Review of Novel Corona Virus Disease (Covid-19) in India

 

Ghanshyam Sevak, Yashpal Singh Chauhan*, Narendra Parihar, Mahendra Singh Rathore

Geetanjali Institute of Pharmacy, Udaipur, Rajasthan., India.

 

ABSTRACT:

Novel coronavirus also known as severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) was emerged from Wuhan, China and have taken catastrophic form globally. India being a dense populated country is also affected by it’s deadly infection. Bats were considered as its primary host but COVID-19 disease became pandemic via human to human transmission by droplet nuclei. The incubation period ranges upto 14 days and main symptoms of disease were noticed as atypical pneumonia, fever, difficult breathing, decreased SPO₂ level and ultimately death due to respiratory failure depending upon immune status of the patients. Coronaviruses are positive-sense, single-stranded RNA viruses and harbour a genome (30 kb) consisting of two terminal untranslated regions and twelve putative functional open reading frames (ORFs), encoding for non-structural and structural proteins. There are sixteen putative non-structural proteins, including proteases, RNA-dependent RNA polymerase, helicase, other proteins involved in the transcription and replication of SARS-CoV-2, and four structural proteins, including spike protein (S), envelope (E), membrane (M), and nucleocapsid (N). SARS-CoV-2 infection, with a heavy viral load in the body, destroys the human lungs through cytokine storm, especially in elderly persons and people with immunosuppressed disorders. A number of drugs have been repurposed and employed, but still, no specific antiviral medicine has been approved by the FDA to treat this disease. This review provides a current status of the COVID-19, epidemiology, an overview of phylogeny, mode of action, diagnosis, and possible treatment methods and vaccines.

 

 

 

INTRODUCTION:

The epidemic of late December 2019, an outbreak of perplexing novel corona virus, named as SARS-CoV-2 (severe acute respiratory syndrome corona virus 2) is the seventh member of corona virus family that was first identified in Wuhan, a city in the Hubei province in China. It is reported in the seafood wholesale wet market, in December 2019 and infects about 66% of the staff there.

 

 

The market was shut down on January 1, 2020, after the announcement of an epidemiologic alert by the local health authority on December 31, 2019 and it is being exported to a growing number of countries. Early efforts were focused on describing the clinical course, counting severe cases, and treating the disease. Covid-19 has spread rapidly and has been shown to have a wide spectrum of severity. The World Health Organization declared it a Public Health Emergency of International Concern regarding Covid-19 on 30 January 2020, and later declared a pandemic on 11 March 2020. It is one of the deadliest pandemics in history.¹

 

Scientists first identified a human Corona virus in 1965. researchers found a group of similar human and animal viruses and named them after their crown-like appearance. Corona viruses are a big family, called as Coronaviridae. There are four genera within this family, in other words, Alpha-, Beta-, Delta-and Gamma corona virus. The Alpha and Beta corona viruses primarily infect mammals, whereas Delta and Gamma corona viruses primarily some of them cause the common cold in people.²

 

Figure 1: SARS-COV-2 VIRUS

 

Moreover, others infect animals, including bats, camels, and cattle. SARS-CoV-2, the causative agent of COVID-19, is a species within the virus Genus Betacoronavirus. Other species within this genus are SARS-CoV, the causative agent of SARS pandemic in 2002–2004 and the causative agent of the Middle East respiratory syndrome. After its initial discovery in late 2019, SARS-CoV-2 spread throughout the world.

 

Corona viruses are enveloped, positive-sense RNA viruses with a nucleocapsid of helical symmetry having diameter of 60–140nm.² These viruses are characterized by club-like spike projections of protein on the surface, with a crown-like (Latin for crown is ‘coronam’, hence named ‘corona virus’) appearance under the electron microscope. The name was coined by June Almeida and David Tyrrell who first observed and studied human corona viruses and later the name Corona virus was accepted as a genus name by ICTV in 1971.

