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Is national response for Coronavirus? – Meds1us

What is Coronavirus and what it does to your body that makes it so deadly?

COVID-19 is caused by a coronavirus called SARS-CoV-2. Coronaviruses belong to a group of viruses that infect animals, from peacocks to whales. They’re named for the bulb-tipped spikes that project from the virus’s surface and give the appearance of a corona surrounding it.

A coronavirus infection usually plays out one of two ways: as an infection in the lungs that includes some cases of what people would call the common cold, or as an infection in the gut that causes diarrhea. COVID-19 starts out in the lungs like the common cold coronaviruses but then causes havoc with the immune system that can lead to long-term lung damage or death.

SARS-CoV-2 is genetically very similar to other human respiratory coronaviruses, including SARS-CoV and MERS-CoV. However, the subtle genetic differences translate to significant differences in how readily a coronavirus infects people and how it makes them sick.

SARS-CoV-2 has all the same genetic equipment as the original SARS-CoV, which caused a global outbreak in 2003, but with around 6,000 mutations sprinkled around in the usual places where coronaviruses change. Think whole milk versus skim milk.

Compared to other human coronaviruses like MERS-CoV, which emerged in the Middle East in 2012, the new virus has customized versions of the same general equipment for invading cells and copying itself. However, SARS-CoV-2 has a totally different set of genes called accessories, which give this new virus a little advantage in specific situations.

For example, MERS has a particular protein that shuts down a cell’s ability to sound the alarm about a viral intruder. SARS-CoV-2 has an unrelated gene with an as-yet-unknown function in that position in its genome. Think cow milk versus almond milk.

How the virus infects?

Every coronavirus infection starts with a virus particle, a spherical shell that protects a single long string of genetic material and inserts it into a human cell. The genetic material instructs the cell to make around 30 different parts of the virus, allowing the virus to reproduce. The cells that SARS-CoV-2 prefers to infect have a protein called ACE2 on the outside that is important for regulating blood pressure.

The infection begins when the long spike proteins that protrude from the virus particle latch on to the cell’s ACE2 protein. From that point, the spike transforms, unfolding and refolding itself using coiled spring-like parts that start out buried at the core of the spike. The reconfigured spike hooks into the cell and crashes the virus particle and cell together. This forms a channel where the string of viral genetic material can snake its way into the unsuspecting cell.

Why the US is leading the world in confirmed coronavirus cases?

From the first known patient in late January to now almost 100,000 infected, the United States has earned the unwanted distinction of leading the world in confirmed coronavirus cases.

Close to 1,500 people have succumbed to the COVID-19 illness — though for now, the death rate remains far lower than Italy and several European countries.

How did we get here? And what happens next? 

Public health experts say that while we’ve yet to hit the peak of the US epidemic, there are several reasons why the COVID-19 disease has exploded in America.

Early on in the outbreak, President Donald Trump was accused of downplaying its severity, saying that sustained community spread was not “inevitable” even after a senior health official said it was, which could have led to a sense of complacency.

As the illness took root, first in the West Coast states of Washington and California, the US was unable to perform meaningful levels of contact tracing because it was so slow off the mark with testing.

The government initially refused to relax regulatory hurdles that would have allowed states and local health departments to develop their own test kits based on guidelines provided by the World Health Organization, and all early samples were being sent to the headquarters of the Centers for Disease Control and Prevention (CDC) in Atlanta

Then the CDC sent out faulty test kits to the states, adding to delays.

It was not until February 29, the date of the first US death and more than a month after the first confirmed US case, that the government lifted its ban. The private sector entered later, adding to capacity.

“If we could have done contact tracing, we might have found a lot more cases quickly and shut down the hotspots,” Doctor Gabor Kelen, director of emergency medicine at Johns Hopkins University, told AFP.

US officials have defended their response, repeatedly asserting that tests developed by South Korea — which is seen as an example of best practice for its aggressive early testing — sometimes produced false positives.

Kelen disagreed with that reasoning.

One thing I teach my residents: Something is better than nothing, sooner is better than later, and if one test is good, two are better. So let’s get to it — perfect is the enemy of the good, he said.

No national response

Densely populated New York has emerged as the US epicenter of the outbreak, with almost 45,000 cases as of Friday — about half the US total — and over 500 deaths.

Neighboring New Jersey follows, then California and Washington state, then Michigan and Illinois in the Midwest, with clusters focused in major cities.

States or areas that haven’t yet experienced surges should not be complacent, said Doctor Thomas Tsai, a general surgeon, and professor of health policy at Harvard.

“The United States isn’t one monolith, there are 50 different states with different government responses from governors and state public health departments,” he told AFP.

“I think what’s needed is a truly national coordinated effort,” said Tsai, warning that continuing with a “patchwork response” on people’s movements would lead to other states seeing the types of surge experienced in places like New York.

As of Friday afternoon, 61 percent of the US population of 330 million was called to lockdown, meaning 39 percent is not.

What now?

One relative bright spot has been that the fatality rate in the US based on confirmed cases has remained relatively low so far — 1.5 percent, compared to 7.7 percent in Spain and 10 percent in Italy.

Will this trend continue? The short answer is we don’t know, and the experts are divided.

