COVID-19

COVID-19

The 2019 novel coronavirus disease (COVID-19; previously known as 2019-nCoV) outbreak that originated from Wuhan, Hubei province, China, at the end of 2019 was declared a public health emergency of international concern on Jan 30, 2020, by WHO 1).

By early January, terms like “the new coronavirus” and “Wuhan coronavirus” were in common use. On February 11, 2020, a taxonomic designation “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) became the official means to refer to the virus strain, that was previously termed as 2019-nCoV and Wuhan coronavirus. Within a few hours on the same day, the WHO officially renamed the disease as COVID-19.


COVID-19 has high homology to other pathogenic coronaviruses, such as those originating from bat-related zoonosis (SARS-CoV), which caused approximately 646 deaths in China at the start of the decade. The mortality rate for COVID-19 is not as high (approximately 2-3%), but its rapid propagation has resulted in the activation of protocols to stop its spread. This pathogen has the potential to become a pandemic. It is therefore vital to follow the personal care recommendations issued by the World Health Organization 2).

COVID-19 and central nervous system

COVID-19 and central nervous system.

Evidence of the Distribution of ACE2 in the Human Brain

The brain has been reported to express ACE2 receptors that have been detected over glial cells and neurons, which makes them a potential target of COVID-19. Previous studies have shown the ability of SARSCoV to cause neuronal death in mice by invading the brain via the nose close to the olfactory epithelium 3).

THE GENOME OF THE COVID-19 VIRUS

The complete genome of SARS-CoV-2 from Wuhan, China was submitted on January 17, 2020 in the National Center for Biotechnology 4) (NCBI) database, with ID NC_045512. The genome of SARS-CoV-2 is a 29,903 bp single-stranded RNA (ss-RNA) coronavirus. It has now been shown that the virus causing COVID-19 is a SARS-like coronavirus that had previously been reported in bats in China.

Treatment

In the absence of treatment for this virus, there is an urgent need to find alternative methods to control the spread of disease. Zhang et al. conducted an online search for all treatment options related to coronavirus infections as well as some RNA-virus infection and found that general treatments, coronavirus-specific treatments, and antiviral treatments should be useful in fighting COVID-19. They suggested that the nutritional status of each infected patient should be evaluated before the administration of general treatments and the current children’s RNA-virus vaccines including influenza vaccine should be immunized for uninfected people and health care workers. In addition, convalescent plasma should be given to COVID-19 patients if it is available. In conclusion, they suggested that all the potential interventions be implemented to control the emerging COVID-19 if the infection is uncontrollable. 5).


A statement by the Ministry of Science and Technology of China encouraged researchers to focus their efforts on epidemic prevention and to publish their results in Chinese.

The emphasis on publishing clinical research in English helps to facilitate knowledge exchange between Chinese scientists and the rest of the world. They hope the research community will make efforts to disseminate all findings relevant to the outbreak of COVID-19 in Chinese in addition to English publishing outlets. For example, clinical research papers about COVID-19 and SARS-CoV-2 in any Lancet journal were translated into Chinese, and these translated Articles were provided rapidly to the public in China free of charge. Broad dissemination in both Chinese and English will accomplish the goals of communicating timely and crucial findings to the international scientific community, while also disseminating this information to health-care workers on the frontline who need to understand the epidemiological and clinical features of COVID-19. This strategy will improve effective control strategies to ultimately contain the virus and protect the health of the public 6).

Outcome

Diabetes is a risk factor for the progression and prognosis of COVID-19

A total of 174 consecutive patients confirmed with COVID-19 were studied. Demographic data, medical history, symptoms and signs, laboratory findings, chest computed tomography (CT) as well we treatment measures were collected and analyzed.

Guo et al. found that COVID-19 patients without other comorbidities but with diabetes (n=24) were at higher risk of severe pneumonia, the release of tissue injury-related enzymes, excessive uncontrolled inflammation responses and hypercoagulable state associated with dysregulation of glucose metabolism. Furthermore, serum levels of inflammation-related biomarkers such as IL-6, C-reactive protein, serum ferritin, and coagulation index, D-dimer, were significantly higher (p< 0.01) in diabetic patients compared with those without, suggesting that patients with diabetes are more susceptible to an inflammatory storm eventually leading to rapid deterioration of COVID-19.

Data support the notion that diabetes should be considered as a risk factor for a rapid progression and bad prognosis of COVID-19. More intensive attention should be paid to patients with diabetes, in case of rapid deterioration 7).

Operating room preparation for COVID-19

see Operating room preparation for COVID-19.

Lombardy region

The following clinical situations have been defined as neurosurgical emergencies

Cerebral hemorrhages (subarachnoid and intraparenchymal)

Acute hydrocephalus

Tumors at risk of intracranial hypertension

Spinal cord compressions with neurological deficit or at risk of

Traumatic cranial and spinal trauma emergencies 8).

References

1)

WHO. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Jan 30, 2020. https://www.who.int/newsroom/detail/30-01-2020-statement-on-thesecond-meeting-of-the-international-healthregulations-(2005)-emergency-committeeregarding-the-outbreak-of-novel-coronavirus- (2019-ncov) (accessed Feb 1, 2020).
2)

Palacios Cruz M, Santos E, Velázquez Cervantes MA, León Juárez M. COVID-19, a worldwide public health emergency. Rev Clin Esp. 2020 Mar 20. pii: S0014-2565(20)30092-8. doi: 10.1016/j.rce.2020.03.001. [Epub ahead of print] Review. English, Spanish. PubMed PMID: 32204922.
3)

Netland, J., Meyerholz, D. K., Moore, S., Cassell, M., and Perlman, S. (2008) Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J. Virol. 82 (15), 7264−75.
4)

Wuhan seafood market pneumonia virus isolate Wuhan-Hu-1, complete genome. Nucleotide, National Center for Biotechnology Information (NCBI), National Library of Medicine (US), National Center for Biotechnology Information, Bethesda, MD, https://www. ncbi.nlm.nih.gov/nuccore/1798174254 (accessed on 2020-02-28).
5)

Zhang L, Liu Y. Potential interventions for novel coronavirus in China: A systematic review. J Med Virol. 2020 May;92(5):479-490. doi: 10.1002/jmv.25707. Epub 2020 Mar 3. Review. PubMed PMID: 32052466.
6)

Xiang YT, Li W, Zhang Q, Jin Y, Rao WW, Zeng LN, Lok GKI, Chow IHI, Cheung T, Hall BJ. Timely research papers about COVID-19 in China. Lancet. 2020 Feb 29;395(10225):684-685. doi: 10.1016/S0140-6736(20)30375-5. Epub 2020 Feb 17. PubMed PMID: 32078803.
7)

Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, Qin R, Wang H, Shen Y, Du K, Zhao L, Fan H, Luo S, Hu D. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020 Mar 31:e3319. doi: 10.1002/dmrr.3319. [Epub ahead of print] PubMed PMID: 32233013.
8)

Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fontanella MM. Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir (Wien). 2020 Mar 28. doi: 10.1007/s00701-020-04305-w. [Epub ahead of print] PubMed PMID: 32222820.

COVID-19 is an emerging, rapidly evolving situation.

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