User:Papa Baiden/MSKFcovidresponse/Pandemic

Pandemic Main Base Article A pandemic (from Greek πᾶν, pan, 'all' and δῆμος, demos, 'people') is simply an outbreak of an infectious disease that has “travelled” to more than one country or region. The rapid spread of disease to a large number of people in only one population or region within a short period of time is called an epidemic.[i] A widespread disease with a stable number of infected people is an “endemic”, not a pandemic. Widespread endemic diseases with a stable number of infected people such as recurrences of seasonal influenza are generally excluded as they occur simultaneously in large regions of the globe rather than being spread worldwide. Definition and stages A pandemic is an epidemic occurring on a scale that crosses international boundaries.[ii] A disease or condition is not a pandemic merely because it is widespread or kills many people; it must also be infectious. For instance, cancer is responsible for many deaths but is not considered a pandemic because the disease is neither infectious nor contagious.[iii] Infection rates in epidemics (and therefore pandemics) follow a distinct bell-curve shape when plotted on a graph showing the number of people infected against time. The epidemic curve is more often than not simply replicated when the epidemic “travels.” Infectious diseases typically spread in three phases like in the graph below.

Figure:1 Graph of the epidemic curve by Toby Morris. TheSpinoff 9 Match 2020 [iv] Phase one occurs at the start of the curve. If one uses the spread of the Covid-19 epidemic as an example, this would mark the beginning of the spread of the disease, when there were only a few confirmed cases. Phase two of the epidemic curve depicts the “community phase". [v] This is when chains of human infections develop as new layers of people are infected. Phase three of the epidemic curve shows that the outbreak has either been brought under control, or that no new infections are possible. Management There are a number of measures states can take to manage the outbreak of a pandemic. In 2005 the World Health Organisation adopted the International Heath Regulations, a legal framework to prevent, control and respond to public health risks that may spread between countries.[vi] Additionally, the World Health Organisation has developed a detailed manual for dealing with influenza pandemics. The manual was first published in 1999 and revised and updated in 2005 and 2009.[vii] Most of the measures used to combat the Covid-19 pandemic were derived from the International Health Regulations 2005 and World Health Organisation influenza pandemic preparedness guidelines. There has been large discussion over 3T’s approach (Testing, Treatment, Tracing) which allows countries to identify upfront as many cases as possible, before isolating and treating them.[viii] The method then involves tracing all people the infected individual has been in contact with, and isolating them. This method has been made popular by the effectiveness of its implementation in places such as South Korea and Singapore, although these states were said to be better prepared with procedures after the disruption caused by SARS. Social distancing, or more accurately physical distancing, is a public health practice which aims to slow down disease transmission by preventing people from coming into close physical contact with each other to limit the opportunities for the transmission of infectious and contagious diseases. Executive Director Dr Michael J Ryan of the World Health Organization said in a press briefing in March 2019 said that physical distancing “is a temporary measure to slow the spread of the virus, and take pressure of the health system, but not to resolve the virus itself. It’s costly, and needs to be used in a combination of other measures to resolve the problem.” [ix] Dr Ryan made clear the distancing itself will not erase the disease. Current Pandemics HIV/AIDS Main article: Epidemiology of HIV/AIDS Although the WHO uses the term 'global epidemic' to describe HIV[x], it is a pandemic strictly following the word’s definition. As of 2018, approximately 37.9 million people are infected with HIV globally. [xi] There were about 770,000 deaths from AIDS in 2018.[xii] Currently, Sub-Saharan Africa is the region most affected. In 2018, an estimated 61% of new HIV infections occurred in this region [xiii] Coronaviruses Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A new strain of coronavirus (SARS-CoV-2) causes Coronavirus disease 2019, or COVID-19.[xiv] Some coronaviruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans, and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. A new strain of coronavirus which originated in Wuhan, Hubei province, China, in late December 2019,[xv] has caused a cluster of cases of an acute respiratory disease, which is referred to as coronavirus disease 2019 (COVID-19). According to the John Hopkins University Dashboard[xvi], almost 200 countries and territories have been affected by COVID-19, with major outbreaks occurring in the United States, central China, western Europe, and Iran.