COVID-19 pandemic; prevention, treatment, and mental health

KEYWORDS:

• Novel Coronavirus
• vaccine
• quarantine
• treatment
• mental health

The COVID-19 spread rapidly across the Chinese territories, infected large populations in China and caused a large number of morbidities and mortalities in essentially all countries of the world.¹ To mitigate the spread and infection, the Chinese government suspended traveling, social activities, and gatherings at public places.² While, in response to the spread of the infection in other countries, large populations are being quarantined across the globe. The high death rate and rapid transmission of SARS-CoV-2 could increase the risk of psychological health problems such as impairing cognition and inducing anxiety. To mitigate the risk of mental abnormalities, online mental health services have been adopted. However, majority of the older population and foreigners cannot benefit from it. Older people have limited access to the internet and smartphones, foreigners cannot follow the instructions given in Chinese.^3,4

We know that, mistimed exposure to light and constant exposure to light at night cause disruption in circadian rhythms and sleep-wake cycles, which are associated with a higher risk of mental illnesses including stress, and anxiety.^5,6 Normal daily routines are inevitable to maintain circadian rhythms, ^5,6 however, due to the current mass quarantine and restrictions to outdoor activities, millions of people rely on indoor activities, mostly spending time on electronic devices. These individuals experience disturbance in eating routines, exposure to irregular light-dark cycles and disturbed sleep-wake behaviors, which may lead to dysregulation of circadian rhythms and mood swings. Children and young adults are vulnerable to circadian rhythm disruptions, who can develop severe symptoms of mental illnesses.⁷ As children have no or limited exposure to the open environment, playgrounds, and schools. The majority of the Chinese people live in small apartments, thus limiting the availability of space to children for indoor activities. Thus, they can have easy access to using electronic devices or smartphones that may increase the risk of adverse impacts on psychological health. So far, healthcare authorities have neglected this issue, while, ignoring it permanently may cause serious complications in the future. To mitigate the risks of psychological complications, children and young kids are needed to be given full attention and to be engaged in healthy and joyful activities after the epidemic is ended. However, after the end of the quarantine period, the government may enforce the working population to work overtime. Therefore, the healthcare-related authorities should come up with effective plans to provide proper health services and ensure that children’s health is not neglected in the current scenario of the COVID-19 outbreak and in the near future.

The overall risks associated with COVID-19 infection can be mitigated with effective eradication of the infection. Currently, no systematically effective treatment options are available against the SARS-CoV-2. However, among the trialed antiviral drugs, remdesivir alone or in combination with chloroquine or interferon beta showed effectiveness against COVID-19 infection.⁸ Nevertheless, the development of clinical drugs for SARS-CoV-2 is challenging because the repeatedly emerging novel coronaviruses with diverse features require the specific drug for each newly emerged virus. Therefore, designing and development of novel broad-spectrum antiviral drugs that can potentially target all coronaviruses, in general, maybe the only treatment option against reemerging and circulating coronaviruses. As the asymptomatic spread has created a major global concern, requiring a diagnostic strategy that could rapidly detect SARS-CoV-2 with maximum accuracy in suspected patient. Moreover, the symptoms of COVID-19 pneumonia or primarily similar to influenza and seasonal allergies (pollen allergies), ^{9 10–11} therefore using thermo-scanners and physical observations are not very promising. In addition, quantitative realtime PCR based testing is not only expensive but time-consuming, therefore an advanced rapid technology should be developed and practiced. On the other hand, Chinese medical and clinical staffs can be deployed in different countries to provide training and assistance as they have proficiently controlled the outbreak in China. On an urgent basis, the therapeutic strategies advised by the Chinese professionals should also be considered in countries facing serious situations.

The most important component of prevention and controlling the infectiousness is effective vaccination. Unfortunately, an effective vaccine against COVID-19 is not available, while vaccination strategies against SARS-CoV-2 require further evaluation even if they are effective against the SARS-CoV-2.¹² It is deemed necessary that renowned companies and researchers should invest on developing a vaccine that could be used immediately. Interestingly, some vaccines with preventive potential against COVID-19 infection are in pipeline such as the mRNA based vaccine developed by the National Institute of Allergy and Infectious Diseases in the USA, is being trialed. A clinical trial of the DNA-based vaccine INO-4800 developed by Inovio Pharmaceuticals recently began in healthy volunteers in the United States. Approximately 1 million doses of INO-4800 DNA vaccine for COVID-19 will be produced for emergency use and further clinical trials by the end of 2020.^13,14

Moreover, the Center for Disease Control and Prevention (CDC) in China has started working on inactivated virus vaccine that may be used widely if found promising. The Stermirna Therapeutics has reported the development of mRNA based vaccine’s that can soon be available for trials. Nevertheless, more work is required; SARS-CoV specific live-attenuated¹⁵ and rhesus θ-defensin 1 and protein cage nanoparticles based vaccines can be evaluated for COVID-19 infection.^{16, 17} Moreover, monoclonal antibodies should be considered that are effective in inhibiting virus-cell receptor binding and virus-cell fusion.¹⁵

The COVID-19 outbreak will eventually end, but it could cost thousands of lives, millions with severe mental problems, and huge losses to the economy. Dealing properly with this critical situation, the top of government’s agenda should be basics health care delivery such as clinical supplies, sickbeds, medications and proper management for isolation of patients, a network of labs to efficiently work for developing treatment strategies. It is necessary to develop competitive therapeutic optionswhile investigating cross-resistance of other vaccines should be considered. For instance, there is a possibility that vaccines for other infections such as rubella, tuberculosis, malaria, and hepatitis etc. can create resistance to COVID-19 infection. In some regions of the world, the spread of COVID-19 infection is significantly lower.^1,14 These observations suggest that the immune responses in these individuals may be effective against COVID-19 infection that were activated with exposure to an infection in past. However, proper investigations and evaluations are required.

Disclosure of potential conflicts of interest

The authors declare that they have no conflict of interest.

Acknowledgments

The authors acknowledge the Postdoctoral grant from The Second Affiliated Hospital of Zhengzhou University (for SK), and operating grant support from the National Natural Science Foundation of China (grants no: 81870942, 81471174 and 81520108011), National Key Research and Development Program of China (grant no: 2018YFC1312200), and Innovation Scientists and Technicians Troop Constructions Projects of Henan Province of China (for MX).