 

Seven corona viruses can infect humans. The one that causes SARS emerged in southern China in 2002 and quickly spread to 28 other countries. More than 8,000 people were infected by July 2003, and 774 died. A small outbreak in 2004 involved only four more cases. This corona virus causes fever, headache, and respiratory problems such as cough and shortness of breath.³

 

MERS started in Saudi Arabia in 2012. Almost all of the nearly 2,500 cases have been in people who live in or travel to the Middle East. This corona virus is less contagious than its SARS cousin but more deadly, killing 858 people. It has the same respiratory symptoms but can also cause kidney failure.³

 

Table 1: Details of all Known corona virus to infect humans

Sr. No.	Name of virus (According to WHO)	Genus	Host	Month and Year, It Reported First Time	Place, Where it Reported First Time
1.	Human coronavirus- OC43 (HCoV-OC43) “Russian Flu”	Beta corona virus	Human and Cattle	May 1889	1889-1895 First case reported in Central Asian city of Bukhara in Russian empire.
2.	Human corona virus- 229E (HCoV-229E)	Alpha corona virus	Human and Bat	1965	A researcher at the University of Chicago, Dorothy Hamre, first identified
3.	Human corona virus- HKU1 (HCoV-HKU1)	Beta corona virus	Human and Animal	January 2004	First case was identified in Hong Kong in 71-year-old male.
4.	Human corona virus- NL63 (HCoV-NL63)	Alpha Corona virus	Humans	Nov – Dec 2004	It was identified in Netherlands in a seven-month-old child with bronchiolitis.
5.	Severe Acute Respiratory Syndrome Corona virus (SARS-CoV)	Beta Corona virus	Humans, Bats, Palm	February 2003	First identified in china during an outbreak 2002-2004.
6.	Middle East Respiratory Syndrome Related Corona virus (MERS-Cov)	Beta Corona virus	Human, Bats, Camels	September 2012	It was first reported in the kingdom of Saudi Arabia, Jeddah in 2012
7.	Severe Acute Respiratory Syndrome Corona virus 2 (SARS-Cov 2)	Beta Corona virus	Humans	December 2019	First case was identified in Wuhan city, China.

 

 

2. Nomenclature of VIRUSES:

However, virus nomenclature based on the location of its first detection or nationality causes problems such as diplomatic crisis, stigmatization, and even racial profiling, among other things. Because of this, the WHO and other health regulatory bodies have argued that the corona virus should not be given a name that is associated with people or a specific location. In general, the longer it takes to name a virus, the longer lasting a fictitious name becomes. This appears to be a minor issue in comparison to the potentially lethal consequences of the virus's spread. However, the significance of proper naming cannot be undermined.⁴

 

Viruses are named based on their genetic structure to facilitate the development of diagnostic tests, vaccines, and medicines. Virologists and the wider scientific community do this work, so viruses are named by the International Committee on Taxonomy of Viruses (ICTV).

 

ICTV announced “Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2)” as the name of the new virus on 11 February 2020. This name was chosen because the virus is genetically related to the Corona virus responsible for the SARS outbreak of 2003. While related, the two viruses are different. WHO announced “COVID-19” as the name of this new disease on 11 February 2020 where it means CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019).⁴

 

There are many variants of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), the virus that causes corona virus disease 2019 (COVID-19). Some are believed, or have been stated, to be of particular importance due to their potential for increased transmissibility, increased virulence, or reduced effectiveness of vaccines against them. These variants contribute to the continuation of the COVID-19 pandemic.

 

2.1 Nomenclature of variants of SARS –Cov -2:

When it is suggested that political correctness is important while naming deadly viruses, it is because some entities are happy to call them by names that stigmatize those places and people. A recent example is that of the new variant ‘B.1.617.2’ dubbed ‘Indian variant’ as reported in a New Scientist Magazine article. Similarly, the previous variants B.1.1.7, B.1.351, and P.1 are referred to as the UK, South Africa, and Brazil variants, respectively. Such nomenclature results in racism and xenophobia.

 

For example, calling the variant with names such as ‘Indian variant’ has sparked a wave of prejudice against Indians. To avoid these issues, the four corona virus variants that the WHO considers as variants of concern, have now been assigned the Greek letters Alpha, Beta, Gamma, and Delta, in order of their detection.⁵

 

According to the WHO, the new names (Alpha, Beta, Gamma, and Delta) are intended to be simple and avoid prejudice, and they will not replace existing scientific names (such as B.1.1.7, B.1.351 and P.1) assigned by Pangolin, which convey important scientific information.