[xvii] On 11 March 2020, the World Health Organization characterized the spread of COVID-19 as a pandemic.[xviii] [xix] As of 23 April 2020, the number of people infected with COVID-19 reached 2.63 million worldwide, the death toll was 184,249 and the number of patients recovered was 722,055.[xx] Notable Outbreaks Malaria Malaria is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa. Each year, there are approximately 350–500 million cases of malaria.[xxi] Drug resistance poses a growing problem in the treatment of malaria in the 21st century, since resistance is now common against all classes of antimalarial drugs, except for the artemisinins [xxii] Malaria was once common in most of Europe and North America, where it is now essentially non-existent.[xxiii] Malaria may have contributed to the decline of the Roman Empire.[xxiv] The disease became known as "Roman fever".[xxv] Plasmodium falciparum became a real threat to colonists and indigenous people alike when it was introduced into the Americas along with the slave trade.[xxvi] Spanish Flu Spanish flu (1918 to 1920) infected 500 million people around the world,[xxvii] including people on remote Pacific islands and in the Arctic, and killed 20 to 100 million people. [xxviii] [xxix] Most influenza outbreaks disproportionately kill the very young and the very old, with higher survival rate for those in between. But the Spanish flu had an unusually high mortality rate for young adults.[xxx] Spanish flu killed more people than World War I did and it killed more people in 25 weeks than AIDS did in its first 25 years.[xxxi] [xxxii] Mass troop movements and close quarters during World War I caused it to spread and mutate faster; the susceptibility of soldiers to Spanish flu might have been increased due to stress, malnourishment and chemical attacks.[xxxiii] Improved transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease.[xxxiv] Concerns about future Viruses Antibiotic resistance Main article: Antibiotic resistance Antibiotic-resistant microorganisms are sometimes referred to as "superbugs". They may contribute to the re-emergence of diseases which are currently well controlled. [xxxv] For example, cases of tuberculosis that are resistant to traditionally effective treatments remain a cause of great concern to health professionals. Nearly half a million new cases of multidrug-resistant tuberculosis (MDR-TB) are estimated to occur worldwide every year.[xxxvi] China and India have the highest rate of multidrug-resistant TB.[xxxvii] The World Health Organization (WHO) reports that approximately 50 million people worldwide are infected with MDR TB, with 79 percent of those cases resistant to three or more antibiotics. In 2005, 124 cases of MDR TB were reported in the United States. Extensively drug-resistant tuberculosis (XDR TB) was identified in Africa in 2006, and subsequently discovered to exist in 49 countries, including the United States. There are about 40,000 new cases of XDR-TB per year, the WHO estimates.[xxxviii] In the past 20 years, common bacteria including Staphylococcus aureus, Serratia marcescens and Enterococcus, have developed resistance to various antibiotics such as vancomycin, as well as whole classes of antibiotics, such as the aminoglycosides and cephalosporins. Antibiotic-resistant organisms have become an important cause of healthcare-associated (nosocomial) infections (HAI). In addition, infections caused by community-acquired strains of methicillin-resistant Staphylococcus aureus (MRSA) in otherwise healthy individuals have become more frequent in recent years. Viral hemorrhagic fevers Viral hemorrhagic fevers are highly contagious and deadly diseases. Examples include Ebola virus disease, Lassa fever, Rift Valley fever, Marburg virus disease and Bolivian hemorrhagic fever. Viral hemorrhagic fevers have the theoretical potential to become pandemics.[xxxix] Their ability to spread fast enough to cause a pandemic is limited because transmission of these viruses requires close contact with the infected person, and the infected person has only a short time before death or serious illness. The short time between the person becoming infectious and the onset of symptoms allows medical professionals to quickly quarantine infected people, and prevent them from carrying the pathogen elsewhere. Zika virus Main articles: 2015–16 Zika virus epidemic, Zika virus, and Zika fever An outbreak of Zika virus began in 2015 and strongly intensified throughout the start of 2016, with more than 1.5 million cases across more than a dozen countries in the Americas. The World Health Organization warned that Zika had the potential to become an explosive global pandemic if the outbreak was not controlled.[xl] References

