COVID-19Pandemic LessonsfromtheFrontline
Editedby
JorgeHidalgo
GeneralICUandCOVID-19Unit,BelizeHealthcarePartner, BelizeCity,Belize
GloriaRodrı´guez-Vega
DepartmentofCriticalCareMedicine,HIMASanPablo, Caguas,PuertoRico
JavierPerez-Ferna ´ ndez
IntensiveCareSolutions,CriticalCareServices,Baptist Hospital,Miami,FL,UnitedStates
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JorgeHidalgo,GloriaRodrı´guez-Vega,and JavierPerez-Ferna ´ ndez
AlexisU.MacDonald,JohnM.Harahus,ErinHall, MaryJaneReed,andMarieR.Baldisseri
CHAPTER7COVID-19andriskexposureofthefrontline: Heroesormartyrs? ..................................................... 79
MariliaDı ´ az
CHAPTER8COVID-19andsocialmedia ....................................... 85
PatxiPerezFerna ´ ndezandMiguelMorenoArı´ztegui
Introduction...................................................................................85
Thedigitaltransformationofthemedia.Acompromised quality?..........................................................................................86
Paywalls.................................................................................87
Socialmediaandhoaxes.......................................................88
Thevalueoftrueinformation......................................................89
Toolsagainstfalseinformation.............................................90
Policiesandregulations.........................................................91
Scientificsourcestoverifyinformation.......................................92
Thedigitalandtechnologicalplatformsandthepower ofthenetworks.............................................................................94
Thepoliticians’influence......................................................95
Howtocontrolthemediaandinformation..................................95 References.....................................................................................96
CHAPTER9COVID-19andtheroleofmedicalprofessional societies...................................................................... 99
DrewFarmer,JosePascual,andLewisJ.Kaplan
Introduction...................................................................................99
Medicalprofessionalorganizationtypes......................................99
Memberbenefits.........................................................................100
SARS-CoV-2andmedicalprofessionalorganizations..............102 Conclusion..................................................................................105 References...................................................................................106
CHAPTER10NoveltreatmentsandtrialsinCOVID-19 ................. 109
AndrewConwayMorrisandAllisonTong Therapeuticapproaches..............................................................109
Antivirals.............................................................................110
RNA-dependentRNApolymeraseinhibitors.....................110 Proteaseinhibitors...............................................................110
Antimalarials........................................................................110
Antibiotics............................................................................111
Convalescentplasmaandimmunoglobulins.......................111 Antiinflammatories..............................................................111
Immunomodulatorytherapies..............................................112
CHAPTER13Politicsandthepandemic ....................................... 137
MichaelSingh
References...................................................................................146
CHAPTER14Theeffectsofthepandemiconoilservicesand shippingindustry 147
WilliamG.MacDonald
Introduction.................................................................................147
Theoilindustryandshipping.....................................................148
