The virology of SARS-CoV-2

Abstract

The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has far reaching effects on society, the economy and medical treatment. It is all the more important to understand the characteristics of the virus and to utilize them diagnostically, therapeutically and epidemiologically. This article firstly elucidates the medical importance of coronaviruses in general. Then angiotensin-converting enzyme 2 (ACE2) as the binding site of SARS-CoV‑2 and the possible influence on the disease susceptibility are explained. The gold standard for detection of an active SARS-CoV‑2 infection is the direct detection of the pathogen with nucleic acid amplification techniques. At the onset of symptoms, a swab of the upper airway is especially suitable due to the high viral burden. At a later stage direct detection can be achieved in samples from the lower airway or a stool or anal swab. Antigen or antibody tests cannot replace the direct detection of the pathogen; however, the detection of immunoglobulin G antibodies are of special interest for epidemiological questions (seroconversion time of sometimes several weeks). The plaque reduction neutralization test exclusively detects antibodies which neutralize viruses but the procedure is complicated. In addition, the importance of these antibodies with respect to immunity against a second infection is uncertain. Thanks to modern techniques thousands of SARS-CoV‑2 sequences are already available, which show a genomic variability. The D614G mutation in the S spikes seems to cause a higher infectiosity. Mutations can impair the diagnostics and treatment, which makes monitoring necessary.