International COVID-19 Webinar: current scenario, opportunities and challenges

Prof. Ramesh K. Goyal

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Vice Chancellor Delhi Pharmaceutical Sciences & Research University, New Delhi, India, goyalrk@gmail.com

COVID-19 pandemic has emerged as an exceptionally, frightful contagious disease with substantial morbidity and mortality affecting more than 200 countries across the world. There have been over 20 million confirmed cases and 0.7 million deaths by August 2020. SARS-CoV-2 binds to Angiotensin-Converting Enzyme 2 (ACE2), a site that is also involved in the pathology of leading causes of mortality in the world, including cardiovascular, respiratory, and GI dysfunction. ACE2 is a mystery to the medical scientists as it regulates the renin-angiotensin system (RAS), which in turn, has an influence on the cardiovascular system, including the vital organs, kidney, heart, brain, lungs and vasculature. The main molecular link of these morbidities and COVID-19 prognosis appeared to be ACE2 and Open Reading Frame protein (ORF8).
Unfortunately, there has been no remarkable breakthrough in the management of this disease to date, and the patient is given a treatment based on his observable and diagnosable symptoms. Although several attempts have been made in the research and development of the diagnostics, therapeutics, and vaccines for this COVID-19, there exists no chemotherapeutic agent, so far which is effective in COVID-19. To combat this deadly COVID-19, repositioning of many conventional drugs like chloroquine, hydroxychloroquine, but the clinical drug response is not very encouraging, and their toxicity remains an inevitable issue causing severe adverse effects. Major pathophysiological and molecular derangements that have drawn the attention of scientists for the discovery of the medicine that can be used for the treatment of COVID-19 include prevention of binding of the virus with ACE2 receptors leading to viral multiplication, immunostimulation, inflammation, and cytokine surge. These efforts may provide protection to the alveoli of lungs that causes Acute Respiratory Distress or syndrome. In addition, one may also have protection against thrombotic events and embolism. Binding with ORF8 proteins leads to dissociation of iron from the 1-beta chain of hemoglobin, getting attached to the surface glycoprotein porphyrin.
While studying various phytochemicals from plants reported in Ayurveda using molecular docking studies, we found Solanum nigrum L. (family - Solanaceae) to be one of the most effective in herbal medicine for COVID-19. The results were correlated with published pharmacological studies. Since, certain formulations of exclusive Solanum nigrum were available in India, it was given to patient as add-on nutraceutical to some patients in severe stage with no option available for the treatment. It was found to be effective. Based on these observations we have designed a protocol with holistic approach for the treatment of patients with moderate to severe COVID-19 disease. It is expected to bring down the mortality in patients drastically.

Molecular Diagnosis and protocols for Pathogen screening

Dr. Ana Rita Ferreira, Dr. Ana Rita Bezerra, Prof. Manuel Santos

Virus Host-Cell Interactions Lab, IBIMED & Department of Medical Sciences, University of Aveiro, Portugal, arferreira@ua.pt 

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak rapidly spread worldwide, and since its discovery infected more than 25 million people and has led to the death of nearly 1 million people. 
To face SARS-CoV-2 pandemic, molecular testing became essential for coronavirus disease 2019 (COVID-19) diagnosis and pathogen screening. Currently, the most common molecular assay used is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) that allows the qualitative and quantitative detection of viral nucleic acids. Additionally, serologic assays, which detect the presence of specific antibodies against the pathogen, have also been implemented, however they remain as supplemental tools. 
Some of the major bottlenecks of SARS-CoV-2 screening are the capacity to process a high number of samples and reagent shortage. For that, high through-put methods are being explored to overcome these limitations, but none has yet been approved. Nonetheless, molecular testing is critical to obtain an accurate diagnosis, which is essential for implementing proper public health measures that will tackle SARS-CoV-2 dissemination.

COVID-19 AND CANCER: A DEADLY DUO!