TheeffectsofCOVID-19onoilservices,oillogistics, andshippingindustries...............................................................148
Economicimpactofthelockdownonoilservices, oillogistics,andshippingindustry............................................149
Theeffectoftheoilglutontheworld.......................................149
Thefuture...................................................................................150
Disclaimer...................................................................................150
References...................................................................................150
CHAPTER15MillennialsandCOVID-19 ........................................ 153
BenjaminHidalgo,GeraldMarı´n-Garcı ´ a, EdwinWu,andAllysonHidalgo
Personalexperience,conversationswithapost-COVID-19 patient,andsomequestionstothinkabout................................153
MillennialsandtheCOVID-19pandemic.................................160
Perspectivefromanavidtrainee.........................................160
CHAPTER16COVID-19:Datacollectionandtransparency amongcountries ....................................................... 163
ErwinCalgua
Introduction.................................................................................163
LessonslearnedaboutCOVID-19datacollection....................164
LessonslearnedaboutCOVID-19datatransparency................165
Whatcouldbeimplementedtoimprovedatacollection forCOVID-19.............................................................................166
Whatcouldbeimplementedtoimprovedatatransparency forCOVID-19.............................................................................169
Conclusion..................................................................................170
References...................................................................................170
CHAPTER17BrazilianbattleagainstCOVID-19 ........................... 173
FernandoSuparreguiDias,RegisGoulartRosa,and CiroLeiteMendes
Whenandhowdidthesevereacuterespiratorysyndrome coronavirus2pandemicbegininBrazil?..................................173
Psychologicalburdens................................................................201
CHAPTER20COVID-19pandemicinIndia .................................... 205
KapilZirpeandSushmaGurav
Othermeasures...........................................................................207
Pitfallsofourapproach..............................................................208 Futureplan..................................................................................209
CHAPTER21LifeafterCOVID-19:Futuredirections? 211
PravinAmin
Introduction.................................................................................211 Earlierpandemics.......................................................................212
Contributors
PravinAmin
BombayHospitalInstituteofMedicalSciences,Mumbai,India
MiguelMorenoArı´ztegui Advisor,ThePresidentoftheGovernmentofNavarra,Pamplona,Spain
MarieR.Baldisseri
DepartmentofCriticalcareMedicine,UniversityofPittsburghMedicalCenter, GlobalHealthandDisasterMedicine,Pittsburgh,PA,UnitedStates
NataliaLargaespadaBeer MinistryofHealth,Belmopan,Belize
ErwinCalgua
ResearchCenterofHealthSciences,SchoolofMedicine,UniversityofSanCarlos ofGuatemala,GuatemalaCity,Guatemala
Marı´aCruzMartı´nDelgado IntensiveCareUnit,HospitalUniversitariodeTorrejo ´ n;UniversidadFranciscode Vitoria,Madrid,Spain
FernandoSuparreguiDias
HeadCriticalCareDepartment,HospitaldoCirculo,CaxiasdoSul,RS,Brazil
MariliaDı ´ az HospitalAuxilioMutuo;UniversidadSagradoCorazo ´ n,SanJuan,PuertoRico
DrewFarmer
PerelmanSchoolofMedicine,UniversityofPennsylvania,DivisionofTrauma, SurgicalCriticalCareandEmergencySurgery,Philadelphia,PA,UnitedStates
PatxiPerezFerna ´ ndez
President,TheAssociationofJournalistsofNavarra,Pamplona,Spain
DanielGodinez InternalMedicine,BelizeHealthcarePartnersLimited,BelizeCity,Belize
DeepaB.Gotur
DepartmentofMedicine,HoustonMethodistHospital,Houston,TX;WeillCornell Medicine,NewYork,NY,UnitedStates
