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COLLEGE DEPARTMENT

First Semester, School Year 2020-2021

BIOSTATISTICS AND EPIDEMIOLOGY – RSA

NAME: ANGELA P. REYES DATE: NOVEMBER 23, 2020


YEAR & SECTION: 2-A INSTRUCTOR: PROF. JENNY CHUA, M.SC.

Epidemiological and Clinical Aspects of COVID-19

ABSTRACT:
COVID-19 is a highly contagious and pathogenic coronavirus which emerged in China in December 2019, a pandemic
causing respiratory disease that poses a threat to human and public health and safety. The sudden release of COVID-19
revealed that zoonotic viruses and human to human transmission could be contaminated, disturbing and deadly. In view of
earlier studies on human coronaviruses and other zoonotic infections, it was observed that coronaviruses are have quite
common characteristics, especially in SARS-CoV and MERS-CoV. A comparison of the similarities and variations
between these three coronaviruses could benefit significantly to reduce the number of fatalities caused by Covid-19. A
comprehensive review was conducted for various original articles and review studies from PubMed, WHO, JAMA,
Lancet, NEJM and many more. The researcher selected 60 articles that have been published in journals or preprints in
compliance with keywords and qualifications for inclusion and exclusion. This study describes the fundamental virology
of Covid-19, including genomic and receptor characteristics, emphasizing its significant distinction from the previously
known coronaviruses. The researchers also summarizes current information about the epidemiological and pathological
characteristics of COVID-19, as well as recent developments in antiviral treatments and community-level interventions
for COVID-19.

INTRODUCTION OF THE STUDY:


The novel coronavirus (COVID-19) was introduced by a group of patients who had an unrecognized viral pneumonia in a
seafood market in Wuhan, China in the course of December 2019. The virus was isolated from biological specimens and
classified as a beta coronavirus genus, which was also present in Severe Acute Respiratory Syndrome (SARS) which is
also came from China and Middle East Respiratory Syndrome (MERS) which came from Saudi Arabia. COVID-19 is
capable of spreading internationally within one month of initial identification and can be transmitted by direct interaction
between people. The COVID-19 crisis in China showed not just the Chinese healthcare system's inadequacies but also
some main systemic vulnerabilities. For the past few years the emergence of diseases always come from China, the
Chinese government should always be ready to respond to this type of public health emergencies to prevent the disease
from spreading immediately and to avoid the escalating numbers of infection and fatality.

OBJECTIVES OF THE STUDY:


 To avoid further dissemination of disease internationally
 Early diagnosis, isolation and monitoring of patients including management of care for infectious patients
 To provide an overview of the three most deadly coronaviruses
 Recognize areas for improvement in future intervention strategies
 Help inform public health authorities and healthcare professionals in their attempts to combat their progression
 Relay essential risk and case evidence to all communities

SIGNIFICANCE OF THE STUDY:


These dangerous coronaviruses posed awful risks to people, there are no medicines, drugs or vaccines available to show
the increasing need to recognize these lethal viruses and their diseases more thoroughly. Hence, the researcher aims to
summarize the current information, updating and comparing main features of Novel Coronavirus (COVID-19), Severe
Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the researchers also focuses on a
set of features in terms of infectiveness and viral transmission. The researcher mentioned the main features of diseases
caused by this corona virus. It presents widespread analyses systematically on natural history, infectivity, pathogenicity,
incubation period, laboratory tests, diagnosis, special preventions, transmission patterns and risk factors. The researcher
further addresses what they have discovered so far about disease control and prediction.
METHODOLOGY:

There are 60 articles identified through this research


Search Methods and Strategies for
Identification of Studies - Pubmed: 19
- WHO: 10
- BMJ: 5
- JAMA: 4
- Lancet: 3
- NEJM:2

The other 17 articles that used in this research came from:


EuroSurveillance, CMAJ, JCAM, Research gate and science
pub.

The articles used are certainly published from January 5,


2020 to February 28, 2020.

Studies that are irrelevant to the topic are excluded.

