Global Health Issue: The Coronavirus Disease

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Introduction

The coronavirus disease (COVID-19) is an unprecedented global health issue confronting the world today. From Asia, where it was first reported, the virus has spread to almost all corners of the world, causing death, human suffering, and devastating socioeconomic crises universally. The pandemic has affected the health of people and nations, exposing weaknesses in healthcare systems and responses. Families have suffered unparalleled grief, anxiety, and distress from the increasing fatality, massive job losses, lockdowns, and movement restrictions to curb the spread of the virus. This paper describes the COVID-19 condition, its transmission, progression, signs and symptoms, diagnosis, and treatment. A comparison is made between the United States and Germany.

Description of the Global Health Issue

COVID-19 is an ongoing global health crisis that has overstretched health care systems, as the number of infections keeps rising each day. According to the Centers for Disease Control and Prevention [CDC] (2021), to date, over 122 million positive cases have been confirmed globally, including more than 2.7 million deaths, as of March 2021. The pandemics economic and social impacts on many economies due to travel restrictions, lockdowns, and job losses are significant. It has disproportionately affected vulnerable populations all over the world, highlighting the need for global structural responses to end health inequities.

Condition

COVID-19 is a contagious viral respiratory disease that presents with pneumonia-like symptoms. The causative agent is the novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is classified as a betacoronavirus related to SARS and MERS that account for more severe outbreaks reported previously (Cascella, Rajnik, Cuomo, Dulebohn, & Napoli, 2021). This family of viruses contains single-stranded RNA and can spread between species, causing respiratory illnesses of varying severity from flu to SARS. Similarly, COVID-19 is thought to have a zoonotic origin before infecting people. It is suggested that the first transmission to humans occurred through infected wild meat in a wet market in Wuhan, China (Cascella et al., 2021). Soon, the human-to-human spread accelerated across the globe, mainly through contact with asymptomatic patients.

Coronavirus has high transmissibility and pathogenicity, causing severe disease, especially in individuals with poor immune function, such as the elderly and those with underlying comorbid conditions. The average post-exposure incubation period is 5-6 days, but a longer period of 14 days before symptom onset is experienced in some cases (CDC, 2021). Therefore, a two-week quarantine period is mandated to confirm infected cases. The virus triggers an excessive immune reaction or a cytokine storm in the lungs, causing tissue inflammation and damage (Cascella et al., 2021). The autoimmune response account for the clinical presentation of this disease, including fever and breathing difficulties.

Transmission

COVID-19 is believed to have a zoonotic source, but the animal host is unknown. The most probable host of this virus before it infected humans includes bats or pangolins (Cascella et al., 2021). The mechanism of human-to-human transmission involves respiratory droplets or contact with infected surfaces. Coughing or sneezing releases respiratory droplets containing the virus into the immediate environment. Transmission is possible if these infectious particles land on the mouth, eyes, or nose of an individual nearby, usually within one meter (CDC, 2021). Thus, close contact with symptomatic or asymptomatic cases increases the risk of exposure to the virus.

Another mode of transmission includes fomites around an infected person. This indirect route involves contact with infected hands, surfaces, or objects followed by touching ones mouth, nose, or eye. Aerosol transmission of this disease is possible in certain environments or conditions. Aerosol-generating procedures or treatments, including intubation, nebulizers, or cardiopulmonary resuscitation, increase the risk of infection (Cascella et al., 2021). However, the viral load in air samples is usually too low to be transmissible.

Progression

COVID-19 progression involves three phases of increasing symptom severity in patients. The first stage is the early infection or pre-symptomatic point that manifests as mild upper respiratory tract (URT) infection 1-2 days before symptom onset (Cascella et al., 2021). At this point, the individual is highly infectious, as the virus invades the nasal receptors (angiotensin-converting enzyme 2 or ACE-2), replicates, and infects more cells. In some cases, the infection reaches the lungs by attacking ACE2 receptors in alveoli after about 5-14 days of incubation (Cascella et al., 2021). The body responds by secreting chemokines to destroy infected cells. Pus collected in the alveoli inhibits gaseous exchange in the lungs and at this point, the patient exhibits a persistent cough, fever, and breathlessness.