[i] Principles of Epidemiology, Third Edition (PDF). Atlanta, Georgia: Centers for Disease Control and Prevention. 2012. [ii] Porta, Miquel, ed. (2008). Dictionary of Epidemiology. Oxford University Press. p. 179. ISBN 978-0-19-531449-6. Retrieved 14 September 2012. [iii] A. M., Dumar (2009). Swine Flu: What You Need to Know. Wildside Press LLC. p. 7. ISBN 978-1434458322. [iv] Graphic accessed at: https://thespinoff.co.nz/society/09-03-2020/the-three-phases-of-covid-19-and-how-we-can-make-it-manageable. Accessed on 10 April 2020. [v] Wiles S. The three phases of Covid-19 and how we can make it manageable. TheSpinoff. Available at: https://thespinoff.co.nz/society/09-03-2020/the-three-phases-of-covid-19-and-how-we-can-make-it-manageable. Accessed on 10 April 2020 [vi] See: https://www.who.int/ihr/publications/9789241580496/en [vii] ibid [viii] The 3 T’s model: Hitting the nail on the head, The Jordan times, April 2020 http://www.jordantimes.com/opinion/mohammad-majed-abufaraj/3-ts-model-hitting-nail-head [ix] World Health Organisation March press briefing on Coronavirus, Reuters, 2020https://www.pscp.tv/w/1OdJrqYMXMXGX?t=49m58s [x] "WHO HIV/AIDS Data and Statistics". Retrieved 12 April 2020 [xi] Fact Sheet" (PDF). UNAIDS.org. 2018. Retrieved 12 December 2019. [xii] ^ "UN AIDS DATA2019". UNAIDS.org. 2019. Retrieved 5 December 2019. [xiii] See endnote ‘xi’. [xiv] McArdleColumnistBioBioFollowFollowColumnist, Megan McArdle closeMegan. "Opinion | When a danger is growing exponentially, everything looks fine until it doesn't". Washington Post. Retrieved 15 March 2020. [xv] "WHO Statement Regarding Cluster of Pneumonia Cases in Wuhan, China". WHO. 31 December 2019. Retrieved 12 March 2020. [xvi] COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU), accessed April 23rd 2020: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 [xvii] "Covid-19 Coronavirus Pandemic (Live statistics)". Worldometer. 2020. Retrieved 3 April 2020. [xviii] "WHO Director-General's opening remarks at the media briefing on COVID-19—11 March 2020". WHO. 11 March 2020. Retrieved 12 March 2020. [xix] "Coronavirus confirmed as pandemic". BBC News. 11 March 2020. Retrieved 11 March 2020. [xx] "Covid-19 Coronavirus Pandemic". Worldometer. [xxi] "Malaria Facts". Archived from the original on 29 December 2012. Retrieved 7 September 2017. [xxii] White, NJ (April 2004). "Antimalarial drug resistance". J. Clin. Invest. 113 (8): 1084–1092. doi:10.1172/JCI21682. PMC 385418. PMID 15085184. [xxiii] Vector- and Rodent-Borne Diseases in Europe and North America. Norman G. Gratz. World Health Organization, Geneva. [xxiv] DNA clues to malaria in ancient Rome. BBC News. 20 February 2001. [xxv] "Malaria and Rome" Archived 11 May 2011 at the Wayback Machine. Robert Sallares. ABC.net.au. 29 January 2003. [xxvi] "The Changing World of Pacific Northwest Indians". Center for the Study of the Pacific Northwest, University of Washington. [xxvii] Taubenberger JK, Morens DM (January 2006). "1918 Influenza: the mother of all pandemics". Emerging Infectious Diseases. 12 (1): 15–22. doi:10.3201/eid1201.050979. PMC 3291398. PMID 16494711. Archived from the original on 1 October 2009. Retrieved 7 September 2017. [xxviii] Taubenberger JK, Morens DM (January 2006). "1918 Influenza: the mother of all pandemics". Emerging Infectious Diseases. 12 (1): 15–22. doi:10.3201/eid1201.050979. PMC 3291398. PMID 16494711. Archived from the original on 1 October 2009. Retrieved 7 September 2017. [xxix] "Historical Estimates of World Population". Archived from the original on 9 July 2012. Retrieved 29 March 2013. [xxx] Gagnon A, Miller MS, Hallman SA, Bourbeau R, Herring DA, Earn DJ, Madrenas J (2013). "Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality". PLOS One. 8 (8): e69586. Bibcode:2013PLoSO...869586G. doi:10.1371/journal.pone.0069586. PMC 3734171. PMID 23940526. [xxxi] "The 1918 Influenza Pandemic". virus.stanford.edu. [xxxii] Spanish flu facts by Channel 4 News [xxxiii] Qureshi, Adnan I. (2016). Ebola Virus Disease: From Origin to Outbreak. Academic Press. p. 42. ISBN 978-0128042427. [xxxiv] Spanish flu strikes during World War I, 14 January 2010 [xxxv] Researchers sound the alarm: the multidrug resistance of the plague bacillus could spread Archived 14 October 2007 at the Wayback Machine. Pasteur.fr [xxxvi] Health ministers to accelerate efforts against drug-resistant TB. World Health Organization. [xxxvii] Bill Gates joins Chinese government in tackling TB 'timebomb'. Guardian.co.uk. 1 April 2009 [xxxviii] Tuberculosis: A new pandemic?. CNN.com [xxxix] Fears of Ebola pandemic if violent attacks continue in DR Congo". Al-Jazeera. 23 May 2019. [xl] "Zika virus could become 'explosive pandemic'". bbc.co.uk. 28 January 2016.