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Open AccessReview

COVID-19 Is a Multifaceted Challenging Pandemic Which Needs Urgent Public Health Interventions

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Infectious Diseases and Dermatology Section, Pathology, Oncology and Experimental Biology Section, Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy
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Department of Chemical and Pharmaceutical Sciences, Microbiology Section, University of Ferrara, 44124 Ferrara, Italy
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Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44124 Ferrara, Italy
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RDI, Rete Diagnostica Italiana s.r.l, Lifebrain Group, Limena, 35010 Padova, Italy
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Department of Morphology, Surgery and Experimental Medicine, Obstetrics and Gynecology Section, University of Ferrara, 44124 Ferrara, Italy
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Department of Biomedical Sciences and Surgical Specialties; Ophthalmology Section, University of Ferrara, 44124 Ferrara, Italy
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Department of Economy and Management; University of Ferrara, 44124 Ferrara, Italy
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Author to whom correspondence should be addressed.
Microorganisms 2020, 8(8), 1228; https://doi.org/10.3390/microorganisms8081228
Received: 12 June 2020 / Revised: 27 July 2020 / Accepted: 8 August 2020 / Published: 12 August 2020
(This article belongs to the Special Issue COVID-19: Focusing on Epidemiologic, Virologic, and Clinical Studies)
Until less than two decades ago, all known human coronaviruses (CoV) caused diseases so mild that they did not stimulate further advanced CoV research. In 2002 and following years, the scenario changed dramatically with the advent of the new more pathogenic CoVs, including Severe Acute Respiratory Syndome (SARS-CoV-1), Middle Eastern respiratory syndrome (MERS)-CoV, and the new zoonotic SARS-CoV-2, likely originated from bat species and responsible for the present coronavirus disease (COVID-19), which to date has caused 15,581,007 confirmed cases and 635,173 deaths in 208 countries, including Italy. SARS-CoV-2 transmission is mainly airborne via droplets generated by symptomatic patients, and possibly asymptomatic individuals during incubation of the disease, although for the latter, there are no certain data yet. However, research on asymptomatic viral infection is currently ongoing worldwide to elucidate the real prevalence and mortality of the disease. From a clinical point of view, COVID-19 would be defined as “COVID Planet “ because it presents as a multifaceted disease, due to the large number of organs and tissues infected by the virus. Overall, based on the available published data, 80.9% of patients infected by SARS-CoV-2 develop a mild disease/infection, 13.8% severe pneumonia, 4.7% respiratory failure, septic shock, or multi-organ failure, and 3% of these cases are fatal, but mortality parameter is highly variable in different countries. Clinically, SARS-CoV-2 causes severe primary interstitial viral pneumonia and a “cytokine storm syndrome”, characterized by a severe and fatal uncontrolled systemic inflammatory response triggered by the activation of interleukin 6 (IL-6) with development of endothelitis and generalized thrombosis that can lead to organ failure and death. Risk factors include advanced age and comorbidities including hypertension, diabetes, and cardiovascular disease. Virus entry occurs via binding the angiotensin-converting enzyme 2 (ACE2) receptor present in almost all tissues and organs through the Spike (S) protein. Currently, SARS-CoV-2 infection is prevented by the use of masks, social distancing, and improved hand hygiene measures. This review summarizes the current knowledge on the main biological and clinical features of the SARS-CoV-2 pandemic, also focusing on the principal measures taken in some Italian regions to face the emergency and on the most important treatments used to manage the COVID-19 pandemic. View Full-Text
Keywords: SARS-CoV-2; COVID-19; cytokine storm syndrome; COVID-19 planet; hyperinflammation; endothelitis; thromboembolism SARS-CoV-2; COVID-19; cytokine storm syndrome; COVID-19 planet; hyperinflammation; endothelitis; thromboembolism
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MDPI and ACS Style

Contini, C.; Caselli, E.; Martini, F.; Maritati, M.; Torreggiani, E.; Seraceni, S.; Vesce, F.; Perri, P.; Rizzo, L.; Tognon, M. COVID-19 Is a Multifaceted Challenging Pandemic Which Needs Urgent Public Health Interventions. Microorganisms 2020, 8, 1228.

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