A Review of COVID-19: The Main Ways of Transmission and some Prevention Solutions, Clinical Symptoms, more Vulnerable Human Groups, Risk Factors, Diagnosis, and Treatment

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 3, Pages: 884-893

J. Environ. Treat. Tech.

ISSN: 2309-1185

Journal web link: http://www.jett.dormaj.com

A Review of COVID-19: The Main Ways of

Transmission and some Prevention Solutions,

Clinical Symptoms, more Vulnerable Human

Groups, Risk Factors, Diagnosis, and Treatment

†

†2

Nasrin Beheshtkhoo , Mohammad Hassan Alipour , Reza Nemati , Reza Baghbani ,

Farahnaz Behzad , Mostafa Shafiee , Mohammad Amin Jadidi Kouhbanani *, Ali Jangjou *,

Mohsen Mehrabi *

¹Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences,

Tehran, Iran

Social Security Organization,Shahid Beheshti Hospital,Shiraz,Iran

Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran

Research Institute for Fundamental Sciences (RIFS), University of Tabriz, Tabriz, Iran

Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical

Sciences, Shiraz, Iran

Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Department of Medical Nanotechnology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran

Received: 06/03/2020

Accepted: 19/05/2020

Published: 20/09/2020

Abstract

COVID-19 is a virus that causes acute respiratory syndrome. Although it is less deadly than other members of its family, i.e. SARS

and MERS, its extremely rapid transmission rate has become a widespread concern today. Airborne droplets, environmental surfaces,

nasal mucosa, urine and fecal samples are among the routes for the transmission of this virus. Both temperature and humidity factors

affect the viability of the virus and its mortality rate. Increasing the ambient temperature makes the virus unstable, while lowering the

temperature contributes to its stability. Due to the fact that the main route for the transmission of this virus is the particles containing the

virus, observing the social distance of at least one meter, using masks as well as air purification systems can reduce the risk of virus

transmission to some extent. This contagious virus has made life difficult for everyone in the community, especially pregnant women,

children and the elderly. This viral infection can be diagnosed in many ways, including laboratory tests, molecular tests, the chest X-ray

and CT scan. It is worth noting that chest CT scan is more sensitive than other methods and is used as the first line of diagnosis. Despite

numerous efforts, no definitive cure has yet been found and isolation of those involved is recognized as first-line treatment. The

treatments so far can be divided into three categories: general treatments, pharmacological treatments, and diet. General treatments

involve isolation, mask use, oxygen therapy, room ventilation and more. Because of the rapid spread and the many challenges that this

viral infection has created, scientists have used many of the drugs that were previously used to treat the influenza, malaria, AIDS, etc.,

some of which have been used to treat the viral infection. It should be noted that some of these drugs were very effective on some

people's bodies. Some of these drugs were even used for pregnant mothers. A proper diet and the use of certain vitamins such as iron,

zinc, vitamins A, B, C, E can also be effective in preventing and treating this viral infection. Many efforts to develop a vaccine against

this virus infection began about two weeks after the outbreak and the attempts to reach this goal continues.

Keywords: COVID-19, SARS, MERS, Diagnosis, Treatment

Introduction¹

targeted by the coronavirus are the lungs and the human

respiratory system (Fig.1), followed by complications such as

acute respiratory syndrome (SARS‐CoV‐2). In terms of genetic

sequencing, it is shown that COVID-19 has an 80% similarity

to SARS-COV and an 50% similarity to MERS-COV, from

The coronavirus belongs to the crown-like family of

viruses, named after the appearance of the virus under an

electron microscope as the viruses have crown-like spikes

protruding from their surfaces. The main organs of the body

Corresponding authors: (a) Mohammad Amin Jadidi Kouhbanani, Department of Medical Nanotechnology, School of Advanced

Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. E-mail: mohammadjadidi1993@gmail.com; (b)

Mohsen Mehrabi, Department of Medical Nanotechnology, School of Medicine, Shahroud University of Medical Sciences, Shahroud,

Iran. E-mail: Mm.nanotech@gmail.com and (c) Ali Jangjou, Department of Emergency Medicine, School of Medicine, Shiraz University

of Medical Sciences, Shiraz, Iran. E-mail: ali_jangjou@ymail.com.