Prof. Bhoomika M. Patel

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Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India, drbhoomikampatel@gmail.com

The Covid-19 outbreak has challenged the entire medical community including the oncology community whose major concern now becomes protecting the vulnerable cancer patients without jeopardising cancer treatments. The incidence of the Covid-19 among the patients suffering from cancer is high. The prevalence rate of Covid-19 in cancer patients ranges from 0.92% to 3.4% as revealed by various systematic.  
There are several challenges for the cancer patients. The first and foremost challenge is that they are highly vulnerable for Covid-19 due to weak immune system. The second challenge is that there is very high risk of death in the cancer patients which have been reported in several meta-analyses studies. Another challenge is that the risk of severe complications from Covid-19 in cancer patients is very high as compared to those who do not. The challenges levied by Covid-19 impact every aspect of care, beginning with diagnosis and moving towards the way to end of-life care for patients. 
For every challenge, there has to be some solutions. First of the unprecedented solutions for cancer patients include preventing such patients from contracting Covid-19. The diagnostic and imaging procedures have to be prioritized for cancer patients in advanced stage. Implementation of tele-multidisciplinary tumor boards, reducing myelosuppresive agents, use of oral therapy wherever possible, modifying the course of radiation to reduce number of visits are some of the alternatives for better management. 
In addition to clinical management, there has been a very adverse impact of Covid-19 on cancer research. Many of the basic laboratories are closed and the research has been dampened. The industries and academia have halted various clinical trials pertaining to cancer research. Finally, we need to focus on improving research on cancer care as they along with Covid-19 form a deadly duo combination.

How South Africa is responding to pandemic crisis of Covid-19

Prof. Salim S Abdool Karim

Centre for the AIDS Programme of Research in South Africa (CAPRISA) and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, U.S.A., Salim.AbdoolKarim@caprisa.org

The first case of COVID-19 in South Africa, on March 5, 2020, was a man who had returned from Italy. With 402 cases at 18 days, the government announced a national lockdown, implemented 4 days later when the doubling time was 2 days and there were 1170 cases from 28,537 tests. During 35 days of the strict national lockdown, the doubling time slowed to 15 days with a total of 5,647 cases (103 deaths) from 207,530 tests by April 30. As restrictions eased, the number of cases and deaths rose steadily, peaking in mid-July with the country recording over 600,000 cases (over 13,000 deaths) and has conducted over 3.5 million tests.
The primary goal of South African national Covid-19 response was to “flatten the curve” by reducing coronavirus spread over an extended period. The response comprised eight overlapping stages. The first stage focused on preparing for COVID-19 including establishing testing capacity. Stage 2 was the declaration of a national state of disaster, that led to the banning international travel, closing schools, restricting gatherings and implementing programs promoting social distancing and hand hygiene. Stage 3 was the national lockdown. Stage 4 was widescale screening through the deployment of over 28,000 community healthcare workers to the highest risk communities to undertake house-to-house active case-finding. Stage 5 was hotspot identification and mitigation to identify localised outbreaks and implementation of prevention measures. Stage 6 focused on medical care, including construction of field hospitals. Stage 7 involved preparation for deaths and burials and the mental health challenges of bereavement. The final stage focuses on vigilance through case finding and monitoring immunity levels through serosurveys in preparation for subsequent waves of the epidemic.

A glimpse in intensive care of COVID-19 patients: an experience from Brazil

Dr. Izabela Brugugnolli​, MD

Specialist in Intensive care Medicine, Faculty of Medicine, Centro Universitário Padre Albino - UNIFIPA - FAMECA, Catanduva - São Paulo, Brazil, izabrug@hotmail.com

For most patients affected by the infection caused by COVID-19  hospitalization is necessary; for some, the Intensive Care Unit (ICU) is the only possible way. With the advance of the pandemic, medical knowledge at the bedside on a daily basis has also improved and, in a country with limited resources like Brazil, reinventing itself is the way. Thus, we will bring our experience with the care and treatment to patients affected by COVID-19 in its most serious presentations in the city of Catanduva, state of São Paulo, located in southeastern Brazil. Our city is medium-sized, however, we are responsible for regional support covering a population of 350,000 people. The work in the Intensive Care Unit was organized and implemented within our public health system in a University Hospital. Through the formation of a solid, cohesive and humanized team of diverse professionals (doctors, nurses, physiotherapists, psychologists, social workers) health care can be offered with quality, seeking to minimize the physical and emotional damage caused by the disease to the population.

Research priorities response to COVID-19

Prof. Yazdan Yazdanpanah, MD

Chair of The Global Research Collaboration for Infectious Disease Preparedness, Head of Infectious Disease department at Bichat Claude Bernard Hospital, Paris and Professor of Medicine at Paris Diderot University, France, yazdan.yazdanpanah@aphp.fr 

Abstract to be disclosed