at INDUS-INTERNATIONAL UNIVERSITY

1. Awareness Talk on Novel Coronavirus, COVID-19
Shambaditya Goswami
Associate Professor
NIMS Institute of Pharmacy, NIMS University, Jaipur, Rajasthan
Dated: 04/12/2020

2. Awareness Talk on Novel Coronavirus, COVID-19
Current status
Treatment prospect
General Awareness
Introduction

3. INTRODUCTION

4. COVID-19 is a disease caused by a new strain of
coronavirus.
'CO' stands for corona
'VI' for virus,
'D' for disease.
Formerly, this disease was referred to as '2019
novel coronavirus' or '2019-nCoV.

5. • The current global pandemic is caused by a novel coronavirus,
SARS-CoV-2, a member of the Coronaviridae family, and
similar to SARS-CoV (Severe Acute Respiratory Syndrome
Coronavirus) and MERS-CoV (the Middle East Respiratory
Syndrome Coronavirus), whose outbreaks were in 2003 and
2012, respectively.
• Last year in December, there was an outbreak of pneumonia of
unknown origin in Wuhan, Hubei Province, China. The World
Health Organization (WHO) announced this outbreak as a
global pandemic on March, 11, 2020

6. Coronavirus Outbreak
2003 2012 2019

9. CoVs are positive-stranded RNA viruses with a crown-like
appearance under an electron microscope (coronam is the Latin
term for crown) due to the presence of spike glycoproteins on the
envelope.
The subfamily Orthocoronavirinae of the Coronaviridae family
(order Nidovirales) classifies into four genera of CoVs:
Alphacoronavirus (alphaCoV), Betacoronavirus (betaCoV),
Deltacoronavirus (deltaCoV), and Gammacoronavirus
(gammaCoV).
The betacoronaviruses of the greatest clinical importance
concerning humans are OC43 and HKU1 (which can cause the
common cold) of lineage A, SARS-CoV and SARS-CoV-2 (which
causes the disease COVID-19)

10. How COVID invades?
 It is transmitted through respiratory droplets from coughing and sneezing and enters the nasal system by
inhaling and starts replicating. ACE2 is the main receptor for the COVID-19 virus.
 The spike protein (S protein) present on the surface of COVID-19 is pinched inside the host cell binding to
the ACE2 receptor. Here, the enzyme furin is present in the host cell and plays a vital role for the virus to
enter, which was absent in SARS-CoV.
 Next, the virus starts to propagate with limited innate immune response and can be detected by nasal
swabs.
 The virus then propagates and reaches the respiratory tract, where it faces a more robust innate immune
response. At this stage, the disease is clinically manifest and an innate response cytokine may be
predictive of the subsequent clinical course.
COVID-19 virus binds to the ACE2 receptor after
activation of the spike protein by trans-membrane
protease serine 2 (TMPRSS2).

11. Effect of COVID-19 on the Organs
Pulmonary effects
Autopsy studies indicate that in the acute phase the patients have classic diffuse alveolar
damage. It is caused by disruption of endothelial and alveolar cells. This leads to fluid and
cellular exudation and hyaline membrane formation.

12. Inflammation and endotheliitis
COVID-19 can lead to a much greater production of cytokines by white blood cells . A surge of
catecholamines may precede and contribute to cytokine storm, also called as hypercytokinemia or
cytokine release syndrome. This maladaptive response can lead to systemic inflammatory response
syndrome (SIRS), acute respiratory distress syndrome (ARDS), multi-organ injury, shock, and death.
Inflammatory response may continue to increase even when the viral load is diminishing.
Effect on coagulation
Bleeding is not common in COVID-19. Deep vein thrombosis (DVT), venous thromboembolism,
pulmonary embolism (PE) and cor pulmonale, systemic and pulmonary arterial thrombosis and
embolism, ischemic stroke and myocardial infarction (MI) are reported. DVT and PE are common
among the dead.
Cardiac effects
Ischemic cardiac injury can occur in patients with established coronary artery disease (CAD). The
primary causes are plaque rupture, thrombosis and inadequate oxygen supply. However, the
reported incidence of acute MI has declined in the COVID-19 period

14. CURRENT STATUS

15. Current status

16. Status: World
Coronavirus cases: 64,502,620
Deaths: 1,493062
Recovered: 44,715,332
Closed Cases: 46,207,373; Recovered/Discharged: 97%; Death: 3%
*Data on: 2nd Dec, 2020
https://www.worldometers.info/coronavirus/