†

These authors contributed equally to this work.

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 3, Pages: 884-893

which both are generated as they have (SARS-COV and

MERS-COV) emanated from bats. However, the COVID-19

mortality rate is much lower than those of SARS-COV (9.14%)

and MERS-COV (34.4%), respectively [1- 3].

COVID-19 is an enveloped and non-segmented virus with

single-stranded RNA. Its beta-coronavirus genus includes

SARS-COV belonging to the family of coronavirus with a

Airborne particles can be detected up to three hours after

aerosolization [34]. Respiratory particles move under the

influence of gravitational force, however, their infectious and

pathogenic potential is unknown. 17 aerosol is less than 10 μm

in diameter, which is transmitted from the body of an infected

person to the outside environment during coughing or sneezing,

even when the infected person has no clinical symptoms or

mild symptoms, thus enabling environmental transfer [35, 36].

Additionally, the exhaled air through people infected with the

virus is another main source of virus transmission. Nonetheless,

using masks, observing a distance of at least one meter and

allocating a separate room with proper ventilation for people in

home quarantine is a helpful way of preventing the spread of

the virus to others [22, 37-41].

subfamily of Orthocoronavirinae, and

a subgenus of

Sarbecovirus. The amino acid sequence of this virus is very

similar to that of the SARS-COV [4, 5]. In vitro studies have

shown that SAR-CoV-2 can be transmitted from animal to

human as well as from human to human because this virus, like

SARS-CoV, uses ACE2 (angiotensin-converting enzyme 2) as

a cellular receptor for cell entry and since this receptor is

expressed in a wide range of animals (except mice and rats) as

well as humans [6, 7].

2.2 Environmental Surfaces

Nonstructural protein 2 (NSP2) and nonstructural protein 3

NSP3) are two SARS-CoV-2 structural proteins, both of

which play an infectious role in this virus and are involved in

its differentiation. There are also two strains of SARS-CoV-2,

i.e. type L (70%) and type S (30%). When compared, type L is

shown to be more aggressive and more contagious than type S

Numerous studies have revealed that in addition to direct

transmission through viral droplets, indirect transmission

through infected surfaces to the virus is also possible. Viral

particles may survive on surfaces for two or three days [34, 42].

Virus droplets on the surface are a potential source of virus

transmission since they can live on the surface for a long time

[43].

(

[

8, 9]. According to a number of studies, the COVID-19 virus

first attacks the respiratory mucosa cell and then the other cells.

When these cells are invaded, a set of intracellular interactions

eventually leads to the activation of a large number of immune

mediators, including inflammatory cytokines, adapter protein

3.2 Nasal Mucosa, Urine and Fecal Samples

These cases can be also other sources of virus transmission

[44]. Possibility of nucleic viral diagnosis viral acids are found

in urine, feces, and gastrointestinal mucosa. There is some

evidence that the virus can be detected in stool samples, even

in cases where the throat swabs were negative. Detection of the

virus in fecal samples indicates the possibility of transmission

through the digestive tract or is re-exposed through aerosols

that may contain viruses. Therefore, the necessary standards

should be observed to prevent the transmission of the virus

during fecal transport in patients with COVID-19 [45-47].

(MyD88), interferon I (IFN-α / β) in the lower airways, as a

result of which the lungs of the infected person can be

damaged, thus the critical condition for the person. That is the

reason why the blood plasma of people infected with COVID-

9 experience increased levels of cytokines and chemokines

including IL-1, IL-2, IL-4, IL-7, IL-10, IL-12, IL-13, IL-17,

GCSF, macrophage, colony-stimulating factor MCSF, IP-10,

MCP-1, MIP-1α, liver growth factor (HGF), IFN-γ and TNF-α

[

10-20]. The most common ways, through which COVID-19 is

transmitted from one human to another include droplets and

respiratory fluid, as well as person-to-person contact or feces

4.2 Influence of Temperature and Humidity

Some studies have shown that there is a negative

relationship between ambient temperature and absolute

humidity and mortality from COVID-19. Evidence has shown

that environmental cold can reduce immune system function

and make conditions worse for people suffering from COPD.

