Coronavirus Disease From Molecular to Clinical Perspectives

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 PUBLIC HEALTH IN THE 21ST CENTURY

CORONAVIRUS DISEASE

FROM MOLECULAR TO
CLINICAL PERSPECTIVES

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 PUBLIC HEALTH IN THE 21ST CENTURY

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 PUBLIC HEALTH IN THE 21ST CENTURY

CORONAVIRUS DISEASE

FROM MOLECULAR TO
CLINICAL PERSPECTIVES

YILDIZ DINCER
EDITOR
Copyright © 2021 by Nova Science Publishers, Inc.

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Library of Congress Cataloging-in-Publication Data

Names: Dincer, Yildiz, editor.

Title: Coronavirus disease : from molecular to clinical perspectives /
Yildiz Dincer, Istanbul University, Turkey, editor.
Description: New York : Nova Science Publishers, [2021] | Series: Public
health in the 21st century | Includes bibliographical references and
index. |
Identifiers: LCCN 2021006064 (print) | LCCN 2021006065 (ebook) | ISBN
9781536192964 (hardcover) | ISBN 9781536193114 (adobe pdf)
Subjects: LCSH: COVID-19 (Disease) | COVID-19 (Disease)--Treatment.
Classification: LCC RA644.C67 C675 2021 (print) | LCC RA644.C67 (ebook) |
DDC 616.2/414--dc23
LC record available at https://lccn.loc.gov/2021006064
LC ebook record available at https://lccn.loc.gov/2021006065

Published by Nova Science Publishers, Inc. † New York

This book is dedicated to all COVID-19 victims and healthcare
professionals serving in defiance of their lives
 CONTENTS

Preface ix
Chapter 1 Epidemiology and Pathogenesis of COVID-19 1
Seda Salman Yılmaz and Gökhan Aygün
Chapter 2 Transmission of SARS-COV-2 and Prevention Strategies 13
Bilgul Mete, Ahmet Furkan Kurt and Gökhan Aygün
Chapter 3 Clinical Aspect of COVID-19 29
Aslıhan Demirel and Fehmi Tabak
Chapter 4 Diagnosis of COVID-19 51
Mert A. Kuskucu and Fehmi Tabak
Chapter 5 Treatment Optıons for COVID-19 Patıents 59
Hakan Yavuzer and Pınar Arman
Chapter 6 Intensive Care Management of COVID-19 Patients 75
Olcay Dilken and Yalim Dikmen
Chapter 7 Anatomical Basis of the COVID-19 87
Mehmet Üzel and Ö. Alp Taştan
Chapter 8 Genetic Background of Differences in the Incidence
of Corona Virus Infection 103
R. Dilhan Kuru and İlhan Onaran
Chapter 9 The Clinical Course of COVID-19 in Elderly Patients 129
Hakan Yavuzer and Rabia Bag Soytas
Chapter 10 SARS COV-2 in Pediatric Patients: Hematological Face
of the Disease 145
Tulin Tiraje Celkan and Ayşe Gonca Kacar
viii Contents

Chapter 11 COVID-19 and Ophthalmology 165

Ceyhun Arici and Burak Mergen
Chapter 12 The Impact of the COVID-19 Pandemic on Patients with Diabetes 183
Zeynep Mine Coskun and Sema Bolkent
Chapter 13 The Impact of COVID-19 Pandemic on the Patients
with Chronic Respiratory Diseases 197
Buket Caliskaner Ozturk
Chapter 14 The Impact of the COVID-19 Pandemic on Patients
with Cardiovascular Diseases 213
Serap Yavuzer and Veysel Suzan
Chapter 15 The Impact of the Covid-19 Pandemic on Cancer Patients 225
Hande Turna
Chapter 16 COVID-19 from General Surgery Perspective 237
Selen Soylu and Serkan Teksoz
Chapter 17 Cytokine Storm and Oxidative Stress in Severe COVID-19 247
Yildiz Dincer and Selin Yuksel
Chapter 18 Antioxidant Agents in the Treatment of COVID-19 259
Mujgan Cengiz
Chapter 19 Vaccıne Development Studıes for COVID-19 275
Yesim Tok and Gökhan Aygün
Chapter 20 Molecular Approaches in COVID-19 Treatment 283
Mehmet Güven and Bahadır Batar
About the Editor 299
Index 301
 PREFACE

