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1. Overview of COVID-19 and its challenges

1.1 COVID-19: The terminology

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.[1] 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."[2] 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.[3][4] 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.

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).[5] 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."

Consistent terminology is vital to communicating technical material to a global audience.[6][7] With that in mind, it's beneficial to ensure everyone is clear one the terms used. For purposes of this guide:

  • Coronavirus disease 2019 (otherwise known as COVID-19) is the respiratory disease being discussed in this guide.
  • SARS-CoV-2 is the virus responsible for COVID-19.
  • Coronavirus (or Coronaviridae) is a family of related viruses, of which SARS-CoV-2 is a member.
  • 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).
  • 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).

1.2 COVID-19: History and impact (so far)

The first known case of COVID-19 dates back to November 2019, "according to government data seen by the South China Morning Post."[8] By the middle of December, infections were at 27, and by the end of the year the number was 266.[8] 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[8], and the WHO was notified.[1] At the start of 2020, that number grew to 381 known cases[8], jumping to more than 7,700 confirmed and 12,000 suspected cased by the end of January.[2] 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.[2] 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."[2] However, at the same time, the virus was already beginning to spread in locations such as Australia[9], France[10], Germany[11] Italy[12], Japan[13], South Korea[14], Spain[15], the United Kingdom[16], and the United States.[17]

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."[3][4] By the end of the month, the WHO warned a "very high" likelihood the virus's spread could turn into a full pandemic.[18]

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.[19]


TO BE CONTINUED...

1.3 Challenges of managing the disease in the human population

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.

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.[20][21][22]

Other aspects of the disease that make this difficult to manage include:

  • 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[23]) 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.[24] However, many people continue to not take self-quarantines and other forms of social distancing seriously[25][26][27][28], and presymtomatic (and asymptomatic) carriers are thus more prone to spreading the virus.[29][30]
  • 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.[29][30][31][32] 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[33][34], 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).[34] This initial uncertainty of transmission routes, along with mixed messages about masks and their effectiveness for COVID-19[34][35][36], makes social distancing an even stronger necessity to limit community transmission of the disease.
  • 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.[37] Similarly, viral load—a quantification of viral genomic fragments—also tends to correlate with clinical symptoms.[38] However, we are still in the investigative stages of determining if that similarly holds true to COVID-19.[37][39][40] 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.[37] 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.[37]
  • 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.[41][42][43] 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.[44][45] Current thinking is SARS-CoV-2 either attacks heart tissues, causing myocardial dysfunction, or inevitably causes heart failure through a "cytokine storm,"[41][42][44][45][46][47], an overproduction of signaling molecules that promote inflammation by white blood cells (leukocytes).[48] 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.[47][49] 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.


References

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