Some laboratory findings have shown that phagocytic function

of pulmonary alveolar macrophages decreases under the

influence of cold stress. Breathing cold air can lead to bronchial

contraction, which can increase the susceptibility of the lungs

to infection caused by the COVID-19 virus. Humidity is also

another factor as evidence has shown that reducing ambient

humidity can be dangerous. Dry air respiration can also lead to

respiratory epithelial damage and lead to COVID-19 virus

infection [42, 48-52].

[

21-23]. Given the well-known responsibility of the virus in

causing respiratory diseases, it only affects some of its hosts'

lungs and causes mild, severe or critical symptoms, depending

on the host body. The incubation period of the virus is reported

to range from 2 and 14 days; a period when, on average, every

person has the potential to spread the infection to 2.2

individuals, explaining the virus's widespread dissemination

[

24-26]. However, the mortality rate of COVID-19 is less than

that of SARS and MERS [24, 26]. The resistance of this virus,

moreover, will decrease at 56 ° C for 30 minutes, as well as at

the presence of 75% ethanol, peracetic acid and chlorine-

containing solutions [27].

The Main Transmission Ways and Some

.2 Some Solutions to Reduce Virus Transmission

Given that early detection of infection can prevent further

Prevention Solutions

.2 Airborne Droplets

transmission of the disease, effective strategies in areas are as

follows: specimen collection environment, collectors, sampling

methods and specimen management. Such strategies can

reduce the risk of infection with this virus. Designing special

rooms for nasopharyngeal swab sampling, installation of air

conditioning systems, use of ultraviolet air purifiers,

disinfection of medical devices, desired surfaces, floor, walls

with 1000 mg solution / L chlorine-based and places that come

in contact with the discharge from the body of infected people

such as saliva, vomiting should be dried first with a clean cloth

and then with a clean cloth soaked in 2000 mg / L chlorine-

based solution covered for 30 minutes [53, 54].

One of the main ways, through which this virus is

transmitted is viral droplets caused by coughing and sneezing.

These droplets are often heavy and can be scattered over a

maximum radius of 2 meters [28]. Small virus droplets can

travel up to ten meters and thus transmit the virus from an

infected person to a healthy person. This is considered as one

of the main routes of virus transmission in indoor environments

[

29]. Airborne droplets are the first route of human-to-human

transmission of the virus. Transmission of the virus at a

distance of one meter (about 3 feet) has a higher risk of

transmission. However, the maximum distance required to

transmit the virus is still unknown [30-33].

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 3, Pages: 884-893

Figure 1: The Major Organ Infected with Coronavirus

Due to the persistence of SARS-CoV-2 aerosols in the air

for several hours, the use of air purifiers can be considered as a

complementary measure to prevent the transmission of this

virus. Using HEPA filters can effectively eliminate virus-laden

aerosols. But one problem that has yet to be solved is that the

filters used must be completely disposed of as medical waste or

disinfectant to prevent secondary contamination and re-

transmission of the infection, and the instructions are still there.

Moreover, there are no proper guidelines for addressing this

issue [55-60]. The use of electrostatic air filtration and

purification systems with different technologies including

Kronos Air Technologies can be used to disinfect air. The use

of these systems can be effective in places such as hospitals and

other public facilities [59].

spread, as well as its resultant stress, bring about mental and

spiritual health problems for pregnant mothers. Stress is known

to be a causative agent for preeclampsia, depression, increased

nausea, vomiting, low APGAR score, and preterm labor during

pregnancy. Therefore, the rising prevalence of the virus is

likely to pose many risks to pregnant women in different

countries. Meanwhile, no information is available on the effect

of the virus on pregnancy outcome in the first and second

trimesters of pregnancy, but infection with the virus in the third

trimester of pregnancy appears to increase the risk of premature

rupture of fetal membranes, preterm delivery, and fetal

tachycardia. It has been also reported that the vertical

transmission risk through amniotic fluid, cord blood, and milk

samples are negative. Whether or not the virus can be

transmitted vaginally from mother to fetus has not yet been

confirmed. Moreover, it has not yet been confirmed if the virus

increases the risk of miscarriage and stillbirth. Such

uncertainties and concerns have caused pregnant mothers to

terminate early and elective cesarean delivery. Furthermore, it

should also be noted that, in addition to the above-mentioned

problems, pregnant mothers' continued use of detergents

containing sodium calcium and alcohol detergents can also lead

to poisoning [34-46].

