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| | <div class="nonumtoc">__TOC__</div> |
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| | | text = This is sublevel32 of my sandbox, where I play with features and test MediaWiki code. If you wish to leave a comment for me, please see [[User_talk:Shawndouglas|my discussion page]] instead.<p></p> |
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| | | ==Sandbox begins below== |
| ==1. Overview of COVID-19 and its challenges== | |
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| ===1.1 COVID-19: The terminology===
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| A pneumonia-like outbreak was fully in process in Wuhan, located in the Hubei province of China, by December 2019. The [[World Health Organization]] (WHO) was notified by the end of the month that the cause could be a novel threat to the larger populace.<ref name="HuiTheCont20">{{cite journal |title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—The latest 2019 novel coronavirus outbreak in Wuhan, China |journal=International Journal of Infectious Diseases |author=Hui, D.S.; Azhar, E.I.; Madani, T.A. et al. |volume=91 |pages=264–66 |year=2020 |doi=10.1016/j.ijid.2020.01.009 |pmid=31953166}}</ref> By the end of January, the WHO had declared the growing viral threat a Public Health Emergency of International Concern (PHEIC), an act which includes with it a need "to implement a comprehensive risk communication strategy."<ref name="WHOStatement20">{{cite web |url=https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) |title=Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) |author=World Health Organization |publisher=World Health Organization |date=30 January 2020 |accessdate=31 March 2020}}</ref> As the disease progressed beyond its Chinese origins, public confusion slowly grew regarding the terminology surrounding the disease. Leaders at the WHO and the Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses came to different naming conclusions, differing in their naming conventions and adding to the confusion.<ref name="EnserinkUpdate20">{{cite web |url=https://www.sciencemag.org/news/2020/02/bit-chaotic-christening-new-coronavirus-and-its-disease-name-create-confusion |title=Update: ‘A bit chaotic.’ Christening of new coronavirus and its disease name create confusion |author=Enserink, M. |work=Science |date=12 February 2020 |accessdate=30 March 2020}}</ref><ref name="JiangADistinct20">{{cite journal |title=A distinct name is needed for the new coronavirus |journal=The Lancet |author=Jiang, S.; Shi, Z.; Shu, Y. et al. |volume=395 |issue=10228 |page=949 |year=2020 |doi=10.1016/S0140-6736(20)30419-0 |pmid=32087125}}</ref> In the end, "COVID-19" has ended up as the common disease name, caused by the [[SARS-CoV-2]] virus, which is a member of the [[coronavirus]] family. Today, however, some still refer to the disease simply as "coronavirus," which is in errror.
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| This isn't the first time a disease has had a different name from its associated virus. One should look back to 1982, when the U.S. [[Centers for Disease Control and Prevention]] (CDC) gave the name "acquired immune deficiency syndrome" or "AIDS" to the disease associated with the human immunodeficiency virus (HIV) (a member of the retrovirus family).<ref name="OppenheimerCauses92">{{cite book |url=https://books.google.com/books?id=CmME6xfdEFAC&pg=PA49 |chapter=Chapter 2: Causes, Cases, and Cohorts: The Role of Epidemiology in the Historical Construction of AIDS |title=AIDS: The Making of a Chronic Disease |author=Oppenheimer, G.M. |editor=Fee, E.; Fox, D.M. |publisher=University of California Press |pages=49–83 |year=1992 |isbn=0520077784 |accessdate=31 March 2020}}</ref> It took time for the layman to get used to the terminology, and even then some still ended up mistakenly refering to the disease as "HIV."
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| Consistent terminology is vital to communicating technical material to a global audience.<ref name="KohlTheGlobal">{{cite book |title=The Global English Style Guide: Writing Clear, Trnaslatable Documentation for a Global Market |author=Kohl, J.R. |publisher=SAS Institute |year=2008 |isbn=9781599946573}}</ref><ref name="MagathlinControl91">{{cite journal |title=Controlling the Unruly: Terminology |journal=1991 Proceedings 38th International Technical Communication Conference |author=Megathlin, B.A.; Langford, R.S. |page=WE22–WE24 |year=1991}}</ref> With that in mind, it's beneficial to ensure everyone is clear one the terms used. For purposes of this guide:
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| * '''Coronavirus disease 2019''' (otherwise known as '''COVID-19''') is the respiratory disease being discussed in this guide.
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| * '''SARS-CoV-2''' is the virus responsible for COVID-19.
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| * '''Coronavirus''' (or ''Coronaviridae'') is a family of related viruses, of which SARS-CoV-2 is a member.
