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The Outbreak of Communicable Diseases: A Case Study of SARS-CoV-2


Task: Prepare a report on the critical review of literature on COVID-19(causedbySARS-CoV-2) which is one of the emerging communicable diseases threat. It should include role of agent, host and environmental factors, potential policy responses.


An Introduction to Epidemiology
If we consider the etymological roots of the word ‘epidemiology’, its association with the word epidemic becomes clear as daylight. When one talks about an epidemic, the conjuring up of the image of an acute outbreak of a communicable diseases seems evident both from a practical and an etymological perspective, but medical science denotes the term to a visible excess of infections seen over time in case of any disease (Webb, Bain& Page, 2017). For example, many developed countries have showed signs of being under an epidemic of lung cancer over the past few decades. If one looks at pattern of the outbreak of lung cancer over the years, it becomes apparent that there is a disparity among male and female patients observed with the same condition. It is seen that the cases in men grew sharply between the years 1950 and 1980, but are in decline for the past few decades, while those in women are observed to rise at a later point in the timeline and are only in decline in recent times (Webber, 2019). The disparity can be attributed to the fact that women, as a homogenised group, only took up smoking long after men had already started, driven by campaigns targeted particularly to them. If the medical community describes this ‘excess’ of infections as an epidemic situation, it is only due to optimally paying attention to the urgency of the outbreak that exponentially increasing numbers and figures demand. The word ‘epidemiology’ is derived from the conjunction of Greek epi, meaning upon, demos, meaning people, and logia, meaning study (Connolly, 2005). Therefore, epidemiology can be described as a study of whatever is ‘upon the people’ – as a discipline in itself, epidemiology asks questions like ‘what conditions are presently affecting the people?’ and ‘who, among the people, are getting ill’? (Hawker et al. 2018). The sudden outbreak of COVID-19 virus has reminded the medical community of the importance of epidemiology as a discipline, and this essay will try to address some of the situational and institutional conjecture that can be arrived at from analysing the data of the outbreak found from various corporate and governmental agencies.

COVID 19 – An Introduction
The outbreak of the COVID 19 virus has taken the modern technocratic world by surprise, and healthcare workers are falling short of providing adequate care for a brimming number of patients that are getting admitted to the hospital. According to a report published by the Naturemagazine, the spread of severe respiratory illness called coronavirus disease 2019 (clinically known as Sars-CoV-2) has become unmanageable for the health infrastructure of both developed and underdeveloped nations (Chen &Wherry, 2020). The outbreak of the disease has already assumed certain epidemiological criterion for it to be declared a pandemic by World Health Organization, and the graveness of the situation becomes clear from the statistics updated by national health institutions in their websites. By looking at the cumulative data received from these agencies, the impact of the pandemic on the global populace has become evidently clear, the outbreak having infected a significant portion of the demography of over 100 countries in a matter of weeks. What is needed to mitigate the effects of the virus, then, is a trans-national response plan that can prepare the national health systems for this unprecedented challenge. Countries that are unfortunate enough to be adversely affected by the SARS-CoV-2 virus has some valuable warnings for the rest (Livingstone & Butcher, 2020). While some countries such as China has implemented stringent containment measures, resulting in the reduction of new cases by 90 percent, for some others including Iran and Italy the containment measures have not directly led to the reduction of cases.

A Study in Epidemiology - The Case of Italy
If we consider the case of Italy in particular, the country has had 12462 confirmed cases of coronavirus 2 as of March 11, among which 827 cases have led to acute morbidity, according to InstitutoSuperiore di Sanita (Livingstone & Butcher, 2020). In the timeline concerned, only China has surpassed the mortality rate of Italy. The mean age of people who died in the outbreak of COVID-19 in Italy is 81 years – and studies have found that the majority of the patients who died of this outbreak have had some underlying health concerns. In cases where patients had cardiovascular problems, diabetes mellitus, cancer or smoking habits prior to the recognition of the disease, it is seen that these underlying causes increased the risk of morbidity to a greater degree. While it is true that these patients had prior illnesses that made their immune system more vulnerable to the attack of the coronavirus, it is also worth noticing that all of them had acute respiratory distress syndrome (ARDS), which was the resultant factor of pneumonia triggered by acute respiratory syndrome coronavirus 2 (Livingstone & Butcher, 2020). As a consequence, these patients, who would not have died from underlying co-morbidities, needed artificial respiratory support and even then, conceded defeat. If the data provided by the governmental agencies is tallied to find emergent patterns of morbidity, we shall know that among the patients who died of this outbreak, 42.2 percent were aged between 80 to 89 years, 32.4 percent were aged between 70 to 79 years, and 8.4 percent were aged between the years 60 to 69, while a mere 2.8 percent were of 50 to 59 years of age (Onder, Rezza&Brussaferro, 2020).