Clinical Symptoms

The clinical symptoms of the virus are similar to those of

SARS and MERS. Also, depending on their host body, the

symptoms range from mild to severe which include fever,

cough, shortness of breath, myalgia or fatigue, sputum

production, headache, hemorrhage, diarrhea, respiratory

distress syndrome (ARDS), heart damage, acute kidney injury

(AKI), septic shock, and increased inflammatory cytokines,

It is noteworthy that the COVID-19 mortality rate among

pregnant mothers has been lower than that of SARS and MERS.

However, no information has yet been confirmed as to the

effect of COVID-19 on the placenta and embryo development,

while SARS has been shown to affect the placenta and to

impose possible limitations on fetal growth (fibrin deposition)

namely, IL2, IL7, IL10, GCSF, IP10, MCP1, MIP1A and

TNFα [28, 29].

The Influence of Race, Age, and Gender on the

COVID-19 Outbreak and Spread

As mentioned above, the coronavirus uses ACE-2 receptors

to enter its host's cells. It is a molecular surface highly

expressed in lung AT2 cells, upper esophageal epithelial cells,

and ilium absorptive enterocytes cells. In addition, the

expression level of ACE-2 is much higher in Asian populations

than in those of the European and American ones. Gender also

affects the expression level of this receptor in such a way that

it has a higher expression level in males than in females [30,

[

37, 47-54]. In general, the data on the impact of COVID-19 on

pregnant mothers and their infants are insufficient and the

reported evidence and results are inconsistent [55]. Meanwhile,

measures which pregnant women are advised to take are as

follows: they should avoid public places as much as possible,

unnecessary travel, and contact with sick people. They should

also observe personal hygiene, use counseling services to

maintain their psychological well-being and prevent stressful

situations. Finally, COVID-19-suspected pregnant mothers

should be isolated. The urgent measures to be taken include

oxygen therapy if needed, monitoring of contraction, as well as

the connection of the fetus and the uterus to them [56, 57].

Additionally, the measures to be taken in order to prevent

the transmission of the virus from the mother to the neonates

1]. In terms of the age group, patients aged 30 to 79 years,

with a mean age of 47, are also more susceptible [32, 33].

Corona Virus in Pregnancy

The weaker immune system during pregnancy makes

pregnant women susceptible to many diseases. The COVID-19

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 3, Pages: 884-893

are to temporarily separate the fetus from the mother for at least

two weeks with no breastfeeding [58]. Also, the factors that can

have an impact on the mother and fetus's rate of infection and

severity are the stage of pregnancy when the mother is infected,

the mother's age, the pregnant mother's diet, differences in

immune response, environment and delivery conditions, and

the effects of the drugs [51].

Disadvantages: Due to insufficient studies and experimental

data, further studies are required to confirm the disadvantages

of laboratory tests [27, 76, 77].

2.9 Molecular Tests (Genomic methods)

Advantages: Nasopharyngeal swab, sputum, secretion of the

lower respiratory tract, blood and feces, out of which the most

common is the nasopharyngeal swab.

Corona Virus in Children

Considering the COVID-19 high contagion level, the

Disadvantages: Due to a detection rate of less than 50%,

repeated testing is required. The most common disadvantage is

nasopharyngeal, but in bronchoalveolar lavage fluid, the higher

is the detection rate, the greater will be the risk of infection

transmission sampling [78, 79]. Although genomic methods of

infection diagnosis can be effective and useful, they are

expensive, especially when used on a large scale. Real-time

reverse transcription-polymerase chain reaction (RT-PCR)

conducted on respiratory tract specimens [39, 80, 81] can be

widely used as the gold standard genomic method, although its

limitations should be taken into account, including a limited

detection window of specimens taken from nasopharyngeal

swabs, false sampling, and sample contamination, which

results in false-positive or false-negative results, difficulty

obtaining samples, sample preparation, time-consuming

procedure, and the lack of diagnostic kits [82-84]. Other

disadvantages of this method in some cases are the need for

long-term transportation, and the use of cold chains or

inappropriate additives that may affect the sample and

subsequently the result [85-87]. If the sample cannot be

collected from the lower respiratory tract or this part of the

respiratory tract does not show symptoms, the upper respiratory

tract may be used to collect the sample. To this purpose, the

sample must be a combination of nasopharyngeal and

oropharyngeal swabs [88].

