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*Corresponding author: E-mail: asadulhabib698@gmail.com; 
 
 
 

Asian Journal of Immunology 
 
3(1): 114-123, 2020; Article no.AJI.56168 
 

 
 

 

 

General Overview of Coronavirus Disease 2019 
(COVID- 19): A Summary of Evidence 

 
Mohammad Asadul Habib1* 

 
1
Department of Food Technology and Nutrition Science, Noakhali Science and Technology University, 

Sonapur-3814, Bangladesh. 
 

Author’s contribution 
 

The sole author designed, analyzed and interpreted and prepared the manuscript. 
 

Article Information 
 

Editor(s): 

(1) Dr. Jaffu Othniel Chilongola, Tumaini University, Tanzania.  
Reviewers: 

(1) Pichon Maxime, University Hospital of Poitiers, France.  
(2) Karen Miyuki Asano, Instituto Pasteur, Brazil.  

Complete Peer review History: http://www.sdiarticle4.com/review-history/56168 

 
 
 
 

Received 30 March 2020  
Accepted 11 April 2020 
Published 15 April 2020 

 
 

ABSTRACT 
 

Coronavirus disease 2019 (COVID-19) has spread throughout China and gained world-wide 
attention as a result of acute respiratory illness due to a novel coronavirus (SARS-CoV-2), 
traditionally known as COVID-19. On 30 January 2020, the World Health Organization (WHO) 
officially announced the outbreak of COVID-19 a public health emergency of international 
concern.A third introduction of a highly pathogenic and large-scale coronavirus disease in humans 
was the SARS-CoV-2 outbreak as a result of a severe acute respiratory syndrome coronavirus 
(SARS-CoV) in 2003 and the Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. 
Medical signs of COVID-19 patients include fever, cough, exhaustion and a limited number of 
patients with signs of gastrointestinal infection. Elderly and people with underlying diseases are 
susceptible to infection and prone to adverse results that could be associated with acute respiratory 
distress syndrome. There are currently few specific antiviral approaches available but many 
effective antiviral and repurposed drug candidates are under urgent investigation. The aim of this 
review was to summarize the recent medical advancement of COVID-19's epidemiology, 
transmission, and clinical characteristics, and discussed current treatment and scientific 
developments to fight the novel coronavirus outbreak. 

 
 

Mini-Review Article 



 
 
 
 

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115 

 

Keywords: SARS-CoV; SARS-CoV-2; MERS-CoV; COVID-19; outbreak; Coronavirus. 

 
ABBREVIATIONS 
 
SARS-CoV : Severe Acute Respiratory 

Syndrome 
MARS-CoV : Middle East Respiratory 

Syndrome  
China CDC : Chinese Center for Disease 

Control and Prevention 
COVID-19 : Coronavirus Disease 2019 
2019-nCoV : Novel Coronavirus 2019 
TCM : Traditional Chinese medicine 
WHO : World Health Organization 
PPE : Personal Protection Equipment 
FFP3 : Filtering Face Pieces (Protection 

in three classes against dangers) 
N95 : Respirators and Surgical Mask 
 

1. INTRODUCTION 
 

In late December 2019, a cluster of pneumonia 
cases of unknown origin in Wuhan, China was 
creating alarm among health officials. The 
Wuhan Municipal Health Commission issued an 
alert on 31 December, a rapid response team 
was sent to Wuhan by the Chinese Center for 
Disease Control and Prevention (China CDC) 
and a notification was sent to the World Health 
Organization (WHO) [1-4]. Potential influenza, 
avian influenza, adenovirus, acute coronavirus 
syndrome (SARS-CoV), and Middle East 
coronavirus (MERS-CoV) were all potential 
causes excluded. Wuhan's Huanan Seafood 
Wholesale market was involved in 
epidemiological testing, which has been shut 
down and disinfected and active cases have 
been identified [2,4,5]. On January 7, 2020, the 
latest coronavirus identified the causative 
pathogen, followed by the development of 
genomic characteristics and test methods [2,4-7]. 
Now known as the COVID-19, both SARS-CoV 
and MERS-CoV are distinct, but they are closely 
related [5,8]. Early cases suggested that COVID-
19 (i.e. a new name for a disease caused by a 
novel coronavirus) may be less severe than 
SARS and MERS. Neither SARS-CoV nor 
MERS-CoV can be more infectious in 2019, but 
the incidence of disease among rapidly 
expanding numbers of people and evidence of 
transmission from human to human [3,9-12]. This 
review summarized the recent medical 
advancement of COVID-19's epidemiology, 
pathogenesis, and clinical characteristics, and 
discussed current treatment and scientific 
developments to fight the novel coronavirus 
outbreak. 