 

2.1.1 PANGOLIN Nomenclature – Researchers and public health agencies are using the Pango (Phylogenetic Assignment of Named Global Outbreak) Lineages nomenclature worldwide to track the transmission and spread of SARS-CoV-2, including variants of concern. This website documents all current Pango lineages and their spread, as well as various software tools that can be used by researchers to perform analyses on SARS-COV-2 sequence data.⁶

 

Table 2: Details about the different variants of SARS Cov -2

Sr. No.	Name of variant (according to who)	Name of variant (according to Pongo Nomenclature)	First outbreak	Month and year, it reported first time
1.	Alpha (VOC/ DesV)	B.1.1.7	Britain (UK)	September. 2020
2.	Beta (VOC)	B.1.351	South Africa	September 2020
3.	GAMMA (VOC)	(P.1) B.1.1.28.1	Brazil	December 2020
4.	Delta and Delta Plus (VOC)	B.1.617.2 AND AY.1/AY.2	India	December 2020
5.	Epsilon (DesV)	B.1.429,B.1.427	USA	September 2020
6.	Zeta (DesV)	(P.2)B.1.1.28	Brazil	January 2021
7.	ETA (DesV)	B.1.525	United Kingdom and Nigeria	December 2020
8.	Theta (DesV)	P.3	Philippines	January 2021
9.	LOTA (DesV)	B.1.526	USA	December 2020
10.	KAPPA (DesV)	B.1.617.1	India	December 2020
11.	Lambda (VOI)	C.37	Peru	December 2020
12.	MU (VOI)	B.1.621	Columbia	January 2021
13.	Omicron (VOC)	B.1.1.529	South Africa	November 2021

*VOC- Variant of concern, VOI – Variant of Interest, DesV- De – escalated variants

*The datas are taken from European Centre for Disease Prevention and Control (ecdc)

 

 

3. SYMPTOMS OF COVID-19:

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. These symptoms may also be different according to variant of corona virus. Some variants produce mild symptoms in normal adults, whereas some variants like delta or delta plus more prone to produce infection in lungs and can develop Pneumonitis in many patients. Omicron variant produces mild symptoms like mild fever ,cough and cold with body ache, so less deaths were reported during third wave. Symptoms may appear 2-14 days after exposure to the virus. Anyone can have mild to severe symptoms. People with these symptoms may have COVID-19:⁷

·      Fever or chills

·      Cough

·      Shortness of breath or difficulty breathing

·      Fatigue

·      Muscle or body aches

·      Headache

·      New loss of taste or smell

·      Sore throat

·      Congestion or runny nose

·      Nausea or vomiting

·      Diarrhea

 

The virus can lead to pneumonia, respiratory failure, heart problems, liver problems, septic shock, and death. Many COVID-19 complications may be caused by a condition known as cytokine release syndrome or a cytokine storm. This is when an infection triggers your immune system to flood your bloodstream with inflammatory proteins called cytokines. They can kill tissue and damage your organs. If you notice the following severe symptoms in yourself or a loved one, get medical help right away:

·      Trouble breathing or shortness of breath

·      Ongoing chest pain or pressure

·      New confusion

·      Can’t wake up fully

·      Bluish lips or face

 

On average it takes 5–6 days from when someone infected with the virus for symptoms to show, however it can take up to 14 days. Seek immediate medical attention if you have serious symptoms. Always call before visiting your doctor or health facility. People with mild symptoms who are otherwise healthy should manage their symptoms at home.^7,8

 

3.1 Risk Factors:

Anyone can get COVID-19, and most infections are mild. The older you are, the higher your risk of severe illness. You also a have higher chance of serious illness if you have one of these health conditions:⁸

·      Chronic kidney disease

·      Chronic obstructive pulmonary disease (COPD)

·      A weakened immune system because of an organ transplant

·      Obesity

·      Serious heart conditions such as heart failure or coronary artery disease

·      Sickle cell disease

·      Type 2 diabetes

 