increase in the number of infected adults has increased the

number of children infected with this virus at the same time

[

29]. Likewise, since the virus can be easily transmitted through

individual contact or through contaminated surfaces, children

can become infected through their parents, and or, with the

entrance of a contaminated child into the school and further

expansion of the community; a stage that could become the

main distributor of COVID-19. Many studies have revealed

that the COVID-19 transmission in children can have a rapid

prevalence and occurrence, but children appear to develop a

milder form of the infection, the so-called "second-generation"

of COVID-19, which is very contagious. [59, 60].

One possible explanation for this mild infection in children

could be that pneumonia occurs when lung tissue is destroyed

and this mechanism can be less effective in children. As a

result, the disease is milder and less fatal in children [61].

Nonetheless, the psychological impact of the virus and its

consequences on children should not be overlooked. The

prolonged confinement at home, fear of infection, hopelessness

and boredom, lack of contact with classmates, friends, and

teachers can be even more problematic and can leave lasting

effects on children and adolescents as many of the issues and

problems an adult faces are deeply rooted in their childhood

[

62, 63].

Corona in the Elderly

The COVID-19 risk of affliction and mortality increases in

.9 The Chest X-ray (CXR)

Advantages: It can show bilateral infiltrates as well as

increased and thickened right lower lung markings, diffuse,

bilateral, reticular, or airspace infiltrates, which, depending on

the patient's history, may be related to bronchitis or pneumonia

the elderly compared to the other groups. As age rises, the

immune system also becomes weaker and more susceptible to

a variety of diseases and infections, accounting for the greater

susceptibility and mortality levels observed in people over 60

years old, especially those with chronic diseases such as

cardiovascular one [64].

[

89, 90].

Disadvantages: Since it is not very sensitive, it is not a good

diagnostic tool in the early stages of the disease as it may show

a normal outcome despite infection and illness in the body[91].

Risk Factors

The COVID-19 risk factors include: allergic diseases such

.9 CT Scan of Chest

as asthma, higher SOFA score, older age, cytokines, and

chemokine response, damage to the epithelium, immune cell

dysfunction, genetic predisposition, higher d-dimer, COPD,

smoking behavior, kidney disease, hypertension, diabetes,

gender, heart disease, coronary and lung disease, exposures

Advantages: CT scan imaging is a non-invasive, first-line

imaging technique in screening, detection, monitoring and

supervising during treatment. Additionally, compared to other

methods, it also has fewer limitations [92]. Analysis of some

observations from the chest CT scan has shown that, because

of its high sensitivity, this imaging technique can be useful in

early detection of disease. Furthermore, some even believe that

CT scans are more sensitive than PCR [93]. CT images taken

from patients show ground-glass opacity, bilateral patchy

shadows and bilateral pleural effusions [25]. As mentioned

above, the symptoms of the virus in children are milder than in

adults, which is shown by the CT scans as the CT findings are

the modest [94, 95]. The results of the observations from CT

images also indicate the severity of the disease [96-98].

Computed tomography (CT) can be used as the first and fastest

reference for diagnosis, especially in cases where the person

under examination is suspected to be clinically symptomatic,

thus leading to the initiation of the measures and treatments

needed to treat the individual in the shortest possible time [99].

[

65-74], recent surgery or chemotherapy, cancer. especially

lung cancer [75], the interval between the onset and

exacerbation of symptoms until hospital admission, populated

communities, and crowded places [25] .

Diagnosis

.9 Laboratory tests

Advantages: Lymphocytopenia, CRP, LDH, leukocytopenia,

all of which are manifestations of pulmonary virus infection,

were increased in patients undergoing laboratory tests.