2. SARS-CoV 
 
16 years ago in 2003, severe acute respiratory 
coronavirus syndrome (SARS-CoV) stunned the 
world by its high virulence and efficient 
transmissibility among humans [6,13,14], 
triggering the first large-scale epidemic of the 
21st century. Globally, there were over 8,000 
patients infected and 774 deaths. SARS harmed 
the economy with a decline in domestic demands 
and foreign travel, in addition to the major burden 
on the health system [15]. 

 
2.1 Transmission of SARS-CoV 
 
SARS-CoV is believed to be an animal virus that 
spread to other species (civet cats) and first 
infected humans in southern China's Guangdong 
province in 2002, from an as-yet-uncertain 
animal source, possibly bats [16]. SARS-CoV 
seemed to be the main mode of transmission via 
respiratory droplets [16] as well as fecal-oral 
transmission may be [14]. Apart from the super-
spreaders, two to four secondary cases were 
estimated to infect every person [17]. It was 
estimated that the median incubation duration 
was four to seven days [18] and that peak viral 
load was reached on the 10th day of illness              
[14]. SARS-CoV may affect all age               
groupings. Particularly at risk were health care 
staff and immune-compromised patients             
[19]. 

 
3. MERS-CoV 
 
In September 2012, Saudi Arabia first reported 
MERS-CoV infection, but in April 2012 the 
retrospective outbreak was confirmed in Jordan. 
Almost 2500 cases of MERS CoV (with at least 
850 related deaths) from 27 countries around the 
world have been recorded worldwide by 2019; all 
MERS cases have been linked to travel or 
residence, with more than 80 percent involving 
Saudi Arabia in and around the Arab Peninsula 
[20]. In the Republic of Korea in 2015, the 
biggest known MERS outbreak outside the           
Arab Peninsula was caused. The outbreak was 
linked to the return of a traveler from the                
Arab Peninsula. Countries across Europe, Asia, 
North Africa, the Middle East, and the US               
have also reported cases of patients who have 
been either moved to treatment or who have 
become ill after their return from the Middle East 
[21]. 



 
 
 
 

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116 

 

3.1 Transmission of MERS-CoV 
 
MERS-CoV may also be transferred through 
direct contact, respiratory droplets (particles > 5 
micrometers) or aerosols (particles < 5 
micrometers) from one person to another. The 
development of infection in people whose only 
risk was close contact with people who had 
MERS has been identified as a person-to-person 
transmission [21]. The MERS-CoV reservoir is 
supposed to be dromedary camels, but the 
mechanism of transmission from camels to 
humans is unknown. Many cases were identified 
as direct transmission between people and 
humans in health facilities. If MERS is suspected 
in a patient, steps to prevent the transmission of 
infection in the healthcare sector must be 
undertaken promptly [21]. 

