Corona COVID-19 virus is increasingly global, when will it peak?

Already 9,278 lives have been lost. 130,538 patients are still struggling. However, 85,831 people have proven that illness due to a new type of Corona Virus or COVID-19 can be cured.

The data was quoted from , on Thursday (03/19/2020). As of 19.33 West Indonesia Time, there were 225,647 positive cases of the Corona COVID-19 Virus worldwide.

Meanwhile, the COVID-19 epidemic curve in China, as the epicenter of the outbreak, shows that this new type of Corona Virus has peaked about three weeks ago. Now, the curve continues to move down, as new cases get fewer and more patients get better.

The World Health Organization (WHO) states, the COVID-19 pandemic in the world is now centered in Europe. Because more cases are reported every day than recorded in China at the height of the epidemic.

Italy, Iran and Spain are the countries with the largest cases outside China in the Coronavirus COVID-19 Global Cases data map  by Johns Hopkins CSSE . The largest number of cases of Corona COVID-19 infection was recorded in China, with 81,137 cases, alongside Italy which reached 35,713 cases.

The highest mortality rate was recorded in Hubei Province, China, which reached 3,130 people. But the biggest death toll outside of China is in Italy, which penetrates 2,978 people.

The third largest case of Corona COVID-19 infection is recorded in Iran, which reached 17,361 cases with 1,135 deaths. While the fourth largest case was recorded in Spain, which reached 14,769 cases with 638 deaths. 

In total, the Corona COVID-19 virus has now spread to 176 countries and regions throughout the world.

The researchers also tried to trace. Finding out what makes this virus easily spread to almost the entire world. Numerous genetic and structural analyzes have identified a key feature of the virus - protein on its surface - which might explain why COVID-19 triggered by the SARS-CoV-2 virus infects human cells easily.

To infect cells, SARS-CoV-2 uses a spike protein that binds to the cell membrane, a process that is activated by certain cell enzymes. Genomic analysis of this virus revealed a different surge protein from close relatives, namely SARS-CoV which triggered severe acute respiratory syndrome (SARS) which also had an outbreak in 2002.

Although the triggers for COVID-19 and SARS come from one family, according to scientists' studies, they do not have the same furin activation site. Furin is an enzyme that functions as a protein activator in the human body.

Furin-like cleavage sites (furin-like cleavage site)  was recently found in SARS-CoV spike protein-2.

That is an important finding. Because furin is found in many human tissues, including the lungs, liver and small intestine, which means the virus has the potential to attack many organs, said Li Hua, a structural biologist at Wuhan Huazhong University of Science and Technology, China.

This finding could explain some of the symptoms observed in people with Corona Virus, such as liver or liver failure, said Li, who co-authored the genetic analysis of the virus uploaded to the ChinaXiv precast server on February 23. SARS and other Corona Viruses in the same genus as the new virus do not have furin activation sites, he said.

"Cornell University virus expert Gary Whittaker said the furin activation site makes the virus different from SARS in terms of its entry into cells, and might affect virus stability and transmission," he explained, as quoted by Nature . His team published another structural analysis of the surge protein corona virus on bioRxiv on February 18.

Several other groups have also identified activation sites that allow viruses to spread efficiently among humans.

In Indonesia, there were 309 positive confirmed cases of COVID-19. A total of 15 patients of whom have recovered, while 25 others died. Making Indonesia the country in Southeast Asia with the highest mortality rate, 8.4 percent.

Professor Amin Soebandrio from the Eijkman Institute stated, the spread of the Corona COVID-19 Virus in the world today is very much influenced by something that limits the movements of the virus and also that limits humans themselves. 

"This means that if a person is infected but not sick, then he will not be a source of transmission to other people, or even if he becomes a source of the number becomes smaller than the sick," Amin said when contacted us. 

