Generic placeholder image



ISSN (Print): 2666-7967
ISSN (Online): 2666-7975

Review Article

COVID-19: A Review on Epidemiology, Clinical Features and Possible Potential Drugs Based on Available Case Studies

Author(s): Kirtikumar C. Badgujar*, Dipak V. Patil, Dipak V. Dhangar, Vikrant P. Patil and Ashish B. Badgujar

Volume 2, Issue 3, 2021

Published on: 13 August, 2020

Page: [299 - 312] Pages: 14

DOI: 10.2174/2666796701999200813190838


The emerging novel coronavirus disease 2019 has caused a global outbreak and significant public health concern. The World Health Organization (WHO) has announced a coronavirus disease outbreak a pandemic with a global public health emergency of international concern. As of now, 12th April 2020 almost 18,37,404 cases have been confirmed globally (in 209 countries) with almost 1,13,274 fatalities. This increasing number has created anxiety throughout the world, which has severely affected the whole world's culture, societies, behavioral patterns, peace and economics. At present, research on novel coronavirus is in the preliminary stage. There is no vaccine or specific antiviral to treat coronavirus disease. Also, very few case studies are available; hence it has become difficult to treat and to control this pandemic situation. In view of this, the present systematic review is done to highlight clinical epidemiology features, radiographic characteristics, and potential drugs based on available clinical case reports. Biomarkers for early diagnosis and impact of age, sex, pre-existing comorbidity on COVID-19 is also discussed. Further, this paper also outlines various possible antiviral chemical drug agents that can be potential and promising to treat this coronavirus disease in 2019. This review may be helpful for the medical practitioner, public health workers and government authorities to manage and deal with novel coronavirus disease 2019.

Keywords: COVID-19 epidemiology, coronavirus, clinical characteristics, potential drugs, antiviral agents, SARS-CoV-2, pediatric, pregnant women.