 
4. COVID-19 
 
Coronaviruses are a broad family of viruses that 
cause disease from the common cold to more 
severe diseases like Middle East Respiratory 
Syndrome and Severe Acute Respiratory 
Syndrome. COVID-19 is an unexplained modern 
mutation of human beings. The COVID-19 
source is still unknown although the initial cases 
were related to the Huanan South China Seafood 
Market. While many of the early patients worked 
in or visited the market, none of the exported 
cases came into contact with the market, 
suggesting either human to human transmission 
or a more widespread animal source [22]. In 
addition to seafood, social media sources report 
that the Huanan South China Market has sold 
snakes, birds, and other small mammals, 
marmot, and bat. The WHO announced that 
environmental samples taken from the 
marketplace have reported positive for the novel 
coronavirus but no specific animal association 
has been identified [22]. An initial report indicated 
that snakes may be the potential source based 
on codon use [23], but others rejected the claim 
[24]. Researchers are currently working on 
defining the COVID-19 source, including possible 
animal intermediate vectors. 

 
The appearance of SRAS and MERS-CoV is the 
product of a zoonotic reservoir. In 2002, SARS-
CoV, the first highly pathogenic human 
coronavirus, was introduced with the animal-to-
human transmission in wet markets. SARS-CoV 
viral RNA was found in both palm civets and 
raccoon dogs sold in these wet markets [25]. 
SARS-CoV was however not present in animals 

and it appeared that the intermediate reservoirs 
of those species were an adapted virus for 
infecting humans more efficiently. Further 
surveillance efforts in bat species have reported 
closely associated coronaviruses [26]. More 
recent research has shown that many bat 
coronaviruses can infect human cells without 
needing intermediate adaptation [27,28]. 
Furthermore, human serology data show bat 
coronavirus protein recognition and suggest that 
low-level zoonotic transmission of SARS-like bat 
coronavirus occurs beyond recognized outbreaks 
[29]. MERS-CoV also has a zoonotic virus with 
possible bat origins [30,31], but camel contact 
and endemic infection are commonly recorded in 
the primary MERS-CoV cases [32]. The epidemic 
was significantly reduced by strict quarantine and 
elimination in SE Asia of live markets for SARS-
CoV. A similar solution to MERS-CoV was not 
feasible due to the cultural value of camels, and 
occasional outbreaks in the Middle East remain. 
These SARS and MERS lessons highlight the 
importance of the ongoing outbreak to         
rapidly determine the source of the COVID-19 
disease. 
 

4.1 Update Situation of COVID-19 
 
As of 9 April 2020, 79,385 people had died so far 
from the COVID-19 coronavirus outbreak.1, 
356,780 confirmed cases occurred in 206 
countries and territories (Fig. 1) [33]. It is 
important to emphasize that there is an 
underreporting of these numbers due to the lack 
of diagnosis in many countries. 
 

4.2 Transmission of COVID-19 
 
Many domestic and wild animals may serve as 
coronavirus hosts, including camels, cattle, cats, 
and bats [34]. Animal coronaviruses usually are 
not known to spread among humans [35]. There 
are exceptions, however, such as SARS and 
MERS, which are transmitted by cough or 
sneezing primarily by close contact with infected 
people by respiratory droplets. Regarding 
COVID-19, early patients were confirmed to have 
some link to the Huanan Seafood Market in 
Wuhan, China, indicating that these early 
infections were due to transmission from animal 
to human. Nonetheless, later cases among 
medical staff and others with no history of 
exposure to that market or visiting Wuhan              
were recorded, which was taken as an          
indication of human-to-human transmission 
[11,36-39]. 



 
 
 
 

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117 

 

 
 

Fig. 1.  Coronavirus disease (COVID- 19) update situation (According to 9 April 2020) 
 

Table 1. Potential treatment options of COVID-19 
 

Classes Potential treatment options Reference 

Anti-viral > 85% of patients received antiviral agents, including oseltamivir (75 mg 
every 12 h orally), ganciclovir (0.25 g every 12 h intravenously) and 
lopinavir / ritonavir tablets (400/100 mg twice daily). Remdesivir is currently 
being evaluated and known to prevent MERS-COV in more than 10 
medical establishments in Wuhan. 

[44]  

Anti-
malarial 

An ancient antimalarial, chloroquine phosphate, has been effective in 
inhibiting the exacerbation of pneumonia due to its anti-viral and anti-
inflammatory activity. 