SushmaGurav
RubyHallClinic,Pune,Maharastra,India
ErinHall DepartmentofTraumaSurgery,GeisingerMedicalCenter,Danville,PA,United States
JohnM.Harahus
GeisingerBiocontainmentUnit,GeisingerMedicalCenter,Danville,PA,United States
AllysonHidalgo
Biochemistry,ArizonaStateUniversity,Phoenix,AZ,UnitedStates
BenjaminHidalgo HealthScience,Phoenix,AZ,UnitedStates
JorgeHidalgo
GeneralICUandCOVID-19Unit,BelizeHealthcarePartner,BelizeCity,Belize
StevenH.Hsu
DepartmentofMedicine,HoustonMethodistHospital,Houston,TX;WeillCornell Medicine,NewYork,NY,UnitedStates
LewisJ.Kaplan
PerelmanSchoolofMedicine,UniversityofPennsylvania,DivisionofTrauma, SurgicalCriticalCareandEmergencySurgery,Philadelphia,PA;SocietyofCritical CareMedicine,MountProspect,IL,UnitedStates
RyanJ.Logue
DepartmentofMedicine,HoustonMethodistHospital,Houston,TX,United States
DeenaLynch
Brisbane,QLD,Australia
AlexisU.MacDonald
DepartmentCriticalCareMedicine,GeisingerMedicalCenter,Danville,PA, UnitedStates
WilliamG.MacDonald
TheBritishEastIndiaCompanyLimited,Birkenhead,Merseyside,United Kingdom
GeraldMarı´n-Garcı ´ a CriticalCare-EmergencyMedicinePhysician,VACaribbeanHealthcareSystem, SanJuan,PuertoRico
CiroLeiteMendes
HeadIntensiveCareUnit,HospitalLauroWanderley,UniversidadeFederalda Paraı´ba;HeadIntensiveCareUnit,HospitalNossaSenhoradasNeves, JoaoPessoa,PB,Brazil
AndrewConwayMorris
DivisionofAnaesthesia,DepartmentofMedicine,UniversityofCambridge; JohnVFarmIntensiveCareUnit,Addenbrooke’sHospital,Cambridge, UnitedKingdom
ObashinaOgunbiyi
IntensiveandCriticalCareSocietyofNigeria,BeninCity,Nigeria
JosePascual
PerelmanSchoolofMedicine,UniversityofPennsylvania,DivisionofTrauma, SurgicalCriticalCareandEmergencySurgery,Philadelphia,PA,UnitedStates
LornaPerez
MinistryofHealth,Belmopan,Belize
JavierPerez-Ferna ´ ndez
IntensiveCareSolutions,CriticalCareServices,BaptistHospital,Miami,FL, UnitedStates
MaryJaneReed
GeisingerBiocontainmentUnit,GeisingerMedicalCenter,Danville,PA,United States
GloriaRodrı´guez-Vega
DepartmentofCriticalCareMedicine,HIMASanPablo,Caguas,PuertoRico
RegisGoulartRosa
IntensiveCareUnitandResearchProjectsOffice,HospitalMoinhosdeVento, PortoAlegre,RS,Brazil
MichaelSingh
OfficeofthePrimeMinisterofBelize,Belmopan,Belize
JacquelineY.Steuer
ManagerCriticalCareServicesAPNteam;NorthShoreUniversityHealthSystem, Evanston,IL,UnitedStates
RishiSuresh
TexasA&MSchoolofMedicine,CollegeStation,TX,UnitedStates
AhmedRedaTaha
ClevelandClinicLernerCollegeofMedicine,CaseWesternReserveUniversity, CriticalCareInstitute,ClevelandClinicAbuDhabi,AbuDhabi,UnitedArab Emirates
AllisonTong
SydneySchoolofPublicHealth,TheUniversityofSydney,Sydney,NSW, Australia
LailaWoc-Colburn
DivisionofInfectiousDiseases,EmoryUniversitySchoolofMedicine,Atlanta,GA, UnitedStates
EdwinWu
IntensiveCareSolutions,BaptistHospital,Miami,FL,UnitedStates
KapilZirpe
RubyHallClinic,Pune,Maharastra,India
Preface
Bytheendof2019,theworldwitnessedtheappearanceofanewstrainofviruscausingrespiratoryandsystemicillnessintheregionofWuhan,China.Progressively, mediaattentiongrewtothatareaandnewswerebeingwatchedwithconcernby someandskepticismbyothers.However,itwasnotuntilthelatestFebruaryand thebeginningofMarch2020,whentheinfectionspreadtoEuropeandtheUnited States,thattheworldstartedtofocusattentiontothisdisease.Eventhen,themedia andpublicopinionweredividedintotheneedsorappropriatenessoftheresponses thatdifferentcountriesweredevelopingabouttheconvenienceofborderclosuresor theimplementationofquarantinefortravelersorevenclosecontacts.
Theyearof2020hasbeenonethathumanitywillrecallasa“darkone,”notonly bytheCOVID-19pandemicbutalsobytheerratic,disorganized,andsometimes misdirectedresponseofpublicauthorities,media,andprivateindividuals.Aconglomerateofopinions,thelackofevidencetoformulatehealth-carepoliciesand responses,andthefeelingoftheabsenceofinternationalcooperationhavebeen themarkersofthisyear.Theserepresentamotivetolearnandevolveforfuture eventstocome.
