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COVID-19 Glossary of Terms

Adaptive design: Trials with an adaptive study design are flexible in that they utilise interim results to modify the trial’s course based on pre-specified rules. Changes can be made in real time to find the best treatment for patients. Ineffective treatments can quickly be dropped and replaced by other substances that might have emerged from research or clinical findings. It is often more efficient, informative, and ethical than trials with a traditional fixed design since it makes better use of resources such as time and money and might require fewer participants.

Antibody: An antibody is a protein produced by the immune system in response to the presence of a foreign substance, called an antigen. The human body considers disease-causing organisms, such as bacteria and viruses, as antigens. The antibody protects the body by attaching themselves to the antigen, which eventually leads to the removal of the antigen from the body. Antibodies are also called immunoglobulins.

Anti-inflammatory agents: These drugs reduce inflammation in the body by blocking processes and substances in the body that cause inflammation. Acute inflammation of the skin or a joint may manifest as redness, swelling, and pain, but chronic inflammation in the body (e.g., of the vessels) often goes unnoticed for a long time. Anti-inflammatory agents are used to treat many different health conditions.

Antiretrovirals: These drugs are used to prevent a retrovirus from replicating by blocking certain stages of its life cycle. In this way, the retrovirus cannot make copies of itself (replicate). The term is primarily used for antiretroviral drugs that treat the human immunodeficiency virus.

Asymptomatic transmission: Asymptomatic means no symptoms. This term is therefore used to describe the transmission of an infection (e.g., a virus) from a person who does not show symptoms at the time.

Chloroquine: This drug has been used for decades to prevent and treat malaria where it has shown excellent results and good safety and tolerability. It is also used to treat rheumatic diseases. Chloroquine decreases the acidity of certain compartments of the cell, which creates a challenging environment for viruses. Small studies indicated a possible benefit of chloroquine phosphate against the lung infection (pneumonia) that is caused by COVID-19. It is cheap and adverse effects are mostly related to overdosing.

Clinical: This describes all processes concerned with or based on the direct observation and treatment of a disease in patients rather than studies or theoretical considerations.

Community spread (community transmission): is said to have occurred when people have been infected without any knowledge of contact with someone who has the same infection

Contact tracing: a process that begins with identifying everyone a person diagnosed with a given illness (in this case COVID-19) has been in contact with since they became contagious. The contacts are notified that they are at risk, and may include those who share the person's home, as well as people who were in the same place around the same time as the person with COVID-19 — a school, office, restaurant, or doctor's office, for example. Contacts may be quarantined or asked to isolate themselves if they start to experience symptoms and are more likely to be tested for coronavirus if they begin to experience symptoms.

Containment: refers to limiting the spread of an illness. Because no vaccines exist to prevent COVID-19 and no specific therapies exist to treat it, containment is done using public health interventions. These may include identifying and isolating those who are ill and tracking down anyone they have had contact with and possibly placing them under quarantine.

Controlled: In research, a clinical trial that entails two groups used for comparison purposes is called a controlled trial. For example, in a controlled treatment study, one group of participants receives the treatment (e.g., a drug) while the participants in the “control” group do not.

COVID-19: Stands for coronavirus disease 2019. However, it is often mistakenly used as the name of the virus.

CROWN Coronation study: The Chloroquine RepurpOsing to healthWorkers for Novel CORONAvirus PrevenTION study is a global collaboration to test whether chloroquine (or hydrochloroquine) can prevent the infection or mitigate the severity of COVID-19 in frontline health workers. This randomised multicentre trial has an adaptive design.

Data and safety monitoring board: This body is a critical part of the governance of a clinical trial. It consists of clinical research experts and patient advocates who are independent of the researchers and institutions who perform the clinical trial. Their task is to monitor the progress and regularly review the safety and effectiveness data while the trial is underway. Based on its assessment, the board can recommend that a trial be stopped early. The board might consider that the research question has been answered or be concerned about the safety of patients.

DNA: Deoxyribonucleic acid is a long molecule that contains the unique human genetic code. It is essential for all known forms of life and present in all biological cells.

Double-blind study: This is currently considered the best and most reliable form of research, particularly if it is also placebo-controlled (see below). In a double-blind study, neither the doctors nor the study participants know who is receiving which treatment. This is meant to eliminate the power of suggestion if participants know that they receive the tested drugs. It is also meant to prevent an unconscious bias of researchers when they evaluate the results because they know who received the tested drug.

Epidemic: A disease outbreak in a community or region

Evidence: This term most commonly refers to proof that supports a claim or belief. In medicine, it refers to proof that is based on sound research, not opinion.

Flattening the curve refers to the epidemic curve, a statistical chart used to visualize the number of new cases over a given period of time during a disease outbreak. Flattening the curve is shorthand for implementing mitigation strategies to slow things down, so that fewer new cases develop over a longer period of time. This increases the chances that hospitals and other healthcare facilities will be equipped to handle any influx of patients.

Evidence-based medicine: This term describes a systematic approach to solving a clinical problem, for example, how to treat a patient, that combines defined principles and methods. It aims to integrate the best available evidence from research with both the doctor’s expertise and the patient’s values.

