The University of Louisville Journal of Respiratory Infections


Introduction: SARS-CoV-2 is the etiologic agent of Coronavirus Disease 2019 (COVID-19), a highly contagious, emergent, acute, viral pneumonia that emanated sporadically in Wuhan, China in December 2019. COVID-19 became pandemic in February 2020 leading to 4,942,687 confirmed cases, over 321,987 deaths and grounded several economies around the world as of May 2020. Although global researchers, epidemiologists and medical professionals rose steadily to contain the disease, indepth knowledge and concerted efforts are still evolving on the virus. This research sought to elucidate the biological Strengths, the Weaknesses, Opportunities, and Threats to SARS-CoV-2, with a view to understanding and devising holistic strategies at combating, mitigating, and overcoming the scourge of COVID-19.

Methods: This systematic review and narrative synthesis utilized PubMed, Google, DOAJ, ProMed, recent literatures and other databases to search and finally select about 98 publications on Coronaviruses, 2019-nCoV, and COVID-19 disease, using text word searches to generate the specific terms following the PRISMA method. Relevant publications were reviewed and compared, findings were synthesized using a narrative method and presented qualitatively.

Results: Some identified Strengths of SARS-CoV-2 include: The ability to effectively cross the species barrier and establish productive infection in humans; SARS-CoV-2 is a new strain of Coronavirus; three virulence factors (Nsp1, Nsp3c and ORF7a) interfere host’s innate immunity and immune escape; ORF8 and ORF10 proteins are uniquely associated with SARS-CoV-2; genetic fitness of the spike protein facilitates attachment and fusion; existence of polybasic cleavage site in the genome; SARS-CoV-2 has a short serial interval of 4.0 days; and the ability to resurge and enter into regular circulation after the initial pandemic wave. The Weaknesses include: Angiotensin-Converting Enzyme 2 (ACE2) is the sole receptor for SARS-CoV-2; Host protease processing during viral entry is a significant barrier for several lineage B Coronaviruses; and SARS-CoV-2 critically requires Porphyrin to inhibit human heme metabolism. The Opportunities harnessed by SARS-CoV-2 include: Host cellular receptors for SARS-CoV-2 infection are expressed by several important organs in the human body; Ease of travel, globalization and aviation are potentials for global spread; Underlying illnesses, age, gender, smoking and immune suppression; Knowledge is yet evolving on the underlying pathogenic mechanisms of SARS-CoV-2; Potential silent transmission via blood and blood products; No approved COVID-19 vaccine; Confounding pattern of signs and symptoms; and Disproportionate ‘‘Cytokine storm’’ or damaging evolution of effective defenses. The Threats to SARS-CoV-2 include: Prohibition of mass gatherings; Prompt hospitalization, isolation and quarantining infected individuals; Repurposing proven antimalarial/antiviral/anti-inflammatory drugs; Deployment of rapid laboratory equipment and procedures for prompt detection; Potential antiviral activities of Coagulation Factor Xa, IIa (thrombin) and Convalescent plasma; Elucidation of the genome sequences; and global COVID-19 research funding.

Conclusion: SARS-CoV-2 explores its biological strengths, conserves its weaknesses, and exploits the host opportunities to decimate human populations. For interventions to overcome the virus and get out of the COVID-19 pandemic, research scientists, the academia, funders, industry, healthcare professionals and the citizenry should scale up all promising research by strategically focusing on decreasing the Strengths and Opportunities, while capitalizing on the Weaknesses of and Threats to the virus.


The author(s) received no specific funding for this work.



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