LessonsfromtheFrontLine exploressomefirst-handexperiences,fromthose whohavebeeninvolvedinthisfight,inthefirstlineoftheresponse,fromthose whohavesufferedthedisease,andfromthosewhohavebeenaffecteddirectlyor indirectlybytheCOVID-19andwhoseliveshaveabruptlychanged.Withtheexperiencesandopinionsreflectedonthebook,wewouldliketomakeacallforattention tosomeaspectsthatneedseriousimprovementtocopewithfuturedisasters,hopefullynottobeseensoon.
Wehaveexploredtheimpactofthepandemicintotheeconomywiththepolitical ramificationsthathavebeeninvolvedinsomepoliciesinvokedinthenameofhealth butquestionableintheirmotivesandimplementations.Wehavealsoreflectedthe experiencefromthosewhohaveworkedfrontline,theiropinions,theirsorrows, andtheirsuggestionsonhowtoimproveourhealth-caresystemlocally,regionally, andbeyondborders.Weechoedthethoughtsofthosewhohavesufferedthedisease andrenderedtheirinsidefeelingsintothesepages.Wehaveconveyedthevoiceof mediaprofessionals,concernedabouttheerraticandsometimesmisleadinginformationappearingeverywherewithaspecialmentiontosocialmediathathasrevealed anincrediblevaluefortrueandfakenews.Finally,wehaveincorporatedthevoiceof theprofessionalsocietiesandadministrationsinanattempttoconsolidateandorganizefutureefforts.
Webelievethatthe LessonsfromtheFrontLine isawindowdisplayofthejourneythattheworldhasengagedin2020,ayearthatbroughtupchallenges,confusion,
deception,andthegreatestspiritofmankind.We,theeditors,believethathumanity haslearntfromourmistakesandthattheyear2020hasmadeusstronger,andwesee inalltheseprocessesaglimmerofhopeforourhumanrace.Togetherwefight, togetherwewin.
JavierPe ´ rez-Ferna ´ ndez,MD
JorgeHidalgo,MD
GloriaRodrı´guez-Vega,MD
Thesuddenappearance ofSARS-CoV-2 1
JorgeHidalgoa,GloriaRodrı´guez-Vegab,andJavierPerez-Ferna ´ ndezc
aGeneralICUandCOVID-19Unit,BelizeHealthcarePartner,BelizeCity,Belize, bDepartmentof CriticalCareMedicine,HIMASanPablo,Caguas,PuertoRico, cIntensiveCareSolutions,Critical CareServices,BaptistHospital,Miami,FL,UnitedStates
Introduction
Numerousviralinfectionshaveriseninthelastdecades,causingseverediseases associatedwithlethality.Diseaseshavevariedinepidemiologyandmorbidity althoughpeoplewithriskfactorssuchasage,cardiovasculardiseases,diabetes, andotherchronicdiseaseshavemostcommonlysufferedmoreseriousconsequences.Theworldpopulationisagingandsoistheprevalenceofnoncommunicablediseases.Thus,thepotentialgroupofpeople,whoarethemostatriskof sufferingmajorconsequencesifinfectedbyavirus,isvast.Onesuchexampleis thenovelcoronavirus(nCoV),identifiedinWuhan,China,whichwasisolatedon January7,2020,causingseverepneumonia.1
Thischapteranalyzestheemergence,firstoutbreaksoutsideChina,andtheepidemiologydataandmodelsthathasguidedpublichealthpolicies.TheperiodcoveredinthischapterhadincludedthefirstnotificationofcasesbyChinauntilthe declarationofapandemicbytheWorldHealthOrganization(WHO)onFebruary 11,2020.Thischapteralsodescribessomeofthesimilaritiesbetweenthisvirus andpreviouscoronaviruses(CoVs)likesevereacuterespiratorysyndrome (SARS)-CoV(2002)andmiddleeastrespiratorysyndrome(MERS)-CoV(2012).
Theancestors:Coronavirusandhumans
CoVs,alargefamilyofsingle-strandedRNAviruses,havebeencirculatingonEarth forcenturies.WhileCoVsarewidelydetectedinbats,othermammals,birds,and reptiles,CoVsareseldomseeninhumanscausingmainlymildrespiratoryinfections. Itwasnotuntilthefirstdecadeofthetwenty-firstcenturywiththeappearanceofthe SARSoutbreakthattheirclinicalimportancewasrecognized.
CoronaviruseshavethelargestknownRNAgenome,withasizeof27–32kb.The spikeglycoprotein(S)protrudesfromthesurfaceoftheviralparticle(hencethe
COVID-19Pandemic. https://doi.org/10.1016/B978-0-323-82860-4.00004-5 Copyright # 2022ElsevierInc.Allrightsreserved.
name“coronavirus”)andisresponsibleforreceptorbindingandmembranefusion. Therefore,itisbelievedtorepresentakeydeterminantofhostrangerestriction.2
TherearefourmainsubgroupsofCoVs,namelyalpha,beta,gamma,anddelta. HumanCoVswerefirstidentifiedinthemid-1960s.CommonhumanCoVsare endemicgloballyandcausingmildrespiratorydiseaseare229E(alphaCoV), NL63(alphaCoV),OC43(betaCoV),andHKU1(betaCoV.Theytendtobetransmittedpredominantlyduringthewinterseasonintemperateclimatecountries;they arewelladaptedtohumans,andnonehavebeenfoundtobemaintainedinananimal reservoir.3,4
Onthecontrary,SARS-CoVandMERS-CoVaremostlybasedonzoonotic reservoirs,withoccasionalspilloverin tothesusceptiblehumanpopulation,possiblyviaanintermediatehostspecies.Thus,inthefirstyearsofthiscentury, SARS-CoVdemonstratedthatanimalCoVshavethepotentialtocrossoverspeciestohumans.Inthelate2003,angiotensin-convertingenzyme2wasidentified asthereceptorofSARS-CoVonthesurfac eofhumancells,allowingthespillover intohumans.5
TheindexcasesofmanyoftheseSARS-CoVearlycaseclusters(fromNovember 2002toJanuary2003)werefoodhandlersworkinginrestaurantswhereavarietyof exoticanimalswereslaughteredonthepremises.6 InFebruary2003,theChinese MinistryofHealthannouncedthestrangeoutbreakofanatypicalpneumoniain theGuangdongProvinceofsouthernChina.Newsofthis“mysterious”disease spreadfast,asdidthedisease.Duringsubsequentweeks,theoutbreakbecame self-sustaining,withclustersoftransmissioninhospitalsspillingbackintothecommunity.TheidentificationoftheSARS-CoVdidnothappenuntilalmostthree monthslater(April2003).7
SARSspreadsrapidlyalongroutesofairtravel,affecting25countriesandterritoriesacrossfivecontinents,withanestimated8096casesandatleast774deaths (casefatalityrate 10%).TheoutbreakcontinueduntilJuly2003,whentheWHO declared“allknownchainsofhuman-to-humantransmissionoftheSARSvirusnow appeartobebroken.”8 SARSwaslesstransmittableinthefirstdaysofillness,leadingpatientstobemoreinfectiousastheybecamemoresymptomatic,providingan opportunityforcasedetectionandisolationtointerrupttransmission.However,the highertransmissionbyseverepatientshascontributedtotransmissioninhospitals, especiallywhentheyunderwentaerosol-generatingprocedures.TheSARS-CoVwas alsounusuallylastingonsurfaces,moresothanotherCoVsorotherrespiratory viruses,makinginfectioncontrolinhospitalsachallenge.9 Asawarenessgrew, patientsbegantobeidentifiedandhospitalizedearlierintheillness,andaseffective infectioncontrol,modalitieswerebetterimplemented,itbecamepossibletointerrupttransmissioninthecommunityandhospitals.10