The head of the Eijkman Molecular Biology Institute considers that the handling measures in Indonesia will be difficult compared to other countries, given the shape of the Indonesian archipelago while most other countries are continental. But it also brings benefits for Indonesia because the virus does not spread easily because there are oceans separating each region. 

"So at this time we cannot fully imitate, for example Korea or China or other countries that have been seen as successful even though they have not been 100%," Amin said. 

The step that now really needs to be done, according to him, is to quickly identify those who are infected and then limit so that they do not become new sources of transmission. 

"And so on those who are infected are quickly sought for contact, quickly limited again, so that the space for movement will be limited." 

In the end, he added, community participation will be an important factor. In this case, he refers to efforts to maintain personal hygiene and health. 

"The most important thing is to return to community participation to be very important if everyone applies it, which means to maintain hygiene and to avoid contracting it," he said. 

He also regretted that there were still many people who were still unaware of the importance of maintaining personal hygiene and health, especially as there were still many people gathered outside the house. 

"Every individual is not contagious and cannot transmit to others only." 

Maria Van Kerkhove, who heads the WHO disease unit, warned, "it's impossible for us to say when this ( Corona COVID-19 Virus ) will peak globally."

"We hope it will be faster than too long," he stressed.

Second Wave Pandemic COVID-19

South Korea, China and Singapore are among the Asian countries facing the  second wave of Corona Virus , driven by imported cases from abroad. 

China, where the virus was first reported to appear, reported no new domestic cases on Thursday for the first time since the outbreak began, as reported by the BBC . 

But the report reported 34 new cases among people who had just returned to China.

Singapore also reported 47 new cases, of which 33 were imported, 30 of them were Singaporeans who had recently returned. 

South Korea also experienced a surge in new cases on Thursday with 152, although it is unclear how many imported cases. 

A new cluster there is centered in a nursing home in Daegu, where 74 patients tested positive.

Japan reported three new cases on Wednesday March 18. But Hokkaido, Japan's worst-affected region with 154 cases, began ending its state of emergency since late February, after officials said the spread of the virus was likely to end.

Local officials urged people to remain cautious and stay at home, but said "there was no surge in infected patients that caused the collapse of the medical environment".

"We have taken strong steps to refrain from coming out, but from now on, we will move to the stage of reducing the risk of spreading infection while maintaining social and economic activities," Hubernur Naomichi Suzuki said.

The Chinese National Health Commission (NHC) reports no cases have been transmitted domestically in China for the first time since the virus appeared in late December 2019.

In addition, it was also said there were no cases at all in Wuhan, the epicenter of the outbreak that had been in lockdown status   since early 2020. However, 34 cases came from abroad.

The four countries have all shown success in controlling domestic cases, but there are fears that increasing cases in other countries could undermine their progress.

Source of COVID-19 from Humans or Nature?

The results of research published in the scientific journal, Nature Medicine, reveal the source of the Corona COVID-19 Virus before it spread throughout the world. As quoted from  Science Daily , the results of analysis of public data related to the sequence or genome sequence (genome sequence) of SARS-CoV-2 and related viruses found no evidence that the virus was created by humans in the laboratory.

"By comparing available genomic sequence data for known Corona Virus strains, we believe that SARS-CoV-2 comes from a natural process," said Kristian Andersen PhD, associate professor of immunology and microbiology at Scripps Research, one of the authors report of the study.

Besides Andersen, a number of other scientists also took part in the study and writing of the paper entitled, 'The proximal origin of SARS-CoV-2'. These include Robert F. Garry from Tulane University, Edward Holmes from the University of Sydney, Andrew Rambaut from the University of Edinburgh, and W. Ian Lipkin from Columbia University.

Corona virus is a large family (family) of viruses that can cause disease with a wide severity. Although it was categorized in the 1960s, the first known severe disease caused by the Corona Virus was Severe Acute Respiratory Syndrome (SARS) which started to become an epidemic in China in 2003.

