Iranian Journal of Medical Microbiology

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In Wuhan, China, a number of unidentified pneumonia cases were registered at the end of December 2019. An epidemiological analysis of the early cases of 2019 New Coronavirus pneumonia was presented that several cases in Wuhan, China were exposed to the Huanan seafood industry (1, 2). Early steps to contain the outbreak were quickly taken by the government and health researchers in the country and etiological testing begun. On January 12, 2020, the current virus was temporarily named the New Coronavirus 2019 by the World Health Organisation (WHO). The new Coronavirus outbreak was declared a public health emergency of international significance by WHO on January 30, 2020. (PHEIC). The WHO formally called the illness caused by the new Coronavirus Corona Virus Disease 2019 on February 11, 2020 (COVID-19). It was called Extreme Acute Respiratory Syndrome by the International Committee for the Classification of Viruses (CSG) research group on the same day. A total of 77041 cases of COVID-19 infection were confirmed in China on February 23, 2020. In 2002, this figure exceeded the prevalence of severe respiratory syndrome (SARS) in China (3, 4).
The virus is like a membrane protein appendage and comprises of membrane proteins such as polymerases, proteases, helixes, neucleoproteins and polyproteins, as well as other auxiliary proteins (5). By creating bilayer vesicles, Coronaviruses block the expression of pattern recognition receptors (PRRs) and, as a result, the innate immune system does not recognize them and continues to proliferate within the vesicles. They inhibit the production of type I interferons as one of the most important antiviral agents. Coronaviruses also interfere with the delivery of antigens by immune cells (6).
 

 
Figure 1. Coronavirus and ACE-2 receptors
(Image source: Downloaded from jmums.mazums.ac.ir at 12:17 +0330 on Wednesday January 20th 2021)

 
It is suspected that the current Coronavirus-2019 is spread via droplets, near contact, aerosols, and probably Transmission of fecal-oral, and patients may transmit the virus to other persons during the incubation phase (1, 2). Pathogenic processes, clinical symptoms, and novel pathways of transmission of Coronavirus-2019 could be clarified by viral receptor dissemination. As a receptor for the new Coronavirus-2019, which is necessary for its entry, the angiotensin-converting enzyme2 (ACE2) has been proposed. Multinucleated Coronavirus infection in 2019 may include widespread expression of ACE2 in different cells, such as AT2 lung cells, upper esophagus, cells of the epithelia, and absorbed ileum and the big bowel enterocytes (7, 8).
The WHO report also notes that in environmental samples obtained from the Hanan seafood industry, the new Coronavirus-2019 was found (4), although it is not yet known what particular species of animals are carrying the new Coronavirus-2019. Out of the 585 environmental tests available in the Hanan Seafood Industry, 33 were positive for the most recent Coronavirus-2019. Some of them include a number of live animals, but do not include bats, such as hedgehogs, badgers, rodents, turtles, birds, and possibly pangolins. Therefore, it is possible that bats did not have direct human interaction, and it remains difficult to actively spread the virus from bats to humans. Since, while SARS-CoV (SARS Coronavirus) and MERS-CoV (Merconavirus Coronavirus) originated from bats as the primary and natural reservoir in the past, they were transmitted to humans via the hosts of a cat (civet) and camel (1, 2).
The S-virus protein enters target cells in the upper respiratory tract when it enters the human body by binding to angiotensin converting enzyme (ACE-2) 2 receptors and can lead to the clinical picture of acute respiratory distress syndrome in 4% of cases. 20-30% of patients need hospital treatment and about 50% of people do not show symptoms after infection. A substantial affinity between Coronavirus and these receivers shows that communities with high expression of ACE-2 are more vulnerable to the infection (9).
Monitoring epidemiological measures, latest solutions for diagnosis, including RT-PCR and microarray-based assays, may be successful, includes prevention steps. Specimens like throat exudations, saliva, underneath inhalator tract spatters, gore, and piss can be found with the recently detected COVID-19 nucleic acids (1, 2, 10, 11).
Furthermore, the 5^th infection prevention and management recommendations version (IPC) specifies that retrieving plasma should treat patients with serious and essential illnesses (12). Some experiments have shown that the presence of tuberculosis and avian mycobacteria and the development of pneumonia are causing the death of Coronavirus affliction. Tuberculosis infection, the frequency and persistence of the disease in persons with Coronavirus for this reason improves, both active and latent.
Countries such as Italy, Spain and the United States, which do not include BCG in their vaccination program, have suffered more. The death toll was higher in Wuhan, China, where mycobacterium infections are more prevalent. Although the first BCG strain was imported in Iran in 1908, but its mass production and universal prescription to dates back to 1983; this means that all people under the age of 36 have received the vaccine (13).
Coronavirus infections have been a medical intimidation to the general population and health workers around the world. However, there is little information about this new bug. There is currently an assessment and development of an appropriate antivirus treatment and vaccine alternative. What we will do now is to enforce infection prevention steps actively to deter the dissemination of the latest COVID-19 via Anthropo-to-Anthropo transition in 2019. The condition can also be supervised by common safety authorities. The better the answer would be, the more information available about this new virus and its prevalence. In order to provide or purchase time for improved public health care services, a better definition of COVID-19 to direct public health advice, and the prompt production of diagnosis, prevention and vaccination, any attempt has been made to delay the spread of the disease (14, 15). It is expected that successful treatment of the current 2019 Coronavirus and COVID-19 can be addressed towards the next coming with the discovery of vaccines, medications and initiatives.
The results of the present study include a number of stakeholders, including the government, health care workers in the country, the Central Corona Anti-Corruption Headquarters, the National Corona Anti-Corruption Resolution Support Council, and all organizations that have been infected in some way. In order to identify some of the literature used in the research, a brief description of these terms is provided below.