The world is experiencing an unprecedented challenge due to coronavirus disease

(COVID-19) pandemic. In December 2019, a novel severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), first emerged in a seafood wholesale market in Wuhan,
China, caused an outbreak of COVID-19. Due to the rapid spread of COVID-19, on
March 11, 2020, the WHO announced COVID-19 as a pandemic. As of January 13,
2021, a total of 92,138,941 laboratory-confirmed cases included 1,973,295 deaths
reported globally. The majority of the infected individuals exhibit mild to moderate
respiratory illness and recover without requiring special treatment. However, older people
and those with underlying medical problems like cardiovascular disease, diabetes,
chronic respiratory disease, and cancer may rapidly progress to acute respiratory distress
syndrome, septic shock, coagulation disorders, multi-organ failure, and death. Although
the course of COVID-19 is usually mild in children, in rare cases, children can be
severely affected due to the development of the multisystem inflammatory syndrome.
The worldwide spread of COVID-19 caused fear, anxiety, depression, panic attacks, and
a general decrease in overall wellbeing in the population. Due to the high infectivity rate
of COVID-19, the unexpected and rapid influx of large numbers of patients, especially
patients who need intensive care, have caused great pressure on the health care systems.
Healthcare professionals who occupy the front line during pandemics are at increased risk
concerning their physical and mental health. Our knowledge of this novel virus is limited.
A better understanding of the pathogenesis of COVID-19 will provide important insight
into its management and reduce the mortality rate. In this book, based on the latest global
scientific data as well as our experiences, we purposed to give the readers an overview of
COVID-19 pathogenesis and transmission routes; anatomical basis and clinical aspects of
the disease; current diagnostic and treatment strategies; intensive care management of
COVID-19 patients; the clinical course of the disease in children and elderly patients; the
genetic background of differences in the incidence of new SARS-CoV-2 infection; the
impact of the COVID-19 pandemic on patients with chronic diseases such as diabetes,
x Yildiz Dincer

cancer, cardiovascular diseases, chronic respiratory diseases; ocular manifestation of the

COVID-19; organization of ophthalmology and general surgery for the safe treatment
during the pandemic period; overproduction of reactive oxygen species due to cytokine
storm and their role in tissue damage leading acute respiratory distress syndrome and
coagulopathies; role of antioxidant therapy to limit tissue damage; molecular approaches
in COVID-19 treatment, and vaccine studies. I hope this book will be a valuable resource
for researchers in the field of COVID-19 and will be helpful for medical doctors to deal
with the pandemic.

Yildiz Dincer
Istanbul, January 2021
In: Coronavirus Disease ISBN: 978-1-53619-296-4
Editor: Yildiz Dincer © 2021 Nova Science Publishers, Inc.

Chapter 1

EPIDEMIOLOGY AND PATHOGENESIS

OF COVID-19

Seda Salman Yılmaz1, PhD and Gökhan Aygün2,, MD

1
Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty,
Department of Covid-19 Diagnosis Laboratory, Istanbul, Turkey
2
Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty,
Department of Medical Microbiology, Istanbul, Turkey

ABSTRACT

COVID-19 is a pandemic caused by the coronavirus, Severe Acute Respiratory

Syndrome Coronavirus (SARS CoV-2), that affects the entire world, which can result in
death, especially in the elderly and people with underlying disease (hypertension,
diabetes mellitus, coroner artery disease). The number of patients and deaths continues to
increase rapidly in the world. Today, the most important source of infection is sick
people. Contagiousness in the asymptomatic and presymptomatic period is the most
important problem in preventing the pandemic. The most important route of transmission
is the droplets. Aerosols can be transmitted by aerosol- generating procedures in health-
care. Fomites that spread to the immediate environment of sick people play a role in
transmission through contact. There is insufficient data on other transmission routes. In
the first period, COVID-19, which spread as a travel disease, spread to all societies in
closed environments (home, meeting, public transportation, ceremonies, prisons, long-
term care units...) where many people are together. Local outbreaks occur, especially in
hospitals and health centers. There are many uncertainties in the pathophysiology of
Covid-19. Studies at different stages of the disease and with different methodologies are
published and this provides conflicting data. Lymphopenia, cytokine storm, ferritin
elevation, and D-dimer elevation were found to be associated with poor prognosis. Acute
respiratory distress syndrome (ARDS) and sepsis are the most important causes of


Corresponding Author’s Email: [email protected].
2 Seda Salman Yılmaz and Gökhan Aygün

mortality. In this section, a perspective for the future is presented by addressing the issues
in the light of the available data.

