacy against the novel coronavirus has adverse effects and lacks evidence. In contrast, initial data on the role of ACE inhibitors augmenting the onset of severe forms of SARS-CoV-2 infection has discouraged their use and triggered the onset of severe cardiovascular events 7,8 . Children and carrying mothers: The nascent immune system in children may explain the unique spectrum with infants and young children ≤5 years more likely to succumb to severe clinical symptoms than older children (ie, ≥6 years) 9 . The decline in the immune activity during pregnancy can increase the risk and could lead to maternal morbidity, death 10 . This article is protected by copyright. All rights reserved face contact) or the onset of infection post 14 days of contact to a known infected person (the average maximum incubation period) are low and should not be over-exaggerated 13 . The rising infodemic, stigmatization on Covid19 yields panic and precludes the implementation of epidemic control measures. A flattened or crushing the curve is not anticipated to change the area under the curve 14 . Covid19 in high risk individuals display severe respiratory symptoms, multi organ involvement and may require a long term rehabilitation as in a chronic disease. 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