Coronavirus disease 2019 (COVID-19): the portrait of a perfect storm

The "novel" coronavirus disease 2019 (abbreviated "COVID-19") is the third coronavirus outbreak emerging during the past two decades. This infectious disease, sustained by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has been recently declared a global pandemic by the World Health Organization. Despite the concerning epidemiological burden, many people, including some policymakers, are underestimating this pandemic and are remaining enigmatically inactive against a human pathology which, for a combination of reasons, can be reasonably defined as a perfect storm (i.e., the "wrong virus" at the "wrong time"). These many paradigmatic aspects include SARS-CoV-2 structure and peculiar biology of infection, high risk of inter-human transmission, long incubation time combined with early and sustained viral load, existence of asymptomatic or mildly-symptomatic carriers, viral shedding for days after symptom relief, unfavorable progression towards respiratory distress and death in up to 5-10% of patients thus causing dramatic healthcare challenges, as well as environmental contamination. Last but not least, the combination of the current case fatality rate with the extraordinary number of people that could be potentially infected by SARS-CoV-2 would permit to estimate that the worldwide deaths for COVID-19 may even approximate those recorded during World War II if appropriate restrictive measures for preventing human-to-human transmission are not readily undertaken. Everybody should be inexcusably aware that this is not a drill, and that the consequences of inadequate action will be tragedy.

[1]  Wei Han,et al.  A case of 2019 novel coronavirus infected pneumonia with twice negative 2019-nCoV nucleic acid testing within 8 days. , 2020, Chinese medical journal.

[2]  L. Yang,et al.  Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak , 2020, International Journal of Infectious Diseases.

[3]  Oon Tek Ng,et al.  Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. , 2020, JAMA.

[4]  Ting Yu,et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study , 2020, The Lancet.

[5]  MingKun Li,et al.  Genomic diversity of SARS-CoV-2 in Coronavirus Disease 2019 patients , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  Huanqin Han,et al.  SARS-CoV-2 RNA more readily detected in induced sputum than in throat swabs of convalescent COVID-19 patients , 2020, The Lancet Infectious Diseases.

[7]  Don Klinkenberg,et al.  Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020 , 2020, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[8]  Y. Hu,et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China , 2020, The Lancet.

[9]  Dylan H. Morris,et al.  Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 , 2020, The New England journal of medicine.

[10]  Ivan Griffin,et al.  COVID-19: combining antiviral and anti-inflammatory treatments , 2020, The Lancet Infectious Diseases.

[11]  Jizhen Ren,et al.  Clinical characteristics of hospitalized patients with SARS‐CoV‐2 infection: A single arm meta‐analysis , 2020, Journal of medical virology.

[12]  Jianjun Gao,et al.  Discovering drugs to treat coronavirus disease 2019 (COVID-19). , 2020, Drug discoveries & therapeutics.

[13]  G. Lippi,et al.  Physical inactivity and cardiovascular disease at the time of coronavirus disease 2019 (COVID-19) , 2020, European journal of preventive cardiology.

[14]  Yan Zhao,et al.  A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version) , 2020, Military Medical Research.

[15]  Wei Han,et al.  A case of coronavirus disease 2019 with twice negative nucleic acid testing within 8 days , 2020, Chinese Medical Journal.

[16]  Liang Peng,et al.  Recurrence of positive SARS-CoV-2 RNA in COVID-19: A case report , 2020, International Journal of Infectious Diseases.

[17]  Taiwen Li,et al.  High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa , 2020, International Journal of Oral Science.

[18]  S. Cauchemez,et al.  Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature , 2014, BMC Infectious Diseases.

[19]  G. Chowell,et al.  Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020 , 2020, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[20]  G. Lippi,et al.  The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks , 2020, Clinical chemistry and laboratory medicine.

[21]  R. Lu,et al.  Detection of SARS-CoV-2 in Different Types of Clinical Specimens. , 2020, JAMA.

[22]  Cecile Viboud,et al.  Global mortality associated with seasonal influenza epidemics: New burden estimates and predictors from the GLaMOR Project , 2019, Journal of global health.

[23]  Elisabeth Mahase Covid-19: WHO declares pandemic because of “alarming levels” of spread, severity, and inaction , 2020, BMJ.

[24]  Pengfei Sun,et al.  Clinical characteristics of hospitalized patients with SARS‐CoV‐2 infection: A single arm meta‐analysis , 2020, Journal of medical virology.

[25]  Hannah R. Meredith,et al.  The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application , 2020, Annals of Internal Medicine.

[26]  G. Lippi,et al.  Which lessons shall we learn from the 2019 novel coronavirus outbreak? , 2020, Annals of translational medicine.

[27]  A. M. Leontovich,et al.  The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2 , 2020, Nature Microbiology.

[28]  G. Lippi,et al.  The novel coronavirus (2019-nCoV) outbreak: think the unthinkable and be prepared to face the challenge , 2020, Diagnosis.

[29]  Min Kang,et al.  SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients , 2020, The New England journal of medicine.

[30]  Mario Plebani,et al.  Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis , 2020, Clinica Chimica Acta.

[31]  Zunyou Wu,et al.  Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. , 2020, JAMA.

[32]  Jing Zhao,et al.  Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia , 2020, The New England journal of medicine.

[33]  N. Linton,et al.  Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19) , 2020, International Journal of Infectious Diseases.

[34]  MingKun Li,et al.  Genomic diversity of SARS-CoV-2 in Coronavirus Disease 2019 patients , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  Mario Plebani,et al.  Laboratory abnormalities in patients with COVID-2019 infection , 2020, Clinical chemistry and laboratory medicine.

[36]  G. Remuzzi,et al.  COVID-19 and Italy: what next? , 2020, The Lancet.