The second stage is the pulmonary phase which is characterized by full-blown pneumonia. It comprises two parts: stage IIA which manifests as pneumonia-like symptoms and IIB which includes hypoxia (Cascella et al., 2021). The latter phase necessitates admission and supplemental oxygen to keep the patient life. The pulmonary phase develops about a week after symptom onset. The third stage is the hyper-inflammation period during which the patient deteriorates rapidly. Acute respiratory distress syndrome (ARDS) develops, showing as highly inflamed lungs and fluid buildup in the alveoli 14 days after symptom onset (Cascella et al., 2021). As a result, a gaseous exchange is inhibited and the oxygen level in the blood drops. At this point, the patient needs ventilatory support to help with breathing. Systemic complications, such as dyspnea, renal failure, and septic shock are common at this stage, increasing the mortality risk.

Signs and Symptoms

The clinical presentations and symptom severity depend on the stage of the disease. For mild (uncomplicated) illness, URT symptoms are observed, including slight fever, dry cough, sore throat, nasal blockage, myalgia, fatigue, and migraines (CDC, 2021). Some asymptomatic patients report a loss of taste and smell due to the infection. Moderate pneumonia manifests with respiratory symptoms, including coughing and breathlessness, but acute dyspnea is absent. Severe cases present with serious and prolonged dyspnea, fever, and respiratory distress (CDC, 2021). Hypoxia is another complication that may be present in severe COVID-19, which often degenerate into ARDS. Digestive symptoms, including diarrhea, are also experienced in a few cases. Chest CT scans usually reveal lung abnormalities and septic shock that is linked to high mortality if vasopressors are not used.

Diagnosis

Suspected cases or patients presenting with fever of URT symptoms are eligible for COVID-19 testing. Epidemiological factors, including contact with an infected person, are other criteria for doing a test. The recommended diagnostic methods are molecular and serological tests and imaging. A sample or sputum collected from the URT region (nose or oropharynx) is amplified in a reverse polymerase chain reaction (RT-PCR) and specific probes are used to confirm COVID-19 viral genetic material (Cascella et al., 2021). The process is repeated after treatment to ascertain viral clearance before discharge.

A serological diagnosis tests serum samples for antibodies released as an immune response to COVID-19 infection. However, its level of specificity and sensitivity is presently low (Cascella et al., 2021). Further research is required to develop this diagnostic method for use in broad-based surveillance. Imaging techniques, such as Chest X-ray examination and computed tomography can reveal lung changes, including alveolar opacities, due to COVID-19 infection (Cascella et al., 2021). The results indicate the stage of infection and response to treatment and care.

Treatment

No specific pharmacological agents are recommended for the disease, but symptomatic treatments and supplementary oxygen are indicated for dyspnea or ARDS. As suggested by Cascella et al. (2021), mechanical ventilators can be used in intensive care settings to help patients with severe lung damage breathe. Other procedures that can improve outcomes include non-invasive ventilation and intubation to manage the alveolar fluid buildup. Pharmacological agents, including corticosteroids (dexamethasone) and antiviral agents (remdesivir) can be effective for managing ARDS to reduce mortality (Cascella et al., 2021). Antibodies purified from recovered individuals are another treatment option that is under clinical trials. In recent weeks, COVID-19 vaccines with varying levels of efficacy have been released for mass inoculation to create heard immunity and curb transmission.

A Comparison to another Country

The United States is one of the most affected countries, regarding the incidence rate and death toll. Further, the statistics and responses differ from those of European countries, such as Germany. The number of confirmed cases in the US is over 30.5 million, with a death toll of about 550,000, compared to 2.6 million and 75,000 in Germany, respectively (CDC, 2021). The difference can be attributed to dissimilar responses by the governments to the pandemic. While Germany was quick to impose restrictions, lockdowns, and wearing of facemasks, the US was slow to adopt these measures, allowing the disease to spread.

Conclusion

COVID-19 is a major health crisis facing the world today, and its impact on public health, social, and economic spheres is significant across the globe. This novel viral disease is caused by SARS-CoV-2 that is thought to have a zoonotic origin. Human-to-human transmission occurs through respiratory droplets or contact with infected surfaces. The disease presents with URT symptoms, such as fever, coughs, and shortness of breath. Molecular and serological tests are used to test COVID-19, while supplemental oxygen, ventilators, and antiviral agents are indicated for symptom management.

References

Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S. C., & Napoli, R. D. (2021). Features, evaluation, and treatment of coronavirus (COVID-19). Treasure Island, FL: StatPearls.

Centers for Disease Control and Prevention. (2021). Cases, data, and surveillance. Web.

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