COVID-19, being a dreadly viral infection, has put the entire globe in a pandemic situation in the present scenario. The RNA virus was first reported in later 2019; various diagnostic modalities are applied including polymerase chain reaction (PCR) since PCR detects RNA viruses and their strain. Though many theories had been proposed and accepted worldwide, the path and sequelae of COVID-19 is debatable especially after the release of the autopsy analysis conducted at Italy, the results of which turned out to be a revolutionary tool in managing COVID-19 patients. The coronavirus could be classified based on its characteristics into many types such as O, A2, A2a, A3, B, B1, totally numbering to 11 strains. It has been proved by research studies including an Indian institute's study that “A2a” strain is the most predominant and virulent strain. The basic pathogenic molecular mechanism of SARS-Cov2 is by entering the lung system and cells and disrupting the 1-β chain of hemoglobin and extracting out the porphyrin rings and dissociating the iron content from it, thereby releasing iron into the circulation. The increased Hb production eventually leads to increase in the blood viscosity level with recurrent and diffuse micro- and macrocirculatory thrombosis in the form of blood clot, the major underlying reason substantiating the elevated levels of D-dimer among the infected patients and thus explaining the cause of sudden deterioration and death. COVID-19 management warrants a multidimensional approach in management, and judicious laboratory diagnosis plays a vital role in picking up the infected cases. Scientific reviews throws light on the primary underlying pathophysiology, thereby redirecting the mode of approach and subsequent management and proclaiming that the grave condition is associated with disseminated intravascular coagulation with microthrombi warranting rationale treatment with anti-inflammatory and anti-coagulant drugs rather than empirical and irrational usage of mechanical ventilators.
Team NCPERE. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) – China. Team NCPERE. China CDC Weekly 2020; vol. 28. pp. 113–122.
Indian Council for Medical Research. COVID-19 testing. [Online] [Cited: March 28, 2020.] https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloroquinasprophylaxisforSARSCoV2infection.pdf.
EMR Division, Ministry of Health and Family Welfare, Government of India. Guidelines on Clinical Management of COVID-19 infection. [Online] https://www.mohfw.gov.in/pdf/ Guidelines on Clinical Management of COVID 19 12020.pdf.
Wu Y, Guo C, Tang L, Wang C, Luo F, Yu X, et al. Prolonged presence of SARS-CoV-2 viral RNA in fecal samples. Lancet Gastroenterol Hepatol 2020;5(5):434–435. DOI: 10.1016/S2468-1253(20)30083-2.
Tang B, Xia F, Tang S, Bragazzi NL, Li Q, Sun X, et al. The effectiveness of quarantine and isolation determine the trend of the COVID-19 epidemics in the final phase of the current outbreak in China. Int J Infect Dis 2020;95:288–293. DOI: 10.1016/j.ijid.2020.03.018.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18(4):844–847. DOI: 10.1111/jth.14768.
McGonagle D, Sharif K, Regan A, Bridgewood C. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev 2020;19(6):102537. DOI: 10.1016/j.autrev.2020.102537.
George MR. Hemophagocytic lymphohistiocytosis: review of etiologies and management. J Blood Med 2014;5:69–86. DOI: 10.2147/JBM.S46255.
Shoenfeld Y. Corona (COVID-19) time musings: our involvement in COVID-19 pathogenesis, diagnosis, treatment and vaccine planning. Autoimmun Rev 2020;19(6):102538. DOI: 10.1016/j.autrev.2020. 102538.
Nicholls JM, Poon LL, Lee KC. Lung pathology of fatal severe acute respiratory syndrome. Lancet 2003;361(9371):1773–1778. DOI: 10.1016/S0140-6736(03)13413-7.
Seguin A, Galicier L, Boutboul D, Lemiale V, Azoulay E. Pulmonary involvement in patients with hemophagocytic lymphohistiocytosis. Chest 2016;149(5):1294–1301. DOI: 10.1016/j.chest.2015.11.004.
Franks TJ, Chong PY, Chui P, Ren J, Zhao Y, Hu L. Lung pathology of severe acute respiratory syndrome (SARS): a study of 8 autopsy cases from Singapore. Hum Pathol 2008;34(8):743–748. DOI: 10.1016/S0046-8177(03)00367-8.
Yao XH, Li TY, He ZC, Wen R, Sun P, Xing QS. A pathological report of three COVID-19 cases by minimally invasive autopsies. Zhonghua Bing Li Xue Za Zhi 2020;49(5):411–417. DOI: 10.3760/cma.j.cn112151-20200312-00193.
Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol 2020;15(5):700–704. DOI: 10.1016/j.jtho.2020.02.010.
Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004;351(25):2611–2618. DOI: 10.1056/NEJMoa041747.
Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012;125(6):773–781. DOI: 10.1161/CIRCULATIONAHA.111.040766.
Hwang DM, Chamberlain DW, Poutanen SM, Low DE, Asa SL, Butany J. Pulmonary pathology of severe acute respiratory syndrome in Toronto. Mod Pathol 2005;18(1):1–10. DOI: 10.1038/modpathol.3800247.