“Low CFR (case fatality rate) is not reassuring,” David Fisman, an epidemiologist at the University of Toronto, told AFP.

“It will rise because it takes people time to die. My best guess is that the US is on the cusp of an absolutely disastrous outbreak.”

The experts agreed that nationwide social distancing measures were urgently needed to continue to try to “flatten the curve” — slowing the rate of infection so that hospitals aren’t overrun, as the case is currently in New York.

But from a scientific point of view, the pathogen could “down mutate” and become less virulent as time goes on, said Kelen, as similar viruses typically do.

The heat and humidity of summer could also slow its spread, experts have said.

Forecasters at the University of Washington’s School of Medicine believe the peak of the outbreak may come in mid-April with more than 80,000 deaths, based on current trends.

Their model suggests 38,000 deaths at the lower end and 162,000 at the higher end.

What the Corona Virus outbreak can teach us about Public Health?

Together, we are facing COVID19 & we must use the window of opportunity to intensify our preparedness for it. And more than ever it’s time to let science & evidence lead policy. If we don’t, we are headed down a dark path that leads nowhere but division and disharmony,” Dr. Tedros (Director of WHO) on Twitter.

The emergence of COVID19 – the official name for the Corona Virus outbreak, has underlined the urgent need for doing away with narrow walls around academic disciplines, or the exclusivist approach we have taken to human well-being.

With little thought given to context, scientists have cautioned us for long, our economic policies are bound to create a nightmare for the planet. Whether it is the environment (think about the Amazon fires) or the animals perishing in the bush fires, or the disappearing coastal cities.

COVID19 reads like the latest in a series of planetary alarms ringing out. What makes it central to our concerns is the direct impact on human health.

So BrainGain Magazine spoke to experts at the University of Toronto’s Dalla Lana School of Public Health, to understand the scope of the challenge we are facing, and how we can best respond.

For one, they counseled against the short-sightedness. Dr. David Fisman, Professor in the Division of Epidemiology at the School said, ‘Many emerging infections are appearing in the context of rapid urbanization, human encroachment on wilderness, and the use of wild animals as food. We need a more balanced and respectful approach to other living things on the planet, or we will pay the price.’

Dr. Kerry Bowman, Assistant Professor, Department of Community and Family Medicine added, ‘The wildlife trade and the commodification of wild species, as well as environmental destruction, have all contributed to these emerging outbreaks. We need to do better in this area.’

To be effective, prevention, containment, and cure cannot just be limited to humans. They must be part of a holistic strategy. Here is where the WHO’s One Health approach comes in. According to Dr. Fisman, ‘Most emerging infectious disease (SARS, MERS, Nipah, influenza too) jump to humans from animals. “One Health” is the idea that human, animal, and environmental health are interwoven.

To solve these problems, we need to break down boundaries between disciplines. Veterinarians, human public health experts, environmental scientists all need to interact and share information.”

This understanding has led to an evolution in the study of Public Health. The subject is no longer limited to medicine or epidemiology but also includes the study of Artificial Intelligence & Statistics and Systems.

According to Dr. Bowman, ‘Public health is evolving rapidly all over the world. One of the ways it is evolving is [by] taking a much more global perspective on outbreaks. There is no country on earth that can only focus on the protection of their own people’s health and safety, because of globalization. Public health is also now far more interdisciplinary, looking beyond biological factors to political, social, and cultural factors.’

The Dalla Lana School of Public Health at the University of Toronto, for instance, prioritizes meaningful collaboration across disciplines. It hosts research, training, and service hubs like the Institute of Health, Policy, Management & Evaluation, Centre for Vaccine-Preventable Diseases, Waakebiness – Bryce Institute for Indigenous Health, Joint Centre for Bioethics, and the Centre for Critical Qualitative Health Research.

So Public Health has seen a ‘blurring of the lines between epidemiology and other data-heavy disciplines, including computer science, economics, and geography. Computing power and the availability of genetic information (both on human populations and disease-causing microbes) is transforming how we understand health and disease.’ (Dr. Fisman).

Accordingly, the curriculum is designed as a response to contemporary public health challenges. ‘Toronto has had direct experience with the SARS outbreak,’ said Dr. Bowman. ‘And as a result, many changes were made to public health protocols and awareness. That spills over into the School of Public Health. Students get to study real-life cases as they occurred right in the city of Toronto. The school also does a lot of social and epidemiological research related to emerging outbreaks. We are part of the global scholarship in these areas.’

At the world’s leading universities, the study and practice of Public Health are founded on multidisciplinary research, a clear vision of the inter-connectedness of each inhabitant of this planet, and a strong drive to inspire communication between research centers, think tanks, government departments, and citizens. At the heart of this evolution is the understanding that for Public Health to exist, whether as a subject or an idea, it has to be inclusive and comprehensive. Apart from the technological advances, this seems to be a key takeaway of the COVID19 outbreak – the need for comprehensive care.

To conclude in the words of Dr. Fisman, “Public health is a tough discipline: it gets political, and you deal with crises.  It’s changing all the time so people in our field need to adapt and learn on the fly.  But at the end of the day, you also need to care about the populations you’re serving. Health risks tend to be greatest in disadvantaged populations, so you need to be compassionate to do this job.

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