key: cord-0850103-ptizke03
authors: Ali, Imran; Alharbi, Omar M.L.
title: COVID-19: Disease, management, treatment, and social impact
date: 2020-04-22
journal: Sci Total Environ
DOI: 10.1016/j.scitotenv.2020.138861
sha: 760c0666af9d836d442964820aede8106e3d6117
doc_id: 850103
cord_uid: ptizke03

Abstract COVID-19 was originated from Wuhan city of Hubei Province in China in December 2019. Since then it has spread in more than 210 countries and territories. It is a viral disease due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. The patients show flu-like symptoms with a dry cough, sore throat, high fever, and breathing problems. The disease due to SARS-CoV-2 was named as COVID-19. About 2.2 million people have been infected with more than 0.15 million deaths globally. The United States of America is the most affected country with the highest patients of about 0.7 million. Despite great efforts, there is no treatment of this disease. However, prevention and management are the best options. This article describes SARS-CoV-2, disease, prevention and management, treatment and social impact on society. It was analyzed that a combination of antiviral drugs with hydroxyl-chloroquine and azithromycin (with the consultation of a medical practitioner) may be the best option to treat the patients, depending on the patient's conditions and symptoms. However, Unani therapy may be useful along with allopathic treatment. It is urgently advised and requested that all the persons should follow the preventive measures, managements and quarantine strictly without any religious discrepancy otherwise the situation may be the worst. Also, there is an urgent requirement to educate our new generation for science and technology to fight against any such disaster in future; if any. There is no need to be panic and proper prevention and management are essential to combat this disease. This article may be useful to create awareness among the public, to prevent, manage and treat COVID-19.

J o u r n a l P r e -p r o o f mention that it is not necessary to have COVID-19 if these symptoms are seen because such types of symptoms are also seen in the case of other virus infections, except breathing and diarrhea problems. The pathological conditions of coronavirus include greater counts of chemokines, cytokines, and leukocytes, and high levels of plasma pro-inflammatory cytokines and C-reactive protein. The chances are greater of COVID-19 if there is shortness of breath, dry cough, and a person comes in the contact with a COVID-19 patient or traveled with COVID-19 effected area. Under such a situation, the clinical test for COVID-19 is a must. However, some persons recover easily while others may take some time depending on the health conditions and the age of the patients. WHO categorized the COVID-19 virus as of β-CoV of group 2B (Carlos et al., 2020) . The genome of this virus is identified and it resembles the SARS-CoV (80% similarity) and MERS-CoV (50% similarity) (Lu et al., 2020a; Ren et al., 2020) . It is interesting to note that both MERS-CoV and SARS-CoV have their origin in the bats (Cui et al., 2019) .

During the last few decades, it was observed that coronaviruses can infect rats, mice, cats, dogs, horses, turkeys, cattle and pigs. Occasionally, these animals may communicate coronaviruses to humans. The coronavirus is spread by the sneezing, cough droplets and contact.

Normally, this virus enters the body through the mouth, nose, and eyes (Transmission of Novel Coronavirus, 2019). It has been reported that the virus may infect a person at a distance of about a 6 feet (1.8 meters) radius. The virus can survive for 2 hrs to few days in cough and sneezing droplets lying on the surface or ground. An infection may be by touching an object or surface which has already a virus but it is not the major course of the infection. This virus has been detected in stools of the patients but no infection via stool has been reported. The cellular infection model is very similar to SARS-CoV. The main target of this virus is lungs and the virus spikes (binding domains) get attached to the cell receptors of the lungs.

J o u r n a l P r e -p r o o f 5 These are known as angiotensin-converting enzyme 2 (ACE2) receptors (Jaimes et al., 2020; wan et al., 2020) . Belouzard et al. (2009) reported that a proteolytic cleavage occurs at SARS-CoV S protein at position (S2') interceded the membrane fusion and viral infectivity. The chances of the infection may arise if a person comes in contact with the infected person. Now, COVID-19 has become pandemic as per the WHO report. The data of the patients in the different countries at a different time was analyzed and the efforts are made to find out the routes of transmission globally. Consequently, the routes of COVID-19 pandemic in most of the effected countries are shown in flow chart ( Figure 1 ).

The prevention and management are very important issues to control COVID-19. Therefore, there is a great need for the collective efforts of the public and the government. The regular and the proper care of the homes and hospitals are very important to control this calamity. The regular recommendations to minimize the infection are cleaning of your area. The most important is to avoid sneezing and cough at the public place. The hand cleaning with soap and sanitizer, mouth and nose coverage with mask during sneezing and coughing are essential.

