INTERNATIONAL JOURNAL OF CLINICAL AND MEDICAL CASES (ISSN:2517-7346)

The Novel Coronavirus COVID-19 was first identified in China and became a global health problem due to its pathogenicity and widespread distribution around the world. On March 11, the World Health Organization declared COVID-19 a global pandemic, its first designation since it declared H1N1 flu a pandemic in 2009. This study aims to map international scientific production on the Novel Coronavirus. The search term “COVID-19” was used in the ISI Web of Knowledge / Web of Science^TM database, analysing the records that present the term selected for the search. As a methodological path, a bibliometric research was carried out in academic works on the Web of Science^TM, identifying, after applying the refinement filters, 64 publication records in 36 different journals. As the main results of the analyses, the top journals of the theme and the most cited articles were identified. Although this research does not cover all scientific production information about the new Corona virus “COVID-19”, it was possible to search for documents of high scientific relevance so that we have an overview of the scientific production world on the subject.

Coronaviruses are enveloped RNA viruses that are widely distributed among humans, other mammals and birds and that cause respiratory, enteric, liver and neurological diseases [1,2]. Although these viruses generally have low pathogenicity, two epidemics have occurred on the last two decades: the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and the Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, both emerging from animal reservoirs to cause global occurrence in humans with alarming morbidity and mortality [3].

In late December 2019, Chinese authorities reported clusters of patients with pneumonia of unknown cause that were epidemiologically linked to a large market selling many species of live animals in Wuhan, Hubei Province, China [4]. Chinese scientists isolated the virus from a patient in a short time and on January 7, 2020 published the sequencing of the SARSCoV-2 genome, thus facilitating the monitoring of the evolution of the virus around the globe [5]. On January 30, 2020, World Health Organization (WHO) declared the COVID-19 outbreak a global health emergency and on March 11, 2020, it declared COVID-19 a global pandemic, its first designation since it declared H1N1 flu a pandemic in 2009 [6].

As of March 20, 2020, the COVID-19 was affecting 186 countries and territories around the world and 1 international conveyance (the Diamond Princess cruise ship harboured in Yokohama, Japan). There had been 234,073 confirmed cases of COVID-19 and 9,840 deaths at that time [7].

The rapid progression and little knowledge of the infection by COVID-19, opened the eyes of researchers spread by the globe in the search for more information, definitions, analyses and studies about the pathogen and its interaction with the human body. Much already has been published in the last months and we have objectives to make a bibliometric study. An earlier bibliometric analysis evaluated the scientific literature on different coronaviruses [8], but this study aims to map international scientific production on the SARS-CoV-2.

The search term “COVID-19” was used in the the ISI Web of Knowledge / Web of Science^TM database, analyzing the records that present the term selected for the search. As a methodological path, a bibliometric research was carried out in academic works on the Web of Sciencetm, identifying, after applying the refinement filters, 64 publication records in 36 different journals. As the main results of the analyzes, the top journals of the theme and the most cited articles were identified.On March 20, a search was performed in the Web of Science^TM collection, filling out the citation indexes and document types as “All”, resulting in 64 articles found.

After carrying out the bibliometric survey in the main collection of Web of Science^TM, 64 articles on COVID-19 were identified. These articles are published in 36 different journals indexed to the database in question and were written by 352 authors who have links to 156 institutions, located in 28 countries. To achieve these articles, 724 references were used, with an average of approximately 11.3 references per article. In Table 1-6 and Figure 1-3 below, these results are presented. All articles are from the year 2020.

The journals that were cited at least 9 times in the database articles were selected for the graph showed on Figure 1, which corresponded to 10 among the 458 presented under parameters of the VOSviewer software. Countries that had at least 3 articles were selected for the graph showed on Figure 2, which corresponded to 8 among the 27 countries presented, under parameters of the VOS viewer software.

The words that were cited at least 3 times were selected for the graph showed on Figure 3, which corresponded to 9 among the 103 keywords presented, under parameters of the VOSviewer software.  