[45]  

Herbal 
treatments 

Traditional Chinese medicine has been widely used during the last SARS-
COV outbreak and is currently being used in China. The five most 
commonly used herbs were Astragali Radix (Huangqi), Glycyrrhizae Radix 
Et Rhizoma (Gancao), Saposhnikoviae Radix (Fangfeng), Atractylodis 
Macrocephalae Rhizoma (Baizhu), and Lonicerae Japonicae Flo. 

[46]  

 
Chinese health authorities 'new guidelines 
outlined three primary transmission routes for 
COVID-19: 1) transmission of droplets, 2) 
transmission of contacts and 3) transmission of 
aerosols. Transmission of droplets has been 
documented when respiratory droplets (as 
formed when an infected person coughs or 
sneezes) are ingested or inhaled in close 
proximity by people nearby; the transmission of 
contact can occur when an individual touches a 
virus- surface or object and then touches his or 
her mouth, nose, or eyes; and transmission of 
aerosols can occur when inhaled high dose of 

aerosols into the lungs in a relatively closed 
environment [34,40]. 
 

4.3 Clinical Manifestation and Diagnosis 
of COVID-19 

 
The complete clinical consequence is not yet 
apparent, because the symptoms recorded vary 
from mild to extreme with even death in some 
[35]. The complete clinical consequence is not 
yet apparent, because the symptoms recorded 
vary from mild to extreme with even death in 
some reported include headache, diarrhea,



 
 
 
 

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Table 2. Clinical trials identified at Clinicaltrials.gov related to drug repositioning for COVID-19 treatment [47]  
 

Intervention Clinical Condition Sponsor N
o 

test/Status Beginning/ 
Estimated end 

Phase 

Hydroxychloroquine 30 participants with 
pneumonia caused by 2019-
nCoV 

Shanghai Public 
Health Clinical Center 

NCT04261517 
/Recruiting patients 

6-2-2020 /31-12-
2020 

3 

Chloroquine 10000 participants in a 
prophylaxis study for COVID-
19 

University of Oxford NCT04303507 / 
Not yet recruiting 

May 2020 / May 2022 N/A 

Human immunoglobulin Pneumonia caused by 2019-
nCoV with 80 participants 

Peking Union Medical 
College Hospital 

NCT04261426 / 
Not yet recruiting 
patients 

10-2-2020 / 30-06-
2020 

2 and 
3 

Remdesivi Severe respiratory infection 
caused by 2019-nCoV with 
452 participants 

Capital Medical 
University 

NCT04257656 / 
Recruiting patients 

6-2-2020 / 31-05-
2020 

3 

Remdesivir 308 participants with 
mild/moderate respiratory 
infection caused by 2019-
nCoV 

Capital Medical 
University 

NCT04252664/ 
Recruiting patient 

05-02-2020 / 27-04-
2020 

3 

Arbidol (umifenovir) Pneumonia caused by 2019-
nCoV with 380 participants 

Jieming QU, Ruijin 
Hospital 

NCT04260594 / 
Not yet recruiting 
patients 

7-02-2020 / 30-12-
2020 

4 

Arbidol or lopinavir-ritonavir or oseltamivir 400 participants infected 
with2019-nCoV 

Tongji Hospital NCT04255017 / 
Recruiting patients 

01-02-2020 / 01-07-
2020 

4 

Arbidol or lopinavir-ritonavir 125 participants infected with 
2019-nCoV 

Guangzhou 8th 
People's Hospital 

NCT04252885 / 
Recruiting patients 

28-01-2020 / 31-07-
2020 

4 

Darunavir-cobicistat combination Pneumonia caused by 2019-
nCoV with 30 participants 