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| * '''Severe acute respiratory syndrome''' (otherwise known as '''SARS''') is a different respiratory disease, which surfaced in the early 2000s, caused by a related but different type of coronavirus (SARS-CoV or SARS-CoV-1).
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| * '''Middle East respiratory syndrome''' (otherwise known as '''MERS''') is a different respiratory disease, which surfaced in 2012, caused by a related but different type of coronavirus (MERS-CoV).
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| ===1.2 COVID-19: History and impact (so far)===
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| The first known case of COVID-19 dates back to November 2019, "according to government data seen by the ''South China Morning Post''."<ref name="MaCorona20">{{cite web |url=https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back |title=Coronavirus: China’s first confirmed Covid-19 case traced back to November 17 |author=Ma, J. |work=South China Morning Post |date=13 March 2020 |accessdate=31 March 2020}}</ref> By the middle of December, infections were at 27, and by the end of the year the number was 266.<ref name="MaCorona20" /> By that time, Chinease health authorities had been updated that the pneumonia-like symptoms of patients in China's Hubei province may have been the symptoms of a disease caused by a novel (new) coronavirus<ref name="MaCorona20" />, and the WHO was notified.<ref name="HuiTheCont20" /> At the start of 2020, that number grew to 381 known cases<ref name="MaCorona20" />, jumping to more than 7,700 confirmed and 12,000 suspected cased by the end of January.<ref name="WHOStatement20" /> By that time, the WHO had convened a second meeting of its Emergency Committee to discuss the declaration of a PHEIC, saying the then-called "2019-nCoV" constituted a health emergency of international concern.<ref name="WHOStatement20" /> This spurred the publishing of WHO technical advice to other countries, with a focus on "reducing human infection, prevention of secondary transmission and international spread, and contributing to the international response."<ref name="WHOStatement20" /> However, at the same time, the virus was already beginning to spread in locations such as Australia<ref name="HuntFirst20">{{cite web |url=https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/first-confirmed-case-of-novel-coronavirus-in-australia |title=First confirmed case of novel coronavirus in Australia |author=Hunt, G. |publisher=Australian Department of Health |date=25 January 2020 |accessdate=31 March 2020}}</ref>, France<ref name="JacobCorona20">{{cite web |url=https://www.lefigaro.fr/sciences/coronavirus-trois-premiers-cas-confirmes-en-france-20200124 |title=Coronavirus: trois premiers cas confirmés en France, deux d’entre eux vont bien |author=Jacob, E. |work=Le Figaro |date=24 January 2020 |accessdate=31 March 2020}}</ref>, Germany<ref name="SPIEGELBayer20">{{cite web |url=https://www.spiegel.de/wissenschaft/medizin/corona-virus-erster-fall-in-deutschland-bestaetigt-a-19843b8d-8694-451f-baf7-0189d3356f99 |title=Bayerische Behörden bestätigen ersten Fall in Deutschland |author=Der Spiegel |date=28 January 2020 |accessdate=31 March 2020}}</ref> Italy<ref name="SevergniniCorona20">{{cite web |url=https://www.corriere.it/cronache/20_gennaio_30/coronavirus-italia-corona-9d6dc436-4343-11ea-bdc8-faf1f56f19b7.shtml |title=Coronavirus, primi due casi in Italia «Sono due cinesi in vacanza a Roma» Sono arrivati a Milano il 23 gennaio |author=Severgnini, C. |work=Corriere della Sera |date=30 January 2020 |accessdate=31 March 2020}}</ref>, Japan<ref name="SimJapan20">{{cite web |url=https://www.straitstimes.com/asia/east-asia/japan-confirms-first-case-of-infection-with-new-china-coronavirus |title=Japan confirms first case of infection from Wuhan coronavirus; Vietnam quarantines two tourists |author=Sim, W. |work=The Straits Times |date=16 January 2020 |accessdate=31 March 2020}}</ref>, South Korea<ref name="Jin-wooConfirmation20">{{cite web |url=https://www.mk.co.kr/news/society/view/2020/01/80017/ |title=신종 코로나바이러스 한국인 첫환자 확인 |author=Jin-woo, S. |work=Maekyung.com |date=24 January 2020 |accessdate=31 March 2020}}</ref>, Spain<ref name="LindeSanidad20">{{cite web |url=https://elpais.com/sociedad/2020/01/31/actualidad/1580509404_469734.html |title=Sanidad confirma en La Gomera el primer caso de coronavirus en España |author=Linde, P. |work=El País |date=31 January 2020 |accessdate=31 March 2020}}</ref>, the United Kingdom<ref name="BallHunt20">{{cite web |url=https://www.thetimes.co.uk/article/hunt-for-contacts-of-coronavirus-stricken-pair-in-york-dh363qf8k |title=Hunt for contacts of coronavirus-stricken pair in York |author=Ball, T.; Wace, C. |work=The Times |date=31 January 2020 |accessdate=31 March 2020}}</ref>, and the United States.