5 24 21 Summary Corona Virus Update by H. Robert Silverstein, MD, FACC for the Preventive Medicine Center Clyde W. Yancy, MD, Vice Dean for Diversity and Inclusion Chief of Cardiology in the Department of Medicine, Feinberg School of Medicine at Northwestern University in Chicago Clyde W. Yancy, MD: “I’m exhausted by the stress; disheartened by the toll on human life; concerned deeply about the exposure to healthcare workers- BUT, I am emboldened by the display of courage, selflessness, compassion, and sacrifice that I see in physicians, nurses and health care workers across the country.” “It is not a case of ‘don’t confuse me with the facts’, but the best clinical insights exceed so called knowledge by at least one step.” History, precedents, similarities, virus structure and invasion, pathology, physiology, lethality vs safety in perspective, China, geography, EU vs USA comparison, time-line, media, politics, pandemic modelling, symptoms, lockdown, economics, joblessness, vascular-platelet-glycocalyx clotting, testing, ventilators, medications, vaccines, supplements, diet: This 2019 corona virus CoV2-19 is an entirely new RNA virus with 30 proteins. Corona viruses have the largest known viral genome. The RNA of a corona virus is single-stranded. The word 1 “VIRUS” means “poison.” A human cell has 20,000 different proteins. Being an RNA virus, it is similar to hepatitis C; it is not a DNA virus like hepatitis B. There are 200 viruses that can cause the common cold and several of these are corona viruses. “Corona” is Latin for “crown” which is how the virus looks in the microscope as if it has an encircling crown. The specific CoV2-19 genetic RNA fact and its “SPIKE” projections will affect anti-viral treatment design and decisions. That virus spike binds to and fuses with host cells. “The SARS-CoV-2 spike protein trimer is only ~10nm in size (1/100,000 of a millimeter) and there are approximately 100 of these on the surface of a single viral particle, which itself is about 100 nm in diameter.” CoV2-19 was detected by it having a new genetic sequence as recognized by GenBank—it may have been around for a thousand years, but it is just now discovered. The Chinese symbol for it is pronounced “wayGee” and means both “crisis” and “opportunity”: two sides of the same coin. The first known novel and important coronavirus was called SARS = Severe Acute Respiratory syndrome. There are only 2 known previous serious corona virus outbreaks: SARS and Middle East respiratory syndrome = MERS, the latter epidemic was smaller, but with a 1/3 (33%!) death rate! A REMARABLY lucid and up-to-date VIDEO explanation of of corona virus variants, there genetic make-up, infectivity, and epidemiology. BASIC RESEARCH by Jeremy Kamil of Louisiana State University as of 3/34/21. In case the link does not work, go to VuMedi to view this: https://www.vumedi.com/video/convergent-evolution-in-sars-cov-2-what-do-7-of-the-emerging- variants-have-in-common-is-the-virus-ru/?token=64cc855f-7b31-4533-bfeb- bdf40e2f7c7f&utm_source=COVID%20Interests %20Criteria_79170&utm_medium=Video&utm_campaign=%2803/29%20covid %29%20Convergent%20Evolution%20in%20SARS-CoV-2%3A%20What%20Do%207%20of %20the%20Emerging%20Variants%20Have%20in%20Common%3F%20Is%20the%20Virus %20Running%20Out%20of%20New%20Major%20Adaptions%3F&utm_content=Convergent %20Evolution%20in%20SARS-CoV-2%3A%20What%20Do%207%20of%20the%20Emerging %20Variants%20Have%20in%20Common%3F%20Is%20the%20Virus%20Running%20Out %20of%20New%20Major%20Adaptations%3F&utm_term=COVID- 19%20Prevention&link_data=eyJidWxrX21haWxfYWN0aW9uIjoiYyIsInJlY2lwaWVudF9pZC I6MTE4MzMwNTA3OSwibWFpbF9pZCI6NzkxNzB9%3A1lQte7%3AUmkEMNQUCzMTwB 3o3t9K1bhcuQo&mail_id=79170 This Covid-19/CoV2-19 corona virus was originally named for its site of ORIGIN (Wuhan, China) as was the Ebola (a river in Zaire) virus, German measles, Rocky Mount spotted fever, Norovirus (Norwalk, Connecticut), and Spanish flu, etc. Corona virus-19/CoV2-19 was first documented mid- November, 2019, in China. Although the Chinese government stated that the virus originated in the United States, almost certainly it originated in either what is called a live or “wet” market where wild animals are sold for food in Wuhan, China, or the virus escaped the research Wuhan National Biosafety 2 Laboratory close to Wuhan, China: the latter is considered a reasonable possibility. In Practice Update b1/29/21 by Jonathan Temte, MD, PhD-condensed by HRS SARS-CoV-2 Variants and Why They Matter A concise overview of viral “variants”, has been provided by Lauring and Hodcroft.1 Mutation within a genome is the rule and not the exception, and that rates of change are governed by internal (biochemical) and external (selection) processes. Coronaviruses—by the very nature of their RNA-based genome—have an intrinsically higher rate of mutation than DNA-based viruses. That said, they manifest a lower rate