SARS-Cov2: A Review of this Novel Coronavirus

Background: Coronaviruses are a group of RNA viruses responsible for respiratory and gastrointestinal illness. Of this group two have been associated with pandemics in recent years. As of December 2019, a new coronavirus (SARS-CoV2) was reported in Wuhan, China which despite best efforts has spread internationally prompting panic and universal public-health measures. Methods : A literature review was conducted utilising the PubMed database in March 2020. Search terms included ‘Wuhan’ OR ‘Coronavirus’ OR ‘2019-nCoV’ OR ‘SARS-CoV2’ AND ‘pneumonia’ OR ‘Outbreak’ OR ‘Infection’. These were used in isolation and combination to yield results. Papers were selected if they explored the diagnosis, management, transmission and/or treatment of SARS-CoV2. Following these 68 papers were screened of which 48 papers were included in this review. Results & Discussion: Early studies highlight that SARS-CoV2 has an incubation period of between 3–7 days and commonly presents with fever (93%), cough (69.8%) and dyspnoea (34.5%) and prominent upper respiratory tract symptoms. Patients are predominantly male and there is high prevalence of significant comorbid disease in fatal cases (overall case: fatality ratio- 2–3%). Encouragingly, supportive treatments are mainstay with the need for invasive ventilation and extracorporeal life support (ECLS) low. Diagnosis of SARS-CoV2 is made by demonstration of the virus by RT-PCR of throat/lavage specimens; however given the propensity for false negatives, CT-imaging is being used diagnostically with characteristic findings reported and can even detect disease in the asymptomatic phase where transmission is possible. International interventions have been to adhere to 14-day observation periods for suspected cases, the wearing of N95 facemasks alongside social distancing and hand-hygiene due to fomites. While antiviral treatments have been trialled in case-series no clear consensus has been made regarding their use but it remains clear that concurrent antibiotics are mainstay with restrictive fluid replacement. Emerging therapies which may show benefit include chloroquine, remdesivir, tocilizumab, azithromycin and sunitinib with the discontinuation of ACE inhibitors proposed. Conclusion : SARS-CoV2’s impact is greatest in the elderly and comorbid. Research has indicated key targets which may be important in producing effective treatments and an efficacious vaccine. On-going aims must be to try to alter behaviours and limit viral spread through social distancing, good hand hygiene and Personal Protective Equipment (PPE). Future trials must attempt to prognosticate patients further and understand the role if any of redeployed treatments which have showed some promise. In addition, questions surrounding long term immunity require further investigation.