Thoroughly washing foodstuff before cocking may help in this regard. The simple house-keeping disinfectants may kill the virus on the surfaces. Regularly cleaning of the surface by the disinfectants may control the virus outbreak. It is always better to avoid the interactions with anyone; suspecting respiratory problems symptoms like sneezing, coughing, breathing problem, etc. It is also advisable to stay at home if anyone has flue and common cold-like symptoms. It is also better not to go to school, work and public places, not use public means of transport (aircraft, train, metro, bus, taxi, etc.) . Some important suggestions may include avoiding travel, and collection at a particular place. The drinking of hot water after every hour may be helpful.

Plenty of lukewarm water (~ 5 L per day) may help in this regard. The governments should provide facilities for the decontamination of the hands at the public places. The guidelines are available for healthcare providers, medical staff, researchers and public health individuals (Jin et al., 2020) . They can use to control COVID-19 globally. During the entire period of COVID-19, it was realized that this disease is spreading among those who are not taking it seriously and are not following the directions of WHO and the local government. In India, some people are trying to target one community for the spreading COVID-19 while this virus does not recognize and race, creed, sex, age, and religion. Therefore, it is urgently advised and requested that all the persons should follow the preventive measures, managements and quarantine strictly without any religious discrepancy otherwise the situation may be the worst.

There is no precise treatment for coronavirus but prevention, management and supporting healthcare may provide relief in the outbreak of COVID-19. However, some approaches have been or may be used to control this disease. These approaches may be categorized in Allopathic, Unani and Homeopathic treatments. But before all this treatment, plenty of testing facilities should be available to the health care sectors.

Allopathic treatment and management include oxygen therapy, intravenous fluid infusion with life support in dangerous cases. It is also advisable to contact a medicinal practitioner if the flue like symptoms prevails. Coronavirus may show comparable proteins for virus replication to human immunodeficiency virus (HIV). Therefore, HIV protease inhibitors and nucleoside analogs may be operative to treat COVID-19 (Lu et al., 2020b) . A combination of lopinavir and Journal Pre-proof J o u r n a l P r e -p r o o f 7 ritonavir, previously used for SARS-Cov and MERS-Cov, may be useful (Chu et al., 2004; Momattin et al., 2019) . China is doing clinical trials of remdesivir, which was developed for the Ebola virus. Besides, other anti-viral medicines like oseltamivir, ganciclovir, ribavirin, favipiravir, nelfinavir, arbidol, remdesivir and galidesivir are being examined for COVID-19 treatment (Agostini, et al., 2018; Chen, et al., 2020; Guangdi, et al., 2019; Sheahan, et al., 2020; Xu, et al., 2020) . reported that a combination of remdesivir and chloroquine may be effective to treat COVID-19 disease. Besides, the peptide (EK1), neuraminidase inhibitors, DNA synthesis inhibitors (tenofovir disoproxil and lamivudine) may be useful to control COVID-19. Also, 2 (ACE2)-based peptides (an angiotensin-converting enzyme), 3CLpro-1 (3CLpro inhibitor) and vinylsulfone protease inhibitors are known to show antiviral activities (Liu et al., 2020) . Recently, an Italian patient of COVID-19 is treated in Sawai Man Singh (SMS) Hospital, Jaipur India by giving a combination of lopinavir (200 mg) and ritonavir (50 mg) twice a day. Besides, the patient was also given a combination of oseltamivir and chloroquine medicine. The patient test was found negative for COVID-19. Cheng et al. (2006) extracted some saikosaponins (a group of oleanane derivatives, usually as glucosides) and tested against the proliferation of some viruses. The authors reported that saikosaponin B2 (6 µM) inhibited human coronavirus 229E effectively. In this way, the saikosaponin B2 along with other glucosides may be tested for COVID-19. The broad range of spectrum antibiotics may be used to control the additional bacterial infection after a virus attack. Some drugs are under clinical trial and results are still awaited. The best approach to fight with viruses is vaccination. Therefore, scientists are trying to develop a vaccine for this virus and probably may be available after some time.