On 8th of March, 2020, the Italian government implemented stringent measures to prevent the spread and transmission of the virus. In the region of Lombardy, it had exclusively restricted movements, which ultimately intended to limit the transaction of the virus by those who were affected and not diagnosed yet, and minimise the likelihood of new infections (Onder, Rezza&Brussaferro, 2020). Notwithstanding the economic damage that this country faced, along with others, the decision of containment was indeed courageous, but not enough to restrict the movement of the virus. At present, the health system’s capacity to provide internal care units for those who suffered from acute respiratory distress from CoV-2 induced pneumonia remains minimal even in developed countries, and in developing countries, the situation is only graver. Between March 1 and March 11, the percentage of people getting admitted to intensive care units from the disease in Italy oscillated between 9 and 11 percent of the people actively infected (Onder, Rezza&Brussaferro, 2020). Most of the countries have imposed lockdown measures since the outbreak, but managed to only slow down, and not confine, the spread of the virus, with the exception of New Zealand and South Korea. Amidst the new normal that enforces policies like social distancing and the use of safeguarding equipment, it is vital to go back to the roots and locate the origin of the virus (WHO 2020).

Environmental and Host Factors
COVID-19 (known in virology as SARS-CoV-2, since its association to the family of SARS virus that caused the 2014 outbreak is apparent) was first detected in the Wuhan region of China, before it took the world by storm (Le et al, 2020). The pandemic, in question, is caused by a pathogen that is zoonotic in its nature (meaning transmitted to humans from animals), and an increasing number of such outbreaks in the recent times, including Avian Influenza and Ebola have found in its centre a zoonotic virus. The increasing number of virus getting transmitted to humans through animals, consumed or otherwise, is indicative of a degradation in ecological and environmental balance and city spaces encroaching upon indigenous and animal lands. The emergence of zoonotic viruses have indicated a thorough destabilization of the wildlife’s ecology in the Chinese anthropomorphic society – viruses that remained dormant in the pathology of such animals had finally found a way to a human body. Humankind is disturbing the environmental balance by ways of deforestation and consumption of animals.According to Chen &Wherry (2020), bats are most likely to be carriers of the SARS-CoV-2 virus. Among the early recorded cases, many were attributed to the workers who worked in the animal market of Wuhan, known to sell both dead and alive animals of consumption. However, the ability to switch hosts and cause interspecies infection indicates the characteristic diversity of these viruses. It is also speculated that there was a middle host between bats and humans, probably a pangolin. Pangolin is a rare animal breed and the inclusion of pangolins in the food chain, which may be dogmatised in the western society, has historical roots in the Specific case of Chinese society – the Great Chinese Famine forced the Chinese government to start marketing live or dead meat of the wildlife.However, this lead is not watertight, since the first known COVID affected was reported to not have any connection to the seafood market whatsoever while 27 of the early 41 cases reported to have come in contact with the seafood market (Chen &Wherry, 2020). In the United States, the first case saw the declaration of a quarantine period of 14 days to be observed by other foreigners who had come to the American soil from China, and it was an important step for the confinement of the outbreak, but unfortunately not adequate (Le et al, 2020). In due time, the pandemic spread from China to US, Japan, Italy, France, Germany, Vietnam and India – and ignorant carriers from Wuhan or other cities fuelled the spread of the virus – until a great many of developing and developed countries restricted international travel. Unprecedented global chaos was created in the form of the pandemic, which affected social, economic and political structures of the nations.

