CORONAVIRUS
Resti Yudhawati
DEPARTMENT OF PULMONOLOGY AND RESPIRATORY MEDICINE
FACULTY OF MEDICINE AIRLANGGA UNIVERSITY
• The name
“coronavirus,”
coined in 1968, is
derived from the
“corona”-like or
crown-like
Weiss SR and Martin SN, 2005
RNA VIRUS
INFLUENZA PANDEMI
SARS-CoV, MERS-CoV,
2019-nCoV
,
Cahscient.fies.eordpress.com/2008/textbook-mikrobologi15.doc 3
Orthomyxoviridae Coronaviridae
- Ada 3 stubtipe (influenza A, B, C) Virus 229E, OC43, NL63, HKU1 menyebabkan gejala
URI relatif ringan
Pandemik: Epidemik
influenza A: 2002 – 2003
1918 (H1N1) Novel coronavirus
Flu Spanyol , 100 juta kematian disebut:
1957 (H2N2) SARS-CoV 8098 kasus, 774 kematian
Asian flu, 2 juta kematian 2012-2013
1968 (H3N2) Novel coronavirus,
Hongkong flu, 500 ribu kematian Semenanjung. Arab:
2003 (H5N1) MERS-CoV 2494 kasus, 858 Kematian
China (Avian Influenza), 345 fatal Kematian 2019 -
H1N1 pdm 2009 2019-nCoV (Wuhan CoV) → COVID 2019
USA , 12,469 Kematian
Indonesia → Indonesia → SARS-CoV< MERS-CoV (-)
H5N1 2003 – 2017 Covid 2019 →
(201 kasus, 167 kematian )
H1N1 pdm 2009
TAXONOMY
• Order: Nidovirales
• Family: Coronaviridae
• Genus: Alphacoronavirus, Betacoronavirus,
Gamacoronavirus, Deltacoronavirus
• ssRNA positive-strand virus
• Mammals ( humans, bats, cows, pigs)
Coronaviruses • Birds, chickens
Zoonosis
Alpha coronavirus
• Type Species : Human coronavirus 229 E, miniopterus Bat
coronavirus HKUB
Beta coronavirus
• Type Species : SARS CoV, MERS CoV, Human coronavirus
OC43, Wuhan coronavirus (2019-nCoV)
Gama coronavirua
• Type species: Avian corona virus, duck coronavirus
Delta coronavirus
• Type species: Bulbul coronavirusHKU11, Munia coronavirus
Classification of human coronavirus.
Alphacoronavirus Betacoronavirus
Lim et al, 2016
• 2019- novel Cov Beta coronavirus → COVID 19
Human coronaviruses
(HCoVs)
• HCoVs have long been considered inconsequential
pathogens, causing the “common cold”
• 21st century, 2 highly pathogenic HCoVs—(SARS-
CoV) and (MERS-CoV) emerged from animal
reservoirs to cause global epidemics
• December 2019, novel coronavirus (2019-nCoV), was
recognized in Wuhan, China, and has caused serious
illness and death
Paules et al, 2020
1. Human coronavirus 229E (HCoV-229E)
2. Human coronavirus OC43 (HC0V-OC43)
3. SARS-CoV
4. Human coronavirus NL63 (HCoV-NL63,
New Haven coronavirus)
5. Human coronavirus HKUI
6. Middle East respiratory syndrome
coronavirus (NERS-Cov)
7. COVID-19
Structural proteins :
• Glycoproteins spike (S)
• Envelope (E)
• Membrane (M)
• Nucleocapsid (N)
Positive SS RNA
26-32 KB
Animal origins of human coronaviruses
16
Cui et al., 2020
Genome organisation of human coronaviruses (HCoVs)
Lim et al, 2016
Cellular Receptor
• CoV infection is initiated by the attachment to specific host
cellular receptors via the spike (S) protein.
• The host receptor is a major determinant of pathogenicity,
tissue tropism and host range of the virus
Lim et al, 2016
SARS-CoV MERS-CoV
Jia
Cui et al., 2020 Cui et al., 2020
Respiratory epithelia , renal and Lower airway, gastrointestinal tract
cardiovascular tissue, and epithelia of and kidney
the small intestine Paules et al, 2020
Jia et al, 2005
Pneumonia, diarhea, kidney injury
Pneumonia, diarhea, kidney injury,
Acute cardiac injury
Coronavirus replication cycle
Cui et al., 2020
MERS-CoV : SARS-CoV
• Clinical similarity
• Cause severe illness in people.
• Zoonosis
• Person-to-person transmission appears to be very low
• SARS-CoV rapidly spread across the globe, but not
MERS-CoV
,
Human Transmission
• Direct exposure (physical contact) → touching, feeding, cleaning,
slaughtering, milking
• Indirect exposure (No physical contact) → visiting exposure areas
(markets, racing tracks, farms)
Novel Coronavirus (2019-nCoV)
(Wuhan Coronavirus)
WHO, Data as reported by 18 February 2020*
Genetically distinct from other
known coronavirus that infect humans
(MERS CoV, SARS CoV)
Zhu N, 2020
• Preliminary analyses indicate that 2019- nCoV has some amino acid
homology to SARS-CoV and may be able to use ACE2 as a
receptor.
