The relevance of masks, discussion on countries that have successfully contained the spread of COVID-19, and recent WHO announcement.
Facing the New World: A COVID-19 Reality Part 5
Written by: Kavya, Akshaya, Haritha
As we all know, COVID-19 is spreading like wildfire. The rapid rate at which COVID-19 has been spreading, especially in the United States, is a major cause for concern. Several countries have successfully curtailed the spread of the disease by adhering to various social methods including contact tracing. It is imperative that we learn from those countries in order to return to the ‘normal’ world and decrease the number of deaths caused by COVID-19. Here we discuss contact tracing, the countries that have been successful in combating COVID-19, and the recent WHO announcement on COVID-19 and its role in our future realities.
What is contact tracing and why is it important?
Contact tracing involves identifying people who have contracted the disease and working with them to identify people they might have come into contact with to help curtail the spread of the disease (1). There are several steps involved in contact tracing: the first is to identify the people who are infected and then interview them to find out who they have been in contact with (1). The second step is to contact those who have had contact with the infected person for potential exposure and to refer them for testing (1). It is then essential for these people to monitor their symptoms for COVID-19 and make sure that they quarantine themselves. During this 14 day home-quarantine period, they should be made aware of the resources and services available to them (1). Contact tracing is so important simply because it is the best tool available to us in the absence of a vaccine to lessen the impact of the outbreak.
What measures did the countries with the highest COVID-19 cases fail to adhere to?
Countries such as the U.S. have been unable to control the high number of cases being reported in recent weeks as a result of inadequate measures being taken. To further explain, the inability to control and contain the outbreak of COVID-19 is because these countries have not enacted proper and necessary regulations, and did not accomplish this soon after the warning of a pandemic. Secondly, there has been fairly weak enforcement of these rules, which have led individuals to refrain from following and respecting the reasons for why they have to “sacrifice their freedom.” There have been shelter-in-place restrictions that were issued, but in several places around the U.S., businesses and other public spaces were reopened before having to close down again. The proper use of contact tracing would allow for better limitation and control of the spread of COVID-19, as individuals in contact with the infected person are much more easily identified and tested for. Enforcing proper guidelines backed by scientific evidence to suppress the spread of this virus will eventually start to decrease the number of cases in these countries.
Countries that have succeeded: What have they implemented?
Generally, countries which have responded carefully to the pandemic have limited the direct and indirect impacts of the pandemic; they didn’t try to choose between either one. Such countries have avoided the exchange of having a high mortality and a high socioeconomic impact of the pandemic (3). One country which has succeeded in properly taking measures to reduce the impacts of COVID-19 is New Zealand, which brought the number of cases down and has been able to open up the country internally (3). Being an island nation, the country was able to almost entirely prevent the outbreak, similar to other island nations such as Taiwan, Australia and Iceland (3). Other than island nations though, several other countries have been able to reduce the impacts of the virus. Some of these countries are Norway, Uruguay, Switzerland, South Korea, and Germany, which have had a smaller, direct impact (3). They were able to reduce indirect impacts because they enacted lockdown measures earlier during the pandemic.
Let’s dive deeper into some of the policies and regulations these countries have implemented as a response to the spread of COVID-19 in order to learn what we can apply, and to understand the varying effects of the virus on different countries.
South Korea
South Korea is one of the countries which was able to quickly flatten the curve of the epidemic without having to negatively impact the economy by closing off businesses. They took the initiative to implement necessary regulations quickly enough, by enforcing stay-at-home orders, and other stricter measures which other high income countries have also come to utilize (4). According to the epidemic preparedness and response framework, they employed three phases: detection, containment, and treatment through collaboration of the government and the scientific community (4). In terms of detection, South Korea created many testing centers and new screening clinics around the country to allow for many individuals to be aware of their conditions. They were able to administer 15,000 to 20,000 tests every day (4). Moving onto the next phase, the country focused heavily on isolating patients with COVID-19 and used contact tracing with many epidemiological intelligence officers for the best tracing efforts (4). For treatments, South Korea has built temporary hospitals and increased supplies of PPE, as well as increased the number of available health workers to meet the demands they were facing (4). The quick response to COVID-19 was seen as a result of the inadequate response from the country when it experienced the impacts of the MERS virus in 2015, where the government was able to work with the Ministry of Health and Korean Centers for Disease Control and Prevention to create proper reforms to the health system (4). For more information about how South Korea came to be such a successful country against the COVID-19 pandemic, please click here.
