Question

Using the Web Resources provided this week*, identify a current epidemiological concern either at the local, national, or global level. Address the following questions:

What is the epidemiological concern?

What population is it affecting?

What potential population may be affected if this concern is not addressed?

What are the risk factors associated with the epidemiological concern?

What public health recommendation can you make to alleviate your identified epidemiological concern?

Based on the reading how might you evaluate the effectiveness of the evidenced-based strategies?

Answer 1

a)• WHO Director-General in his regular media stated that WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction. WHO therefore have made the assessment that COVID-19 can be characterized as a pandemic.

The COVID-19 pandemic is considered as the most crucial global health calamity of the century and the greatest challenge that the humankind faced since the 2nd World War. In December 2019, a new infectious respiratory disease emerged in Wuhan, Hubei province, China and was named by the World Health Organization as COVID-19 (coronavirus disease 2019). A new class of corona virus, known as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has been found to be responsible for occurrence of this disease

b)The outbreak of the new coronavirus infection, COVID-19 was initiated from the Hunan seafood market in Wuhan city of China in December 2019, and within a couple of months it has turned out to be a global health emergency. Live animals like bat, frog, snake, bird, marmot and rabbit are frequently sold at the Hunan seafood market (Wang et al., 2020b). Genomic analysis revealed that SARS-CoV-2 is phylogenetically related to severe acute respiratory syndrome-like (SARS-like) bat viruses, bats could therefore be the possible primary source. Although the intermediate source of origin and transfer to humans is not clearly known, the rapid human to human spreading capability of this virus has been established. As per the latest update of WHO on 18 April 2020, the outbreak of COVID-19 had spread in more than 200 countries. Approximately 146,198 people had died after contracting the respiratory virus out of nearly 2,164,111 confirmed cases, whereas more than 402,989 people have recovered from the disease. These numbers are changing rapidly. The detailed up-to-date information about COVID-19, is available in the WHO.

More than 200 countries/regions have reported confirmed COVID-19 cases, including China, Italy, Iran, S. Korea, India, Switzerland, Taiwan, USA, Sweden, Singapore, Sri Lanka, France, Australia, Malaysia, Spain, United Arab Emirates, UK, Nepal, Finland, Netherlands, Japan, Belgium, Russia, Thailand, Philippines, Cambodia, and Germany (Fig. 2). After hitting China in January 2020, COVID-19 severely out broke in countries like South Korea, Iran, and Italy in late February and early March, 2020. As far as the number of COVID infected patients is concerned, USA is at the top of the list followed by Spain (Fig. 1). In USA, more than 30,000 people died of this disease. According to the report of the Chinese government and the WHO, the current outbreak has infected some 84,180 people in China out of which more than 4642 people have died so far as of April 18.

c)• The COVID-19 virus infects people of all ages. However, evidence to date suggests that two groups of people are at a higher risk of getting severe COVID-19 disease. These are older people; and those with underlying medical conditions. WHO emphasizes that all must protect themselves from COVID-19 in order to protect others.

The COVID-19 outbreak affects all segments of the population and is particularly detrimental to members of those social groups in the most vulnerable situations, continues to affect populations, including people living in poverty situations, older persons, persons with disabilities, youth, and indigenous peoples. Early evidence indicates that that the health and economic impacts of the virus are being borne disproportionately by poor people. For example, homeless people, because they may be unable to safely shelter in place, are highly exposed to the danger of the virus. People without access to running water, refugees, migrants, or displaced persons also stand to suffer disproportionately both from the pandemic and its aftermath – whether due to limited movement, fewer employment opportunities, increased xenophobia etc.

If not properly addressed through policy the social crisis created by the COVID-19 pandemic may also increase inequality, exclusion, discrimination and global unemployment in the medium and long term. Comprehensive, universal social protection systems, when in place, play a much durable role in protecting workers and in reducing the prevalence of poverty, since they act as automatic stabilizers. That is, they provide basic income security at all times, thereby enhancing people’s capacity to manage and overcome shocks.

d) risk factors

Asthma (moderate-to-severe)

Moderate-to-severe asthma may put people at higher risk for severe illness from COVID-19.

Actions to take

• Follow your Asthma Action Plan.
• Keep your asthma under control.
• Continue your current medications, including any inhalers with steroids in them (“steroids” is another word for corticosteroids).
• Know how to use your inhaler.
• Avoid your asthma triggers.
• If possible, have another member of your household who doesn’t have asthma clean and disinfect your house for you. When they use cleaning and disinfecting products, have them:
  • Make sure that people with asthma are not in the room.
  • Minimize use of disinfectants that can cause an asthma attack.
  • Open windows or doors and use a fan that blows air outdoors.
  • Always follow the instructions on the product label.
  • Spray or pour spray products onto a cleaning cloth or paper towel instead of spraying the product directly onto the cleaning surface (if the product label allows).