17. Status: India
Coronavirus cases: 9,523,678
Deaths: 138,467
Recovered: 8,958,524
Closed Cases: 9,096,991; Recovered/Discharged: 98%; Death: 2%
*Data on: 2nd Dec, 2020
https://www.worldometers.info/coronavirus/

18. Status: India
Daily New Cases
Sept 11, 2020: 97,654
Dec 2, 2020: 33,761
65.42% less cases since last 3 months
*Data on: 2nd Dec, 2020
https://www.worldometers.info/coronavirus/

19. GENERAL AWARENESS

20. General Awareness

21. Awareness
Mask
Hand Hygiene
Social Distancing

24. World Health Organization (WHO) clearly
indicated the way of hand wash with soap water
and alcohol.
Hand washing and hand rubbing as the part of
hand hygiene is very simple, but very important .
Effective hand hygiene provides protection
against not only, from novel corona virus, but
also, from harmful pathogens.
If the hand hygiene, or cleaning is not done at
the right time, the risk of contamination will be
very high.
HAND HYGIENE

25. Effective hand hygiene can be done by the soap
water and alcohol based sanitizers.
Formula of sanitizer as per WHO
Formula for hand rub or sanitizer
Ethanol (96%)
Or Iso propyl alcohol (99.8%)
Hydrogen peroxide 3%
Glycerol 98%

26. Hand Hygiene and Missed areas
Goswami S et al,2020, IJPR
HAND HYGIENE

27. The missed areas and use of moisturizer after
every hand wash should be kept in our mind
during the sanitization process.
According to WHO guidelines; there are said steps
for proper hand washing techniques that are
helpful in maintaining proper hand hygiene.
The prolonged use of hand sanitizer and their
allergic effects may be minimized by using
alternative herbal ingredients.
HAND HYGIENE

28. 0 – Wet hands with water.
1 – Apply enough soap to cover all hand surfaces.
2 – Rub hands palm to palm.
3 – Right palm over left dorsum with interlaced
fingers and vice versa.
4 – Palm to palm with fingers interlaced.
5 – Backs of fingers to opposing palms with fingers
interlocked.
6 – Rotational rubbing of left thumb clasped in right
palm and vice versa.
7 – Rotational rubbing, backwards and forwards with
clasped fingers of right hand on left palm and vice
versa.
8 – Rinse hands with water.
9 – Dry hands thoroughly with a single-use towel.
10 – Use towel to turn off faucet.
11 – Your hands are now safe.
Hand Hygiene – Cleaning hands with soap and water (Source WHO)

29. Treatment Prospect

30. Vaccines
UK First in World to Approve Pfizer-BioNTech Vaccine as on Dec,2,
2020
Britain's Medicines and
Healthcare products Regulatory
Agency (MHRA) granted
emergency use approval to the
Pfizer-BioNTech vaccine, which
they say is 95% effective in
preventing illness, in record time
- just 23 days since Pfizer
published the first data from its
final stage clinical trial.

33. 1. Vaccine: ZyCoV-D (Applying for Phase 3 human trials)
Formula & Company: Zydus Cadilla
Plot: Ahmedabad, Gujrat.
2. Vaccine: Covaxin ( Phase 3 human trials)
Formula: Bharat Biotech & ICMR
Company: Bharat Biotech
Plot: Hyderabad.
3. Vaccine: Covishield (Phase 3 trials)
Formula: Oxford University & AstraZeneca
Company: Serum Institute of India
Plot: Pune, Maharastra

34. There is no definitive treatment except vaccination
for this pandemic disease to date.
Only supportive pharmacological and non-
pharmacological therapeutic measures and
alternative herbal/traditional medicines can protect
the patients from this homicidal virus.
Pharmacological Therapy:
Some anti-viral and anti-malarial drugs are given to
the patients in certain conditions by following
proper therapeutic guidelines as supportive
therapy.

35. DRUGS USES EFFECT IN COVID-19
Hydroxychloroquine Malaria, HIV, SARS,
Rheumatoid arthritis
It blocks the ability of virus for replication
by boosting up its pH and turns the
acidic environment of endosomes and
lysosomes in basic.
Lopinavir/Ritonavir HIV/AIDS Inhibits the effect of 3-Chymotrypsin like
protease (3CLpro) and disrupting the
ability of viral replication.
Remdesivir Ebola, SARS, MERS Disrupts the viral RNA production.
Favipiravir Japan flu Active metabolite T-705-RTP prevents
the replication and proliferation of viral
genome.
Tocilizumab Rheumatoid Arthritis Blocks the viral signal transduction.
Oseltamivir Influenza viruses type
A
It inhibits viral neuraminidase to stop
spreading the infectious virus in the host
cell.
Acyclovir HSV, VZV It terminates the viral chain and
ineffective the action of virus.
Goswami S et al,2020, PBR