The inclusion criteria: 7 review authors screened the titles and


Data Collection and Analysis abstracts of all retrieved records.

The studies were individually chosen and the findings of the


final selection were analyzed.

This is where the final decisions was made for each study if
the researcher is going to use it or not.

Extraction of data: conducted by the same seven review


Data Extraction and Management authors

The authors employed a structured form characteristics


comprising of:

- genetic diversity of coronavirus genus


- mode of transmission
- incubation period
- infectivity
- pathogenicity
- virulence
- immunogenicity
- diagnosis,
- surveillance
- clinical case management
- special measures in community level and health care
facility.

Each dispute was resolved after the data collection process


had been concluded and reviewers for each subject consulted.

SIGNIFICANT RESULT & FINDINGS:


The results are reported in 12 different sections: genetic differences between SARS, MERS, and COVID-19 epidemics,
transmission and incubation period, infectivity, pathogenicity, virulence, immunogenicity, diagnosis, surveillance,
examples of surveillance systems in different countries, clinical case management, special intervention in community
level, and special interventions for healthcare providers. These sections are based on the comparison of three corona
viruses that emerged during the process of discussion.
Genetic differences between SARS, MERS, and COVID-19 epidemics.
The study showed that COVID-19 virus is closely connected (98% similarity) to a bat-derived SARS-CoV and MERS-CoV. By
metagenomic RNA sequencing and viral insulation from samples of bronchoalveolar fluid lavage in patients with serious pneumonia,
the causative agent of COVID-19 is an unidentified beta coronavirus. In terms of both the number of affected individuals and the
geographic distribution of outbreak zones, Covid-19 strongly beats SARS and MERS epidemic.
Transmission and Incubation period.
This coronaviruses can be transmitted directly or by respiratory droplets. COVID-19 particles can be airborne and target people's poor
immune system and there is also a restricted amount of evidence that COVID-19 can be transmitted through fecal-oral. Studies
indicated that the incubation period for COVID-19 was 4.8 days while some indicated that the incubation period was 6.4 days or
longer which was up to 24 days.
Infectivity.
An infectivity test context is a way of knowing the degree of transmissibility or contagiuosity of the coronavirus. The infectivity index
was similar to two for pathogens in MERS and SARS epidemics indicating that the individual infected was able to infect 2 individuals
via direct contact. Hence, the COVID-19 was comparable to 2.2 and indicates that COVID-19 infectivity is more contagious than the
two coronaviruses.
Pathogenicity.
In mild and severe cases, there was a median period for starting symptoms of recovery 2-6 weeks, with the period between starting
and developing severe symptoms such as hypoxia was one week. According to WHO, COVID-19 disease seems unusual for children
with mild symptoms, approximately 2.4 percent of the total cases reported in children and adolescents under 19, while older cases
over 60 years of age and those with a history of chronic conditions are more at risk of serious disease and death.
Virulence.
The result of the SARS-CoV and MERS-CoV was lower than the COVID-19 fatality rate. The average case fatality rate of COVID-19
was 2.3% in China, and other studies indicated a case fatality rate of 0.9% in Beijing and some studies indicate a documented case
fatality rate of 5.3% to 8.4%. The case fatality rate was higher in the population over 80 years in a study of confirmed cases in China
and no deaths in an age group under 10 years in China.
Immunogenicity.
Covd-19 has restricted immunogenicity because studies of B and T cells found that both the SARS-CoV and the COVID-19 virus had
similar proteins. In RT-PCR test, false positive and false negative test results were registered and additional antibody such as negative
IgM and positive IgG results are treated by hospitals in China as a condition for recovery. COVID-19 incidence in recovered cases
emphasizes the need for a more efficient and effective vaccine to develop.
Diagnosis.
The COVID-19 RT-PCR test is an authentic reverse transcription test for the identification of nucleic acid in COVID-19 in upper and
lower respiratory samples obtained from patients whose carrying COVID-19 by a healthcare professional for the testing of individuals
without indications or other factors suspected of having COVID-19 infection. Recent studies from an IgM-IgG rapid combined test
have shown that RT-PCR has some drawback as the standard COVID-19 diagnostic process.
Surveillance.
The establishment of a modern outbreak surveillance system is known to be a crucial indicator of disease prevention. Databases offer
