The present global coronavirus infection is caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome- COV-2). The published data suggests the virus was not engineered, modified, or mutated in the lab but had a similar genome that is seen in an animal carrier.1 The origin of the pathogenic COVID-19 virus in China is thought to be from bat or pangolins. The published data of WHO indicates the probable source of COVID-19 is bat and wet market of China near the city of Wuhan.2 The first case of COVID-19 infection was reported in December 2019 at Wuhan, China.2 The published reports suggest Infection caused by SARS-CoV-2 coronavirus rapidly spreads along the upper respiratory tract and causes severe acute respiratory syndrome (SARS) resulting in difficulties in breathing. The SARS CoV-19 is also known as COVID-19 infections.
What is COVID-19 Virus Disease &Community Spread?
Covid-19 spreads rapidly from infected individuals to healthy individuals during close contact. The salivary and sputum droplets can travel up to 5 to 6 feet during sneezing and coughing. Similarly, the infected droplets of saliva, as well as sputum during the usual speech, can travel up to 3 to 4 feet. The viruses within droplets pass into the human body through mouth, nose, and eyes. Such COVID-19 virus spread is identified as community spread.
The rapid community spread of COVID-19 coronavirus from an infected individual to several healthy individuals often occurs in a crowded and thickly populated residential area. Surprisingly community spread is a lot less in the densely populated country like India3 (Table 1) compared to Sweden and Spain. The health authorities in India had implemented strict guidelines of isolation, quarantine, and mitigation. On the contrary, Sweden had suggested the least voluntary guidelines of quarantine and Spain was late in implementing strict guidelines. The results of the community spread of COVID-19 are shown in Table 1.(Data as on May 11, 2020)
Table 1: May 11, 2020
How to Prevent Rapid Community Spread of COVID-19 Infection?
COVID-19 community spread in Netherland, Sweden, and France is comparable (see Table 1). Though voluntary mitigation and quarantine were less strict in Sweden. The World Health Organization, Center for Disease Control and Prevention USA (CDC), and UNESCO4 have periodically suggested guidelines since January 2020 for prevention of the rapid spread of COVID-19 coronavirus infection. The individual suffering from the COVID-19 virus can spread infection during incubation as well as the symptomatic period. The spread of contagious infection can be restricted within the local community if the spread is controlled by isolation, quarantine, and mitigation.
The disease like COVID-19 started as a endemic community illness at city of Wuhan. The spread of endemic disease in Wuhan was aggressively controlled by isolation, mitigation, and quarantine. Despite such stringent measures, the deadly contagious endemic COVID-19 infection rapidly spread within the local population and became an epidemic disease. The endemic COVID-19 infection became epidemic when some of the people from the town of Wuhan went to the neighboring and distant cities in China. Similarly, several visitors, residents, and employees in the city of Wuhan went abroad to different countries that resulted in COVID-19 infection being pandemic. The local authorities and WHO failed to recognize the deadly COVID-19 infection was spreading across the world. Such a pandemic spread of COVID-19 could have been prevented by the isolation of infected individuals and the quarantine of healthy individuals. The past experience of similar endemic diseases has indicated strict quarantine of healthy individuals and isolation of infected patients is necessary to prevent disease becoming epidemic and pandemic. Today almost all the countries in the world has rapidly spreading COVID-19 cases and experienced deaths of several citizens. The further spread can be prevented by following strict guidelines of isolation, quarantine, and mitigations.
The individual suffering from mild symptoms like running nose, sore throat, and cough are tested for COVID-19 infection. Positive tested individuals are isolated at home or step-down health facilities. Isolation prevents the spread of infection to members of family, friends, and colleagues.
- Isolation of Infected Individuals
Patient suffering with COVID-19 infection may present mild or severe symptoms.
- Mild Symptoms- Isolation of mild symptomatic individual at home or hospital is recommended. Running nose, cough and sore throat is considered early and mild symptoms. The individual kept in isolation during the period of symptoms andfor additional two weeks after mild symptoms are no longer observed..
- Severe Symptoms And Breathing Difficulties- Cough, fever and breathing difficulties are considered severe COVID-19 symptoms. Individual suffering with such severe symptoms are admitted in hospital or ICU (Intensive Care Unit) for observation and treatment. The individual is advised an additional 2 to 4 weeks of isolation at home after discharge from the hospital.