Why you might be at higher risk

COVID-19 can affect your respiratory tract (nose, throat, lungs), cause an asthma attack, and possibly lead to pneumonia and serious illness.

Chronic kidney disease being treated with dialysis

Chronic kidney disease being treated with dialysis may increase a person’s risk for severe illness from COVID-19.

Actions to take

• If you are on dialysis, you should NOT miss your treatments.
• Contact your dialysis clinic and your healthcare provider if you feel sick or have concerns.
• Plan to have enough food on hand to follow the KCER 3-Day Emergency Diet Plan pdf iconpdf icon[PDF – 8 pages]external iconexternal icon for dialysis patients in case you are unable to maintain your normal treatment schedule.

Why you might be at higher risk

Dialysis patients are more prone to infection and severe illness because of weakened immune systems; treatments and procedures to manage kidney failure; and coexisting conditions such as diabetes.

Chronic lung disease

Chronic lung diseases, such as chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), idiopathic pulmonary fibrosis and cystic fibrosis, may put people at higher risk for severe illness from COVID-19.

Actions to take

• Keep taking your current medications, including those with steroids in them (“steroids” is another word for corticosteroids).
• Avoid triggers that make your symptoms worse.

Why you might be at higher risk

Based on data from other viral respiratory infections, COVID-19 might cause flare-ups of chronic lung diseases leading to severe illness.

Diabetes

Diabetes, including type 1, type 2, or gestational, may put people at higher risk of severe illness from COVID-19.

Actions to take

• Continue taking your diabetes pills and insulin as usual.
• Test your blood sugar every four hours and keep track of the results.
• Make sure that you have at least a two-week supply of your diabetes pills and insulin.
• Follow the sick day guidelines for people with diabetes.

Why you might be at higher risk

People with diabetes whose blood sugar levels are often higher than their target are more likely to have diabetes-related health problems. Those health problems can make it harder to overcome COVID-19.

Hemoglobin Disorders

Hemoglobin disorders such as sickle cell disease (SCD) and thalassemia may put people at higher risk for severe illness from COVID-19.

Actions to take

• Ask your healthcare provider about telemedicine or remote healthcare visits, and know when to go to the emergency department.
• Work with your healthcare provider to manage medications and therapies for your disorder (including hydroxyurea, chelation therapy, blood transfusions, and prescriptions for pain management) and any other health condition you may have (such as diabetes, high blood pressure, and arthritis).
• Try to prevent vaso-occlusive episodes or pain crises by avoiding possible triggers.
• Review our healthy living with SCD guide or our healthy living with thalassemia guide for tips to help you stay healthy.
• Find SCD resources and thalassemia resources to help navigate care and increase knowledge and awareness of SCD and thalassemia.
• Let friends and family know about the need for healthy blood donors.

Why you might be at higher risk

Living with a hemoglobin disorder can lead to serious multi-organ complications, and underlying medical conditions (such as heart disease, liver disease, diabetes, iron overload, kidney disease, viral infections, or weakened immune system) may increase the risk of severe illness from COVID-19.

Immunocompromised

Many conditions and treatments can cause a person to have a weakened immune system (immunocompromised), including cancer treatment, bone marrow or organ transplantation, immune deficiencies, HIV with a low CD4 cell count or not on HIV treatment, and prolonged use of corticosteroids and other immune weakening medications. People who are Immunocompromised

Actions to take

• If you are immunocompromised, continue any recommended medications or treatments and follow the advice of your healthcare provider.
• Call your healthcare provider if you have concerns about your condition or feel sick.

Why you might be at higher risk

People with a weakened immune system have reduced ability to fight infectious diseases, including viruses like COVID-19. Knowledge is limited about the virus that causes COVID-19, but based on similar viruses, there is concern that immunocompromised patients may remain infectious for longer than other COVID-19 patients.

Liver disease

Chronic liver disease, including cirrhosis, may increase risk for serious illness from COVID-19.

Actions to take

• Take your medications exactly as prescribed.

Why you might be at higher risk

Severe illness caused by COVID-19 and the medications used to treat some severe consequences of COVID-19 can cause strain on the liver, particularly for those with underlying liver problems. People living with serious liver disease can have a weakened immune system, leaving the body less able to fight COVID-19.