Generally, the Unani medicines (plant-based medicines) are non-toxic and without any side effects. Unani and Ayurvedic methods of the treatment are based on the plant materials. The different parts of the various plants are well known for a long time for their anti-viral activities (Li et al., 2005; Lin et al., 2014; Kim et al., 2010) . The most important plants are Glycyrrhiza glabra, Allium cepa, Allium sativum, Ocimum sanctum, Ocimum tenuiflorum, Piper nigrum, Cinnamomum verum, Daucus maritimus, Curcuma longa, etc. An aqueous extract of these plants along with lemon juice and honey was found to be effective for flu and common cold virus infections. The ingredients present in this recipe have ant-viral properties (Bano, et al., 2017; Chang, et al., 2013; Bayan, et al., 2014; Fatima, et al., 2016; Ghoke, et al., 2018; Hashemipour, et al., 2014; Jiang, et al., 2013; Konowalchuk, et al., 1978; Lee, et al., 2012; Miladi, et al., 2012; Omer, et al., 2014; Praditya, et al., 2019; Weber, et al., 1992) . The root of Licorice (Glycyrrhiza glabra) is known to have a good antiviral potential (Wang et al., 2015a) . This plant is native of Asia and Europe and recognized as a weed. Fiore et al. (2008) carried out an in vitro study of constituents. Therefore, an aqueous extract of this plant along with other plants as mentioned above may be useful to control COVID-19. On January 29, 2020, the Government of India issued an advisory based on Indian traditional medicine practices Ayurveda, Homeopathy and Unani, New Delhi. The advisory includes the ways of preventive management and described a list of some Unani medicines. The interested persons may find these medicines at https://pib.gov.in/PressReleasePage.aspx?PRID=1600895# and can use after proper consultation with the Unani medical practitioners.

In homeopathy, arsenic at very low concentration is considered beneficial for several diseases including viral infections. Recently, Directorate of AYUSH, New Delhi, India issued an order dater on January 30, 2020, to take prophylactic medicine to avoid coronavirus infection.

The directorate suggested taking 4 pills of Arsenic Album-30 medicine once daily in empty stomach for 3 days. Arsenic Album-30 is highly diluted arsenic trioxide and work as homeopathic prophylaxis. It is important to mention here that there is no clinical evidence for Arsenic Album-30 medicine as an effective medicine. After that, a criticism for homeopathy came into existence and it was called as pseudoscience. An article is published in Taiwan Medical News on February 18, 2020 (https://www.thailandmedical.news/news/india-slammedfor-proposing-usage-of-homeopathy-to-prevent-coronavirus) and some people criticized homeopathy to manage COVID-19 infection. The persons who criticized are Dr. David Robert Grimes (Irish science write) and Dr. Edzard Ernst (an emeritus professor, University of Exeter, UK and a critic of homeopathy). However, Dr. Mitchell Fleisher (second vice president, American Institute of Homeopathy) advised to carry out a comparative clinical study on the acute coronavirus infection by giving to homeopathic medicines to an individual and experimental group, and allopathic medicines to another, for 250 patients in each group. It was Journal Pre-proof stated to confirm the scientific truth. But after this statement again Dr. David Robert Grimes criticized it as completely unethical and according to him, Homeopathy has no reasonable mechanism of action. Furthermore, he added that it is irresponsible to propose a trial for a serious pandemic. He also mentioned that many studies on homeopathy have indicated that it does not work. Also, the news director of Thailand Medical News Jakkapong Watcharachaijunta criticized the use of homeopathic medicine in controlling COVID-19. At this point, it is very important to mention the work of Dr. Robert T. Mathie (2013) whose research work described that Arsenicum album medicine as effective to reduce fever, runny nose, headache, sore throat in the patients with swine flu symptoms. During writing this article under this section, it was realized that the subject matter is debatable and needs the scientific study to support the working of Homeopathic medicine for COVID-19. It is suggested that some research work should be funded by the government and the research should be carried out to make the situation clear. It is significant to add here that personally I (Prof. Imran Ali) used some homeopathic medicine when living in India for some diseases and found them effective. Besides, I also observed that some homeopathic medicines are effective to treat a variety of diseases.

It is observed that early deaths were in older people, probably because of the poor immunity, which fosters faster progress of COVID-19 (Li et al., 2002; . Therefore, it is significant to boost our immune system. It is important to suggest that people should use some supplements to boost their immune systems. Healthy people should take plenty of citrus fruits having various vitamins. Some dry fruits (almonds, walnuts, and dates) are also useful to improve the immune system. However, older people and the patients may take vitamins and zinc supplements with the consultation of medical practitioners. The important vitamins are A, C, D and E. It is also advisable to take zinc and iodine intakes. It is too wise not to smoke and Journal Pre-proof take other narcotic products. Always an adequate sleep is essential to boost up the immune system. Avoid any stress and do proper and regular exercises.

In the present scenario, COVID-19 has affected all the sectors of society. There is a big loss globally, and it cannot be estimated exactly. However, some aspects are discussed herein.

