Tackling SARS-CoV-2 Pandemic: The Way Forward

The world is engaged in containing the COVID Pandemic and controlling further spread and deaths. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. Some nations have done a better job than rest of the world. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. There is a strong case that COVID-19 could be with us in one way or another until a vaccine comes on the market or herd immunity is achieved. A long crisis, could stretch the international order to its breaking point. The virus has succeeded in confining almost all human beings in their homes. Balancing act between public health crisis and complex societal implications is an inescapable necessity. The pandemic will alter the world for-ever. An economic slowdown, severe recession, plummeting revenue, increased expenditure, and mental health issues could be the emerging challenges. There will be increased confidence in technology and nations will invest more in public health. We are passing through fragile and critical times in history. People around the world can prevail in response to this extraordinary challenge. Investing in public health, preparedness, and relying on science will bring a better future. Think of one world, one humanity to shape and secure our future.


Characteristics of SARS-CoV-2
COVID-19 caused by SARS-CoV-2 has spread rapidly all over the world. The pattern of infection of COVID-19 is unique and unpredictable. Previous studies have suggested that, similar to SARS-CoV, COVID-19 might interact with the angiotensin-converting enzyme 2 receptor in humans. The amino acid sequence of the nucleocapsid (N) protein of COVID-19 is 90% identical to that of SARS-CoV.
COVID-19 might cross-react with the N protein antibodies of SARS-CoV; however, these antibodies might not provide cross-immunity. In addition, similar to SARS-CoV, COVID-19 (SARS-CoV-2) might inhibit the RNA interference defense mechanism of the host organism [6].
Super-spreaders release significantly higher levels of viral particles compared to other infected individuals, which increases their chances of spreading the infection.
Coronaviruses are enveloped non-segmented positive-sense RNA viruses belonging to the family coronaviridae and order nidovirales. Coronaviruses target the upper respiratory tract, which leads to several ailments, including pneumonia. However, they might also affect central nervous system leading to long-term neurological damage. The RNA genome of coronaviruses encode for sixteen nonstructural proteins (nsp 1 -16) with known or predicted RNA synthesis and modification functions, and they have been also suggested to trigger evolution of large genomes [7].
Virus characteristics primarily define the risk of infection. These characteristics include the efficacy of the virus to spread, the severity of the disease after infection, and the efficacy and success rates of the available medical resources to contain the spread of the virus. With no vaccine or medication, community intervention becomes the most important response strategy against the pandemic.
In a nutshell, COVID-19 risk can be defined as the risk of exposure versus risk of serious illness and death.
SARS-CoV-2 presents six strains. Mutation rate has remained low. In European countries, strain G is widespread. L strain from Wuhan is disappearing gradually. The general risk factors of COVID-19 include advanced age and suffering from other chronic medical conditions such as diabetes, cardiac disorders,

Countries Experience
Countries like Singapore, South Korea and New Zealand, and regions like Hong Kong in China, Taiwan in China moved quickly to contain the transmission of COVID-19. Most countries were unable to contain the initial outbreak and moved to flatten and fight. Leadership of these countries relied on time tested public health principles to protect their citizens from COVID-19.
The COVID-19 pandemic is straining healthcare systems (infrastructure, human, materials and financial resources). It has exposed the weak public health systems and lack of preparedness.
There have been successes as well as failures. The leaders who have opted timely the toughest strategies have been able to decline the highest wave of Pandemic and have pulled out their countries much faster from the pandemic.
Leadership and political will make a difference. We must balance quick wins with long-term planning. Balanced realism with optimism is the attitude all global leaders need to adopt. With proper focus on short term wins with long term goals we can win the battle against COVID-19.

Indian Scenario
India with over 1.38 billion population has to have robust and evidence-based health care management and action plans in place with extraordinary monitoring, supervision and continuous assessment in place to control this pandemic.
India has 0.9 hospital beds/1000 population as compared to 13

The US Response
COVID-19 is a disaster for Americans. As on today, it has more cases and deaths than other countries. The American government's inaction has allowed the virus to spread inside its borders, and it has actively increased the risk to other countries. A faulty diagnostic kit rolled out by the American Centre for Disease Control & Prevention and slow approvals for other testing kits led to the disease spreading under the nose of the administration. The key problem with the kits is what's known as a negative control. CDC's test uses the polymerase chain reaction (PCR) assay to find tiny amounts of the SARS-CoV-2 genome in, say, a nose swab. To make sure a test is working properly, kits also include DNA unrelated to SARS-CoV-2. The assay should not react to this negative control, but the CDC reagents did at many, but not all, state labs [13].
Because of slow initial response to the pandemic, tens of thousands more people could die. Millions more could lose their jobs, if the situation is not brought under control on a war-footing. Social distancing and lockdown are an inescapable necessity. It took the US 99 days to hit 1 million, 43 days to get to 2 million, and 28 days to reach 3 million. Fifteen days later, it hit the 4 million case mark, and took 17 days more to reach 5 million on 9 August 2020. A high number of deaths above normal in the US (over 200,000 in mid-August) is higher than it would be in a normal year. It is argued that the official death counts may be substantially underestimating the overall effects of the coronavirus. Amid Pandemic, nearly 11% of adults in the US said they had seriously considered suicide in the previous 30 days as the coronavirus pandemic takes a toll on Americans.

