A Review Paper on Pandemic Covid-19

Covid – 19 national disasters of India declared on 13 March 2020. The word Covid 19-means China originated virus in December 2019.Covid19 is emerging disease worldwide and perhaps a pandemic as declared by WHO on 11 March 2020, and came into existence from Wuhan China, Hubei province on 1 December 2019. Covid-19 which not only caused havoc but also lead to an economic crisis because of health care systems.Some advancement in health and its regulations. It hasmainly affected elderly persons and immunocompromised patients; pregnant women have not shown more chances of infection until now. Patients mainly present with cough, fever, shortness of breath.patient are categorized as suspected and con irmed cases, high risk and.moderate risk. Here is a discussion on pathology, clinical aspects, gynaecological aspects, forensic aspects, diagnosis, management, prevention. Preventive measures include self-isolation, quarantine, wearing a mask, use of alcohol-based sanitizer and are discussed further. Its management has antiviral therapy, ventilators support. This has set an example of community spread. It is a concern of public health emergency. It has geared up hospitals for an increase in the number of beds, staff and an emergency.


INTRODUCTION
Covid -19 caused by coronaviridae from coronaviruses has alpha, beta, gamma, delta forms. Mostly infect animals except for gamma coronaviruses which affect birds-severe acute respiratory syndrome (SARS-COV-2) which is Covid-19 ( Figure 1). SARS is human affected by alpha and beta forms.
Middle east respiratory syndrome Covid-19 (2012Covid-19 ( -2018. The novel coronavirus is a part of SARS -COV 2, which is caused by . Animal sources are bats and snake. Human source is a human transmission.

Epidemiology
Covid -19 starts its spread from Wuhan China Hubei province on 1 December 2019, then on 31 December 2019 WHO China reported it to be pneumonia of unknown aetiology. 1 January 2020 Wuhan seafood market closed for anticipation. 7 January 2020 Chinese identi ied Novel Coronavirus .9jan 2020 irst death Wuhan China. 13 January it affected Thailand. 30 January irst case was reported in Kerala India WHO declared public health of emergency concern. 11 February 2020 WHO named as Covid-19 $ (World Health Organization, 2020) 7 February 2020 WHO named Novel coronavirus. 11 March 2020 WHO declared as Novel coronavirus as a pandemic. Type of epidemic it has are single exposure, multiple exposures, propagated exposure. Associated comorbidities are CVS, DM, Chronic respiratory disease, HTN, Carcinoma $ (Lippi et al., 2020)

Pathology
The causative agent for Novel coronavirus is SARS-COV-2. Source of infection is cases. The incubation period is 2 -14 days. Mode of transmission is droplets, contact with cases, fomites. Coronavirus is enveloped carrying petal or club-shaped or crownlike pepper glycoprotein spikes giving the appearance of solar Corona large 120 to 160 nm helical symmetry, linear, positive RNA (non-segmented genome) (Figure 2). Spike like molecule attaches to airway epithelium, cell of lung haveACE 2 receptor interacts with receptor cause damage to airway epithelium .macrophage and dendritic damage cytokine release causes systemic dysfunction caused to age group more than 65 years, immunocompromised, males more than females.
Transcription process after entering into host cell virus particle uncoated genome enters cytoplasm attach to host cell ribosomes for translation. It has RNA dependent polymerase RdRp irst protein which helps viral genome to transfer into new RNA copies using host cell matching. RdRp gene coding translation stops by stop codon known as a nested transcript (Wu et al., 2019).

Clinical Manifestation
Covid 19 is life-threatening as it spreads by secondary transmission rate is high, and death is due to an ARDS which causes hypoxia and which causes by bilateral pneumonia. Hypertension is the most important comorbid condition associated with Covid 19 as if the patient takes ACE inhibitor than as Covid-19 has high susceptibility for ACE 2 receptor. So HTN will have more chance.
The suspected cause is de ined as a patient with acute respiratory infection with cough fever shortness of breath, and rhinorrhea may present or absent. Or In 14 days before the onset of symptoms has met any of the epidemiological criteria. Epidemiological criteria include. Close contact with con irmed or probable case .travel to impact zone. Worked attended a health care facility where the infection is being treated.
Con irmed case: Lab diagnosis, irrespective of clinical state.