Nowadays, the whole world is just like a family where everyone has to contribute to run the family. Similarly, the production of various items including medicines, machines, motor vehicles, computers, mobiles, etc. are controlled by many countries. Generally, the different components are being manufactured in various countries while these are assembled in other countries -Globalization. It is just like a chain process where the progress is stopped if even a single chain-link gets collapsed. It is a well-known fact that China is the biggest manufacturer of the various components, APIs and other raw materials while China is the most affected country due to COVID-19. And that is why the whole world is affected economically very badly due to a decrease in industrial production. The travel ban has been imposed by some countries resulting in millions of dollars loss to the airlines and tourism industry. There is a shortage of medicines, sanitizers, masks, and other commodities, which has hiked the prices of these items many times.

The various functions, especially scientific conferences, business meetings, sports events, fashion shows, and the marriage parties are suggested to avoid, which is a big social impact on society. The Kingdom of Saudi Arabia has provisionally banned Umrah (pilgrimage) for the pilgrims to Mecca and Medina (the two holiest cities of the Islam religion). All these factors affected the local and global share markets badly. The USA big stock indexes such as S & P 500

Index, NASDAQ-100, Dow Jones Industrial Average, etc. have shown sharp fall since 2008.

Many countries have banned to attend the classes in schools, colleges, and the Universities and millions of the student are not getting a good quality of education. It is very difficult to assess Journal Pre-proof this loss in terms of money but has a big disadvantage to the students and their families. Briefly, there is a big loss to the worldwide economy and the expert assessed a loss of about 2.7 trillion US dollars (https://www.bloomberg.com/graphics/2020-coronavirus-pandemic-global-economicrisk/).

As expected SARS-CoV is zoonotic and originated from the bats. It is observed that many people are consuming various animals as food-stuffs. Some animals like bats, snakes, cats, mice, rats, dogs, pigs, etc. should not be consumed as these may have dangerous microbes while the only safe animals should be consumed. Moreover, it is also advisable that we should consume vegetables and fruits as maximum as possible in our food. There is an urgent need to educate our new generation for science and technology to fight against any such disaster in future; if any. Of course, the world is progressing towards advancement and even then We don't have highly specialized research centers. Therefore, there should be highly specialized research centers under the umbrella of WHO and funded by all the countries of the world. These centers should be located in the various parts of the world and be efficient, capable and specialized to control any calamity in the world in the future. The most important required research centers are for viral diseases, bacterial illnesses, mosquito, and insect-based diseases, cancer, etc. These centers are essential to combat any future calamity in the world if any. A paper was published by Casanova et al. in 2010 Casanova et al. in (2010 and the authors studied the effect of temperature and humidity on the survival of gastroenteritis virus (TGEV) and mouse hepatitis virus (MHV) on the surface.

The authors reported that the chances of the virus's survival are poor at 40 ºC or high temperature with low humidity. Furthermore, the authors reported that TGEV and MHV could be used as conservative surrogates for modeling experience, transmission risk and control measurements for enveloped viruses like influenza virus and SARS-CoV virus on the surfaces. Therefore, it may be Journal Pre-proof J o u r n a l P r e -p r o o f 13 expected that the propagation of SARS-CoV-2 will decrease at high temperatures and low humidity. Now, we are at the end of April 2020 and progressing towards the summer. Therefore, it is expected that the coronavirus cases will decrease in the coming time; especially in the middle east countries. problems. The disease due to SARS-CoV-2 was named as COVID-19. Still, there is no treatment of this disease. However, prevention and management are the best options. A combination of antiviral drugs with hydroxyl-chloroquine and azithromycin (with the consultation of a medical practitioner) may be the best option to treat the patients, depending on the patient's conditions and symptoms. However, Unani therapy may be useful along with allopathic treatment.

Probably, the number of COVID-19 cases may decrease in the coming time as the summer is approaching and the rate of virus transmission may be low at high temperature and low humidity.

It was realized that this disease is spreading among those who are not taking it seriously and are not following the directions of WHO and the local governments. Therefore, it is urgently advised and requested that all the persons should follow the preventive measures, managements and quarantine strictly without any religious discrepancy otherwise the situation may be the worst.

Also, there is an urgent requirement to educate our new generation for science and technology to fight against any such disaster in future; if any. There is no need to be panic and proper J o u r n a l P r e -p r o o f 14 prevention and management are essential to combat this disease. Briefly, there is a need for collective efforts globally without any religious discrepancy to fight against such diseases in the future.

The authors are thankful to the administration of Taibah University, Al-Madinah Al-Munawarah and Government of Saudi Arabia for providing facilities and the encouragement to write this article.

The authors have no conflict of interest.

No funding source for this work.

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