Lymphocytopenia can be used as an indicator of infection with

COVID-19 in the clinic. C-reactive protein, erythrocyte

sedimentation rate, lactate dehydrogenase, and a prolonged

prothrombin time can also be measured.

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 3, Pages: 884-893

Disadvantages: Even though a computed tomography (CT)

scan of the chest is definitely the most useful method of

pneumonia diagnosis, it is risky for pregnant women as the

fetus is exposed to X-rays. If CT scan is performed, it should

be done in a way that minimizes radiation and therefore reduces

damage to the fetus [100]. Fig.2 shows these diagnostic

pathways. Is there any association between results obtained

from RT-PCR and CT scans? And is the sole using one of these

two tests alone sufficient to fully diagnose the disease?

According to the observations made so far computed

tomography imaging can be performed as the first line of

diagnosis and monitoring. In some cases, despite the negative

results of RT-PCR, CT scan of chest imaging shows evidence

of virus infection, especially in patients with early-stage

disease [101]. If the RT-PCR test results are negative, it is best

to use a set of factors including exposure history, symptoms,

typical CT imaging features, and clinical diagnosis [99].

One possible reason for the fact that RT-PCR results are

shown to be negative at an early stage may be the probable

kinetics of SARS-CoV-2 since the incubation period of the

virus is approximately six days (from 2 to 11 days) and the

average time for the onset of symptoms and hospitalization is

about seven days (4-8 days) and the average duration of

symptoms is about 13 days (24-5) [102-104]. What has recently

been approved by the Food and Drug Administration (FDA) is

that a negative result of RT-PCR testing as a single element

cannot completely rule out SARSCoV-2 infection and that

repeated testing is required, especially with samples derived

from nasopharyngeal and oropharyngeal swabs. Finally, it can

be said that the best way to diagnose this viral infection is

incorporating all of the listed cases: RT-PCR (repeat if negative

in suspected patients) + clinical evidence (probability of

exposure, signs, symptoms (+ CT scan of the chest [105, 106].

[114-116]. Nelfinavir, pitavastatin, perampanel, and

praziquantel may also be effective against this virus [117].

Kaletra is also an effective anti-HIV drug recently

recommended for the treatment of this virus. The use of

interferon in viral infection can also be effective, though it has

a controversial result. Penciclovir, nitrazine, nalfamusta,

redexivir (GS-5734) and favivir (T-705) can also be effective

in the treatment of this viral infection [118-123]. Arbidol,

darunavir, cobicistat, polyclonal IgG immunoglobulin (SAB-

301) are also recommended [81, 124]. Niclosamide reduces

virus function in infected cells and is dose-dependent [125] and

glycyrrhizin also prevents virus uptake and infiltration at the

early stages of virus replication [126] as well as shown in vitro

to inhibit the reproduction of SARS-CoV2, whereas IFN-α is

an antiviral used to treat hepatitis [127]. Similarly, imatinib is

shown to be effective in the treatment of SARS-CoV-2 viral

infections by preventing endosomal membrane virions [128].

Other sets of drugs including saquinavir, carfilzomib,

atazanavir, tipranavir, fosamprenavir, enzaplatovir, presatovir,

abacavir, bortezomib, elvitegravir, maribavir, raltegravir,

montelukast, deoxyrhapontin, polydatin, chalcone, disulfiram,

carmofur, shikonin, ebselen, tideglusib, PX-12, TDZD-8,

cyclosporin A, cinanserin , as well as some Chinese herbal

remedies such as Rhizoma Polygoni Cuspidati and Radix

Sophorae Tonkinensis may have effective compounds against

SARS-CoV-2 [129]. Shufeng Jiedu Capsule (SFJDC) and

Lianhuaqingwen capsules are also two Chinese medicines

shown to play a significant role in both prevention and

treatment of this viral infection, although further studies and

tests are required to prove their functioning. [130, 131].