<ref name="HolshueFirst20">{{cite journal |title=First Case of 2019 Novel Coronavirus in the United States |journal=New England Journal of Medicine |author=Holshue, M.L.; DeBolt, C.; Lindquist, S. et al. |volume=382 |issue=10 |pages=929–36 |year=2020 |doi=10.1056/NEJMoa2001191 |pmid=32004427}}</ref>
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| As the disease continued to spread in February, naming conventions came together, with the WHO declaring the disease's name "COVID-19," short for "coronavirus disease 2019."<ref name="EnserinkUpdate20" /><ref name="JiangADistinct20" /> By the end of the month, the WHO warned a "very high" likelihood the virus's spread could turn into a full [[pandemic]].<ref name="MulierWHO20">{{cite web |url=https://www.bloomberg.com/news/articles/2020-02-28/who-raises-global-risk-for-coronavirus-to-very-high-from-high |title=WHO Raises Global Risk for Coronavirus to Very High |author=Mulier, T. |work=Bloomberg |date=28 February 2020 |accessdate=31 March 2020}}</ref>
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| On March 11, 2020, the WHO declared the outbreak of SARS-CoV-2 a pandemic, noting more than 118,000 confirmed cases and 4,000 deaths on all continents except Antarctica.<ref name="GumbrechtWho20">{{cite web |url=https://www.cnn.com/2020/03/11/health/coronavirus-pandemic-world-health-organization/index.html |title=WHO declares novel coronavirus outbreak a pandemic |author=Gumbrecht, J.; Howard, J. |work=CNN Health |date=11 March 2020 |accessdate=31 March 2020}}</ref>
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| TO BE CONTINUED...
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| ===1.3 Challenges of managing the disease in the human population===
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| COVID-19 has presented numerous societal challenges, from supply line interruptions and economic sagging to overwhelmed healthcare systems and civil disorder. However, these are largely the social, economic, and political ripple effects of a disease that has brought with it a set of inherent attributes that make it more difficult to manage in human populations than say the flu.
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| However, COVID-19 is not the flu, and it is indeed worse in its effects than the flu, contrary to many people's perceptions. Yes, COVID-19 and the flu have some symptom overlap. Yes, COVID-19 and the flu have some transmission type overlap. But from there it diverges. COVID-19 is different in that is more prone to be transmitted to others during the presymptomatic phase. The disease may also be transmittable in other ways, such as an airborne route, though research is ongoing. Hospitalization rates are higher, perhaps up to 10 times higher than the flu, and hospital stays are longer with COVID-19. People are dying more often from COVID-19 too, up to 10 times more often than people stricken with the flu. And of course, whereas people have been acquiring the flu vaccine yearly, limiting the percentage of the population that becomes ill, there is yet no vaccine for COVID-19, meaning everyone is susceptible.<ref name="HuangHow20">{{cite web |url=https://www.npr.org/sections/goatsandsoda/2020/03/20/815408287/how-the-novel-coronavirus-and-the-flu-are-alike-and-different |title=How The Novel Coronavirus And The Flu Are Alike ... And Different |author=Huang, P. |work=NPR: Goats and Soda |date=20 March 2020 |accessdate=01 April 2020}}</ref><ref name="ResnickWhy20">{{cite web |url=https://www.vox.com/science-and-health/2020/3/18/21184992/coronavirus-covid-19-flu-comparison-chart |title=Why Covid-19 is worse than the flu, in one chart |author=Resnick, B.; Animashaun, C. |work=Vox |date=18 March 2020 |accessdate=01 April 2020}}</ref><ref name="KumarCOVID20">{{cite web |url=https://abcnews.go.com/Health/covid-19-compared-flu-experts-wrong/story?id=69779116 |title=COVID-19 has been compared to the flu. Experts say that's wrong |author=Kumar, V. |work=ABC News |date=27 March 2020 |accessdate=01 April 2020}}</ref>