Graphical Abstract
Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol 2020; 92(4): 401-2.
[] [PMID: 31950516]
Xinhuanet News Report. Available from:
Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017; 39(5): 529-39.
[] [PMID: 28466096]
Corman VM, Muth D, Niemeyer D, Drosten C. Hosts and sources of endemic human coronaviruses. Adv Virus Res 2018; 100: 163-88. Adv Virus Res 2018; 100: 163-88.
[] [PMID: 29551135]
Zumla A, Chan JFW, Azhar EI, Hui DS, Yuen KY. Coronaviruses - drug discovery and therapeutic options. Nat Rev Drug Discov 2016; 15(5): 327-47.
[] [PMID: 26868298]
WHO. World Health Organization Available from:
Wang LS, Wang YR, Ye DW, Liu QQ. A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence. Int J Antimicrob Agents 2020; 2020105948
Worldometer. Coronavirus. Available from: https://www.
Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 2020; 55(5)105955
[] [PMID: 32234468]
Su Z, Wu Y. A multiscale and comparative model for receptor binding of 2019 novel coronavirus and the implications of its life cycle in host cells. BioRxiv 2020; 2020958272
[] [PMID: 32511419]
Kim JY, Choe PG, Oh Y, et al. The first case of 2019 novel Coronavirus pneumonia imported into Korea from Wuhan, China: implication for infection prevention and control measures. J Korean Med Sci 2020; 35(5)e61
[] [PMID: 32030925]
Chang D, Lin M, Wei L. Epidemiologic and clinical characteristics of Novel Coronavirus infections involving 13 patients outside Wuhan, China. JAMA 2020; 2020: 323(11): 1092-3.
Lim J, Jeon S, Shin HY, et al. The author’s response: case of the index patient who caused tertiary transmission of coronavirus disease 2019 in Korea: the application of lopinavir/ritonavir for the treatment of COVID-19 pneumonia monitored by quantitative RT-PCR. J Korean Med Sci 2020; 35(7)e89
[] [PMID: 32080993]
Li J, Li S, Cai Y, Liu Q. Epidemiological and clinical characteristics of 17 hospitalized patients with 2019 novel Coronavirus infections outside Wuhan, China. MedRxiv 2020; 2020: 1.
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223): 507-13.
[] [PMID: 32007143]
Kim JY. Letter to the editor: case of the index patient who caused tertiary transmission of coronavirus disease 2019 in Korea: the application of lopinavir/ritonavir for the treatment of COVID-19 pneumonia monitored by quantitative RT-PCR. J Korean Med Sci 2020; 35(7): e88. In:
[] [PMID: 32080992]
Maxmen A. Slew of trials launch to test coronavirus treatments in china. Nature 2020; 578: 347-8.
[] [PMID: 32071447]
Zhang T, He Y, Xu W, Ma A, Yang Y, Xu KF. Clinical trials for the treatment of Coronavirus disease 2019 (COVID-19): a rapid response to urgent need. Sci China Life Sci 2020; 63(5): 774-6.
[] [PMID: 32124179]
Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020; 382(10): 970-1.
[] [PMID: 32003551]
Chen D, Xu W, Lei Z, et al. Recurrence of positive SARS-CoV-2 RNA in COVID-19: a case report. Int J Infect Dis 2020; 93: 297-9.
[] [PMID: 32147538]
Zhao D, Yao F, Wang L, et al. A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias. Clin Infect Dis 2020; 2020: ciaa247.
[] [PMID: 32161968]
Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China. Clin Infect Dis 2020; 71(15): ciaa272.
[] [PMID: 32176772]
Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020; 56(1)105949
Ding Q, Lu P, Fan Y, Xia Y, Liu M. The clinical characteristics of pneumonia patients coinfected with 2019 novel coronavirus and influenza virus in Wuhan, China. J Med Virol 2020; 92(9): 1549-55.
[] [PMID: 32196707]
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1063-9.
[] [PMID: 32031570]
Liu K, Fang YY, Deng Y, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl) 2020; 133(9): 1025-31.
[] [PMID: 32044814]
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
[] [PMID: 31986264]
Liu Y, Yang Y, Zhang C, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci 2020; 63(3): 364-74.
[] [PMID: 32048163]
Raoult D, Hsueh P, Stefani S, Rolain J. COVID-19 therapeutic and prevention. Int J Antimicrob Agents 2020; 55(4)105937
Kang S, Peng W, Zhu Y, et al. Recent progress in understanding 2019 novel coronavirus (SARS-CoV-2) associated with human respiratory disease: detection, mechanisms and treatment. Int J Antimicrob Agents 2020; 55(5)105950
[] [PMID: 32234465]
Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020; 20(6): 689-96.
[] [PMID: 32220650]
Chen ZM, Fu JF, Shu Q. New coronavirus: new challenges for pediatricians. World J Pediatr 2020; 16(3): 222.
[] [PMID: 32037473]
Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 Coronavirus disease in China. Pediatrics 2020; 145(6)e20200702
[] [PMID: 32179660]
Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol 2020; 55(5): 1169-74.
[] [PMID: 32134205]
Yasri S, Wiwanitkit V. Clinical features in pediatric COVID-19. Pediatr Pulmonol 2020; 55(5): 1097.
[] [PMID: 32196995]
Sun D, Li H, Lu XX, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center’s observational study. World J Pediatr 2020; 16(3): 251-9.
[] [PMID: 32193831]
Cai JH, Wang XS, Ge YL, et al. First case of 2019 novel coronavirus infection in children in Shanghai. Zhonghua Er Ke Za Zhi 2020; 58(2): 86-7.
[] [PMID: 32102141]
Li Y, Guo F, Cao Y, Li L, Guo Y. Insight into COVID-2019 for pediatricians. Pediatr Pulmonol 2020; 55(5): E1-4.
Sivaraman D, Pradeep PS, Manoharan SS, Bhat CR, Leela KV, Venugopal V. Current strategies and approaches in combating SARS-CoV-2 virus that causes COVID-19. Lett Drug Des Discov 2020; 17(5): 672-4.
Kumar S. Poonam, Rathi B. Coronavirus disease COVID-19: a new threat to public health. Curr Top Med Chem 2020; 20(8): 599-600.
[] [PMID: 32133964]
Wang S, Guo L, Chen L, et al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis 2020; 71(15): ciaa225.
[] [PMID: 32161941]
Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395(10226): 809-15.
[] [PMID: 32151335]
Yu N, Li W, Kang Q, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis 2020; 20(5): 559-64.
[] [PMID: 32220284]
Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women With Coronavirus Disease (COVID-19) pneumonia. Am J Roentgenol 2020; 215: 1-6.
[] [PMID: 32186894]
Dong L, Tian J, He S, et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; 323(18): 1846-8.
[] [PMID: 32215581]
Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9: 51-60.
Fan C, Lei D, Fang C, et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis 2020.ciaa226
[] [PMID: 32182347]
Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020; 2020: ciaa200.
[] [PMID: 32119083]
World Health Organization. Coronavirus disease (COVID-19): Pregnancy and childbirth. Available from:
Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020; 30(3): 269-71.
[] [PMID: 32020029]
Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14(1): 72-3.
[] [PMID: 32074550]
Liu J, Cao R, Xu M, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 2020; 6: 16.
[] [PMID: 32194981]
The Scientist. Remdesivir works against coronaviruses in the lab. Available from:
Hue L, Yeming W, Jiuyang X, Bin C. Potential antiviral therapeutics for 2019 Novel Coronavirus. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43E002
Clinicaltrials. Comparison of lopinavir/ritonavir or hydroxychloroquine in patients with mild Coronavirus Disease (COVID-19). Available from:
Sheahan TP, Sims AC, Leist SR, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun 2020; 11: 222.
Guo D. Old weapon for new enemy: drug repurposing for treatment of newly emerging viral diseases. Virol Sin 2020; 35(3): 253-5.
[] [PMID: 32048130]
Chu CM, Cheng VCC, Hung IFN, et al. HKU/UCH SARS study group. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004; 59(3): 252-6.
[] [PMID: 14985565]
Guo YR, Cao QD, Hong ZS, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res 2020; 7(1): 11.
[] [PMID: 32169119]
Zeldin RK, Petruschke RA. Pharmacological and therapeutic properties of ritonavir-boosted protease inhibitor therapy in HIV-infected patients. J Antimicrob Chemother 2004; 53(1): 4-9.
[] [PMID: 14657084]
Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther 2020; 14(1): 58-60.
[] [PMID: 32147628]
Wu C, Liu Y, Yang Y, et al. Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods. Acta Pharm Sin B 2020; 10(5): 766-88.
[] [PMID: 32292689]
Clinicaltrials. The efficacy of lopinavir plus ritonavir and arbidol against novel coronavirus infection (ELACOI). Available from:
Doucette KE, Aoki FY. Oseltamivir: a clinical and pharmacological perspective. Expert Opin Pharmacother 2001; 2(10): 1671-83.
[] [PMID: 11825310]
Furuta Y, Komeno T, Nakamura T. Favipiravir (T-705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad, Ser B, Phys Biol Sci 2017; 93(7): 449-63.
[] [PMID: 28769016]
The Pharma Letter. Russia’s RDIF backs ChemRar for the production of favipiravir against COVID-19 Available from:
Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med 2006; 3(9)e343
[] [PMID: 16968120]
Li Z, Bai T, Yang L, Hou X. Discovery of potential drugs for COVID-19 based on the connectivity map. Transl Med 2020; 2020: 1.
Zeinalian M, Salari-Jazi A, Jannesari A, Khanahmad H. A potential protective role of losartan against coronavirus-induced lung damage. Infect Control Hosp Epidemiol 2020; 41(6): 752-3.
[] [PMID: 32248854]