Thezoonoticsourceoftheviruswasidentifiedaftertheoutbreakended;the investigationsledtothedetectionofthevirusinarangeofmammalianspeciesavailableinthewetmarkets.Peopleworkinginthesemarketshadahighprevalenceof antibodiestoSARS-CoV,evenwithoutahistoryofhavingSARS.SARS-CoV crossedthespeciesbarrierintomaskedpalmcivetsandotheranimalsinlive-animal
marketsinChina;geneticanalysissuggestedthatthisoccurredinthelate2002.SeveralpeopleincloseproximitytopalmcivetsbecameinfectedwithSARS-CoV.11
TheemergenceofSARSin2003demonstratedtheinterconnectionoftheworld andhowrapidlyanewdiseasecanspread,duetotheexponentialincreaseininternationaltravelandtrade.Thatimpulsedtheneedtoreviewinternationalmechanisms formonitoringandcontrolofemergingdiseases;notonlyforthefourseriousinfectiousdiseasesincludedintheoriginalInternationalHealthRegulations(IHR)from 1969.12 In2005,theWorldHealthAssembly,representing196countries,agreedto implementtherevisedIHRasacommitmenttobuildtheircapacitiestodetect, assess,andreportpublichealtheventsunderabroaderrangeofpublichealthemergencyofinternationalconcern(PHEIC).TheWHOplaysthecoordinatingrolein IHRand,togetherwithtechnicalpartners,helpscountriestobuildtheircapacities todetectandcontainpublichealthhazards.
AlmostadecadelateroftheSARS-CoV,anewCoVemergedinSaudiArabiain 2012,subsequentlynamedMERS-CoV.MERS-CoVisabeta-coronavirus,likethe SARS-CoV.Itcausesseverepneumoniaaswellasrenalfailure.Indexcaseshave originatedintheArabPeninsula(Jordan,Qatar,SaudiArabia,andtheUnitedArab Emirates),whiletravel-associatedcaseshavebeendiagnosedintheEuropeanUnion, NorthAfrica,Asia,andtheUSA.ThereceptorforMERS-CoVhasbeenidentifiedto bedipeptidylpeptidaseIV,whichisexpressedinthehumanrespiratorytractandis conservedacrossmanyspecies,includingbats.12 Thisvirus,originatedfrombats, usescamelsanddromedariesasintermediaryhosts;and,althoughtheoutbreak declinedoverthetime,theriskofnewcasesisstillconsideredtoexistastheanimal reservoirpersists.13 BytheendofDecember2019,27countriesreportedatotalof 2502laboratory-confirmedcasesofMERS,including861associateddeaths (case–fatalityrate:34.4%);themajorityofthesecaseswerereportedfromSaudi Arabia(2106cases,including783relateddeaths,case–fatalityrate:37.2%). Reportedcasesareclassifiedasprimary(directspilloverfromcamels)orsecondary (human-to-humantransmission,mostlyhealthcareworkers);theproportionbetween thosecategorieschangedoverthetime,intheperiodJuly–December2019,33% wereprimarycases,6%weresecondarycases,and31%ofunknowncontacthistory. AsinSARS-CoV,human-to-humantransmissionofMERS-CoVoccursmainly associatedwithhealthcare.14 Thepredominanceofnosocomialtransmissionisprobablyduetothefactthathighervirusshedding(highviralloadsinrespiratorytracts) occursaftertheonsetofsymptomswhenmostpatientsarealreadyseekingmedical care. 15 Asanexample,intheperiod2013–2019,approximately20%ofthecasesof MERSwerehealthcareworkersinSaudiArabia.16
AffectedcountriesreducedtheglobalthreatofMERSbyaddressingknowledge gapsabouttransmission,enhancingsurveillance,andstrengtheningtheabilityto detectcasesearlyandcontainoutbreaksthroughimprovedinfectionprevention andcontrolmeasuresinhospitals.Preventinginternationalspreadandsustained transmissionhasbeenimprovedbylocalpolicies,betterpreventionandcontrolmeasuresinhospitals,restrictionofcamelmovementinaffectedareas,strongerandmore comprehensiveinvestigationsofcasesandclusters,andimprovedcommunication.17