3.1.1 Conditions that could lead to severe COVID-19 illness include:

·      Moderate to severe asthma

·      Diseases that affect your blood vessels and blood flow to your brain

·      Cystic fibrosis

·      High blood pressure

·      Dementia

·      Liver disease

·      Pregnancy

·      Smoking

·      Thalassemia

·      Type 1 diabetes

·      Damaged or scarred lung tissue (pulmonary fibrosis)

·      A weakened immune system because of a blood or bone marrow transplant, HIV, or medications like corticosteroids.⁹

 

4. Test and Diagnosis:

COVID-19 diagnostic testing done to find out if you are currently infected with SARS-CoV-2, the virus that causes corona virus disease 2019 (COVID-19).⁹

 

·      RT-PCR test: it also called as molecular test, this COVID-19 test detects genetic material of the virus using a lab technique called reverse transcription polymerase chain reaction (RT-PCR). A fluid sample collected by inserting a long nasal swab (nasopharyngeal swab) into your nostril and taking fluid from the back of your nose or by using a shorter nasal swab (mid-turbinate swab) or a very short swab (anterior nares swab) to get a sample. In some cases, a long swab is inserted into the back of your throat (oropharyngeal swab), or you may spit into a tube to produce a saliva sample.

 

·      Antigen test: This COVID-19 test detects certain proteins in the virus. Using a long nasal swab to get a fluid sample, some antigen tests can produce results in minutes. Others may send to a lab for analysis. Genomic sequencing has been very important for the COVID-19 response. New variants are forming all the time, so genomic data has guided countries to make quick and informed public health decisions since the start of the pandemic.¹⁰

 

4.1 Who should be tested for current infection?

·      People who have symptoms of COVID-19.

·      Most people who have had close contact (within 6 feet for a total of 15 minutes or more over a 24-hour period) with someone with confirmed COVID-19.

·      Fully vaccinated people with no COVID-19 symptoms do not need to be tested following an exposure to someone with COVID-19.

·      People who have tested positive for COVID-19 within the past 3 months and recovered do not need to be tested following an exposure as long as they do not develop new symptoms.

·      People who have taken part in activities that put them at higher risk for COVID-19 because they cannot physically distance as needed to avoid exposure, such as travel, attending large social or mass gatherings, or being in crowded or poorly ventilated indoor settings.

·      People who have been asked or referred to be tested by their healthcare provider, or state.

The COVID-19 RT-PCR Test is a real-time reverse transcription polymerase chain reaction (rRT-PCR) test for the qualitative detection of nucleic acid from SARS-CoV-2 in upper and lower respiratory specimens (nasopharyngeal or oropharyngeal swabs, sputum, lower respiratory tract aspirates, bronchoalveolar lavage, and nasopharyngeal wash/aspirate) collected from individuals suspected of COVID-19 by their healthcare provider, as well as upper respiratory specimens (nasopharyngeal or oropharyngeal swabs, anterior nasal swabs, or mid-turbinate swabs) collected from any individual, including individuals without symptoms or other reasons to suspect COVID19.¹¹

 

Figure 2: Sample Collection technique

 

5. Transmission:

The virus is transmit mainly via the respiratory route, when people inhale droplets and particles that infected people release as they breathe, talk, cough, sneeze, or sing. The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19, but infection can occur over longer distances, particularly indoors. People are at their peak of infectiousness when their symptoms start, and are infectious for up to 3 days prior to this. Their infectiousness declines after the first week, but they remain contagious for up to 20 days, and can spread the virus even if they never developed any symptoms.

Experts believe the virus that causes COVID-19 spreads mainly from person to person. There are several ways this can happen:

 

5.1 Droplets or aerosols. This is the most common transmission. When an infected person coughs, Sneezes, or talks, droplets or tiny particles called aerosols carry the virus into the air from their nose or mouth. Anyone who is within 6 feet of that person can breathe it into their lungs.

 

5.2 Airborne transmission. Research shows that the virus can live in the air for up to 3 hours. It can get into your lungs if someone who has it breathes out and you breathe that air in. Experts are divided on how often the virus spreads through the airborne route and how much it contributes to the pandemic.