Table 1. The latest scientific evidence related to COVID-19

Reference: (https //www.sid.ir/Blog/Post/70373/)
 

Figure 3. Conceptual model of research

 
It should be said that the boundary between personal and governmental factors is that in the personal factor, man determines his position and status based on individual success or failure (33); But in the government factor, it should be said that environmental and external factors are influential and these factors, due to the changing conditions, situations and events of society, are beyond the will and ability of the individual and the important element of society (government) must decide about them (34).

The best way to fight the Coronavirus-2019 epidemic regulation of the origins of infection in the absence of effective therapies. Early identification, monitoring, isolation and quarantine and supportive treatment interventions include strategies; Disseminating disease data in a timely manner and ensuring civil order is both very successful and beneficial. For people, preventive precautions will successfully avoid the onset of the new 2019 Coronavirus outbreak, including personal grooming, wearing standard masks, proper rest and sufficient ventilation in the room (35).
The present study is a type of causal research in terms of the scope of application at the level of applied research and in terms of methodology. Using Friedman test and using Excel and SPSS software version 25 (SPSS Inc., Chicago. IL., USA), the factors are ranked to improve the situation and reduce the number of patients. In this test, we have a group of people or subjects who have been assessed in at least two situations or two different time periods. And in terms of the average rankings of the groups, it determines whether these groups can be from a community or not? The scale in this test must be at least ranked. This test is a non-parametric corresponding to the F test and is usually used and substituted on ranking scales instead of F. The goal is to compare changes in scores (median) over several (two or more of them) conditions or spans of time (median). In this test, the degree of calculation of the component must be sequential. In order to rate or prioritize variables, researchers typically use this measure.
A total of 402 people living in the province of Alborz, Iran, were included in the thematic nature of the research and, based on literature, the population eligible for research. It should be noted that all members of the statistical community were interviewed (some did not fully answer a number of questions and are in fact missing data that are included in the descriptive statistics section). To collect research data, field method and 7-point Likert questionnaire were used. This type of questionnaire consists of a scale of 7 points: very short, low, low to mild, average, average to moderate, much and very much, which according to the degree of importance from the respondent's point of view, can obtain one of these ranks. . The research was conducted in two stages. In the first stage, the effective factors on increasing the number of patients with Coronavirus were determined by studying the research background and announcements of the Central Headquarters for Corona and library studies. According to the conceptual model of the study, 12 factors as factors affecting the increase in the number of Coronavirus patients were extracted and then analyzed by experts. These factors include: 1. Insufficient of personal hygiene (which includes: frequent hand washing, use of masks, use of gloves, use of disinfectant gel or alcohol for disinfection, washing of home appliances, refusal) Avoid leaving masks. Gloves and wipes soaked in disinfectant in other places), 2. Travel, 3. Insufficient rest of the patient with the virus, 4. Inadequate nutrition, 5. Not taking seriously the warnings of the Crisis Management Headquarters 6. Insufficient of awareness of the symptoms of the virus, 7. Confidentiality of the disease by the infected person, 8. Attendance at public ceremonies, 9. Attendance at medical centers due to unnecessary issues, 10. Use of public vehicles, 11. Economic pressure and Insufficient of medicine, 12. Failure of the Crisis Management Headquarters in quarantining cities.
In the following, the method used in the present study is described in three sections.
Part One: Reliability
To evaluate the reliability of the questionnaire, we calculate the Cronbach's alpha with the help of SPSS software version 25. The results are calculated as follows and shown in Table 2.
The total number of respondents to the questionnaire is 402 and the number of valid and correctly received answers is 383. In Table 3, the Cronbach's alpha value is calculated.