Paules et al, 2020
Phylogenetic Analysis of 2019-nCoV and Other Betacoronavirus
Genomes in the Orthocoronavirinae Subfamily
Rhinolophus sinicus
Zhu N, 2020
Coronavirus disease 2019 (COVID-19)
SARS-CORONAVIRUS
SARS-CoV-2 ~ (2002)
COVID 19
How dose 2019-nCoV spread
Huanan seafood
Market
Large seafood market selling
many species of live animals
The reservoir or intermediary →
Suspected Animals sold for food
Natural reservoir
or Intermediate
host ?
96% ~ COVID-19
Natural reservoir
pangolin
Intermediate host
Human to Human spread ??
Human to Human spread
• 20 January 2020 → Human-to-human spread was confirmed in Guangdong
Human-to-human transmission of 2019-nCoV occurs, as evidenced by the
infection of 15 health care practitioners in a Wuhan hospital
Respiratory droplets Receptors binding site
COVID-19
ARDS, Syok septik
• > 60 thn
Gejala (-) • Komorbid
• Immunocompromised
Gejala (+),
demam, batuk, sesak
Clinical features of patients infected with 2019 novel
coronavirus in Wuhan
41 patients confirmed 2019-nCoV
• Underlying diseases (diabetes, hypertension and cardiovascular disease (32%)
• exposed to Huanan seafood market (66%)
• Common symptoms : fever (98%], cough ( 76%), and myalgia/ fatigue (44%);
• Less common symptoms were sputum production, headache, haemoptysis, and
diarrhoea
• Dyspnoea (55%) (median time from illness onset to dyspnoea 8·0 days)
• Lymphopenia. (63%)
• All 41 patients had pneumonia with abnormal fndings on chest CT.
• Complications included ARDS (29%)), aemia (15%), acute cardiac injury ([12]) and
secondary infection (10%).
• Admitted to an ICU (32%), Died (15%)
• Procalcitonin <0·1 ng/mL (69%] Huang Cet al, 2020
Abnormal fndings on chest CT
A B
Huang Cet al, 2020
Severity (COVID-19)
• Illnesses have ranged from infected people
with little to no symptoms to severely ill and
dying.
Ongoing investigations
CDC, 2020
Incubation period
• Current estimates of the incubation period of the
virus range from 2-14 days
• Detailed epidemiological information from more
people infected is needed
• Transmission can occur from asymptomatic
individuals or during the incubation period ??
WHO, 2020
Management
• Supportive Care (Oxygen, Fluid, Ventilator)
• Anti viral are being studied (Chloroquine,
Ritonavir, Remdesivir)
• So far, the fatality rate of 2019-nCoV is lower than
that of SARS-CoV and MERS-CoV; however, the
ultimate scope and effects of the outbreak remain to
be seen.
CDC, 2020
SARS CoV (2002)
8.098 → 774 Kematian (9.6%)
MERS CoV (2012)
2494 → 858 Kematian (34%)
COVID -19
71.429 → 1775 kematian (2,4%)
• Fatality rate can change as a virus can mutate, according to
epidemiologists. WHO, 2020
The Effects of Temperature and Relative Humidity on
the Viability of the SARS Coronavirus
• The dried virus on smooth surfaces retained its viability for over 5
days at temperatures of 22–25◦C and relative humidity of 40–50%
(typical air-conditioned environments).
• virus viability was rapidly lost at higher temperatures and higher
relative humidity (e.g., 38◦C, and relative humidity of >95%).
Chan, 2011
Laboratory examination
Specimens
▪ Nasopharyngeal swab
▪ Oropharyngeal swab
▪ Nasal aspirate,
▪ Combined nasopharyngeal and oropharyngeal swab
▪ Endotracheal aspirates
▪ Bronchoalveolar lavage
38
Spesimen dari
Rumah Sakit
REAL-TIME
POLYMERASE CHAIN
REACTION
PREVENTION
NO VACCINE
• Isolation Px Covid-19
• Avoid travel to outbreak area
• Stay away from crowds
• Stay > 2 m away from anyone with symptoms
• For Healthcare Workers : Droplet and contact precautions
(surgical mask, gowns, gloves, eye protection) , N95 respirator
(procedures that produce aerosol)
• CoV (SARS coronavirus) was lost after heating at 56◦C for 15 minutes but
that it was stable for at least 2 days following drying on plastic. Inactivated
by ultraviolet light, alkaline (pH > 12), or acidic (pH < 3) conditions.
Chan, 2011
THANK YOU
