1. Introduction
Epidemic outbreak of a viral disease is a curse for human civilization and represents a serious issue to public health. In last two decades, several viral diseases have been reported such as the Ebola, Swine flu, Bird flu, Hanta virus, H1N1 influenza and severe acute respiratory syndrome coronavirus (SARS-CoV) 1. Among all viral outbreaks, epidemic of SARS-CoV has been more severe and shown to have high transmission rate. SARS is a zoonotic disease caused by SARS-CoV2, first emerged in China in 2002 and later it was reported in other parts of the world in 2003 and affected 8,908 people with 9.6% fatality rate. Similarly to new COVID-19, the nosocomial transmission of SARS-CoV was related with travel history. The primary reservoir is also suspected through bats, although unproven and more intermediary source also suggested transmission via civet cats in the wet markets in Guangdong3. MERS (Middle East respiratory syndrome), a novel lethal zoonotic disease of humans caused by another member of corona virus family i.e. MERS-CoV. Humans are thought to acquire MERS-CoV infection through contact with camels or camel products with a fatality rate of 35% while nosocomial transmission is also a hallmark 4. In late 2019, the recent outbreak of a novel human coronavirus (beta-coronavirus) that is now termed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or HCoV19 or COVID-19) has reported in Wuhan, China, which announced as a pandemic by World Health Organization (WHO) 5. On December 2019, WHO office of China perceived 29 cases of pneumonia like disease in Wuhan, however they unable to identify the causative agent, and classified it as "pneumonia of unknown etiology." The Chinese Center for Disease Control and Prevention (CDC) had organized an intensive outbreak investigation program6 and now the etiology of this illness has attributed to a novel virus belonging to the coronavirus (CoV) family, COVID-19.
1.1 Primary findings and scientific features of COVID-19:
Corona viruses (CoV) have become the major pathogens of emerging outbreaks of respiratory disease. They are a large family of single-stranded RNA viruses (+ssRNA) that can be isolated in different animal species7. For reasons yet to be explained, these viruses can cross species barriers and cause human illness ranging from common cold to more severe diseases such as MERS and SARS. The most common symptoms include fever, cough, and shortness of breath, while muscle pain, sputum production and sore throat are less common8, 9. In January 2020, pathogen of several groups of patients with lower respiratory tract infection was isolated and identified as novel coronavirus (2019-nCoV) through unbiased sequencing and other scientific techniques 10. The reported genomic studies showed that identified 2019-nCoV have similarity with SARS-CoV which was found in bats. Furthermore, it suggested that angiotensin-converting enzyme II (ACE-2) is a possible target receptor for this novel virus to enter inside the cell11-14. The most affected organ by COVID-19 is lungs which have most abundant ACE2 receptor in the type II alveolar cells. . The virus uses a special surface glycoprotein, called "spike", to connect to ACE2 receptor and enters the host cell15. Incubation period of the COVID 19 is 2-14 days. However, a case with an incubation period of 19 days was observed in a JAMA study of 5 cases and published on Feb. 2116. In addition on Feb. 22, a case with an incubation period of 27 days has been reported by Hubei Province local government 17. Hence, virus should be differentiated from the common cold by clinical presentations and available test parameters. There are some unique features for COVID-19 such as persistent antigenic changes and cause severe pneumonia and multi-organ failure which may leads also mortality18. Aim of this review is to provide the literature of early findings on the clinical manifestation, epidemiology, causes, transmission, clinical diagnosis, as well as prevention and control of COVID-19. This review can deliver evocative information to policy makers and governments in decision to make strategies for handling this pandemic at community, national, and international levels.
2.0 Global COVID 19 Burdens and Mortality
Globally, the incident rate of COVID-19 is increasing very rapidly. Total 2,285,210 positive corona cases with 155,124 deaths have been reported in 206 countries till April 20, 202019. Although, average rate of death per number of diagnosed cases is 4.1%.Furthermore, it ranges from 0.2% to 15% depending on age and other health problems20. The mortality rate was reported 4.9% in Wuhan, 3.1% in Hubei Province, and 2.1% throughout the China 21. After China, USA, Italy, Spain, France, Germany and Iran have emerged as epic centers of COVID 19 and transmitted to other countries with an alarming high rate (Fig-1). In USA 723,605 confirm positive cases and 34,203 death were reported followed by Spain 191,726 and Italy, 115,242 positive corona virus cases and 20,043 and 23,227 death have been found till April 20, 2020. The average of death rate in Italy seems to be very high in comparison to any other country22.