ABSTRACT
The resurgence of the Covid-19 epidemic in the fall of 2020 in France and in many countries around the world raises many questions. The situation of SARS-CoV-2 infection in France after the first epidemic wave in spring 2020 approximatively indicates more than 30,000 deaths, 3 to 4 millions people infected, 50% asymptomatic infections. These data encourage us to modify the initial perception of this infection, which was imagined to be benign, with massive, homogeneous and rapid distribution ("tsunamic"), and comprising a large majority of asymptomatic forms. This invites us to reassess the hypothesis of a major role of superspreaders in the spread of the infection, which would be more limited and discontinuous ("saltatory") than expected, as for SARS-CoV-1 and MERS-CoV. The role of viral load in the transmission and clinical expression of infection also needs to be assessed. To fight against the spread of the epidemic, generalized confinement a posteriori appears to have a disproportionate cost compared to its effectiveness, whereas the application of barrier gestures (breathing mask, hand hygiene, social distancing) should be promoted without any restriction, along with the diagnosis and temporary isolation of infected persons. While the Covid-19 epidemic is a medical challenge for human societies, it is also a moral challenge that they may not ignore.
Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Antiviral Agents/therapeutic use , COVID-19/prevention & control , COVID-19/therapy , COVID-19/transmission , COVID-19 Testing , COVID-19 Vaccines , Combined Modality Therapy , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , France/epidemiology , Hand Hygiene , Humans , Masks , Nasal Mucosa/virology , Oxygen Inhalation Therapy , Physical Distancing , Quarantine , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology , Seasons , Severe Acute Respiratory Syndrome/epidemiology , Social Change , Social Values , Virus Replication , COVID-19 Drug TreatmentABSTRACT
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is a coronavirus responsible for COVID-19 (coronavirus disease 2019) which resulted in a cluster of cases of pneumonia that originated in China around 31 December 2019 and has subsequently spread across the globe. Currently, COVID-19 represents a health emergency worldwide, leading, in severe cases, to pneumonia, severe acute respiratory syndrome, multiorgan dysfunction or failure, and death. In the context of limited scientific knowledge and evidence of SARS-CoV-2 infection, guidance is becoming increasingly necessary for pathologists who have to perform postmortem investigations on COVID-19 cases. The aim of the present report is to share a procedure applicable to cases of COVID-19-related death, particularly in cases of death without medical intervention and in the absence of an ascertained SARS-CoV-2 infection and/or COVID-19 diagnosis, therefore providing support for diagnostic activity in the present COVID-19 pandemic. For this purpose, a standard operating procedure for correct swab collection, autopsy investigation and tissue sampling is provided.
Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Forensic Sciences/standards , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Respiratory System/virology , Specimen Handling/standards , Virology/standards , Autopsy , COVID-19 , Cause of Death , Coronavirus Infections/pathology , Coronavirus Infections/virology , Host Microbial Interactions , Humans , Italy , Pandemics , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Predictive Value of Tests , Respiratory System/pathology , SARS-CoV-2ABSTRACT
The ongoing outbreak of the coronavirus disease 2019 (COVID-19) as named by the World Health Organization has millions of confirmed cases around the world and has claimed hundreds of thousands of lives. The virus was named SARS-CoV-2 in February by International Committee on Taxonomy of Viruses. COVID-19 presents as fever, dry cough, dyspnea, headache and pneumonia. In a small subset of severe cases, the disease quickly progresses to respiratory failure and even death. Since the 21st century, there have been three major outbreaks caused by human coronaviruses, including the severe acute respiratory syndrome (SARS) that broke out in 2003, the Middle East respiratory syndrome (MERS) in 2012, and the recent pandemic of COVID-19. Since 2003, significant progress has been made in the study of SARS-CoV and MERS-CoV concerning their natural origins, pathogenesis, antiviral development and vaccine design. Since SARS-CoV-2 and SARS-CoV are closely related, previous findings on SARS-CoV are highly relevant to a better understanding as well as diagnosis, treatment, prevention and control of SARS-CoV-2. In this review, we highlight recent progresses in the field; compare the biological characteristics of SARS-CoV and SARS-CoV-2; summarize the urgently-needed diagnostic, treatment, prevention and control options; and provide future perspectives for the outcome of the outbreak and research questions to be answered, including some of the difficulties in vaccine development. Hopefully, our comments and suggestions would prove useful for the control of the SARS-CoV-2 epidemic in China and the world.