Importance of Healthcare Personnel
Healthcare workers have played a major role in mitigating the crisis at the front lines, providing optimum care for vulnerable patients. In the context of COVID-19 in particular, the health care professionals advance critical care to patients while also ensuring that infection limitation and control measures are strictly implemented in health care facilities to prevent infection and spread of the disease within the facilities themselves. As of April 8, 2020, a significant number of cases among health care workers have been reported to World Health Organization. According to the report, which cumulates data from 52 countries, the total number of health care personnel affected by this disease is 22073 (Carlos et al, 2020). However, due to the fact that there is no systematic way to consider how the disease has been affecting health care workers, one cannot omit the possibility that the data is under-represented, and varies from the actual number of healthcare workers affected by the pandemic situation globally. To this date, there remains a lack of study in this domain, since only a limited number of national reports and publications that provides the actual numbers of health care workers infections. To take an example, a research publication from China CDC acknowledges that as of 17th February 2020, the number of health care personnel infected from the disease is 3.8 percent (Surveillances, 2020). At the same time, a national situation reportage from 10th April 2020 shows that in Italy, the number of infections among health care professionals is tantamount to 15314 infections, which represents 11 percent of all coronavirus 2 cases in the given timeframe (Onder, Rezza&Brussaferro, 2020). Further researches in this domain have addressed the clinical and epidemiological characteristics of infections among healthcare professionals. These studies have found that majority of the infected health care professionals suffered from mild infection, and responded to treatment, but severe outcomes, including morbidities have also been reported.

Impact on Developing Countries – A Case Study
In developing countries, where health infrastructures were not prepared for a large-scale pandemic outbreak, the crisis has assumed violent proportions. The condition in Nigeria posits a perplexing situation in this context. The first confirmed case was recorded by the Nigerian Centre for Disease Control on 27th February 2020, and the carrier was an Italian citizen in Lagos who tested positive for the virus (Adegboye, Adekunle&Gayawan, 2020). The second victim was a person from Ogun who came in contact with the Italian. The chain reaction of the pandemic infection had already started, and as a consequence a mandatory confinement period of 3 months was imposed on the Nigerian populace. All socio-economic operations and business activities were brought to a halt. The closing of local marketplaces, all public and private firms as well as the national border and transportation networks inflicted a significant blow to over 200 million Nigerians whose lives were literally brought toa halt in the process. The most vulnerable in the national demography were the young populace, amounting to 13 million (Nkengasong&Mankoula, 2020). For this population, added to the 90 million that live on 2 dollars a day on average, the consequences of the pandemic was dire, as they were unable to support their families. The country had also seen acute outbreaks of Ebola in 2014 and Lassa in the year 2019, but the impact of the COVID-19 outbreak in the country assumed unprecedented proportions (Reuben et al, 2020). The outbreak of the virus only worked to worsen the critical economic condition of the country, accelerating the violence inflicted upon public by the deprived youths (Nkengasong&Mankoula, 2020).

Policy Responses to Mitigate the Virus Threat – A Case Study
Legal frameworks guide administrators, public policy makers as well as healthcare personnel to manage the spread of a communicative disease such as COVID 19 across a country (Nelson & Williams, 2014). In this context, the Infectious Diseases (Prevention, Control and Eradication) Act of Bangladesh holds special importance. The act in question was passed by the Bangladesh parliament and came into force on 14 November 2018 (Truelove et al, 2020). The act is structured in a way that raises awareness of, controls, prevents and eradicates the threat posited by communicable diseases in order to address public health hazards and reduce the risk of community infection. Bangladesh is a country that has problems of population, inadequate infrastructure, pervasive poverty, bare minimum sanitation, environmental disasters and overcrowded public health care systems. Bangladesh has been subjected to the dengue outbreak since 2000, a condition that has yet not been contained. In the year 2019 alone, an estimate of 100,000 patients were admitted to various hospitals from dengue fever, and the death toll estimate is 164 (Shammi, Bodrud-Doza, Islam &Rehman, 2020). The absence of a comprehensive awareness programme and a clinical management framework that can support the pressure of a severe outbreak has increased the effect of dengue fever epidemic, resulting often in high mortality rate.