 

5.3 Surface transmission. A less common method is when you touch surfaces that someone who has the virus has coughed or sneezed on. You may touch a countertop or doorknob that's contaminated and then touch your nose, mouth, or eyes. The virus can live on surfaces like plastic and stainless steel for 2 to 3 days. To stop it, clean and disinfect all counters, knobs, and other surfaces you and your family touch several times a day.

 

5.4 Fecal-oral. Studies also suggest that virus particles can be found in infected people's poop. But experts aren't sure whether the infection can spread through contact with an infected person's stool. If that person uses the bathroom and doesn't wash their hands, they could infect things and people that they touch.¹²

 

Figure 3: Way of transmission for corona virus

 

 

6. Prevention:

To prevent infection and to slow transmission of COVID-19, do the following:

 

6.1 Get Vaccinated and stay up to date on your COVID-19 vaccines

COVID-19 vaccines are effective at preventing you from getting sick.

 

COVID-19 vaccines are highly effective at preventing severe illness, hospitalizations, and death. Getting vaccinated is the best way to slow the spread of SARS-CoV-2, the virus that causes COVID-19. CDC recommends that everyone who is eligible stay up to date on their COVID-19 vaccines, including people with weakened immune systems.

 

6.2 Wear a mask:

Everyone ages 2 years and older should properly wear a well-fitting mask indoors in public in areas of substantial or high community transmission, regardless of vaccination status.

 

 

6.3 Stay 6 feet away from others:

Inside your home: Avoid close contact with people who are sick, if possible. If possible, maintain 6 feet between the person who is sick and other household members.

If you are taking care of someone who is sick, make sure you properly wear a well-fitting mask and follow other steps to protect yourself.

 

Indoors in public: If you are not up to date on COVID-19 vaccines, stay at least 6 feet away from other people, especially if you are at higher risk of getting very sick with COVID-19.¹³

 

6.4 Avoid poorly ventilated spaces and crowds

If indoors, bring in fresh air by opening windows and doors, if possible. If you are at increased risk of getting very sick from COVID-19, avoid crowded places and indoor spaces that do not have fresh air from the outdoors.

 

6.5 Wash your hands often

Wash your hands often with soap and water for at least 20 seconds especially after you have

been in a public place, or after blowing your nose, coughing, or sneezing.

It’s especially important to wash your hands:

·      Before eating or preparing food

·      Before touching your face

·      After using the restroom

·      After leaving a public place

·      After blowing your nose, coughing, or sneezing

·      After handling your mask

·      After changing a diaper

·      After caring for someone sick

·      After touching animals or pets

 

If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.¹⁴

 

6.6 Cover coughs and sneezes

If you are wearing a mask: You can cough or sneeze into your mask. Put on a

new, clean mask as soon as possible and wash your hands.

If you are not wearing a mask: Always cover your mouth and nose with a tissue when you

cough or sneeze, or use the inside of your elbow and do not spit. Throw used tissues in the

trash. Immediately wash your hands with soap and water for at least 20 seconds. If soap and

water are not readily available, clean your hands with a hand sanitizer that contains at least

60% alcohol.¹⁵

 

6.7 Clean and disinfect

Clean high touch surfaces regularly or as needed and after you have visitors in your home.

This includes tables, doorknobs, light switches, countertops, handles, desks, phones,

keyboards, toilets, faucets, and sinks.

If someone is sick or has tested positive for COVID-19, disinfect frequently touched

surfaces:

Use a household disinfectant product from EPA’s List N: Disinfectants for Coronavirus (COVID-19) external icon according to manufacturer’s labeled directions.

If surfaces are dirty, clean them using detergent or soap and water prior to disinfection.¹⁶

 

6.8 Monitor your health daily:

Be alert for symptoms:

Watch for fever, cough, shortness of breath, or other symptoms of COVID-19.

Take your temperature if symptoms develop.¹⁷

 

Figure 4: Way of prevention for transmission of corona Virus

 

 

7. Covid-19 In India:

The COVID-19 pandemic in India is part of the worldwide pandemic of Corona virus disease 2019 (COVID-19) caused by SARS Cov-2. As of 23 May 2021, India has the second-highest number of confirmed cases in the world (after the United States) with 26.7 million reported cases of COVID-19 infection and the third-highest number of COVID-19 deaths (after the United States and Brazil) at 307, 231 deaths. The first case of COVID-19 in India, which originated from China, was reported on 30 January 2020. The first cases of COVID-19 in India were reported in the towns of Thrissur, Alappuzha and Kasargod.

