COVID-19 Report
COVID-19 Report: On the last day of 2019, 31 December, China Health Authority alerted the World Health Organization to some pneumonia cases manifesting with an unknown etiology in the City of Wuhan, Hubei Province in central China…
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COVID-19 Report
Solution
Profile of COVID-19
On the last day of 2019, 31 December, China Health Authority alerted the World Health Organization to some pneumonia cases manifesting with an unknown etiology in the City of Wuhan, Hubei Province in central China. The earliest reported case had been on 8 December 2019, and by 7 January 2020, a novel coronavirus, initially abbreviated as 20-nCoV by WHO was identified from a sample patient’s throat swab (Harapan et al, pars 1-2). Being part of Coronaviruses (CoVs), it belongs to a group of members of the family Coronavridae whose characteristic morphology is the outer fringe or corona with embedded envelope protein.
The CoVs cause a wide spectrum of disease in multiple species with those attacking humans categorized as HCoVs and primarily lead to multiple respiratory diseases like pneumonia, common cold, bronchitis, severe acute respiratory diseases and Middle East Respiratory Syndrome. CoVs are RNA viruses that require RNA- dependent RNA polymerases (RdRPs in course of their life cycle. Essentially, CoVs life cycle requires the action of RdRPs this forming part of the reason why RdRPs form potential targets for pharmacological and other therapeutic interventions in the treatment and management of CoVs – based diseases.
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The Spread
COVID -19 can be spread either through droplet transmission or airborne transmission. WHO notes that ‘Respiratory infections can be transmitted through droplets of different sizes: when the droplet particles are >5-10 µm in diameter they are referred to as respiratory droplets,’ (1) and as droplet nuclei when the droplets are equal to or greater than 5µm making them remain in the air for longer periods and can be transmitted over distances greater than 1M. In droplet transmission, the person is in close contact within 1M with another one who has respiratory symptoms like coughing and sneezing.
Unlike droplet transmission, airborne transmission means the presence of microbes within the droplet nuclei considered too equal to or greater than 5µm in diameter can remain in the air for longer periods (exceeding 15 minutes) and can be transmitted over diseases longer than 1M. Airborne transmission means it is highly contagious become its transmission is possible is in settings and circumstances where aerosols are generated. These include open suctioning, non-invasive positive pressure ventilation, bronchoscopy and endotracheal intubation, among others. While current studies have found the presence of COVID-19 in feces, no reports of fecal-oral transmission of the COVID-19 virus have been reported up to date (WHO 1).
The Disease
Signs and symptoms of COVID- 19 are many and manifest in different patients in different ways and severity. Among the most common symptoms are fever, a dry cough, and tirednessness (Lei, Shaoqing, ET al.3). Other less common symptoms include diarrhea, sore throat, aches and pains, headache and conjunctivitis. These may also be accompanied by a rash on the skin or discoloration of the toes and fingers together with loss of taste or smell. As the disease progresses, serious symptoms may clinically manifest as shortness of breath or difficulties in breathing, chest pain or pressure and loss of speech or movement.
Lei and colleagues aver that the patient’s immune function is a major determinant of the disease severity, and populations with low immune function, such as older people, are more vulnerable and have high mortality after COVID-19 infection(7). Herein mean incubation period to mean the period between infection and the onset of symptoms for COVID-19 ranges between 4-6 days, with approximately 95% of the patients developing symptoms within 14 days. Studies also indicate that the viral load of COVID-19 is highest in the upper respiratory tract around the day of symptoms onset but gradually declines over time.
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This period marks the beginning of the contagious period. The end of the contagious period is not definitively known, considering that the viral loads drop in the first seven days, but shedding has been found to continue for more than 100 days (Cevik Muge et al., pars 3-7). After an incubation period of up to 14 days, the disease progresses in symptomatic patients from mild to severe to critical and finally death for those who succumb to the disease. The main risk factor for severe illness in COVID-19 is comorbidities like underlying cardiovascular diseases, diabetes and those individuals whose immunity is compromised and advancing age.
Flattening the Curve
Migone opines that Canada had the benefit of observing ‘the novel COVID-19 pandemic spread in China, Iran and Western Europe’ (383) and was, therefore, able to explore a response that was as highly cooperative as it was broad. The first response measures occurred before mid-March 2020 when many policy choices and the emergency response framing at all institutional levels followed incremental and exhortative patterns (383). At the sub-national level like Toronto and Vancouver, policies involved screening of international travelers.
