Critical medical ecology and SARS-COV-2 in the urban environment: a pragmatic, dynamic approach to explaining and planning for research and practice.
- 作者列表："De Ver Dye T","Muir E","Farovitch L","Siddiqi S","Sharma S
BACKGROUND:Practitioners and researchers in the midst of overwhelming coronavirus disease 2019 (COVID-19) outbreaks are calling for new ways of looking at such pandemics, with an emphasis on human behavior and holistic considerations. Viral outbreaks are characterized by socio-behaviorally-oriented public health efforts aimed at reducing exposure and prevention of morbidity/mortality once infected. These efforts involve different points-of-view, generally, than do those aimed to understand the virus' natural history. Rampant spread of SARS-CoV-2 infection in cities clearly signals that urban areas contain conditions favorable for rapid transmission of the virus. MAIN TEXT:The Critical Medical Ecology model is a multidimensional, multilevel way of viewing pandemics comprehensively, rooted simultaneously in microbiology and in anthropology, with shared priority for evolution, context, stressors, homeostasis, adaptation, and power relationships. Viewing COVID-19 with a Critical Medical Ecological lens suggests three important interpretations: 1) COVID-19 is equally - if not more - a socially-driven disease as much as a biomedical disease, 2) the present interventions available for primary prevention of transmission are social and behavioral interventions, and 3) wide variation in COVID-19 hospitalization/death rates is not expected to significantly be attributable to a more virulent and rapidly-evolving virus, but rather to differences in social and behavioral factors - and power dynamics - rather than (solely) biological and clinical factors. Cities especially are challenged due to logistics and volume of patients, and lack of access to sustaining products and services for many residents living in isolation. CONCLUSIONS:In the end, SARS-CoV-2 is acting upon dynamic social human beings, entangled within structures and relationships that include but extend far beyond their cells, and in fact beyond their own individual behavior. As a comprehensive way of thinking, the Critical Medical Ecology model helps identify these elements and dynamics in the context of ecological processes that create, shape, and sustain people in their multidimensional, intersecting environments.
背景: 在大量冠状病毒疾病 2019 (新型冠状病毒肺炎) 爆发中，从业人员和研究人员呼吁寻找新的方法来看待这种流行病，重点是人类行为和整体考虑。病毒暴发的特点是社会行为导向的公共卫生努力，旨在减少暴露和预防一旦感染的发病率/死亡率。这些努力涉及不同的观点，一般来说，比那些旨在了解病毒的自然史。SARS-CoV-2 在城市中蔓延的迹象清楚地表明，城市地区存在有利于病毒快速传播的条件。 正文: 批判医学生态学模型是一种多维、多层次的全面看待流行病的方式，同时植根于微生物学和人类学，对进化、背景、压力源、稳态、适应和权力关系。用批判的医学生态视角看待新型冠状病毒肺炎暗示了三个重要的解释: 1) 新型冠状病毒肺炎与生物医学疾病一样是一种社会驱动的疾病，如果不是更多的话，2) 目前可用于初级预防传播的干预措施是社会和行为干预，以及 3)新型冠状病毒肺炎住院率/死亡率的巨大差异预计不会显著归因于一种毒性更强且快速进化的病毒，而是社会和行为因素的差异-和权力动力学-而不是 (单独) 生物和临床因素。城市尤其受到挑战，因为物流和患者数量，以及许多隔离的居民无法获得持续的产品和服务。 结论: 最终，SARS-CoV-2 作用于动态的社会人，纠缠在结构和关系中，这些结构和关系包括但远远超出了他们的细胞，事实上超出了他们自己的个人行为。作为一种综合的思维方式，批判性医学生态学模型有助于在生态过程的背景下识别这些元素和动力学，这些生态过程创造、塑造和维持人们在多维、交叉的环境中。
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.