People aged 65 years and older

Older adults, 65 years and older, are at higher risk for severe illness and death from COVID-19.

Actions to take

• Take your medications for any underlying health conditions exactly as prescribed.
• Follow the advice of your healthcare provider.
• Develop a care plan that summarizes your health conditions and current treatments.
• Prepare yourself to stay home for long periods using this checklist.

Why you might be at higher risk

Although COVID-19 can affect any group, the older you are, the higher your risk of serious disease. Eight out of 10 deaths reported in the U.S. have been in adults 65 years or older; risk of death is highest among those 85 years or older. The immune systems of older adults weaken with age, making it harder to fight off infections. Also, older adults commonly have chronic diseases that can increase the risk of severe illness from COVID-19.

People who live in a nursing home or long-term care facility

Many cases of COVID-19 in the U.S. have occurred among older adults living in nursing homes or long-term care facilities

Actions to take

• Carefully follow your facility’s instructions for infection prevention.
• Notify staff right away if you feel sick.
• Ask your caretakers about the actions that are being taken at your nursing home or long-term care facility to protect you and your loved ones, including if and how they are limiting visitors.

Why you might be at higher risk

The communal nature of nursing homes and long-term care facilities, and the population served (generally older adults often with underlying medical conditions), put those living in nursing homes at higher risk of infection and severe illness from COVID-19.

Serious heart conditions

Serious heart conditions, including heart failure, coronary artery disease, congenital heart disease, cardiomyopathies, and pulmonary hypertension, may put people at higher risk for severe illness from COVID-19.

Actions to take

• Take your medication exactly as prescribed. Continue angiotensin converting enzyme inhibitors (ACE-I) or angiotensin-II receptor blockers (ARB) as prescribed by your healthcare provider for indications such as heart failure or high blood pressure. This is recommended by current clinical guidelines.

• Make sure that you have at least a two-week supply of your heart disease medications (such as those to treat high cholesterol and high blood pressure).
• People with hypertension should continue to manage and control their blood pressure and take their medication as directed.

e) Activities that should receive highest priority will vary with the level of community COVID-19 transmission, characteristics of the priority populations to be served, local capacity to implement effective prevention and control activities, and availability of effective interventions

Depending on the level of community spread, public health departments may need to implement prioritization and preservation strategies for public health functions for identifying cases and conducting contact tracing. For HIV, TB, STD, and Viral Hepatitis prevention and control programs, recommended prioritization strategies based on level of community spread

• dentify critical public health activities
• Plan for discontinuation of non-essential public health activities
• Plan for implementation of flexible work (e.g., telework) and sick leave policies
• Implement triage prior to entering facilities to rapidly identify and isolate patients with respiratory illness (e.g., phone triage before patient arrival, triage upon arrival)
• Isolate patients exhibiting symptoms of COVID-19
• Develop alternate telemedicine practices for patients exhibiting symptoms of COVID-19 or other infectious diseases
• Within health department settings, implement social distancing measures, and encourage increased hand hygiene (access to soap and water and alcohol-based hand sanitizer, tissues), encourage respiratory hygiene (face masks and respirators), increased cleaning and disinfection

f)based on the readings, evaluation based on social ditensing ,sfirst was distancing only for adults >60 years of age, in which contacts for this group were reduced by 95%. The rationale for this scenario is that older adults are at highest risk for hospitalization and death and should have the most drastic restrictions in their contacts. Similar policies were implemented in early April in some countries, such as Sweden. In the second scenario, adults >60 years of age would reduce social contacts by 95% and children would reduce contacts by 85%, assuming that most of the contacts of children occur at school and would be reduced due to school closures. This scenario corresponds to an intervention in which the high-risk group is fully protected. In addition, it reduces the contact rates for children, who are known to be a major part of the chain of transmission for other respiratory infectious diseases. Research indicates that children are infected with SARS-CoV-2 as often as adults . At this point, whether their infectiousness also is reduced is unclear. In the third scenario, adults >60 years of age reduce contacts by 95% and adults <60 years of age reduce contacts by 25%, 75%, or 95%. This scenario corresponds to a policy in which high-risk age groups still are protected and younger adults are somewhat restricted in their contacts. However, persons in essential businesses can continue working and children can resume school, which is crucial considering school closures have been shown to have an adverse effect on the economy . In the fourth scenario, contacts are reduced for every group; adults >60 years of age reduce contacts by 95%, children by 85%, and adults <60 years of age by 25%, 75%, or 95%. This scenario represents many interventions currently in place throughout the world.