Table 2. Reliability

Table 3. Statistics on durability 

For the 12 factors listed in the questionnaire, the calculated value of Cronbach's alpha is equal to 0.874, which indicates the good reliability of the questionnaire used.
Part 2: Check whether the sample is normal or abnormal
In this section, in order to select a test to compare the factors affecting the increase in the number of patients with Coronavirus, we must first check whether the sample is normal or abnormal. For this purpose we use the Kolmogorov-Smirnov test. The test results are calculated and displayed in Table 4.
In the Kolmogorov-Smirnov test table, we have examined the normality of the sample and according to the calculated levels of significance, the sample is not normal and to compare the factors affecting the increase in the number of Coronavirus patients, we must use a non-parametric test.
Part 3: Selecting the appropriate statistical test
Due to the abnormality of the sample and the comparison of 12 factors affecting the increase in Coronavirus infection, we use the non-parametric Friedman test, the results of which in the findings section, in the ranking table (Table 7), the average ranking of each factor affecting The incidence of Coronavirus has increased.

 
Table 4. Checked for Kolmogorov-Smirnov 

Table 5. Test Statistics

The result of Friedman test is shown in Table 5.

4. What is the role of malnutrition in the spread of this virus?

 

5. How serious is the warning of the Crisis Management Headquarters in increasing the number of patients?

 

 

6. To what extent is the Insufficient of knowledge about the symptoms of the virus effective in increasing the number of patients?

 

7. To what extent has the infection been concealed by the infected person?

 

  

8. What is the effect of attending public ceremonies on increasing the number of patients?

 

 

9. To what extent is attending medical centers effective due to unnecessary issues in the spread of this virus?

 

  

10. How effective is the use of public transportation in increasing the number of patients?

  

11. What is the role of economic pressure and drug shortages in the increase and spread of this virus?

 

12. What is the impact of the crisis management headquarters' failure to quarantine cities in increasing the number of people infected with the virus?

 

13. Gender

 

14. education

Finally, according to Table 6, for each of the indicators separately, the mean and median, their standard deviation and variance are calculated.

Table 6. Calculation of mean, median, standard deviation, variance

According to the results in Table 7, the most important factor in increasing the number of patients with Quid-19 in Alborz Province is the factor of non-compliance with personal hygiene with a rank of 8.52 and other factors are listed in this table, respectively.
 
Table 7. Ranking table

The goal of this research was to prioritize the variables affecting the increase in the number of patients with Coronavirus from the perspective of the people of Alborz province. Therefore, according to the objectives and questions of the research, which were presented in detail, the questions were tested and considering the results, the most effective factors in increasing the number of patients with Coronavirus were identified.
As you can see in Table 5 test Statistics, the value of test statistics (Chi-square) with 11 degrees of freedom and a significant level of 0.00 have been calculated. Due to the P-value that is less than 0.05, the assumption that the factors mentioned above have the same effect on Coronavirus infection is rejected and indicates the difference between different factors on Coronavirus infection in the eyes of the people. Accordingly, according to the ranking table, the cause of non-observance of personal hygiene (regular hand washing, use of masks, use of gloves, use of gel or alcohol for disinfection, washing of items purchased for the home, refusal to leave Masks, gloves and wipes soaked in disinfectant in other places) have the most impact and other factors, respectively: the failure of the Crisis Management Headquarters to quarantine cities, attend public events, travel, insufficient rest for patients with Coronavirus concealment of the disease by the infected person, economic pressure and Insufficient of medicine, use of public vehicles, not taking seriously the warnings of the Crisis Management Headquarters, attending medical centers for unnecessary reasons, Insufficient of knowledge about the symptoms of Coronavirus and finally poor nutrition in Corona viruses are effective. The results of the present study are consistent with the results of the following researches:

• The new 2019 Coronavirus is believed to be spread via globules, near contact, solvents, and likely transmission from excremental and buccal, according to studies, and patients may spread the virus to other people during the incubation phase (1, 2). Enterococcus operations, clinical signs, and transmission mechanisms of the new 2019 Coronavirus could be clarified by viral receptor spread. As a receptor for the new Coronavirus-2019, which is necessary for its entry, angiotensin-converting enzyme 2 (ACE2) has been proposed. In neonatal Coronavirus multinuclear infection 2019, widespread expression of ACE2 in different cells such as lung AT2 cells, upper esophagus, epithelial cells, and ileum and colon absorption enterocytes can be involved (36, 37). Thus, a potential route for excremental and buccal contagion is for current Coronavirus infection-2019, in addition to respiratory and body interaction.
• In another study, treatment of the sources of infection is the best way to handle the COVID-19 epidemic in the absence of effective therapies. Strategies include early notice, surveillance, containment and isolation, and preventive treatment, so disseminating epidemic knowledge in a timely fashion and maintaining civil order is very effective and beneficial. For people, preventive precautions will successfully avoid the onset of the current 2019 Coronavirus outbreak, including personal grooming, wearing surgical masks, proper rest, and sufficient ventilation in the space (38).
• Scientists have shown that the corona virus has always been circulating among animals, but due to human interaction with animals, the virus entered the human body and in the process of interaction with humans evolved and was able to Adapt to humans and has caused disease. A report in the Guardian (April 12, 2020) explores the nature of the disease and understands that in the animal world, viruses of this kind are still in circulation. Knowing the degree to which the virus will harm the ecosystem, "Understanding the extent to which the virus can affect the species," it can take us to its source" (39).
• Fukuyama (2020), in his discussion of the post-Crohn's Coronavirus outbreak, expresses doubts about the end of easy democracies of democracy / authoritarianism, and states in an interview that "I doubt when the disease will end. The easy duplications of democracy / authoritarianism should be discarded, and the effects of the virus on socio-economic spheres will increase the likelihood of polarization and increase the likelihood of popular revolutions or street riots against these governments (40).
• In a new paper, Wu et al. (41) examine the relationship between the success of states in the United States in conducting rapid corona testing and the state's stock of trust and social capital, and find a positive relationship between the two.
• In another paper, Wu et al. (42) examined the issue of public trust and the success of policies to address the Corona crisis and showed that the higher the public confidence in society, the more likely it is that policies such as social distancing will succeed. And people are more likely to avoid transmitting the virus to others.

• According to a study by observing the infection through this virus in family members as well as health and medical staff, it was shown that human-to-human transmission of this virus occurs through respiratory droplets and infected objects (43, 44).

• According to research results, a person may also become infected with the Coronavirus through touching an infected object or surface. In this way, the person enters the body after contact with the infected surface. The highest rate of virus transmission is when a person has clinical symptoms. However, some patients are able to transmit their infection to others before the onset of clinical symptoms (46).

 
According to the findings of the current research and similar studies, taking measures in these areas, respectively, is one of the most important measures that can be effective in the prevailing conditions in society. If these issues are properly addressed, we will take the biggest step towards controlling and combating the disease, and to a large extent, the spread of the corona virus among other citizens will be prevented. It is hoped that the results of the present study, in addition to providing sufficient knowledge of this invasive and contagious virus, will help to win this battle, the implementation of which always leads to correct and timely control decisions by countries; Efforts to take protective and personal hygiene measures are also essential.

With gratitude and thanks to the trained Professor Dr. Mohammad Ehsanifar, who has always been the strongest reference for the author to complete this research in all areas of expertise with his successful points.

The authors declared no conflict of interest.