Keywords: COVID-19, epidemiology, pathogenesis

INTRODUCTION

Coronaviruses; enveloped single-stranded, positive-sense RNA viruses. The

coronavirus has a large genome of approximately 30 000 bases and an RNA polymerase
activity with “proofreading” activity to correct mutations. This family is found in many
mammals, especially cats, dogs, pigs, and bats, and includes important human pathogens.
Viruses that adapt to new hosts with genetic recombination and variations in different
hosts become important pathogens for humans when they gain the ability to be
transmitted and spread from person to person. These viruses, which can settle in the
respiratory and digestive systems in many mammals, were first identified as the agents
with upper respiratory tract infection (HCoV-NL63, H.CoV229E, HCoV-OC43,
HCoVHKU1). With the clinic of Severe Acute Respiratory Syndrome Coronavirus
(SARS) in 2003 and Middle East Respiratory Syndrome (MERS) in 2012, it was
observed that it could cause diseases and epidemics with high mortality in humans with
pneumonia. SARS-CoV-2 is an agent with long spike structures (9-12 nanometers) in
dimensions of 60-120 nanometers. Bats were found as the reservoir of this virus, and
although pangolin as an intermediate host was identified as the most likely source, this
issue has not been fully clarified. A new coronavirus was identified as the cause of a
series of pneumonia cases at the end of 2019 in Wuhan, a city in China’s Hubei province.
This infection, which spread rapidly, resulted in an epidemic throughout China and then
spread to other countries in the world, this epidemic was declared by WHO as a Public
Health Emergency of International Importance (PHEIC). In February 2020, the World
Health Organization took the name Covid-19 disease, which means coronavirus disease
19, and the virus that causes COVID-19 was named SARS-CoV-2. WHO declared
COVID-19 as a pandemic on March 11, 2020. On September 25, 2020, a total of
32.110.656 detected cases and 980.031 COVID-19 deaths were recorded worldwide, and
the numbers continue to increase [1].

EPIDEMIOLOGY

The global epidemiology of COVID-19 in the first phase of the pandemic was
evaluated as a cross-sectional analysis using web-based surveillance [2]. In the web-
based surveillance study, almost two-thirds of the COVID-19 cases first reported were
 Epidemiology and Pathogenesis of COVID-19 3

those with travel links to China, Italy, or Iran. In the first period of the outbreak sixty-fixe
studies were evaluated and most of these have been reported from China. It has been
stated that most of these are due to family contacts. The major types of cluster infections
were families, gatherings, religious organizations, transportation, community
transmission, conferences, shopping malls, respectively [3]. Although there were many
household contagion clusters among the early cases, the numbers in these clusters were
low (2-22 cases) clusters in occupational or community settings tended to be larger
(gathering 112, shopping mall 40, religion 53 cases was found to be affected) and
physical distance was a possible risk to slow the progression of SARS-CoV-2 was
supportive of its role [4]. A total of 161 studies (n = 17 648) provided data for the mode
of transmission. The most common mode of transmission was travel‐related (58.1%, 95%
CI: 51.1‐64.8), followed by close contacts (43.1%, 95% CI: 37.2‐49.2), and finally
community spread (27.4%, 95% CI: 18.4‐38.7) [5]. At present, general findings show that
test strategies, socioeconomic differences, and reporting systems of countries affect the
spread in society.
In children, it is stated that the number of cases detected is less, the disease has a
milder course, and asymptomatic cases are more common in this situation. In a systemic
review and meta-analysis, it is stated that approximately 4% of patients with a diagnosis
of COVID-19 are symptomatic, having underlying diseases play a role in this course [6].
Severe or critical illness has been reported among 2.5% to 5% of pediatric cases, and
more recently, 4% of cases were reported as severe or critical, and pre-existing medical
conditions have been suggested as a risk factor for severe disease and ICU admission in
children and adolescents [7]. Several countries affected by the COVID-19 pandemic
reported cases of children who were hospitalized in intensive care units due to a rare
pediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory
syndrome in children (MIS-C) [8], characterized by a systemic disease involving
persistent fever, inflammation and organ dysfunction following exposure to SARS-CoV-2
[9, 10].
COVID-19 course has not been shown to be worse in pregnant women. Pregnant
women are often tested for SARS-CoV-2 infection at admission for hospital delivery.
According to this may explain the high proportion of asymptomatic cases found among
pregnant women in different countries. In addition, infants and newborns have been
described as more vulnerable to severe COVID-19 than other pediatric groups [11, 12].
Although a low mortality rate (0.006%) has been reported for this group in most cases
[13, 14]. Among the COVID-19 cases with serious illness and death and the rates of
people with underlying health conditions are remarkable. Primary health conditions
reported among COVID-19 patients and admitted to the intense care unit (ICU) include
hypertension, diabetes, cardiovascular disease, chronic respiratory disease,
immunocompromised status, cancer, and obesity. A high proportion of long-term care
facilities and nursing homes in Europe and the world are also severely affected by