C228 Task 2 International Disease Outbreak

Disease outbreaks involve the occurrence of disease cases above normal expectancy. These outbreaks are normally caused by infections transmitted through person-to-person contact, animal-to-person contact, or other environmental media. Depending on the type of outbreak and its severity, the number of cases varies and may even surpass previous outbreaks. While the exact causes of many outbreaks may be unknown, environmental factors like water supply, sanitation facilities, climate, and food are observed to contribute to major disease outbreaks (Geng et al., 2021). This discussion focuses on global pandemics, risk factors associated with disease transmission, reporting protocols, and measures to avert breakouts in the future.

1. Specific Outbreak

Pandemics have occurred throughout history and appear to be increasing in frequency. The increasing emergence of viral diseases from animals is among the contributing factors to global pandemics. Pandemics can cause a significant widespread increase in mortality and morbidity. In this discussion, I will focus on the coronavirus disease (COVID- 19) that occurred recently and still affects many people. Reported in early 2019, the disease has spread to almost every region in the world and caused massive loss of lives and damage to the world economy. I will discuss the disease outbreak, countries involved, transmission media, reporting protocol, and measures to prevent similar outbreaks.

1. Description of a Chosen Specific International Outbreak

The 2019 novel coronavirus disease (COVID- 19) is a communicable respiratory disease caused by a new strain of coronavirus that affects humans. Up to date, scientists are still learning about the disease including disease transmission and specific control measures. The disease was officially named COVID- 19 on 11th Feb 2019 by the World Health Organization and has since spread internationally affecting almost all countries. Recent reports indicate that only four countries including North Korea, Turkmenistan, Tuvalu, and Nauru have reported zero cases of COVID- 19 (World Health Organization (WHO), 2021). This discussion focuses on the COVID- 19 outbreak in China and its spread to the United States.

In late December 2019, an outbreak of mysterious pneumonia was reported in China. The disease was characterized by fever, dry cough, fatigue, and occasional gastrointestinal symptoms leading to hospitalization of many people. According to the initial reports, the outbreak occurred in a seafood wholesale wet market, the Huanan Seafood Wholesale Market, in Wuhan, Hubei, China (Wu et al., 2020). The increasing spread of the outbreak led to the shutdown of the market on 1st January 2020 following the announcement of an epidemiological alert by the local health organization on 31st December 2019 (Wu et al., 2020). The disease continuously spread to many cities in China including the provinces of Hubei, Zhejiang, Guangdong, Henan, and Hunan among many others prompting further investigation.

The announcement of the COVID- 19 outbreak in China led to many countries screening for patients with similar symptoms.

The WHO had announced that the new pandemic could have stemmed from a new coronavirus and travel precautions were at the forefront of experts’ concerns. On 20th January 2020, three airports in the US started screening for coronavirus because most people from Wahun traveled through them. On 21st January 2020, a Washington state resident became the first person in the US with a confirmed case of the 2019 novel coronavirus having returned from Wahun on 15th January 2020 (Adhikari et al., 2020). Following a series of investigations regarding the disease, it was determined that the virus was spread from person to person prompting the use of quarantine measures.

B1. Epidemiological Determinants and Risk Factors

The coronavirus belongs to a family of viruses that cause most infections in animals with very few cases reported in humans. These viruses cause symptoms like pneumonia, fever, breathing difficulty, and lung infection. The WHO named the disease COVID- 19 following the outbreak in 2019 and the tendency to affect the lower respiratory system just like pneumonia (WHO, 2021). Epidemiologically, the COVID- 19 disease started in Wahun China among people linked to a local seafood market. Soon it was established that close contact with infected individuals led to contracting of the disease. Further investigations established that the disease occurs through exposure to the virus and both the immunosuppressed and the normal population appear susceptible (Adhikari et al., 2020). Most adult patients between the age of 35 and 55 years appear to be most affected by the disease with children and infants being the least affected. It is hypothesized that people with poor immune function like the elderly and those with renal or hepatic dysfunction are at greater risk.

The COVID- 19 has been found to have higher levels of transmissibility and pandemic risk compared to other strains of the coronavirus. The CDC reports indicate that the effective reproductive number of COVID- 19 is 2.9 compared to the average 1.77 of the SARS viruses (Adhikari et al., 2020). The average incubation period of COVID- 19 is not well known but has been estimated to be between 2 to 11 days. The latest guideline from Chinese health authorities states the average incubation period to be 7 days and a wider range of 2 to 14 days depending on individuals affected. Following the initial reports, the estimated mortality rate for the disease was 11% to 15% (Adhikari et al., 2020). The disease has killed about 755,000 people in the United States and 4850 people in China.