Meanwhile, the second disease that is endemic is Middle East Respiratory Syndrome (MERS) which began in Saudi Arabia in 2012.

And, on December 31, 2019, Chinese authorities notified the World Health Organization (WHO) of a new corona virus outbreak that caused severe disease, which was later named SARS-CoV-2.

Until now, the virus has triggered a COVID-19 pandemic that spread throughout the continent, except Antarctica. Shortly after the epidemic occurred, Chinese scientists sequenced the SARS-CoV-2 genome and provided data for researchers around the world.

Andersen and his colleagues used the sequence data to explore the origin and evolution of SARS-CoV-2 with a focus on a number of unique features of the virus.

The scientists analyzed genetic patterns (genetic templates) of spike proteins , armatures or protectors on the outside of the virus that they use to capture and penetrate the outer walls of human and animal cells.

More specifically, they focus on two important features of surge proteins: receptor-binding domain (RBD), a type of hook attached to a host cell, and a cleavage site that allows viruses to open gaps and enter host cells.

Proof of the origin of COVID-19

The scientists found that the RBD portion of the SARS-CoV-2 spike protein had evolved so that it could effectively target molecular features on the outside of human cells called ACE2 - receptors involved in regulating blood pressure.

The SARS-CoV-2 spike protein is in fact very effective for binding to human cells. From there, the scientists concluded, it was the result of natural selection and not a product of genetic engineering.

This evidence for natural evolution is supported by SARS-CoV-2 backbone data , which is the overall molecular structure.

If someone tries to engineer a new corona virus as a pathogen, for example, they must make it from a backbone virus that is known to cause disease.

However, scientists found that SARS-CoV-2's backbone differs substantially from that of other corona viruses, which have been known previously, and most resemble related viruses found in bats and pangolins.

"These two viral features, mutations in the RBD portion of different spike proteins and backbones, rule out the alleged manipulation of laboratories as a potential origin of SARS-CoV-2," Andersen said.

Andersen's findings and colleagues were welcomed by Josie Golding, PhD, leader of the Wellcome Trust epidemic, based in the UK.

He said the findings were very critical by presenting evidence-based opinions to ward off rumors circulating about the origin of the SARS-CoV-2 virus that triggered the COVID-19 pandemic.

So, Where Did the COVID-19 Trigger Virus Come from?

According to scientists, based on analysis of the genome sequence, there are two possibilities,

First, viruses evolve to current pathogenic conditions through natural selection in non-human hosts and then jump to humans.

The process is similar to the Corona Virus outbreak that occurred before, humans are infected with the virus after direct exposure to ferrets (SARS) and camels (MERS).

The researchers suspect that bats are the most likely reservoir for SARS-CoV-2. However, so far there have not been recorded cases of direct transmission from bats to humans.

Vaccines and Medicines COVID-19

The Corona COVID-19 virus pandemic cannot be controlled only by strategies to strengthen the body's immunity. A leading Chinese scientist in respiratory disease, Zhong Nanshan said, the vaccine would be the key to overcoming it. 

"There is no evidence that a person becomes immune forever to diseases related to coronavirus after being infected once," he said at a press conference in Guangzhou, Wednesday, March 18, 2020 as quoted by China Daily  Thursday (3/19/2020).

"Controlling infectious diseases from source and upstream is the most ancient and most effective method," added Zhong.

China has moved quickly in developing vaccines and needed international cooperation in this regard, said Zhong, an epidemiologist and pulmonologist who is also one of the leading specialists who played an important role in China's war against COVID-19 and SARS in 2003.

"No matter which country produces the first vaccine, it will certainly not be able to supply sufficient quantities to the whole world," he said again, adding that the vaccine must be available from various sources.

Responding to questions about the origin of the novel coronavirus , Zhong said that although Wuhan first reported the outbreak, there was no evidence that the city was the source of the new Corona Virus that caused COVID-19.

More needs to be understood about COVID-19 and important international cooperation in areas such as drug development, said Zhong again.

