Question

Explain how the global health issue affecting the international health communities is the current coronavirus disease 2019 (COVID-19) pandemic?

Answer 1

Greetings of the day!

Answer:

current coronavirus disease 2019 (COVID-19) pandemic: global health issue affecting the international health communities.

On December 31, 2019, the Chinese government announced an outbreak of a novel coronavirus, recently named COVID‐19. During the following weeks the international medical community has witnessed with unprecedented coverage the public health response both domestically by the Chinese government, and on an international scale as cases have spread to dozens of countries. While much regarding the virus and the Chinese public health response is still unknown, national and public health institutions globally are preparing for a pandemic. As cases and spread of the virus grow, emergency and other front‐line providers may become more anxious about the possibility of encountering a potential case. This review describes the tenets of a public health response to an infectious outbreak by using recent historical examples and also by characterizing what is known about the ongoing response to the COVID‐19 outbreak. The intent of the review is to empower the practitioner to monitor and evaluate the local, national and global public health response to an emerging infectious disease.

PAST PANDEMICS AND THEIR IMPACT

Looking back: a review of SARS‐2003

To better understand the current novel coronavirus outbreak as well as the robust Chinese public health response, it is useful to examine the initial local and national reactions to the 2003 Severe Acute Respiratory Syndrome (SARS) coronavirus outbreak. The apparent index case starting the SARS epidemic was reported in Guangdong Province, a coastal province in South China, in November 2002. After a local government official became ill, then succumbed to the infection, several other cases were reported in surrounding cities.4

In mid‐December 2002, local health authorities took notice, followed by rapid notification of the provincial government and the national Ministry of Health by January 2003. Initial investigative reports of the outbreak were marked “top secret” and could only be opened by high‐ranking officials. No public notifications had been made at this point and no mention was made of the outbreak in the news media until at least February 2003. This “fatal period of hesitation” led to wide‐spread speculation and fear among the local population and rumors of a “deadly flu” began to spread, undermining public trust in the government's response. Even following initial news conferences describing the outbreak, government officials continued to minimize the risks of the outbreak. Not until April 2003 did the Chinese Center for Disease Control and Prevention (CDC) issue a nationwide bulletin on preventing spread of the illness, by which time outbreaks had already occurred in Hong Kong, Vietnam, Singapore, and Toronto, Canada, among others.

Once mobilized, the Chinese public health machine was able to quickly control and ultimately eliminate the outbreak within a year.5 It remains unclear how much damage could have been avoided had the Chinese government been able and willing to communicate accurate outbreak data in a transparent and timely manner. One of the most striking features of the current COVID‐19 outbreak are the reports of detainment of journalists, threats to whistleblowers, punishment of government officials, and deletion of social media posts in apparent efforts to control the image of the outbreak. This has contributed to a widespread distrust of the communications by the Chinese government and public health officials reminiscent of the SARS epidemic.

THE INITIAL COVID‐19 PUBLIC HEALTH RESPONSE

On January 30, 2020 the World Health Organization (WHO) took the “last resort” step of declaring a PHEIC, only the 6th time the WHO has been galvanized to take such an action. The announcement came amid reports of evacuation, lockdown, quarantine, travel restrictions and international border closures. The COVID‐19 has demonstrated the challenges and successes when applying these public health principles to an ongoing crisis.

Challenges in the COVID‐19 public health response

Shortcomings often emerge in the first few weeks of an outbreak and have emerged in COVID‐19 pandemic. Incomplete or poorly communicated preliminary data may hamper the national and international response. For example, the relatively low CFR rate (∼2% compared to >60% in Ebola Virus cases, >30% in MERS‐CoV cases, and >9% in SARS‐CoV cases) raises concerns for subclinical and unreported infections. This restricts public health officials’ ability to determine whether this ongoing Chinese epidemic (widespread disease transmission within a nation) has yet made the jump to a pandemic (widespread disease transmission occurring in multiple nations). Similarly, the competence of the Chinese CDC in identifying the outbreak and implementing rapid control measures is threatened by reports of “narrative controlling” preventing effective communication between frontline practitioners and the global outbreak response. In an outbreak that seems to change hourly, a delay of days or weeks diminishes the responders’ ability to truly assess the impact, transmissibility, extent of spread, and virulence of the disease. As such, much of the characterizations of COVID‐19 should be understood as preliminary and subject to change as data becomes more readily available.

These persistent knowledge gaps regarding the outbreak remain concerning. The European Center for Disease Prevention and Control (ECDC) rapid risk assessment publication on January 22, 2020 points out that “in the absence of detailed information from the ongoing outbreak investigations in China, it is not possible to quantify the extent of human‐to‐human transmission.” A similar concern exists regarding the Chinese algorithm for testing, case definitions, means of identifying PUIs, or surveillance of contacts.Without this information it remains difficult for NPHIs to determine specific risk of transmission, quantify virulence, or estimate CFR with any certainty. Some of the more extreme policies enacted by individual governments may stem from this deficit in effective communication and transparency.