COVID- 19 outbreak has posed an enormous threat to the public around the world with various risk factors associated with the disease. For instance, it is observed that the male gender is at greater risk of getting the disease compared to women (Geng et al., 2021). Secondly, older age contributes to getting the disease and is related to the aspect of reduced immunity (Geng et al., 2021). The younger generation has less severe cases of COVID- 19. Other risk factors that are still under investigation include pregnancy, race, overcrowding, and certain occupations.

B2. Route of Transmission

Many domestic animals including camels, cats, cattle, and bats are established to host coronavirus. Although animal coronaviruses do not spread to humans, it is observed that SARS and MERS spread through close contact with infected people (Adhikari et al., 2020). Following the outbreak in Wahun, China, it may be possible that animal-to-person transmission resulted in the outbreak. The latest guideline describes three main routes of transmission including droplets transmission, contact transmission, and aerosol transmission (WHO, 2021). Droplets transmission occurs during sneezing or coughing whereby a close individual inhales or ingests them. Contact transmission occurs when a person or object touches a surface contaminated with the virus while aerosol transmission occurs when respiratory droplets mix in the air and are inhaled by another person.

B3. Impact in My Community at a Systems Level

Across every sphere, from health to the economy, COVID 19 has led to serious consequences. Although the medium-sized community I reside in has yet to see many cases of COVID 19, various measures are put in place to counter the effects of the outbreak. Initially, the healthcare system changed the typical methods of operation including limiting the number of patients served to minimize transmission. Visits to the primary care providers are limited to many institutions utilizing telemedicine to limit exposure. Increased isolation measures and delayed non-emergency services have ensured the protection of the people against the disease. The increased transmission of the disease has led to the creation of COVID 19 centers and isolation facilities within hospitals to ensure the disease is contained. Local planning agencies have been involved in increasing the supply of personal protective equipment (PPE) to protect healthcare workers from being exposed. Schools in my community have developed virtual and hybrid learning to lower the ratio of students interacting during learning. New measures including masking and social distancing are put in place to prevent the spread of the disease.

B4. Reporting Protocol for an Outbreak in My Community

I reside in the state of California and the California Department of Public Health (CDPH) has specific guidelines on reporting COVID 19 outbreaks. According to special rules AB 685, the CDPH defines an outbreak as three positive cases in 14 days (California Department of Public Health (CDPH), 2021). However, emergency regulations allow the local public health department to define outbreaks differently. Upon learning of an outbreak, an employer must report the cases within 48 hours to the local health department (CDPH, 2021). Secondly, the administrator of each health facility, clinic, or other settings where an outbreak is established is responsible for administrative procedures to assure that reports are made to the local health officer.

B5. Two Strategies to Prevent an Outbreak in My Community

The first strategy to prevent COVID- 19 outbreak in my community is the use of vaccination. The vaccines are available for anyone older than 12 years and are now available in several healthcare facilities (CDPH, 2021). The second strategy to prevent the disease involves the maintenance of hygiene practices, especially hand washing. It is recommended to wash hands with soap and water for at least 20 seconds or use a hand sanitizer. Keeping hands clean at regular intervals helps prevent the spread of germs based on the transmission routes of the disease.

References

Adhikari, S. P., Meng, S., Wu, Y. J., Mao, Y. P., Ye, R. X., Wang, Q. Z., Sun, C., Sylvia, S., Rozelle, S., Raat, H., & Zhou, H. (2020). Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: A scoping review. Infectious Diseases of Poverty, 9(1), 29. https://doi.org/10.1186/s40249-020-00646-x

California Department of Public Health. (2021). Tracking COVID- 19. https://www.cdph.ca.gov/Programs/CID/DCDC/pages/immunization/ncov2019.aspx

Geng, M. J., Wang, L. P., Ren, X., Yu, J. X., Chang, Z. R., Zheng, C. J., An, Z. J., Li, Y., Yang, X. K., Zhao, H. T., Li, Z. J., He, G. X., & Feng, Z. J. (2021). Risk factors for developing severe COVID-19 in China: An analysis of disease surveillance data. Infectious Diseases of Poverty, 10(1), 48. https://doi.org/10.1186/s40249-021-00820-9

World Health Organization (2021). Coronavirus disease. https://www.who.int/health-topics/coronavirus#tab=tab_1

Wu, Y. C., Chen, C. S., & Chan, Y. J. (2020). The outbreak of COVID-19: An overview. Journal of the Chinese Medical Association : JCMA, 83(3), 217–220. https://doi.org/10.1097/JCMA.0000000000000270