The Eurasian Journal of Medicine
Review

Unclear Issues Regarding COVID-19

1.

Department of Chest Diseases, Ufuk University School of Medicine, Ankara, Turkey

2.

Department of Chest Diseases, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey

3.

Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey

4.

Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey

5.

Department of Occupational Health and Diseases, Adana City Research and Training Hospital, Adana, Turkey

6.

Department of Chest Diseases, Kutahya University of Health Sciences School of Medicine, Kutahya, Turkey

7.

Yuzuncu Yil University, Dursun Odabas Medical Center, Internal Medicine Intensive Care Unit, Van, Turkey

8.

Department of Pediatric Pulmonology, Gazi University School of Medicine, Ankara, Turkey

9.

Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey

10.

Department of Chest Diseases Kirikhan State Hospital, Hatay, Turkey

11.

Department of Physiotherapy and Rehabilitation, Yeditepe University Faculty of Health Sciences, Istanbul, Turkey

12.

Department of Nursing and Health Services, Yeditepe University Faculty of Health Sciences, Istanbul, Turkey

13.

Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey

14.

Department of Chest Diseases, Unye State Hospital, Ordu, Turkey

15.

Internal Medicine Intensive Care Unit, Hacettepe University School of Medicine, Ankara, Turkey

16.

Department of Chest Diseases, University of Health Sciences, Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey

17.

Department of Allergy and Immunology, Uludag University School of Medicine, Bursa, Turkey

18.

Department of Pathology, Ankara University School of Medicine, Ankara, Turkey

19.

Department of Chest Diseases, Baskent University School of Medicine, Ankara, Turkey

20.

Department of Chest Diseases, Kestel State Hospital, Bursa, Turkey

21.

Department of Chest Diseases, Bilecik State Hospital, Bilecik, Turkey

22.

Department of Chest Diseases, Duzce University School of Medicine, Düzce, Turkey

23.

Department of Chest Diseases, Bingol State Hopital, Bingöl, Turkey

24.

Department of Thoracic Surgery, Ondokuz Mayis University School of Medicine, Samsun, Turkey

25.

Department of Chest Diseases, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey

26.

Department of Chest Diseases, Ataturk University School of Medicine, Erzurum, Turkey

Eurasian J Med 2020; 52: 191-196
DOI: 10.5152/eurasianjmed.2020.20092
Read: 303 Downloads: 93 Published: 11 June 2020

Scientists from all over the world have been intensively working to discover different aspects of Coronavirus disease 2019 (COVID-19) since the first cluster of cases was reported in China. Herein, we aimed to investigate unclear issues related to transmission and pathogenesis of disease as well as accuracy of diagnostic tests and treatment modalities. A literature search on PubMed, Ovid, and EMBASE databases was conducted, and articles pertinent to identified search terms were extracted. A snow-ball search strategy was followed in order to retrieve additional relevant articles. It was reported that viral spread may occur during the asymptomatic phase of infection, and viral load was suggested to be a useful marker to assess disease severity. In contrast to immune response against viral infections, cytotoxic T lymphocytes decline in SARS-CoV-2 infection, which can be partially explained by direct invasion of T lymphocytes or apoptosis activated by SARS-CoV-2. Dysregulation of the urokinase pathway, cleavage of the SARS-CoV-2 Spike protein by FXa and FIIa, and consumption coagulopathy were the proposed mechanisms of the coagulation dysfunction in COVID-19. False-negative rates of reverse transcriptase polymerase chain reaction varied between 3% and 41% across studies. The probability of the positive test was proposed to decrease with the number of days past from symptom onset. Safety issues related to infection spread limit the use of high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) in hypoxic patients. Further studies are required to elucidate the challenging issues, thus enhancing the management of COVID-19 patients. 

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