 

By mid-May 2020, five cities accounted for around half of all reported cases in the country Mumbai, Delhi, Ahmedabad, Chennai and Thane. On 10 June, India's recoveries exceeded active cases for the first time. Infection rates started to drop in September, along with the number of new and active cases.18

 

Figure 5: Covid-19 in India

 

A second wave beginning in March 2021 was much larger than the first. By late April, India led the world in new and active cases. On 30 April 2021, it became the first country to report over 400,000 new cases in a 24-hour period.

 

On 19 March 2020, Prime Minister Modi asked all Indians to observe a 14-hour Janata curfew ("People's Curfew") on 22 March, and to thank essential workers by clapping or ringing bells at 5 p.m. outside their homes. The curfew was used to evaluate the feasibility of a national lockdown.

 

On 24 March, with 519 confirmed cases and 9 deaths in the country, the Prime Minister announced that India would be placed under a "Total Lockdown" for at least three weeks. All non-critical businesses and services were ordered closed except for hospitals, grocery stores, and pharmacies, and there was a "total ban" on leaving the home for non-essential purposes. All public transport was suspended, after that, it is extended many time for months. In view of stop the spreading, the infection transmission of second wave many states again put on curfews and partial lockdown of many parts of country.^19,20

Third wave of Covid 19 was begun in India at approximately starting month of year 2022. The new variant of corona virus called as Omicron having higher rate of transmission but low impact on patients. During the initial spread of Omicron, many states imposed night curfew and weekend lockdowns. But within around one month the cases were decline and till mid of the February 2022, almost states on India taken back the restriction. In the third wave less deaths were occurred and most of the infected peoples develops only mild symptoms.²¹

 

8. Treatment:

During the first two COVID waves, a lot of experimental drugs came to the forefront, which although helped patients cope with their symptoms, also introduced them to many other complications. Out of the many, some treatments have been discontinued, while many others have come to light. Doctors and medical professionals prioritized treating their patients first over considering long term health complications.

 

Drugs like Ivermectin, Hydroxychloroquine and anti-HIV drug combination, Lopinavir/Ritonavir gained much momentum during the initial wave of coronavirus, the Indian Council of Medical Research (ICMR) ordered the discontinuation of these treatments and crossed it out of it's treatment protocol. The government panel was retained Remdesivir and Tocilizumab in its treatment protocol for patients with moderate to severe illness. The former works towards inhibiting the multiplication of the virus, whereas the latter is a monoclonal antibody that puts a stop to a possible cytokine storm.²²

 

On 23 March, the National Task Force for COVID-19 constituted by the ICMR (Indian council of medical research) recommended the use of Hydroxychloroquine for the treatment of high-risk cases in June 2020, India approved the repurposing of generic versions of the antiviral medication Favipiravir for the treatment of mild-to-moderate COVID-19 symptoms manufactured by by Glenmark, Cipla and the Indian Institute of Chemical Technology and Lupin Limited. In July 2020, the Indian firm Biocon received emergency authorization for the use of the repurposed drug Itolizumab in treatments for chronic plaque psoriasis, one of the symptoms of the Covid -19 disease.²³

 

On 23 April 2021, Cadila Healthcare received an emergency authorization to repurpose Peginterferon alfa-2b, a medication used to treat hepatitis C, as a treatment for moderate COVID-19 in adults. On 8 May 2021, DCGI gave permission for emergency use of the drug 2-deoxy-D-glucose developed by DRDO (The Defence Research and Development Organisation) in collaboration with Dr. Reddy's Laboratories as an adjunct or alternative therapy for treating moderate to severe cases of COVID-19.²⁴

 