Frontline workers: These are employees who provide an essential service or key public service. The term is currently mostly used for those who are critical to the COVID-19 response or delivering essential public services. Frontline health workers are those directly providing services to communities where they are most needed.

HIV: The human immunodeficiency virus is a retrovirus that causes the acquired immunodeficiency syndrome, which is a chronic, potentially life-threatening condition that affects the immune system.

Hydroxychloroquine: This drug is very similar to chloroquine in its mechanism of action. It also alkalises certain compartments of the cell, thereby creating a challenging environment for viruses. It is approved for the treatment of malaria, rheumatoid arthritis, and an autoimmune condition called lupus erythematodes.

Incubation period: the period between exposure to an infection and when symptoms begin.

Isolation: the separation of people with a contagious disease from people who are not sick.

Immunity: This describes a state where a person is protected from an infectious disease. If exposed to the disease, they will not become infected. This may occur after a previous infection with the disease-causing organism or vaccination.

Infection: In an infection, disease-causing organisms invade a persons’ body and multiply there. This leads to a reaction of the person’s body tissues aimed at fighting the agent.

Infectious: Infectious means that something can be passed, directly or indirectly, from one person, animal, or plant to another.

Infectious diseases: These are diseases that result from an infection. Infectious diseases are caused by small organisms, such as bacteria, viruses, parasites, or fungi that spread. They are also called communicable or transmissible diseases.

Informed consent: In healthcare and research, informed consent means that enough information is provided to a patient to make an informed decision. To this end, the patient has to understand the information and the implications of acting on that information. The doctor or researcher has the duty to obtain this consent because they are able to answer the patient’s questions and provide further details.

Institutional review board (IRB): This is a body established to protect the rights and welfare of human research subjects recruited to participate in research. These boards are appointed by institutions that are involved in research. They review the protocol and methods that are proposed for a study to ensure that they are ethical and decide whether or not the study should be conducted. IRBs may either approve, reject, or ask for more information or changes in the study protocol. Other terms are independent ethics committee, ethical review board, or research ethics board.

Interferon-beta: A drug with antiviral and antiproliferative (meaning inhibiting cell growth) effects that is used to treat multiple sclerosis. It has shown effects in an animal model of MERS (see below).

Intensive care: This refers to the specialised treatment for patients who are seriously ill and require intensive treatment and close monitoring. Most of these patients have at least one organ that does not function well. For example, they may not be able to breathe on their own.

Intensive care unit (ICU): This is the department of a hospital that provides the critical care and life support for severely ill and injured patients.

Intravenous: This term describes the delivery of fluids directly into a person’s veins. This may be the injection of a small volume of a drug using a syringe or the infusion of larger volumes of fluid.

Lopinavir/ritonavir: This is a licensed treatment for the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) that it causes. The combination of these two substances inhibits an important enzyme (protease) of the HIV, but other viruses as well, specifically coronaviruses. The combination has shown some effects against COVID-19 and was tested in a small cohort of patients in China, where it did not show an effect in very ill patients.

Mitigation: refers to steps taken to limit the impact of an illness. Because no vaccines exist to prevent COVID-19 and no specific therapies exist to treat it, mitigation strategies may include frequent and thorough handwashing, not touching your face, staying away from people who are sick, social distancing, avoiding large gatherings, and regularly cleaning frequently touched surfaces and objects at home, in schools, at work, and in other settings.

MERS: The Middle East respiratory syndrome is also caused by a coronavirus. It was first reported in Saudi Arabia in 2012 and has since spread to other countries. Most patients become severely ill with fever, cough, and shortness of breath, and many die.

Mortality: In medicine, this term is used for the death rate or the number of deaths in a certain group of people in a certain period of time. For example, mortality may be described for patients with a certain disease, such as patients with cancer or an infectious disease.

Pandemic: An epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.

Phase III trial: Any new drug or a previously approved drug that is tested for their effect on a new or different disease, is tested in several stages before it can be used in daily routine. These clinical trials are mostly divided into four phases. In phase III, it is presumed that a drug is able to treat the disease based on the results of the previous phases. Its therapeutic effect is examined in a few hundred to a few thousand patients. The aim is to establish the efficacy, effectiveness, and safety of the drug.

Physical distancing measures: These include prohibiting people coming together in larger groups (countries use different limits for that), cancelling sporting events, concerts, and other large gatherings during an epidemic. They help to slow transmission of the disease-causing organism, e.g., a virus, and reduce the burden on the health system. By doing so, they may make the epidemic manageable, when it might otherwise overwhelm the health system, and allow targeted and focused measures.

Placebo: This is a substance that has no known therapeutic effect on its own. It is used as a control in studies testing new drugs.

Placebo effect: This describes a beneficial effect that is produced by a placebo and cannot be attributed to the properties of the placebo itself. It is, therefore, explained by the patient's belief in that treatment.

Pneumonia: A chest infection where the small air pockets of the lungs, called the alveoli, fill with fluid, making it more difficult for the patient to breathe.

Principal investigator: The Principal Investigator provides leadership to a study or research project. They are responsible for the management and integrity of the design, conduct, and reporting of a study and for managing, monitoring, and ensuring the integrity of any collaborative relationships.