Zhong and the team plan to issue a report next week on clinical treatment in treating Corona Virus COVID-19 patients.

Zhong stressed the importance of nucleic acid testing for people returning from abroad, because import cases now constitute the majority of new cases in China. According to him, the virus remained highly contagious and some infected people showed no symptoms when entering the Bamboo Curtain Country.

COVID-19 drug is ready for mass production

China completes its clinical research on Favipiravir, an antiviral drug to treat Corona Virus or COVID-19. Favipiravir is an influenza drug that was licensed for clinical use in Japan in 2014.

The result, Favipiravir showed no adverse reaction in clinical trials, said Zhang Xinmin, Director of the National Center for Development of Biotechnology of China under the Ministry of Science and Technology.

More than 80 COVID-19 patients participated in clinical trials at the Third People's Hospital in Shenzhen, Guangdong, southern China, including 35 patients receiving Favipiravir treatment and 45 patients in the control group.

The results showed that patients who received Favipiravir treatment became COVID-19 negative in a shorter period of time compared to patients in the control group, as reported by Xinhua, Wednesday (3/18/2020).

A multicenter randomized clinical study led by Zhongnan Hospital at Wuhan University also showed the therapeutic effect of Favipiravir was far better than the control group.

"Favipiravir has been recommended to the medical treatment team, and must be included in the diagnosis and treatment plan for the Corona COVID-19 Virus as soon as possible," Zhang said.

A Chinese pharmaceutical company has pocketed permission to mass produce this drug and ensure a stable supply, Zhang added.

Doctors in Japan are reported to use Favipiravir, also known as Avigan in clinical studies of COVID-19 patients with mild to moderate symptoms. The hope, Favipiravir or Avigan can prevent the virus from multiplying in the patient's body.

However, information from a source at the Japanese Ministry of Health indicates that the drug is not effective in patients with more severe symptoms.

"We have given Avigan to 70 to 80 patients, but it seems ineffective when the virus has already multiplied (in the patient's body)," the source told the Mainichi Shimbun .

The same limitation was identified in studies involving COVID-19 patients treated with a combination of HIV antiretroviral lopinavir and ritonavir, the source added.

Stem Cell Therapy

A 65-year-old woman from Kunming, China experienced a significant recovery condition after being declared infected with the Corona Virus. Patients who had been in intensive care at the Hospital of the Baoshan surprisingly recovered after being given stem cell therapy or stem cells by scientists in China, as quoted from the SCMP .

Doctor Hu Min, who led the research team claimed that the patient was able to stand up and walk again after being given a stem cell injection.

Stem cells, aka stem cells, are pure stem cells or cells that can divide themselves as many times as needed. This ability is also used to replace damaged cells and overcome a particular disease.

Stem cells can be obtained from four sources namely 3-5 day old embryos, umbilical cords, the patient's own body tissues such as fat or spinal cord (adult stem cells) and genetically modified pluripotent stem cells.

"Even though only one case is successful, it can be very important and inspire similar clinical practice in treating critically ill Covid-19 or Corona Virus patients," the study said.

However, this method of treatment is still considered controversial according to clinical trials from the World Health Organization (WHO).

The elderly patient arrived in Kunming on January 21, 2020 after traveling from Wuhan, the capital of Hubei province, China which is thought to be the center of the spread of the plague.

A week later he fell ill with a mild fever, fatigue and cough. Following strict guidelines set by the government for the treatment of coronavirus patients, doctors are advised to give antiviral drugs and antibiotics.

His condition was initially good, but suddenly dropped dramatically a few days later. When the condition goes down, the state of the organs in the body also decreases. So that doctors move quickly and consult with the hospital's ethics committee and patient's family, stem cell therapy begins on February 9 for patients affected by the Corona Virus.

Doctors are considering using stem cell therapy because COVID-19 has caused severe damage to the lungs, liver and other organs.