The already underfunded public health care system has been strained by these conditions, in the middle of which, the COVID-19 pandemic has further exacerbated the crisis. The outbreak of the novel coronavirus was first reported in Bangladesh on 8 March 2020, and the High Court took prompt action by urging the government to take note of the situation (Truelove et al, 2020). The Ministry of Health and Family Welfare issued an official gazette where it listed COVID-19 as an infectious disease and a national public health emergency. The gazette is said to be empowering the government in taking action against people who do not follow government issued health regulations, which results in better monitoring of the spread of the contagious acute respiratory condition. This act has provisions to implement strict regulatory measures in case of outbreak of such crisis. For instance, section 16 of the act connotes that in case a premise is found to be infected, access to the premise by the public is prohibited until thorough disinfection of the place. If disinfection remains impossible under particular circumstances, the act directs the owner of the premise to destroy it (Shammi, Bodrud-Doza, Islam &Rehman, 2020). If it appears to the District General that the contagious area is not adequately disinfected, public entry to that particular area may be prohibited, controlled and restricted. With the application of these legal frameworks by cooperation or coercion, the state can mitigate the threat of a public health emergency such as COVID-19 to a great degree.

Search for a Vaccine
The cases, first thought of as pneumonia cases ofaetiology that remained hidden in the early months, were linked to the SARS and MERS outbreaks in the past decades (Le et al, 2020). The World Health Organization declared the virus outbreak as a pandemic on March 11, 2019. 41,269,142 confirmed cases of severe acute respiratory syndrome coronavirus 2 have been found till date, among which 30,771,153 cases had positive outcomes. The causative agent of the ongoing pandemic is said to belong to the Betacoronavirus genus of the family of coronaviridae (Shin et al, 2020). Even if the virus is thought to have descended from bats, the family of the viruses are common human pathogens that cause seasonal colds (Shin et al, 2020). The genomic sequence of the virus resembles SARS virus that affected the Chinese populace in 2003 (Magnus, 2006). The current virus, along with Severe Acute Respiratory Syndrome virus and Middle East respiratory syndrome virus, constitute the three most life-threatening variants of all recorded human coronaviruses. The virus has a single-stranded and linear RNA genome, which encodes four structural proteins, sixteen non-structural proteins and a few accessory proteins (Shin et al, 2020). Since the global impact of the virus as a human pathogen is unprecedented in history, it is a clarion call for healthcare professionals across nations to come up with a vaccine that can prevent the ongoing pandemic and mitigate further outbreaks (Thomas, Thomas & Weber, 2001).

There are several stages which the vaccine development procedure must go through before a vaccine gets approved for commercial dealing, and these are as follows: exploratory stage, pre-clinical stage, clinical developmental stage, regulatory approval, manufacturing and quality control (Heymann, 2008). In the exploratory stage, antiviral drugs are tested for a given pathogen to see how the subject reacts to the treatment. In the preclinical stage, scientists test a new vaccine on animals to see if they develop an immune response. As of present time, 92 validated preclinical vaccines remain in development. During phase I of a clinical trial, a trial vaccine is given to a small group of healthy participants to see if they affect their immune systems in a positive manner. This phase is the safeguarding phase, where researchers conduct a safety study of the vaccine. Researchers have found that the N protein or the Nucleocapsid protein is found in abundance in the COVID-19 virus and therefore is a suitable protein for making antigens (Shin et al, 2020). Research institutions have also started working on inactivated or live attenuated whole-cell vaccines that include multiple antigenic components. However, due to genome size, the process of generation of infected clones take a long amount of time. Protein vaccines, on the other hand, such as the N protein vaccine involve injecting coronavirus proteins directly into the body to create an immunopathology. However, they posit a question about efficiency, since global production capacity may be limited in case of protein vaccines (Le et al, 2020). Ongoing studies and researches also include Nucleic acid vaccines, which are typically immunogenic.

The global pandemic situation of twenty-first century is different from the outbreak of plagues in medieval times, due to the fact that medical science has made considerable progresses in the last century (Noah, 2006). Moreover, information and data science has become more sophisticated and due to that, magnanimous amounts of patient data can be processed within a few minutes. The processing of large amounts of data is instrumental in the trial stages of developing a vaccine for coronavirus 2, and saying that a vaccine can be prepared in a matter of years is no easy feat even in the twenty-first century. The current study concludes that the outbreak of the virus has not been contained successfully yet, but the world is trying its best to cope with the impact of the outbreak of such a disease.

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