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COVID-19

COVID-19’s Impact on the Mental Health of Non-Frontline Physicians and Physician Assistants

By Alex Sunday

Published 5:41 EST, Sat November 13, 2021

Research Question

How has the COVID-19 pandemic affected the mental health of non-frontline physicians and physician assistants at an Orange County clinic?

Abstract

The COVID-19 virus originated in the Hubei Province of Wuhan, China in December of 2019. The virus inflicted a multitude of mental health detriments onto healthcare workers who were tasked with the treatment of COVID-19 patients. Moreover, a delineation between non-frontline and frontline healthcare workers was soon created as media networks and governments became interested in frontline healthcare at large-capacity hospitals. Unfortunately, in current pandemic research, several generalizations of the mental health of non-frontline healthcare workers (categorizing the group into one variation of healthcare worker) have been made and have led to a heightened focus and justification of this focus on frontline healthcare workers who are often in close proximity to COVID-19 patients. As a result, this research study examines non-frontline physicians and physician assistants to fill in the research concerning the mental health of a variation of non-frontline healthcare workers during the COVID-19 pandemic. Through a case study at a small clinic (comprising five tested variables: risk, physical changes, anxiety, work environment, and technology’s impact on mental health) and a survey research approach, it was determined that physician assistants face higher levels of risk, work environment stress, and adverse implications of technology on their mental health than physicians. This discovery was primarily attributed to closer physician assistant contact with patients and thus more healthcare responsibilities (filing case reports and creating treatment plans) than physicians. Ultimately, from this study’s findings, it is evident that employer action is immediately required as both physician and physician assistants reported high levels of the five variables tested. 

Introduction

The COVID-19 disease originated in Wuhan, China, and was a contagious disease that spread to nations in early January of 2020. COVID-19 altered human interaction, educational institutions, and the mental health of individuals. Eventually, hospitals and healthcare systems in regions with large populations such as New York, Los Angeles, and Beijing became overwhelmed because of the large numbers of patients admitted, coupled with an absence of personal protective equipment (PPE) for healthcare professionals. As a result, global coverage of the COVID-19 pandemic was relayed in major news networks such as FOX News or CNN. This media attention directed focus to frontline healthcare workers (HCWs) in high-risk areas. Importantly, frontline physicians and physician assistants were physically, emotionally, and psychologically strained because of detrimental effects from COVID-19: an influx of disease-carrying patients, lack of employer support, potential risk of contracting and spreading the virus to family, friends, and associates, and years of ensuing psychological trauma. 

As a result of the increased media concentration on frontline HCWs, governmental and corporate networks have neglected the psychological well-being of non-frontline HCWs during the COVID-19 pandemic. Researchers have conducted limited research on the mental health of non-frontline HCWs because of the perceived importance of frontline medical staff who are in closer proximity to COVID-19 patients. Moreover, the research on non-frontline HCWs is concentrated on physicians, indicating that researchers have generalized non-frontline HCWs to be individuals with medical and doctorate degrees rather than acknowledging the subgroups of clinical workers – physician assistants, nurse practitioners, and physical therapists. To reverse these generalizations, this research study uncovers and analyzes the extent to which the mental health of a non-front line clinic’s physicians and physician assistants has been affected by COVID-19. 

Literature Review

Although COVID-19 was discovered recently in December 2019, there has been a copious amount of global research on the virus’s impact on medical employees. Apart from physical health detriments of COVID-19, including chronic respiratory issues and neurovascular effects, HCWs face lasting mental health consequences – anxiety, stress, fatigue, changes in mood, and depressive symptoms – which ultimately hinder their performance in the workplace. These indicators of a decline in mental health are referred to as occupational stressors – psychological determinants that arise from career-related activities. Furthermore, as COVID-19 spread to multiple regions of the world, the delineation between non-frontline and frontline HCWs was exacerbated by researchers and the global population primarily concerned with emergency medicine and large-capacity hospitals. For instance, investigators Kristen Santarone, Mark McKenney, and Adel Elkbuli of the Department of Surgery at the Kendall Regional Medical Center constructed a summative paper describing how physicians face emotional fatigue and burnout attributed to occupational stress in the COVID-19 pandemic. In addition, Santarone and her colleagues documented how frontline physicians are increasingly accustomed to social isolation and are vulnerable to depression and anxiety. Ultimately, the researchers’ descriptive analysis concluded with how medical journals should direct most of their informative solutions when discussing the mental health of HCWs, to solely focus on the betterment of frontline medical workers due to their closer proximity to COVID-19 patients. 

To fully understand the division of non-frontline and frontline HCWs in the coronavirus-2019 pandemic, examining the similar circumstances in the Severe Acute Respiratory Syndrome (SARS) outbreak of 2002 to 2004 is required. Within this context – especially at the epicenters of China, Vietnam, and Hong Kong – many hospitals were overwhelmed by the amount of SARS patients admitted. As a result, the risk of transmission of the virus to frontline HCWs significantly increased and promoted the insurgence of mental health issues. Ping Wu and her colleagues, associate professors for the Department of Psychiatry at Columbia University, researched the psychological implications of SARS on Beijing HCWs at a sizable hospital. Wu and her associates used a mixed-methods cross-sectional study that presented hospital employees with an opportunity to detail their encounters with SARS, including increased work exposure or fear of contracting the virus. The researchers’ study found that ten percent of 549 HCWs at the hospital suffered from post-traumatic stress symptoms up to three years after contact with the SARS virus. Additionally, through descriptive and bivariate analysis, the researchers manufactured a regression equation that illustrated the prevalence of ongoing burnout even after the SARS outbreak. To further strengthen the proposal of severe burnout among hospital employees, the regression equation integrated associations between the prevalence of post-traumatic stress symptoms and two dependent variables – work exposure and quarantining. Although the study provided valuable insight into the mental health of HCWs during the SARS outbreak, a chief delimitation of the research was the deficiency of information on the mental health of HCWs at local hospitals. 

The presence of SARS in the early 2000s coerced world attention and network headlines to focus on medical employees at substantial hospitals instead of non-frontline HCWs that faced a similar degradation of mental health. Additionally, governments and private businesses disproportionately developed solutions in favor of frontline HCWs. Similar to Ping Wu and her associates, Robert Maunder and his colleagues, members of the Department of Psychiatry at the University of Toronto, conducted an observational study at the Mount Sinai hospital and neighboring clinics where HCW descriptions of their ordeals with SARS patients were analyzed. With direct commentary from medical employees, the researchers uncovered an underwhelming amount of hospital protection for HCWs. As a result, Maunder and his associates presented the information to private entities, finding the corporate response to the SARS outbreak – intensive screening and distribution of personal protective equipment (PPE) – to be almost immediate. However, this corporate initiative was only administered for the Mount Sinai hospital as the neighboring clinics were deemed non-essential. Thus, governmental and corporate attitudes toward favoring frontline medical employees are not newly discovered but were highly emphasized during past outbreaks. 

The global public, researchers, and world governments have categorized healthcare workers into non-frontline and frontline HCWs during the COVID-19 pandemic while demonstrating favoritism to individuals with a higher risk of contracting the virus. In a contemporary context, many research publications have attempted to include studies of COVID-19’s impact on the mental health of non-frontline HCWs, unlike in previous global or regional outbreak research. However, these research studies have rarely produced solutions that address the relevant circumstances of non-frontline HCWs. Instead, the research primarily promotes solutions for frontline and non-frontline HCW groups by assuming both worker variations face identical work environments and administrative personnel. For instance, Xie Zhang and his colleagues, members of the Ningbo Medical Centre Li Hulli Hospital in China, conducted a cross-sectional study in Wenzhou, China, on 524 medical staff – 150 of which were frontline HCWs. The study utilized the Patient Health Questionnaire (PHQ), Insomnia Severity Index (ISI), and Occupational Stress Questionnaire (OSQ) to ascertain that frontline HCWs were more susceptible to insomnia, anxiety, and occupational stress as opposed to non-frontline HCWs. As a result, the researchers concluded that the psychological burden of COVID-19 was more intense among frontline medical workers. The cross-sectional study provided crucial information for policymakers to engineer solutions that primarily assisted those with frequent exposure to the virus. Although Zhang and his associates knew the different occupational circumstances between non-frontline and frontline medical workers, they fabricated solutions that were interchangeable for both variations of medical employees resulting in counterproductive research for non-frontline medical workers. Moreover, the researchers generalized non-frontline HCWs as one subgroup of HCW. Ultimately, although comparisons to frontline HCWs address the mental health of non-frontline HCWs during the COVID-19 pandemic, solutions seldom mitigate the decline in the mental health of non-frontline employees who provide healthcare for many individuals. 

Comparable to Zhang and his colleagues, Muna Alshekaili and her research organization, members of the Centre of Studies and Research at the Oman Ministry of Health conducted a cross-sectional study on healthcare settings and mental health of non-frontline and frontline HCWs during the COVID-19 pandemic. The study surveyed 1139 Oman HCWs through a Depression, Anxiety, and Stress Scale (DASS-21) – a screening report aimed at measuring depressive symptoms, anxiety, and stress. Al Shekaili and her associates found that higher frequencies on the DASS-21 were reported in frontline HCWs, indicating a decline in mental health attributed to COVID-19. The cross-sectional study compared demographic and psychological effects in frontline and non-frontline HCWs, illustrating that frontline HCWs were more susceptible to a drastic decline in mental health. Importantly, unlike Zhang and his associates, the Oman cross-sectional study focused on insomnia and sleep deprivation as predictors of COVID-19’s impact on the mental wellbeing of HCWs. However, a similar conclusion was made by the Oman researchers that claimed frontline HCWs should be allotted more governmental and corporate funding because of their closer proximity to the virus. Additionally, Alshekali and her colleagues offered solutions for frontline HCWs, including psychological intervention to ensure the development of coping mechanisms and the promotion of resilience tactics. 

Although there is extensive research published on the mental health of HCWs, governmental agencies and private entities have neglected non-frontline medical workers, opting to direct their resources into frontline medical employees during the coronavirus-2019 pandemic. Additionally, comparative studies on non-frontline and frontline HCWs serve to justify the sole focus on frontline HCWs by engineering solutions for the totality of medical workers using statistics from both worker variations and generalizing non-frontline HCWs as one specific sub-group of HCW. This research malpractice, assuming the impact on the mental health of non-frontline and frontline HCWs is indistinguishable, is detrimental and counterproductive. Furthermore, throughout contemporary research, no efforts have been made to reconcile governmental interests with the wellbeing of employees residing in local hospitals, clinics, and urgent care centers. Regarding bureaucratic unwillingness to assure equal representation of medical workers that face a similar degradation of livelihood, this research study attempts to fill in the gap on the mental health of different variations of non-frontline HCWs by conducting a case study at a local clinic that examines the mental health of non-frontline physicians and physician assistants.

Methodology

This research study utilizes a mixed-methods approach consisting of a case study and survey methodology to measure participants’ mental health and allow for a more focused interpretation of data. Additionally, risk, anxiety, physical changes, work environment, and technology’s impact on mental health were variables that were measured through questionnaires in this research study. Ultimately, it was predicted that physicians would face a more significant decline in mental health due to their perceived, heightened responsibilities in the clinic as opposed to physician assistants. 

Table A. Variable Description

VariablesDescription
RiskThe participant’s psychological response to the possibility of contracting COVID-19. This variable evaluates participant perception of their personal risk compared to other individuals whose employment does not reside in the medical field. Moreover, this variable measures participant perceived safety. 
AnxietyThis variable measures levels of anguish or worry over self-contraction of the virus, family, associate or acquaintance contraction of the virus, and the possibility of future, lasting detriments attributed to COVID-19.
Physical changesDefined as any disruption in normal sleep routine correlated to the emergence of COVID-19. This may take the form of newly-discovered insomnia or any reports of change in sleep. Moreover, participant unproductiveness, mood changes, and affinity to taking on new tasks are measured. 
Work EnvironmentThis variable measures participant opinion on their work environment, psychological support from colleagues, working hours, workload (influx of patients), and employer support.  
Technology’s Impact on Mental HealthDefined as participant opinion on TeleMed (an online medical platform where medical professionals may virtually administer medicine).

Case Study Research

As this research study identifies COVID-19’s effect on the mental health of non-frontline physicians and physician assistants at a clinic, a case study emphasis is required. MeanThat™, an academic research platform, rationalizes that case studies are most effective when concentrating on a selective participant population. Moreover, MeanThat™ claims that holistic case studies, a deviation from a case study that analyzes the totality of situations, are useful for mental health research because of their ability to isolate and identify variables in participants. Following their findings, this research study acquires data from a select number of individuals at a sole clinic. In previous pandemics, a similar case study methodology was used to research HCW mental health. For example, Grainne M. McAlonan and her colleagues, members of the Translational Neuroscience department at King’s College London, researched HCWs during the peak period of the SARS outbreak at two general care hospitals in Hong Kong using a case study methodology. In these hospitals, the researchers instituted questionnaires containing the Perceived Stress Scale-10 item (PSS-10) index in addition to routine observational analysis that was kept constant within both hospitals. The use of a case study allowed McAlonan and her associates to identify the frequencies of mental health detriments in a small number of individuals because of their localized research. Ultimately, their interpretation of data concluded that indicators of stress and burnout persisted in HCWs for approximately one year after the outbreak had concluded. Moreover, McAlonan and her research staff asserted, when selecting their method, that a case study methodology was more beneficial to pandemic mental health research than other approaches such as an experimental method due to a case study’s effectiveness of examining variables within a specific participant population. 

Although case studies are generally effective in pandemic research, they may become one-dimensional if they do not incorporate other sub-groups of research methodology, unlike experimental research, which only requires the identification of variables and control to be effective. As a result, to ensure effectiveness, this research study will utilize survey methods incorporated into a case study approach to provide extensive results, interpretations, and conclusions. 

Survey Research

The final methodology of this research study’s mixed-methods approach entails quantitative survey research. Specifically, this research study utilizes two distinct quantitative surveys: the COVID-19 Questionnaire-8 (Scale) and COVID-19 Questionnaire-9 (MHCQ). The COVID-19 Questionnaire-8 (Scale) is an 8 item scale survey that asks participants structured questions to quantify variables such as workload, risk, and sleep habits. Furthermore, each question has the phrases strongly disagree, disagree, neutral, agree, and strongly agree as possible answer choices. Questions are scored on a 1-5 scale with a potential of a total of 40 points – the higher a respondent’s scores, the more likely their mental health has regressed during the COVID-19 pandemic. The COVID-19 Questionnaire-9 (MHCQ) is a 9 item survey containing questions ranging from anxiety levels to implications of co-workers on participant mental health. Moreover, answer choices consist of a 0-5 index and a “prefer not to respond” choice selection to mitigate any discomfort that may arise from questions. The “0-5” index translates into “never, rarely, once in a while, sometimes, almost always, and always” respectively. The survey is scored on a tally system of 0-5 and each “prefer not to answer” response is omitted from the data. This MHCQ and Scale questionnaire correlates to the Beck Anxiety Inventory (BAI) and Patient Health Questionnaire (PHQ) – questionnaires found in research dissertations concerning COVID-19’s impact on HCW mental health and have also been utilized by the National Institute of Health.