In addition to a lack of transparency, some experts have also called into question the specific measures employed by the Chinese government. A recent review of the efficacy of travel checkpoint temperature screening during the Ebola Virus and SARS outbreaks revealed that no cases were identified by these measures.The complete lockdown of the city of Wuhan is an unprecedented intervention, and its efficacy will be of great interest to the public health community.

Successes in the COVID‐19 public health response

There are some improvements in the Chinese response to the crisis as compared to prior public health events. In contrast to the decisions made by Chinese health authorities and government officials during the 2003 SARS outbreak, the existence of the initial patient cluster was rapidly reported to the WHO China Office in December 2019, with a novel coronavirus being identified by early January 2020. The speed of cluster identification and pathogen isolation is likely due to additional investment in public health resources and infrastructure by China's CDC.8 The Chinese government has demonstrated commitment to controlling spread of the virus, including closure of the seafood market in Wuhan, cessation of public transport, screening at travel checkpoints, travel restrictions, closure of cultural landmarks and businesses, and cancellation of the Lunar New Year celebrations. Media sources and inhabitants of Wuhan have described the situation as “complete lockdown” in a city of >11 million people, representing an “unprecedented public health intervention.”

GLOBAL HEALTH ISSUE

The WHO was notified of numerous cases of pneumonia on 31st December 2019, specifically in Wuhan, Hubei Province of China . After preliminary investigation, the virus did not match any existing viruses, and this heightened concerns among scientists because the route of transmission was not known since it is a new virus . On 7th January, approximately a week later, the Chinese government confirmed they had identified the new virus, and it is a coronavirus which belongs to the group of viruses that include the common cold, and viruses such as SARS and MERS . With the evolving nature of this current pandemic, and the frequent changes in statistics and figures, as at 29th March 2020, there have been 697,994 confirmed cases of COVID-19 from 202 countries and territories and one conveyance ship, and 33,421 deaths recorded, with majority of the world’s population on lockdown to avert the further spread of the infection .

Explicitly, the Western Pacific Region (Nineteen countries and territories affected) has a total number of 104,146 confirmed cases, with 3,660 deaths; the European Region (Sixty countries and territories affected) has a total number of 397,719 confirmed cases, with 24,246 deaths, the South-East Asia Region (Ten countries affected) has a total number of 4,333 confirmed cases, with 164 deaths, the Eastern Mediterranean Region (Twenty-one countries and territories affected) has total number of 46,623 confirmed cases, with 2,828 deaths, the Region of the Americas (Fifty-one countries and territories affected) has a total number of 141,282 confirmed cases, with 2,461 deaths, the African Region (Forty-one countries and territories affected) has a total number of 3,179 confirmed cases, with 55 deaths, while the Conveyance Diamond Princess ship has a total number of 712 confirmed cases, with 7 deaths . Presently, the European Region with Sixty countries and territories affected with a total number of 397,719 confirmed cases and 24,246 deaths have now overtaken the Western Pacific Region which included China as the current epicenter of the current COVID-19 pandemic . The African region with Forty-one countries and territories affected has the lowest number of confirmed cases and deaths with 3,179 and 55 respectively. However, massive sensitization and heightened preventive measures which includes rigorous contact tracing and wider testing should be intensified so as to prevent against explosive community transmission and mortalities of COVID-19 due to the weak health care system in the African continent . Initially, the majority of confirmed cases of COVID-19 has been in China where the outbreak started, however, massive COVID-19 cases and mortalities have occurred in other countries as well, for instance in the United States of America, Italy, Iran, France, Britain, France and Spain . The exact number of individuals who have contracted the virus could be far higher as people with mild symptoms are not been detected due to shortages in test kits, especially in developing countries.

CONCLUSION

As hospital systems and emergency departments monitor and prepare for the COVID‐19 outbreak, there are still many unanswered questions. The situation is dynamic with cases identified nearly hourly. The stakes are high, as the CFR and morbidity of the virus appears to be higher than influenza. The extent of media coverage regarding this outbreak means that the management of any cases identified outside of China will be heavily scrutinized both regarding disease‐related outcomes and the adherence to public health guidelines for protection of the larger population. It is imperative that providers are familiar with the public health considerations of encountering a person under investigation or confirmed case. To this end, providers should take care to consume accurate and timely information to inform their respective institution's triage and treatment practices. For links to updated guidelines please see Appendix A. While progression to a pandemic may not be inevitable, emergency and other front‐line medical providers have an obligation to stand in readiness.