Come 9 March, and the first death was reported leading the Provinces and Territories to declare states of emergency between 12 March- 22 March. Specifically, on 14 March, the national government banned foreign nationals except those from the U.S. Most of the Federal government’s policies and the provincial governments were effective (384). However, limitations remain and need to be addressed. For example, there are shortages in personal protective equipment for health care professionals, stretched supply lines, poor communication among health agencies, and the pace of decisions in the second policy phase (384).
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Clinical Micro and COVID-19
The fight against Covid 19 brings together professionals ranging from healthcare practitioners to epidemiologists and clinical microbiologists. Clinical microbiologists are performing the critical role of designing, developing, and evaluating diagnostic tests. Rapid testing is one of the critical measures necessary for effective overcoming and control of the pandemic.
Microbiologists play a critical role in facilitating rapid testing, early detection, and implementing crucial disease management decisions by health care practitioners. Microbiologists also guide specimen collection, help confirm the diagnosis of Covid-19, assist in the development of covid-19 among other antiviral therapies, and take part in defining infection control practices.
At the core of the clinical microbiologists’ roles is conducting the R.T. – Polymerase Chain Reaction (PCR) tests, which shows if the individual has an active coronavirus infection. RT-PCR is a molecular test that detects genetic material present inside the virus particle (Tang et al. 5). The test involves reactions that begin with converting the virus’ RNA into DNA and then amplified to make numerous copies that can be assessed (FDA). The PCR test then detects the virus’ DNA, confirming a diagnosis. Multiple amplification cycles facilitate better detection even in low genetic material levels, making the PCR test highly sensitive.
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The tests can be offered at the point of care (POC), with the latest development being the FDA approved Lucira COVID-19 All-In-One Test Kit (FDA). The test utilizes RT-LAMP technology to detect RNA of the N gene for the virus. The RT-LAMP technology plays the role of amplification in two phases that convert RNA target to cDNA and amplify the cDNA.
The amplification causes a P.H. change and a subsequent color change, which is detected by the test kit’s electronic elements, processed with the kit’s microprocessors to indicate the patient’s infectivity status displayed with led lights marked as either positive, negative, or invalid (FDA). The FDA notes that a positive test may show in as few as 11 minutes, negative or invalid in 30 minutes (4).
In New York, patient testing is offered state-wide in clinics and designated drive-through sampling sites. The drive through sampling sites help reduce the flow of people with symptoms or at risk of the disease in healthcare settings where they can infect other people (NYC Department of Health). At the drive-through sampling sites, tests are by appointment only, with the priority being on symptomatic individuals or individuals in close contact with individuals with positive cases.
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This involves public health workers, first responders, nursing home workers, and the general public. In most of the POC, the state uses antigen testing for diagnostic testing, antibody testing to understand the baseline infection rate, and recommends rapid molecular tests through supporting guidelines (NYC Department of Health). The state also utilizes contact tracing to identify and trace people who have had contact with those diagnosed with the disease. The initiatives combine to form a nation-leading response program that has helped identify and manage the disease.
Outlook for a COVID-19 Vaccine
The adverse effects of the pandemic warrant vaccine development to curb its fast-rising prevalence. Therefore, health agencies support vaccine development by conducting research and development and ensuring compliance with large-scale production, manufacture, and testing for antibodies (Elisabeth). There have been subtle developments with several COVIID-19 candidate vaccines, statistics of incidence and prevalence, and superheroes in the fight against SARS-CoV-2.
In the race for vaccine development, it is important to study vaccine efficacy on different viruses by administering the test on non-human subjects.
Studies show that governments and research institutions were more focused on identifying and developing novel vaccines and medicines to treat severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) during the last decade. As of 2020, there are insignificant developments towards the fight against the current pandemic, given that no vaccines have been approved as safe and effective (Elisabeth 2020). Nevertheless, over the past few months, there have been developments detailing that some vaccines are through to Phase III clinical trials and awaiting approval.
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The World Health Organization asserted that developing a vaccine against SARS-CoV-2 would take more than 18 months. Consequently, the rapidly rising infection rates triggered international alliances and government efforts to spearhead research activities that would allow vaccine development against shortened timelines. An alliance between Pfizer and BioNTech’s have become frontrunners in developing a candidate vaccine.
They announced significant milestones, including efficacy data from a total of 170 confirmed cases of COVID-19 detected in their Phase III trial and safety data from a randomized subset of at least 8000 participants 18 years and older (COVID, Team CDC, et al. 2020). The progress also included a submission to the Food and Drug Administration for an Emergency Use Authorization (EUA) of their COVID-19 candidate vaccine.
