The coronavirus pandemic is changing its status very fast. Biological experts and virologists are continually working in coordination with other country health experts to monitor developments and offer additional guidance relating to new virus information.
The virus is an invisible threat, perhaps due to the changes in human behaviors, changing climate, and lack of universal health care. The outbreak that is fast breaking barriers is a wake-up call to authorities as it exposes the vulnerabilities existing in the public health system. New measures have to be in place to help rebuild the health sector. For now, we can use measures such as quarantine and isolation.
To contain the virus, governments should strive to build testing centers in strategic locations. The convenience of testing sites helps because the moment signs of COVID-21 show up, people can quickly get tested and seek possible treatment.
The test and treat approach is the reason why countries like South Korea and China are successfully containing the pandemic. Bring in the United States, and the reverse is true because of a non-coordinated effort on primary health care.
The World Health Organisation (WHO), the American Food and Drug Administration (FDA), and the Center for Disease Control and Prevention (CDC) agree on one thing. No drug or vaccine is available as a cure or has some effectiveness in treating COVID-19.
China gave a guideline that health professionals can use. These guidelines cover screening, epidemiological, treatment, diagnosis, and nursing. This includes direct treatment using antivirals, and the use of 2 capsules of lopinavir twice a day, in combination with alfa-interferon injection. The recommendation relies on previous success stories of using the same medications to manage SARS and MERS.
However, Korean doctors say that antiviral medications are unsuitable for healthy and young patients. The dose works well for old patients whose pre-existing conditions and showing severe symptoms. However, these medications can be used if working with Ribavirin and Interferon prove ineffective.
Remdesivir has been a drug of choice given to several patients with coronavirus in the United States, Japan, and Europe. The clinical trials on the efficiency of Remdesivir are currently taking place in China with the outcome expected in April 2020. In these trials, Remdesivir shows activity against coronavirus with inhibitive properties.
The activities of Remdesivir act as an inhibitor of SARS and MERS, which can replicate in humans as they enter through CoV receptors. The drug has some prophylactic and therapeutic properties against the mouse model with an injection of coronavirus.
Remdesivir has its growing reputation based on the ribonucleic acid (RNA) molecule. Scientists are giving it a high priority because of its positive expectations on cells infected with coronavirus; it responds well to lab rats and primates. It is one of the component drugs in Ebola trials which share some similarities with coronavirus.
Its functionality relates to the adenosine analog that has the RNA chains aiding in early termination; its action is immediate. Remdisvir detects entry of a virus into the host cell, thus inhibiting cell activity.
Sofosbuvir and Ribavirin
Experimental data using RNA from COVID-19 show a tight binding when the two drugs are used in combination to fight the virus. Such an experiment shows that using the two combination drugs could help in the management of coronavirus.
The World Health Organization does not support using corticosteroids in patients tested positive for CORVID-19. The reaction suggests corticosteroids do not increase the chances of survival and could lead to more harm. In China, using corticosteroids is bound to bring some controversies. You can use it but with a lot of caution.
Before the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) become a pandemic, vaccine specialists thought that using chloroquine and hydrochloroquine will have similar effects as it does on middle-eastern respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). Chloroquine has the same effects as hydrochloroquine with mild side effects.
When the two are prescribed as a combination in managing malaria and other autoimmune symptoms, they reduce the cytokine activities in the latter stages of a critically ill COVID-19 patient.
Hydrochloroquine produces a strong reaction when used to manage SARS-CoV-2 in microorganisms. The family name, Betacoronavirus of all the coronaviruses, does not show positive reactions, and that is why some controversies are still in place about using them for SARS-CoV and MERS-CoV. Chloroquine distributes equally throughout the body when taken orally. The drug is affordable and safe, with no side effects.
As a healthy professional, trying your best to match the expectations of the patients and community at large is a tall order. Coronavirus pandemic does not give you much time to reduce the number of casualties it churns every day.
Working in such an environment means handling patients in five different areas:
Health personnel will conduct tests on patients to determine their vulnerability to the coronavirus outbreak. Anytime you deal with a PUI, put on the recommended personal protective equipment (PPE). The PPE should at least have a disposable face shield for one-time use only.
Before dressing in the "work" uniform, health workers are required to practice hand hygiene using a suitable alcohol-based hand sanitizer before and after removing PPE. Dress far away from the patient's home, once testing is done, remove your attire at a distance from that patient and leave them outside for disposal.
Dealing with a person of interest with symptoms but had a previous interaction with a COVID-19 patient, maintain a considerable distance. Get to know her fever levels or if they experience any respiratory difficulties. If the answers given correspond to the PUI threshold, refer the patient for further medical examination.
All tests for COVID-19 should take place in the open if the weather allows. If the same is to take place indoors, make sure the person isolated and the room has proper ventilation. As a medic, be careful when collecting swabs because the action may induce a cough or lead to sneezing. You can perform aerosol-generating procedures as the last thing on a PUI.