Principi N, Esposito S. Chloroquine or hydroxychloroquine for prophylaxis of COVID-19. The Lancet 2020; 20(10): 1118.
Yao X, Ye F. In vitro antiviral activity and projection of optimized dosing design of HCQ for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020; 71(15): 732-9.
[]] [PMID: 32150618]
Badgujar K, Badgujar AB, Patil VP, Dhangar DV. Hydroxychloroquine for COVID-19: a review and a debate based on available clinical trials/case studies. JDDT 2020; 10(3): 304-11.
Chang TC, Wang LF, Lin YS, Yang CS, Yu CY, Lin YL. 25: HCQ activates host antiviral innate immunity. Cytokine 2014; 70(1): 33-4.
Sperber K, Quraishi H, Kalb TH, Panja A, Stecher V, Mayer L. Selective regulation of cytokine secretion by hydroxychloroquine: inhibition of interleukin 1 alpha (IL-1-alpha) and IL-6 in human monocytes and T cells. J Rheumatol 1993; 20(5): 803-8.
[PMID: 8336306]
Molina JM, Delaugerre C, Le Goff J, et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Med Mal Infect 2020; 50(4): 384.
Clinicaltrials. Clinical trials for Hydroxychloroquine. Available from:
Barratt R, Shaban RZ, Gilbert GL. Clinician perceptions of respiratory infection risk; a rationale for research into mask use in routine practice. Infect Dis Health 2019; 24(3): 169-76.
[] [PMID: 30799181]
Leung NHL, Chu DKW, Shiu EYC, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020; 26(5): 676-80.
[] [PMID: 32371934]
Holland M, Zaloga DJ, Friderici CS. COVID-19 Personal Protective Equipment (PPE) for the emergency physician. Vis J Emerg Med 2020; 19100740
Smereka J, Szarpak L. The use of personal protective equipment in the COVID-19 pandemic era. Am J Emerg Med 2020; 38(7): 1529-30.
[]] [PMID: 32305157]
Ortega R, Gonzalez M, Nozari A, Canelli R. Personal protective equipment and Covid-19. N Engl J Med 2020; 382(26)e105
[] [PMID: 32427435]
Panuganti BA, Pang J, Califano J, Chan JYK. Procedural precautions and personal protective equipment during head and neck instrumentation in the COVID-19 era. Head Neck 2020; 42(7): 1645-51.
[] [PMID: 32348594]
Lau JTF, Fung KS, Wong TW, et al. SARS transmission among hospital workers in Hong Kong. Emerg Infect Dis 2004; 10(2): 280-6.
[] [PMID: 15030698]
Liu M, Cheng SZ, Xu KW, et al. Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study. BMJ 2020; 369: m2195.
[] [PMID: 32522737]
Centers for disease control and preventions. Using personal protective equipment (PPE). Available from:
Melgaço JG, Azamor T, Ano Bom APD. Protective immunity after COVID-19 has been questioned: what can we do without SARS-CoV-2-IgG detection? Cell Immunol 2020; 353104114
[] [PMID: 32361409]
Cao WC, Liu W, Zhang PH, Zhang F, Richardus JH. Disappearance of antibodies to SARS-associated coronavirus after recovery N Engl J Med 2007. 357: 1162e3.
Wu LP, Wang NC, Chang YH, et al. Duration of antibody responses after severe acute respiratory syndrome. Emerg Infect Dis 2007; 13(10): 1562: e4
Kirkcaldy RD, King BA, Brooks JT. COVID-19 and postinfection immunity: limited evidence, many remaining questions. JAMA 2020; 323(22): 2245-6.
[] [PMID: 32391855]
Bao L, Deng W, Gao H, et al. Reinfection could not occur in SARS- CoV-2 infected rhesus macaques. Preprint BioRxiv 2020; 2020: 1.
Ali I. COVID-19: are we ready for the second wave? Disaster Med Public Health Prep 2020; 2020: 1-3.
[] [PMID: 32379015]
Wise J. Covid-19: Risk of second wave is very real, say researchers. BMJ 2020; 369: m2294.
[] [PMID: 32518177]
Xu S, Li Y. Beware of the second wave of COVID-19. Lancet 2020; 395(10233): 1321-2.
[] [PMID: 32277876]
Vaid S, McAdie A, Kremer R, Khanduja V, Bhandari M. Risk of a second wave of Covid-19 infections: using artificial intelligence to investigate stringency of physical distancing policies in North America. Int Orthop 2020; 2020: 1581-9.
[] [PMID: 32504213]
Monaghan KJ. Institute of Medicine (US) Forum on Microbial Threats. In:Knobler S, Mahmoud A, Lemon S, et al, Eds Learning from SARS: preparing for the next disease outbreak: Workshop Summary Washington (DC). National Academies Press US 2004.
Low DE. Learning from SARS: preparing for the next disease outbreak: workshop summary Washington (DC). National Academies Press US 2004. [
He D, Chiu AP, Lin Q, Cowling BJ. Differences in the seasonality of Middle East respiratory syndrome coronavirus and influenza in the Middle East. Int J Infect Dis 2015; 40: 15-6.
[] [PMID: 26417877]
WRAL. CDC chief says there could be second, possibly worse coronavirus outbreak this winter Available from:
Argulian E. Anticipating the ‘second wave’ of health care strain in COVID19 pandemic. JACC Case Rep 2020; 2(5): 845-6.
[] [PMID: 32296782]

© 2022 Bentham Science Publishers | Privacy Policy