Blog

COVID-19

Corona virus is a species of enveloped RNA virus that has caused respiratory diseases like severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) in humans. A new strain of the virus from same family namely Severe Acute Respiratory Syndrome Corona virus-2(SARS-COV-2) has been causing highly infectious disease in these past 2 years .This disease has been named as COVID-19. COVID-19 was first detected in Wuhan, china on 2019 (Cui, J., Li, F., Shi, Z. & L., 2018). COVID-19 was declared a public health emergency of international concern on 30 January 2020 and a pandemic on 11 march 2020 by World Health Organization (WHO) (WHO, 2020).

 

The incidence of COVID-19 around the world hit 258,830,438 confirmed cases as of 27 November 2021, with 5,174,646 cumulative deaths. In Asia alone 81,718,199 people were infected with COVID-19 and about 1,207,498 total deaths. Nepal detected the first case of COVID-19 infection on 23rd January. The rate of infection hiked up in Nepal reaching 820,285 cases and a cumulative death 11,516 as of November 27, 2020 (Wolrdometers, 2021).

The virus that causes COVID-19 is SARS-COV-2 which is an enveloped positive stranded RNA virus that enters the host body through ACE-2 receptors. ACE-2 receptors are found in type-II pneumocytes. Viruses that cause illness in humans are likely introduced via  zoonotic transmission from animals (Martins et al., 2020).

COVID-19 infection takes about 2-14 days, with a median of 4 to 5 days from exposure with infected person to the onset of symptoms. The transmission of COVID-19 virus, SARS-COV-2 occurs mainly via the respiratory droplets from an infected person. The respiratory droplets produced during coughing or sneezing, the droplets enter the body of healthy person by a close contact with infected peson. The close contact is when a person is exposed to the infected person within 2 meter of distance for a total of 15 minutes in 24 hour. Getting the droplets land on eyes, nose, mouth or by touching your face with hands that are infected or touching contaminated utensils and greeting unclean hands infected with COVID-19 will put you at risk of contracting the virus {Center for Disease Control (CDC), 2020}.

 COVID-19 can manifest as fever, cough, congestion, sore throat, shortness of breath, muscle pain, body ache. Occasionally people also experience diarrhea, nausea, vomiting, loss of sense of taste and smell. People above the age of 60 with one or more co-morbidities are likely to develop more serious illness like, pneumonia, Acute respiratory distress syndrome causing severe lung damage. People also expirence symptoms like fatigue, myalgia and in severe cases septic shock, metabolic acidosis, and bleeding and coagulation dysfunction (chen et al., 2019). Further, difficulty breathing, persistent pain or pressure in the chest, new confusion, inability to wake up or stay awake, bluish lips or face are the warning emergency signs of severe illness due to COVID-19  (Maragakis, 2021).

COVID-19 can be detected through RT-PCR (real-time polymerase chain reaction assay test). This is the gold standard for diagnosis which identifies viral genome targets in respiratory tract using nasopharyngeal swab during the first week of symptoms. Vaccinated people with known exposure are advised to use safety measure during this period. While, unvaccinated people are advised to quarantine for 7 days and watch for symptoms. Serological test can also be used to detect the virus and yields accurate results after 2 week or more of onset of first symptoms (Goudouris, 2021).

The management of COVID-19 depends upon the severity of the symptoms. People with mild to moderate symptoms are advised for home isolation. People on home isolation must use separated bathroom and personal utensils. Isolation should be continued till the 10^th day after developing first symptom or positive RT-PCR test for asymptomatic individuals. Further, additional 3 days without symptoms is advised before terminating the isolation period. Individuals who develop symptoms in the last 3 days period should extend their isolation longer. The people with severe symptoms should get help in COVID treating facilities around them. Clinical management of COVID-19 is providing supportive care and symptomatic treatment. Antiviral like Remdisevir and corticosteroids along with fluid management, oxygen has been seen helpful for critically ill patients (CDC, 2020).   

The Health Emergency Operation Center (HEOC) of Nepal has given us guidelines to stay safe and protected during this period. The guideline includes advice on using mask, avoiding crowded places, frequent hand washing for at least 20 seconds with alcohol-based hand rub containing 60% or more alcohol or soap and water, social distance of at least 1 meter distance from others. The mask worn should cover nose, mouth and should be secured over the chin avoiding any gaps between face and mask for effectiveness. Further, the mask is advised to change daily and the used mask should be discarded in a closed bin to avoid contamination. Quarantine is advised for people who have a known exposure to infected people for 7 days. Fully vaccinated individuals can however, stay protected and watch for symptoms {Health Emergency Operation Center (HEOC), 2020}.

 In general, evidence shows that restricting the movement of people and goods during public health emergencies is ineffective on long run situations. As restrictions may interrupt needed aid and technical support, may disrupt businesses, and may have negative social and economic effects on the affected countries. However, in certain circumstances, measures that restrict the movement of people may prove temporarily useful, such as in settings with few international connections and limited response capacities WHO emphasizes on crucial preventive measures like public health preventive measures like vaccination, hand washing, social distancing, travel restrictions, early case detection, contract tracing and quarantine (WHO, 2020).

 The first case detected in Nepal was on January 23. Although the virus has very high transmission rate, Nepal didn’t get its second case until March 23. Nepal had initiated several preventive measures such as strengthened the health desk in International and other airports, closing border, quarantining and physical distancing.  In Nepal, for the management of pandemic the country added 150 hospitals as designated COVID hospital. Measures including a country‐wide lock down beginning in march 24 and development of IEC(Information, education and communication) has been developed with a motive of spreading awareness and been broadcasted via radio, television, internet to prevent community level transmission {Ministry of Health and Population (MOHP),2021}.

 The containment of the disease is possible only with the change in behaviors as preventive measures. A well‐aware public about the COVID‐19, its, could be one of the best strategies to prevent and slow transmission. Therefore, for effective planning and implementation of preventive measures, it is crucial to examine the awareness and attitude of Nepalese population during COVID19 outbreak ( poudel, shrestha, karmacharya & pathak, 2020). How well do people know about the infection and their perception of illness is essential to control the infection (Asraf, garima, singh, ram & tripti, 2020).