Management of SARS-CoV-2 Infection
Clinical diagnosis is done based on symptoms, chest imaging, etc. However, the infection can be confirmed only by genetic testing of samples obtained from the respiratory tract (such as throat swabs). Due to absence of appropriate antiviral therapy, the patients are kept on supportive care [14]. The suspected individuals must be isolated, until confirmation. If they are confirmed to be positive, then they must be quarantined. Furthermore, since asymptomatic transmission is also possible, it is necessary to test all the persons who have been in the areas with known transmission. In addition, the symptomatic mothers who are still breastfeeding must maintain proper hygiene before and after handling of the baby. whether an individual has previously been infected [17].
South Korea has shown an exemplary performance by significantly slowing the infection spread in the country with a population of 50 million without any lockdowns or other severe measures that were adopted by China. It has demonstrated that diagnosis at large scale is key to epidemic control, along with case isolation and contact tracing [18].
A speedy recovery would depend on most of the world getting the pandemic under control or achieving herd immunity.
Timely detection of hypoxia and availability of Pulse Oximeters can prevent death. The first trigger is silent hypoxia. In these patients, microvasculitis occurs in lungs, microclots are formed due to vascular endothelial dysfunction with resultant intussusception of the artery i.e. the artery is partially thrombosed and partially patent so perfusion is maintained. Such patients may be given one dose of antiviral (remdesivir), one dose of LMWH (low molecule weight heparin), water-soluble aspirin stat and home oxygen therapy before shifting to a hospital. The COVID-19 has forced many around the world to rethink their daily lives, from work to school to entertainment. In response to travel bans, school closures, and social distancing recommendations to limit the spread of the virus, many people have turned to digital tools to keep some semblance of normality.

S. A. Tabish Health
According to the International Labour Organization, the labor and economic crisis induced by the COVID-19 pandemic could lead to a rise in global employment from 5.3 million to 24.7 million. Overall, the global impact has been predicted to be in the range of $77 billion to $347 billion or 0.1% to 0.4% of global GDP [19].
According to the UN's trade and development agency, UNCTAD, apart from the tragic human consequences of the COVID-19 coronavirus epidemic, the economic uncertainty it has sparked will likely cost the global economy $2 trillion in 2020. Heavily indebted developing countries, particularly commodity exporters, face a particular threat. There is a need to take urgent steps to reduce the economic impact [20].
In the long-term the pandemic will reduce the productive capacity of the global economy. Greater moves toward selective self-sufficiency can be anticipated given supply chain vulnerability.  The losses in learning today, and in their future development, are hard to fathom. Child nutrition is another vital concern. With classrooms shuttered, the nearly 310 million children worldwide who rely on school meals are missing out on this daily dose of nutrition. There is also a danger that girls will drop out of school, leading to an increase in teenage pregnancies [21].

State of Children
Another concern is delay in routine immunization of children that makes them vulnerable to disease. Once the pandemic is over, every child in need must be vaccinated. Uunprecedented international solidarity is crucial for children and humanity [10] [11] [12].

Emerging Perspectives
As scientists strive to understand the respiratory COVID-19 disease and the vi- Awake prone position appears to be safe.

Several published reports of early clinical descriptions of COVID-19 have
emerged from Hubei province in China, and many more will come. These early reports, typically simple descriptive case series of patients hospitalized with COVID-19 (mostly with pneumonia), provide valuable information on the more severe end of the disease spectrum. The current best estimate is that about 81% of people with COVID-19 have mild disease and never require hospitalization.
These cases have not yet featured much in published clinical descriptions [22].  Such testing requires Biosafety Level 3 laboratory facilities, but the ability to determine the strength of antibodies capable of inhibiting viral infection is crucial for both short-term therapeutics and long-term vaccine development [23]- [30].

S. A. Tabish Health
New Cochrane review shows that antibody tests could have a useful role in detecting if someone has had COVID-19, but that timing is important. The tests were better at detecting COVID-19 in people two or more weeks after their symptoms started, but we do not know how well they work more than five weeks after symptoms started. The immune system of people who have COVID-19 responds by developing proteins in the blood called antibodies that attack the virus. Detecting antibodies in people's blood may indicate whether they currently have COVID-19 or have had it previously [31].

Search for Effective Treatments
Many of the drugs being developed or tested for SARS-CoV-2 are antivirals. Favipivarir too is recommended for new recurrent flu. Even if there is a breakthrough in vaccine development by researchers, it will not be easy to manufacture nearly 8 billion doses in a short period. The logistics like vials and cold chain for transportation and storage will be a much bigger challenge. Affordability will be another factor.

Conclusion
In a world of 7.8 billion people, countries have to be in a state of emergency preparedness to tackle emerging infectious diseases. It needs an aggressive and focused action, with coordination among all departments of the governmenthealth, security, finance, commerce, transport, trade, information, diplomacy, etc. The approach to tackle this pandemic has to be solidly evidence-informed, robust, pragmatic and effective. Creating awareness about wearing mask, social distancing, frequent handwashing, robust contact tracing, providing quality healthcare to COVID-19 patients, availability of quality PPE to health professionals and looking after weaker sections of society are crucial to flatten the curve of pandemic. It needs political will. Balancing act between public health crisis and complex societal implications is an inescapable necessity. Scientists must find an effective therapy on a war footing. During these most difficult times in human history, nations need to ensure that people can meet their needs and that businesses can pick up once the acute phases of the pandemic pass. Social unrest and food riots must be pre-empted. Nations will have to prioritise spending.
Special attention needs to be paid towards education and mental health of children and young adults. People around the world can prevail in response to this extraordinary challenge. Investing in public health, preparedness, and relying on science will bring a better future. The world will emerge resilient from COVID pandemic if the crisis prompts a radical reset of our economic and social life with policies that invest in people with the objective of one humanity, one world.

Conflicts of Interest
The author declares no conflicts of interest regarding the publication of this paper.