Mental health researchers used survey methodologies in previous pandemics as well as the current coronavirus-2019 outbreak. For instance, Mariela Mosheva and her colleagues, researchers at the Sheba Medical Center in Tel Hashomer, Israel, utilized a survey methodology consisting of the BAI and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires to conduct their research. The researchers used the BAI and PROMIS systems to measure socio-demographic characteristics, anxiety, and resilience traits. As a result of the quantifiable statistics generated from the BAI and PROMIS, Mosheva and her associates were able to construct a multivariable linear regression model that found that mental exhaustion, fear of contracting the virus, spreading the virus to family members, and disruptions in standard sleep patterns were vital contributors to an HCW decline in mental health. Without statistical data, the researchers would not have drawn accurate and detailed conclusions resulting in counterintuitive research.

Survey research is a generic methodology that is universally applicable to many studies. Thus, pandemic researchers such as Mariela Mosheva and her associates do not solely use surveys to conduct their research. Alternatively, researchers use a combination of survey, interview, experimental, observational, or case study methods to examine the mental health of HCW participants in outbreaks of disease. Specifically, Mosheva and her researchers claimed that a case study approach per survey research was more appropriate for mental health research than observational or experimental methods because of its ability to collect data for a small number of individuals. Importantly, in the modern context of the COVID-19 pandemic, solely quantifiable statistics are not adequate to reach conclusive findings. As a result, this research study uses survey research in addition to case study methodologies to accurately identify and interpret the effects of COVID-19 on the mental health of non-frontline physicians and physicians’ assistants. 

Results

Procedures

During the data collection process, the COVID-19 MHCQ and COVID-19 Scale surveys were instrumental to conducting research. In this case study, 38 non-frontline healthcare workers – 19 physicians and 19 physician assistants – responded to both questionnaires over an allotted seven days. Each participant completed each survey independently without the influence of loved ones, associates, and familiar individuals. In addition to responding to the questionnaires, each participant stated their profession and designation – but for security purposes – their identities became nominal (participant A, participant B, etc.). The questionnaires, COVID-19 MHCQ (9-item) and COVID-19 Scale (8-item), accounted for five variables – work environment, physical changes, anxiety, risk, and technological impact on mental health. 

Work Environment

The Work Environment Variable (WEV) was measured as a combination of scores from the COVID-19 MHCQ and Scale questionnaires. Across the questionnaires, eight questions were presented to the participants, requesting information on their physical work environment, coworkers (their physical and emotional support), workload management (influx of patients and longer shifts), and employer support (monetary, physical, or emotional). Each response had a point value ranging from 0 to 5 points, and the scores were additive, leading to the end range of the WEV: 0-40. Additionally, the scores were divided into six categories (0-7, 8-15, 16-23, 24-30, 31-35, 36+) to delineate among the responses; the subgroupings translated into 0-7: stress-free WE, 8-15: slightly stressful WE, 16-23: stressful WE, 24-30: exacting WE (hinders productivity), 31-35: almost unmanageable WE, 36+: unmanageable WE. The score range 16-30 was prioritized because the intermediate-range indicated a stress-inducing environment, and most responses resided in this range. 

Table A. WEV Questions

Question #QuestionQuestionnaire
2Has your work environment been helpful in managing stress (issuance of beneficial work-related policies, supportive staff, perceived employer empathy/consideration for employees, etc.)?MHCQ
3Do you feel as if your working hours are negatively impacting your mental health (increased presence of stress, more commitments, etc.)?MHCQ
6Have your co-workers positively impacted your mental health (supported you with compassion, understanding, and any other positive emotional qualities)?MHCQ
10How often have you had to trust your co-workers to accomplish something (tasks, support, etc.) for you? MHCQ
2My workload has not been manageable during the last two months (more patients, longer workdays, less physical support concerning the absence of some staff members, etc.)Scale
6My work environment before the COVID-19 pandemic was more tolerable (fewer distractions, absence of fear concerning contraction of disease, etc.).Scale
7During the past two months, I have not received psychological support from my co-workers and friends (daily check-ins, counseling, etc.) Scale
8During the past two months, I have not received support from my employer (monetary, new policies, etc.). Scale

Graph Set A. WEV

Physical Changes

The Physical Changes Variable (PCV) was measured as a combination of scores from the COVID-19 MHCQ and Scale questionnaires. The PCV accounted for unproductiveness, mood changes, affinity to facing new tasks, and change in sleep patterns. Five questions from the COVID-19 MHCQ and Scale questionnaires were needed to test for the PCV. Each response had a point value ranging from 0 to 5 points, and the scores were additive, leading to the end range of the PCV: 0-25. Moreover, the 0-25 point range was categorized into five subgroupings that translated into 0-5: unnoticeable PC, 6-10: irritating PC but nondestructive to medical practice, 11-15: PC conduces slightly intolerable medical practice, 16-20: almost unmanageable medical practice attributed to PC, 21-25: unmanageable medical practice attributed to PC. No score range was prioritized for the PCV data collection process. 

Table B. PCV Questions

Question #QuestionQuestionnaire
9My sleep schedule has suffered as a result of the COVID-19 pandemic. Scale
4During the past two months, have you felt unmotivated?MHCQ
5During the past two months, have you felt unproductive?MHCQ
8Have you noticed any changes in mood?MHCQ
9How often have you been willing, more than usual, to take on new tasks (clinical responsibilities, family responsibilities, etc.)?MHCQ

Graph Set B. PCV

Anxiety

The COVID-19 MHCQ survey measured the Anxiety Variable (AV). Moreover, the AV defined anxiety as a response consisting of fear, dread, and uneasiness; the AV was present in one question of the COVID-19 MHCQ survey. The 0-5 point range translated into 0: no symptoms of worry or fear, 1: slight symptoms of anxiety, 2: symptoms of anxiety are noticeable but do not hinder the quality of medical practice, 3: the slight decline of quality of medical practice attributed to anxiety, 4: noticeable decline in quality of medical practice attributed to anxiety, 5: medical practice is unmanageable/implausible due to anxiety symptoms. A score range was not prioritized for the AV data collection process as the 0-5 point range was categorized into single-digit subgroups.

Table C. AV Questions

Question #QuestionQuestionnaire
5During the last two months, my anxiety levels have increased (increased presence of uncontrollable worry/anguish).Scale

Graph Set C. AV

Risk 

The COVID-19 MHCQ and Scale questionnaires measured the Risk Variable (RV). The RV measured respondents’ perception of risk compared to their acquaintances, families, and colleagues whose careers did not reside in the medical field. Additionally, the RV accounted for the respondent’s perception of safety, or lack thereof, at the non-frontline clinic concerning personal protective equipment (PPE), variations of patients that received healthcare, and an evaluation of colleague precaution to the COVID-19 pandemic. Moreover, the RV was prevalent in three questions in the COVID-19 MHCQ and COVID-19 Scale questionnaires, and a 0-15 point range measured the RV. Specifically, this 0-15 point range was divided into four subsections/categories that translated into 0-3: no fear of participant safety, 4-7: slight fear of participant safety, 8-11: visible symptoms and reservations of administering healthcare during COVID-19 but does not hinder the quality of medical practice, 12-15, the participant was deeply concerned of their safety, thus leading to a decline in their medical practice. A score range was not prioritized for the RV data collection process. 

Table D. RV Questions

Question #QuestionQuestionnaire
3I feel as if I am at more risk than many of my friends/family members whose employment does not reside in the medical field.Scale
4I have worried/been concerned more about my safety during the COVID-19 pandemic than I have ever before.Scale
7Does the risk of contracting COVID-19 have a negative impact on your medical practice (less likely to see new patients, fear of direct contact with patients, a decline in administrative healthcare quality, etc.)? MHCQ

Graph Set D. RV

Technology’s Impact on Mental Health 

The Technological Impact on Mental Health Variable (TIMHV) was measured in the COVID-19 Scale questionnaire. The TIMHV accounted for the TeleMed – a virtual medicine platform for medical practitioners during COVID-19 manufactured for the administration of healthcare – and its impact (ex. difficult for the participant to ensure quality healthcare for their patients) on the mental health of physicians and physician assistants. Additionally, in this context, mental health was defined as a state of personal well-being. The TIMHV was presented to respondents in one question of the COVID-19 Scale questionnaire; the variable had a point range of 0-5 that translated into 0: TeleMed is beneficial for the participant’s mental health, 1: TeleMed’s few drawbacks do not hinder the quality of the participant’s administrative healthcare, 2: software issues are prevalent but do not interfere with participant medical practice, 3: TeleMed is slightly confusing to utilize but manageable for participants, 4: TeleMed’s numerous problems significantly hinder participant mental health, 5: TeleMed is unusable for a participant. There was not a score range prioritized for TIMHV data collection. 

Table E. TIMHV Questions

Question #QuestionQuestionnaire
10TeleMed is helpful in mitigating stress and anxiety (do not have to see patients physically, easy to use and navigate, etc.).Scale

Graph Set E. TIMHV 

Discussion

Correlational/Statistical Analysis

On average, 84.4% of physicians and 94.7% of physician assistants consider their clinical work environment to be slight to moderately stress-inducing. External factors such as an influx of patients or clinical responsibilities (filing more case reports, managing schedules, and creating virtual or in-person appointments for patients) contributed towards negative respondent opinions. Specifically, participants believed that their parent company could exert more effort in mitigating declines in HCW mental health. The 10.3% difference between physician assistants and physicians regarding their outlook on work environment issues may be ascribed to administrative focus on physicians with medical degrees. Although non-frontline physicians and physician assistants are not considered to be as essential as frontline medical professionals, within the employee construct at California clinics, physicians are deemed to be more integral to patient healthcare than physician assistants due to a certain level of expertise and training achieved during medical school and residency programs. In the context of the COVID-19 pandemic, when California healthcare administrative officers consider the employees required in healthcare service, a medical director (MD) is legally obligated to occupy the clinic while physician assistants are deemed optional per the state legislature.

Negative physical changes – unproductiveness, mood changes, changes in sleep pattern, and affinity to facing new tasks – were rampant among both physician and physician assistant respondents. In particular, physicians who scored between 6-20 (89.5%) were 9% higher than physician assistants (79%). However, physician assistant respondents incurred more outliers – 21.1% scored 16+, indicating that COVID-19 incited unmanageable conditions for more physician assistants than physicians. This phenomenon can be attributed to job insecurity among physician assistants because of California’s requirement for clinics to contain more physicians with medical degrees than physician assistants. Moreover, physician assistants were not accustomed to longer working hours and potential burnout because of their nine-to-five workday schedule. Alternatively, before the COVID-19 pandemic, physicians were expected to participate in demanding shifts (12 or more hours per day). For both physician and physician assistant respondent groups, 10.5% agreed that the COVID-19 pandemic did not perpetuate any negative physical changes. This outlier is rooted in situational factors that are common occurrences in the medical field (ex. physicians incurring a relaxed schedule during COVID-19). Similarly, the anxiety variable results determined that 52.6% of physicians and 42.1% of physician assistants experienced anxiety-related symptoms that do not harm their healthcare administration. 65.8% of total respondents experienced little to no symptoms of worry or fear-related anxiety concerning their medical practice during the last two months of the COVID-19 pandemic. Slight to moderate anxiety in respondents is most attributed to personal and immediate family health concerns because of subsequent responses to increased risk. Specifically, for physician assistants, salary uncertainty is a plausible factor for moderate anxiety because of a decline in career availability. 

For the risk variable (RV), 47.4% of physicians and 57.9% of physician assistants scored between 8-11, suggesting that reservations of administering healthcare due to increased perceived risk existed among both non-frontline HCW variations. Moreover, physician assistants (26.3%) who scored between 12-15 were 10.5% more likely to incur personal safety concerns leading to a decline in medical practice quality than physicians who scored between 12-15 (15.8%). This phenomenon is correlated to the proximity of physician assistants to patients. While physicians usually examine a patient once or twice then deliberate in forming a diagnosis, physician assistants are constantly performing numerous tests (eyesight, heartbeats, hearing, and reflex). As a result, the risk of contracting COVID-19 or similar diseases is disproportionate to physician assistants. Moreover, as deduced from the WEV results, the employer may not have sufficient physical or mental health policies. 

According to TIMHV results, physician assistants considered the TeleMed application to be less beneficial for their profession than physicians. For instance, the percentage between physician assistants (89.5%) and physicians (68.4%) scored between 2-4 was 21.1%. Physician assistants are more likely to conceive online medical platforms as inefficient because diagnosing illness, developing treatment plans, and prescribing medications are difficult tasks to accomplish without conducting in-person examinations. However, physicians discuss treatment plans with their patients and schedule in-person appointments using the TeleMed online application. Moreover, TeleMed automates much of the medical process, suggesting that physician assistants may not be as crucial to patient healthcare as previously conceived due to the flexibility of online medical platforms during COVID-19.

Implications

From the five variables tested – work environment, physical changes, anxiety, risk, and technology’s impact on mental health, it is evident that non-frontline HCWs face degradation in personal well-being stemming from the COVID-19 pandemic. Moreover, regardless of designation (physicians and physician assistants), non-frontline medical professionals that participated in this case study reported high levels of work environment stress and fear of contracting the coronavirus-2019 disease. Although this case study generated results from 38 participants, the correlational and statistical analysis provided from the research should be applied to other non-frontline healthcare establishments (urgent cares, small hospitals, and dentistries) for the intent of collecting data and subsequently developing beneficial solutions for this underrepresented group. The delineation between physician and physician assistants was integral to the foundations of this case study due to popular misconceptions which generalize all non-frontline healthcare workers as incurring identical mental health detriments. In actuality, HCWs at local clinics are primarily physicians and physician assistants. As a result, from this case study, employer policies will more likely pertain to a specific employee rather than a generalized majority, and regional awareness will follow as non-frontline HCWs are essential in treating patients in their local communities.

Limitations

In the data collection process, a plausible limitation was participant weariness or fear of responding truthfully to the COVID-19 MHCQ and Scale questionnaires. Although the questionnaires contained an informed consent form and a presurvey statement detailing how participant identity would not be revealed, per the Institutional Review Board (IRB), at the final publication of the research paper, there may have been some fraudulent responses in the dataset. The possibility of untruthful answers could have skewed the dataset and fabricated minor inaccuracies in the statistical and correlational analysis. Another limitation resides in the structure of the questions presented to the HCW respondents; questions may have been perceived as invasive or incessantly personal. As such, participants may have not responded to the entirety of the COVID-19 MHCQ and Scale questionnaires, leading to a skew in the dataset. Additionally, an integral limitation exists in consonance with the sample size and case study nature of the research. For instance, 50 physicians and physician assistants are employed at the non-frontline clinic, but only 76% ultimately were evaluated in the case study. The remaining 24% of non-frontline HCWs may have altered the dataset.