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| Other aspects of the disease that make this difficult to manage include:
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| * ''Median incubation period'': According to research published in ''Annals of Internal Medicine'', the median (i.e., the central tendancy, which is less skewed than average<ref name="NRCSMedian">{{cite web |url=https://www.wcc.nrcs.usda.gov/normals/median_average.htm |title=Median vs. Average to Describe Normal |author=National Water and Climate Center |publisher=U.S. Department of Agriculture |accessdate=01 April 2020}}</ref>) incubation period is 5.1 days, with 97.5% of symtomatic carriers showing symptoms within 11.5 days. The authors found this to be compatible with U.S. government recommendations of monitored 14-day self-quarantines if individiuals were at risk of exposure.<ref name="LauerTheInc20">{{cite journal |title=The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application |journal=Annals of Internal Medicine |author=Lauer, S.A.; Grantz, K.H.; Bi, Q. et al. |year=2020 |doi=10.7326/M20-0504 |pmid=32150748 |pmc=PMC7081172}}</ref> However, many people continue to not take self-quarantines and other forms of social distancing seriously<ref name="PinskerWhatDo20">{{cite web |url=https://www.theatlantic.com/family/archive/2020/03/convince-family-take-coronavirus-seriously/608356/ |title=What Do You Tell Someone Who Still Won’t Stay Home? |author=Pinsker, J. |work=The Atlantic |date=19 March 2020 |accessdate=01 April 2020}}</ref><ref name="KeatingWhenThe20">{{cite web |url=https://www.buzzfeednews.com/article/shannonkeating/coronavirus-social-distancing-self-isolation-quarantine |title=When The People You Love Can’t Accept That They Need To Stay Home |author=Keating, S. |work=BuzzFeed News |date=17 March 2020 |accessdate=01 April 2020}}</ref><ref name="JacksonPolice20">{{cite web |url=https://www.cnn.com/2020/03/31/us/violating-coronavirus-orders-trnd/index.html |title=Police are arresting and fining people for violating social distancing orders |author=Jackson, A. |work=CNN |date=31 March 2020 |accessdate=01 April 2020}}</ref><ref name="WFLA8Hawaii20">{{cite web |url=https://www.wfla.com/community/health/coronavirus/hawaii-police-arrest-visiting-tampa-man-for-violating-14-day-quarantine/ |title=Hawaii police arrest visiting Tampa man for violating 14-day quarantine order |author=WFLA 8 On Your Side Staff |work=WFLA News Channel 8 |date=31 March 2020 |accessdate=01 April 2020}}</ref>, and presymtomatic (and asymptomatic) carriers are thus more prone to spreading the virus.<ref name="MandavilliInfected20">{{cite web |url=https://www.nytimes.com/2020/03/31/health/coronavirus-asymptomatic-transmission.html |title=Infected but Feeling Fine: The Unwitting Coronavirus Spreaders |author=Mandavilli, A. |work=The New York Times |date=31 March 2020 |accessdate=01 April 2020}}</ref><ref name="MockAsymptom20">{{cite web |url=https://www.discovermagazine.com/health/asymptomatic-carriers-are-fueling-the-covid-19-pandemic-heres-why-you-dont |title=Asymptomatic Carriers Are Fueling the COVID-19 Pandemic. Here’s Why You Don’t Have to Feel Sick to Spread the Disease |author=Mock, J. |work=Discover |date=26 March 2020 |accessdate=01 April 2020}}</ref>
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| * ''Presymptomatic and asymptomatic virus shedding'': As mentioned in the previous point, carriers can be contagious during the presymptomatic phase of the disease, and even while remaining symptom-free.<ref name="MandavilliInfected20" /><ref name="MockAsymptom20" /><ref name="YuenSARS20">{{cite journal |title=SARS-CoV-2 and COVID-19: The most important research questions |journal=Cell & Bioscience |author=Yuen, K.-S.; Fung, S.-Y.; Chan, C.-P.; Jin, D.