- Asymptomatic carrier- Asymptomatic positive tested individuals are also known as an asymptomatic carrier. The asymptomatic carrier patient is advised to stay in isolation at home for two week. If isolation is not possible because of the small house and several family members staying together, then such asymptomatic carrier is admitted in isolated step-down facilities provided by local health or government authorities. Asymptomatic carrier could be symptomatic or remain asymptomatic during 14 days of isolation. If such individual become symptomatic then he is treated accordingly.
- Isolation of Individuals Exposed To Infected Individuals- Such individuals are advised to get salivary or blood test. If the test is negative, then individual is advised to stay in isolation at home or step down health care facilities for 14 days.Individual suffering with mild or severe symptoms are treated accordingly.
Guidelines for quarantine are provided by WHO (World Health Organization), CDC (Centers for Diseases Control and Prevention), and local government health authorities. The quarantine period can be anywhere from 2 weeks to several months. During quarantine period healthy elderly, adults and children are advised to stay in the house and not to meet neighbors, family members, and colleagues. During the quarantine period, schools, colleges, banks, offices, and factories are closed. Some employees can work from home using computers and telephone facilities. The emergency and essential workers are allowed to work and expected to follow all guidelines of mitigation such as maintaining 6 feet or more distance if meeting clients, use masks and gloves. The quarantine adults are allowed to visit the grocery store, doctor’s office, pharmacy, and post office. Quarantine guidelines hopefully protects healthy individual from getting COVID-19 infection. Individuals adults and children suffering with mild or severe symptoms should go to ER or see primary care physician as soon as possible.Nobody should ignore symptoms like running nose, cough, sore throat, body ache, fever, or breathing difficulties. During the quarantine period, one must wear masks and gloves during any outdoor activities, grocery shopping, visit the doctor’s office, or communication with another individual.
Mitigation is the action taken by the task force to reduce the severity and spread of COVID-19 infection. The task force is established by the federal government, State government, Mayor’s office, and County Commissioner. The task force includes experienced experts from specialties like medicine, pharmacy, and business.
- The Goal of Mitigation-
Mitigation is the action taken to reduce spread of COVID-19 as well as provide adequate support to treat the infection. Following steps are taken during mitigation period of any infectious disease.
- Action such as isolation and quarantine prevents rapid spread of COVID-19 in the community.
- Established guidelines of isolation and quarantine for healthy children, adults, senior citizens, nursing home patients, hospital nursing staff, and physicians.
- Established adequate supply of Personal Protection Equipment
- Established guidance of distancing
- Health Care Facilities
- Established all health care facilities are equipped and well staff to take care of an optimum number of patients suffering from COVID-19.
- Provide an adequate number of bedsin hospital and step down observation units.
- Provide an adequate number of life-supporting equipment.
- Periodically estimate number of hospital beds needed to treat COVID-19 patients.
- Periodically estimate how many numbers of step-down beds needed.
- Health Care Support
Evaluate staffing need of following experts at hospital, ICU and stepdown observation facilities.
- Other staffs
- Diagnostic Test
- Provide an adequate number of test kits to diagnose COVID-19 infection
- Establish a sufficient number of facilities to test COVID-19 infection and also provide an appropriate test kit to evaluate the presence of antibodies in the blood.
- COVID-19 coronavirus epidemic has a natural origin Science Daily: March 17, 2020 https://www.sciencedaily.com/releases/2020/03/200317175442.htm
- Origin of SARS-CoV-2 (26 March 2020) World Health Organization (WHO) https://www.who.int/health-topics/coronavirus/who-recommendations-to-reduce-risk-of-transmission-of-emerging-pathogens-from-animals-to-humans-in-live-animal-markets
- More immunity genes in Indian. https://www.natureasia.com/en/nindia/article/10.1038/nindia.2008.254 doi:10.1038/nindia.2008.254 Published online 1 August 2008
- Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Nussbaumer-Streit B1, Mayr V1, Dobrescu AI1, Chapman A1, Persad E1, Klerings I1, Wagner G1, Siebert U2,3,4,5 ,Christof C1, Zachariah C1, Gartlehner G1,6. Cochrane Database Syst Rev. 2020 Apr 8;4:CD013574. doi: 10.1002/14651858.CD013574.
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