Currently, the pandemic is a disaster for societies, governments, and researchers. Pfizer and BioNTech’s entry into the global market, together with other companies, signifies significant progress and hope for people and countries adversely affected by the pandemic.
- Global statistics show that 64,508,746 cases, 1,492,998 deaths, and 41,495,720 recoveries have so far been recorded
- In Africa, South Africa has been severely impacted, recording 796,472 cases and 21,709 deaths.
- The U.S. has recorded the highest figures globally: 13,921,371 cases and 273,799 deaths.
- State-level prevalence for New York State has recorded 296,997 cases, 61,802 hospitalizations, and 19,603 confirmed deaths.
- The caseload in Queens for a 7-day average is at 447 cases
- I live in Roseville, ZIP code 10312, with a 7.78 positivity rate for every 100,000 people tested.
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The Essential Heroes
Healthcare systems play an outstanding role in the fight against the global pandemic. The medical professionals and frontline workers have become our superheroes since they prioritize sick populations ahead of family and individual needs. The global pandemic has drawn much attention to healthcare systems despite being overburdened by challenges relating to recruitment, deployment, retention, and experienced health workers’ protection.
These challenges, together with the pandemic, have crippled the healthcare industry (Elisabeth 2020). COVID-19 pandemic has highlighted the need for sustainability through meaningful investments. Moreover, social dialogues and partnerships delineate resilient healthcare systems that function to safeguard future healthcare needs.
COVID-19 and You
The covid-19 pandemic led to a drastic shift in my lifestyle habits. Besides more time at home, I also had time to reflect on my health and the activities I could take to promote my health. Among them was a shift to a better diet. Since I spent most of my time at home, I decided to shift to a better diet, mostly plant-based and whole foods. I also started counting calories. Secondly, I took up home exercises. At least four times a week, I do home exercises.
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Learning about the danger the virus had on individuals with underlying conditions such as diabetes pushed me to adopt a more active lifestyle and a better diet. I also changed my sleeping habits and shifted to an 8 hour sleep routine for the first time in over five years. This led to better sleep quality and reduced stress levels. While the pandemic adversely affected most people and livelihoods, to me, it underlined the need for self-care and being actively involved in health promotion.
Works Cited
- Cevik, Muge, et al. “SARS-CoV-2, SARS-CoV-1 and MERS-CoV viral load dynamics, duration of viral shedding and infectiousness: a living systematic review and meta-analysis.” SARS-CoV-1 and MERS-CoV Viral Load Dynamics, Duration of Viral Shedding and Infectiousness: A Living Systematic Review and Meta-Analysis (2020).
- COVID, Team CDC, et al. “Geographic Differences in COVID-19 Cases, Deaths, and the Incidence-United States, February 12-April 7, 2020.” MMWR Morbidity and mortality weekly report 69 (2020).
- FDA. “Coronavirus (COVID-19) Update: FDA Authorizes First COVID-19 Test For Self-Testing At Home”. U.S. Food and Drug Administration, 2020, https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-covid-19-test-self-testing-home
- FDA. “Coronavirus Disease 2019 Testing Basics”. U.S. Food and Drug Administration, 2020, https://www.fda.gov/consumers/consumer-updates/coronavirus-disease-2019-testing-basics.
- Harapan, Harapan, et al. “Coronavirus disease 2019 (COVID-19): A literature review.” Journal of Infection and Public Health (2020).
- Lei, Shaoqing, et al. “Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection.” EClinicalMedicine (2020): 100331.
- Mahase, Elisabeth. “Covid-19: Pfizer and BioNTech submit the vaccine for U.S. authorization.” (2020).
- Migone, Andrea Riccardo. “Trust, but customize: federalism’s impact on the Canadian COVID-19 response.” Policy and Society 39.3 (2020): 382-402.
- NYC Department of Health. “COVID-19 Testing”. Department of Health, 2020, https://coronavirus.health.ny.gov/covid-19-testing.
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- Omer, Saad B., Preeti Malani, and Carlos Del Rio. “The COVID-19 pandemic in the U.S.: a clinical update.” Jama 323.18 (2020): 1767-1768.
- Tang, Yi-Wei, et al. “Laboratory diagnosis of COVID-19: current issues and challenges.” Journal of clinical microbiology 58.6 (2020).
- World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations: scientific brief, 27 March 2020. No. WHO/2019-nCoV/Sci_Brief/Transmission_modes/2020.1. World Health Organization, 2020.
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