36. Data show that Remdesivir was superior to placebo
in shortening the time to recovery in adults who
were hospitalized with Covid-19 and had evidence of
lower respiratory tract infection.
(Funded by the National Institute of Allergy and
Infectious Diseases and others; ACTT-1
ClinicalTrials.gov number, NCT04280705.)
Remdesivir

37. Remdesivir
Goswami S et al,2020, PBR

38. WHO has issued a conditional recommendation against the use of remdesivir in
hospitalized patients, regardless of disease severity, as there is currently no
evidence that remdesivir improves survival and other outcomes in these
patients.
This recommendation, released on 20 November, is part of a living guideline on
clinical care for COVID-19. It was developed by an international guideline
development group, which includes 28 clinical care experts, 4 patient-partners
and one ethicist.
https://www.who.int/news-room/feature-stories/detail/who-recommends-against-the-use-of-remdesivir-in-covid-19-
patients

39. Evidence on the safety and key indicators
of efficacy of favipiravir in COVID-19 from
trials/registries in Russia, Japan, China,
and Thailand, it appears to be useful in
the management of COVID-19, particularly
mild to moderate disease; however, large
randomized controlled trials are required
to demonstrate whether this effect
translates to clinical benefits like
shortening the disease course, early
hospital discharge, and reducing the need
for oxygen requirement. It is now
commercialized in many countries like
Russia, Bangladesh, Pakistan, Jordan,
Egypt, and Saudi Arabia for COVID-19
treatment.

40. Alternative approach
Natural Therapeutic Approach
TCM (Traditional Chinese Medicines)
Self care

41. Triterpine Glycosides
Scrophularia scorodonia
Kanthamala
Artemisia annua
ज्‍वर‍रोध
Lycoris radiate Pyrrsia lingua
Nigella sativa
Kalonji Seeds
Zingiber officinalae

42. Green Tea:
Active Constituents: Epigallocatechin gallate,
epicatechingallate, and gallocatechin-3-gallate.
Mechanism: Interact with catalytic residues of COVID-19
main protease (M pro ), which is a potential drug target.
Giloy:Tinospora cordifolia
Active Constituents: Alkaloids, terpenoids, lignans,
steroids.
Mechanism: Control viral replication by regulating the
function of Coronavirus Main Proteinase (3CLpro)
Aswagandha:Withania somnifera
Active Constituents: Alkaloids, steroidal lactones,
saponins.
Mechanism: Withanone from Withania somnifera may inhibit the
entry of SARS-CoV-2 by disrupting the interactions between

43. Brown algae (Ecklonia cava)
Root tubers of Rheum officinale
Broussonetia papyrifera
TCM (Traditional Chinese Medicines)
• Glycyrrhiza
• Poria cocos
• Tangerine peel
• Ophiopogon japonicas
• Astragalus membranaceus
• Scutellaria baicalensis
• Saposhniovia divaricata root
• Atractylodes macrocephala
• Honeysuckle,
• Atractylodes lancea

44. TCM (Traditional Chinese Medicines)
Name of the Medicine Active Constituents/Herbs Use
Qingfeipaidu decoction
(QFPD)
Maxingshigan decoction, Wuling powder, Xiao
chaihu decoctions,
and Sheganmahuang decoction.
Useful in early, lightly, and
heavily infected patients and
also recommended for the
treatment of critical patients.
Sheganmahuang
decoction (SMD)
Rhizoma Belamcandae, Ephedra
sinensis, Rhizoma
Zingiberis Recens, Asarum sieboldii, Radix
Asteris, Flos Farfarae, Ziziphus
jujube, Pinelliae Rhizoma Praeparatum Cum
Zingibere, Schisandra chinensis seeds”
Usful in asthma.
Maxingshigan decoction
(MXSG)
Herba ephedrae, Herba glycyrrhizae, Semen
armeniacae amarum, Gypsum fibrosum.
Reduces lung inflammation
and improves the general
condition in influenza and
pneumonia.
Shuanghuanglian Weeping Forsythia (Forsythia suspense),
Honeysuckle (Lonicera sp.), Chinese skull cap
(Scutellaria baicalensis).
Common cold, fever, sore
throat. It enhances the
immune power.

45. Self care

46. THANK YOU
Awareness Talk on Novel Coronavirus, COVID-19