On June 1 2020, The Drug Controller General of India (DCGI) has approved Mylan’s Remdesivir Lyophilised Powder for Injection 100 mg/vial for restricted emergency use as a COVID-19 treatment in India. The approval is part of the DCGI’s accelerated approval process to address urgent, unmet needs amid the pandemic. It is an antiviral drug approved for use in adults and pediatric patients (12 years of age and older and weighing at least 40 kilograms) for the treatment of COVID-19 requiring hospitalization.25

 

On 28 December 2021, the Indian drug regulator cleared the first anti-viral Covid-19 pill Molnupiravir. It was developed by US-based biotechnology company Ridgeback Biotherapeutics in collaboration with US Pharma giant Merck and will now be manufactured by 13 Indian drug manufacturers. The drug, in India, has been cleared for the treatment of adult patients with Covid-19 and “who have a high risk of progression of the disease.” Molnupiravir is an anti-viral pill that works by introducing errors into the SARS-CoV-2 virus’ genetic code, which prevents the virus from further replicating.26

 

9. Vaccines: an Introduction:

In India, till 1850, the vaccine was imported from Great Britain. However, there were real logistic challenges in transport of vaccine to India. Following a recommendation of British Government, the Government of India accepted a request of Dr Haffkine to come and conduct Cholera vaccine trial in India. In 1893, Dr Haffkine conducted vaccine trials in Agra, Uttar Pradesh, and showed the efficacy of his vaccine in the effective control of the disease. Though Haffkine knew the process for the development of cholera vaccine, he had proven its efficacy here in India (and Personal Communication: Dr Abhay Choudhury, Director, Haffkine Institute, 2012).

 

Figure 6: Dr Haffkine

 

A plague epidemic started in India in 1896 (which led to the enactment of Epidemic Act of 1896, which is still applicable in the country). The Government of India requested him to work on the development of plague vaccine and provided him a two-room set in Grant Medical College, Mumbai, to set up his Laboratory. Dr Haffkine developed plague vaccine in 1897 and it is arguably, the first vaccine developed in India.

 

This laboratory was called Plague Laboratory since 1899, renamed as Bombay Bacteriological Lab in 1905, and then finally named as Haffkine Institute in 1925, as it is known today.²⁷

 

Germs are all around us, both in our environment and in our bodies. When a person is susceptible and they encounter a harmful organism, it can lead to disease and death. The body has many ways of defending itself against pathogens (disease-causing organisms). Skin, mucus, and cilia (microscopic hairs that move debris away from the lungs) all work as physical barriers to prevent pathogens from entering the body in the first place.^27,28

 

When a pathogen does infect the body, our body’s defence, called the immune system, are triggered and the pathogen is attacked and destroyed by defence cells. Vaccines contain tiny fragments of the disease-causing organism or the blueprints for making the tiny fragments. They also contain other ingredients to keep the vaccine safe and effective. These latter ingredients are included in most vaccines and have been used for decades in billions of doses of vaccine.²⁸

 

9.1 How Vaccines Work against Corona Virus – SARS CoV-2 is the virus that causes COVID-19. The spike protein on the surface of SARS-CoV-2 is an example of an antigen. Vaccines are the best way to train our immune system to recognize viruses, or pieces of viruses, called antigens. Our immune system creates antibodies and other defenses to protect us. When vaccinated people are exposed to SARS-CoV-2, their immune system will recognize the viral antigens and spring into action to keep them healthy.²⁹

 

9.2 Types of Vaccine Platforms - All vaccine platforms are designed to train our immune system. There are two categories of COVID-19 Vaccines: Component Viral Vaccines and Whole Virus Vaccines.³⁰

 

Component Viral Vaccines:

·      Protein Subunit: Contains isolated and purified viral proteins

·      Virus-like Particles (VLP): Contains viral proteins that mimic the structure of the virus, but no genetic material

·      DNA-based and RNA-based: Contains viral genetic material (such as mRNA) which provides the instructions for making viral proteins

·      Non-Replicated Viral Vector: Contains viral genetic material packaged inside another harmless virus that cannot copy itself.