Although this research does not cover all information from scientific productions about the new Corona virus “COVID-19”, it was possible to search for documents of high scientific relevance so that we have an overview of the scientific production world on the subject.

Regarding the evolution of publications, in the period from 2019 to March 2020, we had 64 articles published on the corona virus, totalling an approximate value of 724 cited references. These articles were written by 352 authors from 156 higher education students in 28 countries. These numbers are constantly growing due to the current global situation.

The coronavirus caused two large-scale pandemics two decades ago: SARS and Middle East Respiratory Syndrome (MERS) [9]. The human virus is one of the major pathogens for respiratory infection. We can find two highly pathogenic viruses, like SARSCoV (found mainly in bats) [5] and MERSCoV, which cause severe injuries, respiratory syndrome in humans and four others (HCoVOC43, HCoV229E, HCoVNL63 and HCoVHKU1) that induce mild upper respiratory disease. The main SARSCoV outbreak involving 8422 patients occurred between 2002 and 2003 and spread to 29 countries globally [10]. The number of deaths is increasing rapidly.

These facts corroborate the relevance of studies developed in China, due to the large number of patients evaluated, as well as their imaging and laboratory findings.

Regarding the relationship between the most cited articles on the Web of Science (Global Citation Score), we highlight the publication by Guan et al. [11]. The work was carried out in autonomous regions and municipalities in China until January 29, 2020. Data were extracted from data from 1099 patients with Covid- 19 confirmed by a laboratory of 552 hospitals in 30 provinces, making it possible to trace clinical characteristics about the virus in its phase initial and clinical progression.

During the initial phase of Covid-19 the diagnosis of the disease was made by the diversity of symptoms, results of examinations and in the severity of the disease according to its presentation [12].

The work published in the New England Journal of Medicine, a highly prestigious journal in the medical academy, with an impact of 70,670 (2018), addresses the clinical characteristics of patients with corona virus. It is important to note that the clinical characteristics of Covid-19 mimic those of SARS-CoV, fever was identified in 43.8% of patients in presentation and, along with cough, were the dominant symptoms. Gastrointestinal symptoms were uncommon, but may be present, which suggests a difference in participation in viral tropism compared to SARS-CoV, MERS-CoV and seasonal influenza. The presence of fever in Covid-19 is more frequent than in infection with SARS-CoV (1%) and MERS-CoV.

It was possible to analyse, based on the articles, that some patients, especially the most severe, had infections from bacteria and fungi. The high rate of drug resistance of A baumannii can cause difficulties with anti-infective treatment, leading to a greater chance of developing septic shock. In the case of severe mixed infections, in addition to pathogenic virulence factors, the host’s immune status is also one of the important factors. Old age, obesity and the presence of comorbidities may be associated with increased morbidity and mortality. When populations with low immune function, such as the elderly, diabetics, people with HIV infection, people with long-term use of immunosuppressive agents and pregnant women, are infected with 2019-nCoV, immediate administration of antibiotics to prevent infections can reduce complications and mortality [12].

As for handling these cases, precautions in the air are highly recommended, such as a tested N95 respirator and other personal protective equipment. To prevent the spread of the disease in healthcare settings that care for patients infected with 2019-nCoV, the onset of fever and respiratory symptoms should be closely monitored among healthcare professionals. Testing of respiratory samples should be done immediately when a diagnosis is suspected. Serum antibodies should be tested among healthcare workers before and after exposure to 2019-nCoV to identify asymptomatic infections [13].

Regarding therapeutics, much has been discussed about it. However, the treatment indicated by Wang et al. [20] is Chloroquine, a widely used antimalarial and autoimmune drug. This drug has recently been reported as a potential spectrum antiviral drug. It is known that chloroquine blocks infection by the virus, increasing the endosomal pH, in addition to interfering in the glycosylation of SARS-CoV receptors. Chloroquine has an immunomodulatory activity, which can synergistically improve its antiviral effect in vivo. Chloroquine is distributed throughout the body, including the lung, after oral administration [14-18]. 