Shanghai Public 
Health Clinical Center 

NCT04252274 / 
Recruiting patients 

30-01-2020 / 31-12-
2020 

3 

TCM combination with lopinavir-ritonavir, 
α-interferon via aerosol 

150 participants infected with 
2019-nCoV 

Beijing 302 Hospital NCT04251871 / 
Recruiting patients 

22-01-2020 / 22-01-
2021 

N/A 

Recombinant human interferon α2β 328 participants with COVID-
19 

Tongji Hospital NCT04293887 / 
Not yet recruiting 

01-03-2020 / 30-06-
2020 

1 

Carrimycin or lopinavir-ritonavir or arbidol 
or chloroquine phosphate 

520 participants with COVID-
19 

Beijing YouAn Hospital NCT04286503 / 
Not yet recruiting 

23-02-2020 / 28/02-
2021 

4 



 
 
 
 

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Intervention Clinical Condition Sponsor N
o 

test/Status Beginning/ 
Estimated end 

Phase 

Danoprevir-ritonavir and interferon 
inhalation or lopinavir-ritonavir or TCM 
plus interferon inhalation 

50 participants with 
pneumonia caused by 2019-
nCoV 

The Ninth Hospital of 
Nanchang 

NCT04291729 / 
Recruiting 

14-02-2020 / 30-04-
2020 

4 

Xiyanping or lopinavir-ritonavir-interferon 
inhalation 

384 participants with 
pneumonia caused by 2019-
nCoV 

Jiangxi Qingfeng 
Pharmaceutical Co. 
Ltd. 

NCT04275388/Not 
yet recruiting 

19-02-2020 / 14-12-
2020 

N/A 

Xiyanping combined with lopinavir-ritonavi 80 participants with COVID-
19 

Jiangxi Qingfeng 
Pharmaceutical 

NCT04295551 / 
Not yet recruiting 

14-03-2020 / 14-04-
2021 

N/A 

Combinations of oseltamivir, favipiravir, 
and chloroquine 

80 participants with COVID-
19 

Rajavithi Hospital NCT04303299 /Not 
yet recruiting 

15-03-2020 / 30-11-
2020 

3 

Thalidomide 40 participants with COVID-
19 

First Affiliated Hospital 
of Wenzhou Medical 
University 

NCT04273581 / 
Not yet recruiting 

18-02-2020 / 30-05-
2020 

2 

Thalidomide 100 participants with 
pneumonia caused by 2019-
nCoV 

First Affiliated Hospital 
of Wenzhou Medical 
University 

NCT04273529 / 
Not yet recruiting 

20-02-2020 / 30-06-
2020 

2 

Vitamin C 140 participants with severe 
pneumonia caused by 2019-
nCoV 

Zhi Yong Peng NCT04264533 / 
Recruiting 

14-02-2020 / 30-09-
2020 

2 

Methylprednisolone 80 participants infected 
with2019-nCoV 

Peking Union Medical 
College Hospital 

NCT04244591 / 
Recruiting patients 

26-01-2020 / 25-12-
2020 

2 

Pirfenidone 294 participants with severe 
pneumonia caused by 2019-
nCoV 

Huilan Zhang NCT04282902 / 
Recruiting 

04-02-2020 / 01-06-
2020 

3 

Bromhexine hydrochloride 60 participants with 
suspected and mild 
pneumonia caused by 2019-
nCoV 

Second Affiliated 
Hospital of Wenzhou 
Medical University 

NCT04273763 / 
Enrolling by 
invitation 

16-02-2020 / 30-04-
2020 

N/A 

Bevacizumab 20 participants with severe 
COVID-19 pneumonia 

Qilu Hospital of 
Shandong University 

NCT04275414 / 
Recruiting 

February 2020 / May 
2020 

2 and 
3 

Fingolimod 30 participants with COVID-
19 

1° Affiliated Hospital of 
Wenzhou Medical 
University 

NCT04280588 / 
Recruiting 

22-02-2020 / 01-06-
2020 

2 



 
 
 
 

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hemoptysis, runny nose, and phlegm-producing 
cough [35,41]. Patients with mild symptoms have 
been reported to recovery after 1 week and 
serious cases of alveolar damage to the virus 
have been reported to lead to death. The cases 
of death were mainly patients of medium age and 
older adults with preexisting conditions (tumors, 
cirrhosis, hypertension, heart artery disease, 
diabetes, and Parkinson's) [42]. The 
recommendations for case identification list the 
following symptoms: fever, drop in lymphocytes 
and white blood cells, new pulmonary infiltration 
of chest x-rays and no progress in symptoms 
after 3 days of antibiotic treatment [36]. 
 