Conclusion

The mental health of non-frontline physicians and physician assistants at a medical clinic is in jeopardy, as the results, analysis, and implications of this case study suggest: both physicians and physician assistants expressed external psychological and physical factors such as anxiety, fear of COVID-19 contraction, unproductiveness, the negative impact of technology, unsatisfactory employer and associate support, and mood changes. Although the case study contrasted physicians and physician assistants, their mental health has experienced a similar degradation. However, the initial hypothesis was ultimately disproved, as on average, physician assistants faced a larger degradation in mental health than physicians regarding the findings on the five tested variables. Comparable to the SARS outbreak, the COVID-19 pandemic has altered how non-frontline medical establishments operate. Moreover, physicians and physician assistants alike are at risk of losing their employment status and contracting the uncontrolled virus while incurring severe mental health detriments. 

The results of the case study illustrate why domestic and global powers should concentrate resources in non-frontline medical practices because of their importance to a local and frequently underrepresented community. For instance, the clinic evaluated in this case study provides resources to underserved individuals – people of color, low-income individuals, workers compensation patients, and disabled individuals. As a result, the importance of immediate action from local and international governments is evident. If the mental health of these non-frontline physicians and physician assistants continues to regress, the quality of healthcare for the individuals they serve will likewise begin to decline. Moreover, the basis of this case study should be applied to other local hospitals in regions of the United States and abroad due to the absence of research on non-frontline healthcare professionals during the COVID-19 pandemic. 

Future researchers should implement the COVID-19 MHCQ and Scale surveys in their respective research endeavors because of the expansive variables covered in all facets of the questionnaires – work environment, physical changes, anxiety, perception of risk, and technology’s impact on mental health. Furthermore, researchers should use this case study’s findings and interpretations to develop relevant solutions that address the problems faced by physicians and physician assistants. Importantly, these two subsets of HCWs in future studies should not be generalized as their experiences and acquired trauma during the COVID-19 pandemic slightly differs. Ultimately, the mental health of non-frontline healthcare professionals should be prioritized when discussing pandemic-related healthcare issues because of their illustrious impact on society coupled with underwhelming provisions for their humanitarian efforts.  

Alex Sunday, Youth Medical Journal 2021

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3.6 Research Strategy: Survey. Mean that, 2018                                      https://www.youtube.com/watch?v=ru_GHuJdInU. 

3.7 Research Strategy: Case Study, 2016. https://www.youtube.com/watch?v=ectS1ote8uA.

Alshekaili, Muna, Walid Hassan, Nazik Al Said, Fatima Al Sulaimani, Sathish Kumar Jayapal, Adhra Al-Mawali, Moon Fai Chan, Sangeetha Mahadevan, and Samir Al-Adawi. “Factors Associated with Mental Health Outcomes across Healthcare Settings in Oman during COVID-19: Frontline versus Non-Frontline Healthcare Workers.” BMJ Open 10, no. 10 (October 10, 2020). https://doi.org/10.1136/bmjopen-2020-042030. 

Antonijevic, Jovana, Iva Binic, Olivera Zikic, Snezana Manojlovic, Suzana Tosic‐Golubovic, and Nikola Popovic. “Mental Health of Medical Personnel during the COVID‐19 Pandemic.” Brain and Behavior 10, no. 12 (2020). https://doi.org/10.1002/brb3.1881. 

Dosil, María, Naiara Ozamiz-Etxebarria, Iratxe Redondo, Maitane Picaza, and Joana Jaureguizar. “Psychological Symptoms in Health Professionals in Spain After the First Wave of the COVID-19 Pandemic.” Frontiers in Psychology 11 (2020). https://doi.org/10.3389/fpsyg.2020.606121. 

Lung, For-Wey, Yi-Ching Lu, Yong-Yuan Chang, and Bih-Ching Shu. “Mental Symptoms in Different Health Professionals During the SARS Attack: A Follow-up Study.” Psychiatric Quarterly 80, no. 2 (2009). https://doi.org/10.1007/s11126-009-9095-5. 

Maunder, Robert, Jonathon Hunter, Leslie Vincent, Nathalie Peladeau, Molyn Leszcz, Joel Sadavoy, Lieve M Verhaeghe, Rosalie Steinberg, and Tony Mazzulli. “The Immediate Psychological and Occupational Impact of the 2003 SARS Outbreak in a Teaching Hospital.” Canadian Medical Association Journal 168, no. 10 (June 1, 2003): 1245–51. 

Mcalonan, Grainne M, Antoinette M Lee, Vinci Cheung, Charlton Cheung, Kenneth Wt Tsang, Pak C Sham, Siew E Chua, and Josephine Gws Wong. “Immediate and Sustained Psychological Impact of an Emerging Infectious Disease Outbreak on Health Care Workers.” The Canadian Journal of Psychiatry 52, no. 4 (April 4, 2007): 241–47. https://doi.org/10.1177/070674370705200406. 

Mosheva, Mariela, Nimrod Hertz‐Palmor, Shirel Dorman Ilan, Noam Matalon, Itai M. Pessach, Arnon Afek, Amitai Ziv, Yitshak Kreiss, Raz Gross, and Doron Gothelf. “Anxiety, Pandemic‐Related Stress and Resilience among Physicians during the COVID‐19 Pandemic.” Depression and Anxiety 37, no. 10 (2020): 965–71. https://doi.org/10.1002/da.23085. 

Santarone, Kristen, Mark Mckenney, and Adel Elkbuli. “Preserving Mental Health and Resilience in Frontline Healthcare Workers during COVID-19.” The American Journal of Emergency Medicine 38, no. 7 (April 15, 2020): 1530–31. https://doi.org/10.1016/j.ajem.2020.04.030. 

Wu, Ping, Yunyun Fang, Zhiqiang Guan, Bin Fan, Junhui Kong, Zhongling Yao, Xinhua Liu, et al. “The Psychological Impact of the SARS Epidemic on Hospital Employees in China: Exposure, Risk Perception, and Altruistic Acceptance of Risk.” The Canadian Journal of Psychiatry 54, no. 5 (May 15, 2009): 302–11. https://doi.org/10.1177/070674370905400504.

Wu, Wenzhi, Yan Zhang, Pu Wang, Li Zhang, Guixiang Wang, Guanghui Lei, Qiang Xiao, et al. “Psychological Stress of Medical Staffs during Outbreak of COVID‐19 and Adjustment Strategy.” Journal of Medical Virology 92, no. 10 (2020): 1962–70. https://doi.org/10.1002/jmv.25914. 

Zhang, Xie, Ke Zhao, Guohua Zhang, Ruihua Feng, Jianjun Chen, Dongwu Xu, Xiaodong Liu, et al. “Occupational Stress and Mental Health: A Comparison Between Frontline Medical Staff and Non-Frontline Medical Staff During the 2019 Novel Coronavirus Disease Outbreak.” Frontiers in Psychiatry 11 (2020). https://doi.org/10.3389/fpsyt.2020.555703.

Categories
COVID-19

Racial Disparities in COVID-19 and Asthma Care in the US

By Brooke Weiner

Published 6:44 EST, Weds October 6th, 2021

Throughout the COVID-19 pandemic, the term “pre-existing condition” has been anything but unfamiliar to us all. This heightened focus on individuals at increased risk for contracting COVID-19 or experiencing it more severely has brought long-standing racial disparities in healthcare to light. 

One notable risk factor for COVID-19 is asthma, a chronic condition that narrows and inflames the airways of the lungs. According to the Centers for Disease Control (CDC), one in thirteen people have asthma [1], and it is caused by hypersensitivity or overreaction of the immune system. This sensitivity causes inflammation in the lungs, which makes it extremely difficult  for those diagnosed to breathe at certain times or during an asthma attack [2], making individuals more vulnerable to COVID-19. 

Financial burden is one aspect of asthma care subject to cause inequity. The most common treatment for an asthma attack is an albuterol inhaler, which contains a medication that relaxes the muscles in the lungs and opens the airway to allow for airflow. In circumstances that necessitate a hospital visit, treatment includes other medications with a breathing tube to be used in life-threatening circumstances [3]. In 2018, the annual medical cost of asthma was $3,266 per person [4]; in the same year, the mean yearly salary of an American individual was around $50,000 [5]. Essentially, those diagnosed with asthma must set-aside 6% of their salary to breathe, to perform an innate human function necessary for survival. 

However, there are other aspects of asthma that create deeper disparities. Data from 2019 shows that in the United States, 11.2% of Black Americans were diagnosed with asthma, in comparison to the respective 7.6% and 6.8% of white and Hispanic populations [6]. Many questions stem from these statistics, such as why this noticeable gap exists. Where does it come from? Why does this resemble another disproportionate statistic from n the spring of 2021, stating that Black Americans were twice as likely to have died from COVID-19 than White Americans [7]?

According to the Asthma and Allergy Foundation of America (AAFA), disparities in asthma are driven mostly by “structural determinants such as systemic racism, segregation, and discriminatory policies,” and by “social determinants such as socioeconomic status…neighborhood and physical environment… social support networks, and access to health care” [8]. Although asthma has genetic associations, its hereditary nature is not specific to Black Americans alone. Therefore, a supposed difference in Black Americans’ genetics is no justification for asthma’s disproportionate affliction upon that community in particular; instead,  environmental factors are the main determinant in obtaining this condition.

In the United States, both historically and presently, Black individuals have been and are more physically segregated than any other racial or ethnic group [9]. Today, when researchers studied 171 of the largest urban areas in the United States, the resulting data showed that the area with White individuals of the lowest socioeconomic status  still had more resources than a comparable area in which Black Americans reside [10]. For example, the areas in which Black Americans live are less likely to have recreational facilities, such as playgrounds and swimming pools, for exercise [11]. 

Unsurprisingly, where an individual lives and the quality of the air in that location are the biggest determinants in having asthma. Poor residential conditions, like overcrowding, may predispose individuals to viral illnesses or indoor allergens [11]. In addition, these impoverished areas have difficulty with trash removal and are more likely to have landfills nearby. For example, landfills in Alabama, which are mostly located in areas with substantial Black populations and residents below the poverty line, are filled with waste from all across the US [12]. These landfills release methane and carbon dioxide [13], and as a result, “research reveals that segregated, inner-city areas have higher rates of air pollution,…which can exacerbate asthma symptoms” [11]. The living conditions in these segregated areas may negatively impact the resident’s practice of healthy behaviors, encouraging poor health habits that increase one’s morbidity and risk for developing  asthma [11]. For these reasons, not only are Black Americans 40% more likely to have asthma than their White counterparts [14], they are also three times more likely to die from asthma than any other group [15]. 

As of September 9th, 2021, Black Americans faced 2.8x the COVID-19 hospitalization rate and 2.0x the COVID-19 death rate in comparison to White individuals, yet only encountered a 1.1x increase in COVID-19 cases [16]. The lower magnitude of cases among Black Americans may be due to a limited availability of testing, with the  greater magnitude of hospitalization and death rates likely being attributed to the previously aforementioned prevalence of asthma. In addition, this could also be due to the fact that, prior to the current wide availability of vaccines, Black Americans made up a small percentage of the total number of Americans vaccinated [17]. These low vaccination rates stemmed from personal concern of the COVID-19 vaccine itself, originating from a long history of racial inequities and injustice in healthcare in the United States, in addition to limited environmental access.  

While it will not happen overnight, increasing focus in two areas, environmental justice in communities with poor residential conditions and racial justice in healthcare and governmental policy, combats the very root of these inequities. Healthcare is so much more than having access to high-quality medical care or a hospital nearby; environmental factors are much more at play than most realize. It is critical to educate the public and governmental officials on the intersection of environmental justice and racial justice, advocating for the protection of both the people and the planet, directly helping communities to address climate injustices. 

However, the complete elimination of these inequities must come from “political will and commitment to implement new strategies to…dismantl[e] the structures of racism…that can counteract the pervasive negative effects of institutional discrimination on health” [11]. It is important to note the strides being made on a larger scale within the World Health Organization (WHO), the CDC, and the United States Environmental Protection Agency (EPA) who are working to reduce, prevent, and control the burden of disparities in asthma and asthma care. 

COVID-19 and asthma are only two of many conditions that disproportionately affect the population based on racial and social determinants. While the media did cover disparities in COVID-19 hospitalization and death rates, racial inequities in healthcare did not materialize with the pandemic. Affecting the care of millions of individuals on a daily basis, they have occurred on a large scale since the foundation of our nation, spanning wide ranges of health conditions and concerns. If there is any time to make a change, it is now, as we recover and rebuild from the loss our community has faced.

Brooke Weiner Youth Medical Journal 2021

References

[1] 2019 National Health Interview Survey (NHIS) Data | CDC. 11 Jan. 2021, https://www.cdc.gov/asthma/nhis/2019/data.htm.

[2] Asthma | NHLBI, NIH. https://www.nhlbi.nih.gov/health-topics/asthma

[3] “Hospital Stay for Asthma Attack: Treatments and More.” Healthline, 30 Mar. 2020, https://www.healthline.com/health/severe-asthma/hospital-after-asthma-attack.

[4]  Nurmagambetov, Tursynbek, et al. “The Economic Burden of Asthma in the United States, 2008-2013.” Annals of the American Thoracic Society, vol. 15, no. 3, Mar. 2018, pp. 348–56. PubMed, doi:10.1513/AnnalsATS.201703-259OC.  

[5] National Average Wage Index. https://www.ssa.gov/oact/cola/AWI.html.  

[6] CDC. “Asthma’s Effect on the Nation.” Centers for Disease Control and Prevention, 14 Jan. 2021, https://www.cdc.gov/asthma/asthmadata.htm.

[7] “Color of Coronavirus: COVID-19 Deaths Analyzed by Race and Ethnicity.” APM Research Lab, https://www.apmresearchlab.org/covid/deaths-by-race.

[8] Asthma Disparities – Reducing Burden on Racial and Ethnic Minorities | AAFA.Org. https://www.aafa.org/asthma-disparities-burden-on-minorities.aspx.

[9] Massey D, Denton N. American Apartheid: Segregation and the Making of the American Underclass. Cambridge, MA: Harvard University Press; 1993 

[10] Sampson RJ, Wilson WJ, Hagan J, Peterson RD. Toward a theory of race, crime, and urban inequality. In: Hagan J, Peterson R, eds. Crime and Inequality. Stanford, CA: Stanford University Press; 1995:37–54

[11] Williams DR, Sternthal M, Wright RJ. Social determinants: taking the social context of asthma seriously. Pediatrics. 2009 Mar;123 Suppl 3(Suppl 3):S174-84. doi: 10.1542/peds.2008-2233H. PMID: 19221161; PMCID: PMC3489274. 

