How is the COVID-19 pandemic evolving?

Origins and impact

In December 2019, a novel coronavirus, SARS-CoV-2, was identified as the cause of an outbreak of viral pneumonia in Wuhan, China. The disease, later named coronavirus disease 2019 (COVID-19), rapidly spread globally and was subsequently declared a pandemic by the World Health Organization.

This novel virus presents particular threats: there is no known pre-immunity, no available vaccine, limited treatments are available, and the virus is manifesting as being highly contagious. Recent experience with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which also are caused by coronaviruses, has helped healthcare systems prepare for COVID-19. However, the virulence of COVID-19 has left many healthcare systems exposed, and unable to deal with a pandemic on this scale.

COVID-19 has tested all members of society but particularly healthcare workers, who are facing the risks of the virus as well as bearing witness to suffering and distress. The spread of COVID-19 is unprecedented and healthcare systems are battling to respond. Countries around the world have shut borders and moved to social distancing to limit spread. This has had disastrous effects on economies around the world, as unemployment soars and stress and anxiety increases.

There is a rapid race around the world to develop a vaccine and to develop appropriate treatments. However, until these strategies are available, we are left with having to implement public health strategies, such as handwashing, social distancing and wearing masks. Many of these strategies have been practiced for decades by nurses.

Testing and tracing

Testing is widely advocated as a means both to understand and to slow the spread and impact of the virus. Tests allow us to identify infected individuals, take steps to isolate those infected, and help in the tracing and quarantining of their contacts. Testing for COVID-19 also informs our understanding of the pandemic. For example, several studies have demonstrated that many individuals test positive for the symptom before declaring symptoms. At time of writing, there are two tests available: one for the presence of the virus, establishing whether an individual is currently infected, and the other for the presence of antibodies. However, many countries have been unable to initiate widespread testing and contact tracing.

Managing infection rates

The shortage of personal protective equipment (PPE) has been a concern to nurses globally and has been implicated in infections and spread. This is the case in many high income countries and the world watches and waits for how the pandemic will impact on low and middle income countries (LIMC). For many countries however, data on testing is either incomplete or else unavailable. Similarly, there is a lack of ventilators and other supportive treatments. For LIMC such as in Africa, who are no strangers to epidemics, 1.2 billion people remain at tremendous risk.

As COVID-19 is a new disease, we are learning new information about risk factors and spread every day. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. This includes people with heart, liver and kidney disease and diabetes. People who are immunocompromised, have poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immunotherapy agents are also at an increased risk.

Emerging data suggest a disproportionate burden of illness and death among racial and ethnic minority groups and our understanding of this is evolving. Living conditions may contribute to underlying health conditions and we now see that the impact of COVID-19 has accentuated the impact of social determinants of health. We will be looking more closely at working with vulnerable communities in the next step in the course.

Over to you

• Based on your own experience, are you able to identify the part of your patient population who are experiencing more severe cases of COVID-19?
• What factors do you think might be contributing to these complications?
• How do you think nurses can mitigate these circumstances?

Share your thoughts with other learners in the Comments section.