4.4 Old Tricks and New Challenges in 
Treating COVID-19 

 
No vaccine or special antiviral drug protocol is 
currently used to treat seriously ill patients. 
Patient management focuses primarily on 
providing treatment, e.g. oxygenation, ventilation, 
and fluid control. As part of a vital management 
phase of COVID-19, combined treatment of low 
dose systemic corticosteroids and anti-viral and 
interferon atomization was encouraged [43]. 
Table 1 also included other recorded              
therapeutic drugs used for treating seriously ill 
patients. 
 

4.5 Clinical Trials for COVID-19 Treatment 
on Drug Repositioning 

 
A study listed 24 clinical trials (Table 2), in which 
19 clinical phase 2, 3, or 4 studies were 
performed.The eligibility requirements for the 
retrieved studies were: include a base 
identification number for clinicaltrials.gov; 
describe the number of participants and the 
timeframe for study; describe the clinical 
conditions of the participants, and use treatments 
with medicines already tested or approved for 
any other disease in patients infected with the 
novel coronavirus SARS-CoV-2 (2019-nCoV). 
Clinical trials may be an effective technique as 
they promote the development of new groups of 
medicines; they are cost-effective and require 
less time to market; and pharmaceutical supply 
chains exist for manufacturing and distribution 
[47]. 
 

4.6 Prevention of COVID-19 
 

Preventive approaches concentrate on patient 
isolation and careful infection management, 
including effective screening and clinical care 
steps to be followed for infected patients. For 

example, during specimen collection droplets, 
touch and airborne precautions should be taken 
and sputum induction avoided. 

 
The general guidelines of WHO and other 
organizations have issued the following general 
recommendations [48]: 

 
 Avoid close contact with people suffering 

from acute respiratory infections. 

 Wash your hands frequently, particularly 
after contact with infected people.  

 Avoid unprotected farm and wild animal 
contact. 

 People with acute airway symptoms should 
stay a little away, cover their coughs or 
sneezes with disposable tissues, and wash 
their hands with sanitizer or soaps. 

 Strengthen the implementation of 
appropriate hygiene procedures for the 
prevention and control of diseases, in 
particular in emergency medicine 
departments. 

 Immunosuppressed people can prohibit 
public meetings. 

 
The most effective technique for the population is 
to wash their hands regularly and use portable 
hand sanitizing to avoid contact with their face 
and mouth after engaging with an area that is 
possibly polluted. Health workers caring for 
infected people should make use of contact and 
airborne precautions which include PPE masks, 
eye protection, gowns and gloves, such as N95 
or FFP3 masks, to avoid pathogen transmission. 
Scientific research is going to develop a vaccine 
for coronavirus [48]. 
 

5. CONCLUSION  
 

In the context of rapidly increasing outbreaks of 
COVID-19, proactive steps by long-term care 
facilities are required to recognize and eliminate 
potentially infected staff and visitors, actively 
track potentially infected patients and enforce 
effective infection prevention and control 
measures to prevent COVID-19. Scientific 
researchers conduct numerous clinical trials 
related to drugs that can be an important strategy 
because they promote the development of new 
classes of medicines and I hope these 
repositioning trials will help to identify alternatives 
for COVID-19 treatment. 
 

CONSENT 
 

It is not applicable. 



 
 
 
 

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121 

 

ETHICAL APPROVAL 
 

It is not applicable. 

 
COMPETING INTERESTS 
 

Author has declared that no competing interests 
exist. 
 

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