[12] “‘We’re Not a Dump’ – Poor Alabama Towns Struggle under the Stench of Toxic Landfills.” The Guardian, 15 Apr. 2019, http://www.theguardian.com/us-news/2019/apr/15/were-not-a-dump-poor-alabama-towns-struggle-under-the-stench-of-toxic-landfills 

[13] “Basic Information About Landfill Gas | US EPA”. US EPA, 2021, https://www.epa.gov/lmop/basic-information-about-landfill-gas#methane

[14] CDC. “Asthma’s Effect on the Nation.” Centers for Disease Control and Prevention, 14 Jan. 2021, https://www.cdc.gov/asthma/asthmadata.htm.

[15] Asthma and African Americans – The Office of Minority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=15.

[16] CDC. “Cases, Data, and Surveillance.” Centers for Disease Control and Prevention, 11 Feb. 2020, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

[17] Pham, Olivia, et al. “Latest Data on COVID-19 Vaccinations by Race/Ethnicity.” KFF, 8 July 2021, https://www.kff.org/coronavirus-COVID-19/issue-brief/latest-data-on-COVID-19-vaccinations-

Categories
COVID-19

How has COVID-19 Changed our Attitudes Towards Medicine?

By Catherine James

Published 9:03 EST, Aug 30, 2021

The COVID-19 pandemic, due to the novel SARS-CoV-2 beta coronavirus, arose in Wuhan, China in December 2019. By July 2021, the virus had affected one hundred and eighty-five million people in two hundred and nineteen countries, causing four million deaths [1]. 

COVID-19 has upturned healthcare delivery and its public perception more than any other event since the inception of the NHS in 1948. We have witnessed, first-hand, how COVID variants in distant countries have rapidly reached the UK, and have seen stark limitations in healthcare systems under pandemic pressures. Reduced healthcare access has necessitated a shift to increased self-care with individuals accepting increased responsibility for pandemic suppression through personal hygiene, sanitizing, handwashing, lockdown adherence, and mask-wearing [2]. Digitalization and remote healthcare delivery have been accepted to reduce COVID infection risk [3]. 

The COVID-19 pandemic has resulted in a resurgence of respect for the diligence, dedication, and professionalism of National Health Service health workers. [4]. Increased volunteering and social cohesion have resulted [6]. Finally, the COVID-19 pandemic has shone a spotlight on the environmental effects of human behavior and the necessity for global collaboration to eradicate the pandemic virus [7].

Figure 1: The SARS-CoV-2 virus

SARS-CoV-2 beta-coronavirus, with a 5% case fatality rate, binds with high affinity to the ACE2 receptor on human cells, and its spike protein, cleaved by TMPRSS2 exposes a fusion peptide which facilitates entry and release of viral RNA into infected cells, producing 100-1000 new virions per day. The infection fatality rate is 1% with a mean duration from symptom onset to death of 18 days. [8]

The COVID pandemic is the first pandemic that our generation has witnessed and increased knowledge of pandemic structures, virus pathology, replication, and dissemination processes has ensued. Populations have become aware of the vulnerability of humanity to infectious disease and the lack of a successful cure for COVID-19 has introduced widespread unease in our sophisticated, developed world. No individual has been immune from COVID-19, and our lack of autonomy over this pandemic has disturbed individuals and communities [9]. COVID-19 has had a major impact on population mental health, with doubling in rates of self-reported depression, anxiety, and emergency psychiatric referrals.  

Global tracking of COVID-19 statistics has enabled populations to witness the epidemiology and rapid spread of the virus together with its associated morbidity and mortality to a much greater extent [10], while televised images from around the globe have demonstrated visually the shocking adverse impacts of the pandemic. Consequently, the population responsible for the suppression of the pandemic has been realized leading to greater adherence of individuals to restrictive measures, lockdowns, and PPE use [2]. With this greater personal sense of responsibility and involvement, greater cynicism and mistrust of government health policy have occurred [9]. Individuals have challenged health policy to a much greater extent placing more emphasis on authoritative international voices such as the World Health Organization [11], direct scientific data, and views of medical professionals. Greater individual knowledge of COVID-19, epidemiology, R factors, vaccination, and health implications has resulted [12]. Effects of globalization on health have become obvious with greater awareness of the environmental and medical risks of worldwide human behavior. Similarly, the necessity for all nations to eliminate COVID-19 to protect everyone has become clear [13].

Within the UK, the COVID-19 pandemic has brought a resurgence of respect and admiration for the National Health Service and the dedication, professionalism, and diligence of health care workers [14]. The great charitable efforts of individuals such as Captain Tom and social measures such as clapping for the NHS on Thursdays have introduced greater cohesion in the battle against the disease. Communities have come together to support their vulnerable, weaker, and self-isolating members, ensuring food, safety, and medicine delivery. Individuals have been more willing to volunteer in healthcare and volunteers have contributed substantially to the production of personal protective equipment, healthcare provision, and vaccine clinic delivery. Engineering and manufacturing companies have produced PPE and ventilators for the NHS [15-16]; political red tape has been abolished to give accommodation to the homeless; unnecessary work, political tasks, and appraisals have been removed from medical staff to enable them to concentrate on clinical care; medical students have offered childcare to enable health workers to attend work; supermarkets have provided priority shopping for vulnerable individuals and health staff. Communities have stood together to support their local populations, their NHS, and their nation. The multidisciplinary collaboration of many different health professionals, researchers, nurses, pharmaceutical specialists, and key workers has been witnessed and appreciated for the first time.

Equally, limitations in health service capacity and a necessity for healthcare rationing have become more obvious to the public [17]. Access to routine hospital care has been restricted, diagnosis of chronic disease and cancer delayed, ITU and specialist equipment insufficient, leading to complex ethical issues in clinical practice. Individuals have been grateful for their medical care from non-specialist medical or surgical staff deployed to ITU or COVID wards and have accepted care in mega-hospitals further from their homes, such as the Nightingale Hospitals. This appears to have led to an increased sense of gratitude and efforts to bolster the service and help in any way possible. Individuals have demonstrated a greater willingness to adopt self-care strategies for health and illness, using online exercise programs, pharmacy services, and community facilities to a much greater extent than before the pandemic [3]. Inappropriate use of accident and emergency, and general practice services has declined, and populations have embraced telephone triage and telemedicine digital technology to consult remotely with their healthcare professionals for the first time [18]. Indeed, almost 70% of UK adults were more likely to consider self-care because of the pandemic, 31% were more likely to visit a pharmacy and 51% were less likely to see a GP appointment for illness [19]. According to a 2016 survey, “86% agreed that A&E and GP appointments should be used only when essential” [3]. These altered attitudes to healthcare attendance and digitalized models of remote consulting provide insight and possible solutions to increase the availability of health services around the globe and reduce the unnecessary burden upon current healthcare systems. Fear of hospitalization or COVID-19 has led to under-reporting of significant symptoms in many individuals, resulting in delayed cancer diagnosis and adverse health consequences [20]. Equally, a reduced feeling of support for health disorders has led to increased mental health issues for many individuals [21]. Work is now needed to determine the correct balance between remote and in-person consultations, advance remote digitalization consultation solutions, support empowerment and self-care with positive mental health, and provide optimal patient care outcomes.

Finally, COVID-19 has shone a spotlight on the environmental risks of human behavior and the vital necessity to alter our habits to prevent future disease and pandemic occurrences. Relationships between global travel, urbanization, climate change, and increased human-animal contact on disease pathogenesis and pandemic occurrence are now alarmingly clear [7]. Ironically, COVID-19, through lockdowns and the absence of non-essential manufacturing and travel, has also demonstrated the immense positive environmental change that occurs with altered human attitudes and behavior. 

In summary, COVID-19 while dramatically reducing healthcare access, diagnosis of cancer, and chronic disease, has had immensely positive effects on personal responsibility for health, trust in medical professionals, self-care, and social cohesion. Empowerment of individuals to manage their health and illness, utilize health services appropriately and work together for optimal collective health outcomes have been positive outcomes of the pandemic. Equally, huge advances in remote digital healthcare technology have been made, which could in the future help secure access to high-quality healthcare globally, even in remote regions of the world. These changes in attitudes, behaviors, engagement, and personal responsibility due to COVID-19, are exactly those needed to deliver optimal global healthcare and preserve our planet and humanity.

Catherine James, Youth Medical Journal, 2021

References:

  1. Worldometers.info. 2021. Coronavirus Update (Live): 139,451,176 Cases and 2,992,717 Deaths from COVID-19 Virus Pandemic – Worldometer. [online] Available at: <https://www.worldometers.info/coronavirus/#countries&gt; [Accessed 15 April 2021].
  2. Haug, N., Geyrhofer, L., Londei, A., Dervic, E., Desvars-Larrive, A., Loreto, V., Pinior, B., Thurner, S. and Klimek, P., 2020. Ranking the effectiveness of worldwide COVID-19 government interventions. [online] Nature: Human Behaviour. Available at: <https://www.nature.com/articles/s41562-020-01009-0&gt; [Accessed 15 April 2021].
  3. Jarvis, S., Evans, D. and Riddalls, M., 2020. Self-care after coronavirus – survey results – PAGB. [online] PAGB. Available at: <https://www.pagb.co.uk/latest-news/pagb-self-care-survey/&gt; [Accessed 15 April 2021].
  4. Andalo, D., 2020. ‘There’s so much respect for the NHS right now’: interest in healthcare degrees on the rise. [online] The Guardian. Available at: <https://www.theguardian.com/education/2020/aug/14/theres-so-much-respect-for-the-nhs-right-now-interest-in-healthcare-degrees-on-the-rise&gt; [Accessed 15 April 2021].   
  5. Sloan, M., Gordon, C., Harwood, R., Lever, E., Wincup, C., Bosley, M., Brimicombe, J., Pilling, M., Sutton, S., Holloway, L. and D’Cruz, D., 2020. The impact of the COVID-19 pandemic on the medical care and health-care behaviour of patients with lupus and other systemic autoimmune diseases: a mixed methods longitudinal study. [online] Oxford Academic. Available at: <https://academic.oup.com/rheumap/article/5/1/rkaa072/6033663&gt; [Accessed 15 April 2021].
  6. Abrams, D. and Broadwood, J., 2021. Social cohesion in the context of COVID-19 | Nuffield Foundation. [online] Nuffield Foundation. Available at: <https://www.nuffieldfoundation.org/project/social-cohesion-covid-19&gt; [Accessed 15 April 2021].
  7. Gavi.org. 2020. 5 reasons why pandemics like COVID-19 are becoming more likely. [online] Available at: <https://www.gavi.org/vaccineswork/5-reasons-why-pandemics-like-covid-19-are-becoming-more-likely&gt; [Accessed 15 April 2021].
  8. Plapp, F., 2020. The COVID-19 Pandemic: A Summary. [online] The Pathologist. Available at: <https://thepathologist.com/subspecialties/the-covid-19-pandemic-a-summary&gt; [Accessed 15 April 2021].
  9. McCartney, M., 2021. Medicine: before COVID-19, and after. [online] The Lancet. Available at: <https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30756-X/fulltext&gt; [Accessed 15 April 2021].
  10. Roshan Abraham, A., 2021. Global COVID-19 death toll surpasses 3 million amid new infections resurgence. [online] U.S. Reuters. Available at: <https://www.reuters.com/article/us-health-coronavirus-global-casualties-idUSKBN2BT0V9&gt; [Accessed 15 April 2021].
  11. UN News. 2020. 5 reasons the world needs WHO, to fight the COVID-19 pandemic. [online] Available at: <https://news.un.org/en/story/2020/04/1061412&gt; [Accessed 15 April 2021].
  12. Ning, L., Niu, J., Bi, X., Yang, C., Liu, Z., Wu, Q., Ning, N., Liang, L., Liu, A., Hao, Y., Gao, L. and Liu, C., 2020. The impacts of knowledge, risk perception, emotion, and information on citizens’ protective behaviors during the outbreak of COVID-19: a cross-sectional study in China. [online] BMC Public Health. Available at: <https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09892-y&gt; [Accessed 15 April 2021].
  13. Mas-Coma, S., Jones, M. and M Marty, A., 2020. COVID-19 and Globalisation. [online] NCBI. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184197/&gt; [Accessed 15 April 2021].
  14. Pereira, P., Lewis, R., Thorlby, R. and Warburton, W., 2020. News: Respect and Gratitude to Health Workers on “World Patient Safety Day 2020” | WONCA Europe. [online] Woncaeurope.org. Available at: <https://www.woncaeurope.org/news/view/respect-and-gratitude-to-health-workers-on-world-patient-safety-day-2020&gt; [Accessed 15 April 2021].
  15. Microsoft News Centre UK. 2020. Global companies come together to make ventilators for the NHS. [online] Available at: <https://news.microsoft.com/en-gb/2020/03/30/global-companies-come-together-to-make-ventilators-for-the-nhs/&gt; [Accessed 15 April 2021].
  16. Williamson, J., 2020. Every UK manufacturer helping to produce PPE and equipment for NHS workers – The Manufacturer. [online] The Manufacturer. Available at: <https://www.themanufacturer.com/articles/every-uk-manufacturers-helping-to-produce-ppe-and-equipment-for-nhs-workers/&gt; [Accessed 15 April 2021].
  17. Srinivas, G., Maanasa, R., Meenakshi, M., Adaikalam, J., Seshayyan, S. and Muthuvel, T., 2021. Ethical rationing of healthcare resources during COVID-19 outbreak: Review. [online] US National Library of Medicine. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869626/&gt; [Accessed 15 April 2021].
  18. Bestsennyy, O., Gilbert, G., Harris, A. and Rost, J., 2020. Telehealth: A quarter-trillion-dollar post-COVID-19 reality? [online] McKinsey & Company: Healthcare Systems and Services. Available at: <https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality&gt; [Accessed 15 April 2021].
  19. Hamlin, M., Steingrimsson, S., Cohen, I., Bero, V., Bar-Tl, A. and Adini, B., 2020. Attitudes of the Public to Receiving Medical Care during Emergencies through Remote Physician–Patient Communications. [online] NCBI. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400122/&gt; [Accessed 15 April 2021].
  20. The BMJ Opinion. 2020. Counting the invisible costs of covid-19: the cancer pandemic – The BMJ. [online] Available at: <https://blogs.bmj.com/bmj/2020/11/05/counting-the-invisible-costs-of-covid-19-the-cancer-pandemic/&gt; [Accessed 15 April 2021].
  21. Panchal, N., 2021. The Implications of COVID-19 for Mental Health and Substance Use. [online] KFF. Available at: <https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/&gt;
Categories
Commentary COVID-19 Health and Disease

The Exoticization of Epidemics

By Rhea Argwal

Published 1:30 EST, Tue August 24, 2021

Abstract: 

During an epidemic, scientists tend to search for sources of the outbreak. If the outbreak has foreign origins, scientists often enlist the help of anthropologists to study local practices and customs since cultural awareness is necessary for any public health campaign or outbreak control. However, the role of anthropologists seems to extend further than that. Anthropologists identify ‘risky behaviours’ present within a society which may escalate an outbreak. Yet, these ‘risky behaviours’ always tend to be rooted in cultural contexts. Scholars tend to ignore socioeconomic factors, such as overcrowding, poverty, etc., which may have a greater hand to play in the proliferation of a disease through a population. This instinctive ignorance lets slip the presence of racism and Eurocentric bias in the subconscious beings of scientists and researchers. 

Ebola and Africa [1980s]

The Ebola Virus Disease (EVD), a rare and fatal disease, was first discovered in 1976 in the Democratic Republic of Congo (DRC) (Centers for Disease Control and Prevention , 2021). After an incident on a shipping boat in 1989, Western media’s interest in the virus erupted. Due to its foreign origins, media and Western society linked the source of the outbreak to practices in African culture (Jones, 2011). 

The Ebola virus is a zoonotic disease meaning that the virus had been transferred from animals — specifically nonhuman primates (monkeys, gorillas, and chimpanzees) — to people. Thus, enlightened with this information, scholars proposed the Bushmeat Hypothesis: “hunting, slaughtering, and eating infected gorilla or monkey meat is the primary cause of the virus’s entrance to a new population (Jones, 2011).

This argument became one of the dominant explanations of the Ebola outbreaks as it provided a correlation between cultural practice and a viral outbreak. However, doing so overshadowed other arguments which may have been greater factors at play; factors such as overcrowding, poor sanitation, and inadequate provision of healthcare, exacerbated by a legacy of colonialism were responsible for much of Ebola’s spread. However, cultural factors were emphasised more than sociopolitical and economic factors. Africans were presumed to have beliefs rooted in witchcraft and superstitions which may have hindered efforts by doctors and scientists to control the outbreak (Jones, 2011). Disputing this notion was a Harvard professor and a medical anthropologist, Paul Farmer, who was at the forefront of the Ebola epidemic control. The failure to control the outbreak did not occur due to local customs and traditions but rather due to distrust in the healthcare system and the government. 

People fled the medical system, not because of superstitions, but mostly when the medical system was unable to rescue or treat its patients as constituted.”

(Paul Farmer in an interview with Ashish Jha on Lessons from Ebola)

Due to the lack of adequate hospital infrastructure, doctors had implemented a disease control paradigm that concentrated its efforts on isolating suspected cases and confirmed cases without providing actual care (unlike the current COVID-19 care centres). This approach was rendered ineffective. Distrust in the healthcare system further grew and people started turning to traditional healing systems as a desperate resort. 

The erroneous depictions of the Western media and the presumptions of Western society of the Ebola outbreak reveal the lingering presence of racism in our society and the remnants of colonialism. Additionally, it affirms the presence of bias in biomedical research.

AIDS as a Haitian Disease [the 1980s]

It is the 1980s. Haiti, a Caribbean country, has been receiving widespread publicity as the possible birthplace for AIDS. Acquired Immunodeficiency Virus (AIDS) is a chronic and fatal condition caused by the human immunodeficiency virus (HIV); HIV is a sexually transmitted infection (STI) that weakens one’s immune system. A severely damaged immune system progresses into AIDS as it is unable to protect the body from infections or cancers that a person with a healthy immune system wouldn’t normally acquire (Mayo Clinic, 2020). Upon the emergence of an AIDS epidemic, scientists begin investigating the sources of the outbreak. In an eruption of imagination, Western society and media speculated that voodoo rites, sacrificial practices, the eating of cats, and ritualized homosexuality, were the causes of the epidemic – “a rich panoply of exotica” (Farmer & Kim, Anthropology, Accountability, and the Prevention of AIDS, 1991). The speculations gave rise to stereotypes that were enforced time and time again by the U.S. press. Also notable was the media representation of Haitian-Americans: black, poor, immigrants, and associated with cult-like religious practices. As media sensationalized and misrepresented the Haitian-American community, incidents of harassment began to propagate. People of Haitian origin bore the stigma of a fatal condition. The statement of one Haitian-American physician mirrors this sentiment: 

“After all the wild theories of voodoo rites and genetic predisposition were aired and dispelled, and the slip-shod scientific investigation was brought to light, the public perception of the problem remained the same that if Haitians have AIDS, it is very simple because they are Haitians (Farmer & Kim, Anthropology, Accountability, and the Prevention of AIDS, 1991).”

However, none of the speculations and gossip surrounding the epidemic had any epidemiological research to back them up.  As a matter of fact, declarations of plausible theories of the sources of the outbreak by scientific researchers had slowly begun unravelling the lies illustrated by the press. On December 1, 1982, the following statement was made: 

“Homosexuals in New York take vacations in Haiti, and we suspect that this may be an epidemic Haitian virus that was brought back to the homosexual population in the United States.” 

(Dr. Bruce Chabner of the National Cancer Institute, 1982) 

At the 1988 conferences of the American Anthropological Association, researchers congregated to discuss “Ethical Considerations in Anthropological Research.” The focal point of the meetings was the failure to lighten the burden of stigma on the Haitian-American community, aggravated by the spread of misinformation. Further addressed was the economic damage of Haitian businesses, which were boycotted by tourists and investors, and the rise in unemployment within the Haitian-American community. Nevertheless, in February 1990, the Food and Drug Administration (FDA) ruled that no person of Haitian origin will be allowed to donate blood (Farmer & Kim, Anthropology, Accountability, and the Prevention of AIDS, 1991). The incessant discrimination against the community, not only resulted in economic damage but also a decline in the mental and emotional health of members of the ethnicity. All this, due to the deep-rooted racism in a system that embraced popular societal opinion rather than verified scientific research. 

SARS – CoV – 2 (COVID-19) Pandemic [2020]: Hate Crimes Against South East Asians

SARS-CoV-2, colloquially known as COVID-19, originated in Wuhan, the capital city of the Hubei province, China. The virus evidently has zoonotic origins (similarly to Ebola) with genetic similarities to bat genomes. The COVID-19 virus first caused a viral outbreak in the Hubei province region, soon spread to surrounding provinces and all over China. In China, it has declared an epidemic. Subsequently, the virus infiltrated borders and crossed seas through international travel and infected millions of people; On March 11, 2020, the World Health Organization (WHO) had declared the COVID-19 viral outbreak, a pandemic (World Health Organization, 2020). 

Proclaimed as a zoonotic disease, researchers began investigating the source of the animal-to-human transfer and traced it back to the Wuhan Southern China Seafood Market where wild animals were being sold. The bushmeat theory, first proposed during the Ebola outbreak, found new ground almost 40 years later in the SARS-CoV-2 epidemic. However, the magnitude of this viral outbreak significantly surpassed the Ebola epidemic; millions, if not billions, of lives, have been affected around the world; trillions of dollars are being spent on reviving an economy that has seen its deepest slump since the Great Depression. Now, at a very vulnerable state, with dear lives lost, people need someone to take blame and responsibility. Hate incidents and crimes against the Chinese and Asian communities increased. The pandemic had given rise to stigma and discrimination. News media picked up on this sentiment and began referring to the SARS-CoV-2 virus as the “Chinese virus,” or the “Wuhan virus.” Associations of such may have provoked people to detest a community that was struggling with an outbreak, too (Xu, et al., 2021). 

“Pandemics do not materialise in isolation. They are part and parcel of capitalism and colonisation. The countries that struggled to contain and control major epidemics in the recent past, from Haiti to Sierra, had deficient public health systems prior to these crises, partially as a result of their colonial histories. Moreover, products of capitalism – from war to migration to mass production and increased travel – contribute massively to the proliferation of diseases.”

(Edna Bonhomme, Postdoctoral Fellow at the Max Planck Institute for the History of Science in Berlin, on the topic of COVID-19 and Inequality (Bonhomme, 2020))

In the three occurrences discussed above, there seems to also be three recurrent themes. Firstly, the sudden media interest in the three cases amplified the racialization of these epidemics. Arguably, the media played the biggest role in the dramatization of the epidemic’s events. Unexpectedly, scholars often also shared the view proposed by the popular press. The prejudices and biases present in these scholars subconsciously affected their judgements in an epidemic control centre or a research centre, thus adversely influencing the healthcare quality available in these countries. Additionally, in the media frenzy, the western way of living was enforced as the norm, painting foreign cultures as exotic. This is where the remnants of colonialism become apparent once again. Lastly, through analysis of media reports and scholarly articles or journals, one can understand that some researchers subliminally undermine indigenous knowledge and accept biomedical research as the divine truth. 

Media Manipulation: Sensationalism 

Western media portrayals in each of the three case studies seem to have subconsciously depicted Western ways of living as norms by contrasting them with the ways of living of other ethnic communities. This juxtaposition depicts the complex and vibrant cultures of various ethnic groups around the world as simply exotic. Exotic, meaning interesting, different, and ‘other’. The exoticization of an ethnic community and its practices alienates its members, thus leaving them more susceptible to racial discrimination. This dramatization is not only demeaning for an ethnic community but also an exploitation of the credibility the masses of people associate with news media reporting. 

Systematic Racism, Stigma, & Discrimination

The existence of systematic racism, ingrained within institutions — in the laws, policies, and decisions — are mainly what hinders the provision of healthcare in epidemic control centres; it is what distorts epidemiological research. The erroneous conclusions of such scientific and anthropological research attribute the causes of an epidemic to local practices, traditions, and customs of an ethnic community while hardly considering sociopolitical or economic factors. This, in addition to media sensationalism, places a degrading spotlight on a community that may be suffering as well. Stemming from such situations is stigma and racial discrimination. At a moment when people are at their most vulnerable state, systematic racism and media sensationalism give rise to hate crimes as currently seen occurring against the South East Asian community due to the COVID-19 pandemic. 

Worth Found in Indigenous Knowledge 

When planning epidemic centre controls in different countries, scientists and anthropologists often study the local practices, customs, and traditions — indigenous knowledge. However, the lens with which this body of knowledge is viewed indicates that scholars believe indigenous knowledge serves to hinder the provision of healthcare rather than aid its use. Subliminally, all scholars undermine indigenous knowledge and regard it as ‘backwards’. Associated with many of these communities is a cumulative body of knowledge and know-how honed through years of observations, experiments, and reflections. Although these practices have been developed through years of observations, it is not possible to ascertain their reliability or accuracy since they have not been assessed by the wider intellectual community as of now due to there being notions that indigenous knowledge is retrogressive and anti-development. If we aspire to put in the effort to inspect the accuracy of indigenous knowledge, we may be able to verify that the majority of their claims may be accurate and, in fact, useful in developing future theories or innovations, instead of labelling them as regressive. 

Conclusion

In conclusion, the notion that any ethnic community’s customs or traditions hamper epidemic control efforts should be challenged. Publishing unverified scientific information that may be linking the source and spread of an outbreak to an ethnic community can prove to be very degrading and even detrimental for members of a community, leaving them predisposed to scorn and resentment. Although our world has come a long way from its colonizing history, the legacy and remnants of it can still be seen today in the form of the exoticization of ethnic practices through systematic racism. 

Rhea Agarwal, Youth Medical Journal, 2021 

Bibliography

Altman , L. (1983). The New York Times Archives Newspaper July 31, 1983, Section 1, Page 1 . DEBATE GROWS ON U.S. LISTING OF HAITIANS IN AIDS CATEGORY. https://www.nytimes.com/1983/07/31/us/debate-grows-on-us-listing-of-haitians-in-aids-category.html.&nbsp;

Bonhomme, E. (2020, May 18). COVID-19 and Inequality: The Racialization of Pandemics. (t. G. (GRIP), Interviewer)

Centres for Disease Control and Prevention. (2018). Hospital with Ebola Patients (Drc, 1976). https://www.dw.com/en/ebola-outbreak-who-puts-10-countries-on-high-alert/a-43746378. https://www.dw.com/en/ebola-outbreak-who-puts-10-countries-on-high-alert/a-43746378.&nbsp;

Centres for Disease Control and Prevention. (2021). History of Ebola Virus Disease. Retrieved June 27, 2021, from https://www.cdc.gov/vhf/ebola/history/summaries.html

Economic Development Department. (2020). Systematic Racism. Cabinet Secretary Keyes on Systemic Racism & the Role of Businesses. https://gonm.biz/stories/cabinet-secretary-keyes-on-systemic-racism-the-role-of-businesses.&nbsp;

Elkins, R. (2017). Protests Against FDA Ban on Blood Donations from Haitians and people of Sub-Saharan African origin, 1990. Trump Reopens an Old Wound for Haitians. https://www.newyorker.com/news/news-desk/trump-reopens-an-old-wound-for-haitians.&nbsp;

Jones, J. (2011). Ebola, Emerging: The Limitations of Culturalist Discourses in Epidemiology. The Journal of Global Health.

Farmer, P. (2010). The Exotic and the Mundane: Human Immunodeficiency Virus in Haiti (1990). In P. Farmer, Partner to the Poor . California : University of California Press .

Farmer, P., & Kim, J. Y. (1991). Anthropology, Accountability, and the Prevention of AIDS. The Journal of Sex Research Vol. 28, No. 2, Anthropology, Sexuality and AIDS .

Mayo Clinic. (2020). HIV/AIDS. Retrieved June 29, 2020, from https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524

Scotti , E. (2014). Ebola Investigation Team in Drc, 1976. The Original Ebola Hunter. https://www.thedailybeast.com/the-original-ebola-hunter.&nbsp;

Unknown , U. (2021). Stop Asian Hate . Amid Rise in Anti-Asian Attacks, Advocates Call For Black and Asian Solidarity. https://www.ny1.com/nyc/all-boroughs/news/2021/03/18/amid-rise-in-anti-asian-attacks–advocates-call-for-black-and-asian-solidarity-.&nbsp;

World Health Organization . (2020). Coronavirus Disease 2019 (COVID-19) . Retrieved June 29, 2021, from https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200423-sitrep-94-covid-19.pdf?sfvrsn=b8304bf0_4#:~:text=All%20available%20evidence%20for%20COVID,be%20handled%20by%20humans.

Xu, J., Sun, G., Cao, W., Fan, W., Zhihao Pan, Z. Y., & Li, H. (2021). Stigma, Discrimination, and Hate Crimes in Chinese-Speaking World amid Covid-19 Pandemic. Asian Journal of Criminology, 16(1 ), 51-74.

Categories
COVID-19

Long COVID (PASC)

By Suhani Khandelwal

Published 8:53 PM EST, Thurs April 22, 2021

Introduction

Post-Acute Sequelae of SARS-CoV-2 infection (PASC) or chronic COVID syndrome (CCS) and long-haul COVID or Long COVID. 

Recent studies have shown that COVID-19 has long term impacts on patients health, irrelevant of their age and medical history. For example, 35% of COVID  symptomatic adults with a positive outpatient test reported that even 2–3 weeks later they had not returned to their original state of health. Furthermore, 20% of the subjects between 18 to 34 years who were in good health, confirmed that some of the symptoms were prolonged. The US Center for Disease Control and Prevention (CDC) lists fatigue, shortness of breath, joint and chest pain as some of the long-term symptoms of COVID-19. Coronavirus long-haulers have also reported cognitive impairment, depression and headaches.  

The impact of SARS, however, continues as survivors’ exercise capacity and health status are significantly impaired for over 24 months. Another study revealed that 40% of people recovering from SARS still had chronic fatigue symptoms 3.5 years after being diagnosed. This may be because long COVID affects organs and can cause inflammation of the heart muscles, pulmonary issues, hair loss and skin rashes. However, we still do not know just how long these symptoms will persist or why they occur.

Reference Studies

At the Jin Yin-tan Hospital in Wuhan, over a span of 5 months, 1733 patients undertook a series of symptom questionnaires, physical examinations, and a six-minute walking test to study the long term impact of COVID. In it, 63% of subjects reported fatigue or muscle weakness and 26% had sleep difficulties. In addition, 23% of participants experienced anxiety or depression. Severely ill patients had significantly impaired pulmonary diffusion capacities, abnormal chest imaging manifestations, and had the longest recovery period. Furthermore, the decline of neutralising antibodies raises concern for severe acute respiratory syndrome coronavirus 2 re-infection.

As far as researchers know now, there is no one type of person who is more likely to suffer from long-term COVID-19 symptoms and issues, though some doctors say they are seeing far more females showing such symptoms. Ryan Hurt, an internist who leads post-COVID-19 syndrome research at the Mayo Clinic, said that even though only 10% of the approximately 20,000 COVID positive patients are considered long-haulers at the clinic, 60-80% of them are women.

Organ damage caused by COVID-19

Although COVID-19 is seen as a disease that primarily affects the lungs, it can damage many other organs, increasing the risk of long-term health problems. Organs that may be affected by COVID-19 include:

  • Heart- Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscles, even in people who only experienced mild COVID-19 symptoms. Increasing the risk of heart failure and other heart diseases in the future.
  • Lungs- The type of pneumonia often associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to long-term breathing problems.
  • Brain- Strokes, seizures and Guillain-Barre syndrome, a condition that causes temporary paralysis, have also been associated with COVID. Increase the risk of developing Parkinson’s disease and Alzheimer’s disease.

Blood clots and blood vessel problems

COVID-19 can make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from small clots blocking capillaries in the heart.

Other parts of the body affected by blood clots include the lungs, legs, liver and kidneys. COVID-19 can also weaken blood vessels and cause them to leak, contributing to potentially long-lasting problems with the liver and kidneys.

Problems with mood and fatigue

People who have severe symptoms of COVID-19 often have to be treated in a hospital’s intensive care unit and are often put on ventilators. Simply surviving this experience can make a person more likely to later develop post-traumatic stress syndrome, depression and anxiety.

Because it’s difficult to predict long-term outcomes from the new COVID-19 virus, scientists are looking at the long-term effects seen in related viruses, such as the virus that causes severe acute respiratory syndrome (SARS).

Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens with physical or mental activity but doesn’t improve with rest. The same may be true for people who have had COVID-19.

Many long-term COVID-19 effects still unknown

Much is still unknown about how COVID-19 will affect people over time. However, researchers recommend that doctors closely monitor people who have had COVID-19 to see how their organs are functioning after recovery. Many large medical centres are opening specialized clinics to provide care for people who have persistent symptoms or related illnesses after they recover from COVID-19.

It’s important to remember that most people who have COVID-19 recover quickly. But the potentially long-lasting problems from COVID-19 make it even more important to reduce the spread of the disease by following precautions such as wearing masks, avoiding crowds and keeping hands clean.

Suhani Khandelwal, Youth Medical Journal 2021

References

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32656-8/fulltext

https://www.nature.com/articles/d41586-021-00586-y

https://www.webmd.com/lung/what-is-long-covid-pasc

https://theconversation.com/how-many-people-get-long-covid-and-who-is-most-at-risk-154331

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351

https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update-36-long-term-symptoms.pdf?sfvrsn=5d3789a6_2

Categories
COVID-19

Evaluating the Coronavirus Vaccine

Introduction

Following months of research, development, and clinical trials, two COVID-19 vaccines were authorized for emergency use by the United States Food and Drug Administration (FDA). The first in this sequence was the Pfizer-BioNTech vaccine, authorized on December 11, 2020. This vaccine will be available for distribution to individuals over the age of 16. The second authorized vaccine authorized on 18th December 2020 was the Moderna COVID-19 vaccine, for those over the age of 18.  Although immunization is now available for frontline workers such as residents of nursing homes and healthcare providers, it will be months before the average citizen is vaccinated. Nevertheless, fear has settled in the hearts of Americans, months or possibly a year in advance regarding a vaccine that isn’t even readily available for them. For the COVID-19 vaccine to effectively reverse the effects of the coronavirus in the United States, it is imperative for Americans to make an informed decision about receiving the vaccine. This begins with providing accurate facts, figures, and explanations regarding the immunization as quickly as possible.

The COVID-19 Vaccine Debate

A universal concern of the COVID-19 vaccine is whether or not it can be trusted due to its short timeline from research to distribution. Aware of this paradigm in vaccine development, scientists were methodic in not providing hope for immediate success. It is true that on average, vaccines take 10 years to fully develop and distribute. The quickest any vaccine had been developed prior to the 2020 COVID-19 vaccine was for mumps in the 1960s, with a development timeframe of four years (Ball, 2020.)

Today, the effectiveness or safety of medical developments cannot be assessed based on time alone. There are many factors to consider beyond time. As with the COVID-19 vaccine, some of the factors that have shortened the development timeline are the unique structural integrity of the virus itself and the innovative mRNA virus development stratagem.

COVID-19 Structural Analysis

The coronavirus protein contains a spike module (review figure A) which is compatible with mRNA retroviral immunizations. This protein has the potential for the optimization of antigen design. A strong antigen design ensures that the vaccine has pinpoint accuracy in targeting either the full-length protein of the virus or the receptor-binding domain (Lurie et. al, 2020.)  Additionally,  while COVID’s initial symptoms progress into acute respiratory disorders, the coronavirus is a type SARS/MERS virus. And as plenty of vaccinations for SARS/MERS viruses exist, built using different platforms, meant researchers could easily manipulate the structures of these existing vaccinations to create one that immobilizes the coronavirus. Thus, no time was spent on manufacturing specific vaccination bases (Lurie et. al, 2020.)

Figure A: The COVID-19 Module

*The red clusters indicate the presence of spike modules. These spikes, when replicated in a vaccine, allow for the effective inoculation of antibodies into the target virus cell.

Traditional Vaccine Development

Traditionally, making vaccines required live virus strains suspended in cell culture. The most common class of retroviral cell culture is a shell vial culture. In this type of culture, viral strains are centrifuged onto a single layer of cells and the growth of the virus is determined by changes in antigen patterning. Once these cultures displayed structural changes that hinder its ability to infect, also known as cytopathic effects, researchers were able to confirm that the culture is positive. These concoctions were then purified in bulk  to regulate its effects in the human body (Neergaard, 2020.) It is expected that there is some level of safety concern among vaccine consumers due to mass vaccine production practices and possible errors.

mRNA Vaccine Development

The mRNA approach to vaccine fabrication is radically different from the conventional means of development. By eliminating the requirement for a live strain of the virus to be present in the vaccine. An mRNA vaccine replicates a harmless piece of the target virus with the purpose of generating an immune response. The vaccine then chemically synthesizes RNA to target infectious cells. This modern approach to vaccine production is activated by utilizing a snippet of genetic code that delivers instructions for producing polypeptide chains. These chains then target foreign virus proteins, starting the immune response (Neergard, 2020.) With novel viruses, such as COVID-19, the structure of the protein can be utilized with the advantage of presenting a promising immunogen in the vaccine itself. Another way that mRNA technology reduces the time traditionally associated with vaccine development protocols is that it uses a synthetic processing mechanism. This method does not require facilitating culture growth or fermentation on an inordinate scale. Already, this shaves off a significant portion of time in the development process that would otherwise be allocated to ensuring the safety of the vaccine.

What is in the Vaccine?

The second concern in question regards the composition of the vaccine. Currently, there are two widespread misconceptions that undermine the potential of the vaccine. First, it is alleged that the immunizations will contain microchip tracking devices. Second, there is a notion that live strings of the virus will be present in the vaccination. Moderna and Pfizer, the two major distributors of the COVID-19 vaccine in the United States have debunked these assumptions in their respective official statements with the FDA, confirming that these concerns are invalid.

The mRNA-1273 vaccination that has been authorized under the title of “Moderna COVID-19 Vaccine” by the FDA encodes an S-2P antigen in conjunction with a SARS-CoV-2 glycoprotein. This glycoprotein is an inactive protein agent of the virus. S-2P is stabilized with proline replacements at amino acid positions 986 and 987, located in the top of the central helix in the S2 subunit. These proline replacements ensure that the chemical body is stable. The lipid nanoparticles of the vaccine consisting of four essential fats in a 1:1 ratio of lipid to mRNA. Lipids act to replicate the outermost surface of the coronavirus on ordinary cells, promoting immunity. This concentrated solution is diluted in standard saline (FDA, 2020.)

The Pfizer vaccination authorized under the title of “Pfizer-BioNTech COVID-19” vaccine has a similar chemical composition to its Moderna counterpart. The primary differences between the two vaccines lie in the ingredients used to maintain the pH and stability of each respective vaccine. The Moderna vaccine is suspended in a solution of tromethamine,  tromethamine hydrochloride, acetic acid, sodium acetate, and sucrose (FDA, 2020.) The Pfizer vaccine is suspended in potassium chloride, monobasic potassium chloride, sodium chloride,  dibasic sodium phosphate dehydrate, and sucrose.

Although the ingredients lists are slightly different for each vaccine, ultimately the results are the same, states Jamie Alan, an assistant professor of pharmacology and toxicology for an interview with Prevention. However, the slight formulaic differences could explain the different storage requirements for each. The Pfizer vaccine must be stored at a strict -70 degrees Celsius. On the other hand, the Moderna vaccine must be shipped in -20 degrees Celsius but can be comfortably stored in a refrigerator unit for 30 days afterwards (Miller, 2020.)

*Although the ingredients of the vaccines slightly vary in nature, there are no significant differences between the two vaccines. One is not inherently better than the other. However, it is recommended to talk to your provider before receiving an administration of the vaccine to discuss safety concerns (allergies, possible reactions) pertinent to you.

Conclusion

There are two primary concerns for the American public with regard to the coronavirus vaccines. The first is a debacle of time. While historically vaccines have taken an average of 10-15 years for successful development and testing before public use. The vaccines by Moderna and Pfizer have been developed, tested and distributed in a matter of months. This concern is made invalid when one considers the technological advances made in vaccine development in the years prior to the coronavirus pandemic. Because COVID-19 replicates a SARS/MERS virus, researchers don’t require time to develop a specialized basic suspension for a COVID-19 vaccine. The second is a matter of safety. Both major distribution companies have announced that the vaccine is composed of mRNA, lipids, and a standard saline solution reassuring the public that there will be no viral strain in the vaccine. 

Sabriyah Morshed, Youth Medical Journal 2021

References

@NicholasFlorko, N., Florko, N., Goldhill, O., Branswell, H., About the Authors Reprints Nicholas Florko Washington correspondent Nicholas Florko is a Washington correspondent for STAT, Nicholas Florko Washington correspondent Nicholas Florko is a Washington correspondent for STAT, . . . Says:, R. (2020, December 29). Frustration over vaccine rollout grows as new variant reported in U.S. Retrieved December 31, 2020, from https://www.statnews.com/2020/12/29/public-health-experts-grow-frustrated-with-pace-of-covid-19-vaccine-rollout/

Anne Trafton | MIT News Office. (2020, December 11). Explained: Why RNA vaccines for Covid-19 raced to the front of the pack. Retrieved December 31, 2020, from https://news.mit.edu/2020/rna-vaccines-explained-covid-19-1211

Ball, P. (2020, December 18). The lightning-fast quest for COVID vaccines – and what it means for other diseases. Retrieved December 31, 2020, from https://www.nature.com/articles/d41586-020-03626-1

Fox, M. (2020, December 14). When can I get a coronavirus vaccine? Retrieved December 31, 2020, from https://www.cnn.com/2020/11/30/health/covid-vaccine-questions-when/index.html

Jackson, L., Al., E., Group*, F., Author AffiliationsFrom Kaiser Permanente Washington Health Research Institute (L.A.J.) and the Center for Global Infectious Disease Research (CGIDR), Heaton, P., F. P. Polack and Others, . . . Group, A. (2020, November 12). An mRNA Vaccine against SARS-CoV-2 – Preliminary Report: NEJM. Retrieved December 31, 2020, from https://www.nejm.org/doi/full/10.1056/nejmoa2022483

Lurie, N., Interview with Dr. Nicole Lurie on rapid vaccine development, Author AffiliationsFrom the Coalition for Epidemic Preparedness Innovations, F. P. Polack and Others, S. F. Lumley and Others, & Group, A. (2020, December 31). Developing Covid-19 Vaccines at Pandemic Speed: NEJM. Retrieved December 31, 2020, from https://www.nejm.org/doi/full/10.1056/NEJMp2005630

Miller, K. (2020, December 17). What’s in the COVID-19 Vaccines? We Asked Experts to Explain the Ingredients. Retrieved December 31, 2020, from https://www.prevention.com/health/a35002158/pfizer-vs-moderna-covid-19-vaccine-ingredients/

Neergaard, L. (2020, December 07). Years of research laid groundwork for speedy COVID-19 vaccines. Retrieved December 31, 2020, from https://www.pbs.org/newshour/health/years-of-research-laid-groundwork-for-speedy-covid-19-vaccines

U.S Food and Drug Administration. (2020, December 18). FDA Takes Additional Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for Second COVID-19 Vaccine. Retrieved December 31, 2020, from https://www.fda.gov/news-events/press-announcements/fda-takes-additional-action-fight-against-covid-19-issuing-emergency-use-authorization-second-covid

U.S Food and Drug Administration. (n.d.). Moderna COVID-19 Vaccine. Retrieved December 31, 2020, from https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/moderna-covid-19-vaccine

Categories
COVID-19

A Newly Discovered Coronavirus Variant

Introduction

A new variant of the SARS-CoV-2, known as B.1.1.7, has been discovered in the rising cases in the United Kingdom and has been spreading very rapidly. The U.K. government estimates that the new coronavirus strain is more than 70% transmissible than other variants currently in circulation. 

This new variant of the coronavirus has come to the attention of researchers in mid-December when there was a surge in coronavirus cases as well as it began to show up more frequently in patient samples from various parts of Southern England. However, it seems that this variant has been collected from patients from early September. The new variant of the disease was first detected in September, by November a quarter of new cases in London were attributed to it. However, by mid-December, it had reached three-quarters of all new cases. The mutated coronavirus strain that’s been spreading in the U.K. appears to be more contagious which will likely lead to higher levels of hospitalizations, placing further strain on health care systems around the world

The new variant of COVID-19 involves mutations in the structure of the virus. Jeffrey Barrett, director of the COVID-19 Genomics Initiative at the Wellcome Sanger Institute in the UK, noted that 23 nucleobases of the virus’s genetic code had changed, including 17 that could potentially impact the way the virus behaves and spreads.

Actions Taken Against the New SARS-CoV-2 Strain

Currently, over 40 countries have suspended travel with the United Kingdom in response to this new strain. Various European countries along with other countries are restricting travel from Britain since the new variant of the SARS-CoV-2 virus is spreading very rapidly in the United Kingdom. For example, according to the Ministry of External Affairs (MEA), India has temporarily suspended its Vande Bharat flights from the United Kingdom due to the emergence of a new strain of coronavirus. 

Countries throughout Europe and the world announced that they would no longer admit any travelers from Britain, which includes Austria, Belgium, Italy, Ireland, Germany, France, and the Netherlands. Additionally, Boris Johnson, the prime minister of the United Kingdom, had introduced a new “Tier 4” level of restrictions, affecting 16.4 million people, including around 9 million people in all 32 London boroughs and much of southeast England.

Is the New Coronavirus Variant in the United States?

Currently, the new coronavirus variant has been identified the state of Colorado. No other US State has identified the variant yet. However, ongoing travel between the United States and the United Kingdom coupled with the increasing prevalence of the new variant in the UK makes the likelihood of it arriving in the US extremely high   Furthermore, only about 51,000 viruses of the 17 million US cases have been sequenced.   Given the small fraction of U.S. infections that have been sequenced, the variant could already be in the United States without having been detected.

Dr. Fauci, the United States leading infectious diseases expert, said on “Good Morning America” Tuesday morning that it’s “certainly possible” that the strain has hit the U.S. already. “When you have this amount of spread within a place like the U.K., you really need to assume that it’s here already … it certainly is not the dominant strain but I would certainly not be surprised at all if it is already here,” Fauci warns. 

Implications of the New COVID-19 Variant

There are many potential consequences of the new COVID-19 variant. For example, the new COVID-19 variant is able to spread more quickly in humans. There is already evidence that one mutation, D614G, has this property to spread more quickly. In the lab, G614 variants propagate more quickly in human respiratory epithelial cells, out-competing D614 viruses. There also is evidence that the G614 variant spreads more quickly than viruses without the mutation.

Although there is currently no evidence whether or not the new COVID-19 variant is able to produce more severe illness than the other coronavirus variants, this new strain has the ability to cause either milder or more severe disease in humans. Furthermore, the new COVID strain has the ability to evade vaccine-induced immunity. This is because FDA-authorized vaccines are “polyclonal” which means that it has the capability to produce antibodies that target several parts of the spike protein. The virus would likely need to accumulate multiple mutations in the spike protein to evade immunity induced by vaccines or by natural infection.

Lastly, the new variant has the ability to evade vaccine-induced immunity. This brings up a concern that once a large proportion of the world’s population is vaccinated, there will be an immense amount of pressure that could favor and accelerate the emergence of such variants by selecting for “escape mutants.” Though there is no evidence that this is currently occurring, many experts believe that escape mutants are unlikely to emerge because of the nature of the virus.

Will the recent vaccines that are in the process of distribution protect us against the new COVID strain?

Pfizer and Moderna have recently started to administer COVID-19 vaccinations on health workers and at-risk people. With the discovery of the new COVID strain, Pfizer and Moderna are in the process of testing their FDA-authorized vaccines against the new strain of the virus. Both of these companies anticipate that it will take about a couple of weeks before they can confirm whether or not their vaccine will protect us against the new coronavirus strain. As of now, there is no evidence that the vaccines will not be effective against the new strain. 

However, Moderna expects its mRNA-based vaccine, mRNA-1273, will provide immunity against the new strain. On the other hand, Pfizer is generating data on neutralizing the new strain from blood samples of people immunized with their vaccine.

Some experts believe that mRNA-based vaccines will likely be effective against the new coronavirus strain found in the United Kingdom. This is due to the fact that the genetic material in mRNA-based vaccines can be quickly re-engineered to match that of the mutated protein. However, many experts believe that the new strain may reduce the efficacy rates of the vaccines. 

Conclusion

As countries around the world are beginning to roll out coronavirus vaccines, the U.K. reported yet another strain of the virus which is reported to be even more transmissible than the recently discovered B117 strain. At present, scientists and researchers have not found the said variant of the virus more deadly but have found it 70% more transmissible than its previous versions. Scientists are vigilantly researching this new COVID strain and are trying to determine the current vaccine efficacy against the new variant. The question of when COVID-19 will come to an end still remains unclear. The only way to find out is by testing patients and analyzing case studies to find answers to the questions and concerns on the rise regarding the new mutation of COVID-19. 

Samiksha Komatireddy, Youth Medical Journal 2020

References

[1] “The Guardian View on a New Covid Strain: a More Stringent Lockdown Beckons | Editorial.” The Guardian, Guardian News and Media, 20 Dec. 2020, www.theguardian.com/commentisfree/2020/dec/20/the-guardian-view-on-a-new-covid-strain-a-more-stringent-lockdown-beckons.

[2] Bloomberg.com, Bloomberg, www.bloomberg.com/news/articles/2020-12-24/new-virus-strain-s-transmissibility-to-cause-more-deaths-study.

[3] Times, Los Angeles, and Jennifer Gould. “New, More Infectious Strain of Coronavirus Worries California.” KTLA, KTLA, 22 Dec. 2020, ktla.com/news/california/new-more-infectious-strain-of-coronavirus-worries-california/.

[4] (WFAA), Author: William Joy. “Disease Experts Urge Caution, Not Panic over New Strain of COVID-19.” Wfaa.com, 24 Dec. 2020, www.wfaa.com/article/news/health/coronavirus/disease-experts-urge-caution-not-panic-over-new-strain-of-covid-19/287-e6439ea4-1b25-4287-add2-725a8755190b.

[5] McKie, Robin. “What Is the New Covid Strain – and Will Vaccines Work against It?” The Guardian, Guardian News and Media, 19 Dec. 2020, www.theguardian.com/world/2020/dec/19/what-is-the-new-covid-strain-and-will-vaccines-work-against-it.

Categories
COVID-19

COVID-19 Vaccine Research and Development Update

Introduction

Early Monday, November 9th, Reuters announced that a vaccine for COVID-19 was being developed by Pfizer and that it had demonstrated extraordinary results with the conclusion of their Phase 3 trial. Their vaccine has proven to be effective over 90% of the time. Yet, creating a vaccine this effective has been a particularly hard experience, not just scientifically but emotionally for millions of people worldwide. Until the vaccine becomes widely available is it essential that we all must continue to wear masks to ensure the safety of ourselves and those around us. 

Past Developments

As of July, two vaccines had reached phase 3 in the world, both of which were being developed in Brazil. The first of these vaccines was developed by Oxford University in collaboration with AstraZeneca labs. The technical name of this vaccine is ChAdOx1 nCoV-19. ChAdOx1 is a non-replicating common cold vaccine, which was the foundation for this vaccine. ChAdOx1 nCoV-19 was tested on 5000 volunteers at an undisclosed location in Rio de Janeiro, São Paulo. Prior to this, the vaccine had already been tested on animals and smaller groups of people, showing promising results. This vaccine entered its final phase on July 27, and in less than a month, the Brazilian government began discussing the production of millions of doses with AstraZeneca. President Bolsanaro set aside $360 million for a licensing deal with AstraZeneca. These funds would have been able to cover up to 100 million doses of the vaccine if proven to be successful. However, at the beginning of the trial, the deal was to provide up to 30 million doses of the vaccine. It has also been said that if the vaccine works, then an additional 70 million vaccines will be produced by this company. The second major vaccine being developed in Brazil was created by China’s Sinovac Biotech. Sinovac Biotech worked in partnership with the Brazilian public health center, the Butantan Institute. The vaccine is called CoronaVac. Much like the Oxford vaccine, the Sinovac vaccine entered phase 3 of clinical trials relatively recently, on June 21. 9000 health care workers received the vaccine, and if the vaccine had proven to be effective, the Butantan institute had the right to produce 120 million doses. 

Despite how renowned Brazil’s research institute is, its public healthcare system has suffered in recent years, experiencing budget cuts and also fighting against the spread of misinformation. These experiences were so detrimental that 2019 was the first time in 25 years where Brazil didn’t fulfill its vaccination goal for any of the shots it routinely administers. Money alone is not enough; experts believe that this process could take up to 10 years due to the difficulty of transferring technology and the underinvestment of the facilities. If Brazil’s institutions are unable to meet their goals, not only would that mark yet another failure in President Bolsonaro’s efforts to combat the virus, but it would also cause Brazil vulnerable and in desperate need of medical supplies. 

Current Stance of Vaccine 

While the vaccines are being developed in Brazil, early November 9th Pfizer announced that current data from its COVID-19 vaccine demonstrates the vaccine is more than 90% effective. The Pfizer team determined this statistic by analyzing the first 94 confirmed cases among their 43,000 volunteers who either received the trial vaccine or a placebo. Their analysis showed that fewer than 10% of infections were in participants who had been administered the vaccine, meaning over 90% of the positive cases were from those who had received the placebo. 

While this is exciting news, it’s important to realize this does not mean that the vaccine is going to arrive in a matter of days; there is still much more testing left. On Sunday, November 8th, approximately 39,000 volunteers of the 43,000 volunteers who had participated in Phase 3 of trials received the vaccine. Their end goal is to reach 164 confirmed cases of COVID-19 infection. To achieve this goal, Pfizer has developed technology in which messenger RNA, mRNA, essentially tricks cells into producing a protein that resembles the virus. In theory, the immune system would learn to attack these placebos and would eventually respond the same way with the actual virus. Though it is unclear how long protection from the virus will sustain. The most likely case, of what’s to happen, is that the vaccine will be administered on a yearly basis. 

Additionally, Pfizer believes that they are on track to create over 50 million doses by the end of this year and over 1 billion next year. They will be able to reach this extraordinary number as they have multiple manufacturing centers and have already signed production contracts with multiple governments. 

Conclusion 

The importance of this vaccine goes beyond medical advancements. It’s fair to say 2020 has not gone the way anyone has expected it to. Emotions have run high since March and this news could not have come at a better time, especially when the United States is reaching upwards of 100,000 new cases. The emotional aspect of the vaccine is equally as important as the medical advancement. 

A highly effective vaccine is great news especially as we approach 8 months of quarantine. However, it is essential that we continue to listen to science these upcoming months. Until an effective vaccine is not only officially created, but also widely available, we have to continue to wear masks. Masks are currently the best way to combat the virus and until a vaccine is readily available this is the best way to protect ourselves and loved one from COVID-19. 

Afifa Zahid, Youth Medical Journal 2020

References

  1. Almeida, Nelson. “Chinese COVID-19 Vaccine Starts Final Tests In Brazil.” Barron’s, Barrons, 21 July 2020,www.barrons.com/news/chinese-covid-19-vaccine-starts-final-tests-in-brazil-01595362806. 
  2. McCoy, Terrence. “Brazil, Ravaged by the Coronavirus, Becomes Key Testing Ground for Vaccine.” The Washington Post, WP Company, 2 July 2020, http://www.washingtonpost.com/world/the_americas/brazil-oxford-astrazeneca-sinovac-coronavirus-vaccine-trials/2020/07/01/53db68fa-bad0-11ea-80b9-40ece9a701dc_story.html.&nbsp;
  3. Andreoni, Manuela, and Ernesto Londoño. “Coronavirus Crisis Has Made Brazil an Ideal Vaccine Laboratory.” 
  4. Reuters. “Brazil’s Bolsonaro Says COVID-19 Vaccinations Won’t Be Mandatory.” NBCNews.com, NBCUniversal News Group, 4 Sept. 2020, http://www.nbcnews.com/news/latino/brazil-s-bolsonaro-says-covid-19-vaccinations-won-t-be-n1239298.&nbsp;
  5. Limited, Bangkok Post Public Company. “Chinese Covid-19 Vaccine Starts Final Tests in Brazil.” https://Www.bangkokpost.com, http://www.bangkokpost.com/world/1955559/chinese-covid-19-vaccine-starts-final-tests-in-brazil.&nbsp;
  6. Burger, L., & Weiss, P. (2020, November 09). BioNTech hopes COVID-19 vaccine will immunize for at least a year. Retrieved November 09, 2020, from https://www.reuters.com/article/us-health-coronavirus-vaccines-pfizer-du/biontech-hopes-covid-19-vaccine-will-immunize-for-at-least-a-year-idUSKBN27P1J2
  7. Can face masks protect against the coronavirus? (2020, August 20). Retrieved November 09, 2020, from https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449
  8. Erman, M., & Steenhuysen, J. (2020, November 09). ‘Great day for humanity’: Pfizer says COVID-19 vaccine over 90% effective. Retrieved November 09, 2020, from https://www.reuters.com/article/us-health-coronavirus-vaccines-pfizer/pfizer-and-biontech-say-their-covid-19-vaccine-is-over-90-effective-idUSKBN27P1CT
  9. Kounang, N. (2020, November 09). Pfizer says early analysis shows its Covid-19 vaccine is 90% effective. Retrieved November 09, 2020, from https://www.cnn.com/2020/11/09/health/pfizer-covid-19-vaccine-effective/index.html
Categories
COVID-19

An Analysis of Joe Biden’s 7-Point Healthcare Policy

Introduction

With the election hovering over the heads of 328 million Americans, President Donald Trump and former vice president Joe Biden are projecting their final pitches to the American consensus in an effort to sway the course of this year’s election. Although a diverse range of issues have been front and center throughout both candidates’ campaigns, just one of those issues is exorbitantly more pressing to Americans: how each prospective administration would approach the novel coronavirus outbreak. In short, the outcome of the 2020 election hinges on the debacle of who will present the more captivating response to this imminent public health threat. While both candidates have clearly addressed this topic, only one address is considerably more attractive. This point is in favor of Joe Biden’s 7-point healthcare policy.

How Have Trump and Biden Addressed the Coronavirus?

As of August 2020, the United States accounted for 4% of the global population, but 25% of all coronavirus cases (Levitt, 2020.) On many occasions, President Trump has downplayed the severity of the pandemic and falsely suggested that the case count was escalating due to increased coronavirus testing. Thus far, he has pulled the United States out of the World Health Organization (WHO) and pushed for the reopening of schools. He has signed off on legislation that solely pertains to economic relief with no regard to the ongoing pandemic. In contrast, Biden has pledged to place his confidence in scientists and medical leaders. In addition, he would support expanded testing, reverse the decision to withdraw from the WHO, and provide essential workers with additional pay. He would only reopen schools “after sufficient reduction in community transmission” (Levitt, 2020.) These propositions are snippets from Biden’s 7-Point healthcare policy. Medical leaders agree that Biden’s plan is not innovative, but necessary. Dr. Ira B. Wilson, a professor and health service director at Brown University’s Warren Alpert School of Medicine, states in an interview for Healthline: “My perspective on the [Biden] plan is that it is not earthshakingly innovative or anything like that — it’s just the basic work of public health. It’s not like we don’t know how to do this.” Also, in an interview for Healthline, Dr. Amanda D. Castel, a tenured professor in the department of epidemiology at George Washington University, asserts that the issue within the pandemic is that there is a lack of federal strategy in public health crisis management (Mastroianni, 2020.) This brings into question the depth of Biden’s new policy and how the American electorate has reacted to it.  

What is the 7-Point Healthcare Policy?

As the title suggests, there are seven sub-policies to execute under this stratagem:

1.      “Fix Trump’s testing-and-tracing fiasco to ensure all Americans have access to regular, reliable, and free testing.”

A Pandemic Testing Board similar to former President Franklin Roosevelt’s war production board, which improved the efficacy of producing war goods, would be set up. By doing such, Biden hopes to magnify the number of coronavirus tests currently administered in the United States by at least double.

2.      “Fix personal protective equipment (PPE) problems for good.”

Under this sub-policy, federal responsibility would be taken over marginalized and economically unable communities to ensure adequate access to PPE. Biden would also make certain that all goods are American-sourced and manufactured so that the United States wouldn’t be reliant on other countries during a time of crisis.

3.      “Provide clear, consistent, evidence-based national guidance for how communities should navigate the pandemic — and the resources for schools, small businesses, and families to make it through.”

The responsibility of taking the lead on managing the public amidst the current state of public health would be handed to the Centers for Disease Control from the federal government. Instead, the federal government would help schools, small businesses, and families stay afloat during this time. The government would establish a renewable fund for state and local governments to prevent budgeting shortfalls and provide small businesses a “restart package” that would aid in covering the costs of necessary business adaptations to operate safely, such as Plexiglas and PPE.

4.      “Plan for the effective, equitable distribution of treatments and vaccines.”

In the event that a vaccine is released and approved by the Food and Drug Administration, the federal government would introduce it to the market in a manner where price inflation does not occur. The vaccine would be available to all, as opposed to the wealthy and well-connected.

5.      “Protect Older Americans and Others at High Risk.”

As proposed by senator Kamala Harris, this sub-policy intends to establish a COVID-19 Racial and Ethnic Disparities Task Force. This task force would provide oversight and recommendations concerning disparities present in the public health and economic response. Further, the flow of information about the coronavirus would be more transparent, assisting elderly Americans in being informed about what precautions they should take.

6.      “Rebuild and expand the defenses that Trump has dismantled to predict, prevent, and mitigate pandemic threats, including those coming from China.”

The White House National Security Directorate for Global Health and Biodefense set forth by the Obama-Biden administration and eliminated by the Trump administration in 2018 would be reintroduced. The relationship between the WHO and the United States would be mended as it is fundamental to coordinating a global response.

7.      “Implement mask mandates nationwide by working with governors and mayors and by asking the American people to do what they do best: step up in a time of crisis.”

This one is a no-brainer and should have been implemented right when the pandemic started. There would be a nationwide mandate on sporting face masks.

*All information under the heading “What is the 7-Point Healthcare Policy?” is derived from presidential candidate Joe Biden’s official campaign website. For more information on Biden’s policies, visit https://joebiden.com/. Please vote in an informed and responsible manner.

How Has the American Electorate Reacted to Biden’s Plan?

A recent survey publicized by the American Journal of Public Health finds that the number of citizens in the United States that would like the government to partake in a more overshadowing role in the healthcare system than during the first wave of the pandemic increased by an astounding 40%. This indicates that Americans believe that the federal government should quit hiding around and delaying a proper response to the pandemic. However, Dr. Wilson asserts that the difficulty that already surrounds implementing a proper coronavirus response has been gravely heightened because it has now been exposed to partisan lenses. A response to the virus is now political as opposed to protecting American citizens. If Biden wins the election, Wilson warns that federal infrastructure will have to be rebuilt, the WHO has to be re-entered, and American foreign relations must be restored, especially with the Chinese whose trust America has lost (Wilson, 2020.) The relationship with China is particularly of interest because the United States had engaged in a multitude of scientific collaborations with them. As it stands today, the current state of the United States will only make progress on resolving the coronavirus exceedingly difficult. Still, a secondary survey conducted by the American Journal of Managed Care insinuates that voters aged 18-29 trust Biden on taking the lead in healthcare over Trump on an outcome of 62% to 25%. Trump makes up for this gap with his supporters aged 65 and above but still falls short of Biden by five percentage points. It will be interesting to witness the outcome of this year’s election as the survey highlights that healthcare policy is the paramount deciding factor on who the electorate will confide their vote in for 71% of Americans.

Conclusion

This year’s election is likely to be settled based on which candidate presents a better agenda for healthcare policy. While Trump has built an agenda embedded in misinformation, Biden sets forth a plan that is not innovative or original in any form but is necessary to be implemented. Although Biden has maintained bipartisan support on his policies concerning the healthcare system and a proper response to the novel coronavirus pandemic throughout his campaign, undiscussed concerns still remain if Biden is elected president. These concerns are rooted in the extensive aggregate of time required to re-establish the role of the WHO in the United States, repair American relationships with foreign countries that have lost their credence in the United States, and rebuild federal infrastructure. Nonetheless, the 2020 election has been quite the spectacle up to date and will continue to be such no matter who will win the election. With this in mind, be sure to vote if you are eligible. Your vote is pivotal in not only deciding the direction in which healthcare policy will shift moving forwards, but all policy.

Sabriyah Morshed, Youth Medical Journal 2020

References

Barry, C. L., Han, H., Presskreischer, R., Anderson, K. E., & Mcginty, E. E. (2020). Public Support for Social Safety-Net Policies for COVID-19 in the United States, April 2020. American Journal of Public Health. doi:10.2105/ajph.2020.305919

Caffrey, M. (2020, October 8). More Americans Trust Biden to Lead US Health Care System, West Health-Gallup Poll Finds. Retrieved October 24, 2020, from https://www.ajmc.com/view/more-americans-trust-biden-to-lead-us-health-care-system-west-health-gallup-poll-finds

COVID Timeline. (2020, October 21). Retrieved October 24, 2020, from https://joebiden.com/covid19/

Levitt, L. (2020, September 03). Trump vs Biden on Health Care. Retrieved October 24, 2020, from https://jamanetwork.com/channels/health-forum/fullarticle/2770427

Mastroianni, B. (2020, October 20). Why Experts Support Biden’s 7-Point Plan to Beat COVID-19. Retrieved October 24, 2020, from https://www.healthline.com/health-news/why-medical-experts-support-joe-bidens-7-point-plan-to-beat-covid-19#1

Sabriyah Morshed, Youth Medical Journal, 2020

Categories
COVID-19

Neurological Complications of COVID-19

COVID-19 Background

COVID-19, also known as Severe Acute Respiratory Syndrome Coronavirus Two (SARS-CoV-2 for short), is an infectious respiratory illness that is the cause of the “COVID-19 Pandemic”. The first case of this respiratory illness was reported in late December 2019 in Wuhan, China. From December 2019 to present day, there has been a rapid increase in cases with the United States being a contender for the most cases at a total of more than seven million cases and approximately 210,000 deaths. Worldwide, there are a total of almost thirty-eight million cases with about one million deaths. 

Neurological Complications

COVID-19 impacts the neurological functioning of many people diagnosed with this illness and causes detrimental effects to the nervous system. This is leading to a rise in mortality in the ceaseless COVID-19 pandemic. Currently, there are many efforts being made in research to uncover many of the neurological complications in patients affected by COVID-19. These complications include headache, dizziness, myalgia, loss of smell and taste, with more serious complications including the worsening of strokes and seizures. It remains uncertain where the development of these complications occur, although it seems that these complications are typically prevalent in older patients with pre-existing risk factors which include Type two diabetes, cancer, chronic kidney disease, sickle cell disease, coronary artery disease, etc. Neurological functioning is being impacted by COVID-19 mainly due to hypoxic-ischemic injury to the brain. In other words, COVID-19 is causing a lack of oxygen in the brain because of low oxygen levels in the blood.

Figure 1: SARS-CoV-2 invasion of the CNS and symptoms of the direct invasion. 

CNS = central nervous system; BBB = blood-brain barrier

There have also been reports of brain inflammation as one of the neurological complications of COVID-19. Many of the people who went through the symptoms of having brain inflammation also experienced a rare disorder which is called acute demyelinating encephalomyelitis (ADEM). ADEM is triggered by the viral infections of the SARS-CoV-2 which leads to damage of the myelin sheaths that surround the nerves in the brain. This disturbs the homeostasis of the brain and causes death of the neurons. 

In order for the brain to remain at the optimal level of homeostasis, the autonomic nervous system and its related limbs have to function properly.  Another neurological disorder that is the result of COVID-19 is Guillain-Barré syndrome. Guillain-Barré syndrome is a rare neurological disorder in which the immune system attacks healthy nerves in the body. This disorder is also involved in the damage of the myelin sheath. Overall, the main neurological complications of COVID-19 include seizures, brain inflammation (ADEM), anosmia, hypoxia, Guillain-Barré syndrome (very rare), and stroke being a primary concern for many doctors and researchers. 

Case Studies

According to the medical article, “Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients”, the authors included a clinical study of seven hundred sixty-five COVID-19 patients. In a clinical study of seven hundred sixty-five COVID-19 patients, about 18% of the patients had neurological complications such as acute myelitis and Guillain-Barré syndrome. Clinical studies have also shown that the loss of the sense of smell is turning out to be one of the most common symptoms in patients diagnosed with COVID-19, indicating that olfactory dysfunction is a prognostic factor. Another article, “Neurological manifestations of COVID-19 and other coronaviruses: A systematic review” discusses seven case studies that were done in patients diagnosed with a positive coronavirus test result. The investigation had concluded that encephalitis was a prevalent disorder in the pediatric age range. The case study investigation had four hundred nine patients, who were diagnosed with COVID-19, had an onset of neurological complications such as headaches, dizziness, epileptic seizures, neuralgia, and only about 1.4 percent of the patients had the Guillain-Barré syndrome. 

Conclusion

The coronavirus pandemic has caused a lot of tension throughout the world with a death toll of more than one million people and a drastic total of more than thirty-eight million cases. Doctors and scientists have found that some patients diagnosed with a positive coronavirus results also have an onset of neurological complications. Although many of the neurological complications aren’t life-threatening, about ten to 20 percent of the complications are requiring hospitalizations and are fatal. Such complications include brain inflammation, acute cerebrovascular diseases, meningitis, hypoxic encephalopathy and the most rare of all the complications which is Guillain-Barré syndrome. There have been many case studies done to highlight that some of the more crucial disorders are very rare with having only about one percent of the patients in a case study be diagnosed with a rare complication. These neurological complications raise concerns and questions regarding how much worse the complications could get if and when the virus strain gets more stronger, crushing the world with a possible second wave. The only way to find out is testing patients and analyzing case studies to find answers to the questions and concerns on the rise about COVID-19. 

Samiksha Komatireddy, Youth Medical Journal 2020

References

[1] Iadecola, C., Anrather, J., & Kamel, H. (2020). Effects of COVID-19 on the nervous system. Cell, 183(1), 16-27.e1. https://pubmed.ncbi.nlm.nih.gov/32882182/

[2] Stafstrom, C. E., & Jantzie, L. L. (2020). COVID-19: Neurological considerations in neonates and children. Children (Basel, Switzerland), 7(9). doi:10.3390/children7090133

https://pubmed.ncbi.nlm.nih.gov/32927628/

[3] Orsini, A., Corsi, M., Santangelo, A., Riva, A., Peroni, D., Foiadelli, T., … Striano, P. (2020). Challenges and management of neurological and psychiatric manifestations in SARS-CoV-2 (COVID-19) patients. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 41(9), 2353–2366.

https://pubmed.ncbi.nlm.nih.gov/32767055/

[4] Bostanciklioglu, M. (2020). Severe acute respiratory syndrome coronavirus 2 is penetrating to dementia research. Current Neurovascular Research, 17. doi: 10.2174/1567202617666200522220509 

https://pubmed.ncbi.nlm.nih.gov/32442082/

[5] Özdağ Acarli, A. N., Samanci, B., Ekizoğlu, E., Çakar, A., Şirin, N. G., Gündüz, T., … Baykan, B. (2020). Coronavirus disease 2019 (COVID-19) from the Point of View of neurologists: Observation of neurological findings and symptoms during the combat against a pandemic. Noro Psikiyatri Arsivi, 57(2), 154–159. 

https://pubmed.ncbi.nlm.nih.gov/32550783/

[6] Correia, A. O., Feitosa, P. W. G., Moreira, J. L. de S., Nogueira, S. Á. R., Fonseca, R. B., & Nobre, M. E. P. (2020). Neurological manifestations of COVID-19 and other coronaviruses: A systematic review. Neurology, Psychiatry, and Brain Research, 37, 27–32.

https://pubmed.ncbi.nlm.nih.gov/32834527/

[7] Yachou, Y., El Idrissi, A., Belapasov, V., & Ait Benali, S. (2020). Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 41(10), 2657–2669.

https://pubmed.ncbi.nlm.nih.gov/32725449/

[8] Baig, A. M., & Sanders, E. C. (2020). Potential neuroinvasive pathways of SARS-CoV-2: Deciphering the spectrum of neurological deficit seen in coronavirus disease-2019 (COVID-19). Journal of Medical Virology, (jmv.26105). doi:10.1002/jmv.26105

https://pubmed.ncbi.nlm.nih.gov/32492193/