Germany
As opposed to South Korea, Germany utilized four different phases of preparedness and response framework (5). Additionally with detection, containment, and treatment, they also used prevention. The country has a strong enabling environment with a good healthcare system, expert scientific institutions, and protocols which helped to further the response to COVID-19. They were not able to prevent the outbreak completely, but were able to quickly contain it. Germany's capacity to administer many tests has caused it to become a leader in tests per confirmed case in the European Union (5). This has helped reduce the number of deaths by creating a better containment strategy for the elderly. Prevention techniques were formed by bringing together health authorities and scientific institutions including the Robert Koch Institute in order to obtain data and understand the epidemiology behind the virus (5). In terms of detection, “one of the first diagnostic tests for COVID-19 was developed at Berlin’s Charité hospital, and the government worked to mobilize the country’s public and private laboratories to rapidly scale up testing capacity,” and “...later, Germany became a pioneer in polymerase chain reaction (PCR) testing, which continues to feature prominently in the national strategy” (5). Germany was able to contain the virus with the implementation of long-term care facilities, even though it has a larger population of older people (5). Additionally, the country, with its many facilities, was able to quickly act and prevent a huge outbreak internally. Even after Germany relaxed some of its social distancing policies, there has not been an increase in cases. For more information about what Germany is doing to prevent the virus and detailed, contextual information, click here.
Vietnam
From the beginning, Vietnam has not had many cases amongst its people, due to their “...well-developed public health system, a strong central government, and a proactive containment strategy based on comprehensive testing, tracing, and quarantining” (6). Vietnam used the methods of detection and containment of COVID-19 to prevent a heavy case-fatality rate and number of cases by increasing testing in specific areas and following three degrees of contact tracing (for positive cases). In order to contain the virus in a quick and organized manner, every positive individual was required to stay in quarantine centers which were taken care of by the government, keeping transmission at a low rate (6). Areas of higher transmission were additionally locked down. Similar to Korea, Vietnam followed through with swift action because of its experience with SARS in 2003, as well as avian influenza from 2004 to 2010 (6). The country was able to use this experience and its infrastructure in order to properly act when the outbreak spread on a global scale. For more information about Vietnam’s actions toward containment of COVID-19, click here.
From understanding what other countries which have been able to take proper and informed decisions to prevent and contain the virus, other countries which have been struggling to do so can learn and work to improve their own conditions. For example, we can learn to employ some of the preparedness methods to reduce the spread of the virus, and better enforce some of the much-needed regulated policies. Simple acts in changing your lifestyle can go a long way, as social distancing and wearing a mask have been shown to reduce transmission rates greatly. It is important to recognize that while government policies and actions have great effects on containing the virus, each of us is responsible for following the protocols issued by the scientific community even if they are loosely enforced to ensure the safety of our communities. We need to treat this from a bottom-up perspective (individual to the collective community) rather than a top-down approach (rather than administration to the local governments).
Do N-95 respirator masks, Surgical masks, Cloth coverings actually protect us?
There are many different types of masks to choose from depending on the situation. N-95 respirator masks and surgical masks are two of the most popular options for health professionals. What is the difference between these types and do they actually protect us?
N-95 masks
N-95 masks are designed to achieve a very close fit. These masks are tight and form a seal around the nose and mouth. They are mainly effective against aerosol particles. The biggest drawback is that these masks can cause suffocation for those who have chronic cardiac or respiratory problems. They also tend to cause a lot of heat buildup within the mask. This issue can be solved by using masks with exhalation valves, however, masks with valves should not be used in a sterile environment. Additionally, N-95 masks are not suitable for children or people with facial hair (7).