 

Figure 7: Component Viral vaccines

 

·      Replicating Viral Vector: Contains viral genetic material packaged inside another harmless virus that can copy itself.³¹

 

Whole Virus Vaccines:

·      Inactivated: Contains copies of the virus that have been killed (inactivated)

·      Live-Attenuated: Contains copies of the virus that have been weakened (attenuated)

 

9.3 How vaccine helps?

Vaccines contain weakened or inactive parts of a particular organism (antigen) that triggers an immune response within the body. Newer vaccines contain the blueprint for producing antigens rather than the antigen itself. Regardless of whether the vaccine is made up of the antigen itself or the blueprint so that the body will produce the antigen, this weakened version will not cause the disease in the person receiving the vaccine, but it will prompt their immune system to respond much as it would have on its first reaction to the actual pathogen Some vaccines require multiple doses, given weeks or months apart. ³²

 

9.4 Covid -19 Vaccine In india:

There are more vaccine candidates simultaneously in the pipeline for COVID-19 than ever before for an infectious disease. All of them are trying to achieve the same thing – immunity to the virus, and also some might be able to stop transmission. They do so by stimulating an immune response to an antigen, a molecule found on the virus. In the case of COVID-19, the antigen is typically the characteristic spike protein found on the surface of the virus, which it normally uses to help it invade human cells.

 

India began its vaccination programme on 16 January 2021, and by April was administering 3–4 million doses a day. India has authorized the British Oxford–AstraZeneca vaccine (Covishield), the Indian BBV152 (Covaxin) vaccine, and the Russian Sputnik V vaccine for emergency use. As of 25 May 2021, the country had administered over 200 million vaccine doses. In January 2021, the DGCI initially approved the Oxford–AstraZeneca vaccine, manufactured by the Serum Institute of India (SII) under the trade name "Covishield", and BBV152 (Covaxin) a vaccine developed by Bharat Biotech in

 

association with the Indian Council of Medical Research and National Institute of Virology.³³

 

In Initial Phase I started on 16 January 2021 and targeted 10 million health workers first followed by 20 million frontline workers. Phase 2 began on 1 March 2021 to cover 45+ year old with co-morbidities and 60+ year old. On 1 April, vaccinations were opened for everyone above 45 years. Shortages in vaccine supplies were evident in March. In April 2021, the DCGI approved the Russian Sputnik V vaccine, which was trialled in India by Dr. Reddy's Laboratories. Phase 3 of the vaccination campaign was opened up to include all eligible adults (18+) from 1 May 2021 following a surge in cases in April, a second wave. In the sequence of Emergency use authorization (EAU) India has approved around eight vaccines till December 2021 to achieve maximum vaccination goal as soon as possible.^33,34

Table 3: Details of vaccines and there manufacturer for COVID -19

Sr. No.	Name of vaccine	Manufacturing Company	Type of vaccine	Emergency use authorization (eau)
1.	Covaxin	Bharat Biotech, India	It is a Inactivated viral vector vaccine, non replicating strain of Chimpanzee cold virus (Adenovirus).	January 2021
2.	Covishiled	Serum Institute of India (SII) And Oxford /AstraZeneca(Formulation)	Non-Replicated Viral Vector Vaccine It contains an inactivated SARS-Cov -2, Which is disable for replication	January 2021
3.	Sputnik V	The Gamaleya National Center (Manufactured under license by Dr. Reddy's Laboratories, with additional production from Serum Institute of India)	Adenovirus viral vector vaccine	April 2021
4.	mRNA-1273	Moderna	RNA vaccine composed of nucleoside-modified mRNA	Jun 2021
5.	AD26.COV2.5	Johnsons and Johnsons	Viral vector vaccine based on a human adenovirus	August 2021
6.	ZYCOV – D	Zydus Cadila	DNA plasmid-based COVID-19 vaccine	August 2021
7.	Corbevax / Becov 2A	Biological E Ltd. (BE)	It is a protein subunit vaccine	December 2021
8.	NVX-COV2373 / Covovax	Serum Institute of India (SII)	It is a protein subunit vaccine	December 2021

 

On The Arm Where You Got The Shot	Throughout The Rest Of Your Body
·      Pain ·      Redness ·      Swelling ·      Tenderness	·      Tiredness ·      Headache ·      Muscle pain ·      Chills ·      Fever ·      Nausea

Figure 8: Side effects of Covid-19 vaccines