Systematic Review of Clinical Insights into Novel Coronavirus (CoVID-19) Pandemic: Persisting Challenges in U.S. Rural Population.
新型冠状病毒 (新型冠状病毒肺炎) 大流行临床见解的系统综述: 美国农村人口的持续挑战。
- 作者列表："Lakhani HV","Pillai SS","Zehra M","Sharma I","Sodhi K
:(1) Introduction. A recent viral outbreak of novel coronavirus (CoVID-19) was declared as a pandemic by the World Health Organization (WHO) due to its global public health concern. There has been an aggressive growth in the number of emerging cases suggesting rapid spread of the virus. Since the first reported case of CoVID-19, there has been vast progress in understanding the dynamics of CoVID-19. However, there is an increasing evidence of epidemiological disparity in disease burden between urban and rural areas, with rural areas having minimal pandemic preparedness and their own healthcare challenges. Therefore, this review aims to provide insight on the pathogenesis and the transmission dynamics of CoVID-19 along with pharmacological and non-pharmacological intervention strategies to mitigate the clinical manifestation of this virus. This review also aims to assess existing challenges of the CoVID-19 pandemic in rural areas based on past pandemic experiences and the effect on rural population. (2) Methods. A literature review was conducted using databases such as PubMed, Science Direct, Academic Search Premier, ProQuest, and Google Scholar, along with information from governmental organizations such as Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO). (3) Results. The causative virus, with its likely zoonotic origin, has demonstrated high pathogenicity in humans through increasing human-to-human transmission leading to extensive mitigation strategies, including patient quarantine and mass "social distancing" measures. Although the clinical manifestation of symptoms is mild in majority of the virus-inflicted population, critical patients may present with pneumonia and acute respiratory distress syndrome, exacerbated by pre-existing comorbidities, eventually leading to death. While effective coronavirus disease (CoVID-19)-specific vaccines and drugs are under clinical trials, several pharmacological and non-pharmacological interventions have been adapted to manage symptoms and curtail the effect of the virus to prevent increasing morbidity and mortality. Several persisting challenges have been noted for mitigating CoVID-19 in rural areas, including the poor healthcare infrastructure, health literacy, pandemic preparedness along with the fact that majority of rural population are frail subjects with pre-existing comorbidities. (4) Discussion. The increasing rate of incidence of CoVID-19 presents its own challenges, burdening healthcare institutions and the global economy, and impacting the physical and mental health of people worldwide. Given the clinical insights into CoVID-19 and the challenges presented in this review for the U.S. rural population, mitigation strategies should be designed accordingly to minimize the morbidity and mortality of this contagion.
(1) 引言。由于全球公共卫生问题，新型冠状病毒最近爆发的新型冠状病毒肺炎 (世卫组织) 被宣布为大流行。新出现的病例数量急剧增加，表明病毒迅速传播。自第一例新型冠状病毒肺炎报告以来，在了解新型冠状病毒肺炎动态方面取得了巨大进展。然而，越来越多的证据表明，城市和农村地区的疾病负担存在流行病学差异，农村地区的大流行准备和自身的医疗挑战最小。因此，本综述旨在提供关于新型冠状病毒肺炎的发病机制和传播动力学的见解，以及减轻该病毒临床表现的药理学和非药理学干预策略。本综述还旨在根据过去的流行病经验和对农村人口的影响，评估农村地区新型冠状病毒肺炎流行病的现有挑战。(2) 方法。使用PubMed、Science Direct、学术搜索Premier、ProQuest和Google Scholar等数据库进行文献综述，以及来自政府组织的信息，如疾病控制和预防中心 (CDC) 和世卫组织。(3) 结果。致病病毒，其可能的人畜共患病起源，通过增加人传人在人类中表现出高致病性，导致广泛的缓解策略，包括患者检疫和大规模的 “社会疏远” 措施。虽然在大多数病毒引起的人群中，症状的临床表现是轻微的，但危重患者可能会出现肺炎和急性呼吸窘迫综合征，并因先前存在的合并症而加剧，最终导致死亡。虽然有效电晕病毒病 (alzheimer's disease，新型冠状病毒肺炎) 特异性疫苗和药物在临床试验中，一些药物和非药物干预措施已经适应于控制症状和抑制病毒的作用，以防止发病率和死亡率的增加。注意到在减轻农村地区新型冠状病毒肺炎方面持续存在的若干挑战，包括卫生保健基础设施差、卫生知识普及、大流行的防备，以及大多数农村人口是身体虚弱的受试者，患有先前存在的合并症。(4) 讨论。新型冠状病毒肺炎发病率的上升带来了自身的挑战，加重了医疗机构和全球经济的负担，并影响了全世界人民的身体和精神卫生。鉴于对新型冠状病毒肺炎的临床见解以及本综述中针对美国农村人口提出的挑战，应相应地设计缓解策略，以尽量减少这种传染病的发病率和死亡率。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.