Surgical masks
Surgical masks, on the other hand, are loose fitting and may come with or without a face shield. The main purpose of these masks is to serve as a barrier to splashes or splatter from liquids containing germs like viruses and bacteria. They also help reduce saliva secretions and respiratory droplets from the wearer’s nose and mouth into the air around them. Surgical masks are made in different thicknesses to protect against different types of liquid secretions. Since they are loose fitting, however, they do not provide complete protection against germs and contaminants. The bottom line: surgical masks and N-95 masks are meant to provide barrier protection if worn properly. Surgical masks are loose fitting and mainly protect from liquid splashes whereas N-95 masks are tight fitting and protect from aerosol particles.
Cloth coverings/masks
The CDC recommends anyone above the age of 2 who isn't from the same household to wear cloth coverings/masks. They have been shown to ease the spread of COVID-19 especially in public places where social distancing measures are hard to maintain (8). They work by preventing respiratory droplets from traveling into the air and onto other people who can inhale them by holding these droplets within the cloth mask when the wearer sneezes, coughs or talks. They are; however, not a substitute for PPE in settings where PPE are required like hospitals and healthcare situations (8). Cloth masks do not provide as much protection as surgical or N-95 masks, but are a much better alternative to not wearing any mask.
WHO announcement and the New Reality:
On July 9th, Tedros Adhanom Ghebreyesus, Director and General of WHO (World Health Organization), announced that an Independent Panel for Pandemic Preparation (IPPP) will be formed in order to study the pandemic response around the world as well as gain insight for structuring protocols and guidelines to effeciently combat future pandemics (11). This panel will be involved in compiling data from around the world and ensuring that countries are making proper efforts in alleviating pandemic conditions.
WHO also discusses recent research conducted. The research suggests that COVID-19 can be airborne in transmission as well. In the early days, airborne transmission was viewed with skepticism as there was not enough evidence to support it. WHO recognizes four modes of transmission including contact and droplet, airborne, fomite, and other biological transmissions (10). Contact and droplet transmission refers to direct contact with an infected person. Fomite transmission refers to the contamination of surfaces that may be present for long periods of time depending on the environmental conditions (10). Other biological transmissions include urine and feces contact from an infected person. Let’s talk more in depth about airborne transmission.
Airborne transmission by definition means that the pathogen remains infectious in the air and is able to spread through the air over some distance and time (10). This mainly concerns aerosols formed during medical procedures. These aerosols evaporate in the air and then when inhaled can directly enter the respiratory tract. Although some studies suggest that COVID-19 may spread through the air during normal speech, there has been no concrete evidence for this as of yet. More studies have to be conducted in order to determine whether air transmission occurs significantly through normal speech. Therefore, it is important to wear PPE when in public as air transmission remains a possibility and can infect someone as they simply breathe in air.
It has been six months since the beginning of the pandemic and we have all seen tremendous changes in how the world operates. We can’t help but wonder what our world will be like after COVID-19. Clearly, the pandemic has brought out underlying issues of our society into the spotlight. Economies will have to adopt different strategies as remote work is favorable. Much of the entertainment industry was hard hit and must accommodate online platforms in order to sustain. Governments need to create sustainable ways to aid unemployed workers. Reliance will be placed on technological innovations and governments will need to ensure that collective efforts between industry and individuals are made to support each other in an inclusive environment. Ian Bremmer, president and founder of Eurasia Group, states that there will be deglobalization where companies will start to move towards localizing business and favoring regional business chains as compared to business abroad, where more regulations are likely to be enforced (9). It’s also likely that virus screening will be implemented for years to come, states Sergio Rebelo, professor at Kellogg School of Management at Northwestern University (9). There will be a lot of demand to detect infections as early as possible in order to avoid global pandemics, especially at international airports.
Despite all the suffering we must endure, the pandemic has helped us realize what is truly essential in our lives. Through these hard times, we are able to reflect upon our actions in society as well as on the environment. We are taught to live mindlessly in a fast-paced society that it is almost impossible to realize our effect on the world around us. The slowdown caused by the pandemic has helped create an awareness of the choices we must make in order to sustain our world. We hope that our priorities will remain as strong once we return to the new normal.
References:
Emerging COVID-19 success story: South Korea learned the lessons of MERS
Emerging COVID-19 success story: Germany’s strong enabling environment
Emerging COVID-19 success story: Vietnam’s commitment to containment
Transmission of SARS-CoV-2: implications for infection prevention precautions
Independent evaluation of global COVID-19 response announced
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