an updated, reliable summary of the coverage and effectiveness of COVID-19 in a given country and the evidence used to guide the
COVID-19 public health response. The surveillance system should be handled promptly, and the monitoring system's capability
should be tracked.
Examples of surveillance systems in different countries.
In China, public authorities widen their searching in order to find further cases in all provinces and to trace close contacts and to detect
cases if they are active and reactive. In Thailand, Japan and Korea the travelers who have arrived in their country was obliged to
quarantine for 14 days, the government also asked their people to quarantine, they also established contact tracing, screening programs
and closely monitoring of situation in provinces and cities where the disease occurred. Also, Korea developed the Blue (Level 1) to
Yellow (Level 2 of the 4-level national crisis management system) national warning levels. In America, CDC operates its urgent
response system to prevent the ongoing disease, to track closer contacts, to check passengers' entry to the USA following the initial
COVID-19 case.
Clinical Case Management.
COVID-19 mild common symptoms of cold are having dry cough, sore throat, low fever, headache, body aches are cases where
additional intervention is necessary in the early stage of the disease. Studies on the potential benefits and effectiveness of other
medicines, such as Remedesevir, Chloroquine, Vitamin C, Umifenovir Oseltamivir, Lopinavir/Ritonavir, are still studying in China
and some of the medicines are proven and safe, but not for COVID-19. Some steroids and methylprednisolone appear to be common
remedies in the recent pandemic, but WHO does not recommend their use for COVID-19, with the exception of acute respiratory
distress. However, an appropriate anti-viral medicine or vaccine for safety and effectiveness of COVID-19 has not yet been tested and
a number of the vaccines are currently undergoing preclinical testing.
Special intervention in community level.
The government's position in this pandemic is immense, it needs to inform its people about enhanced screening programs, monitoring
of the spread of disease and community quarantine. Another intervention is to ban or delay flights from some country or any
passengers who have traveled to China for up to 14 days. Additional concrete steps to address the pandemic at the community level
includes the postponement of school opening, social distancing, mass cancelation of activities, worship services, touring, concerts and
other events. These type of community level interventions wasn’t easy, everyone is affected, but doing these simple steps just by
staying at home will save someone else’s life.
Special interventions for healthcare providers.
Healthcare providers have long been urged to wear PPEs, but they are burdensome for healthcare providers as they face massive stress
as they are likely to get infected and to convey illness by direct interaction with their family. In order to help their emotional well-
being and operational responses, authorities must handle the mental health workload of healthcare staff. The high hospital infection
risk in the recent pandemic demonstrates how critical it is for health care providers in regular interaction with confirmed patients to
routinely investigate signs in order to isolate them in positive tests.
CONCLUSION & RECOMMENDATION:
The highly pathogenic COVID-19 pandemic has raised enduring severe burdens and risks for humanity and some
medicines were deemed promising choices for treatment with COVID-19, they were experimentally classified as
ineffective because the therapeutic effects were not really successful or the findings were not relatively acceptable. Further
study is required urgently to discover the secrets of these deadly corona viruses and their associated infections,
particularly in developing advanced medicines and vaccines, and successful action should also be established to minimize
the burden and danger of infections and corona viruses spread in future. This pandemic has revealed neglected weaknesses
in global monitoring and response, weaknesses which continue to exist despite an apparent damage done during previous
outbreaks.
As the community with shared future for man and human society, I recommend that all international leaders are in
need to support preparations in low income countries especially to organize global resources to equip hospitals and
supplies, to protect horrid infections and to offer personal protective equipment such as facing to the general population to
help avoid a pandemic outbreak. In the collaborative efforts to address COVID-19, I recommend to the international
community to develop a greater collaboration, communication and strong unity in fighting against this COVID-19
pandemic.

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