Question

As the COVID-19 epidemic rages in Ghana, many are seeking answers to the following questions: 1. What are the risk factors for getting infected with COVID-19? 2. What are the risk factors for having symptomatic infection i.e. feeling unwell? 3. What are the risk factors for severe disease (needing hospitalization) and death once a person is infected with COVID-19? Out of the under listed, choose a study design to answer any ONE of the three research questions above: 1. Case-based (prevalent cases) 2. Case-based (incident cases) 3. Case-Cohort (incident cases) 4. Density/Nested (incident cases) 5. Case-Crossover (incident cases) 6. Retrospective cohort 7. Community trial 8. Randomized controlled trial Question 1 Describe the design you select for carrying out the study to answer the research question you selected. In your description, be sure to capture as many elements as possible which highlight the design. E.g. if the simple case-control design was one of the options and you had selected it (note it is not one of the options), you would have to clearly define who your cases would be and who your controls would be, as well as when and how you would identify them etc. Type your response here. Word limit: min 600, max 1,000 Question 2 Provide three specific and practical reasons for your choice of study design for the research question you selected as opposed to any other of the designs. Do not simply state the generic strengths or advantages of your chosen study design, but make them specific to the research question. Type your response here. Word limit: min 200, max 500 Question 3 For each study design you have described to address the research questions, provide three possible research biases and how you would solve them. Do not simply state generic biases and how they are addressed, but be practical about it and how it relates specifically to the research question.

Answer 1

1. Risk factors include

AEROSOL EXPOSURE

CONTACT EXPOSURE
DROPLET EXPOSURE

SYMPTOMATIC RISK FACTORS

OLD AGE

CARDIAC DISEASE
DIABETES MELLITIS
OTHER IMMUNOCOMPRAMISED CONDITION

3. COVID-19 and Heart Disease

Although COVID-19 most often affects the airway and lungs, these organs work together with the heart to drive oxygen to the body’s tissues. When the lungs are overtaxed due to illness, the heart has to work harder, which creates challenges for people who are already living with heart disease.

The American Heart Association notes that viral illnesses similar to COVID-19 can raise the risk of a heart attack in people with a buildup of plaque in their blood vessels. Research shows that viral illness can make it more likely that a piece of the plaque lining the vessels could break off and block blood flow to the heart.

Lung Disease and COVID-19

Chronic airway and lung diseases such as chronic obstructive pulmonary disease (or COPD, such as emphysema), asthma, pulmonary fibrosis and interstitial lung disease can set the stage for a more severe infection with the new coronavirus because of scarring, inflammation or lung damage.

It’s very important for people with these conditions to work with their doctors and ensure they have adequate supplies of maintenance and rescue medications on hand.

Diabetes as a Risk Factor for COVID-19

People living with diabetes have an increased risk of getting very sick from the new coronavirus. Diabetes type 1 and type 2 both cause an increase in blood sugar. Poorly controlled blood sugar can make viral diseases, including COVID-19, more dangerous, possibly because higher blood sugar can create an environment where viruses are likely to thrive.

In addition, diabetes increases inflammation and weakens the immune system, making it harder for people living with the condition to fight off disease in general.

Those living with diabetes should adhere to their medication regimens and do everything possible to keep their blood sugar under control. Having an adequate supply of medications and staying in close touch with the doctor can add to peace of mind.

Coronavirus prevention guidelines apply to everyone

Whether or not they are in a high-risk category, everyone needs to take steps to protect themselves and others from catching or spreading COVID-19. Severe illness is occurring in people who have no known risk factors, including young adults and even children. Physical distancing, frequent, thorough handwashing and other guidelines such as wearing a cloth face covering if physical distancing isn’t possible are appropriate to help lower the risk for everyone, especially the most vulnerable.

2.

Objective To examine the protective effects of appropriate personal protective equipment for frontline healthcare professionals who provided care for patients with coronavirus disease 2019 (covid-19).

Design Cross sectional study.

Setting Four hospitals in Wuhan, China.

Participants 420 healthcare professionals (116 doctors and 304 nurses) who were deployed to Wuhan by two affiliated hospitals of Sun Yat-sen University and Nanfang Hospital of Southern Medical University for 6-8 weeks from 24 January to 7 April 2020. These study participants were provided with appropriate personal protective equipment to deliver healthcare to patients admitted to hospital with covid-19 and were involved in aerosol generating procedures. 77 healthcare professionals with no exposure history to covid-19 and 80 patients who had recovered from covid-19 were recruited to verify the accuracy of antibody testing.

Main outcome measures Covid-19 related symptoms (fever, cough, and dyspnoea) and evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, defined as a positive test for virus specific nucleic acids in nasopharyngeal swabs, or a positive test for IgM or IgG antibodies in the serum samples.

Results The average age of study participants was 35.8 years and 68.1% (286/420) were women. These study participants worked 4-6 hour shifts for an average of 5.4 days a week; they worked an average of 16.2 hours each week in intensive care units. All 420 study participants had direct contact with patients with covid-19 and performed at least one aerosol generating procedure. During the deployment period in Wuhan, none of the study participants reported covid-19 related symptoms. When the participants returned home, they all tested negative for SARS-CoV-2 specific nucleic acids and IgM or IgG antibodies (95% confidence interval 0.0 to 0.7%).

Conclusion Before a safe and effective vaccine becomes available, healthcare professionals remain susceptible to covid-19. Despite being at high risk of exposure, study participants were appropriately protected and did not contract infection or develop protective immunity against SARS-CoV-2. Healthcare systems must give priority to the procurement and distribution of personal protective equipment, and provide adequate training to healthcare professionals in its use.