Prophylaxis: This term refers to measures, for example a drug or action taken to prevent disease.

Quarantine: separates and restricts the movement of people who have a contagious disease, have symptoms that are consistent with the disease, or were exposed to a contagious disease, to see if they become sick

Randomisation: This term refers to the random allocation of patients to a certain treatment in studies, mostly with the help of a computer/software. The main purpose is to avoid bias in this allocation by ensuring that each patient has a known (most of the time, equal) chance of being assigned to any of the treatments. After randomisation, it is assumed that any difference in the patients’ outcomes can be explained only by the treatment they received.

Remdesivir: An experimental drug that was previously tested during the Ebola crisis, but has shown antiviral effects against SARS and MERs in animal studies, and potentially against COVID-19 in clinical studies. There are also case reports of COVID-19 patients who were treated with remdesivir with positive results.

Repositioning or repurposing drugs: This refers to an approach where drugs that are already approved for a different disease are tested for their effect in a new or emerging disease. The development of new drugs targeting a specific disease takes many years. Repurposing is, therefore, used when treatment is urgently needed.

Respiratory system: This term describes the organs and other parts of the body that are involved in breathing. Breathing means that oxygen in the air is brought into the lungs and from there moved through the body. It starts with inhaling air into the nose or mouth. The air travels down the windpipe and from here into the different sections of the lung. In the smallest air pockets of the lung, oxygen and carbon dioxide are exchanged with the blood. Oxygen is essential for all body functions.

Retinopathy: Any damage to the retina of the eyes, which may cause vision impairment, is called retinopathy. It may occur in several diseases, e.g., diabetes or high blood pressure, but can also be caused by some drugs.

Retrovirus: This is a virus that is composed of ribonucleic acid (RNA). Retroviruses have an enzyme called reverse transcriptase, which gives them the unique property of transcribing their RNA into deoxyribonucleic acid (DNA, the hereditary material in humans) after entering a cell. The retroviral DNA is then integrated into the chromosomal DNA of the host cell and expressed there.

Ritonavir: Because lopinavir is quickly broken down by enzymes in the human body, it is given with ritonavir, which enables lopinavir to stay active for longer.

RNA: Ribonucleic acid is one of the major biological macromolecules that are essential for all known forms of life. It is present in all cells.

RNA polymerase: This is a key enzyme of RNA viruses and indispensable for replicating their genome after they infected cells.

SAHPRA: The South African Health Products Regulatory Authority is tasked with the monitoring, evaluating, investigating, inspecting, and registering of all health products (=regulation). This includes, for example, clinical trials and medical devices.

SARS: The severe acute respiratory syndrome is a respiratory illness caused by a coronavirus called SARS-associated coronavirus (SARS-CoV). It was first reported in Asia in 2003 and then spread to more than two dozen countries.

SARS-CoV-2: short for severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 is the official name for the virus responsible for COVID-19.

Social distancing: also called physical distancing, refers to actions taken to stop or slow down the spread of a contagious disease. For an individual, it refers to maintain enough physical distance (a minimum of six feet) between yourself and another person to reduce the risk of breathing in droplets or aerosols that are produced when an infected person breathes, talks, coughs or sneezes.

Solidarity trial: This is a global collaboration of more than 100 countries to examine the effect of four different treatments and the local standard of care in hospitalised adult COVID-19 patients. This randomised multicentre trial has an adaptive design.

Spike protein: This protein is the doorway of the severe acute respiratory syndrome coronavirus 2 into human cells. It is a large protein on the virus surface that it uses to bind to another protein (called a receptor). This binding leads to a fusion between the viral and the human cell wall, allowing the genome of the virus to enter the cell and begin infection.

Standard of care: In the context of COVID-19 studies, this is the regular support that hospitals treating COVID-19 patients use currently, for example, supplementary oxygen.

Vaccine: A biological preparation that stimulates a person’s immune system to become immune to (=protected from) a specific disease. It typically contains an agent that resembles the disease-causing microorganism but does not cause the full spectrum of the disease. Instead, the agent stimulates the body's immune system to recognize the agent as a threat and destroy it. The immune system remembers the characteristics of the agent and will react in the same way should the microorganism enter the body in the future. This is called active acquired immunity.

Ventilation: A patient who is unable to breathe or breathes insufficiently may be assisted by a machine that moves breathable air into and out of their lungs. This process is also called mechanical ventilation and delivers breaths to the patient.

Ventilator: A machine that provides mechanical ventilation to patients (also called a respirator).

Virus: a virus is the smallest of infectious microbes, smaller than bacteria or fungi. A virus consists of a small piece of genetic material (DNA or RNA) surrounded by a protein shell. Viruses cannot survive without a living cell in which to reproduce. Once a virus enters a living cell (the host cell) and takes over a cell's inner workings, the cell cannot carry out its normal life-sustaining tasks. The host cell becomes a virus manufacturing plant, making viral parts that then reassemble into whole viruses and go on to infect other cells. Eventually, the host cell dies

WHO: The World Health Organization is a specialized agency of the United Nations responsible for international public health.

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