At this moment, only patients with COVID-19 infections should have the priority of getting treatment in a clinical setting. Dealing with such patients demands that you know what to expect based on the latest data from China. The information should describe patients in both the intensive care and pediatric unit.
The coronavirus has an incubation period of 4 to 7-days. Patients will show signs of fever, cough, fatigue, and difficulty in breathing. Some patients may record difficulty in breathing as a cough with sputum, headache, and sore throat. Others will show symptoms like diarrhea and nausea before and respiratory difficulties sets in.
When the fever breaks in a patient, it is difficult to tell whether it is full-blown or intermittent.
Information on the effects of COVID-19 on children and infants is scanty. However, some reports indicate children with coronavirus show mild forms of illnesses in the form of fever, coughs, and nasal congestion.
Some patients may require direct admission to intensive care to stabilize their breathing. More testing at the clinical stage give more information the management can use in planning.
Before you decide on whether a patient deserves to get treatment inside or outside the health facility, health workers are advised to look at things like age, underlying illnesses, and pregnancy. The decision to monitor patients at home or in a hospital setting should be on a case-by-case basis. Such decisions rely on clinical data as well as the patient's willingness to self-isolate to avoid the risk of transmission while at home.
Personal protective equipment in a hospital setting include respirators, gowns, facemasks, and eye protection. The government needs to take over the supply of PPE in support of health officials and local doctors. They should ensure that doctors work in a realistic environment. The equipment plays a significant role in the provision of health care by keeping pathogens outside hospitals.
A government that maintains a working health system should have enough pieces of equipment to respond to any pandemic or unexpected demand. Poor public health management, like what we have seen in some countries like the USA and Italy, has led to the surge of coronavirus death-related cases.
Any of these equipment should fulfill the following conditions:
To satisfy these demands now and in the future, the facility must have a system that supports proper inventory to manage the equipment. Proper management enables health providers to deliver the best service. The health center needs to understand that health care relies on the availability of such equipment.
Adequate distribution of PPE is possible if the hospital can manage to control the number of patients coming into their facility. In the face of a pandemic such as a coronavirus outbreak, some facilities services may be put on hold and cater to the immediate cases that require the use of PPEs.
When resolving to give proper care, your PPE must conform to international standards. Some hospitals have reported a lack of necessary pieces of equipment. In such cases, you may resort to using disposable clothing and equipment to serve an urgent need. When there is no clear alternative, you can use reusable patient gowns that you can clean when necessary.
Governments can step in to help health care providers by availing some critical PPE supplies. Surgical masks and face guard are quite vital in keeping the caregivers safe in their line of work.
Prevention or delaying the transmission of coronavirus in isolation centers or homes is a challenge to health care providers. Isolation or social distancing seems to be ideal when dealing with the pandemic, yet we have limited information on how long the virus stays inside the body.
As a health care provider, let your patient know the specifics she has to follow to avoid cross-contamination with close interactions. Proper use of PPE creates a barrier against droplets from patients, thus encouraging you to keep working. Enforce standard precautions on all patients in isolation regardless of their risk status
Patients in isolation may experience loneliness when separation takes place in privacy. Isolation disrupts social relationships and erodes a person's self-esteem after spending an unknown number of days in isolation.
A person who has a COVID-19 infection and is in isolation at the home environment with so many people should go back to the hospital. You may need to discontinue home isolation if, in the last three days, your fever goes down without any medication and no longer experiences difficulty in breathing.
You can step out of isolation when in the previous 7-days, you show no sign of COVID-19 symptoms.
Using this approach will reduce the instances of secondary infections because the risk of infections is low. No patient should leave the isolation ward before all results are out.
The precautions are high in reducing the spread of coronavirus among household members. People in close contact should persistently monitor their progress health-wise and call healthcare centers the moment signs of a viral attack is evident.
People living in close proximity should at least know what to do when one of them gets an infection. Healthcare professionals may find time to help senior citizens get basic supplies. Families living in one house should leave one room for the person under investigation if such an arrangement is available. Otherwise, call the hotline and talk to a health care professional.
It is also advisable to limit the number of visitors coming to visit your home if they do not have a pressing need. Make sure that shared spaces have enough ventilation and flow of air.
Judging by the way the coronavirus pandemic has caught most governments' health off guard, the problem of proper provision of first-line health care will not go away with the virus. Failure to handle these issues as a crisis will leave the in a health crisis leaving millions at the mercy of this virus and any future pandemic.
Following the South Koreans example, other countries should borrow a leaf and think of emphasizing on testing and treating COVID-19 for everyone. In such circumstances, states and governments need to take charge of the health of every citizen now that we have a global problem.
The best a country can offer its citizens is to support research institutions to lead in the production of vaccines. The production of medicine and healthcare should not be left in the hands of private business owners. In the meantime, let us hope everyone is learning from the coronavirus pandemic.