A Comprehensive Review of the Cross- Disciplinary Impact of COVID-19 in India

A novel coronavirus (2019-nCoV) responsible for a severe acute respiratory disorder (SARS-CoV-2) in humans, with its epicentre in Wuhan, China emerged in December 2019. This coronavirus, by far, has hit >200 countries, affecting 7 million worldwide accounting 11% death of the affected population. The transmission is majorly caused by human-to-human contact and, through fomite. In view of the increasing number of COVID-19 cases and the absence of definitive treatment or vaccinations, WHO has deemed the viral infection a pandemic of international concern. In such grave situations, there is a need for expanding the health sector workforce, government and police workforce, sanitation and prevention strategies. The current article describes the virology aspect, control of COVID-19 and revisits the various treatment options available at present this deadly infection. Epidemiology of COVID-19 is also discussed to further understand the pandemic status of India. The article also discusses implicating quarantine or social distancing, and in extreme cases, lockdown or alternative approaches such as herd or indirect immunity, as a measure to control the pandemic. Lockdown or social distancing will give rise to economic, emotional, political and social downfall in the country. It is estimated that a lockdown period will set back the country, possibly, by $240 billion, yet it stands unavoidable in the spread of control of infection. Thus, policymakers should strategize economic revival depending upon the best possible data and critical understanding.

WHO declared SARS-CoV-2 epidemic a health emergency of international concern. Similar situation was tackled in past with MERS-CoV with respect to discovery of a fatal infectious viral strain, uncertainty of its origin and transmission, invariable and irreversible threat to global economy [Zumla and Memish, 2014]. However alarming this situation might appear, discovering vaccination and treatment might take months or even years. The purpose of this review article is to provide researchers with a platform to find intricate information on this novel coronavirus.

Expected Origin and Structure:
Innovative Vector Control Consortium (IVCC) named the novel beta-CoV as SARS-CoV-2. Sequence analysis suggested that 2019-nCoV possesses a genome that belongs to Betacoronavirus genus and is closely related to bat-SL-CoV ZC45, bat-SL-CoV ZXC21 and is distantly related to SARS-CoV. CoVs  . S protein is thought to be involved in host tropism by recognition and attachment to receptor angiostensin-converting enzyme 2 (ACE2) on the outer host cell membrane [Tilocca et al., 2020, Shereen et at., 2020. NSPs which is 58% of the viral genome are found to be conserved and implies dependence on structural proteins to invade new hosts. [Ketkar et al., 2020] 2020]. The ACE-2 receptor on the host cell membrane that is responsible for viral entry in to the host, has also been implicated in cardiovascular diseases (CVD). When compared with normal individuals, patients with CVD show exacerbated symptoms . However, 1% of the cases of COVID-19 patients in China were tested positive even in absence of any peculiar symptoms [Wu et al., 2020].
Additionally, clinical features of secondary hemophagocytic lymphohistiocytosis (sHLH), which is triggered by viral infections, are unremitting fever, cytopenias and hyperferritinamea. Cytokine profile similar to sHLH is associated with COVID-19 disease and is characterized by increase in IL-2, IL7, granulocyte colony stimulating factor, interferon-γ inducible protein, monocyte chemoattractant protein, macrophage inflammatory protein 1-α, and tumour necrosis factor-α. Recent report on a multicentre study of 150 confirmed COVID-19 patients in Wuhan, China, revealed elevated ferritin (mean 1297·6 ng/ml in nonsurvivors vs 614·0 ng/ml in survivors) [Mehta et al., 2020]. Radiological findings of 81 patients in Wuhan China suggested that COVID-19 pneumonia shows Chest CT imaging abnormalities even in pre-symptomatic phase of the infection.
Thus combination of clinical, laboratory and imaging findings should serve a proper early diagnostic tool for detecting COVID-19 patients . Infection is simultaneously diagnosed with the aid of real-time fluorescence polymerase chain reaction (qRT-PCR) of fluid from bronchoalveolar lavage [Sohrabi et al., 2020.

Treatment of COVID-19:
Chloroquine phosphate has shown apparent safety and efficacy against COVID-19 in multicentre clinical trials. . According to 23 ongoing trials in China, Chloroquine was found effective in  Anti-malarial drugs, anti-viral drugs, convalescent plasma therapy, and cytokines have been used to manage and treat COVID-19. However the uncertainty of the efficacy of these drugs across the globe, age-related discrepancies and prevalence of co-morbid situation has led into adopting preventive or control measures to spread the infection.

Rationale to Implementation of preventive measure for COVID-19 infection in India
As of now, no vaccine has been developed for SARS-CoV-2. So the best way to deal with this situation is proper protection and sanitation, identifying early indications of the disorder, early and quick diagnosis,

Epidemiology of COVID-19 in India
Correlating the epidemiology of this disease in China to India (Figure 1.)

Impact of ' Virality of Virology' on India
India faced the longest COVID-19 national lockdown in the world which has been extended to May 31 st 2020. India adopted safety measures like contact tracing, restricted mobilization and extensive testing in a 'toughly and timely' manner which also WHO praised [Lancet, 2020]. However, governments' sudden implementation of lockdown sent a wave of paranoia amongst the immigrants with informal economical background. Since a novel infection, Covid-19 has caused fear, stigma, confusion, and anxiety leading to political, religious and social imbalance in the country and worldwide [Lancet, 2020].   [Lancet, 2020].

India and Impact of COVID-19 on Education:
'Education' is one of the strongest predictors of health and wealth of a country as impact of long term closure of schools will affect the mental state of children who will be returning after a long hiatus due to learning should be adopted to educate students in the current pandemic situation. Conducting physical examinations is difficult specifically for courses which require on-campus practical sessions. This situation should be considered as an opportunity to come up with innovative ideas to educate the youth of the society and revolutionize education system as a whole.

India, COVID-19 and Policy Making
Non-communicable conditions such as cancer, heart stroke, depression and mental disorders accounted

Alternative Measures under 'Herd Immunity'
COVID-19 will continue to exist until immunity against it is acquired through natural (sufficient infection of world's population) or acquired (vaccine) ways [Brodin, 2020]. Critical analysis of measures to control or treat COVID-19 by closing school, universities, followed by completely locking down cities or countries, is taking us to an alternative strategy of Herd Immunity. Alternate strategy suggested by Kwok et al.,2020 was to expose the population apart from elderly and people with co-morbidities to SARS-CoV-2 in order to increase population immunity. Antibody Cross-Reactivity and Partial immunity Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 11 June 2020 doi:10.20944/preprints202006.0131.v1 (or other common coronaviruses) may contribute towards achieving herd immunity. However, by the time herd immunity is acquired, the number of people who could potentially die of COVID-19 will be too adverse to accept [Kwok et al., 2020]. Yet another strategy, while approaching towards herd immunity, that can be applied is where the patients recovered from COVID-19 can be temporarily employed at the hospital settings based on their skill set. But in such indirect immunity approach, we are still lacking results on 're-infection'. Also herd immunity will prove ineffective if the virus mutates, and this possibility cannot be ruled out completely [Ryan et al., 2020].
United Kingdom's plan to save lives was pivoted around herd immunity. However, when brutal consequences were observed, the strategy was ruled impermissible [Horton., 2020]. Thus, lockdown might effectively delay the rate at which India will acquire herd immunity as abrupt exposure to 1.2 billion population to the virus will put stress on the health care sector. However, early June, India

Conclusion:
The current review article focuses on the control, epidemiology, diagnosis, possible treatment, economic, depend on the fiscal stimulus adopted by the policy makers but will also be determined by the cooperation and responsible behavior regarding personal sanitation embraced by its citizens.