of mutation than influenza viruses due to the presence of genetic code for an enzyme that corrects some transcription errors. Understanding the nomenclature of a changing genome: Mutation is any substitution in a nucleotide within genome sequence o can result in an amino acid change in protein synthesis o can be neutral without affecting the protein structure Variant describes a group of viruses with change in the genomic sequence o can involve a single mutation or many mutations Strain is used to describe a variant that imparts a phenotypic change in a virus o transmissibility o virulence (higher morbidity or mortality) o antigenicity As variants arise, other forces come into play. Arriving in a population with high susceptibility, there can be the “founder effect,” wherein the variant takes off as the only virus around. Natural selection can favor viruses with higher transmissibility, or the ability to escape from existing host immunity. Purifying selection results in the removal of mutations that are deleterious in hosts. The concerned is mainly about those strains that have the potential to be more transmissible, have higher virulence, or alter the immune response gained from previous infection or vaccination. Three strains have come under scrutiny lately.2 In addition, all three have now been identified in the United States: UK (B.1.1.7) appears to have emerged with a large number of mutations in southeastern UK and has spread rapidly, implying heightened levels of transmissibility. South Africa (1.351) has multiple mutations in the spike protein, the antigenic basis for current vaccines. Brazil (P.1) emerged with 17 unique mutations, including three in the receptor-binding domain of the spike protein 3 1. Lauring AS, Hodcroft EB. Genetic variants of SARS-CoV-2—what do they mean? [published online ahead of print, 2021 Jan 6]. JAMA. 2021 Jan 6. doi: 10.1001/jama.2020.27124. Online ahead of print. https://jamanetwork.com/journals/jama/fullarticle/2775006 2. CDC. Emerging SARS-CoV-2 variants. Updated January 15, 2021. https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/ scientific-brief-emerging-variants.htm “Characteristics of, and Important Lessons From, the Coronavirus Disease 2019 (CoV2-19) Outbreak in China: Summary of a Report of 72,314 Cases From the Chinese Center for Disease Control and Prevention. By Zunyou Wu, MD, PhD. The Chinese Center for Disease Control and Prevention recently published the largest case series to date of coronavirus disease 2019 (COVID-19) in mainland China (72 314 cases, updated through February 11, 2020).1This Viewpoint summarizes key findings from this report and discusses emerging understanding of and lessons from the COVID-19 epidemic. Epidemiologic Characteristics of the COVID-19 Outbreak. Most case patients were 30 to 79 years of age (87%), 1% were aged 9 years or younger, 1% were aged10 to 19 years, and 3% were age 80 years or older. Most cases were diagnosed in Hubei Province (75%)and most reported Wuhan-related exposures (86%;ie, Wuhan resident or visitor or close contact with Wuhan resident or visitor). Most cases were classified as mild (81%; i.e., non-pneumonia and mild pneumonia). However, 14% were severe (i.e., dyspnea, respiratoryfrequency30/min, blood oxygen saturation93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, and/or lung infiltrates >50% within 24 to 48 hours), and 5% were critical (ie, respiratory failure, septic shock, and/or multiple organ dysfunction or failure) (Box).1The overall case-fatality rate (CFR) was 2.3% (1023 deaths among 44 672 confirmed cases). No deaths occurred in the group aged 9 years and younger, but cases in those aged 70 to 79 years had an 8.0% CFR and cases in those aged 80 years and older had a 14.8% CFR. No deaths were reported among mild and severe cases (HRS FINDS THE LATTER STATEMENT A BIT UNBELIEVALBE OR IS A TYPING ERROR FOR “NON-SEVERE”). The CFR was 49.0% among critical cases. CFR was elevated among those with preexisting comorbid conditions—10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for hypertension, 5.6 % for cancer & 3.8% for health care workers. 5/29/20 A S Zubair JAMA Neurol “Currently, there are 7 Corona viruses that can infect humans, including human coronavirus (HCoV)–229E, HCoV-NL63, HCoV- HKU1, HCoV-OC43, MERS-CoV, SARS-CoV-1, and SARS-CoV-2.8 Beta coronaviruses SARS-CoV-2, SARS-CoV-1, and MERS-CoV are associated with severe disease in humans.1,3,8 Although HCoV are typically associated with respiratory tract disease, 4 3 HCoV have been shown to infect neurons: HCoV-229E, HCoV-OC43, and SARS- CoV-1.” Medical Xpress 7/14/20: “An estimated 60% of known infectious diseases and 75% of all new, emerging, or re-emerging diseases in humans have animal origins. SARS- CoV-2 is the newest of seven coronaviruses found in humans, all of which came from animals, either from bats, mice or domestic animals.