Laboratory Diagnosis
For testing, a doctor should use PPE kit, gloves, nitryl latex-free .specimen collection URT nasopharyngeal and oropharyngeal. LRT BAL and tracheal aspirate. Nasopharyngeal swabs are taken by tilting hard and insert swab stick With synthetic ibre with plastic shaft.sent for RRTP real-time pcr. The nodal of icer at the ield level is district collector (Han et al., 2020) (Figure 4).

Treatment
Lopinavir and ritonavir are given for. All positive lab patience. Hypoxia, low BP, organ dysfunction.

Complication
Non cardiogenic pulmonary oedema due to which lung compliance is less.

Obstetrics and Gynecology Role
1. There is no transmission by vertical transmission for which sample taken are amniotic luid, cord blood, neonatal throat swabs, breast milk swabs from infected mothers.
2. Transmission more commonly occurs by close contact from mother to child. 5. When the patient goes to labour that time feota may have cardiac compromised so electric foetal monitoring is used 6. No indication of C section unless she has respiratory dysfunction.
7. Delayed cord clamping in positive patients.neonate tested for Covid 19, separated from mother for 14 days, breast milk can be given to neonate (Won et al., 2020).

Forensic Medicine Role
A pathological or clinical autopsy can be done 1. Consent needs to be taken.
2. PPE kit nitryl gloves avoid the risk of cuts puncture wounds face shield goggles ( Figure 6).
3. Following PPE kit should be worn during the autopsy: • Double surgical gloves • Fluid resistant impermeable grown • Waterproof apron • Goggles or face shield and Disposable N95 mask.

Duties of Doctors
1. The doctor should notify the public health authority 3. Should tell about quarantine 4. Inform public health authority for cases of Communicable diseases 5. The physician has to treat without any fear to get the infection. Epidemic Disease Act 1. Titles and descriptions-whenever existing regulations of the central government is not enough to control the spread. State or central has to empower special regulations for diseases.

Duties of Hospitals
2. Not to allow any people or any vessel coming from abroad to stop an epidemic.
3. Quarantine for those who are exposed.
4. Punishment for violation Of regulations or order is punishable under act 188IPC.
5. Legal protection to implementing of icer's acting underact.
6. Section 269 negligent act likely to spread infection of disease dangerous to life.
7. Section 270 malignant act likely to spread infection of disease dangerous to life (Loeffelholz and Tang, 2020).

Vaccine Research
1. Who said in February that it would take around 18 months to have a vaccine.
3. Avoid touching of eyes, nose or mouth with unwashed hands.
4. Respiratory hygiene cover your mouth and nose with a tissue when cough sneeze and dispose of it or do it with sleeve.
5. Use of Surgical mask. 6. Self-isolation for diagnosed or suspected cases 7. Self-quarantine for recent travel history on contact with infected patients.
8. Social distancing by quarantine, travel restrictions to containment zone, close school temples shopping malls avoid crowds areas.
9. Avoid contact with sick persons.
10. Arogya setu application which creates awareness connects people to heath system, risk assessment Case update, how many people get checked for disease from your location.
11. Toll-free 12. The disinfectant used in the walkthrough tunnel is 1%sodium hypochlorite (Ling et al., 2020) Category of patients

Category A
High risk includes patients with fever cough shortness of breath history of travel to the area has a recent transmission-any patient with respiratory illness or contact with any case of covid 19 in the last 14 days.

Category B
Patients moderate risk asymptomatic passengers coming from China Iraq Korea Germany elderly more than 60 years asthmatic HTN DM.
Action: Quarantine facility monitor for 14 days if any symptoms then do isolation.

Category C
Low-risk asymptomatic passengers are coming from Covid 19 affected country.
Wang, Y., Song, B., Gu, X. 2020. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet.