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9. Older adults with coexisting chronic health conditions, 7 8 like coronary heart disease and hypertension, lung disease, or diabetes; health risk factors such as tobacco use9 and air pollution (e.g., in international hotspots for COVID-19, such as Wuhan, Northern Italy, and South Korea, which have pretty high levels of air pollution) 10, make viral respiratory infections such as COVID-19 particularly dangerous. Given the recency of the COVID-19 pandemic, scientists are still determining the full picture of the disease symptoms and severity.
The U.S. Centers for Disease Control and Prevention (CDC) suggests that symptoms of COVID-19 may appear in as few as 2 days or as long as 14 days after exposure to the virus 11.
Reported symptoms in patients have varied from mild to severe, and can include fever, cough and shortness of breath 12.
In general, studies of hospitalized patients have found that
- about 83 to 98 % of patients develop a fever,
- 76 to 82 % develop a dry cough and
- 11 to 44 % develop fatigue or muscle aches.
- Other symptoms, including headache, sore throat, abdominal pain, and diarrhea, have been reported, but are less common.
- While 4 % of the people worldwide confirmed as having been infected have died,
WHO has been careful not to describe this figure as a mortality rate or death rate.
This is because during an evolving epidemic it can be misleading to look simply at the estimate of deaths divided by cases to date.
Given that the actual prevalence of COVID-19 infection remains unknown in most countries, it poses an unparalleled challenge with respect to global containment and mitigation.
These issues reinforce the need to strengthen the response to the COVID-19 pandemic across all IDA/IBRD countries to minimize the global risk and impact posed by this disease.
10. Containment and Mitigation Response.
As of March 29, 2020, the outbreak has resulted in an estimated 685,623 confirmed cases, 32,137 confirmed deaths, and 145,696 recovered cases in 177 countries/regions 13.
COVID19 continues to infect thousands and spread rapidly across the globe (Figure 3). As COVID-19 seems to spread from person to person in a similar manner as other cold or influenza viruses (i.e., face to face contact with a sneeze or cough, or from contact with secretions of those infected), non-pharmaceutical interventions, both individual and collective, constitute a critical pillar for COVID-19 control—particularly, since there are no licensed vaccines or antivirals for treatment yet. Experience from different countries is now demonstrating that in the face of wider community transmission with multiple foci, a strategy of containment must be complemented by mitigation
- (i) close monitoring of changes in epidemiology and
- the effectiveness of public health strategies and their social acceptance;
- (ii) enhanced communication strategies to provide the population with information for self-protection, including hand washing;
- (iii) intensive control measures, including isolation of patients and persons testing positive for the virus, contact tracing and health monitoring, strict health facility
infection prevention and control, including safe water and sanitation in health facilities, and active disease surveillance and containment activities;
- (iv) preparation for resilience of health systems in all countries, as is done at the time of seasonal influenza, anticipating severe infections and the course of disease in older people and other vulnerable populations at risk of severe disease (e.g., people with co-occurring chronic health conditions); and
- (v) in the case of widespread community transmission, mitigation activities, such as social distancing measures
e.g.,7 Fauci, AS, Lane, C, and Redfield, RR. 2020. “Covid-19 — Navigating the Uncharted.” New Eng J of Medicine, DOI: 10.1056/NEJMe2002387
8 Shi, S. 2020. “Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China.” JAMA Cardiol. Published online March 25, 2020, doi:10.1001/jamacardio.2020.0950.
9 Marquez, PV. 2020. “Does Tobacco Smoking Increases the Risk of Coronavirus Disease (COVID-19) Severity? The Case of China.”
10 Calma, J. 2020. “Air pollution could make the COVID-19 pandemic worse for some people. Pollution piles on top of other risk factors.” Accessed at:
11 US Centers for Disease Prevention and Control site. Accessed at: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
12 Del Rio, C. and Malani, PN. 2020. “COVID-19—New Insights on a Rapidly Changing Epidemic.” JAMA, doi:10.1001/jama.2020.3072
13 https://coronavirus.jhu.edu/map.html, Johns Hopkins Center for Systems Science and Engineering
14 Heymann, DL, Shindo, N, on behalf of the WHO Scientific and Technical Advisory Group for Infectious Hazards. 2020. “COVID-19: What is Next for
Public Health?”. The Lancet, DOI.org/10.1016/SO140-6736(20)30374-3.