With regard to the 10 articles with the greatest impact identified in the study, we conclude that the number of deaths is increasing rapidly. On January 24, 2020, 835 laboratory- confirmed infections in China were reported, with 25 fatal cases. Reports of exported cases were released in many provinces in China and in other countries. Some health workers were also infected in Wuhan [12].

In this review and bibliometric analysis, the main highlights related to the findings present in the most cited works on the topic were explained. Access to this type of information becomes relevant in the process of constructing scientific knowledge, as it provides data that can support groups and research centers for locating academic journals specialized in the topic with greater representation, sharing results and helping to combat this pandemic.

1. WEISS SR, LEIBOWITZ JL. Coronavirus Pathogenesis. Advances In Virus 181 Research. Elsevier 2011;85-164.
2.  Masters PS, Perlman S. Coronaviridae. In: Knipe DM, Howley PM, eds.Fields virology. 6th ed. Lippincott Williams & Wilkins, 2013;825-58.
3. CUI Jie, Fang LI, Zheng-li SHI. Origin and evolution of pathogeniccoronaviruses. Nature Reviews Microbiology. 2018;17:181-192.
4. Wuhan Municipal Health Commission, Report of clustering pneumonia of unknown etiology in Wuhan City, 2019.
5.  Lu R, Zhao X1, Li J, Niu P, Yang B, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor 194 binding. The Lancet. 2020 Feb;395(10224):565-574.
6. WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February2020.
7.  WHO. Coronavirus disease 2019 (COVID-19): Situation Report – 60. 2020.
8. Bonilla-Aldana DK, Quintero-Rada K, Montoya-Posada JP, Ramírez Ocampo S, Paniz-Mondolfi, et al. ASARS-CoV, MERS-CoV and now the2019-novel CoV: Have we investigated enough about coronaviruses?– A bibliometric analysis. Travel Med Infect Dis. 2020 Jan -Feb;33:101566.
9.  Peng Z, Xing-lou Y, Xian-guang W, Ben H, Lei Z, et al. A pneumoniaoutbreak associated with a new coronavirus of probable bat origin.Nature. 2020;579:270-273.
10. Chen N, Zhou M, Dong X, Qu J, Gong F, et al. Epidemiological andclinical characteristics of 99 cases of 2019 novel coronaviruspneumonia in Wuhan, China: a descriptive study. Lancet. 2020Feb;395(10223):507-513.
11. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, et al. Clinical Characteristicsof Coronavirus Disease 2019 in China. N Engl J Med. 2020Apr;382(18):1708-1720.
12.  Wei-jie G, Zheng-yi NI, Yu HU, Wen-hua LIANG, Chun-quan OU, et al.Clinical Characteristics of Coronavirus Disease 2019 in China. N EnglJ Med 2020 Apr;382:1708-1720.
13. Huang C, Wang Y, Li X, Ren L, Zhao J. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020Feb;395(10223):497-506.
14. Wang M, Cao R, Zhang L, Yang X, Liu J, et al. Remdesivir and chloroquineeffectively inhibit the recently emerged novel coronavirus (2019-nCoV) invitro. Cell Res. 2020 Mar;30(3):269-271.
15. CHAN Jasper Fuk-woo, YUAN Shuofeng, KOK Kin-hang, Kelvin Kaiwang, CHU Hin, et al. A familial cluster of pneumonia associated withthe 2019 novel coronavirus indicating person-to-person transmission:a study of a family cluster. The Lancet. 2020 Feb;514-523.
16.  Zhu N, Zhang D, Wang W, Li X, Yang B, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020Feb;382(8):727-733.
17.  Wang D, Hu B, Hu C, Zhu F, Liu X, et al. Clinical Characteristics of138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020 Feb.
18.  Li Q, Guan X, Wu P, Wang X, Zhou L, et al. Early Transmission Dynamicsin Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl JMed. 2020 Mar;382(13):1199-1207.