As mentioned above, SFJDC, a traditional Chinese

medicine for the treatment of influenza, is also recommended

to be used for SARS-CoV-2 viral infection [132]. Nitazoxanide

is an antiprotozoal agent that potentially inhibits certain

viruses, including 2019-nCoV [123]. Losartan, Telmisartan,

Olmesartan are drugs used to control high blood pressure and

kidney disorders, which can be used to control blood pressure

in patients hospitalized with SARS-CoV-2 infection [133,

0 Treatment

In this field, isolation is the first step to prevent the

transmission of the disease to other people. Other preventive

measures are the use of masks, adequate rest, ventilation of

rooms, the use of oxygen when needed, controlling fever and

cough, no use of antibiotics and routine antivirals such as

oseltamivir in cases where SARS-CoV-2 infection is diagnosed

by diagnostic methods. Although using corticosteroids has not

yet been confirmed to cure the infection, low to moderate doses

of these drugs for a short period are recommended by Chinese

doctors. To date, there is generally no approved treatment,

however, antiviral drugs such as ribavirin, lopinavir-ritonavir,

administered to treat SARS and MERS, have also been used

34]. Some drugs are also used to treat SARS-CoV-2 virus

infections during pregnancy including Kaletra (lopinavir and

ritonavir), remdesivir and chloroquine. Given the current

situation and the very sensitive status of pregnant mothers, it

seems reasonable to use these drugs. Although there is no

definitive cure for this viral infection and more evidence is

needed to confirm it, the current sensitive conditions partially

justify their use for pregnant women [55]. In addition to the

above-mentioned drugs that are against viral infection caused

by COVID-19, proper nutrition and strengthening the immune

system can also play a major role in preventing and combating

the virus and the resultant infection. Use of vitamins, namely,

A, B, C, D, E, omega‐3, polyunsaturated fatty acids (PUFA),

selenium, zinc, and iron, all help strengthen the immune system

and can play a major role in preventing and also helping to cure

this viral infection [135, 136]. There have been several attempts

to develop a vaccine against the COVID-19 virus, however, an

estimated 18 months are required for the vaccines to be

accessible as put by the WHO [137].

[

24, 107-109]. Remdesivir has also been used to treat this viral

infection with good results [110]. Researchers believe that, in

addition to antiviral and antibiotic interventions, neuraminidase

inhibitors, RNA synthesis inhibitors can also be effective in the

treatment of this viral infection. Nucleoside analogues and

HIV-protease inhibitors can also be used to reduce viral

infection [111]. Moreover, 75mg oseltamivir, 500mg lopinavir,

00mg ritonavir orally and twice daily as well as 0.25g

ganciclovir were used intravenously for 3 to 14 days [112].

Also, the EIDD-2801 compound with the potential to

counteract seasonal and pandemic influenza virus infections

can also be taken to fight SARS-CoV-2 viral infection [113].

Chloroquine, a drug widely used in the treatment of

malaria, is reported to have a wide application in the treatment

of patients with SARS-CoV-2 viral infections with good

results. Chloroquine and hydroxychloroquine have very mild

side effects such as cardiovascular disorders due to its narrow

window of treatment, accordingly the use of this drug should

be strictly regulated and not recommended for self-treatment

Several research groups have been working to develop the

vaccine in the very weeks following the outbreak of COVID-

9 viral infection. To achieve this objective, the selection of the

target antigen and vaccine substrate is likely based on studies

conducted on the vaccines developed for SARS-CoV and

MERS. The factors to be taken into account in the development

of the COVID-19 vaccine are target antigen(s), immunization

route, correlated-immune protection, animal models,

scalability, production facility, target product profile (TPP),

outbreak forecasting and target population [2, 138].

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 3, Pages: 884-893

Figure 2: Illustrates Ways to Detect Coronavirus

1 Conclusion

Authors’ contribution

All authors of this study have a complete contribution for

data collection, data analyses and manuscript writing.

Depending on its host body immune system, its rate of

infection and its severity, the 2019-nCoV virus is divided into

three mild, acute, and critical categories. According to the

observations, this virus is relatively moderate in children and is

critical and acute in the elderly. Some risk factors including

age, gender, race, exposure, etc., can also impact its prevalence

and severity. CT scans are believed to be among the best

diagnostic tools in the early stages of the disease. To date, the

best treatments used include general treatments, nutritional

treatments, and medications. It should be noted that a definitive

cure for the virus and its resultant infection has not yet been

identified.

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