SARS-CoV-2 Infection, Inflammation, Immunonutrition, and Pathogenesis of COVID-19.

The COVID-19 pandemic, caused by the coronavirus, SARS-CoV-2, has claimed millions of lives worldwide in the past two years. Fatalities among the elderly with underlying cardiovascular disease, lung disease, and diabetes have particularly been high. A bibliometrics analysis on author's keywords was carried out, and searched for possible links between various coronavirus studies over the past 50 years, and integrated them. We found keywords like immune system, immunity, nutrition, malnutrition, micronutrients, exercise, inflammation, and hyperinflammation were highly related to each other. Based on these findings, we hypothesized that the human immune system is a multilevel super complex system, which employs multiple strategies to contain microorganism infections and restore homeostasis. It was also found that the behavior of the immune system is not able to be described by a single immunological theory. However, one main strategy is "self-destroy and rebuild", which consists of a series of inflammatory responses: 1) active self-destruction of damaged/dysfunctional somatic cells; 2) removal of debris and cells; 3) rebuilding tissues. Thus, invading microorganisms' clearance could be only a passive bystander response to this destroy-rebuild process. Microbial infections could be self-limiting and promoted as an indispensable essential nutrition for the vast number of genes existing in the microorganisms. The transient nutrition surge resulting from the degradation of the self-destroyed cell debris coupled with the existing nutrition state in the patient may play an important role in the pathogenesis of COVID-19. Finally, a few possible coping strategies to mitigate COVID-19, including vaccination, are discussed.

SARS-CoV-2 Lambda (C.37): An emerging variant of concern?

Many SARS-CoV-2 variants have high infectivity and transmissibility. The viral genome data show that the COVID-19 curves of daily case numbers were shaped by the emergence of the variants, including Alpha 202012/01 GRY (B.1.1.7; the U.K.), Beta GH/501Y.V2 (B.1.351, B.1.351.2, and B.1.351.3; South Africa), Gamma GR/501Y.V3 (P.1, P.1.1, and P.1.2; Japan, Brazil), Eta G/484K.V3 (B.1.525; Nigeria, the U.K.), Delta G/478K.V1 (B.1.617.2, AY.1, AY.2, and AY.3; India), Iota GH/253G.V1 (B.1.526; the U.S.A.), and Kappa G/452R.V3 (B.1.617.1; India). The Lambda (C.37) variant was reported in Peru initially; this has spread to 41 countries in four continents. Seven out of eight mutations in this variant are associated with the viral spike protein, akin to mutations in the other variants. These mutations have implications for effectiveness of the vaccines and neutralizing antibodies in immunized subjects and those previously infected with the virus and are thought to facilitate the viral invasion into host cells and help the virus evade the host immune system. Widespread dissemination of the viral variants may cause severe clinical consequences, lengthy hospitalizations, and unfavorable prognoses. Healthcare systems will be stretched, and health workers will be fatigued. Fast, equitable, and widespread vaccination with strict adherence to hygiene protocols will control the rising curves of the pandemic due to the new variants.

Implications of the Emergence of a New Variant of SARS-CoV-2, VUI-202012/01.

Twelve months after the realization that SARS-CoV-2 caused a respiratory syndrome in Wuhan, China, with the constantly worsening COVID-19 pandemic and economic crisis globally, and with international news of vaccine development, a new viral variant, referred to as "SARS-CoV-2 VUI-202012/01" or "B.1.1.7" has been reported in London and southeast England. The variant may have emerged in late September 2020 and carries some 17 mutations. Whether a single or a combination of different mutations would change the viral transmissibility, virulence, clinical and epidemiological presentations, or vaccine efficiency is unknown. Transmission by asymptomatic carriers of the new variant is also unknown. Mutation pressure by antiviral agents or vaccines have not yet been induced; however, additional mutations are expected following global vaccination and, later, after administration of validated treatments. Thus, preparedness for fast emergence of new variants is prudent. One can also expect less virulent but highly transmissible variants, which could facilitate herd immunity. Development of clinical and rapid laboratory tests is required to follow up the vaccinated individuals for a secondary infection potentially by the new variant. Importantly, restrictive countermeasures, personal hygiene, face-masking, spatial distancing, and travel bans remain pertinent in fighting the virus.

Criticality of physical/social distancing, handwashing, respiratory hygiene and face-masking during the COVID-19 pandemic and beyond.

Physical/social distancing, handwashing, respiratory hygiene and face-masking have been recommended as realistic counterstrategies to control the COVID-19 pandemic. These strategies have been critical in the fight against the present pandemic in many countries. Here we detail the background to such countermeasures, present some examples in different settings and finally emphasise that they should remain in place worldwide as a cultural and behavioural "new normal" until a vaccine or a decisive treatment for COVID-19 is developed and made available globally.

Tackling the COVID-19 Pandemic.

After the initial outbreak of the SARS-CoV-2 epidemic (now called COVID-19)-in Wuhan, China-and its subsequent fast dispersion throughout the world, many questions regarding its pathogenesis, genetic evolution, prevention, and transmission routes remain unanswered but fast explored. More than 100,000 confirmed, infected cases within a relatively short period of time globally corroborated the presumption that a pandemic will develop; such a pandemic will require a suite of global intervention measures. Consequently, different countries have reacted differently to the COVID-19 outbreak, but a uniform global response is necessary for tackling the pandemic. Managing the present or future COVID-19 outbreaks is not impossible but surely difficult. Barring the live-animal trade at the markets; revising the regulations and rules of customs, import or export across borders; supporting and expediting projects to develop vaccines and antiviral drugs; immediate quarantine of the involved regions; and also producing and supplying a large number of protective facemasks and preventing its stockpiling or smuggling are the main actions suggested to deal with the present or a forthcoming COVID-19 outbreaks. Increasing numbers of infected cases had heightened concerns about the public health and welfare. Thus, preparing for the next probable pandemic of COVID-19 demands scrutinization of the lessons we have learnt so far.