-Y. |volume=10 |at=40 |year=2020 |doi=10.1186/s13578-020-00404-4 |pmid=32190290 |pmc=PMC7074995}}</ref><ref name="DiamondAsympt20">{{cite web |url=https://www.infectioncontroltoday.com/covid-19/asymptomatic-carriers-covid-19-make-it-tough-target |title=Asymptomatic Carriers of COVID-19 Make It Tough to Target |author=Diamond, F. |work=Infection Control Today |date=17 March 2020 |accessdate=01 April 2020}}</ref> This contagion is a result of what's called [[viral shedding]], when the virus moves from cell to cell following successful reproduction. When the virus is in this state, it can be actively found in a carrier's body fluids, excrement, and other sources. Depending on the virus, the virus can then be introduced to another person via those sources. In the case of COVID-19, the route of transmission is still being studied<ref name="JordanEnviron20">{{cite web |url=https://news.stanford.edu/2020/03/26/understanding-spread-covid-19/ |title=Environmental engineers at Stanford discuss how to identify factors affecting COVID-19 transmission |author=Jordan, R. |work=Stanford News |date=26 March 2020 |accessdate=01 April 2020}}</ref><ref name="GreenfieldboyceWHO20">{{cite web |url=https://www.npr.org/2020/03/28/823292062/who-reviews-available-evidence-on-coronavirus-transmission-through-air |title=WHO Reviews 'Current' Evidence On Coronavirus Transmission Through Air |author=Greenfieldboyce, N. |work=NPR |date=28 March 2020 |accessdate=01 April 2020}}</ref>, though water droplets (from sneezes, cough, talking, etc.) and potentially even aerosolized water droplets (water droplets from the body that have become fine spray or suspension in the air).<ref name="GreenfieldboyceWHO20" /> This initial uncertainty of transmission routes, along with mixed messages about masks and their effectiveness for COVID-19<ref name="GreenfieldboyceWHO20" /><ref name="CSTEditorialIgnore31">{{cite web |url=https://chicago.suntimes.com/2020/3/31/21200144/coronavirus-covid-19-masks-wear-cdc-pritzker-trump-public-health-virus-face-cough-sneeze |title=https://chicago.suntimes.com/2020/3/31/21200144/coronavirus-covid-19-masks-wear-cdc-pritzker-trump-public-health-virus-face-cough-sneeze |title=Ignore the mixed messages and wear that mask |author=Chicago Sun Times Editorial Board |work=Chicago Sun Times |date=31 March 2020 |accessdate=01 April 2020}}</ref><ref name="MulhollandToMask20">{{cite web |url=http://www.rfi.fr/en/international/20200329-to-mask-or-not-to-mask-mixed-messages-in-a-time-of-coronavirus-crisis-france-covid-19-spread-droplets |title=To mask or not to mask: mixed messages in a time of crisis |author=Mulholland, J. |work=RFI |date=29 March 2020 |accessdate=01 April 2020}}</ref>, makes social distancing an even stronger necessity to limit community transmission of the disease.
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| * ''Understanding of high viral loads and infectious doses'': Respiratory diseases such as influenza, SARS, and MERS see a correlation between the infectious dose amount and the severity of disease symptoms, meaining the higher the infectious dose, the worse the symptoms.<ref name="GeddesDoesA20">{{cite web |url=https://www.newscientist.com/article/2238819-does-a-high-viral-load-or-infectious-dose-make-covid-19-worse/ |title=Does a high viral load or infectious dose make covid-19 worse? |author=Geddes, L. |work=New Scientist |date=27 March 2020 |accessdate=01 April 2020}}</ref> Similarly, viral load—a quantification of viral genomic fragments—also tends to correlate with clinical symptoms.<ref name="HijanoClinical19">{{cite journal |title=Clinical correlation of influenza and respiratory syncytial virus load measured by digital PCR |journal=PLoS One |author=Hijano, D.R.; Brazelton de Cardenas, J.; Maron, G. et al. |volume=14 |issue=9 |at=e0220908 |year=2019 |doi=10.1371/journal.pone.0220908 |pmid=31479459 |pmc=PMC6720028}}</ref> However, we are still in the investigative stages of determining if that similarly holds true to COVID-19.<ref name="GeddesDoesA20" /><ref name="LiuViral20">{{cite journal |title=Viral dynamics in mild and severe cases of COVID-19 |journal=The Lancet Infectious Diseases |author=Liu, Y.; Yan, L.-M.; Wan, L. et al. |year=2020 |doi=10.1016/S1473-3099(20)30232-2 |pmid=32199493}}</ref><ref name="JoyntUnder20">{{cite journal |title=Understanding COVID-19: what does viral RNA load really mean? |journal=The Lancet Infectious Diseases |author=Joynt, G.M.; Wu, W.K.K. |year=2020 |doi=10.1016/S1473-3099(20)30237-1}}</ref> Early research seem to indicate, for example, there is little difference between the viral load of those with mild or no COVID-19 symptoms and those with more severe symptoms.<ref name="GeddesDoesA20" /> More research must be performed to better understand how viral load infectious dose plays a role in transmission. Given these unknowns, social distancing, wearing masks, and other means of minimizing exposure remain the best defense aginst the disease.<ref name="GeddesDoesA20" />
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| * ''Cardiovascular issues'': Coronaviruses and their accompanying respiratory infections are known to complicate issues of the cardiovascular system, which in turn may "increase the incidence and severity" of infectious diseases such as SARS and COVID-19.<ref name="MadjidPotent20">{{cite journal |title=Potential Effects of Coronaviruses on the Cardiovascular System |journal=JAMA Cardiology |author=Madjid, M.; Safavi-Naeini, P.; Solomon, S.D. |year=2020 |doi=10.1001/jamacardio.2020.1286 |pmid=32219363}}</ref><ref name="XiongCorona20">{{cite journal |title=Coronaviruses and the cardiovascular system: acute and long-term implications |journal=European Heart Journal |author=Xiong, T.-Y.; Redwood, S.; Prendergast, B.; Chen, M. |at=ehaa231 |year=2020 |doi=10.1093/eurheartj/ehaa231 |pmid=32186331}}</ref><ref name="DrigginCardio20">{{cite journal |title=Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic |journal=Journal of the American College of Cardiology |author=Driggin, E.; Madhavan, M.V.; Bikdeli, B. et al. |year=2020 |doi=10.1016/j.jacc.2020.03.031 |pmid=32201335}}</ref> While the exact cardiac effect COVID-19 has on patients is still unknown, suspicion is those with "hypertension, diabetes, and diagnosed cardiovascular disease" may be more prone to having cardiovascular complications from the disease.<ref name="OttoCardiac20">{{cite web |url=https://www.the-hospitalist.org/hospitalist/article/219645/coronavirus-updates/cardiac-symptoms-can-be-first-sign-covid-19 |title=Cardiac symptoms can be first sign of COVID-19 |author=Otto, M.A. |work=The Hospitalist |date=26 March 2020 |accessdate=01 April 2020}}</ref><ref name="ClerkinCorona20">{{cite journal |title=Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease |journal=Circulation |author=Clerkin, K.J.; Fried, J.A.; Raikhelkar, J. et al. |year=2020 |doi=10.1161/CIRCULATIONAHA.120.046941 |pmid=32200663}}</ref> Current thinking is SARS-CoV-2 either attacks heart tissues, causing myocardial dysfunction, or inevitably causes heart failure through a "cytokine storm,"<ref name="MadjidPotent20" /><ref name="XiongCorona20" /><ref name="OttoCardiac20" /><ref name="ClerkinCorona20" /><ref name="MehtaCOVID20">{{cite journal |title=COVID-19: Consider cytokine storm syndromes and immunosuppression |journal=The Lancet |author=Mehta, P.; McAuley, D.F.; Brown, M. et al. |volume=395 |issue=10229 |pages=P1033–34 |year=2020 |doi=10.1016/S0140-6736(20)30628-0 |pmid=32192578}}</ref><ref name="MandavilliTheCoronaCyto20">{{cite web |url=https://www.nytimes.com/2020/04/01/health/coronavirus-cytokine-storm-immune-system.html |title=The Coronavirus Patients Betrayed by Their Own Immune Systems |author=Mandavilli, A. |work=The New York Times |date=01 April 2020 |accessdate=01 April 2020}}</ref>, an overproduction of signaling molecules that promote inflammation by white blood cells (leukocytes).<ref name="TisoncikInto12">{{cite journal |title=Into the eye of the cytokine storm |journal=Microbiology and Molecular Biology Reviews |author=Tisoncik, J.R.; Korth, M.J.; Simmons, C.P. et al. |volume=76 |issue=1 |pages=16–32 |year=2012 |doi=10.1128/MMBR.05015-11 |pmid=22390970 |pmc=PMC3294426}}</ref> What's scary is that like the 1918 Spanish flu, SARS, and other epidemics, some otherwise healthy patients' immune responses are entirely overreactive, leading to acute respiratory distress syndrome (ARDS) or heart failure.<ref name="MandavilliTheCoronaCyto20" /><ref name="BasilioANew20">{{cite web |url=https://www.mdlinx.com/internal-medicine/article/6590 |title=A new potential risk of COVID-19: Sudden cardiac death |author=Basilio, P. |work=MDLinx |date=26 March 2020 |accessdate=01 April 2020}}</ref> Overreactive immune systems and other inherent, sometimes hidden or undiagnosed conditions that may lead to cardiovascular disruption only add to the level of difficulty of properly treating COVID-19.
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| ==References==
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| {{Reflist|colwidth=30em}}
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